More than half of the approximately 615,000 women who undergo hysterectomy each year in the US also have their ovaries removed in order to eliminate their risk of developing ovarian cancer, but a study published in the Aug 1 issue of... Obstetrics & Gynecology suggests that the negative side effects of oophorectomy before age 65 might outweigh the benefits, the AP/Long Island Newsday reports (Stengle, AP/Long Island Newsday, 8/1). William Parker, a clinical professor at the University of California-Los Angeles David Geffen School of Medicine, and colleagues analyzed previously published data on the absolute and relative risk of ovarian cancer, coronary heart disease, hip fracture, breast cancer and stroke for women who had undergone hysterectomy with and without oophorectomy. The researchers then developed a model to predict the optimal course of action for maximizing the survival of women at average risk of developing ovarian cancer (Parker et al., Obstetrics & Gynecology, 8/1). According to the model, prophylactic removal of the ovaries -- which continue to produce small amounts of hormones even after a woman experiences menopause -- does not provide a health benefit, regardless of a woman's age at surgery. In addition, women who have their ovaries removed before age 65 could be at increased risk of heart disease because of the lack of estrogen in the body, Parker said (AP/Long Island Newsday, 8/1). Overall, the younger a woman is when she has her ovaries removed, the more substantial the negative impact on her health and her chances of living to age 80. The researchers conclude that patients and their doctors should weigh the benefits and drawbacks of oophorectomy before deciding to go ahead with the procedure (Goldberg, Boston Globe, 8/1). In an accompanying Obstetrics & Gynecology editorial, reproductive endocrinologist David Olive writes that although the study is not definitive in resolving the value of prophylactic oophorectomy, the findings are "sure to provide significant impact upon clinical practice." The percentage of hysterectomies performed with prophylactic oophorectomies has more than doubled from 25% in 1965 to 55% in 1999, according to national statistics (Rabin, Long Island Newsday, 8/2).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 29 марта 2012 г.
четверг, 22 марта 2012 г.
Does Timing Matter In Hormone Therapy?
Study highlights:
Women who began hormone therapy soon after menopause did not show reduced blood vessel function raising the question of whether the negative effects of hormone therapy in recent trials might be avoided in younger patients.
Results of ongoing rigorous, randomized and controlled studies of younger menopausal women on hormone therapy are needed before considering changes to current guidelines.
The results of this small, observational study do not suggest that women entering menopause should start hormone therapy.
Hormone therapy may have different effects on blood vessels if it is started early in menopause as opposed to later, researchers suggested at the American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology Annual Conference 2008.
"Abnormal endothelial function is a marker of early heart disease. We have found that endothelial function is just as good, if not slightly better, among women who have risk factors for heart disease and have taken hormone therapy around menopause onset as it is among women who are about the same ages but have no risk factors for heart disease and are not taking hormone therapy," said James Arrowood, M.D., lead author of the study and associate professor of internal medicine and cardiology at Virginia Commonwealth University Medical Center in Richmond, Va.
"Previous findings in randomized controlled trials suggesting that hormone therapy could be deleterious to cardiovascular health were conducted in women who started taking hormones years after menopause onset versus observational studies of women initiating hormone treatment around the time that menopause began suggesting cardiovascular benefit."
Conducting an observational trial, Arrowood and colleagues analyzed four groups of postmenopausal women (127 total), average ages 52 to 54 years:
One group was not on hormone therapy, had no heart disease risk factors and was an average 8.1 years postmenopausal.
Another group had risk factors for coronary disease (such as smoking, high blood pressure, high cholesterol or diabetes), was not on hormone therapy and was an average 9.3 years postmenopausal.
Two groups had heart disease risk factors and were on hormone therapy: one was on estrogen alone and was an average of 11.7 years postmenopausal and the other was on estrogen plus progestin therapy and was an average 7.6 years postmenopausal. The estrogen group was an average 10.1 years on hormone therapy and the estrogen plus progestin group was an average 6.6 years on hormone therapy.
"The years that they were postmenopausal and years on hormone replacement indicate that the hormone therapy was started around the time of menopause onset," Arrowood said.
