Posts Tagged "menopause"

Wednesday Bubble: The HRT patch – is it safer?

Posted by Liz on Jun 9, 2010 in HRT | 9 comments

Remember the diva and the doctor sitting on the roof espousing the benefits of the HRT patch? Well, it turns out that some of these patches might not be so safe after all. Results of a study of over 75,000 women published in the British Medical Journal, show that the use of high-dose transdermal (through the skin) HRT patches increases stroke risk by as much as 88%.

Granted, transdermal or through the skin delivery bypasses the liver, which typically makes patches safer than their oral counterparts. However, if the drug isn’t safe, well, then the patch might not be either.

In this latest bit of news, researchers evaluated women between the ages of 50 and 79 who had participated in the ongoing Study of Women Across the Nation (SWAN). Every woman who had had a stroke were matched for comparison to four women in the study, with similar characteristics, who had not. The women were further divided into groups based on their use and type (i.e. oral or patch) of HRT, including estrogen only, estrogen plus progestogen, progestogen only, and the estrogen alternative, tibolone (which is not available in the US).

The researchers say previous and recent studies suggest that oral HRT, including estrogen only or estrogen plus progestogen, is associated with a 30% increased risk of stroke. However, stroke risk differs between high- and low-dose patches. Overall, they report that:

• Low-dose patches do not appear to increase stroke risk, at least in the short-term (they say that they cannot rule out an increased risk with long-term use)
• High-dose patches, regardless of whether or not they are estrogen only or estrogen plus progestogen, appear to increase stroke risk by anywhere from 25% to 88%
• Risk was the highest among women who had used oral HRT before trying transdermal HRT, although this risk appeared to decline the longer the time period between stopping oral and starting the patch
• Findings remained even after adjustments were made for factors that might influence results, including age

What the findings mean

Despite claims to the contrary, it does not appear that HRT offers much protection against heart disease during and after menopause. What’s more, the HRT patch may not actually be safer than oral HRT, at least in so far as the high-dose HRT patch goes. Although the researchers state that they were unable to distinguish between types of stroke when evaluating the SWAN study data, they say that these data show the need to look further into how HRT is delivered, especially as use of the HRT patch becomes the norm.

As I’ve written previously, if your doctor suggests you try HRT for menopausal symptoms, it behooves you to ask the hard questions. While you may save your sleep, mood and a few articles of clothing, you may be placing yourself at a higher risk for cancer, heart disease and other serious conditions.

Flashfree food for thought: lignans and breast cancer risk

Posted by Liz on Jun 7, 2010 in breast cancer | 1 comment

I’ve written previ0usly about the potential benefits of flaxseed in boosting bone health and alleviating hot flashes.  Now, researchers are suggesting that flaxseed and other foods that contain high levels of lignans –  a type of phytoestrogen with both weak estrogen and antioxidant activities – may also help lower the risk of breast cancer in postmenopausal women.

In a large analysis of 21 studies examining possible links between lignan intake and breast cancer risk, the researchers found that including large amounts of lignan in the diet reduced the risk of developing breast cancer by as much as 14% in postmenopausal women. What’s more, risk was reduced by as much as 16% in studies that specifically examined levels of compounds called “enterolignans,” which are created with dietary lignan enters the stomach and interacts with bacteria residing in the intestines. The researchers say that lignan may offer moderate protection against breast cancer because it blocks estrogen activity that promotes tumour growth, perhaps mostly when natural estrogen is low (i.e. during menopause). However, the study did not provide details as to what constitutes “large” amounts of the compounds.

Flaxseed is one of the richest dietary sources of lignan, although it is also found in other foods including sesame seeds, sunflower seeds, whole grain breads, muesli, kale, broccoli, white cabbage and brussel sprouts, apricots and strawberries. You can find a full list of the lignan content in foods here.

Should you start eating more lignan? The good news is that the foods that are richest sources of the phytoestrogen are also quite healthy.  And, wth the potentially added benefits of preventing osteoporosis and lessening hot flashes, it seems that boosting lignan intake is a win-win all around!

Want to read more? Reuters Health has an excellent write up with additional information on the study.

When it comes to calcium, think moderation

Posted by Liz on Jun 4, 2010 in bone health | 3 comments

There’s a new condition emerging among postmenopausal women: calcium alkali syndrome (milk-alkali syndrome).

Milk calcium what?!

A wonderful commentary slated to appear online this month in the Journal of  the American Society of Nephrology highlights the dangers of consuming too much calcium . In it, the author  tells the tale of Chicago bartender Bertram Welton Sippy, who in 1915, introduced his bar patrons with ulcers to the Sippy diet, hourly intake of milk, cream eggs and farina cereal interspersed with Sippy powders on the half hour (i.e. dissolvable antacid like minerals that included calcinated magnesia, sodium bicarbonate and bismuth subcarbonate). A recipe for disaster? You bet, because the overkill of calcium and minerals led to symptoms that include headache, nausea, vomiting, mental clouding, a distaste for milk and eventually, kidney failure. Yikes!

