A Behavioral Group Treatment Program for Menopausal Hot Flashes: Results of a Pilot Study

In the present study, we tested the effectiveness of a cognitive-behavioral group treatment (CBGT) for hot flashes in menopausal women. Treatment was administered over 8, 90 min weekly sessions and consisted of education, relaxation training and cognitive restructuring. Nineteen women meeting STRAW staging criteria for the menopause transition (stages –1 to +1) were randomly assigned to immediate or delayed treatment (wait list) and were asked to monitor their hot flashes and night sweats prospectively. They also completed questionnaires, including the Womens Health Questionnaire and the Menopause Specific Quality of Life Questionnaire to determine psychosocial benefits of treatment. Results suggested that the CBGT was moderately successful in reducing the frequency of total vasomotor symptoms [F (1, 17) = 6.16, p < .01], as measured by daily symptom diaries. While there were arithmetic improvements in psychosocial functioning in this sample, these results were not significant. Despite the limitations of small sample size and possible placebo effect, this pilot study supports the notion that cognitive-behavioral interventions aimed at reducing vasomotor symptoms may be of value for menopausal hot flashes when administered in a small-group format.     

Does menopausal transition really influence mental health? Findings from the prospective long‐term Zurich study

In the prospective long‐term Zurich study, we re‐examined the hypothesized association between mental health problems in women and the transition through menopausal stages. One hundred sixty‐eight women from a population‐based Swiss community cohort were prospectively followed up from age 21 to 50. At age 50, the occurrence of hot flushes/night sweats and sleep disturbances was significantly more frequent in peri‐ and post‐menopausal women. Irritability/nervousness was increased only in peri‐menopausal women, but that association was accounted for by neuroticism trait scores at age 30. Transitions to peri‐ or post‐menopause were not related to changes in either the prevalence rates of DSM major depressive episode or anxiety disorders, or the course of psychopathological syndromes as assessed by the Symptom Checklist 90 ‐ Revised. The null associations held when adjusting for duration of reproductive period or age at menopause. Preceding mental health problems between ages 21 and 41, increased neuroticism trait scores at age 30, and concurrent psychosocial distress were significantly related to mental health problems occurring between ages 41 and 50. Depending upon the cut‐off point that was chosen, the arbitrary dichotomization of a continuous depression outcome produced spurious associations with the menopausal transition. We conclude that mental health problems between ages 41 and 50 are probably not directly related to the menopausal transition, and that previously reported associations could be false positives due to inadequate dichotomizations, reporting bias, undisclosed multiple adjustments or overfitting.     

Primary Menopausal Insomnia: Definition,Review, and Practical Approach

ObjectiveTo present a case of primary menopausal insomnia with hot flashes to introduce recent changes in technology and nomenclature of sleep medicine and to review presentation, diagnosis, and therapies for menopausal insomnia.MethodsClinical findings and results of sleep evaluation in the menopausal study patient are presented with details about polysomnography performed before and after therapy with pregabalin.ResultsA 56.5-year-old female athlete with severe hot flashes and insomnia of 12 years duration was treated with pregabalin, which ameliorated the hot flashes and sweats and improved sleep quality and architecture. Menopause is associated with hormonal and metabolic changes that disrupt sleep. Disruption of sleep can in turn lead to morbidity and metabolic sequelae. Hormonal treatment, although effective, carries risks unacceptable to many patients and physicians. To date, nonhormonal therapies of symptomatic menopause have not been objectively studied for effects on sleep efficiency and architecture. Primary menopausal insomnia is insomnia associated with menopause and not attributable to secondary causes. Polysomnographically, it seems characterized by a high percentage of slow-wave (N3) sleep, decreased rapid eye movement sleep, cyclic alternating pattern, and arousals.ConclusionsPrimary menopausal insomnia is probably mediated through a mechanism separate from hot flashes, and one can occur without the other. Thermal dysregulation and sleep abnormalities of menopause are probably related to more general changes mediated through loss of estrogenic effects on neuronal modulation of energy metabolism, and more clinical direction is expected as this research field develops. Identification of sleep disorders in menopausal women is important, and polysomnographic evaluation is underused in both clinical and research evaluations of metabolic disturbances. (Endocr Pract. 2011; 17:122-131)     

