Estrogen And Perimenopausal Depression
In the months or years before menopause , estrogen levels are erratic and unpredictable. During perimenopause, up to 10% of women experience depression that may be caused by unstable estrogen levels. Some studies suggest that using a transdermal estrogen patch by itself can improve depression during perimenopause — but this is not a standard practice of care. Antidepressants were not given to women in these studies.
Opening The Floodgates For Research
Researchers have suspected that there might be a link between stress and cancer for some time. But the mechanism behind that link remains somewhat elusive, Dr. Hildesheim said. This study makes a significant contribution by identifying various components that might, in part, underlie that connection, he noted.
Whats more, this same mechanism could be contributing to cancer growth and treatment resistance in other ways, Dr. Hildesheim said. The nervous system could be impacting from multiple angles, he added.
A 2019 study, for example, showed that stress hormones can increase;the number of pro-tumor immune cells in tumors. That could mean that stress not only wakes up dormant tumor cells but also provides the right environment for them to grow, Dr. Hildesheim explained.;
Its the worst of both worlds, he said.;
But, like Dr. Perego, he thinks its something that could be addressed by combining treatment approaches. Scientists are working to develop drugs that block the activity of or kill certain kinds of dormant cells called senescent cells. Finding ways to target senescent and dormant cells are two focuses of a recent partnership between NCI and Cancer Research UK.
Chemotherapy, radiation, and targeted therapy can all turn cancer cells into senescent cells. When combined with these traditional treatments, its possible that drugs that target senescent cells may prevent cancer from coming back, Dr. Hildesheim said.;
Study Suggests Progestin Not Estrogen Is The Real Cancer Culprit In Hormone Replacement Therapy
Hormone therapy that includes progestin plus estrogen may increase breast cancer risk, but estrogen alone may lower risk, according to long-term review.
A long-term review of two clinical trials has shed new light on menopausal hormone therapy and breast cancer risk over time.
In earlier clinical trials, combination hormone replacement therapy consisting of progestin plus estrogen was linked to an increased risk of breast cancer and death from that disease.
Women who had a hysterectomy and took estrogen alone were found to have a reduced risk of breast cancer and breast cancer death.
Following those reports, use of both types of HRT declined.
Thirteen years later, researchers set out to determine both the short-term and long-term effects of HRT.
One analysis involved 16,608 women who had not had a hysterectomy. The women were assigned to receive estrogen plus progestin. Results showed this group was at increased risk of breast cancer while taking combination HRT. Within 2.75 years after stopping therapy, the risk was still present but not as high.
Another group of 10,739 women who previously had a hysterectomy were asked to take estrogen alone. This group had a reduced risk of breast cancer while receiving estrogen therapy. That lower risk continued for a few years after therapy ended. The benefit was lost after that.
This research focused on breast cancer risk and did not involve other potential risks of HRT.
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What Are The Symptoms Of Inflammatory Breast Cancer
Symptoms of inflammatory breast cancer include swelling and redness that affect a third or more of the breast. The skin of the breast may also appear pink, reddish purple, or bruised. In addition, the skin may have ridges or appear pitted, like the skin of an orange . These symptoms are caused by the buildup of fluid in the skin of the breast. This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue. Sometimes the breast may contain a solid tumor that can be felt during a physical exam, but more often a tumor cannot be felt.
Other symptoms of inflammatory breast cancer include a rapid increase in breast size; sensations of heaviness, burning, or tenderness in the breast; or a nipple that is inverted . Swollen lymph nodes may also be present under the arm, near the collarbone, or both.
It is important to note that these symptoms may also be signs of other diseases or conditions, such as an infection, injury, or another type of breast cancer that is locally advanced. For this reason, women with inflammatory breast cancer often have a delayed diagnosis of their disease.
Postmenopausal Estrogen And Risk Of Breast Cancer: What Is The Real Story
I am responding to an article in the January 25, 2020, issue of The ASCO Poston the conclusion of the 19-year follow-up on the Womens Health Initiative presented by Rowan T. Chlebowski, MD, PhD, at the 2019 San Antonio Breast Cancer Symposium: Postmenopausal estrogen administration does not increase the risk of breast cancer after all, he said, and, in fact, it may decrease the risk; the real culprit is estrogen combined with progesterone. Given that the WHI was largely responsible for frightening millions of women and their physicians into believing that estrogen causes breast cancera conclusion that it has been modifying and retracting over the past decadeit behooves us to try to understand what is really going on.
The current WHI update report that postmenopausal estrogen does not increase the risk of breast cancer is reinforced by other long-established findings in the medical literature, such as the 70% decrease in breast cancer risk associated with a full-term pregnancy before the age of 18; the lack of benefit resulting from an abortion at the time of breast cancer diagnosis; and the safety of pregnancy after treatment of breast cancer, even among estrogen receptorpositive women.
