The document discusses the experience and lessons learned by the author, a medical doctor specializing in women's health, in treating menopausal women over the course of his career. Some key points made include:
- Looking after menopausal women is a fascinating, gratifying, and complex experience for physicians due to the holistic factors involved.
- Recent large studies like WHI have been misinterpreted by medical professionals and caused unnecessary fear, when properly interpreted they show hormone therapy is generally safe and effective for relieving menopausal symptoms.
- Younger women may receive heart protection from estrogen therapy, and risks of conditions like breast cancer return to normal after stopping therapy.
- Occult breast cancers are actually
This document discusses treatment options for climacteric (menopausal) women based on the experience and perspectives of Dr. Manuel Neves-e-Castro. It begins by introducing Dr. Castro and his background. It then discusses definitions and objectives related to treating climacteric women, including critical objectives like diagnosis, risk identification, and symptom/disease treatment. It also discusses specific objectives and targets related to conditions like cardiovascular disease, CNS issues, bones, reproductive organs, and more. The document provides examples of treatment options and projects for various objectives. It continues discussing controversies, lessons from studies like WHI, effects on heart disease and breast cancer risk, and considerations around hormone therapy.
1) The WHI study found small increases in cardiovascular risks and breast cancer for women taking combined estrogen and progestin HRT. However, the absolute risks for individual women were very small.
2) The results do not necessarily apply to lower drug doses, different formulations, or non-oral routes of administration. Absolute risks were far smaller than relative risks suggested.
3) The main goal for women's health practitioners should be maintaining overall health and disease prevention for postmenopausal women, not long-term hormonal treatment alone. Alternative non-hormonal strategies also exist.
1. Addiction involves multiple factors including genes, environment, and brain mechanisms.
2. Addiction is a developmental disease that typically starts in adolescence and childhood.
3. Addiction is a disease of the brain that affects tissue function similar to other diseases like heart disease.
- Ms. P is a 64-year-old woman diagnosed with fibromyalgia who experiences widespread muscle pain and fatigue. Her pain is aggravated by touch and relieved by rest and heat.
- She has tried numerous medications for fibromyalgia but most resulted in adverse effects. Her current treatment includes acupuncture, pregabalin, hydrocodone, and cyclobenzaprine.
- Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue, memory problems, and sleep disturbances. It affects 2-8% of the population and is considered a centralized pain state involving central nervous system pain amplification.
1) Hormone replacement therapy (HRT) is a misnomer and should be called postmenopause hormone treatment (PMHT) as it is not replacing anything physiological.
2) PMHT refers to the use of estrogens and other hormones when indicated along with non-hormonal treatments and lifestyle changes to maintain health and prevent diseases associated with menopause.
3) It is important not to view HRT/PMHT as obligatory or the only option for postmenopausal women. Treatments must be individualized based on risk factors and health needs.
This document discusses treatment options for patients with hormone receptor-positive, HER2-negative metastatic breast cancer who have progressed on initial endocrine therapy. It considers fulvestrant monotherapy or the combination of everolimus and exemestane as potential second-line hormonal therapies. Trial data is presented showing that fulvestrant 500mg improves median overall survival by 4.1 months compared to 250mg. The TAMRAD trial found the combination of tamoxifen and everolimus increased clinical benefit rate over tamoxifen alone. The BOLERO-2 trial demonstrated that adding everolimus to exemestane significantly prolonged progression-free survival compared to exemestane alone. Subgroup analyses from
The document discusses controversies around the management of perimenopause and postmenopause. There are debates due to a lack of proper evaluation of published results, ignoring the whole woman in medical practice, political lobbying, and a lack of scientific honesty. The document also summarizes discussions and conclusions from several international symposiums on menopause, including debates between European and US perspectives on the implications of clinical trials like WHI for cardiovascular disease and cancer risk in younger women. Overall, the document examines ongoing controversies and perspectives regarding hormone therapy management in the menopausal period.
This weekly medical newsletter summarizes recent studies on a variety of health topics. Key findings include: polyunsaturated fats may increase breast cancer risk while monounsaturated fats decrease it; breastfeeding should be delayed for an hour after vigorous exercise; and dextromethorphan cough medicines should be avoided during pregnancy due to animal studies finding birth defects. The newsletter also reports on studies relating to SIDS risks from infant quilts, benefits of second opinions before elective surgery, and effects of supplements like rhubarb fiber and green tea.
This document discusses treatment options for climacteric (menopausal) women based on the experience and perspectives of Dr. Manuel Neves-e-Castro. It begins by introducing Dr. Castro and his background. It then discusses definitions and objectives related to treating climacteric women, including critical objectives like diagnosis, risk identification, and symptom/disease treatment. It also discusses specific objectives and targets related to conditions like cardiovascular disease, CNS issues, bones, reproductive organs, and more. The document provides examples of treatment options and projects for various objectives. It continues discussing controversies, lessons from studies like WHI, effects on heart disease and breast cancer risk, and considerations around hormone therapy.
1) The WHI study found small increases in cardiovascular risks and breast cancer for women taking combined estrogen and progestin HRT. However, the absolute risks for individual women were very small.
2) The results do not necessarily apply to lower drug doses, different formulations, or non-oral routes of administration. Absolute risks were far smaller than relative risks suggested.
3) The main goal for women's health practitioners should be maintaining overall health and disease prevention for postmenopausal women, not long-term hormonal treatment alone. Alternative non-hormonal strategies also exist.
1. Addiction involves multiple factors including genes, environment, and brain mechanisms.
2. Addiction is a developmental disease that typically starts in adolescence and childhood.
3. Addiction is a disease of the brain that affects tissue function similar to other diseases like heart disease.
- Ms. P is a 64-year-old woman diagnosed with fibromyalgia who experiences widespread muscle pain and fatigue. Her pain is aggravated by touch and relieved by rest and heat.
- She has tried numerous medications for fibromyalgia but most resulted in adverse effects. Her current treatment includes acupuncture, pregabalin, hydrocodone, and cyclobenzaprine.
- Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue, memory problems, and sleep disturbances. It affects 2-8% of the population and is considered a centralized pain state involving central nervous system pain amplification.
1) Hormone replacement therapy (HRT) is a misnomer and should be called postmenopause hormone treatment (PMHT) as it is not replacing anything physiological.
2) PMHT refers to the use of estrogens and other hormones when indicated along with non-hormonal treatments and lifestyle changes to maintain health and prevent diseases associated with menopause.
3) It is important not to view HRT/PMHT as obligatory or the only option for postmenopausal women. Treatments must be individualized based on risk factors and health needs.
This document discusses treatment options for patients with hormone receptor-positive, HER2-negative metastatic breast cancer who have progressed on initial endocrine therapy. It considers fulvestrant monotherapy or the combination of everolimus and exemestane as potential second-line hormonal therapies. Trial data is presented showing that fulvestrant 500mg improves median overall survival by 4.1 months compared to 250mg. The TAMRAD trial found the combination of tamoxifen and everolimus increased clinical benefit rate over tamoxifen alone. The BOLERO-2 trial demonstrated that adding everolimus to exemestane significantly prolonged progression-free survival compared to exemestane alone. Subgroup analyses from
The document discusses controversies around the management of perimenopause and postmenopause. There are debates due to a lack of proper evaluation of published results, ignoring the whole woman in medical practice, political lobbying, and a lack of scientific honesty. The document also summarizes discussions and conclusions from several international symposiums on menopause, including debates between European and US perspectives on the implications of clinical trials like WHI for cardiovascular disease and cancer risk in younger women. Overall, the document examines ongoing controversies and perspectives regarding hormone therapy management in the menopausal period.
