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Is All Breast Cancer The Same? A Paradox: Estrogen's Relationship to Breast Cancer

Is All Breast Cancer The Same? A Paradox: Estrogen's Relationship to Breast Cancer

Most women are aware of a link between estrogen and breast cancer. Yet, there are three types of breast cancer: ductal (80%), lobular (10%), and inflammatory (1% to 5%), all of which have different receptor characteristics that guide treatment. Approximately 75% of breast cancer is estrogen-receptor (ER) positive. However, there are conditions in which estrogen both fuels and, at other times, kills ER-positive breast cancer cells.  One type of breast cancer does not even recognize estrogen at all. It is estimated that in 2015, there will be 231,840 new cases of breast cancer and 60,290 cases of breast carcinoma in situ. And it is predicted that 40,290 women will die of this disease (cancer.org). Understanding the types of breast cancer offers promise for improved surveillance, prevention, and more effective treatments.

Hot Flash Connection to Puberty

Hot Flash Connection to Puberty

Puberty is a dynamic process that occurs as young women emerge into their reproductive lives.  The prepubertal process begins in the hypothalamus.  There, gonadotrophin-releasing hormone neurons secrete gonadotrophin-releasing hormone (GnRH).  Gonadotrophin-releasing hormone, in turn, enters the portal system in pulses, stimulating the pituitary to produce luteinizing hormone (LH) and follicle stimulating hormone (FSH), both of which act on the maturing ovary to initiate the production of estrogens and androgens and then progesterone once ovulation occurs.  Once produced, rising levels of estrogen communicate back to the hypothalamus to slow the process.  But how does estrogen control this feedback process since there are no estrogen receptors on the GnRH neurons?  And what does this have to do with menopausal hot flashes?

Update on Timing of Hormone Replacement Therapy in Menopause

Update on Timing of Hormone Replacement Therapy in Menopause

In 1964, Dr. Robert Wilson, a gynecologist in New York City, advocated in his book Feminine Forever that all menopausal women should receive hormone replacement therapy (HRT).  The outrage of the feminist movement led the National Institutes of Health (NIH) to fund the Women’s Health Initiative (WHI) in 1991 to determine if HRT could safely protect women’s cardiovascular and bone health.  In July 2002, the trial was prematurely canceled due to findings of a statistical increase in both breast cancer and stroke.  Based on these findings and the resultant publicity, millions of women stopped their HRT, and doctors stopped prescribing HRT.  As a result of this precipitous change, the majority of menopausal women have gone without HRT for more than a decade.

Doctor, Why Does It Hurt Down There?

Doctor, Why Does It Hurt Down There?

Over 60% of women in menopause complain, often silently, of vaginal dryness and pain during intercourse. As a consequence, they may seek to avoid that level of intimacy, a behavior that can impact negatively on their relationships and, for some, may lead to loneliness and depression. Why?

Understanding Menopause

Understanding Menopause

Recent advances in the biology of menopause have helped clarify the importance of female hormones in women’s overall health. Improved patient education that allows women to engage in formal conversations with their care providers helps clinicians to individualize menopause management for their patients. In essence, while menopause is a complex process, it can be understood at a basic level by viewing it simply as a process of hormone withdrawal.  And the hormone of most importance is estradiol, cyclically produced in large amounts by the ovaries during the reproduction years, reflecting the high numbers of eggs that rapidly decrease in number as one approaches menopause.