Question for the ladies re hep c and menopause

[wed1942]

I was just diagnosed with Hep C in Nov 2007. My liver functions were elevated slightly in 2006. I was blaming it on some meds I had started taking maybe two years prior to that for my heart but when my doc saw that my liver functions had quadrupled from 2006 to 2007, he had me go to a GI doc and that's when we discovered the Hep C. What I'm wondering, is if anyone has noticed that the virus seemed to have become more active when they went through menopause. That's the only other thing that has happened in the last few years that is a change. I'm thinking I was exposed to the virus way back in 1969 through blood transfusions that I had or maybe a needle stick I had on the job in 1997. I'm a nurse. That seems unlikely though because it was more of a scratch than an actual stick although it did draw blood. Back then they only checked us for Hep B, not C, if we had a stick and that was negative on me and the patient. (I had the Hep B vaccine back in 1991). All of my labs have been normal up until 2006, when my SGOT and SGPT were only slightly above normal. Of course, I had never been tested for Hep C and all of the other things I've had checked now. My Iron level and ammonia level are both elevated as well as the alphafetoprotein, tumor marker. I'm a Genotype 1 and stage 3-4. I'm just really wondering why all of a sudden all of this seems to have been stirred up after almost 40 yrs of nothing. Could it be the menopause? And if so, wonder if taking hormones would slow things back down. I don't take anything I don't have to take. Only those two heart meds. I'm 55 now, soon to be 56. Will be talking to the hepatologist about treatment plans probably in two weeks. Have an endoscopy scheduled this Tuesday. Thanks for your input ahead of time.

[BoceprevirGal]

Hi Will~ Yeah, I remember reading that article, back when I was struggling with all these hot flashes, and started rersearching Hep C and estrogen replacement. I ended upcompromising, by using a cream, that you rub in.
   But when I brought the estrogen cream up with my Hepa Doctor, she snapped something about estrogen causing "heart problems". I suppose, because some of these meds already put a strain on us older folks' hearts, etc.
   I havent had the nerve, to look up "Interferon", to read all the warnings and side-effects, because I'm kind of afraid it would freak me out (like when I read the warnings about Procrit), so I hadn't checked, to see if I could "mix" my "Estrace" cream, with the now four meds I'm on~

[BoceprevirGal]

Yes, and my mother fought and survived breast cancer, at my age, as well.

[jules2551]

I had non-hodgkin lymphoma about 20 yrs ago.  And the one thing my Dr told me was to never take hormones.  Even though the studies were just coming out then they were more concerned with breast cancer.  So in my mind I didn't want another cancer.  

[willbb]

Hey Dee  :)

[willbb]

Yes ..there certainly is heaps of study data that says women who may be prone to cancer (ie, a past cancer,family history etc. that HR may exacerbate the incidence.)

I was just copying above how it seems  by studies done that there is evidence that pre -menstrual and  post menstrual women who are low on estrogen that do estrogen re-placement seem to have lower incidence of progressive fibrosis.

With cancer prevalence today ..it would sure seem like a tricky balancing act.  

It would seem that the doctors ..especially ones treating women with HCV and post menstrual need to  really know there stuff..

best..
Will

[Dee1956]

Your input is appreciated, as always
Cheers!

[jules2551]

Will the whole reason I never took hormones because there were various studies out about cancer and estrogen replacement therapy.  So I thought I was doing myself a favor

Jules

[willbb]

Well, it's a good think you never took "the hormones" then, because they are contraindicated for liver problems, so my Doctor wouldn't even give them to me.
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While it is a fact that when the balance of Estogen,  Progesteon and Testosterone are not properly balanced this can lead to increased problems as it pertains to progression of fibrosis for post menopausal women (as the studies I copied above state)

however perhaps you missed this portion of the recommendations upon review of these studies?? (below)
-------------------------------------------------

Best..
Will


The researchers surmise that estrogen may have a protective benefit for younger women with HCV. They recommend the use of estrogen replacement therapy for menopausal women.