This weekly medical newsletter summarizes recent studies on a variety of health topics. Key findings include: polyunsaturated fats may increase breast cancer risk while monounsaturated fats decrease it; breastfeeding should be delayed for an hour after vigorous exercise; and dextromethorphan cough medicines should be avoided during pregnancy due to animal studies finding birth defects. The newsletter also reports on studies relating to SIDS risks from infant quilts, benefits of second opinions before elective surgery, and effects of supplements like rhubarb fiber and green tea.
This talk was given by Dr. Jennifer Huggins of Cincinnati Childrens Hospital, at the Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day, on July 22nd, 2017.
Toluwalase Ajayi MD presented on palliative care for patients with dementia. Key points include:
- Dementia prevalence is increasing as the population ages and life expectancy rises.
- Palliative care aims to improve quality of life for patients and families dealing with dementia.
- Management involves a multidisciplinary team and focuses on both pharmacological and non-pharmacological approaches.
- Advance care planning is important to help families navigate challenging end-of-life decisions as the disease progresses.
New Concepts in Micronutrient Adequacy and Health Optimization - Cady = May 1...Louis Cady, MD
In this presentation, Dr. Cady revisits the BioPhotonic Scanner and current concepts in lack of nutrient adequacy in the contemporary diet. The role of appropriate supplementation with vitamins, minerals, and antioxidants is reviewed.
The Role of Estradiol in Idiopathic Anterior Uveitis during the Eumenorrheic ...CrimsonpublishersMSOR
Women with idiopathic anterior uveitis do not appear to relapse while pregnant. Relapses are reported more frequently and more intensely during premenstrual and menstrual stages. These observations suggest that uveitis may be related to fluctuations of sex steroid hormones.
Susan Mitchell-Care of the Patient with Advanced Dementia: What Physicians Ne...jewishhome
This document discusses care of patients with advanced dementia. It summarizes that dementia is a terminal illness and the most common complications are feeding problems and infections. Aggressive interventions are less likely when families understand the prognosis and expected complications. Tube feeding is not recommended as it does not provide benefits and antibiotics for pneumonia may prolong life but cause more discomfort. Most hospital transfers can be avoided by managing complications in the nursing home based on the goals of comfort care. The document emphasizes making ethical decisions guided by the patient's goals of care rather than feeling compelled to offer all possible interventions.
KMorton Gender dimorphism and its effect on mortality in traumatically brain ...Karissa Morton
This study investigated the effect of gender dimorphism on mortality in 962 patients with traumatic brain injury (TBI) admitted between 2000-2009. The mean age of patients was 41.12 years and males were younger than females. No significant differences in mortality between males and females were found overall or when stratified by age. Females had significantly longer hospital and ICU stays than males. Logistic regression also found no gender to be a significant risk factor for mortality in TBI patients. The study concluded that no association between gender and mortality was identified.
Skeptics in the Pub talk slides - Prof. Edzard Ernst 2011-09-13Nick Sharratt
Slides from the talk given by Prof. Edzard Ernst to the Plymouth Skeptics in the Pub group 13th Sept 2011
Images removed which may otherwise breach (c)
Slides with a green background are explained to be tongue in cheek. Yellow backgrounds are "take home messages"
The Psycholegal Implications of Brain Traumaaweisman
This document summarizes a case involving a woman charged with assault with a deadly weapon who presented a covert neurological condition as a defense. She had undergone surgery to remove a pituitary adenoma tumor less than two months before the assault. Neuropsychiatric complications are common with pituitary tumors and their removal, including mood, anxiety, psychotic and cognitive symptoms. Her defense argued the tumor and surgery may have influenced her behavior. She was given a suspended sentence and probation, and showed no further aggression after approximately 15 months.
This document discusses lifestyle factors and their impact on health and aging. It suggests that lifestyle modifications through practices like exercise, nutrition, stress management and social support can help maintain health and prevent disease by affecting aging at the cellular level. Specifically, it discusses how telomeres and telomerase are markers of biological aging and how lifestyle interventions may help preserve telomere length and telomerase activity to slow cellular aging. Overall, the document advocates that lifestyle medicine which focuses on prevention through lifestyle changes may be more effective than medical treatments alone.
Influence of health behavior on mortality in women diagnosed with ductal carc...Christopher Veal
1) The study examined how health behaviors like BMI, physical activity, alcohol consumption, and smoking affected mortality outcomes in 1,925 women diagnosed with ductal carcinoma in situ (DCIS).
2) Over an average of 6.7 years of follow up, 196 deaths occurred including 87 from cancer and 34 from cardiovascular disease.
3) Current smoking one year prior to DCIS diagnosis was associated with over twice the risk of all-cause mortality compared to never smokers. Greater physical activity levels prior to diagnosis were associated with half the risk of all-cause mortality. Moderate physical activity after diagnosis was linked to over two-thirds reduced risk of all-cause mortality.
This talk was given by Dr. Grant Schulert Cincinnati Children's Hospital to a group of patient families, at Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day on July 22nd, 2017.
Deterioro en el estado general y pérdida de pesoIntegrarsalud
1) Unintentional weight loss of 10% or more in 6-12 months is defined as involuntary weight loss.
2) Common causes include cancer, gastrointestinal disorders, endocrine diseases, and psychological factors.
3) Involuntary weight loss is associated with increased mortality, hospital complications, disability, and reduced quality of life.
This document provides an overview and summary of a presentation on assessing pain, sedation, and delirium in intensive care unit patients. It discusses:
- The importance of using validated scales like the Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS) to accurately assess sedation levels in patients receiving sedatives.
- The challenges of assessing delirium given confounding factors like a patient's sedation level, wakefulness, and other psychiatric diagnoses. Scales like the Confusion Assessment Method for the ICU (CAM-ICU) are used but their accuracy depends on a patient's sedation.
- How pharmacokinetic factors like drug-
Rare Pulmonary Diseases in Systemic JIA. This presentation tracks the increased use of biologics to treat SJIA and observes the trends in rare pulmonary diseases.
What Cancer Patients Need to Know about Cardio-Oncologybkling
This document discusses the link between cancer and cardiovascular disease. It introduces cardio-oncology as a new medical specialty that addresses the cardiovascular effects of cancer therapies to prevent cardiac dysfunction. Many cancer treatments can be cardiotoxic, and cancer survivors often die of cardiac complications rather than cancer recurrence. There are also shared risk factors for cancer and heart disease like smoking, obesity, diabetes, and lack of physical activity. Diet, inflammation, and other biological processes also link the development of the two diseases. Cardio-oncology aims to monitor and manage cardiac risks in cancer patients and survivors.
Fibromyalgia can be resolved by medical herbalismmorwenna2
A recent public awareness survey by the National Fibromyalgia Association illustrates a significant lack of understanding about Fibromyalgia: nearly half of the general public (45%) has never heard of Fibromyalgia, many people who are knowledgeable about the disorder incorrectly believe that nothing can be done to manage it, and nearly half (48%) of all healthcare providers are reluctant to diagnose a patient with the condition (National Fibromyalgia Association, 2007).
- Fibromyalgia affects 3 to 6 million Americans, with 80-90% being women who are usually diagnosed in middle age.
