Posts by Liz

Wednesday Bubble: HRT – wait a moment!

Posted by Liz on Jun 16, 2010 in HRT | 0 comments

Back in early May, I wrote a post about the difficulties in stopping hormone replacement therapy (HRT) and the disturbing fact that doctors have no guidelines to follow in order to advise their patients on the best strategies. Today’s Bubble is a perfect companion to that piece, as it addresses the fact that research now shows that women who start HRT and then stop it have a tendency to have significantly greater and more severe  menopausal symptoms than had they never started HRT at all.

Writing in the online edition of Menopause journal, researchers say that among 3,496 postmenopausal women who completed a pre- and post- stopping therapy survey during the Women’s Health Initiative study (a trial that compared estrogen/progestin to placebo and was subsequently halted when HRT was found to double the risk of breast cancer) :

• Those who had not reported having hot flashes at the start of the study were more than five times as likely to report moderate to severe hot flashes after stopping HRT compared with women with no symptoms who took sugar placebo pills. However, women who had reported having hot flashes at the study’s start were only slightly more likely to report hot flashes after stopping HRT
• A similar pattern was seen for night sweats, i.e. women who had none at the study’s start were almost twice as likely to report them after stopping HRT
• Age at stopping HRT was increasingly associated with more joint pain, i.e. the older the woman, the higher the risk for experiencing joint pain

The researchers say that although there have been previous reports of  a surge in vasomotor symptoms like flashes and sweats after stopping HRT, these findings show that estrogen, either alone or with progestin, may promote symptoms when HRT is stopped, even if a woman was not experiencing them when she started therapy. More specifically, the risk for menopausal vasomotor symptoms and joint stiffness is four to seven times more in women with and without prior symptoms when HRT is stopped.

The takeaway message is that it’s not only important to consider the health risks associated with HRT but also, what happens when you stop it. Clearly, even if your symptoms disappear while on HRT, your risk for symptoms after stopping therapy is fairly high.

You should always weigh the risk benefit ratio before starting any type of therapy. HRT may not be worth the trouble. Or the multiple risks.

p.s. More on this study from my friends at Reuters Health.

Is topical HRT hurting your pet?

Posted by Liz on Jun 14, 2010 in HRT | 2 comments

File this one under “OMG.” I ran across a piece this past weekend that discussed the effect that topical hormones, particularly HRT, might be having on your pets. Although experts from the North American Menopause Association (NAMS) are quoted as saying that they’ve not heard of this before, the reporter  uncovered five years worth of discussion on veterinary internet boards. Evidently, vets are seeing female animal patients with swollen vulvas and male patients with enlarged mammary glands and smaller than normal penises.

It appears that exposure occurs when owners apply topical hormone gels, lotions and sprays to the arms (i.e. elbows, wrists) and legs and then handle or snuggle with their pets. The problem has also been associated with pets unwittingly licking the areas where owners have applied the drugs.

Evidently, the Food and Drug Administration is looking into this as is the NAMS. In the interim, if you are using topical hormones, you might want to be more careful where you apply them (e.g. inner thigh or abdomen) and be sure to wash your hands before handling your pets.

And if your animal is exhibiting unusual signs? Bring them into the vet immediately.

Has anyone encountered this before? I’d love for readers to weigh in.

Wednesday Bubble: The HRT patch – is it safer?

Posted by Liz on Jun 9, 2010 in HRT | 9 comments

Remember the diva and the doctor sitting on the roof espousing the benefits of the HRT patch? Well, it turns out that some of these patches might not be so safe after all. Results of a study of over 75,000 women published in the British Medical Journal, show that the use of high-dose transdermal (through the skin) HRT patches increases stroke risk by as much as 88%.

Granted, transdermal or through the skin delivery bypasses the liver, which typically makes patches safer than their oral counterparts. However, if the drug isn’t safe, well, then the patch might not be either.

In this latest bit of news, researchers evaluated women between the ages of 50 and 79 who had participated in the ongoing Study of Women Across the Nation (SWAN). Every woman who had had a stroke were matched for comparison to four women in the study, with similar characteristics, who had not. The women were further divided into groups based on their use and type (i.e. oral or patch) of HRT, including estrogen only, estrogen plus progestogen, progestogen only, and the estrogen alternative, tibolone (which is not available in the US).

