North American Menopause Society

Menopausal symptoms more troublesome for cancer survivors.

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Recent data suggest that the severity of menopausal symptoms tends to be worse in women who survive cancer compared with other women. However, psychological and social quality of life measures were better among cancer survivors, researchers wrote.

“The reason for this difference in emotional well-being is not known but may be attributable to the better social and psychological support associated with a cancer diagnosis compared with that ofmenopause,” Jennifer L. Marino, MPH, PhD, of the department of obstetrics and gynecology at the University of Melbourne in Australia, and colleagues wrote.

The researchers measured differences in symptoms, severity, impact on quality of life and sexual function between cancer survivors and non-cancer patients at The Menopause Symptoms After Cancer Clinic.

The researchers recorded cancer survivors’ (n=934) and non-cancer patients’ (n=155) menopausal symptoms using the Greene Climacteric Scale; past-week symptoms using the Functional Assessment of Cancer Therapy breast cancer subscale and endocrine symptom

Subscale; and sexual symptoms using Fallowfield’s Sexual Activity Questionnaire.

The majority of patients were previously diagnosed with breast cancer (82%), while a smaller proportion was diagnosed with gynecological cancer (10.5%), or hematologic and colorectal malignancies (7.5%).

According to data, cancer survivors were more likely to be severely affected by vasomotor symptoms such as hot flushes and night sweats (OR=1.71; 95% CI, 1.06-2.74) and reported more frequent (6 vs. 3.1 in 24 hours;P<.001) and more severe (P=.008) hot flushes, compared with non-cancer patients.

 “Seventy-nine percent of cancer survivors and 61% of non-cancer participants reported current severe vasomotor symptoms. Thirty-six percent of cancer survivors and 23% of non-cancer participants scored in excess of the upper bound of the published reference range for vasomotor symptoms,” researchers wrote.

Conversely, cancer survivors demonstrated less psychological and somatic symptoms compared with non-cancer patients (P<.001). Further, they reported better quality of life. However, there were no statistically significant variations in physical or functional well-being, gynecologic symptom severity or sexual function, researchers wrote.

“Both expected and surprising, these results highlight that all menopausal women, including cancer survivors, need effective treatment options for their hot flashes and sexual symptoms,” Margery Gass, MD, executive director of the North American Menopause Society, said in a press release.

PERSPECTIVE

 

JoAnn E. Manson

  • A burgeoning number of women worldwide are both cancer survivors and entering menopause. It is clearly a clinical challenge to treat menopausal symptoms in women with a history of cancer because many are not candidates for estrogen therapy. The study by Marino and colleagues indicates that cancer survivors may have a higher prevalence and severity of vasomotor symptoms than women without a history of cancer. The findings highlight the importance of evaluating cancer survivors for the presence of menopausal symptoms, assessing their needs for treatment and discussing available treatment options. Additional research in this field and an expanded arsenal of nonhormonal treatment options for menopausal symptoms will be essential to improve the clinical care of this growing patient population. In this regard, the recent approval by the FDA of a nonhormonal treatment for vasomotor symptoms is a step in the right direction.
  • JoAnn E. Manson, MD, DrPH, NCMP
  • Past-president of the North American Menopause Society
    Endocrinologist and professor of medicine, Harvard Medical School and Brigham and Women’s Hospital
    Chief of Preventive Medicine, Brigham and Women’s Hospital

 

Source: Endocrine Today

Hormone Therapy Has Many Favorable Effects in Newly Menopausal Women: Initial Findings of the Kronos Early Estrogen Prevention Study (KEEPS)

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Estrogen /progesterone treatment started soon after menopause appears safe and relieves many of the symptoms menopausal women face as well as improving mood and markers of cardiovascular risk, according to a multicenter randomized study

presented at the North American Menopause Society (NAMS) Annual Meeting in Orlando, Florida.

 

“The KEEPS provides invaluable information for women close to menopause and their clinicians,” said S. Mitchell Harman, MD PhD, director of the the Kronos Longevity Research Institute, the organization that sponsored the study. “The data showed improvements in cognition, mood, menopausal symptoms, and sexual function in younger women. In addition, some measures showed slight evidence that hormone therapy might be cardio-protective in this age group, although results were not definitive and would require additional study.”

