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			<title>CeMCOR News - July 2012</title>
			<description>CeMCOR News - July 2012</description>
			<author>CeMCOR</author>
			<pubdate>Tuesday 31st of July 2012 09:24:02 PM</pubdate>
			<subject>CeMCOR News - July 2012</subject>
			<content><![CDATA[Email



 





 
 
 

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 July 26, 2012
 Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.  
 In today's edition: 

 CeMCOR Celebrates 10 Years Help us celebrate ten more successful years 
 Progesterone Effectively treats Hot Flushes Dr. Jerilynn Prior discusses how progesterone works to treat hot flushes 
 CeMCOR Research News: We are recruiting for our study of Progesterone for Perimenopausal Night Sweats 
 Women's Health in the News: Links to women's health stories in popular media. 
CeMCOR Celebrates 10 Years 
 As a subscriber to the e-newsletter for the Centre for Menstrual Cycle and Ovulation Research (CeMCOR), I know that you understand the value of CeMCOR&#8217;s research into the causes of ovulation disturbances and their implications for women&#8217;s health. Each CeMCOR newsletter comes packed with new information about the cutting-edge research that you want to know about &#8211; in fact, you can find my most recent article highlighting the exciting findings of our study on progesterone as an effective treatment for hot flushes below.  It&#8217;s been ten years since the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) began its first study. Never could we have imagined how many women would be affected by the research we have conducted to date.   The recognition the Centre has received on the international stage for our education and research into the changes in women&#8217;s menstrual cycles and ovulation physiology and their effects on the bones, hearts, breasts, and brain, has only served as confirmation that we are headed in the right direction. Our research will help us to generate new, more effective, programs and practices that will ultimately lead to new standards in women&#8217;s health.  As the only Centre in the world focusing on ovulation and the causes for and consequences of ovulation disturbances, we feel a tremendous sense of pride and at the same time, responsibility&#8211;responsibility towards women everywhere, to their families and to our communities. Physicians, health workers and women themselves, rely on the information, research and advice we provide free of charge through this e-newsletter, our website and other publications. In fact, over a million users have visited our website in the last five years, gaining access to information not available anywhere else.  It is thanks to the generous support of our donors we have been able to accomplish so much. Donations to the Centre have been key in helping us to achieve our goals to date, and they continue to be an essential part of our efforts as we move into the next decade.  In fact, cutting-edge research is already underway in areas including osteoporosis, heart disease and breast cancer. These studies could allow us to address the underlying cause of these conditions much earlier in women&#8217;s lives. Just think of the impact this research could have on women&#8217;s health and within our communities.   Stick around, there&#8217;s a lot more to come.  You can support the Centre for Menstrual Cycle and Ovulation Research by donating online or by calling 604.827.4111 (toll free 1.877.717.4483).  

Progesterone Effectively Treats Hot Flushes 
   by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research.
 Imagine an Experience&#8212;a collection of typical and mostly negative things&#8212;that affects over 80% of one half of the population during five to 15 years of their lives (1).  It disrupts concentration, disturbs sleep and changes internal temperature (2), alters blood flow and heart function and is associated with bone loss and osteoporosis (3). Yet. . .it is deemed trivial, just a nuisance. . . according to half of the population that rarely experiences it.  Finally--its primary treatment is a hormone that causes blood clots and cancer of the uterus and breasts; increases risks for gallbladder surgery, incontinence and memory troubles. . .  What is this Experience?  Hot flushes and night sweats!  Wouldn&#8217;t you feel proud if you proved that a new (and likely safer) treatment than estrogen works for night sweats? The Centre for Menstrual Cycle and Ovulation Research just completed a scientific study showing that progesterone is effective hot flush treatment (4). We, at CeMCOR are proud of that and happy that women with severe night sweats now have a treatment choice.  This is CeMCOR&#8217;s major achievement in her first 10 years.  Why did we begin the Progesterone hot flush trial?  In July, 2002 the Women&#8217;s Health Initiative (USA) large estrogen plus progestin (a synthetic progesterone knock-off) randomized controlled trial was stopped years early because ovarian hormone therapy(OHT) caused more harm than benefit (5). This hit the news like a bombshell. Before that, everything miserable was caused by &#8220;estrogen deficiency&#8221; so, &#8220;bob&#8217;s-your-uncle&#8221;, estrogen fixes it. That is, until those notions were scientifically tested and proven wrong (5;6).  What did women do? They stopped OHT. Even if they had severe hot flushes. Guess what? Not only did the hot flushes come back&#8212;they were worse than before they started hormones. It was this urgent need for an effective alternative to estrogen for severe hot flushes that triggered CeMCOR to start the trial of Progesterone for hot flushes in 2003.  What causes hot flushes?  As mentioned, we used to think hot flushes meant estrogen deficiency&#8212;only in the last 10 years have we recognized that hot flushes occur in menstruating women who have high estrogen levels (7). What gives? Our current understanding is that hot flushes are caused by dropping estrogen levels from whatever level the brain has gotten used to. Thus dropping from high estrogen to normal can trigger night sweats, and does. That explains why, in perimenopause, I had night sweats and high-estrogen-caused sore breasts at the same time!  Estrogen withdrawal (dropping estrogen levels) causes release of a flood of brain hormones (neurotransmitters). One that is especially important is called norepinephrine and when it is released, the core temperature increases and the temperature at which we start to sweat decreases. This means there are few temperatures at which a woman feels comfortable. Women who have hot flushes (compared to those without) have a narrow range of internal temperatures at which they neither sweat nor shiver (called the thermoneutral zone)(2)! How does estrogen help hot flushes? It prevents that estrogen withdrawal reaction and avoids norepinephrine release.   What makes hot flushes worse?  Hot flushes are all &#8220;in her head&#8221;, right? Is a woman&#8217;s emotional stress (or her reaction to it) the culprit? Yes and No. Now we know the hot flushes begin in the brain--we also know they are made worse by intense emotions and stress. Life stresses, like being very poor, make hot flushes worse. For example, in a large study of several thousand midlife USA women of white, black, Hispanic, Chinese and Japanese ancestry, women who reported difficulty paying for basics like food and shelter, experienced more hot flushes (8). Women having the highest education reported fewer night sweats. Chinese and Japanese women had the fewest hot flushes. They were better educated and their Asian genetics means that they have enzymes that rapidly break estrogen into pieces and excrete it, possibly preventing the brain from &#8220;getting used to&#8221; high estrogen levels.  An even better test of this stress-hot flush idea was a randomized trial by Canadian psychology researchers who invited menopausal women having eight or more hot flushes a day to attend two sessions a week apart in which hot flushes were monitored electronically (called galvanic skin response&#8212;the same monitoring used for a lie detector test). In one session women came into a quiet room with soft lighting, soothing background music and magazines to read or a chance for a chat with a new friend. In the other session the lights were glaring, loud noises happened unexpectedly and women were forced to watch a violent video. Women were significantly less likely to have hot flushes in the peaceful 4-hour session (9). After all, norepinephrine is a stress hormone and part of &#8220;flight or fight&#8221; response system.   Smoking cigarettes releases stress hormones and makes hot flushes worse (10). Cigarette smokers are twice as likely to have troublesome hot flushes as non-smokers (10). Alcohol may also worsen hot flushes&#8212;some women report a hot flush within minutes of their first sip.   By contrast, things like yoga breathing, relaxation (11), acupuncture (12;13) and aerobic exercise training decrease the stress response and improve hot flushes. These practices are certainly important for women to use in self-management. However, for women with more than fifty sweat-soaked hot flushes a week, they are helpful but insufficient.  So, why and how would progesterone work for hot flushes?  It is natural to assume that, if estrogen relates to hot flushes, that progesterone would work somehow. These two hormones always work together or counterbalance each other. Broadly speaking, estrogen is the activating and growth-stimulating hormone; progesterone is the calming, growth-slowing and maturity inducing hormone (14). Progesterone causes many brain effects such as improving sleep (15), increasing core temperature and breathing and decreasing harmful responses to brain injury (16). The balancing actions of estrogen and progesterone are illustrated by control of our core temperature&#8212;progesterone increases core temperature (hence the basal body temperature test for ovulation). However, the high estrogen peak at mid-cycle decreases core temperature (17). When young women are put in a hot room during the progesterone-rich second half of the cycle (but not with the same testing early in the cycle when progesterone is low), the internal temperature at which they begin sweating increases (2). This means that women are less likely to sweat when progesterone levels are high. This likely prevents hot flushes.  Another reason that progesterone may help hot flushes is because of its brain calming actions (16). Progesterone improves sleep (15) and prevents external noises from disturbing those reporting normal sleep (18). One study showed decreased levels of anxiety in women randomized to take progesterone compared with placebo (19). Therefore progesterone may help hot flushes by decreasing brain &#8220;irritability&#8221;.  What did the CeMCOR progesterone-hot flush trial actually show?  133 healthy, non-smoking early postmenopausal women with troublesome hot flushes and night sweats were sorted by chance into taking the active progesterone or an identical, inactive medication (placebo) (4). After one month of hot flush record-keeping, they took experimental medicine for three months. On average women in this study were in their early 50s and about three years since their last menstruation. They had about 9 hot flushes a day (including about 2 night sweats). Adjusted for the baseline and compared with those women on placebo, women on progesterone had 4.3 fewer hot flushes a day, a quite statistically important difference. No women on progesterone stopped the trial because their blinded medicine was ineffective&#8212;there were several dropouts for poor hot flush control on placebo. Finally, there were no serious side effects. Women on progesterone compared with women on placebo also reported a significant improvement in their sleep (4).  This trial shows that women with troublesome hot flushes who want to avoid or stop estrogen can take progesterone and it will be effective for them. This is especially true if they use relaxation methods, exercise regularly and avoid smoking. Although fewer than one in 10 women have fifty sweat-soaked hot flushes per week, these women are in need of a treatment that is effective. In a part of our trial examining only women with frequent/severe hot flushes, progesterone was even more effective compared with placebo (Prior Gynecological Endocrinology, in press July 2012). We also asked women to keep tracking their hot flushes at the end of the trial&#8212;after one month, women who had been on progesterone still had fewer hot flushes than at baseline, but women on placebo were back to original levels (Prior Gynecological Endocrinology, in press July 2012). Therefore progesterone is not only effective for night sweats but works differently than estrogen and doesn&#8217;t cause an increase in hot flushes when it is stopped.   In summary&#8212;Many women both in perimenopause* and in menopause experience hot flushes that disturb sleep, upset concentration and alter a whole host of healthy body functions (1;2;3). These hot flushes may last, we now know, an average of four years (20); for women whose flushes start in perimenopause they may last for 14!  It is a major accomplishment for any research group to design, register, fund, complete, analyze and publish a definitive and innovative randomized controlled trial. The fact that CeMCOR accomplished this through individual donations (without government grants or drug company money) makes ours a truly remarkable achievement.  *Note, we are currently testing progesterone for hot flushes in perimenopause&#8212;see Research News below! 
Research News
Study participants needed - Perimenopausal Hot Flushes
 Hot and bothered? Are you a woman suffering from hot flushes or night sweats?  CeMCOR invites perimenopausal women 35 to 57 who have menstruated within the past 12 months to participate in our Perimenopausal Hot Flush Study. If you are troubled by hot flushes and/or night sweats click here for more info about becoming a partcipant or contact the study coordinator:   E-Mail: hotflush-study@interchange.ubc.ca  Phone: 604 875-5960  Help CeMCOR continue this significant research by simply clicking on the button below.  
Women's Health in the news
  
  



 Shift work link to 'increased risk of heart problems' - BBC News - July 26, 2012 
  



 Later Pregnancy, Lower Risk of a Cancer - New York Times - July 30, 2012
 



 Bike's handlebar level can affect women's sexual health - CBC News - July 9, 2012 
 Women&#8217;s access to health care is now the target of political debate - Or Bodies, Ourselves - June 26, 2012
 Reference List

 
  Williams RE, Kalilani L, DiBenedetti DB, Zhou X, Granger AL, Fehnel SE et al. Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States. Climacteric 2008; 11(1):32-43. 
 Freedman RR, Subramanian M. Effects of symptomatic status and the menstrual cycle on hot flash-related thermoregulatory parameters. Menopause 2005; 12(2):156-159. 
 Pinkerton JV, Stovall DW. Is there an association between vasomotor symptoms and both low bone density and cardiovascular risk? Menopause 2009; 16(2):219-223. 
 Hitchcock CL, Prior JC. Oral Micronized Progesterone for Vasomotor Symptoms in Healthy Postmenopausal Women&#8212;-a placebo-controlled randomized trial. Menopause. In press. 
 Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in health postmenopausal women: prinicple results from the Women's Health Initiative Randomized Control trial. JAMA 2002; 288:321-333. 
 Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004; 291(14):1701-1712. 
 Gangar KF, Cust MP, Whitehead MI. Symptoms of oestrogen deficiency associated with supraphysiological plasma estradiol concentrations in women with oestradiol implants. Br Med J 1993; 299:601-602. 
 Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000; 152:463-473. 
 Swartzman LC, Edelberg R, Kemmann E. Impact of stress on objectively recorded menopausal hot flushes and on flush report bias. Health Psychology 1990; 9:529-545. 
 Whiteman MK, Staropoli CA, Langenberg PW, McCarter RJ, Kjerulff KH, Flaws JA. Smoking, body mass, and hot flashes in midlife women. Obstet Gynecol 2003; 101(2):264-272. 
 Freedman RR, Woodward S. Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am J Obstet Gynecol 1991; 167:436-439. 
 Borud EK, Alraek T, White A, Fonnebo V, Eggen AE, Hammar M et al. The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial. Menopause 2009; 16(3):484-493. 
 Wyon Y, Lindgren R, Lundeberg T, Hammar M. Effects of acupuncture on climacteric symtpoms, quality of life and urinary excretion of neuropeptides among postmenopausal women. Menopause 1995; 2(1):3-12. 
 Clarke CL, Sutherland RL. Progestin regulation of cellular proliferation. Endocr Rev 1990; 11:266-301. 
 Schussler P, Kluge M, Yassouridis A, Dresler M, Held K, Zihl J et al. Progesterone reduces wakefulness in sleep EEG and has no effect on cognition in healthy postmenopausal women. Psychoneuroendocr 2008; 33(8):1124-1131. 
 Gibson CL, Coomber B, Rathbone J. Is progesterone a candidate neuroprotective factor for treatment following ischemic stroke? Neuroscientist 2009; 15(4):324-332. 
 Stachenfeld NS, Silva C, Keefe DL. Estrogen modifies the temperature effects of progesterone. J Appl Physiol 2000; 88(5):1643-1649. 
 Caufriez A, Leproult R, L'hermite-Baleriaux M, Kerkhofs M, Copinschi G. Progesterone prevents sleep disturbances and modulates GH, TSH, and melatonin secretion in postmenopausal women. J Clin Endocrinol Metab 2011; 96(4):E614-E623. 
 Dennerstein L, Spencer-Gardner C, Gotts G, Brown JB, Smith MA. Progesterone and the premenstrual syndrome: a double blind crossover trial. Br Med J 1985; 290:1617-1621. 
 Politi MC, Schleinitz MD, Col NF. Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis. J Gen Intern Med 2008; 23(9):1507-1513.
 
 
Ask Jerilynn
 
 Hi there. I am 41 and my 12-year old daughter got her period two years ago. I've struggled with PCOS since my teens - now I'm worried that my daughter is also getting irregular periods, rapid weight gain, bad acne and low self-esteem. Is there any way that we can stop her from getting PCOS? Read more... Read more...
    
 
 
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			<title>CeMCOR News - September 2011</title>
			<description>CeMCOR News - September 2011</description>
			<author>CeMCOR</author>
			<pubdate>Tuesday 20th of September 2011 10:48:04 PM</pubdate>
			<subject>CeMCOR News - September 2011</subject>
			<content><![CDATA[

Email
 


 
 

 

 See this email online
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 September 19, 2011  Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.   In today's edition: 



 The Politics of Perimenopause Dr. Jerilynn Prior discusses the issues around women's access to relevant perimenopausal health care 

 CeMCOR Research News: We are recruiting for our Oxidative Stress and Bone study - eligible women aged 35-47 can get a free bone density scan and a free 3 month supply of a natural antioxidant 

 The Estrogen Errors: Why Progesterone is Better for Women's Health.  

 Women's Health in the News: Links to women's health stories in popular media.



