BATON ROUGE, Louisiana: Louisiana became the first American state Friday to outlaw a controversial abortion procedure that involves partially removing the fetus intact from a woman's uterus, then crushing or cutting its skull to complete the abortion.
The new law allows the procedure in only one situation at any time during pregnancy: when failure to perform it would endanger the mother's life. The procedure would be a crime in all other cases, even if the pregnancy is expected to cause health problems for the mother.
Anti-abortion activists call the procedure "partial-birth abortion;" surgeons and abortion rights activists call it "dilation and extraction."
Democratic Gov. Kathleen Blanco signed into law criminal penalties for doctors who perform the surgery: fines of between $1,000 (€725) and $10,000 (€7,256), and jail terms of between one and 10 years.
The statute is parallel to a federal ban that President George W. Bush signed into law in 2003, which was upheld in April by the U.S. Supreme Court.
Lawmakers in other states are expected to consider similar bans. Louisiana is the first to enact one, according to the New York-based Center for Reproductive Rights, an abortion-rights group.
Unlike in many developed countries, where abortion is considered a medical procedure beyond the reach of politics, it remains among the most politically sensitive subjects in the United States, and is likely to be a hotly debated issue through the campaign to the November 2008 U.S. presidential election, especially by conservative Republicans.
The procedure is the subject of angry debate between anti-abortion groups, who support state bans, and abortion-rights groups, who opposed the federal ban and have fought state bans, including the Louisiana legislation.
Planned Parenthood officials argued against the Louisiana ban in legislative committee hearings, but received a chilly response from lawmakers. Only a handful of legislators voted against either bill.
Blanco has also signed legislation requiring that all women seeking an abortion be notified that fetuses can feel pain by 20 weeks gestation, and doctors who perform the procedure to discuss the availability of painkillers for fetuses.
Supporters said the bill would provide important information to women seeking abortions — and that it could help stop abortions. Opponents say doctors do not agree on whether fetuses can feel pain at 20 weeks.
Nationwide, there are just a few thousand such abortions, according to rough estimates, out of more than 1.25 million abortions in the United States annually. Ninety percent of all abortions occur in the first 12 weeks of pregnancy, and are not at issue.
source : www.iht.com
Showing posts with label reproduction. Show all posts
Showing posts with label reproduction. Show all posts
Friday, July 13, 2007
Why Women Don't Nurse Longer
Why Women Don't Nurse Longer
A Babytalk exclusive report on why breastfeeding can be controversial
You've heard it by now: A mom should breastfeed her baby for at least the first year of life, as recommended by the American Academy of Pediatrics. Today, more new moms than ever try to nurse. In 2004, the most recent year for which government statistics are available, about 70 percent of U.S. mothers reported that they had tried breastfeeding, according to the Centers for Disease Control and Prevention (CDC). That's up from 55 percent in 1993.
But then consider this: At 6 months, only 36 percent were still nursing. At 12 months, the number dips to 17 percent — fewer than one in five mothers. While moms know that breastfeeding gives babies the best start in life, legions of them find it difficult — if not downright impossible — to nurse longer than six months, let alone up to the one-year milestone.
Whether it's a baby who has trouble latching on, a work schedule that doesn't allow time for pumping, or a lack of support at home, the forces that conspire against women who want to breastfeed are far-reaching in their scope. And despite the medical establishment's wholehearted endorsement of breastfeeding, the general public hasn't gotten the message. A full 57% of Americans disapproves of public breastfeeding (according to a recent survey by the American Dietietic Association). Breastfeeding moms are stared at, get rude comments, and are even asked to leave restaurants and stores. For many women, the public disapproval is the last straw when they're having other breastfeeding difficulties....so they give up.
Many moms who plan to nurse are caught off-guard by the challenges breastfeeding can present. In fact, according to a nationally representative Babytalk survey, 46 percent of moms said that breastfeeding required more time than they'd expected and 56 percent wished that they had been able to nurse longer than they did. Here's what's undermining women's efforts, and how you can get the support you need to keep going.
Nursing problems
Experts agree that much of breastfeeding success hinges on getting off to a good start. After delivering, however, many women only take a single hospital class or secure a brief session with a nurse or lactation consultant. Odds are that a new mother is home by the time her milk comes in and problems arise.
Frustrated, exhausted, and panicked that her child isn't getting enough to eat, a mom can lose confidence and quit nursing. "I breastfed my firstborn for about a week and then gave up. He wasn't latching on properly, and it hurt so much that I'd cry every time," says Diane Burdick of Pensacola, Florida. Like Burdick, nearly half the moms in Babytalk's survey stopped nursing because they had trouble getting the baby to latch on correctly, felt that they didn't produce enough milk, or had other problems, such as clogged ducts.
If you're having trouble, it's critical that you get help as soon as possible, before your milk supply decreases. A lactation consultant can help (find one at gotwww.net/ilca), as can a free breastfeeding support group (visit LaLecheLeague.org to locate one). Your child's pediatrician may have advice, too — and should let you drop by to weigh your baby as often as you want to make sure she's eating enough. You can also read Babytalk's award-winning story "You Can Breastfeed". But don't beat yourself up if it doesn't work out, says breastfeeding expert Marianne Neifert, M.D. "Success isn't always related to the amount of effort a mom puts in."
source : www.parenting.com
A Babytalk exclusive report on why breastfeeding can be controversial
You've heard it by now: A mom should breastfeed her baby for at least the first year of life, as recommended by the American Academy of Pediatrics. Today, more new moms than ever try to nurse. In 2004, the most recent year for which government statistics are available, about 70 percent of U.S. mothers reported that they had tried breastfeeding, according to the Centers for Disease Control and Prevention (CDC). That's up from 55 percent in 1993.
But then consider this: At 6 months, only 36 percent were still nursing. At 12 months, the number dips to 17 percent — fewer than one in five mothers. While moms know that breastfeeding gives babies the best start in life, legions of them find it difficult — if not downright impossible — to nurse longer than six months, let alone up to the one-year milestone.
Whether it's a baby who has trouble latching on, a work schedule that doesn't allow time for pumping, or a lack of support at home, the forces that conspire against women who want to breastfeed are far-reaching in their scope. And despite the medical establishment's wholehearted endorsement of breastfeeding, the general public hasn't gotten the message. A full 57% of Americans disapproves of public breastfeeding (according to a recent survey by the American Dietietic Association). Breastfeeding moms are stared at, get rude comments, and are even asked to leave restaurants and stores. For many women, the public disapproval is the last straw when they're having other breastfeeding difficulties....so they give up.
Many moms who plan to nurse are caught off-guard by the challenges breastfeeding can present. In fact, according to a nationally representative Babytalk survey, 46 percent of moms said that breastfeeding required more time than they'd expected and 56 percent wished that they had been able to nurse longer than they did. Here's what's undermining women's efforts, and how you can get the support you need to keep going.
Nursing problems
Experts agree that much of breastfeeding success hinges on getting off to a good start. After delivering, however, many women only take a single hospital class or secure a brief session with a nurse or lactation consultant. Odds are that a new mother is home by the time her milk comes in and problems arise.
Frustrated, exhausted, and panicked that her child isn't getting enough to eat, a mom can lose confidence and quit nursing. "I breastfed my firstborn for about a week and then gave up. He wasn't latching on properly, and it hurt so much that I'd cry every time," says Diane Burdick of Pensacola, Florida. Like Burdick, nearly half the moms in Babytalk's survey stopped nursing because they had trouble getting the baby to latch on correctly, felt that they didn't produce enough milk, or had other problems, such as clogged ducts.
If you're having trouble, it's critical that you get help as soon as possible, before your milk supply decreases. A lactation consultant can help (find one at gotwww.net/ilca), as can a free breastfeeding support group (visit LaLecheLeague.org to locate one). Your child's pediatrician may have advice, too — and should let you drop by to weigh your baby as often as you want to make sure she's eating enough. You can also read Babytalk's award-winning story "You Can Breastfeed". But don't beat yourself up if it doesn't work out, says breastfeeding expert Marianne Neifert, M.D. "Success isn't always related to the amount of effort a mom puts in."
source : www.parenting.com
Monday, July 9, 2007
Low testosterone levels in post-menopausal women associated with heart disease
Post-menopausal women with lower levels of testosterone are more likely to suffer from heart disease. Research, published in the June edition of the European Journal of Endocrinology, shows that higher testosterone levels in post-menopausal women may have a protective effect against cardiovascular disease.
Researchers led by Dr Erik Debing at the Free University of Brussels in Belgium examined the levels of sex hormones in natural post-menopausal women (i.e. those not taking hormone replacement therapy) and their association with the presence of atherosclerosis. Atherosclerosis is a condition where the arteries become hardened and blocked by the deposition of substances such as cholesterol. It is commonly seen as a precursor to heart disease. The research team examined 56 post-menopausal women who had atherosclerosis of the carotid artery (the artery that supplies blood to the head and neck) and compared the levels of sex hormones in their blood with 56 age-matched controls.
While they found no significant difference between the levels of other sex hormones, women with atherosclerosis had significantly lower testosterone levels than women who were free from the disease (0.23?0.12 vs. 0.31?0.20 µg/l). Even after the researchers had controlled for other risk factors associated with heart disease (such as diet, high blood pressure, smoking and diabetes), the relationship between low testosterone levels and atherosclerosis remained strong.
Although the hormone testosterone is usually associated with men, women also produce some testosterone, mainly from their ovaries and adrenal glands. Testosterone performs many essential functions in the bodies of both men and women including maintaining muscle strength and bone density. While statistics show that the risk of heart disease increases in post-menopausal compared to pre-menopausal women, the reasons for this have remained unclear.
Traditionally seen as a male disease, heart disease is now one of the leading causes of death in post-menopausal women in Europe. This is the first time that a case-control study has been carried out, directly comparing the levels of sex hormones in post-menopausal women with and without atherosclerosis of the carotid artery. Further work is now required to enhance our understanding of the mechanisms behind this relationship and the implications for health provision.
Researcher Dr Erik Debing said:
"This is the first time that a case-control study has found that post-menopausal women with athlerosclerosis have lower testosterone levels. Athlerosclerosis is the main precursor to heart disease, one of the major causes of death in post-menopausal women. Our work suggests that higher levels of testosterone may have a protective role against atherosclerosis in women who have undergone the menopause.
This research represents an important step forward in our understanding of the causes of atherosclerosis and will allow us to develop more effective treatments and advice. We now need to carry out further research to examine why low testosterone levels in post-menopausal women may predispose them to develop cardiovascular disease."
source : www.news-medical.net
Researchers led by Dr Erik Debing at the Free University of Brussels in Belgium examined the levels of sex hormones in natural post-menopausal women (i.e. those not taking hormone replacement therapy) and their association with the presence of atherosclerosis. Atherosclerosis is a condition where the arteries become hardened and blocked by the deposition of substances such as cholesterol. It is commonly seen as a precursor to heart disease. The research team examined 56 post-menopausal women who had atherosclerosis of the carotid artery (the artery that supplies blood to the head and neck) and compared the levels of sex hormones in their blood with 56 age-matched controls.
While they found no significant difference between the levels of other sex hormones, women with atherosclerosis had significantly lower testosterone levels than women who were free from the disease (0.23?0.12 vs. 0.31?0.20 µg/l). Even after the researchers had controlled for other risk factors associated with heart disease (such as diet, high blood pressure, smoking and diabetes), the relationship between low testosterone levels and atherosclerosis remained strong.
Although the hormone testosterone is usually associated with men, women also produce some testosterone, mainly from their ovaries and adrenal glands. Testosterone performs many essential functions in the bodies of both men and women including maintaining muscle strength and bone density. While statistics show that the risk of heart disease increases in post-menopausal compared to pre-menopausal women, the reasons for this have remained unclear.
Traditionally seen as a male disease, heart disease is now one of the leading causes of death in post-menopausal women in Europe. This is the first time that a case-control study has been carried out, directly comparing the levels of sex hormones in post-menopausal women with and without atherosclerosis of the carotid artery. Further work is now required to enhance our understanding of the mechanisms behind this relationship and the implications for health provision.
Researcher Dr Erik Debing said:
"This is the first time that a case-control study has found that post-menopausal women with athlerosclerosis have lower testosterone levels. Athlerosclerosis is the main precursor to heart disease, one of the major causes of death in post-menopausal women. Our work suggests that higher levels of testosterone may have a protective role against atherosclerosis in women who have undergone the menopause.
This research represents an important step forward in our understanding of the causes of atherosclerosis and will allow us to develop more effective treatments and advice. We now need to carry out further research to examine why low testosterone levels in post-menopausal women may predispose them to develop cardiovascular disease."
source : www.news-medical.net
How NIH Misread Hormone Study in 2002
On July 9, 2002, federal government health officials announced that they had halted a major study of menopause hormones, saying the drugs increased a woman's risk of heart attack by 29%.
But in the five years since, it's become clear that some aspects of what was initially reported from the $725 million Women's Health Initiative study were either misleading or just wrong. Although the government initially said the findings applied to all women, regardless of age or health status, additional data published in recent months show that the age of a woman and the timing of hormone use dramatically changes the risk and benefits. WHI data published in April in the Journal of the American Medical Association showed that women in their 50s who took a combination of estrogen and progestin or estrogen alone had a 30% lower risk of dying than women who didn't take hormones.
Last month, the New England Journal of Medicine reported that 50-59-year-old women in the WHI who regularly used estrogen alone showed a 60% lower risk for severe coronary artery calcium, an important risk factor for heart attack.
How could the heart risks of menopause hormones for this crucial cohort change so dramatically in just five years? Officials from the National Institutes of Health, which directed the study of more than 27,000 women, say the interpretation of the WHI has simply evolved as researchers have used different methods to analyze the voluminous body of data.
The average age of women in the study was 63. While older women in the study did show a heart risk, researchers eventually focused on women in their 50s who were closer to menopause, finding that hormones were more likely to protect those women's hearts than harm them.
But critics including some of the WHI's own investigators, speaking out for the first time, say that NIH officials initially overgeneralized in large part because they excluded many of the study's own investigators and physicians from the first review. As a result, key questions that could have clarified the data far sooner weren't asked.
Just 11 days before the public announcement in July 2002, the WHI's 40 investigators met in Chicago, where they were told the study had been stopped early. Several people who attended the meeting say several WHI researchers were stunned and angry when they were given final page proofs of the study report for the Journal of the American Medical Association. Although some researchers expressed concern that the results were too broadly interpreted, it was too late to make meaningful changes to the JAMA article. Many investigators who had spent nearly a decade working on the WHI had no input in the final and most important paper.
"I think that had the initial report been written by a broader group, as almost all of our later papers have been, it would have been framed differently," says Robert D. Langer, the former principal investigator for the WHI's clinical center at University of California, San Diego, who was among those who protested at the time. He has since served as an expert witness for hormone maker Wyeth. Dr. Langer says he remains concerned that the interpretation of the WHI has unnecessarily scared a generation of women from the treatment.
