TIME medicine

Hormone Treatments Raise Cancer Risk Even After They’re Stopped

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Estrogen and progestin therapy to treat menopause has led to controversial and confusing recommendations. But in the latest and longest term look at the data, experts say the risks of the hormones may last long after women stop taking them

Researchers admit that when it comes to hormone therapy — estrogen and progestin — to treat the symptoms of menopause for women, they don’t have a lot of consistent or convincing answers. They thought the medications could not only help menopause symptoms but also protect against heart disease, although some studies showed the added hormones could also raise risk of breast cancer. The resulting advice to women seeking answers about whether hormone therapy is for them has been anything but satisfying.

Now the scientists involved in the first large trial of hormone therapy, the Women’s Health Initiative (WHI), have continued to study those women who participated in the 1990s and found some surprising results. Reporting in the journal JAMA Oncology, they say that the risk of breast cancer for women taking the combination of estrogen and progestin remains the same seven to eight years after they stop the drugs than while they were taking them.

MORE: Hormone Replacement Therapy After Menopause: What Women Need to Know

The estrogen helps to maintain levels of that hormone as natural amounts start to drop during menopause, and the progestin protects the uterus from potential tumors arising from excess amounts of estrogen. They also found that for the quarter or so post-menopausal women who have had a hysterectomy, and can take estrogen alone, the hormone can lower their risk of breast cancer.

The WHI was created to study the health effects of hormone therapy on the millions of women taking them. Some small studies had suggested that the hormones could protect women from heart disease; women tend to have heart attacks about a decade or so later than men on average, and researchers believed some of that protection came from estrogen. But doctors were concerned about the known connection between estrogen and breast cancer, since during puberty estrogen contributes to breast tissue growth, and wanted to understand how the benefits for the heart matched up against the risks to the breast, so they enrolled more than 26,600 women aged 50 to 79 years in the WHI.

MORE: Estrogen After Menopause Lowers Breast Cancer Risk for Some Women

They intended to study them until 2005, but in 2002, they stopped the trial when it became clear that there was a group of women experiencing higher heart disease rates. It turned out that these were the women taking hormones, either the combination or estrogen alone.

MORE: The Truth About Hormones

The results completely changed menopause treatment, and led to a precipitous drop in the use of the medications; in the U.S., where about 40% of women turned to the hormones, only 15% did after most experts agreed that they should only be used in the short term, for about a year or so during and just after menopause. The assumption was that the benefits in lowering breast cancer risk would be similar — if women stopped taking the hormones, then their risk would decline.

That seemed to be true, at least for the first year or so after discontinuing the therapy. But in 2013, Dr. Rowan Chlebowski, an oncologist at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, and one of the initial investigators on WHI, reported that the benefit didn’t hold for long. He found that if women who had previously been on estrogen and progestin therapy were studied for more than eight years, their risk of breast cancer started climbing back up, to levels that were on par with when they were taking the medications.

That finding, however, contradicted other results from studies. And to make matters more confusing, the women who had had a hysterectomy, and no longer had a uterus so could take estrogen alone, did not seem to experience the same increased risk of breast cancer. All of this data prompted Chlebowski to do a more detailed analysis of the WHI data on women who agreed to continue to participate years after they stopped taking the hormone therapy.

MORE: Making Sense of Hormone Therapy After Menopause

In the current study, it’s clear that the combination of estrogen and progestin increases breast cancer risk, he says. The drop in risk that occurs immediately after the therapy is stopped is likely due to the changing hormone environment. Any small or emerging tumors that were already present before hormone treatment started may eventually start growing again years later.

For women who have had a hysterectomy, taking estrogen alone does not increase breast cancer risk and may, according to the latest results, even provide some protection against the disease.

“It looks like hormones have longer term lingering effects,” says Chlebowski. “For estrogen and progestin together, we see an increase in risk even years after you stop. But for estrogen alone, it looks like the hormone may be more favorable in reducing breast cancer risk than we thought before. The estrogen alone findings are now quite compelling that we may had to call lit risk reduction.”

