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Menopause Update Archive Memory failing? Using it may prevent loosing it. Mammograms- Are they still necessary? Will you feel better on HRT? Why is the doctor in your bedroom? Bladder Infection? Can be costly if you're not careful. Boutique medicine- Great if you can afford it. Scared to Death! Hay fever: old treatment may be better than new. Home Menopause Test-Approved. New permanent contraceptive device available in Canada. Depression in Older Adults- A New Guid. Should You Be Taking That Pill? Beans, Beans, They're Good for Your Heart. Slow age-related vision loss! Chocolate-Good For You? A Consensus on Penile Length. Buying medicine online? Beware! Asthma Drug Linked to Bone Loss. Medical Problem? Check the Internet, your doctor does. Drug shows promise for long-term weight loss. The G-Spot: Review Sheds Light. Exercise Through Menopause. Sleep Better with Estrogen. Anxiety Gene Found on Chromosome 15. Menopause Online acclaimed by from North American Menopause Society. Ovarian Cancer and Hormone Replacement Therapy. Having Surgery? Hold the herbs. Sexual side effects? Stop the pill. Hormone Replacement Therapy Losing Support. The Patch vs. The Pill. Stand Strong against osteoporosis Designer Estrogen Fails to Prevent Memory Loss Mimicking Menopause Wrinkle Prunes - Not Skin Americans love their herbs and supplements Garlic - Tastes good and it is good for you The Survey says--Plastic Surgery is Up Food Scares - Read Beyond the Headlines Weight Loss on the Internet Foods to Tame Hot Flashes New test can reassure those with abnormal Pap Bush moves to limit international family planning Relieve headaches without drugs Fruit Extract effective for PMS Eating Soy increases Bone Density U.S. Government rules on "Organic" Foods The Male Pill: One Small Step Closer. What Your Teens Think About Sex Tying Your Tubes Considered Free of Menstrual Irregularities Womens disorder receives national recognition The Rhythm Method: No Rhyme For ThirdAge Women Herb Found Safe in Pregnancy. New Laser Treatment for Vaginal Bleeding Sex enhancing drug tested in women Sex after menopause Breast Cancer and The Pill Once-a-month birth control now available in US The Abortion Pill Receives FDA Approval Controversy surrounds mammograms usefulness Male Menopause-Fact of Fallacy? New Patch Increases Sex Drive Postmenopausal Hysterectomy Increases Risk of Heart Attack Breast Cancer Risk Greater In Older Women Who Used Oral Contraceptives Older women not given options in breast cancer treatment Back to Top Memory failing? Using it may prevent loosing it.      Most memory lapses are not a sign of Alzheimer's disease (AD), however there are lessons to be learned from AD research. Scientists have found the more mentally stimulating activity you engage in the less your risk of developing AD. These activities can be as simple as reading newspapers or magazines; reading books; playing games such as cards, checkers, crosswords, or other puzzles; and going to museums.      Since ancient times people were aware that aging could bring memory loss and that some of their elders faced the sad prospect of "senility" or "second childhood." Only in the past 20 years has Alzheimer's disease (AD), the condition chiefly responsible for this outcome, became recognized as a defined illness. The exact causes of AD are still not known and there is still no cure. An estimated 4 million Americans now have AD, with as many as one in three families.      Robert S. Wilson, Ph.D., and colleagues at the Rush Alzheimer's Disease Center, and Rush-Presbyterian-St. Luke's Medical Center in Chicago, IL conducted a recent study. Over 800 older Catholic nuns, priests, and brothers without memory problems were recruited from 40 groups across the United States. During the 4.5 years of the study 111 participants developed AD.      The results, published in the February 13, 2002, Journal of the American Medical Association, were encouraging. Dr Wilson found those who engage in the most mentally stimulating activities, such as those listed above, had the lowest risk of developing AD. He concluded, "These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD." Back to Top Mammograms- Are they still necessary?      That bastion of early cancer detection, the mammogram, has come under fire of late. Once in the forefront of the war angst cancer the mammograms usefulness is being scrutinized.      A mammogram is a low dose X-Ray of the breasts used to detect breast cancer before it can be felt on self-breast exam or a clinical, professional exam. The recommendations are for all women to obtain a baseline exam between 35 and 40 years of age. Then, various authorities recommend screening mammograms every 1-2 years from age 40 to 50, then yearly after 50.      So what's the problem? For one thing; mammograms are not perfect, they often raise false alarms. Most, actually 90% of abnormal mammograms are not due to cancer. A repeat X-ray or ultrasound can be reassuring but of those that go on to biopsy 75% are still not cancerous. These false positives result in needless anxiety; many hospitals are setting up rapid diagnostic breast care centers where the time from abnormal mammogram to biopsy is reduced from a month, which was typical, to 24 hours.      The main problem with mammograms is ductal carcinoma-in-situ (DCIS). DCIS is an early cancer that is being diagnosed more frequently with the widespread advocacy of mammography. The mammograms popularity surged after a 1970 study showed that regular screening could reduce the breast cancer death rate by more than 30 percent. The problem with DCIS is that it may go away on it's own and if it doesn't go away it may be just as easy to treat when it is large enough to be felt. Treatment of DCIS is now surgery, often with radiation therapy, however some doctors are critical of this approach especially where it occurs in multiple locations in the breast requiring extensive surgery.      At this point few experts are recommending that you skip your mammogram, The National Academy of Sciences states that having regular mammograms "substantially decrease" the risk of dying from breast cancer. Back to Top Will you feel better on HRT?      In the past, hormone replacement therapy (HRT) has been touted for its beneficial effect on heart disease and osteoporosis, two major causes of mortality and injury in postmenopausal women. Now it seems HRTs greatest usefulness may be limited to the treatment of those women with hot flashes.      We have recently seen a proliferation of drugs to treat and prevent osteoporosis, such as Evista, Fosamax and Actonel; they do a much better job than HRT. There has been a tremendous effort to screen and treat high cholesterol, high blood pressure, and obesity, the major causes of heart disease. Recent data from studies has prompted the experts to warn that HRT should not be used for the prevention of heart disease. So why take HRT?      Dr. Mark A. Hlatky, of Stanford University School of Medicine in California, along with other researchers has looked at data from the Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. This data involved 2763 postmenopausal women. The women either took conjugated equine estrogens (estrogen)0.625 mg plus medroxyprogesterone acetate (progesterone)2.5 mg or placebo (sugar pill). The study went on for three years.      The results published in the Journal of the American Medical Association showed that women with hot flashes who were taking HRT felt better. They had improved mental health and fewer depressive symptoms compared to those taking the placebo. While the women who were free of symptoms did not show any benefit from HRT. Dr Hlatky concluded, "Hormone therapy has mixed effects on quality of life among older women. The effects of hormone therapy depend on the presence of menopausal symptoms … women with flushing had improvements in emotional measures of quality of life." Back to Top Why is the doctor in your bedroom?      The British Medical Journal has devoted this week's issue to medicalisation, (pronounced: medical-ah-zation) a somewhat pejorative term. It is said to occur when doctors and the medical community at large try to control, treat, or fix a problem that has heretofore been the province of others. Doctors are now taking a look at how medicine has taken over the management of childbirth, old age, death and sex. Take sex for example, there was a time when morality, including sexual morality was the business of religion.      It is unclear exactly when doctors began commenting on sexual practices. One of the first, Dr. William Acton railed against masturbation going as far as to make up a disease called "spermatorrhoea" which he said would cause, among other things an "inaptitude for work". While men were admonished for masturbation women were labeled as "reservoirs of infection." I can recall in my US military basic training our health catechism included "She may look clean but…"      The modern era started in the with Sigmund Freud, who was a neurologist, his theories of sexuality proscribed the way healthy adults develop their normal or abnormal sexual nature, of course, at the time he wasn't taken seriously. Since then his popularity has waxed and waned, and it wasn't until 1973 that the American Psychiatric Association removed homosexuality from its list of psychiatric disorders. Freud opened the door to other doctors to comment on and study human sexual behavior. In came Kinsey's books Sexual behavior in the human male in 1948, and five years later Sexual behavior in the human female. Masters and Johnson followed with Human sexual response in 1966. Professor Graham Hart of the University of Glasgow comments "Mass surveillance inadvertently establishes norms and standards for sexual behaviour against which people can measure themselves and be measured. This can bring benefits when Kinsey reported on the heterogeneity of sexual conduct in America, Americans who had previously felt deviant gave a collective sigh of relief. There are also risks attached to such transparency many people will feel inadequate when faced with evidence of extremes of sexual performance." This may lead to relationship problems and further involvement of the medical community.        Medical science now recognizes that sex serves another critical function aside from procreation, even if religious authorities do not. Sex is recognized as a channel for intimacy between couples that can strengthen or weaken a relationship. The problem now is the tendency for the medical profession to want to improve the pleasure of sex with drugs such as Viagra, and surgery such as penile implants and vaginal procedures. Professor Hart concludes, "The problem with an overly medical approach to sexual behaviour is that social and interpersonal dynamics may be ignored. People choose one another for their uniqueness. The last century saw a considerable increase in acceptance of diversity of sexual expression it would be a shame if this century saw diversity replaced by uniform expectations of performance and desire." Back to Top Bladder Infection? Can be costly if you're not careful. Chicago Il.-      According to a new study if your diagnosed with a bladder infection the prescription you're given could cost from $1.79 to $70.98. Why the difference? According to a national survey it depends on what type of MD you see. Even though the Infectious Disease Society of America recommends the $1.79 treatment many physicians aren't listening. There are three commonly used antibiotics for the treatment of uncomplicated UTIs (urinary tract infections). They are; BactrumÒ DS at $1.79 for a 10 day course, MacrobidÒ at $23.34, and CiproÒ at $70.98.      Dr. Elbert S. Huang, MD, MPH, at the University of Chicago and Randall S. Stafford, MD, PhD, at Stanford University, Stanford, Calif. conducted a study to see just who was prescribing what and why. They looked at over 1400 women aged 18 to 75 years with uncomplicated UTIs. The report published in the Archives of Internal Medicine, revealed some unsettling facts. Physicians are tending to use the more expensive antibiotics, even though they can cause resistance to develop. Dr Huang noted "…we can report that physicians are managing UTIs in a fashion that raises concerns about antimicrobial resistance and costs."      General practitioners and Family Practice physicians are most likely to use the economical brand, Internists are the like to prescribe the most expensive drug, and Obstetrician/Gynecologists prefer the mid priced cure.      Some physicians cite pregnancy, drug allergies, and resistant germs as reasons they use the more expensive drugs. But those reasons are not enough to explain the overkill uncovered by this study. Back to Top Boutique medicine- Great if you can afford it.      Physicians around the country are setting up new exclusive health plans of their own, but on a smaller scale than previously envisioned. Rather than competing with huge health maintenance organizations (HMO's) some small physician groups are offering old-fashioned "personal physician" services to those who can afford it. Called boutique or concierge medicine for up to $20,000 a year you can purchase VIP medical care. VIP treatment may include same day appointments with a physician you know, more time face to face with the doctor, basic tests, house calls, and even the doctor's cell phone number. In order to provide this care physicians often will limit their practice to 150-300 patients.      It used to be that everyone had a personal physician who was available 24 hours a day. Today things are different because of the increase in expensive technology and the intervention of insurance companies. The average patient may need to wait weeks to get an appointment to see an unfamiliar doctor for 15 minutes.      Physicians like the boutique model because they get paid cash up front and don't have to haggle with HMOs or insurance companies. They also get a chance to get to know their patients well and practice high quality medicine. Some physicians have actually increased their income while having more time for research and family.      