Entries in menopause (20)


FDA Approves New Drug for Hot Flashes

iStockphoto(NEW YORK) -- The Food and Drug Administration approved a new and somewhat controversial drug to treat moderate to severe hot flashes and night sweats associated with menopause on Friday.

There are several drugs that treat hot flashes, which up to 75 percent of women experience, but Brisdelle is the first one that is non-hormonal. It contains a low dose of paroxetine, which is used in higher doses in the antidepressant drug Paxil.

Many are surprised that the FDA approved the drug after an expert advisory panel voted ten to four against it, saying it risks outweighed its benefits. But the FDA says many women are now opposed to hormonal treatments since being linked to increased risk of breast cancer.

“There are a significant number of women who suffer from hot flashes associated with menopause and who cannot or do not want to use hormonal treatments,” said Hylton V. Joffe, director of the Division of Bone, Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research. “[Friday’s] approval provides women with the first FDA-approved, non-hormonal therapeutic option to help ease the hot flashes that are so common in menopause.”

According to the FDA, the most common side effects of Brisdelle are headache, fatigue, and nausea and vomiting.

Copyright 2013 ABC News Radio


Vitamin D and Calcium Not Recommended for Certain Women

iStockphoto/Thinkstock(WASHINGTON) -- The government is telling healthy postmenopausal women to skip daily doses of vitamin D and calcium.

According to the United States Preventive Services Task Force, these supplements taken in low doses to prevent bone fractures won't do older women any good if they're already in good health.

In fact, the task force says 400 international units or less of vitamin D and 1,000 milligrams or less of calcium "could increase the likelihood of kidney stones," a painful condition affecting the urinary tract.

However, low doses of vitamin D and calcium are still okay for people with osteoporosis, a bone disease leading to increased risk of fracture, or vitamin D deficiencies.

The task force did not have any conclusive evidence of what benefits or disadvantages these supplements might have for men and premenopausal women.

Copyright 2013 ABC News Radio


Hormone Therapy Without Menopause Symptoms Discouraged

iStockphoto/Thinkstock(WASHINGTON) -- The U.S. government renewed its recommendation against prescribing hormone therapy to postmenopausal women for the prevention of chronic conditions like heart disease and bone loss, but didn't tackle whether women should take hormones to relieve their hot flashes and night sweats.

"The evidence shows that the harms of hormone therapy for the prevention of chronic conditions outweigh the benefits, which is what the evidence also showed in 2005," said Dr. Kirsten Bibbins-Domingo, a member of the Task Force.  The task force only looks at preventative medicine and would not typically make a recommendation regarding whether women should use hormone therapy to relieve their menopause symptoms.

Since doctors haven't regularly prescribed hormones for chronic disease prevention since 2002 study findings showed the dangers of long-term hormone therapy, some doctors are worried patients will be confused by the Task Force recommendation.

"At the present time, the pendulum has already swung away from the use of hormone therapy for chronic disease prevention," said Dr. JoAnn Manson, chief of preventative medicine at Brigham and Women's Hospital in Boston.  "Recently, the consensus of the 15 top medical societies saying hormone therapy still has an important clinical role in management of night sweats and other menopause symptoms."

Like birth control and other drugs, hormone therapy comes with a set of risks, Manson said.  As such, doctors should not prescribe them if they outweigh the benefits for a particular patient.  If the patient has no symptoms, which would be the case if she is taking hormone therapy simply for "chronic disease prevention," the risks do not outweigh the benefits.

Two hormone therapy studies came out within a week of each other this month, generating excitement in the medical community because they showed positive results of using short-term hormone therapy for women who start it shortly after their last menstrual period: the Kronos Early Estrogen Prevention Study nicknamed KEEPS, and a Danish study.

However, the Task Force did not consider either of them because they were not available when it was making its decision, Bibbons-Domingo said.

"In the context of the larger body of evidence the Task Force considered when making this recommendation, it is unlikely that this study would have altered the balance of harms versus benefits and led the Task Force to a different recommendation," Bibbons-Domingo said.

According to the review published in the Annals of Internal Medicine, researchers looked at studies from 2002 forward and chose nine on which to base the Task Force recommendation.  They found that estrogen and progestin reduced bone fractures but increased invasive breast cancer stroke and other ailments.

