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Menopause. 2004 Jan-Feb;11(1):11-33 Publication Type: Practice Guideline
Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society.
North American Menopause Society.
North American Menopause Society, Cleveland, OH 44101, USA.
OBJECTIVE: To create an evidence-based position statement regarding the treatment of vasomotor symptoms associated with menopause.
DESIGN: The North American Menopause Society (NAMS) enlisted clinicians and researchers acknowledged to be experts in the field of
menopause-associated vasomotor symptoms to review the evidence obtained from the medical literature and develop a document for
final approval by the NAMS Board of Trustees. RESULTS: For mild hot flashes, lifestyle-related strategies such as keeping the
core body temperature cool, participating in regular exercise, and using paced respiration have shown some efficacy without
adverse effects. Among nonprescription remedies, clinical trial results are insufficient to either support or refute efficacy
for soy foods and isoflavone supplements (from either soy or red clover), black cohosh, or vitamin E; however, no serious
side effects have been associated with short-term use of these therapies. Single clinical trials have found no benefit for
dong quai, evening primrose oil, ginseng, a Chinese herbal mixture, acupuncture, or magnet therapy. Few data support the
efficacy of topical progesterone cream; safety concerns should be the same as for other progestogen preparations. No
clinical trials have been conducted on the use of licorice for hot flashes. Among nonhormonal prescription options,
the antidepressants venlafaxine, paroxetine, and fluoxetine and the anticonvulsant gabapentin have demonstrated some
efficacy for treating hot flashes and were well tolerated. Two antihypertensive agents, clonidine and methyldopa,
have shown modest efficacy but with a relatively high rate of adverse effects. For moderate to severe hot flashes,
systemic estrogen therapy, either alone (ET) or combined with progestogen (EPT) or in the form of estrogen-progestin
oral contraceptives, has been shown to significantly reduce hot flash frequency and severity. Clinical trials have
associated ET/EPT with adverse effects, including breast cancer, stroke, and thromboembolism. Several progestogens
(both oral and intramuscular formulations) have shown efficacy in treating hot flashes, including women with a
history of breast cancer, although no definitive data are available on long-term safety in these women.
CONCLUSIONS: In women who need relief for mild vasomotor symptoms, NAMS recommends first considering
lifestyle changes, either alone or combined with a nonprescription remedy, such as dietary isoflavones,
black cohosh, or vitamin E. Prescription systemic estrogen-containing products remain the therapeutic
standard for moderate to severe menopause-related hot flashes. Recommended options for women with
concerns or contraindications relating to estrogen-containing treatments include prescription
progestogens, venlafaxine, paroxetine, fluoxetine, or gabapentin. Clinicians are advised to
enlist women's participation in decision making when weighing the benefits, harms, and scientific
uncertainties of therapeutic options. Regardless of the management strategy adopted, treatment
should be periodically reassessed as menopause-related vasomotor symptoms will abate over time
without any intervention in most women.
Am J Obstet Gynecol 1999 Jul;181(1):66-70
Reduced thermoregulatory null zone in postmenopausal women with hot flashes.
Freedman RR, Krell W
Departments of Psychiatry and Behavioral Neurosciences, Obstetrics and Gynecology, and Internal Medicine (Pulmonary), Wayne State University School of Medicine, Detroit, Michigan, USA.
OBJECTIVE: Most menopausal hot flashes are preceded by small elevations in core body temperature. If the thermoneutral zone between the thresholds for sweating and shivering is reduced in women with symptoms, the triggering mechanism for hot flashes could be explained. STUDY DESIGN: We studied 12 postmenopausal women with symptoms and 8 without symptoms. We measured body temperatures with a rectal probe, an ingested telemetry pill, and a weighted average of rectal and skin temperatures. Each woman underwent 3 experimental sessions: determination of the sweating threshold by body heating, determination of the shivering threshold by body cooling, and replication of the sweating threshold with exercise. RESULTS: The women with symptoms had significantly smaller interthreshold zones than did the symptom-free women for all 3 measures of body temperature: rectal temperature, 0.0 degrees C +/- 0.06 degrees C versus 0.4 degrees C +/- 0.18 degrees C (P <.005); telemetry pill temperature, 0.0 degrees C +/- 0.11 degrees C versus 0.4 degrees C +/- 0.18 degrees C (P <.005); and mean body temperature, 0.8 degrees C +/- 0.09 degrees C versus 1.5 degrees C +/- 0.20 degrees C (P <. 0006). Sweat rates were significantly higher among the women with symptoms (0.06 +/- 0.002 mg. cm(-2). min(-1)) than among the women without symptoms (0.03 +/- 0.001 mg. cm(-2). min(-1), P <.05). Sweating thresholds during exercise did not significantly differ from those during body heating. During exercise all the women with symptoms and none of the women without symptoms had hot flashes. CONCLUSIONS: Menopausal hot flashes in women with symptoms may be triggered by small elevations in body temperature acting within a reduced thermoneutral zone.
