Monthly Archives: February 2015

While waging the ‘war’ against cancer, we have lost sight of the broader view of health

Watermelon: one a day is perhaps too much. Photograph: Alamy

Sometime ago the first patient of the day pulled up a chair and declared, “well, you are the final stop, doctor. No one else can find what’s wrong with me.”

Since he threw down the gauntlet like that, we regarded each other with some curiosity. To me, he looked well but then, many cancer patients do while harbouring insidious disease. He, meanwhile, had also sized me up. Eyeing the pile of chemotherapy orders on my desk, he says, “but I will tell you this much, I don’t have cancer.”

His resolute demeanour rather than the more typical trepidation caught my attention enough to enquire ”how do you know you don’t have cancer?”

“I just do.”

The 78 year-old retired teacher had a distant history of an early prostate cancer, successfully removed 11 years ago. He had been reasonably well until developing diarrhoea six months ago, initially managed by his family doctor. But when the symptom seemed to worsen he was sent to a surgeon and a gastroenterologist, who between them ordered a bewildering array of tests without each other’s knowledge. Leafing through the mound of paperwork now forwarded to me I counted the tests under my breath. Two CT scans and two ultrasound scans, a gastroscopy and colonoscopy, two 24-hour stool and urine collections, and nearly 50 blood tests, from the pedestrian to the quirky, many duplicated; the diagnoses entertained ranged from HIV to irritable bowel but the patient seemed none the wiser and certainly no better.

Finally, with no leads left, he was sent to oncology with the suggestion to obtain a PET scan, which has a higher resolution for detecting silent cancer although it seemed a long arc to draw between distant cancer and present diarrhoea.

So far, the patient was correct. There really was no evidence of cancer and reviewing the results, I did not think that another scan would change that. With literally no investigation left wanting, I went back to the time-tested rule of obtaining a history. That, and the fact that I couldn’t send him out after less than 10 minutes telling him he was the most thoroughly investigated patient I had ever met and he didn’t really need to see me.

No, he didn’t smoke or drink alcohol. He had begun experiencing episodic chest pain on exertion and lately, he had been dragging his knee due to arthritis but when he had mentioned these things to the doctors they had all advised him to sort out the diarrhoea first. “Once people think you have cancer no one wants to know about your other problems.”

“Tell me about your diet”, I mused.

“I eat really well”, he answered, somewhat defensively.

“I don’t doubt it but tell me what you eat.”

“I have a watermelon every morning and then…”

I am certain that I would have missed this vital clue had I not been paying full attention to his words, admittedly as there was little else to distract me.

“Did you say a watermelon?”

“Yes, I eat a fresh watermelon every morning. Then I try to get through some other fruits.”

“But that’s a lot of watermelon”, I exclaimed.

“Tell me about it. It takes ages to get through!”

“But why do you each so much watermelon?”

It was his turn to look at me quizzically. “Because fruit is healthy for you.”

After that, it didn’t long to establish that his diarrhoea was caused by fructose malabsorption from consuming an extraordinary amount of watermelon in addition to other fruit. When I told him my hunch his face lightened with relief and gladness. He stopped his watermelon habit and the diarrhoea disappeared. On his final visit, he rued, “I wish someone had figured this out earlier to save the hassle and the cost of the last six months, but they all wanted to find the cancer.”

I thought of that patient recently when I read a provocative essay in the Health Affairs blog. The authors, an oncologist and a researcher, state that the National Cancer Institute was allocated nearly 5bn dollars in 2014 to fight the disease that Americans feared most. The last few years have seen conventional treatment options replaced by very expensive, and with notable exceptions, marginally beneficial drugs and interventions that can nonetheless cause significant toxicity, pain and suffering to the patient.

Whilst waging the “war” against cancer, we have lost sight of the broader view of health, which includes such things as quality of life, the sociological and psychological context of disease, and the interplay of other important illnesses with cancer.

Using findings from a revealing new study, The National Social Life, Health and Aging Project (NSHAP), the authors describe how the emphasis on a disease rather than the whole patient is misplaced. Modern technology has made a cancer diagnosis more commonplace. Successful treatment of early cancers is creating a generation of survivors whose remaining lives are branded by the physical consequences and emotional fallout from a cancer diagnosis. And in the case of breast and prostate cancer, two of the commonest, there is growing debate about the wisdom of aggressively diagnosing and treating variants of the disease that many patients die with, not of.

