Monthly Archives: September 2016

Selenium: It’s What Your Thyroid Needs

April 2016

Selenium: It’s What Your Thyroid Needs

We recently discussed the importance of iodine for thyroid health. We’ve also talked about vitamin D and iron and their affects on the gland, but one mineral that hasn’t gotten as much publicity is selenium. This mineral is a vital part of optimal thyroid function and may even prove to be extremely beneficial for those suffering with Hashimoto’s Thyroiditis, an autoimmune disease.

Selenium is a mineral that exists in two forms: inorganic and organic. Soils contain the inorganic form which plants convert to the organic form. It is naturally found in certain foods and added to others in effort to prevent selenium deficiency. While selenium deficiency is not believed to be common among healthy adults, it is most likely to be found in individuals that suffer from digestive issues that cause poor absorption of nutrients, as well as individuals with inflammation caused by chronic infection. Other factors include smoking, regular alcohol consumption, and taking birth control pills. The symptoms associated with selenium deficiency include,

  • Fatigue
  • Low immunity
  • Poor concentration (brain fog)
  • Fertility/reproductive issues
  • Heart problems
  • And more!

It’s interesting that these symptoms are similar to those associated with hypothyroidism…

While it is fine-and-dandy to read about various minerals, you are probably wondering what role selenium plays in thyroid function and the answer is: a very big one! Selenium is a component that helps make up the enzymes that remove the iodine molecules from T4, thus making it T3. Meaning selenium is vital in the conversion of the inactive to the active form of the thyroid hormones. Another responsibility of the mineral is the protection of the thyroid from oxidative damage. The thyroid makes hydrogen peroxide which is used to make thyroid hormones; however, these reactions can lead to oxidative damage. If the individual has low levels of selenium, the thyroid will suffer.

There are many studies available showing the connection between low selenium levels and thyroid disease, and others supporting the idea of selenium supplementation in certain thyroid conditions. For instance, an observational study was conducted in China in 20151. It included over 6,000 participants ranging in age from 18-70 years of age. These individuals completed questionnaires discussing their diet and underwent clinical examinations. The study concluded that the risk of thyroid disease was 69% higher for those living in low-selenium areas versus those in the adequate-selenium areas.

Another study published in 2002 discussed selenium’s affect on TPO (thyroid peroxidase) antibodies2. The researchers reported that they gave 200mcg of sodium selenite on a daily basis to individuals suffering from Hashimoto’s disease that had high levels of TPO antibodies. After three months, the participants’ levels were redrawn and there was a decrease of the TPO antibody value by 66.4%. Only nine of participants’ levels returned to normal.

There are many other studies that show the wonderful affects of selenium; however, this does not mean you should run out and start self-supplementing. Studies are still being conducted to determine if there are long-term health risks involved in supplementation and even if long-term supplementation is necessary.

There are a few foods you can try to improve your selenium levels slightly. These include,

  • Fish
  • Red meat
  • Eggs
  • Chicken
  • Garlic
  • Wheat germ

While all of these are great, Brazil nuts are selenium-rich and can help boost levels by consuming just a few a day.

Selenium levels may be something to discuss with your doctor especially if you suffer from thyroid disease. Ask your treating physician to add it to your next round of blood work and ask about their thoughts on selenium supplementation.

1. Qian Wu, Margaret P. Rayman, Hongjun Lv, Lutz Schomburg, Bo Cui, Chuqi Gao, Pu Chen, Guihua Zhuang, Zhenan Zhang, Xiaogang Peng, Hua Li, Yang Zhao, Xiaohong He, Gaoyuan Zeng, Fei Qin, Peng Hou, and Bingyin Shi-Low Population Selenium Status Is Associated With Increased Prevalence of Thyroid Disease

2. Gärtner R1, Gasnier BC, Dietrich JW, Krebs B, Angstwurm MW. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations.

Why Is Arthritis More Common in Women Than Men?

Ask Well: Why Is Arthritis More Common in Women Than Men?