The researchers say previous and recent studies suggest that oral HRT, including estrogen only or estrogen plus progestogen, is associated with a 30% increased risk of stroke. However, stroke risk differs between high- and low-dose patches. Overall, they report that:

• Low-dose patches do not appear to increase stroke risk, at least in the short-term (they say that they cannot rule out an increased risk with long-term use)
• High-dose patches, regardless of whether or not they are estrogen only or estrogen plus progestogen, appear to increase stroke risk by anywhere from 25% to 88%
• Risk was the highest among women who had used oral HRT before trying transdermal HRT, although this risk appeared to decline the longer the time period between stopping oral and starting the patch
• Findings remained even after adjustments were made for factors that might influence results, including age

What the findings mean

Despite claims to the contrary, it does not appear that HRT offers much protection against heart disease during and after menopause. What’s more, the HRT patch may not actually be safer than oral HRT, at least in so far as the high-dose HRT patch goes. Although the researchers state that they were unable to distinguish between types of stroke when evaluating the SWAN study data, they say that these data show the need to look further into how HRT is delivered, especially as use of the HRT patch becomes the norm.

As I’ve written previously, if your doctor suggests you try HRT for menopausal symptoms, it behooves you to ask the hard questions. While you may save your sleep, mood and a few articles of clothing, you may be placing yourself at a higher risk for cancer, heart disease and other serious conditions.

Flashfree food for thought: lignans and breast cancer risk

Posted by Liz on Jun 7, 2010 in breast cancer | 1 comment

I’ve written previ0usly about the potential benefits of flaxseed in boosting bone health and alleviating hot flashes.  Now, researchers are suggesting that flaxseed and other foods that contain high levels of lignans –  a type of phytoestrogen with both weak estrogen and antioxidant activities – may also help lower the risk of breast cancer in postmenopausal women.

In a large analysis of 21 studies examining possible links between lignan intake and breast cancer risk, the researchers found that including large amounts of lignan in the diet reduced the risk of developing breast cancer by as much as 14% in postmenopausal women. What’s more, risk was reduced by as much as 16% in studies that specifically examined levels of compounds called “enterolignans,” which are created with dietary lignan enters the stomach and interacts with bacteria residing in the intestines. The researchers say that lignan may offer moderate protection against breast cancer because it blocks estrogen activity that promotes tumour growth, perhaps mostly when natural estrogen is low (i.e. during menopause). However, the study did not provide details as to what constitutes “large” amounts of the compounds.

Flaxseed is one of the richest dietary sources of lignan, although it is also found in other foods including sesame seeds, sunflower seeds, whole grain breads, muesli, kale, broccoli, white cabbage and brussel sprouts, apricots and strawberries. You can find a full list of the lignan content in foods here.

Should you start eating more lignan? The good news is that the foods that are richest sources of the phytoestrogen are also quite healthy.  And, wth the potentially added benefits of preventing osteoporosis and lessening hot flashes, it seems that boosting lignan intake is a win-win all around!

Want to read more? Reuters Health has an excellent write up with additional information on the study.

When it comes to calcium, think moderation

Posted by Liz on Jun 4, 2010 in bone health | 3 comments

There’s a new condition emerging among postmenopausal women: calcium alkali syndrome (milk-alkali syndrome).

Milk calcium what?!

A wonderful commentary slated to appear online this month in the Journal of  the American Society of Nephrology highlights the dangers of consuming too much calcium . In it, the author  tells the tale of Chicago bartender Bertram Welton Sippy, who in 1915, introduced his bar patrons with ulcers to the Sippy diet, hourly intake of milk, cream eggs and farina cereal interspersed with Sippy powders on the half hour (i.e. dissolvable antacid like minerals that included calcinated magnesia, sodium bicarbonate and bismuth subcarbonate). A recipe for disaster? You bet, because the overkill of calcium and minerals led to symptoms that include headache, nausea, vomiting, mental clouding, a distaste for milk and eventually, kidney failure. Yikes!

While men were the primary victims of the condition in the last century, it appears that a new group of victims started to emerge in the 90s – postmenopausal women who have increased their intake of calcium and vitamin D to combat osteoporosis. And although calcium, not milk, is the primary driver, the condition is the third most common cause of hospital admission for significantly elevated blood calcium levels.

It appears that the necessity to preserve our bones has created a modern version of the Sippy diet.

The best strategy for reducing the risk of calcium-alkali syndrome is to moderate your intake of calcium supplements. In fact, the authors say that although an average of more than 4 g/day of supplemental calcium is most commonly linked to illness, small numbers of women have developed it on as little as 1 to 1.5 g calcium a day. Of note, while younger adults are able to store excess calcium in bone, aging seems to reduce this natural defense and instead, calcium tends to leave the bone (thereby leaving us more susceptible to fragile bones and osteoporosis) and in turn, a potential build up in the bloodstream. Still, the authors emphasize that calcium supplements in moderation are a necessary and beneficial option for women at risk for osteoporosis. The trick is to limit supplemental calcium intake to no more than 1.2  to 1.5 grams daily because our bones need protection. Read the label. And speak to your healthcare practitioner. When it comes to protecting our bones through supplementation, moderation appears to be the key.

p.s. Stay away from the Sippy diet. It’s a sippier slope (sorry, couldn’t resist!).