[BoceprevirGal]

Well, it's a good think you never took "the hormones" then, because they are contraindicated for liver problems, so my Doctor wouldn't even give them to me.
   But that must've been a shock, to have just found out, last year, that you have it. I remember when I discovered I had it:  I became pregnant, with my second child, at age 29 years, and they ran the test. I remember coming out of the Doctors office, feeling shocked, but glad that I didn't have HIV.
    I had always read that symptoms usually take around 20 yrs, to surface, and mine did start, after 20 yrs went by, almost exactly~

[jules2551]

Wow this is really interesting stuff.  I went through menopause early around 45.  And a couple years later I developed the PCT skin conditions.  This was probably my first sign of Hep C.  Dermatologist didn't catch it and never ran blood tests.  Just gave me steroids and the PCT stopped.  Then last year I went to get my cholesteral checked and low and behold I had Hep C.  I have been to Drs throughout the years and my liver enzymes were never elevated before.  And I've probably had Hep C for 30 years and I am g2/s3.  And I never took hormones

[BoceprevirGal]

  My ALT/AST went from it's typically high elevation (from over the last 20 yrs) of twice as elevated as normal range, while still having my period, to a walloping ALT/AST of 400/500 once the ol monthly "friend" was gone.
    So many of my Hep C symptoms seemed like sever "heat" symptoms...continual, sweaty hot-flashes, accompanyed by extreme mentla irritbility: almost unbearable!
   Then, around 7 months ago, I found out my platelets dropped, from 157, to 120....yikes, I went running to get my biopsy, at age 49 yrs, tefrified! It was a stage 2 fibrosis, but low platelets are a bad sign, so I went into treatment, in Feb 2012.
   Now, I wish I had gotten that biopsy, in 2008, thatmy Gastro Doc ordered, but I thought I was "too busy"  : (  I always recommend everybody get a biopsy now~

[willbb]

The data is well known but more studies need to be done in this area to flush out the full scope of the issue.

Yes, menopause plays a significant role in determining the progression of fibrosis along with response to treatment.

Yes, women typical don't progressive to fibrosis and cirrhosis as men do.


Some notes of studies below expound on these issues:
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Article From HCV Advocate From 2009 December 2009 HCV Advocate

http://hepatitiscnewdrugs.blogspot.com/2010/10/women-treating-and-living-with.html

HEALTWISE: Hepatitis C Update
Lucinda K. Porter, RN

"In the first study, Hepatitis C and Menopause:

Interplay of Age, Gender, HCV Replication and Activity in Progression and Consequence for Therapy, Trépo, Bailly, Moreno, Lemmers, Adler, and Pradat investigate the differences in fibrosis progression among HCV patients. Previous studies revealed the possibility that estrogen may have anti-fibrogenic effects, so researchers specifically looked at fibrosis development in the light of gender, age, and menopause.

They looked at 163 enrollees, ages 23 to 84 years with a mean age of 55; 56% were male. Slightly more than half (55%) had progression of fibrosis, measured by a METAVIR fibrosis score of at least F3. Overall, males had higher progression rates at 66% versus 41% for women. However, for those under the age of 50, fibrosis progression was 51% for males versus 11% for females. Over age 50, the rate jumps to 77% for males versus 61% for females.

These data show a strong relationship between gender and fibrosis progression. The researchers surmise that estrogen may have a protective benefit for younger women with HCV. They recommend the use of estrogen replacement therapy for menopausal women.

Another interesting discovery appeared in this study. In general, viral loads dropped with age except in the group of post-menopausal women. There was no explanation for this.

The second study examined similar issues. Early Loss of Exposure to Estrogens is Critical in Determining Entity of Fibrosis and Response to IFN in Women with Hepatitis C is the title of a poster presented by Karampatou, Pazienza, Lei, Di Leo, Francavilla, and Villa. After observing that post-menopausal women with HCV had increased progression of fibrosis, these researchers wondered whether the correlation was due to aging and/or longer durations of infection or to menopause.

