Lowered HRT Use May Have Cut Heart Attacks

(HealthDay News) -- The decline in the use of hormone replacement therapy (HRT) to treat menopause symptoms has been mirrored by a drop in the rate of Heart attacks among American women, a new study finds.

But there's been no decrease in the rate of strokes, researchers noted.

Hormone replacement therapy was widely used to treat menopause symptoms until 2002, when researchers published a study that said HRT increased the risk of heart attack. After that, the use of HRT among women ages 50-69 decreased from more than 30 percent to less than 15 percent, the researchers said.

In this new study, the researchers examined U.S. death records, hospital discharge data and national surveys of medication usage between 1990 and 2005 for women ages 40-79. The analysis revealed a decrease in heart attacks but no reduction in the number of hospitalizations or deaths from stroke.

"We were surprised that HRT had such divergent effects on stroke and acute myocardial infarction (heart attack) in the overall population," lead author Dr. Kanaka Shetty, of the RAND Corporation in Santa Monica, Calif., said in a news release.

The study appears in the May issue of the journal Medical Care.

The decrease in heart attacks among American women may be due to factors other than reduced use of HRT, suggested Dr. Nieca Goldberg, a cardiologist at Total Heart Care in New York City whose practice focuses primarily on women.

"The reduction in hormone therapy coincided with the American Heart Association's and National Heart, Lung, and Blood Institute's women and heart disease awareness campaigns," Goldberg said in a news release.

"The lower rate of heart attacks may be due to better screening for heart disease risk factors and better awareness of women's heart attack symptoms by physicians," Goldberg said. "It's premature to attribute the decline in heart attack rates to the decline in hormone therapy."

More information
The U.S. National Institutes of Health has more about HRT.

New drug for menopause being tested

An experimental menopause treatment was shown to reduced hot flashes, trouble sleeping and other symptoms, while reducing breast tenderness and possibly protecting against breast cancer breast cancer. full story

HRT After Menopause Reduces Symptoms

(HealthDay News) -- Hormone replacement therapy, even when it's started many years after menopause, can reduce some of the quality-of-life problems caused by menopause, such as sleep problems and hot flashes.

Australian researchers report that women who started hormone replacement therapy (HRT) after menopause and took it for an average of one year had significant improvements in sexual functioning, and fewer sleep problems, hot flashes and sweating than did women taking a placebo.

"The greatest benefits and least risk from HRT are seen in the 99 percent of women who commence HRT for symptom relief near menopause. [This] trial studied much older women who started HRT on average 13 to 14 years after menopause when they had fewer symptoms. Even in this group, improved quality of life was seen in many [taking HRT]," said study author Dr. Alastair MacLennan, head of obstetrics and gynecology at the Women's and Children's Hospital at the University of Adelaide in Australia.

Results of the study were published in the Aug. 22 issue of the British Medical Journal.

Hormone replacement therapy has been under major scrutiny since the Women's Health Initiative (WHI) study was stopped in 2002 because of increases in blood clots, heart disease, stroke and breast cancer risk in women initiating HRT long after menopause. MacLennan's study (dubbed the WISDOM study), which began in 1999 and was originally intended to follow women for up to 10 years on HRT, was also stopped after the WHI findings were released due to concerns that the risks of HRT might outweigh the benefits.

Even though the trial was stopped early, MacLennan and his colleagues had one-year follow-up data for 2,130 women between the ages of 50 and 69. The average age in this study was 63.8.

The women had been randomly assigned to receive either a combination hormone replacement therapy or a placebo. At the time of follow-up, 1,043 were on HRT and 1,087 were on placebo.

Women taking HRT had improvements in many quality-of-life symptoms. For example, hot flashes occurred in 30 percent of the women in the HRT group before starting the hormones, but in just 14 percent at the one year follow-up. In comparison, 29 percent of women taking placebo had hot flashes at the start of the study, while 25 percent were still experiencing them at the follow-up. Improvements were also seen in night sweats, insomnia and vaginal dryness.

Women in the HRT group were, however, more likely to report breast tenderness and vaginal discharge.

