Hormone replacement therapy…timing is everything, right?
Hormone replacement therapy (HRT) continues to be a hot topic in the menopausal world. And no wonder! Because the deeper we dive into the controversies, the more information we seem to learn about its dangers.
If you search for hormone replacement or HRT on this blog, you’ll find that the dialogue has nothing but consistent. And while naysayers may try to accuse me of a personal vendetta against hormones, it’s actually not the case. I started Flashfree for several reasons, the most important being that I wanted to provide enough information about menopause and aging and treatment strategies to enable women to think on their feet, consider the facts and have intelligent dialogues with their peers and practitioners before making any decisions that could affect their health and wellbeing as they grow older. Moreover, although I am a strong proponent of alternative strategies to combat the unpleasantries of dwindling hormones, I still believe strongly in the benefits of certain Western approaches to treating illness. However, I also a strong believer in integrative strategies that combine the best of our knowledge in an individualized fashion; my mantra is ‘treat the individual, not the masses.’ Hence, when I read about the history of the menopause in general and HRT in particular, what I see is disease mongering at its finest, examples of fear and loathing and mostly, a disrespect of women. And I care too much about women’s health to remain silent.
Last Friday, several of my colleagues sent me a link to the following study:
“Breast cancer risk in relation to the interval between menopause and starting hormone therapy.”
This newly-published study in the Journal of the National Cancer Institute is one of the largest to date since the findings of the now infamous Women’s Health Initiative (WHI) study linking Preempro to breast cancer. In it, investigators used observational information culled from over a million postmenopausal women in the United Kingdom to determine how type and timing of hormone therapy might influence the risk of developing breast cancer.
A bit of context is necessary for those of you who are unfamiliar with the major criticisms of WHI, namely that that the women studied were not representative of the normal menopausal population, were older, started hormone therapy later in life (i.e. >5 years from when menopause started) when their risks for disease were greater, and that the type of hormone replacement, namely the progestin component, were not taken into consideration. WHI was also criticized for not focusing on the small percentage of women in the study who took estrogen-only and were not at greater risk for breast cancer. (If you want to read more about that particular issue, check out the write up on data presented at this past year’s San Antonio Breast Cancer Conference.)
In the UK study, the average age of participants was 56.6, considerably younger than the study population in WHI. More than half (55%) of participants reported having used hormones at some point and 35% were current users, and the rest, had never used hormone therapy. Study participants were matched by socioeconomic status, childbirth information, BMI, physical activity, alcohol consumption and smoking to insure that these factors did not influence the study findings.
Overall, 15,759 breast cancers developed and were diagnosed approximately a year and a half after the last point of contact:
- Despite contentions by some experts that starting combination hormonal therapy within 5 years of menopause is safe, women between the ages of 50 and 50 who began HRT less than 5 years after menopause had the highest rates per year of breast cancer — .61% per year — that twice that of women who had never used hormones (.31%).
- Current users of estrogen also demonstrated increased breast cancer rates (.43%) who started hormones within or less than 5 years after menopause started.
- The risk of developing breast cancer was roughly 1.5 times higher among women on combination hormone therapy who started within 5 years than women who started 5 year or more from menopause.
- The risk of developing breast cancer among past users of hormonal therapy tended to decline over time after use of hormones stopped, and within 14 years, were almost equivalent to never users.
Mind you, the study is not without fault and may be criticized on the basis of the fact that it relied on observational information rather than randomized controlled results. In other words, data were collected and then analyzed based on what they inferred. The research might also be questioned due to the fact that information about use of hormones was reported over a year before cancer was diagnosed, thereby possibly leading to mischaracterization of hormone users/non users and estimates of the risk for developing breast cancer. Nevertheless, the researchers say that taking these factors into account, breast cancer risk among hormone users regardless of type, would have increased by a factor of at least 1.2.
The key take-away message from this new study is that it’s may be impossible to define the safest parameter for using hormone therapy. For certain women, HRT may never be safe. For others who are willing to risk life-threatening conditions for fewer hot flashes, HRT may be worth the gamble. As always, ask the hard questions.
Timing is everything, right? Maybe not when it comes to hormone replacement.
Read MoreDepression and menopause: can acupuncture help?
Depression and menopause. It keeps coming up as a topic and so I’m going to continue to write about it until researchers find an effective way to battle depression during menopause, effective meaning that it is an acceptable strategy for women who prefer alternatives to pharmaceutical agents, effective in that it addresses the underlying causes of depression in menopausal women, including fluctuating estrogen levels, sleep disturbances, night sweats, hot flashes and life factors, and effective in that it is affordable. It’s a tall order, isn’t it?
