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Senior Citizen Health & Medicine
Estrogen plus Testosterone May Increase Breast
Cancer in Postmenopausal Women
But, alternative, complementary therapies don't
relieve menopause
 July
25, 2006 The effective treatment of the symptoms of menopause has been
a major quest, but it seems to run into multiple road blocks when the
women are studied in their senior years. Two studies reported in the
Archives of Internal Medicine Women well illustrate the challenge. One
says women who take a combination of estrogen and testosterone may have
an increased risk of breast cancer, and another says alternative and
complementary therapies don't seem to relieve the menopause-related
symptoms.
As women age, their natural levels of the hormone
testosterone tend to decrease, according to background information in
the first article. Some evidence suggests that many of the symptoms of
menopause-including decreased sex drive, worse moods and poorer quality
of life-are related to this decline in testosterone.
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Related Stories |
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Postmenopausal Women See No Increased Risk of Breast
Cancer with Estrogen-Alone
April 11, 2006 - Estrogen-alone hormone therapy
does not increase the risk of breast cancer in postmenopausal women,
according to an updated analysis of the breast cancer findings of the
Womens Health Initiative (WHI) Estrogen-Alone Trial.
Read more...
Estrogen May Increase Blood Clots in Postmenopausal
Women, Breast Cancer in Blacks
April 11, 2006 - Estrogen therapy may increase the
risk of venous thrombosis, the formation of blood clots in the veins,
among postmenopausal women who have had their uterus removed, according
to a study in the April 10 issue of the Archives of Internal Medicine,
one of the JAMA/Archives journals. Another study in this issue says
hormone therapy, including estrogen, appears to be associated with
increased risk of breast cancer among black women.
Read more...
Postmenopausal Women With Hysterectomy Should Not
Take Estrogen
The U.S. Preventive Services Task Force issued a new
recommendation against the routine use of estrogen by older women
May 17,2005 A government task force that in 2002
found insufficient evidence against the routine use of estrogen by
post-menopause, post-hysterectomy women has now changed its collective
mind. Today they will publish a new recommendation against the routine
use of estrogen to prevent chronic conditions, such as heart disease,
stroke and osteoporosis.
Read more...
Read more
on
Health & Medicine |
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Clinical trials have shown that taking testosterone
in combination with estrogen may reduce these symptoms and also promote
bone health. Only one estrogen plus testosterone therapy is currently
available to U.S. women, but the number and prevalence of such
treatments are expected to increase in coming years, the authors write.
Rulla M. Tamimi, Sc.D., Brigham and Women's
Hospital and Harvard Medical School, Boston, and colleagues studied the
long-term effects of estrogen plus testosterone therapy in 121,700 women
who were part of the Nurses' Health Study.
The study enrolled female nurses between the ages
of 30 and 55 years beginning in 1976. The women completed an initial
questionnaire and follow-up surveys every two years that included
questions about menopausal status, medical conditions and the use of
postmenopausal hormone therapy. For those who reported a diagnosis of
breast cancer, medical records were reviewed for verification.
During 24 years of follow-up, 4,610 cases of breast
cancer occurred among postmenopausal women.
Overall, only 33 women included in this analysis
reported current use of estrogen and testosterone in 1988.
Women who were currently taking estrogen plus
testosterone (29 women) had a 77 percent higher risk of developing
breast cancer than those who had never used hormone therapy; this was
higher than the increased risk associated with current estrogen use (15
percent) and current use of estrogen plus progestin (58 percent).
When the researchers considered only women who had
gone through menopause naturally rather those whose menopause began when
they had a hysterectomy, those who took estrogen plus testosterone (17
women) had 2.5 times the risk of breast cancer than those who had never
used hormones.
Enzymes in the breast tissue may convert
testosterone to estradiol, an estrogen-like hormone that may contribute
to the development of breast cancer, the authors write.
Previous studies have indicated that women who use
estrogen plus testosterone therapy have higher levels of estradiol and
testosterone circulating in their bodies than women who take estrogen
alone. Higher levels of testosterone alone have also been linked to
increased breast cancer risk in postmenopausal women.
The number of women in the study who used estrogen
plus testosterone therapy increased dramatically over time, from 33 in
1988 to 550 in 1998. This reflects a broader trend that makes the
results especially important, the authors write.
"Given the substantial evidence implicating
combined estrogen plus progestin therapy in breast cancer and the
results of the present study regarding estrogen plus testosterone
therapy, women and their physicians should reconsider use and, more
specifically, long-term use of these therapies," they conclude.
"Although postmenopausal therapies may provide
improvement with respect to sexual functioning, general well-being and
bone health, the increased risk of breast cancer may outweigh these
benefits."
Editor's Note: This study was supported by a
Public Health Service grant and a SPORE in Breast Cancer grant from the
National Cancer Institute, National Institutes of Health, Department of
Health and Human Services, and the Breast Cancer Research Fund. Dr.
Colditz is supported in part by an American Cancer Society Cissy Hornung
Clinical Research Professorship. Please see the article for additional
information, including other authors, author contributions and
affiliations, financial disclosures, funding and support, etc.
Complementary and Alternative Therapies Show Little
Benefit in Treating Menopause Symptoms
Insufficient evidence exists to support the use of
complementary and alternative therapies to relieve menopause-related
symptoms, according to a review article in the July 24 issue of the
Archives of Internal Medicine, one of the JAMA/Archives journals.
