Sunday, 19 December 2010

News on Hormone Replacement Therapy from #Menopause Matters

A recent report from the San Antonio Breast Cancer Symposium showed that estrogen only use in postmenopausal women reduced the incidence of breast cancer. The information is based on further analysis of the Women’s Health Initiative ( WHI ) trial, and in fact, this finding was reported in 2004, two years after the initial publication from the trial, but received very little publicity at that time. The message in 2002 was that HRT had been shown to have significant risks and that the risks may outweigh the benefits. Almost overnight, the confidence in the use of HRT was lost, such that many women stopped taking HRT and many doctors stopped prescribing.
So why now the complete turn around according to information from the same study?
The results reported in 2002 were from the whole age range of women in the trial, who were aged between 50 and 79 years and these women had taken combined HRT (estrogen plus progestogen) or placebo. The highly publicised risks, which included increased risk of breast cancer, were in fact very small and when different age groups were later reviewed, the risks of combined HRT for women under 60 years, who are most representative of women who generally take HRT for symptom control, were minimal and for most of these women, combined HRT provided more benefits than risks. The risk of breast cancer in this group was increased only if women had taken combined HRT before the trial, and then for the 5 years of the trial and thereafter was of the order of 8 extra per 10,000 women per year.
This new report confirms the findings published in 2004 for the group of women in the trial who had had a hysterectomy and took either estrogen only HRT or placebo. In the women taking estrogen only, the risk of breast cancer was reduced, suggesting that estrogen alone acts differently on the breast compared to estrogen combined with progestogen. It could be suggested then that more women should be encouraged to take estrogen only HRT , but if the uterus is still present, some form of progestogen must still be given to prevent estrogenic stimulation of the lining of the uterus. Research and developments should now be focused on HRT which provides the benefits of estrogen on symptom control, bone protection and cardiovascular protection, while minimising the need for progestogen.
When considering the use of HRT, women and their doctors or nurses need to consider potential risks and benefits of HRT , and of different types. Balancing risks and benefits is not unique to HRT and takes place with the use of many medications. Other risk factors for breast cancer exist and include a history of breast cancer in mother or sister, paternal aunt or grandmother, increased breast density at mammograms, certain types of breast disease, obesity, alcohol and physical inactivity. Factors that reduce the woman’s risk of breast cancer include an early age of first full-term pregnancy, long-term breast feeding, exercise and no history of fibrocystic breast disease. These findings should be considered when prescribing or considering hormone therapy in postmenopausal women.
It is becoming very clear that the initial reports from the WHI trial exaggerated risks of HRT and that in fact for most women, when use appropriately, the benefits of HRT outweigh the risks, especially in women able to use estrogen only.

Commenting for the International Menopause Society, Professor David F. Archer, MD ( Norfolk , VA , USA ) said:
The re-analysis of the WHI data is reassuring to both women and physicians that women at low risk for breast cancer do not increase the incidence of breast cancer while using conjugated estrogen-only therapy. This finding supports the position of the International Menopause Society that any decision on the use of hormone therapy be based on an assessment of individual risks and benefits. These are different for each woman, and so the decision on hormone use should be taken after evaluating the risks and benefits, and subsequent discussions between a woman and her physician.

See much more about the menopause, and treatment options at

Sunday, 12 December 2010

News from #menopause matters

It really is worth trying really hard to lose weight if you are menopausal! A new study looking at the effects of weight loss on urinary symptoms in menopausal women also showed a reduction in menopausal symptoms. Weight loss of course also reduces cardiovascular risk, which increases in women after the menopause and is by far the number one cause of death in postmenopausal women. Use the time of the menopause to think about diet and lifestyle factors which can not only reduce menopausal symptoms, but also reduce risk of later health problems.
Woman's Hour featured an interesting discussion on HRT, listen again at
The WHI trial continues to hit the headlines, the latest confirming the finding that women in the trial who had had a hysterectomy and took estrogen only, had a lower risk of breast cancer than those taking placebo. Increasingly, estrogen has been shown to have many benefits and HRT should be seen as an important option for treating menopausal symptoms.
We have upgraded our website to include a new section on Premature Menopause at  , information on psychological symptoms of the menopause at , an updated section on Contraception at and a redesigned index which is clearer and easy to navigate.
Finally, issue 22 of Menopause Matters magazine is now available and you can subscribe for only £15.00 per year. Subscriptions help us to continue to fund and develop Menopause Matters, helping women UK-wide, and world-wide.

