Study participants were fitter, felt better -- and were less bothered by hot flashes

Thursday, February 16, 2017

THURSDAY, Feb. 16, 2017 (HealthDay News) -- After menopause, moderate exercise can help women manage hot flashes, become more fit and feel better, a new study suggests.

Researchers found that a 20-week exercise program helped women boost their fitness levels, lose a little weight and give higher ratings to their physical and mental well-being.

That included a reduction in hot flashes and night sweats -- two of the most bothersome symptoms of menopause.

Researchers led by Debora Godoy-Izquierdo, of the University of Grenada in Spain, reported the findings online Feb. 15 in the journal Menopause.

The study offers good news to women who want alternatives to hormones for managing menopause symptoms, according to Dr. JoAnn Pinkerton, executive director of the North American Menopause Society.

Hot flashes and night sweats are the most common reasons that women seek treatment for menopause symptoms, said Pinkerton, who was not involved in the study.

For some, she said, the problems are severe enough to warrant hormone therapy. But most women can find relief in other ways.

"Exercise, stress reduction and adequate sleep are very important for women who are becoming menopausal," Pinkerton said. "For a majority of women, lifestyle changes may be enough to get the hot flashes to be less bothersome, as well as help prevent the weight gain and mood changes common during this time."

For the new study, the researchers recruited 234 women who were at least one year past menopause. Overall, 166 women were sedentary, and half of them were assigned to stick with their usual lifestyle, while the other half started the 20-week exercise program.

The rest of the women were already physically active, and they served as a second comparison group.

The exercise program consisted of three one-hour workouts per week. Each session was supervised and involved moderate aerobic exercise, like fast walking, along with strength training.

The women in this program also received psychological counseling, aimed at helping them with "self-regulation" and behavior changes.

After 20 weeks, the study found, women in the exercise program had lost a small amount of weight, on average. But the bigger changes were seen in their fitness levels, blood pressure and "health-related quality of life."

In general, the women gave higher ratings to their physical and mental health, and said they were less bothered by hot flashes and other menopause symptoms.

Those benefits were still apparent at the one-year mark. At that point, the researchers said, the women looked more like the group that had been active all along, rather than those who'd remained sedentary.

There was one exception: After initially losing a little weight, women in the program typically went back to their starting weight.

But regardless of weight, improvements in fitness levels are critical, according to Dr. Chip Lavie, medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans.

"Improving fitness is one of the most important things that any person, including a postmenopausal woman, can do to reduce their mortality and mortality from cardiovascular disease," said Lavie, who was not involved in the study.

In this study, the women's fitness levels were gauged by, among other things, their resting heart rate and how fast they could walk 1 kilometer.

Those measures reflect how well the heart and blood vessels are working. But, Lavie said, studies have tied fitness to other health benefits, too -- including improvements in stress and depression symptoms.

"And only small improvements in fitness are needed to induce these benefits," Lavie said.

As for why exercise might help with hot flashes, Pinkerton pointed to a couple reasons.

Exercise, she said, is thought to boost levels of certain brain chemicals, such as dopamine and serotonin -- which are important for mood, sleep and other functions. And those chemicals are sometimes lower during the hormonal fluctuations that come with menopause.

And one study, Pinkerton said, found that women who exercised were better able to "regulate their body heat."

The program in this study did involve psychological and behavioral counseling -- which may also have helped the women manage their menopause symptoms, according to Pinkerton.

But that does not necessarily mean women need such a comprehensive program.

Other research, Pinkerton said, has found that simpler exercise routines can help women manage hot flashes. It took only 30 minutes of any aerobic exercise -- like walking, jogging, bicycling or swimming -- three or more times per week, she noted.

SOURCES: JoAnn Pinkerton, M.D., executive director, North American Menopause Society, and professor, obstetrics and gynecology, University of Virginia Health System, Charlottesville; Chip Lavie, M.D., medical director, cardiac rehabilitation and prevention, and director, exercise laboratories, John Ochsner Heart and Vascular Institute, New Orleans; Feb. 15, 2017, Menopause, online

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Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age — United States, 2013–2014

Pelvic inflammatory disease (PID) is a clinical syndrome of the female reproductive tract characterized by inflammation of the endometrium, fallopian tubes, or peritoneum. CDC assessed the burden of self-reported PID in a nationally representative sample using data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014 cycle.

• by Molly Walker 
  Staff Writer, MedPage 

Overall fertility rates and reproductive rates have fallen among U.S. women from 1990 to 2014, despite a 10-year spike from the mid-1990s to the mid-2000s, said CDC researchers.

