Monthly Archives: May 2016

Estradiol variability, stressful life events, and the emergence of depressive symptomatology during the menopausal transition

This recent study provides further evidence that fluctuating oestrogen levels has a negative effect on women’s emotions, especially depression. Oestrogen is very effective in treating depression  in most women.  See under “Women’s health issues – depression”on my web-site for more information.

Menopause. 2015 Oct 21. [Epub ahead of print]

Estradiol variability, stressful life events, and the emergence of depressive symptomatology during the menopausal transition.

Gordon JL1, Rubinow DR, Eisenlohr-Moul TA, Leserman J, Girdler SS.

Author information



The aim of the study was to examine the role of estradiol fluctuation in triggering depressive symptoms in the menopausal transition and assess the role of recent very stressful life events (VSLEs) as a moderating factor in this relationship.


A total of 52 euthymic women in the menopausal transition or early postmenopause (age 45-60) who were assigned to the placebo arm of a randomized controlled trial of hormone therapy provided the data for this report. At enrollment, women’s experience of recent VSLEs, depressive symptoms, serum estradiol, and progesterone were assessed. At months 1, 8, and 14, depressive symptoms and hormones were reassessed, and participants underwent a stressor battery involving a speech and a mental arithmetic task. Participants rated their feelings of anxiety, fear, anger, and rejection. The standard deviation of estradiol provided an index of hormone variability over the entire 14 months.


Greater estradiol variability across the 14 months predicted greater depressive symptoms at month 14, though only in women reporting a higher number of VSLEs at baseline (39% of women reported ≤1 recent event). Greater estradiol variability also predicted greater feelings of rejection to the laboratory stressor at months 8 and 14. Furthermore, among women reporting higher VSLEs at baseline, feelings of rejection in response to the laboratory stressor at month 8 predicted depressive symptoms at month 14.


These data suggest that estradiol variability may enhance emotional sensitivity to psychosocial stress, particularly sensitivity to social rejection. Combined with VSLEs proximate to the menopausal transition, this increased sensitivity may contribute to the development of depressed mood.

Compounded non-FDA-approved menopausal hormone therapy prescriptions

This study shows the growth in use of menopausal compounding prescriptions (Bioidentical HRT) in the USA. It has now reached the same level as use of the standard synthetic HRT used by most doctors. The reason for this is that women find they get better results with BHRT, and the fact it is more natural appeals to most women.

Menopause. 2015 Dec 7. [Epub ahead of print]

Compounded non-FDA-approved menopausal hormone therapy prescriptions have increased: results of a pharmacy survey.

Pinkerton JV1, Constantine GD.

Author information



From a survey of compounding pharmacists, specific questions regarding compounded menopausal hormone therapy were used to estimate compounded hormone therapy (CHT) prescribing in the United States.


A national online survey was conducted by Rose Research-a market research company consisting of 12,250 US pharmacists from independent community pharmacies (ICPs) and compounding pharmacies (CPs). Pharmacists who completed the survey and met the prespecified criteria were eligible. Data from the survey were extrapolated to estimate overall CHT prescription volume and annual costs of CHT prescriptions for the United States based upon industry data from the National Community Pharmacists Association and IBISWorld.


Surveys were completed by 483 pharmacies, including 365 ICPs and 118 CPs. On the basis of the survey responses and extrapolated industry data, an estimated 26 to 33 million CHT prescriptions were filled annually, with total sales estimated at $1.3 to $1.6 billion. CPs (vs ICPs) accounted for a higher proportion of CHT prescriptions. More than half of the ICPs (52%) and CPs (75%) expected continued compounding business growth, with most predicting 5% to 25% growth within 2 years, despite the potential effect of restrictive legislation regarding compounding.


On the basis of extrapolated data from numbers of prescriptions reported by pharmacists participating in the survey, the volume of CHT seems to approach that of Food and Drug Administration (FDA)-approved menopausal hormone therapy, and growth in the CHT market is expected. Thus, physicians should educate themselves and the women consulting them about the differences between the FDA-approved and the less-tested CHT formulations. More research on the efficacy, safety, and consistency of non-FDA-approved CHT is needed.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

A shift in social attitudes can make menopause a positive experience

I have been away for the last 2 weeks visiting my son and his family in Japan. This was my first visit and it was a wonderful experience. My son, who attended Uni here 25 years ago, said prices have not changed at all since then. Taxi fares, a beer, a sushi roll, cup of coffee – are all the same as they were then. We had a trip to Kyoto and stayed in a Ryokan, a very interesting experience. Having Trevor with his Japanese language skills and knowledge made all the difference. I apologize if emails and other messages were unread and not responded to, but I am sure you will understand.

A shift in social attitudes can make menopause a positive experience
February 11, 2016 6.09am AEDT .