Am J Human Biol. 2001 Jul-Aug;13(4):453-64. Publication Type: Review
Physiology of hot flashes.
Freedman RR.
Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan 48201, USA. aa2613@wayne.edu
Hot flashes are the most common symptom of the climacteric, although prevalence estimates are lower in some rural and non-Western areas. The symptoms are characteristic of a heat-dissipation response and consist of sweating on the face, neck, and chest, as well as peripheral vasodilation. Although hot flashes clearly accompany the estrogen withdrawal at menopause, estrogen alone is not responsible since levels do not differ between symptomatic and asymptomatic women. Until recently it was thought that hot flashes were triggered by a sudden, downward resetting of the hypothalamic setpoint, since there was no evidence of increased core body temperature. Evidence obtained using a rapidly responding ingested telemetry pill indicates that the thermoneutral zone, within which sweating, peripheral vasodilation, and shivering do not occur, is virtually nonexistent in symptomatic women but normal (about 0.4 degrees C) in asymptomatic women. The results suggest that small temperature elevations preceding hot flashes acting within a reduced thermoneutral zone constitute the triggering mechanism. Central sympathetic activation is also elevated in symptomatic women which, in animal studies, reduces the thermoneutral zone. Clonidine reduces central sympathetic activation, widens the thermoneutral zone, and ameliorates hot flashes. Estrogen virtually eliminates hot flashes but its mechanism of action is not known.
Maturitas 1998 Jun 3;29(2):139-46
Physical exercise and vasomotor symptoms in postmenopausal women.
Ivarsson T, Spetz AC, Hammar M
Department of Health and Environment, Faculty of Health Sciences, University Hospital, Linkoping, Sweden.
BACKGROUND: The mechanisms causing postmenopausal vasomotor symptoms are unknown, but changes in hypothalamic beta-endorphins have been suggested to be involved. beta-endorphin production may be increased by regular physical exercise. OBJECTIVE: To assess if physically active women suffered from vasomotor symptoms to a lower extent than sedentary women. MATERIAL AND METHODS: All women (n = 1323) in the ages ranging from 55-56 years in the community of Linkoping Sweden, were included. In a questionnaire these women were asked about their physical exercise habits and their complaints from vasomotor symptoms. Only those 793 women who had reached a natural menopause were grouped into sedentary, moderately or highly active women, based on a physical activity score. RESULTS: Only 5% of highly physically active women experienced severe hot flushes as compared with 14-16% of women who had little or no weekly exercise (P < 0.05; relative risk 0.26; CI 95%: 0.10-0.71). This was not explained by differences in body mass index, smoking habits or use of hormone replacement therapy. Women who used hormone replacement therapy were more physically active than non-users (P < 0.05). CONCLUSION: Fewer physically active women had severe vasomotor symptoms compared with sedentary women. This may be due to a selection bias but also to the fact that physical exercise on a regular basis affects neurotransmitters which regulate central thermoregulation.
Acta Obstet Gynecol Scand 1990;69(5):409-12
Does physical exercise influence the frequency of postmenopausal hot flushes?
Hammar M, Berg G, Lindgren R
Department of Obstetrics & Gynecology, University Hospital, Linkoping, Sweden.
The frequency of moderate and severe hot flushes was investigated in a group of women (n = 142) who took part in organized physical exercise on a regular basis, and a control group of all women 52 and 54 years old in the city of Linkoping, Sweden (n = 1,246). Only women with natural menopause and without a history of hormonal replacement treatment were statistically compared in the study. It appeared that moderate and severe vegetative symptoms with hot flushes and sweatings were only half as common among the physically active postmenopausal women (21.5%) as in the control group (43.8%). Although this could be due to a positive selection of these physically active women, it might also be due to the fact that exercise may affect the mechanisms that elicit hot flushes in peri- and postmenopausal women.
Maturitas. 1998 Nov 30;31(1):29-34.
The relationship between stress-coping and vasomotor symptoms in postmenopausal women.
Nedstrand E, Wijma K, Lindgren M, Hammar M.
