Posts made in December, 2010

Monday A-Musings…It’s a pillow. No. It’s Chillow!

Posted by Liz on Dec 20, 2010 in hot flash | 2 comments

Newsflash: hot flashes and soy…more on genistein

Posted by Liz on Dec 17, 2010 in hot flash | 0 comments

There’s some exciting news on the soy isoflavones front: for the first time, researchers have shown that a synthetic formulation of genistein, a plant-based estrogen component of soy, may actually reduce both the frequency and severity of hot flashes. Genistein is an interesting isoflavone, in that studies have linked it to some truly potentially important benefits, including preventing or reducing heart disease risk and attenuating bone loss in menopausal women. While the verdict is still out on its role in these conditions, it does appear to influence hot flashes and only in the best way possible! Moreover, this is the first time that a synthetic formulation has shown to have some degree of benefit in this regard.

Granted, this is a small study of only 84 menopausal women, 40 of whom took synthetic genistein for 12 weeks and 40 who took a sugar placebo tablet. The results? By the study’s end, women taking 1, 30-mg capsule daily reduced the number of hot flashes by half (51%, from about 10 per day to 5 per day) and also experienced significant declines in how long they lasted. The synthetic formulation, which was standardized, was also shown to be safe and did not detrimentallly impact the lining of the uterus. Notably, however, the researchers did note that there are not enough data to recommend isoflavones to women who’ve had breast cancer or at high risk for developing, even though current data suggest that exposure does not adversely affect breast tissue density or cancer cell proliferation, meaning that it is likely that with more study, they will ultimately prove safe for use in breast cancer patients.

Your key take-away is that there may be a viable option for women who are flashing but want to stay away from hormones. However, this is what we still need to know:

• Will genistein work on larger groups of menopausal women?
• Is formulation important?
• Is the 30 mg dose the lowest dose that will confer these sort of benefits?
• Are there any other factors that these women had in common that might be influencing outcomes?

As with any novel data like these, it’s great to be cautiously enthusiastic. Stay tuned!

Wednesday Bubble: word to the wise – move early, move often, keep moving

Posted by Liz on Dec 15, 2010 in weight | 2 comments

I’m not bursting bubbles this week but rather  illusions about physical activity.  This advice is for women AND men. And not just for the midlife set:

Maintaining high activity levels throughout the young adult years may help to reduce weight gain during middle age.

It’s intuitive, isn’t it? And yet, obesity has been steadily increasing since 1973 and now affects almost a third of adults in the US. And while battling the bulge definitely becomes more challenging with age,  it appears that there is a rather easy solution: Move early. Move often.

In a newly published study of over 3,000 men and women, researchers found that habitual activity, described as maintaining high intensity activity (including sports, exercise, home maintenance and occupational activities) totaling roughly 150 minutes/week over a period of 20 years resulted in:

• A weight gain of approximately 6 lbs to 13 lbs less per year in men and women respectively, compared to peers who were exercising only moderately or lightly
• A lower increase in body mass circumference (measured by BMI) by as much as 1.2 inches to 1.5 inches per year in men and women, respectively, compared to peers who were only exercising moderately or lightly

These outcomes, which were especially notable in women, remained even when the researchers accounted for such factors as race, education, smoking, age, BMI at the study’s start, alcohol use and daily caloric intake.

One of the remaining questions is how much activity is needed to sustain these sort of changes, especially as we transition into middle age. That’s where experts disagree, with some claiming that 30  minutes daily is enough and others, suggesting that women in particular require at least 60 minutes daily. There is also indication that higher activity alone might not be enough to counter age-related weight gain although the findings only partially support this.  The bottom line is that there is no time like the present to start instilling good habits, which why I’m challenging you to share this post broadly, especially among the young adult women in your life. As I’ve written time and again, the earlier the intervention, the likelier you are to remain healthy and stave some of those troublesome menopausal symptoms.

Young or old, start moving, move often and keep moving.

Estrogen only? Fanning the flames of the HRT debate

Posted by Liz on Dec 13, 2010 in breast cancer | 6 comments

A study presented at the esteemed San Antonio Breast Cancer Symposium last week has fanned the flames about the benefits versus risks of hormone replacement for menopausal symptoms. In this study, which ironically was pulled from the site press release highlights after experts questioned its merit, researchers did a reanalysis of data from the Women’s Health Initiative trial, the infamous 2002 study that was halted after Preempro was shown to increase breast cancer risk. Their findings? That women who had participated in the estrogen only arm of the study, had had benign breast disease, had had hysterectomies and had family histories of no breast cancer actually had significant reductions in breast cancer incidence. What’s more, 75% of women who did not have benign breast disease at the study’s start also had a reduced risk of developing breast cancer.