Critics of boutique medicine say this type of business practice will make it more difficult for middle class and uninsured patients to get health care as more and more MD's rush to join the boutique model. While some physicians who take concierge patients also see regular patients, many do not. Some professionals question the ethics of catering to a wealthy clientele while others go without basic medical services. Back to Top Scared to Death! San Diego, CA.-      It seems Japanese and Chinese people believe the number 4 is so unlucky that they often pay for it with their life. It doesn't help that in their respective languages the words 4 and death are homonyms. Perhaps you have heard of someone dying from fright or at least you've seen someone on television or in the movies so affected. They usually are known to have a "heart condition" or are on "heart medication".      Professor David Phillips of the Department of Sociology at The University of California at San Diego has found that Japanese and Chinese patients die on the fourth of the month much more frequently than on any other day and more frequently than other patients who do not fear the number 4. Published in The British Medical Journal, Professor Phillips reviewed over 47 million death certificates including over 200,000 Japanese and Chinese Americans who died between 1973 and 1998. He found mortality for Japanese and Chinese Americans peaked on the fourth of the month but it had no effect for other Americans. The effect was especially pronounced if the cause of death was listed as heart failure.      Researchers in California have named this phenomenon the Baskerville effect. In The Hound of the Baskervilles, by Sir Arthur Conan Doyle Charles Baskerville (who was known to have a heart condition) died from a heart attack induced by stress. It has been shown that stress can cause changes in blood pressure and heart rate but there has not been a scientific link between stress and heart attack or death until now. You may be wondering if more Americans die on the thirteenth. They don't, the reason is that there is no linguistic link in English between the number 13 and death.      The authors concluded, "Our findings are consistent with the scientific literature and with a famous, non-scientific story. The Baskerville effect exists both in fact and in fiction and suggests that Conan Doyle was not only a great writer but a remarkably intuitive physician as well." BMJ 2001;323:1443-1446 Back to Top Hay fever: old treatment may be better than new. Landquart, Switzerland-      European researchers have discovered or should I say re-discovered that the common herb butterbur (Petasites hybridus) can effectively relieve the symptoms of hay fever. What's more, butterbur works without the sedation and drowsiness often associated with over the counter drugs. The season for sneezing, runny nose, itchy eyes, and nasal congestion will be upon us soon. Known in medical circles as seasonal allergic rhinitis, it is not caused by hay and does not cause a fever. Hay fever is now treated with new non-sedating drugs such as Zyrtec and Claritin. These drugs are available by prescription only and are expensive.      Dr. Andreas Schapowal, consultant in ear, nose, and throat medicine at the Allergy Clinic in Landquart Switzerland has studied the problem. Dr. Schapowal took 125 patients with hay fever and divided them into two groups. Group A received Zyrtec and group B received butterbur. The Zyrtec was given once a day and the butterbur four times a day for two weeks, neither group knew which treatment it was receiving. The results; published in the British Medical Journal, showed that both groups improved equally, however the Zyrtec group complained about drowsiness and fatigue the butterbur group did not.      Scientists concluded "Butterbur should be considered for treating seasonal allergic rhinitis when the sedative effects of antihistamines need to be avoided." Other physicians express concerns with butterburs' potential for toxicity, although this study did not demonstrate serious side effects, you should always choose a reliable brand and follow the instructions on the bottle. Source: British Medical Journal 2002;324:144 Back to Top Home Menopause Test-Approved Kernersville, NC-      The Food and Drug Administration has approved a do it yourself at home menopause test. The test measures the concentration of a chemical called follicle stimulating hormone (FSH) in the urine. Some physicians are doubtful that at $59.95 the test will be worthwhile.      Genua 1944 Inc. a company based in Toronto makes the test, which is marketed by Physicians Laboratories. The company also sells Revival Soy; a soybean based powder used for making shakes, an excellent product which I have recommended for years. Both the test and the soy supplement are only available from a web site or by calling an 800 number.      "The Menopause Home Test puts a simple and convenient menopause test into the hands of women, giving them fast and, more importantly, accurate results for which they can seek sound and appropriate treatment," said Aaron T. Tabor, M.D., medical director of Physicians Laboratories.      FSH is elevated in menopause, however it can be normal during the often tumultuous perimenopause. The perimenopause is the time leading up to menopause when bothersome symptoms such as irregular bleeding, hot flashes, night sweats and mood swings first appear. A perimenopausal woman testing her urine at home will often find a normal FSH, possibly resulting in apprehension and confusion. Dr Tabor is quick to point out that women should "…seek a physician's guidance on appropriate therapy for symptoms and preventive health care against serious diseases." However the web site paints a grim picture of physicians offices "You schedule an appointment with a doctor--have blood drawn with a needle--make a co-payment--wait 3-4 days--return to doctor's office for results--make 2nd co-payment." I would like to point out that during the office visit, the doctor is also explaining the complexities of menopause and looking for other causes of "menopausal" symptoms such as thyroid disease, PPMD, or Sjogren's syndrome.      For more information on the test go to Menopause Test, for more information on menopause go to Menopause-Online or see your doctor. Back to Top New permanent contraceptive device available in Canada San Carlos, CA-      Have you completed your family but are still fertile? Does your husband go running off with his hands between his legs every time you mention the word vasectomy? Worried about the pill? There is a new permanent contraception procedure involving an implantable device. It is called Essure made by Conceptus an American company based in California.      The procedure requires no incisions, drugs or hormones, and it can be performed in a doctor's office. The procedure requires the doctor to insert two small metal springs into the uterine tubes via a hysteroscope. A hysteroscopy is where a small telescope is advanced through the vagina and cervix into the uterine cavity and then up to the tubal openings. The physician then inserts the springs into both tubes where they cause scaring and thereby block the tubes. With the tubes blocked the sperm cannot meet the egg and therefore conception does not take place.      Surgical tubal sterilization is the most common form of birth control worldwide, 50% of American women in the 40-45 age group have choosen it. In general a tubal ligation requires a hospital outpatient visit to an operating room with general anesthesia. Two incisions are made and recovery at home is usually from 3-7 days. In experienced hands Essure may prove to be a less invasive, safer and less expensive alternative to tubal ligation. We will keep an eye on the Canadian experience and report back.      Meanwhile if you are interested in participating in an American trial you may visit the Conceptus web site for more information. Back to Top Depression in Older Adults- A New Guide. New York, N.Y.-      It is estimated that 15% of adults over the age of 65 are depressed. What is different in this age group is that depression is usually associated with a medical illness and may increase the risk of heart disease. Most studies on treating depression were conducted on younger adults; older patients have been neglected. We know depression can significantly affect the quality of life of older adults. A new report, "Treatment of Depression in Older Persons," published in the medical journal Postgraduate Medicine makes specific recommendations concerning the treatment of older adults. The report also includes a Guide for Patients and Families.       George S. Alexopoulos, MD, Professor of Psychiatry at Weill Medical College of Cornell University, conducted a survey of 50 national experts in geriatric psychiatry. Antidepressant medication with or without psychotherapy was the top rated treatment. The medications recommended most were in a class of drugs called the selective serotonin reuptake inhibitors (SSRIs). The two top SSRIs chosen were CelexaÔ and ProzacÔ. "Because these guidelines provide treatment strategies devised specifically for an older population, they address clinical questions that had been unanswered until now," said Dr Alexopoulos. Are you depressed? The National Institute of Mental Health recommends the following test. Have you experienced any of these symptoms for more than 2 weeks? If you answer "yes" to 4 or more of the symptoms a physical and psychological evaluation by a physician and/or mental health specialist should be sought. · A persistent sad, anxious or "empty" mood · Loss of interest or pleasure in ordinary activities, including sex · Decreased energy, fatigue, feeling "slowed down" · Sleep problems (insomnia, oversleeping, early-morning waking) · Eating problems (loss of appetite or weight, weight gain) · Difficulty concentrating, remembering, or making decisions · Feelings of hopelessness or pessimism · Feelings of guilt, worthlessness, or helplessness · Thoughts of death or suicide; a suicide attempt · Irritability · Excessive crying · Recurring aches and pains that don't respond to treatment If someone has recently experienced a loss, these feelings may be part of a normal grief reaction. But, if the feelings persist with no lifting mood, the person may need professional treatment. Back to Top Should You Be Taking That Pill? Rockville, MD-      According to findings published in the Journal of the American Medical Association there may be widespread inappropriate medication use among older Americans. Previous studies have found up to one in four seniors using unsafe prescription drugs. The problem is widespread with over 6 million people at risk of adverse reactions.      An expert panel has compiled a list of medications that should be avoided by older adults. Dr. Chunliu Zhan from the Agency for Healthcare Research and Quality, looked at medication use in over 2400 men and women aged 65 years or older. Dr. Zhan compared the patients' medications with the "Always Avoid" and the "Rarely Appropriate" list. The researchers found an alarming 21% of elderly patients in the United States were using potentially inappropriate medications. The doctors concluded that this is a serious problem and recommend changes in physician prescription practices. They also warn " At a time when the United States is considering the addition of a prescription drug benefit to Medicare, we should recognize the potential for increased inappropriate prescriptions and develop appropriate measures to protect Medicare beneficiaries from the harms of inappropriate prescriptions." Check the Always Avoid list: · Seconol or other barbiturates · Dalmane · Diabinese · Demerol · Talwin · Tigan · Bentyl · Cystospaz · Pro Banthine Back to Top Beans, Beans, They're Good for Your Heart New Orleans, La-      Well maybe not the way the old rhyme goes but scientists have come to the conclusion that certain beans otherwise known as legumes can reduce your risk of coronary heart disease, CHD (heart attack). Heart attack claims the lives of more women than men in the United States and women are twice as likely to die after a heart attack than men. Legumes are a food group including beans, peas, peanuts, lentils and soybeans. They are among the oldest cultivated plants and are a principle food source in much of the world. Soybeans have been touted as the premier health food for years especially for women where claims for soy include treating menopausal symptoms such as hot flashes, and preventing breast cancer and osteoporosis.       Researchers at the Tulane University School of Public Health and Tropical Medicine would like to add the prevention of heart attack to the list of benefits of the bean. Supported by the National Heart, Lung, and Blood Institute doctors studied 9632 men and women. All participants were examined at the onset of the study to be sure none had preexisting heart disease. They were then followed for an average of 19 years with food frequency questionnaires filled out every three months.       Dr. Paul Whelton, the principle investigator, announced, "Legume consumption 4 times or more per week compared with less than once a week was associated with a 22% lower risk of CHD." The group concluded "Our study indicates a significant inverse relationship between legume intake and risk of CHD and suggests that increasing legume intake may be an important part of a dietary approach to the primary prevention of CHD in the general population".      