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Health A-Z

Health A-Z

For information on a particular condition or topic try our Health A-Z with links to this and other Jean Hailes websites or use the website search function.

Health Tips

Challenging the myths around dieting and weight from our Health for Women website

A few simple lifestyle changes can prevent kilo creep, without dieting. Learn more...

 
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Link between endometriosis and ovarian cancer probed

Some women with endometriosis, a chronic inflammatory disease, are predisposed to ovarian cancer, and a genetic screening might someday help reveal which women are most at risk, according to a new US study presented at the American Association for Cancer Research (AACR) Annual Meeting on 7 April 2014.


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Analysis reveals inflammation pathway linked to complex cases of endometriosis

One in ten women are affected by endometriosis at some point during their reproductive years, but cases vary widely in the location of disease (ovaries, peritoneum, vagina, rectum, or any combination thereof) and the symptoms it causes (some women have none, some suffer different types of pain, some become infertilie, some don't). Scientists at the Massachusetts Institute of Technology (USA) may have moved a step closer to understanding how the disease develops, which may help to diagnose and classify cases, and even develop new strategies for treatment.


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Full-fat dairy actually helps avoid obesity

For decades women and men have been swapping to "low-fat" forms of milk, cheese and yoghurt in an attempt to lower their cholesterol levels and avoid obesity. However, an analysis last year of 16 relevant studies (with a total of more than 300,000 subjects) has conculded that consuming high-fat dairy products "within typical dietary patterns" is in fact associated with a reduced risk of obesity.


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IVF babies mostly grow up to be healthy adults

Most children conceived via assisted reproductive technology (ART) such as in vitro fertilisation (IVF) grow into healthy young adults, with a quality of life and educational achievement comparable to those of non-ART conceived peers, according to the largest study yet into the effects of ART in young adults.


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'Emotional similarity' in others helps us cope with stress

Sharing a threatening situation with a person in a similar emotional state can protect you from stress, according to a recent US study.

Sarah Townsend, assistant professor of management and organization at the University of Southern California Marshall School of Business, asked 52 female undergraduate students to give a speech in front of a small audience and on camera - commonly a stressful task. Before making their speech, participants were paired up and encouraged to discuss with each other how they were feeling about making their speeches. Levels of the stress-related hormone cortisol were measured in each participant before, during and after their speeches.


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2 in 5 women worry about ability to conceive, but many don't know what affects their chances

40% of women aged 18-40 in a recent US surveyed expressed concern about their ability to conceive, but many did not know key facts about what factors influence women's chances of conception.

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Most new mums don't enjoy parenthood until Baby is 6 months old

The average first-time mum doesn't enjoy motherhood until their baby is six months old, and one in six don't really start to enjoy it for 12 months, according to a UK survey by Neurofen for Children.


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PCOS associated with higher risk of gestational diabetes and type 2 diabetes

In women aged 28-33, the presence of polycystic ovary syndrome (PCOS) is independently associated with a higher risk of gestational diabetes and type 2 diabetes, independent of Body Mass Index (BMI), according to a recent study at Monash University. Prof. Helena Teede and colleagues analysed data on more than 9,000 women across ten years from the Australian Longitudinal Study on Women's Health. After adjusting for age, BMI, hypertension, smoking and demographic factors, the odds of gestational diabetes (in women who had been pregnant) and type 2 diabetes both remained increased in women with PCOS. The authors recommend "aggressive screening, prevention and management of dysglycaemia" (abnormal blood sugar levels) in women with PCOS.

Higher risk of birth problems after assisted conception

The risk of serious birth complications such as stillbirth, preterm birth, low birth weight and neonatal death is around twice as high for babies conceived by assisted reproductive therapies (e.g. IVF) as for naturally conceived babies, according to researchers at the University of Adelaide.

Prof. Michael Davies and colleagues at the University's Robinson Institute compared the outcomes of more than 300,000 births (including more than 4,300 births from assisted reproduction) in South Australia over a 17-year period. "Very low and low birth weight, very preterm and preterm birth, and neonatal death were markedly more common in births from IVF [in-vitro fertilisation] and, to a lesser degree, in births from ICSI [intracytoplasmic sperm injection]," said Prof. Davis. The findings were published online by PLOS ONE.


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High blood pressure during pregnancy could elevate risk of future stroke

A systematic review at the University of Calgary (Canada) has found that women who had high blood pressure (particularly pre-eclampsia) during pregnancy could be at higher risk of stroke in future. Dr Aravind Ganesh and colleagues reviewed nine studies, which followed women for 1-32 years after pregnancy, and found consistent evidence that women with a history of high blood pressure in pregnancy are more likely to experience stroke in later life.