Department of Health and Environment, University Hospital, Faculty of Health Sciences, Linkoping, Sweden.
OBJECTIVE: The objective was to assess whether menopausal women with vasomotor symptoms had a lower stress-coping than menopausal women without symptoms and if stress-coping changed when vasomotor symptoms had been effectively treated with estrogens. The objective was also to assess whether menopausal women, effectively treated for vasomotor symptoms, had a higher neuroticism score than women without such symptoms. METHODS: Two groups of physically and mentally healthy postmenopausal women were recruited from the outpatient clinic at the Department of Obstetrics and Gynaecology, University Hospital of Linkoping, Sweden. Sixteen women with vasomotor symptoms (target group) were treated with oral 17 beta-estradiol, 2 mg/day during 3 months. A comparison group was formed comprising 17 women without vasomotor symptoms. The Kupperman Index was used to cover menopausal characteristics in all women at baseline as well as at the second visit after 3 months. Stress-coping was measured by means of the Stress Coping Inventory, which is an instrument developed to measure of the individual's appraisal of having adaptive resources for handling stressful situations. At the second visit all women were also asked to complete the Eysenck Personality Inventory. RESULTS: Women in the target group had a significantly lower stress-coping than women in the comparison group at baseline as well as after 3 months. Stress-coping did not change after estrogen therapy, although the vasomotor symptoms had virtually disappeared. Women in the target group successfully treated for vasomotor symptoms, had a significantly higher neuroticism score compared to the comparison group. CONCLUSIONS: Differences in behaviour patterns and personality are probably two reasons why some women report or seek advice due to vasomotor symptoms and some women do not. Stress-coping in women with moderate to severe vasomotor symptoms is unaffected by estrogens.
Menopause. 2003 Jan-Feb;10(1):81-7
Hot flushes in a male population aged 55, 65, and 75 years, living in the community of Linkoping, Sweden.
Spetz AC, Fredriksson MG, Hammar ML.
Divisions of Obstetrics and Gynaecology, Faculty of Health Sciences, University Hospital, Linkoping, Sweden.
OBJECTIVE: Hot flushes are as common in castrated men as in menopausal women. We investigated whether hot flushes exist in a normal aging male population and to what extent. DESIGN: A questionnaire was sent to all men living in Linkoping, Sweden, who were 55, 65, and 75 years old ( = 1,885). The questionnaire asked for demographic data, medical history, mood status, medication, castrational therapy, and smoking, exercise, and alcohol habits, among other items. We asked specifically for current hot flushes unrelated to exercise or a warm environment. RESULTS: Of the questionnaires received, 1,381 were eligible for evaluation; 33 were analyzed separately because these men had been castrated. Hot flushes of any frequency were reported by 33.1% of noncastrated men, 4.3% reported flushes at least a few times per week, and 1.3% reported daily flushes. Half of the men reporting flushes were also bothered by them, ie, almost every sixth man in total. We found a relation between occurrence of hot flushes and other symptoms thought to be related to low testosterone concentration, such as decreased muscle strength or endurance, decreased enjoyment of life, sadness or grumpiness, and lack of energy ( < 0.05). CONCLUSIONS: Hot flushes occur in one third of a population of noncastrated older men, approximately half of whom consider flushes as bothersome. Neither the mechanisms nor whether the symptoms would respond to testosterone supplementation is known. Androgen substitution to treat symptoms possibly related to a male climacteric is still controversial. Studies are needed to evaluate the needs for and the effects of androgen treatment on vasomotor symptoms.
Medscape Womens Health. 1999 Jan-Feb;4(1):1. Publication Type: Review
www.medscape.com/Medscape/WomensHealth/journal/1999/v04.n01/
Exercise at menopause: a critical difference.
Burghardt M.
Fowler-Kennedy Sports Medicine Clinic, University of Western Ontario Faculty of Medicine, London, Ontario, Canada.
Even at menopause, fitness can reduce the risk of heart disease, osteoporosis, and diabetes, yet only 38% of women over age 19 exercise regularly. A sports medicine expert recommends that exercise be encouraged and prescribed, even for women with a variety of comorbidities.
Women Health 1998;27(4):81-111 Publication Type: Review
"Run, Jane, run": central tensions in the current debate about enhancing women's health through exercise.
