Wednesday Bubble: Just say “no”
Gonna burst that hormone bubble at least one more time. Seems that the synthetic hormone Livial, which is billed as an alternative to HRT, significantly increases the risk of breast cancer recurrence. Ouch!
Livial is a selective tissue estrogenic regulator (SERM), which mimics estrogen’s activity with regards to strengthening bones. The agent has mostly been marketed in Europe for treatment of hot flashes, night sweats and bone loss, as well as a treatment for osteoporosis.
In a study reported in the current issue of The Lancet Oncology, researchers evaluated the effectiveness of 2.5 mg/day of Livial compared to placebo in more than 3,000 women with a history of breast cancer. Although the agent had a positive effect symptoms and bone density, the trial was stopped six months early because women taking Livial had a 40% increased risk of having their breast cancer return.
The researchers state that the likely reason for this increase is that Livial interferes with the protective effect of different cancer drugs and might stimulate dormant tumors to become active again.
Clearly, Livial should not be used in women with a history of breast cancer. Then again, with data definitively showing an increased risk of cancer and heart disease with use of hormone therapy, why take a chance to begin with?
What are your thoughts? Is estrogen worth the risk for a few less symptoms? Or are you better off taking an alternative route?
Read MoreTalking the talk: hormone therapy
Is your healthcare provider more or less likely to suggest hormone therapy (HT, estrogen only) when you see them for menopausal symptoms? What’s more, how do you know?
Results of a study in the Ahead of Print edition of the journal Menopause suggest that certain factors do influence prescriber habits.
Researchers measured how often 249 primary care (i.e. internists and family practitioners) and ob/gyns prescribed HT to their patients (ages 45 to 80) in a given year based on electronic pharmacy data. In addition to examining information on the providers themselves, data on perceptions of patients’ views on the Women’s Health Initiative trial results (WHI, which examined the link between HRT and heart disease), provider views on the WHI study and how prepared they felt to counsel patients were also analyzed. 57% of the providers in the study were women.
The findings? How often HT was prescribed appeared to vary by geographical location and the number of years a provider had been at a specific organization (which may reflect the age of the provider). More than half of those surveyed believed that they had expert knowledge about data coming out of recent HT trials.
In fact, primary care providers who felt that they had this degree of knowledge were significantly more likelier than their colleagues who did not to recommend hormone therapy. In contrast, ob/gyns who were more likely to prescibe HT were those who believed that they well prepared to counsel their female patients on hormone therapy. These practitioners also tended to believe that the results of the trials had been exaggerated.
Regardless of specialty, younger patients and patients who did not have other diseases that may exacerbate risk were most often prescribed HT.
So, what do these study results mean exactly?
The researchers write that HT prescribing may be “driven by factors outside of evidence-based medicine,” such as prescriber self-perception and age. If this is true, then the lack of provider bias could potentially influence prescribing habits and in turn, exposure to HT.
As the researchers say, “women, who when inquiring about HT risk and benefits, deserve unbiased and well informed counseling to make informed decisions.” And that it “is likely that some doctors need additional training to ensure this level of advice.”
For you, this means to be sure to be prepared when you make that first appointment to discuss therapeutic options for troublesome menopausal symptoms. Do the homework before you enter your provider’s office so that you are ready to ask the right questions.
In addition to the link provided above, which discusses the WHI data in detail, I encourage you to visit the following sites for unbiased information about menopause and its treatment:
The bottom line is that if your provider is talking the talk, be sure that you know why you’re going to walk the walk.
Read MoreWednesday Bubble: I’d walk a mile
Fact or fiction? I’ve written previously about the link between cigarette smoking and hot flashes. In fact, the association consistently arises in many of the studies I’ve run across. When I first posted about this, it seemed to push a lot of buttons, primarily because many of my contemporaries, myself included, smoked at one point in our lives.
Hence, I was intrigued when I found this study in the journal Obstetrics and Gynecology discussing the underlying cause of the association between cigarette smoking and hot flashes.
In the study, perimenopausal women who were either experiencing or not experiencing hot flashes were asked to complete a questionnaire and provide a blood sample so that researchers could measure their hormones.
The results showed that women who were current smokers had significantly higher levels of androstenedione (a precursor to sex hormones) and higher ratios of androgens to estrogens than women who never smoked. Additionally, current smokers had significantly lower levels of progesterone than never smokers.
Nevertheless, while both former and current smokers had increased odds of experiencing hot flashes (1.4 times greater for former and 2.4 times greater for current) than never smokers, this link was not altered or influenced in women who were also taking hormones.
Researchers have long believed that factors that influence estrogen levels, such as a higher body mass index (which increases them) or cigarette smoking (which decreases them) protect against or lead to vasomotor symptoms, respectively. Yet, in this particular study, hormone changes did not weaken the effect of smoking on hot flashes.