- It is characterized by widespread pain in the muscles and soft tissues. Common symptoms include fatigue, sleep issues, headaches, and tender points in various areas of the body.
- While drugs can help manage symptoms, natural therapies like exercise, stress reduction, and nutrition have shown more long-term promise for fibromyalgia sufferers. Regular exercise in particular can help reduce pain and fatigue and improve overall health.
ANA testing is confusion and many times getting a positive ANA complicates the clinical picture. A few tips to know what to do when you have a positive ANA.
Holly Thacker, Update on: Menopause, Hormone Therapy, Sex, Politics, and the ...Cleveland HeartLab, Inc.
This document provides an overview and summary of a presentation on menopause, hormone therapy, cardiovascular health, and women's health issues. It discusses the aftermath of the Women's Health Initiative study 12 years later, compares risks of hormone therapy to other medications, and examines risk/benefit ratios of hormone therapy for cardiovascular disease. It also addresses politics surrounding women's health issues and "war on women" narratives related to hormone therapy. The presentation aims to provide an updated perspective on these issues based on newer research findings.
This document discusses the history and scientific evidence around hormone replacement therapy (HRT) and its relationship to breast cancer. It notes that while early studies found HRT improved quality of life and reduced fractures, the large Women's Health Initiative studies from the 1990s-2000s found HRT increased risks of breast cancer, heart disease, and blood clots. However, sub-analysis indicated lower risks for younger women using HRT short-term. Current recommendations are that HRT may be used at lowest effective dose for shortest time to treat menopausal symptoms.
The document summarizes research on cancer, stress, and personality. It finds that while stress may accelerate tumor growth in animal models, studies do not show stress causes cancer in humans. Childhood adversity is linked to increased risk behaviors but its relationship to cancer is unclear. Personality does not determine cancer risk but may impact progression. Psychotherapy improves mood in cancer patients but does not extend survival. It can reduce chemotherapy side effects through classical conditioning approaches.
This talk was given by Dr. Jennifer Huggins of Cincinnati Childrens Hospital, at the Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day, on July 22nd, 2017.
Toluwalase Ajayi MD presented on palliative care for patients with dementia. Key points include:
- Dementia prevalence is increasing as the population ages and life expectancy rises.
- Palliative care aims to improve quality of life for patients and families dealing with dementia.
- Management involves a multidisciplinary team and focuses on both pharmacological and non-pharmacological approaches.
- Advance care planning is important to help families navigate challenging end-of-life decisions as the disease progresses.
New Concepts in Micronutrient Adequacy and Health Optimization - Cady = May 1...Louis Cady, MD
In this presentation, Dr. Cady revisits the BioPhotonic Scanner and current concepts in lack of nutrient adequacy in the contemporary diet. The role of appropriate supplementation with vitamins, minerals, and antioxidants is reviewed.
The Role of Estradiol in Idiopathic Anterior Uveitis during the Eumenorrheic ...CrimsonpublishersMSOR
Women with idiopathic anterior uveitis do not appear to relapse while pregnant. Relapses are reported more frequently and more intensely during premenstrual and menstrual stages. These observations suggest that uveitis may be related to fluctuations of sex steroid hormones.
Susan Mitchell-Care of the Patient with Advanced Dementia: What Physicians Ne...jewishhome
This document discusses care of patients with advanced dementia. It summarizes that dementia is a terminal illness and the most common complications are feeding problems and infections. Aggressive interventions are less likely when families understand the prognosis and expected complications. Tube feeding is not recommended as it does not provide benefits and antibiotics for pneumonia may prolong life but cause more discomfort. Most hospital transfers can be avoided by managing complications in the nursing home based on the goals of comfort care. The document emphasizes making ethical decisions guided by the patient's goals of care rather than feeling compelled to offer all possible interventions.
KMorton Gender dimorphism and its effect on mortality in traumatically brain ...Karissa Morton
This study investigated the effect of gender dimorphism on mortality in 962 patients with traumatic brain injury (TBI) admitted between 2000-2009. The mean age of patients was 41.12 years and males were younger than females. No significant differences in mortality between males and females were found overall or when stratified by age. Females had significantly longer hospital and ICU stays than males. Logistic regression also found no gender to be a significant risk factor for mortality in TBI patients. The study concluded that no association between gender and mortality was identified.
Skeptics in the Pub talk slides - Prof. Edzard Ernst 2011-09-13Nick Sharratt
Slides from the talk given by Prof. Edzard Ernst to the Plymouth Skeptics in the Pub group 13th Sept 2011
Images removed which may otherwise breach (c)
Slides with a green background are explained to be tongue in cheek. Yellow backgrounds are "take home messages"
The Psycholegal Implications of Brain Traumaaweisman
This document summarizes a case involving a woman charged with assault with a deadly weapon who presented a covert neurological condition as a defense. She had undergone surgery to remove a pituitary adenoma tumor less than two months before the assault. Neuropsychiatric complications are common with pituitary tumors and their removal, including mood, anxiety, psychotic and cognitive symptoms. Her defense argued the tumor and surgery may have influenced her behavior. She was given a suspended sentence and probation, and showed no further aggression after approximately 15 months.
This document discusses lifestyle factors and their impact on health and aging. It suggests that lifestyle modifications through practices like exercise, nutrition, stress management and social support can help maintain health and prevent disease by affecting aging at the cellular level. Specifically, it discusses how telomeres and telomerase are markers of biological aging and how lifestyle interventions may help preserve telomere length and telomerase activity to slow cellular aging. Overall, the document advocates that lifestyle medicine which focuses on prevention through lifestyle changes may be more effective than medical treatments alone.
Influence of health behavior on mortality in women diagnosed with ductal carc...Christopher Veal
1) The study examined how health behaviors like BMI, physical activity, alcohol consumption, and smoking affected mortality outcomes in 1,925 women diagnosed with ductal carcinoma in situ (DCIS).
2) Over an average of 6.7 years of follow up, 196 deaths occurred including 87 from cancer and 34 from cardiovascular disease.
3) Current smoking one year prior to DCIS diagnosis was associated with over twice the risk of all-cause mortality compared to never smokers. Greater physical activity levels prior to diagnosis were associated with half the risk of all-cause mortality. Moderate physical activity after diagnosis was linked to over two-thirds reduced risk of all-cause mortality.
This talk was given by Dr. Grant Schulert Cincinnati Children's Hospital to a group of patient families, at Systemic Juvenile Idiopathic Arthritis (or SJIA) Family Day on July 22nd, 2017.
Deterioro en el estado general y pérdida de pesoIntegrarsalud
1) Unintentional weight loss of 10% or more in 6-12 months is defined as involuntary weight loss.
2) Common causes include cancer, gastrointestinal disorders, endocrine diseases, and psychological factors.
3) Involuntary weight loss is associated with increased mortality, hospital complications, disability, and reduced quality of life.
This document provides an overview and summary of a presentation on assessing pain, sedation, and delirium in intensive care unit patients. It discusses:
- The importance of using validated scales like the Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS) to accurately assess sedation levels in patients receiving sedatives.
- The challenges of assessing delirium given confounding factors like a patient's sedation level, wakefulness, and other psychiatric diagnoses. Scales like the Confusion Assessment Method for the ICU (CAM-ICU) are used but their accuracy depends on a patient's sedation.
- How pharmacokinetic factors like drug-
Rare Pulmonary Diseases in Systemic JIA. This presentation tracks the increased use of biologics to treat SJIA and observes the trends in rare pulmonary diseases.
