Selección de Resúmenes de Menopausia

Mayo de 2010

Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile

Semana del 26 de Mayo al 8 de Junio de 2010

BMJ. 2010 Jun 3;340:c2519. doi: 10.1136/bmj.c2519.

Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study.

Renoux C, Dell'aniello S, Garbe E, Suissa S.

McGill Pharmacoepidemiology Research Unit, Center for clinical epidemiology, Jewish General Hospital, and the Departments of Epidemiology and Biostatistics and of Medicine, McGill University, Montreal, Canada H3T 1E2 , Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine, University of Bremen, 28359 Bremen, Germany

Objectives. To determine the risk of stroke associated with oral and transdermal routes of administration of hormone replacement therapy. Design. Population based nested case-control study. Setting. About 400 general practices in the United Kingdom contributing to the General Practice Research Database. Participants. Cohort of all women in the database aged 50-79 years between 1 January 1987 and 31 October 2006 who were members of a practice that fulfilled predefined quality criteria and without a diagnosis of stroke before cohort entry. For each case of stroke occurring during follow-up, up to four controls were selected from among the cohort members in the risk sets defined by the case. Exposure to hormone replacement therapy (HRT) was categorised into oestrogens only, oestrogens plus progestogen, progestogen only, and tibolone. Oestrogens were further subdivided according to the route of administration (oral v transdermal) and dose (high v low). Main outcome measures. Rate ratio of stroke associated with current use of oral and transdermal HRT compared with no use. Current use was considered as a prescription whose duration included the index date. Results. There were 15 710 cases of stroke matched to 59 958 controls. The rate of stroke in the cohort was 2.85 per 1000 per year. The adjusted rate ratio of stroke associated with current use of transdermal HRT was 0.95 (95% CI 0.75 to 1.20) relative to no use. The risk of stroke was not increased with use of low oestrogen dose patches (rate ratio 0.81(0.62 to 1.05)) compared with no use, whereas the risk was increased with high dose patches (rate ratio 1.89 (1.15 to 3.11)). Current users of oral HRT had a higher rate of stroke than non-users (rate ratio 1.28 (1.15 to 1.42)) with both low dose and high dose. Conclusions: The use of transdermal HRT containing low doses of oestrogen does not seem to increase the risk of stroke. The presence of residual confounding, however, cannot be entirely excluded in the interpretation of this finding.

Int J Obes (Lond). 2010 Jun 1. [Epub ahead of print]

An increase in high-density lipoprotein cholesterol after weight loss intervention is associated with long-term maintenance of reduced visceral abdominal fat.

Matsuo T, Kato Y, Murotake Y, Kim MK, Unno H, Tanaka K.

Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.

Abstract

Objectives:It is generally agreed that excess abdominal fat, in particular visceral abdominal fat (VAF), is related to an increased risk for obesity-related complications. We examined the association between metabolic risk factors and maintaining VAF after weight loss intervention.Methods:A total of 54 postmenopausal, obese women who achieved a VAF loss of at least 10% from their baseline values during a 14-week intervention were enrolled as subjects. Body weight, VAF assessed by CT scans, and metabolic risk factors (that is, blood pressure, lipids and glucose) were measured at baseline (week 0), post-intervention (week 15), and at a 2-year follow-up (week 105). The subjects were divided into two groups according to their changes in VAF between weeks 15 and 105 (follow-up period): (1) VAF gainers (VAF changes >0 cm(2), n=28) or (2) VAF maintainers (VAF changes </=0 cm(2), n=26).Results:The mean change in VAF of all subjects during the 14-week intervention was -34+/-16 cm(2) (-29.7+/-12.3%) (P<0.01). Along with this change, improvements (P<0.05) were observed in all metabolic risk factors except for high-density lipoprotein cholesterol (HDLC). During the follow-up period, there were interactions between the two VAF groups in HDLC, triglycerides (TG) and total cholesterol (TC)/HDLC ratio (all P<0.01). In particular, the HDLC of VAF maintainers improved, and the value at week 105 exceeded baseline level (P<0.01). However, systolic and diastolic blood pressure, TC and low-density lipoprotein cholesterol in the VAF maintainers increased (all P<0.05) back to their mean baseline level despite a further decrease in their VAF during the follow-up period (P<0.01).Conclusions:This study shows that long-term maintenance of VAF after weight loss intervention is associated with improvements in HDLC and TG among obese, postmenopausal women.

Br J Cancer. 2010 Jun 1. [Epub ahead of print]

gamma-Glutamyl transferase and breast cancer risk.

Fentiman IS, Allen DS.

Research Oncology, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.