Hapless patients discover that their more pressing concerns are casually relegated to the bottom of the healthcare hierarchy. An elderly man is told that the dizziness that prevents him from walking safely is not as important as his cancer although he says he wouldn’t even know that he had cancer. A woman observes that every health complaint is regarded through the prism of her cancer history even though the low-grade cancer was incidentally discovered and never considered a threat. “I am more than the sum of my cancer history”, she protests.

With all the attention focused on cancer and its manifold complications, patients are exasperated by the inattention to their other health problems, often more concerning and relevant to quality of life. The NSHAP compellingly found that even in cancer survivors, a fracture after age 45, disordered sleep, diabetes and frailty were much more important predictors of health status than their cancer. Lack of exercise, poor mobility and mental illness confidently herald overall health decline yet they are largely ignored by prevailing models of research and clinical care. Funding to combat cancer is never far from the news and no amount ever seems sufficient. With this in mind, the authors suggest a rather elegant but startling solution to the cancer “crisis”: stop paying so much attention to it.

There is a visceral fear associated with the very name of cancer but not all cancers are the same and should not be treated thus. While aggressive cancers merit aggressive management, other patients benefit far more from a holistic consideration of their health needs. The authors suggest we reconceptualise healthcare to consider a more appropriate paradigm that swings away from the diagnosis in favour of the whole person. This means genuinely exploring individual healthcare needs, goals of care, and patient preferences, not only espousing them on paper as we have long tended to do. Then we may have greater hope of moving towards the sensible World Health Organisation (WHO) definition of health as being not merely the absence of illness but the presence of a life imbued with quality.

As a practicing oncologist in a country with an aging population, I have never been more convinced of the practical value of this vision to patients.

I recently met a wonderful patient in his 80s, flanked by his two sons. He clutched my hand and pleaded with me to stop the incessant march of doctors and interventions to pin down suspected cancer in the twilight of his life. What dismayed me most was the fear in his eyes of being a victim of the excesses of medicine. “I dread that no one will listen to me, yet there will be no winners.”

Relief flooded his face when I pledged to honour his wishes. For him, and others like him, the real crisis in cancer involves the failure to regard the diagnosis in the context of a larger life. There is no better time for change.

Bugs as treatment: coming to a clinic near you…

17 October 2014, 3.24pm AEDT

Bugs as treatment: coming to a clinic near you…

When you’re sick, you want the most effective treatment to help get you back on your feet. But what if that involved bugs? Maggots and leeches have been used for decades and are still supplied to hospitals…

A parasite wants to live with you, and to do that it needs to convince your body’s immune system to ignore it. Sebastian Kaulitzki/Shutterstock

When you’re sick, you want the most effective treatment to help get you back on your feet. But what if that involved bugs?

Maggots and leeches have been used for decades and are still supplied to hospitals for speciality treatments. Researchers are now investigating whether hookworms can allow people with coeliac disease to safely consume wheat.

Leeches and maggots

Creepy crawlies have long been used for various types of treatment. Historical references from ancient Greece show that leeches were used as far back as 270 BC, probably for bloodletting.

Over the years, leeches have been used for many purposes. With their potent secretions, leeches make microsurgery or plastic surgery more successful by preventing venous blood from collecting.

Maggots secrete a host of factors to dissolve dying tissue. AijaK/Shutterstock

The modern story of the maggot in wound healing is that one fortunate solder in the First World War was found to have survived a life-threatening wound apparently because it was covered with maggots. The maggots ate the dead and dying flesh and helped to keep the wound from becoming fatally infected.

Today, wound healing is still an issue where modern medicine is not available, or where conventional therapies are ineffective, as with Bairnsdale Ulcer (Buruli ulcer) in Victoria, Australia, where “mighty maggots” are being trialled as a better treatment.

Although maggots are still used in some hospitals today, your chances of having a typical wound heal with or without maggots is about the same.

Worms and bacteria

Researchers first noticed that parasitic infection reduced the symptoms of inflammatory bowel diseases (IBD) in the 1980s and it’s now an area of active research. At the time, the researchers didn’t know why this would be the case and a number of other factors (such as diet and living conditions) made it difficult to establish a clear cause and effect.