No significant differences were seen in reports of depression between the two groups.

The study authors wrote that if women are considering taking HRT many years after menopause, they needed to balance the benefits of hormone therapy against the possible risks when started after menopause, which include heart disease, blood clots and an increased risk of breast cancer.

"I think this is an important study, because since WHI, many have lost sight of the significant benefits of hormone therapy," said Dr. Steven R. Goldstein, an obstetrician and gynecologist at New York University Langone Medical Center. "This study reinforces the notion that for women with these symptoms, HRT can improve your quality of life. And, the worse your symptoms, the more they'll improve."

Plus, both MacLennan and Goldstein pointed out that most women would initiate HRT near menopause, when these symptoms tend to be most severe, and at that time, potential risks are much lower, and the benefits are likely greater.

"For relief of symptoms, it's OK to go on HRT, as long as you have none of the absolute contraindications, like a history of deep vein thrombosis," concluded Goldstein.

More information
To read more about hormone replacement therapy, go to the American Academy of Family Physicians.

Build Better Bones and Prevent Osteoporosis

How people in their 30s, 40s, and 50s can fend off osteoporosis
by Ross Weale

Strong bones are important for healthy aging. To avoid osteoporosis and up your bone density, eat leafy greens, quit smoking, and drink your milk! Watch Health magazine contributor Samantha Heller's appearance on the Today show on March 26 to learn more.



SAMANTHA HELLER
Samantha Heller, RD, is the nutrition coordinator at the Fairfield Connecticut YMCA. A certified dietitian/nutritionist and exercise physiologist, Heller earned her master's degree in nutrition and applied physiology from Teachers College at Columbia University. She served as the senior clinical nutritionist and exercise physiologist at NYU Medical center in New York City for almost a decade and created and ran the outpatient nutrition program for the NYU Cardiac Rehabilitation Program. She has also been a fitness instructor for 15 years. Heller specializes in nutrition, wellness, stress management, and fitness for people who are fighting heart disease, diabetes, cancer, and obesity.

A contributing editor to Health magazine, her writing has also appeared in numerous other magazines, including Men's Fitness, Men's Health, and Glamour, as well as sites such as Fitness.com.

Severe Menopause Symptoms Raise Heart Risks

(HealthDay News) -- Women who have the most severe menopausal symptoms may also be at a higher risk of cardiovascular disease, a new study suggests.

Dutch researchers surveyed 5,648 women, aged 46 to 57, about their menopausal complaints and collected data on other health information such as their cholesterol and blood pressure.

Night sweats were reported by 38 percent of women; flushing by 39 percent.

Those with flushing had higher cholesterol levels than those without the symptom. They also had higher blood pressure, higher body mass index (BMI, a ratio of weight to height) and a slightly higher chance of developing heart disease over the next decade. The women with night sweats had comparable results.

The researchers, from the University Medical Center Utrecht, conclude that the connection between severity of symptoms and heart disease risk may be the result of reduced beneficial effects of estrogen on the functioning of blood vessel walls, as estrogen declines during menopause.

The Dutch researchers were scheduled to present their findings Friday at the American Heart Association's Cardiovascular Disease Epidemiology and Prevention Conference, in Colorado Springs, Colo.

"The implication is the women with the worst symptoms may be at higher risk, clinically, for heart disease," said Dr. Suzanne Steinbaum, director of women & heart disease, at the Heart & Vascular Institute at Lenox Hill Hospital, in New York City.

But the American Heart Association does not advise postmenopausal women to take hormone therapy to reduce heart disease or stroke risk, due to clinical trials that show the hormones, over time, actually increase cardiovascular risks. Hormone therapy is only recommended to relieve very severe symptoms of menopause, and only for the shortest possible period.

The take-home point from this study for the general population, according to Steinbaum, is to pay close attention to improvement in lifestyle habits before menopause and before estrogen levels decline. "One of the things I talk about is lifestyle management to control high blood pressure, high cholesterol," she explained.

If women keep in check the risk factors of heart disease, such as high blood pressure and high cholesterol, by eating healthfully and exercising often before menopause, the transition "doesn't have to be as terrible" as many women fear it will be.

