Until 2002, hormone therapy was routinely used to treat menopausal symptoms and protect long-term health. Then a large clinical trial unearthed its health risks. What does this mean to you?
During menopause, your ovaries decrease production of the female hormones estrogen and progesterone. This decline in hormones puts a permanent end to menstruation and fertility, but it can also cause hot flashes, mood swings, vaginal dryness and urinary problems. The solution? For decades, doctors routinely eased these symptoms with hormone replacement therapy — medications containing female hormones to replace the ones the body is no longer making. And it was widely believed that boosting estrogen levels after menopause could also ward off heart disease and osteoporosis, while improving quality of life and keeping women young.
Then, in 2002, a large clinical trial called the Women's Health Initiative (WHI) reported that hormone therapy actually posed more health risks than benefits for women in the clinical trial. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And up to two-thirds of women on the therapy discontinued its use, often without talking to their doctors.
Today, there's plenty of confusion about hormone replacement therapy, which is now commonly called hormone therapy. The truth is that hormone therapy is not the magical cure for aging that it was once believed to be, but it's still the most effective treatment for unpleasant menopausal symptoms for most women. If you're facing menopause, learn more about the benefits and the risks of hormone therapy.
What are the risks of hormone therapy?
The Women's Health Initiative found that women taking the combination estrogen-progestin (Prempro) used in the study had an increased risk of developing certain serious conditions. According to the study, over one year, 10,000 women taking estrogen plus progestin compared with a placebo might experience:
■Seven more cases of heart disease
■Eight more cases of breast cancer
■Eight more cases of stroke
■18 more cases of blood clots
Based on these numbers, the increased risk of disease to an individual woman is small. However, the overall risk to menopausal women as a group became a substantial public health concern. In addition, researchers found that women taking combination estrogen-progestin had an increase in abnormal mammograms. The higher number of false-positives — signs of possible breast cancer that ultimately prove inaccurate — was probably due to estrogen, which increases breast tissue density.
For women taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease. But researchers did find that over one year, 10,000 women taking estrogen compared with a placebo might experience 12 more cases of stroke and six more cases of blood clots in the legs, plus an increase in mammography abnormalities. This last point is important, because women who take estrogen or combination estrogen-progestin therapy may need more frequent mammograms and additional testing.
What are the benefits of hormone therapy?
Estrogen remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.
Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:
■Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
■Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
■Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.
For women who undergo menopause naturally, estrogen is typically prescribed as part of a combination therapy of estrogen and progestin. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.
Who should consider hormone therapy?
Despite the inherent health risks, estrogen is still the gold standard for treating menopausal symptoms. For women who experience moderate to severe hot flashes or other menopausal symptoms, the benefits of short-term therapy outweigh the potential risks.
Data surrounding hormone replacement therapy can be scary and confusing. But the absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms. Talk with your doctor about your personal risks.
Who should avoid hormone therapy?
Women with breast cancer, heart disease or a history of blood clots should not take hormone therapy for relief of menopause symptoms. Women who don't suffer from menopause symptoms should not take hormone therapy for preventing memory loss or strokes. Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.
If you take hormone replacement therapy, how can you protect yourself from the added risks?
Recent analysis of the WHI data and other trials suggests that there are several ways to reduce the inherent risks of hormone therapy. Talk to your doctor about these strategies:
■Time it right. The risk of hormone therapy causing heart disease is not significantly raised in women under age 60. In fact, some studies suggest that estrogen may protect the heart when taken early in your menopausal years.
■Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms. On the other hand, don't be scared to continue treatment as long as you have debilitating menopausal symptoms.
■Find the best delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream or slow-releasing suppository or ring that you place in your vagina. If you experience only isolated vaginal symptoms, estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That's because estrogen applied directly to your vagina is more effective at a lower dose than is estrogen given in pill or skin patch form.
If you haven't had a hysterectomy and are using oral or skin patch hormone therapy, you will also need progestin, which is available in a pill, combination pill, vaginal gel, intrauterine device or combination skin patch. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.
What can you do if you can't take hormone therapy?
Women shouldn't have to suffer through menopause. You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you change your exercise or eating habits before you try medication. If lifestyle changes aren't providing enough relief from bothersome symptoms, there are many medications besides hormone therapy to relieve discomfort.
The bottom line: Hormone therapy isn't all good or all bad
Clearly, hormone replacement therapy hasn't lived up to its billing as a panacea for age-related disease. But the news isn't all doom and gloom either.
The only way to determine if hormone replacement therapy is the best treatment for you is to talk to your doctor about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. Review your current treatments with your doctor on a regular basis to make sure they're still your best option.
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Monday, January 19, 2009
Barack Obama will swear his presidential oath of office on the bible Abraham Lincoln used.
He will rest his left hand on the tome, which was borrowed from the Library of Congress, to recite his 35-word oath.
According to the Presidential Inaugural Committee, the 44th US president was “deeply honoured” to be given access to the Lincoln Bible, which has not been used for any presidential inauguration since 1861 when his illustrious predecessor, the 16th president, was sworn in.
Emmett Beliveau, of the PIC, said: “The president-elect is committed to holding an inauguration that celebrates America’s unity, and the use of this historic bible will provide a powerful connection to our common past and common heritage.”
After the swearing in watched by millions, Obama will enjoy a relatively secluded lunch with around 200 congressional leaders, Supreme Court justices and members of his incoming cabinet.
Once again, the 44th US president has opted to evoke the spirit of his political idol Abraham Lincoln, serving the seafood, game and root vegetables he liked best on replicas of his White House china.