Studies show Chinese women view advanced age as a positive time of wisdom and maturity. from
Carolyn Ee
PhD Candidate and researcher at the Department of General Practice; GP and Acupuncturist, University of Melbourne

Disclosure statement

Carolyn Ee receives funding from the National Health and Medical Research Council (Postgraduate Scholarship).
It’s a sensation familiar to three out of every four women going through menopause. First, there’s a sudden and intense feeling of heat, accompanied by extreme sweating and redness in the face and chest. This is followed by chills. Then, it’s repeated several times an hour around the clock.

An estimated one million Australian women suffer hot flushes, and suffer they do. They don’t just leave women feeling hot and bothered, but also have considerable impact on quality of life.

Hot flush episodes go on for an average of three to four minutes at a time. For some women, they can last up to an hour.

Flushes aren’t usually a transient experience either. They persist for an average of five to seven years. About 40% of women will still experience them into their early 60s.

Despite this high prevalence, women usually suffer alone, breaking their silence only with close girlfriends or partners.

Social attitudes around menopause need to shift toward valuing the experience and maturity that comes with ageing. This will inevitably reduce the menopausal distress women experience.

Avoiding social interactions

Patients have told me they avoided social interactions because they’ve been embarrassed about their hot flushes, which over time led to depression. Some said they avoided shopping because they feared being mistaken for a shoplifter – as the sweating and red face made them appear nervous and guilty.

Women have told me their symptoms were ruining their lives and they were at the absolute end of their tether. Studies have backed this anecdotal evidence, showing hot flushes left many women feeling embarrassed, physically unattractive and stupid.

Angelina Jolie’s decision to remove both ovaries was a milestone in Western perceptions of menopause. Dan Himbrechts/AAP

Women across the world experience menopausal symptoms differently. In China, for instance, the prevalence of hot flushes is relatively low, at around 20% to 30%.

While biological differences may certainly play a role, there are suggestions cultural differences shape these experiences. One study showed Chinese women viewed ageing positively; some felt it signalled a time of wisdom and maturity.

By contrast, in the West, menopause conjures up themes around loss of femininity, beauty and sexuality. Such negative cultural attitudes could contribute to the severity of hot flushes experienced by Western women.

Menopause in the workforce

Hot flushes and other menopausal symptoms, including sleep disturbance and memory loss, can have a considerable impact on women at work. This is highly relevant as women of menopausal age comprise 17% of the Australian workforce.

A large Australian study on menopausal women in the workplace found many felt stressed and anxious at work, which led to poor self-esteem and loss of confidence. Some said their symptoms made them lose concentration and focus.

Unfortunately, it also showed managers and human resources staff weren’t skilled at effectively managing menopausal staff. Women reported “gendered ageism”, such as feeling “invisible” once they reached menopausal age. Some felt they had been overlooked for promotions and other opportunities because they were viewed as no longer intellectually desirable.

A study from the United Kingdom reported criticism and even harassment directed at women taking menopause-related sick leave.

Positively though, the study outlined strategies women found helpful at their place of work. These included having control over ambient temperature, access to cold water and toilets, and understanding from managers about menopause-related sick leave and flexibility of working hours.

Treatment options

Hormone replacement therapy (HRT) is effective for relieving menopausal symptoms, with studies showing up to a 75% reduction in frequency compared to placebo.

But new research suggests that despite its effectiveness and although it’s safe for many women, particularly those under 60, HRT is significantly underused. This means the majority of women suffering from severe hot flushes remain untreated.

Access to cold water can be helpful. from

Some women find complementary therapies, such as acupuncture, help relieve symptoms. But trials testing the effectiveness of these therapies have been conflicting. Our recent study, for instance, showed acupuncture was as effective as sham acupuncture for relieving hot flushes.

Strategies other women find helpful are: layering of clothing, such as removing a cardigan when a flush happens; avoiding triggers such as hot drinks, and psychological techniques such as communicating with openness and humour.

Mind-body interventions such as meditation may help, and there is growing interest among researchers and clinicians in the role of cognitive behavioural therapy.

The increasing evidence for the effectiveness of psychological techniques strengthens the idea that social attitudes and perceptions of the condition can impact its severity.

A positive experience

Actress Angelina Jolie’s decision to remove both her ovaries and therefore enter menopause was heralded as a milestone. It was a time when Hollywood, and indeed society, was finally forced to have a conversation about menopause.

It takes a beautiful young celebrity facing the risk of breast cancer for society to finally bring up this last taboo.

There are positives of going through menopause. Women speak of a new independence from menstruation and worrying about birth control. It can be an empowering life stage if a cultural shift leads to awareness, support, and open and honest communication.

Organisations should recognise menopause as an occupational issue and build capacity to support women through this difficult transition. Menopause must become normalised as a natural and commonly occurring event.

Four common myths about exercise and weight loss

Four common myths about exercise and weight loss

January 13, 2016 6.38am AEDT

Exercise isn’t the best way to lose weight, in fact it’s one of the hardest. Nottingham Trent University/Flickr, CC BY-SA

It’s that time of year when many are trying, and some are failing, to live up to their New Years’ resolution of losing weight. Many of these probably include resolutions to be more physically active in striving for this goal. But first, there are some common misconceptions about exercise and weight loss that need to be addressed.