As we learn more about how parasites work, it is becoming obvious that successful parasites came prepared with a full toolbox of chemicals. With the creepy crawlies, these tools do things like thin blood so that the leech – or mozzie – can get a better feed.

Leeches release a combinations of blood thinners and anaesthetics. gbohne/Flickr, CC BY-SA

In the parasites, they also include molecules which interact directly with the human immune system. A parasite wants to live with you, and to do that it needs to convince your body’s immune system to ignore it.

Parasites that cause chronic infections have evolved ways to manipulate the immune system by switching it from high inflammation and “attack” mode, to low inflammation and “damage control mode”. This switching may have an incidental calming effect on inflammatory diseases like IBD and coeliac disease.

Interestingly, this is a similar argument for why the bacteria H. pylori is good for you in that it may reduce the severity of IBD. But while it could potentially be used as an edible vaccine, the down side is the risk of gastric cancer (in addition to ulcers), so there are good reasons to heed the warning “the only good Helicobacter is a dead Helicobacter”.

Hookworms to treat coeliacs

Coeliac disease is a problem where the body’s immune system attacks fairly innocuous proteins from wheat. This attack also damages the intestine and causes serious problems for sufferers, giving them few options but to avoid gluten altogether.

The immune system attack in coeliac disease is similar to what happens in IBD – ulcerative colitis and Crohn’s disease – and all three problems are often put together under the general heading of autoimmune diseases.

Michael Mosley ingested a tapeworm for his BBC documentary Michael Mosley.

Recently, the hookworm has been shown to release substances that calm the immune system, allowing the parasite to live peacefully in your gut. This calming effect may be helpful for IBD and recently it has been investigated against coelic disease.

Researchers at Brisbane’s Prince Charles Hospital tested the idea that the immune-calming effect of the hookworm could help people with coeliac disease during a small but well-designed clinical trial. While a previous study had not found an improvement in gluten tolerance, the new study was careful to slowly increase the levels of gluten.

As the researchers point out, the level of increased tolerance achieved was not enough to allow their patients to eat a whole meal of gluten, but it was enough that accidental (or incidental) ingestion of gluten would not cause problems.

Is it worth it?

Maggots secrete a host of factors to dissolve dying tissue. But it’s the actual action of the maggots eating the dying tissues that does the work.

With leeches, they release blood thinners and anaesthetics in a combination that has been difficult to replicate, though I believe this will be possible in the near future.

With parasitic infection of the gut, do you need the actual bug – or could you take a pill containing something that the bug secretes?

A handful of studies have identified molecules with immune-altering effects. But these proteins are “foreign” to the human immune system and may cause inflammation or other problems in own right. So far these molecules are showing promise as vaccines against neglected parasitic infections, but other applications may be some time off.

Personally, I hope these problems can be solved because the alternative – using the whole parasite – is not only distasteful, it also comes with the risk of disease.

Physical exercise and Memory

Clin Interv Aging. 2014;9:51-62. doi: 10.2147/CIA.S39506. Epub 2013 Dec 18.

Physical exercise and cognitive performance in the elderly: current perspectives.


In an aging population with increasing incidence of dementia and cognitive impairment, strategies are needed to slow age-related decline and reduce disease-related cognitive impairment in older adults. Physical exercise that targets modifiable risk factors and neuroprotective mechanisms may reduce declines in cognitive performance attributed to the normal aging process and protect against changes related to neurodegenerative diseases such as Alzheimer’s disease and other types of dementia. In this review we summarize the role of exercise in neuroprotection and cognitive performance, and provide information related to implementation of physical exercise programs for older adults. Evidence from both animal and human studies supports the role of physical exercise in modifying metabolic, structural, and functional dimensions of the brain and preserving cognitive performance in older adults. The results of observational studies support a dose-dependent neuroprotective relationship between physical exercise and cognitive performance in older adults. Although some clinical trials of exercise interventions demonstrate positive effects of exercise on cognitive performance, other trials show minimal to no effect. Although further research is needed, physical exercise interventions aimed at improving brain health through neuroprotective mechanisms show promise for preserving cognitive performance.

Exercise programs that are structured, individualized, higher intensity, longer duration, and multicomponent show promise for preserving cognitive performance in older adults.

Having Fun in the Operating Theatre.

Having Fun in the Operating Theatre.

by Dr Andreas Obermair.

