Author Archives: Dr Colin Holloway

What’s the point of sex? It’s communication at a biological level


What’s the point of sex? It’s communication at a biological level

January 16, 2017 6.02am AEDT

Today’s piece looks at how a woman’s immune system responds to sexual intercourse and facilitates healthy pregnancy.

Most people think just one sperm is needed to fertilise a woman’s egg and make a healthy pregnancy. This underpins a common view that all the other sperm – and all the other sex – are surplus to requirements, at least when it comes to conceiving a pregnancy.

However, biologists now believe sexual intercourse is not just a sperm delivery process, but also a kind of biological communication. Regardless of whether fertilisation occurs, sperm and other components of the ejaculated fluid trigger subtle changes in the immune system of women.

This has consequences for pregnancy should it happen later. More broadly, the importance of regular sexual activity also has implications for fertility planning, and for IVF and other forms of assisted reproduction, which generally do not take sexual practice or history into account.

Sperm swim in a soup of molecular messages

Evidence from animal research and clinical studies has led researchers to conclude seminal fluid – the fluid sperm are bathed in following ejaculation – plays an important role in fertility.

Seminal fluid contains small molecules that act as biological signals. Once deposited in the vagina and the cervix of a woman, these persuade the woman’s immune system to adopt a profile that tolerates (that is, recognises and accepts) sperm proteins known as “transplantation antigens”.

The tolerant profile matters if fertilisation takes place. Immune cells recognise the same transplantation antigens on the developing baby, and so support the process through which the embryo implants into the wall of the uterus and forms a healthy placenta and fetus.

So over time, repeated contact with the same male partner acts to stimulate and strengthen a tolerant immune response to his transplantation antigens. The immune system of a woman responds to her partner’s seminal fluid to progressively build the chances of creating a healthy pregnancy over at least several months of regular sex.

Some forms of infertility and disorders of pregnancy are caused by immune rejection, when the process of tolerance is not adequately established.

Healthier pregnancy after months of sex

A condition known as preeclampsia provides useful insights into how exposure to seminal fluid influences the success of pregnancy. Preeclampsia is an inflammatory disorder of pregnancy that compromises growth of the fetus, and often causes prematurity in babies. It can be life-threatening for mothers if left untreated.

Preeclampsia is more common when there has been limited sexual contact with the father before pregnancy is conceived, and is associated with insufficient establishment of immune tolerance in the mother.

The length of time a couple have had a sexual relationship seems more important than the frequency of intercourse. In a study of first pregnancies in 2507 Australian women, around 5% developed preeclampsia. Affected women were more than twice as likely to have had a short sexual relationship (less than six months) compared to the women who had healthy pregnancies.

Women with less than three months sexual activity with the conceiving partner had a 13% chance of preeclampsia, more than double the average occurrence. Among the few women who conceived on the first sexual contact with the father, the chance of preeclampsia was 22%, three times higher than the average. Low birth weight babies were also more common in this group.

Sperm swim in a soup of molecules that trigger an immune response in women. from

No relationship is observed between frequency of sexual activity during pregnancy and risk for preeclampsia, so it’s the duration of exposure before conception that counts most.

Setting up a profile of immune tolerance that supports healthy pregnancy seems to be specific to the conceiving partner. Women who change partners return to a baseline state, and must rebuild immune tolerance with the new partner.

Women who use barrier methods such as condoms or cervical caps (which lower the exposure of the vagina and cervix to seminal fluid and sperm), and then conceive shortly after stopping contraception, have an elevated risk of preeclampsia.

In contrast, women using an intrauterine device before conception have been found to have a slightly lower risk of preeclampsia.

Sex during IVF can increase conception chances

The importance of sex in creating the right environment for healthy pregnancy is also observed in clinical studies in IVF and other methods of assisted reproduction. Fertility is improved when couples have intercourse in the period when an embryo is transferred to the uterus.

Combined data from more than 2000 patients across seven studies showed the occurrence of a detectable pregnancy increased by 24% after vaginal contact with seminal fluid near the time of egg collection or embryo transfer. A study of Australian and Spanish couples showed intercourse in the days just before or just after embryo transfer boosted pregnancy rates by 50%.

These studies focused on the early stages of pregnancy, with further research required to assess whether sexual intercourse influences rates of full term pregnancy after assisted reproduction.

