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One dose of HPV vaccine may be enough

Women vaccinated with one dose of a human papillomavirus (HPV) vaccine had antibodies against the viruses that remained stable in their blood for four years, suggesting that a single dose of vaccine may be sufficient to generate long-term immune responses and protection against new HPV infections, and ultimately cervical cancer, according to a study recently published [1]. 

"The latest Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention on vaccination coverage indicates that in 2012, only 53.8 percent of girls between 13 and 17 years old initiated HPV vaccination, and only 33.4 percent of them received all three doses," said Mahboobeh Safaeian, Ph.D., an investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute (NCI) in Bethesda, Md.

"We wanted to evaluate whether two doses, or even one dose, of the HPV 16/18 L1 VLP vaccine [Cervarix] could induce a robust and sustainable response by the immune system," she added. "We found that both HPV 16 and HPV 18 antibody levels in women who received one dose remained stable four years after vaccination. Our findings challenge previous dogma that protein subunit vaccines require multiple doses to generate long-lived responses." 

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Neck injections for hot flushes

A shot in the neck of local anesthesia may reduce hot flushes by as much as 50 percent for at least six months, a recent Northwestern Medicine® study found.

"We think we are resetting the thermostat in women who are experiencing moderate to very severe hot flushes without using hormonal therapies," said David Walega, MD, chief of the Division of Pain Medicine at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine. Walega presented the results of the initial study at a recent American Society of Anesthesiologists annual meeting. 

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Women’s Health Initiative - Update 2013

Hormone replacement therapy (HRT) has been under considerable scrutiny since 2002 when a large US government study, the Women’s Health Initiative (WHI) reported that HRT, specifically the combination of estrogen and progestin together, increased the risk for blood clots, stroke, breast cancer and heart attacks.

The WHI, which consisted of three clinical trials and an observational study, was conducted to address major health issues causing morbidity and mortality in postmenopausal women. The study was stopped early by the researchers and they concluded that the risks of HRT outweighed the benefits.

Although the WHI study was designed to evaluate the role of HRT in the prevention of diseases related to aging, many women and their doctors also abandoned HRT as therapy for menopausal symptoms.

Additional research over the past 10 years, has found shown that the level of risk with HRT depends on the individual woman, her health history, age, and the number of years since her menopause began. It is women below the age 60 years and recently started menopause, who are at a lower risk when taking low doses of HRT compared with women over 60.

The paper by Manson JE, Chlebowski RT, Stefanick ML, et al.(1) published in the October 3, 2013 issue of the Journal of the American Medical Association, sets out to report a comprehensive, integrated overview of findings from the two WHI hormone therapy trials with extended postintervention follow-up.

Reference

1 Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368

Expert Comment

International Menopause Society (IMS)

The North American Menopause Society (NAMS)

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Use of Pharmacologic Interventions for Breast Cancer Risk Reduction:

American Society of Clinical Oncology Clinical Practice Guideline

The updated pharmacologic interventions for breast cancer risk reduction from the 2009 American Society of Clinical Oncology (ASCO) guideline was published by the American Society of Clinical Oncology in July 2013.

The authors undertook a systematic review of randomized controlled trials and meta-analyses published from June 2007 through June 2012 using MEDLINE and Cochrane Collaboration Library. The primary outcome of interest was breast cancer incidence (invasive and noninvasive). The secondary outcomes included breast cancer mortality, adverse events, and net health benefits. Guideline recommendations were revised based on an Update Committee's review of the literature.

Nineteen articles met the selection criteria and six chemoprevention agents were identified: tamoxifen, raloxifene, arzoxifene, lasofoxifene, exemestane, and anastrozole.

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Calcium and vitamin D help hormones help bones

Should women take calcium and vitamin D supplements after menopause for bone health? Recommendations conflict, and opinions are strong. But now, an analysis from the major Women's Health Initiative (WHI) trial throws weight on the supplement side—at least for women taking hormones after menopause. The analysis was published 26 June 2013 in Menopause, the journal of The North American Menopause Society.

Among the nearly 30,000 postmenopausal women in the hormone trial, some 8,000 took supplemental calcium (1,000 mg/day) and vitamin D (400 iu/day), and some 8,000 took look-alike placebos. These women came from all the hormone groups in the study—those who took estrogen plus a progestogen (required for women with a uterus), those who took estrogen alone, and those who took the hormone look-alike placebos. The researchers looked at how the rates of hip fracture differed among women who took hormones and supplements, those who took hormones alone, and those who took neither.