Guests will begin their meal with a seafood stew of scallops, prawns and lobster with a puff pastry top, washed down with a 2007 Sauvignon Blanc from Duckhorn Vineyards in California’s Napa Valley.
Following on will be a brace of American birds: duck breast with sour cherry chutney and herb roasted pheasant with wild rice stuffing accompanied by Molasses-whipped sweet potatoes and winter vegetables. Another Californian wine, a 2005 Goldeneye Pinot Noir from the Anderson Valley, will be served alongside.
The desert will be cinnamon apple sponge cake and sweet cream glace, during which guests will be invited to toast their new leader with some a Korbel Natural “Special Inauguration Curvee” California Champagne, 18 magnum cases of which have been dispatched to the White House for the occasion.
Around two million people are expected to brave the cold to watch the 44th President of the United States and his inaugural parade.
Most spectators will be forced to stand throughout – tickets for the 5,000 seats costing £17 on the 1.7 mile route went on sale at 1pm on Friday and sold out within a matter of minutes.
Among the estimated 13,000 people and 90 groups taking part in the parade down Pennsylvania Avenue are ceremonial military regiments, citizens’ groups, marching bands and floats.
Children from Obama’s Punahou High School left Hawaii, where the president grew up, arrived last week in a bid to acclimatise to the cold before they perform.
Obama and his family will ride along the parade route in a new armored Cadillac that has already been nicknamed “The Beast”.
People attending the inauguration have been asked to limit the use of mobile phones amid fears a surge in calls, texts and photo messages will overwhelm the networks.
The move comes as carriers are spending millions to temporarily upgrade their networks in Washington in anticipation of a rise in demand.
The companies believe thousands of people at the inauguration will want to share the experience with friends and family at home, but have asked their customers to delay using their phones.
Joe Farren, spokesman for the Cellular Telecommunications and Internet Association, said: “If some of these estimates come true, people should anticipate delays with regards to sending text messages or making phone calls or getting onto the internet.
“We can only bend the laws of physics so much.”
Virtually every entertainer in American has been pressed into service for a series of balls to celebrate the inauguration.
Barack Obama and his wife will attend ten official events tonight, finishing at 3am, including the Neighbourhood Ball which is being held for Washington residents.
Another 14 unofficial balls also being staged including the Africa on the Potomac ball, the Inaugural Purple ball and the Human Rights Campaign’s Equality ball.
Nicole Gianturco, of Event Emissary, the company organising the Blue Diamond Ball and the Green Inaugural Ball, said this year’s focus was less on glitz and more on good causes.
“These balls are incredibly expensive and people are saying, 'Let’s scale back here and there because we want to have a platform, we want our message to go out, to be on the new administration’s first 100 days’ agenda,” she said.
American cities have seen a rush on cosmetic procedures such as Botox and lip plumping injections as partygoers get ready for the inaugural parties.
Beauty salons and cosmetic dermatologists in Washington DC and other major cities have witnessed a surge in demand for “quick fixes” such as wrinkle-smoothing injections or microdermabrasion ahead of the balls.
Cosmetic dermatologist Tina Alster said: “We have been absolutely swamped since the election with people desiring rejuvenation procedures for the forthcoming inauguration.”
Hema Sundaram, a cosmetic and laser surgeon who runs two offices in the Washington area, added: “My normal load for cosmetic procedures has doubled, except for hyaluronic acid fillers – Perlane and Restylane – which have almost tripled.”
The pair told the paper their clients included Washington socialites and political professionals as well as lobbyists and lawyers.
The pilot who crash landed his plane in New York’s Hudson River has been invited to attend the inauguration.
Captain Chesley B. ”Sully” Sullenberger and his family have been invited to Washington along with five crew members from Flight 1549.
The captain’s wife, Lorraine Sullenberger, and daughters have still not seen him since he was hailed a miracle by officials and aviation experts.
Mrs Sullenberger’s wife said they were excited about the invitation. She said: “Our daughters would love to go see the Jonas Brothers. I would love to go. It’s in the works, I believe.”
No presidential inauguration would be complete without a plethora of souvenirs created to honour the new president and his family.
Shops have sprung up all over the capital offering everything from badges, flags, T-shirts and hats to iPod cases, Obama action figures, playing cards, thongs and even condoms.
Amazon set up a special website, Inauguration Day 2009, offering traditional souvenirs along with widescreen televisions and digital recorders for those watching at home, and Obama Blend Kenyan coffee and a Patriotic Party Kit with US flag paper plates, cups and napkins to get them in the spirit.
Those attending the event in Washington were offered Washington travel guides, fur-lined hats and cameras, while those wanting to get into their new president’s mind were offered some of his favourite books, including an Abraham Lincoln biography.
Tourists in Kenya are being lured away from the country’s famous game parks and white-sand beaches by a new attraction – the Obama Safari.
Tour firms are already offering tailored safaris to Kenya’s little-visited west, and especially to the village of Kogelo where the president-elect’s step-grandmother Sarah Obama still lives and where his father, also called Barack, is buried.
Itineraries include a trip to Mama Sarah’s modest homestead, although curious tourists are kept at bay by a new 6ft fence installed just before last year’s election.
Visitors can see the Senator Barack Obama secondary school, and walk through the market where the president wrote of haggling over maize prices with cheerful traders when he last visited his family.
“Explore the humble village and its primary school, health centre and secondary school named after the president elect,” boasts one tour operator in publicity for its ’Seven night Obama Package’, costing £500.