March 2018 Health Bulletin

We have been tardy in updating you on activities of the Women’s Health Research Program and what’s new in women’s health as the team has been frantically writing research funding applications through January and February. This seems a lot of time spent looking for money to undertake research. But our time spent is consistent with the findings of a study that estimated over 500 years of Australian researchers’ time went into one single research application funding round in 20141. Considering that success rates are often between 10-20%, this is an exceptionally poor use of academic time. Nonetheless the grants are in and we are back on deck and sharing our research findings.

The Women’s Health Research Program predominantly undertakes studies addressing hormone action, depletion and replacement in women. In line with this we conducted an exhaustive review of all publications that have studied the use of testosterone as an alternative to estrogen in treating vaginal dryness and painful intercourse in well women, and in women with invasive breast cancer taking an aromatase inhibitor as part of their treatment plan 2.

We identified 6 clinical trials, 3 in well women and 3 in women who had a past diagnosis of breast cancer. Although there was a suggestion of intra-vaginal testosterone being beneficial, four of the six studies lacked a placebo group and in only one study were patients unaware if they were getting testosterone or an alternative/placebo. Some of the studies used very high dose testosterone and safety data were limited. We concluded that the information available suggests testosterone might prove to be effective and safe for the treatment of vaginal symptoms after menopause but more research is needed.

Following on from this, we have been funded by the National Breast Cancer Foundation to undertake a robust study of the effectiveness and safety of intra-vaginal testosterone therapy for women with invasive breast cancer, taking an aromatase inhibitor, who have vaginal symptoms – dryness, itching and/or painful intercourse. Our study has been completed and the data analysed. We will be presenting the complete study findings at the World Congress on the Menopause in Vancouver in early June this year.

In a separate study, we have examined whether women who are being treated for breast cancer with an aromatase inhibitor are more likely to experience gynaecological issues3. This was a prospective, observational, community-based cohort study of Australian women with invasive breast cancer recruited within 12 months of diagnosis in the Bupa Health Foundation Health and Wellbeing after Breast Cancer Study (Bupa Study). The research was published in the Journal of Sexual Medicine in late 2017.

1,053 of the 1,305 who completed the initial 5 years of Bupa Study follow-up agreed to be re-contacted, and 992 of these women alive 10 years after diagnosis were sent the study questionnaire. The main findings were that women taking an aromatase inhibitor were significantly more likely to experience low sexual desire associated with distress than women with breast cancer not taking an aromatase inhibitor (55% versus non-users 38%). The women not taking an aromatase inhibitor had a similar prevalence of sexual problems to  that reported by our team for women in the general community4.  Women taking an aromatase inhibitor were also more likely to have fecal incontinence than other women with breast cancer (30% versus 16% of non-users). This is the first study to suggest that the profound estrogen depletion achieved with an aromatase inhibitor adversely effects bowel function.

The findings from this study reinforce the need for women being treated for breast cancer to discuss any sexual symptoms or pelvic floor symptoms with their doctor as their symptoms may be associated with their treatment.

References

  1. Herbert DL, Barnett AG, Clarke P, Graves N. On the time spent preparing grant proposals: an observational study of Australian researchers. BMJ Open. 2013;3(5).
  2. Bell RJ, Rizvi F, Islam MR, Davis SR. A systematic review of intra-vaginal testosterone for the treatment of vulvo-vaginal atrophy. Menopause. 2018;in press.
  3. Robinson PJ, Bell RJ, Christakis MK, Ivezic SR, Davis SR. Aromatase inhibitors are associated with low sexual desire causing distress and fecal incontinence in women, an observational study. J Sex Med. 2017;in press.
  4. Worsley R, Bell RJ, Gartoulla P, Davis SR. Prevalence and predictors of low sexual desire, sexually-related personal distress and hypoactive sexual desire dysfunction in a community based sample of midlife women. J Sex Med. 2017;in press.



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