Women’s Health and Wellness – thirdAGE https://thirdage.com healthy living for women + their families Tue, 13 Jun 2023 00:54:58 +0000 en-US hourly 1 https://wordpress.org/?v=5.7.2 Hormones and Hypertension https://thirdage.com/hormones-and-hypertension/ Tue, 13 Jun 2023 12:49:00 +0000 https://thirdage.com/?p=3077101 Read More→]]> Women ages 45 years and older taking estrogen hormone therapy in pill form were more likely to develop high blood pressure than those using transdermal (topical, applied to the skin) or vaginal formulations, according to new research published today in June 2023 in Hypertension, a peer-reviewed American Heart Association journal.

A woman’s body produces less estrogen and progesterone after menopause, changes that may increase the risk for cardiovascular diseases including heart failure, according to the American Heart Association.

Hormone therapy may be prescribed to relieve symptoms of menopause, in gender-affirming care and in contraception, and previous studies have found that some hormone therapies may reduce cardiovascular disease risk in menopausal women under 60 years of age or for whom it has been fewer than 10 years since menopause. The authors of this study noted that while high blood pressure is a modifiable risk factor for cardiovascular disease, the potential effects of different types of hormone therapy on blood pressure in menopausal women remain uncertain.

“It’s really important to have greater knowledge on safe and effective hormonal treatments for women during menopause. At the end of the day, it’s an individualized decision about what is best for the person going through menopause and should include open dialogue with their physician or health care team,” Ahmed said. “We need large, randomized studies factoring in all the complexities of hormone therapy around this important transition period in the female lifecycle.”

“We know estrogens ingested orally are metabolized through the liver, and this is associated with an increase in factors that can lead to higher blood pressure,” said lead study author Cindy Kalenga, an M.D./Ph.D.-candidate at the University of Calgary in Alberta, Canada.

“We know that post-menopausal women have increased risk of high blood pressure when compared to pre-menopausal women. Fthermore, previous studies have shown that specific types of hormone therapy have been associated with higher rates of heart disease,” Kalenga said. “We chose to dive deeper into factors associated with hormone therapy, such as the route of administration (oral vs. non-oral) and type of estrogen, and how they may affect blood pressure.”

This study involved a large group of over 112,000 women, ages 45 years and older, who filled at least two consecutive prescriptions (a six-month cycle) for estrogen-only hormone therapy, as identified from health administrative data in Alberta, Canada between 2008 and 2019. The main outcome of high blood pressure (hypertension) was identified via health records.T

First, researchers investigated the relationship between route of estrogen-only hormone therapy administration and risk of developing high blood pressure at least one year after starting the treatment. The 3 different routes of hormone therapy administration were oral (by mouth), transdermal and vaginal application. Additionally, researchers evaluated the formulation of estrogen used and the risk of developing high blood pressure. For this study, the researchers reviewed medical records of individuals taking estrogen-only hormone therapy. The two most common forms of estrogen used by study participants were estradiol — a synthetic form of estrogen that most closely mimics what is naturally produced in women’s bodies in the premenopausal years — and conjugated equine estrogen, an animal-derived form of estrogen and the oldest type of estrogen therapy.

The analysis found:

Women taking oral estrogen therapy had a 14% higher risk of developing high blood pressure compared to those using transdermal estrogen and a 19% higher risk of developing high blood pressure compared to those using vaginal estrogen creams or suppositories.

After accounting for age, a stronger association was seen among women younger than 70 years of age compared to women older than 70.

Compared to estradiol, conjugated equine estrogen was associated with an 8% increased risk of developing high blood pressure.

Taking estrogen for a longer period of time or taking a higher dose was associated with greater risk of high blood pressure, the authors noted. According to Kalenga, the study’s findings suggest that if menopausal woman take hormone therapy, there are different types of estrogen that may have lower cardiovascular risks.

“These may include low-dose, non-oral estrogen — like estradiol, in transdermal or vaginal forms — for the shortest possible time period, based on individual symptoms and the risk–benefit ratio, Kalenga said. “These may also be associated with the lowest risk of hypertension. Of course, this must be balanced with the important benefits of hormone therapy, which include treatment of common menopausal symptoms.”

The average age of natural menopause among women worldwide is about 50 years of age. Current evidence supports that initiating menopausal hormone therapy in the early stages may have cardiovascular benefits, though not in the late stages of menopause, according to the American Heart Association’s 2020 Statement on Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. Previous studies have found that menopausal hormone therapy may help relieve symptoms of menopause, including hot flashes, night sweats, mood changes or sleep disturbances.

“Over a quarter of the world’s population of women are currently older than the age of 50. By 2025, it’s estimated that there will be one billion menopausal individuals on the planet,” said study co-author Sofia B. Ahmed, M.D., M.M.Sc., a professor of medicine at the University of Calgary, Alberta, Canada. “Approximately 80% of people going through menopause have symptoms, and for some it lasts up to seven years. While menopause is a normal part of the aging process, it has huge implications for quality of life, economic impact, work productivity and social relationships. We need to give people the information they need to choose the most effective and safe hormonal treatments for menopause.”

The study had several limitations. The impact of different forms of hormone therapy on high blood pressure outcomes were based only on medical records. The study did not include women younger than the age of 45 and did not collect data about hysterectomies or menopausal status; however, the researchers used initiation of estrogen therapy in women over the age of 45 to indicate postmenopausal status. The researchers included estrogen-only therapy in this study, which is most often prescribed for women who have had a hysterectomy (surgical removal of the uterus), whereas women with an intact uterus may receive a combination of estrogen and progestin, another type of hormone. This means these findings may only be considered for women taking estrogen-only hormone therapy, the authors noted. Additionally, the study’s findings cannot offer definitive insights on other populations who may benefit from estrogen hormone therapy, including women who have an intact uterus or women who experience premature or early menopause.

The research study reviewed women in Canada, which may present differences. However, current guidelines in Canada align with U.S. guidelines from the American College of Obstetricians and Gynecologists. Both recommend the use of hormone therapy in women with appropriate indications and note that hormone therapy should not be considered as prevention or treatment of hypertension or heart disease.

]]> A pragmatic approach to the management of menopause https://thirdage.com/a-pragmatic-approach-to-the-management-of-menopause/ Fri, 26 May 2023 04:00:00 +0000 https://thirdage.com/?p=3077058 Read More→]]>
KEY POINTS

  • Menopausal symptoms can occur for as long as 10 years before the last menstrual period and are associated with substantial morbidity and negative impacts on quality of life.

  • Menopausal hormone therapy is indicated as first-line treatment of vasomotor symptoms, and is a safe treatment option for patients with no contraindications.

  • Though less effective, nonhormonal treatments also exist to treat vasomotor symptoms and sleep disturbances.

  • It is critical that clinicians inquire about symptoms during the menopause transition and discuss treatment options with their patients.

Menopause is defined as 1 year of amenorrhea caused by declining ovarian reserve or as the onset of vasomotor symptoms in people with iatrogenic amenorrhea. It is preceded by perimenopause or the menopause transition, which can last for as long as 10 years. Although many treatments exist for menopausal symptoms, fears around the risks of menopausal hormone therapy and lack of knowledge regarding treatment options often impede patients from receiving treatment. In this review, we summarize the evidence for treating menopausal symptoms and discuss their risks and benefits to help guide clinicians to evaluate and treat patients during the menopausal transition (Box 1).

Box 1: Evidence used in this review

We searched PubMed from inception until April 2022 using the term “menopause” with keywords “symptoms,” “diagnosis” and “treatment.” We also reviewed relevant articles from the reference lists of selected articles. Selected articles included a combination of systematic reviews, practice guidelines, randomized controlled trials and cohort studies.

