We know this because of the very first academic analysis of 1500 documents unsealed in a lawsuit against pharmaceutical giant Wyeth (now part of Pfizer). The litigation was filed in July 2009 against menopausal hormone manufacturers by 14,000 women whose claims related to the development of breast cancer while taking the hormone therapy Prempro (conjugated equine estrogens – horse urine to you and me).  The case itself has been well documented, and the facts that were revealed during it came as quite a shock and it is that disquiet which is behind the US federal court decision to release the documents to the public.

An investigation of these documents by Dr. Adriane Fugh-Berman, associate professor in the Department of Physiology at Georgetown University Medical Center in Washington DC was just published in PLoS Medicine. She analyzed dozens of ghostwritten reviews and commentaries about Prempro which were published in medical journals and journal supplements. Her conclusion?

“facts were manipulated within the articles to promote unproven benefits and to downplay the harms of Prempro. What’s more, the articles were deliberately written in a way to place any competing therapies in a negative light.”

No prizes for guessing what those competing therapies were — the pharmaceutical companies have never been keen on alternatives to HRT such as bio-identical natural hormones like progesterone.  These articles were widely circulated to physicians directly and also to the drug salesmen who represent the products of pharmaceutical companies like Wyeth.  They were used to convince doctors that Prempro was a good product and to inform them about how and why it should be given to menopausal women.  It was certainly effective as a campaign because it was enthusiastically prescribed by doctors and resulted in millions of packs of Prempro being sold.
Just why did doctors fall for this?  The simple answer is that the information was presented to them in a form that they trusted — that is as respectable research and scientific reports.  The problem is that any original research was ‘spun’ so that they received a misleading account of both the benefits and drawbacks to the drug.  This was done by hiring DesignWrite, a medical education and communication company to produce ghostwritten articles that took the basic research and in many cases turned it on its head.

Well what is wrong with a bit of creative writing?  As a writer and creative coach myself I could say nothing at all, but there is a great deal that is seriously wrong when it comes to distorting the facts that potentially have fatal effects on women’s health.  How did they do this?

Firstly, the ghostwriters were told to mitigate the perceived risks of breast cancer associated with it and also to defend and promote alleged cardiovascular benefits of HRT.   Alleged is certainly right as the supposed facts presented were unsupported by scientific evidence and in fact the reverse was certainly already known; that there are risks associated with HRT and cardiovascular disease.

Secondly, Wyeth also used ghostwriters to promote a range of other conditions for which HRT might be beneficial and for which there is absolutely no proof whatsoever such as the prevention of dementia, Parkinson’s disease, vision problems, and even wrinkles.  This aspect of their work is certainly well known to me, as at one time I seriously considered writing a small pamphlet entitled “101 uses of HRT you never knew about” because every time there was any negative press about HRT a positive report for a previously unknown use would hit the media the following week.
So why would they go to all this trouble?  The answer of course, as ever, is profit because these misleading reports enabled them to sell a great deal more of their product.  It was certainly a profitable business for the ghostwriters as just for Prempro alone they were paid between $20-$25,000 an article and in total produced 20 articles which reflected the positive spin that Wyeth wanted to have put on their product.

Last Word
I will leave it to Dr. Adriane Fugh-Berman to have the last word, and this is what she concluded in her study:

“Given the growing evidence that ghostwriting has been used to promote HRT and other highly promoted drugs, the medical profession must take steps to ensure that prescribers renounce participation in ghostwriting, and to ensure that unscrupulous relationships between industry and academia are avoided rather than courted,”

I couldn’t have put it better myself.

Research presented at the Annual Meeting of the Society for the Study of Ingestive Behaviour – which I suspect is something to do with food or at least what we put into our bodies – has recently reported that a diet rich in soy prevents weight gain in post-menopausal female rats.

Now I have nothing against soy, indeed it’s extremely helpful for many women during menopause and some find it particularly good for hot flashes, but it is the reasoning behind the claim that has puzzled me. They are saying that previous research suggests that reduced levels of the hormone oestrogen during menopause are responsible for the increased body weight and abdominal fat often experienced by postmenopausal women.

As oestrogen is the hormone responsible for adding to our womanly curves I am not quite following the logic here. They do admit that while oestrogen replacement therapies can reduce weight gain, they also have unwelcome side effects, prompting a search for alternative methods of treatment.

Now, as I understand it, women continue to make oestrogen during menopause to compensate for the lack of it from the ovaries. It is made from our adrenal glands and from fat cells, so that a small amount of weight gain at menopause is nature’s way of making up for any deficiency.

