Archive for the ‘Hormone Physician’ Category

Hormone Replacement Therapy Market report focuses on the market size, segment size (mainly covering product type, application, and geography), competitor landscape, recent status, and development trends. Furthermore, this research report is spread across 112 Pages and provides detailed cost analysis, supply chain, exclusive information, vital statistics, trends, and competitive landscape.

The Hormone Replacement Therapy Market size to grow from USD 16398.52 million in 2021 to USD 32290.63 million by 2027, at a Compound Annual Growth Rate (CAGR) of 11.96% during the forecast period. Global Hormone Replacement Therapy market report aims at estimating the market size and growth potential of the market across different segments, such as components, deployment mode, organization size, types, application, and region. The Hormone Replacement Therapy market has been segmented into major regions: United States, Europe, China, Japan, India, Southeast Asia, Latin America, and MEA. This report covers an in-depth competitive analysis of the key players along with their company profiles, key observations, product and business offerings, recent developments, and key market strategies.

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The report evaluates and categorizes global vendors in the Hormone Replacement Therapy Market based on Business Strategy (Business Growth, Industry Coverage, Financial Viability, and Channel Support) and Product Satisfaction (Value for Money, Ease of Use, Product Features, and Customer Support) that helps businesses in better decision making and understanding the competitive landscape.

Which are the prominent Hormone Replacement Therapy Market players across the globe?

Top Key Players covered in the report are:

This is accomplished by current information on the most vital drivers, current trends, risks and restrictions, opportunities, and the most promising development areas. It will also help in analyzing new business strategies to execute further business expansion and growth during a forecast period.

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Short Summary About Hormone Replacement Therapy Market:

The global Hormone Replacement Therapy market size was valued at USD 16398.52 million in 2021 and is expected to expand at a CAGR of 11.96% during the forecast period, reaching USD 32290.63 million by 2027.

The report combines extensive quantitative analysis and exhaustive qualitative analysis, ranging from a macro overview of the total market size, industry chain, and market dynamics to micro details of segment markets by type, application, and region, and, as a result, provides a holistic view of, as well as a deep insight into the Cobalt Tetroxide market covering all its essential aspects.

For the competitive landscape, the report also introduces players in the industry from the perspective of the market share, concentration ratio, etc., and describes the leading companies in detail, with which the readers can get a better idea of their competitors and acquire an in-depth understanding of the competitive situation. Further, mergers and acquisitions, emerging market trends, the impact of COVID-19, and regional conflicts will all be considered.

In a nutshell, this report is a must-read for industry players, investors, researchers, consultants, business strategists, and all those who have any kind of stake or are planning to foray into the market in any manner.

Which region is expected to hold the highest market share in the Hormone Replacement Therapy Market?

Geographically, the report includes several key regions, with sales, revenue, research on production, consumption, market share, and growth rate, and forecast (2017 -2027) of the following regions:

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The report focuses on the Hormone Replacement Therapy market size, segment size (mainly covering product type, application, and geography), competitor landscape, recent status, and development trends. Furthermore, the report provides detailed cost analysis, and supply chain. Technological innovation and advancement will further optimize the performance of the product, making it more widely used in downstream applications. Moreover, Consumer behavior analysis and market dynamics (drivers, restraints, opportunities) provide crucial information for knowing the Hormone Replacement Therapy market.

Based on types, the Hormone Replacement Therapy market from 2017 to 2027 is primarily split into:

Based on applications, the Hormone Replacement Therapy market from 2017 to 2027 covers:

Whats Included in the Report

TO KNOW HOW COVID-19 PANDEMIC AND RUSSIA UKRAINE WAR WILL IMPACT THIS MARKET REQUEST SAMPLE

Some of the key questions answered in this report:

Following Chapter Covered in the Hormone Replacement Therapy Market Research:

Chapter 1 mainly defines the market scope and introduces the macro overview of the industry, with an executive summary of different market segments ((by type, application, region, etc.), including the definition, market size, and trend of each market segment.

Chapter 2 provides a qualitative analysis of the current status and future trends of the market. Industry Entry Barriers, market drivers, market challenges, emerging markets, consumer preference analysis, together with the impact of the COVID-19 outbreak will all be thoroughly explained.

Chapter 3 analyzes the current competitive situation of the market by providing data regarding the players, including their sales volume and revenue with corresponding market shares, price and gross margin. In addition, information about market concentration ratio, mergers, acquisitions, and expansion plans will also be covered.

Chapter 4 focuses on the regional market, presenting detailed data (i.e., sales volume, revenue, price, gross margin) of the most representative regions and countries in the world.

Chapter 5 provides the analysis of various market segments according to product types, covering sales volume, revenue market share, and growth rate, plus the price analysis of each type.

Chapter 6 shows the breakdown data of different applications, including the consumption and revenue with market share and growth rate, with the aim of helping the readers to take a close-up look at the downstream market.

Chapter 7 provides a combination of quantitative and qualitative analyses of the market size and development trends in the next five years. The forecast information of the whole, as well as the breakdown market, offers the readers a chance to look into the future of the industry.

Chapter 8 is the analysis of the whole market industrial chain, covering key raw materials suppliers and price analysis, manufacturing cost structure analysis, alternative product analysis, also providing information on major distributors, downstream buyers, and the impact of COVID-19 pandemic.

Chapter 9 shares a list of the key players in the market, together with their basic information, product profiles, market performance (i.e., sales volume, price, revenue, gross margin), recent development, SWOT analysis, etc.

Chapter 10 is the conclusion of the report which helps the readers to sum up the main findings and points.

Chapter 11 introduces the market research methods and data sources.

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Years considered for this report:

Detailed TOC of Hormone Replacement Therapy Market Forecast Report 2022-2027:

1 Hormone Replacement Therapy Market Overview1.1 Product Overview and Scope of Hormone Replacement Therapy Market1.2 Hormone Replacement Therapy Market Segment by Type1.2.1 Global Hormone Replacement Therapy Market Sales Volume and CAGR (%) Comparison by Type (2017-2027)1.3 Global Hormone Replacement Therapy Market Segment by Application1.3.1 Hormone Replacement Therapy Market Consumption (Sales Volume) Comparison by Application (2017-2027)1.4 Global Hormone Replacement Therapy Market, Region Wise (2017-2027)1.4.1 Global Hormone Replacement Therapy Market Size (Revenue) and CAGR (%) Comparison by Region (2017-2027)1.4.2 United States Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.4.3 Europe Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.4.4 China Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.4.5 Japan Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.4.6 India Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.4.7 Southeast Asia Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.4.8 Latin America Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.4.9 Middle East and Africa Hormone Replacement Therapy Market Status and Prospect (2017-2027)1.5 Global Market Size of Hormone Replacement Therapy (2017-2027)1.5.1 Global Hormone Replacement Therapy Market Revenue Status and Outlook (2017-2027)1.5.2 Global Hormone Replacement Therapy Market Sales Volume Status and Outlook (2017-2027)1.6 Global Macroeconomic Analysis1.7 The impact of the Russia-Ukraine war on the Hormone Replacement Therapy Market

2 Industry Outlook2.1 Hormone Replacement Therapy Industry Technology Status and Trends2.2 Industry Entry Barriers2.2.1 Analysis of Financial Barriers2.2.2 Analysis of Technical Barriers2.2.3 Analysis of Talent Barriers2.2.4 Analysis of Brand Barrier2.3 Hormone Replacement Therapy Market Drivers Analysis2.4 Hormone Replacement Therapy Market Challenges Analysis2.5 Emerging Market Trends2.6 Consumer Preference Analysis2.7 Hormone Replacement Therapy Industry Development Trends under COVID-19 Outbreak2.7.1 Global COVID-19 Status Overview2.7.2 Influence of COVID-19 Outbreak on Hormone Replacement Therapy Industry Development