The total fertility rate, which measures the potential impact of current fertility patterns on reproduction or completed family size, declined approximately 10% from 2,081.0 births per a hypothetical cohort of 1,000 women in 1990 to 1,862.5 per 1,000 in 2014, reported Brady E. Hamilton, PhD, and Sharon E. Kirmeyer, PhD [deceased], of the CDC Division of Vital Statistics.

These rates declined 5% from 1990 to 1997, with a 8% spike from 1997 to 2007, before falling 12% from 2007 to 2014 -- with a less than 1% increase from 2013 to 2014.

Writing in National Vital Statistics Reports, the authors said that from 1990 to 2014, the total fertility rate was "below replacement level" -- which is defined as the level that a given generation can exactly replace itself -- in every year except 2006 and 2007. It is defined as 2,100 births per 1,000 women.

Total fertility rates and gross reproduction rates fell among all races and Hispanic subgroups during the examined time period with the exception of Cuban American women, they noted.

The total gross reproduction rate (defined as the average number of daughters per 1,000 births, assuming none of them were to die) also exhibited a 10% decline -- dropping from 1,015 per 1,000 in 1990 to 909 per 1,000 births in 2014. The authors noted that the gross reproduction rate closely parallels the total fertility rate because of the "narrow variability of female births relative to male births."

With a decline in birth rates comes a decline in population. If the intrinsic rate of natural increase, or the rate of change of population size resulting from the continuance of age-specific birth and mortality rates over a given year of time, is negative, that indicates a population decline. The rate in 2014 was -3.7 per 1,000. In fact, the authors noted that the rate has been negative every year from 1990 to 2014, except for 2006 and 2007.

This was also the first time that the report examined reproduction and intrinsic rates by race and Hispanic origin of the mother for non-Hispanic white, non-Hispanic black, and Hispanic groups, said the authors.

These trends varied by demographic groups. Total fertility rates for Hispanic women exceeded replacement every year during the examined time period, but rates for non-Hispanic and Asian/Pacific Islander women were "consistently below replacement" during that time.

But the largest declines in gross reproduction rate from 1990 to 2014 were seen among American Indian/Alaska Native women (-41%), Hispanic women (-28%), and non-Hispanic black women (-26%). By contrast, the gross reproduction rate among non-Hispanic white women fell 5% during that time. The net reproduction rate (which incorporates mortality rates into the estimates) saw similar, albeit slightly smaller declines among these groups.

The authors noted that the difference between gross reproduction rate and the net reproduction rate has "diminished considerably over the year, reflecting the decline in age-specific mortality rates of women in childbearing years."

• Primary Source

  National Vital Statistics Reports

  Source Reference: Hamilton BE, Kirmeyer SE "Trends and variations in reproduction and intrinsic rates: United States, 1990-2014" Natl Vital Stat Rep 2017; Volume 66, Number 2. Published online February 22, 2017.

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2017 Awards - Nominations due March 15, 2017!

View the 2017 Awards Grid for full award details.

• Preceptor Award
  

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Thank you to all that attended last night's webinar!

Opiate Use Disorder and Women's Health
Presented on February 21, 2017
Presented by Cresta Jones, MD

View webinar recording and handouts here. 

Special thank you to our speaker, Cresta Jones, MD, from the Medical College of Wisconsin. 

Plan to join us for our next webinar on June 20, 2017. 

June 20, 2017
Topic: Menopause: Where are we now?
Speaker: Elyse Watkins, DHSc, PA-C
7 PM CT/8 PM ET/5 PM PT

Presentation Objectives:

• Describe the Women’s Health Initiative study and its subsequent effect on exogenous hormone utilization during menopause.
  
• Discuss the current evidence-based guidelines on hormone therapy for menopausal women.
  
• Differentiate the various treatment options currently available for vasomotor symptoms and vulvovaginal atrophy due to menopause.
  
• Describe the risks and benefits of hormone therapy during menopause. 
  

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This program has been reviewed and is approved for a maximum of 1.00 AAPA Category 1 CME credits by the PA Review Panel. PAs should claim only the credit commensurate with the extent of their participation in the activity. 

This program was planned in accordance with AAPA's CME Standards for Live Programs and for Commercial Support of Live Programs. 