What that means is that you may benefit from adding beans to your diet even if you don't have heart disease. Remember heart disease is the number one killer of women over the age of 35. Arch Intern Med. 2001;161:2573-2578 Back to Top Slow age-related vision loss! Rockville, MD--      Commonly used antioxidant vitamins have been shown to moderate the progression of age-related vision loss called macular degeneration (AMD). AMD is the leading cause of vision loss and blindness for people over 65 there is no known cure or treatment. Researchers calculate that if the 6 million people at risk AMD were treated for five years with this simple vitamin regime 250,000 would be spared any vision loss. These vitamins and zinc are commonly found in over-the-counter preparations labeled as eye, or vision enhancing supplements. Before this study there was very little evidence that these pills worked.      The Age-Related Eye Disease Study involved 11 eye centers across the country. It was a high quality clinical trial designed to test the effect of antioxidant vitamins and zinc. Over 3640 adults, aged 55-80 years, with some degree of AMD, were studied for 6 years. The patients were divided into four groups. The first group was given antioxidants, the second was given zinc, the third received antioxidants with zinc, and the fourth got sugar pills. The scientists reported "...treatment with zinc alone or in combination with antioxidants reduced the risk of progression to advanced AMD." The authors concluded that persons older than 55 years should have a dilated eye exam (dilation requires the use of a medication instilled in eye). If the exam shows specific signs of AMD patients "should consider taking a supplement of antioxidants plus zinc such as that used in the study". There is some evidence from a previous study that smokers who take high doses of beta carotene may have an increased risk of developing lung cancer. Therefore, if you are a smoker, your possible increased risk from cancer needs to be taken into consideration before starting beta carotene.       Regimen Used; Vitamin C, 500 mg; vitamin E, 400 IU; beta carotene, 15 mg; zinc, 80 mg; and copper, 2mg. Back to Top Chocolate-Good For You?      Are you addicted to chocolate? Many people report an irresistible urge for chocolate, an insatiable appetite that has to be satisfied daily. Dr. Kris-Etherton wanted to find out if there is a reason for this universal love of chocolate. Are there any benefits or risks of eating chocolate? Participants in a new study from The Pennsylvania State University ate a carefully controlled diet. They ate chocolate pudding, chocolate cookies, brownies, chocolate milk, a total of 22 g cocoa powder and 16 g dark chocolate a day. This well designed study compared the chocolate diet with an average American diet containing the same amount of fiber, caffeine and other nutrients. The study went on for two months, during which time the 23 participants had their blood cholesterol levels monitored.      The results show HDL, or good cholesterol was 4 % percent higher in those eating the chocolate. Antioxidant levels (those natural anti-aging substances) were also up by 4%. Dr. Kris-Etherton and colleagues have come to the conclusion that chocolate can actually reduce your risk of heart disease. They said "The inclusion of dark chocolate and cocoa powder in a diet that is rich in other food sources of antioxidants, such as fruit, vegetables, tea, and wine ... may consequently reduce the risk of heart disease." Source; American Journal of Clinical Nutrition, 2001;74:596-602 Back to Top A Consensus on Penile Length. Mumbai, India--      Researchers in India have embarked on a project to estimate the average penis size of close to half a billion men. Why, you may ask? It seems public health officials are concerned with the 15% failure rate for condoms in India. Their claim - one size does not fit all. We are not short of research on penile size. A recent search on MEDLINE, the National Library of Medicine's search engine, found over one hundred studies on penile size. Drs. Wessells and Lue at the Department of Urology, University of California School of Medicine, San Francisco, measured 80 normal American men to determine what is average. The findings indicate who should be considered abnormal and thus should be considered for penile implants. They found an average size of 4 in. flaccid and 5.8 in. erect.      Physicians at the Department of Urology, University of Florence, Italy decided to check 3300 young men (for no specific reason) and found that penile dimensions are highly correlated with height and weight. They measured up to the Californians. Israeli engineers undertook a study to "identify clinical and engineering parameters of the flaccid penis for prediction of penile size during erection." Forces were measured with specially designed gauges, relationships were calculated and a complex engineering model was developed.      Getting back to the condom issue, apparently young German men often complain of condoms falling off, whereas older men do not. Doctors at the Department of Urology, University of Essen, compared 111 men, 18 to 19 years old with 32 men, 40 to 68 years old. They found the older men had longer flaccid lengths 3.9 inches vs. 4.1 inches and greater circumference, but virtually the same erect length. Indian officials will use new technology for their study. A digital photo will be taken and a computer will calculate size. Results will be sent to the World Health Organization in hopes of modifying the specification currently used for condoms. "The idea is to have two to three optimal sizes and shapes of condoms, which could cover the population," said Sujoy Kumar Guha professor at the Department of Biomedical engineering at the Indian Institute of Technology, Delhi, India. Back to Top Buying medicine online? Beware!      There are many legitimate websites offering medications, herbs, supplements, and even prescription drugs at discounted prices. They often provide free information on interactions, alternative treatments, dosages, and side effects. Most are convenient, safe and can save you money. Now that the security of credit card transactions has been worked out, attention has turned to unscrupulous practices. There are problems with some web sites ranging from physicians prescribing drugs without ever meeting the "patients", to taking your money and not delivering the goods.      Only twenty-one states have or are developing policies regarding Internet prescribing. The American Medical Association (AMA) is targeting sites whose MO. is to have the buyer fill in an online questionnaire, which is reviewed by a physician who then prescribes a drug such as Viagra. The AMA has condemned these practices as unethical and unprofessional. Furthermore, you may receive the wrong product or worse, contaminated products. The Food and Drug Administration Has offered the following tips: Check with the National Association of Boards of Pharmacy (www.nabp.net, (847) 698-6227) to determine whether a Website is a licensed pharmacy in good standing. Don't buy from sites that offer to prescribe a prescription drug for the first time without a physical exam, sell a prescription drug without a prescription, or sell drugs not approved by FDA. Don't do business with sites that have no access to a registered pharmacist to answer questions. Avoid sites that do not identify with whom you are dealing and do not provide a U.S. address and telephone number to contact if there's a problem. Don't purchase from foreign Websites at this time because generally it will be illegal to import the drugs bought from these sites, the risks are greater, and there is very little the U.S. government can do if you get ripped off. Beware of sites that advertise a "new cure" for a serious disorder or a quick cure-all for a wide range of ailments. Be careful of sites that use impressive-sounding terminology to disguise a lack of good science or those that claim the government, the medical profession, or research scientists have conspired to suppress a product. Steer clear of sites that include undocumented case histories claiming "amazing" results. Talk to your health-care professional before using any medications for the first time. Consumers who suspect that a site is illegal can report it to FDA. Back to Top Asthma Drug Linked to Bone Loss. Boston, MA--      Steroids are wonder drugs with a multitude of uses; they have saved many lives. However they are a two edged sword. There are numerous complications of steroid use. When taken orally, (in pill form) they can cause osteoporosis (thinning of the bones). Inhaled steroids have been a blessing, the small inhalers or 'puffers' allow asthmatics to pursue a more normal lifestyle. A new study just published in the New England Journal of Medicine has found that even the inhaled steroids can cause osteoporosis.      Dr. Elliot Israel led a team of researchers at Brigham and Women's Hospital (BWH) in Boston. They studied 109 women ages 18 to 45 years old who were premenopausal and used inhaled steroids for their asthma. The National Heart, Lung, and Blood Institute (NHLBI) sponsored the study, which lasted three years. They found that inhaled steroids caused bone loss and that the more often the women used the puffers the more bone was lost.      In a separate press release NHLBI Director Dr. Claude Lenfant cautioned "We encourage all patients with asthma to work with their doctors on a comprehensive treatment plan; that is, the lowest possible dose of inhaled steroids that controls their asthma symptoms as well as measures to maintain good bone health, such as adequate calcium and vitamin D intake." Back to Top Medical Problem? Check the Internet, your doctor does. Hamilton, Ontario--      With the quality of health related information on the Internet constantly improving, researchers at the Hamilton Regional Cancer Center in Canada asked. Who uses the Internet more; patients, doctors, or nurses? To find out Dr Alejandro Jadad and colleagues from McMaster University compared use of the Internet by cancer patients, with their nurses and doctors at the same hospital over the same period. Between July 1998 and January 2000, questionnaires were mailed to 1448 patients. The surveys were conducted face-to-face with 30 physicians and 37 nurses. Their results published this week in the Journal of the American Medical Association showed 100% of physicians used the Internet. While 72% of the nurses used the Internet, only 47% of the patients did so. At the time of the survey, 16% of patients did not have access to the Internet, some said it was too expensive, 17% had never heard of it. The scientists found usage by patients increased during the first 6 months by 10% but then decreased slightly.      The authors concluded "Our findings... suggest that the gap in Internet use between patients and health care professionals is still wide... that some members of the public are not interested in using it, and that the rate of Internet use does not appear to be increasing rapidly."      Last year the Canadian Medical Society surveyed over 3700 physicians on their Internet use and found three-quarters used the Internet for e-mail and browsing the World Wide Web. Back to Top Drug shows promise for long-term weight loss. Bad Rothenfelde, Germany -- A German drug; sibutramine, available in the U.S. as the prescription drug Meridia, has been shown to help many patients loose weight and keep it off. For women; being overweight is associated with an increase in diabetes, gallbladder disease, coronary heart disease, high blood pressure, and arthritis. It is believed that weight loss of even 5% to 10% can significantly reduce the incidence and severity of these diseases. Many doctors feel that patients who have failed diet and exercise alone might benefit by the addition of a prescription medication. Dr Alfred Wirth conducted a trial involving over one hundred private practices and 3 university hospitals in Germany. The study included 1102 obese adults in a treatment regimen that lasted 44 weeks. Published in this week's Journal of the American Medical Association, the study found an overall weight loss of 17 pounds. What is more impressive is that 60% of the participants experienced at least a 5% weight loss. Common side effects consisted of dry mouth and constipation 2% dropped out of the study due to adverse reactions. The authors concluded, "Treatment of obesity requires long-term therapy, which can be hampered by difficulties in achieving patient compliance. Sibutramine, administered for 48 weeks to a typically obese population, results in clinically relevant weight loss compared with placebo." Back to Top The G-Spot: Review Sheds Light. Pleasantville NY-- The G-spot refers to a highly sexual arousing area of the vagina located a few inches inside on the top. The validity of this spot has been called into question, whether it exists or not is hotly debated. While up to 84% of American women believe it exists, many experts are skeptical. America's foremost sex therapist Dr. Ruth Westheimer is passionate about the topic she believes it is a holdover from the old Freudian dichotomy of "mature orgasms" and "immature orgasms". According To Sigmund Freud, a mature orgasm only occurs during sexual intercourse while the orgasms that occur at other times such as during masturbation are immature and thereby somehow inferior. Dr Ruth in her usual inimitable way says this is a throwback to the days when male chauvinists ruled the female body. Dr Terence Hines of the Department of Psychology at Pace University in his search for the elusive G-spot has published a comprehensive review in the American Journal of Obstetrics and Gynecology. The spot was first proposed in 1950 by Dr Grafenberg; whose name it bears. Although he demonstrated no evidence for its existence, several subsequent books, publications and a majority of American women take it for granted. Let's look at the evidence. After a three hour training session two gynecologists examined eleven women. They felt four out of eleven had G-spots. In another study four women had biopsies taken from the alleged area, none showed an increase in nerve endings. Well that's it, not much, as far as research goes. Dr Hines concludes, until more research is done "…the G-spot will remain a sort of gynecological UFO: much searched for, much discussed, but unverified by objective