Posted by on December 9, 2015 - 3:50pm

Do you have questions about menopause? Are you ever curious about hormone therapy treatments? You’re not alone!  Every year over two million women in America alone enter into menopause, and most have questions.  The Women’s Health Research Institute wants to provide answers with our informational menopause website: menopause.northwestern.edu.  This site is tailored to the needs of women, offering up-to-date information on menopause and symptom management.  The site even offers a personalized “Menopause Self Assessment,” which enables women to evaluate their own symptoms and health status that they can then print out and share with their healthcare providers.

Menopause marks the transition in every woman’s life when menstruation and fertility decline and eventually end.  Menopause symptoms affect women differently, so treatments vary from woman to woman.  The many stages of menopause may seem overwhelming, but women should find comfort in the numerous treatment options developed by leading researchers and clinicians.  Empowering women with educated choices regarding their health provides them with the tools to live longer and stronger in their journey during and after menopause. Click here to learn more about menopause and the different ways you can navigate your menopausal transition.

Posted by on October 19, 2015 - 1:11pm

Back in the early 2000s flawed reports surfaced that suggested hormone replacement therapy (HRT) was linked to increased risks of heart disease and breast, ovarian and womb cancers--scientists recently concluded these theories are false. This new research, which followed women for a decade, has found no evidence that HRT is linked to any life-threatening condition! This is good news for the millions of menopausal women who may want to use HRT to control their hot flashes, night sweats, and depression.

HRT boosts levels of estrogen and progesterone and is the most widely recognized therapy to treat severe menopausal symptoms. In the 1940's, the FDA approved the use of estrogen to treat hot flashes associated with menopause. Because women felt better while taking hormones, the list of other beneficial claims relative to the effects of aging grew despite the lack of extensive research. In 1990, the FDA found that the research done to date was not adequate to take hormones to prevent conditions like heart disease. This led to an extensive 15 year, multiphase drug trial called the Women's Health Initiative on hormone therapy for menopausal women, which caused widespread uncertainty for women regarding the safety of hormone therapy and caused many to stop using HRT completely.

Yet this new study by the New York University school of medicine tracked 80 women using HRT for 10 years and compared them with a control group who were not using the medication. The HRT group suffered no more incidences of cancer, diabetes, or heart disease than the control group. Menopausal symptoms can be frustrating and can interfere with daily life. Knowing that there are safe therapies to control these symptoms should be a comfort for women everywhere!

Check out the Women's Health Research Institute's menopause website (menopause.northwestern.edu) to learn more about symptoms and therapy options!

Source: The Telegraph

Posted by on March 11, 2015 - 3:49pm

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Vasomotor symptoms, mainly in the form of hot flashes, are the most commonly reported menopausal symptom.  While many people assumed a connection, data was inconsistant, it was only recently that cross sectional survey using the Menopause Health Questionnaire from Mayo Clinic  was conducted that compared users and non-users of caffeine beverages.  A total of 2,507 surveys were completed and after adjusting for menopause status and smoking (caffeine users smoked more than non-users), the researchers found that caffeine users reportied higher vasomotor symptom scores. 

There was some evidence of a decrease in neurocognitive symptom bother in premenopausal (not post menopausal women) with caffeine use but more study is need to determine if this is true.  Interestingly, other menopausal symptoms (sleep, blowel/bladder function, sexual function, and general/other symptoms) did not show an association with caffeine use.

To read more on menopause, visit menopauseNU.org or read the full report HERE

Posted by on December 20, 2014 - 4:23pm
 Unsubstantiated claims, lack of scientific safety and efficacy data, and lack of quality control continue to surround custom-compounded bioidentical hormone products and yet, many women seem to believe that they are somehow "safer" than lab synthesized hormones.   FDA-approved hormone therapy provides tested and regulated therapy without the risks of unregulated and untested custom preparations that often include custom compounded therapies.

