Update on the KEEPS trial, vitamin D & mental health, and what I’m reading

October midlife roundup

Welcome to the first Midlife Round Up. The beginning of every month I’m highlighting one or more of the following: the latest midlife news, interesting studies, something I’m doing, pertinent articles, and products that have caught my eye.

Let me know what you think by leaving a comment or replying to this email.

The Menopause Society Conference

If you haven’t heard, the North American Menopause Society changed their name to the Menopause Society. And the Menopause Society just had their annual conference this past weekend.

A couple of not-yet-published studies presented there caught my eye. First is a continuation of the KEEPS trial. This is a randomized control trial comparing oral estrogen to transdermal estradiol in healthy midlife women within three years of menopause. Both groups are taking micronized progesterone.

According to reports from the conference, there were no significant differences in cognitive abilities in those taking hormones and not for up to 10 years. This is helpful, as some studies show a benefit with hormone therapy and others a detriment. Hopefully, this will be a sign to researchers that we need to look at other factors in helping midlife women. I have some ideas if any researchers are reading this ; )

Another study I first heard about from Hot Flash Inc’s Instagram account is about effectiveness of hormone therapy in women with a BMI >30. The five-year study examined the health records of 119 women and divided them into groups depending on BMI. Those with a BMI greater than 30 were less likely to get symptomatic relief from hormone therapy.

Some reasons for this include the fact that higher levels of estrogen in this group. According to a pooled analysis with eight studies, women with a BMI >30 had 83% higher levels of estradiol and 60% higher levels of estrone. Perhaps giving more estrogen is not always the answer. And I also wonder if vitamin D plays a role as this group also had more dark-skinned subjects. Vitamin D has been found to effect menopausal symptoms.

This was the first study to look at this relationship, which is quite surprising. It’s also just a pilot study and has not been peer-reviewed so no major conclusions can be drawn.

Vitamin D and suicide prevention

With September being suicide prevention month, I took a quick dive into vitamin D’s role.

According to the CDC suicide rates have increased 33% from 2001 to 2018, followed by a slight two-year decline only to ramp back up in 2021. One of those groups on the rise is white midlife women.

Emerging research reveals vitamin D not only plays a role in psychiatric disorders but also in suicide attempts.

Researchers speculate that low vitamin D may increase depression and suicide risk via neuroinflammation. For instance, a meta-analysis showed that suicidal patients have higher IL-6 and IL-B, two inflammatory markers. Studies also show a relationship between neuroinflammation and the intensity of suicidal ideation in psychiatric patients. 

Vitamin D has strong immunomodulatory effects that help to mitigate inflammatory responses. So, when vitamin D dips too low, it can increase pro-inflammatory cytokines. 

Most intriguing was a study this year with US Veterans. Researchers collected medical data from 2010 to 2018, grouping more than half a million veterans into those who were supplemented with vitamin D and those who weren’t.

The vitamin D supplementers had a 45% lower risk of suicide attempts. Blacks and veterans with vitamin D levels <19ng/ml had a 64% reduced risk. Higher dosages also resulted in greater risk reduction than lower doses.

None of this means vitamin D causes depression or suicide but it could play a role. Yet we still do not have universal screening for vitamin D, even in those with mental health issues. So, we need to advocate for ourselves and our loved ones and ensure that we get tested for vitamin D

As this review points out, vitamin D is important to midlife women and may also contribute to certain symptoms and health conditions.

Articles, podcasts & more

A couple of posts caught my eye. First is this one from Alana Kirk from Your Midlife Matters Substack: What are your midlife friction points? In it she describes all those friction points that “…can  drain so much unnecessary time and energy from your day, your relationships and your enjoyment of life.”

I’ve got a few of these.

She writes about how we can either tolerate or tackle these friction points. When we tolerate them, we often suffer more as it steals our energy. Tackling them takes courage, but it often is as bad as we think it will be.

It also surprised me to see Peter Attia discussing probiotics and vaginal health in The potential of probiotics in promoting female health. He provides a nice summary of the importance of maintaining healthy bacteria throughout the lifecycle including menopause:

Several studies have investigated the effects of lactobacilli-containing supplements, administered either orally or as vaginal suppositories, on the vaginal microbiome in adult women. The majority of these trials have observed a significant increase in the levels of vaginal lactobacilli following supplementation.

Although he focuses on bacterial vaginosis (BV) and not UTIs which come more common as women age, it’s nice to see this being talked about!

I think individual testing will be key since we all have our own, unique bacteria. Companies like Evvy are already doing it even if the science isn’t quite there.

Last is an episode I listened to on the Hotflash Inc Podcast with Paula Rastrick, a psychotherapist who was prescribed too high levels of estrogen in the UK and it really messed with her.

Why Paula Rastrick wants you to go low and slow on HRT

She is also a trauma survivor and discusses the research on trauma and how it’s neglected in the menopause world. I kept saying “yes, yes…” listening to her talk. She says the menopause focus is too narrow, and we need to consider research in other disciplines. I couldn’t agree more.

If you’re at the point you want to consider hormone therapy, Menopause Chicks has a mastering menopause class that is really helpful.

Well, that’s it for now. I hope you have a great week!