Among her suggestions: Exercise at least 20 to 30 minutes three to five days a week, and eat a diet filled with fiber, vegetables, fruits, multi-grains, legumes and omega-3 fatty acids.

In a second study, also scheduled to be presented Friday at the conference, French researchers found the type of hormone delivery method affects the risk of blood clots in postmenopausal women.

Researchers from Paul Brousse Hospital in Villejuif, France, compared women who did not use hormones with those who used estrogen, taking it either orally or transdermally with a patch. Some women took only estrogen, others took estrogen plus progesterone, pregnane, norpregnane or nortestosterone.

The researchers found that transdermal estrogen alone or in combination with progesterone or pregnane derivatives did not raise the risk for blood clots, while other delivery systems did.

They looked at a population of nearly 86,000 French women -- including 984 with blood clots -- who were followed for more than 10 years.

"This [study] is one more piece of the puzzle," said Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City. When women take hormones orally, she said, the metabolism involves much more processing through the liver, for instance.

While the study concluded that the patch delivery is less risky when it comes to blood clots, Wu said "the indications remain the same" for hormone therapy. It should be used only for very severe menopausal symptoms interfering with daily life, for the shortest possible time.

More information
To learn more about menopause and heart disease risks, visit the American Heart Association.

Balancing Your Hormones Without Drugs... You Can Feel Good Again $19.95 [ learn more ] Hormone imbalance can be reversed! Look and feel better than ever, just take the time to learn about yourself and read the information contained in this just released e-book about reversing hormone imbalance. Are you ready to finally look and feel great? If so... read on... - E-Book Version.(BH)

Depression Linked to Bone Loss in Younger Women

(HealthDay News) -- Premenopausal women struggling with depression have lower bone mass than do non-depressed women in the same age range, a new study found.

The bone loss was most pronounced in certain regions of the hip, which is troubling given that hip fractures are one of the most serious -- and potentially fatal -- consequences of osteoporosis.

The level of bone loss seen in the depressed women was the same or higher than that associated with other, established risk factors for osteoporosis, including smoking, low calcium intake and lack of physical exercise, the researchers said.

The findings, published in the Nov. 26 issue of the Archives of Internal Medicine, could have implications for the prevention of osteoporosis.

"Premenopausal women with depression should be screened for low bone mass," said Dr. Giovanni Cizza, senior author of the study who conducted the research while at the U.S. National Institute of Mental Health. "They should do a bone mineral density measurement, because osteoporosis is a silent condition. Until someone fractures, you don't know you have osteoporosis."

Cizza is now a staff clinician at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

A woman's bone mass peaks during youth then thins after menopause. Previous, preliminary studies had suggested that depression might be a risk factor for low bone mass in older women.

For this study, Cizza and his colleagues looked at 89 women with depression and 44 women without depression. The women ranged in age from 21 to 45. The depressed women were taking antidepressant medications.

Seventeen percent of the depressed women had thinner bone density in the femoral neck, a vulnerable part of the hip. Only 2 percent of non-depressed women, by contrast, had thinner bone in this area.

Twenty percent of depressed women also had low bone density in the lumbar spine, compared with 9 percent of the non-depressed women.

Blood and urine samples also revealed that the depressed women had lower levels of "good" proteins called cytokines. "The bad cytokines that may cause bone loss are higher," Cizza said.

It's not clear what role antidepressants might play, but by relieving the depression, the drugs may also help bone mineral density, the researchers said.

More information
To learn more about bone health, visit the National Osteoporosis Foundation.

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Eating Disorders: A Midlife Crisis for Some Women

(HealthDay News) -- You starve yourself, shedding pounds, and it feels too good to ever stop.
Or you eat lots -- as much as you want, more than you want -- and then sneak away from your loved ones to purge it all.

But you're not 16, not 19, not 21. Not a young woman at all. You're in your 30s, 40s, or 50s. And you can't stop.

Anorexia and bulimia used to be considered health problems that afflicted teenage girls. But doctors are finding that a growing number of older women are now being diagnosed with some sort of eating disorder.