What Cancer Patients Need to Know about Cardio-Oncologybkling
This document discusses the link between cancer and cardiovascular disease. It introduces cardio-oncology as a new medical specialty that addresses the cardiovascular effects of cancer therapies to prevent cardiac dysfunction. Many cancer treatments can be cardiotoxic, and cancer survivors often die of cardiac complications rather than cancer recurrence. There are also shared risk factors for cancer and heart disease like smoking, obesity, diabetes, and lack of physical activity. Diet, inflammation, and other biological processes also link the development of the two diseases. Cardio-oncology aims to monitor and manage cardiac risks in cancer patients and survivors.
Fibromyalgia can be resolved by medical herbalismmorwenna2
A recent public awareness survey by the National Fibromyalgia Association illustrates a significant lack of understanding about Fibromyalgia: nearly half of the general public (45%) has never heard of Fibromyalgia, many people who are knowledgeable about the disorder incorrectly believe that nothing can be done to manage it, and nearly half (48%) of all healthcare providers are reluctant to diagnose a patient with the condition (National Fibromyalgia Association, 2007).
- Fibromyalgia affects 3 to 6 million Americans, with 80-90% being women who are usually diagnosed in middle age.
- It is characterized by widespread pain in the muscles and soft tissues. Common symptoms include fatigue, sleep issues, headaches, and tender points in various areas of the body.
- While drugs can help manage symptoms, natural therapies like exercise, stress reduction, and nutrition have shown more long-term promise for fibromyalgia sufferers. Regular exercise in particular can help reduce pain and fatigue and improve overall health.
ANA testing is confusion and many times getting a positive ANA complicates the clinical picture. A few tips to know what to do when you have a positive ANA.
Holly Thacker, Update on: Menopause, Hormone Therapy, Sex, Politics, and the ...Cleveland HeartLab, Inc.
This document provides an overview and summary of a presentation on menopause, hormone therapy, cardiovascular health, and women's health issues. It discusses the aftermath of the Women's Health Initiative study 12 years later, compares risks of hormone therapy to other medications, and examines risk/benefit ratios of hormone therapy for cardiovascular disease. It also addresses politics surrounding women's health issues and "war on women" narratives related to hormone therapy. The presentation aims to provide an updated perspective on these issues based on newer research findings.
This document discusses the history and scientific evidence around hormone replacement therapy (HRT) and its relationship to breast cancer. It notes that while early studies found HRT improved quality of life and reduced fractures, the large Women's Health Initiative studies from the 1990s-2000s found HRT increased risks of breast cancer, heart disease, and blood clots. However, sub-analysis indicated lower risks for younger women using HRT short-term. Current recommendations are that HRT may be used at lowest effective dose for shortest time to treat menopausal symptoms.
The document summarizes research on cancer, stress, and personality. It finds that while stress may accelerate tumor growth in animal models, studies do not show stress causes cancer in humans. Childhood adversity is linked to increased risk behaviors but its relationship to cancer is unclear. Personality does not determine cancer risk but may impact progression. Psychotherapy improves mood in cancer patients but does not extend survival. It can reduce chemotherapy side effects through classical conditioning approaches.
The document discusses controversies around the management of perimenopause and postmenopause. There are debates due to a lack of proper evaluation of published results, ignoring the whole woman in medical practice, political lobbying, and a lack of scientific honesty. The document also summarizes discussions and conclusions from several international symposiums on menopause that debated the implications of studies like the Women's Health Initiative and addressed controversies around hormone therapy and risk of conditions like cardiovascular disease and breast cancer.
What Black Women Need to Know About Endometrial Cancerbkling
Dr. Kemi Doll, gynecologic oncologist at the University of Washington Medical Center, shares her passion for improving the lives of black women affected by this disease through her extensive research and knowledge about endometrial cancer.
This webinar is being put on in partnership with ECANA.
Developing a cancer survivorship research agenda - Prof Patricia GanzIrish Cancer Society
The document summarizes challenges and opportunities for developing a cancer survivorship research agenda. It notes that the aging population will lead to a large increase in cancer cases and survivors in coming decades. Cancer survivors often face significant physical and mental health issues. More research is needed to understand late effects of treatments and better deliver palliative care, prevention, and health promotion to survivors. Opportunities exist to form interdisciplinary teams, study symptoms and comorbidities, develop safer therapies, and test new models of survivor care. Where to start depends on available populations and expertise. Translational research integrating population health and scientific discovery is key.
This document discusses the relationship between estrogen and breast cancer. It summarizes research showing that sufficient estrogen levels are important for breast health and that the risk of breast cancer increases with estrogen deficiency associated with aging. While some studies have linked hormone replacement therapy (HRT) to increased breast cancer risk, this document argues that these studies used synthetic hormones rather than bioidentical hormones and did not consider differences in hormone levels and cycling. The document concludes that, when administered properly, bioidentical estrogen therapy may reduce breast cancer risk by inhibiting growth and inducing apoptosis of cancer cells.
The document discusses controversies around the management of menopause and quality of life (QoL) for menopausal women. It discusses two types of medical practice - individual clinical medicine and population-based social medicine. It argues practitioners should not overemphasize epidemiological associations that are not necessarily cause-effect findings. The document also discusses interactions between cardiovascular disease, osteoporosis and obesity, and reviews evidence that hormone therapy may be safe and effective for relieving menopausal symptoms in younger women.
Menopause typically occurs around age 51 and is defined as the cessation of menstrual periods for one year. It marks a major decline in estrogen and progesterone levels. Common symptoms include hot flashes, sleep disturbances, mood changes, and vaginal dryness. Long-term risks of estrogen deficiency include osteoporosis, heart disease, and cognitive decline. Historically, hormone replacement therapy (HRT) was widely used to treat menopausal symptoms but large studies in the early 2000s like the Women's Health Initiative found increased risks of breast cancer and heart disease with HRT use. This led to a reevaluation of HRT recommendations focusing on using the lowest effective dose for the shortest duration possible to manage menopausal symptoms
Health News Coverage: Just How Bad It Is, Why It Matters, and What Doctors Ca...Ivan Oransky
The document summarizes research on the quality of health news coverage and discusses why improving coverage matters and what doctors can do to help. Key findings include:
- Many news stories do not adequately report on the benefits and risks of medical treatments, tests, and drugs or mention costs.
- For many groups, media and doctors are the top sources of health information, so inaccurate coverage can influence health behaviors.
- Doctors can help by developing relationships with reporters, answering questions, reviewing press releases, and providing context on new studies through their own blogs or comments to reporters.
This document summarizes key learnings from major observational studies and clinical trials on menopause. It discusses that systemically administered progestogens may negate some benefits of estrogens and slightly increase breast cancer risk with treatment durations over 5 years. It notes that isolated estrogens did not impact breast cancer risk in hysterectomized women compared to controls in WHI. It also states that metabolic effects of estrogens and progestogens may differ based on administration route and regimen of sequential vs. continuous combined therapy.