While men were the primary victims of the condition in the last century, it appears that a new group of victims started to emerge in the 90s – postmenopausal women who have increased their intake of calcium and vitamin D to combat osteoporosis. And although calcium, not milk, is the primary driver, the condition is the third most common cause of hospital admission for significantly elevated blood calcium levels.

It appears that the necessity to preserve our bones has created a modern version of the Sippy diet.

The best strategy for reducing the risk of calcium-alkali syndrome is to moderate your intake of calcium supplements. In fact, the authors say that although an average of more than 4 g/day of supplemental calcium is most commonly linked to illness, small numbers of women have developed it on as little as 1 to 1.5 g calcium a day. Of note, while younger adults are able to store excess calcium in bone, aging seems to reduce this natural defense and instead, calcium tends to leave the bone (thereby leaving us more susceptible to fragile bones and osteoporosis) and in turn, a potential build up in the bloodstream. Still, the authors emphasize that calcium supplements in moderation are a necessary and beneficial option for women at risk for osteoporosis. The trick is to limit supplemental calcium intake to no more than 1.2  to 1.5 grams daily because our bones need protection. Read the label. And speak to your healthcare practitioner. When it comes to protecting our bones through supplementation, moderation appears to be the key.

p.s. Stay away from the Sippy diet. It’s a sippier slope (sorry, couldn’t resist!).

No bones about it: the best things in life are sea

Posted by Liz on May 28, 2010 in bone health, diet | 3 comments

Did you know that eating fish that live in the sea might help boost bone health and density? Although most of the attention on the link between osteoporosis and diet has focused on calcium, milk and soy, a few studies suggest that other nutrients, such as polyunsaturated fatty acids and omega-3s, may also play a role.

According to novel research published in the journal Osteoporosis International,  a greater intake of sea fish, but not shellfish or freshwater fish, is linked to as much as almost a 7% increase in bone-mineral density and an almost 10% increase in bone mass in general and in the hip areas in particular. On average, the women studied, all of whom were menopausal, were eating about .8 ounces of sea fish a day — about 16% of their total daily protein intake, and about 2 ounces daily of sea fish and shellfish combined. Factors like body weight, smoking, and alcohol did not appear to influence the association between fish from the sea and bone benefits. (Note – the study did not specifically address the exact types of fish that they women were eating other than to say, it wasn’t freshwater or shellfish.)

Interestingly, prior studies have found similar links between higher bone mineral density and a high consumption of seafood among menopausal women. Researchers say that a higher intake of fish versus animal protein or low quality foods may account, at least in part, for the higher bone mass.And while they are unable to offer any reasonable explanation for why sea fish, especially the oily types like salmon or mackerel or tuna benefit bone health while freshwater fish does not, they say that it might be due to the high level of vitamin D , which has long been associated with favorable bone mass. Omega-3 fatty acids are also thought to play important roles.

The take-away on this is to eat more fish from the sea. Clearly, environmental concerns, like overfishing and high level of mercury, may influence your seafood selection, however, Seafood Watch offers some great resources how to make safe and careful choices.  What I love about this information is that it not only serves to encourage healthier eating, which can help keep those pounds away (My friend Danielle Omar wrote a great guest post about sea veggies and weight about a month ago), but also provides another strategy for keeping bones healthy as we age. Yup, the best things in life are sea.

Wednesday Bubble: rhubarb rules the day

Posted by Liz on May 26, 2010 in herbal medicine | 10 comments

Today’s Bubble is straight from the research files and it’s not burstable. In fact, I’m pretty excited about this.

Researchers say that a phytoestrogen extract from Siberian rhubarb (rhapontic rhubarb), better known in studies as “ERr 731,’ is an effective alternative to HRT for alleviating menopausal symptoms.

Evidently Siberian rhubarb has been used for decades to treat menopausal symptoms, both in Germany, where it is readily and commercially available, and in Chinese medicine. Clinical studies suggest that ERr works very similar to estrogen in the body and in fact, has been shown to have properties that are equivalent to SERMS – selective estrogen receptor modulators – which are synthetic compounds that mimic the action of estrogen in the body without necessarily causing some of its harmful effects.

When I delved further into ERr 731, I found numerous, well-designed studies that demonstrate its benefits in perimenopausal women including:

• A significant decline in the number and severity of hot flashes over the short-term (i.e. 3 months) by as much as 50%, with further improvements through the long-term (i.e. 6 months).
• Improvements in other menopausal symptoms such as sleep disruption, mood and vaginal dryness.
• Improvements in self-reported quality of life.
• Minimal if any side effects and no changes in uterine or vaginal tissues among women taking the extract, suggesting that it may be safe in terms of breast or uterine cancer.

In the U.S., ERr 731 is marketed as a supplement called Estrovera. Although it appears to be safe, like any drug, you should speak to your practitioner before trying it.

I’m heartened to see that an herb that been in use for decades in both Western and Eastern cultures in finally available to US women. I’ll continue to monitor for additional studies but in the interim, I’d love to hear from you if you are taking Estrovera.