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Short-term use of hormone replacement therapy (HRT) and ovarian cancer risk

hormone replacement therapyA meta-analysis of 52 epidemiological studies, involving a total of 21488 women with ovarian cancer, almost all from North America, Europe and Australia, was published in The Lancet on 13 February 2015 (see About the study). The findings from the study suggest that taking hormone replacement therapy (HRT) for the menopause, even for just a few years, is associated with an increased risk of developing ovarian cancer.

Comment from AMS

Dr Anna FentonDr Anna Fenton BHB, MBChB, PhD, FRACP
AMS President

"This recent meta-analysis from the Collaborative Group raises the possibility of an increased risk of ovarian cancer with use of estrogen or combined estrogen-progestogen therapy.

The data is heavily influenced by the Million Women Study which is widely acknowledged to have significant flaws. There has been no correction for the BMI of the women, their previous use of the contraceptive pill or age at menopause.

In the days since the study was released examination of the relative and absolute risk calculations have shown them to be incorrect. The revised absolute risk increase appears to now sit at just under 1 extra case per 10,000 women per year; somewhat less than the study initially suggested.  

Ovarian cancer is a rare condition but all the risks and benefits of hormone therapy need to be carefully considered when treating women at menopause.

Women should not stop hormone therapy based on this study but if they are concerned they should discuss the findings with their doctor." 

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Women play dangerous waiting game with heart symptoms

Heart disease a leading cause of death for women yet they are more likely than men to dismiss pain and delay seeking medical help

When heart symptoms strike, men and women go through similar stages of pain but women are more likely to delay seeking care and can put their health at risk, according to a study presented at the Canadian Cardiovascular Congress.

"The main danger is that when someone comes to the hospital with a more severe or advanced stage of heart disease, there are simply fewer treatment options available," says Dr. Catherine Kreatsoulas, lead author of the study and a Fulbright Scholar and Heart and Stroke Foundation Research Fellow at the Harvard School of Public Health.

Dr. Kreatsoulas, an epidemiologist, says we don't know enough about how people perceive their heart symptoms and at what stage they are prompted to seek medical care. Her study included patients with suspected coronary artery disease, just prior to undergoing their first coronary angiogram test.

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Coping with change revisited

hot flashesSometimes a "natural part of life" needs a little bit of expert knowledge and understanding to better cope with changes. In the Washington Post article Treating menopausal symptoms: What you need to know by Janice Lynch Schuster on October 13 2014, she contrasts her activities surrounding understanding the onset of menstruation with her unpreparedness for the changes of menopause.

Some key comments in the article show the consequences of the Women’s Health Initiative (For more information see Women’s Health Initiative Update 2013) where the conclusions drawn back in 2002 led to an 80% drop in hormone therapy prescriptions worldwide(1).

From Treating menopausal symptoms: What you need to know 

...The more current analyses of the Women’s Health Initiative data, along with other recent studies, indicate that for women in their 50s, just entering menopause, HT is a relatively safe treatment that can be used for up to five years and is not associated with an increased risk of heart disease (although women should still be screened and treated for risk factors, such as high blood pressure and breast cancer)...

...Richard J. Santen, president of the Endocrine Society, says that following the 2002 findings from the Women’s Health Initiative, which indicated that hormone therapy was harming women, prescriptions for it fell by 80 percent worldwide. At the same time, he says, medical training programs began to overlook training new doctors how to care for menopausal women...

...“For someone who has been debilitated by symptoms, you need to find a doctor who will really talk to you and listen to your concerns. The doctor should assess your risk factors and understand the benefits and risks you face. Right now, people just don’t know enough about the data, and it is easier for doctors not to prescribe at all,” Chang says...

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Soy may help women's hearts if they start early

A diet rich in soy may help feminine hearts, but timing matters, finds a new study published online Menopause, the journal of The North American Menopause Society.

Lifelong soy consumption, similar to the diet of women in Asia, produces the least atherosclerosis. Switching to a Western diet after menopause, similar to Asian migrants to North America, leads to just as much atherosclerosis as a lifelong Western diet, and switching to soy from a Western diet after menopause helps only if there isn't much atherosclerosis already.

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Alzheimer's disease and B vitamins

Taking B vitamins doesn't slow mental decline as we age, nor is it likely to prevent Alzheimer's disease, conclude Oxford University researchers who have assembled all the best clinical trial data involving 22,000 people to offer a final answer on this debate.

Elevated plasma homocysteine is a risk factor for Alzheimer disease, but the relevance of homocysteine lowering to slow the rate of cognitive ageing is uncertain.

The researchers aim was to assess the effects of treatment with B vitamins compared with placebo, when administered for several years, on composite domains of cognitive function, global cognitive function, and cognitive ageing.

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Acupuncture: the answer to hot flushes

In the 2,500 plus years that have passed since acupuncture was first used by the ancient Chinese, it has been used to treat a number of physical, mental and emotional conditions including nausea and vomiting, stroke rehabilitation, headaches, menstrual cramps, asthma, carpal tunnel, fibromyalgia and osteoarthritis, to name just a few. Now, a meta-analysis of randomized controlled trials which is being published this month in Menopause, the journal of The North American Menopause Society (NAMS), indicates that acupuncture can affect the severity and frequency of hot flushes for women in natural menopause.

An extensive search of previous studies evaluating the effectiveness of acupuncture uncovered 104 relevant students, of which 12 studies with 869 participants met the specified inclusion criteria to be included in this current study. While the studies provided inconsistent findings on the effects of acupuncture on other menopause-related symptoms such as sleep problems, mood disturbances and sexual problems, they did conclude that acupuncture positively impacted both the frequency and severity of hot flushes.

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Weight loss and hot flush reduction

Now women have yet one more incentive to lose weight as a new study has shown evidence that behavioral weight loss can help manage menopausal hot flushes.

The pilot study, which was published online last month in Menopause, the journal of The North American Menopause Society (NAMS), consisted of 40 overweight or obese white and African-American women with hot flushes, which are the most prevalent symptom of menopause. In fact, more than 70% of women report hot flushes during the menopausal transition, with many of these women reporting frequent or severe hot flushes. Since women with hot flushes are at greater risk for poor quality of life, sleep problems and a depressed mood, interest in identifying methods for managing hot flushes is growing. In addition, newer data indicate that hot flushes are typically persistent, lasting an average of nine years or more.

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Sex hormones and heart disease risk in mid-life women

As hormone levels change during the transition to menopause, the quality of a woman's cholesterol carriers degrades, leaving her at greater risk for heart disease, according to research from the US. 

The first-of-its-kind evaluation was done using an advanced method to characterise cholesterol carriers in the blood.

The results call for further research to evaluate the menopause-related dynamic changes in sex hormones on the quality of cholesterol carriers over time, as well as increased emphasis on the importance of healthy diet and exercise for women undergoing menopause.

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Older mums at birth of last child and exceptional longevity

Women who had their children later in life will be happy to learn that research suggests an association between older maternal age at birth of the last child and greater odds for surviving to an unusually old age.  

In the study which used Long Life Family Study data, 311 women who survived past the oldest fifth percentile of survival (according to birth cohort-matched life tables) were identified as cases, along with 151 women who died at ages younger than the top fifth percentile of survival who were identified as controls. Looking at the cases of all 462 women, the study found a significant association for older maternal age, whereby women who had their last child beyond age 33 years had twice the odds for survival to the top fifth percentile of survival for their birth cohorts compared with women who had their last child by age 29 years. More specifically, women between the ages of 33 and 37 having their last child had an odds ratio of 2.08. The odds ratio for older women was 1.92.

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