Sources and more information
- The Effects of Hormone Replacement Therapy on the Body,
healthline, 07 November 2014.
- Our posts tagged HRT and menopause.
- Watch this health infographics album on Flickr
Because Social Media increases Awareness and brings the DES Community Together
The Effects of Hormone Replacement Therapy on the Body.
Menopausal women using SSRIs “at risk for fractures”
Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally.
Female patients without mental illness, aged 40–64 years, who initiated SSRIs were compared with a cohort who initiated H2 antagonists (H2As) or proton-pump inhibitors (PPIs) in 1998–2010, using data from a claims database. Standardised mortality ratio weighting was applied using the propensity score odds of treatment to adapt the distribution of characteristics among patients starting H2A/PPIs to the distribution among SSRI initiators. Poisson regression estimated risk differences and Cox proportional hazards regression the RR of fractures among new users of SSRIs versus H2A/PPIs. Primary analyses allowed for a 6-month lag period (ie, exposure begins 6 months after initiation) to account for a hypothesised delay in the onset of any clinically meaningful effect of SSRIs on bone mineral density.
Fracture rates were higher among the 137 031 SSRI initiators compared with the 236 294 H2A/PPI initiators, with HRs (SSRI vs H2A/PPI) over 1, 2 and 5 years of 1.76 (95% CI 1.33 to 2.32), 1.73 (95% CI 1.33 to 2.24) and 1.67 (95% CI 1.30 to 2.14), respectively.
SSRIs appear to increase fracture risk among middle-aged women without psychiatric disorders, an effect sustained over time, suggesting that shorter duration of treatment may decrease fracture risk. Future efforts should examine whether this association pertains at lower doses.
Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition
The menopause is part of the natural ageing process and is caused by a change in the balance of the body’s sex hormones.
Frequent menopausal vasomotor symptoms (VMS), including hot flashes and night sweats, lasted for more than seven years during the transition to menopause for more than half of the women in a large study and African-American women reported the longest total VMS duration, according to a new article published online by JAMA Internal Medicine.
Women who experienced hot flashes and night sweats at a younger age tended to have them last longer, the study found, as did women with less education and greater levels of stress.
HRT increases ovarian cancer risk
Researchers from the University of Oxford analysed 52 previous studies involving 21,000 women found that even those who took it for less than five years raised the risk level, although it reduces once they had stopped.
The study, published in the Lancet medical journal, has led to calls for medical guidance on HRT to be updated given the “causal relationship” and the Medical and Healthcare Products Regulatory Authority (MHRA) said it would look at the findings.
The researchers said: ‘The increased risk may well be largely or wholly causal; if it is, women who use hormone therapy for five years from around age 50 have about one extra ovarian cancer per 1,000 users and, if its prognosis is typical, about one extra ovarian cancer death per 1,700 users.
‘The findings that ovarian cancer risk is greatest in current users of hormone therapy, falls after use ceases, and varies by tumour type, strongly suggest a causal relationship – ie: that among otherwise similar women, use of hormone therapy increases the probability of developing the two most common types of ovarian cancer, and hence ovarian cancer as a whole.
‘At present, the WHO, European, and US guidelines about hormone therapy do not mention ovarian cancer, and the UK guidelines – which are due to be revised – state only that risk may be increased with long-term use.
‘The definite risk of ovarian cancer that is observed even with less than five years of use starting at around age 50 is directly relevant to current patterns of hormone therapy use, and hence directly relevant to medical advice, personal choices, and the current efforts to revise UK and worldwide guidelines.’
” Our advice has always been that the lowest effective dose of HRT should be used for the shortest possible time.
‘We will evaluate the findings of this study and its implications for shorter term use and update product information as necessary.
‘Women on HRT should have regular health check-ups and their need to continue treatment should be reassessed at least annually. Any woman on HRT who has any questions should speak to her doctor who is best placed to advise.”
Prenatal exposure to maternal cigarette smoke may play a role in programming age at menopause
Menopause onset, on average, occurs earlier among women who smoke cigarettes than among women who do not smoke. Prenatal smoke exposure may also influence age at menopause through possible effects on follicle production in utero.
Smoking information was obtained from the mothers of 4,025 participants in the National Cooperative Diethylstilbestrol Adenosis (DESAD) Project, a US study begun in 1975 to examine the health effects of prenatal diethylstilbestrol exposure. Between 1994 and 2001, participants provided information on menopausal status. Cox proportional hazards modeling compared the probability of menopause among participants who were and were not prenatally exposed to maternal cigarette smoke.
Participants prenatally exposed to maternal cigarette smoke were more likely than those unexposed to be postmenopause (hazard ratio = 1.21, 95% confidence interval: 1.02, 1.43). The association was present among only those participants who themselves had never smoked cigarettes (hazard ratio = 1.38, 95% confidence interval: 1.10, 1.74) and was absent among active smokers (hazard ratio = 1.03, 95% confidence interval: 0.81, 1.31).
In this cohort of participants predominantly exposed to Diethylstilbestrol (DES) , results suggest that prenatal exposure to maternal cigarette smoke may play a role in programming age at menopause. The possibility that active cigarette smoking modifies this effect is also suggested.
Prenatal DES exposure may reduce osteoporosis protection
Included in this study were 5,573 women who participated in the NCI DES Follow-up Study between 1994 and 2006. Data on reproductive history and medical conditions were collected on the first follow-up questionnaire in 1994 and subsequently on the 1997, 2001, and 2006 questionnaires.
The results of the study showed that women who had fewer than 25 years of menstruation (between the start of menstrual cycles and menopause) had a higher incidence of osteoporosis when compared with women who menstruated for 35 years or more. The association of years of menstruation with osteoporosis was shown observed in both DES-exposed and unexposed women, but was stronger among women who had not been prenatally exposed to DES.
