HRT

Early menopause and HRT among hormonal factors linked to heightened rheumatoid arthritis risk

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  • Researchers are reporting that hormonal changes related to menopause and hormone replacement therapy may increase the risk of developing rheumatoid arthritis.
  • Women who have more than four children could also have a higher risk of developing the painful condition.
  • Researchers note that women are two to three times more likely to develop rheumatoid arthritis, which could explain why estrogen may be involved in raising the risk.

Having four or more children, developing early menopause, and getting hormone replacement therapy are some factors that might contribute to the development of rheumatoid arthritis in older women.

That’s according to a new study published in the journal RMD Open.

Researchers collected data from 223,526 women who were UK Biobank participants. The scientists looked at information on hormonal and reproductive factors related to rheumatoid arthritis.

They reported that a number of factors increased the risk of developing rheumatoid arthritis, albeit to different degrees.

The scientists followed the women for an average of about 12 years. During that time, 3,313 (1.5%) developed rheumatoid arthritis.

Specifically, the scientists found the following results:

Pregnancy and the number of children

There wasn’t a significant difference between women who had been pregnant and those who had not.

However, researchers said there was an association between the number of children and rheumatoid arthritis risk.

The scientists reported that women who had four or more children were at higher risk of developing the disease.

Age at first period

The researchers used 13 as the reference age of the first period.

They found that women who were 12 and younger or older than 14 had a higher risk of developing rheumatoid arthritis.

However, those over age 14 had a more substantial risk than those who were younger than 12.

Menopause-related risk factors

The researchers reported that women who were older and had longer childbearing years had a greater risk of developing rheumatoid arthritis.

Postmenopausal women were also at a higher risk.

The number of years between the first period and menopause are reproductive years. Women who had less than 33 years between the two stages had a higher risk of rheumatoid arthritis.

The researchers also found that women who had a hysterectomy or oophorectomy had a higher risk.

Exogenous hormone use

The scientists did not find a direct link between oral contraceptives and rheumatoid arthritis.

However, they reported an association between the length of time the women took the contraceptives compared to those who had never used them.

Reaction to the rheumatoid arthritis risk study

“[This is] a fascinating and novel study exploring the relationship between the hormonal milieu and the development of RA (rheumatoid arthritis),” said Dr. Kecia Gaither, an OB/GYN and a specialist in maternal fetal medicine as well as the director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx.

“It is well known that women are two to three times more likely to develop this disease over men, so that fact that estrogen may inherently be involved lends credence to the observation,” Gaither, who was not involved in the study, told Medical News Today.

“However, there are a myriad number of risk factors related to RA development besides sex,” she added. “Obesity, prior joint damage, periodontal disease, tobacco abuse, stress, and low socioeconomic status (which has stress as an underlying denominator).”

Tailoring treatment for rheumatoid arthritis

Rheumatoid arthritis can show up differently in women than in men, according to the National Institute of HealthTrusted Source.

For example, some people can have a few stiff joints with mild inflammation. Another person might have additional inflamed joints.

Triggers can also be different. One person might find viral infections cause a flare of symptoms. Another might see the condition develop with stress.

Experts say these differences mean physicians should tailor treatment to individuals.

“For some women, when they are faced with menopause and the loss of hormones, specifically estradiol, they may see a rise in RA symptoms,” said Dr, Michael Krychman, an OB/GYN and the medical director of Women’s Health Services at MemorialCare Saddleback Medical Center in California.

“It is important for [healthcare professionals] to look at the complete picture, and while data is confusing and there may be some conflicting results (some studies show no exacerbation of RA symptoms during menopause), it remains important to practice precision and tailor a woman’s specific health plan to her global symptoms,” Krychman, who was not involved in the study, told Medical News Today.

“I think this information can be utilized to have more cogent discussions with patients, particularly those who have a family history of RA and have other associated risk factors,” Gaither said. “Referral to a rheumatologist, given the parameters noted in the study and with family history and other noted risk factors, would be a prudent course of action.”

However, a referral isn’t the end of the process.

A study published in the scientific journal PNAS found that “structured information–sharing networks among clinicians significantly reduce diagnostic errors and improve treatment recommendations, as compared to groups of individual clinicians engaged in independent reflection.”

“The importance of collaboration and data review is essential when you have a chronic medical condition such as RA,” said Krychman. “As a women’s health menopausal expert, I collaborate and work closely with my patient’s rheumatologist to tailor her hormone therapy and analyze her symptoms.”

