For a number of years now, women have recognized that soy supplements, which contain phytoestrogens, or plant derived estrogens, may help to control their menopausal symptoms related to lowered estrogen levels. Despite their widespread use, few studies have demonstrated the safety of long term soy supplement use. As soy contains plant derived estrogenic compounds, safety concerns include the risk of estrogen related cancers such as breast and uterine cancers. A recently published study in American Journal of Clinical Nutrition demonstrated that daily supplementation for 2 years with up to 120 mg of soy hypocotyl isoflavones carried minimal risk in healthy postmenopausal women. Although this information is encouraging, it only applies to the safety of the specific isoflavone supplement utilized. The studied supplement is manufactured in the Netherlands (Frutarom, Belgium www.frutarom.com) and contains only the hypocotyl portion of the soy bean. The contents of this supplement may be very different than those of over the counter supplements sold in the United Sates.
Posted: December 29th, 2010 | Author: drpoynor | Filed under: estrogen, general health, great health at every age, gynecology, menopause, nutrition & diet | Tags: news, reviews | No Comments »
Hormone Replacement Therapy Is Linked to More Aggressive Breast Cancer
It was demonstrated in the initial analysis of the Women’s Health Initiative Study that women who were treated with estrogen and progestin had an elevated risk to develop breast cancer. This recent analysis has further demonstrated that these cancers are also more likely to be more advanced at the time of diagnosis.
Estrogen Therapy Accelerates Ovarian Cancer Growth
Researchers from the University of Colorado have demonstrated that estrogen can cause some types of ovarian cancer to grow faster in mouse models. About 60% of ovarian cancers will have estrogen receptors, and estrogen can cause these cancers to grow faster in these animal models.
Soy based Supplement, Natural S-equol, Can Reduce Hot Flashes, and Muscle and Joint Pain in First Study of US Women
This information was recently presented in poster form at the North American Menopause Society. S-equol is a whole soy germ –based supplement. It was recently shown to decrease the frequency of moderate to severe hot flashes and reduces menopausal associated muscle and joint pain. S-equol [7-hydroxy-3-(4'-hydroxyphenyl)-chroman] is a compound resulting — when certain bacteria are present in the digestive tract — from the natural metabolism, or conversion, of daidzein, an isoflavone found in whole soybeans. However, not everyone who consumes soy can produce s-equol. S-equol selectively binds to the estrogen receptor, most strongly to the receptor beta. Additional clinical evidence has also demonstrated that S-equol can help preserve bone.
Manufacturing Plan for Hot Flash Drug Candidate Menerba Approved by the FDA
Menerba is an oral, botanically derived drug candidate designed to treat hot flashes associated with menopause. Its action is through the estrogen receptor beta. The designs for the definitive studies are currently being planned with the FDA and the drug’s manufacturer, Bionovo.
The National Institute of Health is Increasing Funding to Study the Health Effects of Botanical Estrogens
The Botanical Research Center based at the University of Illinois, will receive a large portion of the funding, as well as University of Mississippi, Oregon State University and the FDA’s National Center for Toxicological Research. The research will utilize the expertise of a multidisciplinary team of researchers to address the many unknowns associated with use of botanical estrogens. Examples of naturally derived phyto estrogens are from soy, licorice root, wild yam and dong quai, Prior research related to the efficacy of the naturally derived estrogens has lead to mixed results. Some research has even demonstrated that some of these agents may interfere with breast cancer treatment and induce cognitive problems.
Non-Hormone Treatments of Hot Flashes
A new Cochrane review finds that a variety of non-hormonal treatments (mostly non-hormonal drugs) can offer women who have had breast cancer some relief from hot flashes. Relaxation therapy, the anti hypertensive Clonidine, the anti convulsant gabapentin and the anti depressants that inhibit serotonin reuptake were found in review to have a mild to moderate effect.
Menopause Associated Depression Can be Treated with an Antidepressant
Pristiq was recently demonstrated to be effective in treating menopause associated depression in the Journal of Clinical Psychiatry. . This data was recently published study generated from Virginia Commonwealth University. This is the first study to demonstrate the effectiveness of an antidepressant specifically related to perimenopause and post menopause.
Progestin Type May Alter Breast Cancer Risk in Hormone Replacement Therapy
In animal studies recently published in Cancer Prevention Research from the University of Missouri, researches compared synthetic progestins (medroxyprogesterone acetate – MPA), norgesterel, norethindrone, and megesterol acetate. Animal studies have demonstrated that MPA is a tumor promoter, however norgesterel and norethindrone are tumor inhibitors.