Abstract

Background:It has been reported that there is an increased risk of cancer in individuals with elevated levels of serum gamma-glutamyl transferase (GGT).Methods:In the Guernsey Breast Cancer Cohort Study, GGT was measured in sera from 1803 normal women. Among these women, 251 subsequently developed cancer, of whom 96 developed breast cancer.Results:After adjustment for age at entry, height, weight, age at menarche and first birth with nulliparity, there was a highly significant relationship between elevated GGT and breast cancer risk. In the highest quartile, the hazard ratio (HR) was 2.17 (95% confidence interval (CI): 1.19, 3.93). When subdivided by menopausal status, there was a reduced non-significant effect in postmenopausal women, whereas for premenopausal women in the highest quartile, HR was 3.81 (95% CI: 1.37, 10.59). Premenopausal women with serum GGT levels above the normal range had a significantly elevated HR of 4.90 (95% CI: 1.86, 12.94).Conclusions:These results suggest that premenopausal women with high normal (above median) serum GGT or elevated levels (</=40 IU l(-1)) are at increased risk of breast cancer and might benefit from close surveillance, possibly with breast magnetic resonance imaging scans. Serum GGT may mark previous exposure to carcinogens and lead to the identification of DNA adducts involved in mammary carcinogenesis.

Menopause. 2010 May 24. [Epub ahead of print]

Longitudinal association of vasomotor symptoms and psychosocial outcomes among postmenopausal women in the United States: a population-based study.

Van Dole KB, Williams RE, Brown RS, Gaynes B, Devellis R, Funk MJ.

From the 1Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; 2WorldWide Epidemiology, GlaxoSmithKline, Upper Providence, PA; 3Department of Biostatisics, GlaxoSmithKline, Research Triangle Park, NC; and Departments of 4Psychiatry and 5Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Abstract

OBJECTIVE:: Vasomotor and psychosocial symptoms persist as common manifestations of menopause; their explicit association is unclear. We investigated this association among postmenopausal women over a 2-year period. METHODS:: The Menopause Epidemiology Study is a cross-sectional population-based study of women 40 to 65 years old in the United States. We followed participants who were postmenopausal at baseline and at 2-year follow-up (n = 1,506) in the analyses. The vasomotor and psychosocial domains of the Menopause-Specific Quality of Life Questionnaire were used to assess exposure and outcome. Change in symptoms was defined as the difference in the Menopause-Specific Quality of Life Questionnaire domain score from baseline to follow-up 2 years later. Demographic information, behavioral activities, reproductive history, and medication use were evaluated for effect modification and confounding. Covariate-adjusted linear regression was used to assess the relationship between the change in vasomotor symptoms and change in psychosocial symptoms. RESULTS:: One quarter (n = 375) of the women reported an increase in vasomotor symptoms over the 2-year study period. Twenty-two percent of the women reported an increase in both vasomotor and psychosocial symptoms. Current smoking status was found to be an effect modifier: a one-unit increase in the vasomotor domain was associated with a 0.21-unit (95% CI, 0.12-0.29) increase in the psychosocial domain among smokers; this was stronger (0.29, 95% CI, 0.20-0.39) among past or never smokers. CONCLUSIONS:: This study provides further evidence of an association between vasomotor symptoms and psychosocial symptoms using a validated instrument in a population-based study. There is a small increase in psychosocial symptoms with increasing vasomotor symptoms. Clinicians may want to note this association when treating postmenopausal women with either condition.

Menopause. 2010 May 26. [Epub ahead of print]

Association between serum estradiol level and coronary artery calcification in postmenopausal women.

Jeon GH, Kim SH, Yun SC, Chae HD, Kim CH, Kang BM.

From the 1Department of Obstetrics and Gynecology 2Division of Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul; 3Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea.

Abstract

OBJECTIVE:: The aim of this study was to estimate whether coronary artery calcification is associated with serum estradiol (E2) level in postmenopausal women. METHODS:: We performed a multidetector CT scan of the heart and measured the coronary artery calcium score (CACS) in 436 postmenopausal women who did not take postmenopausal hormone therapy. Women were divided into two groups according to the CACS (>/=100 or <100). Serum E2 level, lipid profile, bone mineral densities of the lumbar vertebrae and femoral neck, current statin treatment status, and other coronary risk factors were analyzed in these two groups. RESULTS:: The proportion of women with a higher serum E2 level (>/=20 pg/mL) was significantly higher in the lower-CACS (<100) group compared with the higher-CACS (>/=100) group (34.0% vs 12.5%; P < 0.05). The distribution of CACS was significantly different between women with higher and lower (<20 pg/mL) serum E2 levels (P < 0.05), and the CACS was significantly lower in the group with a higher serum E2 level (P = 0.002). After adjusting various risk factors by weighted logistic regression model using inverse probability of treatment weighting, women with a higher serum E2 level had a reduced chance of having a higher CACS (crude odds ratio, 0.28; 95% CI, 0.08-0.95; P = 0.04; adjusted odds ratio, 0.25; 95% CI, 0.07-0.86; P = 0.03). CONCLUSIONS:: Postmenopausal women with a higher serum E2 level had a reduced CACS independent of age and other coronary risk factors. These retrospective analyses might suggest that a higher level of E2 possibly lowers the calcified-plaque burden of coronary arteries in postmenopausal women.

