Women's Health Archive

Millions of Americans—most of them women—suffer from a bladder condition known as interstitial cystitis. According to a new study of this disorder, fewer than 10% of women with symptoms of interstitial cystitis are actually diagnosed with the disorder, even though it severely affects their lives. Without a proper diagnosis, women with interstitial cystitis are missing […]

A breast cancer drug raises hope for chemoprevention.

One major story that came out of the American Society of Clinical Oncology (ASCO) meeting in June 2011 focused on a study of a drug called exemestane (pronounced ex-ee-MESS-tane). Exemestane is in a class of drugs called aromatase inhibitors, which women take for several years after they've been treated for breast cancer to reduce the chances of getting breast cancer again. Aromatase is an enzyme that's crucial to the production of the hormone estrogen, which in many cases fuels the development and growth of breast cancer. So by inhibiting aromatase, exemestane lowers estrogen levels and therefore the risk of breast cancer recurrence.

The results reported at the ASCO meeting (and published simultaneously in The New England Journal of Medicine) were from a study testing whether exemestane might be able to prevent invasive breast cancer. The 4,560 postmenopausal women (average age, 62.5) who volunteered to be in the study had never had invasive breast cancer, although they did, for various reasons, including their age, have a higher-than-normal risk for getting it in the future. Half the women took exemestane daily; the other half, a placebo. After three years, 11 (0.5%) of the 2,285 women who took exemestane had developed invasive breast cancer, compared with 32 (1.4%) of the 2,275 women who took a placebo.

A large international trial of exemestane (Aromasin), a drug that reduces the risk of breast cancer recurrence, has found that it can also help prevent breast cancer from developing in the first place. That makes exemestane a third option for preventing breast cancer in postmenopausal women who are at elevated risk for the disease. Two other drugs, tamoxifen (Nolvadex, generic) and raloxifene (Evista), are already approved for prevention, but few women take them for that purpose because they can have serious (although rare) side effects such as stroke and blood clots. Exemestane appears to have less frightening side effects — for example, hot flashes, joint pain, and loss of bone density.

All three of these drugs target estrogen, which fuels the growth of most breast cancers, but exemestane works by a different mechanism than the other two. Tamoxifen and raloxifene are selective estrogen-receptor modulators, which bind to estrogen receptors in the breast and block their interaction with estrogen. Exemestane belongs to a different class of drugs, called aromatase inhibitors, which work by blocking the body's production of estrogen. Previous studies have shown that aromatase inhibitors are more effective than tamoxifen in preventing breast cancer from recurring. The study, funded by the drug's maker, Pfizer, and conducted under the auspices of the National Cancer Institute's clinical trials unit, looked at whether exemestane could reduce the likelihood of a first occurrence of breast cancer. Results were presented at the American Society of Clinical Oncology meeting in Chicago on June 4, 2011, and simultaneously published online in The New England Journal of Medicine.

Every year in the United States, hundreds of thousands of women are treated for fibroids — noncancerous growths that form in the uterus. Fibroids can cause pelvic pain, lower abdominal pressure, and heavy menstrual bleeding. Fibroids usually shrink after menopause, and before menopause, symptoms can sometimes be managed with medications. For women with severe bleeding who can't or don't want to "wait it out," the usual approach has been surgery — myomectomy (which removes only the fibroids) or hysterectomy, which removes the uterus (and ends childbearing).

Since 1995, an alternative treatment has been available for women wanting to avoid surgery — uterine artery embolization (UAE), a minimally invasive procedure that shrinks fibroids by cutting off their blood supply. Short-term studies (one to two years) have shown that UAE and surgery produce similar improvement in symptoms and quality of life. Now, a controlled study has found that the same is true even after five years, although women receiving UAE are more likely to require further treatment. Results were published online in BJOG: An International Journal of Obstetrics and Gynaecology (April 12, 2011).

Q. I'm 70 and in good health. My cholesterol levels are normal. Lately, I've started to get little yellow deposits on my eyelids, which I'm told are xanthelasma. What causes these, and how can I get rid of them?

A. Xanthelasma are soft, cholesterol-filled plaques that develop under the skin, usually on or around the eyelids and most often near the nose. They occur mainly in middle-aged and older adults — and in women more often than in men. Xanthelasma are always benign; that is, they're not cancerous and they don't spread the way a cancer might. They rarely impair vision. But they can be a sign of hyperlipidemia — high levels of cholesterol, triglycerides, or other lipids (fats) in the blood.

When cholesterol is measured, so are triglycerides, another type of blood fat that's an independent risk factor for heart disease. High triglycerides increase the likelihood of developing heart disease even when cholesterol levels are normal, especially in postmenopausal women. But triglycerides haven't gotten as much attention as LDL (bad) cholesterol and HDL (good) cholesterol, partly because their role in heart disease and stroke hasn't been well understood.

In recent years, scientists have learned more about how triglycerides are metabolized and how they contribute to atherosclerosis, the clogged arteries that raise the risk of heart attack, stroke, and other cardiovascular problems. High triglyceride levels are often correlated with low HDL and a type of LDL cholesterol that is particularly likely to produce harmful deposits in the arteries. High triglyceride levels are also a component of another heart disease risk factor — metabolic syndrome, a condition that occurs in most people with type 2 diabetes and includes high blood pressure and a large waist size. The American Heart Association (AHA) issued a scientific statement about triglycerides and cardiovascular disease that sets a new, lower optimal level of triglycerides and recommends intensive lifestyle measures for reducing elevated triglycerides. The AHA statement and a review of research were published online April 18, 2011, in the journal Circulation. Here are some of the highlights:

Q. When you talk about breast cancer screening, why don't you mention thermography? I've been using it for several years instead of mammography, which uses radiation.

A. The short answer is, we don't have good evidence that thermography is useful, and it definitely is not a substitute for mammography.

Potato chips and potatoes (baked, boiled, and fried) were the foods most responsible for weight gained gradually over four-year periods among 120,000 healthy women and men in long-term studies. Other key contributors included sugar-sweetened beverages and red and processed meats. On the flip side, yogurt, nuts, whole grains, and fruits and vegetables were linked to weight loss or maintenance. Potatoes may be a “perfect food” for lean people who exercise a lot or who do regular manual labor. But for the rest of us, it might be safer for the waistline to view potatoes as a starch—and a fattening one at that—not as a vegetable.

Women who experience severe premenstrual symptoms may have a condition called premenstrual dysphoric disorder. Antidepressants may relieve these symptoms and, depending on the person, can be taken intermittently instead of daily.

Prospective studies show no increased risk of recurrence.

At one time, soy seemed to be just the ticket for women: heart-healthy, good for bones, and helpful for hot flashes. And then there was the low rate of breast cancer in soy-consuming countries. But as so often with "miracle foods," closer study has dampened some of the enthusiasm.

Early research indicated that soy protein could lower LDL (bad) cholesterol, but later studies were so unimpressive that the American Heart Association asked that food companies no longer be allowed to label soy products as helpful in preventing heart disease. It's still unclear whether soy does much for bones or hot flashes. And although some studies suggest that it may protect against breast cancer, other research has found that isoflavones (a component of soy that binds to estrogen receptors) can spur the growth of breast cancer cells in test tubes and animals. There's also some concern that soy's estrogenic activity may interfere with tamoxifen, a drug used to prevent recurrence in women with estrogen-sensitive breast cancer. As a result, some clinicians advise patients with breast cancer to limit their consumption of soy or avoid it altogether.