Effects of physiologic testosterone therapy on quality of life, self-esteem, and mood in women with primary ovarian insufficiency
With plummeting hormone levels, natural menopause before age 40 can put a damper on women’s mental well being and quality of life. But bringing testosterone back up to normal may not bring them the boost some hoped for, found a new study published online today in Menopause, the journal of The North American Menopause Society (NAMS).
“… Our findings suggest that augmentation of standard estrogen/progestin therapy with physiologic testosterone therapy in young women with POI neither aggravates nor improves baseline reports of quality of life or self-esteem and had minimal effects on mood… ”
Objective: Women with primary ovarian insufficiency (POI) display low androgen levels, which could contribute to mood and behavioral symptoms observed in this condition. We examined the effects of physiologic testosterone therapy added to standard estrogen/progestin therapy on quality of life, self-esteem, and mood in women with POI.
Methods: One hundred twenty-eight women with 46,XX spontaneous POI participated in a 12-month randomized, placebo-controlled, parallel-design investigation of the efficacy of testosterone augmentation of estrogen/progestin therapy. Quality of life, self-esteem, and mood symptoms were evaluated with standardized rating scales and a structured clinical interview. Differences in outcome measures between the testosterone and placebo treatments were analyzed by Wilcoxon rank sum tests.
Results: No differences in baseline characteristics, including serum hormone levels (P > 0.05), were found. Baseline mean (SD) Center for Epidemiologic Studies Depression Scale scores were 10.7 (8.6) and 9.2 (7.8) for testosterone and placebo, respectively (P = 0.35). After 12 months of treatment, measures of quality of life, self-esteem, and mood symptoms did not differ between treatment groups. Serum testosterone levels achieved physiologic levels in the testosterone group and were significantly higher compared with placebo (P < 0.001). Baseline testosterone levels were not associated with either adverse or beneficial clinical effects.
Conclusions: A 150-μg testosterone patch achieves physiologic hormone levels in women with POI. Our findings suggest that augmentation of standard estrogen/progestin therapy with physiologic testosterone therapy in young women with POI neither aggravates nor improves baseline reports of quality of life or self-esteem and had minimal effects on mood. Other mechanisms might play a role in the altered mood accompanying this disorder.
In the first edition of this important bestselling book, praised by Newsday as “the bible for a whole generation of menopausal women”, renowned physician and pioneering women’s health advocate Dr. Susan Love warned about the potential dangers of the long-term prescription of hormone replacement therapy. Her insightful words of caution have been backed up by the stunning results of the recent studies on hormone replacement.
In the revised edition, Dr. Love offers a remarkably clear set of guidelines as to what the studies have shown about the risks regarding:
what effect hormone therapy has on osteoporosis.
She offers definitive expert advice about:
whether or not to go on hormone replacement therapy and, if so, for how long
as well as how to taper off hormones
and she introduces the alternative methods for treating the symptoms of menopause.
Dr. Love stresses that menopause is not a disease that needs to be cured—it is a natural life stage, and every woman ought to choose her own mix of options for coping with symptoms. A questionnaire about your own health history and life preferences helps you develop a program that will best fit your unique needs. With clarity and compassion, she walks you through every option for both the short and the long term, including:
lifestyle changes (diet, exercise, and stress management)
alternative therapies (including herbs and homeopathic remedies)
HRT: Estrogen Won’t Make Women Sharper After Menopause
Low levels of the hormone estrogen are not to blame for mood swings and poor memory after menopause, a new study suggests.
Based on this finding, the researchers believe there’s no reason to use hormone replacement therapy to boost mental well-being after periods stop.