Oncologist. 2010 May 27. [Epub ahead of print]

Obesity and Cancer.

Wolin KY, Carson K, Colditz GA.

Abstract

Abstract Weight, weight gain, and obesity account for approximately 20% of all cancer cases. Evidence on the relation of each to cancer is summarized, including esophageal, thyroid, colon, renal, liver, melanoma, multiple myeloma, rectum, gallbladder, leukemia, lymphoma, and prostate in men; and postmenopausal breast and endometrium in women. Different mechanisms drive etiologic pathways for these cancers. Weight loss, particularly among postmenopausal women, reduces risk for breast cancer. Among cancer patients, data are less robust, but we note a long history of poor outcomes after breast cancer among obese women. While evidence on obesity and outcomes for other cancers is mixed, growing evidence points to benefits of physical activity for breast and colon cancers. Dosing of chemotherapy and radiation therapy among obese patients is discussed and the impact on therapy-related toxicity is noted. Guidelines for counseling patients for weight loss and increased physical activity are presented and supported by strong evidence that increased physical activity leads to improved quality of life among cancer survivors. The "Five A's" model guides clinicians through a counseling session: assess, advise, agree, assist, arrange. The burden of obesity on society continues to increase and warrants closer attention by clinicians for both cancer prevention and improved outcomes after diagnosis.

Endocrinol Metab Clin North Am. 2010 Jun;39(2):287-301.

Low Vitamin D Status: Definition, Prevalence, Consequences, and Correction.

Binkley N, Ramamurthy R, Krueger D.

University of Wisconsin-Madison Osteoporosis Clinical Center and Research Program, 2870 University Avenue, Suite 100, Madison, WI 53705, USA.

Abstract

Vitamin D is obtained from cutaneous production when 7-dehydrocholesterol is converted to vitamin D(3) (cholecalciferol) by ultraviolet B radiation or by oral intake of vitamin D(2) (ergocalciferol) and D(3). An individual's vitamin D status is best evaluated by measuring the circulating 25-hydroxyvitamin D (25(OH)D) concentration. Although controversy surrounds the definition of low vitamin D status, there is increasing agreement that the optimal circulating 25(OH)D level should be approximately 30 to 32 ng/mL or above. Using this definition, it has been estimated that approximately three-quarters of all adults in the United States have low levels. Low vitamin D status classically has skeletal consequences such as osteomalacia/rickets. More recently, associations between low vitamin D status and increased risk for various nonskeletal morbidities have been recognized; whether all of these associations are causally related to low vitamin D status remains to be determined. To achieve optimal vitamin D status, daily intakes of at least 1000 IU or more of vitamin D are required. The risk of toxicity with "high" amounts of vitamin D intake is low. Substantial between-individual variability exists in response to the same administered vitamin D dose. When to monitor 25(OH)D levels has received little attention. Supplementation with vitamin D(3) may be preferable to vitamin D(2).

J Clin Oncol. 2010 May 24. [Epub ahead of print]

Phase III, Placebo-Controlled Trial of Three Doses of Citalopram for the Treatment of Hot Flashes: NCCTG Trial N05C9.

Barton DL, Lavasseur BI, Sloan JA, Stawis AN, Flynn KA, Dyar M, Johnson DB, Atherton PJ, Diekmann B, Loprinzi CL.

Mayo Clinic Rochester, Rochester, MN; Michigan Cancer Research Consortium, Ann Arbor, MI; Upstate Carolina Community Clinical Oncology Program, Spartanburg, SC; and Wichita Community Clinical Oncology, Wichita, KS.

Abstract

PURPOSE Up to 75% of women experience hot flashes, which can negatively impact quality of life. As hot flash physiology is not definitively understood, it cannot be assumed that effective agents represent class effects. Therefore, there is a continued need for rigorous evaluation to identify effective nonhormonal options for hot flash relief. METHODS A randomized, double-blind trial evaluated citalopram at target doses of 10, 20, or 30 mg/d versus placebo for 6 weeks. Postmenopausal women with at least 14 bothersome hot flashes per week recorded hot flashes for 7 days before starting treatment and were then titrated to their target doses. The primary end point was the change from baseline to 6 weeks in hot flash score. Results Two hundred fifty-four women were randomly assigned onto this study. Data for hot flash scores and frequencies showed significant improvement in hot flashes with citalopram over placebo, with no significant differences among doses. Reductions in mean hot flash scores were 2.0 (23%), 7.0 (49%), 7.7 (50%), and 10.7 (55%) for placebo and 10, 20, and 30 mg of citalopram, respectively (P </= .002). Improvement in secondary outcomes, such as the Hot Flash Related Daily Interference Scale, was statistically superior in the 20-mg arm. Citalopram was well-tolerated, with no significant negative adverse effects. CONCLUSION Citalopram is an effective, well-tolerated agent in managing hot flashes. There does not appear to be a significant dose response above 10 mg/d, but broader helpful effects of the agent appear to be more evident at 20 mg/d.