The Politics of Perimenopause    by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research.     Perimenopause and politics make strange bedfellows. But when I say &#8220;politics&#8221; I&#8217;m not referring to opposition parties, majorities or federal elections, but rather &#8220;social relations involving authority or power.&#8221; So what does perimenopause&#8212;the normal transition from regular menstrual cycles until menopause, the final end of cyclic vaginal bleeding&#8212;have to do with politics and power? Everything!  And right now it is not women who hold that power&#8212;but we can.  Through the ages women have struggled for the right to vote, to have bank accounts and own property, to be elected representatives in the halls of political power and even to access to information about family planning, much less to have access to effective contraception. In recent years the struggle was for &#8220;the morning after pill&#8221; (emergency contraception) and its availability without a prescription within 72 hours of contraceptive failure.  I believe that Perimenopause is today&#8217;s women&#8217;s rights struggle. You rightly say, Perimenopause is a phase of life! How can that be an issue of women&#8217;s rights and freedoms? Perimenopause is today&#8217;s &#8220;women&#8217;s rights issue&#8221; for three main reasons: 1) The current definitions of perimenopause don&#8217;t begin early enough to include the most symptomatic women and commonly confuse perimenopause with menopause.  2) Despite research and data to correct historic misinformation, perimenopause continues to be inaccurately presented as &#8220;estrogen deficiency&#8221; and its low progesterone levels are totally ignored.  3) No current perimenopausal therapies are proven effective and safe in randomized controlled trials for women in this midlife reproductive transition.  The purpose of this article is to bring the perimenopausal social relationships involving authority out into the open. This power says who can define perimenopause, which women &#8216;qualify&#8217; to be called perimenopausal, who controls public and medical education about perimenopause and who decides on appropriate treatment. Thus the politics of perimenopause is fundamental to what women can know, how they learn about their experiences and what help they are offered and decide is worth trying for difficult symptoms. We&#8217;ll discuss each of these in turn. I will conclude with what midlife women can do to take back perimenopausal power.  I was born in 1943 and am thus a &#8220;pre-boomer&#8221; who experienced a very difficult perimenopause during the 1990s (when menopause was still a taboo topic). In medical school I was taught that &#8220;menopause&#8221; (as the transition is often wrongly called) caused problems because of dropping and deficient estrogen levels. Yet during my own perimenopause my breasts were sore for almost 10 years and grew (a full two cup sizes). Sometime in those early years, when I hadn&#8217;t yet even developed irregular cycles, I dreamed that I was pregnant! If anything is the opposite of dropping or low estrogen levels it is sore breasts and pregnancy. Yet, despite waking soaked with night sweats and experiencing sore and swollen breasts and flooding menstruation, even today I would not be diagnosed as being perimenopausal. The diagnosis of perimenopause isn&#8217;t allowed until cycles become irregular.(1).   I believe that women have a right to accurate information about their own lives and bodies. I researched published studies of menstrual cycle estrogen levels in younger women compared with perimenopausal women in a combination study called a &#8220;meta-analysis.&#8221; Results proved that estrogen levels average significantly higher than in sexy young women (2). Despite getting that paper published in one of the top endocrinology journals, and the many studies showing the same thing before (3;4) and since (5-8), most family doctors and even gynecologists are unaware of the true hormonal changes of perimenopause&#8212;higher estrogen levels and lower progesterone levels.   Today&#8217;s misinformation about perimenopause, since it is no longer lack of information, must be about politics. There are strong vested interests in preserving the notion that perimenopause and menopause are the same, and that midlife estrogen levels are dropping or low.   Politics also influences perimenopausal treatment. As someone who personally experienced the misery of high estrogen levels in perimenopause (with sore breasts and major menstrual bleeding) I knew that today&#8217;s recommended treatments for it might be harmful rather than helpful. Currently the birth control pill, which, despite being called &#8216;low dose&#8217; has four to five times higher than normal estrogen levels, and menopausal type hormone therapy that is estrogen-based are both recommended therapies. Yet there are not controlled trial data that either are effective in perimenopause. For this reason,I applied for national Canadian funding to do a randomized double blind placebo-controlled study of progesterone compared with birth control treatment for perimenopausal hot flushes, sore breasts and heavy flow. Year after year and for various, but not strong reasons, these grants were rejected. On our fifth try and just recently, we have obtained funding to study progesterone versus a placebo to determine whether it is an effective treatment of perimenopausal hot flushes.  And don&#8217;t blame your family doctor if he/she thinks that you are stressed or depressed or is confused when you say your periods are regular and heavy and you are miserable with night sweats. They&#8217;ve never been taught! Again we are facing politics and power. As a professor involved in research and teaching about women&#8217;s reproduction, I have been trying since the mid-1990s to ensure that second year medical students at my own University of British Columbia learn about the true hormonal and experience changes of perimenopause. Medical students today do not learn the fundamental brain and ovary changes that lead to the higher estrogen and lower progesterone levels of perimenopause, women&#8217;s most symptomatic normal life phase. I have met with teachers, with leaders and despite providing the scientific articles, agreeing to help in any way I could, and even creating a lecture for this purpose, perimenopause is still virtually ignored in the medical school curriculum.      Who can say they are in perimenopause? Currently the transition to menopause (in other words, perimenopause) and menopause itself are considered to be one and the same&#8212;after all they both may have hot flushes, right? Or, alternatively, perimenopause doesn&#8217;t exist. That is what you might believe if you read the following summary from the North American Menopause Society website: &#8220;The years between puberty (when periods start) and menopause are called premenopause.&#8221; (http://www.menopause.org/expertadvice.asp, accessed April 14, 2011).    Or, if perimenopause exists, it only begins when periods have become irregular or are skipped in the early and late menopause transition, respectively as decided by the Stages of Reproductive Aging Workshop in 2001 (1)     That&#8217;s logical because menstruation that is irregular or far apart fits with the idea of dropping or low estrogen levels. However, this means that a 40-something woman is called &#8220;premenopausal&#8221; despite periods that are closer together (although still regular), who is waking in the middle of the night soaked with night sweats around the time of her period, and having the first migraines of her life. For such a woman, no doctor who sticks with current dogma can explain her many miseries.     What are the changes of perimenopause? (or Why am I feeling so miserable?) If you are a woman whose life is changed completely by mysterious new symptoms, you want an explanation. Perhaps you have nausea, your periods are coming every 22 days and you are bleeding for seven of those days. Maybe you feel bloated, have bad headaches and feel depressed before each period. Or maybe you are tired, fall asleep without turning out the light yet wake and toss and turn from two am onwards. What the . . . is going on? When you go to your family doctor, they are likely to be equally puzzled. When you see a gynecologist they will tell you that you have fibroids, or are depressed or need The Pill. If you really push them they may say your estrogen levels are swinging lower and higher. You are very unlikely to be told&#8212;your estrogen levels are higher than normal, you are likely not ovulating normally and making enough progesterone and are in very early perimenopause. Nor are you told the most reassuring thing of all&#8212;this is a normal transition from which you will recover. You will feel a lot better when your cycles get farther apart and you finally reach menopause.   What will safely and effectively treat my perimenopause symptoms?  Current thought processes about perimenopausal treatment go like this&#8212;perimenopause is about dropping estrogen levels therefore estrogen will help. As mentioned earlier, sanctioned and unquestioned treatments for perimenopausal problems are with either supra-physiological estrogen doses in hormonal contraceptives (designed for young women), or hormone &#8220;replacement&#8221; therapy (designed for menopausal women).  However, hot flushes, heavy flow and quality of life have not been shown to improve by treatment of symptomatic perimenopause with the birth control pill compared with placebo (9). In fact, in addition to heavy flow, women on the pill got extra mid-cycle bleeding for the first three months on oral contraceptives (9)! And no studies have shown that perimenopausal hot flushes are improved by menopausal type hormone therapy, either, although there is ample proof that menopausal night sweats and hot flushes are effectively treated by estrogen, or estrogen with progestin (10). We at CeMCOR have recently shown, for the first time, that oral micronized progesterone (Prometrium&reg;), alone, without estrogen, is more effective treatment of menopausal hot flushes than placebo (11).   Given that we know perimenopause is about higher than normal estrogen levels and lower than normal progesterone levels, it makes sense that progesterone might be a safe and effective therapy for perimenopausal hot flushes and night sweats. I know that it was good and helpful treatment for me starting in late perimenopause when I was awake every night sweating and agitated. Progesterone also significantly improves sleep and decreases sleep disturbances (12).    The good news is that in September 2011, CeMCOR is starting a study of progesterone versus placebo for the treatment of perimenopausal night sweats and hot flushes (see Progesterone for Perimenopausal Hot Flushes for more information).  Taking back women&#8217;s power in perimenopause We have seen that currently perimenopause is associated with confusing definitions, is still equated with dropping estrogen levels and in inappropriately treated with estrogen. It is time for that to change.  The first thing you can do to gain power over your own perimenopause is to learn about yourself. The Daily Perimenopause Diary tool gives you a way to track your night sweats and flow and start to learn connections among experiences so that you can make sense for yourself. You can also find information about taking your first morning oral temperature and finding out if you are ovulating and making progesterone for a normal 10-14 days each cycle (see Quantitative Basal Temperature instructions). Plus there are many articles that will help you understand your experiences (e.g Perimenopause:the Ovary's Frustrating Grand Finale) and definition of terms you may find in other websites or articles.  When you go to your family doctor for help with your symptoms you will know what is bothering you most and can take your diary records with you. The CeMCOR website also has a wealth of articles for your physician. These address a physician&#8217;s concerns and have full scientific references (Progesterone for Symptomatic Perimenopause). Most importantly, if a physician offers you oral contraceptives or hormone therapy, question that, and ask instead for something that makes sense with what you know of your experiences. When you read a magazine or newspaper article that talks about dropping estrogen levels or confuses perimenopause and menopause, write a letter to editor to set the record straight. Finally, tell your friends about the information on the CeMCOR website, make a donation, join a study or volunteer. Only by banding together to take back our political power will women gain our reproductive right to accurate perimenopause information, an appropriate diagnosis of early perimenopause and safe and effective treatment if we are symptomatic. Research NewsStudy participants needed - free bone scan 

  We are still looking for more participants for our study on oxidative stress and bone. Non-smoking women from 35 to 47 are invited to apply. Both women with PCOS and women with regular cycles are encouraged to participate. Participants will receive a free natural antioxidant supplement as well as a bone density scan. Click here for more details  

IN BOOKSTORES NOW  The Estrogen Errors: Why Progesterone is Better for Women's Health 
 In The Estrogen Errors, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the US, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking. How to order:  You can order your copy at your favourite online retailer, including Amazon.com, Amazon.ca, and Barnes and Noble.com. A portion of all proceeds from the sale of The Estrogen Errors will be donated to the CeMCOR Endowment Fund.  Or visit your local bookseller and request a copy using the following ISBN number: 978-0-313-35398-7 If you have trouble finding the book, please call our office at 604-875-5927 and we will be happy to help.  Have you read The Estrogen Errors? If so, please help spread the word by posting your review on Amazon!  


 Women's Health in the news



 Giving testosterone a workout - Macleans - September 14, 2011 Aging:Health Gains From a Small Drink a Day - New York Times - September 19, 2011  Trend toward delayed parenthood a wakeup call - Globe and Mail - September 15, 2011 Pregnant Women in Vancouver may not be getting enough Vitamin D - Vancouver Sun - August 24 2011    Reference List

 1. Soules MR, Sherman S, Parrott
E, Rebar R, Santoro N, Utian W et al. Executive summary: stages of reproductive
aging workshop (STRAW). Fertil.Steril. 2001;76:874-8.

 2. Prior JC. Perimenopause: The
complex endocrinology of the menopausal transition. Endocr.Rev.
1998;19:397-428.

 3. Santoro N,
Rosenberg J, Adel T, Skurnick JH. Characterization  of
reproductive hormonal dynamics in the perimenopause. J Clin Endocrinol Metab
1996;81:4,1495-501.

 4. Burger HG, Dudley EC, Hopper
JL, Shelley JM, Green A, Smith A et al. The endocrinology of the menopausal
transition: a cross-sectional study of a population-based sample. J Clin
Endocrinol Metab 1995;80:3537-45.

 5. Hale GE, Zhao X, Hughes CL,
Burger HG, Robertson DM, Fraser IS. Endocrine features of menstrual cycles in
middle and late reproductive age and the menopausal transition classified
according to the Staging of Reproductive Aging Workshop (STRAW) staging system.
J Clin.Endocrinol.Metab 2007;92(8):3060-7.

 6. O'Connor KA, Ferrell RJ,
Brindle E, Shofer J, Holman DJ, Miller RC et al. Total and Unopposed Estrogen
Exposure across Stages of the Transition to Menopause. Cancer
Epidemiol.Biomarkers Prev. 2009;18(3):828-36.

 7. Hale GE, Hughes CL, Burger HG,
Robertson DM, Fraser IS. Atypical estradiol secretion and ovulation patterns
caused by luteal out-of-phase (LOOP) events
underlying irregular ovulatory menstrual cycles in the menopausal transition.
Menopause 2009;16(1):50-9.

 8. Moen MH,
Kahn H, Bjerve KS, Halvorsen TB. Menometrorrhagia in the perimenopause is associated with
increased serum estradiol. Maturitas 2004;47(2):151-5.

 9. Casper RF, Dodin S, Reid RL, Study
Investigators. The effect of 20 ug ethinyl estradiol/1 mg norethindrone acetate
(MinestrinTM), a low-dose oral contraceptive, on vaginal bleeding patterns, hot
flashes, and quality of life in symptomatic perimenopausal women. Menopause
1997;4:139-47.

 10. MacLennan AH, Broadbent JL,
Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy
versus placebo for hot flushes. Cochrane Database Syst.Rev. 2004(4):CD002978.

 11. Prior, J. C. and Hitchcock, C.
L. Progesterone for vasomotor symptoms: A 12-week randomized, masked
placebo-controlled trial in healthy, normal-weight women 1-10 years since final
menstrual flow. Endocrine Reviews 31(3), S51. 2010. 



 12. Schussler P, Kluge M,
Yassouridis A, Dresler M, Held K, Zihl J et al. Progesterone reduces
wakefulness in sleep EEG and has no effect on cognition in healthy
postmenopausal women. Psychoneuroendocr. 2008;33(8):1124-31.


















 
 
 
Ask Jerilynn
 
 My periods are usually two or three months apart and my doctor says it's
 because I'm doing too much exercise. I'm a student, I'm 19 and healthy.
 I excercise every day because I feel good when I do it and not good 
when I don't. I'm slim but I feel good energy at this weight. I'm 
healthy, I eat well, don't smoke. Do you think that too much exercise is
 causing my infrequent periods? 
 Read more...




 
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Telephone: 604&#8211;875-5927 | Fax: 604-875-5915 | E-mail: cemcor@interchange.ubc.ca



































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			<title>CeMCOR News - September 2010</title>
			<description>CeMCOR News - September 2010</description>
			<author>CeMCOR</author>
			<pubdate>Thursday 16th of September 2010 06:48:02 PM</pubdate>
			<subject>CeMCOR News - September 2010</subject>
			<content><![CDATA[

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 September 16, 2010  Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.   In today's edition: 



 Progesterone for Hot Flush Treatment and the Myth of Estrogen Deficiency Dr. Jerilynn Prior discusses the evidence for progesterone therapy in menopause. 

 CeMCOR Research News: Thank you to all the women who volunteered as normal controls in our PCOS study. 

 The Estrogen Errors: Why Progesterone is Better for Women's Health.  

 Women's Health in the News: Links to women's health stories in popular media.



