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			<title>Email Campaign Archives for list &#039;CeMCOR mailing list&#039;</title>
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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>
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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>
			<content><![CDATA[

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 See this email online
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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 




  












 
 
 
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 









  
 
 
 
    


 
 
 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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		</item>
				<item>
			<title>CeMCOR News - February 2009 - Ovulation and Cardiovascular Disease</title>
			<description>CeMCOR News - February 2009 - Ovulation and Cardiovascular Disease</description>
			<author>CeMCOR</author>
			<pubdate>Tuesday 23rd of February 2010 07:28:02 PM</pubdate>
			<subject>CeMCOR News - February 2009 - Ovulation and Cardiovascular Disease</subject>
			<content><![CDATA[

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 See this email online
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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>
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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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 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

     June 4-6, 2009Society for Menstrual Cycle Research conference More...View full calendar 







  
 
 
 
    


 
 
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			<title>CeMCOR Events Annoucements</title>
			<description>CeMCOR Events Annoucements</description>
			<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 


  
 
 
 
    


 
 
 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 - October 2008</title>
			<description>CeMCOR News - October 2008</description>
			<author>CeMCOR</author>
			<pubdate>Tuesday 03rd of June 2008 10:40:01 PM</pubdate>
			<subject>CeMCOR News - October 2008</subject>
			<content><![CDATA[
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 October 31, 2008
 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? Dr. Jerilynn Prior covers the importance of ovulation in the second installment of this multi-part series. Look for more in this series in upcoming newsletters. CeMCOR Research News: Learn about our current research initiatives studying Anovulatory Androgen Excess (aka Polycystic Ovarian Syndrome) and hot flushes. We need your help to find the last 15 participants needed for our trial of progesterone therapy for hot flushes in menopausal women. Thank you to everyone who attended our recent events! CeMCOR hosted two successful women's health events recently: A free public talk by Dr. Jerilynn Prior and a CIHR-sponsored Scientific Cafe. 