Tuesday, 7 December 2010

Psychological symptoms of the #menopause

Many women are aware that the menopause can cause hot flushes and sweats, which may be mild or severe and can last for a short time, or for many years. Although hot flushes (known as flashes in the USA) are the most well recognised symptom of the menopause, there is still much to learn about their actual cause and why they affect women so differently. There is even more to learn about the psychological symptoms of the menopause, which are often unrecognised with little awareness of their association with the menopause. See our new section on psychological symptoms, from a respected author at

Wednesday, 1 December 2010

Gastric cancer risk and #hormones

A new study has shown a link between hormone exposure, both before and after the #menopause, and reduced risk of gastric cancer. See full story at

Sunday, 28 November 2010

Menopause Matters News

We are delighted that we have again been awarded the seal of approval from the Health on the Net Foundation who have recommended  as a good quality health information site. This international award is reviewed annually and it is fantastic to have been awarded this recognition for the 7th year running.
We are also delighted with the next issue of Menopause Matters magazine, out soon and bursting with essential information, personal stories, exercise tips, recipes and much more. Subscribe at for only £15.00 per year. Your support helps us to continue to fund and develop Menopause Matters and help women UK and world wide.
Finally, please take a few minutes to complete our nationwide survey at

Wednesday, 24 November 2010

Vaginal Dryness

Oils, gels, lubricants, what to use?
Vaginal dryness is a very common consequence of the menopause and is due to the effect of estrogen deficiency on the vagina; blood supply, secretions and natural lubrication are all reduced. When this occurs along with thinning of the vaginal walls and loss of elasticity, the vagina can feel dry, itchy and generally uncomfortable, sometimes described as “broken glass” or like a “cheese grater”. Inevitably, this discomfort, reduced sensitivity and reduced response in the vagina, labia and clitoral areas, can have a significant effect on the pleasure of and desire for sexual activity, often leading to emotional distress and relationship problems. Further, vaginal dryness doesn’t just affect sexually active women, discomfort can occur just from sitting or wearing tight clothing.
To treat the underlying cause of estrogen deficiency, replacing estrogen can be extremely effective. This can be either in the form of Hormone Replacement Therapy (HRT) and would be used when other menopausal symptoms such as flushes, sweats, mood changes etc are also present, or, if the vaginal/genital symptoms are the main complaint, can be in the form of vaginal estrogen as a small vaginal tablet (Vagifem), pessary (Orthogynest), cream (Gynest or Ovestin) or a vaginal ring (Estring). These provide a very low dose of estrogen concentrated in the vaginal/genital area and are effective and safe, treating the cause—estrogen deficiency. Both HRT and vaginal estrogens need to be prescribed by a doctor or prescribing nurse.
Many women notice reduced lubrication during sexual activity early on in the menopausal process and wish to manage this, at least initially, with simple lubricants. Many types and brands of lubricants are now available and it can be difficult knowing which one to choose.
Some vaginal products may affect the effectiveness of condoms, whether used for contraception or for preventing sexually transmitted infections. Petroleum-based products (Vaseline, mineral oil and baby oil) may break down latex and can increase the risk of sexually transmitted diseases (or pregnancy) whereas water based products are unlikely to do so.
The most commonly used preparation is K-Y Jelly. K-Y Jelly was first patented in 1904 as a surgical lubricant, for short lasting lubrication during a vaginal examination, perhaps not ideal for a longer lasting effect required during sexual activity. More recently, preparations have been developed which are designed more specifically for reducing vaginal dryness and discomfort. These include Replens, Yes, Sylk, Astroglide, a range of Durex products and, the vaginal ovule, Repadina.
With many options to choose from, vaginal dryness can be treated and need not be simply endured.

Wednesday, 20 October 2010

Insomnia and the menopause

The menopause affects all women and occurs, on average, at the age of 52 years in the western world. Despite around half the population being affected, there is still so much to learn, so much uncertainty and so much confusion around this inevitable phase of a women's life.  Most people associate the menopause with flushes and sweats, but are unaware of the multitude of symptoms that can occur, several of which will be discussed in future blogs. One of the most distressing symptoms is sleep disturbance, or insomnia. Different patterns of sleep disturbance can occur: difficulty getting to sleep, difficulty staying asleep, and early morning wakening, all of which can have a devastating affect on coping, mood, attention and general functioning.
Simple measures such as reducing caffeine intake, taking a hot bath in the evening and generally having time to relax can help, but estrogen replacement in the form of Hormone Replacement Therapy will often cure the problem. Despite much publicity around risks of HRT, when used appropriately in the early menopausal years, the benefits will outweigh the risks for most women.
For more information, advice, downloadable leaflets, podcasts, video clips and a very active online support group, visit the award winning, independant clinician-led website