What is the prevalence and impact of menopausal symptoms?

The median age of menopause is 51 years, which has remained consistent over the last century, despite a trend toward an earlier age of menarche.1,2 “Symptoms of menopause often start during the perimenopausal period, even as early as 10 years before the last menstrual period.1,3 Globally, 1.0%–3.7% of women experience premature ovarian insufficiency, which leads to menopause before age 40 years and has a variety of causes, including chromosomal abnormalities, autoimmune processes, cancer treatment, surgery or idiopathic etiologies.4

Menopausal symptoms are variable and reflect a complex interaction between biological, psychological and social factors. Vasomotor symptoms (e.g., hot flashes, night sweats) are the most commonly reported and may affect as many as 80% of women.5 Most vasomotor symptoms persist for fewer than 7 years after the final menstrual period; however, 25% of women may experience flushing for as long as 10 years, and 10% have these symptoms for more than 10 years.6 In addition, vasomotor symptoms have been shown to independently predict increased cardiovascular risk, bone loss and high bone turnover.7,8

A higher burden of menopausal symptoms is associated with decreased mental and physical quality of life.9 The transition into menopause, irrespective of symptoms, has also been associated with decreased health-related quality of life.10 Symptoms can substantially affect work productivity, as well as health care use and costs.9,11,12

How is menopause diagnosed?

For people older than 45 years who have symptoms of menopause or amenorrhea, a work-up with laboratory tests and imaging is not indicated unless symptoms are suggestive of an alternative diagnosis. Pregnancy should be ruled out among sexually active patients who are not using contraception.

For patients younger than 45 years who present with irregular or absent menstrual cycles, clinicians should order follicle-stimulating hormone (FSH) levels, although FSH levels vary considerably during perimenopause.13 Endocrine disorders should be ruled out as causes of secondary amenorrhea (e.g., hyperprolactinemia, hypothyroidism), as well as pregnancy (Table 1). For patients younger than 40 years who present with irregular cycles and menopausal symptoms, clinicians should conduct a complete work-up for secondary amenorrhea, including a FSH and serum estradiol.

Table 1:

Investigations for secondary amenorrhea when indicated for patients younger than 45 years

 

For patients with vasomotor symptoms that are atypical, more frequent than would be expected or associated with other symptoms not usual in menopause, alternative diagnoses should be considered — such as carcinoid syndrome, pheochromocytoma, and hematologic or solid organ malignant diseases — and investigated accordingly (Table 2).

Table 2:

Red flags and secondary work-up to consider for menopausal patients with vasomotor symptoms

 

How should troubling symptoms be treated?

Menopausal hormonal therapy

Several international societies, including the Society of Obstetricians and Gynaecologists of Canada and the North American Menopause Society, recommend menopausal hormone therapy as the first-line treatment for vasomotor symptoms for both menopausal and perimenopausal patients.14,15 The estrogen component of menopausal hormone therapy reduces bothersome menopausal symptoms, while the progestin protects the endometrium from hyperplasia and reduces the risk of endometrial cancer. Treatment with combined estrogen and progestin regimens (or estrogen alone, in patients who have had a hysterectomy) reduces the frequency and severity of hot flashes and night sweats by around 75%.16 In Canada, systemic estrogens are available in oral form, or as a transdermal patch or gel; vaginal formulations exist in the form of creams, vaginal tablets or an insertable ring. Transdermal estrogen formulations bypass the first-pass effect of the liver and may be safer than other formulations with regard to stroke and clot risk.14 Progestins are available as both synthetic progestins and micronized progesterone, and come in the form of oral pills, transdermal systems (in combination with estrogen) and an intrauterine device (Table 3).

Table 3:

Systemic menopausal hormone therapy products available in Canada

 

Newer, single-dose combination treatments like tissue selective estrogen complexes (TSECs; e.g., conjugated estrogen and bazodoxifene) and selective tissue estrogen activity regulators (e.g., tibolone) can also be used as first-line treatments in place of traditional combination estrogen–progestin products. Tibolone carries similar risks to standard menopausal hormone therapy. 17 Although TSECs have similar adverse effects as menopausal hormone therapy, they are associated with less break-through bleeding and mastalgia; however, they have been unavailable in Canada since 2020 because of a packaging problem that has recently been resolved.

In the absence of contraindications, menopausal hormone therapy is the treatment of choice for patients within 10 years of their final menstrual period or, if this is unknown, younger than 60 years (Table 4).14,16 Standard doses of menopausal hormone therapy for patients of average menopausal age are included in Table 3; doses for patients with premature ovarian insufficiency should be higher.18 Duration of treatment after starting menopausal hormone therapy is no longer limited to 5 years, but rather is individualized, where the safest regimen is used at the appropriate doses to control symptoms.15 For patients with premature ovarian insufficiency, hormone replacement should continue until the average age of menopause, irrespective of symptom burden and in absence of contraindications.

Table 4:

Contraindications to systemic menopausal hormone therapy14

 

In Canada, no product for testosterone treatment has been approved or recommended for menopausal symptoms, but the International Menopause Society has a position statement regarding the off-label treatment of menopausal hypoactive sexual desire.19

Nonhormonal therapies

Although less effective than menopausal hormone therapy,17 nonhormonal options should be considered if menopausal hormone therapy is not appropriate because of contraindications or patient preference.14 Options include certain selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), gabapentinoids, clonidine and oxybutynin (Table 5). Gabapentionoids are particularly useful when taken at night to help alleviate nocturnal symptoms. A newer class, still awaiting approval, is the neurokinin-3 receptor antagonist, which acts to stabilize the temperature control centre in the hypothalamus. 20 Although some herbal supplements have been associated with improvement in menopausal symptoms, a review of nonpharmacologic treatments is beyond the scope of this article; the topic was recently reviewed in a menopause practice guideline by the Society of Obstetricians and Gynecologists of Canada.14

Table 5:

Nonhormonal menopausal treatments and suggested doses14

 

What are the benefits and risks of menopausal hormone therapy?

Benefits

Menopausal hormone therapy can improve vasomotor symptoms by as much as 90% in patients with moderate-to-severe hot flushes.21 It also improves sleep quality22 and mood disturbances. 23,24 Although systemic menopausal hormone therapy may also alleviate genitourinary syndrome of menopause, patients being treated primarily for this issue can be treated with lubricants, moisturizers, vaginal estrogens or oral selective estrogen receptor modulators alone.

Despite early concerns of an increased risk of cardiovascular events with menopausal hormone therapy after the Women’s Health Initiative (WHI) trial,25 increasing evidence shows a possible reduction in coronary artery disease (CAD) with menopausal hormone therapy among younger menopausal patients, specifically those who start menopausal hormone therapy before age 60 years or within 10 years of menopause.26–30 Data from both randomized controlled trials (RCTs) and observational studies consistently show that menopausal hormone therapy is associated with a reduction in CAD events among these patients; menopausal hormone therapy should therefore be preferentially started during these time windows.29 A reduction in overall mortality among patients who begin menopausal hormone therapy before age 60 years has also been reported.27,31

The metabolic benefits of menopausal hormone therapy include an improvement in lipid profile (increase in high-density lipoprotein, decrease in low-density lipoprotein, decrease in lipoprotein [a]), although oral estrogen may also increase triglyceride levels.32 Some studies suggest an improvement in insulin sensitivity and, perhaps, a reduction in risk of diabetes.33–35 For both lipid and insulin sensitivity, the benefits are seen primarily with oral estrogen therapy rather than transdermal formulations, given their hepatic first-pass effects.