 Women's Health in the News: Interesting links to women's health research 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.   In the previous two issues we discussed:  1) Regular cycles can be anovulatory (with plenty of estrogen but no progesterone) or have short luteal phase lengths (meaning plenty of estrogen but not enough progesterone). 2) Ovulation disturbances &#8211; meaning not ovulating or ovulating with too short a time from ovulation until the period (short luteal phase cycle) &#8211; are commonly caused by emotional, social, nutritional or physical stress (like illness or too much exercise for a woman&#8217;s adaptation or food intake). Ovulation disturbances are especially common in the 10-12 years after menarche (the first period) because the brain is just learning how to ovulate. Ovulation disturbances are also extremely common in perimenopause. In perimenopause the coordinated system is falling apart. At this time, the ovary&#8217;s primary goal is to &#8220;get rid of&#8221; any remaining estrogen producing cells to avoid a rogue period at 80. (Aging of women&#8217;s reproduction is a totally different topic that we will cover in the next series of newsletters.)   How can I tell if I am ovulating? That&#8217;s a very important question for a woman who wants to be healthy. The simple answer is - we&#8217;re still in the process of finding out. When we have completed the analysis of a recent study, we hope to know. We have just completed the Menstruation and Ovulation Study (MOS) in which 610 women participated, answered a question about their cycles, collected urines throughout the cycle and kept the daily Menstrual Cycle Diary&#61667; (1) during one menstrual cycle. The purpose of MOS was to determine whether a woman can reliably tell, by the way she feels, that her period is coming. This set of experiences that indicates ovulation is called &#8220;Molimina.&#8221;   What is Molimina? Molimina, from the Greek word meaning the &#8220;work&#8221; of bringing on the flow, includes all the experiences that are specific for ovulation. This is not a laboratory test but rather is something you can observe. The Molimina Question: &#8220;Can you tell, by the way you feel, that your period is coming?&#8221; is an important question to ask yourself every cycle.   Before we get to what I currently think can tell us that we are ovulating, we need to realistically discuss the problems with studying this question. One of the first is that, as women, we are taught to ignore, not to pay attention to, our menstrual cycles. Even those of us who pay attention to our periods, don&#8217;t likely attend to the changing experiences inside our cycles. Another problem is that there are cultural ideas that tend to surface when we don&#8217;t really know the answer to the molimina question. For example, in this culture the only time it is &#8220;ok&#8221; to be ravenous, irritable or bitchy, is before a period. We expect to have so called &#8220;PMS&#8221; or premenstrual syndrome. This expectation may override our actual experiences or colour what we perceive. Then, finally, there are more subtle issues that influence our experiences themselves, such as our inherited metabolism of ovarian hormones, or possibly environmental toxins (like phthalates in plastics, or cadmium in oysters) that can interfere with the breakdown of estrogen.   Many years ago I was excited by the notion that women could know the important fact of whether or not they were ovulating. I asked the Molimina Question of 61 consecutive regularly menstruating women that I saw in my clinical endocrinology practice. As it turns, although menstruating regularly, all of these women had Anovulatory Androgen Excess (AAE, also called Polycystic Ovary Syndrome or PCOS) (2). Each woman described whether or not she could tell that her period was coming (the majority had no clue). I decided, based on my idea of experiences indicating ovulation, whether or not she had molimina, and then asked each woman to get a progesterone blood test during the week before her next period (within 7 days but not counting the day before flow). What I found was: Not being able to tell that the period was coming was an extremely reliable indicator of anovulation and low progesterone levels. What we are learning from MOS is whether that is also true for women who don&#8217;t have AAE.  I believe a woman is ovulatory who both:  &#8226;    knows that her period is coming, and,  &#8226;    experiences tenderness in the high side part of her breasts up under her armpits. She may also experience fluid retention.  If &#8211; however, she only reports moodiness, hunger or front of the breast tenderness &#8211; that suggests estrogen is high just before flow and that she is not ovulating. (Estrogen levels should be dropping at that time of the cycle).    Using the first morning temperature to tell about ovulation Progesterone, as we have discussed, is produced in high levels by the part of the follicle that has released the egg. This remaining hormone-producing nubbin of tissue, called the &#8220;corpus luteum&#8221; which means yellow body in Latin, makes all the progesterone for that one cycle. Progesterone works in every tissue of the body including the brain. One of progesterone&#8217;s actions in the brain is to talk to the temperature centre in the hypothalamus and to raise our internal temperature.   Although the &#8220;basal body temperature&#8221; or BBT method to assess ovulation has been used by many generations of women, it is not reliable. By BBT the temperatures are plotted on a graph (difficult for women, or anyone, to do accurately) and then one simply &#8220;eyeballs&#8221; the graph.   Only since the 1970s have we developed scientific, quantitative ways of assessing ovulation by temperature (3). The most reliable and easy way to use Quantitative Basal Temperature (QBT) methods to determine ovulation and luteal phase length is to take your first morning temperature and write it down on the bottom of the daily Menstrual Cycle Diary sheet. At the end of the cycle, get out your calculator, add up all the temperatures and divide by the number of days for which you have a reading. This gives you the average temperature. Now look at your list of temperatures. Where your temperature goes above and stays above the average until at least the day before flow is your luteal phase length. It should be 10-16 days. (See instructions here [PDF]).  How about using a &#8220;fertility&#8221; test with LH to assess ovulation? I prefer the Quantitative Basal Temperature method because we care about progesterone and it can also tell us about the length of luteal phase. The luteinizing hormone (LH) peak occurs over a day or so and triggers the release of the egg. However, even the best of the LH kits with sticks that you stick in urine, will miss ovulation about 20% of the time. And, although rarely, you can have an LH peak and still not release an egg. Finally, these kits are not cheap.   In the next newsletter we will discuss the ways that doctors and researchers can determine about ovulation.     For next time: How can a doctor tell if I am ovulating? Short of doing an operation and observing the egg actually squirting out of the ovary, as happened recently, there are only indirect ways of telling about ovulation. The three main ways are...   To be continued!    

Research NewsWe are 15 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.  WANTED: Women past menopause to 
evaluate progesterone therapy for hot flushes
 
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. 

Do you have Anovulatory Androgen Excess? [also known as Polycystic Ovary Syndrome (PCOS)] 

 If so, we invite you to become a part of our newest research study. CeMCOR and co-investigators have been awarded the UBC Sharon Stewart Aniridia Grant to probe the possibility that there is more then meets the eye to anovulatory androgen excess (AAE). The study aims to determine whether there could be a genetic link between AAE/PCOS and the cause of a rare eye disorder called Aniridia. We are currently enrolling women aged 19-45 who have been diagnosed with AAE/PCOS. Please send an email to pcoseye-study@interchange.ubc.ca or call 604-875-5232 if you would be interested in participating.  


