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Ultra low-dose estrogen and other health topics

by Judith Paley, MD

This information is intended to be general in nature and should not be relied upon for specific treatment. If you need medical attention, please contact your personal physician's office for an appointment.

It's very clear to me that the WHI investigators have once again decided to take the 'glass half-empty' approach. -----Dr. Wulf Utian, Executive director, North American Menopause Society

Don't think for a moment that the hormone therapy controversy is over. Still another analysis of the final data from the Women's Health Initiative concludes that combination HRT may result in a slight but insignificant increase in ovarian cancer. It also found a small but nonsignificant decrease in endometrial cancer among the hormone users.

Dr. Utian of the North American Menopause Society criticized the paper, noting that the article's abstract as published in a recent issue of JAMA implied that the association with ovarian cancer was firm but the effect on endometrial cancer was not. He went on to add, "They could quite easily have said hormone therapy isn't associated with a significantly increased risk of ovarian cancer and may be associated with a decrease in endometrial cancer....It's almost like they spent a billion dollars on this study and they're going to make headlines, no matter what the outcome." Dr. Shirley Beresford, one of the co-authors of the study, countered: "The implications stated are based on the observation that there is no evidence of prevention against ovarian cancer and that the direction of observed risk was in the direction of harm."

This month's newsletter includes bone protection data from an entirely different sort of hormone therapy regimen. The final word on hormone therapy will clearly be more than one word, and it's not been spoken yet.

Stroke weather

Neurologists and meteorologists have teamed together to chart toxic weather patterns and the health of your brain. If you've noted that rainy, cold days are bad for your mood, you have no idea just how really bad they can be. Couple that forecast with a low pressure system, and the danger of a small vessel stroke soars; team it up with fog and high pressure, and hold on for hemorrhage.

Ultralow dose estrogen and the aging bone

Just a weensy bit of estrogen may make the fracture risk go down. A recent study found that very low dose estrogen increases bone density significantly over no estrogen at all.

Nearly two hundred women took .25 mg of estrogen (estradiol, Estrace, Gynodiol) daily for three years. Those women who had not had a hysterectomy also took 100 mg of progesterone (Prometrium) daily for two weeks every six months. Compared to those on no estrogen--both groups received calcium and vitamin D supplements--the participants on hormones demonstrated increased bone mineral density and decreased markers of bone breakdown. Unfortunately, the study did not continue long enough to evaluate fracture rates.

Low dose estrogen therapy is also available as Premarin .3 mg, and transdermal estradiol patches, .025 or .0375 mg Vivelle Dot or Climara. Studies indicate that these estrogen therapies can be safely combined with intermittent progesterone therapy given every 3-6 months in order to protect the uterine lining in those women who have not had a hysterectomy.

Do statins stop cancer?

Here's interesting news from last month's edition of the Journal of Women's Health. Investigators examined the medical records of 7500 women over 7 years for development of breast cancer. Women on statins (Lipitor, Zocor, Pravachol, etc.) to lower cholesterol levels had a 72% reduction in the risk of breast cancer. These findings were based, however, on a rather small number of cancer cases and will need confirmation in a larger study.

Cholesterol is an integral part of the cell membrane; if cholesterol is not available, cell growth is not possible. Scientists have wondered for years if decreasing either cholesterol availability or production could inhibit tumor cell growth. The Scandinavian Simvastatin (Zocor) Survival Study found that individuals who received the statin therapy had a 27% decreased risk of dying from cancer. Another Zocor study also found a 25% decreased incidence of breast cancer among the female statin users.

Unfortunately, data from statin studies thus far is limited by the relatively few women enrolled and the fairly short follow-up period. If these promising results are confirmed, cancer may be added to the list of disorders decreased by statin use, a list that so far includes heart disease, stroke, Alzheimer's dementia, macular degeneration, and osteoporosis.

Good news for gallbladders

You probably don't spend a minute thinking of this little sack hanging below your liver as it smoothly collects bile and squirts it into the digestive tract in response to high fat meals. Unless, of course, your gallbladder has the gall to fill with stones (crystallized bile salts), causing you pain and angst as it contracts against this load of rocks. Unfortunately, estrogen therapy increases the risk of gallbladder disease as does tamoxifen (one study found that one-third of women on tamoxifen developed gallstones by the 5th year of use). A report at the annual meeting of the North American Menopause Society indicates, however, that Evista (raloxifene) use for 4 years was not associated with any increase or worsening in gallbladder troubles.

Guidelines change for prediabetes

Blood pressure guidelines changed in May of this year, and suddenly high normal isn't normal anymore. Individuals with a systolic BP of 120 to 139 or a diastolic BP of 80 to 89 are no longer considered normal or borderline okay, but rather are classified as "prehypertensive." Just when you least needed one more thing to worry about, the American Diabetes Association (ADA) has also redefined normal, this time with respect to fasting blood sugar levels.

"Impaired fasting glucose" (IFG) is an abnormal state of insulin resistance where high levels of first of the morning blood sugar indicate individuals at high risk for future diabetes. The ADA's new report lowers the limit for the diagnosis of IFG from 110 to 100 mg/dL. If you have a family history of diabetes, tend to carry your weight around your waistline, or have been told you have elevated triglyceride levels, ask your doctor to haul out your previous lab values and check out your blood sugar. It may be time to get really serious about diet and exercise.

Dr. Paley welcomes comments and questions at her femailhealthnews@aol.com address. For more information on her weekly health newsletters for women, go to www.femailhealthnews.com.