Circadian Rhythms in Hot Flashes in Natural and Surgically-Induced Menopause

The aim of this study was to investigate arcadian and ultradian variations in menopausal hot flash. The number of hot flashes per 2-hr period was collected from 25 diurnally-active, perimenopausal women for 1 week in January or February of each year for 3 consecutive years. Fourteen women were experiencing natural menopause (NM) (mean age 51.9 years) and 11 were experiencing surgically-induced menopause (SIM) (mean age 52.0 years). The difference in the number of hot flashes between the two types of menopause at each clock time was not statistically significant; neither was the mean number of hot flashes per 24 hr different between the two groups (Student's f-test). Data when normalized for each woman and placed end-to-end revealed by cosinor analysis circadian rhythmicity in the SIM group (P =0.02) but not in the NM group. A 12-hr periodicity was detected in both groups (P< 0.001 for both). An 8-hr rhythm was detected only for the NM group (P = 0.04). Both groups combined exhibited statistically significant rhythmicities with periods of 24 hr (p= 0.003), 12 hr (P<0.001) and 8 hr (P= 0.005). Regardless of the type of menopause, the women could be separated into two groups based on the temporal pattern of hot flashes during the day. One group was defined by the occurrence of peak frequency of flashes during the morning (0400–0959), while the second group was defined by the occurrence of the peak in the evening (1600–2159). The difference between the two groups in the number of hot flashes during the morning wasstatistically significant (Student's r-test, P = 0.009) as was the number of hot flashes in the evening (Student's r-test, P= 0.03).     

The unique challenges of managing depression in mid-life women

Throughout most of their lives, women are at a greater risk of becoming depressed than men. Some evidence suggests that this heightened risk is associated with increased sensitivity to the hormonal changes that occur across the female reproductive lifecycle. For some women, the peri-menopause and early post-menopausal years may constitute a “window of vulnerability” during which challenging physical and emotional discomforts could result in significant impairment in functioning and poorer quality of life. A number of biological and environmental factors are independent predictors for depression in this population, including the presence of hot flashes, sleep disturbance, history of severe premenstrual syndrome or postpartum blues, ethnicity, history of stressful live events, past history of depression, body mass index and socioeconomic status. This paper explores the current knowledge on the complex associations between mood changes and aging in women. More specifically, the biological aspects of reproductive aging and their impact on mood, psychosocial factors, lifestyle, and overall health are reviewed. In addition, evidence-based hormonal and non-hormonal therapies for the management of depression and other complaints in midlife women are discussed. Ultimately, this article should help clinicians and health professionals to address a challenging clinical scenario: a preventive and effective strategy for the management of depression in the context of the menopausal transition and beyond.     

Effect of oral gamolenic acid from evening primrose oil on menopausal flushing.

OBJECTIVE--To evaluate the efficacy of gamolenic acid provided by evening primrose oil in treating hot flushes and sweating associated with the menopause. DESIGN--Randomised, double blind, placebo controlled study. SETTING--District general hospital and teaching hospital. SUBJECTS--56 menopausal women suffering hot flushes at least three times a day. INTERVENTION--Four capsules twice a day of 500 mg evening primrose oil with 10 mg natural vitamin E or 500 mg liquid paraffin for six months. MAIN OUTCOME MEASURES--Change in the number of hot flushes or sweating episodes a month. RESULTS--56 diaries were analysed, 28 from women taking gamolenic acid and 28 from those taking placebo. Only 18 women given gamolenic acid and 17 given placebo completed the trial. The mean (SE) improvement in the number of flushes in the last available treatment cycle compared with the control cycle was 1.9 (0.4) (P < 0.001) for daytime flushes and 0.7 (0.3) (P < 0.05) for night time flushes in women taking placebo; the corresponding values for women taking gamolenic acid were 0.5 (0.4) and 0.5 (0.3). In women taking gamolenic acid the only significant improvement was a reduction in the maximum number of night time flushes (1.4 (0.6); P < 0.05). CONCLUSION--Gamolenic acid offers no benefit over placebo in treating menopausal flushing.     

