Estradiol-Nature’s Anti-Psychotic

There’s a really nice piece of research in Neuropsychopharmacology (2010) 35, 2179–2192 that demonstrates that estradiol, the primary estrogen made in the ovaries after puberty and before menopause, is an anti-psychotic substance. 

Estradiol had anti-psychotic effects for normal male rats and female rats without ovaries, but had less of an effect in female rats with ovaries.

The most likely explanation of the difference is that rat females with ovaries have progesterone in their bodies, produced by their ovaries. Since progesterone competes with estradiol in the brain, the estradiol isn’t able to work as strongly in the rats with ovaries.

How do you make a rat psychotic? Good question. Feed them amphetamines, evidently. The estradiol helps protect the brain from the damage from the amphetamines, and therefore acts as an anti-psychotic.

Yet another piece of evidence that psychiatrists need to know about hormones to be as effective as possible.

(Source: nature.com)

Eat Chocolate, Be Thinner

According to a study in the Archives of Internal Medicine, in a study of about a 1,000 people, those of us who eat chocolate regularly tend to be thinner than people who don’t.

Who says news websites don’t carry happy news? And just in time for Easter!

The article is paywalled, but the BBC summarizes it here:

http://www.bbc.co.uk/news/health-17511011

Eat a piece of chocolate to celebrate!

The Case of the Missing Hot Flashes

If anyone dares to tell you that you complain too much about your hot flashes, give them this piece of research: According to research performed at Indiana University, School of Nursing, women in studies who report their hot flashes in diaries are missing more than 50% of their hot flashes. Women who were awake recorded their hot flashes between 36%-50% of the time, and when asleep, they recorded their hot flashes only 22%-40% of the time. More than 50% of the hot flashes are not being reported!

How do the researchers know that women won’t reporting anywhere near all of their hot flashes? In addition to keeping a written diary, the study members wore a device that measured the temperature of their skin. A Biolog ambulatory sternal skin conductance monitor, to be exact. The machine measures the temperature of the skin, and a sudden rise in skin temperature has been shown to be highly correlated to a rise in internal body temperature-the classic hot flash. The machine memory was then checked by the researchers and matched against the reported hot flashes in the diaries. 

What does this mean, beyond the old news that women are good at ignoring discomfort? It means that just about any study about hot flashes that relies on the use of written diaries is going to be far less accurate than it could be. The use of this machine, which produces something called an objective measure, is incredibly useful in sorting out which treatments work and which do not. This is particularly important in the treatment of hot flashes since almost any treatment is prone to a placebo effect-it works because we think it will.

You can think of the Biolog machine as a way for the body to talk directly to the researchers, without interference from what the brain thinks “should” happen. 

Read it yourself: http://www.ncbi.nlm.nih.gov/pubmed/15572497

ISGE Conference Day 3

Three cheers for Dr. Adolf Schindler*, who today said something that needs to be said at every meeting that has anything to do with hormones: medroxyprogesterone acetate, known as MPA, brand name Provera, is not the same thing as progesterone, and any academic research paper that has the word progesterone in the title, but refers only to MPA in the paper, should be tossed out for sloppiness. 

MPA has more differences with progesterone than you can shake a stick at, including the nasty fact that MPA has been found to be toxic to brain cells in a couple of studies, while progesterone is protective of brain cells. Just the fact that MPA is a different molecular compound is enough to make mixing it it up with progesterone a prime example of bad science. 

For the tiny minority of you that care, here’s the way the classification should be done: the overall category is progestagens-that’s any compound that has a progesterone-like effect on cells in the uteruses of rabbits and other lab animals. This includes progesterone, the compound made by the corpus luteum of the ovaries of mammals after ovulation occurs. Progesterone can also be made in a lab. Progestins are also included as progestagens, and these compounds are made in a lab, are never found in nature, and have their own characteristics depending on their chemical structure. MPA is a progestin, and so are drospirenone and norethindrone, and many others.

So now you know better than the authors of one study examining the impact of progestins on the hearing organs. The authors used the word progestins, but never bothered to identify which progestin they were talking about. This just drives me nuts. This is like saying that diesel and gas are the same thing. They may both fuel cars, but put the wrong one in the tank, and the engine is ruined. The differences are crucial.

So please, give your progestagen its rightful name. Don’t use the term progestin unless it’s clear what compound you are discussing. 

*Director of the Institute for Medical Research and Education in Essen, Germany. You’ve probably never heard of him, but he is one of the world’s outstanding authorities on gynecological endocrinology, and someone who cares deeply about women’s health. 

Cringing from the Needle

At the biannual meeting for the International Society for Gynecological Endocrinology in sunny Florence, Italy (which is a change, usually it rains heavily when I’m here) I have heard some truly impressive science lectures. However, there has been one extremely cringeworthy moment. In the process of explaining the vast differences in breast impact between two types of hormone therapy, Gunnar Soderqvist told us about his research method. 71 women volunteered to have mammograms and a core biopsy of the left breast done at before starting treatment, and then had another mammogram and breast biopsy done after two months of treatment. 

71 women agreed to two mammograms in the space of two months, and two core biopsies of their healthy breast in two months. What did they offer them? A new car?

Dr. Soderqvist showed us a picture of the needle. I haven’t felt so faint since I saw the amniocentesis needle. Then he showed us a picture of a woman in the mammogram machine, with the breast all squished out the side. It looked so painful-they didn’t show her face, though.

