WOmen were led to believe that taking HRT had serious consequences for them, as a result of the WHI trial in the early 2000s. As a result many women stopped their HRT and suffered severely. We now know that the WHI had got it seriously wrong. This article asks why:

Climacteric. 2012 Aug;15(4):320-5.
A decade post WHI, menopausal hormone therapy comes full circle – need for independent commission.
Utian WH.
Source

Consultant in Women’s Health, Executive Director Emeritus, The North American Menopause Society; Professor Emeritus, Reproductive Biology, Case Medical School , Cleveland, Ohio , USA.
Abstract

ABSTRACT The sudden decision by the National Heart, Lung, and Blood Institute of the National Institutes of Health to terminate the estrogen-progestogen therapy arm of the Women’s Health Initiative (WHI) Study a decade ago now begs two questions: – has women’s health after menopause been helped or harmed as a result of the findings and the way in which they were presented, and, if harmed, what needs to be done to put things right? Time and multiple reviews of specific publications from the WHI lead to the serious question whether a project designed to be of benefit to women’s health has boomeranged, and instead may have resulted in significant impairment to both the quality of life and physical health of postmenopausal women. It is therefore urgent to confirm whether this is so and whether corrective action needs be taken to prevent even more harm. There are two obvious and immediate actions to be called for: (1) The Food and Drug Administration (FDA) needs to revisit the black-box warnings on postmenopausal hormones. Specifically, there needs to be a separation of the advisories for estrogen alone from estrogen and progestogen combined usage. (2) Justification is given to call for an independent commission to scrutinize every major WHI paper to determine whether the data justified the conclusions drawn. Women progressing through and beyond menopause in the next decade need to be spared the unnecessary harm that may have been inflicted on their sisters of the previous decade.

26 July 2012, 6.37am AEST

Cardiovascular disease is the biggest killer of women in Australia. It accounts for more than 40% of all female deaths, which means it kills more Australian women than breast cancer and lung cancer combined. But few women are aware of their risk and many wouldn’t necessarily be able to recognise warning signs.

Part of the difficulty stems from the fact that heart disease is often not obvious and, sometimes, it has no symptoms. High blood pressure (hypertension), for instance, is a major risk factor in cardiovascular disease and can easily go undetected for years. So many women remain unaware that heart disease and stroke are major health issues for them.

Manageable risk factors

Some of the more commonly known modifiable risk factors (things you can change) for cardiovascular disease include smoking, being physically inactive, being overweight, having high cholesterol and high blood pressure, and diabetes.

Most Australian women have at least one risk factor, with many consuming inadequate amounts of fruit and vegetables, and being physically inactive. More than half are overweight or obese, and almost half have high cholesterol.

Women should become aware of their blood pressure, lipids and waist circumference and start to adopt healthy behaviours early. They should also take an active approach by asking their doctor about their risks, rather than waiting for doctors to raise the subject.

Myth busting

A number of myths surrounding cardiovascular disease reinforce inaccurate beliefs and unhelpful behaviours. Many people think cardiovascular disease is a man’s disease, for instance, when it actually affects one in five women compared with one in six men in Australia.

Women have a much lower incidence of heart disease than men of the same age before menopause, but its incidence rapidly increases after menopause.

The death rate from ischaemic heart disease (reduced blood supply to the heart muscle) in women is higher than in men. And warning signs are often different in women than in men, which may lead to missed or inaccurate diagnoses.

Extreme fatigue and shortness of breath are important warning signs of possible heart disease in women and may indicate coronary microvascular dysfunction (a narrowing of the small arteries and blood vessels of the heart that prevents the heart from getting blood).

Other noted symptoms in women may include dizziness, light-headedness or fainting, and upper back pressure.

Gender differences and disparities

The reasons for some of the disparities in levels of understanding and awareness of cardiovascular differences between women and men are related to early research being conducted primarily on the latter, which also means diagnostic tools may not always be as accurate for women as they are for men. And anatomical differences between men and women’s coronary arteries, hormonal effects on the cardiovascular system and body fat distribution may affect gender differences.