Thermoregulatory physiology of menopausal hot flashes: a review

Hot flashes during the climacteric years have long been a frequent clinical complaint, generally considered within the realm of the internist, gynecologist, or endocrinologist. Yet the underlying mechanism of hot flashes remains unknown. Only within the past 10 years has there been significant research on hot flashes as a disturbance of thermoregulation. This paper focuses on thermoregulatory aspects of hot flashes, reviewing current knowledge of the thermoregulatory physiology and endocrinology of hot flashes and discussing future avenues for research. Hot flashes are compared with fever in terms of thermoregulatory changes and speculated mechanisms. Although several substances in the peripheral circulation are found in increased concentrations during hot flashes, none is a trigger for a hot flash. The pattern of hot flash occurrence is striking in its regularity, and the possibility of endogenous rhythmicity is discussed. Recently, investigators have begun to explore a primate model of menopausal hot flashes. These studies are summarized. Finally, the multiple effects of estrogen on various systems of the body and their interrelationships are discussed. An understanding of the mechanism of hot flashes would not only be of importance to women suffering with hot flashes but would further our knowledge of thermoregulatory function and the interactions between thermoregulatory and reproductive systems.     

Symptomatic Menopausal Transition Increases the Risk of New-Onset Depressive Disorder in Later Life: A Nationwide Prospective Cohort Study in Taiwan

Introduction

The role of the menopausal transition and associated menopausal symptoms in the occurrence of depressive disorders has been discussed and debated for a long time. Most previous clinical studies had limited case samples, and did not control the attributable risk of medical comorbidities.

Methods

Patients with a diagnosis of symptomatic menopausal transition and without a psychiatric history were enrolled in 2000 in Taiwan, and compared with age-matched controls (1∶4). These subjects were followed to the end of 2010 to investigate the association between symptomatic menopausal transition and new-onset depressive disorder; the effect of medical comorbidities was also assessed.

Results

A total of 5,837 women with symptomatic menopausal transition were identified, and compared with 23,348 age-matched controls in 2000. The follow-up showed that symptomatic menopausal transition was an independent risk factor for major depression (hazard ratio[HR]: 2.18, 95%CI: 1.79∼2.65) and any depressive disorder (HR: 2.34, 95%CI: 2.08∼2.63) after adjusting age at enrollment, monthly income, residence location, level of urbanization, and comorbid medical diseases. In addition, medical comorbidities, including cerebrovascular disease (HR: 1.77, 95% CI: 1.52∼2.07), cardiovascular diseases (HR: 1.35, 95% CI: 1.15∼1.57), congestive heart failure (HR: 1.35, 95% CI: 1.04∼1.75), and liver diseases (HR: 1.19, 95% CI: 1.03∼1.36) increased the risk of developing any depressive disorder.

Conclusion

Our population cohort study, with the largest study sample and medical record diagnosis thus far, supports an association between symptomatic menopausal transition and depressive disorder in midlife women, and an increased risk of depressive disorder with medical comorbidities.     