means." He goes on, as does Dr Ruth to reassure women, if they fail to find their G-spot do not despair, it may not exist at all. Back to Top Exercise Through Menopause. Indianapolis, Indiana -- Menopause is a good time to start an exercise program. Research by the American College of Sports Medicine (ACSM) has shown benefits of both endurance and strength training into your eighties and nineties. A survey of over 184,000 adults just published in the Journal of The American Medical Association reveled "Twenty-seven percent of US adults did not engage in any physical activity, and another 28.2% were not regularly active." This has led to what the authors called "The continuing epidemics of obesity and diabetes in the United States" with 19.8% of Americans obese and 7.3% diabetic. Metabolism begins to slow in the thirties, often resulting in a noticeable weight problem by menopause; diet decreases the metabolic rate even more. Exercise increases the metabolic rate and can replace body fat with muscle. Other benefits of exercise in menopause include prevention of bone loss, lower blood pressure and cholesterol relief of depression symptoms and insomnia. Symptoms such as hot flashes, night sweats bladder and vaginal atrophy may not be affected. For previously sedentary women traditional exercise regimens recommend walking for15 minutes three times a week and gradually increasing to a 20-60 minute workout session including stretching, resistive weight training, and aerobics. Healthy women should have no problems with the above recommendations however if you have any medical problems or experience any symptoms such as chest pain or shortness of breath you should contact your doctor. Non traditional exercise such as dancing and swimming can be an alternative to the gym. Dance classes are not just for kids; more adults are enrolling in jazz, tap, bebop, and lyrical ballet. "Everyone is born with a natural talent for dance, but this natural talent gets suppressed with the daily stresses of life." says Pamara Perry, former soloist with the Joffrey Ballet. Swimming is a great problem solver. For medical conditions such as lower extremity injuries, that precludes vigorous weight bearing exercise water aerobics may be the answer. Back to Top Sleep Better with Estrogen. Philadelphia, PA -- Insomnia or poor sleep is one of the most common problems seen at menopause. We know poor sleep effects women more than men and worsens as we grow older. Scientific studies from Finland blamed obesity for causing insomnia in menopausal women and exonerated low hormone levels. Most studies have shown no correlation between sleep and the low estrogen seen in perimenopause until now. Michelle Battistini, MD at the University of Pennsylvania Medical Center studied 436 women with regular menstrual cycles. She found that low estrogen levels, especially in the perimenopausal group, were an important factor in poor sleep. Published in this month's issue of Obstetrics & Gynecology the report goes on to identify hot flashes, anxiety, depression and caffeine consumption as contributing factors. The authors conclude "...it is possible that hormone therapy may be helpful earlier in the menopausal transition than is currently the practice." If you suffer from insomnia every night or most nights for a period of one month then you have chronic insomnia. If you're on estrogen and not having hot flashes or night sweats then it's time to look for other causes of sleeplessness. Depression and anxiety disorders are common causes of chronic insomnia. If you feel depressed, you need to be evaluated by a qualified health care provider. Movement disorders such as restless leg syndrome often result in insomnia, there are new medications that may help. Other common causes are shift working, respiratory disorders such as asthma and pain. In up to 30% of people with chronic insomnia no cause can be identified. Medical treatment of these people has generally been with hypnotic drugs (sleeping pills). It is estimated that 25% of the adult population in America took some type of medication for sleep last year. It is generally agreed that sleeping pills should only be in the lowest dose and for the shortest possible time. Sleep hygiene is the name for behavioral techniques that offer the best hope for chronic insomnia. The recommendations are; Go to bed only when sleepy. Do not wait up to a specified time. Use your bedroom only for sleep and sex. Do not read or watch TV in bed. If you are not sleeping, get out of bed. Get up and read in another room Go to bed and get up at the same time each day. Avoid caffeine and alcohol in the evening. Exercise and do enough during the day so you are tired at night. Back to Top Anxiety Gene Found on Chromosome 15. Barcelona, Spain-- Scientists working at the Medical and Molecular Genetic Center in Barcelona have identified a gene that may be responsible for anxiety disorders including panic attacks and phobias. Their research, published in this month's journal Cell may revolutionize the field of psychiatry. For years, it has been assumed that these disorders run in families but this is the first scientific study to prove a genetic predisposition. Anxiety disorders affect women twice as frequently as men. Generalized anxiety disorder is defined as excessive worry and tension, on most days, for at least six months often with restlessness, muscle tension shortness of breath, rapid heart rate, dry mouth, and feeling keyed up. In a small village near Barcelona doctors noticed, that many patients with anxiety disorders also had laxity of the joints. Both of these conditions seemed to run in families. That sparked local psychiatrist Antoni Bulbenas interest, who along with geneticist Xavier Estivill embarked on a hunt for the responsible gene. With several other Spanish scientists they studied 93 individuals and found that a region of chromosome 15 contained many duplicated genes. They named the area DUP25. They then went on to look at 70 patients with anxiety disorders and found 97% had DUP25. When they checked 189 other people without anxiety disorders, only 7% had DUP25. The authors concluded "Anxiety disorders belong to the category of complex diseases for which intense research efforts are focused on the identification of genetic susceptibility factors. DUP25 is probably a major genetic factor of susceptibility for panic and phobic disorders, and it is likely that its identification should have important implications for psychiatry and health." There are no tests for DUP25 on the market yet. However, you can check for joint laxity by extending your arms. If the elbow joint extends more than 180 degrees, it is lax. Back to Top Menopause Online acclaimed by from North American Menopause Society. Cleveland Ohio-- As Menopause-Online enters it's fifth year of providing accurate, unbiased information on menopause we are honored that the North American Menopause Society (NAMS) has chosen us from more than 100 web sites to have a direct link from the NAMS web site. We are among a select group of professionally written and maintained web sites to pass their rigorous set of criteria and go on to be approved by the Board of Trustees. The North American Menopause Society is the nations preeminent professional menopause society. They publish scientific studies in the journal Menopause as well as consumer information in Menopause Management. With more than 2000 professional members; including clinical and basic science experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, and education, they are now moving towards providing menopause information to the public. We are pleased to be recognized as a leading provider of this information and will continue to maintain high standards for our readers. Back to Top Ovarian Cancer and Hormone Replacement Therapy. Atlanta GA-- A recent study has indicated that after 10 years of hormone replacement therapy (HRT) the risk of ovarian cancer increases. We know HRT can cause endometrial cancer if not given with progesterone and is associated with an increase in breast cancer. Over 11 million US women are taking HRT, which has many positive effects including the prevention of osteoporosis. The American Cancer Society's Cancer Prevention Study II, includes over 200,000 postmenopausal women. The women were first contacted in 1982 and followed up in 1996. During the study period hormonal use was associated with a increased risk of death from ovarian cancer which persisted for years after discontinuing the hormones. Back to Top Having Surgery? Hold the herbs. Chicago, IL.-- Undergoing anesthesia involves the administration of numerous potent drugs that have profound effects on the body. Surgery usually involves major disruption in blood flow, the risk of infection and alteration of organ function. With the widespread use of herbal medications, various interactions and side effects have been observed. Twenty-two percent of patients take herbs during what is called the perioperative period (the time before, during, and after surgery). For them, the otherwise minor herbal interactions and side effects may have significant consequences. Dr Michael Ang-Lee of the Department of Anesthesia at the University of Chicago has just published a comprehensive review of the subject. Dr. Ang-Lee and colleges reviewed all of the literature published since 1966 on the 8 most commonly used herbs and made recommendations in the Journal of the American Medical Association on 6. Potential side effects range from heart attack to hemorrhage. Don't be part of the 70% of patients who do not tell their doctors about their herb use. Talk to your surgeon and review the following recommendations together. Consider homeopathy instead. Homeopathic medicines function on an energetic level and do not interact with pharmacologic agents. A single dose (3-5 pellets) of Arnica 30 shortly before, and again shortly after the procedure can be helpful for the trauma associated with surgery. Herb Discontinue prior to surgery Ephedra 24 hours Garlic 7 days Ginko 36 hours Ginseng 7 days Kava 24 hours St. John's Wort 5 days Back to Top Sexual side effects? Stop the pill. Bloomington Indiana-- More women are taking the contraceptive pill today then ever before. Women are also continuing on the pill up to menopause because of the positive effects on bone density and the increased risk of medical complications in a pregnancy after the age of 40. With the advent of low dose pills there are fewer side serious effects to worry about. However, certain side effects can lead to discontinuation. It is easy to say "look Doc I can't take these pills because I'm bleeding all the time" or "my PMS (pre menstrual syndrome) is terrible". Patients are reluctant to talk about another major side effect, sexual problems. Dr. Stephanie Sanders at Indiana University has conducted a trial to see just how common sexual side effects are and if women quit the pill because of them. In a study published in this month's journal Contraception scientists reported on 78 women who were current users of oral contraceptives (OC's). Researchers found that emotional and sexual side effects were the major reasons women were dissatisfied with their OC. After one year, almost half of the women in the study had stopped taking the pill, 14% had switched pills. Decreased sexual arousability and a decrease in the frequency of sexual intercourse and sexual thoughts played a prominent role in the decision to discontinue OC's. The authors concluded that physicians need to prepare women for the possible emotional and sexual side effects of OC's and continue the discussion during their use. Back to Top Hormone Replacement Therapy Losing Support. Seattle, WA-- A recent study confirms that women who survive a first heart attack and start hormone replacement therapy (HRT) are not protected as first thought, but are initially at increased risk of another heart attack. Doctors are looking for ways to prevent second heart attacks; they call it "secondary prevention". The new study published in The Archives of Internal Medicine has prompted the American Heart Association to reevaluate the HRT recommendations. The study in question is called an epidemiological study which means researchers collected data from the patients past history; it was not an on going comparison, or a controlled intervention. Dr. Susan R. Heckbert from the Group Health Cooperative at the University of Washington in Seattle conduced the study. She collected data from 981 postmenopausal women all of whom had recently suffered a first heart attack. Throughout the three and a half years of the study, 186 heart attacks occurred. Dr.Heckbert concluded there was "…no difference in the risk of cardiac events between women who were current users of HRT and those who did not use HRT ". However, there was an increase in the risk of a second heart attack for those on HRT during the first two months after their illness. In the subsequent year the risk turned into a benefit. Women who are on HRT for a year or more have a 25% lower risk of heart attack. The American Heart Association now recommends "…HRT not be initiated solely for its potential protective effects against cardiovascular disease." There are still myriad reasons to initiate HRT and the American Heart Association does not recommend discontinuing HRT if you are already on it. Back to Top The Patch vs. The Pill. Raritan, NJ. -- It is well known that oral contraceptives (OC) otherwise known as "the pill" can have a failure rate of up to 8% if not taken every day. Non-compliance is the number one reason that women on the OC have become pregnant. Almost 50% of pill users report missing one or more pills per cycle. The pill is a combination hormonal preparation containing an estrogen and a progestin. LunelÒ is a new injectable form of the pill and is better for those with poor memories but it needs to be given once a month in a physician's office, which is inconvenient. Now a weekly patch the first "transdermal" contraceptive devises for women is being studied in the