News & Research

Keep up to date with all the current news and research surrounding menopause and women’s health issues.

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    ...

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    ...

Effect Of Combined HRT On Breast Cancer Risk

A Breast Cancer Now Study finds the effect of Combined HRT on breast cancer risk is likely to have been underestimated. The effect of combined hormone replacement therapy (HRT) in increasing a woman’s risk of breast cancer is likely to have been underestimated by a number of previous studies, according to a new prospective study published in the British Journal of Cancer, highlighted on the British Menopause Society Website on 23 August 2016. Women taking combined HRT are 2.7 times more likely to develop breast cancer than non-users, with risk increasing with longer HRT use, Breast Cancer Now Generations Study finds Study comprehensively updated information about women’s HRT use and analysed accurately to allow for age at menopause Research suggests many previous investigations which did not do so may have underestimated the increased risk of breast cancer by up to 60% The new research was part of the Breast Cancer Now Generations Study – a major prospective study led by scientists at The Institute of Cancer Research, London, following more than 100,000 women for 40 years to investigate the causes of breast cancer. Some 39,000 women with a known age at menopause were identified and monitored for six years, with follow-up questionnaires gathering comprehensive data on any HRT use (type and duration) as well as their general health and lifestyle. During this time, 775 of these women developed breast cancer, with the researchers finding that women using combined HRT (for a median duration of 5.4 years) were 2.7 times more likely to develop breast cancer during the period of HRT use than women who had never used HRT. You...

What’s New About Menopause 2016?

  Written by Dr Karen Morton, consultant obstetrician and gynaecologist and Founder of Dr Morton’s – the medical helpline. Congratulations to the organisers of the British Menopause Society’s 26th Annual Conference at the Royal College of Physicians on Thursday and Friday 19 and 20 May 2016. Both content and organisation were excellent, and I am sure every one of the delegates: GPs, gynaecologists and Specialist nurses, will all have left London inspired to give their patients the most up to date advice and to become evangelists for optimising the health of women in their middle years and beyond. So What’s New About Menopause in 2016? What were the take-home messages? The title of the conference was ‘NICE Menopause Guideline: from publication into practice’, so clearly time was spent looking at the key messages from the 29 page NICE recommendation document which was published in the Autumn of 2015. But there were also several lectures on the periphery of what NICE looked at which gave out clear messages for change or enhancement of practice. For me the striking messages were: Women should talk about their problems and get help. Awareness of women’s needs at this time in their lives should have prominence in the workplace. More about this later. Good diet and lifestyle with regular exercise, moderate alcohol intake and not smoking are more important than anything else. OF course! Oestrogen-only HRT (only suitable for women who have had their uterus removed) causes no significant increase in breast cancer. If you have a uterus it must be protected with progestogen and after several years of taking it, this combination probably...

What Selective Estrogen Receptor Modulators (SERMS) Can Do For You

There are many alternatives to hormone therapy for the treatment of hot flashes and other menopause symptoms. One you may not have heard about are Selective Estrogen Receptor Modulators (SERMS). According to the North American Menopause Society NAMS, SERMS selectively activate or block estrogen receptors in certain areas of the body and not others which can make them safer than estrogen alone. There are currently FDA approved SERMS to selectively target, prevent and treat several diseases including breast cancer, osteoporosis and vaginal atrophy. At the time of writing SERMS for menopause have been launched in the US but not in the UK or the EU. Currently, there is no SERM that alone can relieve hot flashes, however, there is a SERM combination being used for hot flashes that combines estrogen with the SERM bazedoxifene. These drugs may be helpful for women with health concerns about hormone therapy but need relief from hot flashes, low bone mineral density, vaginal atrophy and bleeding. As with all medical treatment you should discuss any possible side effects with your Healthcare Professional. Here you will find a video of JoAnn Pinkerton, Executive Director of the North American Menopause Society NAMS discussing what SERMS are and how they can help you. You will also find a SERM’s FAQ page at this source.   Sources: The ABCs of SERMS. Retrieved from http://www.menopause.org/for-women/menopause-take-time-to-think-about-it What Selective Estrogen Receptor Modulator (SERMS) Can Do For Your. Retrieved from...