Myth 1. Exercise is the best way to lose weight

While there is plenty of evidence showing people can lose weight just by being physically active, it is also one of the hardest ways to go about it.

Our energy balance is mostly determined by what we eat and our metabolic rate (the energy you burn when you do nothing). Our energy balance is determined only to a small extent by how active we are. That means losing weight just by being active is very hard work.

The American College of Sports Medicine recommends accumulating 250 to 300 minutes of moderate intensity exercise per week for weight loss. That is twice the amount of physical activity recommended for good health (30 minutes on most days), and most Australians don’t even manage that.

The best way to lose weight is through combining a nutritious, low-calorie diet with regular physical activity.

Just exercising is an extremely difficult way to shed kilos. Nina Hale/Flickr, CC BY

Myth 2. You can’t be fat and fit

Inactive people of healthy weight may look OK, but this isn’t necessarily the case. When you’re not active you have a higher risk of heart disease, diabetes, high blood pressure, osteoporosis, some cancers, depression and anxiety. Several studies have demonstrated the association between premature death and being overweight or obese disappears when fitness is taken into account (although another study disputed this).

This means you can still be metabolically healthy while being overweight, but only if you’re regularly active. Of course, people who are fit and of normal weight have the best health outcomes, so there are still plenty of reasons to try to shed some weight.

Myth 3. No pain, no gain

Or in other words, “no suffering, no weight loss”. As mentioned earlier, if you want to lose weight by being active, you will need to do a lot of it. But while physical activity of a moderate intensity is recommended, guidelines do not say activity needs to be of vigorous intensity.

Moderate intensity physical activity makes you breathe harder and may make it more difficult to talk, but you should still be able to carry on a conversation (such as brisk walking, riding a bicycle at a moderate pace). This is unlike vigorous physical activity, which will make you completely out of breath and will make you sweat profusely regardless of the weather conditions (such as running).

Moderate intensity physical activity is not painful and does not include excessive suffering to meet your goals. A study of weight loss in groups with higher intensity and lower volumes of activity compared to groups of lower intensity and higher volumes of activity did not find significant differences.

Myth 4. Only resistance training will help you lose weight

Resistance or strength training is good for you for several reasons. It increases functional capacity (the ability to perform tasks safely and independently) and lean body mass, and prevents falls and osteoporosis. But the main idea for promoting it to lose weight is that muscle mass needs more energy than fat mass, even when at rest. Therefore the more muscular you are, the higher your metabolic rate, which makes it easier to expend the energy you’re taking on board.

However, building muscle mass takes a serious effort, and you need to keep doing resistance training or significant loss of muscle mass will occur within weeks.

Not everyone enjoys weight lifting, so do what you prefer. Sherri Abendroth/Flickr, CC BY

More importantly though, aerobic or endurance training is also good to help you lose weight. In fact, a recent study demonstrated that endurance training was more effective in producing weight loss compared to resistance training. It’s also likely many people will get more enjoyment out of a brisk walk than a session of weight-lifting, so the most important thing is to pick an exercise routine you enjoy and thus will actually stick to.

To help you get started on your journey to a more active and potentially leaner lifestyle, you can sign up for free physical activity programs such as If you want to take part in our web-based physical activity research study, you can register your interest here.

St John’s Wort, the flower that can treat depression

Weekly Dose: St John’s Wort, the flower that can treat depression

April 20, 2016 12.49pm AEST

St John’s Wort, botanical name Hypericum perforatum, is considered a weed in temperate climates outside its native homelands of Europe, Asia and North Africa. The flowering tops and aerial parts of the plant are used medicinally in the form of tinctures and tablets to treat a number of conditions affecting the nervous and immune systems.

Records of the medicinal use of St John’s Wort date back to ancient Greece. It is believed Dioscorides and Hippocrates used it to cleanse the body of evil spirits. Since the times of the Swiss physician and botanist Paracelsus (1493-1541), St John’s Wort has traditionally been used to treat nerve pain, anxiety, neurosis and depression and externally for bruises, wounds and shingles.


How is it used today?

In modern times, St John’s Wort has been shown to be as effective as placebo and standard antidepressants in the treatment of mild to moderate depression.

In Australia, St John’s Wort is mainly purchased through pharmacies and health food stores with or without the guidance of a health-care professional.

The St John’s Wort products vary in the amount of key constituents they contain. Only a few products actually match what was trialled in the studies with positive clinical outcomes. Variations in the active constituent content will affect the strength and effectiveness of the medicine and its possible safety.

It has become more common for complementary medicine manufacturers to include a standardised amount of the herb constituents on the label. The daily dose range for total hypericin content is 0.75mg to 2.7mg of hypericin daily. The published studies generally used standardised extracts to contain 0.3% hypericin and 2-5% hyperforin.