Jacques Rossouw, a physician with the National Heart Lung and Blood Institute who has overseen the WHI since its inception, confirms that some investigators were upset that they weren't included in writing the first WHI report. "That was an NIH decision supported by the WHI executive committee to keep it to a small group because we realized it was a sensitive paper," he says.
Still, he defends the government's handling of the study results "based on what we knew at the time," and says that study officials wanted to make a dramatic statement. "Our main job at the time was to turn around the prevailing notion that hormones would be useful for long-term prevention of heart disease," he says. "That was our objective. That was a worthy objective which we achieved."
But many in the medical community disagree, saying key questions about long-term use still aren't answered. Although the WHI data clearly show that starting hormones at an older age is risky, what's not clear is whether the heart protection women get starting at a younger age will continue with long-term use.
That was the question that the WHI was supposed to answer when it was launched in 1991 after data from an ongoing trial of nurses showed that women who used menopause hormones have as much as a 50% lower risk of heart attack. But the WHI designers didn't take into account that the timing of hormone use might affect the results and recruited mostly older, symptom-free women. Some of the study participants were already 20 years past menopause when the WHI began.
[chart]
Since mostly older women were recruited, there weren't enough recently menopausal women under 60 to generate conclusive data in some of the findings. But the trends were provocative. Among recently menopausal women who used estrogen and progestin, heart attack risk fell 11%. By comparison, women who started taking hormones 10 or more years past menopause had a 22% to 71% higher risk of heart problems.
In a second part of the study, in which women who had undergone hysterectomy took estrogen without progestin, women who started hormones after the age of 70 had an 11% higher risk of heart problems. But women below 60 in the estrogen-only study had a 37% lower heart risk.
In a bid to draw a more definitive conclusion, the WHI in April 2007 published a report in JAMA combining the data from both hormone trials. That paper showed that the timing of hormone use matters: Younger women appear to receive heart protection, while older women are at risk.
"We now have a refined understanding of the benefits and risks of hormone therapy, and there has been so much reassuring evidence for younger women over the last few years," says Harvard professor and WHI investigator JoAnn Manson, who has no ties to drug firms.
Despite the recent data, questions about long-term use of hormones are far from resolved. While most people now agree that hormones are a reasonable option for women to treat menopause symptoms like hot flashes, the bigger question is whether hormones should be considered in the armamentarium of drugs used for heart protection, along with blood pressure medications and cholesterol-lowering drugs called statins.
The National Heart, Lung and Blood Institute, which oversaw the WHI, firmly believes that menopause hormones shouldn't be used to prevent heart disease because of potential risk of blood clot, stroke and breast cancer.
Indeed, the WHI showed that hormones have a range of risks and benefits. On the plus side, they may protect younger women's hearts, they definitely protect against hip fractures, they lower the risk for diabetes and may lower the risk for colon cancer.
On the other hand, menopause hormones do increase the risk for blood clots and stroke. Women in the WHI who used both estrogen and progestin were at 24% higher risk for breast cancer. But women who regularly use estrogen without progestin had a 33% lower risk of breast cancer.
"Hormone therapy long term has these other adverse events hanging around. It doesn't fit the paradigm of what you are looking for in a viable long-term prevention strategy," says Dr. Rossouw. "If you're going to use something to prevent atherosclerosis, your choice is statins, not hormones."
The data on women who use statins are mixed, but suggest that they lower a woman's heart risk by 15% to 20%. Statins carry their own risks, including liver effects, muscle pain, memory problems and in rare cases a life-threatening muscle disease call rhabdomyolysis. There are no studies showing the risks and benefits of long-term use of statins.
Many doctors now believe that for younger women without a uterus, estrogen should be an option for long-term prevention of heart disease. (The progestin is added to protect against uterine cancer.)
"If this is preventing heart disease and saving lives, I think it's really wrong not to consider it," says Yale associate professor Hugh Taylor, a principal investigator for the Kronos Early Estrogen and Prevention Study, a study of estrogen and heart disease funded by Arizona billionaire John Sperling, an education entrepreneur who was upset with the way the WHI study was initially interpreted. "Some of the other drugs we use for cardiovascular disease don't have the evidence that we have for hormone therapy."
Two important ongoing studies will further illuminate the role estrogen plays in heart disease. The KEEPS study is recruiting 720 women, ages 42 to 58, to study the effects of oral or transdermal estrogen as well as progesterone on the coronary arteries of healthy women. An NIH-funded Early Versus Late Intervention Trial will study 500 women and the effects of hormone therapy given within six years of menopause compared to treatment given 10 or more years after menopause. Both studies will also test whether using natural progesterone, instead of the synthetic progestin used in the WHI, lowers or eliminates the risk of breast cancer associated with combination therapy.
Even though the long-term heart issue is unresolved, some critics say the NIH's handling of the WHI data scared away younger women who might want to use hormones for menopause symptoms. "We've gone to considerable efforts to reassure women and gynecologists that it's okay [to use hormones] in the short term," to treat the symptoms of menopause, Dr. Rossouw says.
Still, since the WHI results were announced in 2002, hormone sales have plummeted 30% to $1.9 billion, according to IMS Health, a health-care information company.
"I don't think it's fair to extrapolate from the data that women should be put on this as a preventative treatment for heart disease," says Michael E. Mendelsohn, a Tufts University professor who recently wrote an NEJM editorial about estrogen and heart disease. "What the data do support is that women who use hormones to treat menopause symptoms can feel reassured that they are not increasing their cardiovascular risk and may be providing some long-term benefit."
source : online.wsj.com
But in the five years since, it's become clear that some aspects of what was initially reported from the $725 million Women's Health Initiative study were either misleading or just wrong. Although the government initially said the findings applied to all women, regardless of age or health status, additional data published in recent months show that the age of a woman and the timing of hormone use dramatically changes the risk and benefits. WHI data published in April in the Journal of the American Medical Association showed that women in their 50s who took a combination of estrogen and progestin or estrogen alone had a 30% lower risk of dying than women who didn't take hormones.
Last month, the New England Journal of Medicine reported that 50-59-year-old women in the WHI who regularly used estrogen alone showed a 60% lower risk for severe coronary artery calcium, an important risk factor for heart attack.
How could the heart risks of menopause hormones for this crucial cohort change so dramatically in just five years? Officials from the National Institutes of Health, which directed the study of more than 27,000 women, say the interpretation of the WHI has simply evolved as researchers have used different methods to analyze the voluminous body of data.
The average age of women in the study was 63. While older women in the study did show a heart risk, researchers eventually focused on women in their 50s who were closer to menopause, finding that hormones were more likely to protect those women's hearts than harm them.
But critics including some of the WHI's own investigators, speaking out for the first time, say that NIH officials initially overgeneralized in large part because they excluded many of the study's own investigators and physicians from the first review. As a result, key questions that could have clarified the data far sooner weren't asked.
Just 11 days before the public announcement in July 2002, the WHI's 40 investigators met in Chicago, where they were told the study had been stopped early. Several people who attended the meeting say several WHI researchers were stunned and angry when they were given final page proofs of the study report for the Journal of the American Medical Association. Although some researchers expressed concern that the results were too broadly interpreted, it was too late to make meaningful changes to the JAMA article. Many investigators who had spent nearly a decade working on the WHI had no input in the final and most important paper.
"I think that had the initial report been written by a broader group, as almost all of our later papers have been, it would have been framed differently," says Robert D. Langer, the former principal investigator for the WHI's clinical center at University of California, San Diego, who was among those who protested at the time. He has since served as an expert witness for hormone maker Wyeth. Dr. Langer says he remains concerned that the interpretation of the WHI has unnecessarily scared a generation of women from the treatment.
Jacques Rossouw, a physician with the National Heart Lung and Blood Institute who has overseen the WHI since its inception, confirms that some investigators were upset that they weren't included in writing the first WHI report. "That was an NIH decision supported by the WHI executive committee to keep it to a small group because we realized it was a sensitive paper," he says.
Still, he defends the government's handling of the study results "based on what we knew at the time," and says that study officials wanted to make a dramatic statement. "Our main job at the time was to turn around the prevailing notion that hormones would be useful for long-term prevention of heart disease," he says. "That was our objective. That was a worthy objective which we achieved."
But many in the medical community disagree, saying key questions about long-term use still aren't answered. Although the WHI data clearly show that starting hormones at an older age is risky, what's not clear is whether the heart protection women get starting at a younger age will continue with long-term use.
That was the question that the WHI was supposed to answer when it was launched in 1991 after data from an ongoing trial of nurses showed that women who used menopause hormones have as much as a 50% lower risk of heart attack. But the WHI designers didn't take into account that the timing of hormone use might affect the results and recruited mostly older, symptom-free women. Some of the study participants were already 20 years past menopause when the WHI began.
[chart]
Since mostly older women were recruited, there weren't enough recently menopausal women under 60 to generate conclusive data in some of the findings. But the trends were provocative. Among recently menopausal women who used estrogen and progestin, heart attack risk fell 11%. By comparison, women who started taking hormones 10 or more years past menopause had a 22% to 71% higher risk of heart problems.
In a second part of the study, in which women who had undergone hysterectomy took estrogen without progestin, women who started hormones after the age of 70 had an 11% higher risk of heart problems. But women below 60 in the estrogen-only study had a 37% lower heart risk.
In a bid to draw a more definitive conclusion, the WHI in April 2007 published a report in JAMA combining the data from both hormone trials. That paper showed that the timing of hormone use matters: Younger women appear to receive heart protection, while older women are at risk.
"We now have a refined understanding of the benefits and risks of hormone therapy, and there has been so much reassuring evidence for younger women over the last few years," says Harvard professor and WHI investigator JoAnn Manson, who has no ties to drug firms.
Despite the recent data, questions about long-term use of hormones are far from resolved. While most people now agree that hormones are a reasonable option for women to treat menopause symptoms like hot flashes, the bigger question is whether hormones should be considered in the armamentarium of drugs used for heart protection, along with blood pressure medications and cholesterol-lowering drugs called statins.
The National Heart, Lung and Blood Institute, which oversaw the WHI, firmly believes that menopause hormones shouldn't be used to prevent heart disease because of potential risk of blood clot, stroke and breast cancer.
Indeed, the WHI showed that hormones have a range of risks and benefits. On the plus side, they may protect younger women's hearts, they definitely protect against hip fractures, they lower the risk for diabetes and may lower the risk for colon cancer.
On the other hand, menopause hormones do increase the risk for blood clots and stroke. Women in the WHI who used both estrogen and progestin were at 24% higher risk for breast cancer. But women who regularly use estrogen without progestin had a 33% lower risk of breast cancer.
"Hormone therapy long term has these other adverse events hanging around. It doesn't fit the paradigm of what you are looking for in a viable long-term prevention strategy," says Dr. Rossouw. "If you're going to use something to prevent atherosclerosis, your choice is statins, not hormones."
The data on women who use statins are mixed, but suggest that they lower a woman's heart risk by 15% to 20%. Statins carry their own risks, including liver effects, muscle pain, memory problems and in rare cases a life-threatening muscle disease call rhabdomyolysis. There are no studies showing the risks and benefits of long-term use of statins.
Many doctors now believe that for younger women without a uterus, estrogen should be an option for long-term prevention of heart disease. (The progestin is added to protect against uterine cancer.)
"If this is preventing heart disease and saving lives, I think it's really wrong not to consider it," says Yale associate professor Hugh Taylor, a principal investigator for the Kronos Early Estrogen and Prevention Study, a study of estrogen and heart disease funded by Arizona billionaire John Sperling, an education entrepreneur who was upset with the way the WHI study was initially interpreted. "Some of the other drugs we use for cardiovascular disease don't have the evidence that we have for hormone therapy."
Two important ongoing studies will further illuminate the role estrogen plays in heart disease. The KEEPS study is recruiting 720 women, ages 42 to 58, to study the effects of oral or transdermal estrogen as well as progesterone on the coronary arteries of healthy women. An NIH-funded Early Versus Late Intervention Trial will study 500 women and the effects of hormone therapy given within six years of menopause compared to treatment given 10 or more years after menopause. Both studies will also test whether using natural progesterone, instead of the synthetic progestin used in the WHI, lowers or eliminates the risk of breast cancer associated with combination therapy.
Even though the long-term heart issue is unresolved, some critics say the NIH's handling of the WHI data scared away younger women who might want to use hormones for menopause symptoms. "We've gone to considerable efforts to reassure women and gynecologists that it's okay [to use hormones] in the short term," to treat the symptoms of menopause, Dr. Rossouw says.
Still, since the WHI results were announced in 2002, hormone sales have plummeted 30% to $1.9 billion, according to IMS Health, a health-care information company.
"I don't think it's fair to extrapolate from the data that women should be put on this as a preventative treatment for heart disease," says Michael E. Mendelsohn, a Tufts University professor who recently wrote an NEJM editorial about estrogen and heart disease. "What the data do support is that women who use hormones to treat menopause symptoms can feel reassured that they are not increasing their cardiovascular risk and may be providing some long-term benefit."
source : online.wsj.com
Sunday, July 8, 2007
Endometriosis Increases The Risk Of Certain Cancers - But the risk is not affected by whether or not a woman has given birth
Doctors in Sweden have shown for the first time that although endometriosis is associated with an increased risk of various cancers, this risk does not depend on the number of times women with the condition have given birth.
Dr Anna-Sofia Melin, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology: "Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and never having given birth (nulliparity) are also known risk factors for different types of cancer, such as breast and endometrial cancer. However, as far as we know, this is the first study to investigate cancer risk among women with endometriosis that also stratifies for parity."
Dr Melin, a specialist doctor in the department of obstetrics and gynaecology at the Karolinska University Hospital in Stockholm, Sweden, and epidemiologists at the Karolinska Institute looked at data from 63,630 women who had been discharged from hospital with a diagnosis of endometriosis between 1969 and 2002. They were identified and followed up via the National Swedish Inpatient Register, the National Swedish Cancer Register and the Swedish Multi-Generation Register.
The researchers identified 3,822 cases of cancer amongst the women with endometriosis. While they found no overall increased risk of cancer, they did find that the women had an elevated risk of certain types of cancer, but that there was no significant difference in risk between women who had never given birth and those who had.
"We found that, contrary to what one might expect, endometriosis and nulliparity did not combine to give a higher risk of cancer," said Dr Melin.
The researchers found that endometriosis increased the risk of developing ovarian cancer by more than a third (37%) above the risk for the normal population of women without endometriosis. There were similar increases in risk for endocrine tumours (38%), kidney cancer (36%) and thyroid cancer (33%). Slightly lower increases were found for brain tumours (27%) and malignant melanoma (23%), and there was a small increased risk of breast cancer (8%). Interestingly, women with endometriosis had a reduced risk of cervical cancer of just under a third (29%).