As I’ve noted time and again, depression is an important issue for many but not all menopausal women, affecting approximately 20% to 40% in a some way or another. Just this week, I wrote about use of the SSRI antidepressants as an alternative to HRT for hot flashes and depression, and possibly as a stop-gap measure until practitioners more widely embrace alternative strategies. On the heels of this study comes another in the Online Edition of Menopause journal, examining data from one of my favourite studies, ACUFLASH. If you don’t feel like clicking on the link and updates about this study, briefly, in ACUFLASH, researchers randomized 399 postmenopausal women (1 year since last menstrual period) regularly experiencing at least 7 hot flashes daily to acupuncture or no treatment. Moxibustion was used at the practitioner’s discretion and sessions could also be extended by two weeks (from 12 weeks), if needed. Although the practitioners met beforehand to discuss possible diagnoses and recommended treatment points, all treatment was individualized. Both groups of patients also received self care recommendations, which consisted of a one-page information leaflet on care of menopausal symptoms (e.g. soy, herbs, physical activity and relaxation techniques) which they were free to add at their own discretion.
Overall, the mean frequency of hot flashes declined by 48% in women receiving acupuncture compared with 28% of women using self-care methods only. This means that 50% of women receiving acupuncture experienced a 50% or greater reduction in how often their hot flashes occurred, compared to 16% of women using self-care. Significant reductions were also seen in hot flash intensity. Additionally, the acupuncture group reported significant improvements in vasomotor, sleep, and somatic symptoms over the course of the study.
So, what about acupuncture and depression?
In the current study, researchers examined a sample of 72 women who had participated in ACUFLASH and had either received self-care only or self-care plus acupuncture. At the start, almost 31% of these women reported depressive symptoms and of these, about 17% were determined to suffer from moderate to severe depression (based on a scientific method that measures the severity of depressive symptoms). Although these figures are higher than what is normally seen in the general population, severe depression is often seen among women experiencing very frequent hot flashes (7 or more in a 24 hour period for at least 1 week). And while both groups reported significant declines in depressive symptoms during the 12 week study period by as much as 16%, the declines were similar in both groups, indicating the acupuncture,while helpful for lessening the severity of hot flashes, did not have a specific effect on depression.
If acupuncture doesn’t help depression, why did the results indicate such a high level of improvement that under normal circumstances, an individual could forgo drugs for needles?
A key finding of the original and follow up ACUFLASH studies was the feeling of control over symptoms that was imparted by being educated about self-care. However, here’s the rub: even though acupuncture was shown to significantly benefit both the intensity and frequency of hot flashes, it didn’t provide an edge over depressive symptoms compared to self care alone. The researchers say that this leads them to believe that although a domino effect is at-play (i.e. hot flashes lead to sleep issues lead to symptoms of depression) there is something else that also influences the depression part of the equation.
In the interim, it’s frustrating, right? You can deal with your hot flashes but you still feel blue, low, out of sorts. There is clearly a link between the hot flashes and sleep and depression. It simply needs to be teased out a wee bit further. Keep the faith. We’ll get there!
Read MoreFlashfree – End the “shhh” and embrace the conversation
I am discovering a pattern: when women learn about Flashfree, they inevitably tell me that they wish that they had a sounding board, someone to talk to about the aging-symptom paradigm, more exchange, more discourse. When I started this blog four years ago, I wanted to become a conduit for that conversation or at the very least, an inspiration. And I know that I’ve been inspired by the interest and the support.
Lately, it’s become so apparent that we need to talk more, listen more, explore more. We need each other.
The following was written during the early days of Flashfree and it’s as relevant now as it was then. So, in a bold move, I am reprising it, in hopes that it will begin that spark that I would like to see carry us through the rest of this year. It’s been a challenging one for many of us. And every day becomes a reminder of what’s most important and what is really not so important. Mostly though? I hope that this space continues to be as much yours’ as mine.
I was talking to a colleague/old friend the other day about this blog. She is a few years older than I and we got into this great conversation about generational gaps when it comes to discussing health issues. Perimenopause and menopause in particular have been huge taboo issues for women for decades.
Take for example, an episode from ‘That 70s Show,’ in which Kitty learns that she is not pregnant but rather, has entered menopause. When she asks her mother (played to a T by none other than Betty White) about her experience, she’s informed that she never went through menopause and has always been “healthy.” It’s funny and sad simultaneously. And definitely well worth the watch. (Fast forward to timecode 3:59.)
As the last of the baby boomers enter middle age, their appetites for health information appear to be ever more insatiable. And yet, some of the savviest and most practical women I know confess that they rarely, if ever, discuss their symptoms, moods or concerns about the changes that they are going through with their friends, let alone their mothers.