MENOPAUSE APPEARANCE AS A RISK FACTOR FOR PSYCHOLOGICAL DISORDERS IN BREAST C...IRENE CHRISTODOULOU
A 51-year-old woman who was pre-menopausal and a smoker was diagnosed with breast cancer after a mammogram. She underwent a mastectomy along with chemotherapy and hormone therapy. Three months after her operation, her quality of life had dramatically declined as she was sleeping too much, had abandoned her job and hobbies, and lost weight without cause. She also stopped following her treatment plan and reported suicidal thoughts. When she saw a psychiatrist, she was diagnosed with major depressive disorder. After antidepressant therapy and psychotherapy, her outlook improved as she regained hope, adhered to treatment, exercised, and strengthened her family relationships. The discussion notes that factors like menopause can lead to serious psychological issues in breast cancer
This document discusses hormone replacement therapy (HRT) and aims to break stigmas around its use. It summarizes recent research showing that for healthy women under 60, the benefits of HRT generally outweigh the risks when initiated soon after menopause. While some studies linked oral HRT to increased breast cancer and heart risks, newer options like transdermal estrogen and bioidentical micronized progesterone may not carry these risks. HRT can help reduce risks of conditions like dementia and osteoporosis linked to estrogen loss. However, risks likely outweigh benefits for some women with hormone-receptive cancer histories. Overall, the document advocates that HRT use should be considered on a case-by-case basis.
1. Collective statistical illiteracy in healthcare is widespread among physicians, patients, and politicians due to non-transparent framing of information and lack of risk communication training.
2. Studies show physicians and the public poorly understand concepts like survival rates, risk reductions, and probabilities related to cancer screenings.
3. Implementing transparent risk communication frameworks in medical education and public health materials is needed to improve informed decision making.
CORONARY ARTERY DISEASE IN WOMEN by DR ABHISHEK RATHOREdrabhishekbabbu
CAD is the leading cause of death in women. Here is the current scenerio of CAD in women. In what matter CAD in women differs from man is presented hare.
This document discusses the basic principles of palliative care, including definitions, goals, ethical issues and barriers. It provides statistics on palliative care needs in Palestine, including causes of death, cancer rates and lack of services. Recommendations are made to establish national palliative care policies and programs, train healthcare workers, ensure availability of pain medications, and incorporate palliative care into existing healthcare systems to improve end of life care.
Near the end of life, providing aggressive chemotherapy can compromise quality of life goals of palliative care. While patients and families may want to continue "fighting cancer", doctors must consider perspectives of patients, families, and palliative care. Guidelines recommend against chemotherapy for patients expected to die within 6 months without clear evidence of benefit, to avoid unnecessary suffering at the end of life. Effective communication and palliative care consultation can help align treatment with patient priorities and values as death approaches.
This document discusses the interpretation of results from the Women's Health Initiative (WHI) study on hormone therapy (HT).
[1] The WHI study was not designed to study the effects of HT in symptomatic women during the early postmenopausal period. It studied older women, on average over 10 years past menopause, using a single continuous regimen of HT.
[2] Initial reports of increased health risks from the WHI study were overstated and not justified based on further analysis, particularly for peri- and early postmenopausal women. More recent analyses show HT may have benefits for cardiovascular health when started soon after menopause.
Este documento resume uma reunião científica sobre a saúde da mulher madura. Aborda temas como o envelhecimento com ou sem terapia hormonal, a abordagem holística à saúde da mulher, e como melhorar a qualidade de vida das mulheres mais velhas através de estratégias preventivas e terapêuticas.
1) The document discusses the history of hormone treatments for menopausal women from ancient times to modern developments.
2) It notes that while hormone treatments helped relieve symptoms, long term use revealed risks like increased chances of endometrial and breast cancer as well as vascular diseases.
3) The document argues that today's focus should be on women's overall health, disease prevention, and treatment options that consider quality of life - not just debating long term hormone use but finding the best approach.
El documento critica a los "terroristas hormonales" que imponen reglas sobre la práctica clínica sin experiencia. Argumenta que los estudios epidemiológicos como el WHI tienen validez interna pero no externa, y que los riesgos asociados con la THR son mínimos. Aboga por que los médicos informen a las mujeres para que tomen sus propias decisiones sobre el tratamiento de
Este documento resume a IX Reunião Científica da SPM. Apresenta informações sobre envelhecimento com ou sem terapia hormonal substitutiva, abordando o assunto de uma perspectiva holística que considera fatores biopsicossociais. Discute também a importância de ações preventivas e terapêuticas para promover a saúde e qualidade de vida das mulheres em idade madura.
Este documento presenta un resumen de las nuevas perspectivas en el manejo de la mujer posmenopáusica. El autor discute los riesgos de depender exclusivamente de la evidencia de estudios epidemiológicos y los medios de comunicación para determinar la práctica clínica, y enfatiza la importancia de considerar la experiencia clínica. También advierte sobre los riesgos de desinformación y alarmismo cuando solo se consideran riesgos relativos sin tener en cuenta riesgos absolutos.
What has been learned from the major observationalfalcaoebarros
The document discusses 4 main lessons learned from major observational studies and clinical trials on hormonal treatments: 1) Progestagens may suppress some benefits of estrogens and slightly increase breast cancer risk with long-term use; 2) Estrogens alone did not increase breast cancer risk; 3) Metabolic effects of hormones differ by route and regimen; 4) Hormones are effective for vasomotor symptoms but not secondary cardiovascular prevention. It also discusses the need for evidence-informed practice over strictly evidence-based medicine and emphasizes balancing risks and benefits of treatments tailored to individual needs and preferences.
This document discusses the crisis facing women and physicians regarding hormone replacement therapy (HRT) and menopause. It notes that volcanic studies like the Women's Health Initiative have spread wrong information about HRT, scaring women and doctors about side effects like breast cancer. As a result, many women give up HRT and suffer from vasomotor symptoms, while doctors fail to persuade them to continue HRT due to its benefits outweighing risks. The document will focus on HRT and breast cancer, reasons for doctors' failed persuasion, and lessons learned from menopausal women over 40 years.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
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7. Looking after a menopausal woman is a
most
fascinating,
gratifying and
complex
vivid experience in the life of a physician.
MNC/05
8. • It is fascinating – because one is dealing
with the holistic dimension of a woman’s
life where there is the interplay of her
macro and micro social environments, of
her self and her id , and of all her body
functions.
MNC/05
9. • It is gratifying – because the help of a
physician who is well aware of that holistic
dimension may lead to very positive
results in terms of the quality of her life,
that are the best reward for a health care
giver.
MNC/05
10. • It is complex – because the abundance of
specific medical literature, and its often
misinterpreted results, leads to a climate of
scare of potential risks that overcomes the
known benefits of treatments.
MNC/05
11. Definition
A Climacteric woman
is a woman (gender based medicine)
is an aging person (geriartrics)
is perimenopausal (hormone deficient)
13. Critical Objectives
a) The diagnosis of health
b) The identification of risk factors
c) The presence of symptoms
• gender related
• age related
• hormone related
14. Critical Objectives
d) The treatment of symptoms
e) The elimination of risk factors
f) The diagnosis of diseases
g) The treatment of diseases
15. Specific Objectives
(S.O.)
1. CV and metabolic
a) obesity
b) dislipidemias
c) hypertension
d) insulin resistance
16. S.O.
2. CNS
a) vasomotor symptoms
b) mood, sleep
c) sexual disfunctions, libido
22. S.O. Targets
1. exercise
2. nutrition
3. mental health
4. sexual conseling
5. pharmacotherapy
a) hormonal
b) non-hormonal
23. S.O. Treatments
P, E+P, E
Androgens
Ca + vit D
bisfosfonates, strontium
Statins, IACE, diuretics, α and β blockers
aspirin
psychotherapy
Serm’s
tibolone
gabapantin
routes, schemes
24. Causes of Death Among Women*
Other Cancers
Heart Disease
15%
Breast Cancer 34%
4%
Diabetes 3%
Chronic Lower 6%
Respiratory
Disease
28% 10%
Other Cerebrovascular
Disease
*Percentage of total deaths in 1999 among women aged 65 years and older.