"It can happen to anybody at any stage of their life," said Dr. Alexander Sackeyfio, a psychiatrist and eating-disorder specialist at the Beaumont Hospital in Royal Oak, Mich. "I think we're becoming more aware of it and are better at diagnosing it."

People tend to make another mistake in their perception of eating disorders -- they assume they are relatively benign psychological problems that are easily treated and without lasting physical effects, said Doug Bunnell, clinical director of the Renfrew Center in Wilton, Conn.

"People are surprised when they learn these have the highest mortality rate of any psychiatric diagnosis, somewhere between 10 and 15 percent," said Bunnell, who's also a member of the National Eating Disorders Association board of directors.

Anorexia produces dramatic weight loss caused by excessive or compulsive dieting. An estimated 0.5 percent to 3.7 percent of women suffer from anorexia nervosa at some point in their lifetime, according to the National Institute of Mental Health.

Anorexics see themselves as overweight even though they're dangerously thin. The process of eating becomes an obsessive minefield and unusual eating habits develop, such as picking out just a few foods and eating them in tiny, carefully measured quantities.

Bulimia is characterized by excessive binge eating followed by purging the food through vomiting, laxatives or over-exercising. An estimated 1.1 percent to 4.2 percent of American females will struggle with bulimia nervosa in their lifetime.

Because of the purging, people with bulimia usually weigh within the normal range for their age and height. But they still suffer the same fears about weight gain as anorexics. So, they often perform bulimic behaviors in secret, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Bunnell said he's seeing more middle-age or even older women coming in for treatment of an eating disorder. But, he's not sure that all of these are new cases developing later in life.
"My experience is that virtually all the women we've seen with eating-disorder symptoms in their 30s or 40s had some prior activity in the more typical age range," Bunnell said. "It may not have been diagnosed, or just short of being serious, but there was a period when they were really struggling with it. We've not seen a lot of brand new, out-of-the-blue eating disorder cases in older women."

Other doctors believe that hormonal fluctuations that occur near menopause could set off an eating disorder, as could mid-life changes like divorce or the departure of grown children. As the family changes, some women find themselves grasping for some semblance of control -- one of the needs that an eating disorder can fulfill.

Complicating matters for the older patient is the fact that women coming in for treatment later in life may find it harder to get the help they need. For decades, the focus has been young women, and only recently has the therapeutic field begun to expand into treatment for older women -- and men, Sackeyfio said.

"No one is catering to their needs," he said. "That's the same problem that gentlemen had for a while."

Bunnell said anorexics tend to be preoccupied with their body shape or weight, and often suffer from anxiety, perfectionism and obsessive-compulsive disorder. By contrast, bulimics tend to be depressed and impulsive, often struggling with substance-abuse issues.

"The anorexic style is more overly controlled, tense and rigid, while the bulemic style is less controlled, impulsive or disregulated," Bunnell said.

Treatment for eating disorders has evolved as well, with doctors now emphasizing a team-based approach, Sackeyfio said.

"Originally, what people would look at was that it is a psychological problem, but it quickly becomes a physical problem," he said. "You need somebody who's aware of those physical changes to work with you if you're a therapist."

Ideally, someone with an eating disorder should be working with a team that includes a psychiatrist, a nutritionist and a physician, Sackeyfio said.

Most important, the people surrounding someone with an eating disorder need to understand that the patient truly is out of control and needs help, Sackeyfio said.

"They aren't spoiled brats who are trying to make people's lives harder," he said. "They really have very little control over the physical changes that they cause in their own bodies."

More information
To learn more, visit the National Mental Health Information Center.

Research Yields Family Clues to Rheumatoid Arthritis

(HealthDay News) -- Women whose brothers are affected with painful rheumatoid arthritis are more likely to develop a severe form of the disease, new research shows.
The finding adds to growing evidence that genes play a key role in the autoimmune disorder, one expert said.

"The importance of this study is that it is beginning to show us how multiple genetic factors can interact and regulate the development and course of rheumatoid arthritis (RA)," said Dr. John Hardin, chief science officer of the Arthritis Foundation and a rheumatologist at the Albert Einstein College of Medicine, New York.