Bioidentical hormones, a marketing term not recognized by the US Food and Drug Administration (FDA), refers to exogenous hormones biochemically similar to those produced within the body and includes 17A-estradiol (predominant estrogen before menopause), estrone (predominant estrogen after menopause), estriol (from placenta), progesterone (ovaries, placenta, and adrenal glands), testosterone (ovaries and adrenal glands), and their conjugates.[1] These are derived from soy and yam precursors and must be chemically processed to make them able to be absorbed by the human body.

Hormones that meet the definition of bioidentical are available as FDA-approved prescription therapies and include estradiol (oral, patch, gel, lotion, mist, and vaginal ring, cream, or tablet) and micronized progesterone (oral or vaginal). The FDA has not approved estriol. Custom-compounded bioidentical hormone products are prepared, assembled, and packaged according to a provider's prescription into gels, creams, lotions, sublingual tablets, subdermal implants, suppositories, or troches.[2] Transdermal therapies avoid the first-pass effect through the liver, and there is evidence that they have a lower clotting risk.[3] Progesterone may have fewer negative effects than synthetic progestins on lipids, sleep and mood, and breast (density, tenderness, and cancer risk) when combined with estrogen. No FDA-approved testosterone therapy (bioidentical or otherwise) is available for women.

Lack of Testing for Efficacy, Safety, and Quality Control

The major difference between FDA-approved hormone products meeting the definition of bioidentical versus custom-compounded products is that the former are regulated by FDA, tested for purity, potency, and efficacy, and sold with FDA-approved product information that includes boxed warnings. Efficacy and safety data, required for obtaining particular product indications, have been demonstrated in randomized, clinical trials with peer-reviewed published reports for FDA-approved bioidenticals but not for custom-compounded products.[4,5]

No large, long-term studies have been done to determine the effectiveness, safety, or adverse effects of custom-compounded bioidentical hormones. In 2008, because of lack of scientific data on estriol, FDA stated that pharmacies should not compound drugs containing estriol unless the prescriber has a valid investigational new drug application.[4]

To read the entire article, visit  Menopause.  To learn more about your options during menopause visit MenopauseNU.org developed by the Women's Health Research Institute at Northwestern University.

 

 

 

Posted by on November 27, 2014 - 11:22am

Early results of the ELITE study find women who started hormone therapy early after menopause saw a significant slowing of atherosclerotic progression, whereas those who waited more than a decade saw no impact on vascular health, supporting the "timing hypothesis".

"ELITE results are consistent with the majority of the literature that shows that women who are young and/or in close proximity to menopause when starting hormone therapy have reduced coronary heart disease and overall mortality," according to study leader  Howard N. Hodis, MD, of the University of Southern California in Los Angeles, and colleagues.

The Women's Health Initiative, aiming for cardiovascular prevention with menopausal hormone therapy, had raised major concerns about stroke and myocardial infarction (MI) in its somewhat older, later menopause population.  The KEEPS study subsequently showed that for a younger (ages 42 to 58) population, this may not be true.

ELITE was designed to directly test the hypothesis that timing makes all the difference in safety of hormone therapy after menopause.

"I think it's important that clinicians not interpret this as you should start estrogen to try to prevent heart disease, but that the younger, newly menopausal woman who has menopausal symptoms should not be denied hormone therapy because of concerns about heart disease risk, as was seen in older women," JoAnn E. Manson, MD, of Brigham and Women's Hospital in Boston, told MedPage Today.

"There are other factors to take into consideration [such as risk of thrombosis]," she explained. "But because a newly menopausal woman is generally at low absolute risk of heart attack, stroke, thrombosis, all of those outcomes, it tends to be a favorable balance of benefit-to-risk."

While suggestive that early hormone therapy wouldn't have an impact on later heart disease risk, "this trial wasn't large enough to look at clinical events," Manson cautioned.

To learn more about this study, click HERE.   To learn more about Menopause, click HERE.


Primary source: American Heart Association
Source reference: Hodis HN, et al "Testing the menopausal hormone therapy timing hypothesis: The early versus late intervention trial with estradiol" AHA 2014; Abstract 13283.