3 Global Hormone Replacement Therapy Market Landscape by Player3.1 Global Hormone Replacement Therapy Sales Volume and Share by Player (2017-2022)3.2 Global Hormone Replacement Therapy Revenue and Market Share by Player (2017-2022)3.3 Global Hormone Replacement Therapy Average Price by Player (2017-2022)3.4 Global Hormone Replacement Therapy Gross Margin by Player (2017-2022)3.5 Hormone Replacement Therapy Market Competitive Situation and Trends

4 Global Hormone Replacement Therapy Sales Volume and Revenue Region Wise (2017-2022)4.1 Global Hormone Replacement Therapy Sales Volume and Market Share, Region Wise (2017-2022)4.2 Global Hormone Replacement Therapy Revenue and Market Share, Region Wise (2017-2022)4.3 Global Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.4 United States Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.5 Europe Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.6 China Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.7 Japan Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.8 India Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.9 Southeast Asia Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.10 Latin America Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)4.11 Middle East and Africa Hormone Replacement Therapy Sales Volume, Revenue, Price and Gross Margin (2017-2022)

5 Global Hormone Replacement Therapy Sales Volume, Revenue, Price Trend by Type5.1 Global Hormone Replacement Therapy Sales Volume and Market Share by Type (2017-2022)5.2 Global Hormone Replacement Therapy Revenue and Market Share by Type (2017-2022)5.3 Global Hormone Replacement Therapy Price by Type (2017-2022)5.4 Global Hormone Replacement Therapy Sales Volume, Revenue and Growth Rate by Type (2017-2022)

6 Global Hormone Replacement Therapy Market Analysis by Application6.1 Global Hormone Replacement Therapy Consumption and Market Share by Application (2017-2022)6.2 Global Hormone Replacement Therapy Consumption Revenue and Market Share by Application (2017-2022)6.3 Global Hormone Replacement Therapy Consumption and Growth Rate by Application (2017-2022)

7 Global Hormone Replacement Therapy Market Forecast (2022-2027)7.1 Global Hormone Replacement Therapy Sales Volume, Revenue Forecast (2022-2027)7.1.1 Global Hormone Replacement Therapy Sales Volume and Growth Rate Forecast (2022-2027)7.1.2 Global Hormone Replacement Therapy Revenue and Growth Rate Forecast (2022-2027)7.1.3 Global Hormone Replacement Therapy Price and Trend Forecast (2022-2027)7.2 Global Hormone Replacement Therapy Sales Volume and Revenue Forecast, Region Wise (2022-2027)7.3 Global Hormone Replacement Therapy Sales Volume, Revenue and Price Forecast by Type (2022-2027)7.4 Global Hormone Replacement Therapy Consumption Forecast by Application (2022-2027)

8 Hormone Replacement Therapy Market Upstream and Downstream Analysis8.1 Hormone Replacement Therapy Industrial Chain Analysis8.2 Key Raw Materials Suppliers and Price Analysis8.3 Manufacturing Cost Structure Analysis8.3.1 Labor Cost Analysis8.3.2 Energy Costs Analysis8.3.3 RandD Costs Analysis8.4 Alternative Product Analysis8.5 Major Distributors of Hormone Replacement Therapy Analysis8.6 Major Downstream Buyers of Hormone Replacement Therapy Analysis8.7 Impact of COVID-19 and the Russia-Ukraine war on the Upstream and Downstream in the Hormone Replacement Therapy Industry

Continued

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Under the Cures Act, patients can access their medical results instantly, allowing them to be more active participants in their own care. But some patients have received sensitive results, including cancer diagnoses, before they can speak to their doctors, leading to "emotional and mental harm," Danielle Friedman writes for the New York Times.

To standardize how patients receive results and increase transparency, the Cures Act, which was passed in 2016, included a provision requiring all medical testing centers to release patients' results "without delay." In addition, HHS in April 2021 began to enforce a rule that made "blocking" patients from their own health information against the law, leading to fines for doctors and hospitals.

According to Friedman, the provision on medical records was intended "bring health care into the modern era" by giving "patients easy access to their medical records, empowering them to play a more active role in their care by eliminating the doctor as gatekeeper."

For the most part, patients say they appreciate being able to access their health information directly.

"I feel more in control," said Yasi Noori-Bushehri, a 32-year-old engineer who has Graves' disease, an autoimmune disorder that affects her thyroid hormone levels. In fact, Bushehri said having access to her medical information has given her confidence to ask her doctor to change her treatment plan.

Similarly, Teresa Christopherson, a 59-year-old who routinely gets updated about the status of her breast cancer online, said receiving test results ahead of time allowed her to feel more prepared before speaking with her doctor.

"You can go into the next appointment having done your homework," Christopherson said, which helped her "ask the right questions" about potential next steps.

"Everyone has the right to their own medical information in real time, not on the doctor's time," she added.

Although having instant access to medical results can be beneficial in some ways, there are times where patients have "learned about life-altering diagnoses and developmentsfrom cancer to chronic illness to miscarriagethrough emails and online portals" instead of through their doctors, who could have eased them into the information, Friedman writes.

For example, Nicki Swann, a 38-year-old professor in Oregon, learned she had colon cancer through an app after she had polyps removed. "I couldn't imagine that anything but good news would be shared in that way," she said.

Although Swann immediately called her doctor's office, the physician was unavailable at that time, and they did not speak about her diagnosis until the following week. "Any cancer diagnosis is going to cause trauma," she said. "But I think it was much worse to receive it in that way."

According to Emily Porter, an ED and sexual health physician in Texas, when difficult medical diagnoses are instantly delivered to patients online, "it cuts off any opportunity for doctors to get ahead of things."

"When information is just given in black-and-white type on MyChart, that's not the full expression of compassionate care," said Elizabeth Comen, an oncologist at Memorial Sloan Kettering Cancer Center. "Yes, it is immediate care, but it's care out of context."

"We have to honor the reality that waiting can feel impossibly hard," Comen added. "But I don't think anything replaces a doctor holding your hand and looking you in the eye and saying: 'I'm going to go through every aspect of this with you in real time. You can ask me your questions. I will read your body language. I will give you tissues. I will be there with you.'"

According to a survey of 1,000 patients from the American Medical Association (AMA), around 42% said they wanted to see their test results as soon as they were available, while 43% said they preferred to speak with their doctors first. However, among patients who preferred instant access, more than half said they would want to speak to their doctor first in the case of a "debilitating, life-limiting or terminal illness."

Currently, the medical results provision includes a "preventing harm exception" that allows doctors to delay a result, but "the bar for what counts as harm is high: The provider must be able to anticipate that the test results could lead a patient to harm himself or herself," Friedman writes. In addition, any exceptions must be requested by a patient beforehand, which may not be possible when an unexpected result is found through a routine test.

To allow providers more control over sensitive test results, AMA has urged HHS to make "common sense" exceptions to the current rule. In a statement published last month, AMA requested language be added to "explicitly allow physicians, using their professional judgment, to withhold some information if immediate or proactive release could cause a patient mental or emotional harm."

Micky Tripathi, the national coordinator for health information technology at HHS, said adjusting to having instant access to medical results "is a really big transition for all of us," but added that officials hoped the Cures Act would encourage patients to be more active in their own care and talk with their doctors about how they want to receive medical information.