Thank you to everyone who attended our recent events!   CeMCOR hosted a very successful free public talk in September at the VGH Paetzold Centre. Dr. Jerilynn Prior's talk, titled "Who Knew? Health Saving Discoveries for Women", covered a variety of women's health topics and a lengthy Q&A session followed.   Demand for this event was much higher than anticipated and as a result, we had to turn away more than 100 people. On November 20th, we are holding an encore presentation so that everyone who wanted to attend the first time can have another chance. If you were one of those who had been turned away in September, you should have already received an invitation to the encore presentation.   Registration will be open to the general public on Nov 7th. Please visit the event listing after November 7th to register online.  CeMCOR hosted our first of three Scientific Cafes earlier this week, sponsored by the Canadian Institutes of Health Research. The topic, "Is Menopause A Disease?" sparked some lively and interesting conversation, and we are grateful to all who attended and shared the experiences and questions.   If you were one of the attendees, you can visit the resource page here. And don't forget about the webinar!  We will be hosting two more Cafes, one in November and one in January. If you are interested in attending one of these free, informal discussion forums, please visit our events page.   Women's Health in the news Study finds drop in use of hormone replacement - Vancouver Sun - June 20, 2008 More than 1 in 4 deliveries in Canada are C-sections, society says - CBC News - June 25, 2008 Women not receiving same level of care for heart disease: MD - Canada.com Hormones May Be to Blame for Women's Cavity Rates - US News and World Report - October 17, 2008 Vigorous exercise protects against breast cancer, new research says - CBC News - October 30, 2008



  

 Reference List for "Is Ovulation (and are normal Progesterone levels) Important for the Health of Women?"






  Prior JC. Exercise-associated menstrual disturbances. In: Adashi EY, Rock JA, Rosenwaks Z, editors. Reproductive Endocrinology, Surgery and Technology. New York: Raven Press, 1996: 1077-1091. 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; 13:123-131.





  

 
 
 
Ask Jerilynn
 
 When a perimenopausal woman feels tired, gains weight and has frozen-cold hands and feet, how can she tell if the cause is a low thyroid or perimenopause? Read more...


 
Upcoming events
    Nov 14, 2008 Join a free webinar! "Is Meopause A Disease?"  More...
  Nov 20, 2008Encore presentation: "Who Knew? Health Saving Discoveries for Women" More...  Nov 27, 2008Scientific Cafe: Are lesbians healthier than straight women? Why or why not? More...  January, 2008Scientific Cafe:Is fertility affected by lifestyle? 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 - March 2008</title>
			<description>CeMCOR News - March 2008</description>
			<author>CeMCOR</author>
			<pubdate>Wednesday 05th of March 2008 06:30:02 PM</pubdate>
			<subject>CeMCOR News - March 2008</subject>
			<content><![CDATA[
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 March 5, 2008
       Welcome to the first edition of 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? Dr. Jerilynn Prior introduces the importance of ovulation in the first installment of this multi-part series. Look for more in this series in upcoming newsletters. CeMCOR Research News: Learn about our current research initiatives studying Anovulatory Androgen Excess (aka Polycystic Ovarian Syndrome), hot flushes in menopausal women, and menstruation and ovulation.
 Media: CeMCOR researchers recently featured in the news.
 Events: Dr. Prior will be on both CKNW and XM Satellite radio in the upcoming month.
 Women's Health in the News: Interesting links to women's health research 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.  