He was not involved in the research, which is published in the October issue of Arthritis & Rheumatism.

According to the Arthritis Foundation, about two million people in the United States suffer from rheumatoid arthritis, an autoimmune, chronic inflammatory disease in which the joints can become extremely painful. In people with RA, the immune system has an abnormal response, mistaking the body's healthy tissue for a foreign invader and attacking it.

Dr. Lindsey A. Criswell, the new study's lead author and a professor of medicine at the University of California, San Francisco, explained that her team "compared the disease features among women who had no brothers with RA to the features of women with one or more brothers with RA."

The researchers focused on 1,004 affected members of 467 families in which two or more siblings have rheumatoid arthritis. "We compared features of the disease in all the men and all the women," Criswell said, trying to build on what is already known about sex differences in the disease.

They found that women whose brothers were affected with the painful form of arthritis in which the body "turns" on itself were more likely to have high levels of an antibody associated with the disease, she said. According to Criswell, this information could be useful to both physicians and patients to help predict the course of the disease.

It's already known that RA affects women three times as often as men, and that it strikes men later in life. While women develop RA anywhere from adolescence to menopause, it is rarely seen in men under age 45.

Criswell's team found that while the disease occurs later in men, male patients showed more signs of "erosive" disease. They were also more likely than women to test positive for rheumatoid factor and antibodies to "cyclic citrullinated peptides" or CCP, both hallmarks of the disease.

Men with RA were more likely to have a history of smoking and to have a gene called HLA-DRB1, a subtype of the genetic marker HLA-DR4, which is known to be associated with the disease. Women whose brothers had RA also had higher anti-CCP antibodies and were more likely to have this gene, compared to females whose brothers do not have RA, lending support to the idea that the disease runs in families.

According to the Arthritis Foundation, people with the genetic marker HLA-DR4 may be at increased risk of getting RA; the marker is found in white blood cells and helps the body differentiate between its own cells and foreign invading ones.

"It has been clear for a long time that RA runs in families," Criswell said. "But like many diseases, the genetic cause is complex. There is not a single gene that determines who will and won't get it but rather a number of genes. We have been facing a challenge of identifying multiple genes in addition to environmental factors."

Genetic information is helpful for a number of reasons. "[It] might influence how we treat them, and whether men or women are at greater risk," Criswell said. Family histories might also alert the doctor and the patient to expect the course of the disease to be more severe.

The study adds to our understanding of the disease, said Hardin. "We have [identified] two genes so far, but it's clear other genes are involved," he said.

The take-home message of the study is that patients should tell their doctor if they have a brother with the disease, Hardin said. Rheumatologists, too, should remember to ask patients if other family members have the disease.

More information
For more on rheumatoid arthritis, head to the Arthritis Foundation.

FIBROCYSTIC BREAST DISEASE

by Tori Hudson, N.D.

Tender or lumpy breasts are one of the most common reasons why women consult their women's health practitioner for assessment and treatment.

Since painful breasts are not always lumpy, and lumpy breasts are not always painful (and neither is usually abnormal), it is useful to create descriptive categories of symptoms and conditions to replace the generic term "fibrocystic."Physiological, Cyclical Pain and SwellingMany women notice painful or sensitive breasts just prior to menstruation.

This has been attributed to a more prominent estrogen than progesterone effect on breast tissue at this time. Occasionally, less progesterone is made late in the cycle, as in irregular ovulation.

Other women may have average amounts of progesterone but increased tissue sensitivity to estrogen with related fluid retention. Most women tolerate this well enough once reassured it is normal, and the symptoms always resolve with menses.

Women who take exogenous estrogen, such as oral contraceptives or estrogen replacement therapy during menopause, may be similarly affected.

Mastalgia Mastalgia refers to any breast pain, unilateral or bilateral, severe enough to interfere with the quality of a woman's life, causing her to seek treatment. Physiologic cyclical mastalgia is this severe about 15 percent of the time, and comprises the bulk of this group.