Tripathi said officials hoped to see health care apps introduce more flexible options that allow providers to designate a patient's preferences on specific cases or ways to allow patients to opt out of receiving certain results right away.

For now, Friedman recommends patients who are undergoing medical tests and concerned about the potential results ask their doctors "for expectations around timing both in terms of when results might be released electronically and when you can expect to hear from the doctor's office, so you can prepare mentally and emotionally." (Friedman, New York Times, 10/3)

Read more here:
Instant access to medical records sounds like a good thing. Is it? - The Daily Briefing

Fast fashion may go easy on your wallet...but is it secretly tough on your health? Here's why one toxicology doctor says she's "most concerned" about what you and your family are putting on.

Fast fashion may cycle through trends at the speed of lightbut it certainly has staying power. As PC Magazine reported this past July, the online retailer Shein dethroned Amazon as the most popular shopping app in the world. But the meteoric rise of some comparable fashion brands is troubling some health experts. In 2021, a team of researchers at the University of Toronto ran tests on some popular clothing and accessories brands. For one fast fashion brand in particular, they found that one in every five items contained unsafe levels of lead.

Why Lead May Be Lurking in Your Favorite Lipstick

And its not just fast fashionor, just leadthat areprompting concern about unsuspectedtoxins in our everyday products. The University of Toronto report also identified another group of chemicals, called phthalates,that the researchers stated were present in some of the clothing they tested. Plus, earlier this year, Environmental Protection Agency-certified labs detected PFAs (per- and polyfluorinated substances) in activewear from popular consumer brands that also may contain PFAS, according to the non-profit consumer organization Fashion FWD.

From cosmetics and soaps to plastic bottles and even our food, were surrounded by chemicals in our daily lives. But just how much should we worry about the chemicals lurking in our clothes?

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At the federal level, the US regulates only two chemicals for the fashion industrylead and phthalatesand thats only for childrens clothing. According to Fashion FWD, The Toxic Substances Control Act requires more stringent testing and oversight around chemicals used in clothing made in the US. It sounds reassuringhowever, apparel made in the US only accounts for about 3% of American fashion.

As Kelly Johnson-Arbor, MD, a medical toxicology physician and the co-medical director at the National Capital Poison Center explains: Fast fashion clothing is often manufactured in developing countries that may not have stringent standards for keeping harmful chemicals out of clothing.

This means that almost all of the clothing items in our closets and drawers are more or less unregulated, meaning were relying on retailers to self-police their factories chemical usage. And according to the 2021 Fashion Revolution Transparency Index, only 26% of the worlds major clothing brands use a Manufacturing Restricted Substances List, which aims to eliminate hazardous chemicals in their factories.

Its worth noting that back in the US, restrictions may be tightening up at the state level. In both California and New York, legislators are pushing for stricter regulation around PFAS in textile products. Federally, the US still lags miles behind the European Union, which currently restricts 33 chemicals in textiles.

Lead is often used by manufacturers for dyeing fabricsparticularly those that are brightly colored, says Trevor Cates, ND, a naturopathic physician and author of the September 2022 book,Natural Beauty Reset.

PFAS generally turn up in clothing items as a coating to make products waterproof, stain-resistant, and breathable, according to a study by the Colorado Public Interest Research Group.

Phthalates work to soften plastic and make it more durable, and so theyre sometimes spun into fabrics to make them soft and pliable, according to the Office of Science and Society at McGill University. Theyre also common in waterproof items like rain jackets, faux leather, screen-printed t-shirts, and see-through accessories, like clear shoes, bags and umbrellas.

The goal of the 1978 ban on leaded paint was implemented to prevent accidental lead ingestion, such as from kids putting paint chips in their mouths or inhaling lead-containing dust. Lead is definitely associated with adverse health effectsincluding developmental delays, Dr. Johnson-Arbor explains.

A 2018 study published in Environmental Science and Pollution Research Internationalillustrated what can happen even if lead is not consumed by mouth. The study suggested that chemicals from clothing can transfer to, penetrate and accumulate in our skin. (The study authors noted that more research was needed for a closer analysis of each specific hazardous chemical of concern.) However, a 2019 peer-reviewed study looked specifically at phthalates in infant clothing and found that clothing does play an important role in exposure to textile chemicals.

Lead is a heavy metal, Dr. Cates says. And what happens with heavy metals is that our body takes them up and stores them in our bones, our blood, and our tissues. So, while exposure to high levels of lead is dangerous (lead poisoning can cause anemia, weakness, kidney failure, brain damage and death, according to the Centers of Disease Control and Prevention)prolonged, low-grade exposure can grow problematic.

As lead stores up in our bodies, chronic symptoms can start to emerge, Dr. Cates explains. These may include abdominal pain, constipation, forgetfulness, nausea, and depression. Lead in particular has been connected to infertility, she adds. The CDC says that people with long-term exposure to lead are also at a greater risk for high blood pressure, kidney disease, and heart disease.

These symptoms can also worsen with ageespecially for women. When estrogen levels drop after menopause, bones can start to deteriorate, Dr. Cates says. The lead thats stored in the bones will then start to be released in the bloodstream, its like you become toxic all over again.

10 Surprising Health Risks that Happen After Menopause

These are known as forever chemicals,' Dr. Cates says. They persist in the environment, and they also dont easily get out of the human body.

PFAS are also considered endocrine-disrupting chemicals because they can mimic hormones in the bodyand theyre extremely common in our lives. In fact, almost all adults in the United States have some level of PFAS in their bloodstreams, says Dr. Johnson-Arbor.

The 5 Best Hormone-Safe Sunscreens, Recommended by Doctors

Dr. Cates says that since the use of PFAS became so widespread, signs of hormonal imbalances are on the rise: greater rates of thyroid disease, breast and prostate cancer, breast development in young boys and the number of women having menstrual problems.

The CDC adds that current research suggests high levels of PFAS exposure may also cause high cholesterol, low infant birth weight, changes in liver enzymes, increased risk of pre-eclampsia (high blood pressure) in pregnant women, decreased vaccine response in children and an increased risk of kidney and testicular cancer.

Phthalates are another group of endocrine-disrupting chemicals. While Dr. Johnson-Arbor emphasizes there is still plenty to learn about the health effects of phthalates (and PFAS), a 2022 review of research found strong evidence that phthalate exposure is associated with low semen quality, childhood asthma and neurodevelopment problems. The researchers said that theres also moderate evidence that phthalates can increase the risk of low infant birth weight, endometriosis, low testosterone, ADHD, Type 2 diabetes, and breast or uterine cancer.

Plus, here are 10 toxic things you didnt know you were feeding your kids

You cant sell a $4 t-shirt without cutting some health and safety corners, so Dr. Cates main recommendation to limit your chemical exposure is to avoid fast fashion retailers altogether. Look for sustainable brands that prioritize natural fabrics and materials, such as cotton, linen, hemp, silk or bamboo. And keep a lookout for chemical keywords such as stain-resistant, waterproof, and shrink-proof.

Since lead is most harmful to young children, people can avoid dressing their infants and children in fast fashion clothing to avoid childhood exposures, adds Dr. Johnson-Arbor. I am most concerned with childrens potential exposure to these chemicals, specifically lead.