Vertinsky P
Department of Educational Studies, Faculty of Education, University of British Columbia, Vancouver, Canada. vertinsk@unixg.ubc.ca
The advancement of access and opportunities for girls and women in health enhancing physical activity in recent decades is a matter of record. Yet despite burgeoning interest and increased female participation in sport and recreational physical activity, few women are active enough to benefit their health. Even after extensive government campaigns are repeatedly used to educate the public, fewer women than men participate in every age group. Something is drastically wrong when exercise is said to be associated with so many health benefits, yet only a small portion of the female population exercises sufficiently to accrue these benefits. It is important to critically evaluate the challenges inherent in achieving social equity in opportunities for healthy physical activity for all women. As we gain new understandings about how health gains can be achieved by reducing social inequality rather than providing more medical care, we can see how involvement in healthy exercise is closely entwined with the social and economic status of women, disempowering stereotypes of the female body and the issue of control over women's bodies. This paper explores central tensions in the current debate about promoting female health through physical activity across the lifespan by focusing upon (i) the continued medicalization of the female body; (ii) adolescence and the tyranny of physical appearance over health and physical activity choices; (iii) menopause and the perpetuation of disempowering stereotypes into old age; and (iv) issues of diversity and the impact of 'race' and ethnicity upon female health and physical activity. These issues are then examined in light of the discourses of recent population health strategies in Canada and the U.S. Surgeon General's Report on Physical Activity and Health (1996) which both (in differing degrees) demonstrate a continued preoccupation with individual lifestyle change and cautious medical prescription for exercise as recipes for better female health.
Menopause 2000 May-Jun;7(3):184-92 Publication Type: Review
Menopause across cultures: a review of the evidence.
Obermeyer CM.
Department of Population and International Health, Harvard University, Boston, Massachusetts 02115, USA.
OBJECTIVE: To review the cross-cultural evidence on menopausal symptoms to assess the extent of variability in symptomatology and the relative weight of hormonal and social factors. DESIGN: Literature review and critical summaries of available studies. RESULTS: Symptoms related to menopause are found in all regions of the world, although everywhere large proportions of women go through menopause uneventfully. The evidence does not support that women in developing countries report fewer symptoms than in industrialized countries. There is a great diversity in symptom frequencies across countries, and the association of symptoms with menopausal status is weak. A number of symptoms thought to be part of menopause are in fact not specific to it, although the evidence does support the narrow estrogen hypothesis of a core of symptoms associated with estrogen decline, namely vasomotor and vaginal symptoms. CONCLUSIONS: The association between hormonal changes and menopause symptomatology is complex and mediated by sociocultural factors.
Climacteric. 2000 Jun;3(2):135-144
Menopausal symptoms: experience of Chinese women.
Zhao G, Wang L, Yan R, Dennerstein L.
Research and Training Center in Women and Children's Health, First Hospital, Beijing Medical University, #1 Xi An Men Street, 100034 Beijing, People's Republic of China.
OBJECTIVES: To investigate the prevalence of symptoms in middle-aged Chinese rural and city women of different occupations; and to explore the relationship between symptoms, hormone levels and other factors. METHODS: This cross-sectional study included 806 women aged 41-60 years, selected by multistage cluster sampling and a structured interview questionnaire. The response rate was 95%. The sample compromised 402 professional urban women and 404 women farmers living in rural areas. Some 209 women were randomly selected from the two groups for hormonal assay and bone mineral density screening. RESULTS: The professional group was more symptomatic than the farming group (p < 0.01). The presence of symptoms was significantly related to an increasing level of education. There were no significant differences between occupational groups in levels of estradiol follicle stimulating hormone (FSH) and luteinizing hormone (LH). Estradiol level and bone mineral density were decreased and FSH and LH increased in the postmenopausal group (p < 0.05) compared with the other menopausal groups. Hot flushes were the only symptom to be significantly associated with hormone levels (estradiol and LH). The occurrence of symptoms was significantly related to indications of bone and joint disease, heart disease, primary dysmenorrhea, decline in sexual interest, irregular menses and feelings of becoming older, sad and lost. These factors were all reported more often by the professional women than by the farmers. CONCLUSION: Symptom experience in mid-life Chinese women is related to both biological and psychosocial factors.
Altern Med Rev. 2003 Aug;8(3):284-302 full text online
Hot flashes - a review of the literature on alternative and complementary treatment approaches.
Philp HA.
Hot flashes are a common experience for menopausal women, with an 85-percent incidence in the West. With the increased knowledge of side effects attributable to conventional treatment options, more women are exploring natural alternatives. Although more definitive research is necessary, several natural therapies show promise in treating hot flashes without the risks associated with conventional therapies. Soy and other phytoestrogens, black cohosh, evening primrose oil, vitamin E, the bioflavonoid hesperidin with vitamin C, ferulic acid, acupuncture treatment, and regular aerobic exercise have been shown effective in treating hot flashes in menopausal women.
