I recommend your Substack to everyone—and I mean EVERYONE—in doctor’s waiting rooms, on Reddit message boards, in Amazon book reviews, in my kitchen—EVERYWHERE. The expression “doing God’s work” comes to mind when I read it. Not 100% sure how I feel about God, but am 150% grateful for this newsletter, which has educated me about the menopause transition more than any other source. Thank you so much, Dr. Jen!! ❤️
Ps: If you’re aware of a (not pharmacy compounded!) oral progesterone prescription in the U.S. that’s NOT made with peanut oil, could you pls post it in a reply here or maybe add it as a P.S. to a future newsletter? Or would vaginal progesterone inserts be a possible alternative? (To protect the uterus when using estrogen) Thanks again.
Greetings Dr. G, for a future post would you consider sharing your thoughts on what good options are for women who have dense breasts and would be interested in getting a mri screening in lieu of or in addition to a mammogram? For some of us who are older and out of gyn care, it’s hard to convince a general practitioner. I’d be glad to pay out of pocket, but then what do you do if there are findings? I have a mother with breast cancer and paternal aunt with ovarian cancer (both in their 60’s). What actually constitutes increased risk? What if you just want to do it? Not only are there new rules about labs having to explain density that go into effect soon, “We Can Do Hard Things” has been chronicling this story as Amanda Doyle pursued an MRI because she was in the 10% most dense and discovered that she had breast cancer.
Thanks for this and all your research and writing and talking.
This post got me thinking because of something that came up for my sister recently and I’ll be keeping this information in mind.
My sister is a couple years younger than me and also going through menopause transition. She has a serious mental illness, for which she takes medication, but past periods of psychosis have had a cognitive impact and her ability process information. Her condition also creates obstacles for whether and how we talk about things. It’s a delicate balance for what we can talk about without her shutting down.
She does get regular medical care thankfully but I have no idea what conversations she’s having with medical professionals about menopause symptoms or how to manage that.
So that makes me want to ask you this question - what would you think about writing about menopause and serious mental illness (schizophrenia and bipolar)? Are there studies about how these conditions may be impacted by menopause? Or care guidelines for health practitioners? Is it ok to take MHT with other mental health medications? What about monitoring for cancer risks?
I’m also going to ask my provincial mental health organization for some resources about this.
As someone with endometriosis I knew the risks were higher but it’s sobering to see them compared to BRCA. Was already preparing to have ovaries out as a preventative measure at the recommendation of my endo surgeon, but your comment about the lack of info about the menopause hormones you then need to take also gives me pause. If you never had endo on your ovaries does that lower the risk? Did the study sub group that I can’t fully understand the terms. Thank you for sharing this information and explaining it to us.
We really can't say anything else based on the study, just that in this group, they found that deep endometriosis was associated with a significantly higher risk of ovarian cancer. How to proceed with risk-reducing surgery hasn't been adequately studied, so it's a bit of a data void. I would certainly not be wrong for someone with deeply infiltrating endometriosis to have risk-reducing surgery! There is data from the WHI and other studies that suggest estrogen-only MHT is associated with an increased risk of ovarian cancer (about double the risk, so less of an increase than we saw with endometriosis in this study), but interestingly, estrogen plus progestogen was NOT associated with an increased risk in the WHI, and so that might factor into a decision about hormones after surgery. With endometriosis, many people recommend both estrogen and a progestogen after removing the ovaries anyway to help reduce the risk of endometriosis recurrence, so that is probably good from an ovarian cancer standpoint as well. Another option would be Duavee. All anyone can do is make the best decision with the information available at the time. The group with deeply infiltrating endometriosis had the highest risk, but the study can't tell where that endometriosis was. Endometriomas had the next highest risk. And superficial endometriosis the lowest risk.
As someone with deep endometriosis - or who had deep endometriosis - I find this concerning and will absolutely discuss with my physician. Should there be additional screening for us?