"There was no significant difference between nulliparous and parous women with endometriosis regarding cancer risk for any of the cancer types. We found a non-significant decrease in ovarian cancer risk the more children a woman had had," said Dr Melin.
Little is known about the possible mechanisms involved in the increased risk of cancer from endometriosis (or decreased risk, in the case of cervical cancer).
Dr Melin said: "The fact that our study did not show an association between cancer risk and parity increases the possibility that it is the endometriosis disease in itself that causes the cancer and not the infertility issue."
"Various theories have been suggested. For ovarian cancer it might be the exposure of the ovaries to the hostile endometrium cells that 'invade' the ovary during the course of the endometriosis disease. Or it could be defects in the immune system that allow the endometriosis to grow and also might allow cancer cells to grow in different parts of the body. Maybe the treatment of endometriosis, hormonal or surgical, can influence cancer development. We do not know yet."
Dr Melin plans to investigate whether hormonal or surgical treatment of endometriosis might be involved in the increased cancer risk, and she also wants to identify which women are more at risk of developing cancer than others.
But she said that it was too early to use the results of her study to give advice to doctors about improved treatments for women with endometriosis.
"Our hope is that doctors in general start to view the endometriosis disease as a serious disease that causes a lot of suffering to the patient and also may lead to cancer. We hope that in the future we will be able to identify those women with endometriosis that may have a more aggressive form of disease with more atypical cells, for instance, and that this may lead to better care for the patient and, hopefully, to a early diagnosis if cancer should occur," she concluded.
source : www.medicalnewstoday.com
Dr Anna-Sofia Melin, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology: "Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and never having given birth (nulliparity) are also known risk factors for different types of cancer, such as breast and endometrial cancer. However, as far as we know, this is the first study to investigate cancer risk among women with endometriosis that also stratifies for parity."
Dr Melin, a specialist doctor in the department of obstetrics and gynaecology at the Karolinska University Hospital in Stockholm, Sweden, and epidemiologists at the Karolinska Institute looked at data from 63,630 women who had been discharged from hospital with a diagnosis of endometriosis between 1969 and 2002. They were identified and followed up via the National Swedish Inpatient Register, the National Swedish Cancer Register and the Swedish Multi-Generation Register.
The researchers identified 3,822 cases of cancer amongst the women with endometriosis. While they found no overall increased risk of cancer, they did find that the women had an elevated risk of certain types of cancer, but that there was no significant difference in risk between women who had never given birth and those who had.
"We found that, contrary to what one might expect, endometriosis and nulliparity did not combine to give a higher risk of cancer," said Dr Melin.
The researchers found that endometriosis increased the risk of developing ovarian cancer by more than a third (37%) above the risk for the normal population of women without endometriosis. There were similar increases in risk for endocrine tumours (38%), kidney cancer (36%) and thyroid cancer (33%). Slightly lower increases were found for brain tumours (27%) and malignant melanoma (23%), and there was a small increased risk of breast cancer (8%). Interestingly, women with endometriosis had a reduced risk of cervical cancer of just under a third (29%).
"There was no significant difference between nulliparous and parous women with endometriosis regarding cancer risk for any of the cancer types. We found a non-significant decrease in ovarian cancer risk the more children a woman had had," said Dr Melin.
Little is known about the possible mechanisms involved in the increased risk of cancer from endometriosis (or decreased risk, in the case of cervical cancer).
Dr Melin said: "The fact that our study did not show an association between cancer risk and parity increases the possibility that it is the endometriosis disease in itself that causes the cancer and not the infertility issue."
"Various theories have been suggested. For ovarian cancer it might be the exposure of the ovaries to the hostile endometrium cells that 'invade' the ovary during the course of the endometriosis disease. Or it could be defects in the immune system that allow the endometriosis to grow and also might allow cancer cells to grow in different parts of the body. Maybe the treatment of endometriosis, hormonal or surgical, can influence cancer development. We do not know yet."
Dr Melin plans to investigate whether hormonal or surgical treatment of endometriosis might be involved in the increased cancer risk, and she also wants to identify which women are more at risk of developing cancer than others.
But she said that it was too early to use the results of her study to give advice to doctors about improved treatments for women with endometriosis.
"Our hope is that doctors in general start to view the endometriosis disease as a serious disease that causes a lot of suffering to the patient and also may lead to cancer. We hope that in the future we will be able to identify those women with endometriosis that may have a more aggressive form of disease with more atypical cells, for instance, and that this may lead to better care for the patient and, hopefully, to a early diagnosis if cancer should occur," she concluded.
source : www.medicalnewstoday.com
New pill ends side effects of hormone replacement
SCIENTISTS have made a breakthrough in hormone replacement therapy which will allow thousands of women to take low doses of HRT without any fear of side effects.
Patients will now be able to take the therapy to treat symptoms such as hot flushes and thinning bones without worrying about the consequences.
Specialists believe it could halt the decline in women turning their backs on HRT following controversial research that raised fears that the treatment can cause heart disease, blood clots and cancer.
The new low-dose pill, Premarin, contains 0.3mg of oestrogen, less than half the standard HRT preparation.
Medical experts believe it can be used to stop hot flushes and thinning bones in women under 50 who have undergone a hysterectomy.
Premarin meets new guidelines to minimise the risk of HRT side effects.
Dr John Stevenson, consultant metabolic physician at the Royal Brompton Hospital in London and chairman of the charity Women's Health Concern, said: "The new tablet is significant because it is giving us another option in treating HRT which we have never had before.
"The other benefit of this tablet is that when you start someone on HRT medication of 0.625mg there is a risk - for the first six months - of blood clots in the lower legs.
"By starting someone on the 0.3mg dose the risk is lowered and it means that if the patient's symptoms don't ease we can increase the dose, taking away that risk."
Stevenson said it should reassure millions of women who have been unnecessarily deterred from taking HRT drugs.
The number of prescriptions has fallen by almost half in six years, down by almost three million from the high of 6.3 million in 2001, with the number of users falling from two million to one million.
Safety concerns arose in 2002 when a US study claimed patients using HRT were at higher risk of heart disease and strokes.
But earlier this year, re-analysis of the data found the extra risks may apply only to patients in their 60s and 70s, who do not normally use HRT.
source : scotlandonsunday.scotsman.com
Patients will now be able to take the therapy to treat symptoms such as hot flushes and thinning bones without worrying about the consequences.
Specialists believe it could halt the decline in women turning their backs on HRT following controversial research that raised fears that the treatment can cause heart disease, blood clots and cancer.
The new low-dose pill, Premarin, contains 0.3mg of oestrogen, less than half the standard HRT preparation.
Medical experts believe it can be used to stop hot flushes and thinning bones in women under 50 who have undergone a hysterectomy.
Premarin meets new guidelines to minimise the risk of HRT side effects.
Dr John Stevenson, consultant metabolic physician at the Royal Brompton Hospital in London and chairman of the charity Women's Health Concern, said: "The new tablet is significant because it is giving us another option in treating HRT which we have never had before.
"The other benefit of this tablet is that when you start someone on HRT medication of 0.625mg there is a risk - for the first six months - of blood clots in the lower legs.
"By starting someone on the 0.3mg dose the risk is lowered and it means that if the patient's symptoms don't ease we can increase the dose, taking away that risk."
Stevenson said it should reassure millions of women who have been unnecessarily deterred from taking HRT drugs.
The number of prescriptions has fallen by almost half in six years, down by almost three million from the high of 6.3 million in 2001, with the number of users falling from two million to one million.
Safety concerns arose in 2002 when a US study claimed patients using HRT were at higher risk of heart disease and strokes.
But earlier this year, re-analysis of the data found the extra risks may apply only to patients in their 60s and 70s, who do not normally use HRT.
source : scotlandonsunday.scotsman.com
Saturday, July 7, 2007
Am I there yet?
The term "perimenopause" is a relatively new one, which has only been in common usage since 1995. Perimenopause is a time of transition when the ovaries decrease the amount of hormones they produce, and as a result, a woman’s periods become less regular. Despite the beginning of perimenopausal symptoms, actual menopause may still be five, eight or even 10 years away.
Age of Onset
Perimenopause usually begins in the early to mid-40s; however, it is possible for it to begin as early as the 30s, or as late as the mid-50s.
Perimenopausal Symptoms
You may have none of the following symptoms, some of them, or all of them:
* Fatigue
* Emotional turmoil
* Memory problems
* Weight gain
* Fluid retention
* Sore breasts
* Painful intercourse
* Migraine headaches
* Irritable bowel-like symptoms or food intolerance
* Sleep disruptions
More In-depth Discussion of Perimenopausal Symptoms
Fatigue
Fatigue is a common symptom of perimenopause. Many women are already working so hard at careers and running households that when the fatigue of perimenopause hits, they don’t recognize it as a symptom of anything. Usually, this additional fatigue is due to insomnia, which is caused by the decrease in estrogen in the woman’s system; however, some of this fatigue can also be caused by the decrease in testosterone in a woman’s system that is occurring at the same time. It is the hormone testosterone that keeps women feeling energized. Once menstruation ceases completely, women often begin to regain their energy and feelings of aliveness.
Emotional Turmoil
Many women experience mood swings during perimenopause. These could be caused by the decreased amount of estrogen in the woman’s system. Research in Australia indicates that depression is at its worst two years after the last menstruation, but starts to lift after that. On the other hand, studies indicate that women are more likely to be depressed in their 20s and 30s than they are during menopause.
Weight Gain
Physical changes in the body include fat shifting from the lower to the central body without increasing the actual amount of overall body fat. During this time, it is harder to lose weight, but easier to put it on. This is true for both men and women as they age, because of a decrease in the rate of metabolism. Still, women between the ages of 45 and 50 put on significantly more weight than men, leading researchers to believe that perimenopausal weight gain can be separated from weight gain that is due to aging. The extra weight actually has an adaptive purpose. The extra fat cells convert androgen into estrogen. They also produce DHEA, an anti-aging hormone. Women with a few extra pounds generally feel better than very thin women.
Painful Intercourse
Forty to 60 percent of menopausal women find that the amount of time and sexual stimulation needed to become lubricated is greater than it was previously. When they do become lubricated, the amount produced is far less than when they were younger. Decreasing levels of estrogen cause less blood to flow to the vagina, which causes decreased lubrication during stimulation. This decrease in lubrication is what makes intercourse painful.
Migraine Headaches
Migraine headaches have an unusual relationship to the menopausal transition. Some women who have suffered with migraines their whole life find they no longer have them when they reach this phase, while other women who have never had migraines begin to have them during perimenopause.
source : health.discovery.com
Age of Onset
Perimenopause usually begins in the early to mid-40s; however, it is possible for it to begin as early as the 30s, or as late as the mid-50s.
Perimenopausal Symptoms
You may have none of the following symptoms, some of them, or all of them:
* Fatigue
* Emotional turmoil
* Memory problems
* Weight gain
* Fluid retention
* Sore breasts
* Painful intercourse
* Migraine headaches
* Irritable bowel-like symptoms or food intolerance
* Sleep disruptions
More In-depth Discussion of Perimenopausal Symptoms
Fatigue
Fatigue is a common symptom of perimenopause. Many women are already working so hard at careers and running households that when the fatigue of perimenopause hits, they don’t recognize it as a symptom of anything. Usually, this additional fatigue is due to insomnia, which is caused by the decrease in estrogen in the woman’s system; however, some of this fatigue can also be caused by the decrease in testosterone in a woman’s system that is occurring at the same time. It is the hormone testosterone that keeps women feeling energized. Once menstruation ceases completely, women often begin to regain their energy and feelings of aliveness.
Emotional Turmoil
Many women experience mood swings during perimenopause. These could be caused by the decreased amount of estrogen in the woman’s system. Research in Australia indicates that depression is at its worst two years after the last menstruation, but starts to lift after that. On the other hand, studies indicate that women are more likely to be depressed in their 20s and 30s than they are during menopause.
Weight Gain
Physical changes in the body include fat shifting from the lower to the central body without increasing the actual amount of overall body fat. During this time, it is harder to lose weight, but easier to put it on. This is true for both men and women as they age, because of a decrease in the rate of metabolism. Still, women between the ages of 45 and 50 put on significantly more weight than men, leading researchers to believe that perimenopausal weight gain can be separated from weight gain that is due to aging. The extra weight actually has an adaptive purpose. The extra fat cells convert androgen into estrogen. They also produce DHEA, an anti-aging hormone. Women with a few extra pounds generally feel better than very thin women.
Painful Intercourse
Forty to 60 percent of menopausal women find that the amount of time and sexual stimulation needed to become lubricated is greater than it was previously. When they do become lubricated, the amount produced is far less than when they were younger. Decreasing levels of estrogen cause less blood to flow to the vagina, which causes decreased lubrication during stimulation. This decrease in lubrication is what makes intercourse painful.
Migraine Headaches
Migraine headaches have an unusual relationship to the menopausal transition. Some women who have suffered with migraines their whole life find they no longer have them when they reach this phase, while other women who have never had migraines begin to have them during perimenopause.
source : health.discovery.com
Wednesday, July 4, 2007
Symptoms Of Early IVF pregnancy – Signs Of An In Vitro Pregnancy
Most of the women under in vitro pregnancy feel confused what would be their symptoms of early IVF pregnancy. Women, who do not conceive naturally, can conceive artificially through in vitro process. Therefore, they often feel whether IVF pregnancy symptoms resemble symptoms of natural pregnancies or not. Following an IVF pregnancy, the egg is taken outside in a Petri dish to fertilize. After fertilization, the egg is again implanted in the body. However, this is an artificial process of being pregnant, the course of the pregnancy advances as the normal period of pregnancy advances. However, after much discussion on IVF pregnancy symptoms, confusions related to this topic has prevailed. Let us talk about the procedures of IVF pregnancy and the symptoms of early IVF pregnancy.
What Is IVF Pregnancy?
This IVF pregnancy has brought ray of hopes to many women who have not been able to become pregnant naturally. Fortunately, this IVF pregnancy also consists of painless procedures. As the egg is fertilized in a Petri dish, it is planted in the womb of by the help of a catheter. The symptoms of early IVF pregnancy come to surface as the fertilized egg is implanted at the walls of uterus. Once the egg is implanted, mother’s body starts generating hormones to support advancement of pregnancy. As the pregnancy symptoms start showing up, take note of each of the signs and prepare a pregnancy journal. However, one must know the date when the egg was fertilized in the womb, otherwise, it is pretty challenging to make a pregnancy journal in case of an IVF pregnancy. So, start with recording the date of the implantation of the fertilized egg in your uterus.
What Are The Symptoms Of IVF Pregnancy?