This question is at the heart of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR). It is also what makes CeMCOR unique. Because CeMCOR focuses on ovulation, rather than simply on menstruation, it has the potential to make new discoveries for women.   Over the next several issues of the new CeMCOR Newsletter, I will be focusing on different aspects of the question about the importance of ovulation for women&#8217;s health. This article will start by asking what we now know about how frequently ovulation occurs or doesn&#8217;t in women with menstrual cycles.   Before I get into that, however, let me say what I believe:   Regular menstrual cycles with consistently normal ovulation during the premenopausal years will prevent osteoporosis, breast cancer and heart disease in women.  So, what do we mean by ovulation? Ovulation literally means the release of an egg from the ovary. That is a key event that leads to pregnancy and the birth of a baby. However, ovulation is also important as the process that leads to production of the menstrual cycle&#8217;s second important hormone&#8212;progesterone. It is the latter meaning of ovulation, having to do with the process of releasing an egg and the production of progesterone that is key, I believe, for women&#8217;s health.  A complex system must be coordinated to allow release of an egg. As is appropriate, that coordination begins in the brain. It would not be prudent, for example, for a woman who was in severe emotional distress, starving or ill to become pregnant. For that reason, I think that regular ovulation tells us a lot about that woman&#8217;s personal environment, social context and health. I called ovulation the &#8220;bellwether of women&#8217;s well being&#8221; (meaning predictor of women&#8217;s whole health) when awarded a Research Lectureship by the University of British Columbia Faculty of Medicine in 2002.   What might cause disturbances in ovulation? A woman must be in good emotional, nutritional and social health to regularly ovulate. It makes sense that a woman who is under emotional stress is less likely to ovulate. For example, student nurses in Japan were shown to ovulate less frequently during their school year, that was full of deadlines and exams, than during their summer break (1). Even the worry that what we eat will cause us to gain weight (called cognitive dietary restraint) is a big enough stress in normal weight premenopausal women that their stress hormone level, cortisol, is higher than in other similar women who aren&#8217;t restrained (2). Those women with eating restraint also had disturbed ovulation (they didn&#8217;t ovulate, called &#8220;anovulation&#8221; or they ovulated but with too short a time from ovulation to the next flow, called &#8220;short luteal phase&#8221; cycles) (3;4).   It also makes sense to not become pregnant if you are starving! Therefore, someone who is not starving but who is eating fewer calories than she burns will also have a subtle change in her menstrual cycle&#8212;she&#8217;ll have disturbed ovulation (5). If she is losing a lot of weight, the period may stop all together.   Being seriously ill will also disturb women&#8217;s (and men&#8217;s) reproduction. For example, older menopausal women who were admitted to the hospital or the intensive care unit with pneumonia or acute heart attack showed low levels of the pituitary hormone, follicle stimulating hormone (FSH), when first admitted (6). As their health improved over about two weeks, FSH levels rose to the normal, high levels of a menopausal woman (6).   What about exercise? Everyone knows that marathon-training women lose their periods. Right? Wrong! And also wrong to blame the changes that may occur in exercising women on the exercise without considering stress and not eating enough. In fact, I was so angry at the notion that women who ran long distances would inevitably develop &#8220;athletic amenorrhea&#8221; that I began studying women&#8217;s menstrual cycles back in 1980! I did a study with two women who kept track of their weights, periods, ovulation and length of the luteal phase as well as how much they ran over a full year. One was trying to become pregnant. The other was training for her first marathon. Both started with normal menstruation and ovulation and experienced multiple short luteal phase or anovulatory menstrual cycles, but neither lost her period. The woman who wanted to become pregnant did when she gained weight by cutting back her exercise (7). The other woman ran her first marathon and after that decreased her running&#8212;her luteal phase length, because she had adapted to her exercise, was normal while running 3-5 miles a day (7).    This is the start of a series of articles on this topic. We will discuss how soon after the first period ovulation begins, how scientists decide if a woman is ovulating, and what we know (or don&#8217;t know) about ovulation in women in the general population. Eventually this newsletter will cover the important issues like how ovulation is important for bone health, prevention of breast and other women&#8217;s cancers, and for protection against heart disease.  Stay tuned! The next installment of this article will appear in the next edition of this newsletter. 

Research News WANTED: Women past menopause to evaluate progesterone therapy for hot flushes
       
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. 

Do you have Anovulatory Androgen Excess? [also known as Polycystic Ovary Syndrome (PCOS)] 

 
      If so, we invite you to become a part of our newest research
study. CeMCOR and co-investigators have been awarded the UBC Sharon
Stewart Aniridia Grant to probe the possibility that there
is more then meets the eye to anovulatory androgen excess (AAE). The
study aims to determine whether there could be a genetic link between
AAE/PCOS and the cause of a rare eye disorder called Aniridia. We will
begin enrolling women aged 19-45 who have been diagnosed with AAE/PCOS
shortly - please send an email to cemcor@interchange.ubc.ca if you
would be interested in participating when the study begins.
      