Credit Stuart Bradford/The New York Times

Roughly one in four women have been given diagnoses of arthritis, compared with about one in five men, according to national health figures. But there are more than a hundred different kinds of arthritis, said Dr. Kelly Weselman, a rheumatologist who spoke on behalf of the American College of Rheumatology, and while some types disproportionately affect women, there are also forms that affect men more.

Osteoarthritis, the most common form of arthritis, affects both genders equally, though different joints may be affected in men and women, Dr. Weselman said. Age, weight and trauma play a role, and those “who have played a lot of sports like soccer and football tend to get osteoarthritis in the joints early.”

Other arthritic disorders affect far more women than men, with rheumatoid arthritis affecting three times as many women as men and lupus, an autoimmune condition that affects many organs, including the joints, affecting nine times as many women.

Gout or gouty arthritis is more prevalent among men until the older ages, when women catch up and the incidence between the sexes evens out.

Over all, Dr. Weselman said, “There are more female-predominant forms of arthritis than there are male-predominant forms. If you add it up, more women are going to be affected.”

Why that is the case isn’t entirely clear. Both rheumatoid arthritis and lupus are autoimmune disorders, which result when the immune system attacks the body’s own healthy cells, and autoimmune diseases are more common among women.

Many hypotheses have been put forth to explain why, said Dr. Robert H. Carter, deputy director of the National Institute of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases. “There’s no question female hormones have an effect on the immune system,” he said, though “it’s less clear that drives dominance of the disease in women.”

Women have more robust immune systems than men generally; they tend to fight infections better and their immune system “revs up faster,” said Kathryn Sandberg, director of the Center for the Study of Sex Differences in Health, Aging & Disease at Georgetown University Medical Center. “That may be a kind of double-edged sword,” she said, “You’re more resistant to infections, but you’re also more at risk for having the immune system go a little nuts and attack your own self.”

Which Type of Exercise Is Best for the Brain?

Which Type of Exercise Is Best for the Brain?
By Gretchen Reynolds

February 17, 2016

Gretchen Reynolds on the science of fitness.

Some forms of exercise may be much more effective than others at bulking up the brain, according to a remarkable new study in rats. For the first time, scientists compared head-to-head the neurological impacts of different types of exercise: running, weight training and high-intensity interval training. The surprising results suggest that going hard may not be the best option for long-term brain health.

As I have often written, exercise changes the structure and function of the brain. Studies in animals and people have shown that physical activity generally increases brain volume and can reduce the number and size of age-related holes in the brain’s white and gray matter.

Exercise also, and perhaps most resonantly, augments adult neurogenesis, which is the creation of new brain cells in an already mature brain. In studies with animals, exercise, in the form of running wheels or treadmills, has been found to double or even triple the number of new neurons that appear afterward in the animals’ hippocampus, a key area of the brain for learning and memory, compared to the brains of animals that remain sedentary. Scientists believe that exercise has similar impacts on the human hippocampus.

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These past studies of exercise and neurogenesis understandably have focused on distance running. Lab rodents know how to run. But whether other forms of exercise likewise prompt increases in neurogenesis has been unknown and is an issue of increasing interest, given the growing popularity of workouts such as weight training and high-intensity intervals.

So for the new study, which was published this month in the Journal of Physiology, researchers at the University of Jyvaskyla in Finland and other institutions gathered a large group of adult male rats. The researchers injected the rats with a substance that marks new brain cells and then set groups of them to an array of different workouts, with one group remaining sedentary to serve as controls.

Some of the animals were given running wheels in their cages, allowing them to run at will. Most jogged moderately every day for several miles, although individual mileage varied.

Others began resistance training, which for rats involves climbing a wall with tiny weights attached to their tails.

Still others took up the rodent equivalent of high-intensity interval training. For this regimen, the animals were placed on little treadmills and required to sprint at a very rapid and strenuous pace for three minutes, followed by two minutes of slow skittering, with the entire sequence repeated twice more, for a total of 15 minutes of running.

These routines continued for seven weeks, after which the researchers microscopically examined brain tissue from the hippocampus of each animal.

They found very different levels of neurogenesis, depending on how each animal had exercised.