Posted by on 15 October 2014 | 0 Comments


As a surgeon, I suspect many people perceive the operating theatre to be among the most frightening and intimidating places they could visit in a lifetime, but in actual fact, it’s quite the opposite.

What may surprise many patients is that as opposed to the formal, rigid nature of conversations, which take place in the office or boardroom, the environment in the operating theatre is vastly different. In theatre, we enjoy a rather relaxed and informal atmosphere, where all members of our team behave as good friends who laugh, converse and continually support each other.

My patients can rest assured that no matter how nervous or stressed they may feel going into theatre, while in our care, their surgery will be carried out under a positive, convivial and relaxed atmosphere.

This is another one of the greatest pleasures of being a surgeon – working with a tight cohort of familiar, experienced and passionate colleagues who make this working environment possible.

Take the flight deck for an example. Non-familiarity between pilot, co-pilot and crew has few serious implications. A Qantas pilot once told me he could easily fly with someone he doesn’t know or like.

Each member of the flight crew has an exact copy of the handbook in front of them. Pilot and co-pilot work through their checklist. If there’s a variation from the norm, there will be another script available elsewhere in the checklist.

By contrast, non-familiarity within surgical teams can bear a myriad of challenges. In an operating theatre, very little is scripted. Surgeons need to be quick problem solvers. There are a multitude of decisions to be made during a single (even “easy”) surgical case.

I love the team I work with, and I love the work we do in the operating theatre, yet there’s no way all possible scenarios can be scripted and taught. In the dynamic setting of theatre, familiar team members adapt much quicker to change. We need to find solutions to problems, small or large, as we go.

While some members of my regular surgical team weren’t necessarily the most experienced when we first began working together many years ago, they shared my excitement and passion for what we do. The longer we’ve worked together, the more efficient we have become.

The familiarity of my team has lead to seamless communication during surgery, confidence in each others actions, consistency and predictability of actions, and the ability for my team to behave as one connected entity. To enjoy ourselves. It’s simply a pleasure to work with them.


A typical surgical team consists of five key roles:

  • Surgeon
  • Surgical Assistant
  • Anaesthetist
  • Scrub Nurse
  • Scout Nurse

While patients may focus their attention to the surgeon, the other roles are critical, too.

For example, nursing staff need to know the technical aspects of all equipment and surgical instruments. If one instrument is faulty or not the best option to solve a problem, it is her job to find a better replacement very quickly

Because unexpected events during an operation can be awkward, time consuming and sometimes challenging, it means my team needs to be as responsive, agile and as confident in one another as possible.

For example, our team recently had to adjust our approach to a surgical procedure that was originally planned as a simple hysterectomy, but we unexpectedly found the patient to have peritoneal spread beyond what was expected.

Under such circumstances, managing serious deviations with a team that is confident and experienced with one another is highly desirable. As a surgeon I can only achieve great results with a great team.

It means surgical processes flow without the need for discussion. I’m handed the necessary surgical instruments without needing to request them. I stretch my hand, and they are given to me. No words exchanged.

This is very important to me, because my biggest priority is concentrating on the anatomy and the procedure without distraction. (Sometimes people say they paid me a visit in theatre but I was oblivious to them.)

  • I don’t need to discuss the adjustment of the operating table, the beanbag I use, the arms-by-the-side positioning with the anaesthetist. S/he simply knows.
  • I don’t need to request certain surgical back-up instruments to be on standby, because they will be there every single time I operate in that theatre.
  • And I don’t need to explain what direction the assistant needs to pull in, and at what time, and how strong. I don’t need to say what to avoid because my surgical assistants know what I need.

Undertaking both simple and complex procedures with my team is a truly rewarding challenge. I am aware that as a surgeon, it is my job not only to make sure I lead a successful operation, but to assemble a team of highly qualified, well trained and passionate co-workers.

Surgery does not need to be a frightening experience; you will always be in the very best hands.

The Woman’s Heart Attack

For my husband, Harold Lear, a doctor who became a patient just that suddenly, it was the first stop in a five-year medical odyssey, one cardiac crisis after another, ending with the ultimate stop in 1978.

Through all the years that followed, it remained my assumption that the Hollywood Heart Attack was it: the paradigm, the norm, the way heart attacks are supposed to happen.

I was relieved of this assumption two years ago, when I had one of my own.