Med Sci Sports Exerc. 2005 Feb;37(2):194-203
Exercise effects on menopausal risk factors of early postmenopausal women: 3-yr erlangen fitness osteoporosis prevention study results.
Kemmler W, von Stengel S, Weineck J, Lauber D, Kalender W, Engelke K.
Institute of Medical Physics, University of Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany. wolfgang.kemmler@imp.uni-erlangen.de
PURPOSE: To determine the impact of multipurpose exercise training on bone, body composition, blood lipids, physical fitness, and menopausal symptoms in early postmenopausal women with osteopenia. METHODS: Forty-eight fully compliant (more than two sessions per week for 38 months) women (55.1 +/- 3.3 yr) without any medication or illness affecting bone metabolism took part in the exercise training (EG); 30 women (55.5 +/- 3.0 yr) served as the nontraining control group (CG). Both groups were individually supplemented with calcium and vitamin D. Bone mineral density (BMD) at various sites (lumbar spine, hip, forearm, calcaneus) was measured by dual x-ray absorptiometry (DXA) and quantitative ultrasound (QUS). Maximal isometric and dynamic strength, maximal oxygen consumption (VO(2max)), CHD risk factors (blood lipids, body composition), and menopausal symptoms were determined. RESULTS: After 38 months, significant differences between EG and CG were observed for the BMD at the lumbar spine (0.7% vs -3.0%) and the femoral neck (-0.7% vs -2.6%), body composition (waist circumference, waist-to-hip ratio), blood lipids (total cholesterol, triglycerides), and menopausal symptoms (insomnia, migraines, mood changes). Maximal isometric strength increased significantly by 10-36% in the EG, whereas, with one exception, changes in the CG were all negative. One-repetition maximum increased significantly at all sites measured (15-43%, P < 0.001). VO(2max) of the EG increased throughout the study with a significant 13.9 +/- 15.6% net increase after 3 yr. No significant changes after 3 yr could be observed in the CG. CONCLUSIONS: Our mixed high-intensity exercise program effectively compensates for most negative changes related to the menopausal transition.
Eur J Appl Physiol. 2003 Sep;90(1-2):199-209. Epub 2003 Jul 09.
Acute hormonal responses of a high impact physical exercise session in early postmenopausal women.
Kemmler W, Wildt L, Engelke K, Pintag R, Pavel M, Bracher B, Weineck J, Kalender W.
Institute of Medical Physics, University of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany. wolfgang.kemmler@imp.uni-erlangen.de
The effect of a single bout of exercise on hormones affecting bone metabolism was studied in 25 early postmenopausal women with osteopenia. The complex training session was performed between 8:00 a.m. and 9:05 a.m. Serum concentrations of dehydroepiandrosterone-sulfate (DHEA-S), total testosterone, free testosterone, 17beta-estradiol, cortisol, human growth hormone (hGH), insulin-like growth factor-I (IGF-I), and insulin-like growth factor binding protein-3 (IGFBP-3) were determined. Blood samples were obtained immediately before (baseline) and after exercise, as well as 2 h and 22 h post-exercise. DHEA-S increased by 10% immediately after exercise and remained increased 2 h later. Testosterone showed no increase immediately after exercise but fell by 21% 2 h post-exercise. Free testosterone was increased by almost 20% immediately after exercise and returned to baseline levels after 2 h. Two hours post-exercise a 20% increase in the estradiol level was measured. Cortisol decreased by 36% during exercise and a further 14% during the next 2 h, a loss higher than the normal diurnal decrease. hGH increased by 80% during exercise and fell 30% under baseline values after 2 h. Even though the assessment period was prolonged to 22 h no significant change could be demonstrated for IGF-I. Serum IGFBP-3 showed a biphasic increase. During the exercise session IGFBP-3 increased by 35%, returned to baseline values 2 h post-exercise and increased again by 40% 22 h post-exercise. In summary, this study showed that a single bout of exercise typically used in osteoporosis prevention programs could have an influence on hormones affecting bone metabolism.
N Engl J Med. 2002 Sept 5;347(10):716-25 Publication Type: Multicenter Study
Walking compared with vigorous exercise for the prevention of cardiovascular events in women.
Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, Perri MG, Sheps DS, Pettinger MB, Siscovick DS.