Those rats that had jogged on wheels showed robust levels of neurogenesis. Their hippocampal tissue teemed with new neurons, far more than in the brains of the sedentary animals. The greater the distance that a runner had covered during the experiment, the more new cells its brain now contained.

There were far fewer new neurons in the brains of the animals that had completed high-intensity interval training. They showed somewhat higher amounts than in the sedentary animals but far less than in the distance runners.

And the weight-training rats, although they were much stronger at the end of the experiment than they had been at the start, showed no discernible augmentation of neurogenesis. Their hippocampal tissue looked just like that of the animals that had not exercised at all.

Obviously, rats are not people. But the implications of these findings are provocative. They suggest, said Miriam Nokia, a research fellow at the University of Jyvaskyla who led the study, that “sustained aerobic exercise might be most beneficial for brain health also in humans.”

Just why distance running was so much more potent at promoting neurogenesis than the other workouts is not clear, although Dr. Nokia and her colleagues speculate that distance running stimulates the release of a particular substance in the brain known as brain-derived neurotrophic factor that is known to regulate neurogenesis. The more miles an animal runs, the more B.D.N.F. it produces.

Weight training, on the other hand, while extremely beneficial for muscular health, has previously been shown to have little effect on the body’s levels of B.D.N.F., Dr. Nokia said, which could explain why it did not contribute to increased neurogenesis in this study.

As for high-intensity interval training, its potential brain benefits may be undercut by its very intensity, Dr. Nokia said. It is, by intent, much more physiologically draining and stressful than moderate running, and “stress tends to decrease adult hippocampal neurogenesis,” she said.

These results do not mean, however, that only running and similar moderate endurance workouts strengthen the brain, Dr. Nokia said. Those activities do seem to prompt the most neurogenesis in the hippocampus. But weight training and high-intensity intervals probably lead to different types of changes elsewhere in the brain. They might, for instance, encourage the creation of additional blood vessels or new connections between brain cells or between different parts of the brain.

So if you currently weight train or exclusively work out with intense intervals, continue. But perhaps also thread in an occasional run or bike ride for the sake of your hippocampal health.

Health Check: five ways to get a better night’s sleep

Sleep problems are common as we get older, and especially in menopause, which is why I have devoted so many posts devoted to this issue.

Five ways to get a better night’s sleep
February 8, 2016 1.41pm AEDT .

Chin Moi Chow
Associate Professor of Sleep and Wellbeing, University of Sydney

Disclosure statement

Chin Moi Chow does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

We devote around seven to eight hours to sleep each night in adulthood and ten to 12 hours in childhood. This amounts to around 200,000 hours in our first 60 years of life.

Not getting enough sleep does a disservice to our brain and physical health. But how can we improve our chances of getting a good night’s rest?

1. Silence the mind

Trying to fall asleep can be a tricky, especially when thought-chatter is involved. Instead of dozing off, we reflect on the activities of the day and events of the past. Negative thoughts tend to surpass positive ones and can set in motion a train of worry and anxiety.

Strategies to shut down thought-chatter include meditation, praying, listening to music, or simply feeling at peace and contented. Accepting the notion that everything else can wait till the morning will help. For most things, you can “sleep on it”.

2. Reduce bad daytime and pre-sleep habits

Stimulants such as caffeinated beverages can delay and disrupt sleep. The day-long use of caffeine (two to three cups) causes a gradual build-up of caffeine in the body. But effects on sleep depends on whether or not the person is a regular coffee drinker.

To avoid it interrupting your sleep, refrain from drinking coffee for at least six hours before bedtime.

Other foods can help us ease into sleep. Consuming foods high in tryptophan such as cherries, cherry juice, pumpkin seeds, milk and yoghurt (consumed at any time daily) or foods that have a high glycemic index such as short-grain rice (three to four hours before bedtime) can help.

At elevated levels, tryptophan makes its way into the brain and is converted to melatonin. Known as the “hormone of darkness”, melatonin is released at night time and induces sleep.

Light powerfully suppresses the release of melatonin and, therefore, sleep. So avoid using electronic devices that emit light in the period just before bedtime. Recent studies suggest even artificial room light can suppress melatonin levels.