The first study to raise the alarm on hormone therapy was the Women's Health Initiative, or WHI, which stopped prescribing hormone pills to its 160,000 participants between the ages of 50 and 79 in 2002, the year it found that the hormones made women more likely to develop aggressive breast cancer.  The participants has been taking the pills for 10 years because doctors believed the pills would prevent chronic diseases.  Follow-ups continued through 2010.

This study was included in the Task Force's recommendation, but Dr. Katherine Sherif, director of the Drexel Center for Women's Health, said the WHI was misleading because its participants were 10 years older than most hormone therapy patients today.

"I've been in this business for 17 years, and no woman who is 63 has ever said to me, 'I need hormones for hot flashes,'" Sherif said, adding that most of her patients are in their late 40s or early 50s.  "It irritates me that people keep falling back on the Women's Health Initiative in that hormones are dangerous for women.  It just isn't that clear cut."

This month, KEEPS followed 727 women ages 42 to 58 (much younger than WHI) for four years, but researchers didn't have enough time to study long term health outcomes like cancer, heart disease and death.  As such, they looked for risk factors, and found that hormone pills made no difference.  KEEPS has yet to publish its data.

The following week, researchers at Hvidovre Hospital in Denmark announced that they'd found proof of the timing hypothesis, which suggests that hormone therapy protects women from heart disease if they start it soon after their last menstrual period.  It looked at 1,000 women ages 45 to 58 over 16 years.  Researchers also found that fewer women on hormone therapy were diagnosed with breast cancer, but the figure wasn't statistically significant.  As such, they concluded hormone therapy did not increase breast cancer risk.

Manson said more research is needed on lower doses of hormone therapy for menopause symptom relief.

Copyright 2012 ABC News Radio


Study Finds Hormone Therapy Safe in Early Menopause

iStockphoto(NEW YORK) -- Researchers in Denmark have become the first to offer statistical proof that hormone therapy is not only safe for menopausal women who begin it early -- it actually reduces their risk of mortality, heart attack and heart failure.

The 16-year randomized study of about a thousand women offers new proof that the "timing hypothesis," which suggests that hormone therapy protects women from heart disease if they start it soon after their last menstrual period, is correct. Researchers also saw no difference in breast cancer risk between those who were assigned the hormone therapy and those who were not.

"It really confirms the timing hypothesis and hopefully will change the way we look at hormone therapy, so it will change the quality of life for many women," said study author Dr. Louise Schierbeck, who works in the department of endocrinology at Hvidovre Hospital in Denmark.

The women took estrogen for about ten years until 2002, when another study, the Women's Health Initiative (WHI), found significant evidence that women taking progestin and estrogen were more likely to develop aggressive breast cancer. Although WHI researchers studied 160,000 women ages 50 to 79, many of whom had chronic diseases already, Danish researchers studied 1,000 women ages 45 to 58, and excluded people who previously had had cancer or other major illnesses, according to the study text, which was published in the BMJ, formerly the British Medical Journal.

Schierbeck's colleagues used Danish hospital data to figure out how many patients died or had other health problems in 2002 and six years later. Both times, they discovered that fewer hormone therapy patients died or had heart disease than the hormone-free patients.

Researchers additionally found that fewer hormone therapy patients had breast cancer or other cancers, but because the findings were not statistically significant, they can only officially conclude that there was no difference in cancer risk for the hormone therapy group and the hormone-free group, Schierbeck said.

Although the study is much smaller than WHI, doctors in the United States are calling it "important" and "encouraging" because it shows that women can relieve their menopausal symptoms, such as night sweats and hot flashes, without worrying that the long-term hormone therapy will eventually kill them.

The study will not affect current guidelines, which recommend as little hormone therapy as possible, because larger studies will be needed to affirm the findings, several doctors agreed. They were especially interested in how the study looked at women who were on hormone therapy for 10 years, which is longer than the WHI study participants were on it.

"This study is likely to lead to a resurgence of interest in studies of how hormones affect the cardiovascular system related to age and to the level of underlying pathology," said Dr. Carl Lavie, the medical director of cardiac rehabilitation and prevention at Ochsner Clinic Foundation and Hospital in New Orleans.

