Menopause has no extra effect on the risk for diabetes, an American study suggests.
Researchers found it had little or no impact on whether women became more susceptible to diabetes, and postmenopausal women had no higher risk for diabetes regardless of whether they experienced natural menopause or had their ovaries removed.
The trial in 1237 women with glucose intolerance (pre-diabetes) aged 40 to 65 included 708 premenopausal women, 328 in natural menopause and 201 with bilateral oophorectomy.
Previous evidence suggested menopause speeds progression to diabetes because postmenopausal women have higher levels of testosterone, a diabetes risk factor.
Menopause August 2011; 18; 857-868
Menopause and risk of diabetes in the Diabetes Prevention Program
Content updated 8 August 2011
Testosterone spray may improve memory in post-menopausal women, a small Australian study suggests.
Lead investigator, Monash University postdoctoral research fellow Dr Sonia Davison, said results offered a potential therapy, where none currently existed, to slow cognitive decline in women.
Researchers compared a control group of 30 women who received no treatment with nine women in early menopause who were healthy, had no cognitive decline and were taking non-oral HRT. They sprayed their skin daily for six months, returning testosterone levels in the blood to those of young women of childbearing age. Tests showed they improved their memory and verbal learning while controls had no improvement.
Findings of the preliminary study, which was co-financed by the spray’s manufacturers FemPharm, were presented at The Endocrine Society’s 93rd annual meeting in Boston.
http://www.newswise.com/articles/view/577468/?sc=mwtn
Content updated 19 July 2011
An American study has found that flaxseed is not helpful in easing hot flushes among breast cancer patients and postmenopausal women.
Preliminary data published in 2007 by Mayo Clinic investigators suggested that consuming 40 grams daily of crushed flaxseed might help manage hot flushes.
Their follow-up randomized, placebo-controlled study in 188 women in 2009 found no significant difference in mean hot flush scores between women taking flaxseed and those taking placebo.
Findings were presented at the American Society of Clinical Oncology annual meeting in Chicago.
http://www.newswise.com/articles/view/577438/?sc=mwtn
Content updated 19 July 2011
A gluten-free diet appears to delay menopause for women with Coeliac disease, a study shows.
The study found that a gluten-free diet which started at least 10 years before menopause prolonged the fertile life span of Coeliac women. Participants were 33 women with Coeliac disease after menopause who had not consumed a gluten-free diet and 25 Coeliac women who had plus 45 controls.
Perception of intensity of hot flushes and irritability was more severe in untreated Coeliac women than controls and researchers said low exercise and quality of life often reported by untreated Coeliac patients might increase the perception of menopausal symptoms.
Coeliac patients not on a gluten-free diet also had a shorter fertile period than control women due to late menarche and earlier menopause.
Menopause June 2011 From menarche to menopause: the fertile life span of celiac women
Content updated 19 July 2011
A study in nearly 850,000 post-menopausal women has found an association between the use of hormone replacement therapy and a lower risk of having peripheral arterial occlusive disease.
Half of patients reported having used HRT but despite being more likely to be slightly older, to have smoked and to have hypertension and high cholesterol than non-users, they were significantly less likely to have PAD (3.3% v 4.1%.)
Researcher, vascular surgeon Dr Caron Rockman from New York University Medical School said: “This data has important implications with regard to a possible protective effect of HRT on atherosclerotic conditions, particularly in patients at higher risk for these conditions due to medical co-morbidities.”
The study was presented at the Society of Vascular Surgery’s 65th vascular annual meeting in June.
http://www.newswise.com/articles/view/576855/?sc=mwtn
Content updated 19 July 2011
A study in more than 60,000 women indicates that early vasomotor symptoms are not associated with increased cardiovascular disease risk.
Emerging evidence previously suggested that women with menopausal vasomotor symptoms had increased CVD risk.
The Women's Health Initiative Observational Study found that early VMS were associated with decreased risk of stroke, total CVD events and all-cause mortality, but late VMS were associated with increased CHD risk and all-cause mortality.
Researchers said the predictive value of VMS for clinical CVD events may vary with the onset of VMS at different stages of menopause.