Anderson RN. Natl Vital Stat Rep. 2001;49:1-13.
25. In the light of present evidence,
doctors and women should be
reassured that the suggested HT’s for
the relief of symptoms in the
menopause
are safe and very effective
26. There are controversies about the
present management of the
climacterium which are due to:
• a lack of culture that prevents a correct
criticism of the published results
• a bad practice of medicine that ignores the
woman in her totality
• political lobbies from the NIH
• a lack of scientific honesty manifested by
many of the WHI writers
• lobbies from several pharmaceutical
industries through the activities of many well
known doctors that “offer” themselves to transmit
their “messages”
27.
28. Many women taking hormones were
urged by their physicians to stop taking
these medications immediately or
decided to stop taking them on their own.
Petitti DB. JAMA. 2005;294:245-246.
29. Based on the WHI study group,
implementation of the results
into clinical practice has little, if
any, scientific basis.
Adam Ostrzenski and Katarzyna M Ostrzenska. Am J Obst Gynecol
2005;193:1599-604
30. The applicability of the WHI
findings to women between age of
51.1 and 56.1 years and younger is
unknown.
Ostrzenski A and Ostrzenska KM.
Am J Obst Gynecol 2005;193:1599-604
31. “W I: Now that the dust has settled…”
H
• To publish data that may or may not
be entirely true or certainly
premature is a disservice to the
medical profession and, most
important, to our patients.
• The majority of the data that were
published is not statistically
significant even at the nominal level.
Creasm W et al. Am JObst Gynecol 2003;189:621-626
an T.
32. “Lessons from the WHI”
“…most articles and broadcast segments
tended to focus exclusively on either the sm all
absolute risks or the larger relative risks,
neglecting the more even-handed picture that
presented both.
Since the sharply increased relative risks got
the most play, news coverage about the trial’s
findings had an alarming cast.”
De nz e r S. Editorial. A I rn M d . 2 0 0 3 ; 1 3 8 : 3 5 2 -3 5 3
nn nte e
33. Biased opinions
be they pro or con,
dishonor the profession
and
harm our patients.
Sacket DL. The arrogance of preventive medicine. Can Med Assoc J
2002;167:363-364
34. NNH / Year
(Number Needed to Harm)
Coronary Heart Disease
W (RR 1.29)
HI 1428
HERS (RR 0.99) 5000
Breast Cancer
W (RR 1.26)
HI 1250
HERS (RR 1.27) 833
MNC
35. Effects of conjugated Equine Estrogen in Postmenopausal Women
with Hysterectomy.JAMA, 2004;291:1701-1712
36.
37.
38. Stroke
“In women 50-59 years not taking HT,
ischemic stroke is expected to occur in
3 out of 1000 women during 5 years.
Five years use of HT would yield 1
additional case of stroke/ 1000 women”
EMAS Statement; 2004.
39.
40.
41. Then, why all this noise?...
Mainly because the conclusions of
recent trials were severely misinterpreted
by the medical professionals, the media
and by the women, themselves
MNC/05
42. “We are drowing in information,
but starved for knowledge”
John Naisbilt
43. Practioners are guided:
• by the best available information that
can be extrapolated with validity to
their patients,and
• by their acumulated experience
MNC/05
44. Public Health doctors are guided by
what epidemiologists suggest ...
but ...
Most epidemiologists only establish
associations of events and seldom
determine cause/effect relationships
MNC/05
45. thus ...
both,the practitioners who act as if they
were public health doctors,
and the public health doctors who act
as if they were clinicians,
should not overemphasize the
epidemiological associations of events
that are not necessarily cause/effect
findings
46. But ... today ...
many • Act in their offices as if they
were public health doctors...
practitioners
many
public health doctors • Act in their departments as if
they were clinicians ...
This is wrong!
47. Effect on the risk of CHD
WHI Significant increased risk
RR 1.29 (CI 1.02-1.63); 29 % increased risk
AR 0.37% vs 0.30% (ie, 37 vs 30 events
annually per 10.000 women)
HERS Nonsignificant decreased risk
RR 0,99 (CI 0.84-1.17); 1% decreased risk
AR 3.66% vs 3.68% (ie, 366 vs 368 events
annually per 10.000 women)
48. Hormones and the Heart
1 in 3 women will die from coronary heart
disease (CHD) in the USA.
1 in 25 women will die from breast cancer
Fitzpatrick LA. JCEM 2003;88(12):5609-10
49. “HRT is associated with a
35% reduction in mortality
for women who suffered
myocardial infarction”.
Shlipack MG, Angeja B, Go AS, et al Circulation 2001;104:2300-2304
50. Hormone replacement therapy:
where to now?
Recent studies suggest HRT may inhibit
the process of atherosclerosis in
healthy arteries soon after menopause,
and observational studies in younger
women starting HRT suggest a potential
cardiovascular benefit
Mikkola TS, Clarkson TB. Cardiovasc Res 2002;53:605-19.
51. Recent reports did not find, for
continuous combined treatments, any
increased risk of either CHD or breast
cancer.
The difference from WHI being that
women were younger, symptomatic
and with lower body weights
Heikkinen J. NAMS 2004, Abstract LB38
Lobo R. Arch Int Med 2004;164:482-484
52. • Manson et al reported a nonstatiscally
significant decreased relative risk of
cardiovascular events in hormone
therapy users who were <10 years from
the onset of menopause.
Manson JE et al. JAMA 2002;288:321-33
53. Hormone therapy for younger
postmenopausal women: how can we
make sense out of the evidence?
At the moment, I believe we can say with
relative certainty that hormone therapy in
younger postmenopausal women
results
in lower coronary heart disease events
and total mortality.
Salpeter S. Climacteric 2005;8:307-310
54. Younger Women May Receive Heart Protection From
Estrogen Therapy
In women ages 50-59 who had undergone a
hysterectomy, a significant protective effect of
estrogen treatment, when both primary (heart
attacks and heart attack death) and secondary
(coronary artery bypass surgery, angioplasty,
confirmed angina pectoris) cardiac endpoints
were considered.
Dr. S. Mitchell Harman, director and president of Phoenix-based
Kronos Longevity Research Institute (KLRI) in Archives of Internal
Medicine 2006;106:357-363
55. WHI Study
WHI investigators reported a statistically
significant (34%) lower risk for the combined
endpoint of myocardial infarction (heart attack),
coronary death, coronary revascularization and
confirmed angina among women who were
between the ages of 50 and 59 at the start of
the study (RR 0.66; 95% CI 0.45-0.96).
Hsia J et al.Arch Intern Med 2006;166:357-363
56. Press Statement IMS
The estrogen plus progestogen arm of the WHI
and the estrogen-alone arm actually showed that
HT does not
increase the risk of coronary heart disease in
the peri- and early menopause,
and may even carry beneficial effects.
Feb 2006
57. Press Statement IMS
Also, in a subgroup of women demographically
similar to those in the WHI, there was no
significant relation between HT and CHD among
women who initiated therapy at least 10 years
after the menopause
(RR = 0.87, 95% CI 0.69–1.10 for estrogen alone;
RR = 0.90, 95% CI 0.62–1.29 for estrogen with progestogen).
