"Wow!" thought Danielle Peterson.* "What on earth is going on in my body?" The 49-year-old Manhattan marketing executive was in the middle of a business meeting when -- in her own words "it was as if there was this sudden pressure drop inside me." Soon her left arm began to tingle from numbness and her chest was seized by a gripping pain.
Fearful she was on the verge of a heart attack, she went to see her primary doctor, a pulmonary specialist who had long treated her for asthma. Despite informing him that she was experiencing cardiac symptoms, he kept her waiting an hour and a half while he saw other patients. Then, after monitoring the electrical activity of her heart with an electrocardiogram machine, he brushed off her symptoms as the flu. "Go home and get some rest," he urged.
At 5:45 the following morning Peterson bolted up in bed wracked by pain. "I'm having a heart attack!" she screamed to her husband. He rushed her to the emergency room of a nearby hospital but once again she was greeted by a doctor who didn't believe her. "You've probably got shingles," he tried to convince her. It took nearly half an hour before another physician appeared in the emergency room, instantly recognized the first doctor's error, and raced to administer a clot-busting drug.
Peterson survived -- but the delay in her diagnosis led to irreversible heart damage: Ten percent of the organ's muscle died. The path toward her emotional recovery has also been strewn with obstacles. Terrified of having another heart attack, she sought out a support group of female heart patients who were dealing with the same issues. But neither her cardiologist nor the American Heart Association could track down such a group in all of Manhattan. "Why don't you go to a cancer group?" she was advised.
Peterson's experience would lead one to think heart disease in women is as rare as hen's teeth. In fact, heart disease kills more women than men each year. And everything about Peterson's case -- including her reluctance to be identified by her real name -- is more typical than most women or their doctors realize.
Cardiovascular disease (including strokes) is the number one killer of U.S. women, claiming the lives of nearly 500,000 of them each year -- or more than die from all types of cancer combined, according to the American Heart Association. It's not only women in the U.S. who need to be concerned. A study in the April 7, 2001 issue of the British Medical Journal also reports that women in the United Kingdom also get less heart disease care than men.
Though it's a preventable disease if caught early, that opportunity is all too often lost. The disease's onslaught is invisible, being caused by plaque deposits that silently accumulate in the arteries over a lifetime. Frighteningly, a woman's first clue to the obstruction of her blood vessels may be a full-blown heart attack (or stroke, if the blockage occurs in the brain.). Two-thirds of women who die of a heart attack have no prior symptoms in comparison to only half of men. Though women over 65 are most vulnerable to the disease's encroachment, middle-aged women are scarcely immune. A staggering one in nine U.S. females between 45 and 64 show evidence of coronary artery disease. And make no mistake -- it can fell them in these vital years (though rarely before menopause). Indeed, heart disease kills twice as many woman in that age group as breast cancer -- the disease women dread most.
Black women are especially imperiled. Heart disease is 69 percent more common among them than in white women, and they are more likely to die of a heart attack before menopause. Medical researchers suspect an interplay of genetics and socioeconomic factors contribute to their starkly elevated risk. Yet in spite of these figures, numerous studies show that doctors are less likely to screen women for their risk of heart disease than men, routinely overlook or discount their symptoms, and often treat female patients less aggressively than their male counterparts. Even paramedics have been slow to recognize and treat women in cardiac distress.
When Judy Mindgram, a computer sales representative in Los Angeles, suffered a massive heart attack at age 40, the paramedics who responded to her call hung out in her house for 35 minutes, urging her repeatedly to admit to cocaine use. Then, though she was vomiting and barely conscious, they made her walk to the ambulance. She got to the hospital so late that she went into cardiac arrest and had to twice be jolted back to life.
"We hear these kinds of stories from female patients all the time," bemoans Dr. Nancy Davenport, a cardiologist on the advisory board for women and heart disease at Washington Hospital Center in D.C. "A man with cardiac symptoms is taken seriously -- a woman's likely to be told she's having a panic attack." So how come women aren't up in arms about the disparity in their care? Why aren't they marching on Washington to focus public attention on female heart disease as they have for breast cancer? Why no special ribbons or funding drives for the number one killer of women?
"Very simply, few women see heart disease as part of the spectrum of illnesses they might get," says Dr. Debra Judelson, medical director of the Women's Cardiovascular Institute of Southern California. "Say the words 'heart disease' and most women think of their husbands -- not themselves." Indeed, a 1995 Gallup poll found that four out of five women 45 to 75 were not aware that heart disease is the leading cause of death in their age group. (Most respondents mistakenly thought cancer, notably breast cancer, was more likely to kill them.) Worse, a surprising number of doctors are just as ignorant. In the same Gallup poll, one-third of primary care physicians also did not know that cardiovascular disease was the biggest killer of women. Another survey of primary care doctors, conducted more recently by the Washington Hospital Center in D.C., revealed that 60 percent felt less skilled at diagnosing heart disease in women than men. Indeed, two-thirds of the physicians surveyed erroneously reported that the warning signs and detection of heart disease are the same in both sexes. In reality, women with coronary artery disease vary from men in their symptoms, diagnosis and response to therapy. Yet all too often they are -- in the words of experts on women's heart care -- treated like "little men."
This glaring gap in knowledge is particularly ironic, for although men on average develop heart disease ten years earlier than women, more women now die of it primarily because heart disease is most prevalent in the latter decades of life. Hence women, with their sizable longevity advantage over men, ultimately live long enough to succumb to the disease in greater numbers.
To shatter the myth that cardiovascular disease is largely a male affliction, the American Heart Association launched a major three-year campaign aimed at educating women and their doctors. But so far it lacks the clout and luster of the breast cancer movement because -- in the parlance of Madison Avenue, the issue just isn't "sexy." Explains Dr. Marianne Legato, professor of clinical medicine and director of the Partnership for Women's Health at Columbia University in New York City, "Women value their breasts, beauty and reproductive capacity foremost because society has mainly appreciated them for bearing and raising children. That makes very good sense from an evolutionary perspective but it's crazy in the context of women now spending one third of their life in their menopausal years."
Still another challenge in awakening women to their biggest health threat is that female victims of heart disease may themselves be reluctant to come forward. One reason is that they may feel partly to blame for their illness, since several of its risk factors -- notably smoking, a high-fat diet and a sedentary lifestyle -- are viewed as controllable. The afflicted may also fear that it earmarks them as old and sickly. "It's bad for business," says one middle-aged victim, explaining her desire for anonymity. "When people know you have heart disease they think of you as super-fragile and won't tell you unpleasant news straight up," explains another victim who declined identification. "I don't want to be treated with kid gloves."
Educational efforts have been further thwarted by the lack of a charismatic celebrity spokesperson to draw attention to the issue. While the breast cancer movement can point to such high-visibility victims as Betty Ford, Olivia Newton John, and the late Linda McCartney, the faces of heart disease are nowhere to be seen.
"Believe me they're around," says cardiologist Judelson. "Being based in Beverly Hills, I know of many famous women with heart disease -- but none want to be spokespersons." Why? Due to the perceived age stigma, she reports, and because screen luminaries will literally be uninsurable by the studios. At the astronomical cost of today's movies, Judelson explains, producers want to make sure a star doesn't drop dead of a heart attack before a picture is completed. "It's different for celebrities with breast cancer," she insists. "They're still insurable because they're not likely to die suddenly."
Whatever the reasons for women's blindness to the peril of heart disease, the ignorance of numerous doctors clearly isn't helping matters. Why are so many of them still lagging in their understanding of female heart problems?
Training practices of the past are a big part of the problem, according to Dr. Susan Blumenthal, assistant surgeon general in the federal government's Department of Health and Human Services. "When I went to medical school we only learned about heart disease in the 180- pound male," says Blumenthal. Until recently, she further points out, women were not viewed as appropriate research subjects because they have menstrual cycles and might get pregnant. As a result, drugs and procedures for heart disease were optimized for men. It wasn't until 1993 that Congress set about rectifying this oversight by passing a law requiring women to be included in all clinical trials. Such studies are just now yielding results, bringing to light numerous sex differences in heart disease.
Women have smaller hearts, weighing 50 to 100 grams less than men's. Their hearts also beat faster, and their arteries are finer and more fragile. In addition, the interplay of their anatomy and hormones influences their cardiovascular systems in unique ways. These differences affect virtually all aspects of their care.
One surprise is that women don't always suffer from the classic male symptom of crushing chest pain. About 15 to 20 percent of women having a heart attack specifically complain of pain high in the abdomen, shortness of breath, and profuse sweating. Preceding or during an attack women may also complain of chronic fatigue, indigestion, pain in the back or jaw, and heart palpitations. Such diffuse symptoms can easily masquerade as run-of-the-mill problems like heartburn or a favorite medical culprit -- mental stress.
Sex discrimination -- namely a tendency for doctors to see women as more emotional and less trustworthy barometers of their own health -- may further contribute to misdiagnoses. In this respect, female doctors may be just as guilty as their male colleagues -- or so suggests a study of doctors in training conducted last year by psychologist Gabrielle Chiaramonte of State University of New York, Stonybrook.
In the study, male and female medical students were given case reports of a 48-year-old man and a 58-year-old women (by age, at equal risk for heart disease). Both patients had identical cardiac symptoms and half of each of their profiles mentioned that the patient was experiencing stress from the denial of a job promotion. The addition of anxiety to a case history brought out a strong gender bias in diagnosis. By in large, both male and female medical students referred the anxious male patient to a cardiologist. In contrast, the majority of the medical students sent the anxious female patient with exactly the same symptoms to a psychologist.
Gender also plays an important role in the evaluation of cardiac risk factors. Early menopause, by depriving the body of estrogen's heart protective benefits, is an obvious example of a risk factor unique to women. Other major risk factors -- elevated cholesterol, smoking, high blood pressure, diabetes and obesity -- are shared by the sexes but vary between them in subtle and sometimes dramatic ways. For a woman, total cholesterol is not as strong an indicator of heart disease as for a man. What counts most is the level of her HDL or good type of cholesterol, says Dr. Mary Ann Malloy, a cardiologist at Loyola University Medical Center in Chicago. Yet until recently national guidelines defined an unhealthy HDL level for women as 35 or under. "That's appropriate for a male," say Malloy, "but ideally it should be over 45 for a female -- the higher the better."
Smoking, everyone knows, is bad for the heart - but mounting clinical evidence points to worse consequences for female smokers than male ones. Women who smoke on average suffer heart attacks fifteen years earlier than those who don't, whereas male smokers typically have heart attacks seven years earlier.
Diabetes has also emerged as a much stronger cardiovascular risk factor for women, contributing to as many as one in five post- menopausal heart attacks. And though excess weight has long been linked to heart disease in both sexes, when it accumulates around the waist, females are especially prone to a cluster of conditions that damage the cardiovascular system, warns Dr. Harriette Mogul, director of the menopause program at New York Medical College in Valhalla. This group of conditions includes high blood pressure, low LDL, and insulin resistance (a precursor to diabetes and a contributor to plaque formation).
