News Forum

GPs with an interest in women's health review the latest papers of significance from research teams across the world.

Cataract: no significant association found with estrogen exposure. Photograph: Sue Ford/SPL
Cataract: no significant association found with estrogen exposure. Photograph: Sue Ford/SPL

HRT and endometrial cancer
Karageorgi S, Hankinson SE, Kraft P et al. Int J Cancer 2009 Jun 23. doi: 10.1002/ijc.24672
The major risk factor for endometrial cancer is unopposed estrogen exposure. These authors studied reproductive factors and postmenopausal hormone use in the 121,700 participants in the Nurses' Health Study. They found that a late menarche decreased the risk independent of BMI. A late menopause increased cancer risk. An advanced age at last birth reduced the risk, although an inverse association with age at first birth and parity diminished after adjustment for age at last birth.

Compared with never users, an increased risk was observed among long-term (five or more years) users of estrogen (RR 7.67, 95% CI: 5.57, 10.57) and combined estrogen plus progestogen (RR 1.52, 95% CI: 1.03, 2.23). As expected, the greater the number of days of progestogen addition (days per month) to estrogen, the lower the risk. Thus there was a significant increased risk for one to eight days per month and a non-significant increased risk for 9-18 days per month and 27 or more days per month.

Normal weight women (BMI <25kg/m2) had the highest risk following estrogen or estrogen plus progestogen use. These women would have less endogenous estrogen than their overweight or obese counterparts.
Miss Margaret Rees is reader in
reproductive medicine and honorary consultant in medical gynaecology at John Radcliffe Hospital, Oxford

Estrogen exposure and cataract
Kanthan GL, Wang JJ, Burlutsky G et al. Acta Ophthalmol 2009 Jun 1. doi:10.1111/j.1755-3768.2009.01565.x
This study assessed the association between exogenous estrogen exposure, female reproductive factors and the long-term incidence of cataract in 2,072 women aged over 49 years in two postcode areas near Sydney, Australia. After adjusting for age, smoking, socioeconomic status, steroid use, hypertension and diabetes, ever having used the OCP had a mild protective effect against incident cortical cataract (OR 0.70, 95% CI 0.50-0.98). However, HRT, age at menarche and menopause, duration of exposure to endogenous estrogen, parity and type of menopause were not found to have significant associations with the incidence of any type of cataract or cataract surgery. MR

Safety and efficacy in the relief of vasomotor symptoms
Pinkerton JV, Utian WH, Constantine GD et al. Menopause 2009 Jun 10. doi:10.1097/gme.0b013e3181a7df0d
Bazedoxifene (BZA) is a selective estrogen receptor modulator which, like raloxifene, leads to endometrial atrophy. It has been studied combined with conjugated estrogens (CE).

The aim of this study was to assess the safety and efficacy of BZA/CE for treating moderate to severe vasomotor symptoms. In this outpatient, multicentre, double-blind, randomised, placebo-controlled study in the US, healthy postmenopausal women (n = 332, age 40-65 years) with moderate to severe hot flushes were randomised to BZA 20mg/CE 0.45mg, BZA 20mg/CE 0.625mg or placebo once daily for 12 weeks. Changes from baseline in the average daily number of moderate and severe hot flushes and daily severity score were assessed at four and 12 weeks. BZA/CE significantly reduced the number and severity of hot flushes at both points (p<0.001). At week 12, BZA 20mg/CE 0.45mg and BZA 20mg/CE 0.625mg reduced hot flushes from baseline by 74 and 80 per cent respectively, compared with 51 per cent for placebo. The safety profile was similar for BZA/CE and placebo, and no unexpected safety findings were reported. MR

Short-term HRT suspension and mammography recall
Buist DS, Anderson ML, Reed SD et al. Ann Intern Med 2009 Jun 2; 150(11): 752-65
Stopping HRT to reduce breast density before mammography has been recommended; however, the evidence supporting this practice is scant. The authors examined whether one to two months of HRT suspension before screening mammography decreased additional mammographic imaging (recall) in 1,704 women aged 45-80 years. This was a three-group randomised, controlled trial in the US, with allocation to no HRT suspension (n = 567) or suspension for one month (n = 570) or two months (n = 567) before mammography.

Mammography recall rates were 11.3 per cent in the no-suspension group, 12.3 per cent in the one-month suspension group and 9.8 per cent in the two-month suspension group. Women in the suspension groups experienced significantly increased menopausal symptoms. Most women who declined participation (58.4 per cent) were unwilling to stop HRT, even briefly. No evidence supports short-term HRT suspension before mammography. MR

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