Feb 2006
58. Press Statement IMS
The WHI study was not designed, and
therefore was not powered, to investigate the
consequences of hormone therapy (HT) in
women below 60 years of age. Therefore,
any attempt to present the results of the study
as indicating that HT may inflict damage to the
heart in general – a message that was accepted
by many medicalsocieties and regulatory Authorities
is simply wrong and must be amended.
59. Hsia J, Langer RD, Manson J et al. Conjugated equine estrogens and coronary heart
disease. Arch Int Med 2006;166:357-65
60. Hsia J, Langer RD, Manson J et al. Conjugated equine estrogens and coronary heart
disease. Arch Int Med 2006;166:357-65
61. Hsia J, Langer RD, Manson J et al. Conjugated equine estrogens and coronary heart
disease. Arch Int Med 2006;166:357-65
63. Menopausal women and their
doctors are scared about the side
effects of HRT
mainly about breast cancer
MNC/05
64. Hormone replacement therapy and
breast cancer: estimate of risk
Extended use of estrogen for
10 years increases risks by 0,5% ,and by
15 years increases risks by 0,9%
upon cessation of HRT, the relative risk
quickly returns to 1.0 !
Coombs N J, Taylor R, Wilcken N. Boyages J. BMJ 2005;331:347-349
65. Breast cancer and the use of HRT
Considering 10.000 women on the
combination HRT then for each year
there would be:
Seven additional cases of heart attacks
Eight cases of stroke,
Eight cases of pulmonary embolus,
Eight cases of invasive breast cancer,
Six fewer cases of hip fractures
Baum M. The Breast 2005;14-178-80
66. Breast cancer survival and the use
of HRT
It must be emphasized that we are
talking about an increased incidence of
the disease, which does not
automatically translate into an increase
in deaths from the disease.
Baum M. The Breast 2005;14:178-80
67. Many Doctors fail to persuade
them to go on with HRT, in
despite of telling that the
benefits are far greater than
any potential risk
MNC/05
68. Breast Cancer
• The doubling time of an initial cancer
cell ,up to the diagnosis of a resultant
1cm tumor ,is most likely greater than
10 years.
• This is why many dormant cancer cells
may exist in a“normal” breast !
MNC/05
69. Breast Cancer
• The diagnosis of a breast cancer after the
initiation of a HRT (with a duration of less than 5
years) is only a proof of its growth stimulatory
effect (not of its carcinogenic effect)
• Therefore, the reversal of the risk to 1 after the
cessation of HRT confirms again only its growth
promoting effect and denies a carcinogenic
effect.
Dietel M., Lewis MA. and Shapiro S. Human Reproduction 2005;20:2052-60
70. Occult Breast Cancer
Clinically occult in situ
BC’s are frequent in
young and middle-aged
women.
Nielsen M et al-Br J Cancer 1987;56:814-9
71. Occult Breast Cancer
Breast malignancy was
found in 22 women
(20%)
Nielsen M et al-Br J Cancer 1987;56:814-9
72. Thus…
• Mammographies give more false
negative than false positive results !
• A “normal” mammography does not
exclude the presence of cancer cells
that may “explode” a few months later…
MNC/05
73. Estrogen replacement therapy in
patients with early breast cancer
The mortality rates from breast cancer for
the ERT users was 4.28% compared with
22.3% in the nonusers.
Natrajan PK and Gambrell RD. Am J Obstet Gynecol 2002;187:289-95
75. Mortality following development of
breast cancer while using
oestrogen or oestrogen plus progestin:
a computer record-linkage
study
W Chen, DB Petitti and AM Geiger.
British Journal of Cancer (2005) 93, 392 – 398
76. This study explored survival after
exposure to oestrogen or oestrogen
plus progestin at or in the year prior to
breast cancer diagnosis
oestrogen plus progestin users had lower
all-cause mortality and breast cancer
mortality
Chen W, Petitti DB and Geiger AM. British Journal of Cancer 2005
93, 392-398
81. A menopausal woman expects
from her attending physician
to be receptive to all of her complains,
to understand her psychic and physical
concerns,
to support her insecurity and
to help overcome her crisis.
MNC/05
82. One may easily conclude that
without an adequate technique of
communication, using the proper
language,
there is no possible help
Thus,
physicians must acquire expertise in
the technique of communication
MNC/05
84. Are there risks?
It is crucial that information be given
about the difference between relative
risks and absolute risks, since the latter
are the major cause of misinformation and
alarmism, being the favorites of the
media…
MNC/05
85.
86.
87.
88. Nurses’s Health Study
from 1980 to 1994 CHD ↓ 31%
↓ Smoking ↓ 13%
↑ Obesity ↑ 8%
↑ THS ↓ 9%
↑ Better nutrition ↓ 16%
Hu FB, Grodstein F et al. Trends in the Incidence of Coronary Heart
Disease and Changes in Diet and Lifestyle in Women. NEJM
2000;343:530-537.
89. “It appears that half of the
benefits in the prevention of
cardiovascular diseases are
not hormone related”!
Mosca L, Grundy SM, Judelson D, et al. Circulation 99;99:2480-4
91. First of all, there are many different
post-menopausal hormone
therapies: different estrogens,
different progestins, different
routes of administration, different
regimens, which have different
profiles.
Neves-e-Castro M. Maturitas 2001;38(3):235-237
92. Second, there are those who know
and those who do not know to
tailor-make it to a particular woman
and to monitor its efficacy in the
targets that have justified its
selection.
Neves-e-Castro M. Maturitas 2001;38(3):235-237
93. Third, there are those who think
that the menopause is a disease to
be treated solely with sex
hormones, and there are those
who believe that the menopause is
an event in a mid-aged woman’s
life.
Neves-e-Castro M. Maturitas 2001;38(3):235-237
94. Hippocrates promoted specific
diets to prevent and cure
diseases such as illnesses of
the heart.
Lyons AS et al. In Medicine: an illustrated History. New York:Abradale
Press,1990:20719
96. Doctors could retrain as
Polymeal chefs or wine advisers
The Polymeal—an evidence based menu that
includes wine, fish, dark chocolate, fruits,
vegetables, garlic, and almonds—promises to be an
effective, safe, cheap, and tasty solution to reducing
cardiovascular morbidity and increasing life
expectancy.
Polymeal could reduce cardiovascular disease by
more than 75%.
Franco O et al. BMJ 2004;329:1447-50
99. A strategy to reduce
cardiovascular disease by more
than 80%
One third of people taking this pill from age 55
would benefit, gaining on average about 11
years of life free from an IHD event or
stroke.
Wald N and Law M. BMJ 2003;326:1419-25
100. Moderate exercise cuts breast
cancer biomarkers in
postmenopausal women
Increased physical activity significantly
reduces serum estrogens in
postmenopausal women and thus may
reduce the risk of breast cancer.
McTiernan A. Cancer Res 2004;364:2923-8
101. Aspirin could be used to prevent
cancer
Three recently published studies indicate
that aspirin, already enjoying a second
lease of life in the prevention of heart
disease, may soon become a first line of
defense against cancer.
London O. BMJ 2003;326:565
102. “Not everything that can be
counted counts;
and not everything that
counts can be counted”
Albert Einstein
103. “There are no really “safe”
biological active drugs.
There are only “safe”
physicians”
K inetzy H 1 9 9 3
am A
106. What are the best recommendations of
the climacteric woman’s doctor?