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Unless you have hot flushes, HRT won't improve your quality of life

Hormones at menopause can help with sleep, memory and more - but only when a woman also has hot flashes, an experiment at Helsinki University in Finland has concluded.

Dr Hanna Savolainen-Peltonen et al. split 150 women who had recently gone through menopause (72 suffering 7+ moderate to severe hot flashes per day; 78 experiencing fewer than 4 mild flushes per day) into two groups: One group received hormone therapy of various kinds for six months, while the others received 'placebo' pills containing no hormones. Hormone therapy helped the women who had moderate to severe hot flashes with their sleep, memory and concentration, anxiety and fears, exhaustion, irritability, swelling, joint and muscle pains, hot flashes, vaginal dryness, and general health. For the women with mild or no hot flashes, though, hormone therapy made no difference.


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Breast density, BMI and ethnicity linked to cancer risk when taking HRT

Whether taking hormone replacement therapy (HRT) changes your risk of breast cancer or not could depend on your ethnicity, your weight and the density or fat content of your breasts, according to a study published in last month's Journal of the National Cancer Institute. Dr Ningqi Hou et al. from the University of Chicago analyzed race/ethnicity, age, body mass index (BMI) and breast density data from 1.6 million postemenopausal women, 9,300 of whom (0.6%) were diagnosed with breast cancer. They reported that HRT correponded with increased rates of breast cancer in Caucasian, Asian and Hispanic women, but not in African American women. Likewise, HRT use was associated with increased breast cancer risk in women with low or normal BMI and very dense breasts, but in overweight women with less dense breasts (i.e. with breast tissue composed largely of fat) HRT was not assciated with any increase in cancer risk.

The authors hope that their findings could be used to help identify women who may use HRT to relieve postmenopausal symptoms without increasing their risk of breast cancer (see press release).

"This large US study suggests that a number of factors influence the risk of breast cancer associated with HRT in postmenopausal women," says Prof Henry Burger, endocrinologist and co-founder of Jean Hailes. "These are generally well known, and include the influence of ethnicity (risk not increased in Black African women) obesity (no increase in risk in obese women), breast density (increase in women with dense breasts)". "The paper has a number of major flaws," warns Prof Burger, "as it provides no information on type or duration of HRT use. It does draw attention to the high risk group of women who are underweight and have dense breasts."

Anti-Müllerian hormone (AMH) tests

Anti-Müllerian hormone (AMH), a hormone produced by follicles as they grow in ovaries, is being investigated as a marker of women's remaining fertility "reserve" and a way of predicting menopause, according to Climacteric (the journal of the International Menopause Society), February 2013. AMH may provide a convenient and non-invasive predictor of ovarian response to surgical or medical interventions, e.g. hysterectomy or chemotherapy, reports the journal; and the hormone may also be useful for diagnosing polycystic ovary syndrome (PCOS), as increased AMH levels are detected in 92% of women with PCOS.

Whilst research suggests that AMH shows promise in both predicting menopause and being a marker of female fertility reserve, says Dr Sonia Davison, editor of Climacteric and an endocrinologist at Jean Hailes, "its current use is limited. The tests that measure AMH vary considerably in different pathology labs and may lack accuracy and precision. In addition, the normal levels of AMH for women of different ages are still under debate."

HRT for preventing heart disease

"A major misperception concerning postmenopausal hormone replacement therapy (HRT) is that the associated risks are large in magnitude and unique to HRT", say Drs Howard Hodis and Wendy Mack in the second part of a two-part review of HRT and prevention of coronary heart disease, published online in May 2013 by the Journal of the American Geriatrics Society.

In part 1, the authors compared data on the effects of aspirin, statins and HRT on coronary heart disease risk - Neither aspirin nor statins were found to be effective in a "primary prevention" setting in women, but starting HRT before age 60 significantly reduced both disease risk and mortality.

In the second article, the authors review safety data from randomised controlled trials, concluding that the risks of HRT are "predominantly rare" (less than 1 event per 1,000 women treated) and it can be used safely for primary coronary heart disease prevention in women under 60 years old or less than 10 years past menopause.

Why do women go through menopause?

On 7 June, The Conversation website published a thought-provoking article by Dr Dyani Lewis, sexual health researcher at University of Melbourne, summarising various theories as to why women experience menopause. "Media focus with regard to menopause typically involves symptoms, treatment options and risks of treatments at and around the menopause," says Dr Sonia Davison, an endocrinologist at Jean Hailes. Dr Lewis' article, says Davison, "takes one step back and looks instead at why human females undergo menopause whereas other mammalian species do not." The article briefly discusses a few theories that may explain why human females undergo menopause. One that interests Dr Davison suggests menopause may serve to reduce "conflict between women and their mothers-in-law" by altering the roles that women of different reproductive status have within the family.