Progesterone for Hot Flush Treatment and the Myth of Estrogen Deficiency    by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research. CeMCOR just presented information showing that oral micronized progesterone (the same molecule as our ovaries normally make, in other words &#8220;bio-identical&#8221;) is highly effective treatment for hot flushes and night sweats and without adverse effects (1). Progesterone is effective for mild or infrequent hot flushes as are a number of antidepressant and other non-hormonal medications. However, progesterone, like estrogen, effectively treats frequent and severe hot flushes. This evidence potentially blows away decades of prejudice about menopause and inappropriate treatment of menopausal women.    For more than 60 years the dominant idea about menopause (by which I mean women&#8217;s normal life phase that begins a year beyond her last menstruation) has been that it involves &#8220;estrogen deficiency.&#8221;  Poor menopausal women (me included)&#8212;not only have we lost our periods, our fertility and our youth, we&#8217;ve lost our estrogen! (As though losing estrogen is the biggest tragedy that could befall you.) But, believe me, having lower estrogens was a blessing after perimenopause&#8212;my breasts stopped hurting and I could eat sensibly instead of being forever hungry.   The &#8220;estrogen deficiency&#8221; idea of menopause is fundamentally wrong. It is perfectly normal, expected and appropriate for estrogen levels to become low in menopause. Further, &#8220;estrogen deficiency&#8221; is a silly idea&#8212;it totally ignores the fact that progesterone levels also decrease. Estrogen and progesterone work together (2) and, in menopause both decrease to low levels. Both of these important ovarian hormones&#8212;having completed their pre/perimenopausal work&#8212;go on holiday.   However, it&#8217;s fine for me to talk about menopause as though it&#8217;s great (and, speaking personally, in many ways it is). But menopause is not a relief if you have frequent (more than 7 per 24 hour day) and intense (2-4 on a 0-4 scale) hot flushes and night sweats as seven percent of USA menopausal women do (3). Having hot flushes, with sweat stinging your eyes and night sweats disrupting your every night&#8217;s sleep, is awful. Then you get a prescription for estrogen and progestin, the hot flushes get better but breasts get sore (4), you get funny bleeding (5) and your doctor wants you to have all kinds of invasive testing. Most of all, you worry about breast cancer. So you decide to stop. But, and this is the cruelty of it&#8212;the hot flushes are worse than they were before, intolerable and you feel miserable (6).   Our wrong concepts about menopause and its treatment have caused women this impossible &#8220;choice&#8221;&#8212;breast cancer or severe night sweats.  Hot flushes are one of the main reasons that menopause has such a bad rap. Well, you say, aren&#8217;t hot flushes and night sweats caused by &#8220;estrogen deficiency&#8221;? Don&#8217;t hot flushes mean &#8220;estrogen deficiency&#8221;? The short answer is No.  Kids and men have low estrogen levels and no hot flushes. So much for our conventional wisdom about what causes hot flushes. For example, at the start of perimenopause I began to have night sweats that drenched me awake the night before my period. There was no way my estrogen levels were low when I was having perfectly regular periods and sore breasts to boot. When we studied all the diaries of all women with regular menstrual cycles and hot flushes we found a pattern&#8212;sore breasts and night sweats both increased around flow (7). Can&#8217;t be low estrogen.  Furthermore, hot flushes can occur in women with very high estrogen levels as a study from Great Britain showed. In that centre it was common for doctors to give symptomatic menopausal women, not a prescription for estrogen pills but a six-month duration estrogen injection. However, women kept coming back before six months. They returned to the clinic at five months, then four. . . .  complaining of what the authors called &#8220;classic symptoms of estrogen deficiency.&#8221; These women had what the article said were &#8220;flushes, sweats, mood swings and irritability&#8221;(8). Puzzled, the investigators measured these women&#8217;s estrogen levels&#8212;they were higher than the average mid-cycle peak of estrogen. How on earth could these hot flushes be caused by estrogen deficiency?  Putting everything we know together, dropping estrogen levels cause hot flushes.  But not just dropping estrogen levels in anybody. For hot flushes to occur, the brain has to have gotten used to high estrogen levels. Hot flushes occur when there is a sudden drop in brain estrogen levels. Estrogen withdrawal. . . .  Hot flushes are estrogen addiction, which is why they often get worse when you stop estrogen treatment (9). Like an addict whose brain becomes used to very high levels of heroin&#8212;when those levels drop she/he feels awful, nauseated, irritable with a racing heart, hot and sweaty. The strongest evidence we have that hot flushes are estrogen addiction is that their physiology strongly resembles an opioid addicted rat!      So&#8212;back to the evidence that progesterone treatment is effective for hot flushes (1)&#8212;hot flushes can&#8217;t be &#8220;estrogen deficiency&#8221; if progesterone effectively treats them. Why is progesterone effective for estrogen addiction? Estrogen and progesterone complement or counterbalance each other in every tissue of our bodies, including our brains. Where estrogen causes brain excitation and irritability, increasing the risk for addiction (10), progesterone decreases the risk for addiction (11) and promotes calmness and healing (12).   In an effort to help women who want to stop estrogen, for many years I&#8217;ve been successfully using progesterone treatment. I wrote about my clinical experience in the article 'Stopping Estrogen Treatment' on the CeMCOR website when we launched it in 2003    In summary&#8212;we&#8217;ve been stuck in the &#8220;estrogen deficiency&#8221; hypothesis of menopause&#8212;we know little about progesterone. We already have randomized controlled trial evidence that oral micronized progesterone decreases sleep problems without morning hang-over effects (13), and effectively treats premenstrual symptoms (14). It is time to concentrate on progesterone. We are at the very beginning of understanding the roles of progesterone in the brain (and, for that matter in most every other tissue of women&#8217;s bodies). At last we can think about menopause as a normal life phase&#8212;and women have a choice to use progesterone rather than estrogen for frequent and severe hot flushes and night sweats (1).  Research NewsCompleted: Healthy women needed to act as controls 

 We are happy to report that we recently completed recruitment of healthy women to act as controls in a study of the role of genetics in Polycystic Ovary Syndrome. We anticipate the blood samples will be ready for analysis very soon. Thank you to all the women who volunteered to be part of this study - we could not have done it without you.   

IN BOOKSTORES NOW  The Estrogen Errors: Why Progesterone is Better for Women's Health 
 In The Estrogen Errors, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the US, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking. How to order:  You can order your copy at your favourite online retailer, including Amazon.com, Amazon.ca, and Barnes and Noble.com. A portion of all proceeds from the sale of The Estrogen Errors will be donated to the CeMCOR Endowment Fund.  Or visit your local bookseller and request a copy using the following ISBN number: 978-0-313-35398-7 If you have trouble finding the book, please call our office at 604-875-5927 and we will be happy to help.  Have you read The Estrogen Errors? If so, please help spread the word by posting your review on Amazon!  


 Women's Health in the news



 Questions over ghostwriting in drug industry - Nature News - September 7, 2010 Removing Fallopian tubes during hysterectomies cuts ovarian cancer - Vancouver Sun - September 11, 2010  Popular osteoporosis drugs linked to rare fracture - CTV.ca - September 14, 2010 New guidelines for pelvic exams - CBC.ca - September 15, 2010   Reference List Prior JC, Hitchcock CL. Progesterone For Vasomotor Symptoms: A 12-Week Randomized, Masked Placebo-Controlled Trial In Healthy, Normal-Weight Women 1-10 Years Since Final Menstrual Flow. Endocrine Society Abstracts . 2010. Ref Type: Abstract Baxter S, Prior JC. The Estrogen Errors: Why Progesterone is Better For Women's Health. Westport: Praeger Publishers, 2009. Williams RE, Kalilani L, DiBenedetti DB, Zhou X, Granger AL, Fehnel SE et al. Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States. Climacteric 2008; 11(1):32-43. Crandall CJ, Aragaki AK, Chlebowski RT, McTiernan A, Anderson G, Hendrix SL et al. New-onset breast tenderness after initiation of estrogen plus progestin therapy and breast cancer risk. Arch Intern Med 2009; 169(18):1684-1691. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in health postmenopausal women: prinicpal results from the Women's Health Initiative Randomized Control trial. JAMA 2002; 288:321-333. Grady D. A 60-year-old woman trying to discontinue hormone replacement therapy. JAMA 2002; 287:2130-2137. Hale GE, Hitchcock CL, Williams LA, Vigna YM, Prior JC. Cyclicity of breast tenderness and night-time vasomotor symptoms in mid-life women: information collected using the Daily Perimenopause Diary. Climacteric 2003; 6(2):128-139. Gangar KF, Cust MP, Whitehead MI. Symptoms of oestrogen deficiency associated with supraphysiological plasma estradiol concentrations in women with oestradiol implants. Br Med J 1993; 299:601-602. Prior JC. Hot flush pathophysiology predicts prevention and treatment - a model of estrogen addiction with progesterone-facilitated withdrawal. J Women's Health 19, 629. 2010. Ref Type: Abstract Anthes E. She's hooked: allure of vices tied to a woman's monthly cycle. The allure of alcohol, drugs and cigarettes ebbs and flows with a woman's monthly cycle. Scientific American May , 1-2. 2010. Ref Type: Magazine Article Evans SM, Foltin RW. Exogenous progesterone attenuates the subjective effects of smoked cocaine in women, but not in men. Neuropsychopharmacology 2006; 31(3):659-674. Gibson CL, Coomber B, Rathbone J. Is progesterone a candidate neuroprotective factor for treatment following ischemic stroke? Neuroscientist 2009; 15(4):324-332. Schussler P, Kluge M, Yassouridis A, Dresler M, Held K, Zihl J et al. Progesterone reduces wakefulness in sleep EEG and has no effect on cognition in healthy postmenopausal women. Psychoneuroendocr 2008; 33(8):1124-1131. Dennerstein L, Spencer-Gardner C, Gotts G, Brown JB, Smith MA. Progesterone and the premenstrual syndrome: a double blind crossover trial. Br Med J 1985; 290:1617-1621.    




  












 
 
 
Ask Jerilynn
 
 I'm a perfectly healthy woman in my early 50s and was sure that I was in menopause because I had been without a period for 20 months. Then one morning I awoke to bleeding, just as if there had been no break. My doctor is insistent that I have to have surgery-I guess a D and C or an endometrial biopsy. What do you think? Read more...




 
Upcoming events

     September 22, 2010Hot Flushes are Estrogen Addiction, Progesterone Aids in Addiction Recovery   More...  October 28, 2010UBC Celebrate Learning Week   More...View full calendar 









  
 
 
 
    


 
 
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Telephone: 604&#8211;875-5927 | Fax: 604-875-5915 | E-mail: cemcor@interchange.ubc.ca






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			<title>CeMCOR News - Summer 2010</title>
			<description>CeMCOR News - Summer 2010</description>
			<author>CeMCOR</author>
			<pubdate>Thursday 01st of July 2010 01:48:01 AM</pubdate>
			<subject>CeMCOR News - Summer 2010</subject>
			<content><![CDATA[

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 June 30, 2010  Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.   In today's edition: 



 Centre for Menstrual Cycle and Ovulation Research at Eight&#8212; 2010 CeMCOR Anniversary Celebration Dr. Jerilynn Prior reflects on the many achievements of CeMCOR over the past 8 years. 

 CeMCOR Research News: Lots of progress recently with two new studies starting up, one finished the recruitment phase, and the release of very exciting study results from our study of hot flushes in menopause. 

 Summer Reading: The Estrogen Errors: Why Progesterone is Better for Women's Health.  

 Women's Health in the News: Links to women's health stories in popular media.



 Centre for Menstrual Cycle and Ovulation Research at Eight&#8212; 2010 CeMCOR Anniversary Celebration   by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research. CeMCOR started with an idea&#8212;ovulation and progesterone are extremely important, although neglected. That notion has grown into a vibrant, virtual organization that has, for the first time, shown that oral micronized progesterone (Prometrium&reg;) is safe and effective treatment for hot flushes and night sweats in healthy menopausal women (1). We have also just obtained Canadian Institute of Health Research support to do a similar randomized controlled trial of Prometrium&reg; for Perimenopausal Night Sweats. Many causes for celebration!  Before 2002 I was a single physician doing research with various others investigators from the University of British Columbia (UBC) and Simon Fraser University (SFU). I dreamed that by formally working with others we could reach out to share what we learn with women everywhere, and be more effective in accomplishing key scientific studies.   When the Centre for Menstrual Cycle and Ovulation Research (CeMCOR) was founded in May of 2002, our vision was &#8220;To reframe scientific knowledge of the menstrual cycle and ovulation in a woman-centred context.&#8221; Over the last eight years, CeMCOR has made major progress in showing that progesterone as well as estrogen is important, not just for women&#8217;s fertility and reproduction, but also for general health and well being throughout women&#8217;s entire lifecycle. This is the only research centre, anywhere in the world, with a research focus on ovulation and that studies the physical and emotional-social causes and effects of ovulation disturbances on women&#8217;s overall health.  Major Achievements  CeMCOR completed the first randomized, controlled trial in 2009 showing that oral micronized progesterone (Prometrium&reg;) is highly effective treatment for hot flushes/night sweats in 133 healthy early menopausal women (1). In 2010, this research was chosen by The Endocrine Society, one of about 12 presentations out of over 6,000, to highlight in a press conference. This achievement is even more remarkable because it was accomplished with individual, private donations to CeMCOR. The Estrogen Errors&#8212;Why Progesterone is Better for Women&#8217;s Health written by Susan Baxter, PhD (Vancouver medical writer and lecturer at SFU) and Jerilynn C. Prior MD was published in 2009 by Praeger Press, a major USA library publisher (2). This book emphasizes the major error in thinking that estrogen is women&#8217;s only important female hormone while ignoring progesterone. The Estrogen Errors has been acclaimed by Dr. Susan Love, breast cancer researcher, author and health advocate, Christianne Northrup, popular women&#8217;s health educator and author, and Judy Norsigian, Executive Director of Our Bodies Ourselves, Boston&#8217;s historic women&#8217;s health book collective (visit www.estrogenerrors.com).    Canadian Institutes of Health Research (CIHR) in 2010 awarded CeMCOR scientists a 4-year major operating grant to conduct a randomized controlled trial of Prometrium&reg; for perimenopausal hot flushes/night sweats. This will be the first trial of a potential hot flush treatment that focuses solely on women who are in this important midlife reproductive transition.  Click here to continue reading about CeMCOR's scientific publications, research funding, and other successes over the last 8 years.... Or, click here to access the full article as a PDF  Research NewsNEW FINDINGS: Progesterone is effective for menopausal hot flushes and night sweats 


 This month (June), CeMCOR researchers Jerilynn Prior and Christine Hitchcock attended the Endocrine Society meetings and presented the results of our research study showing that progesterone is an effective therapy for hot flushes and night sweats in women who no longer menstruate. Women in the study took 3 pills each evening, either 300 mg (3 100 mg pills) or an identical placebo, for 12 weeks. Using a score that integrates both the number and intensity of hot flushes and night sweats, we found 56% improvement in those randomized to progesterone as compared with 28% in those randomized to placebo. The funds to support this work came entirely from the generous donations of individual CeMCOR supporters, and could not have been accomplished without the time and energy of just over 175 women who enrolled as study participants. Thank you for your support! We are delighted to have the data, and will be submitting the results of this study for publication over the summer.

And we have grant funds to test it in perimenopause!  

 On the strength of these results, we have obtained a research grant from CIHR, the Canadian Institutes of Health Research, to conduct a similar research trial in perimenopausal women who have hot flushes and night sweats while they are still menstruating. Perimenopausal women are badly in need of evidence-based therapies; we are very pleased to be able to do this work. It will take us about 6 months to set up the trial; we plan to begin recruitment at the end of the year. Look for the study ads on our web page.

Too young for night sweats? 

  Thank you to
everyone who helped spread the word about our Perimenopausal Night
Sweats study! We recently met our recruitment goal and are no longer
enrolling new participants. We look forward to analyzing the data once
the last few participants are complete in the hopes of learning more
about night sweats in women who are still menstruating.  If you're disappointed to have missed this opportunity to join our study, look for our upcoming perimenopausal therapy study at the end of this year! Upcoming study: Healthy women needed to act as controls 

 In July 2010, CeMCOR will open recruitment for healthy women to act as controls in a study of the role of genetics in Polycystic Ovary Syndrome. In order to join the study, you need to be a woman between age 19-40 with regular menstrual cycles and no clinical signs of androgen excess. When available, study recruitment information will be posted on the CeMCOR homepage.   

NOW AVAILABLE:  Add "The Estrogen Errors" to your summer reading list! 
 Looking for an interesting, informative, and thought- provoking book to add to your summer reading list? In The Estrogen Errors, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the US, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking. How to order:  You can order your copy at your favourite online retailer, including Amazon.com, Amazon.ca, and Barnes and Noble.com. A portion of all proceeds from the sale of The Estrogen Errors will be donated to the CeMCOR Endowment Fund.  Or visit your local bookseller and request a copy using the following ISBN number: 978-0-313-35398-7 If you have trouble finding the book, please call our office at 604-875-5927 and we will be happy to help.  Have you read The Estrogen Errors? If so, please help spread the word by posting your review on Amazon!  


 Women's Health in the news



 Listen online - Seeing Red: A Cultural History of Menstruation - CBC Ideas podcast - June 14, 2010 Hysterectomy rates falling: report - CBC News - May 27, 2010 VIDEO: The Agenda with Steve Paikin: The Pill at 50 - TV Ontario - May 25, 2010. To
mark the 50th anniversary of the birth control pill, Dr. Jerilynn Prior
joins a panel discussion of the cultural and medical significance of
the Pill. 

