Ain’t no Wednesday Bubble: tick tock, part 2: the menopause blood test
I don’t usually interrupt our regularly scheduled Wednesday Bubble but this one’s pretty hot off the presses. Researchers have once again confirmed that concentrations of the anti-Mullerian Hormone (AMH – a protein produced by cells in the ovary and controls follicle development) can help predict when a woman will develop menopause .
I wrote about AMH levels being used in this fashion in a post last year, so this current study simply helps to support the hypothesis that science is gaining ground in the fertility/post-fertility arena. Similar to previous studies, researchers collected blood samples from 266 women between the ages of 20 and 49, thereafter, measuring AMH levels. Additional blood samples were taken at three yearly intervals, along with information about participants’ socioeconomic status and reproductive histories. The women also had physical exams every three years. The researchers then developed a mathematical model that would enable them to predict average age of menopause based on varying levels of AMH throughout the reproductive years, and compared these estimates to age at actual menopause in a subgroup of 63 women.
Presenting the findings at the European Society of Human Reproduction meeting this past Monday, researchers say that they were able to predict actual age of menopause within a margin of error of only three to four years. Moreover, certain AMH levels at certain years of age could accurately predict whether or not a woman was likely to start menopause early, before age 45 or at a more common age, e.g. over age 50.
If AMH is confirmed as a marker in further testing, the researchers say that a blood test could help women start family planning early in their reproductive life. As I wrote previously, it could also be used as a strategy to start effective interventions geared towards ameliorating menopausal symptoms and age-related diseases at specific points in a woman’s life. However, the potential of such a test is not without the negative. I wonder if a blood test that accurately predicts menopause could be used against a woman trying to obtain insurance for a pregnancy gone wrong due to age at which she “should have conceived.” Only time can tell the risks and benefits of such a test. In the interim, it seems that science is well on its way to controlling the tick tock of every woman’s biological clock.
What do you think?
Read MoreWednesday Bubble: An ‘Evolutionary’ not ‘Revolutionary’ Rx for Hot Flashes?
This week’s bubble brought to you by the manufacturers of Amberen™, a new menopausal treatment that bills itself as revolutionary not evolutionary. What they mean by this is that Amberen, a novel, non-hormal treatment for menopausal symptoms, does not represent an evolution of the same herbs (e.g. black cohosh, chaste berry) used by other manufacturers but a revolutionary new approach and strategy to addressing troublesome symptoms during menopause. Personally, I believe that anything that isn’t HRT based is evolutionary, however that aside, this week’s bubble is pretty darn solid and early data, pretty encouraging!
What is Amberen?
Amberen is a food supplement mostly composed of an enzyme known as succinate that is involved in metabolism. Dramatic swings in estrogen that result during menopause significantly affect the sensitive functioning of the hypothalamic-pituitary-ovary (HPO) axis (part of the neuroendocrine system that regulates many processes in the body, including interactions between the glands and hormones). According to published research, very small doses of succinate help to restore the way that the aging HPO axis functions, thereby promoting hormonal balance. In turn, this appears to boost estradiol levels and alleviate menopausal symptoms.
In small clinical studies, Amberen appeared to act as hormones in the body, resulting in self-reported reductions in the frequency of hot flashes, declines in insomnia and headache, and improvements in mood, anxiety and impaired sexual desire. Honestly, it sounds a bit too good to be true, so I am not entirely convinced. However, the researchers are quoted as saying that this approach to jump-starting HPO sensitivity could open the way for safer treatments for a variety of conditions, and not just menopause.
Amberen is not for everyone as it is not inexpensive, requiring at least a $90 commitment upfront (although there is an offer on the website for a 30 day free trial, a further dive shows that it takes at least 90 days to realize its full effects). However a three month on, three month off dosing schedule might be more convenient for women who have trouble remembering to take pills regularly.
Importantly, I did not see any reported details on side effects in the clinical studies I looked at, although the website cautions against women using Amberen if they have any thyroid or high blood pressure issues. I”d like to see more information on that as well.
Like any treatment for menopause, it’s essential to speak to your healthcare professional before diving in and trying Amberen. Personally, I’d like to see larger studies and specific information on side effects before making any real commitment to the product. However, I am intrigued by Amberen’s potential and certainly by this new approach to treatment, a seemingly viable and effective alternative to hormone replacement.
Have you tried Amberen? What do you think?
[Disclosure – I was approached by Amberen’s PR agency to see if I’d be interested in the product. After requesting and reviewing the clinical studies, I decided to write about it. I was not compensated for this piece nor was I sent or accepted any product.]