Exercise plays an important role in decreasing the time it takes to fall asleep and improves sleep quality. The mechanisms by which exercise improves sleep remain speculative. Some suggest it increases slow wave sleep (referred to as deep sleep) and psychological functioning.

The appearance of slow wave sleep is associated with growth hormone release. Growth hormone builds up metabolic molecules and improves muscle mass and muscle strength.

Getting better sleep after you start exercising may also be explained by improved psychological functioning. Exercise promotes well-being and self-esteem, and decreases anxiety and symptoms of depression.

It doesn’t matter what time of day you exercise, as long as the activity is not at the expense of your sleep duration.

3. Stay asleep

Some people have no problem falling asleep but others struggle to sleep through the night.

Being too hot or too cold, noise and light can interrupt your sleep. Make sure your bedroom is quiet, dark and cool (around 20-22°C is optimal).

A full bladder will signal a trip to the bathroom and break your sleep. One way of getting around this is to stop drinking fluids two hours before bedtime. It takes around 60 to 90 minutes for liquids to move through the body and turn into urine.

Since alcohol is a diuretic and disrupts sleep patterns, avoid it close to or at bedtime.

4. Maintain a routine

A structured bedtime and rise time will help establish your sleep-wake pattern. Sleepiness will automatically descend at bedtime. You’ll also wake more easily and may not even need an alarm clock.

5. Break bad sleep beliefs

Being anxious about not getting sufficient sleep may amplify sleep problems. So can worrying about your sleep’s impact on daytime functions such as thinking, memory, emotions and performance.

It can be difficult to change these patterns of thinking. If you’re struggling, you can seek help from a clinical psychologist. They can assist you to make the emotional and behavioural changes needed to promote healthy sleep.

Rest assured that any sleep debt you incur by getting a poor night’s sleep can be repaid through a catch-up sleep.

Sleeping well is about life-long bedtime and rise-time habits. Preparing a conducive sleeping environment, curbing thought-chatter at bedtime and following a structured sleep-wake routine will be a win for all sleepers.

Chinese herbal medicine for menopausal symptoms.

Cochrane Database Syst Rev. 2016 Mar 15;3:CD009023. doi: 10.1002/14651858.CD009023.pub2.

Chinese herbal medicine for menopausal symptoms.

Author information

  • 1National Institute of Complementary Medicine (NICM), Western Sydney University, Locked Bag 1797, Penrith, Sydney, New South Wales, Australia, 2751.



Chinese herbal medicine (CHM) usage is expected to increase as women suffering from menopausal symptoms are seeking alternative therapy due to concerns from the adverse effects (AEs) associated with hormone therapy (HT). Scientific evidence for their effectiveness and safety is needed.


To evaluate the effectiveness and safety of CHM in the treatment of menopausal symptoms.


We searched the Gynaecology and Fertility Group’s Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), MEDLINE, Embase, CINAHL, AMED, and PsycINFO (from inception to March 2015). Others included Current Control Trials, Citation Indexes, conference abstracts in the ISI Web of Knowledge, LILACS database, PubMed, OpenSIGLE database, and China National Knowledge Infrastructure database (CNKI, 1999 to 2015). Other resources included reference lists of articles as well as direct contact with authors.


Randomised controlled trials (RCTs) comparing the effectiveness of CHM with placebo, HT, pharmaceutical drugs, acupuncture, or another CHM formula in women over 18 years of age, and suffering from menopausal symptoms.


Two review authors independently assessed 864 studies for eligibility. Data extractions were performed by them with disagreements resolved through group discussion and clarification of data or direct contact with the study authors. Data analyses were performed in accordance with Cochrane Collaboration guidelines.