Nonhuman primate models of menopause workshop

The Nonhuman Primate Models of Menopause Workshop was held on the National Institutes of Health campus in January 2001. The purpose of this workshop, sponsored by the National Institute on Aging, was to review what is known about the female reproductive aging process in various species of monkeys (particularly rhesus, baboons, cynomolgus, and chimpanzees), including hormone profiles during the menopausal transition, occurrence of hot flashes, extent of age-related and menopause-associated changes in hormone levels on metabolism, bone loss, and impaired cardiovascular and cognitive function. Many aspects of the female reproductive aging process appear to be concordant between humans and these monkey species, but several important features may be species-specific. Those features that appear to parallel human menopause and aging include general similarity of hormone profiles across the menopausal transition, progression to cycle termination through irregular cycles, declining fertility with age, age-related gains in weight and percentage body fat content (with tendencies toward insulin resistance and glucose intolerance), increased low-density lipoprotein cholesterol and decreased high-density lipoprotein cholesterol, declines in serum dehydroepiandrosterone, similarities in temperature-regulation systems, protective responses to estrogen replacement following ovariectomy in terms of bone metabolism, lipid profiles, and cognitive changes. Important differences include relatively short postmenopausal life span, timing in menopause-related changes in hormone secretion, and seasonal menstrual cycles. In addition, the question of whether ovariectomy in young adults is an appropriate model for the consequences of natural or surgical menopause in middle-aged and older adults is unresolved, and the numbers of older female animals available for research on menopause are very limited. The use of animal models is seen by workshop participants to be crucial for a mechanistic understanding of the human menopausal process and its connections to postmenopausal health problems; however, extensive in-depth and broad-based research is required to determine if nonhuman primates are appropriate models of human menopause.     

Hot Flashes and Fatigue Relieved by Metformin

ObjectiveTo describe 3 patients with long-standing hot flashes, excessive sweating, and fatigue whose symptoms were ameliorated with metformin.MethodsIn this case series, we report the findings of laboratory evaluations, including assessments for thyroid, gonadal, adrenal, and pancreatic disorders, in 3 patients referred for endocrine evaluation. A 75-g oral glucose tolerance test with measurement of fasting and postprandial glucose and insulin concentrations was conducted. A trial of metformin, 500 mg twice daily, was initiated in all patients.ResultsEvaluation of factors that are associated with hot flashes and increased sweating did not establish the cause of the patients’ symptoms. The 3 patients had normal glucose tolerance test results and hyperinsulinemia. Metformin therapy markedly relieved the symptoms in all patients.ConclusionsHyperinsulinemia without hypoglycemia may produce a sympathoexcitatory response that manifests as hot flashes and increased sweating. Metformin may have sympathoinhibitory actions that alleviate these symptoms. (Endocr Pract. 2009;15:30-34)     

Geographical distribution of hot flash frequencies: considering climatic influences

Laboratory studies suggest that hot flashes are triggered by small elevations in core body temperature acting within a reduced thermoneutral zone, i.e., the temperature range in which a woman neither shivers nor sweats. In the present study, it was hypothesized that women in different populations develop climate-specific thermoneutral zones, and ultimately, population-specific frequencies of hot flashes at menopause. Correlations were predicted between hot flash frequencies and latitude, elevation, and annual temperatures. Data on hot flash frequencies were drawn from 54 studies. Pearson correlation analyses and simple linear regressions were applied, first using all studies, and second using a subset of studies that included participants only to age 60 (n = 36). Regressions were repeated with all studies, controlling for method of hot flash assessment. When analyses were restricted to studies that included women up to age 60, average temperature of the coldest month was a significant predictor of hot flash frequency (P < 0.01), explaining 29.2% of the variation in hot flash frequency. In a separate equation, the difference between hottest and coldest temperatures was also a significant predictor (P < 0.01), explaining 26.4% of the variation in hot flash frequency. When regressions used all studies but controlled for method of hot flash assessment, average temperature of the coldest month, difference between hottest and coldest temperatures, and mean annual temperature were significant predictors of hot flash frequency. Women reported fewer hot flashes in warmer temperatures, and more hot flashes with increasing seasonality. These results suggest that acclimatization to coldest temperatures or sensitivity to seasonality may explain part of the population variation in hot flash frequency.     

Effect of Season and Light Treatment Upon Hot Flashes in a Perimenopausal SAD Patient

A perimenopausal woman with seasonal affective disorder (SAD, winter depression) presented with a 2-year history of hot flashes occurring only in the wintertime. Prospectively documented hot flashes appeared to follow a seasonal rhythm and a bimodal circadian rhythm. The hot flashes decreased with morning, but not evening, light therapy. These observations are discussed in the context of the literature regarding light's possible role in animal and human reproductive functioning.     