Clearly, an awareness of predisposing factors holds the key to catching a woman's disease early, before she keels over from a heart attack. But many doctors aren't even screening their female patients for the most salient risk factors, so entrenched is in the view that heart disease is a male problem.
Nancy Loving, a 51-year-old public relations executive in Washington, D.C., learned this the hard way. "No one ever told me I was at risk for heart disease -- not my gynecologist, not my general practitioner, not my internist," she says. Yet she'd been a smoker most of her life, was a couch potato, carried 25 excess pounds, had a family history of heart disease, and as she eventually discovered, her cholesterol was a sky-high 313. Her first warning that she was at risk was a heart attack at age 48. That jolt spurred her into action. Loving joined a health club, lost the excess weight, quit cigarettes and through a combination of drugs and dietary changes has lowered her cholesterol by over 100 points. "I've never felt better," she reports. "But it didn't have to take a heart attack to make me shape up."
Even if a doctor does suspect coronary artery disease in a woman, diagnostic testing is further complicated by gender differences. The cheapest and most widely used screening tool, the treadmill stress test, is less accurate for women. Roughly 25 percent have false positives on the test, as compared to 10 percent of men. Consequently, if the test indicates a woman has heart disease, doctors are often inclined to brush off the result as an error and not pursue it any further, reports Dr. Elizabeth Ross, attending cardiologist at the Washington Hospital Center and author of the book Healing and the Female Heart (1996).
More accurate exams for women, says Ross, are the stress echocardiogram, which uses ultrasound to image the heart, and a thallium scan or nucleolite test, which maps the organ using radioactive particles. Most accurate of all, but also a step up in price, is angiography -- the use of a thin tube that is snaked through the arteries to detect blockages. The American Heart Association holds this test as a gold standard for diagnosing heart disease in both sexes.
Not only do women receive inferior diagnostic care, but they are less likely to be treated aggressively once coronary disease is detected. Fewer women than men get clot busting drugs, bypass surgery or balloon angioplasty -- the three main techniques for restoring blood flow to ailing hearts. The fact that the average woman tends to be older and frailer by the time she develops heart disease is a major factor behind this disparity. The more aged and sickly a patient is, explains Ross, the greater the danger posed by such invasive procedures and the fewer years of life she stands to gain.
But there are other reasons as well why women are undertreated. In the case of clot-busting drugs, women often arrive at an emergency room too late to benefit from these compounds, which must be administered within six to eight hours of a heart attack. Just why women take longer than men to reach a hospital is not clear, but a recent Scottish study published last year in the journal Circulation provides a fascinating clue. Women having heart attacks often prefer to call their physicians first, the researchers reported. Men race straight to the emergency room.
To Ross, this suggests women probably have more trouble putting a finger on what's going on since their symptoms can be less specific and harder to interpret than men's. Also, she adds, women are sensitized to being labeled hypochondriacs or neurotic. "They don't want to appear to be making too big a fuss about something that might turn out to be frivolous."
That concern, justified as it may be, is costing them dearly. Because women arrive later and sicker for treatment, they are more likely than men to need emergency bypass surgery, whose mortality rate is far higher than an operation that has been carefully planned in advance.
Still another reason why women receive less aggressive treatment is that they themselves decline it. "Men take the attitude, 'I'm broken, now fix me," reports Dr. Jay Cohn, a cardiologist at the University of Minnesota Medical School, "whereas women often prefer prescription drugs to avoid surgery. They see it as a gentler approach." Ross concurs, noting that many women will tolerate severely restrictive lives rather than submit to an invasive procedure. But the "gentler" route women chose, she says, may also stem from a failure to appreciate their peril. "They can't believe they'll die of heart disease -- a man yes, but not them."
Owing to all these deficiencies in the diagnosis and treatment of women, their disease prognosis is often worse than a man's. A woman is more likely than a man to die of a heart attack, suffer congestive heart failure, stroke or have a second heart attack.
What can women do to prevent heart disease and improve their care? First, they need to recognize their risk and be alert to the symptoms. Just as important, women should get an annual physical and be thoroughly screened for risk factors by a doctor sensitive to how heart disease affects them. "Don't entrust your heart care to a gynecologist," advises Columbia's Legato. "That's like a man leaving his primary care to his sport's physician." In her opinion, it's best to chose a doctor who is either board certified in internal medicine or family practice. (A general practitioner, she cautions, is not a good choice unless he or she is certified in one of those specialties.)
A proper check up, says Legato, should not only include a complete blood work up (with a woman's cholesterol broken down into HDL, LDL and triglyceride fragments), but her heart's electrical activity should be analyzed with an EKG machine. Though far from a perfect instrument, it's useful at detecting abnormalities that can signal arterial blockages and other heart problems, reports Legato. If her EKG suggests potential heart disease, or if she has two or more risk factors (especially if one of her risk factors is a low-HDL score) a woman should be referred to a cardiologist for further evaluation.
Good heart care should also be proactive, Legato emphasizes. A woman should be exploring with her physician specific steps for lowering her personal danger profile-from exercise and other lifestyle changes to cholesterol-lowering drugs. A 2004 report by the American Heart Association strongly recommends that all women who are at high-risk (more than 20 percent chance) for having a heart attack take cholesterol-lowering drugs, preferably statins, even if their LDL is below 100. To find out if you are at low-, intermediate-, or high-risk for a heart attack, use the American Heart Association's risk assessment tool. Although past research has shown that hormone replacement therapy (HRT) may improve the cholesterol profile of menopausal women, keeping arteries more youthful and supple and preventing new plaque formation, new guidelines issued by the National Heart, Lung, and Blood Institute advise against using HRT as an alternative to cholesterol drugs. In addition, using HRT for as short a period as 5 years has recently been shown to increase a woman's risk of heart disease, stroke, blood clots, and invasive breast cancer. Some alternative treatments offer better news -- encouraging new studies raise the possibility of fortifying women's hearts against coronary artery disease by supplementing their diets with folic acid, omega-3 fatty acids, and soy products.
In short, exciting preventive strategies await women who reach for them -- but that's the hitch. Most women remain too fixated on breast cancer to capitalize on the latest advances. This shortsightedness understandably angers women like Loving, who fretted about breast cancer only to be stricken by heart disease. "Breast cancer advocates have drummed up so much excitement for their issue that they've totally eclipsed heart disease as a valid concern for women," she complains.
So why aren't Loving and others like her spearheading their own campaign to put heart disease in the spotlight? "There's simply no organizational structure to build on," says Loving. "I wouldn't even no how to contact women like myself. For goodness sakes, I couldn't even find a support group." L.A.-based victim Mindgram agrees. "I couldn't even locate a support group on the web," she reports.
Since this article was first written, however, several online support groups have sprung up, as well as the National Coalition for Women with Heart Disease.. The obstacles are great, to be sure, but women concerned about heart disease could learn a few lessons from their more vocal sisters in the breast cancer movement. As these feisty activists have shown, a woman who wants superlative care must educate herself and be a powerful advocate for her own treatment. She and others like her must organize into a coalition both for mutual support and to shake politicians and the medical establishment into better awareness of their unique needs. Above all, they must be prepared to step out of the shadows and be counted.
If numbers speak, women with heart disease will be heard.
Tuesday, September 18, 2007
Eight Steps to Preventing Heart Disease
Want to know how to avoid heart trouble? You can start by asking a nurse. Or, better yet, about 84,000 nurses. A 14-year study of 84,129 nurses -- published in the July 6, 2000 issue of the New England Journal of Medicine -- provides a blueprint for protecting the heart. You don't have to be a medical professional to follow it, either. No matter your age, your gender, or your past lifestyle, now's the time to start building a healthier heart.
Keys to a healthy heart
The Nurses' Health Study, conducted by researchers at Harvard Medical School, proved one crucial point: Healthy living can help protect the heart against the ravages of disease and time. The researchers found that one group of women was five times less likely than the others to have suffered a heart attack or to have died from heart trouble during the 14-year study. These strong-hearted women had different backgrounds and came from different parts of the country, but the big story is what they had in common: They ate a nutritious, low-fat diet, they refrained from smoking, they exercised regularly, they maintained a healthy weight, and they drank alcohol in moderation.
These women's healthy practices were a blueprint for good health. And to family doctors and cardiologists everywhere, "healthy diet, no cigarettes, regular exercise, healthy weight, and alcohol only in moderation" serve as a mantra for healthy living. Unfortunately, few people live up to this ideal. Nurses may be health-conscious people in general, but only three percent of the subjects in the Nurses' Health Study met all five criteria.
Chances are, there's still room in your life for some heart-healthy changes. Here's a look at the 8 most important steps to take:
1 . If you smoke, stop.
Cigarettes damage the arteries and speed the buildup of cholesterol and plaque, the first step toward a heart attack. In the Nurses' Health Study, just one to 14 cigarettes per day tripled the risk of heart trouble. Other studies have found that smoking at least 25 cigarettes a day may raise the risk as much as fifteenfold. If you're a smoker, quitting RIGHT NOW is the best thing you can do for your heart. Within two years, the threat of the heart attack will drop to the level of a person who has never smoked.
2. Load up on heart-friendly foods.
For most people, the battle against heart disease should start in the kitchen. By getting less than 30 percent of your calories from fat (less than 10 percent from saturated fats), eating five to seven servings of fruits and vegetables every day, and eating plenty of whole grains, you can lower your cholesterol level, protect your arteries, and slash your risk for a heart attack. Some types of fats, such as omega-3 fatty acids found in fish, may actually lower cholesterol and provide other benefits. Talk to your doctor about how to increase your intake of good fats while cutting down on the "bad" fats.
The right foods can provide dramatic protection. For instance, a study of more than 22,000 men, reported in the February 2001 issue of the International Journal of Epidemiology, found that men who ate two-and-a-half servings of vegetables every day lowered the risk of coronary heart disease (blockages in the arteries that feed the heart) by 20 percent compared with men who ate one serving each day. Each additional serving cut the risk by another 20 percent. The protection was especially strong among men who smoked or were overweight.
Eating right doesn't have to be hard work. You probably already enjoy fruits and vegetables, so why not enjoy them more often? And if you think it's hard to go low-fat, consider this: Most people can cut their intake of artery-clogging saturated fat in half by avoiding butter, margarine, mayonaise, fatty meats, and dairy products made from 2 percent or whole milk.
If you eat a typical diet of 2,000 calories a day, no more than 30 to 35 percent of that should come from fat -- and only 10 percent or less from saturated or "bad" fat. That amounts to no more than 20 grams of saturated fat a day. You can find your saturated fat intake by reading the labels on processed foods, which list the grams of processed fat they contain. In addition, read the product labels and avoid cookies, chips, and other snack foods high in "partially hydrogenated oils," or trans fats, which can also raise your level of artery-clogging cholesterol. It's also safe to assume that restaurant foods that are fried or loaded with cheese and sour cream are probably topping the charts in saturated fat.