We included 22 RCTs (2902 women). Participants were from different ethnic backgrounds with the majority of Chinese origin.When CHM was compared with placebo (eight RCTs), there was little or no evidence of a difference between the groups for the following pooled outcomes: hot flushes per day (MD 0.00, 95% CI -0.88 to 0.89; 2 trials, 199 women; moderate quality evidence); hot flushes per day assessed by an overall hot flush score in which a difference of one point equates to one mild hot flush per day (MD -0.81 points, 95% CI -2.08 to 0.45; 3 RCTs, 263 women; low quality evidence); and overall vasomotor symptoms per month measured by the Menopause-Specific Quality of Life questionnaire (MENQOL, scale 0 to 6) (MD -0.42 points; 95% CI -1.52 to 0.68; 3 RCTs, 256 women; low quality evidence).In addition, results from individual studies suggested there was no evidence of a difference between the groups for daily hot flushes assessed by severity (MD -0.70 points, 95% CI -1.00, -0.40; 1 RCT, 108 women; moderate quality evidence); or overall monthly hot flushes scores (MD -2.80 points, 95% CI -8.93 to 3.33; 1 RCT, 84 women; very low quality evidence); or overall daily night sweats scores (MD 0.07 points, 95% CI -0.19 to 0.33, 1 RCT, 64 women; low quality evidence); or overall monthly night sweats scores (MD 1.30 points, 95% CI -1.76 to 4.36, 1 RCT, 84 women; very low quality evidence). However one study using the Kupperman Index reported that overall monthly vasomotor symptom scores were lower in the CHM group (MD -4.79 points, 95% CI -5.52 to -4.06; 1 RCT, 69 women; low quality evidence).When CHM was compared with hormone therapy (HT) (10 RCTs), only two RCTs reported monthly vasomotor symptoms using MENQOL. It was uncertain whether CHM reduces vasomotor symptoms (MD 0.47 points, 95% CI -0.50 to 1.44; 2 RCTs, 127 women; very low quality evidence).Adverse effects were not fully reported in the included studies. Adverse events reported by women taking CHM included mild diarrhoea, breast tenderness, gastric discomfort and an unpleasant taste. Effects were inconclusive because of imprecise estimates of effects: CHM versus placebo (RR 1.51; 95% CI 0.69 to 3.33; 7 trials, 705 women; I² = 40%); CHM versus HT (RR 0.96; 95% CI 0.66 to 1.39; 2 RCTs, 864 women; I² = 0%); and CHM versus specific conventional medications (such as Fluoxetine and Estazolam) (RR 0.20; 95% CI 0.03 to 1.17; 2 RCTs, 139 women; I² = 61%).


We found insufficient evidence that Chinese herbal medicines were any more or less effective than placebo or HT for the relief of vasomotor symptoms. Effects on safety were inconclusive. The quality of the evidence ranged from very low to moderate; there is a need for well-designed randomised controlled studies

Hops for Hot flushes

J Menopausal Med. 2016 Aug;22(2):62-4. doi: 10.6118/jmm.2016.22.2.62. Epub 2016 Aug 30.

Hops for Menopausal Vasomotor Symptoms: Mechanisms of Action.

Author information

  • 1Students’ Research Committee, Nursing and Midwifery Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • 2Biomaterials Department, Iran Polymer and Petrochemical Institute, Tehran, Iran.
  • 3Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.


Menopause is a critical stage of women’s life associated with various complaints and distresses. Vasomotor symptoms (VMS), such as hot flushes, night sweats, sleep disturbances, and fatigue, are the most common menopause symptoms affecting about 50% to 80% of middle-aged women. Obviously, these symptoms, resulting from estrogen deficiency during menopause, can exert negative effects on women’s health and quality of life and thus require to be managed through approaches such as hormone replacement therapy (HRT). Many herbal treatments for menopause symptoms contain and its components such as 8-prenylnaringenin, 6-PN, isoxanthohumol and xanthohumol. Recent in-vivo studies have highlighted the ability of 8-prenylnaringenin to reduce serum-luteinizing hormone (LH) and follicle-stimulating hormone (FSH), to increase serum prolactin levels and uterine weight, and to induce vaginal hyperplastic epithelium. Previous research has shown that hops extract can strongly bind to both estrogen receptors, stimulate alkaline phosphatase activity in Ishikawa cells, and upregulate presenelin-2 and progesterone receptor mRNA in Ishikawa cells. Numerous clinical trials have documented significant reductions in the frequency of hot flushes following the administration of hop-containing preparations. Nevertheless, further clinical trials with larger sample size and longer follow-up are warranted to confirm such benefits.