The researchers measured flow mediated dilation (FMD), which is a measure of how well the endothelium (the layer of cells that form the inner lining of blood vessels) functions. Keeping in mind that the higher the percentage the better the endothelial function:
The no-risk, no hormone group measured an average 7.4 percent FMD.
The no hormone group with risk factors measured an average 5 percent FMD.
The estrogen group with risk factors measured an average 7.7 percent FMD.
The estrogen-progestin group with risk factors measured an average 8.1 percent FMD.
"Essentially, the hormone therapy groups with risk factors for heart disease had similar endothelial function as the no-risk, no-hormone group of women," Arrowood said. "And they had better endothelial function than women with cardiovascular risk factors who were not on hormone therapy. We also found that it doesn't seem to matter for this measure of blood vessel function whether women are taking estrogen or estrogen and progestin." Women who have had a hysterectomy do not need to take a progestin with their estrogen, but those with an intact uterus do.
"The results of this study do not suggest that women starting menopause should start hormone therapy. Current guidelines say that women should not take hormone therapy to improve their cardiovascular risk and that hormone therapy is only recommended for symptoms of menopause and should be taken at the lowest dose and for the shortest time possible. Other ongoing rigorous, randomized and controlled studies looking at younger menopausal women on hormone therapy may help to clarify our results."
The American Heart Association does not advise women take postmenopausal hormone therapy (PHT, formerly called hormone replacement therapy or HRT) or selective estrogen receptor modulators (SERMs) to reduce the risk of coronary heart disease or stroke.
The study was funded by American Heart Association - Virginia Affiliate (now Mid-Atlantic Affiliate) and in part by National Center and was supported by the General Clinical Research Center at Virginia Commonwealth University.
Co-authors are: Jonathan Potfay, M.D.; Cheryl Stacklin, B.S.N.; Rhonda P. Poole, R.D.C.S.; and Frances P. Fua, M.D.
The American Heart Association strongly supports the HEART for Women Act, bipartisan legislation pending in Congress which would help ensure that heart disease and stroke are more widely recognized and more effectively treated in women. It would also authorize grants to educate healthcare professionals about the prevalence and unique aspects of care for women in the prevention and treatment of cardiovascular diseases.
Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.
The American Heart Association/American Stroke Association receives funding primarily from individuals. In addition, foundations and corporations - including pharmaceutical, device manufacturers and other companies - make donations and fund specific American Heart Association/American Stroke Association programs and events. Revenues from pharmaceutical and device corporations are disclosed at americanheart/.
NR08-1048 (ATVB 08/Arrowood)
Source: Karen Astle
American Heart Association
Women who began hormone therapy soon after menopause did not show reduced blood vessel function raising the question of whether the negative effects of hormone therapy in recent trials might be avoided in younger patients.
Results of ongoing rigorous, randomized and controlled studies of younger menopausal women on hormone therapy are needed before considering changes to current guidelines.
The results of this small, observational study do not suggest that women entering menopause should start hormone therapy.
Hormone therapy may have different effects on blood vessels if it is started early in menopause as opposed to later, researchers suggested at the American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology Annual Conference 2008.
"Abnormal endothelial function is a marker of early heart disease. We have found that endothelial function is just as good, if not slightly better, among women who have risk factors for heart disease and have taken hormone therapy around menopause onset as it is among women who are about the same ages but have no risk factors for heart disease and are not taking hormone therapy," said James Arrowood, M.D., lead author of the study and associate professor of internal medicine and cardiology at Virginia Commonwealth University Medical Center in Richmond, Va.
"Previous findings in randomized controlled trials suggesting that hormone therapy could be deleterious to cardiovascular health were conducted in women who started taking hormones years after menopause onset versus observational studies of women initiating hormone treatment around the time that menopause began suggesting cardiovascular benefit."
Conducting an observational trial, Arrowood and colleagues analyzed four groups of postmenopausal women (127 total), average ages 52 to 54 years:
One group was not on hormone therapy, had no heart disease risk factors and was an average 8.1 years postmenopausal.
Another group had risk factors for coronary disease (such as smoking, high blood pressure, high cholesterol or diabetes), was not on hormone therapy and was an average 9.3 years postmenopausal.