By Janelle Bludorn, MS, PA-C

Posted on: February 15, 2017

Olivia is a 37-year-old healthy female who presented to the emergency department (ED) with pelvic pain and vaginal spotting. She has had a hormonal intrauterine device (IUD) in place for four years, yet continues to have regular menses. Her last regular menses was 3 weeks ago, and she has had light spotting and midline pelvic cramping ever since. The night prior to Olivia's presentation in the ED, the pain acutely worsened (but had since waned). Acetaminophen provided her moderate relief; she was pain-free at time of evaluation. She denied experiencing other symptoms, notably fever, vomiting, dysuria, vaginal discharge, and flank pain. Olivia voiced concern that there could be something wrong with her IUD. Medical History Olivia reported being monogamous with a male partner. Her medical history revealed that Olivia was G4P2Ab2 (meaning, pregnant 4 times, having birthed 2 children and lost 2 pregnancies). Physical Examination At triage, Olivia's vital signs were as follows: BP 109/58 mm Hg; P 61 beats/min; RR 16; T 97.8 F; and SpO2 99% on room air. She appeared well and said she felt comfortable. Her physical examination was unremarkable, other than a report of mild midline suprapubic tenderness. A pelvic examination revealed a small amount of dark blood in Olivia's vaginal vault, IUD strings at the cervical os, and mild bilateral adnexal tenderness without masses or fullness. Initial diagnostic studies performed included complete blood cell count, urinalysis, urine hCG, chlamydia/gonorrhea swabs, and pelvic ultrasound. The CBC and urinalysis were unremarkable. The urine hGC, however, was positive and the pelvic ultrasound revealed a 2.7 cm x 3.4 cm x 2.5 cm mixed echogenicity adnexal structure adjacent to the right ovary. The IUD was visualized in the uterus and there were no findings consistent with an intrauterine pregnancy. Upon these findings, gynecology was consulted and additional diagnostics were obtained. The tests ordered included quantitative hCG, Rh, basic metabolic panel (BMP), and liver function tests (LFTs). Pregnancy of Unknown Location Often, after an initial workup in the ED, providers are left with a diagnosis of pregnancy of unknown location (PUL). This is defined as the absence of pregnancy localization (either intra- or extra-uterine) by pelvic ultrasonography in patients who have a serum beta hCG less than 1,000 IU/L to 1,500 IU/L, a range known as the discriminatory zone (the hCG level at or above one would expect to visualize pregnancy on ultrasonography).1 Any woman classified as having a PUL must be followed closely until a final outcome can be determined. Outcomes include intrauterine pregnancy (IUP), pregnancy failure, or ectopic pregnancy. Current guidelines recommend following the patient's serial beta hGC levels at 48-hour intervals on an outpatient basis. A 50% to 66% rise in hCG levels in a 48-hours period is consistent with likely IUP, while a 21% to 35% decline is more consistent with pregnancy failure.3 A static or irregularly rising or falling hCG level raises concerns for an ectopic location of the pregnancy. Serial ultrasonography and examinations are also indicated based on clinical status and hCG laboratory values. Ruling Out Ectopic Pregnancy Ectopic pregnancy (EP) occurs in approximately 1% of all pregnancies.1 An ectopic pregnancy is defined as a pregnancy that is located anywhere outside of the endometrial cavity of the uterus. The most common location is one of the fallopian tubes, but an EP can also occur at an ovary, or in the cervix or abdominal cavity.2 Since none of these sites are able to support a growing embryo, there is always a chance of rupture and associated hemorrhage. A ruptured ectopic pregnancy is one of the leading causes of pregnancy-related mortality in the U.S., accounting for between 10% to 15% of all maternal deaths. It is, therefore, a true medical emergency and a very important differential diagnosis for emergency medicine providers.2   Making a definite diagnosis of EP in a stable patient can become a prolonged process, but it begins with clinical suspicion. Higher suspicion should occur among women with risk factors. Risk factors that provide strong evidence for association with EP include:2 ·  Pelvic inflammatory disease; ·  Previous ectopic pregnancy; ·  Endometriosis; ·  Previous tubal surgery; ·  Previous pelvic surgery; ·  Infertility treatments; ·  Uterotubal anomalies; ·  History of in utero exposure to diethylstilbestrol; and ·  Cigarette smoking. Risk factors that offer weaker evidence for association with EP include:2 ·  Multiple sexual partners; ·  Early age at first intercourse; and ·  Vaginal douching. The patient in this case was not high-risk for ectopic pregnancy based on the risk factors listed above, so the initial workup aimed at ruling out common causes of irregular vaginal bleeding and pelvic pain in a patient with an IUD, such as pregnancy, ovarian pathology, hormonal IUD side effects or expulsion, dysfunctional uterine bleeding, or mittelschmerz. Managing Ectopic Pregnancy Management options for EP depend on many factors and can include surgical, medical, or expectant modalities. For patients that are hemodynamically unstable, emergent surgical management is indicated. Other indications for surgical management include: ectopic masses >3.5cm, fetal cardiac motion, higher beta hCG levels, known or suspected rupture, or patient preference. Surgical procedures generally include