Menopause: June 2011; 18: 603-610 Vasomotor symptoms and cardiovascular events in postmenopausal women
Content updated 6 June 2011
Comment by Professor Martha Hickey for the Australasian Menopause Society
Background
Previous reports from the Women’s Health Initiative study, a large prospective randomized controlled trial of oral combined equine estrogen (premarin) and medroxyprogesterone acetate (provera), CEE alone or placebo in postmenopausal women have shown an increased risk of invasive breast cancer after long-term us of combined HRT. These findings have changed practice.
Read more...
E Ingelsson, C Lunhdolm, A Johansson, D Altman
Eur Heart J. 2011 Mar;32(6):745-50. Epub 2010 Dec 24
Comment by Dr Anna Fenton for the Australasian Menopause Society
This study of Ingelsson and colleagues examines the link between hysterectomy, bilateral oophorectomy and the risk of coronary heart disease and stroke.
The Swedish Inpatient and Cause of Death registers, which have completeness and accuracy exceeding 98-99%, were used to extract information about hysterectomy and bilateral oophorectomy. Women with a history of cardiovascular disease (CVD) or surgery for malignancy were excluded from the analysis. Information on age and socio-economic status (SES) was available from the registers but adjustment for other CVD risk factors was not possible.
181,441 women were eligible and were matched to women who had not had a hysterectomy but who were of the same age and from the same area of Sweden. Median follow-up was 10.4 years. Hazard ratios were calculated and adjusted for age, time and county + SES.
In women under the age of 50yrs, hysterectomy was associated with a higher risk of coronary events and stroke (HR 1.18, CI 1.13-1.23). Oophorectomy before the hysterectomy appeared to increase the risk still further (HR 2.22, CI 1.01-4.83). The same risk was not seen in women over the age of 50 at the time of the hysterectomy. Interference with ovarian blood supply and reduced hormone production after hysterectomy were considered plausible explanations for the CVD risk.
Limitations to the study include its observational nature. It was unable to adjust for a number of CVD risk factors, including weight, smoking and lipid profile, and may have missed cardiac events that did not require inpatient care. However, the size and accuracy of the registry data is impressive. The results are also comparable to other data showing higher CVD rates among women with an early surgically induced menopause. It suggests that we should weigh carefully the risks and benefits of hysterectomy in younger women.
Content updated 18 April 2011
The evidence for a benefit of herbal and dietary supplements on cognition in postmenopausal women is “not compelling”, researchers say.
A systematic review including 12 randomised controlled trials found five studies suggesting isoflavone, soy and Gingko biloba supplements may improve cognition in postmenopausal women.
However most of the studies were methodologically flawed, the researchers concluded.
Maturitas 2011; 68:256-263
Content updated 3 March 2011
New data from a trial of lasofoxifene, a selective oestrogen-receptor modulator (SERM) show five years of treatment in postmenopausal osteoporotic women does not increase the risk of endometrial cancer or hyperplasia.
The study of >8500 women found lasofoxifene resulted in a small increase in endometrial thickness versus placebo, the authors said.
The new study follows the release of data last year suggesting lasofoxifene reduced the risk of breast cancer in women in the randomised, placebo-controlled PEARL (Postmenopausal Evaluation and Risk-Reduction With Lasofoxifene) trial.
Menopause 2011 18:17-22
Content updated 31 January 2011
In postmenopausal women with osteoporosis, treatment with alendronate in combination with raloxifene has a more pronounced effect than either drug used alone, a small study shows.
Each medication by itself significantly increased bone mineral density and raloxifene had some beneficial effects on lipid metabolism, researchers found.
No significant differences were found in the incidence of adverse effects.
Climacteric 2011 online 23 January
Content updated 31 January 2011
Australian reseachers have developed a simplified screening tool for osteoporosis designed for use in primary care.
A general practice study involving nearly 2500 women was used to develop the Prospective Screening for Osteoporosis; Australian Primary Care Evaluation of Cliical Tests (PROSPECT) tool which will reduce unnecessary radiology tests but ensure women with fractures are not missed, the authors said.