Adenomyosis wasn't considered in this study, and I have not heard of an independent link between adenomyosis and ovarian cancer, although that doesn't mean it doesn't exist
New article published in Nature Genetics (https://www.nature.com/ng/) that may be of interest on the topic of endometrial cells, An integrated single-cell reference atlas of the human endometrium.
Abstract: The complex and dynamic cellular composition of the human endometrium remains poorly understood. Previous endometrial single-cell atlases profiled few donors and lacked consensus in defining cell types. We introduce the Human Endometrial Cell Atlas (HECA), a high-resolution single-cell reference atlas (313,527 cells) combining published and new endometrial single-cell transcriptomics datasets of 63 women with and without endometriosis. HECA assigns consensus and identifies previously unreported cell types, mapped in situ using spatial transcriptomics and validated using a new independent single-nuclei dataset (312,246 nuclei, 63 donors). In the functionalis, we identify intricate stromal–epithelial cell coordination via transforming growth factor beta (TGFβ) signaling. In the basalis, we define signaling between fibroblasts and an epithelial population expressing progenitor markers. Integration of HECA with large-scale endometriosis genome-wide association study data pinpoints decidualized stromal cells and macrophages as most likely dysregulated in endometriosis. The HECA is a valuable resource for studying endometrial physiology and disorders, and for guiding microphysiological in vitro systems development.
Would something like periodic CA-125 screening be beneficial for those of us with endometriosis, or would that just creat more problems? Any other screenings we could ask for, or is it just monitoring of symptoms alone?
I may be higher risk - mom died of ovarian cancer and I had deep endometriosis - but my ovaries and fallopian tubes were removed in my late 40s. I'm not taking any hormones. Should I be?
I recommend your Substack to everyone—and I mean EVERYONE—in doctor’s waiting rooms, on Reddit message boards, in Amazon book reviews, in my kitchen—EVERYWHERE. The expression “doing God’s work” comes to mind when I read it. Not 100% sure how I feel about God, but am 150% grateful for this newsletter, which has educated me about the menopause transition more than any other source. Thank you so much, Dr. Jen!! ❤️
Ps: If you’re aware of a (not pharmacy compounded!) oral progesterone prescription in the U.S. that’s NOT made with peanut oil, could you pls post it in a reply here or maybe add it as a P.S. to a future newsletter? Or would vaginal progesterone inserts be a possible alternative? (To protect the uterus when using estrogen) Thanks again.
My pleasure!
And regarding vaginal progesterone, I wrote about it here https://vajenda.substack.com/p/side-effects-with-progesteroneprogestins
And as far as I know all pharmaceutical progesterone in the US is made with peanut oil. There is a brand in Canada made with sunflower oil.
I don't know about the availability in the USA, however as noted the Canadian generics also contain Prometrium: 100 mg {soybean lecithin}.
Greetings Dr. G, for a future post would you consider sharing your thoughts on what good options are for women who have dense breasts and would be interested in getting a mri screening in lieu of or in addition to a mammogram? For some of us who are older and out of gyn care, it’s hard to convince a general practitioner. I’d be glad to pay out of pocket, but then what do you do if there are findings? I have a mother with breast cancer and paternal aunt with ovarian cancer (both in their 60’s). What actually constitutes increased risk? What if you just want to do it? Not only are there new rules about labs having to explain density that go into effect soon, “We Can Do Hard Things” has been chronicling this story as Amanda Doyle pursued an MRI because she was in the 10% most dense and discovered that she had breast cancer.
Thanks for this and all your research and writing and talking.
This post got me thinking because of something that came up for my sister recently and I’ll be keeping this information in mind.
My sister is a couple years younger than me and also going through menopause transition. She has a serious mental illness, for which she takes medication, but past periods of psychosis have had a cognitive impact and her ability process information. Her condition also creates obstacles for whether and how we talk about things. It’s a delicate balance for what we can talk about without her shutting down.
She does get regular medical care thankfully but I have no idea what conversations she’s having with medical professionals about menopause symptoms or how to manage that.
So that makes me want to ask you this question - what would you think about writing about menopause and serious mental illness (schizophrenia and bipolar)? Are there studies about how these conditions may be impacted by menopause? Or care guidelines for health practitioners? Is it ok to take MHT with other mental health medications? What about monitoring for cancer risks?