 She's Hooked: Allure of Vices Tied to a Woman's Monthly Cycle - Scientific American - May 2010. See also: Dr. Jerilynn Prior's response to this article  Women who experience domestic violence may have higher health-care costs even after abuse ends - WomensHealthMatters.ca - April 29, 2010  




  












 
 
 
Ask Jerilynn
 
 I'm 47 and had my ovaries but not my uterus removed. However, following surgery I wasn't told what to expect, if I needed to take hormones, or what I might experience. I'm having night sweats, hot flushes, and interrupted sleep but still have my usual libido and good vaginal lubrication. Read more...




 
Upcoming events

     September 22, 2010Hot Flushes are Estrogen Addiction, Progesterone Aids in Addiction Recovery   More...View full calendar 









  
 
 
 
    


 
 
 CeMCOR Home  |  Contact Us
 To unsubscribe, please click here. 
CeMCOR: Room 4111 - 4th Floor, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9 
Telephone: 604&#8211;875-5927 | Fax: 604-875-5915 | E-mail: cemcor@interchange.ubc.ca




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			<title>CeMCOR News - February 2009</title>
			<description>CeMCOR News - February 2009</description>
			<author>CeMCOR</author>
			<pubdate>Wednesday 24th of February 2010 07:14:02 PM</pubdate>
			<subject>CeMCOR News - February 2009</subject>
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 February 24, 2010  Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.   In today's edition: 



 Is ovulation (and are normal progesterone levels) important for the health of women? In this final installment of our newsletter series, Dr. Jerilynn Prior discusses the relationship between ovulation and cardiovascular disease. 

 Too young for night sweats? We need just a few more women to join our observational study of perimenopausal night sweats.

 Now Available! The Estrogen Errors: Why Progesterone is Better for Women's Health. A new book from Dr. Jerilynn Prior and Susan Baxter explores the controversy over prescribing estrogen for perimenopausal
women and details why progesterone is actually
a far more effective, and a far less risk-ridden, approach.

 Women's Health in the News: Links to women's health stories in popular media.



 Is Ovulation (and are Normal Progesterone Levels) Important for the Health of Women?  The Essential Balance of Progesterone with Estrogen   by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research. We have been asking, through a series of newsletters, what we know about women&#8217;s health related to normal progesterone levels and ovulation. We have discussed the fact that ovulatory disturbances (meaning anovulation and short luteal phase cycles) are common and hidden within menstrual cycles that seem perfectly normal. I speculate that at least a third of all cycles - in regularly menstruating, healthy women 10-30 years since menarche (their first period) - produce too little progesterone. (We don&#8217;t really know the percentage of cycles with ovulatory disturbances in the general population because no one has studied it. CeMCOR in joint study with Norwegian scientists and funded by Canadian Institutes of Health Research is currently trying to learn what proportion of women&#8217;s cycles is anovulatory.)   In previous newsletters we described how difficult it is to know if we have ovulatory disturbances. Most of the time, unless we are working to become pregnant, we think everything&#8217;s fine. Thus, doctors would call ovulatory disturbances &#8220;subclinical&#8221; because they don&#8217;t come to medical attention. The majority of ovulatory disturbances occur within cycles of normal length, normal flow and even with perfectly normal estrogen levels (1). However, they are lacking any (anovulation) or have too little progesterone production (short luteal phase). Thus, ovulatory disturbances provide an &#8220;experiment of nature&#8221; that allows us the opportunity to understand how progesterone alone - not just in combination with estrogen, its essential partner ovarian hormone - contributes to women&#8217;s health.   Earlier we discussed that estrogen&#8217;s job is to stimulate the growth of cells (i.e. proliferation) but that progesterone&#8217;s role is to decrease that proliferation and induce maturation and differentiation of tissues (2). Although much of our research and treatment has focused on estrogen, which is considered the primary &#8220;woman&#8217;s hormone&#8221;, I believe that progesterone is an essential partner hormone to estrogen. These two important ovarian hormones are meant to work together, complementing or counter-balancing each other in every tissue and every cell of women&#8217;s bodies and across our life cycles (3).   I&#8217;ll say again what I believe, and what we are making progress in proving: Regular menstrual cycles with consistently normal ovulation during the premenopausal years will prevent osteoporosis, breast cancer and heart disease in women.  The purpose of this article is to describe new and suggestive evidence that progesterone is important for preventing women&#8217;s cardiovascular diseases (CVD, heart attacks, strokes and blood clots). However, before we can make sense of any information about progesterone and CVD, we have to put what we currently believe and know into a context.  We are now ready to wrap up this review of progesterone and women&#8217;s health. This final section concerns women&#8217;s risk for heart disease, stroke and diseases of the blood vessels and the relationships of these vascular problems to estrogen and progesterone. Let&#8217;s start with what &#8220;we&#8221; believe&#8212;by this I mean the two main cultural myths that surround women&#8217;s heart disease.   The first myth--women&#8217;s heart disease is the same as men&#8217;s The second myth&#8212;women&#8217;s heart disease is caused by estrogen deficiency  Click here to continue reading about ovulation and cardiovascular disease..... Or, click here to access the full article as a PDF  We will continue with new, exclusive articles in the next CeMCOR newsletter. Stay tuned! Research NewsToo young for night sweats? A few more women needed for  Perimenopausal Night Sweats study 


  Our pilot study is going well, with 18 women enrolled, but we need a few more women before we are done. To participate, you should be 35-50 years old, have night sweats, no hormones in the past 3 months (contraceptives, hormone therapy, creams, rings, etc.), and your periods should come no more than 60 days apart. The study will help us prepare for a therapy trial of progesterone in perimenopausal women, and also help us learn about night sweats in women who are still menstruating.   For more information, including eligibility criteria, visit the study web page. Please help us find participants by telling your friends and putting up study posters [PDF]in your local community centre, coffee shop, gym, etc. NOW AVAILABLE:  The Estrogen Errors: Why Progesterone is Better for Women's Health
 In this revealing work, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the United States, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking. What others are saying about The Estrogen Errors: "Jerilynn Prior can always be trusted to go beyond the surface to what is really happening in women's bodies. She is a true champion in women's health. This book will help you finally understand your body and hormones."   -Susan Love MD President of the Dr Susan Love Research Foundation and author of Dr Susan Love's Breast Book   &#8220;In this provocative book, Jerilynn Prior and Susan Baxter raise many key questions that women's health researchers and clinicians have failed to ask or investigate. They are especially effective in deconstructing prevailing myths about "too little estrogen" during the peri-menopause.&#8221; -Judy Norsigian Executive Director, Our Bodies Ourselves How to order:  You can order your copy at your favourite online retailer, including Amazon.com, Amazon.ca, and Barnes and Noble.com. A portion of all proceeds from the sale of The Estrogen Errors will be donated to the CeMCOR Endowment Fund.  Or visit your local bookseller and request a copy using the following ISBN number: 978-0-313-35398-7 If you have trouble finding the book, please call our office at 604-875-5927 and we will be happy to help.  Have you read The Estrogen Errors? If so, please help spread the word by posting your review on Amazon! 


 Women's Health in the news



 Estrogen pills may increase asthma risk - MSNBC - February 8,2010 New morning-after pill works for up to 5 days - CBC News - January 29, 2010  Time to end pelvic exams done without consent - The Globe and Mail - January 28, 2010

 Menopause, as Brought to You by Big Pharma - The New York Times - December 12, 2010 




  












 
 