We’re back to balance, as menopause is the time when some weight gain will be helpful so dieting frantically is not the answer as being ultra-slim will not have health benefits in the long run. Of course being a seriously overweight isn’t healthy either and what these researchers have found (in postmenopausal rats) is decreased body weight and increased energy expenditure after adding soy phytoestrogens to their regular diet.

One of the researchers, Michelle Murphy from the Monell Chemical Senses Center, Philadelphia, commented “These results have implications for the development of alternative natural treatments for obesity in post-menopausal women. The results of this study highlight the need for further research into the actions of phytoestrogens on food intake in humans to determine the more long-term effects of consuming a soy-rich diet. In this world of an ever-increasing obesity epidemic, finding natural dietary solutions and treatments to combat obesity are of the utmost importance both to worldwide health and the economy.”

Well, obesity is certainly not confined to postmenopausal women and concentrating solely on phytoestrogens is, I think, not really the answer. By all means add soy to your diet but remember that soy products themselves are not necessarily slimming and it might be better instead to focus on improving your overall diet and that old tried and true method of regular, enjoyable, exercise.

Unless of course you think that you and a menopausal rat have something in common.

The research was led by Dr Michael Cant, from the University of Exeter’s School of Biosciences, but I do wonder how much experience of menopausal women he has that drew him to do it?

However science goes bravely forward and has given us for the first time a plausible explanation as to why these species in particular are the only ones in which reproduction ends while there is still plenty of healthy and active life to look forward.  How much killer whales look forward to the future is not actually known but let’s be generous and assume that they too have dreams of holidays in Tahiti when the children have grown up.

What they have discovered is that despite very different social structures between the three species, the research shows that in each case females become increasingly genetically related to those they live with as they get older. Because of this, there is a motivation for older females to do what is best for the survival of those around them.

Or in other words, the female now takes on a ‘grandmother’ role, so that the success rate of breeding in the group can be helped by older females sharing parenting knowledge and stopping breeding to allow younger females easier access to resources.

Of course for us humans this theory has just flown out of the window with the development of IVF and the new menopause prediction tests as I mentioned in my previous articles. Women’s desire to control their fertility and continue having babies at a much older age – even into their 60s – is going to have quite an impact. Grandmothers are no longer going to be as available for baby sitting and are much more likely to be asking their children to do it for them.

Though I do think it could be very helpful when dealing with someone who is unhappy with your menopausal mood swings to remind them that you have a lot in common with killer whales!

The key here of course is ’some extra pounds’ and in fact keeping an eye on your weight from as early as age 20 can help protect you against breast cancer. This finding comes from a National Cancer Institute (NCI) study in the USA of 72,007 postmenopausal women who were enrolled in the NCI’s Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

Their conclusions are startling. When they analysed all the data they concluded that a 30-pound gain over the period from age 20 to menopause for a five-foot, four-inch woman nearly doubled the risk of developing breast cancer after menopause had begun.

Of course other factors such as family history, whether menstruation commenced early (another high risk factor) and if a woman has had children or not were taken into consideration.   However, a simple weight gain of only 2 pounds a year over the period were found to be as significant as any of the traditional risk factors.

This extra weight was revealed to be as significant as family history of the disease, the age at which a woman begins to menstruate (the earlier, the higher the risk), or whether or not she has had children and the age at which she gave birth.

However, you have to keep a sense of proportion because double the risk means that instead of one in a hundred women it could be two, but of course none of us wants to be that second woman.  Keeping a healthy eye on your weight from your twenties onwards obviously makes sense and the two key factors are a good diet that includes plenty of omega-3 fatty acids and regular exercise.

This finding was reported at the American Stroke Association’s International Stroke Conference 2010 and the warning bell is for women having more than 7 grams a day of trans fats, mostly found in processed, baked and fried foods.

Ischemic strokes are caused by blockages in blood vessels in or leading to the brain and the researchers reported positive associations between total fat intake and ischemic stroke incidence and between trans fat intake and ischemic stroke incidence. We know from previous studies shows that different types of fat have different effects on the incidence of coronary heart disease (CHD), with trans fat being identified as a risk factor but those were small scale studies. This one involved 87,230 post-menopausal women ages 50 to 79 who participated in the Women’s Health Initiative (WHI) Observational Study, by answering a food frequency questionnaire when they entered the study and were then followed for an average of 7.6 years.

During that time, 1,049 ischemic strokes occurred and the researchers looked for links between dietary fat intake of all types (saturated fat, monounsaturated fat, polyunsaturated fat and trans fat) and ischemic strokes and covered all health variables including physical activity, drug use, smoking, alcohol and hormone therapy. The top 25% of women had an average total fat intake of 86 grams a day and the lowest 25% consumed just 26 grams a day. With a 40% risk of stroke at the top end of fat intake it makes sense to monitor fat intake, and particularly trans fats to keep their levels down.