Women who suffer from noncyclical pain are more rare, and the pain is less likely to be hormonal in cause. Pain may be due to old trauma, acute infection, or sometimes inflammation of the intercostal cartilage, i.e. costochondritis.

In contrast, breast cancer presents as a unilateral painful firm lump about 5 percent of the time. The majority of the time, breast cancer does not present as breast pain, and especially tends not to present as cyclic present pain. Painful swellings that flux with the cycle unchanging over time are not worrisome as cancer signals.

Breast Nodularity or Diffuse LumpinessBreast lumpiness may be either cyclic or non-cyclic, and may be painful. The distinction between these and normal breasts is often simply a matter of degree. Normal breasts are always irregularly textured because the breast tissue is not homogeneous. It is a mix of glands, fat, and connective tissue.

Glands can vary in prominence, and are more or less obscured by fat or fluid, so all breasts feel different on physical exam. Symmetry is important; finding a mirror-image thickening in the opposite breast indicates a normal condition.

Non-Dominant Masses

Densities that are not symmetrical are largely due to benign non-progressive causes, but do require careful distinction from dominant masses.

When palpation of the lump reveals that the density merges in one or more places with the surrounding breast tissue, it is considered "non-dominant" and may be comfortably observed for change over time. When these lesions are biopsied or, preferably, a sample of cells is taken in the office through a needle to be looked at microscopically (fine-needle aspirate), approximately 70 percent will show "non-proliferative changes" (adenosis, fibrosis, microcysts, mild hyperplasia, and more); 20 percent will show "proliferative changes without atypia" -- mostly epithelial hyperplasia. None of these conditions places one at increased risk for cancer, and all are self-limiting.

Only a fraction, roughly the 5 percent that show atypical hyperplasia, carry a significantly increased risk of breast cancer, especially when coupled with a positive family history.

Dominant Masses

Non-cyclical unilateral lesions are clearly distinct on all sides from the surrounding breast tissue.
They persist over time, and except in the very young, demand some kind of assessment. Although rare, breast cancer can occur in women in their twenties. Assessments in younger women are more difficult due to the dense breast tissue therefore rendering mammograms less accurate. And, since most of these unilateral lesions are benign, mammograms and biopsies deserve a more restrained approach, although continued monitoring and revisiting clinical decisions are very important.

Most commonly dominant masses are either fibroadenomas or gross cysts. A fibroadenoma is a rubbery, smooth, benign, fibrous tumor common in younger women. In women under age 25, it can be observed over time. They generally do not grow bigger. Large cysts are more common in women aged 25 to 50 -- an age group when cancer just begins to appear.

They are softer, squishier, and can be made to disappear by draining them through a needle in the office. Unless they recur frequently, no further treatment is necessary. Recurrent large cysts have been shown to slightly increase cancer risk in some studies but not in others; fibroadenomas do not. Unfortunately, non-cyclical unilateral dominant masses can sometimes be cancerous.

Overview of Alternative Treatments for Cyclic Breast Pain and Swelling

Alternative medicine principles for fibrocystic breast tissue or cyclical pain and swelling include the recognition that the liver is the primary site for estrogen clearance or estrogen metabolism. A compromised liver function can lead to a state of estrogen dominance, contributing to texture and density changes in the breast.

To assure that estrogens are being metabolized properly, it may be necessary to provide nutritional and herbal support for the liver.Digestion and elimination are also fundamental factors involved in a more holistic approach to hormone-related health problems.

Women having fewer than three bowel movements per week have a risk of fibrocystic breasts four to five times greater than women having at least one bowel movement per day. The longer it takes food to move through the colon, the more waste products can be reabsorbed into the bloodstream, creating a potentially toxic physiological environment.

Bacterial flora in the large intestine, such as Lactobacillus acidophilus, improves the transit time of bowel toxins, as well as improving the excretion and detoxification of estrogens.

NutritionRemoval of caffeine from the diet is probably the most well-known alternative lifestyle approach for fibrocystic breasts. The first randomized study of a large number of women was conducted by Dr. Virginia Ernster.