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BRCA gene may influence early menopause

Women with harmful mutations in the BRCA gene, which put them at higher risk of developing breast and ovarian cancer, tend to undergo menopause significantly sooner than other women, allowing them an even briefer reproductive window and possibly a higher risk of infertility, according to a study led by researchers at UC San Francisco.

The study was published online in the journal Cancer on Jan. 29.ver, the study showed that carriers of the mutation who are heavy smokers enter menopause at an even earlier age than non-smoking women with the mutation.

While the authors note that further research is needed, given the size and demographics of the study, women with the abnormal gene mutation should consider earlier childbearing, and their doctors should encourage them to initiate fertility counseling along with other medical treatments, the scientists said.

This is the first controlled study to explore the association between BRCA1 and BRCA 2 and the age at onset of menopause, the authors said.

"Our findings show that mutation of these genes has been linked to early menopause, which may lead to a higher incidence of infertility,'' said senior author Mitchell Rosen, MD, director of the UCSF Fertility Preservation Center and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. "This can add to the significant psychological implications of being a BRCA1/2 carrier, and will likely have an impact on reproductive decision-making,'' Rosen said.

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Decline in memory and thinking skills linked to early surgical menopause

Women who undergo surgical menopause at an earlier age may have an increased risk of decline in memory and thinking skills, according to a study for presentation at the American Academy of Neurology's 65th Annual Meeting in San Diego, March 16 to 23, 2013.

Early surgical menopause is the removal of both ovaries before natural menopause and often accompanies a hysterectomy.

"While we found a link between surgical menopause and thinking and memory decline, women on longer hormone replacement therapies had slower declines," said study author Riley Bove, MD, with Harvard Medical School in Boston and a member of the American Academy of Neurology. "Since hormone replacement therapy is widely available, our research raises questions as to whether these therapies have a protective effect against cognitive decline and whether women who experience early surgical menopause should be taking hormone replacement therapies afterward."

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Calcium, vitamin D, exercise and bone health

February 4, 2013

New guidelines published in the Medical Journal of Australia's open access journal (MJA OPEN) reveal calcium, vitamin D and exercise are the key to Australia's bone health.

'Building Healthy Bones Throughout Life: an evidence informed strategy to prevent osteoporosis in Australia' presents key recommendations for different stages of life.

This 18 month body of work has culminated in today's publication of key guidelines that are essential to the bone health of all Australians. Instigated by Osteoporosis Australia, and commenced with a national summit, over 100 leading experts, from a range of disciplines, had the opportunity to analyse and critique evidence specific to bone health and prevention strategies.

The nation's bone health needs addressing as 1.2 million Australians have osteoporosis and 6.3 million have osteopenia (low bone density)*. Over 80,000 Australians suffer minimal trauma fractures each year.**

Professor Peter Ebeling, Medical Director of Osteoporosis Australia and lead author on the paper said "When we look at optimising bone health, we must look at the whole life cycle and extensive research gives us clear directions on what is required at different ages."

"This paper clearly identifies the central role a combination of adequate calcium, vitamin D and exercise provides at all life stages, to improve our nation's bone health," said Prof Ebeling. 

"The clear message today is we have an opportunity to make a difference to bone health for all Australians. We have the tools, but we now have to use them all. Our call is to both the public and general practitioners to focus more attention on bone health."

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Ovarian Conservation Versus Bilateral Oophorectomy: NAMS Practice Pearl

Ovarian Conservation Versus Bilateral Oophorectomy at the Time of Hysterectomy for Benign Disease

Observational studies suggest that elective bilateral oophorectomy may do more harm than good. Removing the ovaries at the time of hysterectomy for benign disease should be approached with caution, especially for women younger than age 50. For women who choose oophorectomy, some evidence suggests that menopausal estrogen therapy may ameliorate some of the increased risk. An informed consent process covering the risks and benefits of both oophorectomy and ovarian conservation is important.

pdfOvarian Conservation Versus Bilateral Oophorectomy at the Time of Hysterectomy for Benign Disease72.34 KB

 

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