Read MoreDazed and Confused – Revisited
Two years ago i wrote a post about the confusion surrounding therapies, effectiveness, and discerning right from wrong when it comes to clinical trials. Herbal and integrative therapies are perfect examples of the grey areas; many trials have not incorporated some of the most important tenets supporting the use of these strategies, most important of which is individualization. Hence, I wanted to share the post with you again, and hopefully, spark some dialogue that might lead to improvements in how we study and write about the therapies that are offered to patients.
[youtube=http://www.youtube.com/watch?v=pau8Zf7srlU]
A gal pal mentioned to me this morning that she often feels so confused about study findings proving or disproving the value of certain medications or herbs that she often just throws up her hands and does nothing. Many of us are as dazed and confused as she is so that I thought that a few key points about clinical studies might help.
Mike Clarke from the School of Nursing and Midwifery at Trinity College in Dublin wrote a great article a few years ago about the need to standardize results of studies for a specific disease ( in this case, rheumatoid arthritis). He defined the problem as follows:
“Every year, millions of journal articles are added to the tens of millions that already exist in the health literature, and tens of millions of web pages are added to the hundreds of millions currently available. Within these, there are many tens of thousands of research studies which might provide the evidence needed to make well-informed decisions about healthcare. The task of working through all this material is overwhelming enough without then finding the studies of relevance to the decision you wish to make…”
So what do you do? A few key points:
- Consider that every study has the potential for bias. Perhaps researchers are using 7 instruments to measure depression and only highlight findings from 3 of these in order to preserve the most positive or significant results. Clearly, the reader is being led towards certain outcomes and away from others.
- Study designs, types of patients studied, age of patients studied, gender, you name, can differ so it’s difficult, if not impossible to draw definitive conclusions when comparing results of one to another.
- Another issue of great interest to practitioner of Western medicine is whether or not a study is controlled. This means that two groups are compared that are identical in every way except one group is given an experimental treatment and the other, a placebo or standardized treatment. Note that often, real world conditions are often recreated rather than conducted in a real world setting and many studies are not controlled, meaning that the science behind the findings is questionable.
- Alternative and complementary medicines are still incompletely understood among many practitioners of Western medicine. What’s more, products are not regulated as carefully as medicinal agents and manufacturing practices vary. Consequently, studies of these agents or modalities are often inconclusive. And of course, often underfunded and under-appreciated.
No wonder we all feel so dazed and confused!
I’ve written several times about the importance of consulting a practitioner or medical expert before embarking on any regimen for perimenopausal symptoms. Even if you only see someone once, at least that dialogue may be useful for defining a regimen that may work best for you and what you’re going through. And if you live off the beaten track without access toa good practitioner, well then excellent resources like Medline or the American Botanical Council may be be of help in discerning what’s what.
The short answer is that there are no short answers. But with careful guidance and a bit of prudence, you may just be able see the light and smooth out the bumps on this rollercoaster ride we’re all on.
Read MoreWednesday Bubble: the crystal menopause ball
Can you predict the age you will start menopause?
Most women and many experts say that there is a link between when their mothers started menopause and when they will likely start menopause. In fact, the ‘mother’ hypothesis has been explored in numerous studies, with explanations ranging from hormones to genetics to evolutionary selection. However, are there any other determinants or factors that also may come into play? Indeed, it appears that there are. And why is it important? Studies have shown both early (<age 45) and late (>age 56) menopause to be associated with increased health risks, such as heart disease.
Recent data from a study of over 1,000 women, almost of half of which were postmenopausal, show that weight gain and weight loss in the perimenopausal years may play an important role in determining the age that you start menopause.
After evaluating body mass index and height, and the women’s history of weight loss and gain in body mass index from age 25 to menopause, the researchers found that women with a history of losing 11 pounds or more between age 25 (excluding weight gain or losses due to pregnancy) and menopause or gaining roughly 1 pound or more per year during the same time period were more likely to start menopause later than the average age of 50 or 51. The greater the loss or gain, the later menopause began. Other factors that also appeared to influence a later menopause included the number of bleeding days between ages 20 and 30 (with “more” associated with “later”), use of an IUD, a later year of birth and how a woman perceived her economic status. On the other hand, women who smoked or had type 2 diabetes before transitioning to menopause and who had a mother who started menopause earlier than age 50, were more likely to start menopause earl
Wondering why this is important?
Clearly, the more information we have about when menopause might start, the greater our ability to start instituting effective strategies, such as exercise, relaxation, diet, etc, to stave off the numerous health issues that arise as our hormones decline. Some of these strategies might also serve a dual purpose of ameliorating vasomotor symptoms like flashes and night sweats.
Is the crystal ball accurate? Only time will tell. But knowledge is power. Always.
Read MoreWednesday Bubble: No pain, no…killing two birds with one stone?
