Blog of the Society for Menstrual Cycle Research

“A Non-Hormonal ‘Fix-It’ for Women Suffering From a ‘Broken Internal Thermostat’”: Just Wear Athletic Clothing to Bed!

November 15th, 2010 by Heather Dillaway

sleepless.jpgThe title of this blog entry comes straight from a media release about Goodnighties® Recovery Sleepwear. That’s right, now there is finally sleepwear made out of a fabric similar to the fabric worn by “Olympians, Astronauts and Even Racehorses” to wick away the moisture of hot flashes, night sweats, and chills accompanying some women’s perimenopause, menopause, and postmenopause. Using the “power of negative ions,” Goodnighties® sleepwear purportedly offers that rest, relaxation, recovery (and, ultimately, sleep!) that most midlife women are lacking! Some users are quoted on the website as saying that Goodnighties® sleepwear “changed their lives.”

One one hand, this makes complete sense — why didn’t people think of this before? Athletic clothing would help someone deal with hot flashes and night sweats in the middle of the night, if only making it so that one doesn’t have to get up and change their clothes or sheets. And considering we’re currently in a “menoboom” (Barbre, 1998), with the aging and menopause of the Baby Boomers, what a great idea to market moisture-wicking clothing to menopausal women! Talk about a money-maker.

On the other hand, while I think on the whole this is probably a good product for many, I do take issue with some of the language on the site, because of the negative connotations about menopause in particular (e.g., the emphasis on “fixing” “broken thermostats,” “suffering,” and quotes about how 85 percent of women are “known to suffer”). But, this line of clothing is also marketed towards others — those undergoing infertility treatments, “athletes, regular exercisers and weekend warriors with sore muscles,” “people with aches and pains due to injury, surgery, chemotherapy, etc.,” and “[t]hose suffering from painful health issues like fibromyalgia, arthritis and diabetes” — so, it’s not exclusively marketed to menopausal women and not exclusively designed to define menopause as a bad thing.

On another issue, though, the emphasis on relief, recovery, and fixing does make me think that this product is being marketed as something that resolves (negative) symptoms, but I’m not sure how that could be the case? Does anyone have any experience with Goodnighties® sleepwear? Is it actually capable of alleviating the symptoms, or is it just making the public manifestation of the symptom disappear?

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Posted in Advertising, Language, Menopause | 5 Comments »

Hot Flash—Progesterone is an Effective Alternative to Estrogen

July 19th, 2010 by Elizabeth Kissling

Guest post by Jerilynn Prior, Centre for Menstrual Cycle and Ovulation Research

hot flash hellIt’s been two weeks since Chris Hitchcock and I returned from San Diego’s recent Endocrine Society meetings. We are feeling incredibly happy with the success of our protracted, intense commitments to a controlled trial of oral micronized progesterone (marketed in the USA and Canada as Prometrium®) for night sweats and hot flushes/flashes. At the Endocrine Society we presented the first-ever trial showing that the molecularly identical progesterone by mouth is effective treatment for vasomotor symptoms (VMS = hot flushes/flashes and night sweats)(1). We were also invited to present our data at an Endocrine Society-sponsored press conference.

Why did a scientific study require so much from us? First, this trial started in 2003 as the initial scientific venture of the newly founded Centre for Menstrual Cycle and Ovulation Research–thus CeMCOR’s reputation became tied to this trial. Second, despite concerted efforts, we were never able to obtain peer reviewed funding for this study—we successfully supported it with individual private donations. Finally, because of the “estrogen myth” and its corollary negatives about progesterone, I wanted to gain additional accurate information about how Prometrium® works in women’s cardiovascular system from this same study. For that reason we decided to enroll only very healthy women who were within 1-10 years since their final flow—they had to be non-smokers, without obesity, diabetes, or high blood pressure, and further to have normal measured waist circumference, blood pressure, cholesterol, and fasting blood sugar levels. Therefore many women were interested but few were eligible.

Late last fall when we broke to code on this study, we were ecstatic to discover that our trial was highly successful. After only three months’ therapy with Prometrium® (300 mg at bedtime daily) the 127 (of 133 randomized) women’s vasomotor symptoms score (VMS Score, combination of number of flushes times their intensity during the day and during sleep) was decreased by about 60% on progesterone compared to less than 30% decrease on placebo.

In early June we learned the answer to another important question: Does progesterone effectively treat intense VMS? The answer is yes! Although less than half all the treatment-seeking women in our study met the FDA’s criteria for more than 50 moderate-intense VMS/week, the 30 women who did who were randomized to Prometrium® showed significantly more improvement in hot flushes than did women on placebo.