 Menstruation and Ovulation Study
       CeMCOR is pleased to report that we have recently reached our goal of enrolling 600 menstruating women in our Menstruation and Ovulation Study. The CIHR-funded study aims to determine whether a woman can tell from the signals her body gives her whether or not she has ovulated. We hope to have collected all the diaries and samples from our participants by the summer as we are eager to get started on analyzing the data and publishing the results.  A big thank you to all the 600+ women who enrolled in the study - we hope that participating in the study was as informative for you as it is sure to be for us! MediaDoc offers new view of menopause pills Georgia Straight - 
January 10, 2008
 "Her swollen and sore breasts were Dr. Jerilynn Prior&#8217;s first hint that 
menopause wasn&#8217;t what the medical establishment said it was..." Read more from Pieta Woolley's  interview with Dr. Prior.
New medications target menstrual suppression for healthy women and 
girls Network Magazine - Fall/Winter 2007  
 Dr. Christine Hitchcock, CeMCOR Research Associate, is featured in the most 
recent edition of the Canadian Women's Health Network magazine. She outlines the 
position of the Society for Menstrual Cycle Research on the controversial topic 
of menstrual suppression through the continuous use of oral contraceptives. 
According to Dr. Hitchcock: "..it is important 
to note that cycle-stopping contraceptives do not only reduce or eliminate 
menstrual bleeding, but also suppress the complex hormonal interplay of the 
menstrual cycle. The impacts of this cycle on women&#8217;s health are not completely 
understood". Read the full article here. 

Events


      
 
March 7, 2008: Dr. Jerilynn Prior and Candace Newton (www.unlockingsecrets.com) will be the featured guests on the XM Satellite radio show "Broadminded".  Tune in to channel 155 at 9:20am PST to hear Dr. Prior discuss hormones, perimenopause, and much more.   March 29, 2008: Dr. Jerilynn Prior will once again be a featured guest on "House Calls with Dr. Art Hister", the longest running health radio show in Canada. Dr. Prior will spend one hour discussing the latest women's health information and taking listener's calls. Listen to CKNW 980 at 10:00am to learn more about hormones and your health.

Women's Health in the news Breast cancer patients suffer huge income losses - CTV.ca - February 27, 2008 Barbara Seaman, 72; Pioneer in Women's Health Movement - Washington Post - February 29, 2008 Hormone Therapy Increases Frequency of Abnormal Mammograms, Breast Biopsies, Study Finds - Science Daily - February 27, 2008 WHI Follow up Study Confirms Health Risks of Long-Term Combination Hormone Therapy Outweigh Benefits for Postmenopausal Women - National Institute Health News - March 4, 2008    

 Reference List for "Is Ovulation (and are normal Progesterone levels) Important for the Health of Women?"

1. Nagata I, Kato K, Seki K, Furuya K. Ovulatory disturbances.
Causative factors among Japanese student nurses in a dormitory.
J.Adolesc.Health Care 1986;7:1-5.
2. McLean JA, Barr SI, Prior JC. Cognitive dietary restraint is
associated with higher urinary cortisol excretion in healthy
premenopausal women. Am.J.Clin.Nutr. 2001;73:7-12.

3. Barr SI, Prior JC, Vigna YM. Restrained eating and ovulatory
disturbances: possible implications for bone health. Am.J.Clin.Nutr.
1994;59:92-7.

4. Barr SI, Janelle KC, Prior JC. Vegetarian versus nonvegetarian
diets, dietary restraint, and subclinical ovulatory disturbances:
prospective six month study. Am.J.Clin.Nutr. 1994;60:887-94.

5. Loucks AB, Thuma JR. Luteinizing hormone pulsatility is disrupted at
a threshold of energy availability in regularly menstruating women. J
Clin Endocrinol Metab 2003;88(1):297-311.

6. Warren MP, Siris ES, Petrovich C. The influence of severe illness on
gonadotropin secretion in the postmenopausal female. J Clin Endocrinol
Metab 1977;45:99-104.

7. Prior JC, Ho Yeun B, Clement P, Bowie L, Thomas J. Reversible luteal
phase changes and infertility associated with marathon training. Lancet
1982;1:269-70.
 
     
 
        Ask Jerilynn
         
           Could my lack of libido be related my increasingly bad cramps and heavier, longer
flow? Or could it be because I've started the Pill to treat my heavy flow? Read more...
        
      
       
        Upcoming events
         
           
            
               March 7, 2008: Listen to Dr. Prior on XM Satellite Radio 
                March 29, 2008: Tune in to CKNW 980 at 10:00am to hear Dr. Jerilynn Prior answer listener's calls on House Calls with Art Hister.   
            
          
           View full calendar 
        
      
        
         
         
         
            
      
  
   
     
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