Newsflash! Trust your gut: HRT and ulcerative colitis
Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and sores in the lining of the large intestine. The disease affects men and women in equal numbers and risk is higher among Caucasians and Jews. Yet, although it most commonly develops between the ages of 15 and 30, ulcerative colitis has a brand new bag, so to speak: women in menopause taking hormone replacement therapy (HRT). Yikes! Another nail in that HRT coffin. And this time, both combination hormone therapy (i.e. estrogen plus progesterone) and estrogen only appear to play a role.
Investigators will be reporting study findings (which are derived from following more than 108,000 postmenopausal women enrolled in the Nurses Health Study) at the American Gastrointestinal Association’s Annual meeting next month. Information on this group of women was updated every two years for 32 years, including menopausal status, use of hormones and medical diagnoses. The findings? Compared to women who never used hormones, women who did, regardless of type, had a 1.7 times greater risk for developing ulcerative colitis. Notably, this risk increased with longer duration of hormone use and decreased the longer the time period since stopping hormones. In fact, risk declined by almost 25% in women who had discontinued hormones for five or more years.
It was once believed that stress caused ulcerative colitis but experts now hypothesize that it’s triggered by a virus or bacteria that attacks the immune system, or is hereditary. So where do hormones come into play? Apparently, estrogen may play a role in controlling how the lining of the intestine functions to keep out toxins but let in nutrients, electrolytes and water as well as inflammation. Replacing estrogen with hormone therapy may act to create an imbalance that sends the system into overdrive but researchers are still not clear how and why.
Meanwhile? Hormone replacement therapy may increase your risk for developing ulcerative colitis as you age. You should always trust your gut. What is it telling you about HRT?
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Newsflash: Estrogen only joins “avoid long-term hormone therapy use” recommendations
How many times does one need to get hit over the head before they have that “ah-ha” moment?
That’s pretty much the party line when it comes to hormone replacement therapy, or HRT. I’ve been writing about HRT since I started this blog. And I have been reading study after study that ultimately come to the same conclusion: long-term use of any hormones is unsafe.
I know that there are naysayers out there who don’t want to believe. Even the International Menopause Society continues to dispute the link between combined hormones and breast cancer. Yet, I wholeheartedly believe in free will and choice, informed decision-making needs to lead the way when it comes to your health.
And so, in the latest wrench to be thrown into the HRT argument, researchers from Brigham and Women’s Hospital in Boston, reporting from the annual American Association for Cancer Research meeting, that the longer that any hormone replacement is used, regardless of whether or not it is estrogen plus progesterone or estrogen alone, the higher the risk for developing breast cancer.
Did you read that?
Lead researcher Wendy Y Chen is quoted in the Association’s newsrelease as saying that while it’s “already been confirmed that patients shouldn’t be undergoing estrogen plus progesteron hormone therapy for the long term,” (you can read about that here), “what we found is that people should also be careful about longer-term use of estrogen-alone [hormone therapy].”
Chen and her team evaluated data collected during the Nurses Health Study over a period of 28 years. They found that of the 121,700 women who took part in the study who were between the ages of 30 and 55 in 1976, and used combined hormones for 10 to 14.9 years, had an 88% higher risk of developing breast cancer than women who did not use HRT. Moreover, this risk increased to more than two-fold in women using it up to almost 20 years. And although the risk was comparatively lower for women who used estrogen only, they still had an 22% increased risk for up to 14.9 years and a 43% increased risk for up to 20 years compared to non-users.
Importantly, when the researchers restricted the population to the same that was observed in the Women’s Health Initiative study (i.e. healthy, active postmenopausal women ages 50 to 79 with an intact uterus), they observed a decline in breast cancer risk among women who used estrogen only therapy for less than five years but continued to observe an increased risk among women currently using estrogen fo 15 to 20 years.
Chen emphasizes that the data do not demonstrate an increased risk for dying from, although they continue to study this particular factor for additional clues.
So, what’s the upshot?