Absence of exposure to seminal fluid may be one factor explaining why preeclampsia incidence is higher after use of donated eggs or donor sperm, where prior female contact with the donor transplantation antigens has not occurred. The elevated risk after using donor semen can be reduced if multiple prior insemination cycles take place with the same donor.

In couples who conceive using a modified version of IVF known as ICSI (intracytoplasmic sperm injection), preeclampsia incidence is also higher in women who experience minimal exposure to their partner’s transplantation antigens due to very low sperm counts.

In some couples, an imbalance in seminal fluid composition or immune system factors may inhibit or slow down establishment of the tolerant immune profile in women. In other couples, there may be immunological incompatibility that impairs tolerance, regardless of time spent together.

Maybe some couples may just need a little longer having sex for pregnancy to occur.

Immune system acts as a gatekeeper in pregnancy

It is interesting to consider why the immune system is so closely involved in reproduction.

One theory is that females have evolved the ability to sense and respond to the signals in seminal fluid, in order to discern the quality or “fitness” of the male partner’s genetics. Scientists are now seeking to define the key signals on the male and female sides that promote tolerance.

Also, since male smoking, being overweight and other factors may shape how a woman responds to intercourse in a biological sense, it helps explains why dad’s health is just as important as that of the mother in preparing for pregnancy.

Is vulvovaginal atrophy due to a lack of both estrogens and androgens?

Menopause. 2016 Nov 21. [Epub ahead of print]

Is vulvovaginal atrophy due to a lack of both estrogens and androgens?

Author information

  • 11Laval University, Quebec City, Quebec, Canada 2Endoceutics Inc, Quebec City, Quebec, Canada.



The aim of this study was to review the preclinical data showing the role of both estrogens and androgens in the physiology of the vagina, and, most likely, in vulvovaginal atrophy of menopause.


Mass spectrometry-based assays (validated according to the FDA guidelines) for the measurement of sex steroids, their precursors, and metabolites were used. In addition to fixation of the vagina for morphological examination, histomorphometry, immunocytochemistry, immunofluorescence, and quantitative reverse transcription polymerase chain reaction were performed.


The vaginal epithelium of the animals receiving dehydroepiandrosterone (DHEA) was made of large multilayered columnar mucous cells showing distended cytoplasmic vacuoles representative of an androgenic effect. DHEA also stimulates collagen fiber compactness of the lamina propria (second layer)-an effect essentially due to an androgenic effect, whereas stimulation by DHEA of the muscularis in the third vaginal layer is approximately 70% due to the androgenic conversion of DHEA. Stimulation of the surface area of the nerve endings, on the contrary, is exclusively androgenic. Vaginal weight stimulation by DHEA is about 50% androgenic and 50% estrogenic.


Practically all studies on the influence of steroid hormones in the vagina have focused on luminal epithelial cells. Since all estrogens and androgens in postmenopausal women are made intracellularly and derive from the conversion of circulating DHEA, it is of interest to observe from these preclinical data that DHEA exerts both estrogenic and androgenic activity in the three layers of the vagina, the stimulatory effect on nerve density being 100% androgenic. Taking vaginal weight as a global parameter, the stimulatory effect of DHEA in the rat vagina is about equally estrogenic and androgenic, thus illustrating the importance of androgens in vaginal morphology and function, and the likely importance of androgens in vulvovaginal atrophy of menopause.

The use of high-dose estrogens for the treatment of breast cancer.

 I know, I know, everyone is scared of oestrogen. I have over the years tried to point out that oestrogen is actually women’s friend, as it does so many marvelous things for women. However, the scare mongering over the use of oestrogen has scared many women off using it. Even in oestrogen receptor positive breast cancer, oestrogen is used to treat breast cancer. I will be publishing more articles on this over the next week. The word apoptosis means “death”, so when they talk about oestrogen causing apoptosis of breast cancer cells, it means they destroy the cells.

See comment in PubMed Commons below

Maturitas. 2017 Jan;95:11-23. doi: 10.1016/j.maturitas.2016.10.010. Epub 2016 Oct 18.

The use of highdose estrogens for the treatment of breast cancer.

Author information

Pantarhei Oncology BV, Zeist, The Netherlands.
Pantarhei Oncology BV, Zeist, The Netherlands. Electronic address:
Department of Endocrinology, University Medical Center Utrecht, The Netherlands.