Still, some medical professionals were not convinced this study is a big step at all.

"This is a non-informative study with too many shortcomings to list," said Wulf Utian, the founding president and former executive director of the North American Menopause Society, or NAMS. (Preliminary findings of a different study were announced at the NAMS annual conference in Orlando last week.)

What shortcomings? The trial had an "extremely small" number of adverse health events, no placebo control and no description of the randomization method, Utian said.

Shierbeck responded to the study size criticism by saying that she reported statistically significant results.

Pamela Ouyang, a Johns Hopkins professor, said that the 1,000 women followed for almost two decades provides an enormous number of "woman-years" worth of data. Ouyang was one of the doctors who suggested that the guidelines would be rewritten because of this study.

Every doctor interviewed said that women should discuss hormone therapy with their doctors.

Copyright 2012 ABC News Radio


Exercise May Lower Breast Cancer Risk

Jupiterimages/Thinkstock(NEW YORK) -- In addition to keeping hearts healthy and bones strong, there's another reason why women may want to exercise regularly -- a new study published in the journal Cancer found a link between physical activity and reduced breast cancer risk.

A study of more than 3,000 women from Long Island, N.Y., found that women who engaged in 10 to 19 hours of at least mild exercise per from their reproductive years on had about a 30 percent lower risk of developing breast cancer. The effects of physical activity were strongest among postmenopausal women, based on the data analysis.

The women were between the ages of 20 and 98 who participated in the Long Island Breast Cancer Study Project, a series of government-funded studies conducted to investigate possible environmental contributors to breast cancer on Long Island. The women were also predominantly white and upper middle class.

"We didn't see a risk reduction during the time before the first birth," said lead author Lauren McCullough, a doctoral candidate at the UNC Gillings School of Public Health. "There is a strong association seen with postmenopausal women, which is totally in line with other studies."

A separate study published in May by researchers at the Fred Hutchinson Cancer Research Center found that postmenopausal women who lose a moderate amount of weight through exercise and a healthier diet can lower their breast cancer risk because losing fat tissue can reduce the amount of two hormones associated with breast cancer.

McCullough and her colleagues found in their current research that weight also plays a role in the relationship between exercise and breast cancer risk. Gaining too much weight, it turns out, can eliminate some of the risk-reduction benefits of exercise after menopause.

Physically active women who gain more than 11 pounds after menopause are at a higher risk of developing breast cancer, though it's lower than for post-menopausal women who gain a similar amount of weight who don't exercise.

And obese women who exercised had about the same risk as normal-weight women who did no physical activity at all.

"For postmenopausal women, if you are physically active or highly active and maintain or gain just a little bit of weight, you are going to reap the benefits in terms of breast cancer reduction," McCullough said.

The study findings, McCullough added, are especially encouraging for post-menopausal women, since breast cancer tends to strike women who are older more often.

And she hopes if future research can confirm these findings, the data will someday lead to broader public health messages about the benefits of exercise.

"Trying to understand the relationship between physical activity and breast cancer will hopefully better tailor public messages to include cancer risk," she said. "Right now, recommendations from the Centers for Disease and Prevention and the World Health Organization about physical activity are based on risk reduction for cardiovascular disease."

Copyright 2012 ABC News Radio


Early Menopause: The Physical and Emotional Toll

Comstock/Thinkstock(NEW YORK) -- Menopause, with its hot flashes, memory lapses and mood swings, is no walk in the park.  But early menopause, also known as "premature ovarian failure," can take a heavy emotional toll, according to Sheryl Kingsberg, a psychologist specializing in women's health and fertility.

"We're talking about a woman who's not expecting to go through these changes," said Kingsberg, division chief of obstetrics and gynecology behavioral medicine at University Hospitals Case Medical Center in Cleveland.  "It sort of ages her rapidly."

Beyond the shock of becoming "post-menopausal" while same-aged peers are starting families, the sudden drop in estrogen prompts wrinkles and plumps waistlines, Kingsberg said.  It can also cause osteoporosis and "vulvovaginal atrophy" -- the thinning and drying of the vagina.