Variations in the hormonal milieu after menopause may influence neural processes concerned with cognition, cognitive aging, and mood, but findings are inconsistent. In particular, cognitive effects of estradiol may vary with time since menopause, but this prediction has not been assessed directly using serum hormone concentrations. We studied 643 healthy postmenopausal women not using hormone therapy who were recruited into early (-6 y after menopause) and late (10+ y after menopause) groups. Women were administered a comprehensive neuropsychological battery and assessed with the Center for Epidemiologic Studies Depression Scale. They provided serum for free estradiol, estrone, progesterone, free testosterone, and sex hormone binding globulin measurements. Cognitive outcomes were standardized composite measures of verbal episodic memory, executive functions, and global cognition. Covariate-adjusted linear regression analyses were conducted for each hormone separately and after adjustment for other hormone levels. Endogenous sex steroid levels were unassociated with cognitive composites, but sex hormone binding globulin was positively associated with verbal memory. Results for early and late groups did not differ significantly, although progesterone concentrations were significantly positively associated with verbal memory and global cognition in early group women. Hormone concentrations were not significantly related to mood. Results fail to support the hypothesis that temporal proximity to menopause modifies the relation between endogenous serum levels of estradiol and verbal memory, executive functions, or global cognition. Physiological variations in endogenous postmenopausal levels of sex steroid hormones are not substantially related to these aspects of cognition or mood; positive associations for progesterone and sex hormone binding globulin merit additional study.
Risk of endometrial cancer rises with increase in sugar-sweetened drinks
Endometrial cancer is the fourth most common cancer in women, and eighth most common cause of cancer death among women in the United States.
Studies have shown women’s risk of endometrial cancer increases with higher levels of estrogen in the body – for example, increased estrogen due to diethylstilbestrol DES or taking hormone therapy for the symptoms of menopause.
Researchers found that sugar-sweetened beverage intake was associated with an increased risk – up to 78% higher – type I, but not type II of endometrial cancer. However, its association with endometrial cancer is unclear.
Sources: Sugar-Sweetened Beverage Intake and the Risk of Type I and Type II Endometrial Cancer among Postmenopausal Women, Cancer Epidemiology Biomarkers and Prevention, AACR, 22 Nov 2013 – abstract – full PDF
Less Blood Clot Risk Linked to Estradiol Than to Premarin Pills
Women can choose among several types of estrogen pills, which are equally effective at relieving menopausal symptoms. In a head-to-head comparison of two major forms of hormone replacement therapy, a more natural version of estrogen proved less dangerous to the heart than a synthetic one – a patented drug marketed as Premarin.
U.S. Panel Warns Hormone Replacement Therapy Is Too Risky
In their November 2002 recommendations, the U.S. Preventive Services Task Force confirmed that the risk of HRT outweigh its potential benefits.
The USPSTF recommends against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women ; advising women to use HRT to treat symptoms of menopause for only short periods of time.
DES seems to have health effects across the lifespan, especially in the reproductive tract
DES Follow-up Study Summary
A recent analysis of data from questionnaires returned by the participants in the DES Follow-up Study suggests that exposed daughters tend to have a slightly earlier age at natural menopause than unexposed daughters (Hatch EE et al, Age at Natural Menopause in Women Exposed to Diethylstilbestrol in Utero, American Journal of Epidemiology, October 1, 2006). The researchers analyzed data on over 4210 exposed daughters and 1829 unexposed daughters, and accounted for other factors that could be related to the age at natural menopause, such as cigarette smoking, hormone use, pregnancy history, and the age of the mother’s menopause. The average age at menopause was 52.2 years in unexposed women and 51.5 years in DES-exposed women, equivalent to about a nine month earlier menopause. Women who had been exposed to higher cumulative doses of DES tended to have menopause even earlier than those who had lower doses. Although this relatively small difference in age at menopause should not be related to any major health problems among the DES daughters, it does highlight the fact that DES seems to have health effects across the lifespan, especially in the reproductive tract. In general, menopause is thought to occur when the number of ovarian follicles left in the ovaries reaches a ‘critical’ level, therefore it is possible that DES daughters may have been born with a smaller reserve of follicles than unexposed women.