I’m fortunate. I have a mother who is pretty open about these sort of topics. And although she’s 70+, she tries hard to maintain an open attitude about certain things. When I approached her a few months ago about what I was going through, she was very forthcoming about her own experiences. And while her experiences were not exactly like mine (let’s face it; no two women’s experiences will ever be exactly the same), being able to talk about it was very liberating, even if I didn’t find “why” behind my own symptomatology.
Janine O’Leary Cobb, a former professor at Vanier College in Montreal, author of Understanding Menopause and founder of ‘A Friend Indeed,” once said that “it seem[s] to be one of the last things women talk about because it’s so entangled with aging and we don’t want to talk about getting older.”
And yet, research suggests that when we do talk about “it” and about getting older, hopefulness and positivity dominates, even as we acknowledge the more negative, i.e. loss and bodily changes, at the same time. And there a majority of women in this study who said that they feel a greater willingness to embrace personal growth and opportunities being presented to them with ease and sense of self as they age, a liberation, if you will.
So, what’s my point? Well, I’m not suggesting that we embrace the sugar-coated version of perimenopause and menopause that many advertisers would lead us to believe. But if we start having conversations with our gal pals and our mothers and colleagues, well, maybe we can begin moving towards removing the stigma that surrounds the “change” and aging once and for all.
Knowledge and exchange are certainly positive, powerful aphrodisiacs for growth.
Wednesday Bubble: Got a Shmirshky?
It starts with “got a shmirshky?” and ends with ‘the pursuit of hormone happiness.’ Hmm, why does this sound like a really bad movie on Lifetime Network?
Truly, when I first laid eyes on Shmirshky.com, I wanted to hate it. Why? Because I don’t like cutesy names for vaginas like “shmirsky.” And I don’t really understand the tagline or book title – ‘think inside the box’ or ‘pursuit of hormone happiness’. Nor do I care for abbreviations like “PM and M” (i.e. perimenopause and menopause) or “SUMO,” the author “E’s” (read: everyone) imaginary friend who makes her feel bad about herself.
Shall I continue? Or stop right there? Because I know that if you’re reading Flashfree, you’ve got the picture.
HOWEVER…I applaud E for taking a light approach to a daunting subject. And while I’ve not read her ‘quintessential Cliff notes to menopause,’ admittedly I did get a chuckle out of her YouTube video. And I really do love her message of reaching out; after all, one of my primary mandates since starting this blog has been to promote dialogue among women and between women and their providers so that they are better equipped to deal with the many aspects of the changes that are occurring within and without. Moreover, we know with certainty that a little humour and laughter go a very long way towards promoting health and wellness.
So, I’m going to give E a free pass. Menopause certainly is not a tropical vacation but shmirsky cutesie acronyms aside, she may be onto something. At the very least, I’ll read the book before drawing my any final conclusions.
What about you? Got a Shmirshky?
Read MoreThe Top Ten Wednesday Bubbles of 2010
Anyone who knows me knows that I really dislike ‘top ten’ lists. So, for the final Wednesday of 2010, I decided to ‘punk’ myself and go back through the year’s Bubble archives. Here are my favourites but hey, don’t take my word for it; 2010 provided a lot of menopause fodder and folly and I encourage you to select (and comment) on your favs.
Without further ado, I give you…The Top Ten Wednesday Bubbles of 2010
10. This is your brain on midlfe. This one needs no explanation. Just fill in the blank lingering over your head.
9. The Mommy Factor? It’s Personal. Not everyone is suitable for parenthood, i.e. just because you can, doesn’t mean you should.
8. Is Weight Loss All in Your Head? Brain enzymes and brown fat and research, oh my. How do we get here from there?
7. Bisphosphonates…Enough to Make Your Jaw Drop. Essential information about osteoporosis drugs that you can’t afford to miss. Enough to make your draw drop, literally.
6. Ask the Hard Questions. If there’s one overriding theme of Flashfree, this is it. Especially when it comes to hormone replacement therapy.
5. HRT & the Window Hypothesis. The mother of all inventions is the Window Hypothesis. Brought to you by big pharma…
4. Time to Debunk the Myths About Traditional Chinese Medicine. The title says it all. Isn’t it time we stop trying to unravel the mystery and just accept?
3. Playing Russian Roulette – Hormone Replacement & Ovarian Cancer. Still believe that HRT is safe? You might want to take a look at this link to ovarian cancer.
2. Good Girls & Inner Hags – A Journey to Self. Inside every woman lurks a dark goddess. Amy Palko asks if you are embracing her.
1. A Doc and a Diva Walk Up to the Rooftop. Okay, this isn’t a Bubble but it should have been. And it is, by far, my favourite post of the year just because it is so absurd. Move on over Red Hot Mamas! There’s a new world order in town and we’re taking back our menopause. One rooftop at a time.
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