Oestrogen may relieve post-menopausal joint pain

Post-menopausal women, who often suffer from joint pain, could find some long-term relief by taking oestrogen-only hormone replacement therapy (HRT), according to a new report from the Women's Health Initiative (WHI) in the US.

Of the 10,739 post-menopausal women enrolled in the oestrogen-alone arm of the WHI trial, all of whom had had hysterectomies, 77% reported joint pain. After one year of treatment, joint pain frequency was slightly lower among women receiving oestrogen-only HRT (76.3%) than among those who had been given placebo (dummy) pills (79.2%). "These findings suggest oestrogen may provide modest but sustained relief for post-menopausal women who suffer from joint pain," said lead author Dr Rowan Chlebowski of the Los Angeles Biomedical Research Institute in a press release.

Endocrinologist Prof Henry Burger, co-founder of Jean Hailes for Women's Health and past president of both the Australasian Menopause Society and the International Menopause Society, says these findings suggest that conjugated equine oestrogens (at the dose used) may have "a very small effect" to improve joint pain in postmenopausal women without a uterus. However, Prof Burger warns that use of HRT to improve joint symptoms is controversial, and "regrettably, this paper adds nothing to resolve the controversy". While the effect measured was statistically significant, because of the large numbers in the study, he doubts that it is clinically significant - that is worth putting into practice. Prof Burger also notes that the population studied is not representative of women usually treated for menopausal symptoms.

New claims of HRT breast cancer link from WHI

On March 29, the Journal of the National Cancer Institute released online a new report from the Women's Health Initiative (WHI) in the US, purporting to link the use of a particular hormone replacement therapy (HRT) combination (conjugated equine oestrogens + medroxyprogesterone acetate) with increased risk of developing breast cancer and increased risk of dying from the disease. An accompanying editorial, however, notes that most observational studies have linked this HRT combination with "more positive outcomes".

Endocrinologist Professor Henry Burger, co-founder of Jean Hailes for Women's Health and past president of both the Australasian Menopause Society and the International Menopause Society, says the new report is one of several from the WHI claiming an increased risk of breast cancer with this particular HRT combination, but notes that the population studied in WHI was not representative of women usually treated to relieve menopause symptoms. For a discussion of an earlier such report from WHI, see the Jean Hailes Managing Menopause portal.

The new report "adds no new knowledge", says Prof Burger, "and cannot be used to suggest that other combinations of hormones would show similar results."

Importantly, these reports do not give due consideration of the benefits of HRT for women who are suffering severe and distressing menopausal symptoms. The recently published Global Consensus Statement on Menopausal Hormone Therapy provides a balanced view of currently perceived benefit and risk, and concludes that the benefits derived from HRT for women suffering menopausal symptoms under the age of 60, or within 10 years of menopause, will generally outweigh the risks. The decision to take HRT should be individualised, according to each woman's individual symptoms and health status, in consultation with a suitably qualified health professional.

Hints at how hot flushes happen

Hot flushes affect up to 75 per cent of women around the time of menopause, but why dwindling oestrogen levels can make you feel hot and sweaty is still a mystery. Researchers at the University of Arizona (US) have now found a clue to the mechanism behind hot flushes – a "switch" in the brain that controls responses to heat and goes "haywire" when oestrogen levels drop.

"When you flush", explains Professor Naomi Rance in a University of Arizona press release, "your skin gets hot and you can see the redness... It is an attempt of the body to get rid of heat, just like sweating. Except that if you were to measure core temperature at that point, you would find it is not even elevated." This effect can be modelled in female rats – if you remove their ovaries, to simulate menopause, their bodies try to shed heat by increasing blood flow through their tails.

Prof Rance and her team found that if certain brain cells (which show increased activity in postmenopausal women) are inactivated in rats, tail skin temperature stays low, regardless of oestrogen levels or ovary removal. It seems these cells are a critical component of the "black box" connecting oestrogen levels and heat responses.

This research is "a further step" towards clarifying the mechanism of hot flushes, says Jean Hailes endocrinologist Prof Henry Burger; "Whether this will have any implications for treating flushes in future years is not clear."

Sunshine may help ward off rheumatoid arthritis

Regular exposure to sunlight may reduce your risk of rheumatoid arthritis, according to a US study of nearly 222,000 women.