What were the reactions to this news? Some local doctors said they already knew that progesterone was good for VMS! Others people were curious, or skeptical but many realized the importance of providing women with an effective alternative to estrogen for VMS. Other reactions were predictable—many questions about whether this couldn’t really be explained, somehow, by estrogen (Prometrium® is converted into estrogen—not!). And there were several questions about side effects and alleged serious health risks from progesterone (wrongly attributed because of confusion of progesterone with synthetic progestins). Happily I was able to respond that participants had no serious negative effects—more placebo-treated than Prometrium®-treated women dropped out before completion. And it is likely that in estrogen-treated women progesterone decreases breast cancer risk rather than increasing it as medroxyprogesterone does (2). Because of Prometrium®’s significant sleep benefit (3), some women who entered the trial sleep-deprived experienced short-lived morning drowsiness. But the estrogen myth-related mood, bloating, weight gain, migraine headaches, and breast tenderness did not occur.

An epic journey for me, Chris, and CeMCOR ends in triumph. Now that the dust has settled, I am so grateful that CeMCOR’s many researchers over the last six years dedicated themselves to a world class trial, that local donors made the trial possible, and that the Prometrium® and placebo were provided by Schering Canada (for the first two years) and subsequently by the world-wide manufacturer, Besins Healthcare of Belgium.  Continue reading...

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Posted in Menopause, New Research, Pharmaceutical | 1 Comment »

Hot Flashes: Now Especially for Fat Ladies

July 14th, 2010 by Elizabeth Kissling
Photo of art by Czarnobyl by Flickr user urbanartcore.eu || CC 2.0

Photo of art by Czarnobyl by Flickr user urbanartcore.eu || CC 2.0

Since yesterday, although it seems longer, my RSS reader has been clogged with links to news reports about a UCSF study in which some women who lost weight found that their hot flashes diminished. Of course, that’s not what the headlines say. Here’s a sample of some of the titles of current stories about this study on Google news:

  • Hot Flash Relief: Weight Loss Works, What Doesn’t? (US News & World Report)
  • Bad hot flashes? Try dropping a few pounds (MSNBC.com)
  • Losing weight may ease menopause symptoms (NBC13.com)
  • Symptoms of Menopause Can Be Relieved by Weight Loss (Health News)
  • Weight Loss Helped Overweight And Obese Women Reduce Hot Flushes (Medical News Today)

OK, that’s enough – see the trend? Suddenly weight loss is the cure for hot flashes. But in the actual study – which was about urinary incontinence, not menopause -141 women provided researchers with data about their hot flash symptoms six months after the study began. Sixty-five of the 141 women said they were less bothered by their hot flashes six months after participating in the weight loss program, 53 reported no change, and 23 women reported a worsening of symptoms.

Look at those numbers again, more slowly this time: 65 of 141 women who participated in a weight loss program were less bothered by hot flashes after six months. That’s 46% of the women – less than half – who found relief. Almost as many reported no change in symptoms, so why is this being touted as a successful intervention?

Because the women lost weight. Most of the news reports of this research stop just short of fat-shaming, but I submit that is exactly why this study is getting so much media attention. Even though it is well-established that diets do not work, even if you call them a “lifestyle change” or “a whole new way of eating”, and that the BMI (Body Mass Index) is useless as a gauge of health. In fact, fat is not a measure of health. But why pass up an opportunity to shame women about their bodies?

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Posted in Media, Menopause, New Research, Newspapers | 4 Comments »

Of Hot Flushes, Lie Detectors, and Stress

March 7th, 2010 by Elizabeth Kissling

Guest Post by Jerilynn C. Prior, Centre for Menstrual Cycle and Ovulation Research

A hot flush causes failure on a lie detector test! The same galvanic skin response (in simple terms—clammy skin) is positive in both. Why? Because—with every flush—there is massive dogs’ breakfast of neurotransmitters and brain stress hormones released. These are the same brain chemicals that are produced as we struggle to create a plausible falsehood. Both arise from a fundamental, brain pathway that mediates both our physical and emotional responses to “threats” (be they nutritional, emotional, physical or some combination of stressors).

Some years ago a psychologist from London Ontario showed that menopausal women’s hot flushes were increased by stressful environment (1). Menopausal women who regularly experienced eight hot flushes a day attended two randomly-ordered 4-hour sessions a week apart. During the sessions they had flushes objectively documented by galvanic skin response. When they were forced to experience a chaotic environment, loud noises, unpleasant videos and bright lights, each of these women experienced more hot flushes; they did not in the alternative calm and pleasant session (1). Likewise, the large Study of Women Across the Nation showed that perimenopausal women who reported “trouble paying for basics” (like food and shelter) had more hot flushes than did those with economic and social security (2).

Given these fundamental relationships between hot flushes and stress, it is no wonder that “paced respiration,” “yoga breathing,” mindfulness meditation, the relaxation response, acupuncture, exercise training and many other techniques that reduce our central reaction to stress will decrease night sweats and hot flushes.

I totally agree with Janet Carpenter that women are eager to find non-pharmaceutical ways to decrease the number and intensity of night sweats and hot flushes (collectively called vasomotor symptoms, or VMS for short).  However, to put into perspective the new research being done by the investigators at the School of Nursing at Indiana University, we need to realize that the first randomized controlled trial of “yoga breathing” for VMS was published in 1984 (3) and followed in 1991 by a similar study using objective VMS measures (4). Subsequently, studies of acupuncture (5-8), relaxation (9) and relaxation plus other therapies (10) all show that they are better than placebo at decreasing VMS. [Editor’s note: As she stated in the Indianapolis Star interview published March 4, 2010, Dr. Carpenter is building upon previous research. She did not claim to invent the concept of managing hot flashes with breathing techniques.]