Atrial fibrillation (the most common abnormal heart beat) presents a significant risk factor for stroke. This risk factor is higher in women than in men and treatment by anticoagulation (blood thinning medications) is associated with a higher risk of bleeding complications.

Astonishingly, many women receive different health care for cardiovascular disease, atrial fibrillation and stroke. There are also higher rates of misdiagnoses among women and treatment regimes are often less aggressive than their male counterparts.

But there’s not yet enough evidence to determine whether this has any effect on outcomes.

Recognising symptoms

Failure to quickly recognise symptoms and delays in seeking advice and care are among the most common barriers to better cardiovascular health for women. Differences in self-management behaviour (adherence to medication and other lifestyle changes) and access to services, and recovery, may also contribute to poorer outcomes.

Difficulty managing their sometimes multiple conditions likely results from the many roles women play as caregiver, employee and patient, to name just a few. Multiple competing demands may impact on women’s higher rates of psychosocial risk factors including depression, stress associated with work and family, socioeconomic deprivation and adverse life events.

Need for change

The burden of heart disease and stroke in women is set to increase with the ageing population. For improvements in primary prevention, timely diagnosis and clinical management, along with a greater understanding of women’s needs are required from both the community and the government.

Women generally live longer than men, but do so with greater disability, which leads to a loss of independence and more need for support. So longevity becomes an increased social and economic burden to society.

This burden can be significantly reduced through the prevention of heart disease and stroke in the first instance. The time has come to unmask this often silent killer through increased engagement with women, their families, communities, health professionals, organisations, and mass media campaigns.

More information at National Heart Foundation

Here is a video of my granddaughter playing the Violin. Both sides of the family are musical, so it is in her genes.

http://youtu.be/OhPBloSxZLA

My granddaughter, Annabelle, had her 7th birthday yesterday. SHe arranged for all her friends to come around. My, what a production. Bigger than the Sydney Olympics. In the old days(the  fifties) when my siblings and I had a birthday party, it would consist of siblings, best friend or 2, parents and family dog. My Mum would produce a cake, there would be a present (one only) from those present, and a pleasant time would be had by all.

Now, there are 40-50 kiddies, masses of presents, lots of confection/cakes/ lollies and fizzy drinks, noise ++, overactivity++ and thoroughly hyped up littlies. ,  Though my daughter is more conscious of health than most, so does better than most young women her age in avoiding the worst of these issues.  At least she provides them with fruit pieces, carrot sticks and other delights – usually ignored by the assembled hordes.

What are your thoughts on this ?  I encourage you to enter the discussion.

0 July 2012, 10.36am AEST

Masterchef and menstruation: how the media hijacks women’s fertility

A friend involved in a half-hearted pregnancy quest recently asked me about ovulation. A technical question about how and when and the duration. I stared back blankly, offered her a shrug. “Didn’t you spend all last year writing a book about it?” she pressed.

Indeed, I did. A whole book about it. Not about ovulation per se, but about menstruation. About pop culture’s presentation of one of the last remaining taboos. And while a year on that project failed to gift much insight into the mechanics of my monthly hijinks, the media’s relationship with the women’s issue, has since become my obsession.

As Helen (Isabelle Adjani) remarked in the 1981 film Possession: “There is nothing in common among women except menstruation.” Of the deluge of things that make women socially, sexually and aesthetically disparate, menstruation exists as a common experience.

Nearly all women will bleed and just as many will experience its conclusion.

Last week’s Masterchef was pretty gruelling for me. The wonderful untypical TV superstar Amina was wrenched from us without warning. All that’s left now is a gaggle of interchangeable Amina-less names and faces. Shudder

More interesting than Amina’s untimely ousting, however, was Debra’s mentioning of the M-word. Not menstruation – with its ugly mouthfeel – rather menopause, that endgame of all those years of bleeding and concealing and deodorising and discarding.

Be it through crafty editing or just the high-stakes game of competitive cooking, Debra was shown having a fair few kitchen melt-downs. She was pissy and teary and snappy and fatigued. And when eventually asked about it all she divulged that she was a middle-aged woman going through menopause. And everyone laughed gaily: ahh … it all made sense now.