2006 Study Abstract
BACKGROUND: Age at natural menopause is related to several health outcomes, including cardiovascular disease and overall mortality. Age at menopause may be influenced by the number of follicles formed during gestation, suggesting that prenatal factors could influence menopausal age. Diethylstilbestrol (DES), a nonsteroidal estrogen widely prescribed during the 1950s and 1960s, is related to reproductive tract abnormalities, infertility, and vaginal cancer in prenatally exposed daughters but has not been studied in relation to age at menopause. The authors used survival analyses to estimate the risk of natural menopause in 4,210 DES-exposed versus 1,829 unexposed US women based on responses to questionnaires mailed in 1994, 1997, and 2001. DES-exposed women were 50% more likely to experience natural menopause at any given age (hazard ratio = 1.49, 95% confidence interval: 1.28, 1.74). Among women for whom dose information was complete, there were dose-response effects, with a greater than twofold risk for those exposed to >10,000 mg. The causal mechanism for earlier menopause may be related to a smaller follicle pool, more rapid follicle depletion, or changes in hormone synthesis and metabolism in DES-exposed daughters. Age at menopause has been related, albeit inconsistently, to several exposures, but, to the authors’ knowledge, this is the first study to suggest that a prenatal exposure may influence reproductive lifespan.
Age at natural menopause in women exposed to diethylstilbestrol in utero,NCBI, PMID: 16887893, 2006 Oct 1;164(7):682-8. Epub 2006 Aug 3. Full text Oxford Journals Medicine & Health International Journal of Epidemiology link.
Does author relationships with industry affect articles published on hormone therapy?
Background: Even after the Women’s Health Initiative (WHI) found that the risks of menopausal hormone therapy (hormone therapy) outweighed benefit for asymptomatic women, about half of gynecologists in the United States continued to believe that hormones benefited women’s health. The pharmaceutical industry has supported publication of articles in medical journals for marketing purposes. It is unknown whether author relationships with industry affect promotional tone in articles on hormone therapy. The goal of this study was to determine whether promotional tone could be identified in narrative review articles regarding menopausal hormone therapy and whether articles identified as promotional were more likely to have been authored by those with conflicts of interest with manufacturers of menopausal hormone therapy.
Methods and Findings: We analyzed tone in opinion pieces on hormone therapy published in the four years after the estrogen-progestin arm of the WHI was stopped. First, we identified the ten authors with four or more MEDLINE-indexed reviews, editorials, comments, or letters on hormone replacement therapy or menopausal hormone therapy published between July 2002 and June 2006. Next, we conducted an additional search using the names of these authors to identify other relevant articles. Finally, after author names and affiliations were removed, 50 articles were evaluated by three readers for scientific accuracy and for tone. Scientific accuracy was assessed based on whether or not the findings of the WHI were accurately reported using two criteria: (1) Acknowledgment or lack of denial of the risk of breast cancer diagnosis associated with hormone therapy, and (2) acknowledgment that hormone therapy did not benefit cardiovascular disease endpoints. Determination of promotional tone was based on the assessment by each reader of whether the article appeared to promote hormone therapy. Analysis of inter-rater consistency found moderate agreement for scientific accuracy (κ = 0.57) and substantial agreement for promotional tone (κ = 0.65). After discussion, readers found 86% of the articles to be scientifically accurate and 64% to be promotional in tone. Themes that were common in articles considered promotional included attacks on the methodology of the WHI, arguments that clinical trial results should not guide treatment for individuals, and arguments that observational studies are as good as or better than randomized clinical trials for guiding clinical decisions. The promotional articles we identified also implied that the risks associated with hormone therapy have been exaggerated and that the benefits of hormone therapy have been or will be proven. Of the ten authors studied, eight were found to have declared payment for speaking or consulting on behalf of menopausal hormone manufacturers or for research support (seven of these eight were speakers or consultants). Thirty of 32 articles (90%) evaluated as promoting hormone therapy were authored by those with potential financial conflicts of interest, compared to 11 of 18 articles (61%) by those without such conflicts (p = 0.0025). Articles promoting the use of menopausal hormone therapy were 2.41 times (95% confidence interval 1.49–4.93) as likely to have been authored by authors with conflicts of interest as by authors without conflicts of interest. In articles from three authors with conflicts of interest some of the same text was repeated word-for-word in different articles.
Conclusion: There may be a connection between receiving industry funding for speaking, consulting, or research and the publication of promotional opinion pieces on menopausal hormone therapy.