Twenty-five million women will go through menopause
in the next decade, and many of them will experience hot flashes, night
sweats, vaginal dryness, sleep problems and other associated symptoms.
Approximately 40 percent of women seek medical help for these
complaints, according to background information in the article.
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Findings from Women's Health Initiative on
Postmenopausal Hormone Therapy |
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The
Women's Health Initiative (WHI) was a major 15-year research
program to address the most common causes of death, disability
and poor quality of life in postmenopausal women --
cardiovascular disease, cancer, and osteoporosis.
The WHI was launched in 1991 and
consisted of a set of clinical trials and an
observational study, which together involved 161,808
generally healthy postmenopausal women.
The clinical trials were designed to test
the effects of postmenopausal hormone therapy, diet
modification, and calcium and vitamin D supplements on heart
disease, fractures, and breast and colorectal cancer.
The hormone trial had two studies: the
estrogen-plus-progestin study of women with a uterus and the
estrogen-alone study of women without a uterus. (Women with a
uterus were given progestin in combination with estrogen, a
practice known to prevent endometrial cancer.) In both hormone
therapy studies, women were randomly assigned to either the
hormone medication being studied or to placebo. Those studies
have now ended. The women in these studies are now participating
in a follow-up phase, which will last until 2010.
●
Questions and Answers About the WHI Postmenopausal Hormone
Therapy Trials
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The Estrogen-Alone Study
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The Estrogen-Plus-Progestin Study
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Oral Contraceptives and Cardiovascular Disease |
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After the Women's Health Initiative, a large
clinical trial of hormone therapy, was halted because of an increased
risk of breast cancer, many physicians and patients began to seek other
options for menopausal symptoms.
Anne Nedrow, M.D., Oregon Evidence-based Practice
Center and Oregon Health and Science University, Portland, and
colleagues reviewed 70 previous studies of alternative and complementary
therapies for menopause-related symptoms.
Forty-eight of the studies
examined vitamins, proteins, complete diets or other biologically based
treatments; nine focused on mind-body therapies, including meditation
and guided imagery; one studied osteopathic manipulation, a body-based
therapy; two looked at the energy-based treatments reflexology and
magnet therapy; and 10 assessed whole medical systems, such as
traditional Chinese medicine or ayurvedic medicine (a traditional
therapy from India that includes yoga and dietary modifications).
Although some of the individual studies suggested
benefits for certain therapies, the overall quality and quantity of data
was not sufficient to recommend any of the treatments, the authors
write.
The 48 studies of biologically based treatments had mixed
results. For example, of 15 fair- or good-quality studies of the
soy-derived compounds known as phytoestrogens, only four suggested the
supplements provided a benefit in relieving menopause symptoms. In the
four qualifying studies of black cohosh, the root of a native North
American shrub, one large study showed an overall improvement in several
symptoms, while three did not show any benefit for hot flashes. The
studies of energy, mind-body and other types of therapies suggested few
benefits for these treatments for menopause-related symptoms.
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Postmenopausal Women Less Concerned about Breast
Cancer than Younger Women
 Actress, breast cancer survivor Diahann Carroll
joins effort to kelp women understand breast health as they age
July
25, 2006 Older women, the most at risk for developing breast cancer,
were the least likely to realize it according to a recent, national
survey. Being over age 50 places a woman at an increased risk for
developing breast cancer. Yet, only 37 percent of women aged 55 or older
listed breast cancer as a disease they were most concerned about as they
age. Read more...
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Many of the studies had a large placebo effect,
meaning that even women who were not assigned to receive active therapy
still reported improvement in their symptoms. "The large placebo effect
is consistent with preexisting work of menopausal hormonal therapies,"
the authors write. "A study of estrogen compared with placebo reported a
50 percent improvement in frequency of hot flashes in the placebo group.
The placebo effect likely plays an important role in the expanding
number of dietary supplements marketed to menopausal women."
Because many women are using alternative and
complementary therapies to treat their symptoms, often without telling
their physicians, additional rigorous studies are needed to identify
which of these treatments are safe and effective, the authors write.
In
the meantime, "the most important thing that the health professionals
can do for symptomatic menopausal women is to encourage open
communication that allows patients to disclose treatments they are
using," they conclude. "Women value partnership, choice and shared
decision making. Because there is no universal menopausal presentation
or treatment, it is essential that health care professionals provide
accurate information and options for midlife women."
Editor's Note: This study was funded in part by
the Oregon Evidence-based Practice Center under contract to the Agency
for Healthcare Research and Quality, Rockville, Md. Additional support
came from the National Institutes of Health and the Portland Veterans
Affairs Medical Center Women's Health Fellowship. The NIH Office of
Medical Applications of Research funded this research through the Agency
for Healthcare Research and Quality Evidence-based Practice Centers
Program for the NIH-sponsored State of the Science Conference on
Managing Menopause-related Symptoms. Please see the article for
additional information, including other authors, author contributions
and affiliations, financial disclosures, funding and support, etc.
Both studies appear in the July 24 issue of the
Archives of Internal Medicine, one of the Journal of the American
Medical Association/Archives journals.
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