Blood Clot Risk is lower for Estrogen-Only, Transdermal and Vaginal Estrogen Hormone Therapy

New research has found that blood clot risk is lower for estrogen-only, transdermal and vaginal estrogen hormone therapy, which is great news as the risk of blood clots in women increases with age. Menopause, The Journal of North American Menopause Society (NAMS)  has published new research from the Karolinska Institute in Stockholm led by Dr. Annica Bergendal, which found that overall, estrogen-only therapy carries a lower risk of blood clots than treatment with a combination of estrogen and progestin, the synthetic version of progesterone. According to Science Daily the study highlights that the way estrogen is delivered may impact the risks.  There was no increased risk of VTE (venous thromboembolism) in this study for women who used transdermal estrogen (such as patches), either alone or in combination with a progestogen. And women who used vaginal estrogen alone to ease vaginal dryness and other symptoms of genitourinary syndrome of menopause (GSM) also had no increased risk of VTE. Many menopause experts don’t expect vaginal estrogen to raise the risk because absorption into the bloodstream is small and results in levels similar to those in postmenopausal women who use no hormones. But studies on this question have been rare, noted the authors, so this finding is a big help for decision making. This study adds to current knowledge that transdermal estrogen therapies are safer than oral and that different estrogen or progestogen combinations may have different risks.   Sources: Bergendal. A, MD., et al, (March 2016) Risk of venous thromboembolism associated with local and systematic use of hormone therapy in peri and postmenopaual women and in relations to type and route of administration. (Retrieved May...

Cardiovascular death risk after stopping HRT

A study from Finland following 332,202 women who stopped taking HRT between 1994 and 2009, reported an increase in mortality rate from cardiac death or stroke compared both to the baseline population and to women who continued taking HRT. There did appear to be an age effect with an increase in mortality shown if HRT stopped under age 60, but no increase if HRT stopped after age 60. This study adds to the increasing evidence that use of HRT up to the age of 60 provides many benefits and may be harmful to stop too early. Sources: News and Press Releases: Cardiovascular death risk after stopping HRT. Retrieved on 11 May 2016. Retrieved from http://www.thebms.org.uk/newsitem.php?newsid=91 Ref Mikkola TS, Tuomikoski P, Lyytinen H, et al. Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J Clin Endocrinol Metab 2015;100:4588-94      ...

Bone loss after stopping HRT

A 15 year follow up study from Finland has confirmed previous knowledge that that women who stop HRT experience loss of bone mineral density and increased risk of wrist fracture but has also shown that the longer that HRT has been taken, the less is the bone loss and less is risk of wrist fracture. Having taken HRT for only 5 years or less did not make any long term difference but HRT use for 10 years or more provided most benefit. Sources: News and Press Releases: Bone loss after stopping HRT. Retrieved on 11 May 2016. Retrieved from http://www.thebms.org.uk/newsitem.php?newsid=92 Ref Bone loss and wrist fractures after withdrawal of hormone therapy: The 15 year follow-up of the OSTPRE cohort. Saarelainen J et al. Maturitas 2016;85:49-55    ...

NICE Issues First Guideline on Menopause

November 2015, NICE (National Institute for Health and Clinical Excellence) UK, issued their first guideline on menopause to stop women suffering in silence. More than a million women could benefit from the first NICE clinical guideline on diagnosing and managing menopause. I receive many emails from women whose main gripe is that their doctor is dismissive of their menopause symptoms and that discussions about HRT very much depends upon which doctor they are talking to. Hopefully the new guideline will improve the doctor/patient relationship on the subject of menopause for the future. NICE has published wide-ranging recommendations for the NHS on the support, information and treatments needed to address the often debilitating symptoms of menopause. The guideline covers determining if menopause has started, prescribed and non-prescription treatment options that help with the physical and psychological symptoms of menopause and provides clarity on the benefits and risks associated with taking HRT (hormone replacement therapy). The guideline also focuses on the often overlooked needs of women experiencing premature menopause (under the age of 40) and women who have a surgically induced menopause either as a result of treatment for hormone-dependent cancer or gynaecological conditions. HRT and Breast Cancer The guideline also includes a section on breast cancer as part of the section on the long-term benefits and risks of HRT. There has been a great deal written in the media about HRT and breast cancer risk, unfortunately, much of it has been incorrect and alarmist. NICE are reporting risk as absolute figures rather than percentage of relative risk i.e. a risk referred to as ‘doubled’ or ‘100% increase’ sounds much more...