Estrogens are known to stimulate the growth of breast cancer but they are also an effective treatment for this disease (this has been termed the ‘estrogen paradox’). The fact that estrogens can be an effective treatment for breast cancer is something that has almost been forgotten, whereas the fear for estrogens remains. This paper reviews the use of estrogens for the treatment of breast cancer and identifies possible applications. The data summarised in this review demonstrate that highdose estrogens are effective for the treatment of advanced breast cancer, both as first-line treatment as well as for treatment after occurrence of endocrine resistance to TAM and AIs. Essential for efficacy is an extended period of estrogen deprivation before the tumour is subject to estrogen treatment (the gap hypothesis). Research on the mechanism of action has shown that apoptosis induced by estrogens is regulated via the estrogen receptor and growth factor signalling pathways. Highdose estrogens have a negative safety image, especially in terms of side-effects and increased rates of cardiovascular disease, but the safety data reviewed in this paper do not give rise to major concerns. Taking into account their side-effect profile together with their observed clinical efficacy, highdose estrogens should be considered a valuable alternative to chemotherapy in selected patients.

Cureus. 2017 Jul 6;9(7):e1434. doi: 10.7759/cureus.1434.

Estradiol as a Targeted, Late-Line Therapy in Metastatic Breast Cancer with Estrogen Receptor Amplification.

Author information

Internal Medicine, UPMC Presbyterian.
Division of Hematology/Oncology, Magee Women’s Hospital of UPMC.
Pharmacology and Chemical Biology, University Of Pittsburgh.


Estradiol is a major regulator of growth for the subset of breast cancers that express the estrogen receptor (ER, ESR1). Strategies to block ER action, via reduction of estradiol or direct inhibition of ER, have shown major success in the prevention and treatment of breast cancer. However, most ER-positive (ER+) metastatic breast cancers (MBC) eventually become resistant to these interventions. Interestingly, high dose estrogen can induce apoptosis in breast cancer cell lines, and high-dose estrogen has been used for over 50 years as therapy for ER+ breast cancer. The mechanism for growth control of MBC by high dose estrogen is unclear. We present a patient with metastatic breast cancer whose tumor was found to have amplification of ESR1 by tumor genome sequencing. This patient was treated with high dose estradiol and subsequently experienced a sustained partial response, which was predicted by prior experiments with patient-derived xenograft animal models containing breast cancers with ER amplification.

Why you should avoid hospitals in January

Mistakes happen in hospitals – no-one is perfect. I have witnessed many errors in treatment for myself or my family over the years. Luckily, my medical knowledge has allowed me to correct the mistake before too much damage was done. What if I had been a normal patient/father? I would not have known about the error. Most mistakes were of incorrect dosage, or the wrong medication. I strongly advise all of you to check everything – medicines, doses, procedures and ask questions of your medical personnel, especially in hospitals.

Why you should avoid hospitals in January

January is the quietest month in Australia. But for hospitals, which provide care 24/7/365, January is a time of big transition. And for patients, that means January is when things are more likely to go wrong.

More than 3,000 newly graduated doctors will enter the next phase of their training in January. New nurses and allied health professionals, such as physiotherapists and hospital pharmacists, also join the workforce in January.

These new staff fill the posts vacated by people one year ahead of them in the pipeline. Last year’s first-year-out doctor goes into his second year of training, and his predecessor goes into her third-year role or leaves the hospital to join a new workplace.

These new minds and hands, and the massive reshuffles of existing staff, disrupt hospitals. Old informal networks break down as new relationships are forged, and the less-experienced staff learn the hospital’s processes and expectations.

Read more: Reducing medical errors, one patient at a time

Not surprisingly, this staff disruption has an impact on patient care. Around the world, overblown descriptions of the changeover period as the “killing season” and of doctors’ first day in the UK as “Black Wednesday” have become part of medical folklore.

More sober studies of the “July Effect” (so named in the northern hemisphere) have indeed found evidence of worse patient outcomes during the changeover period.

The graph below shows the trend in complications in Australian hospitals over the past few years. It reveals a small but clear “January Effect”. On average, at least one complication occurs in just under 11% of hospital admissions in Australia. But each January, this rate ticks up by more than half a percentage point.

What goes wrong?