So, this is good news, right?

Well, estrogen alone can only be used by women who have had hysterectomies; estrogen plus progestin is used in women with intact uteri in order to avoid uterine cancer. This means that only a subset of women with menopausal symptoms are eligible to use estrogen alone. Moreover, as a physician blogger points out, the findings run counter to most data that show that estrogen use is actually associated with an increased risk of breast cancer. He also notes that abstracts that are accepted as posters at major medical meetings often have flawed or spotty data; in fact, in my years as a medical writer, I’ve often run across abstracts that ultimately disagree with published works.

The bottom line here is that despite the news, using estrogen alone to treat menopausal symptoms might only be an option for a very small percentage of women and may still place them at risk for cancer. At the end of the day, prescribing hormone replacement therapy continues to challenge the Hippocratic Oath: first do no harm.

Musings: Menopause ain’t nothing but a…

Posted by Liz on Dec 10, 2010 in menopause, musings | 2 comments

Number?

Sometimes it is just that. And sometimes it’s not.

I’m reposting this piece, which first ran in June 2009, because a reader recently challenged me on my consistent opinion that menopause is not a disease.

“Menopause is truly a disease. There are many so called true diseases that cause far less damage to a womens body.”

Actually, the conditions that wreak the most havoc on a woman’s body as she grows older appear to more closely associated with aging than with menopause. Theoretically, this would mean that our best strategy to address prevention or risk reduction, right?

Here are the facts:

Australian researchers suggest that many of the more common complaints of menopause may be possibly related to aging in general and not specifically the transition. In fact, in a study presented during last month’s 8th European Congress on Menopause, they reported that menopause is strongly associated with some but not other common complaints.

So what about the other symptoms? After reviewing data from 58,724 women (ages 45 to 50) participating in the Australian Longitudinal Study on Women’s Health, the strongest associations were seen between menopause and hot flashes/night sweats. These findings remained after adjusting for age during the study, age at menopause, smoking history, body mass index, sociodemographics (i.e. education, income, marital status and geographic location) and other factors that might influence outcomes. Other symptoms, including difficulty sleeping, stiff/painful joints and poor or fair self-reported health were also associated with menopause but to a much lesser extent. Headaches, migraines and incontinence appeared to be more strongly related to the aging process.

The researchers say that treatment (in this case, HRT) should be geared primarily towards alleviating vasomotor symptoms. Less clear, however, is how long therapy should be continued, since some symptoms can last for more than seven years. This study is scheduled to appear in Menopause.

Last September, I wrote a post about a survey being reported at the North American Menopause Society’s Annual meeting suggesting that women can actually discern the symptoms of menopause from those of aging.  Interestingly, many of the symptoms overlapped; in fact, 84%, 72%, and 77% of respondents associated vaginal dryness, urinary stress incontinence and weight gain, respectively, strictly with menopause, even though they can also be caused by aging as well.

So, what’s the primary point? It can be difficult to tease apart the effects of aging and the effects of menopause. Clearly, these new Australian data add a bit more to the confusion, and reinforce the point that more research and funding is needed in this particular area.

When I write that “menopause is not a disease and should not be treated like one,” what I am really saying is that disease, especially when it’s chronic can stigmatize, frighten and even create self-loathing. By offering up hormone replacement therapy as the only viable “solution” to preventing and ameliorating the symptoms of menopause and outrightly dismissing gentler alternative strategies, the medical community takes on the stance that Author Louise Foxcroft has written about:  “fear of the menopause is something we have learned, and it has grown out of a general, male and medical distaste for the idea of the menopause perceived as an end to viability, fertility, beauty, desirability and worth. Since the French physician de Gardanne coined the new term ‘ménépausie’ in the early nineteenth century, an onslaught of opinion, etiology, treatments, and not least and lest we forget, profit has followed. Women need to unlearn their dread and recognize that menopause is not, of itself, dread-full; that we are merely the victims of our biological process.”

So which comes first? Menopause and disease or aging and disease? Regardless, we can go out fighting or we can give in.

in all, a good thing, right?