"The term alone is devastating to women," said Kingsberg, describing how the shrinking tissue also loses its sensitivity. "Early menopause is devastating in terms of fertility, sexual identity and self esteem."

Dr. James Grifo, director of reproductive endocrinology and infertility at the NYU Fertility Center in New York, said early menopause is hard to accept but easily managed.

"We can replace what the body stops making," he said, describing hormone replacement therapies that safely and effectively ease the symptoms of menopause.  "We use the same hormones the ovaries would be making at levels lower than those of ovulating women, and that resolves a lot of the symptoms."

Copyright 2012 ABC News Radio


Menopause Hormone Therapy Benefits Hit in Government Report

iStockphoto/Thinkstock(WASHINGTON) -- Hormone replacement therapy may provide relief from the hot flashes, night sweats and other oppressive symptoms of menopause, but when it comes to preventing chronic health problems, a panel of experts for the federal government said HRT isn’t helpful and may be harmful.

The U.S. Preventive Services Task Force on Tuesday recommended against the use of HRT for the prevention of chronic conditions, such as coronary heart disease, breast cancer and fractures, for postmenopausal women.  The panel classified the recommendation as “grade D,” meaning there is “moderate to high certainty” that the risks of HRT outweigh any long-term health benefits that women might gain.

The panel noted that the recommendations don’t apply to women taking HRT to relieve hot flashes, vaginal dryness and other postmenopausal symptoms.  Women’s health specialists say increasing evidence indicates that reasonable use of the therapy to fight those symptoms can have big benefits for women’s quality of life.

“For newly menopausal women who have these symptoms and are in generally good health, the benefits of treatment are likely to outweigh the risks,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.

The USPSTF’s recommendations are the latest chapter in the often-confusing story of hormone replacement therapy, which was once considered a possible tool for preventing chronic maladies such as coronary heart disease and fractures.  But the Women’s Health Initiative, a 10-year study of nearly 70,000 women, found that women who took both estrogen and progestin actually had an increased risk of blood clots, heart attacks and strokes, as well as a higher risk of developing breast cancer.  The trial was halted three years early in 2002.

The USPSTF cited evidence gleaned from the Women’s Health Initiative in its latest recommendations, saying that the use of estrogen-only HRT or a combination of estrogen and progestin was linked with an increased risk of stroke, gallbladder disease, urinary incontinence and blood clots.

For women taking estrogen-only HRT, the panel found modest benefits in the way of reducing bone fractures and smaller reductions in the risk of developing or dying from invasive breast cancer.  But the panel said those small positives were outweighed by the more major risks of the therapy.

Copyright 2012 ABC News Radio


Estrogen Therapy Works Best in Younger Women

Jupiterimages/Thinkstock(NEW YORK) -- A reappraisal of the National Institutes of Health's Women's Health Initiative (WHI) study has found that "the age when women start hormone replacement therapy makes a huge difference," in risk of cancer and heart disease, according to Dr. Robert Langer, lead author of the reassessment, which was published in the journal Climacteric.

Researchers said "mass fear" left millions of women to needlessly suffer from menopause symptoms without the benefits of hormone replacement therapy when researchers of the WHI study found that women who took estrogen were at higher risk of certain cancers and heart disease.

New data showed that the risks only apply to older menopausal women who begin taking the medication late into menopause.

"The balance is towards benefit for women with hot flashes and other reasons to use it who start within 10 years of menopause," said Langer.  "But it's not beneficial for most women who start about 10 years or more into menopause."

Prior to the 2002 study, some research found that the menopausal hormone therapy actually helped to decrease the risk of heart disease, but the 2002 preliminary data found the treatment did not decrease risk and put women at increased risk of some invasive breast cancers and stroke.  Prior to the study results, hormones were one of the most-prescribed drugs in the country.

But the use of estrogen dropped by 71 percent from 2001 to 2009, according to the North American Menopause Society.

Researchers halted the clinical trial altogether three years early in 2002 because of the noted increased risk.

For some women, menopause symptoms are much more than the occasional hot flash.  Depression, low libido, night sweats, panic attacks and vaginal dryness are only a few of the many indications that storm through the body of a menopausal woman.