New staff might be less adept at monitoring patients, leading to the patient becoming malnourished. Or the new staff may not have acquired sufficient technical skills leading to an accidental puncture or laceration during a procedure.

Other hospital complications include pressure sores from not moving enough, infections from hygiene breaches, and being given the wrong dose or type of drug.

In January 2015, about 74,000 hospital patients in Australia had a complication of care, about 3,000 more than would have been expected if there were no January Effect. That is 3,000 people suffering complications that might not have arisen had they received care at “normal” times of the year.

What hospitals can do

Although the effect is clear, the causes – and therefore, solutions – are not. Is it the effect of the new doctors and other staff who are inadequately prepared for their new responsibilities? Or is it team disruption? Or is it that senior staff take their leave over January, resulting in weaker supervision just when it is needed most? Probably all of the above.

To the extent the problem is diminished supervision, start dates for new staff could be pushed back a month or so. Perhaps senior staff leave could be more evenly spread across the year.

Read more – Infections, complications and safety breaches: why patients need better data on how hospitals compare

If the problem is poorly prepared junior staff, then a longer and better induction might be the answer. Typically newly graduated doctors now have a one-week introduction, this could be extended or restructured to include more time to be introduced to the specific practices of units they will be joining.

If the problem is disrupted teamwork, the solution might involve better handover and induction processes, either as part of the formal induction period, or as a structured experience when they join their new unit.

Most likely, all facets will need to be improved.

What patients and their advocates can do

The January Effect underlines the fallibility of the people and systems that deliver our hospital care. Australia’s hospital system is staffed by motivated and highly trained people working in well-developed systems, often using state-of-the-art technologies and medicines.

But people can make mistakes, particularly when they are new to a task. Systems can break down. Patients in Australia can take comfort in the safety and quality of hospital care, but they should not assume it is perfect.

Read more: Blaming individual doctors for medical errors doesn’t help anyone

The burden of fixing health system problems should never rest on the shoulders of those with least power – patients and their families and carers. But patients do have a role. Alert and active patients and their families and carers can help identify and prevent errors – and this role becomes slightly more important in January.

Patients often know when they are about to be given the wrong medication, or when their regular medication has been stopped, or when the care they are about to get has not been fully discussed with them so might be wrong. They can speak up and prevent the problem – but too often they feel put down, disempowered and dismissed.

So the simple message for patients is this: if you see something that doesn’t look right, speak up, and speak up again.

What supplements do scientists use, and why?

I take a range of supplements daily. They include 12 gms fish oil, Turmeric with black pepper and ginger, Aged Kyolic garlic, Magnesium, CoQ 10 and low dose aspirin – I classify that as a supplement as it comes from the willow bark.

What supplements do scientists use, and why?

Supplements are a multi-billion dollar industry. But, unlike pharmaceutical companies, manufacturers of these products don’t have to prove that their products are effective, only that they are safe – and that’s for new supplements only.

We wanted to know which supplements are worth our attention (and money) so we asked six scientists – experts in everything from public health to exercise physiology – to name a supplement they take each day and why they take it. Here is what they said.


Simon Bishop, lecturer in public health and primary care, Bangor University

Turmeric is more familiar as an ingredient in South Asian cooking, adding an earthy warmth and fragrance to curried dishes, but, in recent years, it has also garnered attention for its potential health benefits. I have been taking ground turmeric root as a dietary supplement for around two years, but I have been interested in its use in Ayurvedic medicine for far longer.

Turmeric is used as a traditional remedy in many parts of Asia to reduce inflammation and help wounds heal. Now, mounting evidence suggests that curcumin, a substance in turmeric, may also help to protect against a range of diseases, including rheumatoid arthritis, cardiovascular disease, dementia and some cancers.

The evidence underpinning these claims of health-giving properties is not conclusive, but it is compelling enough for me to continue to take turmeric each morning, along with my first cup of coffee – another habit that may help me live a bit longer.

Turmeric may protect against arthritis, heart disease and some cancers. Trum Ronnarong/

Vitamin D

Graeme Close, professor of human physiology, Liverpool John Moores University

Vitamin D is a peculiar vitamin in that it is synthesised in our bodies with the aid of sunlight, so people who live in cold countries, or who spend a lot of time indoors, are at risk of a deficiency. People with darker skin tone are also more at risk of vitamin D deficiency as melanin slows down skin production of vitamin D. It is estimated that about a billion people are deficient in the vitamin.

