The ‘Top Ten Health Stories in Women’s Health, 2020 Edition’ Howell Webinar in February included a presentation from Dr. Andrea LaCroix, Director of the Women’s Health Center of Excellence at UC San Diego. Her presentation focused on the most relevant research stories and updates for aging women:
- The importance of heart palpitations in midlife
- The effects of COVID in cancer screening results
- Updates on hormone therapy in breast cancer
- Links between adverse childhood experiences and dementia
- Light physical activity to increase our lifespan and maintaining mobility
Overlooked symptoms of hot flashes as new area of research
Among the relevant stories for aging women in 2020, Dr. LaCroix addressed heart palpitations and its effect on the quality of life index during perimenopause, menopause and postmenopausal women. There is little research that specifically addresses variation levels of estrogen and how it relates to palpitations, an overlooked symptom that opens an area of opportunity for research for middle-aged women. “So what we don’t know from these data is which direction does this go? Does this mean that palpitations caused these symptoms or that these symptoms cause the palpitation or that both directions of causality are in play? But I think what this study points out is that this is an overlooked symptom that needs to be studied more.”
- Palpitations are a fairly common symptom in middle aged women
- 25% of women suffered palpitations during hot-flashes
- Palpitations may be related to levels of stress and anxiety
- The study of palpitations and it’s relation to estrogen is a potential area of research.
“The study did report that women with palpitations had more trouble sleeping, so they had higher insomnia scores, higher levels of depression, anxiety and stress, indicating a higher score in the menopausal quality of life scale”, comments Dr. LaCroix.
We had the opportunity to learn, first hand, the details of cutting-edge research affecting women’s health. The presentation took place in February. Her study was published in April of 2021 in the Journal of Women’s Health.
Cancer screening tests during COVID
“The COVID pandemic has caused a real-time, natural experiment in lengthening cancer screening intervals between mammograms that we’ll be learning a lot from as we go forward.”
If you recall, Dr. LaCroix is one of the principal investigators of the WISDOM Trial (Women Informed to Screen Depending On Measures of risk). The study, which today has 30,000 women across the country enrolled, is looking into cancer screening guidelines: should women continue to get a yearly mammogram every year depending on her age, or should screening be based on personal risk factors, where women with the highest risk factors get a mammogram every year (with additional screening) and women with the lowest risk factors get breast cancer screening every two or three years, like it’s done in some European countries?
“Researchers are looking at whether or not the rates of cancer death change as a result of the pandemic. And if they don’t change in the context of current medical practice and cancer treatment, it really means that it is probably acceptable to go longer between screening tests.”
Estrogen and Menopause
While the Women’s Health Initiative (WHI) brought to light the effects of hormone treatment with estrogen/progesterone in the early 2000’s, research trials were brought to a halt due to severe consequences for women: coronary heart disease, invasive breast cancer, pulmonary embolism and stroke. Research initiatives such as the ones that the WHI provided offered guidance to organizations such as the FDA to recommend using the lowest dose of estrogen for the shortest period of time possible, specifically for its relationship to an increased risk of invasive breast cancer.
The risks and benefits of estrogen-based formulation in hormone therapy used today depend on observational studies, and research efforts continue to be limited. Even though the WHI research trial stopped more than 15 years ago, Dr. Lacroix presented research from England that confirms both, the increased risk of breast cancer in women taking estrogen long-term, and the need for observational studies. The study provided a long-term follow-up on the use of hormones in menopause, and monitored 99,000 women aged 50 to 79.
Correlating the WHI results studies with the study from England confirms an even higher need to increase observational studies. “This is the largest and most rigorous study to date since the cancelation of the Women’s Health Initiative research. Today, women are being prescribed low-dose patches and other formulations of estrogen. Even though the FDA recommends using the lowest dose for the shortest period of time possible, there hasn’t been a comprehensive study since the Women’s Health initiative started tracking the effects of HRT. We really need to depend on observational studies to get the answer on the long-term risks and benefits.”
Relationship between Adverse Childhood Experiences and Dementia
The CDC in collaboration with Kaiser Permanente, Southern California identified seven characteristic adverse childhood experiences that are currently used in studies worldwide.
This study followed 17,000 Japanese adults and showed an interesting correlation between an increased risk of dementia with three or more of the seven adverse childhood experiences. For women, family violence and physical and emotional abuse ranked as a higher risk for dementia than parental health, divorce or mental illness.
Data from the CDC additionally shows that there is a significant number of Americans, both men and women, who have a large number of adverse childhood experiences, regardless of poverty and socioeconomic status. “These kind of data needs to be replicated in American women to fully understand the risks of dementia and its relationship with Adverse Childhood Experiences, specifically the long term impact of mistreatment of women. Physical neglect and psychological abuse, allowed to go without intervention, really influences oura health as we get older.
Movement as a mechanism to improve overall health
To conclude her presentation, Dr. LaCroix discussed how mobility positively affects women’s health. It is well known that a sedentary behavior increases one’s mortality risks similar to those of smoking. Latest research studies indicate that simple actions like standing reduce health risks. For this study, every-day activities posed a challenge for scientific research. From wearing a camera, to decoding different standings and developing algorithms to measure through the accelerometer being worn to measure and homogenize standing was then classified into four main categories. The results of walking behaviors is clear: the more women spend standing, the more the risk of mortality is decreased — about 37% for women standing over 1.2 hours per day. For women standing more than 20 minutes per day, their mortality rate decrease around 14%. “When you think about it, we could stand over an hour a day if we put our minds to it.”
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Photograph by Luis Machado.