3. Get moving.
Regular exercise can strengthen your heart, increase your HDL cholesterol (the "good" cholesterol that helps keep your arteries clear), lower your blood pressure, burn off extra pounds, and just plain make you feel good. And it doesn't take an Olympic effort. The American Heart Association recommends 30 to 60 minutes of moderately vigorous exercise every day or at least four times each week – five for those with coronary or other vascular diseases. Of course, exercise can be risky for some people with heart disease. Check with your doctor before starting a new workout program, and work up gradually. Don't be a "weekend warrior" at the gym after being a couch potato all week: It's a recipe for serious injury.
4. Monitor your cholesterol.
Since too much cholesterol contributes to plaque buildup in the arteries, it's best to keep your total cholesterol level below 200 milligrams per deciliter. Anything between 200 and 240 mg/dL is considered worrisome, and a level over 240 is often a serious threat. The basic goal is also to keep your "good" HDL cholesterol high and your "bad" LDL cholesterol level low. If you're a man, your HDL should ideally be at least 40 mg/dL; for women, the American Heart Association recommends an HDL level of at least 45 mg/dL. If you don't already have coronary heart disease and if you have fewer than two of the major risk factors -- obesity, high blood pressure, or a family history of premature heart trouble -- your LDL cholesterol should be below 130 mg/dL (and preferably under 100). If you already have coronary artery disease or diabetes mellitus and your LDL is over 100, your doctor will probably recommend you take cholesterol-lowering drugs to get your LDL below the 100 mark.
5. Watch your weight.
When it comes to the heart, bigger isn't better. A little extra weight can put a strain on your heart, boost your blood pressure, and significantly raise the risk of a heart attack. Ideally, your body mass index (BMI) should be between 18.5 and 24.9. (To calculate your BMI, see our body mass index calculator.) According to guidelines issued by the American Heart Association in July 2002, a simpler alternative to BMI is to measure your waistline - men should measure 40 inches or less and women should measure 35 inches or less. Even if you can't reach that goal, a weight-loss program that combines exercise with a healthy, low-fat diet will do wonders for your heart.
6. If you drink, take it easy.
One or two alcoholic drinks per day can help raise your good HDL cholesterol and prevent dangerous blood clots. (According to federal health agencies, women should limit their alcohol intake to up to one drink a day, since their bodies metabolize alcohol differently than men; men should limit their intake to no more than two drinks a day.) However, any more than a couple drinks a day can increase your blood pressure. Extremely heavy drinkers -- those who put away the equivalent of a six-pack of beer every day for 10 years or more -- can also suffer damage to the heart muscle (cardiomyopathy).
7. Keep your blood pressure under control.
Since high blood pressure increases the risk of coronary artery disease and stroke, it's good to keep yours in the optimum range: 120/80. If you test in the high-normal range -- 130-139/85-89 -- make arrangements to get rechecked in a year. In the meantime, talk with your doctor about lifestyle changes you can make to bring down your reading. If you have high blood pressure, meaning 140/90 or more, your doctor will likely prescribe medication to keep it in check.
8. If you're under too much stress or feeling depressed, seek out help from a psychologist or therapist.
Emotional distress is hard on the heart, and professional help can be a true lifesaver. Several studies suggest that depressed people who are otherwise healthy are more likely to develop heart disease than peers who aren't depressed. For example, a 13-year study of 1,500 subjects conducted at Johns Hopkins University found that an episode of depression increased the risk of heart attack more than fourfold. These studies take smoking and other factors into account, providing strong evidence that depression alone may be enough to cut down a once-healthy heart.
Teach your children
It's not too soon to involve your children: You can help them prevent heart disease in later life by getting used to good habits right now. By exercising and playing with your kids, not smoking, and providing daily fruits, veggies, and whole grains rather than sodas and junk food, you'll set a great example.
Involve the whole family in providing support for each other -- don't just focus on one "unhealthy" member. Don't feel like you have to make all these changes at once, which can lead to frustration and overload. To ensure success, start with simple changes that are reasonable and doable.
Use your common sense
Talk with your physician about the most important steps you need to take to protect your heart. The American Heart Association recommends a checkup every two years, ideally starting at age 20, where your doctor can measure your blood pressure, body mass index, waist circumference, and pulse. You should have your cholesterol and glucose tested every 5 years. If you're 40 or over, the AHA suggests that your doctor measure your risk factors and then calculate your chances of developing cardiovascular disease within the next 10 years. It's also important to seek professional help if you're taking steps that involve some risk (such as beginning an exercise program in middle age) or that are tough to do on your own (like quitting cigarettes).
There are no magic bullets to heart health, so it's good to be wary of those who say there are. Beware of the spectacular claims found on some "health" sites on the Internet: Anyone can post an opinion or claim there without offering proof or documentation. If it's sounds too good to be true, it probably is.
When lifestyle changes aren't enough
Remember, it's never too late to develop healthy habits. The road to a strong heart begins at home, but it may have to take a detour through your doctor's office. If you have high blood pressure, high cholesterol, or diabetes, you'll need medical help to give your heart maximum protection. If you have diabetes, you can significantly reduce your risk of heart disease by maintaining healthy blood sugar levels.
If you're at a high risk for heart disease, your doctor may recommend a daily dose of aspirin. One recent study found that taking this humble drug once a day cut the risk of a heart attack by more than 40 percent. However, a 2005 study found that women didn't see much benefit from aspirin therapy -- their risk of stroke was reduced by 17 percent, but there was no significant reduction in the women's risk of heart attack or death. Because aspirin can cause stomach problems, you shouldn't take regular doses unless your doctor says it's okay. (The American Heart Association also recommends that people on daily aspirin therapy avoid alcoholic beverages.)
Keys to a healthy heart
The Nurses' Health Study, conducted by researchers at Harvard Medical School, proved one crucial point: Healthy living can help protect the heart against the ravages of disease and time. The researchers found that one group of women was five times less likely than the others to have suffered a heart attack or to have died from heart trouble during the 14-year study. These strong-hearted women had different backgrounds and came from different parts of the country, but the big story is what they had in common: They ate a nutritious, low-fat diet, they refrained from smoking, they exercised regularly, they maintained a healthy weight, and they drank alcohol in moderation.
These women's healthy practices were a blueprint for good health. And to family doctors and cardiologists everywhere, "healthy diet, no cigarettes, regular exercise, healthy weight, and alcohol only in moderation" serve as a mantra for healthy living. Unfortunately, few people live up to this ideal. Nurses may be health-conscious people in general, but only three percent of the subjects in the Nurses' Health Study met all five criteria.
Chances are, there's still room in your life for some heart-healthy changes. Here's a look at the 8 most important steps to take:
1 . If you smoke, stop.
Cigarettes damage the arteries and speed the buildup of cholesterol and plaque, the first step toward a heart attack. In the Nurses' Health Study, just one to 14 cigarettes per day tripled the risk of heart trouble. Other studies have found that smoking at least 25 cigarettes a day may raise the risk as much as fifteenfold. If you're a smoker, quitting RIGHT NOW is the best thing you can do for your heart. Within two years, the threat of the heart attack will drop to the level of a person who has never smoked.
2. Load up on heart-friendly foods.
For most people, the battle against heart disease should start in the kitchen. By getting less than 30 percent of your calories from fat (less than 10 percent from saturated fats), eating five to seven servings of fruits and vegetables every day, and eating plenty of whole grains, you can lower your cholesterol level, protect your arteries, and slash your risk for a heart attack. Some types of fats, such as omega-3 fatty acids found in fish, may actually lower cholesterol and provide other benefits. Talk to your doctor about how to increase your intake of good fats while cutting down on the "bad" fats.
The right foods can provide dramatic protection. For instance, a study of more than 22,000 men, reported in the February 2001 issue of the International Journal of Epidemiology, found that men who ate two-and-a-half servings of vegetables every day lowered the risk of coronary heart disease (blockages in the arteries that feed the heart) by 20 percent compared with men who ate one serving each day. Each additional serving cut the risk by another 20 percent. The protection was especially strong among men who smoked or were overweight.
Eating right doesn't have to be hard work. You probably already enjoy fruits and vegetables, so why not enjoy them more often? And if you think it's hard to go low-fat, consider this: Most people can cut their intake of artery-clogging saturated fat in half by avoiding butter, margarine, mayonaise, fatty meats, and dairy products made from 2 percent or whole milk.
If you eat a typical diet of 2,000 calories a day, no more than 30 to 35 percent of that should come from fat -- and only 10 percent or less from saturated or "bad" fat. That amounts to no more than 20 grams of saturated fat a day. You can find your saturated fat intake by reading the labels on processed foods, which list the grams of processed fat they contain. In addition, read the product labels and avoid cookies, chips, and other snack foods high in "partially hydrogenated oils," or trans fats, which can also raise your level of artery-clogging cholesterol. It's also safe to assume that restaurant foods that are fried or loaded with cheese and sour cream are probably topping the charts in saturated fat.
3. Get moving.
Regular exercise can strengthen your heart, increase your HDL cholesterol (the "good" cholesterol that helps keep your arteries clear), lower your blood pressure, burn off extra pounds, and just plain make you feel good. And it doesn't take an Olympic effort. The American Heart Association recommends 30 to 60 minutes of moderately vigorous exercise every day or at least four times each week – five for those with coronary or other vascular diseases. Of course, exercise can be risky for some people with heart disease. Check with your doctor before starting a new workout program, and work up gradually. Don't be a "weekend warrior" at the gym after being a couch potato all week: It's a recipe for serious injury.
4. Monitor your cholesterol.
Since too much cholesterol contributes to plaque buildup in the arteries, it's best to keep your total cholesterol level below 200 milligrams per deciliter. Anything between 200 and 240 mg/dL is considered worrisome, and a level over 240 is often a serious threat. The basic goal is also to keep your "good" HDL cholesterol high and your "bad" LDL cholesterol level low. If you're a man, your HDL should ideally be at least 40 mg/dL; for women, the American Heart Association recommends an HDL level of at least 45 mg/dL. If you don't already have coronary heart disease and if you have fewer than two of the major risk factors -- obesity, high blood pressure, or a family history of premature heart trouble -- your LDL cholesterol should be below 130 mg/dL (and preferably under 100). If you already have coronary artery disease or diabetes mellitus and your LDL is over 100, your doctor will probably recommend you take cholesterol-lowering drugs to get your LDL below the 100 mark.
5. Watch your weight.
When it comes to the heart, bigger isn't better. A little extra weight can put a strain on your heart, boost your blood pressure, and significantly raise the risk of a heart attack. Ideally, your body mass index (BMI) should be between 18.5 and 24.9. (To calculate your BMI, see our body mass index calculator.) According to guidelines issued by the American Heart Association in July 2002, a simpler alternative to BMI is to measure your waistline - men should measure 40 inches or less and women should measure 35 inches or less. Even if you can't reach that goal, a weight-loss program that combines exercise with a healthy, low-fat diet will do wonders for your heart.