US. Now the first clinical trial has been published in the Journal of the American Medical Association. Forty-five centers participated in the study that included over 1400 women aged 18 to 45 years. The study was randomized and blinded it compared the patch, which is applied once a week for three weeks followed by a patch free week, to the pill. Doctors were interested in its failure rate and how often women experienced breakthrough bleeding (cycle control). After one year, they concluded "The contraceptive patch is comparable to a combination OC in contraceptive efficacy and cycle control. Compliance was better with the weekly contraceptive patch than with the OC." About 4% of patches had to be replaced because of detachment and patch users complained of occasional skin irritation. Look for the patch called Ortho Evra to be available later this year. Back to Top Stand Strong against osteoporosis San Antonio TX-- The American Association of Clinical Endocrinologists (AACE) kicked off its new campaign for public awareness of osteoporosis at its10th Annual Meeting in San Antonio, Texas. A new survey was released revealing that knowledge about the disease's most visible symptom is lacking among both patients and physicians. The symptom they are referring to is "low trauma" or silent bone fractures. In women suffering from osteoporosis, fractures of the spinal vertebrae can occur as consequences of bending, walking or even sneezing. "I had been having back pain for years, my internist was treating me with pain pills for arthritis, it wasn't until I saw a gynecologist that I was diagnosed with three vertebral fractures from osteoporosis" says Francis Harkinish 84 from Toms River NJ. "Bone fractures and the complications that follow are serious consequences of osteoporosis, a condition that is especially common in postmenopausal women," says Nelson B. Watts, MD, FACE, director of the Osteoporosis Program at Emory University. "If women and their doctors don't link bone fractures and osteoporosis, many women will continue to go untreated and be at greater risk for subsequent fractures, which often happen within a year after the first." The national survey included over 400 women age 50 and older. Over half of the women did not know that silent fractures were caused by osteoporosis and 21% of women at risk did not know that it causes weak and fragile bones. Partly to blame are physicians, 48% of women surveyed reported that their doctor's did not talk to them about their risk. The survey also included 100 family physicians only 38% of which report telling women over 50 that fractures can be a symptom of osteoporosis. "Untreated fractures from osteoporosis may lead to diminished quality of life, disability and even death. In fact, lifetime risk of death associated with an osteoporotic hip fracture is comparable to that from breast cancer," said Dr. Watts. Back to Top Designer Estrogen Fails to Prevent Memory Loss San Francisco, CA Did you ever find yourself looking in the closet but not knowing what you are looking for only to remember what it was when you got back to the kitchen? Scientists call this phenomenon "age associated memory impairment" (AAMI). This normal consequence of aging usually becomes noticeable around age forty. If you find yourself getting lost on the way home form the story it could be a more serious memory problem such as Alzheimer's Disease, a type of dementia. Women are more susceptible to Alzheimer's and it only occurs after menopause. These facts have lead researchers to speculate that estrogen plays a role in memory preservation. Estrogen promotes growth in brain memory and, in animals, increases the connections between neurons called synapses. Estrogen replacement therapy (ERT) is felt to increase the levels of estrogen in the brain that is correlated with memory. Some studies have shown that estrogen use in postmenopausal women may delay the onset and decrease the risk of Alzheimer's Disease. However, other studies do not support this finding. Because of estrogen's negative effect on the breast, scientists have developed what are called "designer estrogen" drugs that have estrogen's positive attributes, but not the negative side effects. The latest designer estrogen is called Evista®. The drug maker was hoping it would have a positive effect on memory loss. Therefore, in 1996 a large study was commissioned to look at cognitive function in women on Evista. A total of 7478 postmenopausal women (mean age 66 years) were enrolled at 178 sites in 25 countries. The participants were given a battery of tests that measure mental function including memory, attention, concentration, etc. The tests were given at the start of the trial, at six months and after the first, second and third year. One third of the women took 60 mg. Of Evista, one third took 120 mg and one third took a placebo (sugar pill). After three years the results were published in the New England Journal of Medicine. The authors concluded that there was no overall effect. However, they felt there was some evidence of an effect on verbal memory and attention. N Engl J Med 2001; 344:1207-13 Back to Top Mimicking Menopause Jericho, NY-- What occurs in women around age 40-50 is associated with fatigue vaginal dryness headache joint pain dry skin, mouth and eyes? Menopause-No Sjogren's -Yes, (pronounced "show-grins") Sjogren's syndrome is an autoimmune disease in which the body's immune system mistakenly attacks its own moisture producing glands. Many women and their physicians often mistake this condition for early menopause. A new survey conducted for the Sjogren's Syndrome Foundation shows that patients suffer for an average of six years before being accurately diagnosed and treated. "Research shows that hundreds of thousands of women may be undiagnosed and untreated, and this latest survey shows that many are suffering needlessly. We need to more aggressively inform women that these 'dryness' symptoms - often dismissed as normal 'aging' - may indicate Sjogren's and need to be treated " said Alexis Stegemann executive director of the Sjogren's Syndrome Foundation. If left untreated the syndrome can lead to kidney, lung, and liver damage. The survey found that that up to 33% of individuals had to limit their participation in recreational and social functions and reported a negative impact on their romantic relationships. Sjogren's Syndrome remains fundamentally an incurable disease there are no treatments that can reverse the course of the illness. However, drugs can ameliorate some of the symptoms and prevent organ damage. For more information visit The Sjogren's Syndrome Foundation's web page. Back to Top Wrinkle Prunes - Not Skin Melbourne, Australia-- You are what you eat, goes the old adage. An international study just published in the Journal of the American College of Nutrition indicates the old saying may be more than just a cliché. Doctors from Monash University in Australia studied 453 subjects living in Australia, Greece and Sweden who were enrolled in the International Union of Nutritional Sciences (IUNS) "Food Habits in Later Life" study. The principle investigator Dr. Mark L. Wahlqvist wanted to know if food could retard the wrinkling process. All of the subjects had their wrinkles measured. The Swedish, as you might expect, living in the northern latitudes, had the least wrinkles followed by the Greeks while the Australians were the most wrinkled. However, within each nationality those who ate a specific group of foods and avoided another had significantly fewer wrinkles. So, what were the foods? Researchers stated "a high intake of vegetables, legumes and olive oil appeared to be protective against cutaneous actinic, [sun] damage". Alternately a high intake of meat, dairy, and butter appeared to be associated with skin damage. Prunes, apples, and tea were particularly protective for the Australians. It is felt that a diet high in vegetables, legumes, and olive oil contains an abundance of the antioxidant vitamins A, C, and E. These vitamins protect the skin from oxidative damage. You may be only one meal away from saving your skin and preventing wrinkles. Journal of the American College of Nutrition 2001;20:71-80 Back to Top Americans love their herbs and supplements Boston, MA-- Results of a Harvard survey reveal some unusual attitudes held by dietary supplement users. The number of dietary supplement users has grown dramatically in recent years, now almost half of adults in the US take at least one vitamin, herb, mineral, or over-the-counter supplement regularly. The industry has grown to over $15 billion in sales last year. This amount of money has caused the academic medical community to take notice. Dr. Robert Blendon of the Department of Health Policy and Management at the Harvard School of Public Health wanted to know what was behind this incredible growth, and what roll Americans felt their government should play. Towards this end, he reviewed 6 opinion surveys composed of several thousand adults. There were some surprising findings. Most of those surveyed did not tell their physicians about their supplement use because they felt their doctors would know "little or nothing" about them and might be biased against them. One third of regular users felt there was a supplement that could help them live longer. Many users felt that supplements could fight colds (61%), depression (52%), and arthritis (53%). They also felt supplements could be helpful in the treatment of cancer (35%), and AIDS (16%). There was support for government regulation especially where safety was concerned. The report went on to say "We found that a majority of Americans surveyed supported the following: to require that the Food and Drug Administration review the safety of new dietary supplements prior to their sale; to provide increased authority to remove from sale those products shown to be unsafe; and to increase government regulation to ensure that advertising claims about the health benefits of dietary supplements are true." However, many Americans (71%), would continue to take their supplements even if the FDA proved them ineffective. Arch Intern Med. 2001;161:805-810 Garlic - Tastes good and it is good for you. San Antonio, TX -- Scientists at the University of Texas Health Science Center have concluded that garlic "Shows promise for improving some cardiovascular risk factors." After reviewing all of the scientific evidence they have discovered what every Italian cook instinctively knows - you cannot eat too much garlic. Of course, the ancient Egyptians knew of garlic's medicinal properties so great was its influence a clove of garlic often accompanied the Pharaoh on his trip to the afterlife. The Egyptians had 22 different medicinal uses for the herb. Garlic has always maintained a preeminent position in the worlds pharmacopoeias it was a favorite of the Greeks, Romans, and Chinese. "Garlic has powerful properties, and is of great benefit against changes of water and of residence" Pliny the Elder (AD 29-73). More recently, during World War One it was used for it's antibiotic properties. Garlic is now touted as cholesterol and high blood pressure lowering food and it is these indications that the Texas researchers were interested in. Doctors looked at 45 randomized trials and 73 additional studies done over the past 30 years. To be included in the review, studies had to be randomized and controlled and had to have lasted at least 4 weeks. Their findings, published in the Archives of Internal Medicine, showed that when compared to the placebo group (those taking sugar pills) the patients taking garlic had a small but significant reduction of total cholesterol. After one-month cholesterol declined on average 7 points (mg/dl) and 17 points after three months. By using a standardized form of garlic, one that is guaranteed to contain a specific amount of an active ingredient, the numbers were even better, 19 point reduction at one month and 12-24 points after three months. The studies did not show a clear benefit on blood pressure. The major side effects were bad breath and body odor. The principle investigator Dr. Ackermann concluded that studies in humans report promising potential however the trials were of short duration and the active ingredient and mechanism of action have yet to be elucidated. Back to Top The Survey says--Plastic Surgery is Up A tenfold increase in the popularity of plastic surgery in the past ten years is attributed to baby boomers vanity and disposable income, so says The American Academy of Cosmetic Surgery (AACS). The AACS has released it's annual survey announcing that "Lunch-time" procedures such as Botox and light chemical peels showed the largest increase from 1999 to 2000. One third of patients are in the 35-50 age group. Liposuction is the most popular form of cosmetic surgery over 600,000 procedures were done in 2000, followed by eyelid surgery, breast enlargement, and facelift. Men prefer hair transplantation with 178,000 done in 2000 they also like liposuction which in the second most popular cosmetic procedure with 17 percent done on men. The Academy claims surgeon's fees for cosmetic procedures rose only 5 percent over the past decade. The table below gives the average total cost for 14 of the most common procedures. PROCEDURE AVERAGE COST Abdominoplasty or Tummy Tuck $5310 Blepharoplasty or Eyelid Surgery $3130 Botox Injections $434 Breast Augmentation $4556 Breast Lift $4658 Breast Reduction $5430 Chemical Peels $163 Facelift $5416 Fat Injections $1573 Forehead Lift $3353 Hair Transplantation $3661 Liposuction $3816 Rhinoplasty $4109 Sclerotherapy or Vein Surgery $311 Mercury in Fish The FDA has warned that women who are pregnant, nursing, or of childbearing age, as well as children under the age of eight, they should NOT eat swordfish, shark, king mackerel or tilefish. The jury is still out on tuna. These fish are at the top of the aquatic food chain and subsequently concentrate methyl mercury in their bodies. The mercury comes from air pollution and can cause damage to the