menopause

RECENT POSTS

Good News-Bad News On PMS and Menopause

Young women, take heart: if you are among the vast majority of us who suffer from PMS —  the irritability, anxiety, headaches, breast tenderness, or bloating — it doesn’t mean you’re doomed to suffer from hot flashes when you hit menopause.

But don’t go out and celebrate just yet.

Because this is a good news/bad news kind of report:

pixel pro photography/flickr

pixel pro photography/flickr

The Good: Researchers found no connection between having a history of PMS and then experiencing hot flashes during menopause.

The Bad: They did find a connection between PMS and other seriously annoying problems shortly after menopause —  including impaired memory and concentration, poor sleep and depression.

Oh well.

The study of 150 recently menopausal woman published in the journal Menopause, claims its findings — linking a history of PMS with worsened so-called “health-related quality of life” measures, but not with hot flashes — are “novel.”

Here’s more on the mechanics of the connection, from the study:

The resemblance between premenstrual and menopausal symptoms raises a question on whether they also share similar physiological characteristics. One mechanism that has been suggested to contribute to premenstrual symptoms is deficiency in, or abnormal functioning of, neurotransmitters in the central nervous system, Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Hormone Therapy? No To Prevent Disease, Yes To Ease Menopause Woes

Dr. JoAnn Manson considers the evolution of menopause management and hormone therapy (Brigham & Women’s Hospital)

Here’s how we usually describe the medical pendulum swings on hormone treatments for menopausal women:

A couple-three decades ago, some doctors were touting hormone “replacement” therapy as a fountain of youth that might beat back not just hot flashes but many diseases that come with aging. Then research turned up more and more potential risks, from blood clots to strokes and breast cancer. Perhaps, researchers posited, hormone therapy might be okay in younger menopausal women but not in older? The rule became, “It’s complex; talk to your doctor.”

It’s still complex, but a new paper just out in the Journal of the American Medical Association at long last refines 13 years of intense research by the Women’s Health Initiative into a form that I can easily wrap my mind around. In short: Whether you’re in your fifties or beyond, no woman should be taking hormone therapy long-term, in hopes of preventing diseases of aging. Those benefits don’t outweigh the risks. But younger menopausal women with hard-to-take symptoms like hot flashes and night sweats can still consider taking hormones to alleviate them short-term.

To quote Dr. JoAnn E. Manson, the lead author of the new paper and chief of Preventative Medicine at Brigham and Women’s Hospital:

“This is the most comprehensive evidence base available for clinical decision making and it does suggest that hormone therapy should not be used for long-term chronic disease prevention — but it remains an appropriate option for short-term management of menopausal symptoms in early menopause.”

Got that? I asked whether there might be a medical profile that might rule out hormone therapy even for younger menopausal women.

(pennstatelive/flickr)

(pennstatelive/flickr)

Yes, Dr. Manson said, “If a woman is at very high risk of cardiovascular disease — if she’s had a prior stroke or blood clots in her legs or lungs, or has multiple risk factors, she may not be an appropriate candidate for even short-term treatment. But most women who do have the very significant symptoms — of hot flashes and night sweats and interrupted sleep in early menopause — could be considered for short-term therapy to manage these symptoms.”

Only about 15 to 20 percent of newly menopausal women have symptoms severe enough to consider hormones, she said.

An additional note: If “short-term” use of hormone therapy for menopause symptoms may be all right, just how long is short-term? That remains controversial, Dr. Manson said, but it can be as long as several years.

It has surely been a long, zig-zagging journey toward what now looks like nicely definitive data on hormone therapy.

“The science has advanced in incremental steps,” Dr. Manson said, and it really required a large-scale randomized trial, such as the Women’s Health Initiative, to understand the balance of benefits and risks. And it’s taken a while; there have been many swings of the pendulum. Hormone therapy was once believed to be a fountain of youth, and then it was believed to be too dangerous for anyone to use, and now we understand that there are women who are appropriate candidates, for at least short-term use, and hormone therapy should not be used for long-term chronic disease prevention.” Continue reading

Why To Exercise Today: So You Can Be A Cover Girl

A while back, my co-host Carey Goldberg came to me with her classic buoyant optimism: “I have good news,” she chirped. “And arguably less good news.”

The good news: She’d been selected to be on the cover of a new women’s magazine.
The less good: The magazine was called My Menopause.

Only Carey would agree to write a pro bono piece “sharing how she conquered menopause” with a very large picture of herself, surrounded by greenery, amidst headlines like: “Chinese Medicine Treatments For Menopause,” and “What Every Woman Needs To Know About Sexual Dysfunction.”

Screen shot 2013-08-29 at 12.04.01 PM

(My Menopause was launched earlier this year by a local doctor, Machelle (Mache) Seibel, a professor at the University of Massachusetts Medical School; he’s the kind of guy who sings about health issues, from mammograms and stress incontinence to swine flu and bacterial vaginosis.)