One hundred fifty-eight women eliminated all caffeine (coffee, tea, cola, chocolate, and caffeinated medications) from their diets for four months.1 There was a significant reduction in clinically palpable breast findings in the abstaining group compared with the control group, although the absolute change in the breast lumps was quite minor and considered to be of little clinical significance. Several other studies provided mixed reports: three studies show no association between methylxanthines and benign breast disease,2,3,4 and two studies show a correlation with caffeine consumption.5,6
Caffeine content of common items

Beverage
Serving Size
Caffeine (mg)
Coffee, drip
5 oz
110-150
Coffee, perk
5 oz
60-125
Coffee, instant
5 oz
40-105
Doffee, decaffeinated
5 oz
2-5
Tea, 5 minutes steep
5 oz
40-100
Tea, 3 minutes steep
5 oz
20-50
Hot cocoa
5 oz
2-10
Coca-Cola
12 oz
45
Food
Serving Size
Caffeine (mg)
Milk chocolate
1 oz
1-15
Bittersweet chocolate
1 oz
5-35
Chocolate cake
1 slice
20-30
OTC Drugs
Dose
Caffeine (mg)
Anacin, Emprin
2
64
Excedrin
2
130
NoDoz
2
200
Aqua-Ban
2
200
Dexatrim
1
200
How dietary fat affects the human breast is confusing and controversial. Reducing the fat content of the diet to 15 percent of total calories, while increasing complex carbohydrate consumption, has been shown to reduce the severity as well as the actual breast swelling and nodularity in some women.

Reducing the dietary fat intake to 20 percent of total calories also results in significant decreases in circulating estradiol. Since fibrocystic breasts are a result of estrogen dominance, it is logical that decreasing estrogens in the body would improve the symptoms of breast pain and swelling.

However, only a slight reduction in fat intake has repeatedly shown very little, if any, effect on breast problems, including breast cancer. A more rigorous approach to lowering the amount of fat in the diet is clearly needed. Of note, women on a vegetarian diet excrete two to three times more detoxified estrogens than women on an omnivorous diet.Nutritional SupplementsVitamin EFor more than 35 years, clinicians have used vitamin E in the medical management of benign breast disease.

This practice was initially based on positive reports from small numbers of patients as far back as 1965, and in subsequent studies in 1971, 1978, and 1982. When larger numbers of women were studied, vitamin E did not show significant effects. However, two studies demonstrated that vitamin E is clinically useful in relieving pain and tenderness, whether cyclical or non-cyclical.7,8 The studies have been done with varying dosages: 150, 300, or 600 IU daily.

In clinical practice, practitioners generally recommend from 400-800 IU of D-alpha-tocopherol with a minimum trial period of two months.Evening Primrose OilThe pain and tenderness of benign breast disease associated with "cyclic mastalgia" have been alleviated with evening primrose oil, the only one of the fatty acids to be scientifically studied in relation to fibrocystic breasts. In a study of 291 women who took three grams per day of evening primrose oil for three to six months, almost half of the 92 women with cyclic breast pain experienced improvement, compared with one-fifth of the patients who received the placebo.

For those women who experienced breast pain throughout the month, 27 percent responded positively to the evening primrose oil, compared to 9 percent on the placebo.9 Another study of 73 women received three grams per day of evening primrose oil or placebo.

After three months, pain and tenderness were significantly reduced in both cyclical and non-cyclical groups, while the women who took placebo did not significantly improve. IodineThyroid hormone with low or even normal thyroid function may result in improvement of fibrocystic breasts.

These results suggest that iodine deficiency may be a factor in fibrocystic breasts. Breast tissue has an affinity for both thyroid hormone and iodine. Without iodine, it becomes more sensitive to estrogenic stimulation, which in turn produces microcysts high in potassium content. The potassium is believed to be an irritant that produces fibrosis and eventually cyst isolation.

Four types of iodine have been studied in the treatment of fibrocystic breasts, only one of which has been truly effective for both pain reduction and cyst reduction, and free of side-effects on the thyroid gland. All forms of iodine relieve subjective clinical symptoms: sodium iodide (Lugol's solution); potassium iodide; caseinated iodine (protein-bound); and aqueous (diatomic) iodine.

