Wednesday Bubble: herbs and breast cancer
Can herbal medicines used for hot flashes, namely black cohosh and phytoestrogens, be safely used in women who’ve had breast cancer?
If you’ve had breast cancer, you’ve probably been told to stay away from herbal medications, right? Yet, women who’ve had breast cancer know that hot flashes are a common side effect of many cancer therapies. Research also suggests that the older a woman is at the time she receives chemotherapy, the more likely she is to develop menopause as soon as treatment stops. Moreover, roughly 80% of women taking Tamoxifen have hot flashes and about a third of those women rate them as severe. Hormones are not even an option due to the increased breast cancer risk.
The good news is that an extensive analysis of scientific studies shows that black cohosh might be safe for women who have had breast cancer. Although the researchers note that the evidence for the effectiveness of black cohosh for alleviating hot flashes is mixed, they cite research from the National Institutes of Health and other reviews that suggest that use of black cohosh in former breast cancer patients requires only standard screening. They also report that there is “little reason for excluding patients with estrogen-responsive tumors from using black cohosh.” In fact, recent laboratory studies, although not yet carried out in humans, suggest that black cohosh may actually protect the breast from developing tumors.
The case for or against the use of phytoestrogens (e.g. soy, red clover, chaste tree berry and flaxseed) in women with breast cancer is not quite as clear as it appears to be for black cohosh. In one of the largest reviews examining soy or red clover for menopausal symptoms, the outcomes were equivalent to placebo. Other studies have shown that they might be beneficial for women with mild to moderate symptoms who start menopause early. Moreover, while red clover in particular does not appear to affect certain breast cancer risk markers, reports about phytoestrogens in general, especially in estrogen positive cancers is conflicting. Still, the American Cancer Society does not advise against eating soy-rich foods by women who’ve had breast cancer. Some studies have also showed improved prognosis.
If you are wondering if there are any drawbacks, one of the largest challenges is that there are not that many studies looking at herbal medications in women with breast cancer and the ones that do exist are mostly short in duration. The researchers point out that because herbs can take awhile to work, a three month study might be too short to form a conclusion.
Clearly, more study is needed. In the interim, it appears both black cohosh and soy might be safe to try if you’ve had breast cancer. As always, the most important consideration is to speak to a certified practitioner who is well versed in herbal medicine and make sure that she or he works with your oncologist.
Wednesday Bubble: osteoporosis – all bets are off!
Which came first? The chicken or the egg?
When it comes to osteoporosis, all bets are off. Researchers are now saying that age and not estrogen decline is the primary culprit in development of osteoporosis in women. Estrogen simply acts to “accentuate” the negative results.
Aging increases what science refers to as “oxidative stress.” This means that as we age, an imbalance is created between certain molecules that freely circulate in the body (better known as free oxygen radicals) and cause major damage to cell and vessels walls and the body’s natural ability to fight them off. Not surprisingly, oxidative stress has been linked to numerous chronic illnesses, including cancer, heart disease and diabetes.
In so far as osteoporosis goes, the loss of estrogen and androgens decrease our natural defenses against oxidative stress in bone in particular, leading to increased bone breakdown (resorption). The body also starts to overproduce certain hormones that directly affect the the vitality of the skeleton, causing bones to become brittle and more prone to fracture. However, studies also show that bone loss can begin in both women and men as early as age 30 or so, well before any major changes in sex hormone production.
The question is, what can we do about it?
Researchers have also found that there is a specific family of proteins in our bodies that act as a natural defense against oxidative stress. These proteins, better known as FOS (foxhead box transcription factors) are integral to a healthy lifespan and also, preserving bone mass. If researchers can identify what causes the decline in FOS, they may be able to devise strategies to preserve our reserves. Meanwhile, estrogen gets at least a partial reprieve this time.
Sources: Manolagas SC. Endocrine Reviews. 2010. Ambrogini E. Cell Metabolism 2010;2:136-146.
Read MoreUnchain my lungs…estrogen and asthma
As the evidence continues to accrue against the use of combined hormone replacement therapy (HRT), attention must be turned to estrogen-only hormone replacement therapy. However, is it safer?
In the Women’s Health Initiative, which was halted last decade, taking estrogen alone was associated with an increased risk of blood clots, stroke, impaired cognitive function and dementia. In the latest bit of information to hit the news, estrogen-only therapy may also increase the risk for developing asthma.
Results of a 12-year study among almost 58,000 women who were not suffering from asthma at the start of menopause showed that they were 21% more likely to develop asthma symptoms. This risk was significant among women who had been taking estrogen only compared to women who had never used hormones, had a 54% greater risk of developing asthma. The risk was even greater among women who had never smoked, although a small proportion of study participants had allergies prior to developing asthma.
