Penelope Jane Robinson

Menopausal symptoms in breast cancer survivors nearly 6 years after diagnosis.

ObjectiveWe investigated the prevalence and severity of menopausal symptoms, nearly 6 years from diagnosis, in women who had not experienced recurrent breast cancer or a new primary breast cancer (active disease) and were no longer taking oral adjuvant endocrine therapy (OAET). MethodsA total of 1,683 women recruited within 12 months of diagnosis with invasive breast cancer completed an enrollment questionnaire and five annual follow-up questionnaires. Only women who had never reported active disease and were not taking OAET at their fifth follow-up were included in the analysis. Women previously recruited to a study of sex steroid levels provided community control data. Menopausal symptoms were assessed with the Menopause-Specific Quality of Life Questionnaire (MenQOL). ResultsEight hundred forty-three women without active disease and not taking OAET completed the fifth follow-up questionnaire, on average, 5.8 years after diagnosis. Most had stage I (59.5%) and hormone receptor–positive disease (77.9%) at diagnosis and were postmenopausal (92.8%). Those aged 50 to 59 years were more likely to report any symptoms (P = 0.01) and more severe symptoms (P < 0.001) than older and younger women. There was no independent impact of chemotherapy on MenQOL vasomotor and sexual domain scores. Women with breast cancer had significantly higher vasomotor domain (P ⩽ 0.002) and sexual domain (P ⩽ 0.004) scores than community controls. ConclusionsVasomotor and sexual symptoms are highly prevalent in breast cancer survivors and are not simply a function of OAET or chemotherapy. Given the adverse impact of these symptoms, effective interventions are needed to alleviate them in women who have completed their breast cancer treatment.

The contribution of SHBG to the variation in HOMA-IR is not dependent on endogenous oestrogen or androgen levels in postmenopausal women.

Objective  Sex hormone‐binding globulin (SHBG) is a robust predictor of insulin resistance. Whether this is independent of circulating sex steroid levels remains uncertain. The aim of this study was to investigate the determinants of SHBG in postmenopausal women and whether the relationship between SHBG and insulin resistance is independent of oestrogen and androgen levels.

Urinary Incontinence in Young Nulligravid Women: A Cross-sectional Analysis

BACKGROUND Although pregnancy is a risk factor for urinary incontinence (UI), the extent of UI in nulligravid women has not been reported. OBJECTIVE To investigate the rate of UI in a sample of young nulligravid women and its potential risk factors and effect on quality of life. DESIGN Cross-sectional, self-administered questionnaire-based study. SETTING University campuses and medical and allied health clinics. PARTICIPANTS Nulligravid Australian women aged 16 to 30 years. MEASUREMENTS The Questionnaire for Urinary Incontinence Diagnosis, the Psychological General Well-Being Index (PGWBI), the Kings Health Questionnaire, and the International Physical Activity Questionnaire-Short Form. Demographic variables and potential risk factors were also documented. RESULTS 1018 of 1620 questionnaires (63%) were returned, and 1002 provided analyzable data. The mean age of participants was 22.5 years (SD, 3.2). The rate of any UI was 12.6% (95% CI, 10.5% to 14.7%). Incontinence was slightly more common in students than in nonstudents (13.2% [CI, 11.0% to 15.8%] vs. 10.6% [CI, 6.7% to 14.6%]). Rates of UI varied according to sexual activity and use of combined oral contraceptives (COCs), with highest rates reported by students who were ever sexually active and not using COCs (21.5% [CI, 16.7% to 27.3%]). Women with UI reported significantly lower overall well-being than women without UI and had worse PGWBI scores related to anxiety, depression, positive well-being, and self-control. LIMITATION A convenience sample of healthy, well-educated women was recruited, and response rates and participant characteristics varied by setting. CONCLUSION In a sample of young nulligravid women, UI was associated with ever being sexually active and no COC use, as well as lower psychological well-being. Further research is needed to assess the prevalence and risk factors for UI in nulligravid women. PRIMARY FUNDING SOURCE None.