The research on hot flushes and our central stress response is just beginning. But the average 25-50% improvement in VMS in those taking placebos in trials of soy beverage (11) or hormone therapy (12) are evidence that believing a treatment is therapeutic is pretty effective all by itself.  Continue reading...

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New Technique for Management of Hot Flashes

March 4th, 2010 by Elizabeth Kissling

The Indianapolis Star has a short interview today with Professor Janet S. Carpenter of Indiana University’s School of Nursing. Dr. Carpenter is conducting a study of whether menopausal women can control hot flashes through breathing techniques.

She told the Star:

Breathing techniques are something nurses use all the time. After surgery, we teach patients to inhale and take deep breaths to clear the lungs of anesthesia. We also teach patients slow, deep breathing to decrease anxiety. Because the study is blinded, I can’t talk specifically about what the two breathing programs are.

Some research seemed to show that it helped hot flashes. We actually think breathing techniques change a woman’s physiology so she will have fewer hot flashes, and if she has the same number of hot flashes, she will cope with them better.

I’ll look forward to seeing the results of her study (maybe I can talk her into presenting them at the next meeting of the Society for Menstrual Cycle Research!). If her hypothesis is correct, we’ll have an easy, cheap, and medication-free method for helping women cope with the discomfort of hot flashes.


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Hot Flushes Relief Needn’t Enter the Bio-Identicals Fray

November 5th, 2009 by Elizabeth Kissling

Guest Post by Jerilynn Prior, Centre for Menstrual Cycle and Ovulation Research

pharmacy_clipAs a clinician scientist with expertise in hormones and women’s health, I sit in Canada and look at the hype and dis-sing going on about “bio-identicals” in the USA and shake my head. If we don’t want estrogen that is not FDA approved to be used to treat hot flushes, the simple answer is to regulate appropriately. The perpetual debate about bio-identical hormones has now hit USA Today with a headline: “Bioidenticals: Estrogen without FDA approval for menopause?”

In Canada, all hormonal preparations require a prescription. Full stop.  And the pharmacists who compound estriol or progesterone do so with my prescription for a specific dose and clear purpose. Those compounding pharmacists are also regulated the same way as pharmacists who dispense FDA/Health Canada approved medications. End of story.

What bothers me is that I believe there is an intrinsic advantage to  hormones that are molecularly the same as our bodies produce. They are certainly better, a priori than those that are natural for horses or are “similar-but-different.” When oral micronized progesterone (molecularly identical, Prometrium®) is prescribed with estradiol (there are multiple FDA-approved brands of molecularly identical estrogen), there is no increased breast cancer risk.[1] On the other hand, medroxyprogesterone (a similar synthetic derivative of progesterone) with estradiol increases the risk for breast cancer by 79%.[1] That’s called a nasty surprise.

When a hormone treatment is the same as a native hormone we know exactly how it will act, be metabolized, and be excreted. We can learn, if we don’t know, how it interacts with other important factors like age, weight, kidney function, and in relationship to heart disease or breast cancer. So the fact that Wyeth “suggested” that the FDA take compounding and bio-identical hormones to task for false advertising, was simply an effort to regain market share in a legal drug war. They were reeling from the negative results of the Women’s Health Initiative. That’s why they also planned, wrote and published monthly Premarin-positive or estrogen-positive editorials and reviews in house at Wyeth and had them ghost authored by prominent scientists. A turf war.

As a physician, I believe the best treatment for severe vaginal dryness causing repeated bladder infections in older menopausal women is vaginal estriol in a dose of 0.5 mg twice a week.[2] However, there is no FDA/Health Canada approved estriol product. It’s just not available. So, I can prescribe that estriol—the weakest of the three estrogens our bodies make—and a local compounding pharmacist will make it for my patient. And that is a dose and kind of estrogen hormone that doesn’t cause a risk for endometrial (uterine lining) overgrowth or cancer as Premarin cream can (especially if delivered with that ridiculous vaginal applicator and in the doses that are commonly recommended).

What makes me feel both sad and angry is that this bio-identical “tempest in a teapot” (as my grandmother would say) is ignoring the distress of women with severe hot flushes. They are the reason for the popularity of compounded hormones, of the “experts” like Suzanne Somers and those who publicize and back her exuberant and likely imprudent self-medication. I have been cheering since Dr. Leonetti showed that 20 mg twice a day of progesterone cream significantly improved hot flushes.[3] If compounded hormones are evidence-based, as estriol and progesterone cream are for the conditions mentioned, who would fault women for wanting them? Especially when there is sufficient reason to doubt the hormone promises of Big Pharma?  Continue reading...

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Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.