Once again, Reuters has done an excellent job of reporting on this study and has some great quotes from the researchers as well.
Meanwhile, what should you do if you’ve been taking estrogen to combat the symptoms of menopause? As always, you have a choice and only you and your practitioner can determine if you are at risk for developing any of the conditions that are associated with hormonal therapy. The good news? Breathe easy. Yet another reason to lose the hormones…for good.
Read MoreA doc and a diva walk up to the rooftop
Taking the mystery out of menopause, one rooftop conversation at a time. Drifters optional.
Yup ladies, the Nation’s own ‘Red Hot Mama’s”, THE source for everything menopause, has teamed up with Novagyne Pharmaceuticals to promote VIVELLE-Dot®, a hormone replacement topical patch. Perched up on the roof, the doc and diva discuss the changes of menopause, hot flashes and more. The conversation is lively and takes the “pause” out of menopause, so much so that makes you wonder what the heck you’re doing up on a roof with these two ladies.
Better yet, why are they up on a roof?!
Let’s talk about Vivelle for just a minute.
VIVELLE-Dot is a patch that is applied to the skin. It delivers a constant dose of a form of a natural (as opposed to synthetic) estrogen called estradiol, which enters the body through a very small skin patch. VIVELLE-Dot is applied twice weekly.
Granted, transdermal, or ‘through-the-skin’ delivery of medications is generally associated with fewer side effects than oral medications since the drug bypasses the liver and directly enters the blood stream. Still, although estradiol is a bioidentical hormone, with the same molecular structure as estrogen found naturally in the body, potentially seriously risks associated with taking estrogen, endogenous or not, include:
- a 2- to 12-fold risk of developing endometrial cancer, depending on length of time taken and dose
- breast cancer
- dementia
- a 2- to 4-fold increased risk for gallbladder disease
- increased risk of heart attack, stroke and blood clots
Note that using bioidentical hormones is not the same as using bioidentical hormone replacement that is customized to your needs. This is an important distinction to keep in mind the next time that you see the phrase.
Here’s my question: still hanging on the roof with the doc and the diva? Or do you want to drift away?
Menopause isn’t something to “fix,” it’s something to address with safe, effective strategies that don’t turn women into long-term guinea pigs. Do you want to be a Red Hot Mama? Or do you want give the Mama’s a run for their money?
This ain’t your mama’s menopause, it’s yours.’
Read MorePreventing heart disease in menopause. It’s as simple as L-D-L
Aging. It’s associated with all sorts of diseases. In women in particular, heart disease is a big red flag since there is a lot of evidence showing that after age 40, risk for developing heart disease rises and continues to rise.
So, is increased risk due to to aging in general or to menopause in particular? Moreover, is there anything you can do now to reverse the trend?
Researchers have recently solved an important piece of the puzzle, discovering that significant increases in cholesterol coincide with the period right before and immediately after menopause sets in. Coincidentally, at the same time, women experience significant declines in estrogen. In this particular trial, which involved over a thousand women, researchers examined various factors that might contribute to increased heart disease risk (e.g. blood fat levels, blood sugar and blood pressure). They then compared changes in these factors over time and whether they were more in sync with aging or with ovarian changes associated with menopause.
Over the course of three to five years before menopause, a year after, and then three to five years thereafter, substantial changes were noticed in blood fats, namely low-density lipoprotein (LDL) cholesterol, which rose as average of 12 points between the first two time periods and then leveled off a few points higher (from 113 and 116, to 125 to 130. Current guidelines suggest that optimal LDL levels are below 100 and that at the very least, individuals attain LDL cholesterol levels of <130 if they have two more heart disease risk factors (and preferably, lower).
So, what are the take-away messages?
- First, declining levels of estrogen place women at risk for heart disease as they approach menopause, namely due to significant increases in LDL and total cholesterol.
- Second, women nearing menopause need to know their cholesterol numbers and insure that that becomes a priority during a normal checkup.
- Lastly, exercise and diet are key to lowering cholesterol levels, at least initially.
Both the National Lung Blood and Lung Institute and the American Heart Association recommend diets low in saturated fat, trans fat and cholesterol, and rich in whole grains, fiber, fish, lean meats and poultry. Exercise is essential, at least 30 minutes worth daily. Finally watch those risk factors and talk to your practitioner about those that may be problematic and what you can do to address them.
We may not be able to control declining estrogen but we can take positive steps to make sure that it doesn’t affect our risk for heart disease.
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