Posted by on November 21, 2014 - 2:08pm

Today, Many women live beyond age 80 and as a result may be postmenopausal for over 30 years. Each woman has a unique range of symptoms.  Hormone therapy has been widely prescribed since the early 60s despite limited research to relieve unpleasant menopausal symptoms.  However,  alarms were raised in the 1990's that have led to a whole battery of new research on hormone therapy that continues to this day.

So what is the current status of hormonal therapy as a treatment option?   Researchers now know that the timing, dosage, path of metabolism, mode of delivery, drug combination, and years of use all matter and need to be measured against each woman’s risk profile.   New genetic and molecular tools enable us to determine how  individuals may respond differently to  the same medications and hormones.     Doctors have better ways to determine risks for the chronic conditions of aging and how they may be impacted when estrogen drops during menopause.   Non-hormonal options are slowly coming on the market, but these, too, may need the test-of-time to determine if they work without side effects and are not always a better alternative.

Doctors do know much more today that they did when hormone therapy was first used and have begun “personalizing” the treatment approach to relieving menopause symptoms as new findings are published.  Individualization is key, and research continues as new diagnostic tools for efficacy and risk are discovered.   In the meantime, women should realize that ALL medicines we take---from aspirin to antibiotics to cold medicine--carry different levels of risk for each person. In fact, many medications beyond hormone therapy, have been studied primarily in males!

In many cases, hormone therapy,  is a relatively safe and effective drug for some women who are experiencing severe symptoms. Learn all you can about your own risk profiles, assess the severity of your symptoms, and find a clinician who keeps up on the latest research to discuss options.    An excellent on-line tool to help you assess your risk and explore the latest interventions can be found at  menopausenu.org

 

 

 

Posted by on October 12, 2014 - 3:18pm

Perimenopause  is the time when a women naturally starts having menopausal symptoms.  This natural change usually lasts about a year and is often referred to as the 'menopause transition'.  At  this time, fertility declines but a woman may still get pregnant, and effective birth control should be used if she does not want to have a mid-life baby.  Generally, after a year of no menses, a woman can be considered infertile and menopausal.

There are several appropriate birth control methods recommended for perimenopausal women:

  • Hormonal oral contraceptives
  • Non-oral hormonal contraceptives (ring, patch, injection)
  • Intrauterine devices (IUD)
  • Sterilization
  • Barrier Methods (diaphragm, spermicide, sponge, condoms) though these require some discipline to be effective.

Natural family planning method (rhythm) is not recommended during perimenopause because women have irregular periods during this phase and it is hard to predict ovulation.  Emergency contraception is a back up option but it should not be considered as a regular birth control method.

Hormonal oral contraceptives have some benefits during this time including more regular cycles, less cramps and bleeding during periods, decreased risk of certain cancers and maintenance of bone strength.  It may also help with hot flashes and acne outbreaks that are common when hormones are fluctuating.   There are also some risks of oral contraceptives during perimenopause.  They include increased risk of blood clots (especially if a smoker or diabetic), some withdrawal bleeding, and delayed confirmation when menopause is reached.

To learn more about menopause, visit menopauseNU.org

Source:  North American Menopause Society

 

Posted by on September 11, 2014 - 3:25pm

As more post menopausal women change to a low dose local vaginal estrogen to control vaginal atrophy, a group of experts have recommended that the FDA modify the package Black Box Warning label  on the product packaging.  The current warning is based on research done mainly on oral estrogen which is a systemic rather than local therapy.   The local low-dose therapy, in fact, was designed to reduce estrogen exposure to the woman while still providing localized (vaginal) relief from vaginal atrophy.   The panel of experts who wrote the editorial published in the journal Menopause, believe that the current warning is not based on this form of the estrogen and is harming women by discouraging their use of this very effective product that could improve their quality of life and prevent some serious health problems.

Vulvovaginal atrophy (VVA) is a common and progressive condition that is due to the lack of estrogen during and after the menopause.  This results in  the  thinning, drying and inflammation of the vaginal walls that can lead to painful sex and urinary disorders.   Localized estrogen is an approved treatment for this disorder.   To read more about menopause and the latest evidence based treatment options, visit MenopauseNU.org. a site developed by the Women's Health Research Institute at Northwestern University.

