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Hot flush treatment has anti-breast cancer activity, research finds

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Megestrol, a hot flush drug for breast cancer patients, may also curb tumours when added to standard hormone therapy, an early trial has found.

The PIONEER trial tested megestrol acetate, a synthetic form of progesterone, alongside anti-oestrogen treatment in post-menopausal women with ER-positive breast cancer.

After two weeks, patients on the combination saw greater falls in tumour growth rates than those on anti-oestrogen therapy alone.

Dr Richard Baird from the University of Cambridge, who led the trial, said: “On the whole, anti-oestrogens are very good treatments compared to some chemotherapies.

“They’re gentler and are well tolerated, so patients often take them for many years. But some patients experience side effects that affect their quality of life.

“If you’re taking something long term, even seemingly relatively minor side effects can have a big impact.”

Around three-quarters of breast cancers are ER-positive, meaning tumours have high levels of oestrogen receptors and grow in response to the hormone.

Patients are typically offered anti-oestrogen drugs to reduce oestrogen levels and slow growth. However, these can trigger menopause-like symptoms including hot flushes, joint and muscle pain, and potential bone loss.

Low-dose megestrol has already been shown to ease these side effects, helping patients continue treatment. The Cambridge-led trial suggests it may also improve the treatment’s effect against the cancer itself.

The trial recruited 198 patients at ten UK hospitals, randomised into three groups: one receiving only the anti-oestrogen letrozole; one receiving letrozole with 40mg daily megestrol; and one receiving letrozole with 160mg daily megestrol.

Both megestrol doses showed comparable effects in boosting letrozole’s ability to block tumour growth.

Laboratory work by professor Jason Carroll and colleagues showed that progesterone stops ER-positive cancer cells dividing by indirectly blocking the oestrogen receptor.

Professor Carroll said: “These were very promising lab-based results, but we needed to show that this was also the case in patients.

“There’s been concern that taking hormone replacement therapy – which primarily consists of oestrogen and synthetic versions of progesterone (called progestins) – might encourage tumour growth.

“Although we no longer think this is the case, there’s still been residual concern around the use of progesterone and progestins in breast cancer.”

Dr Rebecca Burrell, joint first author, said: “In the two-week window that we looked at, adding a progestin made the anti-oestrogen treatment more effective at slowing tumour growth.

“What was particularly pleasing to see was that even the lower dose had the desired effect.

“Although the higher dose of progesterone is licenced as an anti-cancer treatment, over the long term it can have side effects including weight gain and high blood pressure.

“But just a quarter of the dose was as effective, and this would come with fewer side effects.

“We know from previous trials that a low dose of progesterone is effective at treating hot flushes for patients on anti-oestrogen therapy.

“This could reduce the likelihood of patients stopping their medication, and so help improve breast cancer outcomes. Megestrol – the drug we used – is off-patent, making it a cost-effective option.”

Further studies will be needed to confirm whether the drug has the same beneficial effects over longer treatment periods.

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Cultural stigma is a barrier to menopause help, black women say

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Cultural stigma and a lack of education are making it harder to get menopause help, ethnic minority women in Jersey have said.

The women came together to share their stories at an event in St Helier hosted by Eve Studios and Liberty Underwear.

Participants were encouraged to speak openly about the symptoms they had experienced.

Angela Mowanga, from Jersey, told ITV Channel: “I became dismissive about signs and symptoms. From our parents and our grandparents, they just carried on.

“I hardly heard the word menopause spoken about in my household. We never had things like hot flushes, itchy skin and tiredness.

“So for us to start talking about menopause, there is a taboo around it. A taboo that comes from ignorance but also not being willing to educate ourselves.

“We as women of colour, societies of colour, we have a lot of taboo subjects, which now have to be highlighted with the generation today.

“However, with the modern day, society is changing. And we hope programmes like this can actually be well received.”

Daisy Ayebale, from Jersey, added: “I think it’s important we are listened to. We need the right information from the experts, but we have also been overlooked when it comes to the healthcare system.

“We need to know this information before it’s too late, before you’re gambling with your health. We are glad to be changing the narrative, we are glad to be changing things right now. We are very hopeful.”

Research shows that black women are more likely to experience menopausal symptoms earlier, more intensely and for longer.

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Women urged to be wary of menopause misinformation on social media

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Women are being urged to seek evidence-based advice and avoid menopause misinformation shared on social media.

A seminar co-hosted by the World Health Organization (WHO) mainly examined what is known about the cognitive effects of menopause and current research in the field worldwide.

Dr Nicole Jaff, a South African academic and certified menopause practitioner, said research into menopause and its effects was now at a peak.

She said: “There’s a lot of information out there.

“But I would say please look for the evidence-based information, not for the influencers and the misinformation, but those who are giving guidelines, who are giving information.”