Posted: November 1st, 2010 | Author: drpoynor | Filed under: estrogen, general health, gynecology, menopause | Tags: news, reviews | No Comments »
Many women will experience distressing sexual dysfunction. This may be brought on by stressors in life, or by the declining estrogen and testosterone levels that occur with the aging process. As many as 43% of women between the ages of 18 and 59 years will report sexual problems within the previous year. It is becoming more common in my practice that women report to me sexual issues. I can attribute this to a few reasons: women tend to remain more youthful in their approach to aging and maintenance of sexual function is desired, aging men now have erectile dysfunction medications so that they can remain sexually active, I ask my patients more about these issues and women are more likely to report sexual problems as we have more of a dialogue about this in the popular press. The technical term for lack of libido which causes distress is hypoactive sexual desire disorder (HSDD).
HSDD is defined as the persistent or recurrent deficiency or absence of sexual thoughts, fantasies, and/or desire for, or receptivity to, sexual activity which causes marked personal distress or interpersonal difficulties. There are three components to sexual desire: drive, cognition, and motivation. Drive is the biologic component of desire which is based on neurologic mechanisms and manifested as spontaneous sexual interest. Drive naturally declines with age. Cognition consists of expectations, beliefs and values that influence desire. A woman that believes that sex is a healthy component of life will have a stronger desire than a woman who thinks that sex is inappropriate. Motivation consists of psychological and interpersonal factors that create a willingness to engage in sex. For example, motivation will be influenced by the interpersonal relationships with ones partner.
Common causes of loss of desire in women include declining estrogen and androgen levels, thinning of the genital tissues with age, and progestins. Loss of estrogen can lead to shortening and thinning of the vagina, loss of vaginal elasticity, diminished vaginal lubrication, diminished blood flow, reduced nerve transmission, sleep disruption and mood alterations. These changes lead to vaginal dryness, painful intercourse (dyspareunia), and painful or more frequent urination. Progestins may alter mood and may alter the metabolism of androgens.
One of the largest barriers to physician initiation of a discussion of sexual health with their patients is a lack of knowledge and training in sexual medicine. Indeed, I have had to learn on the job. It was not part of my medical education at any point in my training. Women may not bring up sexual dysfunction with their physicians due to embarrassment. Questions that your physician may ask you include: are you sexually active, are you having any problems with intercourse such as pain, are you having any problems with your libido or sexual desire, are you having any problems reaching orgasm?
Interventions for HSDD include: psychotherapy, sex therapy, and pharmacologic therapies. There are currently no approved FDA drugs for female HSDD. Topical estrogen therapy can increase vaginal lubrication, and vaginal blood flow, which can lead to increased arousal. Systemic estrogen therapy also has the potential also to increase desire. Testosterone therapy can lead to increased desire in a subset of women, but has not been FDA approved. Long-term safety data for androgen therapy is lacking and therefore its use must be very cautiously undertaken. Monitoring of hormone levels and lipid levels is necessary with testosterone use. Other medications which may help some women include DHEA, PD5E inhibitors, and some topical formulations such as Viacreme and Zestra.
In addition to HSDD, additional sexual disorders which may occur in women include sexual aversion disorder (extreme aversion to sexual contact), sexual arousal disorder, orgasmic disorder, dyspareunia (painful intercourse), and vaginismus (difficulty allowing entrance of any object into the vagina despite the desire to).
The bottom line:
If you are having problems with sexual desire, you are not alone.
There are medical interventions for women who are experiencing difficulties.
If you cannot review with your physician, find one that you feel comfortable discussing your problems with.
If your physician is not experienced in the management of sexual health issues, find one that is.
Posted: February 21st, 2010 | Author: drpoynor | Filed under: estrogen, sex | Tags: estrogen, home, libido, sex, testosterone, women | 3 Comments »
The use of estrogen in the treatment of women has radically changed over the past fifteen years. Fifteen years ago virtually all women were encouraged to take estrogen soon after menopause in order to prevent cardiac disease. At this point in time we knew that there may be an elevated risk to develop breast cancer with estrogen therapy, but we counseled our patients that estrogen helped to prevent the leading killer of women, cardiac disease. Then in 2002, the Women’s Health Initiative (WHI) Study changed the landscape of hormone therapy for women.
