Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder caused by hyper-stimulation of ovarian cells which produces androgens, mainly Testosterone. It effects other hormones such as raising DHEA and increasing Insulin levels. Symptoms can vary from obesity, infertility, to acne, increased hair growth and infrequent menstrual periods.

This small study used a common supplement, Resveratrol to help reverse the hype- insulin and hyper-androgenic markers associated with this condition. A significant improvement was made with reducing Testosterone, DHEA and insulin levels after 3 months of treatment compared to placebo.

Resveratrol is an antioxidant that is in a variety of foods. Some of these include dark chocolate, pistachios, peanuts, berries, and of course red wine. To achieve the benefits of the study one would have to drink 100 bottles of red wine per day…..don’t do that!  The home in the treatment group used an oral supplement of micronized trans resveratrol at a dose of 1500 mg daily. Much more practical.

The improvement observed was comparable to or greater than that found in the usual treatment for PCOS which is birth control pills or Metformin. This supplement may help reduce the risk of metabolic problems associated with PCOS which includes diabetes and some cancers. More studies and larger trials should be done before we can strongly recommend this as a treatment for women. But this is very promising…

Early Indication That Resveratrol Corrects PCOS Abnormalities: “”

You have read a lot about the gut microbiome. But you may not have known that the breast also has its own microbiome. This mix of microbes could equally have an important effect on health, according to a new study in Applied and Environmental Microbiology. The results showed that microbes in the breast, even in low amounts, may play a role in preventing or increasing breast cancer risk.

One in eight women are diagnosed with breast cancer in their lifetime. We know that many variables are associated with this risk including age, genetics and environmental factors. With this new growing body of research, bacteria may be considered as one of those environmental factors. We know that breast feeding, since the early 60’s has been associated with a lower risk of breast cancer. Recent work suggests that breast milk supports the growth of beneficial bacteria in the breasts.

According to immunologist Delphine Lee who studies breast cancer at the John Wayne Cancer Institute in Santa Monica California, “It isn’t surprising in and of itself that the breast harbors microbes” The breast is exposed to the environment through the nipple and ductal system. Lactation also lowers breast cancer risk through the release of Oxytocin which clears the ducts of inflammatory debris. Dry brushing and nipple stimulation can actually create a healthy epithelial lining in the ducts.

Gregor Reid, a professor of microbiology and immunology at Western University in Ontario was the senior author of a study that analyzed bacterial DNA in breast tissue samples of 58 women who were undergoing lumpectomies or mastectomies for either benign or cancerous tumors. He and the other researchers also looked at 23 healthy women who underwent breast reductions or enhancements.

Findings showed that women with breast cancer had higher levels of some types of bacteria, including Enterobacteriaceae, Staphylococcus and Bacillus. Women without cancer had higher levels of other bacteria types, such as Lactococcus and Streptococcus. What we don’t know is whether certain bacteria found near breast tumors are the cause of breast cancer or whether they just thrive in the tumor environment.

These long named bacterial species may not mean anything to you now, but it will later as upcoming research will be able to use a patient’s bacterial makeup as a biomarker for cancer screening or to develop probiotics for improving prognosis and treatment outcomes.

Reference: Sheikh, K. “The Breast has its Own Microbiome”. ScientificAmerican.com, Oct 2016. p. 21.

Breakell, D. “Reducing your Risk for Breast Cancer.” Wellcast.org. Keynote, June 2014.

A 10-year study was conducted to compare the effects of transdermal (skin patches) and oral estrogen therapy on risk for cardiovascular events. The study looked at over 5000 women with the average age of 55. They excluded women who had a prior history of blood clots or coronary heart disease or who filled a prescription for any progestin, estrogen injection, gel or spray or a contraceptive pill during the study period or 6 months prior to starting the transdermal or oral estrogen.

Participants were exposed to an average of 16 months of estrogen therapy. Results showed lower venous thromboembolism (blood clots) and strokes among transdermal estrogen users. This is consistent with numerous observational studies. This is biologically plausible with the fact that transdermal application does not elevate liver production of clotting proteins. This supports the view that transdermal estrogen is indeed safer than the oral route with respect to blood clots. The European menopause Society (Maturitas 2011; 69:195) and the Endocrine Society (J Clin Endocrine Metab 2015; 100:3975) both recommend the transdermal formulation for menopausal women at risk for blood clots. This includes women with a previous history of blood clots, smokers and those who are obese).

This information may also explain the statistically significant increase in venous thromboembolism in women that participated in the Women’s Health Initiative Study launched in 1991 who were using oral Prempro (oral estrogen and progestin). That study was primarily looking at the risks and benefits of that particular drug vs hormone replacement therapy. As you can see, not all estrogens are alike nor do they get metabolized the same in the body. Personalizing a women’s hormone therapy is important. Discussing the types of estrogen and explaining the risks and benefits of route of administration is vital in helping women make the right choice that is effective and safe for them.