Long-term use of any kind of hormone therapy, estrogen alone or in combination with progesterone, significantly increases the risk for developing breast cancer. Is this increased risk worth a decline in hot flashes, night sweats, mood swings and vaginal dryness? Only you can decide.
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Wednesday Bubble: is DHEA the path towards a better sex life?
Today’s Bubble is a doozie that can one of two ways: in the yes(!) column or in the no (!) column. I’ll leave it to you to decide.
DHEA is the most abundant sex hormone in circulation and is mostly secreted by the adrenal glands. Research has shown that low DHEA levels in pre- and postmenopausal women may negatively affect sexual functioning, while ample blood levels may enhance sexual functioning, cognitive functioning and wellbeing. Yet, whether or not DHEA really works continues to be controversial. And the reason behind the burgeoning interest is the quest to find a suitable replacement for HRT. The thing is? There are lots of suitable, evidence-based replacements that are not broadly accepted by many medical professionals and many of these are discussed regularly on this blog. Nevertheless, here’s what researchers have just discovered about DHEA.
The researchers, from Pisa, Italy, followed 48 healthy, postmenopausal women for a year. During this time, they divided 36 women who were experiencing troublesome menopausal symptoms and requesting hormone replacement into three groups:
- 12 women who received 10 mg daily of DHEA
- 12 women who were given combined HRT
- 12 women who received the synthetic hormone, tibolone, daily
The fourth group was comprised of 12 women who did not wish to use HRT. They received daily vitamin D (400 IU) and calcium to help combat osteoporosis.
At the start of the study, all of the women reported similar sexual activity. However, after a year of treatment, women taking DHEA had significant increases in sexual interest and activity scoring almost 14 points higher on a questionnaire used to measure sexual interest, satisfaction, vaginal lubrication, orgasm and sexual partner. The women taking HRT experienced similar benefits, and women in both of these groups reported engaging in more sexual intercourse compared to women taking Vitamin D and calcium. Women taking the synthetic hormone also had increased sexual interest scores but they were not as high as the other two hormone groups. The magnitude of improvements in menopausal symptoms was also similar between the DHEA, HRT and tibolone groups.
The reason for this improvement appears to be the effect that DHEA has in terms of improving blood levels of the hormones estradiol and progesterone, both of which decline during menopause. It also appears to positively affect adrenal functioning.
What to think? Well, the study didn’t include any information on side effects. This is what Mayo Clinic has to say in that regard:
“No studies on the long-term effects of DHEA have been conducted. DHEA can cause higher than normal levels of androgens and estrogens in the body, and theoretically may increase the risk of prostate, breast, ovarian, and other hormone-sensitive cancers. Therefore, it is not recommended for regular use without supervision by a licensed health professional.”
Another important fact, acknowledged by the researchers, is that DHEA was only studied in 12 women, hardly enough to draw any firm conclusions. But they do believe that the findings, albeit preliminary, are encouraging, especially for women who “may have problems in taking more conventional HRT.”
Personally, I believe that it’s waaaaay too early to even consider DHEA as an alternative to HRT and in particular, to androgen therapy for sexual health. I want to see more information on side effects before it’s even on the radar. Meanwhile, I would love to hear what you think:
Yes!?
or,
No!?
Read MoreEstrogen and urinary incontinence: is there a link?
One of the most common and (and yet unspoken about) conditions in women is urinary incontinence (UI) or problems with bladder control. Defined as the involuntary loss of urine – either due to a weakening of the pelvic floor muscles and in association with pressure on the bladder (stress urinary incontinence) or due to unknown causes and associated with an uncontrollable urge to pass urine, frequency and nighttime awakening (urge urinary incontinence or overactive bladder) – urinary incontinence is most definitely associated with aging. In fact, roughly 15 million women in the U.S. have stress urinary incontinence and about 20 million, overactive bladder.
There are a multitudes of risk factors for urinary incontinence and they range from weight, vaginal deliveries and pelvic surgery to alcohol use and of course, as mentioned, growing older. However, why is menopausal status also a risk factor?