This remarkable analysis should have been incorporated into the 19-year interpretation of the results presented in San Antonio and published in The ASCO Post article.;
Avrum Bluming, MD
Emeritus Clinical Professor of Medicine
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Why Is This Medication Prescribed
The estradiol cypionate and estradiol valerate forms of estrogen injection are used to treat hot flushes and/or vaginal dryness, itching, and burning in women who are experiencing menopause . However, women who need a medication only to treat vaginal dryness, itching, or burning should consider a different treatment. These forms of estrogen injection are also sometimes used to treat the symptoms of low estrogen in young women who do not produce enough estrogen naturally. The estradiol valerate form of estrogen injection is also sometimes used to relieve the symptoms of certain types of prostate cancer. The conjugated estrogens form of estrogen injection is used to treat abnormal vaginal bleeding that a doctor has decided is caused only by a problem with the amounts of certain hormones in the body. Estrogen injection is in a class of medications called hormones. It works by replacing estrogen that is normally produced by the body.
Conjugated Estrogens Side Effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
heart attack symptoms–chest pain or pressure, pain spreading to your jaw or shoulder, sweating;
signs of a blood clot–sudden vision loss, stabbing chest pain, coughing up blood, pain or warmth in one or both legs;
swelling, rapid weight gain;
memory problems, confusion, unusual behavior;
breast pain; or
vaginal itching or discharge, changes in your menstrual periods, breakthrough bleeding.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Causes Of High Estrogen
High levels of estrogen can develop naturally, but too much estrogen can also result from taking certain medications. For example, estrogen replacement therapy, a popular treatment for symptoms of menopause, may cause estrogen to reach problematic levels.
Your body may also develop low testosterone or low progesterone levels, which can upset your hormonal balance. If you have estrogen levels that are abnormally high relative to your progesterone levels, its known as estrogen dominance.
Estrogen Side Effects And Risks
Hormone therapy is not without its risks. In fact, hormone therapy is not used as widely as it once was because research began revealing complications with long-term use, such as cancer and heart risks.
However, thanks to these studies, doctors and medical researchers have a better understanding of who will benefit most from estrogen therapy and who should try other treatments.
The risk factors and side effects associated with estrogen use include:
- Blood clots: Estrogen increases your risk of blood clots, which can cause stroke, heart attack, and even death.
- Cancer: Estrogen may increase your risk of certain cancers, specifically breast cancer. Talk with your doctor about your personal health history, your family history, and your risk of breast cancer.
- Birth defects: If youre using estrogen or hormone therapy and become pregnant, your pregnancy may end prematurely. If youre able to carry a pregnancy to full term, birth defects are common for babies born to women using estrogen.
- Dense breast tissue: Women who take estrogen may develop dense breast tissue. Dense tissue makes reading mammograms harder, so detecting breast cancer in its early stages may be difficult.
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What Cancer Treatments Can Cause Menopause
Treatments that can cause menopause include:
Surgery to take out your ovaries
Chemotherapy, which may damage the ovaries
Hormone treatments or anti-estrogen treatments that keep your ovaries from producing estrogen
Radiation therapy near your pelvis or lower belly
Ask your health care team if your cancer treatment could cause menopause. If so, you may still be able to have children in the future if you want them. Talk with your health care provider about fertility concerns and preservation, before cancer treatment begins.
The Use Of Vaginal Estrogen By Women With A Current Or Prior History Of Breast Cancer
Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms 16. A nested casecontrol analysis of a cohort study of women with breast cancer who either did or did not use vaginal estrogen showed no increase of recurrence in vaginal estrogen users 17. In another study, the risk of recurrence in women who used vaginal cream was not increased, irrespective of the total dose prescribed 18.
Concerns remain about recurrence risk with use of vaginal estrogen in women with breast cancer who use aromatase inhibitors. Specifically, the threshold for systemic estrogen levels associated with breast cancer recurrence risk has yet to be determined 19. Some authors note that even a small increase in systemic estradiol levels may have a detrimental effect on recurrence risk and that more data are needed before recommendations can be made regarding the use of vaginal estrogen among this population 1620. Typically, aromatase inhibitors decrease circulating estradiol levels from 20 pg/mL to less than 13 pg/mL 2021. Studies have demonstrated an initial increase of serum estradiol with the use of low-dose vaginal estrogen among women taking an aromatase inhibitor, though these levels were not sustained over time and increased cancer recurrence was not noted 11.
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Estrogen And Breast Cancer
The molecular form for one type of estrogenA female sex hormone that is primarily produced by the ovaries. Its primary function is to regulate the menstrual cycle and assist in the production of secondary sex characteristics such as breasts. It may even play a role in the production of cancer cells in the breast tissue. called estriol. High levels of estrogen in the body have been shown to be a risk factorAnything that increases or decreases a persons chance of developing a disease. for breast cancer.
