Is there a connection between hot flashes and heart disease?

A small study looking at the connection between hot flashes and heart disease has just been published in the online journal Menopause. According to the findings of the study conducted by the North American Menopause Society (NAMS) frequent hot flushes during menopause could be a sign of increased risk of heart disease. The study examined 272 women between the ages of 40 and 60 who reported having hot flashes either daily or not at all. The women did not smoke and had no history of CVD (cardiovascular disease). Although the study is small it is an important one with a serious message. Hot flashes/flushes are one of the most common symptoms of menopause. New data has indicated that hot flashes can start much earlier than previously thought, beginning during the late reproductive years. They can continue for ten years and longer, vary in severity and can have an impact on health and quality of life. The study shows younger midlife women (age 40-53 years) having frequent hot flashes may also signal emerging vascular dysfunction that can lead to heart disease. This is due to the hot flashes impacting on the ability of blood vessels to dilate among younger women. Women aged between 54 and 60 do not seem to have this issue which would indicate that when hot flashes occur earlier they could have an effect on a women’s heart disease risk. The study looks at the association between hot flashes and endothelial function. The endothelium is a layer of cells that line the inside of the blood vessels. The assessment of endothelial function is considered a key factor in predicting atherosclerosis...

The Evidence Base for HRT: what can we believe?

Professor Robert D Langer’s paper, ‘The evidence base for HRT: what can we believe?’ is a review of the 2002 Women’s Health Initiative (WHI) clinical trial of hormone replacement therapy (HRT). The study and its findings, you may recall, emphasised the risks of HRT causing worldwide concern and led to many women refusing or stopping treatment. Professor Langer’s paper highlights the serious errors that were made during the WHI study including:- Publication of results with very little involvement from the key investigators. Reported conclusions that did not accurately reflect the scientific findings Although the study was designed to test the effects of HRT in older women – the conclusions applied the exaggerated risk to all women. As a consequence many women who needed HRT have avoided it and subsequently suffered unnecessarily. Since then many clinicians have been trying to disprove the findings of the report. Professor Langer says “in the years since the first WHI report, we have learned much about the characteristics of women who are likely to benefit from HRT. The range of HRT regimens has also increased. Not all women have indications for HRT, but for those who do and who initiate within 10 years of menopause, benefits are both short-term (vasomotor, dyspareunia), and long-term (bone health, coronary risk reduction).”   Things have indeed moved on a great deal since this study. In November 2015, NICE (National Institute for Health and Clinical Excellence) UK, issued the first guideline on diagnosis and management. You can find the guideline for professionals and a simplified version for women patients here.   See Professor Robert D Langer’s paper: ‘The evidence...

Getting your period at a young age may mean early menopause, too

Can getting your period at a young age play a role in when you reach menopause? The average age of menopause is 51, however, for some women this can vary widely from between the age of 40 and 55. A study has found that those women who had started menstruating at 11 or younger were 80 percent more likely to have experienced early menopause than women who were 13 or over when their periods began. The risk was heightened among women who started their periods early and subsequently had no children; they had a fivefold increased risk for premature menopause and double the risk of early menopause compared with women whose periods had started at 12 or later and who had had two or more children.   Sources: Gita D. Mishra et al (Jan 2017) Early menarch, nulliparity and the risk for premature and early natural menopause. Retrieved on 6 February 2017. Retrieved from https://academic.oup.com/humrep/article/2937790/Early-menarche-nulliparity-and-the-risk-for      ...

Effect of HRT on Sleep Quality

Extract from The British Menopause Society. “Many women experience disturbed sleep as a menopausal symptom which can have a significant effect on mood and energy levels and cause distress. In addition poor sleep can lead to increased risk of cardiovascular disease, diabetes and obesity. The role of HRT in improving sleep quality is unclear but a recently published review provides some clarity. The authors reviewed 42 trials which included 15,468 women. It was found that use of hormone therapy was associated with improved sleep quality in women who experienced vasomotor symptoms (flushes and sweats) but not in women who did not have such symptoms. This could mean that it is the vasomotor symptoms which may lead to disturbed, or poorer quality sleep, rather than estrogen deficiency in the absence of symptoms. Hence treatment of the vasomotor symptoms leads to improved sleep as a secondary effect. Since sleep complaints are reported by 40% to 60% of menopausal women, more research would be helpful”. Reference: Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis. Cintron D, Lipford M, Larrea-Mantilla L et al. Endocrine, 2016 Related Articles: Menopause Insomnia Hot Flushes and Night Sweats Sources: Effect of HRT on Sleep Quality (Nov 2016) Retrieved on 28 November 2016. Retrieved from  https://thebms.org.uk/2016/11/effect-hrt-sleep-quality/ Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis. (Retrieved Nov 2016) Retrieved from https://mayoclinic.pure.elsevier.com/en/publications/efficacy-of-menopausal-hormone-therapy-on-sleep-quality-systemati    ...

Guidance on Menopause and the Workplace

On the 25 November 2016, the Faculty of Occupational Medicine of the Royal College of Physicians UK, issued Guidance on Menopause and the Workplace. You can download a copy of the guidance in pdf form here.      ...

Are Hot Flashes Genetic?

A team of UCLA-led researchers may have found a clue in a first-of-its-kind study: genes could be a factor in determining which women get hot flashes. It appears that women who have gene variants that affect a receptor in the brain that regulates estrogen release are more likely to have hot flashes than women who lack them. The study published in the Menopause Journal is a step that could lead to new treatments to relieve the symptom of hot flashes. Dr Carolyn Crandall, professor of medicine in the division of general internal medicine and health service research at the David Geffen School of Medicine at UCLA and the study’s principal investigator said “no previous studies have focused on how variants in women’s genes may be linked with hot flashes, and these results were highly statistically significant.” Furthermore, Dr Crandall said “these associations were similar across European-American, African-American and Hispanic-American women, and they persisted even after we accounted for other facts that might influence hot flashes.”   Sources: Rivero, E., (Oct 2016) Are hot flashes genetic? First-of-its-kind study finds gene variant linked to the symptom in menopausal women. Retrieved from http://newsroom.ucla.edu/releases/are-hot-flashes-genetic. Crandall, Carolyn J. MD, MS; Manson, JoAnn E. MD, DrPH; Hohensee, Chancellor MS; Horvath, Steve PhD, ScD; Wactawski-Wende, Jean PhD; LeBlanc, Erin S. MD, MPH; Vitolins, Mara Z. DrPH; Nassir, Rami PhD; Sinsheimer, Janet S. PhD. (Oct 2016) Association of genetic variation in the tachykinin receptor 3 locus with hot flashes and night sweats in the Women’s Health Initiative Study. Retrieved fromhttp://journals.lww.com/menopausejournal/Abstract/publishahead/Association_of_genetic_variation_in_the_tachykinin.97898.aspx    ...