6. If you drink, take it easy.
One or two alcoholic drinks per day can help raise your good HDL cholesterol and prevent dangerous blood clots. (According to federal health agencies, women should limit their alcohol intake to up to one drink a day, since their bodies metabolize alcohol differently than men; men should limit their intake to no more than two drinks a day.) However, any more than a couple drinks a day can increase your blood pressure. Extremely heavy drinkers -- those who put away the equivalent of a six-pack of beer every day for 10 years or more -- can also suffer damage to the heart muscle (cardiomyopathy).
7. Keep your blood pressure under control.
Since high blood pressure increases the risk of coronary artery disease and stroke, it's good to keep yours in the optimum range: 120/80. If you test in the high-normal range -- 130-139/85-89 -- make arrangements to get rechecked in a year. In the meantime, talk with your doctor about lifestyle changes you can make to bring down your reading. If you have high blood pressure, meaning 140/90 or more, your doctor will likely prescribe medication to keep it in check.
8. If you're under too much stress or feeling depressed, seek out help from a psychologist or therapist.
Emotional distress is hard on the heart, and professional help can be a true lifesaver. Several studies suggest that depressed people who are otherwise healthy are more likely to develop heart disease than peers who aren't depressed. For example, a 13-year study of 1,500 subjects conducted at Johns Hopkins University found that an episode of depression increased the risk of heart attack more than fourfold. These studies take smoking and other factors into account, providing strong evidence that depression alone may be enough to cut down a once-healthy heart.
Teach your children
It's not too soon to involve your children: You can help them prevent heart disease in later life by getting used to good habits right now. By exercising and playing with your kids, not smoking, and providing daily fruits, veggies, and whole grains rather than sodas and junk food, you'll set a great example.
Involve the whole family in providing support for each other -- don't just focus on one "unhealthy" member. Don't feel like you have to make all these changes at once, which can lead to frustration and overload. To ensure success, start with simple changes that are reasonable and doable.
Use your common sense
Talk with your physician about the most important steps you need to take to protect your heart. The American Heart Association recommends a checkup every two years, ideally starting at age 20, where your doctor can measure your blood pressure, body mass index, waist circumference, and pulse. You should have your cholesterol and glucose tested every 5 years. If you're 40 or over, the AHA suggests that your doctor measure your risk factors and then calculate your chances of developing cardiovascular disease within the next 10 years. It's also important to seek professional help if you're taking steps that involve some risk (such as beginning an exercise program in middle age) or that are tough to do on your own (like quitting cigarettes).
There are no magic bullets to heart health, so it's good to be wary of those who say there are. Beware of the spectacular claims found on some "health" sites on the Internet: Anyone can post an opinion or claim there without offering proof or documentation. If it's sounds too good to be true, it probably is.
When lifestyle changes aren't enough
Remember, it's never too late to develop healthy habits. The road to a strong heart begins at home, but it may have to take a detour through your doctor's office. If you have high blood pressure, high cholesterol, or diabetes, you'll need medical help to give your heart maximum protection. If you have diabetes, you can significantly reduce your risk of heart disease by maintaining healthy blood sugar levels.
If you're at a high risk for heart disease, your doctor may recommend a daily dose of aspirin. One recent study found that taking this humble drug once a day cut the risk of a heart attack by more than 40 percent. However, a 2005 study found that women didn't see much benefit from aspirin therapy -- their risk of stroke was reduced by 17 percent, but there was no significant reduction in the women's risk of heart attack or death. Because aspirin can cause stomach problems, you shouldn't take regular doses unless your doctor says it's okay. (The American Heart Association also recommends that people on daily aspirin therapy avoid alcoholic beverages.)
Monday, September 17, 2007
Polycystic Ovarian Syndrome
Definition
Polycystic ovary syndrome (PCOS) is a condition characterized by the accumulation of numerous cysts (fluid-filled sacs) on the ovaries associated with high male hormone levels, chronic anovulation (absent ovulation), and other metabolic disturbances. Classic symptoms include excess facial and body hair, acne, obesity, irregular menstrual cycles, and infertility.
Description
PCOS, also called Stein-Leventhal syndrome, is a group of symptoms caused by underlying hormonal and metabolic disturbances that affect about 6% of premenopausal women. PCOS symptoms appear as early as adolescence in the form of amenorrhea (missed periods), obesity, and hirsutism, the abnormal growth of body hair.
A disturbance in normal hormonal signals prevents ovulation in women with PCOS. Throughout the cycle, estrogen levels remain steady, luteinizing hormone (LH) levels are high, and follide stimulating hormone (FSH) and progesterone levels are low. Since eggs are rarely or never released from their follicles, multiple ovarian cysts develop over time.
One of the most important characteristics of PCOS is hyperandrogenism, the excessive production of male hormones (androgens), particularly testosterone, by the ovaries. This accounts for the male hair-growth patterns and acne in women with PCOS. Hyperandrogenism has been linked with insulin resistance (the inability of the body to respond to insulin) and hyperinsulinemia (high blood insulin levels), both of which are common in PCOS.
Causes and symptoms
While the exact cause of PCOS is unknown, it runs in families, so the tendency to develop the syndrome may be inherited. The interaction of hyperinsulinemia and hyperandrogenism is believed to play a role in chronic anovulation in susceptible women.
The numbers and types of PCOS symptoms that appear vary among women. These include:
Hirsutism. Related to hyperandrogenism, this occurs in 70% of women.
Obesity. Approximately 40-70% of persons with PCOS are overweight.
Anovulation and menstrual disturbances. Anovulation appears as amenorrhea in 50% of women, and as heavy uterine bleeding in 30% of women. However, 20% of women with PCOS have normal menstruation.
Male-pattern hair loss. Some women with PCOS develop bald spots.
Infertility. Achieving pregnancy is difficult for many women with PCOS.
Polycystic ovaries. Most, but not all, women with PCOS have multiple cysts on their ovaries.
Skin discoloration. Some women with PCOS have dark patches on their skin.
Abnormal blood chemistry. Women with PCOS have high levels of low-density lipoprotein (LDL or "bad") cholesterol and triglycerides, and low levels of high-density lipoprotein (HDL or "good") cholesterol.
Hyperinsulinemia. Some women with PCOS have high blood insulin levels, particularly if they are overweight.
Diagnosis
PCOS is diagnosed when a woman visits her doctor for treatment of symptoms such as hirsutism, obesity, menstrual irregularities, or infertility. Women with PCOS are treated by a gynecologist, a doctor who treats diseases of the female reproductive organs, or a reproductive endocrinologist, a specialist who treats diseases of the body's endocrine (hormones and glands) system and infertility.
PCOS can be difficult to diagnose because its symptoms are similar to those of many other diseases or conditions, and because all of its symptoms may not occur. A doctor takes a complete medical history, including questions about menstruation and reproduction, and weight gain. Physical examination includes a pelvic examination to determine the size of the ovaries, and visual inspection of the skin for hirsutism, acne, or other changes. Blood tests are performed to measure levels of luteinizing hormone, follicle stimulating hormone, estrogens, androgens, glucose, and insulin. A glucose-tolerance test may be administered. An ultrasound examination of the ovaries is performed to evaluate their size and shape. Most insurance plans cover the costs of diagnosing and treating PCOS and its related problems.
Treatment
PCOS treatment is aimed at correcting anovulation, restoring normal menstrual periods, improving fertility, eliminating hirsutism and acne, and preventing future complications related to high insulin and blood lipid (fat) levels. Treatment consists of weight loss, drugs or surgery, and hair removal, depending upon which symptoms are most bothersome, and whether a woman desires pregnancy.
Weight loss
In overweight women, weight loss (as little as 5%) through diet and exercise may correct hyperandrogenism, and restore normal ovulation and fertility. This is often tried first.
Drugs
HORMONAL DRUGS
Women who do not want to become pregnant and require contraception (spontaneous ovulation occurs occasionally among women with PCOS) are treated with low-dose oral contraceptive pills (OCPs). OCPs bring on regular menstrual periods and correct heavy uterine bleeding, as well as hirsutism, although improvement may not be seen for up to a year.
If an infertile woman desires to become pregnant, the first drug usually given to help induce ovulation is clomiphene citrate (Clomid), which results in pregnancy in about 70% of women but can cause multiple births. In the 20-25% of women who do not respond to clomiphene, other drugs that stimulate follicle development and induce ovulation, such as human menstrual gonadotropin (Pergonal) and human chorionic gonadotropin (HCG), are given. However, these drugs have a lower pregnancy rate (less than 30%), a higher rate of multiple pregnancy (from 5-30%, depending on the dose of the drug), and a higher risk of medical problems. Women with PCOS have a high rate of miscarriage (30%), and may be treated with the gonadotropin-releasing hormone agonist leuprolide (Lupron) to reduce this risk.
Since women with PCOS do not have regular endometrial shedding due to high estrogen levels, they are at increased risk for overgrowth of this tissue and endometrial cancer. The drug medroxyprogesterone acetate, when taken for the first 10 days of each month, causes regular shedding of the endometrium, and reduces the risk of cancer. However, in most cases, oral contraceptive pills are used instead to bring about regular menstruation.
OTHER DRUGS
Another drug that helps to trigger ovulation is the steroid hormone dexamethasone. This drug acts by reducing the production of androgens by the adrenal glands.
The antiandrogen spironolactone (Aldactazide), which is usually given with an oral contraceptive, improves hirsutism and male-pattern baldness by reducing androgen production, but has no effect on fertility. The drug causes abnormal uterine bleeding and is linked with birth defects if taken during pregnancy. Another antiandrogen used to treat hirsutism, flutamide (Eulexin), can cause liver abnormalities, fatigue, mood swings, and loss of sexual desire. A drug used to reduce insulin levels, metformin (Glucophage), has shown promising results in women with PCOS hirsutism, but its effects on infertility and other PCOS symptoms are unknown. Drug treatment of hirsutism is long-term, and improvement may not be seen for up to a year or longer.
Acne is treated with antibiotics, antiandrogens, and other drugs such as retinoic acids (vitamin A compounds).
Surgical treatment
Surgical treatment of PCOS may be performed if drug treatment fails, but it is not common. A wedge resection, the surgical removal of part of the ovary and cysts through a laparoscope (an instrument inserted into the pelvis through a small incision), or an abdominal incision, reduces androgen production and restores ovulation. Although laparoscopic surgery is less likely to cause scar tissue formation than abdominal surgery, both are associated with the potential for scarring that may require additional surgery. Laparoscopic ovarian drilling is another type of laparoscopic surgery used to treat PCOS. The ovarian cysts are penetrated with a laser beam and some of the fluid is drained off. Between 50-65% of women may become pregnant after either type of surgery.
Some cases of severe hirsutism are treated by removal of the uterus (hysterectomy) and the ovaries (oopherectomy), followed by estrogen replacement therapy.