salpingectomy or salpingostomy, either via laparoscopy or laparotomy.2 Medical management of EP offers the advantages of lower cost, preservation of tubal function, and avoidance of surgery. Many chemical agents have been studied for the medical treatment of ectopic pregnancy. To date, the mainstay of medical treatment is the folic acid antagonist, methotrexate, in either one or two dose regimens.2 Patients with EP whose blood type is Rh negative should be treated with Rho(D) immune globulin in order to prevent Rh incompatibility, which can cause complications for future pregnancies. These complicating conditions range from mild-to-moderate infantile anemia and/or hyperbilirubinemia to severe conditions such as kernicterus, hydrops fetalis, or even death in utero from massive antibody-induced hemolytic anemia.4 Several studies have found that approximately 68% to 77% of ectopic pregnancies resolve without any surgical or medical interventions, making expectant management a potential option. This management modality should be reserved for stable patients with small ectopic pregnancies and falling beta hCG levels who can be trusted to closely follow up with outpatient providers.2 Regardless of which approach is utilized to manage ectopic pregnancy, the patient should have serial beta hCG levels followed until undetectable, out of concern for potential heterotopic pregnancy or treatment failure [2].  Olivia's Diagnosis Olivia's quantitative hCG result was 830 and Rh was negative, while the BMP and LFTs were unremarkable. These findings are consistent with pregnancy of unknown location. Once it had been determined that Olivia was pregnant, an ultrasound raised the concern of implantation in the adnexa and the diagnosis of likely ectopic pregnancy was determined. The gynecology consult service was called into the ED, and members of that team administered Methotrexate to Olivia before performing a Karmen biopsy-for both diagnostic and potentially therapeutic purposes. Additionally, members of the gynecology consult team removed Olivia's IUD. Rho(D) immune globulin was administered intramuscularly. After a period of observation with stable vital signs, Olivia was discharged to her home with strict warnings to return to the ED if symptoms returned and to follow up with the gynecology clinic within 2 days.   Olivia soon followed up with the gynecology clinic to have her serial quantitative hCG levels tested. At that visit, Olivia learned that her Karmen biopsy revealed endometrial cells without chorionic villi, consistent with ectopic pregnancy, and the swab that had been taken to test for both chlamydia and gonorrhea were negative. Olivia's quantitative hCG levels required approximately one month from administration of methotrexate to reach zero. At this time, she elected to resume the hormonal IUD as her method of contraception. Analysis of This Case Intrauterine devices are often mistakenly associated with ectopic pregnancy, although there is no evidence to suggest that modern-day IUDs increase the risk of this condition.2 In fact, because the IUD is such a reliable and reversible contraception method, they decrease the overall risk of pregnancy, including the risk of ectopic pregnancy. Consider, for example, the hormonal IUDs that are currently available, which boast low failure rates of 0.1 to 0.6 per 100 woman-years (WY), and even lower rates of ectopic pregnancy (0.02 to 0.2 per 100 WY).5In fact, the hormonal IUD boasts one of the lowest rates of ectopic pregnancy among other birth control methods (other than complete abstinence).  It is important to note that despite these reassuring statistics and the fact that IUD use does not increase the absolute risk of ectopic pregnancy, if an IUD should fail and result in pregnancy, the implantation is slightly more likely to occur in an ectopic location.2,6 Although we considered EP as an initial differential diagnosis for a woman with a hormonal IUD who had reported weeks of cramping and spotting with a sudden, acute worsening of pain, our initial clinical suspicion for this was not as high as other possible diagnoses. The leading differential diagnoses for Olivia's case were ovarian cyst rupture, ovarian torsion, mittelschmerz, IUD expulsion, IUD-related side effects, or dysfunctional uterine bleeding. Pregnancy (including intrauterine, ectopic, and spontaneous abortion), tubo-ovarian abscess, and sexually transmitted infection were also considered as possible differential diagnoses. Janelle Bludorn is a physician assistant in the emergency department at UNC Health Care and an assistant professor at the University of North Carolina at Chapel Hill School of Medicine. This is a case she encountered in her previous practice at Massachusetts General Hospital emergency department in Boston.  References 1. Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clinical Evidence. 2012:1406. 2. Tenore JL. Ectopic pregnancy. Am Fam Physician. 2000;61(4):1080-1088.  3. Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum. Reprod. Update. 2014;20(2):250-261. 4. Fung K, Eason E, Crane J, Armson A, De La Ronde S, Farine D, et al. Prevention of Rh alloimmunization. J Obstet Gynaecol Can. 2003;25(9):765-773. 5. Heinemann K, Reed S, Moehner S, Do Minh T. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception. 2015;91(4):280-283. 6. Li C, Zhao WH, Meng CX, Ping H, Qin GJ, Cao SJ, et al. Contraceptive use and the risk of ectopic pregnancy: a multi-center case-control study. PLoS ONE. 2014;9(12).