Of course, Carey’s piece is excellent. I got weepy when she described aging and the inevitable physical decline, and losing the “yum” of pleasure in her life; no joy for a child’s achievements, nor at the prospect of a divine slice of chocolate cake.

Her bottom line, however, is brilliant: the thing that saved her, that saves so many of us, is exercise. Not just when you feel like it and not only when the weather’s good, but every day with no excuses, dragging your bum out of the house and letting all those other, far more important things you absolutely must do wait.

For me, exercise has, for decades, helped to preserve my mental health: Continue reading

Study: Hormone Therapy May Not Hurt — Or Help — Menopausal Brains

(pennstatelive/flickr)

Here’s the good news for women on hormone therapy for menopause: A new study suggests it will not increase your risk of dementia or otherwise hurt your brain health.

Now here’s the bad news for women on hormone therapy: It doesn’t look like it will improve your brain health either.

I think of this as the period of the Great Shake-Out on hormone therapy. First came the Fountain of Youth period, with some doctors handing out estrogen and progestin like candy to women during and after menopause.

Then, about a decade ago, came seminal Women’s Health Initiative findings that hormone therapy could carry daunting risks, including higher rates of heart attacks, dementia and cancer in older women.

Research led to a new hypothesis, the “Window of Opportunity” theory: That if women started hormone therapy earlier, more like in their fifties than in their sixties or seventies, they might reap benefits with fewer risks. For heart disease, there’s extensive evidence that is indeed the case.

Now, the “WHIMSY” study — for Women’s Health Initiative Memory Study in Younger Women — just out in the journal JAMA Internal Medicine, does seem to bear out somewhat the earlier-window theory when it comes to brain health. At least when it comes to avoiding harm.

Dr. Fran Grodstein of Brigham and Women’s Hospital, who researches the long-term health effects of hormone therapy but was not involved with this latest study, wrote in a commentary accompanying the paper:

Dr. Fran Grodstein of Brigham and Women's Hospital (Courtesy)

Dr. Fran Grodstein of Brigham and Women’s Hospital (Courtesy)

“Approximately 10 years ago, the Women’s Health Initiative Memory Study (WHIMS) found that postmenopausal hormone therapy in older women caused nearly two-fold increases in dementia risk, worse rates of cognitive decline over time, and decreased brain volume on magnetic resonance imaging, compared with placebo treatment.”

But the new study, which looked at over 1300 post-menopausal women who started taking estrogen in their fifties, found no such heightened risks after seven years.

It didn’t find any brain benefits either, though.

Dr. Grodstein sums up: Continue reading

FDA Approves New Pill To Alleviate Pain During Sex

As we’ve reported, about one-third of women in the U.S. say they experience pain during sex.

There a number of non-medical interventions that can help fix the problem, such as pelvic floor physical therapy, which we’ve also written about here. Still, for some, medication may be called for, so it looks like a positive development that the FDA earlier this week approved a new drug to alleviate the pain that many post-menopausal women experience during intercourse.

MedPage Today reports that the newly approved “selective estrogen receptor modulator (SERM)” called ospemifene (Osphena) is taken as an oral tablet and “targets vulvar and vaginal atrophy resulting from menopause, which is the underlying cause of dyspareunia, or pain during sex.” There are risks, however:

The treatment, however, will come with a boxed warning stating that it may thicken the uterine lining, with the concern that unusual bleeding may be a sign of endometrial cancer or a condition that can lead to it. Continue reading

Weight Loss After Menopause: A Few Tricks Left

(Newbirth35/flickr)

Over the weekend, I unpacked my wedding dress, which had been stored in the back of my mother’s closet and impenetrably sealed for 10 years. I’m happy (but not surprised) to report that my finely bejeweled ivory gown was way too big; I’ve lost 15 pounds since I got married in 2002. (OK, I was pregnant then — but only three months, and hadn’t gained much weight.)

I’m now 48 and my metabolism is clearly slowing down. Frankly, I’m entering that fraught period of life when the odds of losing weight or even maintaining a healthy weight are against me. But I’m fighting back, and so far, winning.

A new study,“Short-and Long-Term Eating Habit Modification Predicts Weight Change in Overweight, Postmenopausal Women: Results from the WOMAN Study,” supports my personal experience. (I love when that happens.) The report underscores the difficulties that post-menopausal woman face in achieving any kind of meaningful weight loss, particularly in the long term. However, the study, published in the Journal of the Academy of Nutrition and Dietetics, finds there are a few tricks lefts — but no magic. Alas, it’s what you already know with no shortcuts: fewer desserts and fatty foods, and substituting fruits and vegetables for meats and cheeses. Continue reading

Five New Rules Of Hormone Therapy For Menopause

(pennstatelive/flickr)

Hormone therapy for menopause is good. Hormone therapy for menopause is bad. Hormone therapy for menopause is….well, it’s complicated. Talk to your doctor.

That’s the short version of the history of Hormone Replacement Therapy over the last couple of decades. And while it’s fine to say that menopause treatment needs to be individualized and you should consult with your doctor, some of us do like to have helpful information already in hand when we begin that discussion.