Menopausal hormone therapy has been consistently associated with a reduction in the incidence of osteoporosis-related fractures.25,36,37 The WHI study provided the best evidence on fracture risk reduction with menopausal hormone therapy, reporting a 34% reduction in hip fractures, a 34% reduction in vertebral fractures and a 23% reduction in other osteoporotic fractures among women who took hormone therapy compared with those who did not.25 Although menopausal hormone therapy is not recommended by most osteoporosis guidelines as a primary treatment, it should be considered as a second-line treatment in symptomatic menopausal patients.38

Risks

Although many RCTs and observational studies have shown an increased risk of breast cancer with menopausal hormone therapy, these findings need to be interpreted carefully in the context of the individual patient. The WHI first reported that patients treated with combined menopausal hormone therapy had an increased risk of invasive breast cancer (hazard ratio 1.2).39 However, the attributable risk is much lower among people aged 50–59 years or among those who start treatment within the first 10 years of menopause, for whom the additional risk of breast cancer is estimated at 3 additional cases for every 1000 women who use combined menopausal hormone therapy for 5 years.40 In the WHI 20-year follow-up study, patients on conjugated estrogen alone showed a lower risk of breast cancer than those on placebo. Other studies also showed a lower risk of breast cancer among those on estrogen alone, compared with those on combined menopausal hormone therapy,41,42 with synthetic progestins conferring a higher risk of breast cancer than micronized progesterone.43 In patients with additional risk factors for breast cancer (e.g., family history, obesity, alcohol intake), the lowest effective dose of micronized progesterone or no progestin should be considered, if appropriate (i.e., TSEC or estrogen alone).

Although early RCT data suggested an increased risk of ischemic stroke among patients on menopausal hormone therapy (odds ratio 1.29), more recent data suggest that this risk is primarily among older patients (aged > 60 yr) who start menopausal hormone therapy after the 10 years following the onset of menopause. 44 For those younger than 60 years, the absolute risk of stroke from standard dose hormone therapy is about 2 additional strokes per 10 000 person-years of use. With regard to venous thromboembolic events, the WHI reported a twofold increased risk with hormone therapy, with the risk highest in the first year of use and with higher doses.25 The reported absolute risk was 2–10 cases per 1000 users with short-term use (< 2 yr) and up to 28 cases per 1000 users with long-term use (> 7 yr).45 Most recent studies show a lower risk of venous thromboembolic events with transdermal estrogen formulations compared with oral treatments.46–48

What are the considerations for starting menopausal hormone therapy?

For average-aged menopausal or perimenopausal patients with no contraindications for menopausal hormone therapy and no specific individual risk factors, no specific hormone regimen is preferred for menopause management. When starting a patient on menopausal hormone therapy, clinicians should consider the patient’s individual risk of disease (e.g., breast cancer, venous thrombolic events, stroke), preferred mode of delivery (oral v. transdermal, combination v. separate dosing), need for uterine protection and cost. Patients with risk factors for specific diseases like breast cancer should be offered an individualized regimen (e.g., the TSEC, conjugated estrogen alone, combination therapy with cyclic progesterone). Similarly, a patient at risk for venous thromboembolic events should be offered low-dose transdermal therapy.

Common adverse effects of menopausal hormone therapy include vaginal bleeding, mastalgia and headache. Unexpected vaginal bleeding is the most common adverse event with menopausal hormone therapy. Investigations for endometrial hyperplasia or cancer should be performed (i.e., ultrasonography, endometrial sampling) if the bleeding persists beyond 4–6 months, or in a patient with risk factors for endometrial cancer. It is not necessary to cease use of menopausal hormone therapy while investigations are ongoing. Options for decreasing unexpected vaginal bleeding include sequential progestin dosing (i.e., 12–14 days of the month); use of a levonorgestrel-releasing intrauterine system, tibolone or the TSEC (when available); or, in rare cases, hysterectomy. Evaluation of the endometrium with ultrasonography and histologic sampling, and titration of the dose of estrogen or progestin based on thickness and histologic phase, can be performed with or without referral to a gynecologist based on the comfort of the managing physician.

Mastalgia is a common estrogenic adverse effect and can raise concerns regarding breast cancer. It will usually improve over the first 3–4 months of treatment. Approaches to managing mastalgia include minimizing estrogen to the lowest effective dose or using conjugated estrogens, cyclic progestin dosing, tibolone or the TSEC (when available).49

Migraine is not a contraindication to the use of systemic menopausal hormone therapy. Migraine symptoms can be improved for some patients by using regular, continuous dosing of both estrogen and progesterone. For patients with contraindications to menopausal hormone therapy, escitalopram and venlafaxine have evidence both for improvement of vasomotor symptoms and migraine suppression.50

Conclusion

Menopause and perimenopause can be associated with distressing symptoms and reduced quality of life. Menopausal hormone therapy is the first-line treatment for vasomotor symptoms in the absence of contraindications. Patients with contraindications to estrogen and progestin therapy can be offered nonhormonal alternatives. Choice of menopause treatments depends on symptoms, patient preference, risk factors, absolute contraindications, availability and costs. Complex patients should be referred to specialists. Important clinical questions remain unanswered and should be tackled by future research (Box 2).

Box 2: Unanswered questions

  • What is the optimal duration of treatment for menopausal hormone therapy?

  • Are any hormonal formulations superior for either cardiovascular or bone protection?

  • What are the optimal hormonal formulations to minimize risk from menopausal hormone therapy with regards to breast cancer and venous thromboembolic events?

  • Will newer nonhormonal agents that act directly on brain receptors offer cardiovascular or bone protection?

  • What is the work-up for vasomotor symptoms that are suspected to be nonmenopausal in etiology?

  • What is the evidence for nonpharmacologic and lifestyle approaches to menopause management?

Footnotes

  • Competing interests: Iliana Lega holds research funding from the Canadian Institutes of Health Research (CIHR) and Canadian Menopause Society, and has received travel support from Diabetes Canada. Michelle Jacobson reports funding from CIHR, travel support from Women’s College Hospital and consulting fees from Abbvie, Astellas, Biosyent, Duchesnay, Lupin and Pfizer. She has received honoraria from Abbvie, Bayer, Biosyent, Duchesnay, Lupin, Organon, Pfizer and Searchlight. She consults on Duavive, Tibolone, Mirena and Estrogel. She is a vice chair with the Ontario Medical Association, and sits on the advisory boards of Pfizer, Duchesnay, Astellas, Lupin and Eisai. No other competing interests were declared.

  • This article was solicited and has been peer reviewed.