Semana del 18 al 25 de Mayo de 2010

Neuroscience. 2010 May 19. [Epub ahead of print]

Neuroprotective mechanism conferred by 17beta-estradiol on the biochemical basis of Alzheimer's disease.

Amtul Z, Wang L, Westaway D, Rozmahel RF.

Faculty of Medicine and Dentistry, Department of Anatomy and Cell Biology, Medical Sciences Bldg, University of Western Ontario, London, ON, Canada N6A 5C1; Department of Biochemistry, University of Western Ontario, London, ON, Canada.

Abstract

Estrogen (17beta-estradiol) plays key regulatory roles in a variety of physiological and biological processes. Several lines of evidence also support its role as a protective factor in Alzheimer's disease; however, the basis of this effect is unclear. Here we show that an early-onset Alzheimer's disease transgenic mouse model expressing the double-mutant form of human APP (Amyloid precursor protein); Swedish (K670N/M671L) and Indiana (V717F) undergoing treatment with 17beta-estradiol show significantly lower levels of APP processing through beta-secretase and enhanced alpha-secretase processing resulting in marked reductions of APP-CTFbeta, Abeta42 and plaque burden, along with increased levels of the non-amyloidogenic sAPPalpha. Moreover, 17beta-estradiol resulted in elevated brain levels of transthyretin, which inhibits aggregation of Abeta into plaques; though the insulin-degrading enzyme, which breaks down Abeta, was significantly reduced. These results illustrate a multifaceted effect of 17beta-estradiol on the biochemical basis of Alzheimer's disease, through effects on APP processing, Abeta levels and factors that affect its clearance and aggregation. Overall, these results support the need for further long-term longitudinal studies to elucidate consequences of menopause as well as hormone therapy on Alzheimer's disease, and explore its potential as a therapeutic avenue for the disease.

Maturitas. 2010 May 19. [Epub ahead of print]

Androgen deficiency in women; role of accurate testosterone measurements.

Demers LM.

Penn State University - MS Hershey Medical Center, 500 University Drive, Hershey, PA 17033, United States.

Abstract

Androgen deficiency in women has been recognized as a distinct clinical syndrome that affects thousands of women particularly women in the postmenopausal period of their life. This syndrome has been described by several names including female androgen deficiency syndrome as well as hypoactive, sexual desire disorder. A recent large survey concerning sexual problems in women also adds personal distress as a potential contributor to the low sexual desire found in some women with sexual dysfunction. Recognition of an androgen deficiency syndrome however, has been controversial and limited to a clinical diagnosis due to the lack of accurate and sensitive methods for measuring androgens in women. Up until now, available methods for measuring the sex steroids have been dependent on antibody based assays that employ a range of different detection systems including the use of isotopes such as tritium and I-125 or chemical signalling molecules that produce chemiluminescence. These assays have become increasingly more sensitive for the measurement of testosterone but are still incapable of providing the proper low-end sensitivity for analyzing testosterone in female blood specimens. Assays for testosterone performed either manually or with highly automated immunoassay instruments have been used to measure testosterone in women but with varying degrees of success. Existing immunoassay-based methods are quite adequate for measuring testosterone levels in males but lack sufficient sensitivity to accurately and reproducibly measure testosterone in females and pre-pubertal children. Recent advances with the use of ultrasensitive methods such as mass spectrometry coupled to either gas or liquid chromatography have improved the technology for measuring testosterone and other low concentration sex steroids like estradiol to the degree that mass spectrometry based methods are now capable of measuring the testosterone levels found in normal women and in women with extremely low levels of testosterone as observed in a true androgen deficiency disorder. This application of mass spectrometry for measuring testosterone should allow clinicians to better define female androgen deficiency and facilitate further investigation in the diagnosis and optimal management of androgen deficiency in women.

J Clin Psychiatry. 2010 May 18. [Epub ahead of print]

Low 24-hour adiponectin and high nocturnal leptin concentrations in a case-control study of community-dwelling premenopausal women with major depressive disorder: the premenopausal, osteopenia/osteoporosis, women, alendronate, depression (POWER) study.

Cizza G, Nguyen VT, Eskandari F, Duan Z, Wright EC, Reynolds JC, Ahima RS, Blackman MR; for the POWER Study Group.

NIDDK/NIH, Bldg 10, CRC, Rm 6-3940, Bethesda, MD 20892-1613, USA. cizzag@intra.niddk.nih.gov.