Other treatment
Hirsutism may be treated by hair removal techniques such as shaving, depilatories (chemicals that break down the structure of the hair), tweezing, waxing, electrolysis (destruction of the hair root by an electrical current), or the destruction of hair follicles by laser therapy. However, the treatments may have to be repeated.
Alternative treatment
PCOS can be addressed using many types of alternative treatment. The rebalancing of hormones is a primary focus of all these therapies. Acupuncture works on the body's energy flow according to the meridian system. Chinese herbs, such as gui zhi fu ling wan, can be effective. In naturopathic medicine, treatment focuses on helping the liver function more optimally in the horomonal balancing process. Dietary changes, including reducing animal products and fats, while increasing foods that nourish the liver such as carrots, dark green vegetables, lemons, and beets, can be beneficial. Essential fatty acids, including flax oil, evening primrose oil (Oenothera biennis), and black currant oil, act as anti-inflammatories and hormonal regulators. Western herbal medicine uses phytoestrogen and phytoprogesteronic herbs, such as blue cohosh (Caulophyllum thalictroides) and false unicorn root (Chamaelirium luteum), as well as liver herbs, like dandelion (Taraxacum mongolicum), to work toward hormonal balance. Supplementation with antioxidants, including zinc, and vitamins A, E, and C, is also recommended. Constitutional homeopathy can bring about a deep level of healing with the correct remedies.
Prognosis
With proper diagnosis and treatment, most PCOS symptoms can be adequately controlled or eliminated. Infertility can be corrected and pregnancy achieved in most women although, in some, hormonal disturbances and anovulation may recur. Women should be monitored for endometrial cancer. Because of the high rate of hyperinsulinemia seen in PCOS, women with the disorder should have their glucose levels checked regularly to watch for the development of diabetes. Blood pressure and cholesterol screening are also needed because these women also tend to have high levels of LDL cholesterol and triglycerides, which put them at risk for developing heart disease.
Prevention
There is no known way to prevent PCOS, but if diagnosed and treated early, risks for complications such as and heart disease and diabetes may be minimized. Weight control through diet and exercise stabilizes hormones and lowers insulin levels.
Polycystic ovary syndrome (PCOS) is a condition characterized by the accumulation of numerous cysts (fluid-filled sacs) on the ovaries associated with high male hormone levels, chronic anovulation (absent ovulation), and other metabolic disturbances. Classic symptoms include excess facial and body hair, acne, obesity, irregular menstrual cycles, and infertility.
Description
PCOS, also called Stein-Leventhal syndrome, is a group of symptoms caused by underlying hormonal and metabolic disturbances that affect about 6% of premenopausal women. PCOS symptoms appear as early as adolescence in the form of amenorrhea (missed periods), obesity, and hirsutism, the abnormal growth of body hair.
A disturbance in normal hormonal signals prevents ovulation in women with PCOS. Throughout the cycle, estrogen levels remain steady, luteinizing hormone (LH) levels are high, and follide stimulating hormone (FSH) and progesterone levels are low. Since eggs are rarely or never released from their follicles, multiple ovarian cysts develop over time.
One of the most important characteristics of PCOS is hyperandrogenism, the excessive production of male hormones (androgens), particularly testosterone, by the ovaries. This accounts for the male hair-growth patterns and acne in women with PCOS. Hyperandrogenism has been linked with insulin resistance (the inability of the body to respond to insulin) and hyperinsulinemia (high blood insulin levels), both of which are common in PCOS.
Causes and symptoms
While the exact cause of PCOS is unknown, it runs in families, so the tendency to develop the syndrome may be inherited. The interaction of hyperinsulinemia and hyperandrogenism is believed to play a role in chronic anovulation in susceptible women.
The numbers and types of PCOS symptoms that appear vary among women. These include:
Hirsutism. Related to hyperandrogenism, this occurs in 70% of women.
Obesity. Approximately 40-70% of persons with PCOS are overweight.
Anovulation and menstrual disturbances. Anovulation appears as amenorrhea in 50% of women, and as heavy uterine bleeding in 30% of women. However, 20% of women with PCOS have normal menstruation.
Male-pattern hair loss. Some women with PCOS develop bald spots.
Infertility. Achieving pregnancy is difficult for many women with PCOS.
Polycystic ovaries. Most, but not all, women with PCOS have multiple cysts on their ovaries.
Skin discoloration. Some women with PCOS have dark patches on their skin.
Abnormal blood chemistry. Women with PCOS have high levels of low-density lipoprotein (LDL or "bad") cholesterol and triglycerides, and low levels of high-density lipoprotein (HDL or "good") cholesterol.
Hyperinsulinemia. Some women with PCOS have high blood insulin levels, particularly if they are overweight.
Diagnosis
PCOS is diagnosed when a woman visits her doctor for treatment of symptoms such as hirsutism, obesity, menstrual irregularities, or infertility. Women with PCOS are treated by a gynecologist, a doctor who treats diseases of the female reproductive organs, or a reproductive endocrinologist, a specialist who treats diseases of the body's endocrine (hormones and glands) system and infertility.
PCOS can be difficult to diagnose because its symptoms are similar to those of many other diseases or conditions, and because all of its symptoms may not occur. A doctor takes a complete medical history, including questions about menstruation and reproduction, and weight gain. Physical examination includes a pelvic examination to determine the size of the ovaries, and visual inspection of the skin for hirsutism, acne, or other changes. Blood tests are performed to measure levels of luteinizing hormone, follicle stimulating hormone, estrogens, androgens, glucose, and insulin. A glucose-tolerance test may be administered. An ultrasound examination of the ovaries is performed to evaluate their size and shape. Most insurance plans cover the costs of diagnosing and treating PCOS and its related problems.
Treatment
PCOS treatment is aimed at correcting anovulation, restoring normal menstrual periods, improving fertility, eliminating hirsutism and acne, and preventing future complications related to high insulin and blood lipid (fat) levels. Treatment consists of weight loss, drugs or surgery, and hair removal, depending upon which symptoms are most bothersome, and whether a woman desires pregnancy.
Weight loss
In overweight women, weight loss (as little as 5%) through diet and exercise may correct hyperandrogenism, and restore normal ovulation and fertility. This is often tried first.
Drugs
HORMONAL DRUGS
Women who do not want to become pregnant and require contraception (spontaneous ovulation occurs occasionally among women with PCOS) are treated with low-dose oral contraceptive pills (OCPs). OCPs bring on regular menstrual periods and correct heavy uterine bleeding, as well as hirsutism, although improvement may not be seen for up to a year.
If an infertile woman desires to become pregnant, the first drug usually given to help induce ovulation is clomiphene citrate (Clomid), which results in pregnancy in about 70% of women but can cause multiple births. In the 20-25% of women who do not respond to clomiphene, other drugs that stimulate follicle development and induce ovulation, such as human menstrual gonadotropin (Pergonal) and human chorionic gonadotropin (HCG), are given. However, these drugs have a lower pregnancy rate (less than 30%), a higher rate of multiple pregnancy (from 5-30%, depending on the dose of the drug), and a higher risk of medical problems. Women with PCOS have a high rate of miscarriage (30%), and may be treated with the gonadotropin-releasing hormone agonist leuprolide (Lupron) to reduce this risk.
Since women with PCOS do not have regular endometrial shedding due to high estrogen levels, they are at increased risk for overgrowth of this tissue and endometrial cancer. The drug medroxyprogesterone acetate, when taken for the first 10 days of each month, causes regular shedding of the endometrium, and reduces the risk of cancer. However, in most cases, oral contraceptive pills are used instead to bring about regular menstruation.
OTHER DRUGS
Another drug that helps to trigger ovulation is the steroid hormone dexamethasone. This drug acts by reducing the production of androgens by the adrenal glands.
The antiandrogen spironolactone (Aldactazide), which is usually given with an oral contraceptive, improves hirsutism and male-pattern baldness by reducing androgen production, but has no effect on fertility. The drug causes abnormal uterine bleeding and is linked with birth defects if taken during pregnancy. Another antiandrogen used to treat hirsutism, flutamide (Eulexin), can cause liver abnormalities, fatigue, mood swings, and loss of sexual desire. A drug used to reduce insulin levels, metformin (Glucophage), has shown promising results in women with PCOS hirsutism, but its effects on infertility and other PCOS symptoms are unknown. Drug treatment of hirsutism is long-term, and improvement may not be seen for up to a year or longer.
Acne is treated with antibiotics, antiandrogens, and other drugs such as retinoic acids (vitamin A compounds).
Surgical treatment
Surgical treatment of PCOS may be performed if drug treatment fails, but it is not common. A wedge resection, the surgical removal of part of the ovary and cysts through a laparoscope (an instrument inserted into the pelvis through a small incision), or an abdominal incision, reduces androgen production and restores ovulation. Although laparoscopic surgery is less likely to cause scar tissue formation than abdominal surgery, both are associated with the potential for scarring that may require additional surgery. Laparoscopic ovarian drilling is another type of laparoscopic surgery used to treat PCOS. The ovarian cysts are penetrated with a laser beam and some of the fluid is drained off. Between 50-65% of women may become pregnant after either type of surgery.
Some cases of severe hirsutism are treated by removal of the uterus (hysterectomy) and the ovaries (oopherectomy), followed by estrogen replacement therapy.
Other treatment
Hirsutism may be treated by hair removal techniques such as shaving, depilatories (chemicals that break down the structure of the hair), tweezing, waxing, electrolysis (destruction of the hair root by an electrical current), or the destruction of hair follicles by laser therapy. However, the treatments may have to be repeated.
Alternative treatment
PCOS can be addressed using many types of alternative treatment. The rebalancing of hormones is a primary focus of all these therapies. Acupuncture works on the body's energy flow according to the meridian system. Chinese herbs, such as gui zhi fu ling wan, can be effective. In naturopathic medicine, treatment focuses on helping the liver function more optimally in the horomonal balancing process. Dietary changes, including reducing animal products and fats, while increasing foods that nourish the liver such as carrots, dark green vegetables, lemons, and beets, can be beneficial. Essential fatty acids, including flax oil, evening primrose oil (Oenothera biennis), and black currant oil, act as anti-inflammatories and hormonal regulators. Western herbal medicine uses phytoestrogen and phytoprogesteronic herbs, such as blue cohosh (Caulophyllum thalictroides) and false unicorn root (Chamaelirium luteum), as well as liver herbs, like dandelion (Taraxacum mongolicum), to work toward hormonal balance. Supplementation with antioxidants, including zinc, and vitamins A, E, and C, is also recommended. Constitutional homeopathy can bring about a deep level of healing with the correct remedies.
Prognosis
With proper diagnosis and treatment, most PCOS symptoms can be adequately controlled or eliminated. Infertility can be corrected and pregnancy achieved in most women although, in some, hormonal disturbances and anovulation may recur. Women should be monitored for endometrial cancer. Because of the high rate of hyperinsulinemia seen in PCOS, women with the disorder should have their glucose levels checked regularly to watch for the development of diabetes. Blood pressure and cholesterol screening are also needed because these women also tend to have high levels of LDL cholesterol and triglycerides, which put them at risk for developing heart disease.