Associations of interleukin-6 with interleukin-1beta, interleukin-8 and macrophage inflammatory protein-1beta in midlife women

Objective: The aim of the present study was to determine the associations of interleukin (IL)-6 with other cytokines and chemokines and to compare these associations in peri- and postmenopausal women. Methods: Ninety-nine perimenopausal and 92 postmenopausal women were enrolled in this study. Serum concentrations of IL-6, IL-1β, IL-2, IL-4, IL-5, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, tumor necrosis factor (TNF)-α, interferon γ, granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage (GM)-CSF, macrophage inflammatory protein (MIP)-1β and monocyte chemotactic protein (MCP)-1 were measured simultaneously using a multiplexed cytokine assay. Results: Among the 17 cytokines, IL-6, IL-1β, IL-5, IL-7, IL-8, IL-10, MCP-1 and MIP-1β were detected in serum in more than 50% of the women. Serum levels of IL-4 and MCP-1 in postmenopausal women were significantly higher than those in perimenopausal women. Serum IL-6 concentrations showed significant and positive correlations with serum concentrations of IL-1β, IL-8, MIP-1β, IL-7 and MCP-1 in women regardless of menopausal status, and these correlations were still significant after adjustment for age and body mass index. Conclusion: Serum IL-6 concentration was found to be closely associated with serum concentrations of IL-1β, IL-8, MIP-1β, IL-7 and MCP-1 in women regardless of menopausal status, suggesting that these cytokines act in concert with the progression of several symptoms and various diseases.     

Distribution and diel vertical migration of the euphausiid Thysanoessa macrura in Gerlache Strait,Antarctica

Thysanoessa macrura was found throughout Gerlache Strait, Antarctica, during four surveys carried out from 30 October to 23 November 1989, with the highest abundance being 332 individuals m^–2 (0–290 m). Reproduction had begun just before the surveys took place, as indicated by the presence of females with attached spermatophores and of larvae. Thirteen-month old females were reproductive. Larvae in 9 depth strata between 0–290 m were dominated by calyptopis stages, and developed from calyptopis 1 to furcilia 1 during November. Larval abundance was not correlated to chlorophyll a concentration, which showed a consistent east-west gradient in Gerlache Strait with highest concentrations (>30 mg chlorophyll a m^–3) in bays of the Antarctic Peninsula. Survival of larvae appeared to not be affected by phytoplankton abundance. Older T. macrura showed strong diel vertical migration between the surface at night and depths to 120 m during mid-day. Larvae were consistently found in the chlorophyll a-rich upper 50 m during night (90%) and day (81%), while adults and juveniles were found in the upper 50m at night (83%), but only 16% remained there during the day.     

Circadian rhythms in hot flashes in natural and surgically-induced menopause

The aim of this study was to investigate circadian and ultradian variations in menopausal hot flash. The number of hot flashes per 2-hr period was collected from 25 diurnally-active, perimenopausal women for 1 week in January or February of each year for 3 consecutive years. Fourteen women were experiencing natural menopause (NM) (mean age 51.9 years) and 11 were experiencing surgically-induced menopause (SIM) (mean age 52.0 years). The difference in the number of hot flashes between the two types of menopause at each clock time was not statistically significant; neither was the mean number of hot flashes per 24 hr different between the two groups (Student's t-test). Data when normalized for each woman and placed end-to-end revealed by cosinor analysis circadian rhythmicity in the SIM group (P = 0.02) but not in the NM group. A 12-hr periodicity was detected in both groups (P less than 0.001 for both). An 8-hr rhythm was detected only for the NM group (P = 0.04). Both groups combined exhibited statistically significant rhythmicities with periods of 24 hr (P = 0.003), 12 hr (P less than 0.001) and 8 hr (P = 0.005). Regardless of the type of menopause, the women could be separated into two groups based on the temporal pattern of hot flashes during the day. One group was defined by the occurrence of peak frequency of flashes during the morning (0400-0959), while the second group was defined by the occurrence of the peak in the evening (1600-2159).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of different ant species on reproductive fitness of Schomburgkia tibicinis (Orchidaceae)