Abstract

OBJECTIVE: Major depressive disorder (MDD) is associated with immune system dysfunction and disruption of multiple circadian systems. Adiponectin is an adipocytokine with anti-inflammatory and antiatherogenic effects. Circulating concentrations are inversely related to adiposity and risks of metabolic syndrome and diabetes mellitus. Our goals were (1) to establish whether premenopausal women with MDD exhibit decreased plasma adiponectin concentrations and/or disruption of circadian adiponectin rhythmicity; (2) to assess whether there is a relationship between adiponectin and MDD; and (3) to explore the temporal relationships among adiponectin, leptin, corticotropin, and cortisol secretion. METHOD: We conducted a case-control study of community-dwelling premenopausal women with DSM-IV MDD (n = 23) and age- and body mass index (BMI)-matched control subjects (n = 23). Main outcome measures were circulating concentrations of adiponectin, leptin, corticotropin, and cortisol measured hourly for 24 hours. Subjects were recruited from July 1, 2001, to February 28, 2003. RESULTS: Women with MDD had approximately 30% lower mean 24-hour concentration of adiponectin than did control subjects. Adiponectin concentration was inversely related to depression severity and total duration of disease, suggesting a causal link. In contrast, mean nocturnal leptin concentration was higher in the MDD versus control groups. Mean leptin concentration was inversely related to cortisol and adiponectin concentrations, both in subjects with depression and in control subjects. In cross-correlation analyses, the relationship between corticotropin and cortisol concentrations was stronger in women with MDD than in control subjects, a finding consistent with hypothalamic-pituitary-adrenal (HPA) axis activation in MDD. CONCLUSIONS: In premenopausal women with MDD, reduced daily adiponectin production may increase the risk of diabetes mellitus, and elevated leptin may contribute to osteoporosis

Osteoporos Int. 2010 Jun;21 Suppl 2:S437-42. Epub 2010 May 13.

Comparing and contrasting the effects of strontium ranelate and other osteoporosis drugs on microarchitecture.

Ferrari S.

Service of Bone Diseases, Geneva University Hospital (HUG), 24 rue Micheli-du-Crest, 1211, Geneva, Switzerland. serge.ferrari@medecine.unige.ch

Abstract

Altered bone microstructure is a major component of osteoporosis and bone fragility. Whilst an important standard by which to diagnose and make treatment decisions for osteoporosis, the evaluation of bone mineral mass by dual-energy X-ray absorptiometry (DXA) at spine or hip is not sufficient for understanding the complex nature of bone microstructure nor to evaluate specific treatment effects on cancellous and cortical bone. Various alternatives to DXA have been developed, enabling the measurement of bone geometry and/or microarchitecture and/or bone strength including hip strength analysis, peripheral and central QCT, 3D analyses of iliac crest bone biopsies, and more recently HR-pQCT, which allows longitudinal assessment of bone microstructure at the distal radius and tibia. The efficacy of treatments for osteoporosis can be evaluated using these techniques. A true improvement of bone microstructure above baseline has not been demonstrated with anti-resorptive treatments; however, they may prevent the decay of cancellous bone and, potentially, cortical thinning. Anabolic agents such as parathyroid hormone (PTH) increase cancellous bone volume and cortical thickness; however, the improvement of cortical bone strength by PTH may be limited by an increase in cortical porosity. Strontium ranelate has been shown to improve not only the trabecular network but also cortical thickness, contributing to its anti-fracture efficacy at vertebral, non-vertebral, and hip sites.

Am J Epidemiol. 2010 Jun 1;171(11):1203-13. Epub 2010 Apr 27.

Reproductive Hormones and Obesity: 9 Years of Observation From the Study of Women's Health Across the Nation.

Sutton-Tyrrell K, Zhao X, Santoro N, Lasley B, Sowers M, Johnston J, Mackey R, Matthews K.

Abstract

The effect of change in reproductive hormones and menopause on incident obesity (body mass index >/=30 kg/m(2)) and severe obesity (body mass index >/=35 kg/m(2)) was evaluated over 9 years in 3,260 US women recruited in the multiethnic Study of Women's Health Across the Nation in 1996-1997. After 9 years, cumulative incidences of obesity and severe obesity reached 21.8% and 12.3%, respectively. In multivariate analysis, hormone changes, chronic health conditions, lower physical activity, race/ethnicity, and age were significantly associated with incident obesity and/or severe obesity. The odds of incident severe obesity increased with surgical menopause (odds ratio (OR) = 5.07, 95% confidence interval (CI): 2.29, 11.20; P < 0.001) and initiation of hormone therapy prior to 12 months of amenorrhea (OR = 2.94, 95% CI: 1.14, 7.58; P = 0.03). Predictors of obesity included an increase in free androgen index (OR = 1.37, 95% CI: 1.12, 1.68; P = 0.002) and a decrease in sex hormone-binding globulin (OR = 0.60, 95% CI: 0.45, 0.80; P = 0.0005). Similar results were found for severe obesity. Obesity rates varied by race, but no hormone-by-race interactions were observed. These longitudinal data demonstrate that higher androgens, lower sex hormone-binding globulin, surgical menopause, and early hormone therapy use predict incident obesity and/or severe obesity in a multiracial cohort of women transitioning into menopause.

Gynecol Endocrinol. 2010 May 20. [Epub ahead of print]

Perceived control over menopausal hot flushes in mid-aged women.

Chedraui P, Pérez-López FR, Aguirre W, Calle A, Hidalgo L, León-León P, Miranda O, Martínez N, Mendoza M, Narváez J, Sánchez H, Schwager G, Quintero JC, Zambrano B, Leimberg ML, Vallarino V, Vega B.

