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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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Exercise boosts diet benefits

Obese older adults can reduce their chances of developing the metabolic syndrome which raises the risk of diabetes and heart disease by adding exercise to a diet regime, research shows.

The study followed 107 obese adults aged 65 and older for one year and randomised them to four groups – weight management with a calorie-restricted diet, three 90-minute exercise sessions a week without dieting, combined dieting with exercise, and controls (no diet or exercise.)

The combination of diet and exercise nearly doubled the improvement in insulin sensitivity compared with dieting alone. The insulin sensitivity index did not improve in controls but improved by 40 per cent in the diet group and by 70 per cent in the combined diet-exercise group.

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Weight loss lowers cancer risk

Even moderate weight loss can significantly reduce levels of circulating oestrogens which are associated with an increased risk of breast cancer, US researchers have found.

Results suggested that losing just five per cent or more of one's weight could cut by a quarter to a half the risk for the most common, oestrogen-sensitive breast cancer said researcher, director of the Prevention Centre at Fred Hutchinson Cancer Research Centre, Dr Anne McTiernan.

The study in 439 overweight to obese sedentary women aged 50 to 75 was the first to show that losing weight through a healthy diet significantly lowered blood oestrogen levels in postmenopausal women and led to average weight losses of 10 percent of their starting weight. The most striking effect was if diet was combined with exercise.

"This shows that it's never too late to make lifestyle changes to reduce your risk for breast cancer," Dr McTiernan said.

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Oestrogen only HRT reduces breast cancer risk

Women who have had a hysterectomy and who use oestrogen-only hormone replacement therapy appear less likely to develop breast cancer in the long term than women who have never used HRT, new findings published by the Lancet today, Wednesday 7 March 2012, indicate.

Researchers followed postmenopausal women for nearly 12 years and found a 23% reduction in the incidence of invasive breast cancer in those who had used conjugated equine oestrogen therapy for an average 5.9 years, compared with women on placebo.

Those on oestrogen therapy who did develop breast cancer were also much less likely to die from the cancer than women who developed breast cancer in the placebo group.

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Smoking lowers menopause age

Women who smoke have a higher risk of early natural menopause, a review of eleven studies involving about 50,000 women has found.

The meta-analysis, published in the February edition of Menopause journal, provides more evidence to suggest that smoking is a significant independent risk factor for early menopause.

Natural menopause usually occurs about age 50. One group of studies in the meta-analysis found smoking increased the risk of menopause occurring before this age by about 43 per cent. Another group of studies found smoking brought forward menopause by about one year.

Early natural menopause is associated with a higher risk of cardiovascular diseases, genital tract cancers and osteoporosis.

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