Most people are aware that we need enough vitamin D to maintain healthy bones, but, over the past few years, scientists have become increasingly aware of other important roles of vitamin D. We now believe vitamin D deficiencies can result in a less efficient immune system, impaired muscle function and regeneration, and even depression.

Vitamin D is one of the cheapest supplements and is a really simple deficiency to correct. I used to test myself for deficiencies, but now – because I live in the UK where sunlight is scarce between October and April, and it doesn’t contain enough UVB radiation during these cold months – I supplement with a dose of 50 micrograms, daily, throughout the winter. I also advise the elite athletes that I provide nutrition support to, to do the same.


Justin Roberts, senior lecturer in sport and exercise nutrition, Anglia Ruskin University

Having diverse beneficial gut bacteria is important for your physical and mental health. However, the balance of bacterial species can be disrupted by poor diet, being physically inactive and being under constant stress. One way to support the health of the gut is to consume dietary probiotics (live bacteria and yeasts), such as yogurt, kefir and kombucha.

I first came across probiotics after years of triathlon training, often experiencing gastrointestinal symptoms – such as nausea and stomach cramps – after training and races. I was also more susceptible to colds. After researching the area, I was surprised at how many people experience similar gastrointestinal problems after exercise. Now I have found that taking a probiotic regularly lessens my symptoms after training and benefits my general health.

A recent study we conducted showed that taking a probiotic in the evening with food, over 12 weeks of exercise training, reduced gastrointestinal problems in novice triathletes.

There is also a wealth of research supporting the use of probiotics for general health benefits, including improving intestinal health, enhancing the immune response and reducing serum cholesterol.


Neil Williams, lecturer in exercise physiology and nutrition, Nottingham Trent University

Prebiotics are non-digestible carbohydrates that act as a “fertiliser” to increase the growth and activity of beneficial bacteria in the gut. This is turn can have positive effects on inflammation and immune function, metabolic syndrome, increase mineral absorption, reduce traveller’s diarrhoea and improve gut health.

I first came across prebiotics in my research to target the gut microbiota in athletes suffering from exercise-induced asthma. Previous research had shown asthma patients to have altered gut microbiota, and feeding prebiotics to mice had been shown to improve their allergic asthma. Taking this as our launching point, we showed that taking prebiotics for three weeks could reduce the severity of exercise-induced asthma in adults by 40%. Participants in our study also noted improvements in eczema and allergic symptoms.

I add prebiotic powder to my coffee every morning. I have found that it reduces my hayfever symptoms in the summer and my likelihood of getting colds in the winter.

Omega 3

Haleh Moravej, senior lecturer in nutritional sciences, Manchester Metropolitan University

I started taking omega 3 after attending a Nutrition Society winter conference in 2016. The scientific evidence that omega 3 could improve my brain function, prevent mood disorders and help to prevent Alzheimer’s disease was overwhelming. After analysing my diet it was obvious that I wasn’t getting enough omega 3 fatty acids. A healthy adult should get a minimum of 250-500mg, daily.

Omega 3 is a form of fatty acid. It comes in many forms, two of which are very important for brain development and mental health: EPA and DHA. These types are primarily found in fish. Another type of omega 3 – ALA (alpha-linolenic acid) – is found in plant-based foods, such as nuts and seeds, including walnuts and flax seeds. Due to my busy schedule as a lecturer, during term time my diet is not as varied and enriched with omega 3 fatty acids as I would like, forcing me to choose a supplement. I take one 1,200mg capsule, daily.

Nothing but real food

Tim Spector, professor of genetic epidemiology, King’s College London

I used to take supplements, but six years ago I changed my mind. After researching my book I realised that the clinical studies, when properly carried out and independent of the manufacturers, clearly showed they didn’t work, and in many cases could be harmful. Studies of multivitamins show regular users are more likely to die of cancer or heart disease, for example. The only exception is supplements for preventing blindness due to macular degeneration, where randomised trials have been generally positive for a minor effect with a mixture of antioxidants.

Why take supplements when you can get all you need from a healthy diet? margouillat photo/

In many cases, there is some experimental evidence these chemicals in supplements work naturally in the body or as foods, but no good evidence that when given in concentrated form as tablets they have any benefit. Recent evidence shows that high doses of some supplements can even be harmful – a case in point being calcium and vitamin D. Rather than taking expensive and ineffective synthetic products, we should get all the nutrients, microbes and vitamins we need from eating a range of real foods, as evolution and nature intended.