 

 

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Posted by on May 7, 2014 - 9:57pm

The average age of menopause in the United States is around 51 years old, but the onset can widely vary. Premature menopause refers to menopause of onset at or before 40 years of age. This can occur because of  a variety of causes, including surgery (i.e. bilateral oophorectomy, removal of ovaries), chemotherapy or pelvic radiation treatments for cancer, chromosomal or genetic defects, and spontaneous premature ovarian failure.

For women undergoing premature menopause, symptoms can be similar to those of regular menopause. Symptoms include  hot flashes, night sweats, vaginal dryness, and mood changes. Longitudinally, however, the symptoms may different between those who undergo premature menopause and those who undergo menopause at roughly the average age. New research shows that premature menopause may be associated with long-term negative effects on cognitive function.

A study based on a sample of 4868 women tested cognition at baseline, two, four, and seven years, and it also looked at the effects of the type of menopause, whether natural or surgical, could play a role.

Natural menopause was reported by 79% of the 4868 participants, 10% underwent menopause from surgical causes, and 11% reported menopause from other treatment causes including radiation or chemotherapy. Approximately 7.6% of the women in the study had a premature menopause, and the study further delineated 12.8% of the women had an early menopause (between 41 and 45 years of age).

Results showed that women who underwent premature menopause had a more than 40% increased risk of poor performance on verbal fluency and visual memory tasks, compared to those who experienced menopause at or after the age of 50. Women who underwent premature menopause also were associated with a 35% increased risk of decline in psychomotor speed. There was no significant association with the risk of dementia.

Both premature menopause secondary to surgery and premature ovarian failure, were associated with long-term negative effects on cognitive function, which cannot entirely be answered by hormone therapy. Researchers agree more studying needs to be done to better understand the potential benefits using hormone therapy.

Healthcare professionals should be aware of the potentially significant impact premature menopause can have on cognitive function in later life. Professionals should also consider these effects when aiding younger women in the decision-making process of undergoing oophorectomy. To learn more about how menopause can affect you long-term, visit Northwestern's menopause website here.

Source: J Ryan, J Scali, I Carrière, H Amieva, O Rouaud, C Berr, K Ritchie, M-L Ancelin.Impact of a premature menopause on cognitive function in later lifeBJOG: An International Journal of Obstetrics & Gynaecology, 2014; DOI: 10.1111/1471-0528.12828

Posted by on April 18, 2014 - 10:00pm

Most women think menopause means low estrogen, hot flashes, and the end to regular and monthly periods. This may not be the case, however. Researchers have found that women may experience an increase in the amount and duration of bleeding, which may occur sporadically throughout the transition of menopause.

Researchers from the University of Michigan utilized data from the Study of Women's Health Across the Nation, in which participants kept track of their episodes from 1996 to 2006. Women were of various ethnicities, including caucasian, Chinese, Japanese, and African-American. This was particularly unique in that previous studies have been limited to caucasians and were of shorter duration.

The results showed that during the menopause transition, women can have prolonged bleeding of 10 or more days, spotting for a week, and heavy bleeding for 3 or more days. 91 percent of the approximately  1,300 women ages 42 to 52 years old in the study, recorded up to 3 episodes of bleeding that lasted at least 10 days. Up to 88 percent of women in the age group reported at least 6 days of spotting, and up to 78 percent recorded at least 3 days of heavy bleeding. No significant differences regarding bleeding episodes were noted amongst race and ethnicities.

More research will need to be done to determine how to evaluate alterations in menstruation during menopause. However, this research reveals some of the qualitative differences in bleeding that women may expect through the menopausal transition. Instead of consistently being alarmed with what their bodies are going through, women can now perhaps be more aware of the changes in bleeding patterns, and what may or may not require medical attention. To discover other physical symptoms that occur and may change with menopause, visit Northwestern's menopause website here.

 

Source: University of Michigan. "Prolonged, heavy bleeding during menopause is common." ScienceDaily. ScienceDaily, 15 April 2014. <www.sciencedaily.com/releases/2014/04/140415203629.htm>.

 

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