2017 brought some exciting and novel developments in women’s health, including some of the major updates we shared from the ESG congress last October. We shared interesting developments in women’s health key topics, including hormone-replacement therapy, contraception, and we have also provided some history behind steroid hormone receptor evolution. Let’s recap the key trends we have seen last year:
Estrogen safety in relation to breast cancer (BC) risk is a widely discussed topic, data from the WHI RCT estrogen alone arm showed a decreased risk in breast cancer in women on the estrogen only treatment, this was also demonstrated in the study by Anderson et al., Lancet, Oncology, 2012, which showed a significant decrease in breast cancer incidence in women using estrogen and fewer deaths from breast cancers and other causes in the treatment arm compared to the placebo group. However, The NURSE study (Sisti et al., Int J Cancer, 2016) showed MHT use increased risk of luminal A and B breast cancer in women who used estrogen at long term treatment but not at short term treatment. Evidence from epidemiology also confirms the length of estrogen exposure increases the risk of breast cancer, as does age at menarche and age at menopause. Literature shows estrogen can promote or even initiate breast cancer, whereas preclinical studies show that aromatase inhibitors and antiestrogens can help prevent breast cancer. Data from the collaborative group on hormonal factors in breast cancer have shown that pre-menopausal women have a higher risk than postmenopausal women of the same age.
Although the results from studies seem to lead to different conclusions, comparing all the data available suggests that for women with a high BMI and high insulin resistance, estrogen could help to decrease BC risk by decreasing insulin resistance.
One of the most prominent changes during menopause is fat gain and change in a women’s body shape. Unlike other menopausal transitions, hormonal interventions currently available are not targeting this issue, which can have a negative impact on the overall health. The Interheart study and some recent data from the WHI, show it’s the site of fat that’s the biggest cause for concern as an increase in abdominal fat is linked to increased CVD risk.
Data from the WHI observation study showed women can be separated into four sections: metabolically benign normal weight, at risk normal weight, metabolically benign overweight and at risk overweight. These four categories scored very differently showing links between phenotypes, metabolic type and insulin resistance. Looking at women who have features of metabolic syndrome, showed they had higher markers such as IL-6. The very skinny or the very obese are more at risk than those who are or moderately obese.
Lower levels of estrogen and progesterone can affect a number of different body functions, such as contraception. It’s important to understand that under the age of 50 women must use contraception for 2 years after diagnosis of menopause, over the age of 50, of they must use contraception for 1 year after diagnosis.
As we discussed in a previous post last October, contraception has also an important impact on diagnosis: if a patients is using a contraceptive doctors need to carry out FSH and LH twice, 6 weeks apart. Whilst tests can be done if a patient has an IUD or is on the POP, patients must stop COC for a cycle and stop DMPA for testing. When diagnosing, it’s important to think about the opportunities for screening and education. Discuss cervical screening, breast self-testing, osteoporosis risk, ovarian cancer, diabetes and incontinence, talk about symptoms and risk factors that increase with age.
Interestingly, now scientists are exploring whether transplanting lab-made ovaries might stop the common symptoms of menopause, such as hot flashes, sleep problems, weight gain, and worse, bone deterioration. In one of the first efforts to explore the potential of such a technique, researchers say they used tissue engineering to construct artificial rat ovaries able to supply female hormones like estrogen and progesterone. The results of the study were published in October last year in Nature communications. When tested in rats, the pieces of tissue, known as organoids, were better than traditional hormone replacement drugs at improving bone health and preventing weight gain. The treatment was also as good as hormone drugs at maintaining healthy tissue in the uterus.
Clinical trials of artificial ovaries are not likely to happen soon but it will definitely be interesting to see what will happen in 2018!