How the cell’s power station survives attacks

How the cell’s power station survives attacks

Salk Institute News, 01/18/2016

Salk scientists discover how mitochondria recover after damage, offering clues to cancer, diabetes and brain disease.
Mitochondria, the power generators in our cells, are essential for life. When they are under attack – from poisons, environmental stress or genetic mutations – cells wrench these power stations apart, strip out the damaged pieces and reassemble them into usable mitochondria. Now, scientists at the Salk Institute have uncovered an unexpected way in which cells trigger this critical response to threats, offering insight into disorders such as mitochondrial disease, cancer, diabetes and neurodegenerative disease – particularly Parkinson’s disease, which is linked to dysfunctional mitochondria. The work appears January 15, 2016 in Science. In the new work, the Salk team found that when cells are exposed to mitochondria damage, a central cellular fuel gauge, the enzyme AMPK, sends an emergency alert to mitochondria instructing them to break apart into many tiny mitochondrial fragments. Interestingly, AMPK is activated by the widely used diabetes therapeutic metformin, as well as exercise and a restricted diet. The new findings suggest that some of the benefits from these therapies may result from their effects in promoting mitochondrial health.

Withdrawal of hormone therapy and increased risk of cardiovascular disease.

Withdrawal of hormone therapy and increased risk of cardiovascular disease. – PubMed – NCBI

Climacteric. 2016 Apr 14:1-3. [Epub ahead of print]

Withdrawal of hormone therapy and increased risk of cardiovascular disease.

Author information

  • 1a Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel.


Many menopause specialists follow the principle of prescribing postmenopausal hormone therapy (HT) for the shortest duration needed, in order to decrease the risk of some related serious adverse effects, such as breast cancer. Based on several large studies, it seems, however, that withdrawal of HT may be associated with immediate, though small increased risk of coronary heart disease and stroke. Cessation of HT correlates with increased risk of fractures as well. This information should be relayed to hormone users while discussing the continuation of HT with their health-care provider, but, since the potential cardiovascular harm is actually very small, it should not deter symptomatic women from using HT when needed.

FDA recommends against use of ovarian cancer screening

FDA recommends against use of ovarian cancer screening

Posted by Andreas Obermair on 12 September 2016 | 0 Comments

Based on recent, high-quality research evidence the U.S Food and Drug Administration (FDA) released a statement that advised against ovarian cancer screening. Health professionals should not recommend ovarian cancer screening tests to women who don’t have any symptoms because of the high possibility of unreliable results.

The FDA announced there are currently no screening tests for ovarian cancer that are sensitive enough to reliably screen for ovarian cancer. On the contrary, there are a high number of inaccurate results that could lead to mismanagement of patients.

In my recent blog I discussed the “8 reasons why ovarian cancer screening fails”. First and foremost, reliable tests are not available. CA125 and ultrasound findings may lead to surgery that could have been avoided. By contrast, some ovarian cancers escape the ultrasound and do not present with elevated CA125. Hence, a negative test will reassure women inappropriately.

In December 2015, the world-wide largest ovarian screening study was published and I summarised the trial results in a blog. The UK study enrolled 200,000 menopausal women 50-74 years in one of three screening groups: 1) yearly ultrasounds, 2) ROCA test (including CA125 blood test and transvaginal ultrasound if needed and 3) control group (no screening).


Whilst the results were to some degree promising, the overall benefit was rather small and there was still a significant proportion of women who developed surgical complications from surgery that could have been avoided. The FDA is concerned about the high false negative and also false positive results. A false negative (the woman does have ovarian cancer but it is not detected through the test) may wrongly assure a woman and cause her not to seek treatments. Similarly, a woman with a false positive (the test indicates an abnormality but the woman does not have ovarian cancer) may undergo unnecessary surgery.The mortality was 0.30% in both screening groups and 0.34% in the no-screening group. Unfortunately, only half of ovarian cancers were detected through screening.

