Menopause

The purpose of the Women’s Health Initiative hormone program was to study the health benefits and risks of hormones for postmenopausal women. In July 2002, we asked women in the estrogen plus progestin part of the program to stop taking their study pills.

Reports of recent studies revealing hormone replacement therapy (HRT) is associated with health risks have left women scared and confused about how to stay comfortable and healthy during menopause.

Estrogen plus progestin therapy does not have a clinically significant effect on postmenopausal women's health-related quality of life, according to this analysis of data from the Women's Health Initiative (WHI), a randomized, double-blind, placebo-controlled trial.

An excerpt from the Menopause & Perimenopause Ask the Expert column

The use of hormone replacement therapy (HRT) in postmenopausal women has been generating a lot of controversy lately. Recent studies have suggested that, contrary to prior assumptions, this regimen may increase the risks for a heart attack and for breast cancer. We asked Andrew M. Kaunitz, MD, a member of our advisory board, to respond to concerns about the safety of HRT--particularly with respect to cardiovascular disease.

A number of perimenopausal women and their health care providers choose to either decline or prematurely discontinue use of oral contraceptives (OCs), despite the availability of formulations that can prevent pregnancy and address perimenopausal symptoms. This lack of use is due to several factors.

Uterine myomas irrespective of whether they are small and asymptomatic (as in the postmenopausal women) or large and symptomatic (as in premenopausal women) considerably affect uterine artery blood flow velocity. Benign uterine leiomyomas are usually easily recognized with gray-scale ultrasonography, but may sometimes be difficult to differentiate from solid ovarian tumours.

The Relationship Between Transvaginal Sonogram and Hysteroscopy Findings in the Assessment of Endometrial Lesions in Postmenopausal Bleeding: A Case Study

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Breast cancer causes more than 40,000 deaths annually and is only second to lung cancer in cause of cancer deaths in women in the United States. Since early identification is key to prompt treatment and the best prognosis, it is crucial to identify women at risk.

A recent study found that postmenopausal women may be at risk of developing breast cancer, and that this risk is tied to factors other than family history.

The most important question to ask is whether or not the fibroids need to be treated at all. The vast majority of fibroids grow as a woman gets older, and tend to shrink after menopause. Obviously, fibroids that are causing significant symptoms need treatment. While it is often easier to treat smaller fibroids than larger ones, many of the small fibroids never will need to be treated. So just because we can treat fibroids while they are small, it doesn't follow that we should treat them. The location of the fibroids plays a strong influence on how to approach them. A gynecologist experienced in the treatment of fibroids can help you determine if they need to be treated.

Menopause is the time in a woman's life when the ovaries stop producing estrogen. Menopause is usually recognized by the cessation of menstrual periods. Other symptoms of menopause include flashes, mood changes, difficulty sleeping, and vaginal dryness. If a woman is not menstruating because she has had a hysterectomy or endometrial ablation, other symptoms of menopause often alert her that menopause is starting.

Approaching menopause, the bleeding pattern for many women will perhaps change, with cycles either becoming shorter initially, and then with time the menstrual interval will begin to lengthen, be variable and perhaps some cycles skipped altogether, and then finally the periods stop entirely. A woman is said to be menopausal if more than 6 months have elapsed and she has not had a period.

Among postmenopausal women with prior hysterectomy, cessation of conjugated equine estrogen (CEE) therapy reduces the risk of stroke, and the risk of breast cancer remains reduced, according to a study to be published on April 6 in the Journal of the American Medical Association.

Concern that risks outweighed the possible benefits of estrogen use caused the cessation of the Women's Health Initiative Estrogen-Alone Trial. However, researchers decided to continue monitoring patients for outcomes despite the study protocol discontinuation to gain insight into the long-term effects of the conjugated equine estrogens (CEE) therapy. What they found was surprising-and somewhat positive.

Inadequate nutrient intake is associated with greater risk for anemia in postmenopausal women, according to a study published in the April issue of the Journal of the American Dietetic Association.

About two-thirds of the U.S. population takes in sufficient amounts of vitamin D, but 8 percent may be at risk for vitamin D deficiency, according to a March data brief published by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

Supplementation with safflower (SAF) oil improves glycemia, inflammation, and blood lipids compared to treatment with conjugated linoleic acid (CLA) in postmenopausal obese women, according to a study published online Jan. 12 in Clinical Nutrition.

According to some estimates, hot flashes affect approximately 32 million women in the United States and may be the most common menopause-related discomfort. Although estrogen can effectively treat this symptom, concerns over estrogen’s safety have caused clinicians and patients alike to seek effective alternatives.

Sexual desire in patients with breast cancer is not affected by adjuvant endocrine therapy, but is significantly reduced in those women with chemotherapy- or gonadotropin releasing hormone (GnRH) agonist-induced menopause, according to a study published online March 2 in The Journal of Sexual Medicine.

After reaching menopause, women experience body composition changes such as loss of lean body mass, increase in body fat mass, and a shift to central or android fat distribution-all of which are associated with negative health issues. Researchers have hypothesized that hormone therapy might help counter these changes, but thus far studies have been limited by size, type (ie, observational), or length of intervention.

Acupuncture may be an effective alternative therapy for reducing menopausal complaints, especially the severity of hot flushes, according to a study published in the March issue of Acupuncture in Medicine.

Postmenopausal women who used to smoke or who currently smoke appear to be at a higher risk of invasive breast cancer than postmenopausal women who never smoked, according to a study published online March 1 in BMJ.

High body mass index (BMI) and low levels of physical activity are associated with increased risk of triple-negative and estrogen receptor-positive (ER+) breast cancers in postmenopausal women, according to a study published online March 1 in Cancer Epidemiology, Biomarkers & Prevention.

Breast cancer incidence rates among non-Hispanic (NH) white women in the United States stabilized between 2003 and 2007 after a sharp decline between 2002 and 2003 that followed a drop in the use of postmenopausal hormone therapy, according to a study published online Feb. 28 in Cancer Epidemiology, Biomarkers & Prevention.

For women taking postmenopausal hormone therapy, breast cancer risk is greater among users of estrogen-progestin formulations, and those who begin treatment earlier, according to a study published online Jan. 28 in the Journal of the National Cancer Institute.

Use of oral bisphsphonates ofr more than one year in postmenopausal women is associated with a 59 percent decrease in the relative risk of colorectoal cancer, according to a study published online Feb. 14 in the Journal of Clinical Oncology.

Nitroglycerin ointment appears to increase bone mineral density (BMD) and decrease bone resorption in postmenopausal women when administered daily, according to research published in the Feb. 23 issue of the Journal of the American Medical Association.

Metabolic syndrome appears to have little impact on sexual function in middle- to old-aged women, according to a study published online Jan. 14 in the Journal of Sexual Medicine.