The results should stress the importance of defining what menopausal symptoms are, and how much they interfere with women’s daily lives. Most health groups now recommend short term hormone therapy, but it’s clear that the risks of breast cancer remain even after exposure. So doctors and patients need to weigh the relief of symptoms against the unhealthy legacy of taking these medications. “There is a little more risk than we thought with estrogen and progestin,” says Chlebowski. “But it’s always difficult to figure out how to categorize that risk. It’s different for each woman.”

TIME Research

Most Women Experience Hot Flashes for Over 7 Years, Study Finds

Symptoms of the menopause last longer than previously thought

Hot flashes, night sweats and other symptoms of menopause typically affect women much longer than previously thought, a median of 7.4 years, according to a new study.

The study, published in JAMA Internal Medicine, looked at a group of nearly 1,500 women with frequent symptoms of the onset of menopause and found significant variations in duration of menopausal vasomotor symptoms (VMS) between ethnic groups.

African-American women experience symptoms for a median of 10.1 years, more than any other ethnic group. On average, Chinese and Japanese women experienced the symptoms for the shortest duration—5.4 and 4.8 years, respectively.

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.

Read More: Do Married People Really Live Longer?

“These findings can help health care professionals counsel patients about expectations regarding VMS and assist women in making treatment decisions based on the probability of their VMS persisting,” said the study, which notes that 80% of women experience such symptoms.

The study challenges the long-held notion that these experiences “minimally affect women’s health or quality of life and can be readily addressed by short-term approaches,” according to a commentary that accompanies the study.

TIME Reproductive Health

Beauty Products May Trigger Early Menopause

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Bogdan Kosanovic—Getty Images

Biology determines when women hit menopause, but exposure to some common household products and pollutants may drive that timing even earlier

Menopause, like puberty, is a reproductive rite of passage, and marks for women the end of their fertility and child-bearing years. But studies show that it’s not just age that can determine when menopause starts — exposure to certain chemicals and pollutants can also play a role.

In one of the most comprehensive looks at possible menopause-disruptors to date, researchers led by Dr. Amber Cooper, from the department of obstetrics and gynecology at Washington University in St. Louis, report in the journal PLOS ONE that such exposure can push menopause up by as much as four years.

Cooper and her team studied 31,575 women enrolled in the National Health and Nutrition Examination Survey conducted by the government. Every two years, the women were surveyed about various health and nutrition issues, including whether they had begun menopause. At some point between 1999 and 2008, each of the participants also provided at least one blood and urine sample which the scientists analyzed for the presence of various chemicals, including dioxins contained in pesticides, phthalates found in fragrance, plastics, cosmetics and hair spray, plant-derived estrogens, and polychlorinated biphenyls, among others. The researchers found that women with the highest levels of 111 of these chemicals on average had menopause anywhere from 1.9 years to 3.8 years earlier than those with lower levels.

How could Cooper be so certain that the exposure was linked to the early menopause? She and her team conducted other analyses, including one of women closer to menopause, between the ages of 45 and 55 years, and found a similar association. They also found that it wasn’t just exposure, but increasing exposure over time that was also connected to problems with ovarian function, another potential consequence of the chemicals on reproductive health. And when they looked at all of the women in the survey from age 30 years on, those with the highest blood and urine measurements were six times more likely to be menopausal than women with lower readings.

“This is the tip of the iceberg,” says Cooper, who stresses that the results don’t prove that exposure to these chemicals causes early menopause, only that the two might be connected somehow. ”We need more longitudinal studies to better understand each of these chemicals.”

Previous studies have linked certain chemicals to disruptions in the reproductive hormones, including estrogen, which can then have unhealthy effects on the heart and bone.

What’s concerning is the fact that with the majority of the chemicals, there isn’t much women can do to reduce their exposure. That’s because each of the compounds have different half lives, or time in which they can linger before completely breaking down. While PCBs have been banned in the U.S. since the 1970s, for example, their long half lives mean people may still be exposed to them in the soil, air and water, and in through animals or other things that have contact with them. Women can try to reduce their exposure to some of these chemicals by using products that do not contain synthetic fragrance—which is listed as “fragrance” or “parfum” and which contains phthalates. Women can also opt for organic beauty products, which would not contain pesticide residues and a number of other chemicals.