In 2000, St John’s Wort made up 25% of all antidepressant prescriptions in Europe. A more recent Australian study reported 4.3% or 17,780 patients who had visited a GP for depression had taken or were taking St John’s Wort.

How does it work?

St John’s Wort has been reported as containing many constituents and demonstrating multiple and simultaneous mechanisms of action.

While individual key constituents have been identified as hypericin (a naturally occurring substance with a few different applications including antidepressive), pseudohypericin and hyperforin (a phytochemical produced in some plants), collectively they exert a number of pharmacological effects including antidepressant activity.

The hypericin and flavonoids (namely hyperforin) and other flavonoid molecules that are found in some fruits and vegetables are thought to play a role in exerting an antidepressant effect by altering nerve chemical messengers known as neurotransmitters. It is considered important available products contain standardised amounts of these components.

St John’s Wort has been shown in non-human studies to assist in keeping the circulating levels of four key neurotransmitters (serotonin, noradrenaline, dopamine and gamma-aminobutyric acid) at levels that improve depressive symptoms.

This is a very distinctive feature of St John’s Wort. No other drug has been demonstrated to affect all four of these chemical messengers with similar potencies. Studies comparing the effectiveness of St John’s Wort with different classes of other anti-depressants that target these neurotransmitters support the proposed multi-targeted mechanism of action of St John’s Wort.

Antidepressants Citalopram (Celexa) and Sertraline (Zoloft) belong to a class of antidepressants known as selective serotonin re-uptake inhibitors (SSRIs). These block the reabsorption of the neurotransmitter serotonin in the brain, making more serotonin available to assist the brain cells to send and receive chemical messages. This in turn boosts mood.

A high-standard systematic review conducted in 2009 concluded St John’s Wort extract was superior to placebo in patients with major depression and similarly effective to standard treatment with SSRIs. They also found fewer people taking St John’s Wort discontinued their treatment. This was due to them experiencing fewer side effects.

The same review also found no significant difference in the effectiveness of St John’s Wort and the older class of antidepressants known as “tri-cyclic”. These work by blocking the absorption of serotonin to improve their availability for sending and receiving chemical messages that improve our mood.

St John’s Wort was reported as more effective in German studies compared to those in non-European-based populations, but it is thought these results were over-optimistic.

Safety and side-effects

Like standard antidepressants, it may take up to four weeks to judge how effective St John’s Wort has been. It is generally well tolerated, but adverse effects may occur. These include mild gastrointestinal symptoms, skin reactions, increased sensitivity to sunlight, fatigue, sedation, restlessness, dizziness, headache and dry mouth.

St John’s Wort affects enzymes in the gastrointestinal tract and liver that are involved in drug metabolism. It can reduce how much of a drug is available in the body by reducing how much is absorbed and excreted. Therefore the potential effectiveness of many drugs can be limited.

This includes drugs used to treat serious conditions such as AIDs, cancer and epilepsy. St John’s Wort can also reduce the effectiveness of the oral contraceptive pill. It should not be taken along with standard antidepressant drugs.

Anyone suspecting they may have symptoms of depression should consult their doctor to ensure a correct diagnosis is made. The use of St John’s Wort should be guided by a health-care professional who is knowledgeable about the quality of available products, effective dosing and safety considerations, including known drug interactions associated with its use.

Oestrogen supplements can reduce the risk of dementia

Women who take oestrogen supplements from before or at the start of menopause and continue with them for a few years have better preserved brain structure, which may reduce the risk of dementia. I have had many posts over the years about oestrogen and better memory, brain function, anxiety and the like.

By Anne Sliper Midling

Published 22.01.16

OESTROGEN SUPPLEMENTS: Globally, one new person is affected by dementia every four seconds. In 2010, 36 million people were estimated to have dementia.

Now, findings in a doctoral thesis from NTNU are showing that oestrogen supplements can reduce the risk of dementia in women.

“Oestrogen supplements can have a positive effect against dementia if women start early enough with treatment,” says Carl Pintzka, a medical doctor and PhD candidate at NTNU.

Carl Pintzka

Carl Pintzka’s PhD research first showed that men have a better sense of direction than women. Now he has studied the relationship between oestrogen supplements and dementia. Photo: NTNU

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The discovery has been published in the journal Neurobiology of Aging.

A sample of 80 women who had used oestrogen supplements through menopause was compared with 80 women who had never used oestrogen supplements. All had participated in the Nord-Trøndelag Health Study (HUNT), a general population based study.

The brain shrinks with less oestrogen

Following menopause, womens’ oestrogen levels drop significantly compared to levels before menopause.

MRIs of the brains of the women in the study showed that those who had taken oestrogen supplements throughout menopause had a larger hippocampus. The hippocampus is one of the most important structures for memory and sense of place, and is one of the structures that is affected early in the progression of Alzheimer’s disease.

Foto av hippocampus

Here’s what the hippocampus looks like. The top row shows the hippocampus in a woman who had not taken oestrogen supplements. The lower row shows a hippocampus in a woman who had taken oestrogen supplements. Photo: Carl Pintzka.