After the egg is implanted in the uterus, and as your pregnancy is determined through an ultrasound, your body commence showing up symptoms of early IVF pregnancy. These symptoms are usually the symptoms of normal pregnancy. Following is a list of probable signs you can expect in an IVF pregnancy –
# Enhanced level of basal body temperature
# An overdue periods or amenorrhea
# Tender and sore breasts
# Cramping sensation in lower abdominal area
source : www.americanchronicle.com
What Is IVF Pregnancy?
This IVF pregnancy has brought ray of hopes to many women who have not been able to become pregnant naturally. Fortunately, this IVF pregnancy also consists of painless procedures. As the egg is fertilized in a Petri dish, it is planted in the womb of by the help of a catheter. The symptoms of early IVF pregnancy come to surface as the fertilized egg is implanted at the walls of uterus. Once the egg is implanted, mother’s body starts generating hormones to support advancement of pregnancy. As the pregnancy symptoms start showing up, take note of each of the signs and prepare a pregnancy journal. However, one must know the date when the egg was fertilized in the womb, otherwise, it is pretty challenging to make a pregnancy journal in case of an IVF pregnancy. So, start with recording the date of the implantation of the fertilized egg in your uterus.
What Are The Symptoms Of IVF Pregnancy?
After the egg is implanted in the uterus, and as your pregnancy is determined through an ultrasound, your body commence showing up symptoms of early IVF pregnancy. These symptoms are usually the symptoms of normal pregnancy. Following is a list of probable signs you can expect in an IVF pregnancy –
# Enhanced level of basal body temperature
# An overdue periods or amenorrhea
# Tender and sore breasts
# Cramping sensation in lower abdominal area
source : www.americanchronicle.com
Wednesday, June 27, 2007
Study to Assess Hormone Therapy Before Menopause
Researchers at eight locations across the United States plan to examine the safety and effectiveness of estrogen therapy during perimenopause, the few years just prior to menopause.
The KEEPS (Kronos Early Estrogen Prevention Study), led by researchers at the University of Wisconsin (UW) School of Medicine and Public Health, will evaluate the effect that four years of estrogen therapy has on mood and cognition in 720 healthy perimenopausal women.
"There has been a tremendous amount of important and valuable research done on the positive and negative health effects of therapy using estrogen in menopausal women," study leader Sanjay Asthana, head of the UW Section of Geriatrics and Gerontology and director of the Geriatric Research, Education and Clinical Center, said in a prepared statement.
"It is my belief that this study will go a long way in helping us understand the complexity of estrogen and related hormones in humans. It is critical that we continue to systematically address all of the clinical issues concerning estrogen treatment and its effects on diseases like Alzheimer's," Asthana said.
The $3.4 million study will be funded by the U.S. National Institutes of Health.
Among its objectives, KEEPS will compare an arm patch that delivers a natural, human form of estrogen to the commonly used oral form of estrogen synthesized from animal sources.
Other goals include determining the best way to counteract the adverse effects of estrogen on the lining of the uterus and investigating which hormone therapy best mimics the menstrual cycle.
source : health.yahoo.com
The KEEPS (Kronos Early Estrogen Prevention Study), led by researchers at the University of Wisconsin (UW) School of Medicine and Public Health, will evaluate the effect that four years of estrogen therapy has on mood and cognition in 720 healthy perimenopausal women.
"There has been a tremendous amount of important and valuable research done on the positive and negative health effects of therapy using estrogen in menopausal women," study leader Sanjay Asthana, head of the UW Section of Geriatrics and Gerontology and director of the Geriatric Research, Education and Clinical Center, said in a prepared statement.
"It is my belief that this study will go a long way in helping us understand the complexity of estrogen and related hormones in humans. It is critical that we continue to systematically address all of the clinical issues concerning estrogen treatment and its effects on diseases like Alzheimer's," Asthana said.
The $3.4 million study will be funded by the U.S. National Institutes of Health.
Among its objectives, KEEPS will compare an arm patch that delivers a natural, human form of estrogen to the commonly used oral form of estrogen synthesized from animal sources.
Other goals include determining the best way to counteract the adverse effects of estrogen on the lining of the uterus and investigating which hormone therapy best mimics the menstrual cycle.
source : health.yahoo.com
Sunday, June 24, 2007
Number Of Abortions In England, Wales Increases 4% In 2006
Number Of Abortions In England, Wales Increases 4% In 2006
Number Of Abortions In England
The number of abortions reported in England and Wales in 2006 increased 4% from 186,400 in 2005 to 193,700 last year, according to figures released Tuesday by the United Kingdom's Department of Health, London's Guardian reports (Ward, Guardian, 6/20). The figures show the overall rate of abortion is 18.3 abortions per 1,000 women and girls ages 15 to 44 living in England and Wales, compared with 17.8 abortions per 1,000 women and girls in 2005 for the same age group. About 89% of the procedures were performed before 13 weeks' gestation and 68% were performed under 10 weeks' gestation, according to the figures (Moynihan, Press Association, 6/19)
The abortion rate was highest among women age 19 at 35 per 1,000. According to the figures, there were 3.9 abortions per 1,000 girls under age 16 and 18.3 per 1,000 girls under age 18, London's Times reports (Hinds, Times, 6/19). The figures also showed that 32% of women who had an abortion had already had at least one previous abortion -- a percentage that remains unchanged from 2005 despite the government allocating 40 million pounds, or about $79.4 million, for contraception education, London's Telegraph reports (Davies, Telegraph, 6/20).
Reaction
Health Minister Caroline Flint said, "We welcome the fact that a higher percentage of abortions are taking place at an early stage." She added, "It is important that women have early access to abortion services as the earlier the abortion, the lower the risk of complications. However, the [National Health Service] needs to work harder to reduce the demand for abortions by improving access to contraception" (BBC News, 6/19). Abortion-rights groups are calling for increased spending on contraceptive services to prevent unintended pregnancy, noting that the average amount spent on contraception per woman in England is 11 pounds, or about $22, the Guardian reports (Guardian, 6/20). Contraceptive services are "in crisis," Anne Weyman, CEO of the Family Planning Service, said, adding, "Services are being cut and clinics are closing up and down the country."
Paul Tully, general secretary of the Society for the Protection of Unborn Children, said, "Without positive support, an abortion can seem unavoidable - but may be bitterly regretted later on," adding, "The government's approach of promoting early abortion is increasing the overall number of abortions" (BBC News, 6/19). Ann Furedi, chief executive of the British Pregnancy Advisory Service, which provides contraception and abortion services, said, "A rise in the number of abortions is not the problem in itself; the real problem is the number of women experiencing unintended pregnancy." Furedi added, "For some of these, abortion will be the solution to the very serious problem of being faced with an unplanned, unwanted pregnancy" (Press Association, 6/19).
According to the Telegraph, the Royal College of Obstetricians and Gynaecologists has called for a review of sex education to help address the issue. The British Medical Association next week is scheduled to vote on a proposal to relax abortion laws by eliminating language that requires women who are less than 13 weeks' pregnant to have the signature of two doctors before undergoing a procedure (Telegraph, 6/20). The proposal also would allow a wider range of medical professionals to perform an abortion (Guardian, 6/20).
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
source : www.emaxhealth.com
Number Of Abortions In England
The number of abortions reported in England and Wales in 2006 increased 4% from 186,400 in 2005 to 193,700 last year, according to figures released Tuesday by the United Kingdom's Department of Health, London's Guardian reports (Ward, Guardian, 6/20). The figures show the overall rate of abortion is 18.3 abortions per 1,000 women and girls ages 15 to 44 living in England and Wales, compared with 17.8 abortions per 1,000 women and girls in 2005 for the same age group. About 89% of the procedures were performed before 13 weeks' gestation and 68% were performed under 10 weeks' gestation, according to the figures (Moynihan, Press Association, 6/19)
The abortion rate was highest among women age 19 at 35 per 1,000. According to the figures, there were 3.9 abortions per 1,000 girls under age 16 and 18.3 per 1,000 girls under age 18, London's Times reports (Hinds, Times, 6/19). The figures also showed that 32% of women who had an abortion had already had at least one previous abortion -- a percentage that remains unchanged from 2005 despite the government allocating 40 million pounds, or about $79.4 million, for contraception education, London's Telegraph reports (Davies, Telegraph, 6/20).
Reaction
Health Minister Caroline Flint said, "We welcome the fact that a higher percentage of abortions are taking place at an early stage." She added, "It is important that women have early access to abortion services as the earlier the abortion, the lower the risk of complications. However, the [National Health Service] needs to work harder to reduce the demand for abortions by improving access to contraception" (BBC News, 6/19). Abortion-rights groups are calling for increased spending on contraceptive services to prevent unintended pregnancy, noting that the average amount spent on contraception per woman in England is 11 pounds, or about $22, the Guardian reports (Guardian, 6/20). Contraceptive services are "in crisis," Anne Weyman, CEO of the Family Planning Service, said, adding, "Services are being cut and clinics are closing up and down the country."
Paul Tully, general secretary of the Society for the Protection of Unborn Children, said, "Without positive support, an abortion can seem unavoidable - but may be bitterly regretted later on," adding, "The government's approach of promoting early abortion is increasing the overall number of abortions" (BBC News, 6/19). Ann Furedi, chief executive of the British Pregnancy Advisory Service, which provides contraception and abortion services, said, "A rise in the number of abortions is not the problem in itself; the real problem is the number of women experiencing unintended pregnancy." Furedi added, "For some of these, abortion will be the solution to the very serious problem of being faced with an unplanned, unwanted pregnancy" (Press Association, 6/19).
According to the Telegraph, the Royal College of Obstetricians and Gynaecologists has called for a review of sex education to help address the issue. The British Medical Association next week is scheduled to vote on a proposal to relax abortion laws by eliminating language that requires women who are less than 13 weeks' pregnant to have the signature of two doctors before undergoing a procedure (Telegraph, 6/20). The proposal also would allow a wider range of medical professionals to perform an abortion (Guardian, 6/20).
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
source : www.emaxhealth.com
Baby Boomer Women Hardest Hit By Pelvic Health Conditions
Baby Boomer Women Hardest Hit By Pelvic Health Conditions
Pelvic Health Conditions
At least one-third of all women (about 35 million) will be treated for a pelvic health condition by the age of 60, with the onset of these conditions highest among Baby Boomers.
Researchers estimate that even more women are affected but silently suffer. Their reluctance to consult a physician is attributed to lack of education and stigma associated with the conditions.
"Women learn about periods, pregnancy and menopause but are unprepared for what happens in between. The fact is, pelvic health conditions can happen at any age, particularly after a woman's had a baby," explained Elizabeth Battaglino Cahill, RN, executive director of the not-for-profit NWHRC.
The D.C.-based health and human services consulting firm, The Lewin Group, looked at four pelvic health conditions: menorrhagia (heavy menstrual bleeding), uterine fibroids, stress urinary incontinence (SUI) and pelvic organ prolapse (POP) for the report. At least one-third of all Baby Boomers (13.5 million) are affected by heavy periods and SUI. Forty percent of women over 40 are affected by POP. By age 50, 80 percent of African American and 70 percent of Caucasian women have developed fibroids.
"We think the sheer magnitude of how many Baby Boomer women are affected matters because such a large group will have the power to set new expectations for pelvic health, driving more women to seek treatment," said Cahill. "Think back to when the default treatment for breast cancer was a total mastectomy. Those rates have dramatically declined primarily because women advocated for more minimally invasive treatment options. The same needs to be true for pelvic health."
Pelvic health conditions can be uncomfortable, painful and embarrassing, and have a significant impact on everyday quality of life. Symptoms range from sexual dysfunction to abdominal pain and pressure, complications with fertility and pregnancy, anemia, low self-esteem and depression.
The report indicates these conditions can be traced to a variety of factors - most commonly, pregnancy and childbirth or genetic factors - but maintaining a healthy weight and lifestyle can help, and understanding the risks, symptoms and treatment options is a woman's first step in getting back to a healthy lifestyle if she does experience a pelvic condition.
"What I find most unsettling is that women are often under- or misdiagnosed for these conditions because they are hesitant to talk to their doctors," said Dr. Pamela Peeke, medical advisor for the NWHRC. "The findings of this report really stress the need for raising awareness about pelvic health."
In fact, the report revealed that 50-75 percent of women who likely have SUI don't tell their physician about their symptoms, and only 10-20 percent of women with POP seek medical care, because they don't know their symptoms are abnormal or they are too embarrassed to ask. As a result, they are never diagnosed and treated.
Treatment varies by patient and should depend on the severity of the condition and how it affects a woman's life. The choice of treatment also depends on whether a woman wants to have children. Treatments can include pelvic floor exercises, medications, minimally invasive procedures like endometrial ablation for heavy periods and sling procedures for SUI.
A key finding in the report showed the rate of hysterectomy (about 600,000 per year) has essentially remained constant for 25 years, and fibroids and menorrhagia are the leading indications for hysterectomy (representing 44 percent of all procedures in 2005), despite the availability of less invasive treatments that are associated with less pain and a quicker return to normal activities.
According to the NWHRC, women will feel more empowered to ask about alternative treatments to hysterectomy when they have access to reliable information.
source : www.emaxhealth.com
Pelvic Health Conditions
At least one-third of all women (about 35 million) will be treated for a pelvic health condition by the age of 60, with the onset of these conditions highest among Baby Boomers.
Researchers estimate that even more women are affected but silently suffer. Their reluctance to consult a physician is attributed to lack of education and stigma associated with the conditions.
"Women learn about periods, pregnancy and menopause but are unprepared for what happens in between. The fact is, pelvic health conditions can happen at any age, particularly after a woman's had a baby," explained Elizabeth Battaglino Cahill, RN, executive director of the not-for-profit NWHRC.
The D.C.-based health and human services consulting firm, The Lewin Group, looked at four pelvic health conditions: menorrhagia (heavy menstrual bleeding), uterine fibroids, stress urinary incontinence (SUI) and pelvic organ prolapse (POP) for the report. At least one-third of all Baby Boomers (13.5 million) are affected by heavy periods and SUI. Forty percent of women over 40 are affected by POP. By age 50, 80 percent of African American and 70 percent of Caucasian women have developed fibroids.
"We think the sheer magnitude of how many Baby Boomer women are affected matters because such a large group will have the power to set new expectations for pelvic health, driving more women to seek treatment," said Cahill. "Think back to when the default treatment for breast cancer was a total mastectomy. Those rates have dramatically declined primarily because women advocated for more minimally invasive treatment options. The same needs to be true for pelvic health."
Pelvic health conditions can be uncomfortable, painful and embarrassing, and have a significant impact on everyday quality of life. Symptoms range from sexual dysfunction to abdominal pain and pressure, complications with fertility and pregnancy, anemia, low self-esteem and depression.
The report indicates these conditions can be traced to a variety of factors - most commonly, pregnancy and childbirth or genetic factors - but maintaining a healthy weight and lifestyle can help, and understanding the risks, symptoms and treatment options is a woman's first step in getting back to a healthy lifestyle if she does experience a pelvic condition.