developing brain and nervous system. The CDC has recently reported that, "…approximately 10% of women have Hg (mercury) levels within one tenth of potentially hazardous levels, indicating a narrow margin of safety for some women and supporting efforts to reduce methylmercury exposure." If you are not in one of the at-risk groups, you still may want to limit your intake to once or twice a month. Bioengineered Foods Genetic engineering sounds bad, after all, we do not want genetic diseases, and genetic mutations are always harmful. Right? Well, not exactly. If it were not for genetic mutations, we would never have evolved into who we are today. Genetically engineered foods are strictly controlled and only allowed to proceed if there is a clear benefit and no new chemical ingredients or allergens are introduced. "Unfounded concerns about hypothetical risks are far outweighed by the real benefits that will soon be realized, if scientific research and development of genetically-modified agriculture is allowed to proceed unhindered." says Gilbert Ross M.D., Medical Director of the American Council on Science and Health. Scientists are working on drought and insect resistant crops, more productive livestock, and produce that does not rot before it can be consumed. Some researchers advise caution. "We believe that the federal government must strengthen the regulatory system governing genetically engineered microorganisms, plants, and animals, so that the risks and benefits can be evaluated carefully, case by case, before they come to market" said Jane Rissler, senior scientist Union of Concerned Scientists, on CBS's 60 Minutes. Advances in bioengineering can go a long way towards ending world hunger and malnutrition. Food Irradiation Exposing people to radiation is dangerous, as we all know it can cause birth defects and cancer. However, exposing food to radiation is the single most effective way to reduce contamination with Salmonella, Trichinella and E.coli, which cause an estimated 60 million illnesses annually. The food does not become radioactive and can not pass on any radiation to the consumer. The United States Food and Drug Administration (FDA) regulates the practice and considers it safe, as does the World Health Organization, the Food and Agriculture Organization of the United Nations, the American Medical Association, and the American Dietetic Association. The CDC's position is that "An overwhelming body of scientific evidence demonstrates that irradiation does not harm the nutritional value of food, nor does it make the food unsafe to eat." The List Goes On Remember the margarine controversy, hormones in chickens, or corn feed in the taco shells? So, where do you go from here? Where can you find reliable and unbiased information? Try the FDA's web site at www.FoodSafety.gov. There you will find my favorite resource, the Bad Bug Book. The FDA also lists health warnings, recalls, and alerts. The problem with food in the American diet, is not its quality. It has never been safer. It is the quantity of calories and lack of variety consumed. Back to Top Food Scares - Read Beyond the Headlines San Francisco CA-- Today's consumer is raised on a diet of sensational and often inaccurate news stories about dangerous foods. While there are real concerns about the food supply, rather than just swallowing the headlines, you need to digest the whole story if your goal is to provide wholesome and nutritious meals for yourself and your family. Mad Cow Disease A real horror story is Mad Cow Disease or bovine spongiform encepalopathy (BSE). This disease has killed several hundred thousand cows and over 90 people in Europe. Thought to be transmitted by a 'prion', an abnormal protein more elusive and indestructible than a virus, BSE can be transmitted to humans who eat tainted beef. Once infected, the victim develops a condition similar to Creutzfelt-Jacob disease. The early symptoms are insidious, mimicking mental illness. They often begin years after an exposure and end in coma and death. Hopefully the worse is over in Britain. Thanks to American officials who banned the import of British beef and by products in 1988, there have never been any cases of BSE in the US. Blood donations continue to be prohibited by anyone who had spent more than six months in Britain between 1980 and 1996. According to the Centers for Disease Control (CDC), "It is extremely unlikely that BSE would be a foodborne hazard in this country." Foot and Mouth Disease As if Mad Cow Disease was not enough hardship for British dairy farmers, Foot-and-Mouth Disease (FMD) has reared its head again. This is NOT the same Hand Foot and Mouth Disease that the neighbor's kid had last fall. Johnny had a mild viral illness that may have included sores on his hands, feet, and mouth for which he probably did not even see the doctor. FMD is also a virus, but it only affects animals. Back to Top Weight Loss on the Internet Providence, RI -- With the unprecedented availability of information, instant communication via e-mail, and confidentiality of the Internet, you would think it would be a great vehicle for self-improvement. Well it is! A study just published in the Journal of the American Medical Association shows that a structured behavioral program delivered over the Internet can result in significant weight loss. Doctors at Brown Medical School/Miriam Hospital and the Virginia Polytechnic Institute developed the program. They studied 91 overweight adults for a period of six months. The subjects were divided into two groups. The first group accessed a web site that provided dietary and nutritional information and organized links to Internet weight loss resources. The second group received 24 weekly lessons via e-mail. They submitted weekly self-monitoring data that was reviewed and feedback was given. There was a bulletin board for participants to exchange information and support each other. The results showed that the behavioral intervention group lost more weight than the education only group. The authors concluded, " …the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs." JAMA. 2001;285:1172-1177 Back to Top Foods to Tame Hot Flashes San Fracisco, CA--      You've heard the ubiquitous advice-- eat tons of tofu, avoid fat, take handfuls of vitamins! Although you may have experienced occasional hot flashes at some time in your life, when it's menopause time, they can be unrelenting and debilitating. If hormone replacement therapy is not your cup of tea then sound dietary advice is in order.      In general the typical American; white flour, fat, dairy, sugar, caffeine and meat, diet is not only unhealthy but goes a long way towards worsening hot flashes. Whereas the much-touted 'Healthy Diet' of whole grains, fruit, vegetables, beans, fish and small amounts of meat CAN actually reduce those flushes. Soy as well as other legumes, some fruits, beans, and vegetables contain estrogen-like compounds called phytoestrogens. Phytoestrogens modulate the estrogen fluctuations that can cause hot flashes in the menopause and even during normal menstrual cycles. The fluctuations are more radical in menopause and the hot flashes can be equally radical.      So, what can you do to increase the phytoestrogens in your diet? Let's go over that food list in more detail. In the U.S. soybeans are most commonly processed into tofu and used as an ingredient in Oriental cooking. You can also make fruit flavored soy milkshakes or use soy milk and flour in cooking your favorite dishes. When eating out in Chinese or Japanese restaurants, look for the dishes with tofu, miso, or tempeh, they all contain soy. There is a plethora of new cookbooks out devoted to soy recipes, and most of the newer editions of traditional cookbooks contain chapters on soy. Beans also contain phytoestrogens, and being more familiar, are easier to incorporated into your diet. Try three-bean salads, chili, and Mexican refried beans. Lentils and peas are also good sources of calcium and fiber. At this point, you may be thinking of buying stock in BeanoÒ, initially it will help reduce gas, however, over time your body will become accustomed to your new diet and produce less gas.      Flaxseeds are a good source of concentrated phytoestrogens. Being more commonly seen in years past, my grandmother used to keep a jarful in the cabinet and feed them to me when she thought I was becoming constipated, I was actually not constipated just moody, however the seeds tasted good so I happily ate them. Flaxseeds can be sprinkled on cereal and other food or ground and added to recipes, they have a nutty flavor and contain alpha-linolenic acid, a nutrient with many benefits. Try to eat 2-3 tablespoons a day.      On the sweeter side, most fruit is rich in phytoestrogens. Concentrate on pears, plums, apples, grapes, strawberries and citrus fruit but don't stop there you should be eating 5-7 servings of fruit and vegetables a day.      Finally, there are some foods to avoid. Many women report that spicy food, wine and caffeinated beverages provoke hot flashes. So Bon Appetite, improving your diet can not only decrease hot flashes but may reduce your risk of cancer and heart disease. Back to Top New test can reassure those with abnormal Pap Bethesda, MD -- Pap test screening is recommended for women either when they become sexually active or reach the age of 18. The test is very successful at finding, signs of cervical cancer, or cells that may turn into cancer in the future. Inherent in any screening test is the possibility of false positives, which is when a test is abnormal but there is no real problem. As a practicing gynecologist, I know it is quite distressing for a woman to get news that her Pap smear is abnormal and that she needs to have another procedure or wait 3-6 months for a repeat Pap. Now, an additional test can be preformed which can dramatically reduce the number of women who would otherwise receive that dreaded telephone call. The procedure is called Human Papilloma Virus (HPV) testing and one company; Cytec will automatically run the test on any abnormal Pap smear they process. The HPV test has been around for years and its usefulness has just been confirmed in a large study funded by the National Cancer Institute. Published in this week's Journal of the National Cancer Institute, researchers from four university medical centers in the U.S. looked at over 5,000 women with abnormal Pap smears. The abnormalities studied, previously referred to as class II and class III Pap's, are now called atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL). The study correctly identified 96.3 percent of the women with ASCUS that needed to go on the next test. "These results indicate that HPV testing is a viable option for women and their doctors to consider when deciding what to do about ASCUS." said NCI's Diane Solomon, M.D., the study's lead investigator. Before this study, no one knew exactly what to do. The options were to repeat the Pap in 3-6 months or perform a colposcopy, a procedure where a specialist, generally a gynecologist looks at the cervix with a microscope-like devise and performs biopsies of any abnormal areas. HPV testing cuts the number of women who need colposcopy in half, thus reducing costs, and the time women must spend in limbo worrying about a possible cancer diagnosis. Cytec's test is called the ThinPrepÒ Pap test and is available in most parts of the U.S. Back to Top Bush moves to limit international family planning Washington DC-- One of President George W. Bush's first acts in office was to reinstate what has been referred to as the Global Gag Rule. This rule severely limits what family planning clinics can revile to their clients. Specifically the policy "…prohibits U.S. assistance to family planning agencies that provide abortion services, referrals, or related information or engage in advocacy regarding abortion policy with non-U.S. funds". Originally implemented by Reagan and then rescinded by Clinton the rule have abortion rights activists, as well many others, wondering how we can prohibit foreign family planning agencies from engaging in counseling activities which are, according to former Secretary of State Madeline Albright would be constitutionally protected if carried out within the U.S. "The end result of this policy will be to increase the number of abortions. The President's action is nothing less than a direct assault on women overseas. It is disheartening that as his first act as President of the United States, George W. Bush has decided to place restrictions on women's access to important preventive health services." said Judith M. DeSarno, President of the National Family Planning and Reproductive Health Association. It should be pointed out that there is a long-standing prohibition on the use of foreign aid for abortions. It seems that this move is a concession the Presidents right to life supporters. However, it would not be surprising if foreign health care providers see this as hypocritical and imperialistic Back to Top Relieve headaches without drugs Mount Royal, NJ February 1, 2001-- Many headache sufferers prefer a non-drug remedy for their pain and would rather prevent a headache than treat it. Unfortunately, when you visit your physician he is likely to prescribe one or more of a myriad of drugs on the market to treat and prevent headaches. Often the drug has an unpleasant or dangerous side effect is costly and may be only marginally effective. Complimentary and alternative practitioners steer people away from medication and toward behavioral treatments such as relaxation training, acupuncture, biofeedback, and stress management. However, do these "alternative" treatments work? The US Headache Consortium is a group of professional organizations that publish guidelines and study treatments. The consortium has looked at some of these non-drug modalities and has published its findings. Researchers collected all of the studies done on behavioral treatments of headache including migraine 355 in all. They discarded most of them for lack of adequate