They analyzed data from 945 HCV-treatment patients of evenly-distributed genotype—541 men and 404 women. In the female group, 252 were menopausal. Most of these were spontaneously menopausal although 50 were surgical. Body weight was lower in pre-menopausal women; however histological steatosis (fatty liver) was not significantly different between the two groups.

Pre-menopausal women had the highest response to HCV-therapy. The sustained virologic response (SVR) was 63% versus 51% of males and post-menopausal women. In short, post-menopausal women responded similarly to treatment as men did.

The researchers concluded that menopause plays a significant role in determining the progression of fibrosis along with response to treatment. Estrogens have a powerful role in the regulation of inflammation and immunity. They recommended that interferon-based therapy be initiated at the youngest possible age, preferably prior to menopause."
----------------------------------------------------------------------------------------------------------------
"HCV Progression & Symptoms in Women

Various studies have shown that hepatitis C progression is slower and liver damage tends to be less severe in women than in men. For one thing, it appears that women are more likely to completely clear HCV from their bodies after infection and never develop chronic disease. It is usually estimated that 80-85% of all people infected with HCV will go on to develop chronic hepatitis C, but the rate is lower for women. A German study of 1,018 young women infected with HCV in 1978-9 through contaminated immunoglobulin transfusions found that after 20 years, about 45% had cleared the virus. Researchers do not know why the HCV clearance rate is higher in women than men.

Women who do have chronic hepatitis C (that is, they still have HCV after six months) tend not to develop liver cirrhosis (scarring), liver cancer, or liver failure as rapidly as men. For all people with chronic HCV, disease progression is usually slow. A majority of people with chronic hepatitis C never develop serious liver damage. Among those who do, the process usually takes years or even decades; the usual estimate is 10-40 years, and may be longer for women. In the German study, only four of the 1,018 women had developed cirrhosis after 20 years. Some experts believe that the female hormone estrogen protects women from liver damage; if this is the case, the protective effect may diminish after menopause, as women’s bodies produce less of the hormone.

Many people with HCV have no symptoms and lead normal lives. Those who do develop symptoms may experience prolonged fatigue (tiredness), fever, headache, loss of appetite, nausea, pain in the abdomen, or pain in the muscles or joints. The types of symptoms are similar in women and men, but women may develop symptoms later or may experience more mild effects.

Several autoimmune conditions, in which the immune system attacks the body’s own tissue, are associated with HCV (for example, cryoglobulinemia, glomerulonephritis, and Sjogren’s syndrome). Because women in general are much more likely than men to have autoimmune conditions, it is not surprising that women with HCV seem to be at greater risk than HCV-infected men for developing these conditions. However, according to Norah Terrault, MD, MPH, of the University of California at San Francisco Division of Gastroenterology, while women with HCV may be more predisposed than men to autoimmune conditions, this does not necessarily mean that these conditions are directly associated with HCV; women may simply be more likely to have co-existing autoimmune conditions that may not be caused by HCV. More study is needed in this area."

[Dee1956]

Hi I know, old post, I have read same thing, as our estrogen drops the protectiveness that we had with it is gone and we get worse.

[Idyllic]

This is a somewhat dated link however it does point me in the right direct to do a little research of my own so I am glad it has been brought back from the dead. Er...maybe "resuscitated" is a better word :)

[mehepc]

Yes- its because we lose our Estogen - which protects the liver and balances our hormones and metabolism. I am going to Sono Bello to get work done- doctor approved because I've gained like 10 lbs a year since I went into menopause. So I'm considered Obese and now I also have high Cholesterol, aargh ! I was completely active all my life then a few car accidents and menopause, routine Life Ins. exam liver enzymes are high- and find out i have Hep C from blood transfusion 23 years ago. Now I am a ( geno 2b ) so started right away on Swansons milk thistle and Liv A.  my alt and ast were around 500 in 6 months they are below 80. Yeah ! Next month sono bello then June I start treatment. A bit concerned because I have Asthma, dont like needles and hate the flu. I have a friend though who went through this and is like 100% better ! I think I may have Insulin resistence but not sure- just want to get this out of my system. Best of luck for all of you.