Two groups had heart disease risk factors and were on hormone therapy: one was on estrogen alone and was an average of 11.7 years postmenopausal and the other was on estrogen plus progestin therapy and was an average 7.6 years postmenopausal. The estrogen group was an average 10.1 years on hormone therapy and the estrogen plus progestin group was an average 6.6 years on hormone therapy.
"The years that they were postmenopausal and years on hormone replacement indicate that the hormone therapy was started around the time of menopause onset," Arrowood said.
The researchers measured flow mediated dilation (FMD), which is a measure of how well the endothelium (the layer of cells that form the inner lining of blood vessels) functions. Keeping in mind that the higher the percentage the better the endothelial function:
The no-risk, no hormone group measured an average 7.4 percent FMD.
The no hormone group with risk factors measured an average 5 percent FMD.
The estrogen group with risk factors measured an average 7.7 percent FMD.
The estrogen-progestin group with risk factors measured an average 8.1 percent FMD.
"Essentially, the hormone therapy groups with risk factors for heart disease had similar endothelial function as the no-risk, no-hormone group of women," Arrowood said. "And they had better endothelial function than women with cardiovascular risk factors who were not on hormone therapy. We also found that it doesn't seem to matter for this measure of blood vessel function whether women are taking estrogen or estrogen and progestin." Women who have had a hysterectomy do not need to take a progestin with their estrogen, but those with an intact uterus do.
"The results of this study do not suggest that women starting menopause should start hormone therapy. Current guidelines say that women should not take hormone therapy to improve their cardiovascular risk and that hormone therapy is only recommended for symptoms of menopause and should be taken at the lowest dose and for the shortest time possible. Other ongoing rigorous, randomized and controlled studies looking at younger menopausal women on hormone therapy may help to clarify our results."
The American Heart Association does not advise women take postmenopausal hormone therapy (PHT, formerly called hormone replacement therapy or HRT) or selective estrogen receptor modulators (SERMs) to reduce the risk of coronary heart disease or stroke.
The study was funded by American Heart Association - Virginia Affiliate (now Mid-Atlantic Affiliate) and in part by National Center and was supported by the General Clinical Research Center at Virginia Commonwealth University.
Co-authors are: Jonathan Potfay, M.D.; Cheryl Stacklin, B.S.N.; Rhonda P. Poole, R.D.C.S.; and Frances P. Fua, M.D.
The American Heart Association strongly supports the HEART for Women Act, bipartisan legislation pending in Congress which would help ensure that heart disease and stroke are more widely recognized and more effectively treated in women. It would also authorize grants to educate healthcare professionals about the prevalence and unique aspects of care for women in the prevention and treatment of cardiovascular diseases.
Statements and conclusions of abstract authors that are presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.
The American Heart Association/American Stroke Association receives funding primarily from individuals. In addition, foundations and corporations - including pharmaceutical, device manufacturers and other companies - make donations and fund specific American Heart Association/American Stroke Association programs and events. Revenues from pharmaceutical and device corporations are disclosed at americanheart/.
NR08-1048 (ATVB 08/Arrowood)
Source: Karen Astle
American Heart Association
четверг, 15 марта 2012 г.
Women Lose Weight At Least A Decade Before Developing Dementia
Women who have dementia start losing weight at least 10 years before the disease is diagnosed, according to a study published in the August 21, 2007, issue of Neurology®, the medical journal of the American Academy of Neurology.
The researchers examined the records of 481 people with dementia and compared them to 481 people of the same age and gender who did not have dementia. The average weight was the same for those in the two groups from 21 to 30 years before the year the disease was diagnosed. But the women who would later develop dementia started losing weight up to 20 years before the disease was diagnosed. On average, those with dementia weighed 12 pounds less than those without the disease the year the disease was diagnosed.
"One explanation for the weight loss is that, in the very early stages of dementia, people develop apathy, a loss of initiative, and also losses in the sense of smell," said study author David Knopman, MD, of the Mayo Clinic in Rochester, MN, and member of the American Academy of Neurology. "When you can't smell your food, it won't have much taste, and you might be less inclined to eat it. And, apathy and loss of initiative may make women less likely to prepare nutritious meals and more likely to skip meals altogether."
Unlike women, men in this study who later developed dementia did not lose weight in the years before diagnosis. Knopman said the difference could be due to hormones, but a social reason seems just as likely.