Got pain? It is possible that if you regularly use aspirin, acetaminophen or NSAIDS (e.g. ibuprofen) during menopause, you may be reducing your risk for breast or ovarian cancer as well. Sort of a two birds with one stone approach. I like it!
This latest bit of great news comes from analyses of blood samples and questionnaires collected from 740 women who participated in a breast cancer trial as part of the Nurses Health Study, an ongoing investigation of factors that influence women’s health. At the time that information was collected, the women had no cancer, were in menopause and had not used hormones.Study findings, which are published in Cancer, Epidemiology, Biomarkers and Prevention showed that on average, mean levels of naturally estrogen (i.e. estradiol), were more than 10% lower among women who reported regular use of aspirin or NSAIDS, and 15% lower among women reporting use of any sort of analgesic agent.
Although this specific study did not look at the link between hormones levels and cancer, previous studies have shown use of NSAIDs may lower breast cancer risk by as much as 12% to 25%; the evidence for ovarian cancer isn’t quite that strong.
Mind you, researchers say that these results don’t actually confirm if aspirin-like drugs cause estrogen levels to drop but there is an association. More research is needed to see if there is a firm link between declines in hormones after analgesic use and lower risk or breast or ovarian cancer. If it is true, there is a possibility that aspirin-like drugs could be used more regularly in this fashion.
Read MoreWISHFIT: women’s research takes a village.
I was heartened to read that the folks at Rush University Medical Center in Chicago have partnered with a community of local women to fight obesity and promote a healthier menopausal transition. What’s especially novel about this program, which is called WISHFIT (Women in Southside Health FIT), is that during the first year of the five-year study, it will be relying on “pioneers” for guidance in designing and testing the program and subsequently spreading the word. One of the program’s primary researchers, Dr. Sheila Dugan, who is an Associate Professor in the Department of Physical Medicine and Rehabilitation at Rush University Medical School, characterizes the approach as “community-based participatory medicine,” with a critical grassroots component. I would go one step further and call it a health 2.0, social media approach to medical research.
The goals of WISHFIT are to ultimately change the behavior of women who are sedentary or engage in physical activity only occasionally in order to help reduce the fat rolls around the midsection (called visceral fat). If you’ve been reading Flashfree for awhile, you will recall that visceral fat is a common problem in menopausal women that is likely related to fluctuating hormone levels as we age. Not only is it unattractive, but the development of fat around the midsection is dangerous because it has been linked with metabolic syndrome, a variety of symptoms that in concordance, increase the risk for heart disease.
Importantly, the National Institutes of Health, National Cancer Institute, National Institute of Diabetes, Digestion and Kidney Diseases are joining forces with Rush to take the study out of the laboratory setting and into the community. In fact, Dr. Dugan explains that research has shown that “there are millions of studies out there that show if we bring women into the University and have them exercise, they will lose weight and improve their fat composition. But when they are left to their own devices, they go back to themselves.” She says that by having a community of postmenopausal women involved in developing a ‘tool kit’ of physical and stress-reducing activities or activities that help them to embrace healthier eating habits, the researchers are hoping that they can help their premenopausal peers incorporate new ways of thinking and acting so that they can get through menopause in healthier ways. She also points to data showing that change is better maintained not only by motivating the individual but also through the support of friends and social networks, which are needed for change to last.
Dr. Dugan notes that two Southside Chicago communities- Beverly and Morgan Park – have been the subject of prior research (Study of Women’s Health Across the Nation or SWAN) that identified the link between hormonal changes and visceral fat. In fact, some of the data also firmly established the link between markers of chronic disease and stress and sedentary lifestyles. The 30 Pioneers selected to lead the project will be women who participated in SWAN.
The five-year program also includes two studies examining 1) how social networks play a role in influencing health behaviors, and 2) if positive reinforcement works as well as financial incentives in getting women to change their lifestyle and become more physically active. An additional component entails before and after ‘person on the street’ interviews to educate and engage the community about what happens during menopause, heart disease and other risks and steps that can be taken to combat it.
“Midlife women already have all sorts of concerns on their minds. They need to have support around allowing themselves to take care of themselves and give themselves the freedom to actually step out of all their roles to do so. Our goal,” she emphasizes,”is to bring energy — spiritual and financial — to the community because we truly believe that the only way that these women will have a chance to take care of themselves is by everyone around them buying into how important it is.”
Noting that they are taking a three-pronged attack that entails community, social and individual level interventions, Dr. Dugan adds that community and social support are the links that have been missing in obesity research in particular. I’d like to believe that these links have also been missing in gender research that focuses on women; in fact, perhaps this model isthe breakthrough that is needed to change some gender inequities in our healthcare.
It really does take a village, doesn’t it? Only time will tell.
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