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Sources

People:

Trevor Cates, ND, a naturopathic physician and author of the upcoming book Natural Beauty Reset

Kelly Johnson-Arbor, MD, a medical toxicology physician and the co-medical director at the National Capital Poison Center

Websites:

PC Magazine: "Shein Unseats Amazon as Most Downloaded US Shopping App"

CBC: "Experts warn of high levels of chemicals in clothes by some fast-fashion retailers"

Mamavation: "Non-Toxic Activewear Guide: PFAS "Forever Chemicals" in Workout Leggings & Yoga Pants"

Fashion FWD: "Going out of fashion: US apparel manufacturers must eliminate PFAS "forever chemicals" from their supply chains"

Fashion FWD: "US policies fall short"

Fashion Revolution: "Fashion Transparency Index 2021"

DLA Piper: "California and New York propose banning textiles containing PFAS; California moves to impose significant reporting obligations"

European Chemicals Agency: "Substances we don't want in our clothes"

Colorado Public Interest Research Group: "Going Out of Fashion: U.S. apparel manufacturers must eliminate PFAS 'forever chemicals' from their supply chains"

Office of Science and Society at McGill University: "Are we at risk from wearing clothing with detectable amounts of PFASs or phthalates?"

Centers for Disease Control and Prevention: "Health Problems Caused by Lead"

Centers for Disease Control and Prevention: "What are the effects of PFAS?"

Journals:

Environmental Science and Pollution Research International: "Chemicals from textiles to skin: an in vitro permeation study of benzothiazole"

Science of the Total Environment: "Phthalates in infant cotton clothing: Occurrence and implications for human exposure"

Environment International: "Human health impacts of exposure to phthalate plasticizers: An overview of reviews"

See the article here:
3 Major Toxins Have Been Found in Popular Clothing BrandsHere's What to Know - The Healthy

Therapeutic developments have been aimed at enhancing outcomes for patients with metastatic hormone-sensitive prostate cancer (mHSPC), an aggressive form of prostate cancer that may rapidly become castration resistant.1 Advances in the understanding of the genomics and biological functions of prostate cancer have resulted in the emergence of several new classes of agents that have improved outcomes in men with prostate cancer, including mHSPC.1 For example, several next-generation androgen receptor (AR) signaling inhibitors have recently received expanded FDA approval to include treatment of men with mHSPC.1-5

Although clinicians have welcomed the addition of novel AR-targeted agents to the mHSPC management arsenal, they have also faced the conundrum of how to best select among them when treatment intensification is needed.

During a recent OncLive Peer Exchange, panel of experts in genitourinary cancer provided an overview of the FDA-approved novel AR-targeted agents for mHSPC, including the pivotal trials that led to their approval. They also shared the factors they consider when selecting among these agents and the rationale for using triplet therapy in some patient subgroups with mHSPC.

Targeting the androgen-signaling axis remains the most effective strategy for treating patients with prostate cancer, which can encompass multiple approaches, including targeting gonadotropin-releasing hormone to prevent release of luteinizing hormone, targeting cytochrome P450 (CYP) 17A1 to restrain androgen synthesis, and directly targeting AR transcriptional activity.1 Four AR-targeted therapies have received approval for the treatment of patients with mHSPC (Table).2-9 Of these treatments, abiraterone acetate (Zytiga) targets CYP17A1, and darolutamide (Nubeqa), enzalutamide (Xtandi), and apalutamide (Erleada) target AR transcriptional activity.1

Darolutamide is the latest AR-targeted therapy to receive expanded indication for the treatment of men with mHSPC.2 Approval for this indication was based on data from the phase 3 ARASENS trial (NCT02799602), which randomly assigned 1306 patients with mHSPC to receive darolutamide 600 mg orally twice daily plus docetaxel 75 mg/m2 intravenously every 3 weeks for up to 6 cycles (n = 651) or docetaxel plus placebo (n = 655).10 The primary end point was overall survival (OS), which was assessed in the primary analysis after 533 patients had died (229 in the darolutamide arm and 304 in the placebo arm).

The primary analysis showed a 32.5% lower risk of death in the darolutamide arm vs the placebo arm (HR, 0.68; 95% CI, 0.57-0.80; P < .001). At 4 years, the OS was 62.7% (95% CI, 58.7-66.7) in the darolutamide arm and 50.4% (95% CI, 46.3-54.6) in the placebo arm. Additionally, darolutamide was associated with significantly greater benefits than placebo for several secondary endpoints, including time to castration-resistant prostate cancer, time to pain progression, symptomatic skeletal eventfree survival, time to first symptomatic skeletal events, and time to initiation of subsequent systemic antineoplastic therapy.10

The FDA approval of enzalutamide for mHSPC was based on data from the phase 3 ARCHES trial (NCT02677896), which randomly assigned 1150 patients with mHSPC to receive enzalutamide plus androgen deprivation therapy (ADT) or placebo plus ADT. Patients were stratified by disease volume and prior docetaxel chemotherapy. The studys primary end point was radiographic progression-free survival (rPFS).

In the ARCHES trial, we showed that enzalutamide delays rPFS, which led to the FDA approval of that therapy, said Andrew J. Armstrong, MD, MSc, who was an ARCHES study investigator. Radiographic progression or death was reduced by 61% in the enzalutamide plus ADT arm vs the placebo plus ADT arm (HR, 0.39; 95% CI, 0.30-0.50; P < .001), and the median rPFS was not reached in the enzalutamide arm vs 19 months in the placebo arm. Benefit with enzalutamide was observed across prespecif ied subgroups, with similar benefit regardless of disease volume (ie, low vs high) and prior docetaxel use. Superiority of enzalutamide vs placebo was also shown in key secondary end points, including time to prostate-specific antigen (PSA) progression, time to initiation of new antineoplastic therapy, PSA undetectable rate, and objective response rate.11

From the 5-year data that was presented at ASCO 2022, we see that many of these men are now being treated successfully for 5-plus years, still on drug, and still going where medians havent even been reached. This is phenomenal for our patients. It emphasizes the need for survivorship, Armstrong said.

The 5-year data come from the updated OS analysis of the phase 3 ENZAMET trial (NCT02446405), which randomly assigned 1125 men to receive testosterone suppression plus open-label enzalutamide (n = 563) or a standard nonsteroidal antiandrogen therapy (ie, standard-care group; n = 562).12 Prior to randomization, up to 12 weeks of testosterone suppression and 2 cycles of docetaxel were allowed. At a median follow-up of 68 months, the HR for death was 30% lower among the enzalutamide arm vs the standard care arm. No major differences were found in enzalutamide efficacy across subgroups. Although benefit was most apparent for patients with low-volume mHSPC not deemed to require docetaxel, patients with synchronous high-volume mHSPC necessitating docetaxel still showed benefit. Exploratory analyses suggested additional benefit with triplet therapy, adding enzalutamide to testosterone suppression and docetaxel.12

Apalutamide was approved in mHSPC based on data from the phase 3 TITAN trial (NCT02489318), which randomly assigned 1052 men with mHSPC to receive apalutamide plus ADT (n = 525) or placebo plus ADT (n = 527).13 At the final OS analysis, which included a median follow-up of 44.0 months, the median treatment duration was 39.3 months with apalutamide, 20.2 months with placebo, and 15.4 months with crossover.