Research Group for the Ecuadorian Climacteric & Menopause Society (SECLIM), Ecuador.

Abstract

Background. Hot flushes (HFs) and night sweats are frequent complaints among both peri- and postmenopausal women. Perceived control of this complaint may vary from one population to another. Objective. To assess perceived control over menopausal HFs and determinant factors among mid-aged Ecuadorian women. Methods. In this cross-sectional study healthy women aged 40-59 years, seeking healthcare centres of eight main cities of Ecuador with more than 100,000 inhabitants, were assessed with the Menopause Rating Scale (MRS) and those presenting HFs were requested to fill out the Perceived Control Index (PCI) and a questionnaire containing socio-demographic data (female and partner). Results. A total of 1154 women participated in this study of which 56% presented HFs (n = 646). According to the MRS, 29.1% and 9.1% of these HFs were graded as severe and very severe, respectively. Mean age of women presenting HFs was 49.5 +/- 5.2 years, with 51.9% having 12 years or less of education, 61.5% being postmenopausal and 47.2% living in high altitude. At the moment of the survey 13.9% were on hormone therapy, 12.8% on phytoestrogens and 7.1% on psychotropic drugs. There was a significant decreasing trend for PCI scores (total and difficulty in control items) from one menopausal stage to the next, with no differences observed for time since menopause onset. Despite this, logistic regression analysis determined that HF severity, as determined with the MRS, was the only single predictive factor related to lower HF perceived control (total PCI score <38) (OR: 1.83 CI 95% [1.15-2.90], p < 0.01). Conclusion. As determined with the PCI, HF severity was related to a lower perceived control among mid-aged women.

Semana del 5 al 11 de Mayo de 2010

Maturitas. 2010 Apr 29. [Epub ahead of print]

EMAS position statement: Managing obese postmenopausal women.

INTRODUCTION: Obesity is a public health problem, with overweight individuals representing approximately 20% of the adult world population. Postmenopausal status is associated with higher prevalence of obesity, as 44% of postmenopausal women are overweight, among whom 23% are obese. Obesity often co-exists with other diseases, the most important being diabetes mellitus, dyslipidemia and hypertension. Furthermore, obesity increases the risk of gynecologic cancer, cardiovascular disease, venous thromboembolism, osteoarthritis and chronic back pain. AIM: To formulate a position statement on the management of the menopause in obese women. MATERIALS AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS: Obese women seeking hormone therapy should be evaluated for their individual baseline risk of developing breast cancer, cardiovascular disease and venous thromboembolism. These risks should be weighed against expected benefit from symptom relief, improved quality of life and osteoporosis prevention. The lowest effective estrogen dose should be used (CEE 0.300-0.400mg or estradiol 0.5-1mg orally daily or 25-50mug estradiol transdermally). With regard to progestogens, although no RCT data exist, there are observational studies showing that micronized progesterone or dydrogesterone may have a better risk profile with respect to breast cancer risk. There are no RCT data comparing various progestogens with regard to VTE risk. There are observational data, however, suggesting that micronized progesterone or pregnane derivatives may be associated with a lower VTE risk in postmenopausal women taking HT compared to nonpregnane derivatives. There is a rationale in suggesting the use of transdermal HT in obese women, since this route of administration has been associated with a lesser risk of venous thromboembolism than oral therapy.

Osteoporos Int. 2010 May 7. [Epub ahead of print]

Stroke in relation to use of raloxifene and other drugs against osteoporosis.

Vestergaard P, Schwartz K, Pinholt EM, Rejnmark L, Mosekilde L.

Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage Hansens Gade 2, DK-

Prior studies have associated fatal stroke with raloxifene. In a cohort study, we found no excess risk of stroke with raloxifene; whereas, an excess risk of stroke and fatal stroke was seen with alendronate and etidronate. However, the excess risks were small. PURPOSE: We aim to study the association between use of raloxifene and other drugs against osteoporosis and risk of stroke. METHODS: This is a nationwide cohort study from Denmark. All users of bisphosphonates and other drugs against osteoporosis between 1996 and 2006 (n = 103,562) as exposed group and three age- and gender-matched controls from the general population (n = 310,683). RESULTS: Before the drugs were started, patients later initiating alendronate or raloxifene had fewer strokes than the controls. In contrast, patients who later did start clodronate have more strokes. Among the later users of other bisphosphonates, strontium ranelate or parathyroid hormone, no change in the risk of stroke was present. Patients who started raloxifene neither had an excess risk of strokes nor of fatal strokes. No dose-response relationship was present. Among users of alendronate, a decreasing overall risk of stroke was seen with increasing dose. However, for fatal strokes, the risk increased with increasing dose of alendronate. Among users of etidronate, no trend with dose was present for overall stroke risk; whereas for fatal strokes, an increasing risk was seen with increasing dose of etidronate. CONCLUSIONS: Raloxifene does not seem associated with an excess risk of strokes. The increase seen for alendronate did not seem to be causal as no classical dose-response relationship was present. The dose-response relationship for fatal strokes with alendronate and etidronate needs further examination. However, the excess risks were small and may be due to the underlying disease.