 
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 February 23, 2010  Is Ovulation (and are Normal Progesterone Levels) Important for the Health of Women?  The Issue of Women's Heart Health   by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research. We have been asking, through a series of newsletters, what we know about women&#8217;s health related to normal progesterone levels and ovulation. We have discussed the fact that ovulatory disturbances (meaning anovulation and short luteal phase cycles) are common and hidden within menstrual cycles that seem perfectly normal. I speculate that at least a third of all cycles - in regularly menstruating, healthy women 10-30 years since menarche (their first period) - produce too little progesterone. (We don&#8217;t really know the percentage of cycles with ovulatory disturbances in the general population because no one has studied it. CeMCOR in joint study with Norwegian scientists and funded by Canadian Institutes of Health Research is currently trying to learn what proportion of women&#8217;s cycles is anovulatory.)   In previous newsletters we described how difficult it is to know if we have ovulatory disturbances. Most of the time, unless we are working to become pregnant, we think everything&#8217;s fine. Thus, doctors would call ovulatory disturbances &#8220;subclinical&#8221; because they don&#8217;t come to medical attention. The majority of ovulatory disturbances occur within cycles of normal length, normal flow and even with perfectly normal estrogen levels (1). However, they are lacking any (anovulation) or have too little progesterone production (short luteal phase). Thus, ovulatory disturbances provide an &#8220;experiment of nature&#8221; that allows us the opportunity to understand how progesterone alone - not just in combination with estrogen, its essential partner ovarian hormone - contributes to women&#8217;s health.   Earlier we discussed that estrogen&#8217;s job is to stimulate the growth of cells (i.e. proliferation) but that progesterone&#8217;s role is to decrease that proliferation and induce maturation and differentiation of tissues (2). Although much of our research and treatment has focused on estrogen, which is considered the primary &#8220;woman&#8217;s hormone&#8221;, I believe that progesterone is an essential partner hormone to estrogen. These two important ovarian hormones are meant to work together, complementing or counter-balancing each other in every tissue and every cell of women&#8217;s bodies and across our life cycles (3).   I&#8217;ll say again what I believe, and what we are making progress in proving: Regular menstrual cycles with consistently normal ovulation during the premenopausal years will prevent osteoporosis, breast cancer and heart disease in women.  The purpose of this article is to describe new and suggestive evidence that progesterone is important for preventing women&#8217;s cardiovascular diseases (CVD, heart attacks, strokes and blood clots). However, before we can make sense of any information about progesterone and CVD, we have to put what we currently believe and know into a context.  We are now ready to wrap up this review of progesterone and women&#8217;s health. This final section concerns women&#8217;s risk for heart disease, stroke and diseases of the blood vessels and the relationships of these vascular problems to estrogen and progesterone. Let&#8217;s start with what &#8220;we&#8221; believe&#8212;by this I mean the two main cultural myths that surround women&#8217;s heart disease.   Myths about women&#8217;s heart disease  1. The first myth--women&#8217;s heart disease is the same as men&#8217;s Obviously it is simpler for doctors, media and organizations to give one consistent message that applies to young and old, woman and man alike. It is also advantageous to pharmaceutical interests and will expand the potential customers to have a one-size fits all marketing campaign. However, these messages are fundamentally untrue. Women&#8217;s heart disease first occurs at an older age than in men. Furthermore, contrary to advertising, women&#8217;s heart disease rates never becomes as high as in men, and the population-adjusted death rate in women remains lower than in men (4). In addition, in a population follow-up study, men whose cholesterol levels were in the lowest quarter of the population level had higher heart attack rates than women with cholesterol levels in the highest quarter of the population level (5). Furthermore, low dose aspirin (a single 325 mg tablet a week, or 81 mg every day) doesn&#8217;t prevent heart disease in women although it has been shown to prevent heart attacks in men (6). And, as opposed to men, there is no credible evidence that the popular lipid lowering drugs (such as statins) are effective at preventing as opposed to treating heart disease in women (7).  Despite this myth of women and men having similar risks for heart disease, there are sex-related disparities in the health care for women and men with acute heart attacks. According to a recent report from Ontario, women are more likely to be taken care of by a family doctor without a specialist than are men of similar income bracket and age. Women are also likely to wait longer before they get infusion of the clot-busting intravenous drugs (thrombolytic) when they come to the emergency room with a heart attack. And finally, women are less likely to have the diagnostic angiogram testing that tells physicians the extent of the cardiovascular risk. These facts are ironic given the messaging that says women and men are at the same risk for heart disease.  2. The second myth&#8212;women&#8217;s heart disease is caused by estrogen deficiency   The reasoning behind this notion goes like this&#8212;young women have lots of estrogen and don&#8217;t get heart attacks. Older menopausal women are &#8220;estrogen deficient&#8221; and get heart attacks. Therefore, lack of estrogen causes women&#8217;s heart disease. That is like saying that headache is an aspirin-deficiency disease!     Ten years before the first Women&#8217;s Health Initiative (WHI) proved me correct in suspecting that cardiovascular disease would not be prevented by estrogen treatment (8), I could &#8220;see&#8221; that this myth about estrogen therapy preventing heart disease was wrong (9). This myth has now, finally, been repeatedly tested in randomized double-blind placebo-controlled trials in both women (8;10) and men (11). In every scientific (randomized, placebo-controlled) test, this estrogen-treatment-heart-disease-prevention myth has failed&#8212;and yet the myth persists (12;13).    The only possible reason for such a nonsensical idea to persist is because it serves some purpose. I can guess that its purpose is to re-enforce the &#8220;woman problem.&#8221; As a culture, we fundamentally believe women to be somehow lacking (the anatomy and physiology of men&#8212;thank goodness) or that women are weak or ill. Pharmaceutical companies, some specialist physicians and those dominant in our culture appear to gain power by treating women&#8217;s &#8220;deficiencies,&#8221; often with estrogen.   What&#8217;s the evidence for the Estrogen-Heart Disease Prevention Myth?   Large observational studies, including some of the data from longitudinal population-based studies like the Framingham Heart Study, have shown that women taking estrogen had fewer heart attacks than did women not taking so-called hormone &#8220;replacement&#8221; therapy (14). The reasons estrogen (here read pill estrogen as in conjugated equine estrogen, CEE, or Premarin) was proposed to prevent heart disease were that it increased the apparently preventative, good high-density cholesterol (HDL) level. Estradiol is also undoubtedly active in the complex nitric-oxide system through which the microcirculation (small blood vessels) is controlled (15). But we knew, even many years ago, that the women who take estrogen treatment differ in heart-protective ways from the women who don&#8217;t&#8212;they are more likely to have a personal physician, to be well educated, to exercise regularly, to be non-smokers, to be of normal weight and without diabetes or high blood pressure (16).   Oral estrogen treatment increases HDL cholesterol and makes blood flow better in small and medium sized blood vessels&#8212;this is called endothelial function because it is controlled by complex changes in endothelial lining of vessels. Estrogen treatment also doesn&#8217;t appear to cause high blood pressure, diabetes or obesity. Although estrogen treatment, in general, has no effect on blood pressure, insulin resistance or obesity in randomized controlled trials&#8212;in some women it does appear to contribute to individual-specific increases in blood pressure, blood sugar and weight gain.   How could estrogen or estrogen-progestin treatment cause the increase in risk for heart disease shown in multiple randomized controlled trials (8;17)? One possible way is through its increased levels of C-reactive protein, a strong marker of inflammation, which is now considered a common pathway to many diseases including heart disease (18). CEE also increases triglycerides that are now known to be more strongly associated with causing women&#8217;s heart disease than HDL levels are at preventing it. Most important of all, oral estrogen increases women&#8217;s risk for blood clots (19). I believe that the formation of clots within arteries is estrogen&#8217;s main negative cardiovascular effect (both on heart attacks and strokes)&#8212;we used to call heart attacks &#8220;coronary thrombosis&#8221; (meaning heart artery blood clots).   The good news about estrogen and blood clots is that estrogen applied through the skin (transdermal estrogen&#8212;as a patch or gel or cream), doesn&#8217;t go from the stomach through the liver first and thus increase levels of blood clotting proteins&#8212;transdermal estrogen does not cause blood clots (20;21). I believe that no one, who needs estrogen treatment, should ever be treated with oral estrogen, given that safer transdermal bio-identical estradiol is available as a patch, gel or cream.   Progesterone, Blood Vessels and Heart Disease I believe that ovulatory disturbances in young menstruating women cause an increased risk for heart disease in older menopausal women. This postulate is a very hard one to test&#8212;large numbers of menstruating women with frequent ovulatory disturbances would need to be given a placebo or cyclic progesterone for years and then followed for at least 10 years following the last menstrual flow. This is because ovulatory disturbances occur in young, menstruating women whereas heart disease is largely a disease of the very elderly. And heart disease takes years to develop.   Despite the difficulty in doing a definitive experiment about progesterone and heart disease, there are many heart disease risk factors that progesterone appears to decrease. We&#8217;ll begin with these CVD markers, and then discuss the two experiments that strongly suggest that ovulatory disturbances cause subsequent heart disease.   Cardiovascular Risk Markers and Progestin or Progesterone We have known since a controlled trial in 1985 that oral micronized progesterone decreased blood pressure in both menopausal women and in men (22). This means progesterone should decrease women&#8217;s risk for strokes for which high blood pressure and blood clotting are major risks. Here it is worth recalling that both the Estrogen-Progestin and the Estrogen-only arms of the Women&#8217;s Health Initiative trials showed higher risks for stroke with hormone treatment compared with controls (8;23). We have repeated the study of progesterone and blood pressure in a randomized double-blind trial in of progesterone for hot flushes in healthy menopausal women and expect to know the results in the next year.   Potential CVD reducing mechanisms have also been shown for medroxyprogesterone MPA (a progestin most closely related to oral micronized progesterone) although MPA is often blamed for heart disease (24). MPA may decrease CVD risk by lowering triglycerides and C-reactive protein levels (Kalyan Pharmacotherapy 2010). These data are from a randomized blinded one-year comparison of CEE and MPA that showed an important difference between estrogen and MPA. Women randomized to MPA had lower triglyceride and C-reactive protein levels at the end of the trial. Although the women on MPA also had lower HDL levels than did those on CEE, their HDL levels remained within the normal range (Kalyan Pharmacotherapy 2010). In that randomized comparison study of estrogen and MPA (the only one that has been published) there were no differences in blood pressure. We have these data about MPA, however, it is difficult to know about the effect of progesterone on cholesterol, other lipids and inflammatory markers because, to our knowledge, no study has compared placebo with oral micronized progesterone without estrogen. Again, we have collected this information in a controlled trial of progesterone for hot flushes and hope to publish the results within a year.  Another observation in the randomized blinded comparison of CEE and MPA is that women on CEE gained more weight (almost five versus about 2.5 kg) (25), and tended to increase their truncal fat more than did those women on MPA (Kalyan Pharmacotherapy 2010). It is abdominal fat that is associated with insulin resistance, diabetes and an increased risk for heart disease. We do know that most women exposed to progesterone can eat this imperceptible amount more and not gain weight. From studies in which young normal-weight women kept a three-day diet diary about a week after flow started and a week before the next flow, we discovered that the women who ovulated were eating about 300 calories more during the luteal than the follicular phase yet kept their weights steady (26). This occurs because progesterone raises our core temperature about 0.2 degrees C. and increased temperature requires increased energy. This fact makes it likely that progesterone aids women in avoiding obesity, insulin resistance and potentially diabetes mellitus, a very important women&#8217;s heart disease risk factor.   Endothelial function is another cardiovascular marker for which there are positive progesterone data. Abnormalities in the control of blood flow by the endothelium of arteries are associated with an increased risk for heart attack. Control of blood flow is a complex process through which nitric oxide is released in the endothelial lining of blood vessels. Some years ago we did a randomized study in which healthy menopausal women came once a week for the study of blood flow. During each session, blood flow in the forearm was measured following standardized stimulations when (a week apart) estrogen, progesterone, estrogen plus progesterone or just the base solution (control) were infused into the local artery (15). This study showed that progesterone was as effective or better at increasing blood flow as estrogen (15). We have repeated this study in women randomized to oral micronized progesterone or placebo and will soon be able to present our results.   Primate and Human Studies of Ovulation and Risk for Heart Disease The most convincing studies are always those with disease outcomes&#8212;like measured blood vessel abnormalities or better yet heart attacks. There are two such studies of the potential association of ovulatory disturbances and risk for CVD&#8212;one is in colonies of female monkeys fed a high cholesterol diet, and the other a study of ovulation over three cycles in a large number of women who were followed for heart attacks in a population-based Dutch study.   The monkey study has the advantage that the animals were captive, could be studied closely and at the end their arteries could be carefully examined for the plaques that indicate a risk for heart attack (27). The scientists first observed that some of the female monkeys were groomed more, got to the food first and were dominant over other female monkeys. They then observed that, although the dominant monkeys tended to weigh more, their menstrual cycles were the same lengths but the stressed, isolated subordinate monkeys were more likely to have ovulatory disturbances. After three years of this monitoring, when they looked at the arteries they found that, although the male monkeys had the most abnormal arteries the subordinate females had similar artery disease. However, the regularly ovulatory, non-stressed dominant female monkeys had little or no artery plaque (27). Although, in this study they did not measure estrogen levels which were likely similar between groups, progesterone levels were lower and cortisol stress hormone levels were higher. Therefore, the lower progesterone levels, the higher cortisol levels or both appear to cause female monkeys serious blood vessel disease.   The study of pre-/perimenopausal women was part of a population-based breast screening programme of over 11,000 women ages 44-49 in 1986-8 who initially completed an extensive questionnaire and brought three consecutive cycle day 22 overnight urine samples to the laboratory (28). About eight years later, local hospital registers were systematically searched for women who had participated looking for those with either acute heart attack or chest pain (angina) plus at least a 50% blockage in a coronary artery on angiography (29). Women with heart disease were matched by age, screening and other variables with three women without CVD&#8212;those with heart attacks (cases) and those without (controls) were compared for things that differed. Researchers found that those with heart attacks were more likely to smoke (60%!), to have treated high blood pressure and to have diabetes. Also, although there were no differences in actual levels of estrogen, progesterone or testosterone in their urine, more of those with heart disease had low levels of progesterone designated as anovulatory levels than did controls. This suggests that those with major heart risk factors (smoking, diabetes, high blood pressure) were more likely to have a heart attack in their mid-50s if they also had been anovulatory earlier. Although this study did not take into account the great differences between ovulatory women in their metabolism and excretion of progesterone, it is suggestive that those without adequate progesterone in perimenopause have higher rates of heart attack later.   Thus both cardiovascular risk factors (like blood pressure, inflammation, triglycerides, less weight gain and improved endothelial function) and two studies of ovulation in female monkeys and women all suggest that ovulation and normal progesterone levels with normal estrogen may be protective for heart disease in women.    Summary - Progesterone Prevents Osteoporosis, Breast Cancer and Heart Disease In this series of newsletter articles we have discussed the difficulties in making a clinical diagnosis of ovulatory disturbances (multiple blood, urine or saliva tests or serial ultrasound studies). We also assert that a motivated woman, with little equipment or cost, can know her own cycle using the Menstrual Cycle Diary and measurements of her first morning temperature analyzed scientifically and accurately using a quantitative method (30;31). We have estimated that approximately 10-20% of women&#8217;s cycles are anovulatory and about a third have short luteal phases thus ovulatory disturbances occur in a high percentage of seemingly normal menstrual cycles. Thus we know that ovulatory disturbances with their normal estrogen but lower progesterone levels are both common and silent.   In this series of articles we have already shown that progesterone is important for women&#8217;s bone health. Progesterone, acting through the bone-forming osteoblast cells, is important for the increased bone gain that occurs in the first years after menarche as cycles are &#8220;growing up&#8221; to become ovulatory (32). We also know that young, healthy and regularly menstruating women with more ovulatory disturbed cycles are silently losing bone (1;33). It may be that, eventually, progesterone will be used as part of the treatment for osteoporosis and used to prevent fractures.    We have also made a strong case that progesterone may prevent breast soreness, lumpiness (sometimes called &#8220;fibrocystic disease&#8221;) and breast cancer risk. We showed that progesterone is necessary for the breast to mature to its grown up, Tanner Stage V form that has a Canadian two-dollar sized darker areola surrounding the nipple (34). That progesterone can stop the excessive cell growth caused by estrogen is also shown in two randomized human trials of hormones applied daily to one breast before a breast biopsy (35;36). Finally, the latest evidence from a large prospective observational study is that progesterone (but not progestins) with estrogen decreases the risk for breast cancer caused by the estrogen alone (37).    This final article suggests that, although women&#8217;s heart disease is under an unscientific cloud of myths and disadvantages in clinical care, that there are evidences that progesterone is positive for heart disease risk factors and some clinical studies suggesting normal ovulation prevents later heart attacks. All of these ideas need testing in well documented prospective studies and randomized controlled trials before they will be proven.   The data to date confirm CeMCOR&#8217;s postulate that normal ovulatory cycles during the premenopausal years prevent later, menopausal osteoporosis, breast cancer and heart disease, the three major health issues for older women in this culture.   Reference List   Prior JC, Vigna YM, Schechter MT, Burgess AE. Spinal bone loss and ovulatory disturbances. N Engl J Med 1990;1221-7. Clarke CL, Sutherland RL. Progestin regulation of cellular proliferation. Endocr.Rev. 1990;266-301. Baxter S, Prior JC. The Estrogen Errors: Why Progesterone is Better For Women's Health. Westport: Praeger Publishers, 2009:1. Tunstall-Pedoe H. Myth and paradox of coronary risk and the menopause. Lancet 1998;1425-7. Isles C, Hole DJ, Hawthorne VM, Lever AF. Relation between coronary risk and coronary mortality in women of the Renfew and Paisley survey: comparison with men. Lancet 1994;702-6. Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JE, Hennekens CH, Buring JE. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N.Engl.J Med. 2005;1293-304. Rosenberg H, Allard D. Evidence for Caution: Women and statin use.  1-36. 2007. Winnipeg, Canadian Women's Health Network. Women and Health Protection. Ref Type: Report Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in health postmenopausal women: prinicpal results from the Women's Health Initiative Randomized Control trial. JAMA 2002;321-33. Prior JC. Postmenopausal estrogen therapy and cardiovascular disease (letter). N Engl J Med 1992;705-6. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard BV, Hsia J, Hubbell A, Jackson R, Johnson KC, Judd H, Kotchen JM, Kuller L, LaCroix AZ, Lane D, Langer RD, Lasser N, Lewis CE, Manson J, Margolis K, Ockene J, O'Sullivan MJ, Phillips L, Prentice RL, Ritenbaugh C, Robbins J, Rossouw JE, Sarto G, Stefanick ML, Van Horn L, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004;1701-12. Coronary Drug Project Research Group. Coronary drug project: findings leading to the discontinuation of the 2.5 mg/day estrogen group. Journal of the American Medical Association 1973;652-7. Derry PS. Hormones, menopause, and heart disease: making sense of the Women's Health Initiative. Womens Health Issues 2004;212-9. Barrett-Connor E. Hormones and heart disease in women: the timing hypothesis. Am.J.Epidemiol. 2007;506-10. Castelli WP, Anderson K, Wilson PW, Levy D. Lipids and risk of coronary heart disease. The Framingham Study. Ann.Epidemiol. 1992;23-8. Mather KJ, Norman EG, Prior JC, Elliott TG. Preserved forearm endothelial responses with acute exposure to progesterone: a randomized cross-over trial of 17-b estradiol, progesterone, and 17-b estradiol with progesterone in healthy menopausal women. J Clin Endocrinol Metab 2000;4644-9. Barrett-Connor E, Bush T. Estrogen and coronary heart disease in women. Journal of the American Medical Association 1991;1861-7. Beral V, Banks E, Reeves G. Evidence from randomised trials on the long-term effects of hormone replacement therapy. Lancet 2002;942-4. Frohlich M, Muhlberger N, Hanke H, Imhof A, Doring A, Pepys MB, Koenig W. Markers of inflammation in women on different hormone replacement therapies. Ann.Med. 2003;353-61. Brosnan JF, Sheppard BL, Norris LA. Haemostatic activation in post-menopausal women taking low-dose hormone therapy: less effect with transdermal administration? Thromb.Haemost. 2007;558-65. Brosnan JF, Sheppard BL, Norris LA. Haemostatic activation in post-menopausal women taking low-dose hormone therapy: less effect with transdermal administration? Thromb.Haemost. 2007;558-65. Canonico M, Oger E, Plu-Bureau, Conard J, Meyer G, Levesque H, Trillot N, Barrellier MT, Wahl D, Emmerich J, Scarabin PY. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation 2007;840-5. Rylance PB, Brincat M, Lafferty K, De Trafford JC, Brincat S, Parsons V, Studd JW. Natural progesterone and antihypertensive action. Br.Med.J. 1985;13-4. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard BV, Hsia J, Hubbell A, Jackson R, Johnson KC, Judd H, Kotchen JM, Kuller L, LaCroix AZ, Lane D, Langer RD, Lasser N, Lewis CE, Manson J, Margolis K, Ockene J, O'Sullivan MJ, Phillips L, Prentice RL, Ritenbaugh C, Robbins J, Rossouw JE, Sarto G, Stefanick ML, Van Horn L, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004;1701-12. Koh KK, Sakuma I. Should progestins be blamed for the failure of hormone replacement therapy to reduce cardiovascular events in randomized controlled trials? Arterioscler.Thromb.Vasc.Biol. 2004;1171-9. Prior JC, Vigna YM, Wark JD, Eyre DR, Lentle BC, Li DKB, Ebeling PR, Atley LM. Premenopausal ovariectomy-related bone loss: a randomized, double-blind one year trial of conjugated estrogen or medroxyprogesterone acetate. J.Bone Min.Res. 1997;1851-63. Barr SI, Janelle KC, Prior JC. Energy Intakes Are Higher During the Luteal-Phase of Ovulatory Menstrual Cycles. American Journal of Clinical Nutrition 1995;39-43. Kaplan JR, Adams MR, Clarkson TB, Koritnik DR. Psychological influences on female 'protection' among cynomolgus macaques. Atherosclerosis 1984;283-95. Gorgels WJ, Graaf Y, Blankenstein MA, Collette HJ, Erkelens DW, Banga JD. Urinary sex hormone excretions in premenopausal women and coronary heart disease risk: a nested case-referent study in the DOM-cohort. J Clin Epidemiol. 1997;275-81. Gorgels WJ, Graaf Y, Blankenstein MA, Collette HJ, Erkelens DW, Banga JD. Urinary sex hormone excretions in premenopausal women and coronary heart disease risk: a nested case-referent study in the DOM-cohort. J Clin Epidemiol. 1997;275-81. Bedford JL, Prior JC, Hitchcock CL, Barr SI. Detecting evidence of luteal activity by least-squares quantitative basal temperature analysis against urinary progesterone metabolites and the effect of wake-time variability. Eur.J Obstet Gynecol Reprod Biol. 2009;76-80. Prior JC, Vigna YM, Schulzer M, Hall JE, Bonen A. Determination of luteal phase length by quantitative basal temperature methods: validation against the midcycle LH peak. Clin.Invest.Med. 1990;123-31. Kalyan S, Barr SI, Alamoudi R, Prior JC. Is Development of Ovulatory Cycles in Adolescence Important for Peak Bone Mass? J Bone Miner.Res 22, S494 - W511. 2007. Ref Type: Abstract Waugh EJ, Polivy J, Ridout R, Hawker GA. A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women. Am.J Clin.Nutr. 2007;1791-801. Prior JC, Vigna YM, Watson D. Spironolactone with physiological female gonadal steroids in the presurgical therapy of male to female transexuals: a new observation. Arch.Sex.Beh. 1989;49-57. Chang KJ, Lee TTY, Linares-Cruz G, Fournier S, de Lignieres B. Influence of percutaneous administration of estradiol and progesterone on human breast epithelial cell cycle in vivo. Fertil.Steril. 1995;785-91. Foidart J, Collin C, Denoo X, Desreux J, Belliard A, Fournier S, de Lignieres B. Estradiol and progesterone regulate the proliferation of human breast epithelial cells. Fertil.Steril. 1998;963-9. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;103-11.   
 
 
Ask Jerilynn
 
 I'm having periods that are usually two or three months apart and my doctor says it's because I'm doing too much exercise. I'm 19, healthy, and studying to be a medical office assistant. I walk, run or kick-box every day. Do you think that too much exercise is causing my infrequent periods? Read more...




 
Upcoming events

     February 27, 2010Moving Beyond the Estrogen Myth to Understand Perimenopause, Calgary AB  More...  April 29, 2010Challenging the Estrogen Myth: Speaking Truth to Power, Vancouver BC  More...View full calendar 









  
 
 
 
    


 
 
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			<title>CeMCOR News - November 2009</title>
			<description>CeMCOR News - November 2009</description>
			<author>CeMCOR</author>
			<pubdate>Friday 27th of November 2009 01:10:02 AM</pubdate>
			<subject>CeMCOR News - November 2009</subject>
			<content><![CDATA[

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 November 26, 2009  Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.   In today's edition: 



 Personal reflections on the creation of The Estrogen Errors In this edition, we take a break from our series on ovulation and women's health to bring you the story of how The Estrogen Errors: Why Progesterone is Better for Women's Health came to be.  