HRT in BRAC positive women

Interesting research that shows taking HRT in BRAC positive women does n0t appear to increase the risk of getting breast cancer.
Menopause. 2014 Jul;21(7):763-8. doi: 10.1097/GME.0000000000000126.

Hormone therapy in oophorectomized BRCA1/2 mutation carriers.

Author information

From the Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy.



BRCA1/2 mutation carriers have greatly elevated lifetime risks of breast, ovarian, and fallopian tube cancers. Bilateral prophylactic salpingo-oophorectomy is recommended to prevent cancer in these women. As it is often performed before natural menopause, it may be accompanied by menopausal symptoms, impaired quality of life, and increased cardiovascular risk.


In this review, we describe the indications, timing, and implications of salpingo-oophorectomy for BRCA-positive women, with a special focus on the risks and benefits of hormone therapy (HT). Furthermore, retrospective and prospective trials of HT in BRCA mutation carriers undergoing prophylactic salpingo-oophorectomy are debated.


Hormonal deprivation after prophylactic salpingo-oophorectomy may negatively impact health and quality of life; most women experience menopausal symptoms shortly after surgical operation. Literature data suggest that HT generally reduces vasomotor symptoms related to surgical menopause, improving sexual functioning without affecting survival.


Despite the limitations of retrospective and prospective observational studies, short-term HT seems to improve quality of life and does not seem to have an adverse effect on oncologic outcomes in BRCA1 and BRCA2 mutation carriers without a personal history of breast cancer. Therefore, randomized and larger trials are urgently needed.

Cimicifuga foetida extract in menopausal women

This is a very interesting study, as it gives women another option for helping the menopausal symptoms. This could also be useful for women who cannot take HRT for whatever reason, eg breast cancer.

Bugbane, also called Rattletop, any of about 15 species of tall perennial herb constituting the genus Cimicifuga of the buttercup family (Ranunculaceae) native to North Temperate woodlands. They are said to put bugs to flight by the rustling of their dried seed heads.

In North America the American bugbane, or summer cohosh (C. americana), about 120 cm (4 feet) tall, and the black cohosh, or black snakeroot (C. racemosa; see photograph), about 180 cm (5.91 feet) tall, have roots that have been used medicinally. C. foetida, native to Europe and Siberia, is used medicinally by the Chinese. These species are sometimes grown in the shady woodland garden for their whitish branched flower stalks that rise strikingly above the large, divided leaves.

Climacteric. 2017 Dec 4:1-6. doi: 10.1080/13697137.2017.1406913. [Epub ahead of print]

Efficacy and safety evaluation of Cimicifuga foetida extract in menopausal women.

Author information

a Department of Obstetrics and Gynecology , Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China.
b Department of Obstetrics and Gynecology , Jiaxing Maternity and Child Health Care Hospital , Jiaxing , China.
c Department of Obstetrics and Gynecology , The Second Hospital of Hebei Medical University , Hebei , China.



The aim of this study was to evaluate the efficacy and safety of long-term treatment with Cimicifuga foetida extract in menopausal women.


A prospective, randomized, controlled clinical trial was conducted. A total of 96 early postmenopausal women were randomly assigned to three groups: group A received 1 mg estradiol valerate daily plus 4 mg medroxyprogesterone acetate on days 19-30; group B received 1 mg estradiol valerate daily plus 100 mg micronized progesterone on days 19-30; group C received 100 mg C. foetida extract daily. The efficacy was evaluated. Safety parameters were recorded.


A total of 81 patients completed the treatment and follow-up visit. The modified Kupperman Menopausal Index scores decreased after 3 months in all groups. No significant changes were observed in the liver, renal function and components of metabolic syndrome in group C (p > 0.05). There were no significant differences in the incidences of metabolic syndrome among the three groups (p > 0.05). After 24 months, the endometrial thickness increased significantly in group B (p = 0.014), but not in the C. foetida extract group (p > 0.05).


C. foetida extract is safe and effective for the treatment of menopausal symptoms in postmenopausal women.

No increased death toll for long-term menopausal hormone therapy.