Dementia Risk and HRT; Gut Alterations and Alzheimer’s; Prescription Opioids and MS

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News and commentary from the world of neurology and neuroscience

Hormone replacement therapy (HRT) was associated with an increased dementia risk in a population-based, longitudinal study in Taiwan. (Neurology)

Post-9/11 U.S. veterans with a history of traumatic brain injury (TBI) were more likely to develop cardiovascular disease than veterans without a TBI history. (JAMA Neurology)

Gut microbiota alterations were seen in Alzheimer’s dementia patients in Kazakhstan, with correlations found between disease severity and certain fecal bacteria. (Scientific Reports)

A meta-analysis reported evidence of a likely causal relationship between a reduction of brain amyloid and less cognitive and functional decline in Alzheimer’s patients. (Alzheimer’s & Dementia)

A woman born without a left temporal lobe described her life as a research subject and her quest to understand brains like hers. (New York Times)

Prophylactic levetiracetam (Keppra) appeared to prevent acute seizures in intracerebral hemorrhage, a small trial showed. (Lancet Neurology)

Prescription opioid use was more common in multiple sclerosis (MS) patients than in those without MS, with mood and anxiety disorders tied to longer opioid use. (Journal of Neurology, Neurosurgery & Psychiatry)

The FDA approved a first-in-market 10 mg midazolam autoinjector to treat status epilepticus in adults, Rafa Laboratories announced.

Coma may be more prevalent in the U.S. than the U.K., crowdsourcing data suggested.

HRT Benefits Outweigh Risks for Certain Menopausal Women

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Menopause Society statement aims to clear up confusion

Every year at this time, MedPage Today‘s writers select a few of the most important stories published earlier in the year and examine what happened afterward. One of those original stories, which appeared June 20, is republished below; click here to read the follow-up.

Hormone therapy is an effective treatment for vasomotor symptoms and genitourinary syndrome due to menopause among certain women, according to recommendations from the North American Menopause Society (NAMS).

In an update of their 2012 Hormone Therapy Position Statement, NAMS suggested the benefits of hormone therapy, particularly for vasomotor symptoms, outweigh the risks among women under age 60, within a decade of the onset of menopause without other contraindications, who also have an increased risk of fracture or bone loss.

Current FDA-approved indications for hormone therapy include the treatment of vasomotor symptoms, prevention of bone loss, genitourinary symptoms, and premature hypoestrogenism caused by castration, hypogonadism, or primary ovarian insufficiency.

The 2017 position statement appears in Menopause: The Journal of The North American Menopause Society.

“There continues to be confusion and fear for women and their providers about the use of hormone therapy for menopausal women,” said JoAnn V. Pinkerton, MD, executive director of NAMS to MedPage Today. “The availability of new clinical trial data, observational studies, and analyses of large trials prompted NAMS to decide to update its position statement.”

Pinkerton, who is a co-author of the position statement, added that “New data includes updates on the large Women’s Health Initiative; new analyses focused on age and time since menopause; and new observational studies providing information about effect of hormone therapy during and after its use.”

An advisory panel of clinicians and researchers in the field reviewed the 2012 NAMS position statement on hormone therapy, and conducted an evidence-based analysis from a literature review.

They stated that the use of estrogen therapy in the right candidates should be administered in the lowest effective dose that meets treatment goals for the patient and healthcare provider. Progestogen therapy among patients with a uterus should be considered in the context of the dosage of estrogen it is combined with, as well as its own potency.

The statement noted that prescribers should acknowledge “different types and doses of progestogens, routes of administration, and types of regimen (sequential or continuous-combined) may have different health outcomes.”

The group suggested there are notably higher risks with initiation of hormone therapy after a decade of the onset of menopause, or among women who are over the age of 60, citing an increased absolute risk for cardiovascular harms including stroke, coronary heart disease, venous thromboembolism, and dementia.

The statement also noted that for women who exclusively have genitourinary syndrome symptoms, such as urinary, vulvar, and vaginal-related symptoms alone, low-dose vaginal estrogen therapy, such as creams, rings, and tablets that contain estradiol or conjugated equine estrogens are considered “generally safe,” but should be more closely considered among women with breast cancer.

Patients who require longer durations of hormone therapy, such as to treat persistent vasomotor symptoms or continued bone loss, should determine the benefit-risk profile with her healthcare provider in addition to reassessment during treatment, the statement recommended.