Dr Elizabeth Arkema et al. of Harvard School of Public Health and Brigham and Women's Hospital studied health records of 106,368 female nurses from the first US Nurses' Health Study (born 1921-1946) and 115,561 female nurses from a second study called NHS II (born 1947-1964). They also estimated the amount of ultraviolet (UV) light that each nurse was exposure to – based on latitude, altitude and cloud cover where the women lived.

Among the women from the first NHS group, those who had been exposed to more sunlight (specifically more radiation in the middle of the UV range) were less likely to have developed rheumatoid arthritis by the end of the study.

The same pattern was not seen among women in the NHS II group, though – The authors think this may be due to different sun-protective behaviours (eg greater use of sunscreen) among women in the later generation.

The researchers propose a mechanism involving vitamin D, which is produced in skin exposed to sunlight and which is necessary for healthy bones, immune system and other essential body processes: Less sun exposure over time means lower lifetime vitamin D levels, which may in turn confer a higher risk of rheumatoid arthritis.

An earlier Australian study, cited by the Harvard team, showed no link between UV radiation from the sun and risk of rheumatoid arthritis.

"The message for the majority of women," says Jean Hailes endocrinologist Dr Sonia Davison, "is to continue their sun-smart behaviour but consider seeing a health professional to discuss their individual need for vitamin D supplementation, as increasingly links are being made that implicate vitamin D in various disease processes."

Increased risk of cervical cancer after tubal ligation

A survey of 2,000 women in Oklahoma (US) has found that women who have had their fallopian tubes 'tied' or cut to prevent any future pregnancy tend to have less frequent Pap tests, and this is putting them at increased risk of cervical cancer.

"In all age groups, women with tubal ligation were more likely to have had no Pap screening in the previous five years, compared to women using other forms of contraception," reported team member Dr Cara Mathews in a press release for the Women & Infants Hospital of Rhode Island.

Taking Pap tests every two years from age 18 to 70 years reduces a woman's risk of developing cervical cancer by up to 90 per cent. Jean Hailes gynaecologist and acting medical director Dr Elizabeth Farrell lists four triggers that should remind women to book regular Pap tests:

• If you're aged 18 to 70 and have had sex (including homosexual sex)

• If you have a new partner

• If you have undergone tubal ligation ("had your tubes tied")

• After menopause (especially if you have a new partner)

Three out of four women who develop cervical cancer have not had a Pap test in the five years before their diagnosis. For more information, see www.healthforwomen.org.au/health-issues/32-pap-test-also-known-as-pap-smear.

HRT early after menopause reduces risk of heart problems

The Danish Osteoporosis Prevention Study, a multicentre trial begun in 1990 to assess whether hormone replacement therapy (HRT) can prevent osteoporotic fractures, was halted in 2002 after another study (the Women's Health Initiative, or WHI, trial) reported adverse affects of HRT. However, researchers continued to follow the health of the Danish study participants for up to 16 more years, noting instances of cardiovascular (heart) disease, cancer and death. Data published in the British Medical Journal in October 2012 (BMJ 2012;345:e6409) show that after 10 years of randomised treatment (HRT or no treatment) early after menopause, those women receiving HRT had a significantly reduced risk of heart failure, heart attack and death - without any apparent increase in risk of cancer, venous thromboembolism (blood clots) or stroke.

Jean Hailes endocrinologist and founding director Prof Henry Burger notes that the WHI trial was not in fact a study of HRT as conventionally used, but was instead a chronic disease-prevention trial to test whether HRT could prevent heart disease in women who were mostly many years past menopause. Data reported by the WHI team in 2002 suggested an increase in risk, causing a dramatic drop in use of HRT, but a decrease in risk was subsequently noted among women younger than 60.

The Danish Osteoporosis Prevention Study, by contrast, randomised women to HRT or no treatment close to the time of menopause. "It is reassuring", says Prof Burger, "in that there was evidence for a decrease in cardiovascular risk, without a concomitant increase in the risks of breast cancer and venous thrombosis, although the numbers were too small to reach a definitive conclusion. Nevertheless, this is the first randomised trial of HRT administered in the conventional fashion, and supports the views expressed by many individuals, as well as menopause and endocrine societies, that HRT given close to menopause is safe and effective".

