Posts Tagged "HRT"

Tender breasts and HRT – Do you need to worry?

Posted by Liz on Oct 16, 2009 in breast cancer | 2 comments

Yes, you do, according to UCLA researchers, who examined data from more than 16,000 postmenopausal women participating in the halted Women’s Health Initiative estrogen plus progestin trial. If you recall, this trial abruptly ended in 2002 when researchers learned that women taking hormone replacement therapy (HRT) had a significantly increased risk for developing breast cancer.

In this latest study, which appeared in the October 12 issue of Archives of Internal Medicine, researchers took a closer look at the data to identify which factors, if any, could predict the possible development of breast cancer in women taking hormones. At the study’s start and every year until it was stopped, participants underwent mammography and were asked to do breast self-examinations. In addition to providing information on factors that might increase their breast cancer risk, they were also asked to to rate the degree of breast tenderness at the beginning of the trial and after one year.

Study findings showed the following:

• Women taking HRT who did not have any sort of breast tenderness at the study’s start had three times the risk of developing tender breasts at the one-year mark compared to women taking placebo.
• Breast tenderness at one year was associated with a 48% higher risk of developing invasive breast cancer than peers who never developed breast tenderness.

The researchers say that they are unclear about the reasons for this relationship and wonder if it might be possibly due to the fact that HRT causes breast tissue cells to multiply rapidly, thereby leading to more tenderness and an increased cancer risk. They also caution that the results just apply to this particular form of combination hormone therapy (which goes by the trade name Premarin®).

So, should you worry?

Emerging evidence continues to point clearly to a skewed risk benefit profile when it comes to hormone therapy, with risks outweighing any subjective benefits such as a decline in hot flashes, improved sleep or less vaginal dryness. It’s up to you to decide if you want to continue using hormones is you presently take them, or if you want to start HRT in the first place. And of course, if you are using hormones and develop breast tenderness, you should contact your practitioner as soon as possible to discuss your symptoms.

Ultimately, we all have control over certain factors in our health lives and don’t have control over others. Choose wisely.

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.

More on breast cancer and HRT

Posted by Liz on Sep 21, 2009 in HRT | 2 comments

When it comes to HRT, the verdict is pretty dismal. Data continue to accumulate demonstrating that the risks associated with HRT may greatly outweigh the benefits. The question is however, when do we finally stop the madness and remove it from the market?

In the interim, I’ve got additional information to share you need to know when considering taking HRT: When HRT  is started and the type of HRT used can influence a woman’s risk for developing breast cancer.

Researchers examined data from over 53,000 postmenopausal women, revealing that 1,726 invasive breast cancers developed over a period of approximately eight years. They also looked at hormone use, including type, when started and how long they were taken.

Key findings, which are published in the online edition of the Journal of Clinical Oncology, showed:

• Taking HRT (estrogen-progestogen) for two years or less within three years after starting menopause increased breast cancer risk by 54%.
• Taking HRT (estrogen -progestogen) for two years or less starting more than three years after menopause did not affect breast cancer risk.
• Regardless of when menopause started, prolonged use of HRT (estrogen-progestogen, more than two years) increased breast cancer risk.
• Hormone treatments containing progesterone did not increase risk of breast cancer if taken for two years or less. (Most hormone treatments in the US contain synthetic progestogens rather than natural progesterone.)

The takeaway is that timing of HRT and how long HRT is taken can significantly affect risk for developing breast cancer. 54% is a significant figure and women considering HRT for their menopausal symptoms should closely examine overall risks and benefits before taking the HRT plunge.

Giving voice

Posted by Liz on Aug 14, 2009 in HRT, voice | 0 comments

Did you know that the female larynx is sensitive to sex hormone changes? Evidently, along with some of the better known symptoms — sleep disturbances, mood swings, hot flashes, night sweats, weight gain, etc — vocal quality may also change in some women.

Experts say that fluctuating sex hormones, i.e. estrogen, progesterone and androgen, can result in a thinning and dryness in the vocal folds (or vocal cords). Because it takes greater effort to make sounds, voice changes can occur. Notably, studies have shown that not all women are affected by these changes nor are they affected in the same ways. However, when women are affected, their voices may get rougher/huskier, lose stability, lose their top notes and vocal range, and change their timbre. Professional singers or actors, or even consultants on the lecture circuit, all of whom rely on their voices to earn a living, are especially affected.