1. Understand what is happening to the body during
the climacteric and the postmenopause
2. Mental occupation
3. Physical exercise
4. Proper nutrition (moderate consumption of red
wine, and abundant fish, vegetables, fruits, soy,
milk, garlic, chocolate, etc)
5. Keep the body mass index (BMI) within normal
limits
6. Keep a normal girdle/hip ratio, waist circumference
7. Refrain from smoking
8. Keep a normal blood pressure
9. Keep the blood lipids within normal values
(statins?)
10. Examine the breasts (palpation, inspection,
mammography)
107. My Message is:
.To prescribe postmenopausal hormonal
treatments when clinically indicated, if
not contraindicated
. No answers from ongoing clinical
trials are indispensable to practice
today a good Medicine
MNC/05
108. Let us not medicalize the
Menopause..
instead…
Let us holistically
approach the Climacteric
and Aging Women.
MNC /05
109. To know the disease a woman has
is as important as
to know the woman who has the
disease
William Osler
110. “Each time we learn something new,
the astonishment comes from the
recognition that we were wrong
before.
In truth, whenever we discover a new fact, it
involves the elimination of old ones.
WE ARE ALWAYS, as it turns out,
fundamentally IN ERROR.”
Lewis Thomas English Biologist (1913-1993)
111. What about the best treatments
during the climacterium and
beyond?
There is a general tendency to consider
that sex steroid hormones are the only
instruments with which to treat women
when they enter in the climacteric phase
of their lives…
MNC/05
112. What about the best treatments
during the climacterium and
beyond?
However, little attention is paid to other
pharmacological interventions (non
hormonal) and strategies that have been
shown to be important for the
prevention of such diseases and to
maintain or improve health.
MNC/05
113. Which is the best treatment?
In general terms, is the one that is wisely
indicated, if not contraindicated, after
balancing benefits and risks, of all strategies
and interventions, hormonal or not.
It must be aimed at specific objectives and
targets that will be monitored at regular intervals
in order to determine its efficacy and to estimate
the occurrence of any side effects, a condition
that will determine its duration.
MNC/05
114. Which is the best treatment?
Patient needs and preferences are decisive, based on
the doctors’ advice. Let it not be forgotten that although
many treatments are available, they are nevertheless
not indispensable. Doctors have the duty to give their
best unbiased information to their patients so that they
may make the right choices and then be compliant.
The woman is the decision maker, if the doctor sees
no contraindication.
Thus,
the best treatment is what she has
chosen.
MNC/05
115. The conclusions of these studies suggest that
the “safe “ woman (NNH between 600-1000
women) to initiate HT is
- between 50-59 years of age
- with vasomotor symptoms
- less than 10 years after the menopause
- being treated with statins
- with a good lipid profile and
- with a Body Mass Index >25
Neves-e-Castro M. Human Reproduction 2003;18:2512-2518
116. This is precisely the profile of the
great majority of women who come
for consultation after their
menopause.
Therefore it seems that what most
gynecologists are doing to their
predominant population of patients is
not unsafe and contributes not only
to a good quality of life but to
prevention, as well.
Neves-e-Castro M. Human Reproduction 2003;18:2512-2518
117. I personally believe that in the healthy early
post menopausal woman the long term HT’s,
other than relieving vasomotor symptoms,
may play an important role in improving QoL
and in the prevention of CVD, osteoporosis
and Alzheimer, under surveillance.
Systemic estrogens, added when needed to
vaginal progesterone or progestagen loaded
IUD’s, may be very beneficial, largely
overpassing minimal risks.
The well-informed woman will be the only
decision- maker.
MNC/05
118. Continuous combined parenteral
estrogen substitution and
intrauterine progestogen
delivery:the ideal HST
combination?
Wildemeersch D, Janssens D and Weyers S.
Maturitas 2005;51:207-214
119. Continuous intrauterine compared
with cyclic oral progestin
administration in perimenopausal
HRT
This method of HRT with the Lng-IUD’s
as progestin delivery system is
efficient in protecting the endometrium
against hyperplasia, and will make
withdrawal bleedings unnecessary.
Boon J et al. Maturitas 2003;46:69-77
120. Relationship between breast cancer and
use of the levonorgestrel-IUD
These results suggest that the use of the
levonorgestrel-releaing intrauterine system
is not associated with an increased risk of
breast cancer
Backman T et al. Obstet & Gynecol 2005;106:813-7
121. Tibolone improves myocardial
perfusion in postmenopausal
women with ischemic heart
disease: an open-label
exploratory pilot study.
In postmenopausal women with ischemic heart
disease, six months of therapy with tibolone
significantly improved stress myocardial
perfusion and the "amount of ischemia."
Campisi R et al. J Am College Cardiol 2006;47:559-564
123. NAMS position statement on
estrogen and progestagen use in
peri-and postmenopausal women
Revised breast cancer statements indicate
that the risk of breast cancer probably
increases with EPT use but not with ET
use.
124. NAMS position statement on
estrogen and progestagen use in
peri-and postmenopausal women
Place no limit on ET/EPT treatment
duration, provided it is consistent with
treatment goals; if monitored regularly, no
stipulation is made regarding when to
reduce or stop therapy
125. If there are no incoming contraindications
we see no reason to establish a time limit
to the duration of therapy, mainly if there is
a recovery of symptoms after its
discontinuation
Cochrane B, NAMS 2004, P53
IMS www.imsociety.org
NAMS www.menopause.org
126. What has been learned from the
major observational studies and
clinical trials?
the first lesson
systematically administered
progestagens may in part suppress
some of the beneficial effects of
estrogens and may also slightly increase
the risk of breast cancer after treatments
with duration greater than five years.
MNC/05
127. What has been learned from the
major observational studies and
clinical trials?
the second lesson
estrogens, when given alone to
histerectomized women, did not appear to
minimally affect the risk for breast cancer
when compared with controls
MNC/05
128. What has been learned from the
major observational studies and
clinical trials?
the third lesson
Metabolic effects of estrogens and
progestagens, as a whole, can differ
depending on the route of administration, i.e.
oral vs. parentheral, and on the combination of
both, in a sequential regimen or in continuous
combined administration.
MNC/05
129. What has been learned from the
major observational studies and
clinical trials?
the fourth lesson
Hormonal treatments are the first
choice for vasomotor symptom relief
as long as they are needed (on and off
assessment). They should not be used for
the secondary prevention of CVD, when
atheroma plaques are already present.
MNC/05
130. What has been learned from the
major observational studies and
clinical trials?
the fourth lesson (cont.)
Conversely ,they may protect from CVD
if started early during the transition
into the post menopause.
Hormonal treatments are preventive of
osteopenia and osteoporosis at any
stage in life
MNC/05
131. What has been learned from the
major observational studies and
clinical trials?
the fifth lesson
Estrogens may prevent degenerative
lesions of the CNS since, so far, they
seem to be the only available drugs with
nerve growth effects
MNC/05
In contrast with the previous slide of perceived health concerns, this slide shows actual rates for cause of death. What is apparent is that a generalized fear of cancer, and breast cancer specifically, skews postmenopausal women’s understanding of their health risks. Such misinformation often represents a barrier when women make decisions about ET/HT. Although the results of the WHI trial have provided and will continue to provide valuable information on the effects of various preventive strategies on chronic disease in menopausal women, they are unlikely to change this misperception. Anderson RN. Deaths: leading causes for 1999. Natl Vital Stat Rep . 2001;49:1-13.