Reference: Simon JA et al. Venous thromboembolism and cardiovascular disease complications in menopausal women using transdermal versus oral estrogen therapy. Menopause 2016 June; 23:600.

Canonico M and Scarabin P. Y. Oral versus transdermal estrogens and venous thromboembolism in postmenopausal women: What is new since 2003? Menopause 2016 June; 23:587.

More than 100 million women use oral contraceptives (birth control pills) globally. These pills come with its conveniences and benefits in providing an effective form of birth control, but they also come with their side effects (headache, irregular bleeding, bloating). Some side effects however, can be dangerous such as venous and arterial thrombophlebitis (blood clots), heart attack and stroke. With so many birth control pills on the market, including generics, it is important to look at which pills are safest to avoid these concerning side effects.

In an observational study of 5 million French women (ages 15-49), researchers examined women taking birth control pills with 30-40 ug ethinyl estradiol (EE) compared to those taking a 20 ug EE pill between 2010-2012. Those containing the lowest amount of estrogen (20-ug EE plus levonorgestrel) had the lowest risk for pulmonary embolism, stroke and heart attack. Common names of these pills include Alesse, Lutera, Lessina, Levlite and Sronyx. Those taking the higher 30-40 ug EE plus Desogestrel pill ( Desogen, Ortho-cept) had the highest risk for blood clots of the lungs (pulmonary embolism).

So if choosing a birth control pill, the lower dose estrogen pill is a safer start. Cigarette smoking negates that risk reduction so please don’t smoke.

Also, we have to remember that pregnancy is associated with a much higher risk for venous thromboembolism then any available estrogen-progestin contraceptive. If remembering to take a pill every day is difficult, then consider a long-acting reversible contraceptive, like the IUD or a progestin implant.

Reference: Weill A et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: Cohort study. BMJ 2016 may 10;353:i2002.

Sexual dysfunction is common in women of all ages, but for women in menopause (both natural and surgically induced) the symptoms are elevated due to declining levels of estrogen and testosterone. Although estrogen therapy improves vaginal dryness and pain, some women prefer to use a non-estrogen option. 

Sex steroids are vital for healthy tissue integrity of the labia, vagina, lower urinary tract and supporting pelvic structures. These tissues are rich in estrogen and androgen receptors. These hormones enhance blood flow to the genital tract which is necessary for general arousal and lubrication. 

The fall in estrogen at menopause and the decline in androgens (mainly testosterone) as we age results in vulvovaginal atrophy (VVA) and an increase in vaginal PH. Theses changes allow the environment to be vulnerable for vaginal infections. Symptoms include vaginal dryness, irritation, itching, infection and pain with intercourse. This leads to diminished sexual desire, arousal difficulties, reduced physical and emotional satisfaction, and relationship issues. 

Vaginal estrogen therapy can thicken and revascularize the vaginal tissue, lower the PH and normalize vaginal flora. Although data show that vaginal estrogen acts locally,  some studies have shown blood estradiol levels increase with vaginal estrogen application. Therefore, researchers have looked for alternatives for women whom cannot or should not risk raising their level of estrogen such as women who have had estrogen receptor positive breast cancer. The adrenal hormone dehydro-epiandrosterone (DHEA) is an important precursor for the biosynthesis of estrone and testosterone. 

A randomized controlled trial of the daily application of three different doses of vaginal DHEA ovules (3.25 mg, 6.5 mg, or 13 mg) was studied over 12 weeks in 218 postmenopausal women who met the entry criteria of dyspareunia (pain with intercourse). This one study resulted in a number of publications to support the effectiveness of this treatment for VVA. In these publications the investigators reported an improvement in the vaginal cells and a reduction in PH. At 12 weeks,  the total Menopause Quality of Life Questionnaire (assessing sexual desire, vaginal dryness, intimacy) scores showed significant greater response for each treatment group verses placebo. 

The improvements seen in this study are interesting. It is possible that the DHEA effects were due to local metabolism to estrone (stored estrogen) and testosterone which binded to the local receptors. Considering how well drugs are absorbed through the vaginal mucosa, this is reassuring. DHEA may be considered a promising treatment alternative but further studies are needed to confirm efficacy and safety. Ideally future studies should evaluate less frequent administration of the DHEA ovule because most women may not like the daily administration. 

Reference: Davis, S. “DHEA for Urogenital Atrophy and Sexual Function.”  The North American Menopause Society e-consult, Medscape Edition. Jan, 15, 2015.