If you are not sure of how much fat a day you take in, there is a handy way to determine it and the example below is based on the average amount that a woman needs which is a total of 2,000 calories a day, but you can be more accurate by exactly working out your daily calorie intake.
1. Take the number of calories you eat each day and multiply it by 30 percent (.30). For example: 2,000 calories x .30 = 600 calories from fat
2. Divide your answer by 9 because there are 9 calories in each gram of fat. This will give you the number of grams of fat per day that should be your goal.
600 ÷ 9 = 65 grams

You can use a calculator if you need to!

Dr John Lee said that normally they would disappear altogether at menopause and that to reduce them a progesterone regime should do the trick. My experience is that many women do suffer from fibroids around their thirties and forties and that they can be a real nuisance.

Fibroids are round, firm benign lumps of the muscular wall of the uterus, composed of smooth muscle and connective tissue, and seldom do you just get one. In size they start small and grow to something the size of an orange, but can get much bigger. The most usual consequences are painful or irregular periods and heavy bleeding, often accompanied by pain.

The usual option offered is a hysterectomy and many women, depending on their age, opt for this. If you have a highly skilled surgeon they can just remove the uterus intact, but this is not usually the case.

Prevention is the best option, so tackling oestrogen dominance is the first step because fibroids are produced by excess oestrogen and their growth is stimulated by it. Ensuring that you have adequate supplies of progesterone is a priority, so establish this with a blood or saliva test, and by using natural progesterone regularly you should be able to shrink the fibroids in size without resorting to surgery.

Once menopause is under way the fibroids will begin to shrink naturally, but if you are around ten years or so off your menopause you need to be aware that you are probably having anovulatory (non-ovulating) cycles and so you are producing much less progesterone than before but still the same amount of oestrogen. To check for this, have a blood or saliva test to check progesterone levels the week following your usual ovulation date. A low reading indicates lack of ovulation and the need to supplement with natural progesterone. 
 
If you experience any of the common signs of oestrogen dominance you will want to keep an eye out for fibroids and take action earlier rather than later to avoid surgery.

It’s estimated that around 30% of menopausal women will get some form of hot flashes. How affected you are will depend on several factors, including where you live and what you eat. Some lucky women never get them at all and they are certainly very much more common in the western world. There is no word in Japanese for instance to cover this phenomenon because there do not seem to suffer from them – unless they have switched to a predominantly western diet. So if you are unlucky enough to suffer from hot flashes it might help to learn why they occur and let you gauge whether or not you are likely to be a sufferer.

The Reasons Why
Although some lucky women escape completely, there are some very good reasons why we experience the heat that we associate with menopause:

1 – Blood Vessels
Hot flashes occur when the blood vessels below the skin dilate. This causes more blood to rush to the skin’s surface, and that is what makes you look red and flushed, and feel that tell-tale rise in temperature. The body’s normal response to this is to try and cool you down, and it does this by making you sweat. When your body temperature increases your body immediately goes into action and how it normally brings your temperature down is through making you sweat. What is unique about hot flashes is that this mechanism kicks in when the outside temperature can be very low and you do not have any signs of fever.

2– Fluctuating hormones
Well you know all about this during menopause, and in fact the changing levels of your hormones are the prime cause of hot flashes. When your hormone levels fluctuate they cause the temperature control mechanism in the body to be disturbed. The centre which controls this is in a part of the brain called the hypothalamus and it seems that it is changing levels of oestrogen and FSH (follicular stimulating hormone) that can upset this delicate balance and cause hot flashes.

Women having hot flashes usually have decreased oestrogen levels and increased FSH levels, but it is important to remember that it is the changes and fluctuations in the hormone levels – rather than the actual amount of hormone being produced – that produces hot flashes.

3 – Surgical menopause
It is to be expected that menopause symptoms come naturally when a woman’s childbearing years are coming to a close and the menopause or perimenopause is under way. However, women who have a hysterectomy or their ovaries removed at an age when they would not normally be going through menopause are more likely to experience more severe and frequent hot flashes after the surgery than in a natural menopause transition.

Even if the ovaries are retained it is no guarantee that an early menopause will not occur, as their effectiveness at producing progesterone will be affected and will diminish over time.

These are the reasons, and I hope it helps explain why you may be feeling hot and bothered. After all knowledge is power, and some women do like to refer to their hot flashes as power surges!