Prevention
There is no known way to prevent PCOS, but if diagnosed and treated early, risks for complications such as and heart disease and diabetes may be minimized. Weight control through diet and exercise stabilizes hormones and lowers insulin levels.
Ovarian Cysts: Am I At Risk?
What are ovarian cysts?
Ovarian cysts are usually solid or fluid-filled sacs that result from fluid accumulated during ovulation. After the menstrual period, these cysts usually shrink or dissolve spontaneously, although they may reoccur in subsequent ovulatory cycles.
Does a cyst mean I have cancer?
No. Cysts are typically a part of the menstrual cycle; even if they continue to grow after they form, they are rarely cancerous. And there is no evidence that women who have benign, or harmless, ovarian cysts are at greater risk than other women for cancerous ovarian growths.
You may be at greater risk for ovarian cancer, however, if
•You have a family history of ovarian cancer.
•You have been given fertility drugs for artificial reproductive techniques such as in-vitro fertilization. (Many physicians have administered the drug Clomid as a first-line treatment to induce ovulation, but it has not been shown that this drug increases the risk of cancer.)
Other possible risk factors include a high-fat diet and having had talcum powder applied near the vagina, according to the National Cancer Institute. Researchers have not done case-control studies on either talc or high-fat diet and ovarian cancer. But an analysis of sex studies on vaginal exposure to talc and ovarian cancer found a statistically significant risk, and studies have linked high-fat diets to some forms of cancer.
Are cysts bad for me?
Not necessarily. There's a tendency to view all ovarian cysts with suspicion, but many cause no problems at all. Cysts related to ovulation, for example, don't cause cancer. But some cysts -- such as those found in girls or postmenopausal women -- are cause for more concern.
Generally, any cyst that persists for more than two to three menstrual cycles or continues to increase in size warrants close evaluation, according to the American College of Obstetricians and Gynecologists.
Is there more than one kind of cyst?
Yes. Cysts related to ovulation are known as functional cysts. Another variety, the follicular cyst, occurs when the follicle fails to burst and stubbornly continues to grow without releasing the egg. A follicular cyst usually disappears after two to three menstrual cycles. Some, however, can grow as large as 2.75 inches -- a little bigger in diameter than a 12 ounce can of soda -- and be quite painful; they may require surgery.
A luteal cyst, another type of functional cyst, grows from the corpus luteum, the substance that remains after the egg is released. This substance usually dissolves, but it can sometimes continue growing and become a cyst.
Some women will develop functional cysts over and over. The good news is that neither the follicular nor luteal cysts lead to cancer.
When multiple cysts are growing on the ovaries at the same time, you have polycystic ovarian syndrome . This condition is a sign of hormonal imbalance; if you have it, your body may be producing too many hormones known as androgens, and your ovaries may not produce eggs without treatment.
When should I get medical attention?
If a cyst is not related to ovulation, your doctor will want to do a thorough examination to determine what to do next. A solid cyst, which lingers through many menstrual cycles, is one to watch out for: It requires medical tests to determine whether it's cancerous.
Since non-solid cysts can also cause problems, you should see a doctor immediately if you're having persistent pain or any of the other problems listed below. If a cyst doesn't dissolve after two or three menstrual periods, it may continue to grow and cause a variety of symptoms, including abdominal pain or pressure or pain during intercourse. It can also result in irregular menstrual periods and dull or knife-like pain.
A cyst can also twist or rupture, causing internal bleeding, severe abdominal pain, nausea, vomiting, dizziness, and faintness. Some cysts can even lead to irregular bowel or bladder function, swelling in the legs or vulva, an increase in facial and body hair, or weight gain.
Be aware that cysts can cause symptoms that mimic other illnesses, including pelvic inflammatory disease, tubal pregnancy, endometriosis, and ovarian cancer. Your doctor may need to run tests to rule out those disorders before her or she can make a diagnosis.
What should I do if I have a cyst?
It depends on what the pelvic exam reveals, whether or not you have symptoms, and your medical history. If your doctor feels a growth on the ovary, he or she will probably order an ultrasound to get a picture of your reproductive tract. This image can show you how large the cyst is, what it looks like, and whether it appears to be cancerous. If you don't have pain, your doctor may want to put you on birth control pills (which help dissolve cysts) and monitor the result.
If you are experiencing pain, nausea, weight gain, an increase in facial hair, or other troubling symptoms, your doctor may also want to do a laparoscopy. A laparoscopy is a micro-surgical procedure that allows your doctor to look at your ovaries and pelvic area through a thin tube with a light at the end, and remove any cysts or growths to examine the tissue.
If the cyst appears to be cancerous, your doctor may do a series of diagnostic tests, since no one test may be conclusive. These include a blood test called CA 125, which detects tumors; other tests allow the doctor to see what's going on inside your body by looking at images from a an MRI, an abdominal CT scan, a barium enema, or an x-ray of the urinary tract. He or she may also do an ultrasonography to examine the ovaries; a fluid-filled benign cyst and a tumor produce different types of sound waves.
If there still is some doubt about whether there is cancer present, your doctor could elect to do a laparoscopy. If there are strong indications that cancer is present, a more extensive procedure called a laparotomy is performed. This is a surgical procedure in which the abdomen is cut open and the tumor or growth removed, and often some of the reproductive organs as well.
Ovarian cysts are usually solid or fluid-filled sacs that result from fluid accumulated during ovulation. After the menstrual period, these cysts usually shrink or dissolve spontaneously, although they may reoccur in subsequent ovulatory cycles.
Does a cyst mean I have cancer?
No. Cysts are typically a part of the menstrual cycle; even if they continue to grow after they form, they are rarely cancerous. And there is no evidence that women who have benign, or harmless, ovarian cysts are at greater risk than other women for cancerous ovarian growths.
You may be at greater risk for ovarian cancer, however, if
•You have a family history of ovarian cancer.
•You have been given fertility drugs for artificial reproductive techniques such as in-vitro fertilization. (Many physicians have administered the drug Clomid as a first-line treatment to induce ovulation, but it has not been shown that this drug increases the risk of cancer.)
Other possible risk factors include a high-fat diet and having had talcum powder applied near the vagina, according to the National Cancer Institute. Researchers have not done case-control studies on either talc or high-fat diet and ovarian cancer. But an analysis of sex studies on vaginal exposure to talc and ovarian cancer found a statistically significant risk, and studies have linked high-fat diets to some forms of cancer.
Are cysts bad for me?
Not necessarily. There's a tendency to view all ovarian cysts with suspicion, but many cause no problems at all. Cysts related to ovulation, for example, don't cause cancer. But some cysts -- such as those found in girls or postmenopausal women -- are cause for more concern.
Generally, any cyst that persists for more than two to three menstrual cycles or continues to increase in size warrants close evaluation, according to the American College of Obstetricians and Gynecologists.
Is there more than one kind of cyst?
Yes. Cysts related to ovulation are known as functional cysts. Another variety, the follicular cyst, occurs when the follicle fails to burst and stubbornly continues to grow without releasing the egg. A follicular cyst usually disappears after two to three menstrual cycles. Some, however, can grow as large as 2.75 inches -- a little bigger in diameter than a 12 ounce can of soda -- and be quite painful; they may require surgery.
A luteal cyst, another type of functional cyst, grows from the corpus luteum, the substance that remains after the egg is released. This substance usually dissolves, but it can sometimes continue growing and become a cyst.
Some women will develop functional cysts over and over. The good news is that neither the follicular nor luteal cysts lead to cancer.
When multiple cysts are growing on the ovaries at the same time, you have polycystic ovarian syndrome . This condition is a sign of hormonal imbalance; if you have it, your body may be producing too many hormones known as androgens, and your ovaries may not produce eggs without treatment.
When should I get medical attention?
If a cyst is not related to ovulation, your doctor will want to do a thorough examination to determine what to do next. A solid cyst, which lingers through many menstrual cycles, is one to watch out for: It requires medical tests to determine whether it's cancerous.
Since non-solid cysts can also cause problems, you should see a doctor immediately if you're having persistent pain or any of the other problems listed below. If a cyst doesn't dissolve after two or three menstrual periods, it may continue to grow and cause a variety of symptoms, including abdominal pain or pressure or pain during intercourse. It can also result in irregular menstrual periods and dull or knife-like pain.
A cyst can also twist or rupture, causing internal bleeding, severe abdominal pain, nausea, vomiting, dizziness, and faintness. Some cysts can even lead to irregular bowel or bladder function, swelling in the legs or vulva, an increase in facial and body hair, or weight gain.
Be aware that cysts can cause symptoms that mimic other illnesses, including pelvic inflammatory disease, tubal pregnancy, endometriosis, and ovarian cancer. Your doctor may need to run tests to rule out those disorders before her or she can make a diagnosis.
What should I do if I have a cyst?
It depends on what the pelvic exam reveals, whether or not you have symptoms, and your medical history. If your doctor feels a growth on the ovary, he or she will probably order an ultrasound to get a picture of your reproductive tract. This image can show you how large the cyst is, what it looks like, and whether it appears to be cancerous. If you don't have pain, your doctor may want to put you on birth control pills (which help dissolve cysts) and monitor the result.
If you are experiencing pain, nausea, weight gain, an increase in facial hair, or other troubling symptoms, your doctor may also want to do a laparoscopy. A laparoscopy is a micro-surgical procedure that allows your doctor to look at your ovaries and pelvic area through a thin tube with a light at the end, and remove any cysts or growths to examine the tissue.
If the cyst appears to be cancerous, your doctor may do a series of diagnostic tests, since no one test may be conclusive. These include a blood test called CA 125, which detects tumors; other tests allow the doctor to see what's going on inside your body by looking at images from a an MRI, an abdominal CT scan, a barium enema, or an x-ray of the urinary tract. He or she may also do an ultrasonography to examine the ovaries; a fluid-filled benign cyst and a tumor produce different types of sound waves.
If there still is some doubt about whether there is cancer present, your doctor could elect to do a laparoscopy. If there are strong indications that cancer is present, a more extensive procedure called a laparotomy is performed. This is a surgical procedure in which the abdomen is cut open and the tumor or growth removed, and often some of the reproductive organs as well.
Ovarian Cancer: Symptoms and Treatment
What is ovarian cancer?
It's a cancer that strikes a woman's ovaries, the small almond-shaped organs that produce and release eggs. Unfortunately, the disease is characterized by symptoms so subtle that they often go unnoticed until the cancer has spread elsewhere. Most women who develop it, in fact, get a diagnosis only when the disease is far advanced. About 15 to 20 percent of ovarian cancer patients will survive more than 5 years after being diagnosed. If the cancer is caught early, however, the five year survival rate is 90 percent.
The American Cancer Society estimates that well over 20,000 women will be diagnosed with ovarian cancer in a given year.
Who's at the highest risk?