Lack of calcium in women linked to higher risk of hormone condition

Recent data from the Nurses' Health Study in the US suggest that women who have a higher dietary calcium intake may be better protected from developing the condition 'primary hyperparathyroidism'. This condition involves overproduction of parathyroid hormone (PTH), which can lead to calcium being leeched out of bones and is a major risk factor for the eventual development of bone thinning in the form of osteopaenia or osteoporosis. The Nurses' Health study is a major US study that has followed over 58,000 female US nurses over time. It has recently reported that those nurses who had a higher intake of calcium within their diet had a lower incidence of primary hyperparathyroidism. There was also a trend for women who took calcium supplements of over 500 mg a day to have a lower incidence of primary hyperparathyroidism. 
What does this mean for Australian women? The debate continues as to the benefits and risks of calcium supplementation, especially when looking at the conditions of osteopaenia / osteoporosis and cardiovascular disease. The experts suggest that having a balanced diet is important, and where possible, that postmenopausal women should ensure that their diet contains an adequate calcium content of between 1000 and 1300mg per day. If supplementation is needed for bone protection or other conditions, or if the diet is very low in calcium, then taking a 500-600mg supplement may be beneficial. Osteoporosis Australia has further guidance for Australian women here.

Pinning down a treatment for hot flushes

Hot flushes affect up to 80 per cent of women going through the menopause, and can last for years. While not considered a "disease", hot flushes and night sweats can be debilitating, embarrassing, and can severely disrupt sleep and lifestyle. Not all women are able to take hormone replacement therapy (HRT), which is the most effective treatment, and some women are reluctant to due to concerns about risks. Unfortunately, there are few other effective treatment options.

Acupuncture is a very safe treatment and has been used by the Chinese as a medical treatment for centuries. It involves the insertion of very fine needles into certain areas of the body known as 'acupuncture points'. Over 90 per cent of people who try acupuncture do not experience any side effects, and serious side effects are extremely rare.acupuncture

'Acupause' is a world first study of acupuncture for menopausal hot flushes, funded by the National Health and Medical Research Council and supported by Jean Hailes for Women's Health, the University of Melbourne, Monash University, RMIT and Southern Cross University. 

Acupause has been running since September 2011, and is still looking for more volunteers to help test acupuncture as a treatment for hot flushes. Almost 100 women have now enrolled in the study, and the researchers are seeking another 180. Volunteers will receive either real or placebo (fake) acupuncture. Treatment is provided for free across metropolitan Melbourne and in Melton, Mornington and Echuca in Victoria; in Ballina/Byron Bay in NSW; and Southport (Gold Coast) in Queensland. For more information see www.gp.unimelb.edu.au/acupause or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Eating disorders don't just affect young women

A US study of body image in women over 50 "busts the myths that disordered eating is the province of adolescent and young adult women", according to lead author Dr. Cynthia Bulik of the University of North Carolina.


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Girls who drink milk have less fat, lower BMI

Girls who drink more milk carry less body fat and have a lower body mass index (BMI), according to a study of 1,001 teens in Portugal.


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"Mummy-blogging" linked to improved wellbeing

It feels appropriate to kick off the Jean Hailes blog with a post about blogging:

New mothers who write blogs may feel less alone and more supported, according to US researchers. Assistant Professors Sarah Coyne and Erin Holmes of Brigham Young University and grad student Brandon T. McDaniel of Penn State University (US) used an online survey to ask 157 new, first-time mothers about their emotional wellbeing and their use of various media, including computers.


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Slowing the biological clock won’t solve family planning dilemmas

In future, women could remain fertile for longer by undergoing an ovarian tissue transplant, according to a paper published in April 2012 by American and Danish researchers.


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Myth - ART can reverse the 'biological clock'

“Modern women have alarming misconceptions about their own reproductive systems and the effectiveness of assisted reproductive technologies”, warn researchers at Yale University (US).


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Stress management alters course of breast cancer

A stress management program for women with breast cancer has been found to inhibit disease processes at the molecular level, turning on genes that produce “healthy” immune responses and turning down expression of genes that promote cancer progression.


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New fertility campaign launch

Jean Hailes is proud to announce the launch of Your Fertility, a campaign to inform Australians about how age and lifestyle factors such as weight, smoking and alcohol use can affect their ability to conceive and have healthy children.


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Memory a real problem at menopause

Complaints of forgetfulness during menopause may reflect real difficulties with attention and ‘working memory’, according to a study in the USA.


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Getting the facts straight on HRT and cancer


Professor Henry Burger was interviewed last week for an article on The Conversation news website, regarding a series of articles published in the Journal of Family Planning and Reproductive Health.


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Social connections

We often worry about the physical factors that affect our health, but sometimes forget about the role of emotional or psychological factors. Social connections, friendships and our relationships with other people help shape who we are and how we behave, but they also impact on our health.


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