Posts Tagged "hormone replacement therapy"

Wednesday Bubble: the soy controversy

Posted by Liz on Apr 7, 2010 in bone health, emotions, hot flash | 0 comments

Do they or don’t they?

Soy isoflavones have been touted as beneficial in everything from improving body composition and lowering breast and colorectal cancer, to addressing menopausal hot flashes and moods. You can read about some of these findings on Flashfree. This week, Reuters Health reported that eating foods rich in soy protein (i.e. 25 grams of soy protein and 60 mg isoflavones) daily did not provide favorable responses from blood fats, implying that soy has little benefit in terms of lowering cholesterol levels and in turn, promoting heart health.

Are you confused yet?

Increasingly, women are turning to soy and other compounds as alternatives to estrogen and hormone replacement therapy, which mounting evidence shows can be associated with a broad range of risks including  increased breast, lung and ovarian cancer to heart disease. And yet, findings from clinical trials examining soy are often contradictory, making it difficult to come to any firm conclusion about its benefits.

What’s the problem? Well, researchers say that part of the problem is poorly designed studies, small number of study participants, wide range of ages and years from menopause, studies that don’t examine the pros and cons of an agent or strategy for a long enough period of time (i.e. longer than a year). In other cases (as I’ve argued previously), the study design does not account for certain factors that are critical to a therapeutic strategy, for example, the opportunity to clearly focus an intervention so that individual factors are accounted for (this was borne out by findings from a trial that examined and provided evidence for the role of acupuncture in easing hot flashes).

There’s good news though! Researchers finally appear to be getting their act together on the soy fron. They’ve announced that they are conducting a well-designed, large trial of soy phytoestrogens. Called  SPARE (Soy Phytoestrogens as Replacement Estrogen), this new study will be looking at the effects of 200 mg soy versus sugar tablet daily — namely on bone health and symptoms —  in 248 menopausal women over a two- year period. They will also be taking daily calcium carbonate plus vitamin D (in ranges of 500 mg to 1000 mg calcium and 200 to 400 IU vitamin D, depending on previous intake).

The study is specifically geared towards looking at spine bone density, but will also be looking at hip density, thyroid levels, menopausal symptoms, mood changes, depression, and quality of life, as well as any changes in blood fats. Study participants are between the ages of 45 and 60 and are within five years from menopause. What’s more, the researchers have also included a large percentage of hispanic women, which allows them to focus on how soy affects this minority group (Notably, the large multiethnic population of women in this study includes Asians, Blacks and Caucasians.)

The researchers say that they hope that the results of SPARE will provide a range of information that is especially relevant to Boomers reaching menopause. They also note that the dose of soy isoflavones being studied is much larger than what’s been studied in previously and are roughly twice that typically consumed in the Asian diet.

I realize that this post is pretty scientific. But what makes it most relevant is that it appears that researchers are finally starting to design studies that might actually show benefit of some of the alternative strategies we have available to us on the market. For those of you who insist on calling these alternatives “snake oil,” all I can say is ‘stay tuned.’

This bubble might finally be shattered; perhaps all that is needed is a better understanding of what it needs to test these substances appropriately.

Every breath you take…lung cancer and HRT

Posted by Liz on Mar 12, 2010 in HRT, lung cancer | 3 comments

Remember last year’s post on hormone replacement therapy and increased risk of deaths from lung cancer? Researchers now report that HRT that combines estrogen and progestin can increase the risk for developing lung cancer, especially when used for long time periods.

In the latest nail in the HRT coffin, researchers evaluated 36,588 peri- and postmenopausal women between the ages of 50 and 76 over six years. During the study, 344 women developed lung cancer. Overall, the findings showed that the longer women took HRT, the higher their risk for developing lung cancer, with use of 10 years or more associated by as much as a 50% increased risk. Note that while an increased risk for developing lung cancer was also seen in women used HRT for up to 9 years, it was about half as much, or 27%.

While the researchers are quick to point out that this study does not prove that HRT causes lung cancer, it does show that taking HRT for certain periods of time can significantly increase the risk for lung cancer, even when other important factors are removed from the equation. Similar increased risk has not been observed in women taking estrogen alone.

In the latest position statement on hormone replacement therapy from the North American Menopause Association, a panel of experts currently conclude that the evidence shows that both smoking and age played an important role in promoting growth of existing lung cancers in women taking HRT, in particular among older women. On the other hand, they say that other studies suggest that HRT theoretically lends some protection against lung cancer in younger women.

Clearly these data are at odds. However, as a wonderful report in Reuters points out, the latest study ‘sheds light on the question’ because it looks at HRT use over a longer period of time.

Every breath you take…could eventually be your last. It all depends on your decision about HRT. Is the short-term gain worth the long-term risk? Only you and your doctor can evaluate your individual risk and determine if HRT is the right choice.

Redux: HRT and lung cancer

Posted by Liz on Oct 2, 2009 in HRT | 0 comments

(Disclaimer: Back in June, I posted study findings that demonstrated a clear relationship between use of hormone replacement therapy (HRT)  and death from lung cancer. Mysteriously, that post has disappeared from the archives. However, just last week, a more thorough analysis was published in online version of The Lancet. Because this issue is so important, I’m writing about it again. I hope that you find the information useful.)

The Women’s Health Initiative trial was a 15 year study examining the most common causes of death, disability and reduce quality of life in over 161,000 postmenopausal women. Researchers halted the HRT arm after definitive associations were seen between combined hormone therapy and increased risk for heart disease, stroke, blood clots and breast cancer. In the two to four years that followed, an excess risk for developing various cancers and for death were also seen. This is especially true for deaths from lung cancer.

Overview

• 16,608 postmenopausal women between the ages of 50 and 79 received once-daily Prempro (conjugated equine estrogen plus medroxyprogesterone acetate) or placebo.
• Overall, women continued to take HRT for approximately 5 to 6 years, until researchers found that risks of taking HRT exceeded the benefits.
• Outcomes were measured via biannual phone calls and yearly clinic visits.
• After they stopped taking hormones, participants were followed for another 2 to 4 years.

The results

The study findings showed that while HRT did not increase the incidence of lung cancer, it did increase the number of deaths from lung cancer, especially among women diagnosed with the non-small cell type. in fact, taking HRT yielded almost twice the risk of death compared to women who never took hormones. What’s more, increased risk remained regardless of smoking status.

Takeaway message

Evidence continues to accumulate that the risks of using HRT greatly outweigh the benefits. These findings are just the latest piece of the story that is, in my opinion, the failure that is HRT.  Indeed, even the researchers say that these data are strong enough that women considering taking HRT should be sure to discuss them with their physicians, especially if they are already at risk for lung cancer.