High estrogen levels in the body are believed to dramatically increase our risk of breast cancer. It is therefore worth understanding what estrogen is and how you can control your estrogen level at the same time as other;breast cancer risk factors.
Can A Person With A Family History Of Breast Cancer Take Hrt
A 2019 article in the journal Archives of Breast Cancer states that there are no guidelines on the safety of HRT use in those with a family history of breast cancer.
A systematic review from 2021 notes that HRT does not have a relevant effect on the risk of cancer in those who carry the BRCA gene.
Another study from 2018 found that the use of estrogen after surgery to remove the ovaries does not increase the chance of breast cancer in those with the BRCA1 gene. However, they also note that further research is needed on the effect of progesterone-containing HRT.
Breast Cancer Now suggests that a person should speak with a doctor before using HRT if they have inherited a breast cancer gene, such as BRCA1 or BRCA2.
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What Clinical Trials Are Available For Women With Inflammatory Breast Cancer
NCI sponsors clinical trials of new treatments for all types of cancer, as well as trials that test better ways to use existing treatments. Participation in clinical trials is an option for many patients with inflammatory breast cancer, and all patients with this disease are encouraged to consider treatment in a clinical trial.
Descriptions of ongoing clinical trials for individuals with inflammatory breast cancer can be accessed by searching;NCIs list of cancer clinical trials. NCIs list of cancer clinical trials includes all NCI-supported clinical trials that are taking place across the United States and Canada, including the NIH Clinical Center in Bethesda, MD. For information about how to search the list, see Help Finding NCI-Supported Clinical Trials.
People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from NCIs Cancer Information Service;at 18004CANCER ;and in the NCI booklet Taking Part in Cancer Treatment Research Studies. Additional information about clinical trials is available online.
Anderson WF, Schairer C, Chen BE, Hance KW, Levine PH. Epidemiology of inflammatory breast cancer . Breast Diseases 2005; 22:9-23.
Types Of Studies Of Hormone Therapy And Cancer Risk
Different types of studies can be used to look at cancer risk from menopausal hormone therapy .
Randomized controlled trials:;In this kind of study, a group of patients get the drug being studied , and another group gets a placebo . Results from this kind of study are powerful because which group a patient is in is based on chance. This helps assure that the groups are similar in all ways, such as risk for cancer, except for the drug thats being studied. This is the best way to see the effects of a drug. These types of studies can also be;double-blinded,;which means neither the people in the study nor their doctors know which group they are in. This lowers the chance that thoughts or opinions about treatment could affect the study results. Unfortunately, these kinds of studies are costly, which limits the number of people in the study, how long the study can continue, and the number of studies done.
A major drawback of observational studies is that the people getting the treatment being studied may have different cancer risk factors than the people who arent. Plus, the treatment can differ between the people being studied. This makes it less clear that the differences seen are only due to the drug being studied and not other factors.
When observational studies and randomized controlled trials have different results, most experts give more weight to the results of the randomized controlled trial.
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Hot Flashes Seem To Be The Result Of Fluctuating Estrogen Levels
Hot flashes are bursts of heat that may begin at a particular point, such as the nape of the neck, and radiate throughout the upper body. Or the whole body may get hot at once. Perspiration, flushing, and heart palpitations often accompany the feeling of heat. A variant of hot flashesnight sweatscan disrupt sleep.
Hot flashes seem to be the result of fluctuating estrogen levels and probably occur during estrogen valleys rather than peaks. Although we think of hot flashes as heat surges, they are actually the bodys attempt to cool off. Blood vessels dilate and the heart races to pump more blood to reach the surface of the body where its cooleran effect that can produce a blush or flush. Sweating is another attempt to bring the bodys temperature down. Hot flashes are often triggered by external factors, such as alcohol, caffeine, and hot foods or beverages. They may also be stimulated by emotional upsets.
There are a variety of ways to treat hot flashes.
The Womens Health Initiative
This study is part of the very large Womens Health Initiative Clinical Trial and the Womens Health Initiative Observational Study. Both studies are commonly called the WHI. Together, the two studies include information from more than 161,608 postmenopausal women who were ages 50 to 79 when they joined between 1993 to 1998. The WHI wants to find any links between health, diet, and lifestyle factors and health problems such as cancer.
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Estrogen Injection May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- breast pain or tenderness
- spotty darkening of the skin on the face
- difficulty wearing contact lenses
- swelling of the eyes, face, tongue, throat, hands, arms, feet, ankles, or lower legs
- difficulty breathing or swallowing
Estrogen may increase your risk of developing cancer of the ovaries or gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of using estrogen injection.
Estrogen may cause growth to slow or stop early in children who receive large doses for a long time. Estrogen injection may also affect the timing and speed of sexual development in children.Your child’s doctor will monitor him or her carefully during his or her treatment with estrogen. Talk to your child’s doctor about the risks of giving this medication to your child.
Estrogen injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .