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Raloxifene fails to slow cognitive decline in older women
SCIENCE AND MEDICINE
Contraceptives do not protect against pelvic inflammatory disease PID symptoms (Epidemiology 2001; Participants—most of whom were 12: 307–12). black and aged 24 years or younger— “We’re looking at what is likely to were interviewed about recent conbe the result of a comtraceptive use and had plex set of behaviours”, endometrial biopsy and says Ness. “Women upper genital tract Rights were not whose partners are isolate evaluation. granted to using condoms may be Condoms were include this the group of women the most common conimage in who are engaged in traceptive method used, more risky sexual followed by oral contraelectronic behaviours to start ceptives, medroxypromedia. Please with. It may sound gesterone, and other refer to the counterintuitive, but for barrier methods, the women involved in team found. Inconprinted journal. long-term monogasistent condom use in mous relationships the 4 weeks before commonly there is a enrolment was associ- Consistent use is essential sense of mutual protecated with a greater than tion. So women who are not in that two-fold increased risk of kind of relationship may be using upper genital tract infecUS task force urges preventive screening condoms, and when they don’t use tion compared with no for chlamydia them consistently, that definitely condom use; infection As part of regular health visits, primary care increases risk.” rates were not affected by physicians should screen for chlamydia all sexually Since the study results suggest that medroxyprogesterone or active women aged 25 years and younger, as well consistent condom use may decrease oral contraceptives. as older women at risk of infection. That is the PID risk, physicians should emphaEndometriosis without “strong” recommendation of the third US sise “correct and consistent use”, upper genital tract infecPreventive Services Task Force, which placed urges Ness. “If the physician takes tion was related to the use chlamydia screening among its top recomthe extra minute to really educate the of contraceptive injections mendations in a report released April 17 woman—not just hand her the conin women with symptoms (www.ahrq.gov/clinic/uspstf/uspschlm.htm). dom or prescription and say ‘go to of PID. A slight decrease Routine chlamydia screening is also recommended the pharmacy’—that’s a very imporin risk was conferred for all symptomless pregnant women aged 25 tant intervention. It sounds obvious, by consistent (100%) years and younger and for other pregnant women at but obviously it is not being done.” condom use, whereas oral risk of infection. No recommendation is made for contraceptive use was symptomless women at low risk. associated with less severe Marilynn Larkin
o barrier or hormonal contraceptive method protects women against pelvic inflammatory disease (PID), report US researchers this week. “It’s a bit of a sobering message”, concedes lead author Roberta Ness (University of Pittsburgh, PA, USA). “There’s been the hope for a long time that consistent condom use would reduce the risk of PID, and our data suggest this might be the case. But the story with condom use is much more complicated in real life than in well-controlled efficacy trials.” Ness and co-workers studied the contraceptive use of 563 women with symptoms in the PID Evaluation and Clinical Health (PEACH) study.
Science Photo Library
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Raloxifene fails to slow cognitive decline in older women
R
aloxifene, which is known to have oestrogen agonist activity on bone, does not have a significant effect on cognitive function in postmenopausal women, according to new research from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial. Kristine Yaffe of the University of California (San Francisco, CA, USA) and co-workers assessed 7487 postmenopausal women who had either taken raloxifene (60 mg or 120 mg a day) or placebo. The team found that after 3 years of treatment there were no significant differences in the cognitive scores of the three groups of women, although there was a trend toward a smaller decline in verbal memory and attention scores among women on raloxifene, (New Engl J Med 2001; 344: 1207–13) However, other studies have shown that raloxifene, a selective oestrogen-receptor modulator, red-
1270
uces the risk of fractures due to osteoporosis in postmenopausal women, and can cross the blood brain barrier where it is believed to have oestrogen-like effects on the central nervous system. This suggests that raloxifene might be able to improve or preserve cognitive function without exposing postmenopausal women to the risks associated with oestrogen therapy, such as breast and endometrial cancer. Also, a number of studies have raised hopes that oestrogen, or some oestrogen-like compounds, may be able to improve cognitive function in older women—significant numbers of oestrogen receptors have been found in areas of the brain crucial to memory and learning, and in animal and cell studies oestrogen has been shown to stimulate neuronal growth and formation of synapses. In some observational studies oestrogenreplacement therapy has appeared
to preserve, even enhance, the cognitive abilities of postmenopausal women. In an accompanying editorial, Richard Mayeux (Columbia University of Physicians and Surgeons, NY, USA) says that the disappointing results of the MORE trial may be because raloxifene is not stimulating the appropriate oestrogen receptors in the brain, or possibly because 3 years of study is not sufficient to detect an effect. Although the results of this study as well as the mixed results of some other trials looking at the cognitive effects of oestrogen replacement are “discouraging”, Mayeux writes. “It would be premature to conclude that the use of oestrogen-replacement therapy or selective oestrogen-receptor modulators has no role in preserving cognitive function.” Michael McCarthy
THE LANCET • Vol 357 • April 21, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Contraceptives do not protect against pelvic inflammatory disease PID symptoms (Epidemiology 2001; Participants—most of whom were 12: 307–12). black and aged 24 years or younger— “We’re looking at what is likely to were interviewed about recent conbe the result of a comtraceptive use and had plex set of behaviours”, endometrial biopsy and says Ness. “Women upper genital tract Rights were not whose partners are isolate evaluation. granted to using condoms may be Condoms were include this the group of women the most common conimage in who are engaged in traceptive method used, more risky sexual followed by oral contraelectronic behaviours to start ceptives, medroxypromedia. Please with. It may sound gesterone, and other refer to the counterintuitive, but for barrier methods, the women involved in team found. Inconprinted journal. long-term monogasistent condom use in mous relationships the 4 weeks before commonly there is a enrolment was associ- Consistent use is essential sense of mutual protecated with a greater than tion. So women who are not in that two-fold increased risk of kind of relationship may be using upper genital tract infecUS task force urges preventive screening condoms, and when they don’t use tion compared with no for chlamydia them consistently, that definitely condom use; infection As part of regular health visits, primary care increases risk.” rates were not affected by physicians should screen for chlamydia all sexually Since the study results suggest that medroxyprogesterone or active women aged 25 years and younger, as well consistent condom use may decrease oral contraceptives. as older women at risk of infection. That is the PID risk, physicians should emphaEndometriosis without “strong” recommendation of the third US sise “correct and consistent use”, upper genital tract infecPreventive Services Task Force, which placed urges Ness. “If the physician takes tion was related to the use chlamydia screening among its top recomthe extra minute to really educate the of contraceptive injections mendations in a report released April 17 woman—not just hand her the conin women with symptoms (www.ahrq.gov/clinic/uspstf/uspschlm.htm). dom or prescription and say ‘go to of PID. A slight decrease Routine chlamydia screening is also recommended the pharmacy’—that’s a very imporin risk was conferred for all symptomless pregnant women aged 25 tant intervention. It sounds obvious, by consistent (100%) years and younger and for other pregnant women at but obviously it is not being done.” condom use, whereas oral risk of infection. No recommendation is made for contraceptive use was symptomless women at low risk. associated with less severe Marilynn Larkin
o barrier or hormonal contraceptive method protects women against pelvic inflammatory disease (PID), report US researchers this week. “It’s a bit of a sobering message”, concedes lead author Roberta Ness (University of Pittsburgh, PA, USA). “There’s been the hope for a long time that consistent condom use would reduce the risk of PID, and our data suggest this might be the case. But the story with condom use is much more complicated in real life than in well-controlled efficacy trials.” Ness and co-workers studied the contraceptive use of 563 women with symptoms in the PID Evaluation and Clinical Health (PEACH) study.
Science Photo Library
N
Raloxifene fails to slow cognitive decline in older women
R
aloxifene, which is known to have oestrogen agonist activity on bone, does not have a significant effect on cognitive function in postmenopausal women, according to new research from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial. Kristine Yaffe of the University of California (San Francisco, CA, USA) and co-workers assessed 7487 postmenopausal women who had either taken raloxifene (60 mg or 120 mg a day) or placebo. The team found that after 3 years of treatment there were no significant differences in the cognitive scores of the three groups of women, although there was a trend toward a smaller decline in verbal memory and attention scores among women on raloxifene, (New Engl J Med 2001; 344: 1207–13) However, other studies have shown that raloxifene, a selective oestrogen-receptor modulator, red-
1270
uces the risk of fractures due to osteoporosis in postmenopausal women, and can cross the blood brain barrier where it is believed to have oestrogen-like effects on the central nervous system. This suggests that raloxifene might be able to improve or preserve cognitive function without exposing postmenopausal women to the risks associated with oestrogen therapy, such as breast and endometrial cancer. Also, a number of studies have raised hopes that oestrogen, or some oestrogen-like compounds, may be able to improve cognitive function in older women—significant numbers of oestrogen receptors have been found in areas of the brain crucial to memory and learning, and in animal and cell studies oestrogen has been shown to stimulate neuronal growth and formation of synapses. In some observational studies oestrogenreplacement therapy has appeared
to preserve, even enhance, the cognitive abilities of postmenopausal women. In an accompanying editorial, Richard Mayeux (Columbia University of Physicians and Surgeons, NY, USA) says that the disappointing results of the MORE trial may be because raloxifene is not stimulating the appropriate oestrogen receptors in the brain, or possibly because 3 years of study is not sufficient to detect an effect. Although the results of this study as well as the mixed results of some other trials looking at the cognitive effects of oestrogen replacement are “discouraging”, Mayeux writes. “It would be premature to conclude that the use of oestrogen-replacement therapy or selective oestrogen-receptor modulators has no role in preserving cognitive function.” Michael McCarthy
THE LANCET • Vol 357 • April 21, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.