These results suggest that the effect of cigarette smoking on hot flashes, while very real and relevant, is not influenced by hormones.
Unanswered questions. Undoubtedly the bottom line is to stop smoking if you continue to do so, not only for heart and lung health, but also, to help avoid those troublesome hot flashes.
Read MoreBreast cancer risk and HRT – what matters most?
Data from the San Antonio Breast Cancer Symposium last month provided definitive evidence that HRT increases the risk of breast cancer by 26% in menopausal women. However, does route of administration (e.g., patch, oral) or type of HRT matter?
According to a study in the journal Breast Cancer Research and Treatment, route of administration does not matter. But the progestagen component does.
Data were extrapolated from 80,377 postmenopausal women living in France and participating in E3N (a study designed to investigate risk factors for cancer) between 1990 and 2002. At the study’s start, the average age of participants was 53 years. HRT types included estrogen only and estrogen plus progesterone, dydrogesterone combinations or other types of progesterone.
Over the study period 2,354 cases of invasive breast cancer occurred. Compared with women who never used HRT, women using estrogen alone had a 1.29-fold increased risk of developing breast cancer. However, breast cancer risk varied significantly depending upon the type of progestagen:
- Risk was significantly lower with estrogen-progestagen HRTS containing progesterone or dehydrogesterone than with estrogen combinations involving other types (e.g., nomegestrol acetate, norethisterone acetate, medroxyprogesterone acetate)
- The aformentioned combinations Ii.e. estrogen plus progesterone or dehydrogesterone) were associated with no or only a slight increase in breast cancer risk (1 fold greater or 1.16 fold greater, respectively).
- The results remained the same when analysis was restricted women whose age at the start of menopause could be most accurately determined.
Although the effect of progestagen remains somewhat unclear, and factors such as experimental conditions, length of time taking them and dose can influence results, the researchers did conclude that some HRT combinations may be safer than others.
Researchers also emphasize that further study is needed, and that medical experts are still unsure how HRT combinations affect other disease risks, such as heart disease, stroke and colorectal cancer.
Meanwhile, if you are taking HRT, talk to your health practitioner and find out which progestagen you’re taking. Better safe than sorry, right?!
Read MoreWednesday Bubble: The incredible shrinking brain
WHAT?!
New research from the Women’s Health Initiative Memory Study hormone trials demonstrates that HRT may shrink women’s brains. No wonder I can’t forget where I placed those files..
The data, which are reported in the January 13 edition of Neurology, show that women who took hormone replacement comprising estrogen with or without the addition of progesterone had an increased risk for dementia and overall decline of cognitive function.
Researchers measured brain volume and size of microscopic brain lesions in 1,403 women who took estrogen therapy for 18 months or combined estrogen/progesterone for three years or a placebo. The women who participated in the study were on average, about 77 years old.
The findings showed that women who took HRT had brains that were several centimeters smaller than women who took placebo.
The areas of the brain that were most affected by therapy? The hippocampus, which is involved in memory formation, and the frontal lobe which is involved in memory recall. However, no differences were seen in the sizes of brain lesions, which negates the possibility that HRT is leading to tiny strokes that cut off the brain’s blood supply and affecting memory.
When I looked into other reports of this study, I found quotes from the researchers that suggest that the greatest risk may be in women who already have memory problems. More importantly, the findings imply that the risks of postmenopausal hormone therapy may greatly outweigh the benefits.
These data do potentially provide some explanation as to why many women going through menopause experience increased forgetfulness. However, it is clear that the story is not yet complete, as many of us not taking hormones still seem to go through weekly, if not daily memory lapses.
Now…where did I put that….
Read MoreNews Flash!!!! More bad news about hormone therapy
Today marks the close of 31st Annual San Antonio Breast Cancer Symposium. And the news that taking hormones to prevent menopause symptoms for five years doubles the risk for breast cancer.
Dr. Rowan Chelboski from the Harbor-UCLA Medical Center presented these bubble bursting results on Saturday. Tracking over 15,000 women originally enrolled in the halted Women’s Health Initiative study (originally designed to examine the use of Wyeth’s Prempro until higher risks of heart disease were observed), the researchers plotted breast cancer cases over time for an average 5.5 years.
Importantly, they saw a clear trend showing increased breast cancer risk at the start of using the pills, a peak in risk as the study ended, and a decline once the women stopped using the pills. At its peak, women using hormones had twice the risk of developing breast cancer as those who never used them.
What’s more, despite the argument that the decline in cancer rates seen after women stopped using hormones might be due to fewer mammograms being done to detect cancer, these new data show that mammogram rates were the same among women taking hormones and those not taking hormones.
So what’s the take-away advice? Experts suggest that hormone use in the short-term (3-4) is still safe but recommend that long-term use be avoided or at the very least, dosage reduced.
Personally? I’d look for other safer solutions for those bothersome side effects of menopause.
What do you think?!
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