The updated statement also noted there are differing benefit-risk profiles when it comes to various hormone therapy administration, such as whether the treatment is given orally, through transdermal patches, vaginal rings, or through sprays or gels. Duration of treatment, progestogen-accompaniment, and the age of the patient at treatment in relation to the onset of menopause are all important factors in regards to hormone therapy, Pinkerton highlighted.

However, the U.S. Preventive Services Task Force (USPSTF) recently released a draft recommendation statement, which recommended against combined estrogen and progestin treatment for postmenopausal women for the primary prevention of chronic conditions. Specifically, the disease-prevention benefits from hormone therapy, for chronic diseases such as diabetes and heart disease, were outweighed by the cardiovascular risks, according to the task force.

Additionally, the USPSTF recommended against use of estrogen therapy among postmenopausal women who have undergone a hysterectomy with the goal of prevention of chronic conditions (“D” recommendation), noting that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

This echoes NAMS’ findings regarding the increased absolute risk for certain populations. However, their updated position statement specifically assessed hormone therapy for symptomatic treatment for menopausal symptoms, not chronic disease prevention.

Despite the range of recommendations regarding hormone therapy, the NAMS updated position statement was endorsed by several medical organizations around the world, including the American Association of Clinical Endocrinologists.

Pinkerton told MedPage Today she hopes the updated position statement will take fear out of the conversations about hormone therapy for menopausal women.”

“Our goal is that this comprehensive review of hormone therapy by national and international experts will give women and providers confidence about using hormone therapy when it is indicated,” she said.

HuffPo Censored and Deleted Anti-Pharma Vaccine Post From Their Website. Read It Here.

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Censorship is alive and well!

In case you missed it, a contributing editor for The Huffington Post managed to slip a shockingly honest vaccine editorial by the Big Pharma watchdogs this morning. The article, titled “Vaccines Are Totally Safe Say The People Who Brought Us Vioxx, Bextra, Trovan, Phen-Fen, Xarelto, Raxar, and Seldane…”, remained published on HuffPo’s site for just a few hours before it was taken down.

When you try to find the article, the link now directs you to a message reading “This post from The Huffington Post Contributor Platform is no longer available on our site.”

Good thing someone was able to screen shot the entire article!

Here is the full article written by Martha Rosenberg. While I disagree strongly that there is such a thing as a safe or necessary vaccine, the rest of the article is brilliantly honest and the Huffington Post should be ashamed of themselves for the role they play in harming our children by censoring such important information.

“Vaccines Are Totally Safe Say The People Who Brought Us Vioxx, Bextra, Trovan, Phen-Fen, Xarelto, Raxar, and Seldane…”

by Martha Rosenberg

It is not surprising mainstream scientists are vaccine absolutists who vilify anti-vaccine activists given that their medical centers, hospital wings, universities and sometimes personal paychecks are funded by Pharma. What is surprisingly is that progressive news sites that challenge government pronouncements on every other level also vilify anti-vaccine activists as “unscientific.”

Are progressive news sites forgetting Vioxx, Bextra, Baycol, Trovan, Meridia, Darvon, HRT, Phen-Fen, Raxar, Seldane, Ketek, Avandia and Xarelto—-all called safe when they were making millions?

Neither mainstream or progressive news sites want to acknowledge the existence of the federal National Vaccine Injury Compensation Program (VICP) which, since 1988, has settled more than 16,000 claims and awarded $3.18 billion in injury settlements. When I asked a vaccine expert why the court existed if vaccines are unremittingly safe he told me that vaccines are so basic to public health yet so non-lucrative (compared to billion dollar pills), the government does not want vaccine makers bankrupted by lawsuits.

But ignoring the court and the ghastly injuries it settles—I was told, off the record, about a woman who lost her fingers and toes from vasculitis caused by a vaccine—mainstream scientists are the ones who are “unscientific.” The truth is not all vaccines are safe, life-saving or necessary and conflicts of interest do exist. Consider the case of Gardasil, a vaccine against the human papillomavirus vaccine types 6, 11, 16, 18.

The Case of Gardasil

A few years ago, Merck aggressively marketed Gardasil, a vaccine against the HPV virus (which is linked to venereal warts and cervical cancer)—even in poor countries where cervical cancer is hardly a leading cause of death compared to malaria or diarrheal diseases. (In developed countries, a Pap test is as effective as a vaccine in preventing cervical cancer.)