I have returned to work after a break of a few weeks over the Christmas holidays. I hope you all enjoyed yourselves and remained healthy and well. I am fired up and ready for the new year and hope to be of service to you and continue to provide up to date and accurate information via these blogs. The information given comes from the best sources (universities, medical schools, Researchers) and I have vetted them for accuracy and usefulness.
Climacteric. 2017 Dec;20(6):531-532. doi: 10.1080/13697137.2017.1386651. Epub 2017 Oct 23.

No increased death toll for long-term menopausal hormone therapy.

Author information

a Sackler School of Medicine , Tel-Aviv University , Tel-Aviv , Israel.


It took many years since the initial publication of data from the Women’s Health Initiative (WHI) study until further analyses and additional accumulated clinical information allowed realization of the full scope of its results. At first, the focus was on morbidity, mainly the slightly higher incidence of cardiovascular events and breast cancer cases among postmenopausal hormone users. Then, the age factor became evident, and the good safety profile of hormone therapy in healthy women initiating treatment near menopause and using it for up to 10 years eased the previous concerns. Now, 15 years after the first release of the WHI data, long-term follow-up of the WHI cohort enables consideration of mortality records as well. These data were recently summarized by the WHI investigators as follows: ‘Among postmenopausal women, hormone therapy with CEE plus MPA for a median of 5.6 years or with CEE alone for a median of 7.2 years was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.’ It seems that the bitter debate on the hazards of postmenopausal hormone therapy has come to an end, since the existing database permits clear and rationalized prescribing decisions.

Calcium in the prevention of postmenopausal osteoporosis

I have published previous blogs on the possible harm from taking calcium. (June 20th 2013 or 2014) Note the latest advice.
Maturitas. 2018 Jan;107:7-12. doi: 10.1016/j.maturitas.2017.10.004. Epub 2017 Oct 3.

Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide.

Author information

Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain. Electronic address:
Institute of Biomedicine, Research Area for Women’s Health, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
Polyclinique de l’Atlantique Saint Herblain, F 44819 St Herblain France, Université de Nantes, F 44093, Nantes cedex, France.
School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, 4006, Australia.
University Women’s Hospital of Tuebingen, Calwer Street 7, 72076, Tuebingen, Germany.
Levent M. Senturk, Istanbul University Cerrahpasa School of Medicine. Dept. of Obstetrics and Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul, Turkey.
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, SW3 6NP, UK.
Department of Obstetrics and Gynecology, University Women’s Hospital, Bern, Switzerland.
University and Helsinki University Hospital, Eira Hospital, Helsinki, Finland.
Women’s Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece.



Postmenopausal osteoporosis is a highly prevalent disease. Prevention through lifestyle measures includes an adequate calcium intake. Despite the guidance provided by scientific societies and governmental bodies worldwide, many issues remain unresolved.


To provide evidence regarding the impact of calcium intake on the prevention of postmenopausal osteoporosis and critically appraise current guidelines.


Literature review and consensus of expert opinion.


The recommended daily intake of calcium varies between 700 and 1200mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful.

Why swimming in the sea is good for you


Health Check: why swimming in the sea is good for you

December 26, 2016 7.41am AEDT

Disclosure statement

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


University of Newcastle provides funding as a member of The Conversation AU.

If you live near the sea, make frequent trips to the beach, or are planning an island holiday this summer, chances are you’re getting more out of it than just enjoyment. It has long been thought sea frolicking has many health benefits.

Historically, doctors would recommend their patients go to the seaside to improve various ills. They would actually issue prescriptions detailing exactly how long, how often and under what conditions their patients were to be in the water.

Using seawater for medical purposes even has a name: thalassotherapy.

In 1769, a popular British doctor Richard Russell published a dissertation arguing for using seawater in “diseases of the glands”, in which he included scurvy, jaundice, leprosy and glandular consumption, which was the name for glandular fever at the time. He advocated drinking seawater as well as swimming in it.

To this day, healing and spa resorts by the seaside abound. They are thought of as places where people can not only let go of their troubles but, in some cases, even cure arthritis.

But does the evidence actually stack up? Does seawater cure skin conditions and improve mental health symptoms?

Doctors used to prescribe patients go to the seaside to improve health. Johnny Chau/Unsplash

Skin conditions and wounds

Ocean water differs from river water in that it has significantly higher amounts of minerals, including sodium, chloride, sulphate, magnesium and calcium. This is why it’s highly useful for skin conditions such as psoriasis.