Apalutamide vs placebo reduced the risk of death by 35% (HR, 0.65; 95% CI, 0.53-0.79; P < .0001) and by 48% when adjusting for crossover (HR, 0.52; 95% CI, 0.42-0.64; P < .0001). The median OS was not reached in the apalutamide arm vs 52.2 months in the placebo arm. Patients who crossed over were analyzed as part of the intention-to-treat population in the placebo plus ADT group. At 48 months, the OS rates were 65.1% for patients who received apalutamide and 51.8% for those who received placebo. Updated analyses of secondary end points based on the f inal data cutoff showed apalutamide plus ADT delayed second PFS and castration resistance (P < .0001 for both).13

Data from the phase 3 LATITUDE trial (NCT01715285) supported the approval of abiraterone acetate for patients with mHSPC. Investigators randomly assigned 1199 patients with mHSPC to receive abiraterone acetate plus prednisone and ADT (n = 597) or matching placebo plus ADT (n = 602).14 Patients had not received prior chemotherapy, radiotherapy, or surgery for metastatic prostate cancer and were stratified based on the presence of visceral disease and ECOG performance status. There were 2 primary end points: OS and rPFS.

At the final OS analysis, which was performed after a median follow-up of 51.8 months, 618 deaths had occurred (275 patients in the abiraterone arm and 343 in the placebo arm). Patients in the abiraterone arm had a significantly longer OS compared with the placebo arm (53.3 months vs 36.5 months; HR, 0.66; 95% CI, 0.56-0.78; P < .0001). Analysis of OS by subgroups found an OS benefit across most subgroups, with the exception of those with an ECOG performance status of 2 and those with a Gleason score below 8. The final analysis did not include a reanalysis of the rPFS, which was 33 months (95% CI, 29.6-not reached) in the abiraterone arm versus 14.8 months (95% CI, 14.7-18.3) in the placebo arm (HR for radiographic progression or death, 0.47; 95% CI, 0.39-0.55; P < .001) in the preplanned interim analysis.14

With many novel AR-targeting therapies to select from, choosing the best one for each patient can pose a challenge for physicians. From the medical oncology perspective, I spend a lot more time taking a good medical history than maybe I was doing when there were fewer options. Especially when I meet a new patient for the first time, I spend a [significant] amount of time taking [a detailed] cardiovascular history, but also general medical health history, MaryEllen Taplin, MD, said. She explained that she looks at factors such as exercise tolerance, baseline respiratory status, and whether patients have had any falls over the past 2 years because these provide clues that help her select the best drug for each individual patient.

If I have a patient who is [older], [is] relatively sedentary, and had a fall 6 months ago, I might shy away from enzalutamide. But 1 of the other 3 choicesapalutamide, darolutamide, or abirateronemight be better for that particular patient. Ill put in the prescription and try to get the prior authorization and copay information based on that, she said. Regarding abiraterone acetate, Taplin said she would avoid it in patients with a compensated cardiac status and diabetes or trending toward diabetes.

In those with a condition such as congestive heart failure, she said, the risk of fluid retention is a contraindication in her opinion, and for patients with diabetes, she has concerns that the concomitant prednisone would affect patients glucose tolerance. For patients who are good candidates for any of the available agents, the panelists noted that decision-making usually revolves around finances. Once you find out what the co-pay is when you submit that prescription, you want to make sure your patient can afford their medication, Tanya B. Dorff, MD, said. Armstrong agreed and noted that costs among these agents may vary considerably. Paradoxically, abiraterone acetate is generic, but it has some of the hardest co-pays because there are very few assistance programs for it. Darolutamide might be easier because of co-pay assistance [access], he said.

He also suggested that COVID-19 vaccination may factor into decision-making with use of abiraterone acetate because of its concurrent administration with prednisone. A small dose of physiologic replacement prednisone would impair the vaccine efficacy, but we dont have a lot of great data there, he said.

Although mHSPC is generally considered an aggressive prostate cancer, it is still a heterogeneous disease that requires an individualized treatment approach to optimize outcomes. Patients who tend to do worse are those with high-volume, de novo metastatic disease, which is different from those who also have metastatic disease but happen to [have a recurrence] years later and theyve finished treatment, Pedro C. Barata, MD, MSc, said. He noted that patients who tend to do worse have been shown to benefit from treatment intensification approaches, such as a triplet regimen that adds docetaxel and an AR-targeted therapy to ADT, as well as strategies such as concomitant radiotherapy of the primary tumor.

To ensure he identifies patients who would benefit from treatment intensification, Barata said he sequences all patients up front. When I have [a patient with] an aggressive molecular profile, it makes me think about treatment intensification at that point, he said. Another trigger he noted is a low PSA level. Its not concurrent with the amount of disease that you see, he said.

During the discussion, Armstrong explained that an analysis of the ARCHES study found that many patients receiving enzalutamide had radiographic progression despite not showing PSA progression, a finding he noted that could be applied to any AR therapy.15 Were all used to lying back and not doing imaging very often when you see that PSA [level] go down. But we saw that approximately one-third of patients with imaging showing progression at soft tissue or new bone metastasis didnt have any rise in PSA [level] at all, and thats kind of a scary thought, he said.

Barata noted that the next step will be identifying all the patient subgroups who would benefit from treatment intensification approaches such as triplet therapy, as well as which intensification approach may be best suited to each subgroup. Ongoing studies are anticipated to help shed light on these areas.

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Novel AR-Targeted Therapies for Metastatic Hormone-Sensitive Prostate Cancer: Which One to Choose - OncLive

Limerick woman Fiona Robinson experienced symptoms of menopause for eight years until she finally joined up the dots and now she wants to help prevent other women from making the same mistake she did.

When she was in her mid-40s, the mum of one started to feel unusually exhausted, with aches in her ankles, but put it down to age and her busy job.

She told RSVP: I would have been very active previous to this. I played basketball and I was always on the go! I was working full-time as an executive assistant and it was very busy, I spent a lot of time on the road.

Then I started having these symptoms I was exhausted, and getting out of bed in the morning was nigh-on impossible. Id put my feet on the ground and my ankles would ache. When I did get up and go to work, after Id come home Id basically just go to bed again.

Read more: Dublin woman Catriona Doyle diagnosed with two cancers after experiencing menopause symptoms

After a while, Fiona also started to experience low motivation, anxiety and hot sweats.

She said: I went to the doctor with a list of complaints, and he took bloods but they didnt show that my symptoms were connected to oestrogen depletion. We now know that bloods arent going to give you the right answer because your hormones fluctuate so much!

One day she was playing basketball and by chance, she got chatting to a woman named Loretta Dignam, who told her that she had quit her marketing job to set up a clinic called The Menopause Hub.

She was talking about the different symptoms of menopause and perimenopause and it finally clicked, Fiona admitted.

She went into The Menopause Hub, where she got seen by a doctor who prescribed hormone replacement therapy.

I couldnt believe the difference it has made. My ability to get up and do things has definitely improved, and the sore ankles and achy bones are much better.

Weight gain has been huge for me, unfortunately. That was partly down to the fact that for so long, I just had no motivation to do anything. If I did, I was so tired the day after that I decided it wasnt worth it, or I wasnt going to do it again. Im going to see a nutritionist to see if I can balance things out.

Fiona says many women out there are in a similar position to her, and dont realise or want to believe that they are going through menopause.

She added: A lot of women dont want to recognise that they are menopausal. They are like No, dont mention that, that means Im getting old!

I know someone who came out in a rash on her chest, and she had sore, dry eyes. I said Thats oestrogen depletion and she just did not want to hear it! We can be our own worst enemies.

Im 58 now and I still have bleeds. I get told I have a lovely healthy womb and Im like Yeahit can stop working now! [laughs]"

Theres also the issue that many doctors dont have much understanding of menopause.

Its like they did a one-hour tutorial on menopause and then that was it! And then there was all the bad publicity around HRT and the inaccuracies around the links to breast cancer.