"Middle-aged and elderly men are less likely to be preparing their own meals," he said. "Their spouses or adult children were more likely making meals for them, which would lessen the effect of the apathy, loss of initiative and loss of sense of smell."
The study conflicts with others suggesting that obesity in middle-age may be a risk factor for dementia. Obesity is also associated with diabetes, hypertension, and cardiovascular disease, which are risk factors for dementia. "We'll need to do more research to look into these differences," Knopman said.
The study was supported by grants from the National Institute on Aging.
The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.
For more information about the American Academy of Neurology, visit aan.
American Academy of Neurology (AAN)
1080 Montreal Ave.
St. Paul, MN 55116
United States
neurology
The researchers examined the records of 481 people with dementia and compared them to 481 people of the same age and gender who did not have dementia. The average weight was the same for those in the two groups from 21 to 30 years before the year the disease was diagnosed. But the women who would later develop dementia started losing weight up to 20 years before the disease was diagnosed. On average, those with dementia weighed 12 pounds less than those without the disease the year the disease was diagnosed.
"One explanation for the weight loss is that, in the very early stages of dementia, people develop apathy, a loss of initiative, and also losses in the sense of smell," said study author David Knopman, MD, of the Mayo Clinic in Rochester, MN, and member of the American Academy of Neurology. "When you can't smell your food, it won't have much taste, and you might be less inclined to eat it. And, apathy and loss of initiative may make women less likely to prepare nutritious meals and more likely to skip meals altogether."
Unlike women, men in this study who later developed dementia did not lose weight in the years before diagnosis. Knopman said the difference could be due to hormones, but a social reason seems just as likely.
"Middle-aged and elderly men are less likely to be preparing their own meals," he said. "Their spouses or adult children were more likely making meals for them, which would lessen the effect of the apathy, loss of initiative and loss of sense of smell."
The study conflicts with others suggesting that obesity in middle-age may be a risk factor for dementia. Obesity is also associated with diabetes, hypertension, and cardiovascular disease, which are risk factors for dementia. "We'll need to do more research to look into these differences," Knopman said.
The study was supported by grants from the National Institute on Aging.
The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.
For more information about the American Academy of Neurology, visit aan.
American Academy of Neurology (AAN)
1080 Montreal Ave.
St. Paul, MN 55116
United States
neurology
четверг, 8 марта 2012 г.
FDA Approves Lysteda To Treat Heavy Menstrual Bleeding
The U.S. Food and Drug Administration approved Lysteda tablets (tranexamic acid), the first non-hormonal product cleared to treat heavy menstrual bleeding (menorrhagia). Lysteda works by stabilizing a protein that helps blood to clot.
Heavy menstrual bleeding is reported each year by about 3 million U.S. women of reproductive age. Women with uterine fibroids may experience heavy menstrual periods. But in most cases, there is no underlying health condition associated with the condition.
"Menorrhagia can be incapacitating for some women," said Kathleen Uhl, M.D., FDA's associate commissioner of women's health. "Heavy menstrual periods can cause pain, mood swings, and disruptions to work and family life."
Tranexamic acid was first approved by the FDA in 1986 as an injection, under the brand name Cyklokapron, and is used to reduce or prevent bleeding during and following tooth extraction in patients with hemophilia, a hereditary bleeding disorder caused by the lack of a blood clotting factor.
The most common adverse reactions reported during clinical trials by patients using Lysteda included headache, sinus and nasal symptoms, back pain, abdominal pain, muscle and joint pain, muscle cramps, anemia, and fatigue. There was a statistically significant reduction in menstrual blood loss in women who received Lysteda, compared with those taking an inactive pill (placebo).
Use of Lysteda while taking hormonal contraceptives may increase the risk of blood clots, stroke, or heart attack, according to Scott Monroe, M.D., director of the Division of Reproductive and Urologic Products in the FDA's Center for Drug Evaluation and Research. Women using hormonal contraception should take Lysteda only if there is a strong medical need, and if the benefit of treatment will outweigh the potential increased risk.
Source: U.S. Food and Drug Administration
View drug information on Lysteda.