[wed1942]

I'm also going to talk to my GYN. He actually cowrote a book on menopause so probably would be interested in this. And he is someone who would definitely care enough to find answers for me. Will be interesting to see what they both say. I'll let you know.

[Forseegood]

what I really hate about some docs is that thing they do - if they don't know about something beforehand, they tell you straight off it isn't true, just because they don't know about it...that will sometimes happen too...

hopefully, he has an open mind and won't do this...there are so many things about this disease that the experts themselves are just finding out, or they are just working with preliminary findings....

[Forseegood]

sorry to sound this way, but don't be surprised if he doesn't know beans about these studies...often docs don't have the time or the inclination to look at all these varying studies, though they should...they should pay someone to do it if they can't...

but we're not in perfect world...if I were you, I don't know how well you can research...but there are a few studies like this out there...I'd print them out and take them to him...and just to be on a safe side, give them to him in the nicest way possible...many of these guys have egos the size of spaceships, and they hate it when patients know more then they do about these things, they are very in to "keeping the facade or all knowing, all seeing" lol....not all of them but many...Some try to be good docs and they are grateful if you call things to their attention....try to hand them to him in the nicest way possible. For all you know, he might even know about them, which would be points for him.....

[wed1942]

Wow, interesting. I'm going to mention the fact that I have just gone through menopause over the last few years to me hepatologist and see what he says. Wonder if taking replacement hormone therapy would once again slow down the progression. Will be interesting to see what he has to say. Thanks for the info.

[Forseegood]

of course it isn't linear, and it does play out differently in everybody...but they had a few major studies, if you put menopause and hep c in a search engine you'll find them, too tired to do it for you...one major French study on women, I think 400 women or something like that...they saw that many of the women didn't become symptomatic or have their damage go up, etc etc...till they reached menopause...another Irish study as well...they think it's because the estrogen level goes down at menopause, hence the estrogen no longer protects you as well against the virus...when some of these women supplemented with estrogen, they seemed to do better...oh well, I'll go look for it, some people are picky, come back later...lol....

Menopause, Hormone Contraception May Accelerate Liver Fibrosis; Perhaps Hormone Replacement Therapy Can Be Helpful
AASLD
Dallas, Nov 9-13, 2001

abstract 195. IMPACT OF PREGNANCIES, ORAL CONTRACEPTION AND MENOPAUSE ON LIVER FIBROSIS PROGRESSION IN WOMEN WITH CHRONIC HEPATITIS C

Vincent Di Martino, Pascal Lebray, Joseph Moussalli, GH Pitié-Salpêtrière and Réseau VHC Paris-Sud, Paris France; Catherine Buffet, HTMpital Bicêtre et Réseau VHC-Paris Sud, Kremlin-Bicêtre France; Thierry Poynard, GH Pitié-Salpêtrière and Réseau VHC Paris-Sud, Paris France

program abstract:
During chronic hepatitis C (CHC), liver fibrosis progression is faster in males than in females. Among all the factors involved in such difference, estrogenes may be a major one since experimental data recently supported that estrogenes may have direct antifibrosing effect. The aim of this work was to evaluate the influence of pregnancies, oral contraceptives and menopause on liver fibrosis (F) and fibrosis progression rate (FPR) in HCV-infected women, taking into account confusing factors such as age, alcohol consumption, and BMI.

