Menopause counseling hot flash: Persistent VMS more common in African-Americans and more new research

February 25, 2015

A review of the latest research on the persistence of vasomotor symptoms, the link between hormone therapy and ovarian cancer risk, and the prevalence of substance use in pregnant adolescents.

Vasomotor symptoms (VMS) during menopause may last much longer than previously had been thought, according to analysis of data from a multiyear, multiracial/multiethnic observational study.

The Study of Women’s Health Across the Nation (SWAN), assessed the transition through menopause among 3302 women who were enrolled at 7 US sites. Spanning February 1996 to April 2013, the research included 1449 women with frequent VMS, considered to be ≥6 days in the previous 2 weeks. All of the participants completed a median of 13 visits during the study.

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Median total VMS duration was 7.4 years. In the 881 women who had an observable final menstrual period (FMP), the VMS persisted after FMP for a median of 4.5 years. Total VMS duration and post-FMP persistence were longest (median >11.8 years and median 9.4 years, respectively) in women who first reported frequent VMS when they were premenopausal or perimenopausal. Conversely, women who first experienced frequent VMS in postmenopause had the shortest total VMS duration (median 3.4 years). Total VMS duration was longest-median 10.1 years-in African-American women, compared to those in other racial/ethnic groups.

Other factors related to longer VMS duration, total duration or post-FMP persistence were younger age, lower educational level, higher depressive symptoms and anxiety at first report of VMS, and greater perceived stress and symptom sensitivity.

The researchers concluded that frequent VMS lasted over 7 years during the menopausal transition in more than half of the studied women and persisted for 4.5 years after FMP. They urged healthcare providers to counsel their patients on the potentially long duration of frequent VMS, particularly in African-American women.

NEXT: What's the impact of short-term hormone therapy on ovarian cancer risk?

 

Meta-analysis links postmenopausal hormone therapy and ovarian cancer

A meta-analysis of worldwide evidence from epidemiology studies shows a causal link between use of postmenopausal hormone therapy (HT) and ovarian cancer. The connection was strongest for current users and for the two most common types of ovarian cancer.

Published in The Lancet, the findings from a multinational group of researchers are based on central analysis of individual participant datasets from 52 epidemiologic studies (17 prospective and 35 retrospective). Follow-up in the prospective studies was censored 4 years after the last recorded use of HT.  During that time, 12,110 postmenopausal women developed ovarian cancer, 55% of whom had used HT.

Women were defined as being postmenopausal if they had reached natural menopause or age 55 years; women younger than age 55 who had undergone hysterectomy were excluded. The data on HT were examined for ever-use, current use, age at first use and last use, total duration of use, and constituents of each preparation. HT preparations last used were classified as estrogen-only or estrogen-progestogen. Tumors were classified as malignant or borderline-malignant and as epithelial or not, with epithelial tumors broken down into serous, endometrioid, mucinous, or clear-cell.

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All of the analyses were stratified by study, center within study, age, and body mass index and adjustment was made for parity, past use of oral contraceptives, and age at menopause.

Even with <5 years of use of HT, risk was increased among women last recorded as current users (RR 1.43, 95% CI 1.31-1.56; P<0.0001). Risk was also increased when current-or-recent use was combined for any duration but with HT use stopped before diagnosis (RR 1.37, 95% CI 1.29-1.46; P<0.0001). The risk was similar for European and American prospective studies and for estrogen-only and estrogen-progestogen formulations. 

Risk differed, however, among the four main types of ovarian cancer (heterogeneity P<0.001) and a definite increase was seen only for the two most common types: serous (RR 1.53, 95% CI 1.40-1.66; P<0.001) and endometrioid (RR 1.42, 95% CI 1.20-1.67; P<0.001). Although risk of ovarian cancer declined the longer it had been since a woman had used HT, at 10 years after stopping long-duration HT, excess risk of serious or endometrioid tumors was still seen (RR 1.25, 95% CI 1.07-1.46; P=0.005). Risk was also significantly greater for ever-users than for never-users of HT (RR 1.20, 95% CI 1.15-1.26, P<0.001 for prospective studies).

Commenting on their findings, the authors of the meta-analysis said that the heterogeneity of the RRS “argues strongly for causality, because it implies that the hormone therapy-associated risks were not due just to confounding and that different ovarian cancer types have different causes.” 

NEXT: Are teens using harmful substances during pregnancy?

 

Pregnant teens likely to use substances

Many pregnant adolescents still use drugs and consume alcohol, in spite of the many messages on the risks, according to a study of nearly 100,000 pregnant and non-pregnant adolescents.

Using data from the National Survey on Drug Use and Health between 2002 and 2012 (n = 97,850), researchers from the University Texas at Austin determined the prevalence of past 12-month and past 30-day substance use or substance use disorders among non-pregnant and pregnant individuals aged 12 to 17. Psychosocial and pregnancy-related correlates of current substance use among a subsample of 810 pregnant adolescents also were examined.

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Pregnant adolescents were significantly more likely to have experimented with a variety of substances and to meet the criteria for cannabis (adjusted odds ratio [AOR] = 2.29, 95% confidence interval [CI] = 1.72-3.04), alcohol (AOR = 1.65, 95% CI = 1.26-2.17), and other illicit drug use disorders (AOR = 2.84, 95% CI = 1.92-4.19).

Those pregnant in early adolescence, considered to be ages 12 to 14, were significantly more likely (AOR = 4.34, 95% CI = 2.28-8.26) than their non-pregnant counterparts to be current substance users. In contrast, pregnant late adolescents, ages 15 to 17, were significantly less likely (AOR = 0.71, 95% CI = 0.56-0.90) to be current substance users than were their non-pregnant counterparts.

Investigators concluded that the data indicate a potential relationship between pregnancy and prior use of substances and continued usage of such substances in pregnancy. From the first trimester to the second and third trimesters, they found the prevalence of substance use did significantly weaken.