  • Contributors: Iliana Lega, Alexa Fine and Michelle Jacobson were involved in the conception and design of this manuscript. All of the authors drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

  • Funding: There is no funding associated with this manuscript.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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Canadian Medical Association Journal: 195 (19)
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Vol. 195, Issue 19
15 May 2023
 

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  • Vacancies: 3 Terms of Employment: This is a full-time position 36 to 40 hours per week Must be available daytime, evenings, and weekends. Part-time, Casual or Locum opportunities are also available. Anticipated Start Date: As soon as possible Salary: Fee for Service (Approximately $235,000 to $335,000 per year) Location: 407 Iroquois Shore Rd. Oakville, ON L6H 1M3 Experience: Minimum one year Education: Doctor of Medicine Work Setting: Medical Clinic Language: English License : CCFP / College of Family Physicians Certificate Licensure by Provincial or Territorial Authorities / Medical Council of Canada Medical Council of Canada Qualifying Examination (MCCQE 1) Family physician’s primary duties: Examining patients and taking their histories Order laboratory tests, X-rays, and other diagnostic procedures Consult with other medical practitioners to evaluate patients’ health Prescribe and administer medications and treatments Inoculate and vaccinate patients to prevent and treat diseases Advise patients on healthcare Communicate health promotion/disease prevention to patients Provide Counselling and support to patients and their families on a wide range of health and lifestyle issues Please apply by: Mail or in-person: 407 Iroquois Shore Rd. Oakville, ON L6H 1M3 Email: onehealthoakville01@gmail.com
  • The Saskatchewan Cancer Agency is looking for a Clinical Associate Locum to join our team in Regina. The Clinical Associate will work with in a multidisciplinary team to provide safe patient-centered care. In collaboration with the oncologist, they will participate in daily rounds, provide care to oncology hospital in-patient, hospital and Cancer Centre outpatients and provide after hour care as per the on call duty schedule. The outpatient role involves primarily assessment and follow-up care. Practice Location: Allan Blair Cancer Centre, 4101 Dewdney Ave, Regina, Saskatchewan Canada S4T 7T1 Population Base: Saskatchewan has a population of 1.2 million. The Allan Blair Cancer Centre provides comprehensive cancer care to those living in the southern parts of the province. Job Requirements: Education: Degree in medicine with subspecialty certification in internal medicine or oncology. Preference given to candidates Oncology experience. Completion of a Canadian Oncology fellowship is considered an asset. Certification through the Medical Council of Canada (or successful completion of the MCCQE1 exam) Credentials: Must be eligible for licensure with the College of Physicians and Surgeons of Saskatchewan. Must be eligible for membership and privileges with the Saskatchewan Health Authority in Regina. Other: Criminal record check CMPA Coverage Written and verbal fluency in English. A minimum of 7.0 in all categories in IELTS exam is required for all international medical graduates. Salary Details: A competitive compensation package is offered and will be commensurate with experience. Salary range for this position is $263,455 – $352,030, plus benefits. How to Apply: For more information regarding this opportunity, contact Dr. Magdi Ali, Regina Team Lead – Clinical Associates, at Magdi.Ali@saskcancer.ca . Interested applicants are invited to submit their letter of intent and curriculum vitae to: Physician Recruitment and Retention Consultant Saskatchewan Cancer Agency 130-1804 McOrmond Drive Saskatoon, Saskatchewan Canada S7S 0A6 p hysician.careers@saskcancer.ca Deadline for application : Applications will be accepted until filled. We thank all candidates for their interest. Only those selected for an interview will be contacted. In accordance with Canadian immigration requirements, preference will be given to Canadian citizens and permanent residents of Canada.
  • The Saskatchewan Cancer Agency operates prevention and early detection programs, conducts innovative research and provides safe, patient and family-centred care at our two comprehensive cancer centres – the Allan Blair Cancer Centre in Regina and the Saskatoon Cancer Centre. The provincial hematology program focuses on the diagnosis and treatment of patients with both benign and malignant hematological conditions, including full provision of autologous and allogeneic stem cell transplant services in our Saskatoon location. Practice Loctation(s): Regina Hematology Clinic, 4545 Parliament Ave, Regina, SK, S4W 0G3 Allan Blair Cancer Centre, 4101 Dewdney Ave, Regina, SK, S4T 7T1 Job Duties: We are looking for two hematologists to join the Saskatchewan Cancer Agency in Regina on a permanent, full-time basis. The positions will have responsibilities in the care of both benign and malignant patients, the proportion of each to be determined in collaboration with the team. A competitive compensation package is offered and will be commensurate with experience. The current salary range is $340,263 to $439,113, plus benefits. Call Schedule Description: The call schedule will be established based on an equal rotational basis with other hematologists in the department(s). Compensation for on-call coverage at the standard rate of payment prescribed by the the Saskatchewan Ministry. Our hematologists are eligible for a clinical appointment in the Division of Oncology, College of Medicine at the University of Saskatchewan and are also involved in teaching medical students and Residents including at the undergraduate and graduate level. Job Requirements: The successful applicant will have obtained or be in the final stages of obtaining certification in Hematology with the Royal College of Physicians and Surgeons of Canada or have equivalent education, training and experience. They must be able to work in a multidisciplinary setting, and engage collaboratively with the team. The successful candidate must also be eligible for licensure with the College of Physicians and Surgeons of Saskatchewan , meet the requirements for membership in the medical staff of the Saskatchewan Health Authority (Regina) and hold valid CMPA coverage. Other Requirements: Criminal record check Written and verbal fluency in English Population Base: The population of Saskatchewan is 1.2 million. The Allan Blair Cancer Centre and Regina Hematology Clinic provide comprehensive cancer care to those living in the southern parts of the province. Saskatchewan is a growing and prosperous province. Saskatchewan offers a world of endless possibilities. Interested applicants are invited to submit their curriculum vitae to: Physician Recruitment and Retention Consultant Saskatchewan Cancer Agency 120-1804 McOrmond Drive Saskatoon, Saskatchewan Canada S7S 0A6 E-mail: physician.careers@saskcancer.ca We thank all candidates for their interest. Applications will be accepted until the position is filled. Review of applicants will be ongoing. Only those selected for an interview will be contacted. For more information on this opportunity, please contact Regina Hematology Team Lead Dr. Abdulhakim Eswedi at Abdulhakim.Eswedi@saskcancer.ca. Community Information: City of Regina: www.regina.ca; www.tourismregina.com Province of Saskatchewan: www.saskatchewan.ca; www.sasktourism.com; www.saskatchewan.ca/immigration Please note, In accordance with Canadian immigration requirements, preference will be given to Canadian citizens and permanent residents of Canada.
  • The Division of Respirology in the Department of Pediatrics at Dalhousie University and the IWK Health Centre is seeking a full-time (1.0 FTE) physician at the Assistant, Associate or Full Professor level. The individual will join a team of two respirologists. The Division provides care to children with a wide variety of respiratory conditions like asthma, sleep medicine, complex respiratory care, home ventilation, non-CF bronchiectasis/PCD, and is the regional Centre for Cystic Fibrosis. In addition to outpatient care, the division provides usual ward care, consult service, and equally divided on-call coverage. Bronchoscopy skills are essential. Additional training in interstitial lung disease, aero-digestive and/or sleep medicine will be an asset to complement our group practice. The successful applicant will contribute to the academic mission of the Department of Pediatrics through research and teaching trainees at different stages of their training. The IWK Health Centre is a tertiary care children’s and women’s facility serving the Maritime Provinces of Canada. Dalhousie University, Atlantic Canada’s leading research university, offers a range of collaborative research and teaching possibilities. Cross-appointment to relevant Departments is possible for interested candidates. Qualifications include an MD degree (or equivalent) from an accredited university, certification in Pediatrics and certification in Pediatric Respirology Medicine (or equivalent). Eligibility for medical licensure in the Province of Nova Scotia is essential. Compensation and academic appointment is commensurate with experience and qualifications. Dalhousie University < http://www.dal.ca/ > is located in Halifax < http://www.halifaxinfo.com/ > , a cosmopolitan port city and the capital of Nova Scotia < http://www.novascotia.com/ > . Halifax is alive with culture and heritage and embraced by the Atlantic Ocean. Interested applicants must submit a current CV and a statement outlining their academic, teaching and research interests. Candidates must also provide the names and contact information for three referees (two of which must be academic). Applications will be accepted July 26, 2023 To apply for this position, please go to: http://dal.peopleadmin.ca Dalhousie University commits to achieving inclusive excellence through continually championing equity, diversity, inclusion, and accessibility. The university encourages applications from Indigenous persons (especially Mi’kmaq), persons of Black/African descent (especially African Nova Scotians), and members of other racialized groups, persons with disabilities, women, and persons identifying as members of 2SLGBTQ+ communities, and all candidates who would contribute to the diversity of our community. For more information, please visit www.dal.ca/hiringfordiversity

 

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]]> Depression And Breast-Cancer Survival https://thirdage.com/depression-and-breast-cancer-survival/ Thu, 27 Apr 2023 11:46:00 +0000 https://thirdage.com/?p=3076965 Read More→]]> In a recent study, having depression before or after a breast cancer diagnosis was associated with a lower likelihood of survival. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

 For the study, Bin Huang, DrPH, of the University of Kentucky Markey Cancer Center, and his colleagues analyzed data from the Kentucky Cancer Registry to identify adult women diagnosed with primary invasive breast cancer in 2007–2011. Utilizing the health claims–linked cancer registry data, the team classified patients as having no depression diagnosis, depression diagnosis only before cancer diagnosis, depression diagnosis only after cancer diagnosis, or persistent depression defined as depression before and after cancer diagnosis. The team also assessed patients’ receipt of first course guideline-recommended treatment as indicated by the National Comprehensive Cancer Network breast cancer treatment guidelines.

 Among 6,054 patients, 4.1%, 3.7%, and 6.2% of patients had persistent depression, depression pre-diagnosis only, and depression post-diagnosis only, respectively. Analyses indicated that 29.2% of patients did not receive guideline-recommended breast cancer treatment. Also, during a median follow-up of 4 years, 26.3% of patients died.

Compared with patients with no depression, patients with post-diagnosis only or persistent depression had a similar likelihood of receiving guideline-recommended treatment, but patients with depression pre-diagnosis only had 25% lower odds of receiving guideline-concordant care, although this finding was marginally significant. Additional research is needed to determine the potential reasons for this association.

 Depression pre-diagnosis only and depression post-diagnosis only (but not persistent depression) were linked with worse survival compared with no depression. Specifically, depression pre-diagnosis was associated with a 26% higher risk of death, and depression post-diagnosis was associated with a 50% higher risk. Also, patients who did not receive guideline-recommended treatment faced a 118% higher risk of death than those who received recommended care.

 Compared with patients residing in non-Appalachian Kentucky, patients residing in Appalachia were 18% less likely to receive recommended care, but investigators did not find any significant differences in survival.

 The findings suggest that diagnosing and treating depression at the time of breast cancer diagnosis and beyond can be critical to patient care and survival.

“A surprising result from this study is that patients with persistent depression did not experience worse survival compared with patients with no depression,” said Huang. “Given that under-diagnosis and under-treatment of depression are common among cancer patients, persistent depression could be an indication that patients’ depression may have been well managed. Hence, this particular result suggests the importance of depression screening and management throughout a cancer patient’s care.”

Huang noted that population-based cancer registry data enhance population-based cancer outcomes research. “Utilizing linked health claims data and cancer registry data in this study demonstrated the value of data linkages across various sources for examining potential health disparities and identifying where improvements in cancer care are needed,” he said. “More rigorous studies are needed in depression management and across various cancer sites and patient populations. Subsequently, results from these research studies may further shape policies and guidelines for depression management in cancer care.”

CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. CANCER is published on behalf of the American Cancer Society by Wiley, one of the world’s largest health publishers.

]]> Shoulder Pain and Estrogen Therapy https://thirdage.com/shoulder-pain-and-estrogen-therapy/ Tue, 18 Oct 2022 12:00:00 +0000 https://thirdage.com/?p=3076263 Read More→]]> A new study shows that post-menopausal women who are on hormone replacement therapy have a lower risk of developing a painful shoulder condition than women who aren’t receiving the treatment.

The research into estrogen therapy and the condition, adhesive capsulitis, was conducted by the Duke University Departments of Orthopedics and Obstetrics & Gynecology. Results were presented Oct. 12 at the meeting of the North American Menopause Society meeting in Atlanta.

“Estrogen plays a role in stimulating bone growth, reducing inflammation, and promoting connective tissue integrity,” said Jocelyn Wittstein, M.D., associate professor in Duke’s Department of Orthopedic Surgery, according to a Duke Health news release. “Not using systemic hormone therapy was associated with a higher risk of adhesive capsulitis in our retrospective cohort study.”

 This retrospective cohort study analyzed medical records of nearly 2,000 post-menopausal women between the ages of 45 and 60 who presented with shoulder pain, stiffness and adhesive capsulitis.

 Among the women in the study, only 3.95% of those who had received hormone replacement therapy were diagnosed with the shoulder condition, compared to 7.65% of women who had not received estrogen replacement. The differences were not statistically significant, likely due to the sample size, but the researchers said the findings should drive further investigation.

 “Given that older women are most commonly affected by adhesive capsulitis, there may be a connection between the loss of estrogen in menopause and this painful shoulder condition,” said Anne Ford, M.D., associate professor in the Department of Obstetrics & Gynecology at Duke University School of Medicine.

]]> Even Small Amount of Breastfeeding Can Provide Heart-Healthy Benefits https://thirdage.com/even-small-amount-of-breastfeeding-can-provide-heart-healthy-benefits/ Fri, 26 Aug 2022 06:00:00 +0000 https://thirdage.com/?p=3076023 Read More→]]> Breast milk has long been recognized as an ideal nutrient to strengthen the immune systems of newborns and infants. The American Heart Association (AHA) now says breastfeeding can also provide many heart-healthy benefits for babies and for their birthing parent.

In a study published in the Journal of the American Heart Association in January 2022, researchers found that women who breastfed at some point during their lives were 17% less likely to die from cardiovascular disease than women who never breastfed. Over a 10-year average follow-up period, women who breastfed were 14% less likely to develop heart disease, 12% less likely to have strokes and 11% less likely to develop any cardiovascular disease. Women who breastfed up to 12 months during their lifetime had lower risks. The analysis included health data for nearly 1.2 million women from eight studies conducted between 1986 and 2009 in Australia, China, Norway, Japan and the U.S. and one multinational study.

Babies who consumed breastmilk, even for a few days, had lower blood pressure at 3 years of age compared to children who never had breast milk, according to another study published in the Journal of the American Heart Association in 2021. Blood pressure was lower among the toddlers who had been breastfed, regardless of how long they were breastfed or if they received other complementary nutrition and foods.

“There’s growing evidence that suggests breastfeeding can play an important role in lowering cardiovascular disease risks. We know that cardiovascular disease risk factors, including high blood pressure, can start in childhood, so giving a baby breast milk even for a few days in infancy is a good start to a heart-healthy life,” said Maria Avila, M.D., an AHA volunteer expert and an assistant professor of cardiology at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. “There have been a number of studies that show breastfeeding can reduce a woman’s risk of heart disease and stroke. People who breastfeed their babies are taking steps to improve their own heart health, as well, so it’s definitely an option to strongly consider.”

For babies’ health, the AHA recommends breastfeeding for 12 months, transitioning to other additional sources of nutrients beginning at about four – six months of age to ensure sufficient micronutrients in the diet.

However, not all birthing parents can or want to breastfeed and Avila said that’s OK. Expressing breast milk or even using donated breast milk and feeding it to a baby in a bottle can also help infants get those important nutrients and possibly the heart-health benefits of traditional breastfeeding. However, if none of those are options, iron-fortified infant formula is recommended, according to Avila.

“Having a newborn can be a stressful time for any parent, and not being able to breastfeed your baby or having a fussy baby who doesn’t want to breastfeed could add to, so know you have options. The most important thing a parent can do for their child is to give them every early start at a heart-healthy life, and that can begin even before conception and with good prenatal care to help reduce their own cardiovascular risks as much as possible,” Avila said. “Along with eating right, staying active and managing blood pressure, cholesterol, weight and other health conditions, real health includes keeping both your body and your mind fit. Make sure you practice self-care and ask for help from your partner, family or other support groups. Enjoy this special time in your family’s life because it really does go back quickly.”

Studies published in the AHA’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content.

]]> Endometriosis and Stroke Risk https://thirdage.com/endometrosis-and-stroke-ris/ Thu, 04 Aug 2022 10:00:00 +0000 https://thirdage.com/?p=3075929 Read More→]]> A large, prospective study found that women with endometriosis may have a higher risk of stroke compared to women without the chronic inflammatory condition, according to new research in July 2022 in Stroke, the peer-reviewed journal of the American Stroke Association, a division of the American Heart Association.

Endometriosis (abnormal growth of endometrial-like tissue outside the uterus) is estimated to affect approximately 10% of reproductive aged women in the U.S., according to study authors. Previous research found that women with endometriosis are at greater risk of cardiovascular diseases such as heart attack, high blood pressure and high cholesterol.

“These findings suggest that women with a history of endometriosis may be at higher risk of stroke,” said Stacey A. Missmer, Sc.D., study senior author and professor of obstetrics, gynecology and reproductive biology at Michigan State University College of Human Medicine in Grand Rapids, Michigan. “Clinicians should look at the health of the whole woman, including elevated blood pressure, high cholesterol and other new stroke risk factors, not only symptoms specifically associated with endometriosis, such as pelvic pain or infertility.”

In this study, researchers led by first author Leslie V. Farland, Sc.D., assistant professor of epidemiology and biostatistics at University of Arizona, in Tucson, examined the association between endometriosis and the development of ischemic stroke (caused by blood clots blocking blood flow) or hemorrhagic stroke (caused by bleeding in the brain) among women enrolled in the Nurses’ Health Study II. The analysis involved 112,056 women who were nurses between the ages of 25 and 42 years old from 14 U.S. states at the start of the study in 1989. The current study ended in 2017. A laparoscopy (surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or to permit a surgical procedure) was used to make the diagnosis of endometriosis. Endometriosis was reported in 5,244 women. Most of the participants (93%), including those diagnosed with endometriosis, were white women.

Researchers analyzed data collected every two years for many possible confounders or risk factors, including alcohol intake, current body mass index, menstrual cycle pattern in adolescence, current oral contraceptive and postmenopausal hormone exposure, smoking history, diet, physical activity, aspirin use, race/ethnicity and income. Additionally, researchers investigated if the link between endometriosis and risk of stroke could be explained by other mediating factors such as high blood pressure, high cholesterol, hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries) and postmenopausal hormone therapy. During the 28 years of follow-up including medical record confirmations, researchers documented 893 strokes.

The analysis found:

Women with endometriosis (5,244) had a 34% greater risk of stroke, compared to those without the condition (106,812).

The largest proportion of the stroke risk associated with endometriosis was linked to hysterectomy and/or oophorectomy (39%) and postmenopausal hormone therapy (16%).

No significant differences were seen in the relationship between endometriosis and stroke across multiple factors – such as age, infertility history, body mass index or menopausal status.

“There are circumstances when a hysterectomy and/or oophorectomy is the best choice for a woman. However, we also need to make sure that patients are aware of the potential health risks associated with these procedures,” Missmer said. “Other research also suggests that hysterectomy is associated with elevated stroke risk even if there is no history of endometriosis.”

“These results do not indicate that women who have endometriosis will have a stroke. Instead, these findings signify only an association of moderate relative risk. The absolute risk of stroke in women is low,” Missmer said. “Women with endometriosis should pay attention to their whole body and discuss added risks and preventive options with their health care team.”

“While we know that adverse pregnancy outcomes are associated with increased risk of premature cardiovascular disease, this study sheds light on the association of gynecological issues such as endometriosis with stroke, which could impact both patients and clinicians,” said American Heart Association Go Red for Women volunteer Garima Sharma, M.B.B.S., who is director of cardio-obstetrics and assistant director of medicine at Johns Hopkins Cardiology in Baltimore. “Most importantly, this study underscores the importance of understanding reproductive and gynecological history.”

The study had several limitations. Data detailing subtypes of strokes was not available. As a result, the relationship between subtypes of strokes and endometriosis could not be evaluated. Another limitation of the study is that researchers were unable to determine the impact of time from endometriosis-associated symptom onset and age at endometriosis diagnosis.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. For more information call 1-888-4STROKE or visit the organization’s website.

]]> The Breast-Cancer Factor in Heart Disease https://thirdage.com/the-breast-cancer-factor-in-heart-disease/ Tue, 22 Mar 2022 11:00:00 +0000 https://thirdage.com/?p=3075242 Read More→]]> Routine mammograms may provide key insights for cardiovascular disease, according to new research: Detection of breast arterial calcifications on breast mammograms was associated with a higher risk of cardiovascular disease in postmenopausal women, according to the research, published in March 2022 in Circulation: Cardiovascular Imaging, a peer-reviewed journal of the American Heart Association. This finding may be useful to help determine women’s risk for heart disease and stroke, according to the study authors.

Breast arterial calcification, calcium build-up within the middle layer of the breast’s arterial wall, is related to aging, Type 2 diabetes, high blood pressure and inflammation, and is a marker of stiffening in the arteries. It is not the same as calcification of the inner layer of the arteries (the layer that is in contact with the blood), which is typically found in people who smoke or those with high cholesterol levels. Breast arterial calcification is a common finding that shows up as white areas in the breast’s arteries on a mammogram however, it is not thought to be related to cancer.

“In an earlier study of this same research group, we reported that among women ages 60 to 79, 26% of the women had breast arterial calcification, and the percentage increased with age to more than half of women having evidence of the finding between ages 75 to 79 years,” said the study’s lead author Carlos Iribarren, M.D., M.P.H., Ph.D., a research scientist at the Kaiser Permanente Northern California Division of Research in Oakland, California. “Research has confirmed the calculators we currently use to assess an individual’s 10-year risk of developing cardiovascular disease are not as accurate in women as they are in men. In our current study, we evaluated if breast arterial calcification, which can be easily seen on a mammogram, provides more information about a woman’s risk of developing heart disease.”

In this study, researchers reviewed health records on a subset of more than 5,000 women selected from among more than 200,000 women who underwent screening mammograms as part of MINERVA (MultIethNic study of brEast aRterial calcium gradation and cardioVAscular disease), a large, racially and ethnically diverse cohort of postmenopausal women. Participants of the current study were actively enrolled in the same health insurance plan, were between the ages of 60-79 years and received at least one regular screening with digital mammography at one of nine facilities of Kaiser Permanente of Northern California between October 24, 2012 and February 13, 2015. The women had no prior history of cardiovascular disease or breast cancer. Researchers assessed the women’s overall health and followed them through their electronic health records for about 6.5 years after the mammogram to find which women had a heart attack or stroke or developed other types of cardiovascular disease, such as heart failure.

The analysis found:

Women who had breast arterial calcification present on their mammogram were 51% more likely to develop heart disease or have a stroke compared with women who did not have breast arterial calcification.

Women with breast arterial calcification were 23% more likely to develop any type of cardiovascular disease, including heart disease, stroke, heart failure and diseases of the peripheral arteries.

Breast arterial calcification was more prevalent among women who self-identified as white or Hispanic/Latina women, and less likely among women who self-identified as Black or Asian women. Iribarren and colleagues noted more research is needed to understand these findings.

“Currently, it is not the standard of care for breast arterial calcification visible on mammograms to be reported. Some radiologists do include this information on their mammography reports, but it’s not required,” Iribarren said. “We hope that our study will encourage an update of the guidelines for reporting breast arterial calcification from routine mammograms. Our study has moved the needle toward recommending routine assessment and reporting of breast arterial calcification in postmenopausal women. Integrating this information in cardiovascular risk calculators and using this new information can help improve cardiovascular risk reduction strategies.”

Iribarren also noted that there would be no added cost or extra radiation exposure for women because the U.S. Preventive Services Task Force (USPSTF) recommends women ages 50-74 years have a mammogram every two years, and for women ages 40-49 years, mammography may be considered for the early diagnosis of breast cancer based on individual risks and as advised by a physician. Mammography screenings, timed according to USPSTF’s guidelines, are covered as a preventive service with no copayment by most health insurance providers including Medicare, Medicaid and private insurance companies, as required by the Affordable Care Act.

Cardiovascular disease followed by cancer are the top two causes of death among U.S. women, according to the American Heart Association’s Heart and Stroke Statistical Update 2022. However, in the U.S., more women report worrying about their risk for breast cancer than heart disease, and only half of women are even aware that heart disease is the leading cause of death in women, according to Natalie A. Cameron, M.D., and Sadiya S. Khan, M.D., M.Sc., FAHA, co-authors of an accompanying editorial for this study, also publishing today in March 2022 in  Circulation: Cardiovascular Imaging.

“This type of calcification may suggest poor heart health, and clinicians may be able to leverage this opportunity to discuss ways to optimize heart health, such as engaging in routine physical activity, high quality diet and maintaining a healthy weight,” said Khan, an assistant professor of medicine in the division of cardiology at Northwestern University’s Feinberg School of Medicine in Chicago. “However, it is really important to note that the absence of breast arterial calcification did not translate into low risk and should not be falsely reassuring when no breast arterial calcification is present. Optimal risk factor control is equally important for all women with and without breast arterial calcification.”

Among the limitations of the study, these findings may not be generalizable to women who do not have health insurance or woman younger than age 60. Iribarren  plans to incorporate women younger than age 60 in future research.

]]> Hypertension and Dental Health https://thirdage.com/hypertension-and-dental-health/ Tue, 08 Mar 2022 11:00:00 +0000 https://thirdage.com/?p=3075177 Read More→]]> Some oral bacteria were associated with the development of hypertension, also known as high blood pressure, in postmenopausal women, according to new research.

The study was published in March 2022 in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

High blood pressure is typically defined by two measurements: systolic blood pressure (the upper number measuring pressure when the heart beats) of 130 mm Hg or higher, and diastolic blood pressure (the lower number indicating pressure between heart beats) of 80 mm Hg or higher.

While previous research has indicated that blood pressure tends to be higher in people with existing periodontal disease compared to those without it, researchers believe that this study is the first to prospectively examine the association between oral bacteria and developing hypertension.

“Since periodontal disease and hypertension are especially prevalent in older adults, if a relationship between the oral bacteria and hypertension risk could be established, there may be an opportunity to enhance hypertension prevention through increased, targeted oral care,” said Michael J. LaMonte, Ph.D., M.P.H., one of the study’s senior authors, a research professor in epidemiology at the University at Buffalo – State University of New York and a co-investigator in the Women’s Health Initiative clinical center in the University’s epidemiology and environmental health department.

Researchers evaluated data for 1,215 postmenopausal women (average age of 63 years old at study enrollment, between 1997 and 2001) in the Buffalo Osteoporosis and Periodontal Disease Study in Buffalo, New York. At study enrollment, researchers recorded blood pressure and collected oral plaque from below the gum line, “which is where some bacteria keep the gum and tooth structures healthy, and others cause gum and periodontal disease,” LaMonte said. They also noted medication use and medical and lifestyle histories to assess if there is a link between oral bacteria and hypertension in older women.

At study enrollment, about 35% (429) of the study participants had normal blood pressure: readings below 120/80 mm Hg, with no use of blood pressure medication. Nearly 24% (306) of participants had elevated blood pressure: readings above 120/80 mm Hg with no medication use. About 40% (480) of participants were categorized as having prevalent treated hypertension: diagnosed and treated for hypertension with medication.

Researchers identified 245 unique strains of bacteria in the plaque samples. Nearly one-third of the women who did not have hypertension or were not being treated for hypertension at the beginning of the study were diagnosed with high blood pressure during the follow-up period, which was an average of 10 years.

The analysis found that 10 bacteria were associated with a 10% to 16% higher risk of developing high blood pressure, and five other kinds of bacteria were associated with a 9% to 18% lower hypertension risk.

These results were consistent even after considering demographic, clinical and lifestyle factors (such as older age, treatment for high cholesterol, dietary intake and smoking) that also influence the development of high blood pressure.

The potential associations for the same 15 bacteria with hypertension risk among subgroups was analyzed, comparing women younger than age 65 to those older than 65; smokers versus nonsmokers; those with normal versus elevated blood pressure at the start of the study, and other comparisons. Results remained consistent among the groups compared.

The findings are particularly relevant for postmenopausal women, since the prevalence of high blood pressure is higher among older women than older men, according to LaMonte.

More than 70% of American adults ages 65 and older have high blood pressure. That age category, the fastest growing in the U.S., is projected to reach 95 million by 2060, with women outnumbering men 2 to 1, according to a 2020 U.S. Census report. The 2020 U.S. Surgeon General’s Call to Action to Control Hypertension underscores the serious public health issue imposed by hypertension in adults, especially those in later life. Identifying new approaches to prevent this disease is, thus, paramount in an aging society.

According to the American Heart Association, nearly half of U.S. adults have high blood pressure, and many don’t know they have it. High blood pressure is a major risk factor for cardiovascular disease and stroke.

“We have come to better appreciate that health is influenced by more than just the traditional risk factors we know to be so important. This paper is a provocative reminder of the need to expand our understanding of additional health factors that may even be influenced by our environments and potentially impact our biology at the endothelial level,” said Willie Lawrence, M.D., chair of the American Heart Association’s National Hypertension Control Initiative’s (NHCI) Oversight Committee. ” Inclusive research on hypertension must continue to be a priority to better understand and address the condition.”

Due to the study’s observational approach, cause and effect cannot be inferred, limiting the researchers’ ability to identify with certainty that only some bacteria are related to lower risk of hypertension while others are related to higher risk. A randomized trial would provide the evidence necessary to confirm which bacteria were causal agents in developing – or not developing – hypertension over time, according to LaMonte.

]]> Three New Scientific Theories to Explain Why Women Are More Susceptible to Autoimmune Disease than Men Are https://thirdage.com/three-new-scientific-theories-to-explain-why-women-are-more-susceptible-to-autoimmune-disease-than-men-are/ Thu, 25 Jun 2020 04:00:09 +0000 http://thirdage.com/?p=3072566 Read More→]]> Although autoimmune disease (AD) affects both genders, women are at an overwhelming disadvantage. Of the approximate 8 percent of the population affected by AD, a whopping 78 percent of those cases are women (NCBI). The National Institutes of Health has officially designated autoimmune disease as a major women’s health issue.

Autoimmunity in and of itself is very complicated, with more than 80 diseases under its umbrella. The rate at which AD affects women over men, is no exception to the complexity of understanding this group of diseases. Through recent studies, scientists have found evidence to support three significant theories to explain why women are so greatly affected by AD compared to men.