scientific rigor. Ultimately 39 high quality studies were reviewed. They found several themes common to the successful treatments. They included; involving the patient in developing a plan, maintaining a partnership throughout the treatment and, if more than one treatment is used, carefully coordinating treatments. Specific treatments found to be effective were relaxation training, which could include meditation, yoga, or self-hypnosis, biofeedback, and behavioral therapy, which is usually conducted with a psychologist. Back to Top Fruit Extract effective for PMS Hüttenberg, Germany, January 24, 2000-- Most women have suffered from premenstrual syndrome (PMS) at some point in their life. Thirty percent of American women are plagued by a monthly combination of irritability, moodiness, headache, and breast tenderness. In its most severe form, known as premenstrual dysphoric disorder (PMDD), it has been used as a defense for murder. Although some authorities such as Dr Christiane Northrop claim PMS exists only in the minds of husbands and bosses, many women still seek solace. Today's healthcare providers and consumers prefer a stepwise approach to relieving the symptoms of PMS. Most start with the more gentle herbs and supplements and if unsuccessful proceed to antidepressants. In Germany Vitex agnus castus or Chaste Berry has been used for many years to treat PMS as well as a host of other "female maladies." The Chaste berry was well known to the ancients "If blood flows from the womb, let the woman drink dark wine in which the leaves of the Vitex have been steeped" Hippocrates ( 460-377 BC ). Following in Hippocrates footsteps Dr. Rued Schellenberg, Senior Consultant at the Institute for Health Care and Science in Hüttenberg, Germany finds "Agnus castus is a well tolerated and effective for the treatment for the premenstrual syndrome, the effects being confirmed by physicians and patients alike." His recommendations are based on a study published in the January 20 edition of The British Medical Journal. The study is randomized, double blind, and placebo controlled therefor considered to be of high quality. Researchers looked at 170 women who were divided into two groups, one group was given one 20-mg tablet of Chaste Berry once a day, the other was given a sugar pill. After three months, the group that took the Chaste Berry reported significantly less irritability, mood alteration, anger, headache, and breast fullness. Four women reported mild and short-lived side effects, consisting of acne, spotting, and rash. This is an important study by virtue of its size and high quality it offers scientific support for a tried and true remedy. The product used in this study is called Vitex agnus castus L extract Ze 440 made by Zeller AG in Switzerland. Remember nutritional supplements are not regulated in the U.S., consult your healthcare provider for their recommendations concerning brands and dosing of alternative products. BMJ 2001;322:134-137 Back to Top Eating Soy increases Bone Density Ibaraki, Japan January, 17,2000-- If you have read anything about diet or nutrition in the past few years, you are sure to have heard about soy. Various authorities have touted soybeans and their products such as tofu, soy milk shakes, and smoothies as panaceas. According to some recent studies, soy can lower your cholesterol, reduce menopause symptoms, and even help prevent breast cancer. Dr. Yoshiaki Somekawa is a physician in Japan (where the diet is rich in soy) is interested in bone loss in menopause. The doctor has published work on the effect of vitamins on bone loss but today is addressing the effects of a high soy diet on bone density, menopausal symptoms and cholesterol. Bone density is a measure of how thick or strong the bone is. Soy is consumed 10-100 times more frequently by Asian women then by western women. The fact that Asian women suffer less from osteoporosis and bone fractures is thought to be related to their diet. In a study published in the January, issue of Obstetrics and Gynecology Dr. Dr. Somekawa and colleagues at two Japanese hospitals studied four hundred seventy-eight postmenopausal women aged 44-80 years. The researchers calculated the daily intakes of isoflavones, which are the active ingredients in soy. The women were then placed in groups according to their level of isoflavone consumption and whether they were approaching to menopause or well into menopause. Their menopausal symptoms, cholesterol, and bone mineral density were measured and compared. They concluded "High consumption of soy products is associated with increased bone mass in postmenopausal women and might be useful for preventing hypoestrogenic effects." Soy may not be a panacea but in this study bone density was significantly greater in the highest soy intake group compared with lowest intake category. In this group of women, a significant effect of soy intake on cholesterol or menopausal symptoms was not found. However, we have previously reported. Dr. Domenico De Aloysio of the University of Bologna found that in 51 women studied, hot flashed decreased by 45% after 12 weeks of eating 60g of soy protein a day, and there have been several studies showing a protective effect of soybean products against the development of breast cancer. Postmenopausal women who do not want to take hormone replacement therapy may be able control their hot flashes and prevent bone loss by supplementing their diet with soy protein. Obstet Gynecol 2001:97:109-115 Back to Top U.S. Government rules on "Organic" Foods Washington DC, January 10, 2001-- After ten years or wrangling, the Department of Agriculture has imposed standards for the use of the term organic in food labeling. The new rules preclude the use of radiation, genetic engineering, sewer-sludge fertilizer, synthetic pesticides, and antibiotics in food labeled organic. These are the first federal standards ever enacted, "the strongest and most comprehensive organic standard in the world" according to Agriculture Secretary Dan Glickman. As with most new regulations, there is controversy. The "non-organic" food industry represented by the National Food Processors Association does not want people to think organic is synonymous with better or healthier. "The term 'organic' is a marketing term, referring to the manner in which the food was produced, not an indicator of quality or safety," says. Dr. Rhona Applebaum, NFPA's Executive Vice President. The organic food industry is celebrating says Katherine DiMatteo, executive director of the Organic Trade Association. "For the first time, there will be consistent standards and labeling for all organic products marketed in the United States. No longer, will there be questions concerning what 'organic' stands for…" she said. However, the consumer still needs to aware that there are four categories of organic. Food only needs to be 95% organic to labeled organic and 70% organic to be labeled "made with organic ingredients." Truly organic food may be labeled "100% organic" and food with less than 70 percent organic ingredients can not use the term organic. Am I the only one confused? Perhaps it is just too complicated to memorize all at once. I only hope the Department of Agriculture does not make any changes until I get used to these rules. Back to Top The Male Pill: One Small Step Closer Victoria, Australia, January 2, 2001-- Scientists at Prince Henry's Institute of Medical Research in Australia are searching for the Holy Grail of contraception the "male pill". Their quest has lead them to the hormone called testosterone. As you may already know, testosterone is the king of all male hormones. Functions such as regulating sex drive, male secondary sexual characteristics and sperm production are controlled by testosterone. Contraceptive researchers have been studying testosterone for some time, however their labors have been futile. Testosterone, being an inflexible hormone, unlike estrogen, had to be given by injection at frequent intervals. Dr. Robert McLachlan has been working on a new implant that continuously releases testosterone. Researchers first tested 29 normal men for 3-6 months. They reported the implant "…reduces sperm output sufficiently for contraceptive efficacy in approximately 70% of Caucasian men… without significant androgenic side effects". Does that mean 30% were fertile? To answer the question doctors went on to study 16 couples and found there were no pregnancies during 214 months of testosterone use. While the findings are a step in the right direction, the men still needed to have their implants changed every 3 months. The female contraceptive implant called Norplant lasts 5 years. Back to Top What Your Teens Think About Sex Washington, DC December 20, 2000-- Two new surveys reveal what teens are doing and thinking about sex. The Kaiser Family Foundation and Seventeen magazine have been collaborating on a series of studies called SexSmarts. The good news is teens are delaying sexual activity. Moreover, two thirds of teens age 15-17 use contraception every time they have sex with condoms reported as their first choice. The bad news is one third do not know that condoms are effective protection against sexual transmitted diseases (STDs) and up to 50% of teens are using the unreliable withdrawal and rhythm methods. A second study published in the January issue of The American Journal of Public Health sheds some light on risk factors for early and promiscuous sexual behavior. Policy makers and administrators have assumed pregnancy and STDs were the result of poverty, single parent households and involved mostly minorities. Parents and teachers however know different, and the National Longitudinal Study of Adolescent Health confirms that peer pressure is the most important variable in determining high-risk sexual behavior. " [This study]…shows that if we really want to help American teens, we can't put them in neat little boxes based on whether they're black or white, rich or poor, or from a one- or two-parent family." "These problems are everyone's problems." said Surgeon General David Satcher. Specific risk factors that parents can watch for are teens romantic involvement's and having friends that drink alcohol. Teens that have avoided sex attribute their abstinence to parental disapproval and possible interference with college plans. Back to Top Tying Your Tubes Considered Free of Menstrual Irregularities Atlanta GA, December 12, 2000 -- Every year almost 700,000 U.S. women choose tubal sterilization as a means of birth control. Eleven million women have undergone these procedures. In the past most were preformed shortly after giving birth, through a small incision just below the belly button. Today most are done via laparoscope (a thin telescope inserted through a tiny incision) as an outpatient. There have been concerns that the procedure can cause heavy or prolonged periods necessitating a subsequent hysterectomy. These concerns have been debated in the medical literature over the past 50 years. Now there is a large prospective (forward looking) study comparing the menstrual cycles of women who have undergone tubal sterilization to women who have not. Researchers at several leading institutions including the Centers for Disease Control and Prevention have just published their findings in The New England Journal of Medicine. Dr. Herbert B. Peterson and associates studied 9514 women who underwent tubal sterilization and 573 women whose partners underwent vasectomy for comparison. Telephone interviews were conducted for five years. The women were asked detailed questions about their periods both before and after their surgical procedures. The scientists concluded, "Women who have undergone tubal sterilization are no more likely than other women to have menstrual abnormalities". In an accompanying editorial Dr. Carolyn Westhoff, M.D. from Columbia University said " These findings are relevant to society and to third-party payers, and we can hope that trends toward greater insurance coverage for contraceptive methods will continue. Meanwhile, women will continue to find tubal sterilization economically sensible as well as acceptable in other ways." A simple finding that should reassure all women who are considering this procedure. N Engl J Med 2000;343:1681-7. Back to Top Womens disorder receives national recognition Washington, D.C. November 29, 2000-- Vulvodynia is a poorly understood women's disorder characterized by vaginal burning and pain. Vulvodynias impact on a women's life ranges from an inconvenient itch to constant pain and the inability to engage in sexual intercourse. Thanks to a new grant by the National Institutes of Health, vulvodynia will receive the recognition it deserves. "This funding is a major milestone for the hundreds of thousands of women suffering from chronic vulvar pain, a condition which interferes with their ability to lead full physical, social and sexual lives. We need to find out what causes vulvodynia and develop better treatment strategies," says Phyllis Mate, Executive Director of the National Vulvodynia Association. While it is suspected to effect hundreds of thousands of women, the true incidence is unknown. Bernard Harlow, Ph.D., Associate Professor of Obstetrics, Gynecology, and Reproductive Epidemiology at Harvard Medical School has planned a five year study to determine just how many women are effected. "We are confident that the data generated will expand our knowledge of potential biological determinants and environmental factors that influence the risk of vulvodynia. It is our hope that this understanding will lead to novel treatments for patients suffering from this debilitating disorder," said Dr. Harlow. Dr Gloria Bachman, M.D., Professor of Obstetrics, Gynecology and Medicine at the University of Medicine and Dentistry of New Jersey, is conducting a study that will concentrate on educating the public, which will include health care providers, who tend to under diagnose or inappropriately treat the condition. The cause of vulvodynia is unknown however allergies