Click to open

“We also examined the shape of the hippocampus and found that areas where hormone therapy had the greatest effect are the same areas that are affected by Alzheimer’s disease in its early stages,” says Pintzka.

Other studies have shown that women who start oestrogen supplements several years after menopause do not benefit from the same positive effect on the hippocampus.

Must start oestrogen from the late 40s

Pintzka’s findings show that boosting oestrogen levels increases the volume of the hippocampus. As of yet there are no drugs that stop or prevent the course of Alzheimer’s disease, and the focus has shifted towards strategies to prevent or delay the onset of dementia. Successful strategies are thought to be those that increase brain volume, and that in particular preserve the hippocampus. The risk of dementia may therefore be reduced for women taking oestrogen supplements around the time of menopause, according to Asta Håberg, Professor of Neuroscience at NTNU and Pintzka’s supervisor.

Until 2002, many women in Norway and internationally took oestrogen supplements during and after menopause. The reasons for boosting oestrogen levels are to reduce hot flashes and osteoporosis and to prevent cardiovascular disease. Then the number of women taking supplements fell dramatically.

Østrogen og kvinner, tabellThe table shows changes in the use of estrogen supplementation as a treatment in women. The table is from sales of products containing estrogens in Norway in the period 1990-2014. Adapted from Drug Consumption in Norway 2010–2014, ed. S. Sakshaug. 2015, Oslo: Norwegian Institute of Public Health.

The studies that scared women

Pintzka points to two specific studies as the reason for the steep decline in the use of oestrogen supplements. In the summer of 2002, a large study of menopausal women conducted by the ”Womens Health Initiative”. was published.

This study landed like a bombshell in professional circles and the media. The conclusion was that the disadvantages of long-term treatment with oestrogen far outweighed the benefits.

The study included 16,000 women and showed that the combination of oestrogen and progestin increased the risk of both heart disease and breast cancer. Furthermore, the study showed that those who took oestrogen supplements had poorer memory and greater risk for dementia than the control group.

Soon after, The Journal of the American Medical Association published another study, which had followed 44,000 women for 20 years. This study showed that oestrogen therapy increased the risk of ovarian cancer if treatment persisted for over 10 years.

Some risks increase, others drop

“It’s true that the risk of some cancers increases with oestrogen supplements, but we also know, for example, that the risk of hip fractures and colorectal cancer drops with their use,” says Pintzka.

According to Håberg, it’s a big question whether the findings of the American studies can be transferred to Norwegian women, because women [in the American studies] started using oestrogen at a later age. “Oestrogen supplements used in the United States are also different from the ones used in Europe,” she says.

More recent studies suggest that boosting oestrogen levels has protective effects on the brain if started around menopause, but that the same treatment could be harmful for women when starting later than a few years after menopause.

“The women who participated in the Women’s Health Initiative study started with oestrogen supplementation 15-30 years after menopause. This was probably too late to expect a positive effect,” Pintzka says.

More and more people will be affected by dementia

According to Norway’s 2014 Public Health Report, Norway has approximately 70 000 people with dementia, and that number is anticipated to increase greatly in the coming years due to a growing population and higher average age.

Norway is not alone in facing this development, which is associated with the increasing average age of the population.

The World Health Organization has identified the fight against neurodegenerative diseases, such as Alzheimer’s and Parkinson’s diseases, as some of the biggest health challenges society faces in the coming years.

Women should start early with oestrogen if they decide to use it

Håberg believes that positive effects on the brain from using oestrogen supplements are highly probable, but whether supplements eventually protect against dementia remains unclear.

“Women who want to take oestrogen supplements should start early to benefit from the positive effect on the brain,” says Håberg.

Pintzka points out that none of the participants in his doctoral thesis had dementia at the start of the study, nor have any developed the disease since the MRIs were taken. He adds that neither he nor his supervisor know how many participants may develop dementia as they continue to age. An NTNU research group plans to follow up on this question in the next HUNT study.

Pintzka is now employed by St. Olav’s University Hospital in Trondheim as a researcher for the National Competence Service for Functional MRI.

How’s your walnut, mate? Why men don’t like to talk about their enlarged prostate


How’s your walnut, mate? Why men don’t like to talk about their enlarged prostate

May 4, 2016 6.33am AEST

Conversation about how often you have to get up at night for a piddle is probably not the most scintillating discourse. But there’s a much bigger reason men don’t like to talk about prostate conditions.

My experience as a practising urologist suggests most men don’t like talking about their enlarged prostate because they actually have no idea what their prostate even is or does, let alone how it can cause problems when it gets bigger with age. They’ve heard of it of course, they know it’s somewhere down there and that it can get cancer in it, but mostly I suspect that’s about the extent of it.

So, let’s get back to basics and explain to these guys (you?) what the prostate is, what it does, and what can happen when it enlarges due to benign prostate hyperplasia (enlargement).

What is the prostate?