Division of Preventive Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston 02215, USA. jmanson@rics.bwh.harvard.edu
BACKGROUND: The role of walking, as compared with vigorous exercise, in the prevention of cardiovascular disease remains controversial. Data for women who are members of minority racial or ethnic groups are particularly sparse. METHODS: We prospectively examined the total physical-activity score, walking, vigorous exercise, and hours spent sitting as predictors of the incidence of coronary events and total cardiovascular events among 73,743 postmenopausal women 50 to 79 years of age in the Women's Health Initiative Observational Study. At base line, participants were free of diagnosed cardiovascular disease and cancer, and all participants completed detailed questionnaires about physical activity. We documented 345 newly diagnosed cases of coronary heart disease and 1551 total cardiovascular events. RESULTS: An increasing physical-activity score had a strong, graded, inverse association with the risk of both coronary events and total cardiovascular events. There were similar findings among white women and black women. Women in increasing quintiles of energy expenditure measured in metabolic equivalents (the MET score) had age-adjusted relative risks of coronary events of 1.00, 0.73, 0.69, 0.68, and 0.47, respectively (P for trend, <0.001). In multivariate analyses, the inverse gradient between the total MET score and the risk of cardiovascular events remained strong (adjusted relative risks for increasing quintiles, 1.00, 0.89, 0.81, 0.78, and 0.72, respectively; P for trend <0.001). Walking and vigorous exercise were associated with similar risk reductions, and the results did not vary substantially according to race, age, or body-mass index. A brisker walking pace and fewer hours spent sitting daily also predicted lower risk. CONCLUSIONS: These prospective data indicate that both walking and vigorous exercise are associated with substantial reductions in the incidence of cardiovascular events among postmenopausal women, irrespective of race or ethnic group, age, and body-mass index. Prolonged sitting predicts increased cardiovascular risk. Copyright 2002 Massachusetts Medical Society
Med Sci Sports Exerc. 2003 Nov;35(11):1846-52 Publication Type: Review
Exercise in cancer survivors: an overview of research.
Courneya KS.
University of Alberta, Edmonton, Alberta, Canada. kerry.courneya@ualberta.ca
PURPOSE: To provide an overview of research that has examined exercise in cancer survivors including recently completed trials at the University of Alberta. METHODS: A search of published studies using electronic data bases and previous review articles. The review is divided into breast and nonbreast cancers, during and after treatment, and trials from the University of Alberta. RESULTS: Forty-seven published studies were located and summarized plus four trials from the University of Alberta. Almost all studies showed beneficial effects of exercise in breast and nonbreast cancer groups alike as well as during and after cancer treatment. CONCLUSION: Preliminary research suggests that exercise may be an effective intervention for enhancing quality of life (QOL) in cancer survivors. The effects of exercise on biomarkers, cancer recurrence, other diseases, and overall survival are unknown. Future research is needed to extend our knowledge beyond breast cancer survivors, conduct second generation studies in breast cancer survivors, examine mechanisms for changes in QOL, compare exercise with other QOL interventions, and examine biomarkers, cancer recurrence, and survival.
Oncol Nurs Forum. 2003 May-Jun;30(3):393-407
Continuing education: Comprehensive menopausal assessment: an approach to managing vasomotor and urogenital symptoms in breast cancer survivors.
Zibecchi L, Greendale GA, Ganz PA.
Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA. lzibec@ucla.edu
PURPOSE/OBJECTIVES: To describe the development and implementation of a comprehensive menopausal assessment (CMA) and intervention program for women with a history of breast cancer. DATA SOURCES: Published articles selected from computerized databases, conference proceedings, bibliographies of pertinent articles and books, and lay publications. DATA SYNTHESIS: The CMA program consisted of a structured, comprehensive assessment of three symptoms (hot flashes, vaginal dryness, and stress urinary incontinence) and an individualized plan of education, counseling, nonestrogen treatments, psychosocial support, referrals, and follow-up. CONCLUSIONS: A structured approach to evaluating and managing vasomotor and urogenital symptoms with, for example, the CMA, may help breast cancer survivors with severe symptoms more effectively manage these symptoms than "usual care." IMPLICATIONS FOR NURSING: Nurses providing care for women with a history of breast cancer can incorporate the key elements of the CMA program into their practice to facilitate more effective management of three common menopausal symptoms that often are undertreated in this patient population.
J Gerontol A Biol Sci Med Sci. 2003 Mar;58(3):266-70.
Effects of exercise training and hormone replacement therapy on lean and fat mass in postmenopausal women.
Figueroa A, Going SB, Milliken LA, Blew RM, Sharp S, Teixeira PJ, Lohman TG.