Symptoms like vaginal dryness and pain on intercourse are more difficult to bring up with a gynecologist than risks of heart disease and breast cancer, said Langer.

"Fears like the risk of breast cancer, or sometimes heart attacks or strokes, surface quickly in those discussions," continued Langer.  "The reporting of the WHI fed those fears to a degree not warranted by the small increase in breast cancer rates that probably only reflected earlier discovery of existing cancers, or by the fact that the heart attack risk and stroke was only seen in women who started more than 10 years after menopause."

Copyright 2012 ABC News Radio


Documentary Reveals the Good, Bad, Ugly of Menopause

iStockphoto/Thinkstock(NEW YORK) -- "When I think of menopause, I think of hate, pure clean hate," one woman said in the new documentary Hot Flash Havoc.

"I told my wife if she goes through menopause again, we're getting a divorce," a husband said.

Nevertheless, "you're very lucky to reach menopause," another woman said. "If you don't reach it, you have some troubles."

Hot Flash Havoc, a film of "menopausal proportions," is a documentary meant to examine menopausal symptoms, reveal the history and society's view on menopause and even question the results from an ongoing National Institutes of Health initiative, which, in 2002, discouraged women from taking estrogen plus progesterone to treat symptoms of menopause.

For some women, menopause symptoms are much more than the occasional hot flash. Depression, low libido, night sweats and panic attacks are only a few of the many indications that storm through the body of a menopausal woman.

The controversial documentary will be released to the public March 30.

The beginning of the documentary creates a playful dialogue on the experiences and expectations of menopause and menstruation.

For one woman, the roundabout way in which she was told about her feminine health left her confused for decades.

"Your Aunt Tilly is going to visit you once a month, and she's going to hang around for about 30 years," the interviewee described how her menstrual cycle was explained. "When Aunt Tilly dies, you'll know about it cause she won't come around no more. Who the hell is Aunt Tilly?"

The majority of the film documents the benefits of estrogen replacement therapy, commonly taken to curb hot flashes and other menopausal symptoms. It particularly criticizes a NIH Women's Health Initiative study, which, in 2002, found that women taking estrogen were at higher risk of certain cancers and heart disease. Researchers halted the clinical trial altogether in 2002 because of the noted increased risk.

Filmmakers and menopause experts interviewed in the documentary argue that the 2002 study results were misrepresented, and led millions of menopausal women to unnecessarily stop taking hormones that otherwise curbed debilitating symptoms sometimes associated with menopause.

And research released last week in the Lancet reignited this debate when a study found that estrogen-only hormone replacement therapy might lower the risk of breast cancer for some postmenopausal women. While the findings were specific to women who have had a hysterectomy, have no increased risk of breast cancer and no increased risk of strokes and blood clots, advocates of hormone therapy welcomed the results.

"Menopause has been this secret filled with shame, anxiety and confusion for centuries," said Heidi Houston, executive producer of the film. "The movie is intended to give information so every woman can make informed decisions about treating menopause and allow women to become health care advocates for themselves."

Prior to the 2002 study, some preliminary research found that the menopausal hormone therapy actually helped to decrease the risk of heart disease, but the preliminary data found the treatment did not decrease risk and put women at increased risk of some invasive breast cancers and stroke. Prior to the study results, hormones were one of the most prescribed drugs in the country.

But the use of estrogen dropped by 71 percent from 2001 to 2009, according to the North American Menopause Society.

"Women with a uterus who are currently taking estrogen plus progestin should have a serious talk with their doctor to see if they should continue it," Dr. Jacques Rossouw, acting director of the WHI at the time, explained in 2002. "If they are taking this hormone combination for short-term relief of symptoms, it may be reasonable to continue since the benefits are likely to outweigh the risks. Longer term use or use for disease prevention must be re-evaluated given the multiple adverse effects noted in WHI."

Dr. Marcia Stefanick, a researcher on the WHI study, told ABC News that the questions the initiative set out to answer were not specifically on menopause, but about the health risks and benefits of menopausal hormones for older women, "for whom they were being prescribed to prevent common diseases of aging women (i.e. heart disease, osteoporosis and dementia)."