Women over 50 are most likely to develop this cancer, although it's found in younger women as well. You're also at higher-than-average risk if one or more of the following symptoms is true of you:
•You have a relative who's had endometrial, colon, or breast cancer, especially one in your immediate family.
•You've had endometrial, colon or breast cancer.
•You have the inherited BRCA1 or BRCA2 gene mutations (together, these seem to account for 16 to 60 percent of all ovarian-cancer cases).
Other possible risk factors include a high-fat diet and the use of talc in the genital area, but they remain unconfirmed.
In a study reported in the Journal of the National Cancer Institute, Norwegian researchers found a correlation between height and weight during a woman's teens and her chances of developing ovarian cancer as an adult. Teens whose body mass index (BMI) was in the top 15 percent or who were roughly 5 feet 7 inches (175 cm) tall or taller were at a greater risk for ovarian cancer later in life.
Researchers previously thought that women who took fertility drugs were at a higher risk for ovarian cancer; however, a comprehensive analysis of available data by University of Pittsburgh researchers released February 1, 2002 found no evidence of this.
Some research also suggests that estrogen replacement therapy (ERT) when used for many years may increase the risk of the disease -- an American Cancer Society study of more than 200,000 postmenopausal women found that women who continued to use ERT after 10 years were twice as likely to die of ovarian cancer as women who had never had estrogen replacement therapy. The link between ERT and ovarian cancer is further supported by a study of over 44,000 women reported in the July 17, 2002 issue of the Journal of the American Medical Association. In this study, women on ERT were found to have a 60 percent greater risk of developing ovarian cancer than women who had never used hormone replacement therapy.
According to a 1998 study, the rate of ovarian cancer that runs in families may be higher among Jewish women than among their non-Jewish counterparts -- a difference the researchers ascribe to the presence of more BRCA1 and BRCA2 genes in the Jewish families. Women who are Ashkenazi (Eastern European) Jews and have an immediate family member who's had the cancer are at significantly greater risk of getting it.
Factors that make ovarian cancer less likely are pregnancy, breastfeeding, and the use of oral contraceptives. A recent study found that oral contraceptives can cut the risk of ovarian cancer in half. And pills that are high in progestin cut that risk even further -- by another 50 percent, according to researchers at the Duke University Medical Center.
Is ovarian cancer always fatal?
No. The earlier the cancer is detected, the greater the chance that treatment will be successful.
What are the signs of ovarian cancer?
A good test for the cancer hasn't been developed yet, although scientists are working on a reliable screening method. But if you consistently experience several of the following problems, make an appointment with your doctor to be on the safe side.
•Bloating, fullness, and pressure in the abdomen
•Pain in the abdomen, pelvis, or lower back
•Unexplained changes in your bowel movements
•Unexplained weight loss or weight gain, particularly weight gain in the abdomen
•Frequent or urgent urination
•Fatigue
•Pain during intercourse
How will my doctor check for ovarian cancer?
First you'll have a pelvic exam. Your doctor will examine the area around your ovaries for unusual lumps and will check the ovaries themselves to see if they're swollen. You may also have a CT or CAT scan, ultrasound, or one of the other tests that provide your doctor with an image of your internal organs. A surgical procedure called a laparotomy is used to confirm the presence of cancer.
Can I be cured?
Yes, if your cancer is caught early. Women diagnosed at an early stage of the disease (they make up about 20 percent of all cases) are ordinarily treated successfully. According to the National Ovarian Cancer Coalition, most of them are cured. Unfortunately for women diagnosed in the later stages of the disease, the survival rate can be as low as 29 percent.
What's the treatment?
Ovarian cancer is usually treated with a combination of surgery and chemotherapy. Sometimes radiation therapy is also used. The surgery is generally what amounts to a radical hysterectomy -- removal of the reproductive organs and some lymph glands -- and it often takes place as soon as the cancer is found, during the laparotomy.
If you have surgery, chemotherapy usually follows. You may also have radiation therapy, in which a beam of radiation is targeted the cancer is used to eliminate it. The radiation treatments are painless, although you may find yourself much more tired than usual.
A blood test to measure something called CA-125, which is produced by ovarian cancer cells, may help your doctor track the effectiveness of your treatment. Since CA-125 is also produced in the body by conditions other than cancer, it shouldn't be used to diagnose the disease, according to the National Ovarian Cancer Coalition. However, researchers have found that once the disease is diagnosed and treated, the levels of CA-125 in your blood may indicate whether the disease is progressing or not.
Should I consider alternative treatments?
Increasingly, women with cancer are choosing to use alternative therapies in addition to the standard ones. Special diets, herbal treatments, and visualization exercises are among the increasingly popular complements to traditional approaches. If you do decide to supplement your treatment with alternative therapies, let your doctor know. It's especially important to tell him or her about the herbal remedies or supplements you're taking, since some of these can interact in a harmful way with prescription or over-the-counter drugs.
It's a cancer that strikes a woman's ovaries, the small almond-shaped organs that produce and release eggs. Unfortunately, the disease is characterized by symptoms so subtle that they often go unnoticed until the cancer has spread elsewhere. Most women who develop it, in fact, get a diagnosis only when the disease is far advanced. About 15 to 20 percent of ovarian cancer patients will survive more than 5 years after being diagnosed. If the cancer is caught early, however, the five year survival rate is 90 percent.
The American Cancer Society estimates that well over 20,000 women will be diagnosed with ovarian cancer in a given year.
Who's at the highest risk?
Women over 50 are most likely to develop this cancer, although it's found in younger women as well. You're also at higher-than-average risk if one or more of the following symptoms is true of you:
•You have a relative who's had endometrial, colon, or breast cancer, especially one in your immediate family.
•You've had endometrial, colon or breast cancer.
•You have the inherited BRCA1 or BRCA2 gene mutations (together, these seem to account for 16 to 60 percent of all ovarian-cancer cases).
Other possible risk factors include a high-fat diet and the use of talc in the genital area, but they remain unconfirmed.
In a study reported in the Journal of the National Cancer Institute, Norwegian researchers found a correlation between height and weight during a woman's teens and her chances of developing ovarian cancer as an adult. Teens whose body mass index (BMI) was in the top 15 percent or who were roughly 5 feet 7 inches (175 cm) tall or taller were at a greater risk for ovarian cancer later in life.
Researchers previously thought that women who took fertility drugs were at a higher risk for ovarian cancer; however, a comprehensive analysis of available data by University of Pittsburgh researchers released February 1, 2002 found no evidence of this.
Some research also suggests that estrogen replacement therapy (ERT) when used for many years may increase the risk of the disease -- an American Cancer Society study of more than 200,000 postmenopausal women found that women who continued to use ERT after 10 years were twice as likely to die of ovarian cancer as women who had never had estrogen replacement therapy. The link between ERT and ovarian cancer is further supported by a study of over 44,000 women reported in the July 17, 2002 issue of the Journal of the American Medical Association. In this study, women on ERT were found to have a 60 percent greater risk of developing ovarian cancer than women who had never used hormone replacement therapy.
According to a 1998 study, the rate of ovarian cancer that runs in families may be higher among Jewish women than among their non-Jewish counterparts -- a difference the researchers ascribe to the presence of more BRCA1 and BRCA2 genes in the Jewish families. Women who are Ashkenazi (Eastern European) Jews and have an immediate family member who's had the cancer are at significantly greater risk of getting it.
Factors that make ovarian cancer less likely are pregnancy, breastfeeding, and the use of oral contraceptives. A recent study found that oral contraceptives can cut the risk of ovarian cancer in half. And pills that are high in progestin cut that risk even further -- by another 50 percent, according to researchers at the Duke University Medical Center.
Is ovarian cancer always fatal?
No. The earlier the cancer is detected, the greater the chance that treatment will be successful.
What are the signs of ovarian cancer?
A good test for the cancer hasn't been developed yet, although scientists are working on a reliable screening method. But if you consistently experience several of the following problems, make an appointment with your doctor to be on the safe side.
•Bloating, fullness, and pressure in the abdomen
•Pain in the abdomen, pelvis, or lower back
•Unexplained changes in your bowel movements
•Unexplained weight loss or weight gain, particularly weight gain in the abdomen
•Frequent or urgent urination
•Fatigue
•Pain during intercourse
How will my doctor check for ovarian cancer?
First you'll have a pelvic exam. Your doctor will examine the area around your ovaries for unusual lumps and will check the ovaries themselves to see if they're swollen. You may also have a CT or CAT scan, ultrasound, or one of the other tests that provide your doctor with an image of your internal organs. A surgical procedure called a laparotomy is used to confirm the presence of cancer.
Can I be cured?
Yes, if your cancer is caught early. Women diagnosed at an early stage of the disease (they make up about 20 percent of all cases) are ordinarily treated successfully. According to the National Ovarian Cancer Coalition, most of them are cured. Unfortunately for women diagnosed in the later stages of the disease, the survival rate can be as low as 29 percent.
What's the treatment?
Ovarian cancer is usually treated with a combination of surgery and chemotherapy. Sometimes radiation therapy is also used. The surgery is generally what amounts to a radical hysterectomy -- removal of the reproductive organs and some lymph glands -- and it often takes place as soon as the cancer is found, during the laparotomy.
If you have surgery, chemotherapy usually follows. You may also have radiation therapy, in which a beam of radiation is targeted the cancer is used to eliminate it. The radiation treatments are painless, although you may find yourself much more tired than usual.
A blood test to measure something called CA-125, which is produced by ovarian cancer cells, may help your doctor track the effectiveness of your treatment. Since CA-125 is also produced in the body by conditions other than cancer, it shouldn't be used to diagnose the disease, according to the National Ovarian Cancer Coalition. However, researchers have found that once the disease is diagnosed and treated, the levels of CA-125 in your blood may indicate whether the disease is progressing or not.
Should I consider alternative treatments?
Increasingly, women with cancer are choosing to use alternative therapies in addition to the standard ones. Special diets, herbal treatments, and visualization exercises are among the increasingly popular complements to traditional approaches. If you do decide to supplement your treatment with alternative therapies, let your doctor know. It's especially important to tell him or her about the herbal remedies or supplements you're taking, since some of these can interact in a harmful way with prescription or over-the-counter drugs.
PMS
What is premenstrual syndrome?
Premenstrual syndrome, or PMS, is the term used for the physical and emotional symptoms that many women have during the seven to 14 days before their menstrual period begins. Almost every woman will endure bouts of PMS at some point in her life, but for an unlucky few -- between 20 and 40 percent -- PMS is a monthly ordeal.
What are the symptoms?
PMS symptoms are so numerous and varied that looking at a rundown can be a little jarring. The good news is that few people experience all of them. Physical symptoms may include these:
•lack of energy, fatigue
•swollen, tender breasts
•abdominal bloating, cramps, nausea, vomiting, diarrhea, constipation
•headache, back pain, body aches
•appetite changes
•swollen hands, feet, or ankles (due to water retention)
•dizziness, fainting
•joint or muscle pain
•flare-ups of acne, cold sores, genital herpes, yeast infections
Mental and emotional symptoms may include these:
•irritability
•anger
•mood swings
•depression
•crying spells
•forgetfulness, difficulty concentrating
•anxiety
•memory loss or forgetfulness
•confusion
What causes PMS?