Department of Exercise Science, Syracuse University, New York 13244, USA. arfiguer@syr.edu
BACKGROUND: Menopause is associated with decreases in lean mass and increases in fat mass. Serum hormone levels and hormone replacement therapy (HRT) may modify the effects of exercise training on body composition in postmenopausal women. METHODS: We assessed the changes in total body and regional lean soft tissue and fat mass (using dual-energy x-ray absorptiometry) in 94 sedentary postmenopausal women, aged 40-65 years, after 12 months of resistance and weight-bearing aerobic exercise training. Women currently on oral HRT (n = 39) and not on HRT (n = 55) were randomized within groups to exercise and no exercise, resulting in four groups: exercise + HRT (n = 20), HRT (n = 22), exercise (n = 24), and control (n = 28). Fasting blood samples were measured for resting serum total levels of estrone, estradiol, cortisol, androstenedione, growth hormone, and insulin-like growth factor 1 at baseline and 12 months. RESULTS: We found significant effects of exercise on increases in total body, arm, and leg lean soft tissue mass, and decreases in leg fat mass and percentage of body fat. There were no interaction effects of exercise and HRT on the changes in muscle strength and body composition. No significant changes in total hormone levels were found after 12 months. CONCLUSIONS: Exercise training resulted in significant beneficial changes in lean soft tissue and fat mass in early postmenopausal women. These changes in body composition were neither influenced by prolonged HRT use nor accompanied by changes in total levels of the hormones determined in this study.
Maturitas. 2000 Jul 31;36(1):49-61 Publication Type: Review
Evaluation of the applicability of HRT as a preservative of muscle strength in women.
Meeuwsen IB, Samson MM, Verhaar HJ.
Mobility Laboratory, Department of Geriatrics and Bone Metabolism, University Medical Centre Utrecht, P.O. Box 85500 (room W01.209), NL-3508 GA, Utrecht, The Netherlands. i.meeuwsen@digd.azu.nl
OBJECTIVES: To review the studies that have been undertaken on the effects of postmenopausal hormone replacement therapy (HRT); especially oestrogen (+progestin) regimens on the preservation of muscle strength. Current knowledge of the mechanisms and actions of steroid- and sex hormones on skeletal muscle tissue will be used in an attempt to clarify the mechanism of action of a possible effect. The objective is to arrive at an agreement on whether or not postmenopausal oestrogen administration has a positive influence on skeletal muscle tissue. METHODS: Peer-reviewed publications were assessed. RESULTS: An age-related decrement in muscle strength can be found in both men and women. However, in women, an extra decline can be observed around the time of menopause. A possible relationship between the additional diminution in muscle strength and altered hormone concentrations after the onset of menopause has been suggested. Since women nowadays spend one-third of their life postmenopausal, it is extremely important to keep the decline in muscle mass as small as possible. Besides the continuation of a physically active lifestyle, HRT was suggested to serve as a protective mechanism. Although, the usefulness of HRT as a preservative of muscle strength appeared controversial. CONCLUSIONS: Skeletal muscle strength is sensitive to training up to a high age, though continuation of physical activity does not appear to protect skeletal muscles completely from age-related decrements. Therefore, the development of another preventive method would be useful. Considering the present knowledge it has all the hallmarks that HRT can be a useful tool in the maintenance of muscle strength in postmenopausal women. None the less, further research is necessary to endorse this theory.
Maturitas 1999 Jan 4;31(2):117-122
Postmenopausal women without previous or current vasomotor symptoms do not flush after abruptly abandoning estrogen replacement therapy.
Hammar M, Ekblad S, Lonnberg B, Berg G, Lindgren R, Wyon Y
Department of Health and Environment, Faculty of Health Sciences, University Hospital, Linkoping, Sweden. matha@gyn.liu.se
BACKGROUND: Most but not all women suffer from vasomotor symptoms around menopause. The exact mechanisms behind these symptoms are unknown, but the rate of decline in estrogen concentrations has been suggested to affect the risk of hot flushes. OBJECTIVE: The objective was to assess whether vasomotor symptoms were induced in women without previous such symptoms, when the women were given combined estradiol and progestagen therapy for 3 months, whereafter therapy was abruptly withdrawn. MATERIALS AND METHOD: After randomization, 40 postmenopausal women without previous or current vasomotor symptoms were treated transdermally with either 50 micrograms/day 17 beta-estradiol or placebo during 14 weeks. During the 13th and 14th weeks, treatment was combined with oral medroxyprogesterone acetate 10 mg/day. Serum estradiol and follicle-stimulating hormone (FSH) concentrations were analysed before and after 12 weeks of therapy. Climacteric symptoms were assessed at the same intervals as well as 8 weeks after the end of therapy. RESULTS: All women had low pretreatment levels of estradiol and high FSH concentrations. During estradiol therapy estradiol levels increased significantly, whereas FSH only decreased slightly. No woman developed vasomotor symptoms after withdrawal of therapy. CONCLUSION: Postmenopausal women without previous or current vasomotor symptoms did not develop such symptoms when estrogen replacement therapy was first instituted and then abruptly stopped. Probably other factors than the rate with which estrogen concentrations decrease determine whether or not a woman will develop vasomotor symptoms. Evidently, estrogens can be prescribed to a woman who has no vasomotor symptoms, without much risk of inducing such symptoms if she decides to abandon therapy, even after 3 months of treatment.