Last year, judges in India’s Supreme Court demanded answers after children died during a trial of Gardasil and Cervarix, GlaxoSmithKline’s counterpart vaccine, a few years earlier.

According to CBS News there was another cloud over Gardasil. “Merck gave $6,000 to [Texas Gov. Rick] Perry’s election campaign fund as part of a national lobbying effort to persuade states that it ought to require Gardasil as one of the vaccines all kids should have before attending school,” it wrote. The director of a Merck-funded pro-Gardasil group was also Perry’s then-chief of staff’s mother-in-law.

Nor did the departure of former CDC director Julie Gerberding to head Merck’s vaccines division look right to many ethics specialists.

Docs Gone Bad

Mainstream scientists have savaged Andrew Wakefield, a British medical researcher found to have conducted fraudulent research linking the measles, mumps and rubella (MMR). His corruption is said to disprove any scientific doubts about vaccine safety.

Yet when researchers in the U.S. have been so corrupt they have gone to jail, mainstream scientists still accept their research. Scott Reuben published fraudulent research on Lyrica, Effexor, Celebrex and other drugs for Pharma. He went to prison for six months but the “science” behind the drugs he promoted stands. Richard Borison, former psychiatry chief at Augusta Veterans Affairs (VA) medical center and Medical College of Georgia, went to prison for 15 years for using clinical trials on veterans of the antipsychotic Seroquel to line his own pockets. The drug went on to earn billions and his for-profit “research” still stands.

As a reporter I have interviewed a man whose blindness was caused by a 1976 flu vaccine for which the government compensated him. More recently I interviewed a parent whose normal toddler was never the same after a vaccine and is now institutionalized. “He cried hysterically for 24 hours,” the parent, who is a medical practitioner, told me.

Pharma is unwise to cast such parents, of whom there are many, as “nuts.” The degeneration of their child is not their imagination. Also, there is no defensible reason for vaccines to be given all at once to a child, which many say heightens risks. Administering clusters of vaccines—once not given to children—has been called a major, new profit center for pediatricians.

But anti-vaccination activists should also not be absolutist. Vaccines are not a “conspiracy”—they are Pharma business as usual. Many are life-saving. Would anyone refuse a rabies vaccine after being bitten by a rabid raccoon? A tetanus shot after a serious wound? Would responsible parents deny their child a whooping cough or polio vaccine?

Like all drugs aggressively marketed these days, patients and parents need to do their own research and weigh benefits and risks—never forgetting Pharma’s spotty safety record.

Hormone Therapy and Dementia Risk: A Critical Window?

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A prospective cohort study reveals a decreased risk for dementia in women taking HT in midlife but an increased risk for those taking HT in later life.

Several observational studies have demonstrated a reduced risk for dementia in women who use hormone therapy (HT). However, well-designed interventional trials of estrogen–progesterone combinations have revealed an increased risk for dementia, cancer, and vascular events associated with HT use. This prospective cohort study was designed to further investigate the critical window theory that estrogen is beneficial only immediately before and immediately after menopause and may have deleterious effects in later life. More than 5000 women without dementia at baseline had been screened between ages 40 and 55 and reported whether they used HT (i.e., midlife use). Thirty years later, the authors identified participants’ HT use (i.e., later-life use) from pharmacy databases. Starting when the cohort reached a median age of 80, the authors identified dementia from ICD-9 coding of diagnoses by neurologists, neuropsychologists, and internists; dementia assessment lasted 7.5 years.

During dementia assessment, 27% of the cohort received a diagnosis of dementia. Women who reported taking HT at midlife but had no evidence of later-life HT use had a significantly decreased risk for dementia diagnosis (adjusted hazard ratio, 0.74). In contrast, those who did not report midlife HT use but had evidence of later-life use had a significant increase in risk (AHR, 1.48). Women who had used HT in both midlife and later life had similar risks to those of women who had no evidence of HT use.

Comment: This study is potentially confounded by self-report data in its early phase and by the limitations inherent in the accuracy of pharmacy records and diagnostic coding in its later phase. Nonetheless, the findings unify data from observational and interventional studies of women using hormone therapy. Moreover, the findings are consistent with animal modeling of a critical window of estrogen-related neuroprotection, which is reportedly associated with improved cerebral blood flow and glucose use and with reduced amyloid deposition in the brain. The bottom line clinically is that HT use around menopause may help protect against dementia, but later use may increase risk.

— Brandy R. Matthews, MD

Published in Journal Watch Neurology January 4, 2011