I’m also going to ask my provincial mental health organization for some resources about this.
I appreciate you greatly.
Take care.
As someone with endometriosis I knew the risks were higher but it’s sobering to see them compared to BRCA. Was already preparing to have ovaries out as a preventative measure at the recommendation of my endo surgeon, but your comment about the lack of info about the menopause hormones you then need to take also gives me pause. If you never had endo on your ovaries does that lower the risk? Did the study sub group that I can’t fully understand the terms. Thank you for sharing this information and explaining it to us.
We really can't say anything else based on the study, just that in this group, they found that deep endometriosis was associated with a significantly higher risk of ovarian cancer. How to proceed with risk-reducing surgery hasn't been adequately studied, so it's a bit of a data void. I would certainly not be wrong for someone with deeply infiltrating endometriosis to have risk-reducing surgery! There is data from the WHI and other studies that suggest estrogen-only MHT is associated with an increased risk of ovarian cancer (about double the risk, so less of an increase than we saw with endometriosis in this study), but interestingly, estrogen plus progestogen was NOT associated with an increased risk in the WHI, and so that might factor into a decision about hormones after surgery. With endometriosis, many people recommend both estrogen and a progestogen after removing the ovaries anyway to help reduce the risk of endometriosis recurrence, so that is probably good from an ovarian cancer standpoint as well. Another option would be Duavee. All anyone can do is make the best decision with the information available at the time. The group with deeply infiltrating endometriosis had the highest risk, but the study can't tell where that endometriosis was. Endometriomas had the next highest risk. And superficial endometriosis the lowest risk.
What about, for someone leery of losing her ovaries, doing a salpingectomy? I believe I've read that most ov. CA actually starts in the tubes.
Thank you so much for your reply
As someone with deep endometriosis - or who had deep endometriosis - I find this concerning and will absolutely discuss with my physician. Should there be additional screening for us?
Great post, as always. You said that OCs lower ovarian CA risk by 28%. I thought it was 50%. Am I going w/ old data?
Thank you for this and all your posts. Does adenomyosis pose a similar heightened risk?
Adenomyosis wasn't considered in this study, and I have not heard of an independent link between adenomyosis and ovarian cancer, although that doesn't mean it doesn't exist
Thank you
New article published in Nature Genetics (https://www.nature.com/ng/) that may be of interest on the topic of endometrial cells, An integrated single-cell reference atlas of the human endometrium.
https://www.nature.com/articles/s41588-024-01873-w
Abstract: The complex and dynamic cellular composition of the human endometrium remains poorly understood. Previous endometrial single-cell atlases profiled few donors and lacked consensus in defining cell types. We introduce the Human Endometrial Cell Atlas (HECA), a high-resolution single-cell reference atlas (313,527 cells) combining published and new endometrial single-cell transcriptomics datasets of 63 women with and without endometriosis. HECA assigns consensus and identifies previously unreported cell types, mapped in situ using spatial transcriptomics and validated using a new independent single-nuclei dataset (312,246 nuclei, 63 donors). In the functionalis, we identify intricate stromal–epithelial cell coordination via transforming growth factor beta (TGFβ) signaling. In the basalis, we define signaling between fibroblasts and an epithelial population expressing progenitor markers. Integration of HECA with large-scale endometriosis genome-wide association study data pinpoints decidualized stromal cells and macrophages as most likely dysregulated in endometriosis. The HECA is a valuable resource for studying endometrial physiology and disorders, and for guiding microphysiological in vitro systems development.
Would something like periodic CA-125 screening be beneficial for those of us with endometriosis, or would that just creat more problems? Any other screenings we could ask for, or is it just monitoring of symptoms alone?
I don't think CA-125 is a great screening tool and it can be elevated with endoemtriosis
I may be higher risk - mom died of ovarian cancer and I had deep endometriosis - but my ovaries and fallopian tubes were removed in my late 40s. I'm not taking any hormones. Should I be?