One word: estrogen.
Indeed, results from the infamous Women’s Health Initiative study demonstrated that women who were randomized to combination hormone therapy or estrogen only were at increased risk for worsening urinary incontinence symptoms or for developing urinary incontinence after only one year of use. However, like other data from this study, questions have been raised with regard to the findings, namely that they are not applicable to the general population. And yet, it is critical to learn if using hormone therapy increases urinary incontinence risk; these conditions significantly affect quality of life and at their severest, limit physical and social activities, limit intimacy and other relationships, limit work productivity and affect overall wellbeing.
Rather than generalize, however, it’s important to take a close look at ethnically diverse populations of women in the community and tease out if there are any specific factors related to estrogen use that increase incontinence risk. That is exactly what a group of researchers did recently, when they examined a group of 167 women in menopause who had been surveyed in 1993, found to have no urinary incontinence and then reinterviewed eleven years later in 2004. In this study, which was published in Menopause journal,the researchers specifically evaluated if the women had used estrogen and if so, for how long (i.e. less than five years or more than five years). The findings? Although none of the women reported having urinary incontinence issues at the first interview, just over a decade later, 28% reported that they had developed urinary incontinence and almost 19%, that they developed urinary incontinence that resulted impacted their ability to function (e.g. avoiding social gatherings, not visiting friends or going to church, or avoiding traveling, shopping or physical activities). What’s more, of the women surveyed who reported that they had used estrogen for more than five years, 15% developed new cases of urinary incontinence with an associated loss of function.
According a related piece in Reuters, the study’s lead investigator says that they didn’t take into account how much estrogen the women were using or if they used it in conjunction with progesterone, so there are weaknesses in the study. Still, it does appear that taking estrogen for more than five years may significantly increase the risk for bladder control issues. The next piece of the puzzle is discovering why it affects bladder function in the first place.
Bladder control issues are serious business. Yet another reason to speak to your doctor before moving forward on hormone therapy. Your move – worth the risk?
Read MoreMenopause: the symptom? Or, the disease?
A few years ago, I ran across the following story on the BBC:
“Woman’s Death Blamed on Menopause.”
“A woman who refused to take hormone replacement therapy died while suffering a menopausal episode, an inquest had heard. Margaret Drew…was killed when she walked out of her family home on to a nearby railway line and was hit by a train…There is no trigger to this at all, except hormones making her do things that she normally wouldn’t do, Dr. Carlyon [Cornwall Coroner) concluded…”
Menopause. The silent killer. Oh really? Drew’s husband claims that his wife was “delightful, lovely and friendly” 99% of the time; the other 1% she’d become “totally irrational.” Yet, she refused to try HRT, he says. On the day of her suicide, he said that his wife was “clearly angry about something.”
Something.
Obviously, the conclusion is that that the “something” is hormones. This reminds me of vintage advertising copy that conveys the simple message that a pill a day can cure all that ails, wipe away the tears, mood swings and instability so that women can “transition without tears” (or better yet, without killing themselves).
Notably, a search in the National Library of Medicine’s PubMed database turned up only one recent study specifically dealing with suicide ideation across reproductive stages. In it, researchers compared data in 8,794 women, and found an increased risk of thinking about suicide among women during perimenopause, not before or after entering menopause. These findings remained after controlling for risk factors such as anxiety and mood disorders. HOWEVER, the researchers noted that the study design did not allow them to form any definitive conclusions about the specific reasons for thinking about suicide.
Another search yielded information that the risk for a major depression increases during perimenopause, primarily as the direct result of vasomotor symptoms. The same does not hold true for women before menopause begins or once they enter menopause. Note that while major depression is a risk factor for suicide, not everyone who is depressed will actually kill themselves.
So, are hormonal fluctuations the sole cause of such deep unhappiness that women want to kill themselves?
