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Menopause
By
Shahida Nisar
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Hormone
Decline & Sleep
Declining levels of the hormone estradiol in the years
just prior to menopause may contribute to sleeplessness
in some women, according to the results of a new study.
In fact, estradiol, an estrogen hormone produced by
the ovaries, ``may be more important than previously
thought for women aged 45 to 49 who report poor sleep,''
Lori E. Hollander and colleagues at the University Pennsylvania
Medical Center in Philadelphia report in the September
issue of the journal Obstetrics & Gynecology.
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| The researchers followed 218 black women
and 218 white women aged 35 to 49 over a 2-year period. The
women answered questions about their sleeping habits and had
blood samples evaluated for various hormones, including estradiol,
at four different times over the course of the study. Most continued
to have regular menstrual cycles during the study. About 17%
of the women reported suffering from poor sleep throughout the
entire study period. While factors such as anxiety, depression
and caffeine consumption affected how well a woman slept, the
investigators also found that low estradiol levels in women
aged 45 to 49 were associated with sleepless nights. Hot flashes
were also associated with difficulty sleeping. What is interesting
about the finding, the authors note, is that the women in the
study were still experiencing regular menstrual cycles and had
not yet entered menopause. The average age of menopause in the
United States is 51 years. The research concluded that the estradiol
association suggests that hormonal changes that occur with ovarian
aging may be associated with poor sleep in some women earlier
than previously thought. Further studies are suggested to test
whether hormone supplementation would be helpful for treating
poor sleep in women 45 and older. |
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Genes
& Menopause
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Women
wanting to know how much time they have left on their biological
clock should consult their mothers, because the age at which
menopause occurs is largely dictated by genes. Scientists
at the Diakonessen Hospital in Utrecht and Wageningen University,
who carried out a study of the genetic factors involved in
menopause, said it was 85% determined by genes. So a woman
is likely to follow the same pattern as her mother or sisters.
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| ``A woman with one or more first-degree relatives
with a history of early menopause is liable to experience earlier
menopause herself,'' said Dr. Jan-Peter de Bruin of Diakonessen
Hospital, who led the research team. ``This same woman is also
expected to start becoming less fertile and to be completely
infertile at an earlier age.'' Most women experience menopause
around the age of 50, but it can occur a decade or more earlier
or later. With many women postponing having children until their
mid-30s or 40s, the findings could have important implications
because sub-fertility and infertility can begin years before
menopause. ``If our hypothesis is correct, it would be sensible
for a woman to make herself aware of the age which her female
relatives have reached menopause. If she wants a family it could
help her decide whether it is wise to postpone motherhood too
long,'' de Bruin said. But he added that even if a woman has
a family history of late menopause it may not be safe to postpone
starting a family. Women are generally thought to be most fertile
between the ages of 20 and 25. Fertility begins to decline after
30. |
| Finding
The Genes |
The scientists studied data on 243 sisters
from 118 families who took part in a breast cancer screening
project that began in the 1970s, as well as information from
22 non-identical and 37 identical sets of twins. Their research
is reported in the journal Human Reproduction. De Bruin and
his team found that the age at which non-twin sisters reached
menopause was 85% to 87% due to genetic factors. In twin sisters,
genetics accounted for up to 71%. Other factors such as smoking,
having children and the birth control pill may also influence
the age at the onset of menopause, which is caused by the depletion
of a woman's eggs. ``Probably the onset of decreasing fertility
and the end of fertility is also triggered by earlier thresholds
in the number of eggs, so the genetic factors that determine
the age of menopause are likely to be the same factors that
determine the rate at which the eggs decrease,'' de Bruin explained.
The scientists are now trying to isolate the genes that control
menopause. In the future de Bruin said women may be able to
take a DNA test that could predict the age at which they could
expect menopause to begin. A better understanding of the genetic
factors influencing the decline of female fertility could also
lead to the development of treatments that may slow down the
process, according to researchers. Postmenopausal black women
may experience a less significant drop in their blood pressure
during sleep than other people, putting them at increased risk
of dying from heart disease. Most individuals experience a slight
dip in blood pressure at night. Recently, nighttime blood pressure
has emerged as a risk factor for heart disease in individuals
with normal blood pressure as well as those with high blood
pressure. The absence of a drop in systolic blood pressure,
the top number in the reading, which measures pressure when
the heart contracts, is now thought to be associated with heart
failure, stroke and heart attack in some elderly people.
In the current study, scientists examined the effect of menopause
on blood pressure dipping in 112 women aged 48 to 55 years with
normal and slightly elevated blood pressure. Postmenopausal
women experienced less pronounced nighttime dips in both systolic
and diastolic blood pressure, which measures pressure when the
heart is between beats. There was no difference in blood pressure
between pre- and postmenopausal women during the day, according
to the report in the August issue of the American Journal of
Hypertension. African-American women also experienced less significant
dips in their blood pressure at night compared with white women,
the report indicates. ``Menopause may mark an increased cardiovascular
risk for both white and African-American women, but the additional
risk may be especially significant for the latter, study conclude.
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Check
Your Breasts
By Christine
Gorman
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Back
in the 1970s, during the golden days of feminism, regularly
examining one’s breasts for cancer was a sign that a
woman had taken control of her life and health and wasn’t
dependent on (mostly male) doctors. Since then breast self-exams
have just seemed like a smart thing to do. After all, mammograms
and medical checkups can’t catch all breast tumors. And
a little empowerment never hurt anybody. Now comes word that
breast self-exams may not be so helpful after all.
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After reviewing eight major studies, a Canadian
task force has concluded that there is little evidence that
the technique saves lives. Indeed, the date the group looked,
at suggest that breast self-exams can do more harm than good,
prompting unnecessary testing of what are in fact normal lumps.
The task force’s recommendation: women should no longer
be routinely taught how to screen themselves for breast cancer.
Before you decide never to look at your breasts again, it pays
to know a little more about this report. First of all, two of
the studies in the Canadian review were conducted in China and
Russia, which do not have access to the most advanced diagnostic
techniques. Under these circumstances you would expect to see
a lot more biopsies of normal tissue. And because it takes so
long for most cancers to grow, you also expect to see the risks
of a screening test show up before any gains.
But even researchers who have doubts about self-exams are worried
that the Canadian group acted precipitously. “It’s
true that as of now, there is no evidence of efficacy,”
says Dr. David Thomas, a principal investigator of the Chinese
study. “But I don’t think we’ve proven that it
doesn’t work.” Thomas Expects further results from
his study, which will become available next year, to help clear
things up.
Meanwhile, there is a large body of evidence to show that the
best way to detect breast cancer is with mammograms and annual
breast exams by a physician. Surveys suggest that many women
regard breast self-exams as just as good as mammography at finding
tumours. That’s simply not the case.
It’s still possible that breast self-exams will prove to
be valuable for many women, say those with a family history
of breast cancer. If you decide regular self-exams make sense
for you, ask a physician or other health professional to teach
you how to do them right. The most important thing is to report
any unusual changes to your doctor. Many breast cancers are
still found by women themselves, often while showering or during
sex. Even if monthly breast exams don’t wind up saving
lives, knowing and what’s not for your breasts could help
save yours. |
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Breast-feeding
Bonus
A
study from the London Institute of Child Health has
found that premature babies who
were fed breast milk were not only healthier infants
but later as teens also had lower blood pressure than
teens who were formula-fed preemies. Researchers working
at London’s
Great Ormond Street Hospital found that from the ages
of 13 to 16 the blood pressure
of breast-fed subjects in the study was on average 3
points lower than that of those who
had been fed formula. It is not certain whether the
same is true for non-preemies.
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