Researchers acknowledge that further study is needed to distinguish between vocal changes that occur as a result of menopause versus those that occur as a direct result of aging. Yet, regardless of the cause and degree that each factor contributes, voice changes can affect almost half of postmenopausal women.

Treatment options include:

• Hormone replacement therapy. Study results have been mixed, with some findings showing improvements in voice complaints and voice function/vocal quality and others, demonstrating none. Further research is needed that evaluates the effect of HRT on the larynx as well as its ability to prevent voice changes if instituted early. Of course, HRT is wrought with other dangers that might make its use, prohibitive or not worth the risk/benefit ratio.
• Voice therapy. Although many questions remain unanswered, vocal coaches  and speech pathologists say that voice therapy can help relieve vocal fatigue. There are exercises that work well to address aging vocal cords, rebuild muscle tone and help women learn how to use their voice more efficiently.The American Speech-Language Hearing Association has a great resource for finding a local professional in your area that specializes in vocal deficiencies.
• Vitamin therapy. Research has shown that multivitamin therapy that includes magnesium, mineral salts, vitamins B5, B6 and E may improve vocal quality and help keep the vocal folds moist. Although experts say that there is not enough evidence for the role of vitamins in voice, vitamins, minerals and anxioxidants play an important role in health regardless of whether voice changes occur.

A quick search on PubMed turned up numerous articles on voice changes during the menopause and the article I sourced for this post (cited below), specifically references nine of these.

I am wondering how many women who are in the menopausal transition are experiencing these problems and are seeing clinicians who might not be aware of the potential link.

What about you? How is your voice quality? Have you noticed any changes?

[Source: D’haseleer E et al. The menopause and the female larynx, clinical aspects and therapeutic options: a literature review. Maturitas (2009) In press.)

Wednesday Bubble: Better living through chemistry? Your aging skin

Posted by Liz on Aug 5, 2009 in appearance, HRT | 2 comments

Still thinking that hormone replacement therapy (HRT) can improve the appearance of aging skin? You may want to think again.

This past March, dermatologists at the American Academy of Dermatologists’ annual meeting once again debunked claims that HRT can improve the appearance of aging, photo-damaged skin. Although I’ve written on this topic previously, the subject is interesting (and relevant) enough to revisit.

Undoubtedly, certain areas of the body are more receptive to estrogen than others, e.g., cells comprising the skin on the face. And while estrogen can increase collagen, help the skin retain water and promote elasticity, its ability to reverse the effects of aging remain questionable.

Dr. Margaret Parsons, assistance clinical professor of dermatology at the University of California-Davis, says that she does not prescribe estrogen to improve skin’s appearance because data have not consistently shown any benefit. Not only doesn’t she believe that topical or oral estrogens offer any sort of long-term solution, but she also points to the risks involved in their use, such as breast cancer.

Consider the evidence (or lack, thereof):

• In a study published last year in the Journal of the American Academy of Dermatology, researchers evaluated whether or not low-dose HRT could improve the appearance of fine lines and wrinkles, skin dryness/texture and sagging. Study participants were 485 women who had been menopausal for about five years.  No significant improvements were seen after 48 weeks of treatment, although researchers suggested that longer use of hormones or different doses might lead to better results.
• In another study, which I wrote about last year, applying topical estrogen to sun-damaged skin, likewise, did not improve the skin’s appearance, although it did appear to promote collagen production in areas that had not seen the light of day, i.e. the hip.
• A third study, published in the early 90s, suggests that use of a topical cream early in menopause and for a longer period of time, may improve the appearance of aging skin. However, this study was only conducted in 18 women over a period of six months, making it difficult to reach any definitive conclusions.

It appears that the jury is still out but deliberations don’t look too promising.

Think about it: are you willing to risk the adverse effects of HRT – cancer, death from lung disease, heart disease – for your appearance?

If you are deadset on erasing a few lines and a few years, there are effective therapies that dermatologist regularly suggest to improve skin’s appearance, for example retinoids, glycolic acid or procedures such as chemical peels, lasers, botox and skin fillers. While they might hit your pocketbook harder than HRT, most do not come with the same degree of health risks. You can learn more about taking care of mature skin in this issue of the American Academy of Dermatology’s SKIN e-newsletter.

Obviously, the best advice is to wear sunscreen regularly, avoid smoking and use a topical retinoid. We may not be able to turn back the clock but we can preserve what we have more responsibly. Estrogen might not be the ounce of prevention that works best.