Researchers aren't sure. They used to think PMS was related to fluctuations in levels of hormones such as estrogen and progesterone. More recent research favors changes in neurotransmitter levels, including mood-altering endorphins and serotonin, and diet -- especially a lack of calcium. It's also possible that these imbalances are related. A dietary imbalance, for example, might cause your hormone or neurotransmitter levels to get out of whack. You're most likely to suffer PMS symptoms after you've given birth, had a miscarriage or abortion, or experienced another event that involves major hormonal upheaval.
What are the best ways to get relief?
You have a wide range of options, including these:
•Get moving. Studies show that physical activity helps to relieve PMS symptoms, perhaps by triggering the release of brain chemicals, including endorphins, which ease pain, relieve stress, brighten mood, and produce a sense of well-being. Exercise also relaxes muscles, which can ease aches. And it fights fluid retention, which can reduce bloating and breast tenderness.
•Try taking calcium supplements. An exciting new study suggested that women who took two Tums E-X tablets twice a day (which provided a total of 1,200 milligrams of calcium) had a noticeable reduction in PMS symptoms. Calcium's benefits didn't kick in until the third month, though, so don't give up if you don't feel better during the first cycle or two.
•Eat healthfully. Get plenty of complex carbohydrates such as whole grain breads, pasta, and cereal; and load up on fruits and vegetables. Unlike sweets, these foods provide steady energy and are high in fiber, which can curb cravings, since fiber-rich foods take longer to digest. Adding nuts, seeds, and soy products to your meals may also fend off PMS. These foods are rich in phytoestrogens (plant estrogens), which recent studies suggest may help adjust hormonal imbalances. Finally, avoid highly salted foods in the weeks leading up to your period (salt can cause you to retain water and feel bloated), caffeine (it's been found to contribute to breast tenderness and can exacerbate anxiety and irritability), and alcohol (it can trigger cravings and aggravate depression, headache, and fatigue).
•Take over-the-counter pain relievers. Aspirin and ibuprofen can relieve many of the bodily aches and pains that come with PMS.
•Talk to your doctor about taking other medications. If your symptoms are severe, ask your doctor if birth-control pills or antidepressants might be helpful. Oral contraceptives can even out fluctuations in hormone levels that cause symptoms. And studies show that the newer SSRI (selective serotonin reuptake inhibitor) drugs, such as Prozac, can effectively relieve both the emotional and physical symptoms of PMS in 75 percent of women. These medications work by increasing serotonin levels, possibly correcting neurotransmitter imbalances that seem to contribute to PMS.
•Get more sleep. Being stressed out or sleep deprived is likely to exacerbate many PMS symptoms, including aches and pains, moodiness, and irritability. Make sure you get plenty of sleep, and try relaxation techniques -- such as massage, meditation, or simply soaking in long hot baths -- as your period approaches.
When should I see a doctor?
If your symptoms are mild and you're managing fine on your own, there's no need to see a physician. But if you're one of the 5 to 10 percent of women with severe PMS, your doctor can probably suggest treatments that will greatly ease your symptoms. Try keeping a diary of your complaints for a few months. This information can help your doctor determine the best course of treatment.
Premenstrual syndrome, or PMS, is the term used for the physical and emotional symptoms that many women have during the seven to 14 days before their menstrual period begins. Almost every woman will endure bouts of PMS at some point in her life, but for an unlucky few -- between 20 and 40 percent -- PMS is a monthly ordeal.
What are the symptoms?
PMS symptoms are so numerous and varied that looking at a rundown can be a little jarring. The good news is that few people experience all of them. Physical symptoms may include these:
•lack of energy, fatigue
•swollen, tender breasts
•abdominal bloating, cramps, nausea, vomiting, diarrhea, constipation
•headache, back pain, body aches
•appetite changes
•swollen hands, feet, or ankles (due to water retention)
•dizziness, fainting
•joint or muscle pain
•flare-ups of acne, cold sores, genital herpes, yeast infections
Mental and emotional symptoms may include these:
•irritability
•anger
•mood swings
•depression
•crying spells
•forgetfulness, difficulty concentrating
•anxiety
•memory loss or forgetfulness
•confusion
What causes PMS?
Researchers aren't sure. They used to think PMS was related to fluctuations in levels of hormones such as estrogen and progesterone. More recent research favors changes in neurotransmitter levels, including mood-altering endorphins and serotonin, and diet -- especially a lack of calcium. It's also possible that these imbalances are related. A dietary imbalance, for example, might cause your hormone or neurotransmitter levels to get out of whack. You're most likely to suffer PMS symptoms after you've given birth, had a miscarriage or abortion, or experienced another event that involves major hormonal upheaval.
What are the best ways to get relief?
You have a wide range of options, including these:
•Get moving. Studies show that physical activity helps to relieve PMS symptoms, perhaps by triggering the release of brain chemicals, including endorphins, which ease pain, relieve stress, brighten mood, and produce a sense of well-being. Exercise also relaxes muscles, which can ease aches. And it fights fluid retention, which can reduce bloating and breast tenderness.
•Try taking calcium supplements. An exciting new study suggested that women who took two Tums E-X tablets twice a day (which provided a total of 1,200 milligrams of calcium) had a noticeable reduction in PMS symptoms. Calcium's benefits didn't kick in until the third month, though, so don't give up if you don't feel better during the first cycle or two.
•Eat healthfully. Get plenty of complex carbohydrates such as whole grain breads, pasta, and cereal; and load up on fruits and vegetables. Unlike sweets, these foods provide steady energy and are high in fiber, which can curb cravings, since fiber-rich foods take longer to digest. Adding nuts, seeds, and soy products to your meals may also fend off PMS. These foods are rich in phytoestrogens (plant estrogens), which recent studies suggest may help adjust hormonal imbalances. Finally, avoid highly salted foods in the weeks leading up to your period (salt can cause you to retain water and feel bloated), caffeine (it's been found to contribute to breast tenderness and can exacerbate anxiety and irritability), and alcohol (it can trigger cravings and aggravate depression, headache, and fatigue).
•Take over-the-counter pain relievers. Aspirin and ibuprofen can relieve many of the bodily aches and pains that come with PMS.
•Talk to your doctor about taking other medications. If your symptoms are severe, ask your doctor if birth-control pills or antidepressants might be helpful. Oral contraceptives can even out fluctuations in hormone levels that cause symptoms. And studies show that the newer SSRI (selective serotonin reuptake inhibitor) drugs, such as Prozac, can effectively relieve both the emotional and physical symptoms of PMS in 75 percent of women. These medications work by increasing serotonin levels, possibly correcting neurotransmitter imbalances that seem to contribute to PMS.
•Get more sleep. Being stressed out or sleep deprived is likely to exacerbate many PMS symptoms, including aches and pains, moodiness, and irritability. Make sure you get plenty of sleep, and try relaxation techniques -- such as massage, meditation, or simply soaking in long hot baths -- as your period approaches.
When should I see a doctor?
If your symptoms are mild and you're managing fine on your own, there's no need to see a physician. But if you're one of the 5 to 10 percent of women with severe PMS, your doctor can probably suggest treatments that will greatly ease your symptoms. Try keeping a diary of your complaints for a few months. This information can help your doctor determine the best course of treatment.
Exercise and PMS
How effective is exercise in relieving PMS symptoms?
A few preliminary studies have found that regular exercise can ease some of the pain and stress that you may have each month during the week or two leading up to your period. In one trial, researchers at the University of British Columbia in Vancouver had eight previously sedentary women work up to running 12 miles per week over six months. At the end of the study, the runners reported less breast tenderness, bloating, and moodiness before their periods. Six normally active women who did not increase their level of exercise felt no changes in their usual premenstrual symptoms. Another study found that women who exercised regularly felt less pain and depression before their periods than nonexercisers. Unfortunately, no studies have looked at how exercise might help women with severe premenstrual syndrome, a clinical disorder in which women find themselves plagued each month by pain, headache, cramps, depression, and fatigue, among other symptoms.
How does it help?
Exercise is a great stress-buster. It also boosts your metabolism and improves your circulation. When you get your blood moving, it carries oxygen and nutrients to the cells more efficiently, so you feel less sluggish. But don't go overboard; extremely vigorous workouts (such as doing step aerobics for two hours a day) may exacerbate rather than relieve some symptoms.
Aerobic activity can also produce brain chemicals known as endorphins that boost your mood and give you a sense of control and well-being, which could help ease the anxiety, depression, and mood swings you may experience each month. Some researchers even think endorphins in the bloodstream can stabilize your blood sugar and cut your cravings for sweets.
What kind of exercise works best?
Moderate aerobic activities like walking, jogging, biking, and swimming for about 30 minutes five times a week may be your best bet. One three-month study of 23 women found that those who participated in an aerobic exercise program saw more improvement in their premenstrual symptoms, particularly depression, than those who did strength training. Yoga can also be helpful. Its combination of gentle stretching, breathing techniques, and meditation can help ease muscle tension, focus your mind, and decrease moodiness
A few preliminary studies have found that regular exercise can ease some of the pain and stress that you may have each month during the week or two leading up to your period. In one trial, researchers at the University of British Columbia in Vancouver had eight previously sedentary women work up to running 12 miles per week over six months. At the end of the study, the runners reported less breast tenderness, bloating, and moodiness before their periods. Six normally active women who did not increase their level of exercise felt no changes in their usual premenstrual symptoms. Another study found that women who exercised regularly felt less pain and depression before their periods than nonexercisers. Unfortunately, no studies have looked at how exercise might help women with severe premenstrual syndrome, a clinical disorder in which women find themselves plagued each month by pain, headache, cramps, depression, and fatigue, among other symptoms.
How does it help?
Exercise is a great stress-buster. It also boosts your metabolism and improves your circulation. When you get your blood moving, it carries oxygen and nutrients to the cells more efficiently, so you feel less sluggish. But don't go overboard; extremely vigorous workouts (such as doing step aerobics for two hours a day) may exacerbate rather than relieve some symptoms.
Aerobic activity can also produce brain chemicals known as endorphins that boost your mood and give you a sense of control and well-being, which could help ease the anxiety, depression, and mood swings you may experience each month. Some researchers even think endorphins in the bloodstream can stabilize your blood sugar and cut your cravings for sweets.
What kind of exercise works best?
Moderate aerobic activities like walking, jogging, biking, and swimming for about 30 minutes five times a week may be your best bet. One three-month study of 23 women found that those who participated in an aerobic exercise program saw more improvement in their premenstrual symptoms, particularly depression, than those who did strength training. Yoga can also be helpful. Its combination of gentle stretching, breathing techniques, and meditation can help ease muscle tension, focus your mind, and decrease moodiness
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