 Too young for night sweats? We are looking for women 
aged 35-50 to join an observational study of perimenopausal night sweats.

 Now Available! The Estrogen Errors: Why Progesterone is Better for Women's Health. A new book from Dr. Jerilynn Prior and Susan Baxter explores the controversy over prescribing estrogen for perimenopausal
women and details why progesterone is actually
a far more effective, and a far less risk-ridden, approach.

 Women's Health in the News: Links to women's health stories in popular media.



 Personal Reflections on the Creation of "The Estrogen Errors"  The Essential Balance of Progesterone with Estrogen   by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research. This newsletter article is an interlude before we complete the series about ovulation and women&#8217;s health. I am taking this opportunity to share with you some of the story behind the publication of The Estrogen Errors.  How did The Estrogen Errors come to be? The short answer is that Susan Baxter, a medical writer and social scientist was pitching an idea for a book based on her Simon Fraser PhD research related to BC&#8217;s Pharmacare and decision-making. The editor at Praeger Press, an academic press that primarily publishes books intended for libraries, instead, suggested Susan write and investigative piece about cosmetic surgery. In rapidly rejecting that idea, Susan indicated she would like to write a book about women&#8217;s health. Around the same time, I think crowning with the successful publication&#8212;after more than 12 years of trying&#8212;of our study showing that medroxy-progesterone was as good for treating hot flushes as estrogen, I happened to have a conversation with Susan&#8217;s VGH physician-husband. He must have told of our meeting. Next thing I knew she was emailing and calling me. When I understood what she was inviting me to, I jumped at the chance.   How am I feeling about this new book?  As time passes since the recent publication of Susan Baxter&#8217;s and my book, The Estrogen Errors&#8212;Why Progesterone is Better for Women&#8217;s Health (Praeger, Conn. 2009), I feel a growing sense of accomplishment. This happy feeling has grown the more this book has allowed me to talk with many, varied people. I have spoken with people with different views, backgrounds and ideas, from women&#8217;s health activists of the Our Bodies Ourselves collective, academic gynecologists in Boston and Munich, menstruation researchers in Spokane, the varied anti-aging conference audience in Paris, as well as those of my friends, family, research participants and former patients attending my October 29th Vancouver book launch. I&#8217;m getting excited about talking with more people at the Vancouver Public Library author talk on December 2.  I seem to be increasingly bubbling with satisfaction because of what this book has (finally) allowed me to say. I feel like I have finally found my voice. I&#8217;ve grown up enough (or clocked multiples of Malcolm Gladwell&#8217;s essential 10,000 hours to achieve expertise) to speak to the whole field of women&#8217;s health and thus to the whole culture out of which our current wrong ideas have grown.    Over the last more than 29 years I have been working away at particular and seemingly small bits in the arena of women&#8217;s health&#8212;the variability of ovulation in women, the relation of exercise to cycles, the relationships of progesterone to changes in bone, hormonal changes in perimenopause, women&#8217;s experiences of perimenopause, the effect of progesterone on hot flushes in healthy menopausal women... this book allows me to step beyond these specific areas of research and say something bigger and more important than the sum of all I&#8217;ve learned.   Here&#8217;s my key message&#8212;the balanced partnership of estrogen and progesterone is critical for women&#8217;s life-long well being. The Estrogen Errors, most of all, allows me to criticize Medicine and Culture&#8217;s approach to women and hormones. The current wrong approach can be summarized:  1) estrogen&#8217;s what makes a girl; and 2) progesterone causes women&#8217;s problems.  This activity of creating a book is a bit like giving birth&#8212;seeing this newborn book in different situations and reflecting varied people&#8217;s view of it, I find I grow increasingly fond. I have (already) forgotten the painful labour involved in writing, revising and answering editor&#8217;s (endless, picky) queries.   I also have almost forgotten how hard it was to co-write a book with someone you don&#8217;t know very well. Not to say that Susan Baxter and I don&#8217;t share a lot. We share a commitment to feminism, we have in common personally difficult perimenopause experiences, and finally, we both desire that women have access to accurate information. Beyond that, however, we differ in our areas of expertise, personal health decisions, circadian rhythms and even our approach to medical research.   All that being said, I believe that The Estrogen Errors is better for our many negotiations and our differing perspectives. I know for sure that this book is more lively and fast-paced because of Susan&#8217;s writing style.   What is my dream for The Estrogen Errors? I don&#8217;t want anything less than that this book is the beginning of a major shift in our ideas about women and hormones. Tall order!   However, I am just getting a glimmer of hope that the world may be ready for a broader and more ecological view of women&#8217;s health than the &#8220;estrogen deficiency gospel according to gynecology.&#8221; For example, I agonized over my recent lectures for gynecologists at the Technical University of Munich and also at my alma mater, Boston University Medicine Center. In both cases, I ended up with a talk titled, &#8220;The Estrogen Myth.&#8221; I could have ducked controversy and just talked about &#8220;Complex Endocrinology of Perimenopause&#8221; or &#8220;An Approach to Hot Flushes and Night Sweats&#8221; but I thought it important to say that our current view is more story than science. So I started with a quote by Bertrand Russell describing how myths are formed. I needed to show how silly it is, really, to even think about estrogen without also imagining progesterone. They are such tightly linked partners in all of women&#8217;s cells and tissues that it is frankly asinine to only focus on estrogen.   I have to say that, although perhaps dubious at the start of my talks, the majority of both gynecology audiences went away with some challenging new ideas, and a few with some changed concepts.   On a more practical note, I hope that the hard-back copies of The Estrogen Errors will totally sell out. Then I expect that this book, which now costs about $50.00 a copy, will go to paperback. As a &#8220;pocket book&#8221; (as my grandmother called them) The Estrogen Errors should become affordable for the majority of women. You can help make it possible for more women to read The Estrogen Errors by asking your local bookstore or library to order it (ISBN: 978-0-313-35398-7). (If you can't find it on line, we probably can get a copy to you. Contact us at cemcor@interchange.ubc.ca and use "Book Purchase" in the subject. We will get it to you ASAP).You can also share the new website and blog with your friends: www.estrogenerrors.com. I also hope that my royalties of about $US 5.00 for each book sale will increase the UBC CeMCOR Endowment Fund. That fund is accumulating so that one day I can retire knowing that The Centre for Menstrual Cycle and Ovulation Research will have leadership to continue into the future.  In the next newsletter we will return to our discussion of ovulation and women's health, with the last installment of this series. Stay tuned! 

Research NewsToo young for night sweats? Join our observational study of Perimenopausal Night Sweats 


  We are looking for women aged 35-50 who are experiencing night sweats to participate in our latest study.This 4-cycle observational study will enroll 20 perimenopausal women with regular (less than 60 days apart) cycles and night sweats.   For more information, including eligibility criteria, visit the study web page. Please help us find participants by telling your friends and putting up study posters [PDF]in your local community centre, coffee shop, gym, etc. NOW AVAILABLE:  The Estrogen Errors: Why Progesterone is Better for Women's Health
 In this revealing work, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the United States, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking. What others are saying about The Estrogen Errors: "Jerilynn Prior can always be trusted to go beyond the surface to what is really happening in women's bodies. She is a true champion in women's health. This book will help you finally understand your body and hormones."   -Susan Love MD President of the Dr Susan Love Research Foundation and author of Dr Susan Love's Breast Book   &#8220;In this provocative book, Jerilynn Prior and Susan Baxter raise many key questions that women's health researchers and clinicians have failed to ask or investigate. They are especially effective in deconstructing prevailing myths about "too little estrogen" during the peri-menopause.&#8221; -Judy Norsigian Executive Director, Our Bodies Ourselves Book orders  You can order your copy at your favourite online retailer, including Amazon.com, Amazon.ca, and Barnes and Noble.com. A portion of all proceeds from the sale of The Estrogen Errors will be donated to the CeMCOR Endowment Fund.  Or visit your local bookseller and request a copy using the following ISBN number: 978-0-313-35398-7


 Women's Health in the news

 Ditching the pill for good: New health concerns have women looking for different choices - Maclean's - November 23, 3009 

 Another Loss for Pfizer in Drug Suits - The New York Times - November 23, 2009 

 Home birth with midwife safe as hospital - CBC News - August 31, 2009  The Society for Menstrual Cycle Research recently launched a new blog. Re:Cycling tackles all matters menstrual and features posts by CeMCOR researchers Dr. Jerilynn Prior and Christine Hitchcock. Check out the blog here! 




  












 
 
 
Ask Jerilynn
 
 I recently read an article in More magazine about extreme bleeding, fibroids and endometrial ablation. I'm a healthy 45-year old yet I've been having gushing and flooding for several months. Should I have the lining of my uterus scraped away? Read more...




 
Upcoming events

     December 2, 2009Meet the authors of The Estrogen Errors at the Vancouver Public Library  More...View full calendar 









  
 
 
 
    


 
 
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			<title>CeMCOR News - Summer 2009</title>
			<description>CeMCOR News - Summer 2009</description>
			<author>CeMCOR</author>
			<pubdate>Friday 07th of August 2009 12:00:03 AM</pubdate>
			<subject>CeMCOR News - Summer 2009</subject>
			<content><![CDATA[

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 Summer 2009  Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.   In today's edition: 



 Is Ovulation (and are normal Progesterone levels) Important for the Health of Women? In this edition, Dr. Prior discusses the complex relationships among ovulation, progesterone and breast health. Look for more in this series in upcoming newsletters.

 CeMCOR Research News: 




 Too young for night sweats? We are looking for women 
aged 35-50 to join this an observational study of perimenopausal night sweats. We're happy to report that we've met the recruitment goal for two studies - our
trial of progesterone therapy for hot flushes in menopausal women and the AAE-Eye normal control phase. Thank you to all who volunteered! 


 Now Available! The Estrogen Errors: Why Progesterone is Better for Women's Health. A new book from Dr. Jerilynn Prior and Susan Baxter explores the controversy over prescribing estrogen for perimenopausal
women and details why progesterone is actually
a far more effective, and a far less risk-ridden, approach.

 Women's Health in the News: Links to women's health stories in popular media.