Initially, truth be told, the mention of the M-word delighted me. Ours is a culture where everything to do with our menstruating selves is kept secret. From the earliest age girls are taught how to ensure that it’s all done secretly and odourlessly and far, far away from men. We’re expected to plug it up privately and get on with the job. And when it’s all over we’re supposed to carry on as always, lest anyone discover the sins and smells of our femaleness.

For Debra to dare put her hand up and say, hey, things aren’t perfect in my body, in my head, in my spirits, I felt a bit chuffed. Daring to speak the unspeakable always delights me.

And then – because I’m an academic and can’t bloody help myself – I thought more about it. Perhaps too much more about it.

For most of 2011, I catalogued and analysed portrayals of menstruation in film and television. I embarked on the book assuming screen silence and ended up with more than 200 screen examples. It was a productive year.

That first periods and late periods and dwindling periods each had a identifiable presence in film and television pleased me; silence breeds stigma and secrecy and misinformation. As a feminist, I want these topics aired.

Less pleasing however, was that the vast majority of those 200+ scenes were negative.

As much as I want for Debra – for any woman – to feel strong enough and safe enough and supported enough to tell her story, I just wish that it didn’t comply with the standard sad sack narrative that the screen has always offered.

Pop culture presents a very standardised tale of menstruation: it embarrasses young girls, puts women in bad moods, sparks bouts of irrationality if not hysteria, interrupts sex lives and is only ever vaguely interesting when it’s late or when we’re willing it not to come.

For menopause, the story is one of mood swings, hot flushes, forgetfulness and that tried and true sitcom staple: excessive facial hair.

The answer isn’t a simple one: if Debra’s experience with menopause is a hard one, she should – unquestionably – have the right to tell it like it is, sister. But her story needs to be supplemented.

We need more stories of those women who bleed for 30-odd years without the dramas and fanfare and homicidal rages that the screen too often offers. Equally, we need tales of women who’ve gone through menopause without the craziness and the moustache and the meltdown.

Lauren Rosewarne’s is author of Periods in Pop Culture: Menstruation in Film and Television.

0 July 2012, 6.35am AEST
Catch cancer? No thanks, I’d rather have a shot!

A couple of years ago, I contributed to a documentary with the intriguing title Catching Cancer. We don’t normally regard cancer as an infection, so it often comes as a surprise to learn that more than 20% of the global cancer burden can be attributed to infections, and that most of these infections…
Author

Ian Frazer
Ian Frazer

Director, Diamantina Institute for Immunology and Cancer Research at University of Queensland

Disclosure Statement

Ian Frazer as co-inventor of the technology enabling the HPV vaccines receives royalties from their sale in the developed world.

The Conversation provides independent analysis and commentary from academics and researchers.

We are funded by CSIRO, Melbourne, Monash, RMIT, UTS, UWA, Deakin, Flinders, La Trobe, Murdoch, QUT, Swinburne, UniSA, UTAS and VU.
Kvpnd5yk-1341536711 Vaccines are the public health measure that, after safe food and water, have saved most lives. Flickr/VCU CNS

A couple of years ago, I contributed to a documentary with the intriguing title Catching Cancer. We don’t normally regard cancer as an infection, so it often comes as a surprise to learn that more than 20% of the global cancer burden can be attributed to infections, and that most of these infections are viruses.

To understand this link, we first need a basic understanding of cancer.
What is cancer?

Put most simply, cancer is a collection of cells that have lost their way. Each cell in our body is a machine programmed by the genetic information it contains to perform a specific job. A cancer cell has a corrupted program, with several genes that have acquired mistakes.

Each cell in our body has (approximately) the same genetic information, and passes this on to daughter cells when it divides. Any cell in our body is programmed to use only a subset of that information, which tells the cell whether to be part of your skin, your brain or your blood.

Much of that programming tells the cell what to do when the environment changes. It might be instructed to produce a protein (such as insulin), to divide, to repair itself, or to die. This programing is generally directed by signals from outside the cell.

A cancer cell will have programming mistakes which stop it responding correctly to external directions. The cancer cell will divide inappropriately, lose its specialist function, and become able to move to places it shouldn’t.