Testosterone levels protect men – According to researchers at the University of Gothenburg, there is a link between the male sex hormone testosterone and protection against autoimmune diseases. Men are generally more protected than women, who only have one-tenth as much testosterone. Their study confirmed that this hormone reduces the number of B cells, a type of lymphocyte that releases harmful antibodies. Testosterone suppresses the protein BAFF, which makes the harmful B cells more viable. Therefore, women don’t benefit from the same protection against these B cells.

These findings support those of a previous study showing the link between varying levels of BAFF and systemic lupus erythematosus (SLE), an autoimmune disease that affects nine women for every one man. Lupus is one of the most common autoimmune diseases among women.

lupus

Skin – Perhaps one of the most interesting findings was uncovered in a study at The University of Michigan three years ago. Researchers discovered that women carry more of a molecular switch, called VGLL3, in their skin than men do. In 2019, further research pointed to evidence showing that having too much VGLL3 in skin cells pushes the immune system into overdrive, leading to a “self-attacking” autoimmune response that can extend beyond the skin, also attacking internal organs.

The same gene expression-level changes in skin cells with extra VGLL3 are also seen in autoimmune diseases such as lupus. It is still not known why women have more VGLL3 in their skin than men. However, men with lupus do show the same VGLL3 pathway activated as in women with lupus.

“The Pregnancy Compensation Hypothesis” and hormones – The idea behind this theory is that a woman’s immune system evolves to support the heightened need for protection during pregnancy. According to Melissa Wilson, PhD and Senior Author of a study conducted at Arizona State University, reduced pregnancy rates in today’s modern, industrialized societies means women’s immune systems don’t have the reproductive challenges they are meant to stand up against. These changes in the reproductive ecology of women makes them more susceptible to autoimmune disease because immune surveillance is heightened.

Furthermore, results from the study concluded that due to a more sedentary lifestyle in modern society, an overabundance of calories supports greater amounts of the female hormone estradiol. Maintaining such high levels of hormones can trigger the onset of autoimmune diseases. So not only do men get protection from AD with their higher levels of testosterone, but women have increased risk of AD due to higher levels of estradiol, thus widening the gap of AD in men versus women.

There is still so much to learn about autoimmune disorders, especially with the various types of diseases being categorized as autoimmune-related. Scientists do know that some of the highest risk factors of AD include genetics, environmental factors, lifestyle and even prior infection. But newer findings, especially those discussed here, suggest that simply being female puts you at higher risk for AD, with lupus seemingly at the top of the list.

Interestingly, a multitude of autoimmune diseases present some of the same early signs, including:

  • Skin rashes, itchiness or flakiness
  • Fatigue
  • Rapid weight gain or loss
  • Digestive tract issues
  • Joint pain
  • Swelling/Bloating
  • Lack of focus
  • Abdominal pain

If you or any women in your life suffer from any of these symptoms without an identified, underlying cause, seeking the advice of a health care professional and medical testing should be considered. Cyrex Laboratories, a leader in advanced clinical testing, offers several screens for the detection of autoimmune-related reactivities. The Array 5 – Multiple Autoimmune Reactivity Screen™ is one of their comprehensive tests offered to measure predictive antibodies, some of which can appear up to 10 years before the clinical onset of disease. This groundbreaking test can help alert at-risk patients in time to stop the development of actual disease in some cases.

Preventative medicine is the best medicine, which is why symptoms should never be ignored. Taking control of your medical wellbeing through smart lifestyle practices, healthy eating and regular physical exams can help you live your best life and prevent disease. Finally, it is important for women to understand how their bodies work, the unique health risks they are susceptible to, and protocols for optimal health.

Dr. Chad Larson, NMD, DC, CCN, CSCS, Advisor and Consultant on Clinical Consulting Team for Cyrex Laboratories. Dr. Larson holds a Doctor of Naturopathic Medicine degree from Southwest College of Naturopathic Medicine and a Doctor of Chiropractic degree from Southern California University of Health Sciences. He is a Certified Clinical Nutritionist and a Certified Strength and Conditioning Specialist. He particularly pursues advanced developments in the fields of endocrinology, orthopedics, sports medicine, and environmentally-induced chronic disease.

]]> 5 Signs That You’re Entering Menopause https://thirdage.com/5-signs-that-youre-entering-menopause/ Fri, 12 Jun 2020 04:00:37 +0000 http://thirdage.com/?p=3072523 Read More→]]> Menopause is a natural part of aging for women, but there is no predictable pattern or timeline for the symptoms, doctors say.

While hot flashes, irritability and weight gain are generally well known, symptoms like anxiety, hair loss, and incontinence can catch a woman by surprise and cause concern, even though they’re normal.

Many myths exist about what to expect when going through menopause. It’s important to know your body well enough to know what’s happening and get reassurance that what’s going on is normal.

Here are five normal menopausal symptoms women can watch for:

  • Anxiety/depression.

    Depression and anxiety shouldn’t be ignored; they can appear as your body changes, and need to be treated. “If you have a history of anxiety and/or depression, you are likely to experience it again in perimenopause – the menopause transition. Decreasing progesterone and overactive adrenals may be partially responsible for the anxiety you’re feeling, and progesterone has been implicated in depression, too. So, don’t think depression and anxiety are just ‘all in your head.

  • Hair loss and hair growth. 

    Hormone changes can cause hair growth where you least want it. At the same time, these hormone changes – specifically, decreasing estrogen and the changing ratio of estrogen to testosterone – are responsible for thinning hair on the scalp, especially on the crown and near the forehead.

hair loss woman

  • Behavioral changes. 

    Behavior can tip off a woman to menopausal symptoms. If you’re not feeling like yourself and your partner has complained about you treating them differently. It could be an indication of lower estrogen levels. Estrogen is actually a key driver of women’s nurturing behavior and desire to take care of others. When levels decline in perimenopause, women can find themselves thinking, feeling and behaving in a way that’s unfamiliar. This biological change can have huge consequences for family dynamics.”

  • Appearance of vagina.

    Age and hormones affect the appearance of the vagina. The pubic hair can go gray, thin, or disappear altogether; the skin can change color; and the labia minora can lengthen or sag. All of these changes are completely normal.

  • Incontinence.

    Decreasing estrogen is responsible for the thinning of the vaginal walls, and that means the urethra doesn’t have the support it used to in order to hold urine in. Urine leakage is very common; around 50% of women will experience some form of incontinence in their lifetime.

Every woman is different, but there’s no need to worry and suffer in silenc. Talk with your gynecologist to learn more about the symptoms, discuss what you’re experiencing, and ways to treat them.

Dr. Arianna Sholes-Douglas, MD, FACOG(www.drarianna.com), author of The Menopause Myth: What Your Mother, Doctor, And Friends Haven’t Told You About Life After 35, is the founder and visionary of Tula Wellness Center, a unique medical practice in Tucson, Ariz., focusing on women’s health and beauty. Dr. Sholes-Douglas has dedicated her career to helping women through the stages of life but currently focuses on treating women experiencing perimenopause and menopause. She is board certified in Obstetrics and Gynecology and Maternal-Fetal Medicine. Dr. Sholes-Douglas, who has practiced medicine for 29 years, specializes in integrative women’s health, a subspecialty of gynecology that incorporates evidenced-based alternative medical therapies to promote healing. She has served as clinical faculty at UCLA, the University of Maryland, and Johns Hopkins School of Medicine. Dr. Sholes-Douglas has made numerous media appearances on the Discovery Health Channel and served as the “Woman’s Doctor” on Baltimore’s NBC news affiliate. Her writing has been published in Good Housekeeping and Essence, and she’s also appeared in Yahoo! News and Prevention.

 

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