The study’s results support the hypothesis that total lifetime exposure to estrogens that occur naturally through a woman’s reproductive years protects against the development of osteoporosis. Furthermore, prenatal exposure to estrogen, in the form of DES, may reduce this protection, although we do not yet know how.
Estrogen is critical for bone formation and growth in women. Estrogen exposures occur throughout life, including prenatally, and change with reproductive events, such as menarche and menopause.
The objective of this study was to investigate the association between age at menarche, age at menopause, and years of menstruation with incidence of osteoporosis and assess the impact of prenatal exposure to diethylstilbestrol (DES), a synthetic estrogen, on such associations.
DESIGN, SETTING, AND PARTICIPANTS:
Participants were 5573 women in the National Cancer Institute Combined Cohort Study of DES (1994-2006). Data on reproductive history and medical conditions were collected through questionnaires at baseline in 1994 and subsequently in 1997, 2001, and 2006. Age-stratified Cox regression models were used to calculate multivariable incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Effect measure modification by prenatal DES exposure was assessed using cubic restricted spline regression models.
MAIN OUTCOME MEASURE:
Osteoporosis was the main outcome measure.
The IRRs for osteoporosis incidence with age at menarche less than 11 years and age at menopause of 50 years or younger were 0.82 (CI 0.59, 1.14) and 0.61 (CI 0.40, 0.92), respectively. Fewer than 25 years of menstruation was associated with an increased incidence of osteoporosis (IRR 1.80; CI 1.14, 2.86) compared with 35 years or more of menstruation. Associations were stronger among women who had not been prenatally exposed to DES.
Our data support the hypothesis that lifetime cumulative exposure to estrogens is protective against osteoporosis. Furthermore, prenatal exposure to estrogen appears to modify these associations, although the mechanism by which this occurs is unknown.
Drugs? No thanks.
Perfectly safe? Forgive me for being skeptical
” Menopause came for me several years ago, when I was in my mid-fifties, and I can’t say that I’ve enjoyed the experience.
Women who proudly refer to their hot flashes as “power surges” are, I think, kidding themselves. But they’re not fooling me! There’s nothing fabulous about your body temperature suddenly rocketing upwards, leaving you dazed and sweating as you attempt to go about your business was if (Gasp!) nothing (Yikes!) is going on.
I work in a public library, which means that it’s not unusual for me to begin checking out your books as cool as a cucumber, and finish the transaction drenched, dizzy and red as a beet… ”
The sweat-drenched woman’s guide to enjoying an unmedicated menopause, by Roz Warren, a writer AND also DES Daughter…
Women who exercise regularly for four years after the menopause can “rapidly decrease” their risk of breast cancer
“Exercise lowers risk of breast cancer after menopause” reports The Independent. This and similar headlines were sparked by a large study of postmenopausal teachers that found increased recreational activity was associated with a 10% decrease in the risk of breast cancer.
The study used questionnaires to estimate the levels of walking, cycling and sport the women did outside of work. Researchers found that women who exercised vigorously for seven or more hours each week were 25 percent less likely to develop breast cancer, compared to those who exercised less than one hour each week. Examples of vigorous activity include basketball, swimming, running and aerobics. The results were similar if women walked briskly, but there was no benefit for walking at normal pace. The results did not differ by the estrogen receptor status of the breast cancer. It also found that women who did the equivalent of walking at least four hours a week or doing sport for two hours a week had a reduced risk of breast cancer. Factors such as body mass index (BMI) did not change the results.
Complete handbook by Barbara Seaman, published in 1981, about birth control, DES, menopause, remedies and more…
Barbara Seaman, author of The Greatest Experiment Ever Performed on Women, previously wrote a book entitled The Doctor’s Case Against the Pill, which was almost single-handedly responsible for calling the attention of Senator Nelson and his committee on drugs, as well as that of the public, to the dangers of hormone contraceptives for women, as well as to the indifference and perhaps denial of the medical profession generally. Now, in the Women and the Crisis in Sex Hormones book coauthored by her husband, a psychiatrist and psychopharmacologist, the subject is extended to a comprehensive examination of the entire contraceptive field.
Written with a biting and sardonic humor at times, it is a remarkable piece of investigative reporting, comprehensive enough to serve as a reliable reference work. It considers alternatives to hormonal contraception, including the diaphragm, cervical cap, intrauterine device, foam, current rhythm methods, sterilization, abortion, the condom, vasectomy, and a pill for men. It considers menopause and the use of hormones in relation to it.
Sources JAMA 1978;239(20):2179. doi:10.1001/jama.1978.03280470091039
The first chapters of this book are about DES history.
Barbara Seaman book – tracks the well-intentioned discovery of synthetic estrogen through the unconscionable and misleading promotion of a dangerous drug: DES
With the ardent tone of a close friend, Barbara Seaman draws on forty years of journalistic research to expose the “menopause industry” and shows how estrogen therapy often causes more problems—including breast cancer, heart attack, and stroke—than it cures. The Greatest Experiment Ever Performed on Women tracks the well-intentioned discovery of synthetic estrogen through the unconscionable and misleading promotion of a dangerous drug.
Barbara Seaman’s groundbreaking book traces the history of estrogen use from its early purveyors, including a well-meaning British doctor who lost control of the marketing of DES and therefore inadvertently led to the DES baby crisis, to Nazi experimentation with women and estrogen, to the present, and looks at how an experiment of this proportion could have been conducted without oversight, intervention, or real knowledge as to what its effects would be.
Barbara Seaman turns up essential, often shocking, information that should have been part of public awareness but, only now, is coming to light.
Read Amazon reviews – GoodReads reviews.