Jaff highlighted research into cognitive changes during menopause and how some women experience brain fog, a term for difficulties with memory, concentration and clear thinking.

She said: “I’m very excited about the non-hormonal treatments that are now available, especially for women who could never take hormone therapy because of breast cancers and various cancers, who can now take it.

“I’m extremely excited about people who are standing up for evidence-based medicine, for science, who are actually fighting back against a lot of the social media and influencers who are not giving evidence-based information and making life very difficult for women because they think they should be forever young or buying this or buying that.”

Jaff advised women and healthcare workers to read new guidelines recently issued by the International Menopause Society. They are available free to download from its website.

The seminar also heard from Professor Aimee Spector, professor of clinical psychology of ageing at University College London.

She raised similar concerns about misinformation, particularly claims linking hormone replacement therapy, known as HRT, to dementia. Some claims suggest HRT reduces dementia risk, while others suggest it increases the risk.

Spector said: “I think there’s also lots of misinformation.

“And I think that there’s huge variations in how even professionals and doctors interpret this information.”

She was part of an international research team commissioned by the WHO last year to assess published studies on the issue.

The institutions involved also included the Global Brain Health Institute at Trinity College Dublin.

Spector said: “The first thing to say is that the quality of evidence was very low.

“Nine out of the 10 studies we looked at were observational, which means that you’re observing patterns over time. But you don’t necessarily know whether that’s due to the hormone therapy or not.

“Our overall recommendation was that there’s insufficient evidence for menopause hormone therapy in terms of either increasing or reducing the risk of dementia. In other words, we don’t know either way.”

Spector said women should therefore decide whether to use HRT to treat menopause symptoms rather than based on concerns about dementia.

She said: “It’s recommended for menopause symptoms, but it’s not recommended to reduce dementia. And I think a lot of people are saying that.”

The Menopause on the Brain webinar was part of an ongoing series hosted by the WHO and other global health agencies.

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Premature menopause is a high blood pressure risk, study finds

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Premature menopause is linked to a higher risk of developing high blood pressure, according to a study of more than 107,000 women.

The risk was highest among women who reached menopause between the ages of 25 and 35.

Researchers said the findings support earlier cardiovascular screening for women who reach menopause before the age of 40.

Dr Stephanie Faubion, medical director for The Menopause Society, said: “The results of this study highlight the potential adverse long-term health outcomes associated with premature menopause, and in particular, the need to regularly screen for cardiovascular risk factors such as hypertension.

“Use of hormone therapy is also routinely recommended in women with premature menopause at least until the natural age of menopause unless contraindications exist.”

Hormonal changes during menopause are known to affect women’s wider health, while earlier menopause has previously been linked to coronary heart disease and stroke.

Coronary heart disease develops when the blood vessels supplying the heart become narrowed or blocked.

However, previous evidence directly linking the timing of menopause to high blood pressure has been mixed.

High blood pressure, also known as hypertension, puts extra strain on the heart and blood vessels and can increase the risk of heart disease and stroke.

Researchers said it can be difficult to separate the direct effects of hormonal changes from factors that often accompany menopause, including weight gain, metabolic changes and other cardiovascular risks.

Metabolic changes affect how the body processes and uses energy, including sugar and fat.

The study analysed data from 107,836 postmenopausal women who joined the UK Biobank between 2006 and 2010. They were followed for a median of almost 15 years.

Researchers divided the women into three groups based on their age at menopause: after 45, between 40 and 45, or before 40.

They also examined whether menopause occurred naturally or followed surgery.

During the follow-up period, 18,508 women, or 17.2 per cent, were diagnosed with high blood pressure.

The proportion increased as the age at menopause fell. Hypertension developed in 16.6 per cent of women who experienced menopause after 45, compared with 18.8 per cent of those who reached menopause between 40 and 45.

Among women who experienced menopause before 40, 22.6 per cent developed the condition.

After taking account of more than 50 factors, including weight, lifestyle habits, family history and laboratory results, premature menopause remained linked to a 12.3 per cent higher risk of hypertension than menopause after age 45.

Further analysis suggested the risk peaked among women who reached menopause between the ages of 25 and 35.

The researchers said this may mean that the cardiovascular risk associated with premature menopause is concentrated among a younger group than the conventional under-40 definition suggests.

Surgical menopause was initially linked to higher rates of hypertension, but the association was no longer significant after other risk factors were taken into account.

The authors said clinicians should consider age at menopause as a distinct cardiovascular risk factor, particularly for women who experience it before 40.

They also called for earlier detection and management of hypertension, alongside individual discussions about hormone therapy.

Hormone therapy replaces hormones that decline during menopause and may be recommended for some women, depending on their individual health and medical history.

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