The prostate is a gland made of solid tissue that sits right under a man’s bladder and surrounds its outlet. The prostate’s job is to make semen so sperm that are shot up from the testes at ejaculation have got transport and food for their journey to the promised land of the female fallopian tube.

The prostate is normally about the size of a walnut, but once men hit their 50s and beyond it’s very common for their prostate to grow. This is not cancer and appears to have nothing to do with cancer. We don’t know exactly why the prostate decides to grow at this point, but it appears to be due to some interplay between hormones.

Because the prostate surrounds the bladder outlet, when it enlarges it sometimes constricts the outlet, causing a weak flow of urine and incomplete bladder emptying. This can lead to other symptoms such as urgency and frequency of urination, commonly at night (nocturia). All together, we call these lower urinary tract symptoms.

The worst-case scenario in benign prostate hyperplasia is when the bladder blocks off altogether (acute retention). This is excruciatingly painful and requires urgent insertion of a catheter, which externally drains the urine.

Benign prostate hyperplasia from


The classic presentation is a middle-aged or older man complaining of these lower urinary tract symptoms. A doctor’s rectal examination, where the back of the prostate can be felt, or an ultrasound will usually then reveal an enlarged prostate. Incidentally, prostate cancer rarely causes lower urinary tract symptoms, but is common in exactly the same age group, complicating its diagnosis.

Symptoms raising a red flag that plain old benign prostate hyperplasia may not be the underlying cause of lower urinary tract symptoms are painful urination (dysuria) and blood in the urine (haematuria). Either of these may indicate cancer or infection of the urinary tract and always require further tests to rule them out. If symptoms are just standard lower urinary tract symptoms such as urgency and frequency of urination, no further tests are required.


The most important thing to know is if the symptoms don’t particularly bother you, you don’t need any treatment at all. Your symptoms might get worse over time, but they can be effectively dealt with if and when they do cause a sufficient impact on quality of life.

Medicines are the most common treatment for bothersome urinary tract symptoms due to prostate enlargement. Many of these can be given as a single daily tablet.

Alpha1-blockers appear to work by relaxing the muscle fibres in the prostate, reducing its constriction of the bladder outlet. These typically provide relief of symptoms within just days of starting them.

Interestingly, one of the drugs usually used to treat erectile dysfunction (tadalafil) works in a similar fashion. Its low-dose form is also approved for use in treating these urinary symptoms.

5-alpha-reductase inhibitors (5-ARIs) are a totally different kind of drug, which shrink the glandular tissue of the prostate, reducing its bulk to eventually reduce constriction by the prostate as well. But these take much longer to work, so their effect typically isn’t noticed for several months. Also, these drugs can sometimes cause erectile dysfunction and reduced libido. One available drug combines both alpha1-blocker and 5-ARI in the one tablet.

Alpha1 blockers and 5-ARIs both act on the prostate, but sometimes it may not be the prostate itself that is causing these symptoms, but overactivity of the bladder instead. So if urgency and frequency of urination are the main symptoms, a drug that works directly on relaxing the bladder muscle (detrusor) might be a better option. A variety of these are now available.

Although some people swear by the natural medicine saw palmetto, the most rigorous examination of the evidence tells us it is no better than placebo.

Surgical options, although highly effective, tend to be reserved for more severe symptoms, or when inadequate bladder emptying has led to the relatively rare consequences of bladder stones, recurring urine infection or kidney failure.

So now you’re up to date with your prostate and benign prostate hyperplasia, you don’t have to be afraid to ask your mates about their walnuts.

Effect of hormone therapy on the risk of bone fractures:

This study confirms something we have known for a long time – oestrogen is the best protection against osteoporosis (bone fractures). Oestrogen also is more effective than premarin, or premia, which is one of the synthetic versions frequently used. The increased thrombosis they mentioned is when the hormones are given as a pill. There is no increased risk if it is given transdermally, either as a cream or a troche.

Menopause. 2015 Oct 27. [Epub ahead of print]

Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials.

Zhu L1, Jiang X, Sun Y, Shu W.

Author information



The aim of this study was to investigate the association between hormone therapy (HT) use and the development of bone fractures.


Using terms related to HT and fractures, we searched PubMed, Embase, and the Cochrane library for randomized controlled trials on HT and the associated risk of fractures published before August 2014. Two evaluators independently selected studies on the basis of predetermined selection criteria, and 28 studies were included in the meta-analysis. Summary estimates were obtained using fixed- or random-effects models as appropriate.


A total of 28 studies included 33,426 participants and 2,516 fractures cases. The overall relative risk of HT was 0.74 (95% confidence interval [CI] 0.69-0.80) for total fractures, 0.72 (95% CI 0.53-0.98) for hip fractures, and 0.63 (95% CI 0.44-0.91) for vertebral fractures. In subgroup analyses, women of an age less than 60 years had lower risk of total fractures compared with women of an age more than 60 years (P = 0.003). Estradiol led to greater decrease in the risk of total fractures compared with conjugated equine estrogens (P = 0.01). There is greater reduction in total fracture risk in trials of follow-up less than 36 months than that of follow-up more than 36 months (P = 0.003). No increase in the incidence of total cancer events but an increase in the incidence of thrombus was found to be associated with HT.