I was put on anti-depressants to try to relieve my anxiety, and I stayed on them for years, when really my anxiety was down to lack of oestrogen. Hopefully doctors are getting better educated on how to treat it and deal with menopause.

Fiona is glad that menopause is less of a taboo subject than it was, and she believes that talking about it more will help women.

If we talk about it honestly, that makes a big difference, she said. Barbara Taylor M.D. has a great quote: If it was a male issue, there would be an ATM every corner an Automatic Testosterone Machine on every corner..

Sharing her advice for others, Fiona said: Dont be afraid of menopause. You cant stop it, you cant change it, its going to happen, and you should listen to the symptoms that others have had. There are so many different help groups out there now you dont have to go through it on your own.

Visit The Menopause Hub's website here for more information.

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Limerick mum says hormone replacement therapy has changed her life after menopause - RSVP Live

California Gov. Gavin Newsom signed AB 2098 by Assemblyman Evan Low (D-Campbell), whichwill punish physiciansand surgeons for unprofessional conduct for advocating for the potential benefits of early treatment with off-label drugs, or those who dare to ask questions about COVID vaccine safety.

Assembly Bill 2098 puts unconstitutional restrictions on free speech by medical professionals. Under AB 2098, doctors will be subject to disciplinary actions by the Medical Board of California and the Osteopathic Medical Board of California if they do not adhere to the approved COVID treatment consensus.

Who approves the consensus, Dr. Peter Mazolewski said last week to the Globe. The medical board? Public health officials? Neither all of the members of the Medical Board nor all of Californias public health officials are licensed medical doctors.

In his signing statement, Gov. Newsom said, To be clear, this bill does not apply to any speech outside of discussions related to Covid-19 treatment within a direct physician patient relationship, as if its constitutional to limit the censorship of doctors to one medical issue. Imagine if doctors were censored over various cancer treatments or heart ailments.

The Governor of the State of California is telling the states licensed physicians that when they are treating a Covid patient, they must remain in the lane of the consensus of the CDC or CDPH treatment protocols.

Laura Powell, founder ofCalifornians for Good Governance explains in a June AB 2098 opposition letter:

There is no question that the bill is aimed at restricting speech based on its content. As such, it would be presumptively invalid and could only be upheld if the government could prove that the law is narrowly tailored to serve a compelling state interest.

Which it does not.

Physicians would be punished simply for doing what they believe is best for their patients, sharing legitimate medical information necessary for their patients to make a true risk/benefit analysis.

The bill is aimed at physicians who acknowledged the 1% mortality rate, questioned mandatory masks, school closures, and challenged the claim that the vaccine would shield patients from getting or spreading Covid. It is also aimed at physicians whochose to prescribe therapeutic treatments during COVID.

Censorship and criminalization are not the bulwarks of a free society, attorney Leigh Dundas said at the AB 2098 protest rally Friday at the State Capitol. The stark reality is if we are to remain a Constitutional Republic, then doctors must remain free to practice medicine.

Science and medicine are constantly evolving by challenging the status quo, Dundas added.

And Dundas warned that if this bill to censor Californias doctors is allowed to stand, guess who is next on the chopping block the press.

Tech entrepreneur Steve Kirsch addressed the AB 2098 protesters Friday. Im labeled a misinformation superspreader, but (Senator) Dr. Pan cant silence me because Im not a doctor.

Its [AB 2098] unconstitutional and anti-science, Kirsch continued. Tenure was created in universities to allow people to speak out without retribution. This is a special law targeted at misinformation for Covid-19, and thats not science.

As Laura Powell noted, The bill does not address the problem identified. The bills authors and supporters point to the problem of doctors who widely amplify falsehoods about Covid-19, but silencing them would violate the Constitution. To remedy the constitutional problems, it would have to be pared down to the point that it would simply duplicate existing law. Proponents are unable to cite a single example of a harm that could be prevented.

As Dr. Pete Mazolewski said, the purpose of Assembly Bill 2098is to circumvent due process against doctors over Covid misinformation conduct.

AB 2098will punish physiciansand surgeons for unprofessional conduct for advocating for the potential benefits of early treatment with off-label drugs, or those who dare to ask questions about COVID vaccine safety.

Does the Centers for Disease Control and Prevention decide approved COVID treatment consensus? EvenCDC Director Rochelle Walensky recently admittedher agencys failures during the COVID-19 pandemic during a message to her staff in August. ABC reported,To be frank, we are responsible for some pretty dramatic, pretty public mistakes. From testing, to data, to communications, Walensky said.

We know there were a lot of problems with the CDC if we speak out right now, we run the risk of losing our licenses, Dr. Mazolewski said.

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Gov. Newsom Signs Bill to Censor CA Doctors Accused of Spreading COVID Misinformation - California Globe

Actress Lucy Hale has been a staple in many of our guilty-pleasure television dramas, from Pretty Little Liars to Katy Keene, but do you remember when she was a brand ambassador of sorts for Bayers Kyleena, an intrauterine device (IUD)? She praised the little birth control implant, saying it was painless, simple, and a no-brainer that she wished she had tried sooner. Kyleena is a hormonal IUD, but theres also an entirely non-hormonal option out there.

Whether you know it as the copper IUD or the coil, youve probably heard about women having a little piece of metal inserted into their womb as one of the many birth control options. Often touted as the better option since we know how many complications hormonal birth control can cause conflicting research suggests that copper IUDs are actually a worse choice and that women should use hormonal IUDs as a result of lower odds of complications, discontinuation, and failure.

So, whats really going on with all of these mixed signals? Turns out there are a lot of pros and cons to IUDs which you should know before you make the choice to get one inserted.

If you opt for a hormonal IUD like Skyla, Liletta, or Mirena, you get anywhere from five to seven years of protection from pregnancy. Choosing a copper IUD like ParaGard gives you up to 12 years of protection from pregnancy. This option can be attractive because your OB/GYN inserts it, and then you can just forget about birth control upkeep. Its really a fix it and forget it method for pregnancy prevention.

When a copper IUD is placed in your uterus, it acts like spermicide by decapitating sperm (yep, the IUD splits the tail from the head of the sperm) so that they cant reach your eggs. Zero chance of movement means zero chance of pregnancy, unless the IUDs effectiveness is interrupted by displacement. Since its hormone-free, once you choose to get it removed, you could hypothetically get pregnant right after removal.

When you compare an IUD to the pill or just a plain-old condom, IUDs are the most effective form of preventing pregnancy. Less than one in 100 women using an IUD will get pregnant each year, while as many as 12% of women using the pill will get pregnant and 18% of women just using condoms will get pregnant.

Lets first establish that hormone-free and side effect-free are not the same thing. Just because youre taking a pass on whichever combination of synthetic hormones other birth control methods pump into your body doesnt mean that you wont feel any symptoms related to having a piece of metal implanted in your uterus.

Nevertheless, by using a non-hormonal IUD, you wont experience those potentially lengthy detox periods when getting off birth control that leave you irregular for anywhere from a couple of weeks to a couple of years. Hormonal IUDs release low doses of hormones into your uterus, so if you opt for one, then you might still face a detox period or any of the potential complications that hormonal birth control poses.

Hormone-free and side effect-free are not the same thing.

Proponents of IUDs also believe that it can decrease your risk of endometrial cancer and cervical cancer, but the decades of data out there dont necessarily differentiate between hormonal and non-hormonal IUDs.