"As it turns out, menopausal hormone therapy did not reduce heart disease in older women and it increased strokes," Stefanick said.

The treatment indeed helps to curb hot flashes. It also helps prevent vaginal dryness and preventive bone loss, she said. While temporary use of the treatment likely has mild risks, women deserve to know them, Stefanick said. And menopausal hormone therapy taken for several years has shown an even greater risk of the adverse health conditions.

But critics of the study said the patient population was skewed. While the study included more than 16,000 women ages 50 to 79, the average age of women in the study was 63. On average, women begin menopause around 51 years of age, when most women will experience the most severe of their symptoms.

"There was no question that there were more risks for women over 60 years of age," Dr. June La Valleur, director of the Mature Women's Center at University of Minnesota Medical Center, wrote in an email. "Women need to have options and to say that no one should use estrogen or estrogen/progestin therapy for menopausal symptoms is absurd."

Dr. Alan Altman, president of the International Society for the Study of Women's Sexual Health and a menopausal expert interviewed on the documentary, told ABC News, "Women were instilled with fear that wasn't necessary and they need to understand that they can let that fear go and make a good, educated decision about menopausal hormone treatment."

New WHI data came out in 2008 and found that three years after women stopped taking the hormone therapy, increased risk of heart disease diminished. But women were still at a slightly increased risk of stroke, blood clots and cancer.

As for Houston, the executive producer said the motivation for the documentary came from her own challenges in dealing with menopause and not knowing all her options.

"Menopause is a natural change that is going to happen to everyone," Houston said. "I believe we have the right to have all the information available to us so we women can make our own choices. Whatever a woman's choice is, whether she wants to take hormones or not, it doesn't matter, as long as she has the options so she can decide on how to have the best quality of life."

Copyright 2012 ABC News Radio


Supermodel Blames Thyroid for Early Menopause at 24

Jemal Countess/Getty Images(NEW YORK) -- Thyroid problems three years ago caused Czech supermodel Karolina Kurkova to develop symptoms of premature menopause and pack 30 pounds onto her 5-foot-11 frame, she revealed this week.

Kurkova, now 27, discussed the maladies linked to her malfunctioning thyroid gland during a panel discussion on models' health and eating disorders, sponsored by the Council of Fashion Designers of America.

"I was 24 and going through menopause -- that was one of my side effects," Kurkova explained Tuesday. "I thought I was going crazy. I was having panic attacks every minute and I didn't know what was happening, because I've been a healthy person. I've exercised all my life. I've always eaten well and taken care of myself."

Despite going through early menopause from a thyroid disorder she didn't identify by name, Kurkova went on to give birth to a son on Oct. 29, 2009.

The weight gain, panic attacks and premature menopause that Kurkova described do not point to a single thyroid diagnosis, according to a thyroid specialist not involved in her care.

"The totality doesn't fit into one, neat little package," said Dr. Robert McConnell, co-director of the New York Thyroid Center at New York-Presbyterian/Columbia University Medical Center.

For example, he said, Kurkova's 30-pound weight gain isn't what's commonly associated with an under-active thyroid gland. Weight gain caused by hypothyroidism, in which the thyroid gland produces too little of the thyroid hormones, is typically modest, "maybe five to six pounds, and it's typically half-fat, half-water," McConnell said.

"People whose thyroid function is low get puffy and waterlogged. Their hands are puffy, their feet are puffy and their face is puffy," he said. They also may have cold intolerance, achiness and feel sluggish and depressed.

Although weight gain and early menopause in a young woman suggests low thyroid, the panic attacks Kurkova mentioned are more commonly associated with a disorder at the other end of the thyroid dysfunction spectrum, called hyperthyroidism, in which an overactive thyroid gland produces too much of the thyroid hormones. That tends to drive weight loss, typically 5 to 10 pounds, McConnell said. Patients with overactive thyroids may feel anxious, sweaty and restless.

The butterfly-shaped thyroid gland lying at the base of the neck is a complex organ, serving as a master control for many processes in the body, including metabolism, bone growth and regulation of body temperature. Diseases of the thyroid are intricately associated with reproductive issues in many stages of a woman's life and are among the most common medical conditions in women, increasing with age.

Copyright 2012 ABC News Radio

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