This very large scale study determined that the risks of hormone therapy outweighed any perceived benefits, and women throughout the country were told to stop taking their estrogen. Unfortunately, this study was flawed from the beginning and did not yield results that were generally applicable to the recently menopausal woman who was considering hormone therapy to control symptoms of this life transition. We have now realized the problems with the WHI study and have swung back to a more reasonable, individualized approach to hormone therapy in women, and have also realized that estrogen therapy may indeed prevent cardiac disease when initiated soon after menopause. Our larger questions which now need to be addressed include the safety and efficacy profiles of various preparations. While prolonged estrogen and progestin use may increase a woman’s risk to develop breast cancer or thromboembolic disease (problems from blood clots) the benefits for some women may outweigh this risk.
The North American Menopause Society (NAMS) has released today an updated position statement on the use of estrogen and progestogen in postmenopausal women. NAMS is a non-profit organization which has previously released position statements from advisory panels consisting of clinicians and researchers who are experts in the field of women’s health. This is an updated version from their 2008 release. Their goal is to clarify the risk benefit ratio of hormone therapy with estrogen and progestin in the treatment of menopause symptoms and disease prevention. They have concluded that the use of hormone therapy should be consistent with treatment goals, benefits and risk for the individual woman. They note that the benefit and risk ratio will change for each woman with her age and her menopausal symptoms as she ages.
The below summarizes and highlights their recent position statement.
Benefits of the use of hormone therapy include:
Relief of vasomotor symptoms (hot flashes and night sweats)Treatment of vaginal atrophy (dryness).
Improvement of sexual function through relief of dryness and increase sexual satisfaction due to increased blood flow and sensation in the genital tissues.
Improvement in urge incontinence (a form of urinary incontinence).
Decreased risk of recurrent urinary tract infections.
Prevention of osteoporosis.
Early initiation of hormone replacement therapy does not increase cardiac disease and may reduce cardiac disease.
May lead to improved mood (data is mixed).
Risks:
Elevated risk of uterine cancer when estrogen is used without a progestin (five times elevated risk after three years of estrogen alone use).
Breast cancer is elevated in women treated with combined estrogen and progestin therapy after 3-5 years of use; however women treated with estrogen alone having a lower risk of developing breast cancer but may increase after 10-15 years of use.
May increase dementia when hormone therapy is initiated in older women (over 65 years).
There is currently no data to determine if one type of estrogen or progestin has a better safety profile, however there are likely to be differences of different regimens Transdermal estrogens (patches and gels or mists) do not increase triglycerides, lead to no change in C reactive protein and have little effect on blood pressure. They may also be associated with a lower incidence of deep venous thrombosis.
Usage recommendations:
A progestin is generally not recommended to be used in conjunction with ultra low dose vaginal and transdermal estrogens; however the addition of progestins may improve vasomotor symptoms.
The lowest effective dose of estrogen consistent with treatment goals, benefits and risks for the individual woman should be the therapeutic goal, with the addition of a progestin added if the woman has her uterus in place.
There is emerging data that the timing of initiation of hormone therapy is important, and that early initiation of therapy may reduce total mortality and heart disease risk. Therapy should not be initiated in women over the age of 60 years without a compelling indication.
The length of use is not well established and extending the use of hormone therapy for an extended period of time if the symptom benefit outweighs the risk and for the woman who is on estrogen replacement therapy for her bones when other treatments are not appropriate.
Bioidentical hormone therapy:
The term “bioidentical hormone therapy” generally refers to estrogens and progestin naturally produced in women. However the term is many times used to describe custom made preparations that are compounded for an individual according to a healthcare provider’s prescription. These are generally made in compounding pharmacies. These compounds have not been tested for safety or efficacy by the FDA and they are not FDA approved. NAMS recommends that filled prescriptions for bioidentical hormone therapy should include a package insert identical to those that have regulatory approval. The FDA has stated that there is no scientific basis for using saliva testing to adjust hormone levels.
Summary:
Therapy should be individualized.
There is a growing body of evidence that each type of estrogen and progestin, route of administration, and timing of therapy has distinct beneficial and adverse effects.
Further research remains essential.
Posted: February 16th, 2010 | Author: drpoynor | Filed under: estrogen, gynecology, menopause, science | Tags: estrogen, home, hormones, menopause, NAMS | 1 Comment »