Summary We studied the effect of four ant species on the reproductive fitness (number of fruits produced) of Schomburgkia tibicinis (Orchidaceae), in the coast of Yucatan, Mexico. Ants forage day and night for the nectar produced by the reproductive structures of the orchid. Ant size is: Camponotus planatus (3–4 mm), C. abdominalis (4–6 mm), C. rectangularis (7–9 mm), and Ectatomma tuberculatum (9–12 mm). The results indicate that ant efficiency in disrupting the activities of the main herbivore, (Stethobaris sp./Coleoptera) varies, and that it is apparently related to ant size, three tendencies are clear: (a) lowest fruit production and highest inflorescence damage are significantly associated with the smaller ants and the control; (b) maximum fruit production and minimum inflorescence damage are significantly associated with the larger ant species; and (c) the increase in ant size tends to have a positive effect on the plant's reproductive output (less dead spikes and more matured fruits). We discuss ant effect on the pollination of the orchid, and emphasize that ant presence should not be associated, in general, with benefit to plants.     

Alterations in Adhesion Molecules,Pro-Inflammatory Cytokines and Cell-Derived Microparticles Contribute to Intima-Media Thickness and Symptoms in Postmenopausal Women

Menopause, the cessation of menses, occurs with estrogens decline, low-grade inflammation, and impaired endothelial function, contributing to atherosclerotic risk. Intima-media thickness (IMT) is an early subclinical biomarker of atherosclerosis. Inflammation may have a role on symptoms: hot flashes, anxiety, and depressive mood, which also are related to endothelial dysfunction, increased IMT and cardiovascular risk. In this study we compared several inflammatory markers in early vs. late postmenopausal women and studied the association of IMT and symptoms with these markers in the full sample. In a cross-sectional design including 60 women (53.1±4.4 years old) at early and late postmenopause, we evaluated the expression of CD62L, ICAM-1, PSGL-1, CD11b, CD11c, and IL-8R on PBMC by flow cytometry. Serum soluble ICAM-1, sVCAM-1, sCD62E, sCD62P, CXCL8, IL-1β, IL-6, and TNF-α levels were quantified by ELISA. Plasma levels of microparticles (MPs) were determined by FACS. Finally, carotid intima-media thickness (IMT) was measured by ultrasound. We observed that ICAM-1 expression by lymphocytes and serum sVCAM-1 levels were augmented at late postmenopause. Late postmenopause women with severe hot flashes had increased expression of CD62L and IL-8R on neutrophils. By multivariate analysis, the carotid IMT was strongly associated with membrane-bound TNF-α, CD11b expression, Annexin V⁺ CD3⁺ MPs, LPS-induced NO production, HDL-cholesterol and age. Depressive mood was associated negatively with PSGL-1 and positively with LPS-induced NO. Finally, Log(AMH) levels were associated with carotid IMT, IL-8R expression and time since menopause. IMT and depressive mood were the main clinical features related to vascular inflammation. Aging, hormonal changes and obesity were also related to endothelial dysfunction. These findings provide further evidence for a link between estrogen deficiency and low-grade inflammation in endothelial impairment in mature women.     

Lipid and lipoprotein profile in menopausal transition. Effects of hormones, age and fat distribution.