Genetic mistakes, once they have arisen, are passed on to the daughter cells, and eventually, the body’s ability to sort the problem fails. When there are enough misbehaving cells present, we recognise this as a cancer.
Where do viruses come in to the picture?

Viruses are not cells, but they infect cells, and have genes that can program the infected cell to make more viruses. To do this efficiently, some viruses instruct an infected cell not to die when it should, but to divide and produce more (infected) daughter cells.

Not all viruses do this: most simply multiply inside the cell and then cause the cell to die, releasing viruses to infect more cells.

But for those viruses that reprogram the cell not to die, the longer the cell lives, and the more daughter cells it gives rise to, the more viruses are produced, and the more successful the virus becomes.

The human papillomavirus that I study behaves like this. That’s why some of them give us warts, which are little mounds of excess skin cells, each acting as a virus factory. But warts are not cancers, so how can some papillomaviruses cause cancer?

Cells have defence mechanisms against viruses – part of the cell’s machinery can tell when the cell is dividing inappropriately, or when stray viral genes are hijacking the cell machinery. Usually these defences cause the cell to die if they detect trouble. But some viruses have acquired the ability to reprogram the cell machinery to overcome these defences, and, in doing so, they set the cell up for trouble.

Papillomavirus cells AJC

Mistakes in our cells’ genes occur quite commonly when our cells divide – there’s a lot of information and the machinery which copies it isn’t perfect. So the cell defences that recognise viruses are part of the machinery that recognises mistakes in the cells’ genes. If the cell finds a serious genetic mistake and can’t fix the problem it dies, rather than dividing.

If a virus has switched off the defences against viruses and genetic mistakes, the cell can divide with mistakes in the gene. These mistakes occur quite commonly if the cell is dividing, and if enough mistakes accumulate that reprogram the cell, the cell can acquire the behaviours of a cancer cell: dividing when it shouldn’t and going where it shouldn’t.
Which viruses cause cancer?

The viruses we recognise as causing cancer include some strains of papillomavirus, two hepatitis viruses (B and C), the glandular fever virus Epstein Barr virus, and some polyoma viruses.

But most people who catch them don’t develop cancers. Even a persisting viral infection such as papillomavirus doesn’t cause a cancer in everyone infected. Through sexual activity, most of us will get infected with the genital papillomaviruses that can cause cancer. Fortunately, most of us get rid of them between 12 months to five years later without even knowing we’ve had the infection.

Even if the infection persists, only a few individuals accumulate enough genetic mistakes in the virus-infected cell for these to acquire the properties of cancer cells.

Cancer-causing viruses are more likely to persist if the immune system is faulty and can’t eliminate them. This can occur, for example, in patients taking immune-suppressive drugs to control autoimmunity or prevent transplant rejection, and in patients with HIV AIDS. In consequence, virus-associated cancers become more common with immune suppression.

This information gives us a clue as to where to look for other virus-causing cancers – if a cancer becomes more common if your immune system is damaged, then maybe a virus is contributing to the risk.

One place we’re looking at the moment is in the skin, because the common squamous skin cancer becomes 30 to 100 times more common with immune suppression. We know that sun damage to the skin is the major cause of the squamous skin cancer, but we suspect a virus or viruses may also contribute to the risk.

A virus may increase your risk of developing skin cancer. Parker Michael Knight

Vaccinating against cancer

We have effective vaccines to prevent infection with some viruses. Vaccines against hepatitis B and papillomavirus, for instance, have reduced the burden of cancer caused by these viruses.

So finding a virus in skin cancers should enable development of a vaccine that would help reduce the burden of this extremely common disease, which affects one in three Australians in their lifetime, and costs more to prevent and treat than any other single cancer type.

It took 25 years from discovery of the papillomavirus, and 15 years from discovery of the vaccine technology, before there was a vaccine to help prevent cervical cancer, which kills over 250,000 women world wide every year. Now, we need to make sure it’s used globally, to prevent this second most common cause of cancer death in women.

Vaccines are the public health measure that, after safe food and water, have saved most lives. Vaccines for the cancers we know or suspect may be linked to viruses should be possible. We know how to do the work. All it will take is funding to support the research scientists working on these vaccines, and time.

How long are you prepared to wait for that shot?