"What I find most unsettling is that women are often under- or misdiagnosed for these conditions because they are hesitant to talk to their doctors," said Dr. Pamela Peeke, medical advisor for the NWHRC. "The findings of this report really stress the need for raising awareness about pelvic health."
In fact, the report revealed that 50-75 percent of women who likely have SUI don't tell their physician about their symptoms, and only 10-20 percent of women with POP seek medical care, because they don't know their symptoms are abnormal or they are too embarrassed to ask. As a result, they are never diagnosed and treated.
Treatment varies by patient and should depend on the severity of the condition and how it affects a woman's life. The choice of treatment also depends on whether a woman wants to have children. Treatments can include pelvic floor exercises, medications, minimally invasive procedures like endometrial ablation for heavy periods and sling procedures for SUI.
A key finding in the report showed the rate of hysterectomy (about 600,000 per year) has essentially remained constant for 25 years, and fibroids and menorrhagia are the leading indications for hysterectomy (representing 44 percent of all procedures in 2005), despite the availability of less invasive treatments that are associated with less pain and a quicker return to normal activities.
According to the NWHRC, women will feel more empowered to ask about alternative treatments to hysterectomy when they have access to reliable information.
source : www.emaxhealth.com
A few more minutes of maternal attachment may reduce anemia in children
A few more minutes of maternal attachment may reduce anemia in children
A study conducted at the University of Granada recommends clamping two minutes after delivery instead of 20 seconds, as it is usually done. The study analyzed the umbilical cords of 151 newborn babies from full-term pregnancies.
C@MPUS DIGITAL In the past, the newborns' umbilical cord was not clamped right after birth, thus allowing the blood flow to stop naturally. This practice, known as "late clamping", was replaced by "early clamping", that is, cutting the cord immediately after the infant is expelled. However, this new practice lacks studies corroborating its benefits. In fact, recent studies on the importance of when clamping should be done have shown contradictory results.
A doctoral thesis carried out at the Department of Obstetrics and Gynecology at the University of Granada by Catalina de Paco Matallana shows that the clamping of the umbilical cord of newborns from full-term pregnancies (that is, infants born after a nine-month pregnancy) two minutes after the infant is expelled from the womb makes no difference to hematocrit or hemoglobin levels of the umbilical cord vein compared to clamping the cord within 20 seconds. Thus, the study shows that early clamping (which is widely performed) is not justified.
Analysis of 151 umbilical cords
The doctoral thesis Repercusiones clínicas y fisicoquímicas del tiempo de ligadura del cordón umbilical en recién nacidos a término (Clinical and Physiochemical Repercussions of Clamping Time of the Umbilical Cord of Newborns from Full-Term Pregnancies) analyzed a total of 151 umbilical cords of newborns from full-term pregnancies. In 79 cases, the umbilical cord was cut within 20 seconds, and in 72 cases it was clamped two minutes after the infant was expelled.
The study found that the partial pressure of oxygen in the umbilical artery of the newborn babies who had late clamping had risen, while there was a lesser need of oxygenotherapy after birth. There were no differences in the removal time of the placenta and the mother's bleeding after birth - one of the reasons why early clamping of the umbilical cord started to be practiced.
De Paco Matallana also analyzed the melatonin concentration (one of the strongest and most currently studied antioxidants), finding differences between the melatonin concentration (aMT) in the umbilical vein and the umbilical artery, the latter being where the concentration is significantly higher. "This suggests that the fetus not only receives melatonin from the mother via the umbilical vein because it crosses the placental barrier, but also that it is produced in stressful situations such as during labor," says de Paco Matallana. Thus, high melatonin concentrations in the umbilical cord, together with the arterial and vein differences according to type of birth, suggest that the pineal gland is used by the fetus and that it can respond during birth.
Preventing anemia in children
As for the concentration of the triacylglycerols (TAG) analyzed in the umbilical vein of both groups, this study found statistically significant differences, as there is a higher concentration of TAG in the group of early clamping. The same is applied to the umbilical artery, where there are also statistically significant differences, with higher a concentration of TAG in the group of early clamping. However, there are no studies corroborating these findings, so more research is needed, although many other studies recommend late clamping "especially because of the beneficial effect on the prevention of anemia in children," says de Paco Matallana.
The author points out that the results of her thesis "show that there are no differences in the hemogram or the general biochemical profile in the umbilical vein in the cases of early and late clamping". Moreover, there were no differences in the viscosity or the melatonin in the umbilical artery and vein, which have traditionally been variables related to early clamping. From a clinical point of view, there were no differences in either group with umbilical clamping at birth.
"This study has not found any scientific evidence to suggest that the practice of early clamping is advisable or to justify the abandonment of late clamping in newborns from full-term pregnancies," says de Paco Matallana. "There are convincing findings for and against the two different types of clamping analyzed in this study, which shows not only the complexity of the problem, but also that research in this field may not be controlled enough or designed correctly."
source ; www.emaxhealth.com
A study conducted at the University of Granada recommends clamping two minutes after delivery instead of 20 seconds, as it is usually done. The study analyzed the umbilical cords of 151 newborn babies from full-term pregnancies.
C@MPUS DIGITAL In the past, the newborns' umbilical cord was not clamped right after birth, thus allowing the blood flow to stop naturally. This practice, known as "late clamping", was replaced by "early clamping", that is, cutting the cord immediately after the infant is expelled. However, this new practice lacks studies corroborating its benefits. In fact, recent studies on the importance of when clamping should be done have shown contradictory results.
A doctoral thesis carried out at the Department of Obstetrics and Gynecology at the University of Granada by Catalina de Paco Matallana shows that the clamping of the umbilical cord of newborns from full-term pregnancies (that is, infants born after a nine-month pregnancy) two minutes after the infant is expelled from the womb makes no difference to hematocrit or hemoglobin levels of the umbilical cord vein compared to clamping the cord within 20 seconds. Thus, the study shows that early clamping (which is widely performed) is not justified.
Analysis of 151 umbilical cords
The doctoral thesis Repercusiones clínicas y fisicoquímicas del tiempo de ligadura del cordón umbilical en recién nacidos a término (Clinical and Physiochemical Repercussions of Clamping Time of the Umbilical Cord of Newborns from Full-Term Pregnancies) analyzed a total of 151 umbilical cords of newborns from full-term pregnancies. In 79 cases, the umbilical cord was cut within 20 seconds, and in 72 cases it was clamped two minutes after the infant was expelled.
The study found that the partial pressure of oxygen in the umbilical artery of the newborn babies who had late clamping had risen, while there was a lesser need of oxygenotherapy after birth. There were no differences in the removal time of the placenta and the mother's bleeding after birth - one of the reasons why early clamping of the umbilical cord started to be practiced.
De Paco Matallana also analyzed the melatonin concentration (one of the strongest and most currently studied antioxidants), finding differences between the melatonin concentration (aMT) in the umbilical vein and the umbilical artery, the latter being where the concentration is significantly higher. "This suggests that the fetus not only receives melatonin from the mother via the umbilical vein because it crosses the placental barrier, but also that it is produced in stressful situations such as during labor," says de Paco Matallana. Thus, high melatonin concentrations in the umbilical cord, together with the arterial and vein differences according to type of birth, suggest that the pineal gland is used by the fetus and that it can respond during birth.
Preventing anemia in children
As for the concentration of the triacylglycerols (TAG) analyzed in the umbilical vein of both groups, this study found statistically significant differences, as there is a higher concentration of TAG in the group of early clamping. The same is applied to the umbilical artery, where there are also statistically significant differences, with higher a concentration of TAG in the group of early clamping. However, there are no studies corroborating these findings, so more research is needed, although many other studies recommend late clamping "especially because of the beneficial effect on the prevention of anemia in children," says de Paco Matallana.
The author points out that the results of her thesis "show that there are no differences in the hemogram or the general biochemical profile in the umbilical vein in the cases of early and late clamping". Moreover, there were no differences in the viscosity or the melatonin in the umbilical artery and vein, which have traditionally been variables related to early clamping. From a clinical point of view, there were no differences in either group with umbilical clamping at birth.
"This study has not found any scientific evidence to suggest that the practice of early clamping is advisable or to justify the abandonment of late clamping in newborns from full-term pregnancies," says de Paco Matallana. "There are convincing findings for and against the two different types of clamping analyzed in this study, which shows not only the complexity of the problem, but also that research in this field may not be controlled enough or designed correctly."
source ; www.emaxhealth.com
Requiring HPV Vaccination For School-Age Girls Too Soon
Requiring HPV Vaccination For School-Age Girls Too Soon
HPV Vaccination For School-Age Girls
It is premature to require middle-school age girls to receive Merck's human papillomavirus vaccine Gardasil for the upcoming school year, Doug Lowy -- head of the National Cancer Institute's Laboratory of Cellular Oncology and one of the scientists responsible for the development of the vaccine -- said on Wednesday, CQ HealthBeat reports (Bartolf, CQ HealthBeat, 6/20).
Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases, and about 99% effective in preventing HPV strains 6 and 11, which together with HPV strains 16 and 18 cause about 90% of genital wart cases, among women not already infected with these strains. FDA in June 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine, which is given in a three-shot series (Kaiser Daily Women's Health Policy Report, 5/18).
Lowy, referring to opposition from parents and pro-abstinence groups who believe the vaccine could promote sexual promiscuity, said, "We should minimize the degree to which [Gardasil is] politically polarized by giving parents the option of opting out of the vaccine."
He added that mandating the vaccine before a long safety record has been established is a risky move because the current research does not indicate how long the vaccine will remain effective or if women will need to receive booster shots. "We know it will work for five years, but having a longer record of high effectiveness would make it more reasonable to mandate the vaccine," Lowy said (CQ HealthBeat, 6/20).
FDA To Review Merck's Application for Additional Gardasil Uses
Merck on Wednesday announced that FDA has accepted its application to FDA for extended approval of Gardasil to help prevent vaginal and vulvar cancers under a standard review period, Reuters reports (Reuters, 6/20).
A study published last month in the journal Lancet found that after three years of follow-up, Gardasil was 71% effective in preventing vaginal and vulvar cancers related to HPV strains 16 and 18 among women who previously had been exposed to HPV strains 6, 11, 16 and 18. It was 100% effective among women who previously had not been exposed to those strains. The vaccine was not effective in fighting vaginal or vulvar lesions that already had formed, according to the study. According to Merck, vaginal and vulvar cancers account for about 3% and 4% of gynecological cancers, respectively. HPV is present in about 80% of the 6,000 vaginal and vulvar cancers diagnosed annually in the U.S. (Kaiser Daily Women's Health Policy Report, 5/18).
According to the AP/Forbes, the application also includes data on immune memory, or the ability of the immune system to continue fighting off HPV after the vaccination. If approved, Gardasil's label would include the additional information (AP/Forbes, 6/20). A standard review period usually takes about 10 months, Merck said, adding that it expects FDA to decide on the application in the first quarter of 2008 (Reuters, 6/20).
U.K. Recommends Gardasil for Girls Ages 12 to 13
The United Kingdom's Joint Committee on Vaccination and Immunisation on Wednesday recommended that girls ages 12 and 13 in the country receive Gardasil, London's Guardian reports (Sample, Guardian, 6/21). The country's Department of Health said it has agreed "in principle" to accept the committee's advice, subject to an independent review of its cost to the National Health Service, the Press Association reports. According to the health department, the vaccine will be administered in three doses over six months and will cost 300 pounds, or about $600, for the full course of treatment. Public Health Minister Caroline Flint said the government hopes to begin vaccinating girls as early as 2008 (Kirby, Press Association, 6/20).
Gardasil has been approved in the European Union and 76 countries worldwide -- including Australia, Canada, and the U.S. Merck and Sanofi-Aventis on Monday announced that Switzerland has recommended that girls ages 11 to 14 in the country receive Gardasil. The Swiss decision follows similar recommendations in Austria, Belgium, France, Germany, Italy, Luxembourg and Norway. Sanofi Pasteur, a joint company of Merck and Sanofi-Aventis, is funding a campaign advocating for European governments to vaccinate young girls with Gardasil (Kaiser Daily Women's Health Policy Report, 6/20).
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
source : www.emaxhealth.com
HPV Vaccination For School-Age Girls
It is premature to require middle-school age girls to receive Merck's human papillomavirus vaccine Gardasil for the upcoming school year, Doug Lowy -- head of the National Cancer Institute's Laboratory of Cellular Oncology and one of the scientists responsible for the development of the vaccine -- said on Wednesday, CQ HealthBeat reports (Bartolf, CQ HealthBeat, 6/20).
Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases, and about 99% effective in preventing HPV strains 6 and 11, which together with HPV strains 16 and 18 cause about 90% of genital wart cases, among women not already infected with these strains. FDA in June 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine, which is given in a three-shot series (Kaiser Daily Women's Health Policy Report, 5/18).
Lowy, referring to opposition from parents and pro-abstinence groups who believe the vaccine could promote sexual promiscuity, said, "We should minimize the degree to which [Gardasil is] politically polarized by giving parents the option of opting out of the vaccine."
He added that mandating the vaccine before a long safety record has been established is a risky move because the current research does not indicate how long the vaccine will remain effective or if women will need to receive booster shots. "We know it will work for five years, but having a longer record of high effectiveness would make it more reasonable to mandate the vaccine," Lowy said (CQ HealthBeat, 6/20).
FDA To Review Merck's Application for Additional Gardasil Uses
Merck on Wednesday announced that FDA has accepted its application to FDA for extended approval of Gardasil to help prevent vaginal and vulvar cancers under a standard review period, Reuters reports (Reuters, 6/20).
A study published last month in the journal Lancet found that after three years of follow-up, Gardasil was 71% effective in preventing vaginal and vulvar cancers related to HPV strains 16 and 18 among women who previously had been exposed to HPV strains 6, 11, 16 and 18. It was 100% effective among women who previously had not been exposed to those strains. The vaccine was not effective in fighting vaginal or vulvar lesions that already had formed, according to the study. According to Merck, vaginal and vulvar cancers account for about 3% and 4% of gynecological cancers, respectively. HPV is present in about 80% of the 6,000 vaginal and vulvar cancers diagnosed annually in the U.S. (Kaiser Daily Women's Health Policy Report, 5/18).
According to the AP/Forbes, the application also includes data on immune memory, or the ability of the immune system to continue fighting off HPV after the vaccination. If approved, Gardasil's label would include the additional information (AP/Forbes, 6/20). A standard review period usually takes about 10 months, Merck said, adding that it expects FDA to decide on the application in the first quarter of 2008 (Reuters, 6/20).