The predictive tool is based on rib-pelvis gap, ever use of oestrogen and BMI.
Menopause 2011 18:53-59
Content updated 31 January 2011
Local oestrogen therapy is the best treatment for postmenopausal vaginal atrophy, according to the latest advice from the International Menopause Society.
Download it here
Content updated 8 December 2010
Four diagnostic tools for excluding endometrial cancer in a patient with postmenopausal bleeding are reviewed.
MATURITAS 2010; online 24 November
Content Updated 8 December 2010
A new study adds weight to the ‘timing theory’ about HRT which suggests initiation of hormone therapy around the time of menopause may have health benefits, whereas initiation later in life likely carries greater risk.
The study of 1500 women found those taking HRT in midlife had a 26% decreased risk of later dementia, whereas those taking it when older had a 48% increased risk.
Annals of Neurology 2010; online 12 November
Content Updated 8 December 2010
The first publication of breast cancer mortality data from the Women’s Health Initiative (WHI) trial shows a small but significant increase in deaths among women using combined oestrogen plus progestin HRT.
A paper based on WHI trial data shows a small but significant increase in deaths among women using combined oestrogen plus progestin HRT.
This is in keeping with the known small increase in breast cancer cases in this group of women after five years of use. The increase does not apply to women taking oestrogen-only HRT.
The use of lowest effective dose of HRT for women at the time of menopause in women who have significant symptoms is still the most effective treatment recommended for those women who are healthy and take it for a limited time.
AMS Executive
Link to the free abstract:
Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in Postmenopausal Women
JAMA. 2010;304(15):1684-1692. doi:10.1001/jama.2010.1500
Professor Martha Hickey MBChB MD FRANZCOG comments on the paper for AMS:
Read more...
The International Osteoporosis Foundation is calling on Health Professionals to be on the lookout for signs of vertebral fracture in patients aged >50 years.
A new IOF report, the Breaking Spine, shows vetebral fractures are under-diagnosed world-wide, with nearly 30% being missed in Australia.
www.iofbonehealth.org/publications/the-breaking-spine.html
Content updated 8 November 2010
SSRIs and Tamoxifen
A population-based cohort study has found that paroxetine use during tamoxifen treatment is associated with an increased risk of death from breast cancer.
The study can be read here.
The following commentary for the Australasian Menopause Society has been written by AMS Council member Professor Martha Hickey MBChB MD FRANZCOG.
Breast cancer affects up to one in every eight Australian women. Up to 25% of breast cancer patients also experience a depressive disorder, and selective serotonin reuptake inhibitors (SSRIs) are commonly used in the treatment of depression. More recently, SSRIs have also been widely used in the management of hot flushes in women who wish to avoid taking estrogen-containing treatments, in particular women with a history of breast cancer (1, 2).
The majority of breast cancers are estrogen-receptor positive. Depending on the stage and grade of tumour, many pre-menopausal and some postmenopausal breast cancer patients with estrogen-receptor positive cancer will be advised to take tamoxifen as an anti-estrogen hormone therapy for five years (or more) following surgery and chemoradiation.
Read more...
Multivitamins and breast cancer risk
An observational study of more than 35,000 postmenopausal women which found an association between multivitamin intake and a small increased risk of breast cancer has received wide media coverage. The study can be found here.
The following commentary was written for the Australasian Menopause Society by AMS council member Professor Martha Hickey MBChB MD FRANZCOG.
Multivitamin supplements are widely used by men and women in the developed world. About 40% of US women reported using multivitamins in 1999–2000 (1). The reasons why people choose to take multivitamins are not well defined, but are likely to relate to perceived benefits for general health and for reduction of specific common conditions such as cardiovascular disease and cancer.
Breast cancer affects up to one in eight Australian women. Any intervention which potentially increases the risk of breast cancer is of significant public health concern since even small increases in risk can translate into large numbers of women affected.
Read more...
Only infrequent incontinence symptoms appear attributable to the menopause, according to researchers who conducted a longitudinal study. Modifiable factors including anxiety, weight gain and diabetes were associated with more frequent incontinence, they found.
Read more...
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