What can women do if they are concerned about their ovarian cancer risk?

The FDA recommends that health professionals consider referring women at high risk for ovarian cancer to a genetic counsellor, gynaecological oncologist, or other specialist to discuss their options.

I realise that some women whose sister, mother, aunt, or other family member developed ovarian or breast cancer are concerned about their own ovarian cancer risk. The FDA identifies women who have reached menopause, women who have a family history of ovarian cancer, and women with the BRCA1 or BRCA2 genetic mutations to have the highest risk for developing ovarian cancer. I would also include women who had treatment for breast cancer in this list.

Ovarian cancer is a serious disease without any early warning signs. Its prognosis is generally poor and I know too many women who get taken away from us too early for ovarian cancer.

My advice to women who are concerned about their ovarian cancer risk is as follows:

  1.  Consider genetic testing: Genetic testing can be done through a blood test. It is the most reliable indicator of your risk for ovarian cancer. Tests are available for $400 at the time of this article. The most cost effective way is to test a patient who developed ovarian, breast or uterine cancer.
  2. If the genetic test indicates that you do have BRCA1, BRCA2 or Lynch syndrome it means that your risk of various cancers is high. You need to see a gynaecological oncologist or a genetic counsellor as soon as possible. There are various options that we can offer you. These options depend on your age and your personal aspirations. Risk-reducing, prophylactic surgery gives you the best chances to survive. Not all options mean that you lose fertility.
  3. If the test does not confirm BRCA1, BRCA2 or Lynch syndrome it could mean one of two things. You are either truly negative and do not carry a mutation and I would assume this if your family history is unremarkable. Or you could carry a mutation that is still not researched or unknown and cannot be tested for. At a conference, which I will attend in October this year, it will be reporting that up to half of all mutations that will cause ovarian cancer cannot be tested for. I know families with a horrendous family history of breast and ovarian cancer who tested negative for BRCA or Lynch. In such circumstances we will need to develop your personal best strategy together.

Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality.

One of the benefits of HRT in the menopause is the reduction in strokes and heart attacks. Over 1/2 of all women over 50 will die from a heart attack, so this benefit of HRT is very significant, and often overlooked when discussing whether to take HRT or not.

Menopause. 2015 Sep;22(9):976-83. doi: 10.1097/GME.0000000000000450.

Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality.

Author information

  • 11Department of Obstetrics and Gynecology, Helsinki University, Helsinki University Hospital, Helsinki, Finland 2Folkhälsan Research Center, Helsinki, Finland 3EPID Research Oy, Espoo, Finland 4National Institute for Health and Welfare, Helsinki, Finland 5Nordic School of Public Health, Gothenburg, Sweden.



Data on the health benefits and risks of postmenopausal hormone therapy (HT) are derived mainly from the use of conjugated equine estrogens. Estradiol-based regimens may have a different risk-benefit profile. We evaluated the risk of death caused by coronary heart disease (CHD), stroke, or any disease among users of estradiol-based HT regimens in a nationwide study in Finland.


A total of 489,105 women who used HT from 1994 to 2009 (3.3 million HT exposure years), as indicated in the nationwide reimbursement register and the national Cause of Death Register, were followed. A total of 28,734 HT users died during follow-up; among the deaths, 3,843 were caused by CHD and 2,464 were caused by stroke. Mortality risk in HT users with varying duration of exposure (≤1 y, >1 to 3 y, >3 to 5 y, >5 to 10 y, or >10 y) was compared with that in an age-matched background population.


Risk of CHD death was significantly reduced by 18% to 54% in HT users and was positively related to HT exposure time. Risk of stroke death was also reduced by 18% to 39%, but this reduction was not clearly related to HT exposure time. Risk of all-cause mortality was reduced in HT users by 12% to 38%, almost in linear relationship with duration of exposure. All these risk reductions were comparable in women initiating HT before age 60 years and women initiating HT at age 60 years or older.


In absolute terms, the risk reductions mean 19 fewer CHD deaths and 7 fewer stroke deaths per 1,000 women using any HT for at least 10 years.