Free Ovarian Cancer Symptom Diary App

Target Ovarian Cancer.org.uk have launched a Free Ovarian Cancer Symptom Diary App. Women who are concerned about ovarian cancer are now able to record their symptoms on a Symptoms Diary App which is intended to help reach an earlier diagnosis. Dr Sharon Tate, Head of Primary Care Development for Target Ovarian Cancer, said “We hear too many stories of women who have been diagnosed with ovarian cancer too late after showing symptoms and visiting their GP numerous times. The Symptoms Diary is an easy way for women to accurately record their symptoms and help them communicate what is happening with their body with their doctors.” According to Target Ovarian Cancer.org.uk only three percent of women are very confident at spotting a symptom of ovarian cancer. Symptoms of Ovarian Cancer Include: Feeling bloated Needing to wee more Tummy pain Always feeling full Three quarters of women are diagnosed once the cancer has already spread. If diagnosed at the earliest stage up to 90% of women would survive five years or more. For more information visit the Target Ovarian Cancer Website. Sources:- http://www.targetovariancancer.org.uk/news/target-ovarian-cancer-launches-symptoms-diary-app...

Menopause Does Not Affect Sleeping Patterns

According to research carried out at the University of Pennsylvania, US, menopause does not affect sleeping patterns. The study was led by Ellen W Freeman, a research professor in the Department of Obstetrics and Gynaecology at the Perelman School of Medicine. The findings were that sleeping patterns did not seem to be affected by the onset of menopause. However, the study showed that women in their late 30s and 40s who already had sleeping problems noted that this was made worse during menopause. Only 25% of women involved in the study developed slight sleeping problems during a 16 year period around menopause (not an insignificant number in my opinion!). Obviously, studies can only give a snapshot of those women taking part in the study. They may have been women who do not suffer from night sweats, restless leg syndrome, anxiety and other menopause symptoms that are very likely to cause women’s sleeping patterns to change. Ms Freeman said “Sleep problems are a major issue for women approaching mid-life, particularly for women who have moderate or severe sleeping problems before reaching menopause as they are likely to experience increased issues throughout the transition.” Related Articles Menopause Insomnia Imagecourtesyof/Freedigitalphotos.net...

Researchers Find Evidence of Longer Menopause Symptoms

I was pleased to read the findings of a 17 year study carried out in Miami which concluded that symptoms from menopause can last considerably longer than previously believed. From the informal interviews I carried out prior to starting the Menopause Health Matters website, many of my interviewees and indeed family members and friends have reported that they are still experiencing menopause symptoms, mostly hot flushes and night sweats for at least 10 years post menopause and in some cases longer. The 17-year study included more than 1,400 women from a variety of racial and geographic groups. It found that symptoms from menopause could last considerably longer than previous believed. Gynecologist Dr. Elizabeth Etkin-Kramer said menopause can last an average of four years longer. “Previous studies suggested that hot flashes and menopausal symptoms would last around three years after the last period, but this study suggests they last longer, up to on average seven years,” she said. Research from the study also suggests that some women of color experience symptoms of menopause longer: African-American and Hispanic women are more likely to have longer menopausal symptoms. “In some women it can last up to 14 years,” Etkin-Kramer said. Related Articles Menopause Facts Imagecourtestyof/Freedigitalphotos.net...

Menopause Symptoms Could be an Early Warning Sign for Bone Deterioration

Hot flushes and night sweats during the menopause can be a clue to your risk of bone deterioration. A study carried out by the David Geffen School of Medicine at the University of California, Los Angeles looked at data from almost 24,000 older women over a period of eight years. Dr Carolyn Cradell said ‘Our findings suggest women who exhibit moderate to severe menopause symptoms are more likely to have issues with bone health than their peers’. Therefore, menopause symptoms could be an early warning sign for bone deterioration. This is the first large cohort study to examine the relationship between menopausal symptoms and bone health in menopausal women.’ The prospective study examined data from 23,573 participants in the Women’s Health Initiative (WHI) Clinical Trial, who were aged between 50 and 79. Related Articles Osteoporosis and...

NAMS Announces New Menopause App

NAMS announces new menopause app. The North American Menopause Society (NAMS) has launched a free iPhone/iPad App  to help women work more closely with their doctors. MenoPro guides users through treatment decisions for a variety of symptoms, including hot flashes, night sweats, and vaginal dryness. Furthermore the app considers your personal preferences, such as your choice between hormonal vs non-hormonal options. This is a major step forward in the relationship between women and their doctors regarding menopause. Related Articles 34 menopause...
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