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Deborah Grady, MD,
MPH is Professor of Medicine, Associate Dean for Clinical and Translational
Research and Director of the UCSF Women's Health Clinical Research Center.
Dr. Grady is an international expert on menopause and the risks and benefits
of postmenopausal hormone therapy. Dr. Grady has trained and mentored
over 40 young researchers interested in women's health and received the
Chancellor's Award for the Advancement of Women and the UCSF Mentor of
the Year award.
415-353-9748; Deborah.Grady@ucsf.edu
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Postmenopausal Hormone Therapy
Postmenopausal hormone therapy is used by millions of women around the world.
Hormone therapy is very effective for treatment of menopausal symptoms and affects
the risk for several diseases including breast and uterine cancer, fractures,
coronary disease, stroke, blood clots, dementia and diabetes. Dr. Grady has
been a leader in studying these potential effects and helping clinicians and
women weigh the risks and benefits.
- Cardiovascular disease. . With colleagues at UCSF, Dr. Grady designed
and conducted the Heart and Estrogen/progestin Replacement Study (HERS), a
clinical trial of 2800 women with known coronary disease. The main results
of this study showed no reduction in risk of heart attack or stroke among
the women who took hormones for 4 years. Subsequently, another large clinical
trial, the Women's Health Initiative (WHI) confirmed that hormones do not
reduce risk of coronary heart disease.
- Breast Cancer.. Dr. Grady was one of the first researchers to combine
the results of multiple studies to show that risk for breast cancer was not
increased among women who took postmenopausal hormone therapy for only a few
years, but was increased about 30% with 5 or more years of use. Several similar
systematic reviews of the medical literature have found the same result, and
the recent large WHI randomized trial confirmed a 30% increased risk of breast
cancer with 5 years of use of estrogen plus progestin.
- Endometrial cancer. Dr. Grady was the first to show that the increased
risk of endometrial cancer was related to the dose and duration of use of
estrogen and could be prevented by adding a progestin.
- Cognitive function and dementia. With colleagues at UCSF, Dr. Grady
conducted a systematic review of previous studies that suggested that hormone
therapy does not improve memory except in women who are suffering from hot
flushes and associated trouble sleeping. In the HERS trial, hormone therapy
had no effect on memory or overall quality of life in women without menopausal
symptoms.
- Blood clots. The HERS trial was the first clinical trial to show
that hormone therapy increases the risk of blood clots in the legs and in
the lungs about 2 to 3-fold. Many other studies have since confirmed this
risk associated with hormone therapy.
Menopause
About 2/3 of women suffer from hot flashes and other symptoms at menopause,
and about 20% seek medical treatment. Postmenopausal hormone therapy is effective
for treatment of hot flashes, but increases the risk of breast cancer, stroke,
and dementia.
Dr. Grady is currently working with colleagues to:
Help understand the
cause of hot flashes. The vasodilation and sweating that occur during a
hot flash appear to occur because the brain senses that body temperature is
too hot, even though the environment is not hot. Dr. Grady is working with physiologists
interested in how the body controls heat to try to better understand how and
why hot flashes occur.
Develop a miniature,
wireless hot flash monitor. Researchers generally ask women to keep a diary
of when hot flashes occur and to rate how severe they are. This is not a very
good measurement, as it is difficult to keep a diary accurately, especially
during sleep. To provide a more objective and accurate measure of the frequency
of hot flashes and their severity, Dr. Grady is working with engineers to develop
a miniature, wireless monitor that will automatically record hot flashes for
up to 7 days.
Develop and test
treatments for hot flashes including:
- Behavioral treatments such as Yoga. Many women report that Yoga is
helpful for hot flashes, but it has not been carefully studied. Yoga
would be a very good treatment for hot flashes because it carries no
risk and is helpful for other conditions.
- New forms of estrogen such as estrogen receptor-beta selective estrogens.
Estrogens remain the most effective treatment for hot flashes. Currently
available estrogens bind to both estrogen receptors - alpha and beta.
Many experts believe that it is the estrogen receptor alpha pathway
that causes most of the risks associated with estrogen therapy. Thus,
if we could develop an estrogen that affects only the beta pathway,
we might be able to treat hot flashes without some of the risks associated
with currently used estrogens.
- Herbal treatments such as Chinese herbs. Herbs have been used to treat
menopausal symptoms for thousands of years in Traditional Chinese Medicine.
Dr. Grady is working with colleagues to study the effectiveness and
safety of these traditional therapies.
- Marketed drugs that might be effective for hot flashes. Some drugs
that are already marketed for treatment of other conditions (such as
depression, pain, and high blood pressure) may also be useful for treatment
of hot flashes.
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