Symptom relief varied a great deal with the different iodines, but only the aqueous or diatomic iodine achieved both symptom relief in 74 percent of the women, as well as objective reduction in nodules and resolution of fibrosis in 65 percent of the patients, without adverse effects on the thyroid gland.10 The recommended dose of aqueous iodine is a prescription of 3-6 mg per day.

Other

Supplements that may improve liver function and thereby perhaps promote a more balanced estrogen metabolism include methionine and choline. B vitamins, particularly vitamin B-6, can help the liver to properly metabolize and conjugate estrogens. Probiotics such as Lactobacillus acidophilus may be able to improve the absorption and transport of estrogen by supporting a normalized intestinal microflora environment.

Botanicals

Herbal therapies for addressing the symptoms of breast pain, swelling, and cystic nodules in breast tissue are largely arrived at from traditional uses of herbal medicines and from observational empirical evidence in clinical practice.

Herbal diuretics can be useful in decreasing breast swelling and the discomfort associated with it.

The most effective of these is dandelion leaf, but other diuretics to consider are cleavers, yarrow, and uva ursi. Poke root has been used in traditional naturopathic medical practices for decades. It can be applied topically as an oil to the breasts, reducing painful lumpiness and nodularity.

Herbal support for the liver improves how the liver metabolizes steroid hormones. Traditional herbs that support the liver and the normalization of biochemical steroid pathways may include burdock root, dandelion root, and milk thistle.

Natural Progesterone

Assuming fibrocystic breasts are at least in part due to a high-estrogen, low-progesterone ratio, then it is logical to use progesterone therapy as a treatment. Many practitioners and women have experienced that the application of natural progesterone in a cream or gel routinely solves the problem. It may be that progesterone is desensitizing the breast to estrogen. General use guidelines are tsp twice per day, on days 15 to 27 of the monthly cycle.

Summary

These simple therapies, along with lifestyle modification, generally yield very satisfying results within 1 to 3 months, even in women with significantly painful breasts. Although uncommon, if there is no change after three menstrual cycles, a more aggressive alternative treatment plan must be initiated.

If this does not bring relief, then the conventional medical approaches, to be contemplated in very difficult, unbearable cases with no response from natural therapies, include decreasing hyperinsulinemia, synthetic progestin, Danazol, Tamoxifen and bromocriptene. Many women's medicine healthcare providers agree that the term fibrocystic breast "disease" or "condition" should be abandoned in favor of a more accurate physiologically based description. Benign breast conditions are present in almost all women to some degree.

Moreover, the widespread misconception that women with painful or lumpy breasts are at increased risk of breast cancer is inaccurate. This reinforces misinformation and fear, and obscures the safe and simple means that exist for obtaining relief and reassurance.

References1 Ernster V, Mason L, Goodson W, et al. Effects of caffeine-free diet on benign breast disease: a randomized trial. Surg 1982;912:263-267.2 Lubin F, et al. A case-control study of caffeine and methylxanthine in benign breast disease. JAMA 1985; 253(16)2388-92.3 Shawer C, Brinton L, Hoover R. Methylxanthine and benign breast disease. Am J Epid 1986;124(4): 603-11.4 Marshall J, Graham S, Swanson M. Caffeine consumption and benign breast disease: a case-control comparison. Amer J Pub Health 1982;72(6):610-12.5 La Vecchia C, et al. Benign breast disease and consumption of beverages containing methylxanthines. JNCI 1985;74(5):995-1000.6 Boyle C, et al. Caffeine consumption and fibrocystic breast disease: a case-control epidemiologic study. JNCI 1984;72(5):1015-19.7 London R, et al. Mammary dysplasia: Endocrine parameters and tocopherol therapy. Nutr Res 1982;7:243.8 London R, et al. Endocrine parameters and alpha-tocopherol therapy of patients with mammary dysplasia. Canc Res 1981;41:3811-13.9 Pye J et al. Clinical experience of drug treatment for mastalgia. Lancet 1985;2:373-77.10 Ghent W, et al. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993. Oct; 35(5):453-60.

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