Twin Sisters Are At High Risk of Early Menopause

woman doctor in office( — Twin sisters face triple the odds of entering menopause prematurely compared to women who don’t have a twin, researchers report. “It’s a three-to-five-fold increase in risk of having menopause before the age of 40,” said study lead author Roger Gosden,
director of reproductive biology at Weill Cornell Medical College in New York City. However, he added, “We have to bear in mind that over 95 percent of women who are twins will still have menopause at the normal time. There shouldn’t be any general alarm.”

The study was published Wednesday in the Oct. 25 online edition of Human Reproduction.

Overall, about 1 percent of adult women have premature ovarian failure (POF), prompting menopause before the age of 40. Not only does this affect fertility, but it may also boost risks for cardiovascular disease and osteoporosis.

The mean age of menopause is 50 to 52 years.

Gosden had already published research on a twin who underwent POF at age 14. The woman’s twin, however, remained fertile and was able to donate ovarian tissue to her sister for a transplant.

“It was that study that stimulated us to do this big survey and to find out how common early menopause is in identical twins and how often there may be discordances,” Gosden explained.

There had already been hints in the medical literature that fraternal twins might be at higher risk of early ovarian failure. The current study confirmed that and added new information about identical twins.

In all, the researchers looked at 428 twin pairs from an Australian twin register and 404 from a British twin registry. These were compared to a control group of 3,483 Dutch women. Women who had undergone a hysterectomy were automatically excluded.

Rates of POF were similar in both registries and three-to-five times higher than the general population at ages 40 and 45. This was true of both fraternal and identical twins.

But in some cases, the twin pairs had very different ages of menopause, sometimes varying by as much as 20 years.

“The biggest mystery surrounds the identical twins because one would expect them to have similar menopause,” Gosden said. “That is true most of the time, but, in some cases, it’s extraordinarily early and may be different from the other twin.”

The reasons are unclear. However, Gosden said that scientists “know why identical twins [can be] very different in terms of their ovaries.”

“We do believe that the problem starts when the woman was actually a fetus, when the eggs were formed,” he continued. “We believe that the infertile sister doesn’t form a normal number of eggs, so she runs out of eggs earlier.”

“The ovary works like an hour glass with a fixed number of eggs,” Gosden explained. “When they’ve run out, the woman has menopause. We believe that the infertile twin has fewer eggs to begin with.”

Now Gosden is moving his research into the clinical stage.

“We’ve been receiving calls from twins where one has had an early menopause, and they’re interested in having a transplant from a fertile twin to an infertile twin to restore ovarian function,” Gosden said. So far, 10 patients have signed up, five of whom have already had transplants. All the transplants have been successful, and three women have become pregnant or delivered babies.

“One of the important things to take out of this study is that one twin could serve as an egg donor or donor of ovarian tissue in order to reverse early menopause for the other twin,” said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York
City. “We have so many advances these days in regard to fertility, so premature menopause is not the terrible thing it once was.”


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Characteristcs of Fast-Growing Melanomas Identified

microscopic image of melanoma

Potentially fatal skin cancers called melanomas are more likely to grow fast
when they’re thicker, symmetrical, elevated, have regular borders or produce
symptoms, a new Australian study found.

“Rapidly growing melanomas can potentially
kill in a matter of weeks,” said lead researcher Dr. Wendy Liu, of the Peter
MacCallum Cancer Center, in East Melbourne.

“They can occur in anyone, not necessarily
those with large numbers of moles and freckles. In fact, they more often occur
in those without large numbers of moles and freckles and elderly men. They are
more often red, rather than brown and black, symmetrical, elevated and
symptomatic,” Liu added.

In the study, Liu’s team investigated the
growth rate of melanoma in 404 patients with invasive melanoma. Patients had
their skin examined, and data about the moles were collected. In addition,
patients were interviewed as soon as possible after

Patients and their families were asked to
recall when they first noticed a spot on their skin from which the melanoma
later developed, and when they noticed the mole had changed or become

The researchers collected data on
demographics, skin cancer risk factors, the characteristics of the tumor and who
first detected the cancer — the patient, a family member or friend, or a

Using this information and the thickness of
the tumor when it was removed, Liu’s group was able to estimate its rate of

The researchers found that about one-third
of all the melanomas grew less than 0.1 millimeters per month, another one-third
grew between 0.1 millimeter and 0.49 millimeters per month, and one-third grew
0.5 millimeters or more per month.

Rapid tumor growth was associated with
tumor thickness, ulceration (formation of a break or sore on the skin),
amelanosis (lack of pigment in the tumor), regular borders, elevation and

Moreover, faster-growing melanomas were
more often found in people 70 and older, in men, and in those with fewer moles
and freckles, the researchers reported.

Factors not associated with the rate of
growth were the number of atypical moles or age spots or liver spots; a history
of sun damage or blistering sunburns; skin type; eye color; family or personal
history of melanoma; and current or childhood sun

“Rapidly growing melanomas no longer fit
the classical description of melanomas,” Liu said. “We need to promote the
awareness of this less common but more aggressive form of melanomas among the
health professionals and the general public.”

But Liu cautioned that “any rapidly growing
skin lesion, regardless of its morphology and perceived risk factors for
melanoma, deserves prompt medical assessment.”

The study findings are published in the
December issue of the Archives of Dermatology.

One expert noted that most cancers have
rapidly growing forms.

“This is not a surprising finding,” said
Dr. Vijay Trisal, an assistant professor of surgical oncology at the City of
Hope Cancer Center, in Duarte, Calif. “You can extrapolate these findings to any
tumors in the body.”

Tumors that are fast-growing are more
aggressive, and can divide faster and invade vessels and organs more quickly,
Trisal said.

Trisal added, however, that asking patients
about the growth of their melanoma is not an accurate basis for estimating the
speed of the cancer’s growth. “It is very subjective,” he said. “It also depends
on where the lesion is. If it’s on the back, it might not be noticed for a long

“Tumors that grow fast are particularly
worrisome, especially if you have no chemotherapy for them,” Trisal said. “For
melanoma, we have no chemotherapy, and the faster they grow, the worse they are,
because that means that the tumor has the ability to get into the blood vessels
and lymph nodes faster.”

People should get medical attention as soon
as they notice a melanoma, Trisal said.

“You can’t just sit there and
watch a melanoma grow and say, ‘Fine, it hasn’t grown in two months, so it is
not that aggressive,’ because you want to get on top of it sooner,” Trisal