 

The Kronos Early Estrogen Prevention Study (KEEPS) was a four-year randomized, double-blinded, placebo-controlled clinical trial of low-dose oral or transdermal (skin patch) estrogen and cyclic monthly progesterone in healthy women aged 42-58 (mean age, 52) who were within three years after menopause at randomization.  727 women were randomized into the following three arms, along with cyclical micronized progesterone (Prometrium®):

–    Oral conjugated equine estrogens (o-CEE) given as Premarin®, 0.45 mg/day  (a lower dose than the 0.625 mg/d used in the Women’s Health Initiative [WHI])

–    Transdermal Estradiol (t-E2) given by Climara® patch, 50 µg/day

–    Placebo

 

Measurements showed that:

    Neither o-CEE nor t-E2 significantly affected systolic or diastolic blood pressure, in contrast to the higher dose of CEE in the Women’s Health Initiative (WHI), which increased blood pressure levels.

    Oral CEE, but not t-E2, was associated with an increase in HDL (“good”) cholesterol. The o- CEE group had a decrease in LDL (“bad”) cholesterol, but also an increase in triglyceride levels (a lipid fraction that is of uncertain significance as an independent risk factor). t-E2 had neutral effects on these biomarkers.

    Transdermal E2 appeared to improve insulin sensitivity (lower insulin resistance) calculated from glucose and insulin levels as “HOMA-IR.”

    During 48 months of treatment with either type of hormone therapy (HT) vs placebo, there were no apparent effects, either beneficial or deleterious, on atherosclerosis progression

assessed by carotid ultrasound and a non-significant trend toward less accumulation of coronary artery calcium (CAC). We conclude that hormone treatment at the doses employed

and in this healthy, recently menopausal population neither significantly reduced nor accelerated progression of atherosclerosis as measured by arterial imaging.

    Improvements in hot flashes, night sweats, mood, sexual function, and bone density were observed with HT vs placebo.

    No significant differences in adverse events (breast cancer, endometrial cancer, myocardial infarction, TIA, stroke, or venous thromboembolic disease) were found among groups. However, the absolute numbers of such events were extremely small in all three treatment groups, making definitive conclusions impossible.

 

Conclusions: KEEPS found many favorable effects of HT in newly menopausal women. The results provide reassurance for women who are recently menopausal and taking HT for short-term treatment of menopausal symptoms.  KEEPS also highlights the need for individualized decision making about hormone therapy, given that o-CEE and t-E2 may have different profiles of effects and different women have different symptom profiles and priorities for treatment. Additional research on HT in newly menopausal women, including differences in effects according to route of delivery, dose, and formulation of hormone therapy, is needed.

 

About Funding

The core KEEPS was funded by the Phoenix-based Kronos Longevity Research Institute which is supported by the not-for-profit Aurora Foundation and carried out at nine U.S. academic medical centers (see appendix). The Cognitive and Affective Study is National Institutes of Health funded ancillary study of KEEPS that was coordinated by investigators based at the University of Wisconsin in Madison, WI.

 

About KLRI

KLRI is a not-for-profit 501(c)(3) organization that conducts state-of-the-art clinical translational research on the prevention of age-related diseases and ways to increase longevity.

Translational research is the critical link between findings from the basic research laboratory and corresponding improvements in clinical care.

Source: KLRI

Hormone Therapy Soon After Menopause: New Findings Get Attention .

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Patients may want to discuss widely reported findings about hormone therapy for early menopausal symptoms presented Wednesday evening at a North American Menopause Society meeting.

The Kronos Early Estrogen Prevention Study (KEEPS) randomized some 700 women within 3 years after menopause to 4 years’ treatment with micronized progesterone (Prometrium) plus either oral conjugated equine estrogens (Premarin, 0.45 mg/day), transdermal estradiol (Climara patch, 50 μg/day), or placebo.

“The data showed improvements in cognition, mood, menopausal symptoms, and sexual function in younger women,” Kronos Longevity Research Institute director S. Mitchell Harman said in a news release. “In addition, some measures showed slight evidence that hormone therapy might be cardio-protective in this age group, although results were not definitive and would require additional study.”

The trials results have not yet been published.

Source:NAMS news release