HT is associated with a reduced risk of total, hip, and vertebral fractures, with a possible attenuation of this protection effect after it is stopped or when it is begun after 60 years. However, there may be an increase in the incidence of thrombus formation associated with HT.

How your friends affect your health

How your friends affect your health
January 25, 2016 6.36am AEDT

Carol Maher
National Heart Foundation Senior Research Fellow in Physical Activity, Sedentary Behaviour and Sleep, University of South Australia

Tim Olds
Professor of Health Sciences, University of South Australia

University of South Australia


Think about your five closest friends. What do they care about? Do they love the gym? Long walks on the beach? Maybe they smoke, or are overweight. You should choose your friends wisely, because they can have a big influence on your health.

Growing evidence suggests disease spreads through social networks. According to a US study which followed 12,000 people for 32 years, if you have a close friend who becomes obese, your chances of becoming obese increase by 171%. And your risk of attempting suicide is four times higher if you have a friend who has tried to kill themselves.

So, if social networks can make you sick, can they also make you healthier? It seems they can, but in one of life’s annoying asymmetries, the health effect doesn’t seem to be as strong as the illness effect.

Recent studies have shown that quitting smoking spreads through social networks. If your significant other quits you have a 67% decreased chance of smoking.

And research confirms what we have always suspected – happiness is contagious. Your chances of becoming happier increase if you are surrounded by happy people.

The strength of the contagion depends on how close you live, and your relationship with the happy person. The strongest effect occurs if you have a happy friend who lives within 1.6km of you (25% increased chance of becoming happy).

Happy siblings or spouses can also help, but less so, increasing your chances of becoming happy by 14% and 8% respectively. Happy co-workers has no effect at all, so it’s OK to be grumpy at work.

Is health really contagious?

But couldn’t all this be due to like people attracting like? Scientists have tested this. It seems the effect really is due to the behaviours spreading over time, from key central “nodes” to their social connections. The spread can be seen up to three degrees of separation, so you can actually influence the friends of your friends’ friends.

The “direction” of the connection is also important. The study examining obesity’s spread through social networks found that if you consider someone your friend and they became obese, your chances of becoming obese increase modestly (57% increased risk).

Yet if they consider you a friend but the feeling isn’t mutual, your risk of obesity is unaffected. Worst of all, if you consider each other as friends and your friend becomes obese, your chances of becoming obese nearly trebles (171% increased risk). But we’re not suggesting that you unfriend your overweight friends as a preventative measure.

As this contagion effect of health has become recognised, researchers have tried to exploit it to improve health. In a 2015 study, public health scientists delivered a multivitamin supplement program in rural villages in Honduras.

The program was spread using word of mouth, starting with 5% of village residents. In some villages they randomly selected the initial targets, and in other villages they randomly selected individuals, asked them to name a friend, and then these nominated friends became the initial targets.

Uptake of the multivitamins was significantly higher in the villages where the initial targets were the nominated friends. This exploits the “friendship paradox”, that on average, your friends have more friends than you do.

What about online social networks?

Online social networks also present a ripe opportunity to deliver health programs. Our recent review identified burgeoning scientific interest in this idea, with promising results. Our study of a gamified Facebook app which helps users team up with online friends to compete in a 50-day physical activity challenge led to a two-hours-per-week increase in physical activity.

Other programs have targeted a wide range of health behaviours, including weight loss, exercise, quitting smoking and sexual practices.

Using online social networks to improve your health isn’t for everyone. Sharing health information online can be confronting. But, on the upside, social networks provide public accountability, opportunities for social support, and friendly rivalry – all powerful motivational tools.
If you are interested in trying an online social networking exercise intervention, join our new study and recommend a friend.

Seeking a ‘Happy Gut’ for Better Health

Well – Tara Parker-Pope on Health

Seeking a ‘Happy Gut’ for Better Health

By Anahad O’Connor January 14, 2016 5:30 am January 14, 2016 5:30 am


For much of his life, Dr. Vincent Pedre, an internist in New York City, suffered from digestive problems that left him feeling weak and sick to his stomach. As an adult he learned he had irritable bowel syndrome, or I.B.S., a chronic gut disorder that affects up to 10 percent of Americans.

Through the process of elimination, Dr. Pedre discovered that his diet was the source of many of his problems. Cutting out dairy and gluten reversed many of his symptoms. Replacing processed foods with organic meats, fresh vegetables and fermented foods gave him more energy and settled his sensitive stomach.

Dr. Pedre, a clinical instructor in medicine at the Mount Sinai School of Medicine, began to encourage many of his patients who were struggling with digestive disorders to do the same, helping them to identify food allergens and food sensitivities that could act as triggers. He also urged his patients to try yoga and meditation to alleviate chronic stress, which can worsen digestive problems.