The behavior of lipoproteins during the menopausal transition and their relationship with sex hormones and body fat distribution is still unclear. Our aim was to evaluate atherogenic IDL, LDL, Lp(a) and antiatherogenic HDL lipoproteins in four groups of women: premenopausal (n = 20), menopausal transition women with menstrual bleeding (n = 31), menopausal transition women with 3 to 6 months amenorrhea (n = 36), and postmenopausal women (n = 30). We also measured their FSH, LH and estradiol levels along with BMI and waist circumference. Menopausal transition and postmenopausal women showed higher values of waist circumference (p < 0.0032), LDL-cholesterol (p < 0.002), IDL-cholesterol (p < 0.002) and apoprotein B (p < 0.0001) than premenopausal women. Total-cholesterol (p < 0.0001), triglycerides (p < 0.004), IDL-cholesterol and Lp(a) were higher in menopausal transition women with amenorrhea and in postmenopausal women in comparison with premenopausal women. After adjustment according to age and waist circumference, multiple regression analysis showed the increase in total-cholesterol and LDL-cholesterol to be linearly associated to menopausal status and estradiol concentration, whereas Lp(a) was only related to menopausal status. Age was found to be an independent variable in relation to apoprotein B concentration changes. The effect of menopausal status on TG levels did not remain in the model when age, waist and BMI were included (beta = 0.05, p = 0.356). HDL-cholesterol levels were the same in all the groups. Menopause, age and the increase in abdominal fat distribution were three independent and significant factors impairing lipoprotein profiles from the beginning of the menopausal transition.     

Soy,Red Clover,and Isoflavones and Breast Cancer: A Systematic Review

Background

Soy and red clover isoflavones are controversial due to purported estrogenic activity and possible effects on breast cancer. We conducted a systematic review of soy and red clover for efficacy in improving menopausal symptoms in women with breast cancer, and for potential impact on risk of breast cancer incidence or recurrence.

Methods

We searched MEDLINE, Embase, the Cochrane Library, and AMED from inception to March 2013 for human interventional or observational data pertaining to the safety and efficacy of soy and red clover isoflavones in patients with or at risk of breast cancer.

Results

Of 4179 records, we included a total of 131 articles: 40 RCTs, 11 uncontrolled trials, and 80 observational studies. Five RCTs reported on the efficacy of soy for hot flashes, showing no significant reductions in hot flashes compared to placebo. There is lack of evidence showing harm from use of soy with respect to risk of breast cancer or recurrence, based on long term observational data. Soy intake consistent with that of a traditional Japanese diet (2-3 servings daily, containing 25-50mg isoflavones) may be protective against breast cancer and recurrence. Human trials show that soy does not increase circulating estradiol or affect estrogen-responsive target tissues. Prospective data of soy use in women taking tamoxifen does not indicate increased risk of recurrence. Evidence on red clover is limited, however existing studies suggest that it may not possess breast cancer-promoting effects.

Conclusion

Soy consumption may be associated with reduced risk of breast cancer incidence, recurrence, and mortality. Soy does not have estrogenic effects in humans. Soy intake consistent with a traditional Japanese diet appears safe for breast cancer survivors. While there is no clear evidence of harm, better evidence confirming safety is required before use of high dose (≥100mg) isoflavones can be recommended for breast cancer patients.     

Reproduction of the calanoid copepod Calanus propinquus in the southern Weddell Sea,Antarctica: observations in laboratory

Reproduction of the dominant Antarctic copepod Calanus propinquus was studied in February–April, 1989 aboard the R.V Dmitry Mendeleev during cruise N° 43 to the Weddell Sea. Single females were kept at 0 °C in the laboratory for 56 days with abundant food concentration (above 300 µg C l^–1 of Platymonas viridis). Females released clutches at night at 2–3 day intervals. Most clutches contained from 10 to 40 eggs, mean 37.3 eggs female^–1. Average carbon content of an egg was 0.37 ± 0.05 µg C. The maximum daily egg production rate of 30–50 eggs female^–1 d^–1 was observed for the first 3 days of the laboratory incubation, corresponding to 3.7–6.2% body C. The state of gonadal development of females showed the decline of the reproductive season in late February. The data suggest that egg laying in the region under study starts in December and lasts until March. The state of ovarian maturation, changes in vertical distribution and biochemical body composition of females suggest the possibility of two-year life cycle in C. propinquus in the southern Weddell Sea.