I automatically crossed my arms in front of my chest and cringed inside. Still, those tough Swedish women allowed the researchers to make some impressive findings about horse estrogens and Provera’s impact breast tissue versus percutaneous(transdermal) estradiol and progesterone. That’s another post, however. 

Progesterone Myths

Thanks to a man by the name of John Lee, millions of women seem to think that progesterone cream will treat their menopause symptoms. Nope. Not even close. There have been a number of studies to see if progesterone will help with hot flashes, or if it will increase bone mass or protect the heart and they all end up conclusively proving that progesterone simply does not play that role in the human female body. So don’t take progesterone expecting it to have the same benefits as estradiol because that is not its function.

If using progesterone cream makes your hot flashes go away, then you are experiencing the placebo effect. The placebo effect occurs when your symptoms respond to a treatment, and the effects are the result of a psychological expectation, rather than an actual chemical effect. This is not to say the placebo effect is a bad thing, but it has limits as a medical treatment.

Here’s the research: Transdermal progesterone and its effect on vasomotor symptoms, blood lipid levels, bone metabolic markers, moods, and quality of life for postmenopausal women

and more: Double-blind placebo-controlled study to evaluate the effect of pro-juven progesterone cream on atherosclerosis and bone density

You can ignore the progesterone hucksters-it s just a sales pitch, without any real science behind it.

Progesterone Myths

Thanks to a man by the name of John Lee, millions of women seem to think that progesterone cream will treat their menopause symptoms. Nope. Not even close. There have been a number of studies to see if progesterone will help with hot flashes, or if it will increase bone mass or protect the heart and they all end up conclusively proving that progesterone simply does not play that role in the human female body. So don’t take progesterone expecting it to have the same benefits as estradiol because that is not its function.

If using progesterone cream makes your hot flashes go away, then you are experiencing the placebo effect. The placebo effect occurs when your symptoms respond to a treatment, and the effects are the result of a psychological expectation, rather than an actual chemical effect. This is not to say the placebo effect is a bad thing, but it has limits as a medical treatment.

Here’s the research: Transdermal progesterone and its effect on vasomotor symptoms, blood lipid levels, bone metabolic markers, moods, and quality of life for postmenopausal women

and more: Double-blind placebo-controlled study to evaluate the effect of pro-juven progesterone cream on atherosclerosis and bone density

You can ignore the progesterone hucksters-it s just a sales pitch, without any real science behind it. They just want to move product.

When Bioidentical Therapy Becomes an Accidental Fertility Treatment

From the file of unintended consequences: a lady in her late forties visited a “hormone therapist ” of dubious science and was given a combination of estrogens, and progesterone, all identical to the hormones made by the adult female body. This lady was not post-menopausal, but perimenopausal, meaning she had not yet stopped having periods.

Unfortunately, the “hormone doc” forgot to tell her that this can boost fertility, and despite the odds, it IS possible to get pregnant in your late forties. OOPS. Her periods stopped, and she thought it was menopause-it was an unplanned pregnancy instead.

Moral of the story-you need birth control right up until you stop having periods, and are confirmed as being in menopause. A birth control method like Nuvaring, which uses progestins and a synthetic estrogen will often be a better choice because the progestin in it can reduce heavy bleeding, decrease ovarian cysts and prevent uterine fibroids-all problems commonly experienced by women in their forties.

The bioidentical hormones aren’t strong enough to suppress ovulation and prevent pregnancy. A pregnancy in the late forties presents a number of serious risks to the mother, risks that are much higher than most birth control methods. That’s why the synthetic progestins and estrogens will often be the best choice for a perimenopausal women who needs extra estrogen for her body and brain, but doesn’t want to have more children.

A nice blog piece that covers this comes from Dr. Elizabeth Vliet at:

http://www.newsmaxhealth.com/dr_vliet/progestin_NuvaRing_safe/2010/07/26/335358.html

Finding Reliable Hormone Information

Women got to hear yet again last week that hormone use might increase their risk of breast cancer from a report by the Million Women Study. Sadly, although this study has  more than a million participants, it was so poorly designed that it is not capable of giving the world terribly useful information about almost anything. There’s lots to say in criticism of the study, but the internet posts by women begging for solid information about what to do in perimenopause or post-menopause suggest that a clear voice is needed. No problem.

The International Menopause Society has a series of statements that are intended for women and their doctors to place the various studies in context and help clarify the relative risks and benefits of hormone therapy. Look at: http://www.imsociety.org/comments_and_press_statements.php?SESSID=5tk73tg09ccs65bcu32m2q4vh2

For another clear and detailed statement about the evidence for and against hormone therapy look at the Endocrine Society Scientific Statement on Postmenopausal Therapy: http://www.endo-society.org/journals/ScientificStatements/upload/jc-2009-2509v1.pdf

For the most part, you should ignore newspaper and internet headlines because they do not place the evidence in context, they are not capable of evaluating your personal needs, and the study may or may not have serious flaws that require a trained researcher months to discover. 

And one more time: the biggest killer of women in the developed world is cardiovascular disease, and not breast cancer. Half of all women in the United States over 50 years of age will die of heart disease. That’s 50% folks. To put it another way, the death rate for female breast cancer in the United States in 2005 was about 40,000. The death rate for cardiovascular disease in 2005 was more than 450,000. So if you are undecided about taking hormone therapy for its heart benefits, you might keep those numbers in mind. Here’s link about heart disease statistics as a bonus:http://www.americanheart.org/downloadable/heart/1200078608862HS_Stats%202008.final.pdf