Mine went like this: altogether well one moment, vaguely unwell the next; fluttery sensation at the sternum, rising into the throat; mild chest pressure; then chills, sudden nausea, vomiting, some diarrhea. No high drama, just a mixed bag of somethings that added up to nothing you could name. Maybe flu, maybe a bad mussel, maybe too much wine, but the chest pressure caused me to say to my second husband, “Could this be a heart attack?” “Of course not,” he said. “It’s a stomach bug.”

Still, that pressure, slight but there, nagged at me. I called my doctor and reported my symptoms. The mention of diarrhea, almost never a presenting symptom in heart attacks, skewed the picture. He said, “It doesn’t sound like your heart. I can’t say a thousand percent that it’s not, but it doesn’t seem necessary to go racing to the emergency room with the way you feel now. Just see it through and come in for an EKG in the morning.”

The pressure eased. I slept, and woke the next morning feeling well. I went for the test mainly because I had said that I would, fully expecting to be told that I was healthy. First the EKG and then the echocardiogram told a different story: a substantial heart attack, “less than massive,” my doctor said, “but more than mild.” We were both stunned.

Suddenly I found myself living in a sequel: same hospital where Hal had worked and died, same coronary unit, same cardiologist, same everything; different husband wheeling me in my wheelchair through the corridors where I had wheeled Hal in his. Ghosts in every corner.

With a stent implanted in an occluded artery, I recovered fast and was cleared to leave in four days, but a bad hospital-acquired infection kept me there four weeks — time enough for a revelatory education about women and hearts.

Surprise No. 1: The biggest killer of American women is not breast cancer, as many people believe. It is heart disease. Should I have been surprised? Of course not. The American Heart Association keeps telling us about our hearts and we keep not listening, possibly because we are so fearful of cancer that we have no fear to spare, as we lie on our beds dutifully palpating ourselves for the lumps that we pray not to find.

Our hearts kill more of us than all kinds of cancer combined.

Surprise No. 2: I learn that Hal’s attack and mine are textbook illustrations of how vivid the gender differences can be. I learn that men more typically have “crushing” pain; women, nausea. That women are likelier to have early warning signs, such as unaccustomed fatigue or insomnia (unaccustomed: That’s the key word here). That we are likelier — this spooked me and kept me, for months, glued to calendars — to die within a year of a heart attack. That our symptoms can be so varied and nuanced that we feel no fear, seek no help, and possibly die — which may be why, although more men have heart attacks, a greater percentage of women die of them.

All these gender distinctions strike me as marvelously curious. I begin, as I did during Hal’s many emergency admissions, interviewing doctors and nurses and keeping a journal.

A nurse practitioner offers a graphic tutorial. Big, broad, a Valkyrie, she plants herself at the foot of my bed, puts one hand beneath her nose, as though in salute, and the other at her pelvis, and says, “In women, from here to here, anything could be a symptom.” Thus encompassing jaw, neck, throat, back, shoulders, chest, arms, diaphragm, abdomen.

“That’s terrifying,” I say.

“It’s just information,” she says. “It’s good to be informed, not terrified.”

The question looms: Why should such differences be?

Answer: Nobody knows for sure.

But if it is not well understood, we do have one good — bad — reason it is not well understood. The reason is gender bias.

Until shockingly recently — in fact, until this millennium — there was minimal research on women’s heart attacks because of widespread belief in the medical community that women did not have heart attacks. (When the American Heart Association introduced its Prudent Diet in the 1950s, it issued a pamphlet titled “The Way to a Man’s Heart.”

Research studies commonly used all-male subjects. Men with abnormal test results were treated far more aggressively than women with the same results. Women reporting the same symptoms as men were at least twice as likely to receive — no surprise here — a psychiatric diagnosis.

In a 1996 national survey of doctors, two-thirds were unaware of gender differences in symptoms and warning signs of heart attacks.

Medicine did not begin cleaning up its act until 2001, when a study from the United States Institute of Medicine analyzed masses of data, confirmed a prevalent gender bias in all areas of medical research, and urged reform. So now there is improvement, though women still make up only 24 percent of all participants in heart-related studies. Just a few days ago, the National Institutes of Health announced that it will distribute $10.1 million in grants for scientists to include more women in clinical trials, which should give us more information.