U.K. Recommends Gardasil for Girls Ages 12 to 13
The United Kingdom's Joint Committee on Vaccination and Immunisation on Wednesday recommended that girls ages 12 and 13 in the country receive Gardasil, London's Guardian reports (Sample, Guardian, 6/21). The country's Department of Health said it has agreed "in principle" to accept the committee's advice, subject to an independent review of its cost to the National Health Service, the Press Association reports. According to the health department, the vaccine will be administered in three doses over six months and will cost 300 pounds, or about $600, for the full course of treatment. Public Health Minister Caroline Flint said the government hopes to begin vaccinating girls as early as 2008 (Kirby, Press Association, 6/20).
Gardasil has been approved in the European Union and 76 countries worldwide -- including Australia, Canada, and the U.S. Merck and Sanofi-Aventis on Monday announced that Switzerland has recommended that girls ages 11 to 14 in the country receive Gardasil. The Swiss decision follows similar recommendations in Austria, Belgium, France, Germany, Italy, Luxembourg and Norway. Sanofi Pasteur, a joint company of Merck and Sanofi-Aventis, is funding a campaign advocating for European governments to vaccinate young girls with Gardasil (Kaiser Daily Women's Health Policy Report, 6/20).
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
source : www.emaxhealth.com
Saturday, June 23, 2007
Estrogen May Offer Some Heart Benefits
Estrogen May Offer Some Heart Benefits
ATLANTA (AP) -- Five years after a landmark study scared millions of women off hormones for menopause symptoms, new research suggests the pills may offer some heart benefits for certain younger women who start taking them in their 50s. Women who took estrogen suffered less hardening of the arteries than those who took dummy pills, researchers reported in Thursday's New England Journal of Medicine.
It was the latest study in recent months to suggest that women who take hormones at the start of menopause seem to gain some health benefits beyond relief from hot flashes. That is in sharp contrast to women who raise their health risks when they take hormones in their 60s and 70s.
In general, experts' advice hasn't changed: Use hormones only as needed to treat hot flashes, sleeplessness and other symptoms at the start of menopause. And use the lowest possible dose for the shortest possible time - no longer than four or five years.
The new study is the latest attempt to sort out how menopause hormones affect the risk of cancer, Alzheimer's disease, stroke and heart problems, and whether those risks and benefits differ by age.
The research concludes that women who started taking estrogen pills in their 50s were 30 to 40 percent less likely to have measurable levels of blockage-causing calcium in the arteries that lead to the heart.
"It seems to be slowing the rate of plaque buildup," said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital. She is the study's lead author.
The research is based on the Women's Health Initiative, a huge federal study started in the 1990s that focused on the risks and benefits of menopause hormones for women.
One phase of the study was suspended in 2002 after researchers detected higher rates of heart attacks, strokes, breast cancer and other problems in women who took an estrogen-progestin combination pill. Many women were startled by the findings; millions stopped taking hormones.
"The heart attack issue was really the thing that surprised us all," said Dr. Michelle Warren, a Columbia University expert who is a consultant for Wyeth Pharmaceuticals, which makes which makes top-selling hormone pills Prempro and Premarin.
Another phase of the big women's study was stopped in 2004 when researchers saw higher risks for strokes and blood clots in women who took estrogen alone. (Levels of heart disease and breast cancer were unaffected by the solo pill.)
Since then, some scientists have begun to slice the large study's data for more nuanced meaning. They note that most of the women in the study were in their 60s or 70s, several years post-menopausal when the research began. New analyses are focusing on women who were in their 50s when they joined the study.
The scientists are researching a "timing hypothesis" that proposes that estrogen can help against clogged arteries and heart disease, but only when given before problems develop and before natural estrogen levels have been low for an extended period of time. Estrogen can trigger heart attacks in women who have advanced atherosclerosis, experts said.
Warren likened it to exercise: When started earlier in life and done regularly, it can protect a heart. "But if I take a woman who's 63 years old, who's never exercised, and start her on it, I can kill her," she said.
In the new research, Manson and her colleagues focused on more than 1,000 women in their 50s who had hysterectomies. Roughly a quarter of U.S. women in that age bracket have had a hysterectomy, Manson said.
The women were either on estrogen or dummy pills for an average of about 7 1/2 years. They then had cardiac scans in 2005 to check for buildup of calcium in the arteries. The women were 64 years old, on average, at the time of the scans. There was no baseline scan of the women when the study started.
One expert who consults for Wyeth, Dr. Howard Hodis of the University of Southern California, celebrated the results as evidence that estrogen -- started at the right time -- could be taken for decades.
Other experts said that is going too far.
"Wishful thinking," said Dr. Jacques Rossouw, a federal researcher who oversees the Women's Health Initiative.
Risks for stroke and blood clots remain with continued hormone use, noted Dr. Nanette Wenger, an Emory University expert on heart disease in women. Still, the latest findings should provide some comfort to menopausal women who are considering taking estrogen, she said. "This is quite an important study."
The risk of serious heart problems for women in their 50s is low. An earlier study by Manson and others estimated that for women in that age group, 27 in 10,000 women would suffer a heart attack in a year, and 17 in 10,000 would have a stroke.
For women on estrogen, the estimates were 17 and 15, respectively, per 10,000.
Hardening of the arteries is considered a strong predictor of heart attacks, but heart attack reduction is the real goal. So far, for younger women, there is no conclusive medical evidence about the impact on heart attacks.
Women who want to prevent heart disease should focus instead on healthy eating, exercise and not smoking, Wenger said.
Manson agreed. "Estrogen is known to have other risks and should be used only for the treatment of menopausal symptoms at the lowest dose for the shortest duration necessary," she said.
source : www.intelihealth.com
ATLANTA (AP) -- Five years after a landmark study scared millions of women off hormones for menopause symptoms, new research suggests the pills may offer some heart benefits for certain younger women who start taking them in their 50s. Women who took estrogen suffered less hardening of the arteries than those who took dummy pills, researchers reported in Thursday's New England Journal of Medicine.
It was the latest study in recent months to suggest that women who take hormones at the start of menopause seem to gain some health benefits beyond relief from hot flashes. That is in sharp contrast to women who raise their health risks when they take hormones in their 60s and 70s.
In general, experts' advice hasn't changed: Use hormones only as needed to treat hot flashes, sleeplessness and other symptoms at the start of menopause. And use the lowest possible dose for the shortest possible time - no longer than four or five years.
The new study is the latest attempt to sort out how menopause hormones affect the risk of cancer, Alzheimer's disease, stroke and heart problems, and whether those risks and benefits differ by age.
The research concludes that women who started taking estrogen pills in their 50s were 30 to 40 percent less likely to have measurable levels of blockage-causing calcium in the arteries that lead to the heart.
"It seems to be slowing the rate of plaque buildup," said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital. She is the study's lead author.
The research is based on the Women's Health Initiative, a huge federal study started in the 1990s that focused on the risks and benefits of menopause hormones for women.
One phase of the study was suspended in 2002 after researchers detected higher rates of heart attacks, strokes, breast cancer and other problems in women who took an estrogen-progestin combination pill. Many women were startled by the findings; millions stopped taking hormones.
"The heart attack issue was really the thing that surprised us all," said Dr. Michelle Warren, a Columbia University expert who is a consultant for Wyeth Pharmaceuticals, which makes which makes top-selling hormone pills Prempro and Premarin.
Another phase of the big women's study was stopped in 2004 when researchers saw higher risks for strokes and blood clots in women who took estrogen alone. (Levels of heart disease and breast cancer were unaffected by the solo pill.)
Since then, some scientists have begun to slice the large study's data for more nuanced meaning. They note that most of the women in the study were in their 60s or 70s, several years post-menopausal when the research began. New analyses are focusing on women who were in their 50s when they joined the study.
The scientists are researching a "timing hypothesis" that proposes that estrogen can help against clogged arteries and heart disease, but only when given before problems develop and before natural estrogen levels have been low for an extended period of time. Estrogen can trigger heart attacks in women who have advanced atherosclerosis, experts said.
Warren likened it to exercise: When started earlier in life and done regularly, it can protect a heart. "But if I take a woman who's 63 years old, who's never exercised, and start her on it, I can kill her," she said.
In the new research, Manson and her colleagues focused on more than 1,000 women in their 50s who had hysterectomies. Roughly a quarter of U.S. women in that age bracket have had a hysterectomy, Manson said.
The women were either on estrogen or dummy pills for an average of about 7 1/2 years. They then had cardiac scans in 2005 to check for buildup of calcium in the arteries. The women were 64 years old, on average, at the time of the scans. There was no baseline scan of the women when the study started.
One expert who consults for Wyeth, Dr. Howard Hodis of the University of Southern California, celebrated the results as evidence that estrogen -- started at the right time -- could be taken for decades.
Other experts said that is going too far.
"Wishful thinking," said Dr. Jacques Rossouw, a federal researcher who oversees the Women's Health Initiative.
Risks for stroke and blood clots remain with continued hormone use, noted Dr. Nanette Wenger, an Emory University expert on heart disease in women. Still, the latest findings should provide some comfort to menopausal women who are considering taking estrogen, she said. "This is quite an important study."
The risk of serious heart problems for women in their 50s is low. An earlier study by Manson and others estimated that for women in that age group, 27 in 10,000 women would suffer a heart attack in a year, and 17 in 10,000 would have a stroke.
For women on estrogen, the estimates were 17 and 15, respectively, per 10,000.
Hardening of the arteries is considered a strong predictor of heart attacks, but heart attack reduction is the real goal. So far, for younger women, there is no conclusive medical evidence about the impact on heart attacks.
Women who want to prevent heart disease should focus instead on healthy eating, exercise and not smoking, Wenger said.
Manson agreed. "Estrogen is known to have other risks and should be used only for the treatment of menopausal symptoms at the lowest dose for the shortest duration necessary," she said.
source : www.intelihealth.com
Women can avoid breast reduction surgery by being fitted for their bras
Women can avoid breast reduction surgery by being fitted for their bras
Doctors in Britain are calling for women to be offered free bra-fittings on the National Health Service (NHS) in an effort to reduce unnecessary breast reductions.
According to the British Medical Association (BMA) if women wore the right size underwear the NHS could save the tens of thousands of pounds each year it currently spends on such operations.
Breast reduction surgery is one of the most common forms of cosmetic surgery carried out in Britain and a large NHS hospital may well carry out over 100 breast reductions a year, at a cost of around £4,500 for each operation.
The BMA says bra-fitting should be a precursor to a referral for breast reduction surgery as studies show that nine in every ten women do not wear the correct size of bra, and 22 per cent have never been measured at all.
An ill-fitting bra, apart from being uncomfortable, can cause wires to dig into breast tissue and chafing and pain in the neck and shoulders, all of which might encourage a woman to feel that a breast reduction operation is the answer.
At their annual conference later this month the BMA intends to announce that the services of bra-fitters should be made available on the NHS as the first step in the referral for breast reduction surgery.
Experts say cosmetic surgeons are often consulted by women who mistakenly thought they needed breast reduction surgery when a correctly fitted bra would have ended their discomfort.
One study found 100 per cent of women requesting breast reduction surgery were all wearing the wrong bra and had underestimated the back size and overestimated the cup size.
The British Association of Aesthetic Plastic Surgeons (BAAPS), say 3,219 people paid to have private breast reduction surgery last year, an increase of 19 per cent on the year before.
There does appear to be agreement with the BMA on the issue from consultant plastic surgeons and from bra expert working for underwear companies.
The major food and clothing chain Marks and Spencer, which sells more bras than any other high street retailer, does offer women a free bra fitting service carried out by trained personnel for any woman to take advantage of.
source : www.news-medical.net
Doctors in Britain are calling for women to be offered free bra-fittings on the National Health Service (NHS) in an effort to reduce unnecessary breast reductions.
According to the British Medical Association (BMA) if women wore the right size underwear the NHS could save the tens of thousands of pounds each year it currently spends on such operations.
Breast reduction surgery is one of the most common forms of cosmetic surgery carried out in Britain and a large NHS hospital may well carry out over 100 breast reductions a year, at a cost of around £4,500 for each operation.
The BMA says bra-fitting should be a precursor to a referral for breast reduction surgery as studies show that nine in every ten women do not wear the correct size of bra, and 22 per cent have never been measured at all.
An ill-fitting bra, apart from being uncomfortable, can cause wires to dig into breast tissue and chafing and pain in the neck and shoulders, all of which might encourage a woman to feel that a breast reduction operation is the answer.
At their annual conference later this month the BMA intends to announce that the services of bra-fitters should be made available on the NHS as the first step in the referral for breast reduction surgery.
Experts say cosmetic surgeons are often consulted by women who mistakenly thought they needed breast reduction surgery when a correctly fitted bra would have ended their discomfort.
One study found 100 per cent of women requesting breast reduction surgery were all wearing the wrong bra and had underestimated the back size and overestimated the cup size.
The British Association of Aesthetic Plastic Surgeons (BAAPS), say 3,219 people paid to have private breast reduction surgery last year, an increase of 19 per cent on the year before.
There does appear to be agreement with the BMA on the issue from consultant plastic surgeons and from bra expert working for underwear companies.
The major food and clothing chain Marks and Spencer, which sells more bras than any other high street retailer, does offer women a free bra fitting service carried out by trained personnel for any woman to take advantage of.
source : www.news-medical.net
Periodontal diseases are a threat to women of all ages
Periodontal diseases are a threat to women of all ages
Two new studies in the June issue of the Journal of Periodontology (JOP) suggest that periodontal diseases are a threat to women of all ages due to hormonal fluctuations that occur at various stages of their lives.
One study looked at 50 women who were between the ages of 20 to 35 with varying forms of periodontitis. The study found that women who currently were taking oral contraceptive pills had more gingival bleeding upon probing and deeper periodontal pockets (signs of periodontitis) than those who were not taking oral contraceptive pills.
"Younger women often think that periodontal disease is a condition associated with old age," explained study author Brian Mullally, PhD. "Our study shows that it is very possible for younger women to experience periodontal disease. It is important for women to alert their dental practitioners of any medications they are taking, such as oral contraceptive pills, because it is possible that their oral health may be affected. It might also be prudent where possible for young women to ensure that their periodontal health has been checked before commencing oral contraceptive therapy."
Another study in this month's issue of the JOP examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.
"Our study's findings are important for postmenopausal women because they suggest that good periodontal health is extremely important in the postmenopausal years," said study author Renee Brennan, PhD. "We found that oral bone loss was associated with presence of oral bacteria. In fact, 62% of the women in our study had at least one species of subgingival bacteria present, and the women with these bacteria had more evidence of oral bone loss. Interestingly, women who had a Body Mass Index in the overweight range were much more likely to have oral bone loss associated with presence of oral bacteria. Oral bone loss has been associated with osteoporosis in this group as well. This association has been difficult to study because many risk factors for periodontal disease and osteoporosis, including smoking, age, medications, and overall general health are similar. It should be noted that our study was limited in that it included a relatively healthy group of mostly Caucasian women and that future studies are needed to determine the effects of periodontal bacteria on bone loss in other groups of postmenopausal women."