Rachel interviewed Dr. JoAnn Manson of Brigham & Women’s Hospital, a leading researcher on menopause treatments, last month and shared several of her takeaways and recommendations here. And now the latest accepted wisdom has been officially distilled still further, in today’s announcement about a new consensus on hormone therapy among 15 medical organizations:

Bottom line: “Hormone therapy is still an acceptable treatment for menopausal symptoms. The purpose of this statement is to reassure women and their providers that hormone therapy is acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women.”

And the five rules:

Major points of agreement among the societies include:

• Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms. Individualization is key in the decision to use hormone therapy.

• If women have only vaginal dryness or discomfort with intercourse, the preferred treatments are low doses of vaginal estrogen. Continue reading

Managing Menopause: Top Takeaways After Ten Years

Dr. JoAnn Manson considers the evolution of menopause management and hormone therapy (Brigham & Women's Hospital)

A decade after women tossed out their hormone pills in disgust and prescriptions for drugs like Premarin and Prempro plummeted, the management of menopause and its related symptoms has become much more personal, with highly individualized treatment plans and more nuanced assessments of risks and benefits.

Dr. JoAnn Manson, of Brigham and Women’s Hospital and Harvard Medical School, was a principal investigator at the Boston site of the pivotal Women’s Health Initiative hormone trials, and says the initial results and subsequent analyses triggered a radical transformation of clinical care that “really changed women’s lives.”

“The WHI is an historic trial that has changed clinical practice and, ultimately, has helped lead us towards a more rational interpretation of the place of hormone therapy in menopause management,” Manson writes in a new editorial commemorating the 10th anniversary of the WHI trial report, published in the journal Menopause with co-author Lubna Pal, of Yale University School of Medicine.

This “more rational” approach to menopause management involves a much closer look at a woman’s personal medical history and specific risk factors, an in-depth discussion with a well-informed clinician on the risks and benefits of drugs and an honest assessment of how bad the symptoms are (whether hot flashes, or night sweats, sleeplessness or sex issues) and what the individual woman is willing to risk in order to alleviate those symptoms.

Manson offered the top takeaways for women currently facing menopause and wondering how to handle it:

1. If You Are Suffering
Hormone therapy continues to have a clinical role in the short-term treatment of hot flashes and night sweats, notes Manson. “If women have symptoms that are interfering with sleep or undermining quality of life, they should talk to a health care provider to see if they’re appropriate candidates for hormone therapy.”

2. Don’t Take What You Don’t Need
Women should not take hormones if they’re asymptomatic, she says. Continue reading

Hormone Replacement Therapy 10 Years Later: Calls For ‘Rational Use’

Many findings in medical research have swung back in forth like a pendulum, but the wisdom on Hormone Replacement Therapy for menopausal women must be one of the biggest medical pendulums (or pendula, to be archaic) of all time. First it was a miraculous bottled Fountain of Youth; then it was the epitome of all that is evil about Big Pharma and paternalistic medicine.

Over the last few years, those pendulum swings have seemed to get smaller, and perhaps a new series of articles published in the official journal of the International Menopause Society might diminish them still further.

The press release notes that it was in 2002 that a major study by the first Women’s Health Initiative, whose investigators include Dr. JoAnn Manson at Brigham and Women’s Hospital, caused a dramatic, fear-fueled drop in the use of hormone therapy.

Now a major reappraisal by international experts, published as a series of articles in the peer-reviewed journal Climacteric (the official journal of the International Menopause Society), shows how the evidence has changed over the last 10 years, and supports a return to a “rational use of HT, initiated near the menopause”.

The reappraisal has been carried out by some of the world’s leading experts in the field, including clinicians who worked on the original WHI study. Summarising the findings of the special issue, authors Robert Langer, JoAnn Manson, and Matthew Allison conclude that “classical use of HT” – MHT initiated near the menopause – will benefit most women who have indications including significant menopausal symptoms or osteoporosis.

It quotes Dr. Manson:

“An important contribution of the WHI was to clarify that, for older women at high risk of cardiovascular disease, the risks of HT far outweighed the benefits. This halted the increasingly common clinical practice of prescribing HT to women who were far from the onset of menopause. Unfortunately, these findings were extrapolated to newly menopausal and healthy women who actually had a favourable benefit: risk ratio with HT. The WHI results point the way towards treating each woman as an individual. There is no doubt that HT is not appropriate for every woman, but it may be appropriate for many women, and each individual woman needs to talk this over with her clinician”.

The authors note that the initial press reaction, following the lead of the WHI press release, over-emphasised a relatively small increase in breast cancer, so distorting the overall view of the report.
WHI researcher Professor Matthew Allison (University of California, San Diego), said:

“It is important to put the results of the WHI trials into context. That is, being obese, not exercising or excess alcohol consumption confer higher absolute risks for breast cancer than HT use.”

The press release offers a summary of the issue’s articles; here are the headlines on everything from bone fractures to cancer, lightly edited: Continue reading