Patients and methods: 472 women with CHC without HBV nor HIV coinfection received an anonymous questionnaire that asked for alcohol and tobacco consumption, presence of diabetes, age at first menstruation, age at pregnancies with or without children, hormonal contraception, age at menopause and its cause if any, and hormonal substitution. These data were completed by those collected in the DOSVIRC database. Liver biopsies performed before antiviral therapy were analyzed using the METAVIR scoring system. The FPR was estimated in case of known date of HCV infection and expressed in milli METAVIR Units of fibrosis per year. Statistical analyses were performed using Kruskall-Wallis rank test and logistic and multiple linear regression models for multivariate analyses.

Results: 212 (44%) women completed the questionnaire. 192 (48±1 years old) underwent adequate liver sample, among whom 99 had 1 to 7 pregnancies (0 to 5 children) during 15±1 months, 86 received oral contraceptive(s) during 31±4 months, 95 had menopause 11±1 years before liver biopsy, and 47 received hormonal substitution during 7±1 years. Only one woman had alcohol intake more than 50g/d. In univariate analysis, F score and/or FPR were significantly lower in women who had one or more pregnancies, who received hormonal contraception, who were seen before menopause or who received hormonal substitution, whereas liver necro-inflammatory lesions(A) were not different (table). After adjustment on age and BMI, multivariate analyses showed that menopause was associated with higher F score and FPR, and that pregnancies were associated with lower FPR ; the effect of oral contraceptives was not significant.

Conclusion: in women with CHC, menopause accelerates the liver fibrosis progression. Such effect seems prevented by hormonal substitution. Pregnancies may have a long-term beneficial impact on liver fibrosis.

editorial note: a pilot study presented at the AASLD Single Conference meeting in June 2001 showed HRT could improve response to HCV therapy for postmenopausal women.
   SEN Virus Variants Are "Unequivocally Transmitted By Blood Transfusion" in the US

[wed1942]

So did you go on hormones after going through menopause? Wonder if that would make a difference. It causes so many potential problems that I haven't even considered it up until now. I don't (knock on wood) have the night sweats, etc. so figured maybe I was going to be lucky and not have any of those symptoms and could go without. It's so strange how this disease works. People look at me and can't believe that I have something so bad and at the stage it is. They keep asking me why aren't I yellow and why aren't I having other symptoms. I just don't know. I tell everyone that I just don't have any answers for myself or for them. I'm just still digging trying to figure out something. I will take the treatments because I'm not ready to give up on something I feel like I haven't even started to fight. I want to be around to harass my kids when they have kids. Thanks for your input. I know I'm going to have lots more questions when I'm told about the treatment next week. Kinda dreading that but at the same time want to get going with it.

[frijole]

I don't know about that.  I think that it is well recorded that liver damage from hepatitis C is not linear -- that it does not progress at an even decline but rather may "head south" at any time.  I think you are very lucky indeed that your enzymes did cause your doctors to test for hep C since you are already a stage 3-4.  

I am 60 and went thru menopause at 50.  I knew I had the antibodies, but never had a viral load test until 2005.  My live enzymes have always been in the 20s so no doctor considered testing me for hep C.  (I know from donating blood in 1993 that I had the antibodies).  Like you, I was probably infected from about 1969 or 1970.  Why have I remained at grade 1, stage 1 for all these years?  I don't know.  I think it is the genetics of the immune system that govern here.

I can't answer your question, but I am glad you are here. Welcome to the forum.  You will find a lot of aswers here and people in the same boat as you.
frijole

[Xenigma]

What I'm wondering, is if anyone has noticed that the virus seemed to have become more active when they went through menopause.
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Yes, I have noticed this and that's when I made my decision to tx.

My vl pre-menopause was around 700,000.  Peri-menopause is was around 1.2 million,
and post menopause it went to about 5 million.
I am ra+ as well and I was constantly hurting and tired.  
My body was fighting hard and wasn't controlling the virus as well as
before menopause and I could feel it.  I could hardly move.

I made a decision to start tx, and I feel better on tx in many ways (not all) than before.
I just did shot 22 and have been UND since week 12.
enigma