Dr. Pedre now has a medical practice specializing in gastrointestinal disorders and is the author of a new book called “Happy Gut.” In the book, Dr. Pedre argues that chronic health problems can in some cases be traced to a dysfunctional digestive system, which can be quelled through a variety of lifestyle behaviors that nurture the microbiota, the internal garden of microbes that resides in the gut.

Recently, we caught up with Dr. Pedre to talk about what makes a “happy gut,” how you can avoid some common triggers of digestive problems, and why fermented foods like kombucha and kimchi should be part of your diet. Here are edited excerpts from our conversation.

How did you end up focusing on the treatment of digestive disorders?

It starts from having grown up with a sensitive digestive system, which was very challenging my entire life. But it wasn’t until I went to medical school and then ultimately learned functional medicine that I really understood what was going on inside the gut. I experimented and changed my diet and tried probiotics and started to resolve my issues. At first I was just doing this because the gut was one of those places where you could make a big difference for patients. I was seeing rapid results. My patients started referring their friends and before I knew it that part of my practice had grown tremendously.

You say that functional medicine informed your ideas about gut health. What is functional medicine?

Functional medicine is a branch of medicine that looks at the body as a system. It is patient-centered rather than disease-focused. We spend more time with our patients listening to their histories to look for interactions between genetic, environmental, mental and other lifestyle factors that can influence the course of their diseases. I think it’s best equipped to deal with the ever-increasing complexity of conditions that patients are going to their doctors for.

What is a “happy gut”?

A happy gut is a gut that is able to do all of the work of digestion. It has a healthy microbiome, it’s able to extract all the nutrients you need from your food without causing any pain, discomfort, bloating or distress, and it creates a bowel movement at least once a day.

Why did you write this book?

I wanted to be able to help more people than I could possibly reach through my practice. And as I was working with people on gut issues, I also came to realize what an essential role the gut plays in so many other aspects of health.

How common are digestive issues in America?

The estimate is that around 70 million Americans suffer from some sort of gut issue, including I.B.S. And I think if you broaden that out to people who suffer intermittently from some sort of gut distress, the number is much larger. There are also many people who maybe don’t realize they have a gut issue but are experiencing other related health issues.

What are the most common gut issues you see?

The biggest one would be irritable bowel syndrome. Behind that there could be something called dysbiosis. That’s basically an imbalance between the good and the bad bugs in the gut. That includes bacteria, yeast and parasites.

What are some of the more common causes of the gut problems you see?

The majority of it comes down to two main factors: diet and environment. And within that, environment can be defined broadly. The overprescribing of antibiotics is a big problem. There was a study recently that showed that just one course of antibiotics will alter the gut flora for up to 12 months. The study looked at a very common antibiotic, Cipro, which we commonly use to treat urinary infections, traveler’s diarrhea and food poisoning.

Can you elaborate on the diet aspect? What are some of the more common offenders?

It’s a variety of things. A lot of people are sensitive to wheat, gluten, soy and dairy products. It could be individual dairy proteins like casein or whey. Humans lack a certain enzyme that breaks down the casein protein. Some people are more susceptible than others. And that can lead to food sensitivities. For some people it could be food additives, or things like preservatives, artificial sweeteners and food colorings. For some people it can be enzyme deficiencies.

What’s the diet you advocate in general?

I think that it should be individualized for every person. But in general I tell my patients to basically eat mostly plants. My approach is a combination of Paleo and vegan. I advocate eating a lot of vegetables, complemented by meat. You should try to choose meat that’s organic, hormone-free and grass-fed. I also believe in incorporating a healthy amount of fats like omega-3’s from avocados, cold-water fatty fish, nuts and seeds.

You also advocate cultured foods, correct?

Yes. Cultured foods have a long tradition. If you go back in history, culturing was a way to extend the life of food and preserve it. But cultured foods also help nurture the good flora in our guts. Whether it’s through a yogurt or kefir or fermented vegetables like kimchi, or a fermented probiotic drink like kombucha, fermented foods are going to help promote a healthy, balanced gut flora. We know that the gut flora can shift very quickly depending on your diet. And I think it needs this continued support from cultured foods.

What is your diet like?

My diet is very similar to the “Happy Gut” diet that I write about in the book. I try to make the majority of my diet salads, greens and steamed vegetables. I bring in healthy fats through nuts and seeds, ideally sprouted. And I love kombucha, so that’s a regular part of my diet. I stay away from dairy and gluten, and during the season when the farmers’ market is near my home, I like to buy my produce there so I can support the local farmers. I also try to minimize my exposure to pesticides.

What do you expect people will take away from this book?

I hope people who are suffering from gut issues and other conditions that may be related to gut health – like fatigue, migraines, allergies and asthma – will see that there is a way to achieve wellness by changing the way you eat and the way you approach your lifestyle. I hope people will learn that it’s more than just a diet. It’s a 360-degree approach to your lifestyle, and the way you balance your stress is just as important as the way that you’re eating.