What we already know is that nearly a half-million women are stricken annually by heart disease. That it is crucial to get help fast. That symptoms may include neck pain, shoulder pain, back pain, belly pain, et al. But what we are still not told is how to know when back pain, that endemic American complaint, is a possible warning sign, and when a cigar is just a cigar?

Here my own doctor supplies a missing nugget of common sense: “Don’t be reporting every little kvetch. Use discretion. But if it is a symptom unlike any you have experienced before, make the call. Get a reality check.”

I think of my Valkyrie: It’s good to be informed, not terrified. It sounds like something cross-stitched on a sampler. In my mind’s eye, it is a sampler, hanging sweetly, safely, on the wall by my bed.

Natural Ways To Boost Your Sex Drive

Dr. Weil’s Women’s Interest Newsletter

Wednesday 03/19/2014

Natural Ways To Boost Your Sex Drive

Looking for a natural way to boost your sex drive? An herbal possibility is the Mexican plant damiana (Turnera diffusa). Although it has not been extensively studied, it has a widespread reputation as a female aphrodisiac. You can readily find damiana preparations in health food stores. Follow dosage recommendations on the label. If you don’t notice any improvement after taking it for a month or two, discontinue use.

Another way to boost your sex drive is through cultivating physical and mental well-being – both are important to a healthy libido. Think about the interplay of emotional charge, mental imagery and body responses associated with intimacy. Hypnotherapy and guided imagery can help you make the most of the mind-body connection in overcoming sexual problems. Many experts say that the greatest aphrodisiac is the human mind.

Contaminated Berries

I have been having a handful of Blueberries and Raspberries for breakfast every morning for the last 20 years. Mostly they have been the Creative Gourmet brand of frozen berries. I did this because you could then have berries all year round, and not just in season, and also because they were Australian grown. Unknown to me (and many others), they were changed to Chinese grown from about a year ago. I checked the label originally, but stopped checking the label every time I bought them. Silly me- I should check every time to make sure they have not changed sources. Like many of you, I am very disturbed by what we have found out. Produce can be imported into one country (New Zealand for example) from say China, relabeled, then sent to Australia as product of New Zealand. If you are concerned about this issue, contact your local representatives and let them know your views, as it is essential our government tighten these rules to avoid this sort of scandal. Otherwise, go to and add your name to the petition going around requesting our government look into this issue and make the necessary changes.

Dr Colin Holloway

Symptoms of ovarian cancer.


Every woman needs to know the symptoms of ovarian cancer. Make sure you do.

It can be difficult to diagnose ovarian cancer because the symptoms are ones that many women will have from time to time, and they are often symptoms of less serious and more common health problems.

But we do know that ovarian cancer is NOT a silent disease. Women who are diagnosed with ovarian cancer report four types of symptoms most frequently:

  • Abdominal or pelvic pain.
  • Increased abdominal size or persistent abdominal bloating.
  • Needing to urinate often or urgently.
  • Feeling full after eating a small amount.

If you have any of these symptoms, they are new for you and you have experienced them multiple times during a 4-week period, download our Symptom diary now. Ovarian Cancer Australia’s Symptom Diary helps you to monitor your symptoms. You can then take the completed diary to your doctor to assist with diagnosis.

To download the print version of our symptom diary click here or get our iPhone App from the iTunes App store by searching Kiss & Makeup.

Other symptoms to be aware of

The Symptom diary will also help you to track any other symptoms that are not usual for you. These may include:

  • Changes in your bowel habits.
  • Unexplained weight gain or weight loss.
  • Bleeding in-between periods or after menopause.
  • Back pain.
  • Indigestion or nausea.
  • Excessive fatigue.
  • Pain during intercourse.

Be aware — but don’t make yourself sick with worry

It is important to remember that most women with these symptoms will not have ovarian cancer. Your doctor should first rule out more common causes of these symptoms, but if there is no clear reason for your symptoms, your doctor needs to consider the possibility of ovarian cancer.

If you are not comfortable with your doctor’s diagnosis or you are still concerned about unexplained persistent symptoms, you should seek a second opinion.

You know your body better than anyone else, so always listen to what your body is saying and trust your instincts.