Obstet Gynecol 2000 Feb;95(2):278-83
Estrogen effects on postural balance in postmenopausal women without vasomotor symptoms: a randomized masked trial.
Ekblad S, Lonnberg B, Berg G, Odkvist L, Ledin T, Hammar M
Department of Health and Environment, Faculty of Health Sciences, University Hospital of Linkoping, Sweden. matha@gyn.liu.se
OBJECTIVE: To assess whether estrogen treatment given to postmenopausal women without vasomotor symptoms improves balance more than placebo. METHODS: Forty healthy postmenopausal women without vasomotor symptoms were randomized to transdermal 17beta-estradiol (E2) 50 microg/day for 14 weeks or identical transdermal placebo patches. Postural balance was measured with dynamic posturography before and after 4, 12, and 14 weeks of therapy. In this test, the visual, vestibular, and somatosensory systems were provoked with increasing difficulty and body sway was measured with a dual forceplate. A low score showed large sway and a score of 100 showed no sway at all. RESULTS: Thirty-eight women completed the study. Both groups had normal balance for their ages and near maximum scores in the three easier balance tests at baseline. In the most difficult test, both groups improved their postural balance significantly (from 13 to 32 and from 22 to 39, respectively) after 4 weeks. Thereafter, no change was seen. One problem was low statistical power, but the relative change in balance did not differ between groups. The comparison did not show even a minute advantage of E2 over placebo, so a study with higher power would probably not have shown a more pronounced effect of estrogen than placebo. The change over time did not differ between groups, which indicates a significant learning effect. CONCLUSION: In women without vasomotor symptoms, estrogen therapy did not seem to increase postural balance significantly more than placebo. However, we could not rule out that estrogens affect postural balance in women with vasomotor symptoms.
Climacteric. 2000 Sep;3(3):192-198
Disturbances in postural balance are common in postmenopausal women with vasomotor symptoms.
Ekblad S, Bergendahl A, Enler P, Ledin T, Mollen C, Hammar M.
Division of Obstetrics and Gynecology, Department of Health and Environment, Faculty of Health Sciences, University Hospital, Linkoping, Sweden.
OBJECTIVES: To establish the prevalence of unsteadiness and rotatory vertigo in peri- and postmenopausal women, and whether balance disturbances are more common in women with vasomotor symptoms and without hormone replacement therapy (HRT). METHOD: A validated questionnaire was sent to all 1523 women aged 54 or 55 years in Linkoping, Sweden. RESULTS: Daily or weekly unsteadiness was reported by 5%, and daily or weekly rotatory vertigo by 4% of all women. The frequency of vasomotor symptoms correlated with reported unsteadiness (rs = 0.23, p < 0.001). Fourteen per cent of women with daily vasomotor symptoms reported weekly or daily unsteadiness, compared with 3% of those without vasomotor symptoms (odds ratio (OR) 7.58, 95% confidence interval (CI) 3.72-15.45). The frequency of vasomotor symptoms correlated with rotatory vertigo (rs = 0.19, p < 0.001). Ten per cent of women with daily vasomotor symptoms reported weekly or daily rotatory vertigo, compared with 2% of women without vasomotor symptoms (OR 5.21, 95% CI 1.07-25.52). No correlation was seen between vasomotor symptoms and falls. Users of HRT had the same prevalence of balance disturbances as non-users. CONCLUSIONS: Women with frequent vasomotor symptoms seem to run a greater risk of unsteadiness and rotatory vertigo than do women without symptoms. This association may not be explained by means of a cross-sectional study, but there might exist a causal connection between vasomotor symptoms and balance disturbances.