BMC Womens Health. 2010 May 4;10(1):15. [Epub ahead of print]

Postmenopausal hormones and sleep quality in the elderly: a population based study.

Tranah GJ, Parimi N, Blackwell T, Ancoli-Israel S, Ensrud KE, Cauley JA, Redline S, Lane N, et al.

BACKGROUND: Sleep disturbance and insomnia are commonly reported by postmenopausal women. However, the relationship between hormone therapy (HT) and sleep disturbances in postmenopausal community-dwelling adults is understudied. Using data from the multicenter Study of Osteoporotic Fractures (SOF), we tested the relationship between HT and sleep-wake estimated from actigraphy. METHODS: Sleep-wake was ascertained by wrist actigraphy in 3,123 women aged 84+/-4 years (range 77-99) from the Study of Osteoporotic Fractures (SOF). This sample represents 30% of the original SOF study and 64% of participants seen at this visit. Data were collected for a mean of 4 consecutive 24-hour periods. Sleep parameters measured objectively included total sleep time, sleep efficiency (SE), sleep latency, wake after sleep onset (WASO), and nap time. All analyses were adjusted for potential confounders (age, clinic site, race, BMI, cognitive function, physical activity, depression, anxiety, education, marital status, age at menopause, alcohol use, prior hysterectomy, and medical conditions). RESULTS: Actigraphy measurements were available for 424 current, 1,289 past, and 1,410 never users of HT. Women currently using HT had a shorter WASO time (76 vs. 82 minutes,P=0.03) and fewer long-wake (>=5 minutes) episodes (6.5 vs. 7.1,P=0.004) than never users. Past HT users had longer total sleep time than never users (413 vs. 403 minutes,P=0.002). Women who never used HT had elevated odds of SE <70% (OR,1.37;95%CI,0.98-1.92) and significantly higher odds of WASO >=90 minutes (OR,1.37;95%CI,1.02-1.83) and >= 8 long-wake episodes (OR,1.58;95%CI,1.18-2.12) when compared to current HT users. CONCLUSIONS: Postmenopausal women currently using HT had improved sleep quality for two out of five objective measures: shorter WASO and fewer long-wake episodes. The mechanism behind these associations is not clear. For postmenopausal women, starting HT use should be considered carefully in balance with other risks since the vascular side-effects of hormone replacement may exceed its beneficial effects on sleep.

Cancer Epidemiol Biomarkers Prev. 2010 May;19(5):1301-10.

Meat mutagens and breast cancer in postmenopausal women--a cohort analysis.

Wu K, Sinha R, Holmes MD, Giovannucci E, Willett W, Cho E.

Department of Nutrition, Harvard School of Public Health, Boston, USA. kana.wu@channing.harvard.edu

Mutagenic compounds produced when meats are cooked at high temperatures have been hypothesized to increase risk of breast cancer. Methods: We examined the association between intakes of the heterocyclic amines (HCA) MeIQx (2-amino-3,8-dimethylimidazo[4,5-quinoxaline), PhIP (2-amino-1-methyl-6-phenylimidazo[4,5-pyridine), DiMeIQx (2-amino-3,4,8-trimethylimidazo[4,5-f]), and meat-derived mutagenic (MDM) activity and risk of breast cancer using a cooking method questionnaire administered in 1996 in the Nurses' Health Study. Between 1996 and 2006, 2,317 breast cancer cases were diagnosed during 533,618 person-years. Results: Higher intake of HCAs or MDM was not associated with elevated risk of breast cancer [multivariate relative risk and 95% confidence interval for the highest versus lowest quintile: MeIQx: 0.90 (0.79-1.03); PhIP: 0.92 (0.80-1.05); DiMeIQx: 0.92 (0.80-1.05); and MDM: 0.98 (0.85-1.12)]. HCA or MDM was not associated with estrogen receptor-positive/progesterone receptor-positive breast cancer risk either. There was some suggestion of a decreased risk of estrogen receptor-negative/progesterone receptor-negative breast cancer with higher intakes of MeIQx, DiMeIQx, and PhIP, but none of the associations were significant. There was little evidence for interaction between intake of cruciferous vegetables and HCA or MDM intake and risk of breast cancer. Conclusion: Higher consumption of mutagens from meats cooked at higher temperature and longer duration was not associated with increased risk of postmenopausal breast cancer. Impact: Overall prospective data including results from our study do not provide support for a substantial increase in risk of breast cancer with higher intake of HCAs

Curr Med Res Opin. 2010 May 7. [Epub ahead of print]

Calcium and vitamin D intake by postmenopausal women with osteoporosis in France.

Czernichow S, Fan T, Nocea G, Sen SS.

Department of Public Health, Avicenne Hospital; University of Paris 13, Bobigny, France.