Psoriasis is a chronic, autoimmune (where the immune system attacks healthy cells) skin condition. People with prosiasis suffer often debilitating skin rashes made of itchy, scaly plaques.

Bathing in natural mineral-rich water, including in mineral springs, is called balneotherapy and has long been used to treat psoriasis. There is also evidence for climatotherapy (where a patient is relocated to a specific location for treatment) in the Dead Sea being an effective remedy for the condition.

People with prosiasis suffer often debilitating rashes made up of itchy, scaly plaques on their skin. from

Patients suffering from psoriasis have themselves reported feeling better after swimming in the ocean, but this may also have to do with sun exposure, which has been found to improve psoriasis symptoms.

Ocean swimming also has benefits for eczema, another immune-mediated condition. Swimming in the sea can be a good exercise option for those with severe eczema as they often struggle to exercise in the heat and chlorinated pools.

But the response of eczema sufferers to saltwater is variable: some find it soothing, others uncomfortable.

There is some evidence to support the idea magnesium absorption is beneficial for the skin of eczema sufferers – presumably because it makes it less dry – as those using Epsom salt baths will attest. This may happen because magnesium-rich seawater may improve moisture retention in the skin, making it stronger and more rigid.

Because it is rich in other mineral salts such as sodium and iodine, ocean water can be considered an antiseptic, meaning it may have wound-healing properties. On the other hand, swimming in the ocean with open wounds may expose you to potential bacterial infections.

Hay fever and sinus issues

Many people with sinus conditions and hay fever find nasal irrigation with salt-containing solutions helpful. from

Nasal irrigation, or flushing of the nasal cavity, with salty solutions is used as a complementary therapy by many people suffering from hay fever as well as inflammation and infection of the sinuses.

Ocean swimming and exposure to the salt environment are possibly associated with reduced symptoms of hay fever and sinusitis, as well as other respiratory symptoms.

This is because the saline effect on the lining of sinuses may reduce inflammation, although scientific evidence for this is less robust.

The director of clinical services at the medical charity Allergy UK claims people who live by, and swim in, the sea tend to have healthier respiratory systems.

She says because seawater is cleansing and mimics the body’s own fluids in the lining of the airways, it doesn’t irritate them.

Meditation and relaxation

Exercising in natural environments has been shown to have greater benefits for mental health than exercising elsewhere. This is because it combines the benefits of exercise with the restorative effects of being in nature. Swimming in the ocean is no less the case.

It can be relaxing, meditative and reduce stress. In his 2014 book Blue Mind, marine biologist Wallace J. Nichols brought together evidence for why people find themselves in a meditative and relaxed state when they are in, on or under water.

One reason is the breathing patterns used during swimming and diving. These stimulate the parasympathetic nervous system (the system that controls organ function and quietens the brain) and have effects on brain waves and hormones that influence the brain positively.

The weightlessness of water can also have a calming effect on the mind, even changing or slowing down brain waves.

It can help provide a distraction from life, giving a sense of mindfulness, which is a state in which one is aware of one’s surroundings in a meditative sort of fashion.

Hydrotherapy (water therapy) and swimming have also been shown to decrease symptoms of depression and anxiety. One study showed the effects of balneotherapy were comparable to a commonly used anti-depressant drug called paroxetine.

Being in the sea can be a meditative experience. Jonny Clow/Unsplash, CC BY

Cold water therapy

Hydrotherapy has been extensively used in rehabilitation, but here I will focus on the health benefits of swimming in cooler ocean water.

Cold-water swimming activates temperature receptors under the skin that release hormones such as endorphins, adrenalin and cortisol. These have therapeutic benefits for musculoskeletal conditions – such as fibromyalgia, which is a condition with chronic pain and tenderness all over the body – and skin discomfort.

Recurrent cold water exposure may also lead to enhanced function of the parasympathetic nervous system, which helps with organ function. This has been linked to an increase in the release of dopamine and serotonin.

Depending on the temperature, swimming in colder waters will use up more calories to preserve body temperature – although the overall effect on fat mass is controversial.

Frequent exposure to cold water has also been shown to increase the body’s immunity.

Overall, you would be wise to make ocean swimming a health habit.