While a hormonal IUD can lighten your periods, a non-hormonal IUD can cause them to get heavier. In your first few months after getting an IUD inserted, you might also have irregular bleeding at unpredictable times. This heavier flow could potentially worsen backaches and cramping. While some womens periods return to a normal flow after half a year, others deal with heavy flows for much longer.

A heavy period means much more than just extra blood to take care of. If your uterine lining is too thick, you likely have developed a hormonal imbalance between estrogen and progesterone. Similarly, you might start experiencing anovulation, which is when you have a period without your body releasing an egg. Research does suggest that increased menstrual bleeding while using the IUD could decrease over time, but intermenstrual spotting over time can still be pesky.

Any OB/GYN worth their snuff will at the very least warn you that because an IUD is a physical, metal implant placed on a sensitive sex organ, you might feel some related pain. This can range from inflammation of your pelvis to full-on pelvic inflammatory disease, backaches, or feeling pain during sexual intercourse. You are also at risk of having your IUD either get stuck in your uterus or even penetrate the uterus. Though this is rare, this complication is very serious in that it can cause organ damage, scarring, and infection.

One writer, Conz Preti, shared in Insider that her copper IUD caused her constant cramping and pain during sex, all while dealing with 10-day long periods. She thought her IUD was poking into her uterus awkwardly, but after an ultrasound showed that it was still in place, her doctors sent her home.

The cramps became constant. Needing to pee made me cramp. Having one of my kids sit on my lap made me jump in pain. Regardless of whether I was ovulating, menstruating, or having penetrative sex, I was in pain, she shared.

A copper IUD doesnt necessarily introduce something foreign into your body. Our bodies need to process copper to keep other minerals like zinc and iron in balance, so you shouldnt fear a copper IUD simply because its metal. That said, if youre introducing an excess of one mineral into your body, you should be prepared for the other mineral levels to become imbalanced. This can create temporary problems like brain fog, mood swings, fatigue, depression, nausea, irritability, or cravings, just to name a few.

Our bodies need to process copper to keep other minerals like zinc and iron in balance.

One woman in a Facebook group dedicated to discussing IUD side effects shared that, among the nutrient and mineral imbalances she faced from her implant, she felt exhaustion, mood swings, migraines, cold hands/feet, dry skin, constipation, problems concentrating, spaciness, high anxiety, and even lost hair in globs. She also reported developing a rare disorder called pulmonary hypertension due to excess levels of copper in her blood.

Lets analyze one of the potential nutrient and mineral imbalances from excess copper: zinc. Your body needs zinc to work in tandem with magnesium and keep your body functioning properly. With adequate levels of zinc, youre less likely to feel stressed, your mental capacity is stronger, your mood is better regulated, and you face a higher chance of fighting off sickness and disease. That latter benefit is why, when Covid-19 began to spread, people suggested taking extra zinc to prevent infection.

After a woman gives birth, doctors may suggest the option of getting back on birth control to prevent any pregnancies so soon after the last one. Non-hormonal IUDs are a more attractive option in the eyes of physicians because they dont interrupt a womans hormone levels like the pill, patch, shot, or implant does while shes breastfeeding.

They might be even more attractive for an older mother because of the length of protection from pregnancy. If you have a geriatric pregnancy in your mid to late 30s and then have a copper IUD implanted in your uterus, youre nearly fully protected from becoming pregnant ever again since you may hit menopause around the time the IUD loses its effectiveness.

That said, having a piece of copper implanted into a major organ causes elevated levels of copper. Your bodys copper levels already increase with multiple births to create blood vessels, and this level doesnt tend to go back to normal after birth. Some women actually experience psychosis and postpartum depression thanks to elevated copper levels.

Though this isnt the case for all mothers, it does naturally lead you to wonder whether elevated copper levels play a role in certain mothers drowning their newborns, committing suicide, or engaging in any other tragic act of violence related to postpartum depression or psychosis.

There has also been talk that, since copper works well as a metal to conduct energy, the implant can potentially cause racing thoughts, insomnia, heart palpitations, and even dizziness.

Before you get too worried, contracting heavy metal toxicity from your IUD is rare. This doesnt mean youre not at risk, though. Healthy women with normal liver function can process minerals like copper, but if you have any pre-existing conditions that affect your livers ability to detox your body, then elevating your bodys copper levels can become unsafe.

Your bodys tolerance for excess copper often depends on hereditary factors. Some people are less able to metabolize and therefore effectively eliminate excess minerals from their body. If you already have a rare genetic disorder like Wilsons Disease, then your body collects copper in glands and vital organs. Again, this disorder is rare, but as life-threatening as it is, introducing extra copper into your body could be fatal.

Some people are less able to metabolize and eliminate excess minerals from their body.

Interestingly enough, some doctors and medical agencies insist that heavy metal toxicity from IUDs is either not possible or so incredibly rare that they downplay any concerns. Take Susan Rubin, associate professor for family and social medicine at Albert Einstein College of Medicine in New York, who claims: There is no such thing as copper toxicity with an IUD.

Well, similar things were said to quell fears about silicone breast implants, but we now know that breast implant illness is the real deal and not just a myth.

Though one womans negative lived experience cant negate all of the positive experiences that other women have had while on the copper IUD, its really valuable to listen to personal stories and treat them with respect.

Another otherwise healthy woman in her twenties got a copper IUD placed because she didnt want to use hormonal birth control and felt no adverse symptoms beyond a heavier period. Suddenly, she started experiencing panic attacks and numbness in her limbs. Her symptoms only went that far, but other women like Olivia Bowden had increasingly severe migraines, panic attacks, memory loss, and reported having issues processing information while on the IUD.

I thought I was getting schizophrenia, or Alzheimers. I started hearing voices in my head. It was always two men chatting to each other, kind of like TV or radio presenters, but I couldn't quite make out what they were saying, Bowden shared.

While there are certainly strong reasons to use a non-hormonal IUD as your preferred form of birth control and the odds of potential complications are in your favor, we shouldnt ignore the risks that these implants pose to your body. However, you dont have to entirely sacrifice side effect-free, effective birth control options. A more natural way to prevent pregnancy with no added side effects whatsoever is trying out Fertility Awareness Methods. These methods are effective without the need for extra pharmaceuticals, and if you try it out, you might even feel more empowered by understanding how your body naturally works.

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Are IUDs Just As Bad As The Pill? Let's Take A Look At The Pros And Cons - Evie Magazine

For women and people assigned female at birth (AFAB), taking care of your health requires more than an annual physical. You should also visit a womens health specialist like an Ob/Gyn, midwife or nurse practitioner each year to keep healthy. More than just a checkup for your breasts/chest and reproductive organs; well-woman exams can also help you develop rapport with a womens health specialist.

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Well-women exams are important for a number of reasons. No. 1 is that they help you to establish care with a specialist so that if there is a problem down the road, you have a provider that you know and feel comfortable talking to, says Ob/Gyn Amanda Elbin, MD.

That comfort level is important, too, especially because many of us may not feel comfortable talking with just anyone about issues down there.

When you have a level of comfort with a provider, its easier to talk openly about sensitive issues, notes Dr. Elbin. Its important to be able to talk with a healthcare provider about your sexual health, your reproductive wishes, abnormal discharge or whatever your concerns may be. So, having regular check-ins helps to make sure youre comfortable with having those discussions when you need to.

We spoke with Dr. Elbin about who needs well-women exams and what you can expect from these annual visits.

Your womens health specialist is your partner in screening for issues like breast cancer, ovarian cancer and cervical cancer that arent a part of a regular physical exam.