Heavy menstrual bleeding is reported each year by about 3 million U.S. women of reproductive age. Women with uterine fibroids may experience heavy menstrual periods. But in most cases, there is no underlying health condition associated with the condition.
"Menorrhagia can be incapacitating for some women," said Kathleen Uhl, M.D., FDA's associate commissioner of women's health. "Heavy menstrual periods can cause pain, mood swings, and disruptions to work and family life."
Tranexamic acid was first approved by the FDA in 1986 as an injection, under the brand name Cyklokapron, and is used to reduce or prevent bleeding during and following tooth extraction in patients with hemophilia, a hereditary bleeding disorder caused by the lack of a blood clotting factor.
The most common adverse reactions reported during clinical trials by patients using Lysteda included headache, sinus and nasal symptoms, back pain, abdominal pain, muscle and joint pain, muscle cramps, anemia, and fatigue. There was a statistically significant reduction in menstrual blood loss in women who received Lysteda, compared with those taking an inactive pill (placebo).
Use of Lysteda while taking hormonal contraceptives may increase the risk of blood clots, stroke, or heart attack, according to Scott Monroe, M.D., director of the Division of Reproductive and Urologic Products in the FDA's Center for Drug Evaluation and Research. Women using hormonal contraception should take Lysteda only if there is a strong medical need, and if the benefit of treatment will outweigh the potential increased risk.
Source: U.S. Food and Drug Administration
View drug information on Lysteda.
четверг, 1 марта 2012 г.
ACOG Welcomes New Federal Regulations Requiring Free Preventive Health Care Services
The American Congress of Obstetricians and Gynecologists (ACOG) supports the federal regulations issued on July 14 requiring new private health plans to provide free preventive health services to their enrollees, particularly as it pertains to women's health. ACOG worked closely with Congress to win inclusion of this important part of the Affordable Care Act and applauds the Obama Administration for working so effectively in bringing this protection to our patients.
The new regulations, issued jointly by the US Departments of Health and Human Services, Labor, and the Treasury, will enable women to get the recommended screenings and immunizations to keep them healthy without worrying about co-payments and deductibles. Health plans will now be required to cover preventive care provided to women under both the US Preventive Services Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, expected to be issued by August 1, 2011.
Preventive services guaranteed in these regulations will help women have a healthy pregnancy and help safeguard them from obesity, heart disease, and breast and cervical cancers.
ACOG recognizes, too, that important work lies ahead. "Last week, I met with the White House and encouraged the Administration to ensure that family planning and contraception, well-women visits, and prenatal counseling are included in the comprehensive guidelines it is developing for women's preventive services," said Richard N. Waldman, MD, ACOG President. "These guidelines should incorporate scientifically and medically sound recommendations from ACOG and should be updated as new science emerges."
As the nation's largest group of physicians providing health care for women, ACOG strongly supports preventive care. Wider access to cervical cancer screening, mammography, prenatal tests, and routine vaccinations will help reduce disparities, prevent diseases, and save lives.
Source:
American Congress of Obstetricians and Gynecologists (ACOG)
The new regulations, issued jointly by the US Departments of Health and Human Services, Labor, and the Treasury, will enable women to get the recommended screenings and immunizations to keep them healthy without worrying about co-payments and deductibles. Health plans will now be required to cover preventive care provided to women under both the US Preventive Services Task Force recommendations and new guidelines being developed by an independent group of experts, including doctors, nurses, and scientists, expected to be issued by August 1, 2011.
Preventive services guaranteed in these regulations will help women have a healthy pregnancy and help safeguard them from obesity, heart disease, and breast and cervical cancers.
ACOG recognizes, too, that important work lies ahead. "Last week, I met with the White House and encouraged the Administration to ensure that family planning and contraception, well-women visits, and prenatal counseling are included in the comprehensive guidelines it is developing for women's preventive services," said Richard N. Waldman, MD, ACOG President. "These guidelines should incorporate scientifically and medically sound recommendations from ACOG and should be updated as new science emerges."
As the nation's largest group of physicians providing health care for women, ACOG strongly supports preventive care. Wider access to cervical cancer screening, mammography, prenatal tests, and routine vaccinations will help reduce disparities, prevent diseases, and save lives.
Source:
American Congress of Obstetricians and Gynecologists (ACOG)
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