Interestingly, just a week after the menopause/train suicide story hit the interwebz, a rather controversial set of data also emerged: since 1972, women’s overall level of happiness has dropped. These findings held true regardless of child status, marital status and age. Researcher Marcus Buckingham, writing in the Huffington Post, said that women are not more unhappy than men because of gender stereotyping and related attitudes, due to working longer hours or because of the inequality of housework/responsibilities at home, but rather, the hormonal fluctuations of menopause may be to blame. What’s more, he leaves us hanging so we’ll tune in for part two of the piece to learn the true cause of our declining happiness or better yet, read his book (which evidently guides women through the process of finding the true role that they were meant to play in life).
Importantly, reactions to this study (and various pundits’ assessment of it) have been mixed. One of the most poignant comments I’ve read asks the question “how is happiness measured? What does it mean?”
I have no idea what caused Mrs. Drew to walk into a train and kill herself. Perhaps she was depressed. Clearly she was suicidal.
I have no idea why research shows that women are less happier than they were three decades ago.
However, is menopause the cause? Aren’t these conclusions an example of how the Menopause Industrial Complex perpetuates societal myths that menopause is a disease that requires treatment? That as women, our attitudes, belief systems and actions are hormonally-based and driven? That we are hysterical beings who need guidance on how to find our way and fulfill our dreams, realize our paths, but only if we calm down?
Feeling angry? Blame it on menopause. Unhappy? Blame it on menopause. Not realizing your dreams? Blame it on menopause. Overworked, overstressed, undervalued? Blame it on menopause.
Blame it on menopause.
I don’t know about you but I’m tired, tired of hearing that menopause is not the symptom but the disease. Isn’t it time we start fighting back?
Read MoreBotanically speaking…EstroG-100
Got botanicals? You might want to get this one. Although the traditional Japanese medicine Kampo supplement TU-025 doesn’t appear to offer much hope in the hot flash department, a well-known botanical supplement widely used in Korea, EstroG-100, may. In fact, it appears that the proprietary blend of Korean herbs in EstroG-100, including Cynanchum wilfordii, Phlomis ubrosa and Angelica gigas are not only safe but help in a number of menopausal symptoms in addition to hot flashes.
So, what’s the lowdown on EstroG-100? Basically, the supplement has been studied in Asian women and we know from other alternative strategies that effectiveness among different ethnicities don’t always translate. Hence, I was pretty interested to learn that researchers decided to see if EstroG-100 would work on menopausal symptoms in a small group of white- and non-White Hispanics and African American women who were pre-, peri or menopausal. Over a three month time period, women either took 2 EstroG-1oo tablets or placebo twice daily and then using a scientific index, self-reported and rated symptoms, including:
- hot flashes
- cold swewats
- numbness, tingling
- insomnia
- nervousness, depression or feeling blue
- dizziness
- fatigue
- muscle and joint pain
- headache
- pounding heart
The study results suggest that EstroG-100 is not only safe, but it has a significant impact on a few very troublesome symptoms, namely hot flashes and sweats, insomnia, nervousness, feeling blue, dizziness and fatigue. Overall, menopausal symptom scores declined by more than half in women using EstroG-100 compared to women taking placebo. Moreover, initial, favorable changes were seen as early as 6 weeks. Estro-G also appeared to have a beneficial effect on the severity of vaginal dryness, a condition that plagues many menopausal women as estrogen levels decline. Even better were findings that EstroG-100 does not have any sort of estrogenic effect, indicating that it may potentially be safely used in women at risk for gynecological cancers. And, use of EstroG-100 does not appear to affect weight, body mass index or liver enzymes, all of which are affected by hormone replacement.
Less clear is how EstroG-100 will work in non-Hispanic white women and that study, along with studies in larger numbers of women may determine it’s overall benefit in menopause. Meanwhile, I’m pretty encouraged. This study addresses a lot of complaints about studies of alternatives; it is well designed, randomized, looks closely at adverse events and includes a variety of ethnic groups and menopausal status. Stay tuned for more on EstroG-100. This botanical may be here to stay!
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