Adverse outcomes are more likely to occur in babies born to mothers with gestational diabetes compared with those born to non-diabetic mothers.

A study in Diabetologia examined the 796,346 deliveries that took place in France after 22 weeks of gestation in 2012, using data from hospital discharges and the national health insurance system.

"Complications of gestational diabetes are well known, such as preterm birth, macrosomia, preeclampsia, and Caesarean section, for example, but large-scale study is rare," one of the co-authors, Sophie Jacqueminet, MD, of Assistance Publique Hôpitaux de Paris, the city's public hospital system, told MedPage Today. "Our study, by limiting the analyses after 28 weeks of gestation, avoided immortal time bias and highlighted the real level of risk of gestational diabetes ... Furthermore, we observed a higher risk of respiratory distress, which had not been clearly established before."

Of the original cohort, 57,629 mothers (7.24%) had gestational diabetes. Investigators then further filtered the analysis to include only deliveries after 28 weeks, the point at which gestational diabetes usually begins to appear, and 37 weeks, to determine the risk of adverse outcomes in term deliveries.

Mothers with gestational diabetes were identified based on their use of glucose-lowering agents, hospital diagnosis at delivery, and overall medical history. Gestational diabetes was classified as "insulin-treated" when insulin was dispensed at least once during pregnancy. Further, as a way of filtering out mothers with undiagnosed pregestational diabetes, Jacqueminet and colleagues excluded those who received insulin or oral glucose-lowering agents at least once during the year after pregnancy.

After the analysis was limited to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3-1.4]), Caesarean section (OR 1.4 [95% CI 1.4-1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6-1.7]), macrosomia (OR 1.8 [95% CI 1.7-1.8]), respiratory distress (OR 1.1 [95% CI 1.0-1.3]), birth trauma (OR 1.3 [95% CI 1.1-1.5]), and cardiac malformations (OR 1.3 [95% CI 1.1-1.4]) all increased in women with gestational diabetes compared with those without diabetes.

For deliveries after 37 weeks, the odds ratio initially rose by 30% for perinatal death in the gestational group compared with the non-diabetes group. No significant differences were observed for the other outcomes in deliveries after 28 weeks.

After this unexpected finding, the investigators then excluded women with gestational diabetes who received glucose-lowering agents at least once during the year after pregnancy. This analysis excluded 1,376 women in the group of deliveries after 28 weeks (6.8% in the insulin-treated group and 0.7% in the non-insulin-treated group) and 1,171 women in the group of deliveries after 37 weeks (7.3% in the insulin-treated group and 0.64% in the non-insulin-treated group).

In this more restricted group, the risk of respiratory distress among deliveries after 28 weeks and of perinatal death among deliveries after 37 weeks in the insulin-treated group were no longer significantly increased (OR 1.0 [95% CI 0.9-1.1] and OR 0.9 [95% CI 0.6-1.5], respectively), the team reported.

However, the risk of perinatal death among deliveries after 37 weeks remained moderately increased in the non-insulin-treated group (OR 1.3 [95% CI 1.0-1.6]).

"The risk of perinatal death is controversial during gestational diabetes in different studies," Jacqueminet noted. "Most of the time this risk is not increased, but after limiting the analysis after 37 weeks, the risk of perinatal death was slightly increased."

The findings underscore the importance of vigilance when treating those with gestational diabetes, she continued: "For physicians and other providers, it is important to consider gestational diabetes with caution even when women are not treated by insulin. Careful monitoring at the end of pregnancy should be implemented to decide the better time to give birth."