"Taking care of your teeth and gums is a lifelong commitment," explained Preston D. Miller, Jr., DDS, President of the American Academy of Periodontology. "Women should pay special attention to their oral health as they enter different stages of their lives because additional periodontal care may be needed during different points such as the reproductive years or menopause. Knowing your ,pocket size, depth can be a good way for women to keep track of their periodontal health; periodontal pockets of one to two millimeters with no bleeding are not a concern but pockets of three and four millimeters may need a more in depth cleaning called scaling and root planing."
source : www.news-medical.net
Two new studies in the June issue of the Journal of Periodontology (JOP) suggest that periodontal diseases are a threat to women of all ages due to hormonal fluctuations that occur at various stages of their lives.
One study looked at 50 women who were between the ages of 20 to 35 with varying forms of periodontitis. The study found that women who currently were taking oral contraceptive pills had more gingival bleeding upon probing and deeper periodontal pockets (signs of periodontitis) than those who were not taking oral contraceptive pills.
"Younger women often think that periodontal disease is a condition associated with old age," explained study author Brian Mullally, PhD. "Our study shows that it is very possible for younger women to experience periodontal disease. It is important for women to alert their dental practitioners of any medications they are taking, such as oral contraceptive pills, because it is possible that their oral health may be affected. It might also be prudent where possible for young women to ensure that their periodontal health has been checked before commencing oral contraceptive therapy."
Another study in this month's issue of the JOP examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.
"Our study's findings are important for postmenopausal women because they suggest that good periodontal health is extremely important in the postmenopausal years," said study author Renee Brennan, PhD. "We found that oral bone loss was associated with presence of oral bacteria. In fact, 62% of the women in our study had at least one species of subgingival bacteria present, and the women with these bacteria had more evidence of oral bone loss. Interestingly, women who had a Body Mass Index in the overweight range were much more likely to have oral bone loss associated with presence of oral bacteria. Oral bone loss has been associated with osteoporosis in this group as well. This association has been difficult to study because many risk factors for periodontal disease and osteoporosis, including smoking, age, medications, and overall general health are similar. It should be noted that our study was limited in that it included a relatively healthy group of mostly Caucasian women and that future studies are needed to determine the effects of periodontal bacteria on bone loss in other groups of postmenopausal women."
"Taking care of your teeth and gums is a lifelong commitment," explained Preston D. Miller, Jr., DDS, President of the American Academy of Periodontology. "Women should pay special attention to their oral health as they enter different stages of their lives because additional periodontal care may be needed during different points such as the reproductive years or menopause. Knowing your ,pocket size, depth can be a good way for women to keep track of their periodontal health; periodontal pockets of one to two millimeters with no bleeding are not a concern but pockets of three and four millimeters may need a more in depth cleaning called scaling and root planing."
source : www.news-medical.net
Estrogen use lowered one risk factor for heart disease among some younger postmenopausal women
Estrogen use lowered one risk factor for heart disease among some younger postmenopausal women
A follow-up study to the federally funded Women's Health Initiative should help allay one concern in a subset of women in their 50s who are considering taking estrogen to relieve hot flashes.
The study shows that among women who have had hysterectomies, estrogen use was associated with a significantly reduced risk for one predictor of future heart attacks.
However, a Stanford University School of Medicine researcher who is the senior author of the follow-up study reminded women that hormone therapy still carries other health risks, such as the increased likelihood of blood clots and stroke, and stressed that the latest findings shouldn't be interpreted to mean that estrogen should be used to prevent heart disease.
"Heart disease is complex, and the effect of estrogen on one risk factor does not adequately predict the risk of having a heart attack," said Marcia Stefanick, PhD, professor of medicine at the Stanford Prevention Research Center and chair of the national steering committee for the overall WHI study. "But this study offers some reassurance for women of menopausal age that it's not unsafe, in terms of the risk of heart attack, to take estrogen, at least for a few years."
The latest study, which will be published in the June 21 issue of the New England Journal of Medicine, shows that women who took estrogen during the WHI study had lower levels of calcified plaque in their coronary arteries than did women who took placebo pills. The result adds yet another nuance to the complicated picture of hormone therapy that has emerged over the last five years.
Hormones relieve hot flashes and other symptoms of menopause. Until WHI was undertaken, observational studies over the years had been interpreted to suggest that hormones also protected women against heart disease, weak bones and dementia.
But WHI - the largest-ever study of postmenopausal women's health - published findings in 2002 that essentially blew up the conventional wisdom about hormone therapy and raised concerns among a few medical organizations that remain critical of the findings.
The hormone therapy portion of the WHI study had two placebo-controlled trials: one (for women who still had their uteruses) in which half of the women were assigned to take a combination of estrogen and progestin, and a similar trial for women who had undergone hysterectomies in which half the participants took estrogen alone. The estrogen-progestin arm was called to an early halt in 2002 when evidence showed that women taking the combined therapy faced a greater risk of breast cancer, stroke, blood clots and, in the first year of treatment, heart attack.
The estrogen-alone arm of the study involved women who had previously undergone a hysterectomy. Half of the women were given a form of estrogen known as conjugated equine estrogens, while the other half were given a placebo. It was stopped in 2004, one year before its scheduled conclusion, because of concerns that estrogen increased the risk of stroke and blood clots, with no benefit in terms of heart disease.
Since the end of both trials, Stefanick and the other WHI investigators have continued to analyze the data for a more detailed understanding of hormone therapy's effects.
Although the initial analysis of the WHI data found that estrogen had no effect on the risk of heart attack among all the women, who ranged in age from 50 to 79, secondary analyses suggested that there might be some benefit for women in their 50s and those within 10 years of menopause. However, the evidence showed no heart health benefit for older women or for those who began taking estrogen more than 10 years after menopause.
To delve into the possible benefit of estrogen in the younger age group, Stefanick and her WHI colleagues at 28 of the 40 original WHI clinical centers across the United States, including Stanford, invited participants who were in the 50-59 age group at the time they were accepted into the estrogen-only trial to have cardiac computed tomography scans to assess one indicator of heart disease, their levels of coronary artery calcium. If a buildup of calcified plaque ruptures, it could block the flow of blood through the arteries, possibly causing a heart attack or stroke.
These scans were completed an average of 1.3 years after the estrogen-only arm was halted in 2004, by which time an average of 8.7 years had elapsed since the women were randomly assigned to either placebo or active estrogen. At the time of the scans, calcified artery plaque was 20 to 40 percent lower in women who had taken estrogen compared with the women assigned to placebo pills. When the researchers narrowed the focus to those women who took 80 percent of their study pills during the trial, the coronary artery calcium score was 50 to 60 percent lower for those on estrogen compared with those on placebo.
But Stefanick noted that there was no way to know whether the reduced plaque levels will continue to be a reliable indicator of the progression of coronary artery disease in these women as they age. She also noted that other researchers have begun exploring whether heart disease in women, particularly those in their 50s, is linked to a more diffuse type of disease involving the small vessels of the heart. It is unclear how the scans for coronary artery calcification account for this disease, she added.
"Regardless, we have to keep in mind that heart disease is only one potential health risk of hormone therapy," Stefanick said. "When women are thinking about taking estrogen, they should consider the overall risk/benefit balance, which includes an increased risk of stroke and blood clots, regardless of age."
A related editorial that will appear in the same issue of the New England Journal of Medicine says the latest findings support the "timing hypothesis," meaning that estrogen use may have beneficial effects on heart health if initiated as "replacement therapy" before ovarian estrogen levels have been low for an extended period. The same hypothesis holds that if the therapy is initiated after a period of estrogen deprivation, it may be harmful.
However, Stefanick said the study data don't address the "timing hypothesis" because "only younger women were studied, so we don't know whether coronary artery calcium was higher or lower in the older women assigned to estrogen vs. placebo. Furthermore, without a baseline CT scan, we have no data about changes over time."
Stefanick said the medical advice for women experiencing hot flashes and other menopausal discomforts remains unchanged: If they choose to start estrogen, they should take the lowest dose that relieves their symptoms and limit the duration of the therapy.
source : www.news-medical.net
A follow-up study to the federally funded Women's Health Initiative should help allay one concern in a subset of women in their 50s who are considering taking estrogen to relieve hot flashes.
The study shows that among women who have had hysterectomies, estrogen use was associated with a significantly reduced risk for one predictor of future heart attacks.
However, a Stanford University School of Medicine researcher who is the senior author of the follow-up study reminded women that hormone therapy still carries other health risks, such as the increased likelihood of blood clots and stroke, and stressed that the latest findings shouldn't be interpreted to mean that estrogen should be used to prevent heart disease.
"Heart disease is complex, and the effect of estrogen on one risk factor does not adequately predict the risk of having a heart attack," said Marcia Stefanick, PhD, professor of medicine at the Stanford Prevention Research Center and chair of the national steering committee for the overall WHI study. "But this study offers some reassurance for women of menopausal age that it's not unsafe, in terms of the risk of heart attack, to take estrogen, at least for a few years."
The latest study, which will be published in the June 21 issue of the New England Journal of Medicine, shows that women who took estrogen during the WHI study had lower levels of calcified plaque in their coronary arteries than did women who took placebo pills. The result adds yet another nuance to the complicated picture of hormone therapy that has emerged over the last five years.
Hormones relieve hot flashes and other symptoms of menopause. Until WHI was undertaken, observational studies over the years had been interpreted to suggest that hormones also protected women against heart disease, weak bones and dementia.
But WHI - the largest-ever study of postmenopausal women's health - published findings in 2002 that essentially blew up the conventional wisdom about hormone therapy and raised concerns among a few medical organizations that remain critical of the findings.
The hormone therapy portion of the WHI study had two placebo-controlled trials: one (for women who still had their uteruses) in which half of the women were assigned to take a combination of estrogen and progestin, and a similar trial for women who had undergone hysterectomies in which half the participants took estrogen alone. The estrogen-progestin arm was called to an early halt in 2002 when evidence showed that women taking the combined therapy faced a greater risk of breast cancer, stroke, blood clots and, in the first year of treatment, heart attack.
The estrogen-alone arm of the study involved women who had previously undergone a hysterectomy. Half of the women were given a form of estrogen known as conjugated equine estrogens, while the other half were given a placebo. It was stopped in 2004, one year before its scheduled conclusion, because of concerns that estrogen increased the risk of stroke and blood clots, with no benefit in terms of heart disease.
Since the end of both trials, Stefanick and the other WHI investigators have continued to analyze the data for a more detailed understanding of hormone therapy's effects.
Although the initial analysis of the WHI data found that estrogen had no effect on the risk of heart attack among all the women, who ranged in age from 50 to 79, secondary analyses suggested that there might be some benefit for women in their 50s and those within 10 years of menopause. However, the evidence showed no heart health benefit for older women or for those who began taking estrogen more than 10 years after menopause.
To delve into the possible benefit of estrogen in the younger age group, Stefanick and her WHI colleagues at 28 of the 40 original WHI clinical centers across the United States, including Stanford, invited participants who were in the 50-59 age group at the time they were accepted into the estrogen-only trial to have cardiac computed tomography scans to assess one indicator of heart disease, their levels of coronary artery calcium. If a buildup of calcified plaque ruptures, it could block the flow of blood through the arteries, possibly causing a heart attack or stroke.
These scans were completed an average of 1.3 years after the estrogen-only arm was halted in 2004, by which time an average of 8.7 years had elapsed since the women were randomly assigned to either placebo or active estrogen. At the time of the scans, calcified artery plaque was 20 to 40 percent lower in women who had taken estrogen compared with the women assigned to placebo pills. When the researchers narrowed the focus to those women who took 80 percent of their study pills during the trial, the coronary artery calcium score was 50 to 60 percent lower for those on estrogen compared with those on placebo.
But Stefanick noted that there was no way to know whether the reduced plaque levels will continue to be a reliable indicator of the progression of coronary artery disease in these women as they age. She also noted that other researchers have begun exploring whether heart disease in women, particularly those in their 50s, is linked to a more diffuse type of disease involving the small vessels of the heart. It is unclear how the scans for coronary artery calcification account for this disease, she added.
"Regardless, we have to keep in mind that heart disease is only one potential health risk of hormone therapy," Stefanick said. "When women are thinking about taking estrogen, they should consider the overall risk/benefit balance, which includes an increased risk of stroke and blood clots, regardless of age."
A related editorial that will appear in the same issue of the New England Journal of Medicine says the latest findings support the "timing hypothesis," meaning that estrogen use may have beneficial effects on heart health if initiated as "replacement therapy" before ovarian estrogen levels have been low for an extended period. The same hypothesis holds that if the therapy is initiated after a period of estrogen deprivation, it may be harmful.
However, Stefanick said the study data don't address the "timing hypothesis" because "only younger women were studied, so we don't know whether coronary artery calcium was higher or lower in the older women assigned to estrogen vs. placebo. Furthermore, without a baseline CT scan, we have no data about changes over time."
Stefanick said the medical advice for women experiencing hot flashes and other menopausal discomforts remains unchanged: If they choose to start estrogen, they should take the lowest dose that relieves their symptoms and limit the duration of the therapy.
source : www.news-medical.net
Baby Boom Women Confronting Pelvic Health Conditions
Baby Boom Women Confronting Pelvic Health Conditions
(HealthDay News) - Baby boomer women still have hysterectomies at nearly the same rate that women did 25 years ago, despite the development of less drastic medical and surgical alternatives, a new report finds.
In 2005, more than 181,000 hysterectomies done in the United States were on Baby Boomers with two common uterine problems - fibroid tumors and heavy bleeding. But both conditions can often be treated with newer, less-invasive approaches, according to the report commissioned by the National Women's Health Resource Center.
The center describes the report as a first-of-its kind study on the prevalence of pelvic health disorders among American women.
Baby Boomer women, born between 1946 and 1964, are now in the age group where other pelvic disorders, such as stress urinary incontinence and pelvic prolapse, are common. Both stress urinary incontinence and pelvic prolapse, when the pelvic organs shift downward, may be significantly under-diagnosed in American women. That lack of diagnosis may be due to several factors, including lack of awareness or the perceived stigma associated with the conditions, according to the report released Tuesday. The National Women's Health Resource Center (NWHRC) commissioned the report because there "are so many new treatment options for pelvic disorders available," said Elizabeth Battaglino Cahill, the organization's executive vice president. "What we're finding out is that so many women don't know about" those options, she added.
Cahill said the report found that many women don't report the symptoms of fibroids, heavy bleeding, stress urinary incontinence or pelvic prolapse out of embarrassment or the belief that they are part of the normal course of aging.
She added that the NWHRC wants to make pelvic health the subject of the kind of discussion that's now commonplace for menopause. That way women will become more aware and ask their doctors about newer treatments, she said.