Cooper advises her patients to be more aware of their potential sources of exposure, including plastics in food packaging, and perhaps try microwaving only in glass and paper containers. “My goal is not to scare women, but raise awareness and promote future research,” she says.

TIME prostate cancer

Hypnosis Reduced This Person’s Hot Flashes By 94%

One man's hot flashes vanished with hypnosis

One man with terrible hot flashes—about 160 a week—found relief through hypnosis.

In a Baylor University case study recently published in the International Journal of Clinical and Experimental Hypnosis, a 69-year-old man referred to as Mr. W underwent seven weeks of hypnotic relaxation therapy for hot flashes, and had positive results.

Although it’s less common, men indeed can get hot flashes, though they are typically less inclined to seek treatment for them. Unlike women, whose hot flashes are usually related to changes in estrogen, prostate cancer survivors can develop hot flashes as well. Hot flashes due to prostate cancer can actually be more severe and last longer than hot flashes among women.

“If a guy has hot flashes, you can’t say, ‘Well, why don’t we put you on estrogen?’ But it’s a pressing problem,” said study author Gary Elkins, director of Baylor’s Mind-Body Medicine Research Laboratory in a statement.

Mr. W, who was a prostate cancer survivor, went under both hypnosis with a therapist, and self-hypnosis. During the hypnosis, Mr.W imagined he was at his favorite fishing spot, sitting on a bucket between two trees on a long shore of grass, watching the water early in the morning. The hypnosis transcript would tell he would experience comfort and coolness, and that he would feel a cool breeze coming across the lake and would feel it on his face. Mr. W reported that he learned how to stop his hot flashes with self-hypnosis, and by the end of the sessions, he had a 94% decrease in hot flashes and a 87% increase in sleep quality.

The findings support earlier studies from the researchers on postmenopausal women and breast cancer survivors. People have varying responses to being hypnotized, but the researchers are hopeful, since it could be a cost effective way for people to deal with their symptoms themselves, without drugs.

TIME menopause

The Best Cures for Hot Flashes

Non-hormonal treatments for hot flashes and night sweats work as well as estrogen therapy, study says

For many women, the symptoms of menopause can feel unbearable, especially those hot flashes and night sweats. Although there’s continuous debate over the risks and benefits of hormone therapy, current recommendations are that women undergoing treatment should take the smallest dose for only a brief period of time. For women who want care for longer, there’s a desire for a non-hormonal alternative.

Estrogen therapy tends to be the go-to treatment, but Brigham and Women’s Hospital (BWH) researchers looked at whether a non-hormonal treatment called venlafaxine hydrochloride is just as effective. Generally, the authors note, venlafaxine hydrochloride is thought to be an inferior treatment.

(MORE: The Truth About Hormones)

The researchers had 339 perimenopausal and postmenopausal women with at least two bothersome symptoms a day take either estrogen therapy, venlafaxine hydrochloride, or a placebo. They discovered that estrogen therapy and venlafaxine hydrochloride were similarly successful at combating menopause-related problems.

After eight weeks, hot flash and night sweat frequency went down by 52.9% among the women taking low-dose estradiol (estrogen therapy) and 47.6% among women taking venlafaxine. Symptoms went down by 28.6% for women taking placebo. The researchers acknowledge that while the findings show estrogen therapy had a slight edge over venlafaxine, it was so small that it’s considered of low clinical significance.

Treating menopause symptoms got complicated when the 2002 Women’s Health Initiative (WHI) study, a 15-year investigation into the factors that contribute to the health of postmenopausal women, was halted three years early when an early data review showed women taking the combination of estrogen and progestin had a higher rate of breast cancer, heart disease and stroke than women taking a placebo. In 2012, the U.S. Preventive Services Task Force confirmed the WHI trial’s findings, concluding after a review of 51 studies published since 2002 that the risks of HRT outweighed the benefits. Given the potential risks, there’s a push to find other options.

The knowledge that treatments that don’t involve hormones are effective and available, is therefore extremely valuable for women seeking relief, the study concludes.

The study is published in the journal JAMA Internal Medicine.

 

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