Obesity is associated with a poorer prognosis in women with hormone receptor positive breast cancer

OBJECTIVE Whether moderate to severe obesity (body mass index (BMI)≥30 to <40kg/m(2)) contributes to breast cancer recurrence and mortality remains uncertain. SUBJECTS AND METHODS 1199 women, recruited within 12 months of their diagnosis of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) invasive breast cancer completed an enrolment questionnaire and an annual follow-up questionnaire every 12 months for another 5 years. The impact of obesity on time to either local or distant recurrence or new breast cancer, or death due to breast cancer was determined by Cox regression. Women in the most extreme categories of BMI (<18.5 and ≥40) were excluded from the analysis. RESULTS Of the 1155 included women, mean age, 58.4±11.6 years, 53.8% had Stage 1 disease and 88.9% received oral adjuvant endocrine therapy (OAET) within 2 years of diagnosis. The likelihood of an event was significantly associated with moderate to severe obesity (HR=1.71, 95%CI, 1.12-2.62, p=0.014), disease beyond Stage 1 (HR=2.87, 95% CI 1.73-4.75, p<0.001), OAET (HR=0.26, 95%CI 0.14-0.46, p<0.001), mastectomy (HR=3.28, 95%CI 1.98-5.44, p<0.001) and radiotherapy (HR=2.12, 95%CI 1.24-3.63, p=0.006). For Stage 1 disease, only moderate to severe obesity (HR 3.23, 95%CI 1.48-7.03, p=0.003) and OAET use (HR 0.41, 95%CI 0.17-0.98, p=0.046) were significantly associated with an event. CONCLUSION Moderate to severe obesity is associated with a poorer invasive breast cancer prognosis; this is also true for women with Stage 1 disease, and is independent of age and treatment.

Testosterone Improves Antidepressant‐Emergent Loss of Libido in Women: Findings from a Randomized, Double‐Blind, Placebo‐Controlled Trial

INTRODUCTION Female sexual dysfunction is a side effect of selective serotonin reuptake inhibitor (SSRI)/serotonin noradrenalin reuptake inhibitor (SNRI) therapy. AIMS The aim of this study is to investigate the efficacy of transdermal testosterone (TT) as a treatment for SSRI/SNRI-emergent loss of libido. METHODS This was a double-blind, randomized, placebo-controlled study. Forty-four women, aged 35-55 years, on a stable dose of SSRI or SNRI with treatment-emergent loss of libido were randomly allocated to treatment with a TT patch delivering 300 mcg of testosterone/day or an identical placebo patch (Pl) for 12 weeks. MAIN OUTCOME MEASURES The primary outcome measure was the change in the Sabbatsberg Sexual Self-rating Scale (SSS) total score over 12 weeks. The 4-week frequency of Satisfactory Sexual Events (SSEs) and the Female Sexual Distress Scale-Revised (FSDS-R) were also measured. RESULTS At baseline, there were no differences between the treatment groups. At week 12, the change in the SSS score did not differ between the two groups. The increase in the 4-week frequency of SSEs was significantly greater for the TT group than for the Pl group (an increase of 2.3 events vs. 0.1, P = 0.02). The between-group difference in the change in the FSDS-R score approached statistical significance (P = 0.06). The mean total serum testosterone level at 12 weeks in the TT group was 2.1 nmol/L. No women withdrew because of androgenic adverse events. CONCLUSIONS TT therapy resulted in a significant increase in the number of SSEs compared with Pl therapy in women with SSRI/SNRI-emergent loss of libido. The lack of improvement in the SSS total score may reflect lack of sensitivity of this instrument for the measurement of change in sexual function. This provides the first evidence that TT therapy may be a treatment option for women with SSRI/SNRI-emergent loss of libido who need to remain on their antidepressant therapy.

Incidence of Total Knee and Hip Replacement for Osteoarthritis in Relation to Circulating Sex Steroid Hormone Concentrations in Women

The increased prevalence of osteoarthritis (OA) in postmenopausal women suggests that changes in either circulating sex steroid concentrations or the tissue response to sex steroids may have a role in the pathogenesis of OA. The aim of this study was to examine whether circulating sex steroid concentrations are associated with the incidence of total knee and total hip replacement for OA.

Breast reconstruction following mastectomy for invasive breast cancer is strongly influenced by demographic factors in women in Victoria, Australia.