Jacqueminet said that moving forward, researchers "need to better know these women," including more about factors like age and body mass index, time of diagnosis, and glucose level at diagnosis.

The authors note that the study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The researchers reported having no relationships with industry.

• Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  Diabetologia

  Source Reference: Billionnet C, et al "Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012" Diabetologia 2017; DOI 10.1007/s00125-017-4206-6.

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Feb. 13 (UPI) -- Researchers at the University of Texas at San Antonio, or UTSA, have found that a drug previously used to prevent infections in cancer patients could also prevent infertility.

Infertility is a common problem for cancer patients, especially in males because cancer treatments often stop sperm production.

The research team discovered a link between the drug G-CSF or granulocyte colony-stimulating factor, and the regeneration of sperm production in men who had cancer as children and were infertile.

"We were using G-CSF to prevent infections in our research experiments," Brian Hermann, assistant professor of biology at UTSA and study author, said in a press release. "It turned out that the drug also had the unexpected impact of guarding against male infertility."

G-CSF stimulates the bone marrow to make neutrophils, which are white blood cells used to fight infections.

Hermann and his team determined that by promoting cell growth, G-CSF was able to regenerate sperm production.

"Male infertility is an intuitive disease and we need creative solutions," Hermann said. "But we need to understand how things work before we can fix them."

The study was published in Reproductive Biology and Endocrinology.

Postmenopausal women with obesity who intentionally lost weight had a lower risk for endometrial cancer, according to results of the Women’s Health Initiative observational study.

“Many older adults think it’s too late to benefit from weight loss, or think that because they are overweight or obese, the damage has already been done, but our findings show that’s not true,” Juhua Luo, PhD, associate professor of epidemiology and biostatistics at Indiana University School of Public Health, said in a press release.

Luo and colleagues evaluated 36,794 postmenopausal women aged 50 to 79 years recruited from 40 clinical centers between September 1993 and December 1998. Weight was measured at enrollment and again at 3 years.

Weight change was categorized as stable (within ± 5%) or a loss or gain (more than 5% change). All incidences of endometrial cancer diagnosed after the 3-year visit served as the primary outcome of the study.

Over a mean follow-up of 11.4 years, 566 women were diagnosed with endometrial cancer.

Multivariate analyses adjusted for baseline BMI, age and menopausal hormone therapy showed that women who had lost more than 5% of weight had a 29% lower risk for endometrial cancer compared with women who had stable weight (HR = 0.71; 95% CI, 0.54-0.95).

When analyzed by baseline BMI, weight loss was associated with significantly lower endometrial cancer risk among women who had been obese (HR = 0.47; 95% CI, 0.29-0.77), but not among women who were overweight (HR = 1.16; 95% CI, 0.74-1.83) or normal weight (HR = 0.8; 95% CI, 0.47-1.35).

Women obese at baseline who intentionally lost weight had a greater risk reduction than women who unintentionally lost weight (intentional, HR = 0.44; 95% CI, 0.25-0.78; unintentional, HR = 0.57; 95% CI, 0.25-1.3). When measured in pounds rather than a percentage, the association persisted among obese women who intentionally lost weight (HR = 0.52; 95% CI, 0.3-0.9).

In a sensitivity analysis of weight loss and endometrial cancer subtypes, researchers observed a stronger association between intentional weight loss and risk for type I endometrial cancer compared with overall results (all women, HR = 0.48; 95% CI, 0.3-0.76; obese women, HR = 0.26; 95% CI, 0.12-0.57).

This study shows that weight loss even later in life is beneficial, according to Jennifer A. Ligibel, MD, ASCO expert in cancer prevention and director of the Leonard P. Zakim Center for Integrative Therapies at Dana-Farber Cancer Institute, who was not involved in the study.

“There have been more than a thousand studies linking obesity to an increased risk for endometrial and other cancers, but almost none that look at the relationship between weight loss and cancer risk,” Ligibel said in the press release. “This study tells us that weight loss, even later in life, is linked to a lower risk of endometrial cancer.”

The researchers would like to further examine the role of weight loss in other populations, according to the release.

“We’re interested to see whether weight loss plays a role in the prevention of other cancers that are linked to obesity, Luo said. “We already know that avoiding obesity is associated with many health benefits, but we do not know enough about the benefits of weight loss for adults who are already obese.” – by Melinda Stevens

Disclosures: Luo reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Luo J, et al. J Clin Oncol. 2017;doi:10.1200/JCO.2016.70.5822.