Is Ovulation (and are normal Progesterone levels) Important for the Health of Women? by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research. I believe that ovulation with a normal luteal phase length &#8211; and normal amounts of progesterone to counterbalance and complement estrogen &#8211; is of key importance for women&#8217;s bone, breast and heart health (1).  The five previous issues in this series have discussed what ovulation is, how it is ignored or assumed in regular cycles and that we have little solid evidence about how frequently or not ovulation occurs among menstruating women in the whole population. The little epidemiology evidence we have suggests that 17% of the time women in the population, often despite regular cycles, do not ovulate. We also have talked about how you can assess your own cycles for ovulation by taking your first morning temperature and analyzing it. This &#8220;quantitative basal temperature&#8221; (2) is much more reliable than the old fashioned BBT methods, especially when coupled with a daily Menstrual Cycle Diary (3). Finally, we discussed the many problems with how ovulation and luteal phase lengths are assessed by physicians.  In the last issue we discussed the importance of ovulation and normal progesterone for building and maintaining strong bones. Estrogen levels rise and fall during the normal menstrual cycle. When estrogen levels fall, there is a small amount of bone loss&#8212;this loss needs to be offset by an increased bone formation, caused by normal luteal phase lengths and normal progesterone in order to prevent bone loss (4;5). Progesterone&#8217;s job is to stimulate bone formation. I believe progesterone could be added to a bone-loss-slowing medication to form improved fracture-preventing osteoporosis treatment for women.   Now it is time to examine the complex relationships among ovulation, progesterone and breast health. We will start by discussing the hormonal influences on breast growth and development during adolescence. Then we will look at the roles estrogen and progesterone play in normal breast cell function. Finally, and of crucial importance, we will review the new evidence that ovarian hormone therapy (OHT, menopausal hormone therapy) with estrogen plus progesterone is not associated with an increased risk for breast cancer. As every woman knows and fears, treatment of menopausal hot flushes with estrogen alone or with estrogen plus medroxyprogesterone (a cousin of natural progesterone) increases the risk for breast cancer. When we understand more we may eventually have evidence that normal ovulation and progesterone levels prevent breast cancer.  Grown up breasts  As you recall from our earlier discussion, at menarche (the first period), our ovaries are making plenty of estrogen. However, at that time our bodies have not yet learned the complex process of ovulating. There is a natural clue in how breasts look that reflects whether or not ovulation has been established (or the breasts have been exposed to the progestins in contraceptives or the standard Pill).   There are a series of reasonably orderly steps that the breasts go through in the process of becoming &#8220;grown up.&#8221; These steps are called Tanner Stages, after the doctor who took pictures of girls&#8217; breast and pubic hair changes yearly from before to several years after menarche. A young child will have breasts that are Tanner Stage I (small circle of skin called the &#8220;areola,&#8221; around the small nipple and both are lying flat against the chest).  Around age 8-10, a small lump, made up of the glands that will eventually form the mature breast, begins to be present beneath the small areola and nipple&#8212;this gives us Tanner Stage II. At the first period we have usually reached Tanner Stage III, meaning that the breast is round and somewhat full but the areola (the now darker bull&#8217;s-eye circle of skin surrounding the nipple) is still small&#8212;about the size of a nickel or quarter. You can see all the stages of breast development in this figure.  Starting about a year or so after the first period, around the time that the first cycles are ovulatory, the areola starts to balloon out and get bigger around. This awkward phase is called Tanner IV and occurs because the ducts are starting to mature under the influence of progesterone. Once ovulation is established, the areola then flattens but is now bigger (about the size of a Canadian two-dollar coin) and is now fully grown up, Tanner V. By this time the breasts will be able to make milk for nursing a baby, their fundamental purpose.   Unfortunately, doctors tend to consider breasts based only on their size&#8212;which continues to increase across adolescence, increases during pregnancy and may increase in perimenopause&#8212;while ignoring the key issue, how big around the areola is. That means that Tanner Stage III and Tanner Stage V can be mixed up. The drawback is that medicine has missed an important clue&#8212;a clear sign that tells us whether or not women have established normal ovulation (or breasts have been exposed to progesterone/ progestins).   Breasts changes with estrogen and progesterone  Have you ever noticed that your breasts get bigger or swollen before your period? Maybe you found that it was sore if you accidentally bumped your nipple at the middle of your cycle. Or perhaps you&#8217;ve had the experience of knowing that you were pregnant even before you&#8217;d missed a period&#8212;the clue, breasts that were too sore to touch! All of these experiences are telling us that estrogen and progesterone are working in our breasts. What is important to understand is what changes each hormone causes and the necessity that estrogen and progesterone be in balance.  Many hundreds of studies have examined breast cells grown in dishes in the laboratory and noted the changes that occur when estrogen or progesterone are added to the cultured cells. In general these studies observe that both estrogen and progesterone stimulate breast cells to grow. Cell growth&#8212;or proliferation as it is commonly called&#8212;is associated with more chance for a mistake and overgrowth of abnormal cells leading to breast cancer. Therefore, for years it has been assumed that both estrogen and progesterone play roles in the risk for breast cancer.   However, cell culture studies often use breast tumour cell lines, or cells that are not natural (because they can continue to grow in culture). In addition, most investigators only observe the cells for a day or two. It turns out that in every tissue studied in many different animals, estrogen initially and continuously causes proliferation (6). However, although progesterone initially causes cell proliferation, it then begins and continues to stimulate cells to differentiate (7). Because more differentiated or more mature cells are less likely to be cancerous, progesterone, according to this measure, should have anti-cancer effects.      The best way to understand what estrogen and progesterone do in breast cells is to study these cells in living, breathing women. This turned out to be possible because women were scheduled for a small surgery to remove a lump that, in each case, turned out to not be cancer. Two excellent randomized, double blind controlled studies have done just that&#8212;in each trial women applied onto the breast that was scheduled for a surgical biopsy a gel containing one of four things: estrogen, progesterone, estrogen and progesterone or just the alcohol base. The first study was in menstruating women who were scheduled for the biopsy on day 11 of their cycle (8). They began applying the gel on the first day of their menstrual period and continued through day 11 when they had surgery. The second study was in menopausal women who were randomized to apply the gel for 14 days with the biopsy scheduled on the 14th day (9). Both of these studies showed that the estrogen and progesterone got into cells and in amounts that were natural; they also showed that breast cell proliferation changed in response to hormones compared with placebo. In both studies, estrogen caused proliferation, and progesterone decreased proliferation. This suggests that estrogen&#8217;s job is to make breasts grow and progesterone&#8217;s job is to stop the growth and allow breast cell maturation.  The next time your breasts become sore or enlarged, ask yourself if estrogen is stimulating your breast cells to proliferate. Also, you might wonder whether your body is making enough progesterone to counterbalance estrogen.  What about history of ovulation problems and breast cancer?  On this question, we have few good answers. Remember that we said it is commonly and wrongly understood that regular cycles mean normal ovulation? We know that women with more years of menstrual cycles (earlier first period, later menopause) have a higher risk for breast cancer (10). But we also know that regular cycles can be anovulatory and without progesterone.   Two moderate sized long cohort studies from the 1980s in women with medical diagnoses associated with ovulation problems&#8212;infertility and anovulatory androgen excess (AAE, also known as polycystic ovary syndrome, PCOS)&#8212;have documented inadequate progesterone and then followed women to observe how many of these women compared with controls, developed breast cancer. The first was a study of 1083 women who were documented between 1945 and 1965 to have infertility that was presumably caused by ovulation disturbances because blocked tubes or problems with their husbands&#8217; sperm were excluded (11). Compared with controls who had other reasons for infertility all of whom were followed through 1978, women with ovulation disturbances showed 5.4 times increased risk for premenopausal breast cancer (11). The second study observed all 1270 women hospitalized for AAE/PCOS at the Mayo Clinic beginning in the 1930s (12) and compared their risk until the late 1970s with women hospitalized for other reasons. The women with chronic anovulation and androgen excess (AAE/PCOS) had a risk for menopausal breast cancer that was 3.6 times higher than their controls (12). Both of these studies suggest that chronic ovulation disturbance (especially if estrogen levels are normal or high as they are in AAE/PCOS) is an important risk for breast cancer.  Risk for breast cancer with ovarian hormone therapy  Multiple large, long observational studies from the 1940s through the 1990s showed that menopausal women who took ovarian hormone therapy, meaning estrogen or estrogen with progestins, appeared to have fewer heart attacks, to be less likely to develop dementia and more likely to live longer. There were concerns, however, that this treatment might cause breast cancer. Plus it was never clear if these women were healthier in the first place, or better at taking pills, or more likely to see their doctors regularly. To test whether menopausal ovarian hormone therapy (OHT) was causing benefit or harm, women scientists pushed the National Institutes of Health in the USA to do randomized controlled trials&#8212;the Women&#8217;s Health Initiative (WHI) hormone trials.   In July 2002 the almost 17,000 women in the estrogen plus progestin (E + P) arm of the WHI were told to suddenly stop their study drug&#8212;this was four years earlier than planned&#8212;because more women taking hormones than taking the placebo developed breast cancer and heart attacks (13). Although the estrogen only (E only) WHI trial in women who had undergone a hysterectomy continued for another two years, it, too, was stopped early. In this case, the reasons for stopping were lack of heart disease prevention and more strokes in those taking estrogen (14). Surprisingly, the E only WHI trial did not show an increase in breast cancer.   Although many had blamed the low dose medroxyprogesterone (2.5 mg/d) in the E + P arm for the increased breast cancer that arm of the WHI showed, it has been known for many years that women who have had pelvic surgery (hysterectomy, even tubal ligation) have a lower risk for breast cancer (15). It is likely that the WHI E only trial didn&#8217;t have enough women in it to show a risk for breast cancer, given the lower risk in women with hysterectomy and especially since that trial had only about 11,000 women enrolled. Our best guess about why hysterectomy decreases breast cancer risk is that, for reasons not yet quite clear, the ovaries are getting less blood flow and hence make lower levels of testosterone, which, because it gets made into estrogen by our bodies, causes lower levels of estrogen itself (16).    How can it be that a cousin of progesterone, medroxyprogesterone, that, like progesterone also causes less breast cell growth/proliferation, should cause breast cancer when taken plus estrogen? Given what we know about estrogen causing proliferation and progesterone or progestins stopping that growth and causing maturation, I initially wondered if the reason for breast cancer increase with E + P might be that it was a full dose of estrogen (Premarin&reg; 0.625 mg/d) but only a quarter luteal phase equivalent dose of medroxyprogesterone (MPA, Provera&reg; 2.5 mg/d). The dose imbalance in the WHI E + P trial is still a probable reason, however, a recent randomized trial in monkeys without their ovaries of hormone therapy with estrogen plus MPA (2.5 mg/d) or estrogen plus progesterone (200 mg/d) for two months showed that estrogen with MPA caused markedly increased breast cell growth but that estrogen with progesterone did not (17). The MPA dose was lower in relative terms than the progesterone dose but the difference in effect was marked. In addition, although there are many guesses, none of which can be proved at the moment, one of the most recent ones is that medroxy-progesterone activates quiet or hiding breast cancer stem cells that estrogen then stimulates to grow (18). Of course, the reason everyone will understand is that breast cancer increase is just one further evidence that estrogen is good and progestins or progesterone are somehow bad.  Although observational studies and randomized ones differ (like in heart disease risk with hormone therapy), in the case of breast cancer, multiple studies have show a greater risk for cancer from estrogen with MPA than with estrogen alone (19). A recent large, observational study from France called the E3N study of women (mostly teachers) in an insurance programme, has provided important information about the progesterone and breast cancer question. (Note that this is not a randomized, double blind placebo-controlled trial like the WHI, therefore it may well have biases we don&#8217;t yet understand.) However, E3N was performed in France, a country that has had oral micronized progesterone therapy (called Prometrium&reg; in North America or Utrogestan&reg; in France) since the 1980s&#8212;in Canada it has been available only since the mid-1990s. The E3N study examined risk for breast cancer in about 80,000 menopausal women followed for about eight years by whether they didn&#8217;t take ovarian hormone therapy (the control group), or used estrogen alone, estrogen with progesterone (about a third of those taking combined therapy), or estrogen with MPA (20). They found that estrogen alone increased the risk 29%, estrogen with MPA increased the risk for breast cancer by 79% but that estrogen with progesterone showed no increased risk (20). This study suggests that MPA differs significantly from its parent hormone, progesterone, especially in relationship to breast cancer risks.  Making sense out of progesterone and breasts  All of the evidence we have right now suggests to me that the currently unknown major risk factor for breast cancer is being exposed to enough or too much estrogen without enough progesterone. One day we may know that having normal ovulatory cycles throughout our reproductive lives is a way to prevent breast cancer. It is clear that estrogen needs to be counterbalanced by progesterone in the breast to prevent tenderness, overgrowth or cancerous growth in breast cells.  We have reviewed the evidence that our breasts need progesterone as well as estrogen to mature into organs with large areolae that have the ability to make milk. Two good randomized studies show that progesterone causes breast cells in women to become more mature and less likely to cause cancer. Yet the Women&#8217;s Health Initiative randomized placebo-controlled trial of estrogen with the progestin, MPA, showed an increased risk for breast cancer not shown in the estrogen only trial, in women who had their uterus and possibly ovaries removed. Finally, a large observational study indicated that estrogen with progesterone therapy did not cause breast cancer although estrogen alone or estrogen with MPA did. Estrogen causes important cell growth that progesterone must transform into mature cells for milk production, normal soft and non-tender breasts and, most importantly, to avoid an increased risk for breast cancer.    In the next newsletter we will discuss ovulation and progesterone related to women&#8217;s blood vessels, cholesterol and risks for heart disease.  Stay tuned! 

Research NewsToo young for night sweats? Join our observational study of Perimenopausal Night Sweats 

 
We are looking for women aged 35-50 who are experiencing night sweats to participate in our latest study.This 4-cycle observational study will enroll 20 perimenopausal women with regular (less than 60 days apart) cycles and night sweats. The primary aim of the study is to determine the feasibility of a potential future randomized control trial of progesterone therapy in perimenopause, and to estimate the number of women who would be needed for that study, as well as to examine whether cyclic hormonal changes affect perimenopausal night sweats.  For more information, including eligibility criteria, visit the study web page. Please help us find participants by telling your friends and putting up study posters in your local community centre, coffee shop, gym, etc. NOW AVAILABLE:  The Estrogen Errors: Why Progesterone is Better for Women's Health
 In this revealing work, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the United States, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking. Like most women in Europe, Prior's patients find progesterone the key to dealing with a life cycle transition that, contrary to Western medicine, these authors do not see as a disease. Challenging medical orthodoxy, this work presents arguments and evidence both women and doctors will find compelling and useful.  You can order your copy at your favourite online retailer, including Amazon.com, Amazon.ca, and Barnes and Noble.com.   Or visit your local bookseller and request a copy using the following ISBN number: ISBN 0-313-35398-0 or ISBN 978-0-313-35398-7


 Women's Health in the news

  Hip and back fractures linked to increased risk of death within 5 years: study - CBC News - August 4, 2009 

 Lung cancer just one of many risks facing women without ovaries - Ottawa Citizen - July 25, 2009 

 Delay in Diagnosis of Menopause-like Condition in Young Women Linked to Low Bone Density - NIH News - June 19, 2009 

 My Brief Life as A Woman - The New York Times - June 2, 2009

 Memory Takes a Hit During Menopause - MedlinePlus - May 26, 2009

  


 Reference List for "Is Ovulation (and are normal Progesterone levels) Important for the Health of Women?" Prior JC. Ovulatory disturbances: they do matter. Can.J.Diagnosis 1997;February:64-80. Prior JC, Vigna YM, Schulzer M, Hall JE, Bonen A. Determination of luteal phase length by quantitative basal temperature methods: validation against the midcycle LH peak. Clin.Invest.Med. 1990;13:123-31. Prior JC. Exercise-associated menstrual disturbances. In: Adashi EY, Rock JA, Rosenwaks Z, editors. Reproductive Endocrinology, Surgery and Technology. New York: Raven Press; 1996. p. 1077-91. Prior JC, Vigna YM, Schechter MT, Burgess AE. Spinal bone loss and ovulatory disturbances. N Engl J Med 1990;323:1221-7. Sowers M, Randolph JF, Crutchfield M, Jannausch ML, Shapiro B, Zhang B et al. Urinary ovarian and gonadotropin hormone levels in premenopausal women with low bone mass. J.Bone Min.Res. 1998;13(7):1191-202. Clarke CL, Sutherland RL. Progestin regulation of cellular proliferation. Endocr.Rev. 1990;11:266-301. Graham JD, Clarke CL. Physiological action of progesterone in target tissue. Endocr.Rev. 1997;18:592-19. Chang KJ, Lee TTY, Linares-Cruz G, Fournier S, de Lignieres B. Influence of percutaneous administration of estradiol and progesterone on human breast epithelial cell cycle in vivo. Fertil.Steril. 1995;63:785-91. Foidart J, Collin C, Denoo X, Desreux J, Belliard A, Fournier S et al. Estradiol and progesterone regulate the proliferation of human breast epithelial cells. Fertil.Steril. 1998;5:963-9. Titus-Ernstoff L, Longnecker MP, Newcomb PA, Dain B, Greenberg ER, Mittendorf R et al. Menstrual factors in relation to breast cancer risk. Cancer Epidemiol.Biomarkers Prev. 1998;7(9):783-9. Cowan LD, Gordis L, Tonascia JA, Jones GS. Breast cancer incidence in women with a history of progesterone deficiency. Am J Epidemiol. 1981;114(2):209-17. Coulam CB, Annegers JF, Kranz JS. Chronic anovulation syndrome and associated neoplasia. Obstetrics and Gynecology 1983;61:403-7. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in health postmenopausal women: prinicpal results from the Women's Health Initiative Randomized Control trial. JAMA 2002;288:321-33. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004;291(14):1701-12. Kreiger N, Sloan M, Cotterchio M, Kirsh V. The risk of breast cancer following reproductive surgery. Eur.J.Cancer. 1999;35:97-101. Laughlin GA, Barrett-Connor E, Kritz-Silverstein D, von Muhlen D. Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study. J Clin Endocrinol Metab 2000;85:645-51. Wood CE, Register TC, Lees CJ, Chen H, Kimrey S, Cline JM. Effects of estradiol with micronized progesterone or medroxyprogesterone acetate on risk markers for breast cancer in postmenopausal monkeys. Breast Cancer Res Treat. 2007;101(2):125-34. Horwitz KB, Sartorius CA. Progestins in hormone replacement therapies reactivate cancer stem cells in women with preexisting breast cancers: a hypothesis. J Clin Endocrinol.Metab 2008;93(9):3295-8. Beral V. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 2003;362(9382):419-27. Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103-11.  












 
 
 
Ask Jerilynn
 
 I'm all confused. Am I in menopause or not? If I am, how come I have regular periods? If I'm not, how come I get night sweats? I have a friend that's menstruating and flushing like me who went to her doctor, had some blood test and was told she was "not in menopause." Can you help me make sense of these confusing words? Read more...









 
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			<title>CeMCOR News - April 2009</title>
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			<pubdate>Monday 12th of January 2009 08:20:02 PM</pubdate>
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 April 6, 2009  Welcome to the Centre for Menstrual Cycle and Ovulation Research newsletter! We hope this newsletter will keep you informed of what's new in women's health research here at CeMCOR.   In today's edition: 



 Is Ovulation (and are normal Progesterone levels) Important for the Health of Women? In this edition, Dr. Prior discusses the role of ovulation and progesterone in building strong bones and preventing osteoporosis and fractures. Look for more in this series in upcoming newsletters.

 CeMCOR Research News: 


 Spread the word! We are only a few participants away from finishing our trial of progesterone therapy for hot flushes in menopausal women.  

 Too young for night sweats? CeMCOR will be beginning a new pilot study of perimenopausal night sweats. We are looking for 20 women 
aged 35-50 to join this observational study. We are looking for 100 healthy women to act as control subjects in our AAE-Aniridia study. Participants will receive a free eye exam. More information, including eligibility criteria, will be posted here when available. 


 Coming Soon! The Estrogen Errors: Why Progesterone is Better for Women's Health. A new book from Dr. Jerilynn Prior and Susan Baxter explores the controversy over prescribing estrogen for perimenopausal
women and details why progesterone is actually
a far more effective, and a far less risk-ridden, approach.

 Women's Health in the News: Links to women's health stories in popular media.



Is Ovulation (and are normal Progesterone levels) Important for the Health of Women? by Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research.
 I believe that ovulation with a normal luteal phase length &#8211; and normal amounts of progesterone to counterbalance and complement estrogen &#8211; is of key importance for women&#8217;s bone, breast and heart health (see Ovulatory Disturbances: They Do Matter) (1).

 The four previous issues in this series have discussed what ovulation is, how it is ignored or assumed to be present in regular cycles and that we know little about the prevalence of ovulation from population-based studies. In fact, in the less than 400 women in epidemiology studied for ovulation, the information suggests that in any given regular cycle you may not ovulate once or twice out of a year&#8217;s worth of 13 cycles. We also talked about how you can assess your own cycles for ovulation by taking your first morning temperature and analyzing it. Quantitative Basal Temperature (QBT), that you can assess yourself, is much more reliable that old-fashioned BBT method, especially when QBT is coupled with a daily Menstrual Cycle Diary&copy;. In the last issue we discussed how medical doctors assess ovulation using a series of expensive and somewhat embarrassing vaginal ultrasound tests, a painful and invasive endometrial biopsy or an inconvenient and not cheap series of blood tests for progesterone in the latter half of the cycle. 
 With this background, it is now time to begin discussing what consistent, normal ovulation means for specific aspects of our health. The above overview from my 1997 article (1) says that I believe ovulation is important for bone, breast and heart health for women. This article will discuss what we know of ovulation and progesterone for building strong bones and preventing osteoporosis and fractures. 

 How Bone Renovates Itself to Prevent Fracture

 Before it will be clear why progesterone and normal ovulation are important for bone health and osteoporosis prevention we need to discuss how bone renews itself. To keep the bone strong, old bone must be removed (by cells called osteoclasts) and replaced with new bone (created by cells called osteoblasts). Estrogen slows the action of osteoclasts and thus prevents bone loss. Progesterone directly stimulates osteoblasts to make new bone.