Continue Article
With that in mind, the group is launching a campaign called "What's Going on Down There?" It seeks to educate women how to maintain pelvic health throughout their lives and to provide information about common pelvic conditions and available treatments.
The number of women 40 to 49 years old who are having hysterectomies is a "secret in plain view," added Henrick Harwood, a vice president of the Lewin Group, which prepared the report for the NWHRC. "It's estimated that at least 25 percent of boomers will have a hysterectomy by the age of 60," he said.
What makes Baby Boom women turn to hysterectomies, the same treatment their mothers and grandmothers underwent, when better, newer options are available?
"That's the real question," said Dr. William H. Parker, an obstetrician and gynecologist and clinical professor at the University of California, Los Angeles School of Medicine.
"The numbers still haven't changed," Parker said, despite such surgical advances as myomectomy, which removes the fibroid rather than the entire uterus, and endometrial ablation, which destroys a thin layer of the uterine lining. "It's shocking," he added.
Parker said some women may not turn to the newer treatments, which have a quicker recovery time and preserve the uterus and ovaries, because the doctor who delivered their children and whom they've seen for 20 years recommended a hysterectomy.
Many doctors, Parker added, aren't trained to do the newer surgeries, insurance companies may not reimburse for them, or women may simply not be aware of them.
"A major part of my practice is giving second and third opinions because women are not getting the information they want," Parker said.
There are other factors that may compel women to continue to have unnecessary hysterectomies.
Dr. David Archer, a reproductive endocrinologist at Eastern Virginia Medical School in Norfolk, said endometrial ablation may not always be the cure for heavy bleeding, called menorrhagia. "The improvement in blood loss may not mean no blood loss at all," he explained. He added that, with a hysterectomy, the bleeding stops, so some women may choose that option to get it over with.
The report said an estimated 33 percent of Baby Boom women have stress urinary incontinence, but only about 47 percent of all women have ever asked their doctor about it. Many women don't realize that treatment may be as simple as floor exercises or biofeedback, or that surgical interventions are also available, the report said.
Some statistics show that as many as 40 percent of women between the ages of 50 and 79 have some form of pelvic prolapse, the report added. But only about 10 percent to 20 percent of women seek medical care, which includes surgical and non-surgical treatments, the report added.
source : www.cbc.ca
(HealthDay News) - Baby boomer women still have hysterectomies at nearly the same rate that women did 25 years ago, despite the development of less drastic medical and surgical alternatives, a new report finds.
In 2005, more than 181,000 hysterectomies done in the United States were on Baby Boomers with two common uterine problems - fibroid tumors and heavy bleeding. But both conditions can often be treated with newer, less-invasive approaches, according to the report commissioned by the National Women's Health Resource Center.
The center describes the report as a first-of-its kind study on the prevalence of pelvic health disorders among American women.
Baby Boomer women, born between 1946 and 1964, are now in the age group where other pelvic disorders, such as stress urinary incontinence and pelvic prolapse, are common. Both stress urinary incontinence and pelvic prolapse, when the pelvic organs shift downward, may be significantly under-diagnosed in American women. That lack of diagnosis may be due to several factors, including lack of awareness or the perceived stigma associated with the conditions, according to the report released Tuesday. The National Women's Health Resource Center (NWHRC) commissioned the report because there "are so many new treatment options for pelvic disorders available," said Elizabeth Battaglino Cahill, the organization's executive vice president. "What we're finding out is that so many women don't know about" those options, she added.
Cahill said the report found that many women don't report the symptoms of fibroids, heavy bleeding, stress urinary incontinence or pelvic prolapse out of embarrassment or the belief that they are part of the normal course of aging.
She added that the NWHRC wants to make pelvic health the subject of the kind of discussion that's now commonplace for menopause. That way women will become more aware and ask their doctors about newer treatments, she said.
Continue Article
With that in mind, the group is launching a campaign called "What's Going on Down There?" It seeks to educate women how to maintain pelvic health throughout their lives and to provide information about common pelvic conditions and available treatments.
The number of women 40 to 49 years old who are having hysterectomies is a "secret in plain view," added Henrick Harwood, a vice president of the Lewin Group, which prepared the report for the NWHRC. "It's estimated that at least 25 percent of boomers will have a hysterectomy by the age of 60," he said.
What makes Baby Boom women turn to hysterectomies, the same treatment their mothers and grandmothers underwent, when better, newer options are available?
"That's the real question," said Dr. William H. Parker, an obstetrician and gynecologist and clinical professor at the University of California, Los Angeles School of Medicine.
"The numbers still haven't changed," Parker said, despite such surgical advances as myomectomy, which removes the fibroid rather than the entire uterus, and endometrial ablation, which destroys a thin layer of the uterine lining. "It's shocking," he added.
Parker said some women may not turn to the newer treatments, which have a quicker recovery time and preserve the uterus and ovaries, because the doctor who delivered their children and whom they've seen for 20 years recommended a hysterectomy.
Many doctors, Parker added, aren't trained to do the newer surgeries, insurance companies may not reimburse for them, or women may simply not be aware of them.
"A major part of my practice is giving second and third opinions because women are not getting the information they want," Parker said.
There are other factors that may compel women to continue to have unnecessary hysterectomies.
Dr. David Archer, a reproductive endocrinologist at Eastern Virginia Medical School in Norfolk, said endometrial ablation may not always be the cure for heavy bleeding, called menorrhagia. "The improvement in blood loss may not mean no blood loss at all," he explained. He added that, with a hysterectomy, the bleeding stops, so some women may choose that option to get it over with.
The report said an estimated 33 percent of Baby Boom women have stress urinary incontinence, but only about 47 percent of all women have ever asked their doctor about it. Many women don't realize that treatment may be as simple as floor exercises or biofeedback, or that surgical interventions are also available, the report said.
Some statistics show that as many as 40 percent of women between the ages of 50 and 79 have some form of pelvic prolapse, the report added. But only about 10 percent to 20 percent of women seek medical care, which includes surgical and non-surgical treatments, the report added.
source : www.cbc.ca
Monday, June 18, 2007
East, Central, Southern African Commonwealth Countries Call For Increasing Funds To Health Sector For Women's Services
East, Central, Southern African Commonwealth Countries Call For Increasing Funds To Health Sector For Women's Services
Members of Commonwealth countries in East, Central and Southern Africa at a conference in Munyonyo, Uganda, agreed to recommend that governments increase budget allocations to health sectors to enable women access to emergency obstetric care without paying medical service fees, Uganda's Monitor reports. Representatives from Kenya, Lesotho, Malawi, Mozambique, Sierra Leone, Tanzania, Uganda and Zambia agreed to the recommendations, which included:
* Eliminating medical service fees for pregnant women;
* Institutionalizing deliveries and maternal death audits;
* Remuneration for medical workers; and
* Strengthening training for midwifery services.
In addition, the recommendations called for developing ways to empower women to seek health services without relying on their husbands and bringing health services closer to women to reduce maternal mortality. According to the representatives, a lack of funds for health services in the region is inhibiting countries from preventing obstetric emergencies -- such as hemorrhaging, obstructed labor, sepsis and eclampsia -- and has led to an increase in maternal mortality.
The three-day conference was organized by the Commonwealth Secretariat and its Health Section and Social Transformation Programmes Division in collaboration with the East, Central and Southern Africa Health Community (Nafula, Monitor, 6/11).
source : www.medicalnewstoday.com
Members of Commonwealth countries in East, Central and Southern Africa at a conference in Munyonyo, Uganda, agreed to recommend that governments increase budget allocations to health sectors to enable women access to emergency obstetric care without paying medical service fees, Uganda's Monitor reports. Representatives from Kenya, Lesotho, Malawi, Mozambique, Sierra Leone, Tanzania, Uganda and Zambia agreed to the recommendations, which included:
* Eliminating medical service fees for pregnant women;
* Institutionalizing deliveries and maternal death audits;
* Remuneration for medical workers; and
* Strengthening training for midwifery services.
In addition, the recommendations called for developing ways to empower women to seek health services without relying on their husbands and bringing health services closer to women to reduce maternal mortality. According to the representatives, a lack of funds for health services in the region is inhibiting countries from preventing obstetric emergencies -- such as hemorrhaging, obstructed labor, sepsis and eclampsia -- and has led to an increase in maternal mortality.
The three-day conference was organized by the Commonwealth Secretariat and its Health Section and Social Transformation Programmes Division in collaboration with the East, Central and Southern Africa Health Community (Nafula, Monitor, 6/11).
source : www.medicalnewstoday.com
The Most Women In Synchronized Breastfeeding Around The World
The Most Women In Synchronized Breastfeeding Around The World
Children for Breastfeeding, Inc., a Philippine-based advocacy group invites you to join us to establish a new record for "The most women in synchronized breastfeeding around the world."
Children for Breastfeeding, Inc. proposed and was authorized by the Guinness World Records Ltd. to initiate the event. Previously, our organization broke the world record for the most women simultaneously breastfeeding in a single site (3,541 with the City of Manila and Nurturers of the Earth in 2006), and in multiple sites (about 14,000 as of the last count in more than 400 sites throughout the Philippines this year). The first attempt of synchronized breastfeeding is tentatively scheduled on August 7, 2007 during the World Breastfeeding Week.
We are calling for volunteers to be national coordinators to submit to us their national tally and the necessary documents. Thus far, New Zealand, Greece, Dominican Republic, Uganda and India have committed to join the attempt. Some breastfeeding coordinators from USA have also siginified tgeri interest and are now consulting their groups. You can create your own web section for this event like New Zealand.
Nurturers of the Earth, our event coordinator will put up a website for this event. We will announce if the website is already online. Meanwhile, please visit the website they put up for Guinness World Record on Simultaneous Breastfeeding in Multiple Sites at www.breastfeedingphilippines.com to know more about our organizations. Click Sabay-sabay, Sumuso sa Nanay web banner to know more about our simultaneous breastfeeding in multiple sites.
The purpose of this activity is to encourage breastfeeding EVERYWHERE IN THE WORLD as a world prayer of thanksgiving for the gift of motherhood and breastfeeding. We also aim to promote it as the only perfect means to nurture our children to better health, and as the most far-reaching and cheapest strategy for the alleviation of poverty. This is especially urgent in an impoverished Third World country inveigled by propaganda to use its meager resources to import formula milk from cows at the cost of its health, and abandoning breastfeeding which is free and nutritious unlike formula milk.
This attempt will be done with the spirit of cooperation rather than competition, to advance the breastfeeding movement. Because of the different time zones in the world, it is necessary to stagger the times of participation, like the celebration of New Year, to the same designated time in every time zone, over a period of 24 hours, starting from the country initiating the attempt. For example, the attempt is first initiated in Manila, Kuala Lumpur, Singapore, Beijing and Hong Kong at 10 am local time; an hour later in the next time zone, 10 am local time in Tokyo and Seoul; the next hour at 10 am local time in Melbourne, Guam and Vladivostok; etcetera, etcetera, for 24 hours till the attempt is made at 10 am local time the next day in New Zealand, Bangkok, Hanoi and Jakarta. May we respectfully invite your hospitals, lying-in clinics and birthing centers to participate in this endeavor to encourage their patients to gather together in one room at the appointed time and breastfeed simultaneously.
According to the Philippine proposal, there will be no minimum in the number of sites required and no minimum in number of nursing women required in each site. Since the advent of the Internet and the computer, it is now possible to document any event simultaneously in the entire world accurately, expeditiously, and in real time. Participation forms may be downloaded anywhere through the Internet, the attempts documented with two independent witnesses at each site, and the results sent back to the initiator through e-mail. Even the attempt of one lone nursing mother in her own house with the required witnesses, may thus be documented. To avoid confusion and cross-purposes, there will be only one attempt authorized by Guinness to proceed at any designated time and date.
Children for Breastfeeding, Inc., a Philippine-based advocacy group invites you to join us to establish a new record for "The most women in synchronized breastfeeding around the world."
Children for Breastfeeding, Inc. proposed and was authorized by the Guinness World Records Ltd. to initiate the event. Previously, our organization broke the world record for the most women simultaneously breastfeeding in a single site (3,541 with the City of Manila and Nurturers of the Earth in 2006), and in multiple sites (about 14,000 as of the last count in more than 400 sites throughout the Philippines this year). The first attempt of synchronized breastfeeding is tentatively scheduled on August 7, 2007 during the World Breastfeeding Week.
We are calling for volunteers to be national coordinators to submit to us their national tally and the necessary documents. Thus far, New Zealand, Greece, Dominican Republic, Uganda and India have committed to join the attempt. Some breastfeeding coordinators from USA have also siginified tgeri interest and are now consulting their groups. You can create your own web section for this event like New Zealand.
Nurturers of the Earth, our event coordinator will put up a website for this event. We will announce if the website is already online. Meanwhile, please visit the website they put up for Guinness World Record on Simultaneous Breastfeeding in Multiple Sites at www.breastfeedingphilippines.com to know more about our organizations. Click Sabay-sabay, Sumuso sa Nanay web banner to know more about our simultaneous breastfeeding in multiple sites.
The purpose of this activity is to encourage breastfeeding EVERYWHERE IN THE WORLD as a world prayer of thanksgiving for the gift of motherhood and breastfeeding. We also aim to promote it as the only perfect means to nurture our children to better health, and as the most far-reaching and cheapest strategy for the alleviation of poverty. This is especially urgent in an impoverished Third World country inveigled by propaganda to use its meager resources to import formula milk from cows at the cost of its health, and abandoning breastfeeding which is free and nutritious unlike formula milk.
This attempt will be done with the spirit of cooperation rather than competition, to advance the breastfeeding movement. Because of the different time zones in the world, it is necessary to stagger the times of participation, like the celebration of New Year, to the same designated time in every time zone, over a period of 24 hours, starting from the country initiating the attempt. For example, the attempt is first initiated in Manila, Kuala Lumpur, Singapore, Beijing and Hong Kong at 10 am local time; an hour later in the next time zone, 10 am local time in Tokyo and Seoul; the next hour at 10 am local time in Melbourne, Guam and Vladivostok; etcetera, etcetera, for 24 hours till the attempt is made at 10 am local time the next day in New Zealand, Bangkok, Hanoi and Jakarta. May we respectfully invite your hospitals, lying-in clinics and birthing centers to participate in this endeavor to encourage their patients to gather together in one room at the appointed time and breastfeed simultaneously.
According to the Philippine proposal, there will be no minimum in the number of sites required and no minimum in number of nursing women required in each site. Since the advent of the Internet and the computer, it is now possible to document any event simultaneously in the entire world accurately, expeditiously, and in real time. Participation forms may be downloaded anywhere through the Internet, the attempts documented with two independent witnesses at each site, and the results sent back to the initiator through e-mail. Even the attempt of one lone nursing mother in her own house with the required witnesses, may thus be documented. To avoid confusion and cross-purposes, there will be only one attempt authorized by Guinness to proceed at any designated time and date.
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