Abstract Objective: To assess dietary calcium and vitamin D intake and their relationship with prescription medication and nutritional supplement use among postmenopausal women with osteoporosis in France. Research design and methods: Telephone interviews were conducted with 207 postmenopausal women with osteoporosis referred by a random sample of physicians from a French national list. Based on a French food frequency questionnaire, patients reported their daily food intake and frequency as well as their use of prescription medications and nutritional supplements. Results: Average daily dietary vitamin D intake was only 144.8 IU (SD 84.6, p < 0.01 compared to the recommended 800 IU), with 30% of the sample taking a vitamin D supplement. No participant had more than 500 IU vitamin D daily from food alone and 78% had less than 200 IU per day. A total of 51% of patients took no vitamin D supplements and had less than 5 hours of sun exposure in a week. Patients who were receiving osteoporosis medications and those who were not had comparable vitamin D intake. The average daily dietary calcium intake was 966.4 mg (SD 273.7, p < 0.01 compared to the 800 mg recommended). Calcium supplements were taken by 38% of participants and older patients tended to take more. Limitations of the study include convenience sampling and patient self-report. Conclusions: Daily vitamin D intake among this sample of postmenopausal osteoporotic women in France was significantly lower than recommended dosages. At least 50% of these patients might benefit by adding vitamin D to their current therapy.

Am J Epidemiol. 2010 May 4. [Epub ahead of print]

Menopause-associated Symptoms and Cognitive Performance: Results From the Study of Women's Health Across the Nation.

Greendale GA, Wight RG, Huang MH, Avis N, Gold EB, Joffe H, Seeman T, Vuge M, Karlamangla AS.

A long-standing, but unproven hypothesis is that menopause symptoms cause cognitive difficulties during the menopause transition. This 6-year longitudinal cohort study of 1,903 midlife US women (2000-2006) asked whether symptoms negatively affect cognitive performance during the menopause transition and whether they are responsible for the negative effect of perimenopause on cognitive processing speed. Major exposures were depressive, anxiety, sleep disturbance, and vasomotor symptoms and menopause transition stages. Outcomes were longitudinal performance in 3 domains: processing speed (Symbol Digit Modalities Test (SDMT)), verbal memory (East Boston Memory Test), and working memory (Digit Span Backward). Adjustment for demographics showed that women with concurrent depressive symptoms scored 1 point lower on the SDMT (P < 0.05). On the East Boston Memory Test, the rate of learning among women with anxiety symptoms tested previously was 0.09 smaller per occasion (P = 0.03), 53% of the mean learning rate. The SDMT learning rate was 1.00 point smaller during late perimenopause than during premenopause (P = 0.04); further adjustment for symptoms did not attenuate this negative effect. Depressive and anxiety symptoms had a small, negative effect on processing speed. The authors found that depressive, anxiety, sleep disturbance, and vasomotor symptoms did not account for the transient decrement in SDMT learning observed during late perimenopause.

J Clin Oncol. 2010 May 3. [Epub ahead of print]

Estrogen Alone in Postmenopausal Women and Breast Cancer Detection by Means of Mammography and Breast Biopsy.

Chlebowski RT, Anderson G, Manson JE, Pettinger M, Yasmeen S, Lane D, Langer RD, Hubbell FA, et al

Los Angeles Biomedical Research Institute at Harbor, University of California.

PURPOSE As the influence of estrogen alone on breast cancer detection is not established, we examined this issue in the Women's Health Initiative trial, which randomly assigned 10,739 postmenopausal women with prior hysterectomy to conjugated equine estrogen (CEE; 0.625 mg/d) or placebo. METHODS Screening mammography and breast exams were performed at baseline and annually. Breast biopsies were based on clinical findings. Effects of CEE alone on breast cancer detection were determined by using receiver operating characteristic (ROC) analyses of mammogram performance. Results After a 7.1-year mean follow-up, fewer invasive breast cancers were diagnosed in the CEE than in the placebo group, but the difference was not statistically significant. Use of CEE alone increased mammograms with short-interval follow-up recommendations (cumulative, 39.2% v 29.6.3%; P < .001) but not abnormal mammograms (ie, those suggestive of or highly suggestive of malignancy; cumulative, 7.3% v 7.0%; P = .41). Breast biopsies were more frequent in the CEE group (cumulative, 12.5% v 10.7%; P = .004) and less commonly diagnosed as cancer (8.9% v 15.8%, respectively, with positive biopsies; P = .04). Mammographic breast cancer detection in the CEE group was significantly compromised only in the early years of use. CONCLUSION CEE alone use for 5 years results in approximately one in 11 and one in 50 women having otherwise avoidable mammograms with short-interval follow-up recommendations or breast biopsies, respectively. Although the breast biopsies on CEE were less commonly diagnosed as cancer, breast cancer detection was not substantially compromised. These findings differ from estrogen-plus-progestin use, for which significantly increased abnormal mammograms and a compromise in breast cancer detection are seen.