or other environmental factors, yeast and other infections or skin conditions can be involved. Treatments have ranged from biofeedback to surgery. Back to Top The Rhythm Method: No Rhyme For ThirdAge Women. Durham, NC. November 22, 2000-- By the time a women enters her forties she hopes her fertility has decreased to the point where she can get off the pill and use a more natural method of contraception. The rhythm method also known as natural family planning was thought to provide adequate protection in this age group. However, a new study has shown that up to 70% of women, especially perimenopausal women are fertile and therefore can get pregnant during the time of month when they thought they were safe. It had been thought that the vast majority of pregnancies occur during a "fertile window" which comprises days 10 to 17 of the menstrual cycle. A recently completed study conducted by the National Institute of Environmental Health Sciences found, "There are few days of the menstrual cycle during which some women are not potentially fertile". Researchers studied 696 cycles from 213 women to determine how effective the rhythm method is. Allen J. Wilcox, M.D., concluded in this months British Medical Journal "Women should be advised that the timing of their fertile window can be highly unpredictable, even if their cycles are usually regular" British Medical Journal Vol. 321, pp 1259-1262. Back to Top Herb Found Safe in Pregnancy Toronto, Ontario November 14, 2000-- Pregnancy is a state of immune suppression and if you have ever been there you know pregnant women are virtual sponges for every cold, flu, stomach or other bug around. Once caught these viruses are notoriously hard to shake. Echinacea is a fairly well studied herb and although the studies are not unanimous in showing efficacy it's safety in non pregnant individuals is accepted and in the past few years Echinacea has made it's way into many medicine cabinets. People will try it when in coming down with another cold. However, patients and physicians alike have been reluctant to use it in pregnancy. Avoiding medicinal herbs, especially during the first trimester has been the gold standard of traditional medicine for the past 100 years. Naturopathic physicians however, often rely on traditional use of herbs rather than waiting for results of studies for which clinical experience tells them what the results will be. Researchers at the Canadian College of Naturopathic Medicine were clever enough to design a study of Echinacea in pregnancy. They said "since at least half of all pregnancies are unplanned, many women inadvertently use echinacea in their first trimester". Therefore, they followed 206 women who used echinacea during pregnancy, 112 of which used it in the first 12 weeks during organogenesis (when basic organs are being formed). These women were compared with closely matched women who didn't take echinacea (control group). When pregnancy outcomes were analyzed the scientists reported no more birth defects, miscarriages, or other complications in the echinacea group then in the control group. "Naturopathic medicine is safe and effective. In order for the world to recognize this, more well constructed scientific studies such as this one are needed. Bravo, to these authors." says Dr. Harry Adelson, a naturopathic researcher at Yale/Griffin Prevention Research Center. Arch Intern Med. 2000;160:3141-3143 Back to Top New Laser Treatment for Vaginal Bleeding Excessive menstrual bleeding (menorrhagia) is common in the peri menopausal period and may effect up to one third of all women. Generally it is self-limiting lasting only one or two cycles but heavy bleeding can become a persistent problem. Frequently physicians will try medical therapy such as progesterone, which is often ineffective or associated with unwanted side effects. In the past a D&C (dilation and curettage) a surgical scraping on the lining of the uterus was routinely performed even though it rarely worked. Often women would end up with a hysterectomy .In the past few years a new technique called endometrial ablation has been used. Ablation is similar to a D&C but in stead of scraping the lining of the uterus off it is destroyed by either freezing or burning by inserting a balloon full of cold or hot liquids. Since it is hard to get the balloon to reach the entire uterine cavity ablation has had a low success rate. Dr. Jacques Donnez and colleagues at The Universite Catholique de Louvain in Brussels have just completed a study of a new laser procedure called ELITT (endometrial laser intrauterine thermal therapy). ELITT promises to be both safer and more effective than older procedures. Dr Donnez used the procedure on 100 women average age 42, with abnormal bleeding. When surveyed 98% reported satisfaction with the procedure only two women needed a subsequent hysterectomy. Researches concluded "The technique is very safe and offers the highest amenorrhea (elimination of bleeding) rate to date in the literature". Fertil Steril 2000;74:791-796. Back to Top Sex enhancing drug tested in women Hauppauge, NY October 31, 2000-- The Nastech Pharmaceutical Company has completed preliminary (Phase I) testing of a new drug aimed at treating female sexual dysfunction. The drug called apomorphine is not exactly new. What is new is that it is a nasal spray. It has been tested in men with erectile dysfunction and compared favorably to Viagra. When given by mouth apomorphine caused undesirable side effects such as dizziness, sweating and vomiting. This study was small, involving only 48 doses however it did indicate that the drug is safe and does not cause any side effects when given via the nasal route. The Phase I study was designed to simply determine the safety and side effects of intranasal apomorphine in healthy female subjects. Formulating drugs to be given by nasal spray is what the company Nastech specializes in. "The results of this study allow us to move forward with Phase II, at home, clinical efficacy studies in women" said Charan Behl, Ph.D. Executive Vice President of Research and Development at Nastech. The phase II studies will determine the effectiveness and correct dose for women experiencing problems with arousal and painfull intercourse. Unlike Viagra, which acts primarily in the genital organs, apomorphine acts in the brain. Back to Top Sex after menopause Worcester, MA October 23, 2000-- Is sex the same after menopause? How does menopause change sexual functioning and what other factors are involved in sex after menopause? These are some of the questions researchers at the New England Research Institutes and the University of Massachusetts Medical School set out to answer. Lead by Dr. Nancy Avis, the scientists studied 200 women who were going through menopause. All of the study participants had sexual partners, went through a natural menopause, and were not on hormone replacement therapy. The women were grouped according to whether they were in early, mid or late menopause. Hormone levels were measured. A thorough survey was undertaken including questions about sexual satisfaction, frequency of sexual intercourse and pain during intercourse. Questions such as "Do you believe that interest in sex declines with age" were asked to try to see if pre conceived notions played a roll. Participants were asked how easily they were aroused now compared with when they were younger and if they had difficulty reaching orgasm. Other issues such as socioeconomic status, general health and marital status were factored into the equation. Findings were published in the current issue of Menopause, the official journal of The North American Menopause Society. Their results indicated that menopause women did believe that sexual desire declines with age and they reported a lower sexual desire and decreased arousal associated with menopause. However what's more interesting is that "...other factors such as health, marital status (or new partner), mental health, and smoking had a greater impact on women's sexual functioning than menopause status". Other findings concluded that women were generally satisfied with their sex life, which included sex about once a week. Menopause 2000;7:297-309. Back to Top Breast Cancer and The Pill Rochester, Minn October 17, 2000 Researchers at the Mayo Clinic report that daughters and sisters of women with breast cancer who took birth control pills prior to 1975 are at increased risk of breast cancer. The scientists revisited a group of 426 women with breast cancer diagnosed between 1944 and 1952. These families were contacted recently, looking for close relatives who have subsequently developed breast cancer. When the relatives were asked about oral contraceptive (OC) use it was discovered that the risk of breast cancer was over three times higher in sisters and daughters who had used OC's then in those who did not. The study published in the October tenth issue of The Journal of the American Medical Association counsels caution when recommending OC's to women at high risk of breast cancer. Until now health care providers have been reassured by a large meta-analysis (a study of studies). The meta-analysis combined findings from over 50 studies and concluded there was only a slight, if any risk associated with OC use. Breast cancer is generally detected earlier in women on the pill, which led physicians to believe the slightly increased rates may have been due to early detection alone. This argument is also used to explain the slight increase in numbers of women who develop breast cancer on Hormone Replacement Therapy. The study at hand raises another question that may have a direct bearing on OC use today. There was no increased risk of cancer among women who started using OC's after 1975. By 1975 the older pills were being phasing out, because they contained high levels of hormones. This could indicate that the new low-dose pills might not pose the same danger as the older high-dose pills did. Alternatively it could be argued that the post 1975 pill use group are just not old enough yet to demonstrate the increased risk. Clearly health care providers who prescribe OC's will now have to take into consideration women's family history of breast cancer before recommending the pill. JAMA. 2000;284:1791-1798. Back to Top Once-a-month birth control now available in US. Peapack, NJ October 10, 2000-- A new birth control option has received U.S. Food and Drug Administration (FDA) approval for prescription use. The drug is called Lunelle™ and is essentially the birthcontrol pill in injection form. Pharmacia Corporation , the makers of Lunelle feel it will be usefull for women already on the pill but who often forget to take it. "Why would a women want to go to her doctor office every month when she can go every three months for a Depo provera™ injection" says Alyce Hilton LPN, a womens health nurse who often administers these injections. Depo provera is a progesterone only injection also made by Pharmacia Corporation. Lunelle is a combination of two hormones estrogen and progesterone. The injection can be given at physicians offices but plans are underway to make it available at pharmacies or other locations such as the workplace. Women on Lunelle will get a monthly period and fertility returns rapidly after discontinuation, 50% became pregnant within 6 months of their last shot. FDA approval was based on a large clinical study of 1,103 women. In the study 782 women used Lunelle and 321 women used a popular oral contraceptive for 15 months. The results showed no unintended pregnancies in the Lunelle group and two in the oral contraceptive group. Lunelle still has the same possible side effects as the pill and Depo provera including weight gain and irregular bleeding Lunelle does not protect against HIV and other sexually transmitted diseases. And unfortunately Lunelle can't be used by men. Back to Top The Abortion Pill Receives FDA Approval Washington, DC October 3, 2000-- On thursday the FDA approved the controversial drug mifepristone also known as RU-486. The medication will not be available by prescription it will be distributed by physicians who meet certain requirements set forth by the FDA. RU-486 will be sold under the brand name of Mifeprex by the New York based pharmaceutical company Danco Laboratories and could be in doctors' offices by late November. According to the FDA in order to qualify the physicians must be able to "accurately determine the duration of a patient's pregnancy and detect an ectopic (or tubal) pregnancy. Physicians who prescribe mifepristone must also be able to provide surgical intervention in cases of incomplete abortion or severe bleeding--or they must have made plans in advance to provide such care through others." The pill works by blocking progesterone, the hormone that supports pregnancy. Without progesterone the body rejects the pregnancy and with the help of a second drug misoprostol taken two days later, the body then expels the pregnancy similar to a miscarriage. Complications have been seen in the original tests conducted in France and in the initial US trials. A small number of women experience heavy bleeding requiring a surgical procedure called a D&C to complete the abortion. For the most part if used by the fifth week of pregnancy or seventh week from the first day of the last menstrual period, the regimen is safe. Safety is not the issue for Judie Brown, president of American Life League. "Contrary to what presidential candidate Al Gore has claimed regarding the 'safety' of this chemical, the fact is, it will not be safe for one child." she said. "The approval of mifepristone is the result of the FDA's careful evaluation of the scientific evidence related to the safe and effective use of this drug," said Jane E. Henney, M.D., Commissioner of Food and Drugs. The FDA's Mifepristone Information Page Back to Top Controversy surrounds mammograms usefulness Toronto, Ontario September 26, 2000-- The Canadian National Breast Screening Study-2 just published in the September 20 issue of the Journal of the Nation