This study explored factors associated with the likelihood of reconstruction after unilateral mastectomy and the wellbeing of women after reconstruction. Data were from a questionnaire completed on average 1.8 years after diagnosis by 1429 women in the BUPA Health and Wellbeing After Breast Cancer Study. Logistic regression was used to model factors associated with reconstruction. The Psychological General Wellbeing Questionnaire was used to assess wellbeing. A total of 25.4% of 366 women who had a unilateral mastectomy had undergone a reconstruction nearly two years after diagnosis. Being younger (p<0.001), educated beyond school (p<0.04), living in the metropolitan area (p<0.001), having private health insurance (p=0.003), not having dependent children (p=0.004) and not having radiotherapy (p<0.001) explained just over 40% of the variation in reconstruction status. There was a modest difference between women who did and did not have a reconstruction in terms of wellbeing. Demographic factors strongly influence the likelihood of reconstruction after mastectomy.

Transdermal testosterone improves verbal learning and memory in postmenopausal women not on oestrogen therapy

The aim of this study was to examine the effects of testosterone on verbal learning and memory in postmenopausal women.

Endogenous estrogen and androgen levels are not independent predictors of lipid levels in postmenopausal women.

ObjectiveThe relationships between endogenous sex hormone levels and cardiovascular disease risk in women are contentious. Our aim was to systematically investigate the relationships between sex steroids and lipid levels in postmenopausal women, taking into account other potential risk factors. MethodsThis is a cross-sectional study of 624 naturally and surgically postmenopausal women not using any systemic hormones or lipid-lowering therapy, with a mean (SD) age of 53.9 (5.8) years, who were recruited in the United States, Canada, Australia, UK, and Sweden between July 2004 and February 2005. The relationships between total testosterone, dihydrotestosterone, estrone, estradiol, sex hormone–binding globulin (SHBG), the homeostasis model assessment for insulin resistance (HOMA-IR), and each lipid variable were explored using multivariable linear regression. ResultsNone of the sex steroids measured made an independent contribution to the multivariable models for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, or triglycerides (TG). The best model for total cholesterol included race and age, and that for LDL cholesterol included race and blood pressure, with each model only explaining 4.8% and 3.3% of the variation in each lipid, respectively. About 7.7% of the variation in non-HDL cholesterol was explained by HOMA-IR, race, and SHBG. HOMA-IR, SHBG, age, and surgical menopause explained 22.8% of the variation in HDL cholesterol, whereas HOMA-IR, SHBG, race, and surgical menopause explained 25.4% of the variation in TG. ConclusionsEndogenous estrogen and androgen levels are not independent predictors of lipid levels in postmenopausal women. HOMA-IR and SHBG each make independent contributions to HDL cholesterol and TG. These factors make little contribution to total and LDL cholesterol.

Continuous-combined oral estradiol/drospirenone has no detrimental effect on cognitive performance and improves estrogen deficiency symptoms in early postmenopausal women: a randomized placebo-controlled trial

Objective This study aimed to explore the effects of continuous-combined estradiol 1 mg/drospirenone 2 mg (E2D) on cognitive performance in healthy, recently postmenopausal women. Methods A 6-month randomized, double-blind, placebo-controlled study was carried out in a university research center. Participants were 23 healthy postmenopausal women aged 49 to 55 years. Cognitive performance was assessed with a computerized cognitive battery administered to all participants on 0, 12, and 26 weeks. Functional magnetic resonance imaging was performed on 13 participants before and after treatment using tasks of verbal fluency and mental rotation. Results E2D was not associated with an overall effect on cognitive performance. Functional magnetic resonance imaging results showed no difference between the groups for verbal fluency or mental rotation task performance at baseline. The mental rotation task was associated with increased blood oxygen level–dependent signalling in the placebo group in both occipital lobes and in the left superior parietal lobe after 26 weeks (P < 0.05), with no changes over time seen in the treatment group. The total menopausal symptom and sexual function domain scores improved after treatment in women randomized to E2D compared with the placebo group (both P < 0.05). Similarly, systolic blood pressure, weight, and body mass index were significantly lower in women randomized to E2D at 26 weeks (P < 0.05). Conclusions E2D has no detrimental effect on cognitive performance in early postmenopausal women. E2D significantly improves menopausal symptoms, sexual function, systolic blood pressure, and weight.