 Our bone has a natural life cycle. We build bone size and strength starting in utero and continuing until the early teen years. Bone then reaches a high point called &#8220;peak bone mass.&#8221; After that, women&#8217;s bone is ideally kept steady through the premenopausal years until bone loss occurs when skipped periods start in perimenopause. It is normal to lose bone at about 2% a year beginning when irregular periods start in perimenopause and continue at that high rate until one year after the last period. From menopause for the first four years, we lose bone at a rate of about 1%. Then bone loss is normally slowed to about half a percent a year because osteoblasts can&#8217;t keep up with the loss caused by osteoclasts.     How Progesterone Works with Bone Cells and Bone Tissue  We all know that estrogen is important for bones and prevents bone loss (although it acts indirectly rather than by talking to osteoclasts) What is clear, but most physicians and even some bone experts don&#8217;t know is that progesterone sits on specific receptors on osteoblasts and stimulates the formation of new bone. There are numerous papers showing that osteoblast cells cultured in a lab grow rapidly and make bone and bone enzymes when progesterone is added to the culture (2-4).  Ovulation and Building Strong Bones in the Teens and Twenties     As we discussed in the second part of this series, it takes a number of years after the first period (called menarche) before the brain, pituitary and ovary learn to have regular ovulation. In fact, the first year after menarche estrogen levels are normal or high and cycles may be regular or irregular but ovulation almost never occurs. In a study of pre-teen and teen growth, bone density, exercise and nutrition performed by UBC nutrition professor, Susan Barr, with assistance from my laboratory (5), we found that the first of these young women to develop an ovulatory cycle was 11 months after menarche and the majority were over one year. When we tracked bone gain, the maximal increase in bone occurred after ovulation first began, rather than with menarche, suggesting that progesterone was important for teen bone growth (Kalyan, J Bone Min Research 2007, abstract).    Ovulation and Keeping Strong Premenopausal Bones  As I mentioned earlier, my first research studied exercising women and tracked their menstrual cycles. We got funding to study women ages 20-40 for one full year and measure their spine bone density at the beginning and the end of that year. We enrolled 66 healthy, normal weight women who were all proven to not only have regular menstrual cycles but to ovulate normally on two cycles using the QBT method (6). However, when we followed these women&#8217;s cycles and ovulation across a year, although all women continued to have regular periods, only 13 women had normal ovulation every cycle, 13 had at least one cycle in which they did not ovulate, and 28 women had more than one short luteal phase cycle. This study showed that the length of the luteal phase (the time of high progesterone production) explained over 20% of the one-year change in bone (calcium or caloric intake explained only 2%). Said another way, these healthy women with enough estrogen and regular cycles but who didn&#8217;t ovulate for even one cycle were losing bone, while those who ovulated every cycle during the year were maintaining bone (7). This was the first study to show that progesterone and ovulation, not just regular cycles and normal estrogen levels were necessary to prevent premenopausal bone loss (7).   Since that study, two further investigations of bone in premenopausal women have shown that ovulation disturbances are related to loss of bone (8;9).  One of these studies showed that the urinary progesterone peak, and the total amount of progesterone were significantly lower in women from a random sample of the population with the lowest bone density compared with cycles from women in the same study with normal bone density (8). The other study assessed ovulation using progesterone levels in saliva and monitored women over 2 years (9).   Progesterone for Preventing Premenopausal Bone Loss  Those studies of bone loss in healthy premenopausal women who have regular cycles but don&#8217;t ovulate normally raised real concerns about bone loss in premenopausal women who have obviously abnormal menstrual cycles (long cycles as well as skipped periods for months at a time). In addition to recommending regular exercise, stable weight, good intakes of calcium and vitamin D, women with abnormal cycles need something to stimulate new bone to grow (see &#8220;ABCs of Premenopausal Osteoporosis Prevention&#8221;).   We wanted to test the idea that progesterone builds bone by performing a randomized trial of cyclic progesterone [pdf] in premenopausal women with abnormal cycles but who were otherwise well. Because, before 1996 natural oral micronized progesterone called Prometrium&reg; was not available in Canada, we designed a trial using the closest cousin of progesterone, the progestin called medroxyprogesterone acetate (MPA, Provera) for the last 10 days of the menstrual cycle if it was regular, or for the month if it was not (10). We enrolled healthy, normal weight women ages 20-40 with amenorrhea (no periods for six months or longer), women with cycles farther apart than 36 days, those with regular cycles but who were not ovulating, or with regular cycles and ovulation but short luteal phases. Women were randomized to cyclic MPA or placebo. The results showed that women with abnormal cycles given cyclic MPA had a significant gain in bone (2-3%/year) while those on placebo MPA lost about 2% of their spinal bone&#8212;the effect of cyclic progestin was very highly significant (10). This study proves that progestin (which, like progesterone stimulates osteoblasts through the progesterone receptor) not only prevents bone loss but also builds new bone in women with disturbed menstrual cycles or ovulation.   To date no study has given cyclic progesterone to perimenopausal women with abnormal ovulation. It is very clear that perimenopausal women with irregular cycles need increased vitamin D and calcium intakes (see the &#8220;ABCs of Midlife Osteoporosis Prevention").      Progesterone&#8217;s Role in Osteoporosis Treatment  Typically menopausal women who have osteoporosis have had a broken bone with a minor fall or are at high risk for breaking bones. Because such women not only have low bone density but are losing bone, the primary treatments are those medications that slow bone loss (such as estrogen, calcitonin or bisphosphonates). One early clinical study of menopausal women taking estrogen plus 5 mg MPA daily showed a greater gain in bone in these women than menopausal women only taking estrogen therapy (11). In addition, we documented that women with osteoporosis treated with the bisphosphonate, Etidronate, plus 10 mg of MPA daily had a greater gain in bone than women on Etidronate alone (12). Neither of those two clinical studies was randomized or placebo-controlled, however.   More convincing evidence that progestins add to the positive effects of estrogen on bone came from a randomized double-blind placebo-controlled study that compared women on standard doses of estrogen with 2.5 mg of MPA daily and on only estrogen (if they had undergone a hysterectomy). These controlled results showed about a one percent greater bone gain on estrogen with MPA than on estrogen alone (13). To date no study has shown that adding progesterone or MPA to a therapy that slows bone loss can prevent fracture more effectively than the bone-loss-preventing osteoporosis therapy alone. We are planning a randomized two-year study of a bisphosphonate plus Prometrium (300 mg/day) compared with the same bisphosphonate plus placebo progesterone. That study will provide the information needed to plan a larger fracture prevention study. All women in any such trial will be treated in the standard way (see &#8220;ABCs of Osteoporosis Treatment&#8221;) in addition to their bisphosphonate and randomized progesterone therapy.     Summary: Progesterone is a Bone-building Hormone  To summarize what we&#8217;ve covered about bone in relationship to ovulation and progesterone, we can say that progesterone sits on specific receptors on the bone-building osteoblast cells. Therefore, women with regular cycles but ovulation disturbances, despite having normal estrogen levels, will continue to lose bone. However treatment with cyclic progestin (and probably progesterone, ideally given for days 14-27 of a 28 day cycle) will significantly increase bone density. Although a few studies in menopausal women have shown that the progestin, MPA, adds to the benefits of bisphosphonate or estrogen treatment, no study has yet been designed to show that progesterone therapy prevents fractures.   In our next newsletter we will cover issues related to progesterone and breast health plus the risk for breast cancer.      Stay tuned! 

Research NewsCeMCOR awarded WHRI Catalyst Grant for an observational study of Perimenopausal Night Sweats 

 
In February 2009, The Centre for Menstrual Cycle and Ovulation Research was awarded a one-year $25,000 Women's Health Research Institute (WHRI) Catalyst Grant for a pilot study of Perimenopausal Night Sweats. This 4-cycle observational study will enroll 20 perimenopausal women with regular cycles and night sweats. The primary aim of the study is to determine the feasibility of a potential future randomized control trial of progesterone therapy in perimenopause, and to estimate the number of women who would be needed for that study, as well as to examine whether cyclic hormonal changes affect perimenopausal night sweats.  CeMCOR will begin to enroll participants in late Spring 2009. Please keep your eye on this page for the invitation to enroll.

WANTED: Women past menopause to 
evaluate progesterone therapy for hot flushes
We are just a few women away from completing our randomized trial of Progesterone therapy
for hot flushes!  
 Please help us to finish the study by passing this on
to those you know in the Lower Mainland area who might be interested.
You can also help us by posting the study flyer [PDF] in your workplace, gym, coffee shop, community centre, etc. 
 We are looking for women to participate in a 5-month research study on
hot flushes, blood vessel function and clotting factors. We are
comparing natural progesterone (Prometrium&reg;) with a placebo (dummy
pill). For more information, including eligibility requirements, click here. COMING SOON:  The Estrogen Errors: Why Progesterone is Better for Women's Health
 In this revealing work, Dr. Jerilynn Prior teams up with Susan Baxter, a medical writer, to explain the controversy over medicine prescribing estrogen for perimenopausal women in the United States, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in U.S. medicine and culture, and why business and politics have played a role in this erroneous thinking. Like most women in Europe, Prior's patients find progesterone the key to dealing with a life cycle transition that, contrary to Western medicine, these authors do not see as a disease. Challenging medical orthodoxy, this work presents arguments and evidence both women and doctors will find compelling and useful.  Estrogen Errors will be available in May 2009 (ISBN: 0-313-35398-0 978-0-313-35398-7). Planning is currently in the works for a book launch in Vancouver. We'll keep you posted on ordering information and book launch events through the website and newsletter.  


 Women's Health in the news Grapefruit diet almost cost woman her leg - CTV.ca News - April 2, 2009

 Lab mistakes, poor oversight flagged in N.L. breast cancer inquiry - CBC News - March 3, 2009 
  After a Devastating Birth Injury, Hope - The New York Times - February 23, 2009
 Online Age Quiz Is a Window for Drug Makers - The New York Times - March 25, 2009  





 Reference List for "Is Ovulation (and are normal Progesterone levels) Important for the Health of Women?" Prior JC. Ovulatory disturbances: they do matter. Can.J.Diagnosis 1997;February:64-80. Tremollieres FA, Strong DD, Baylink D, Mohan S. Progesterone and promogestone stimulate human bone cell proliferation and insulin-like growth factor 2 production. Acta Endocr. 1992;126:329-37. Tertinegg L, Heersche JN. Progesterone stimulates bone nodule formation in rat calvarial cell cultures while estrogen has no effect. J.Bone Min.Res. 1992;7 (Suppl 1):S220. Verhaar HJJ, Damen CA, Duursma SA, Schevens BAA. A comparison of the actions of progestins and estrogens on growth and differentiation of normal adult human osteoblast-like cells in vitro. Bone 1994;15:307-11. Barr SI, Petit MA, Vigna YM, Prior JC. Eating attitudes and habitual calcium intake in peripubertal girls are associated with initial bone mineral content and its change over 2 years. J.Bone Min.Res. 2001;16:940-7. Prior JC, Vigna YM, Schulzer M, Hall JE, Bonen A. Determination of luteal phase length by quantitative basal temperature methods: validation against the midcycle LH peak. Clin.Invest.Med. 1990;13:123-31. Prior JC, Vigna YM, Schechter MT, Burgess AE. Spinal bone loss and ovulatory disturbances. N Engl J Med 1990;323:1221-7. Sowers M, Randolph JF, Crutchfield M, Jannausch ML, Shapiro B, Zhang B et al. Urinary ovarian and gonadotropin hormone levels in premenopausal women with low bone mass. J.Bone Min.Res. 1998;13(7):1191-202. Waugh EJ, Polivy J, Ridout R, Hawker GA. A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women. Am.J Clin.Nutr. 2007;86(6):1791-801. Prior JC, Vigna YM, Barr SI, Rexworthy C, Lentle BC. Cyclic medroxyprogesterone treatment increases bone density: a controlled trial in active women with menstrual cycle disturbances. Am.J.Med. 1994;96:521-30. Grey A, Cundy T, Evans M, Reid I. Medroxyprogesterone acetate ehnances the spinal bone density response to estrogen in late post-menopausal women. Clin.Endocr. 1996;44:293-6. Prior, J. C. and Hitchcock, C. L. Medroxyprogesterone augments positive bone mineral density effects of cyclic etidronate in menopausal women: pilot data from a random sample of clinical charts of menopausal women with osteoporosis. J Bone Mineral Res 17, S474. 2002. Ref Type: Abstract Lindsay R, Gallagher JC, Kleerekoper M, Pickar JH. Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. JAMA 2002;287:2668-76.  












 
 
 
Ask Jerilynn
 
 I'm 42, waking most nights about 1am and having bad hot flushes some nights. I had to stop the Pill because I got increasing migraines. What can I do to help my night sweats and get some good sleep without taking estrogen and making migraines worse? Read more...






 
Ask Jerilynn: Bewildered by bio-identical hormones 
 
 Are bio-identical hormones safe for treatment in menopause? I'm asking because I recently saw Suzanne Somers on the Oprah show discussing hormone replacement with bio-identical hormones. She says they are making her feel great. Read more...






 
Upcoming events

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			<title>CeMCOR Events Annoucements</title>
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			<author>CeMCOR</author>
			<pubdate>Thursday 11th of September 2008 11:24:02 PM</pubdate>
			<subject>CeMCOR Events Annoucements</subject>
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 Sept 11, 2008
 The Centre for Menstrual Cycle and Ovulation Research is pleased to announce our event schedule for the upcoming months. We have four exciting events planned that are free and open to the public. If you are in the Vancouver area, we invite you to join us at any or all of these events! Please pass this email on anyone you think may be interested!   

 Who knew? Health Saving Discoveries for Women: Women's health lecture and discussion forum


 You are invited to a free public talk by Dr. Jerilynn Prior on women's health. She will discuss menopause, perimenopause, hot flushes, Polycystic Ovary Syndrome, hormone therapy, and much more. Plus, you will have a chance to ask your own women's health questions during the Q&A at the conclusion of the talk. Admission is free, but pre-registration is encouraged. All attendees who pre-register will be entered into a draw for one of three free copies of "Estrogen's Storm Season: Stories of Perimenopause" by Dr. Jerilynn Prior. Email cemcor@interchange.ubc.ca to confirm your attendance.   September 23, 2008. 7:00 - 9:00, doors at 6:30pm. VGH Paetzold Centre, 889 W 12th ave Vancouver.   Scientific Cafes  CeMCOR will be hosting a series of Scientific Cafes on important women's health topics this Fall. The Scientific Cafes are designed to be an informal open discussion forum on health-related issues. Each Cafe will have an expert panel present consisting of leading researchers in the field, who will answer questions, provide insight, and facilitate discussion. Anyone and everyone is free to attend a Scientific Cafe - you don't need a science degree, just an interest in discussing the topic and learning more about research in the field.  Funding for the Scientific Cafes is provided by the Canadian Institutes for Health Research (CIHR).    1. Scientific Cafe: Is menopause a disease? We will discuss different perspectives from around the world on gendered aging with input by women doctors from Eastern Europe and India. How does the emergence and popularity of menopause-specific products, pills, and supplements reflect how we view menopause as a society? Hormone Therapy controversies - do women's hormones need replacing? "Bioidentical" vs. "synthetic" hormones: Is one better then the other, and what are the risks of ovarian hormone therapy? Hot flashes and night sweats - is estrogen the only option? Is osteoporosis inevitable? October 28th. 7:00-9:00, doors at 6:30pm. Little Nest, 1716 Charles St, Vancouver 2. Scientific Cafe: Are lesbians healthier than straight women? Why or why not? This discussion will touch upon the physical and mental health of lesbians versus straight women. Do lesbians have higher risk factors for certain condiitons (e.g. insulin resistance, polycystic ovary syndrome)? To what extent are these factors modifiable? Do lifestyle differences in lesbian and straight women account for any differences in health outcomes? Do health care practitioners treat patients they know to be lesbians differently (e.g. not recommending pap smears)? November 27th. 7:00-9:00, doors at 6:30pm. Rhizome Cafe, 317 E. Broadway, Vancouver 3. Scientific Cafe: Is fertility affected by lifestyle? This
exchange will touch upon the following questions: Does diet influence
how easy it will be to conceive? Does exercise and/or stress affect
ovulation (egg release)? If there is no desire to have children, does
ovulation influence other aspects of women's health? How can you tell
if you are ovulating normally?   Postposned until January 2009. Exact date TBC. Keep your eye on the CeMCOR website for updates.   
 
 
Ask Jerilynn
 
 I enjoyed being part of the Menstruation and Ovulation Study and am excited to learn our results. But the menstrual cycle questions got me to thinking. What does it mean to have a regular menstrual cycle? Read more...


 
Upcoming events
 
 

 Sept 23: Who Knew? Health Saving Discoveries for Women  Oct 28: Scientific Cafe: Is menopause a disease? Nov 27: Scientific Cafe: Are lesbians healthier than straight women? Why or why not? January 2009: Scientific Cafe: Is fertility affected by lifestyle? 

 View full calendar 


  
 
 
 
    


 
 
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