Lancet study shows HRT increases risk of ovarian cancer


Some of you may be aware of this news story recently publicized. Those of you on HRT would be concerned, so I need to put it in perspective. The hormones used in the trial were the synthetic forms, using progestins, which are very different and proven to be more harmful than natural (micronised) progesterone. The form these women were given the HRT was mainly orally, which carries much higher risks than transdermal (Creams, patches and Troches). Finally, I have treated nearly 4000 women over 15 years with the Bioidentical HRT, and do not know of 1 case of ovarian cancer in that time in one of these patients. However, all women must be aware of the symptoms of ovarian cancer, so it can be diagnosed and treated early. I will publish the signs of ovarian cancer on this blog soon.

Lancet study shows HRT increases risk of ovarian cancer

Women who take hormone replacement therapy to ease the symptoms of menopause have a significantly increased risk of ovarian cancer, a study of more than 21,000 women has found.

The research published in The Lancet shows that among women aged from about 50 who take HRT for five years, there will be one extra ovarian cancer for every 1000 users and one extra ovarian cancer death for every 1700 users.

While doctors have long suspected HRT may cause some ovarian cancers, this is the largest ever study to assess the link and quantify the risk. It mainly included studies of women from Australia, North America and Europe.

The researchers from the International Collaborative Group on Epidemiological Studies of Ovarian Cancer said the increased risk related to the two most common forms of ovarian cancer (serous and endometrioid) and applied to women taking the two main types of HRT (preparations containing oestrogen only or oestrogen together with progestogen).

Furthermore, they said the increased risk was not altered by the age at which HRT began, body size, past use of oral contraceptives (which are known to protect against ovarian cancer), hysterectomy, alcohol use, tobacco use, or family history of breast and ovarian cancer.

Australian experts welcomed the study as more useful information about the risks of HRT, but said women should not panic about it because ovarian cancer remains rare, with about 1500 diagnoses each year.

Professor of Obstetrics and Gynaecology at the University of Melbourne and Royal Women’s Hospital Martha Hickey described the research as the best information to date on the link between HRT and ovarian cancer. She said although the risk was small, it was worth considering because ovarian cancer can be fatal.

“The chances of it happening are small, but on the other hand ovarian cancer has a very poor prognosis … so it’s important for that reason,” she said.

Professor Susan Davis, a leading endocrinologist at Monash University, described the risk of ovarian cancer as a “small blip” that should be weighed against the benefits of taking HRT, which remains the best available treatment for troubling menopausal symptoms such as hot flushes and sweats. Furthermore, she said HRT was associated with a lower risk of colon cancer, heart disease and improved bone density which protects against osteoporosis and fractures.

The Lancet‘s study on ovarian cancer follows great controversy about the risks of HRT over the past 13 years. In 2002, the Women’s Health Initiative study said the treatment dramatically increased the risk of heart disease, strokes, breast cancer and blood clots.

But a reappraisal of the study published in 2012 said the findings were irrelevant for women in their 50s and that the benefits of taking HRT significantly outweighed the risks for many women experiencing menopausal problems.

About 2 million Australian women are going through or approaching menopause, when menstruation ends and the body’s production of the sex hormones oestrogen and progesterone drops off. About 80 per cent experience moderate or severe symptoms.

Professor Davis said about 10 per cent of women aged 40 to 65 are using some form of HRT in Australia.

Hormones and Blood pressure control.

This study shows that HRT in menopause has a positive effect on Blood Pressure. Also, transdermal (such as creams, patches and troches) work better, and the more natural forms of progesterone are best.
Int J Womens Health. 2014 Aug 11;6:745-57. doi: 10.2147/IJWH.S61685. eCollection 2014.

Modification of blood pressure in postmenopausal women: role of hormone replacement therapy.


The rate of hypertension increases after menopause. Whether estrogen and progesterone deficiency associated with menopause play a role in determining a worst blood pressure (BP) control is still controversial. Also, studies dealing with the administration of estrogens or hormone therapy (HT) have reported conflicting evidence. In general it seems that, despite some negative data on subgroups of later postmenopausal women obtained with oral estrogens, in particular conjugated equine estrogens (CEE), most of the data indicate neutral or beneficial effects of estrogen or HT administration on BP control of both normotensive and hypertensive women. Data obtained with ambulatory BP monitoring and with transdermal estrogens are more convincing and concordant in defining positive effect on BP control of both normotensive and hypertensive postmenopausal women. Overall progestin adjunct does not hamper the effect of estrogens. Among progestins, drospirenone, a spironolactone-derived molecule, appears to be the molecule with the best antihypertensive properties.