The American College of Obstetricians and Gynecologists states that the importance of these preventative care visits go beyond screening for physical abnormalities. Regular visits to a specialist can help you navigate all the other nuances that come with life. That can include things like:

So much of your health is impacted by things outside of your bodys physical functioning, Dr. Elbin says. In addition to screening for physical changes, a lot of what we talk about is your mental health whats going on in your life, how are your relationships. We spend a lot of time working with people and figuring out how we can help them be their best well-rounded, whole person.

Dr. Elbin explains that these appointments are recommended each year for anyone with female anatomy (regardless of their gender identity, and including cisgender women, non-binary people with female anatomy and transgender men). They can also be helpful for anyone who identifies as a woman (regardless of their anatomy).

For women who dont have a vagina, a womans health specialist can work with their primary care physician, or other healthcare providers, to help with managing hormones, medication or other concerns, Dr. Elbin states. A womens health specialist can also be a trusted resource for all people to access a sensitive and welcoming healthcare environment to ask questions or get advice. You may also consider seeking out an LGBTQIA+ specialist for your care.

Well-woman exams should be a part of your regular health maintenance beginning in your teenage years and well beyond menopause.

Even beyond childbearing age, these health practitioners work with you to keep you as healthy as possible, Dr. Elbin says.

Like your annual physical, one component of an annual well-woman exam is taking stock of your current health to understand your risks for certain conditions and to screen for potential health concerns. But a primary care doctor is going to check for different issues than a womens health specialist.

During a physical, a primary care physician will be more likely to check for things like high cholesterol, high blood pressure or unusual moles on your skin.

During a well-woman exam, your healthcare provider is looking primarily for concerns related to your reproductive health, like changes to your menstrual cycle or advising you on contraception options.

Your healthcare provider may do things differently depending on your age, your health status and other factors, but typically, a well-woman visit will start with questions about your overall health. Theyll take your vital signs. And youll get into one of those oh-so-chic hospital gowns to examine your breasts and pelvic area.

Dr. Elbin says theres nothing you need to do to prepare for a well-woman exam except to bring any questions you have and be open to talking about how youre doing.

Come as you are. Theres nothing fancy that you need to do, no products that you need to use and, no, we dont care if you shave your legs. Makes zero difference to us, Dr. Elbin says. (And contrary to some popular beliefs, you can get a well-woman exam when youre on your period.)

Dr. Elbin walks us through what you can expect during a well-woman exam.

Your exam will likely start with reviewing your medical history, including your family history, to understand your current health and note any changes since your last visit.

Questions you may be asked include:

Your exam will likely include some time devoted to taking your vital signs, including your:

Your provider will also likely listen to your heart and lungs using a stethoscope and will feel your neck to check your thyroid.

During the appointment, your provider will likely perform a breast exam to check for any changes, such as lumps or swelling. In most cases, this exam will take place with you lying on a doctors table with your arm above your head. Your doctor will use their fingertips and medium pressure to check your breast tissue for any signs of concern.

If youre between the ages of 21 and 65, another part of your well-woman exam will likely be a pelvic exam. This is a screening where your healthcare specialist will look for any signs of disease in your vagina, uterus, ovaries, fallopian tubes and cervix.

During the pelvic exam, youll lie on your back with your feet in stirrups. Your healthcare provider will use a speculum to look inside your vagina to ensure things look healthy. They may also perform an exam by touch, feeling your uterus and ovaries for any signs of abnormalities.

A pelvic exam may be uncomfortable or cause some mild cramping for some people, but it shouldnt hurt.

Pap smears are recommended every three years for most women and people AFAB between the ages of 21 and 65. Your doctor may recommend them more frequently if you had abnormal Pap smear results in the past.

If its time for your pap smear, your healthcare provider will use a small brush or spatula to gently remove cells from your cervix as part of your pelvic exam. That sample will be sent for testing to check for human papillomavirus (HPV) and signs of cervical cancer.

In addition to your regularly scheduled well-woman exam, Dr. Elbin reminds you to not hesitate to reach out to a healthcare provider with other concerns between annual visits. Some common reasons to consult your Ob/Gyn or other provider include:

If anything changes out of the blue or doesnt feel right, we want to see you and make sure all is well, Dr. Elbin says.

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Well-Woman Exams: Who Needs Them and What To Expect - Health Essentials

Acute suppurative thyroiditis is a rare life-threatening endocrine emergency. The thyroid gland has rich vascularity and lymphatic drainage, has large amounts of iodine in the tissue, generates hydrogen peroxide, and is encapsulated. Owing to these factors, infection of the thyroid gland is rare. The clinical presentation of acute suppurative thyroiditis closely resembles that of subacute thyroiditis, with a differentiation possible only on fine needle aspiration cytology (FNAC). However, differentiating these two conditions is important because the management of these two conditions differs drastically. Management includes intravenous antibiotics, drainage of abscesses, and sometimes surgery may be required. Here, we present a case of thyroid abscess caused by methicillin-resistant Staphylococcus aureus (MRSA), diagnosed using FNAC of the thyroid gland and blood culture.

Inflammation of the thyroid gland referred to as thyroiditis can have various causes. Of these, acute suppurative thyroiditis although rare, is an emergency associated with a high mortality rate if left untreated. Its presentation closely resembles that of subacute thyroiditis which is a common but self-remitting condition. Acute suppurative thyroiditis comprises <1% of thyroid disease.Here, we present a case of a young male with chronic kidney disease (CKD) who was ultimately diagnosed to have acute suppurative thyroiditis.

A 23-year-old male, a diagnosed case of CKDstage 5 - on maintenance hemodialysis twice weekly, with a history of marijuana smoking with no other significant past medical history. The patient presented to the emergency with complaints of fever, which was intermittent, low grade, and undocumented, initially later progressed to high grade associated with chills and rigors in the last four days. The patient noticed a neck swelling 15 days back, progressively increasing in size associated with mild pain and difficulty in swallowing which was more for solids than liquids. The swelling was not associated with any discharge. He also complained of bilateral lower limb swelling and generalized myalgia for one week. He had a history of retrosternal, non-radiating chest pain for 7 days which was associated with palpitations and shortness of breath on exertion

On examination, pulse rate was 175/min which was irregularly irregular, blood pressure was 100/70 mmHg, respiratory rate was 24/min, saturation 100% with 12 liters of oxygen, the temperature was 102F, Glasgow coma scale (GCS) - E4V4M6, the patient was agitated. Pallor and bilateral pitting pedal edema were present on general examination. Respiratory system examination revealed bilateral basal crepitations, other system examinations were within normal limits. Local examination revealed a 105cm swelling on the right side of the neck, that was moving with deglutition, and tenderness present on palpation, but not associated with discharge, redness, or fluctuation.

An electrocardiogram suggested atrial fibrillation for which diltiazem bolus followed by infusion was given. Lung point-of-care ultrasound (POCUS) showed bilateral grouped B lines and pleural shreds with minimal pleural effusion the in lungs. Arterial blood gas revealed severe metabolic acidosis with a pH of7.12 and HCO3 of 11.3 mmol/L. The patient was started on intravenous antibiotics (ceftriaxone, clindamycin) and steroids. Urgent hemodialysis was done for anuria and severe metabolic acidosis. He was then admitted to the intensive care unit. The patient's blood investigations revealed anemia, neutrophilic leukocytosis, thrombocytopenia, hyperbilirubinemia, and deranged kidney and thyroid function tests as shown in Table 1.

Other investigations done are shown in Table 2.

The patient was started on Tab Propranolol 60 mg 6-hourly and Tab Propylthiouracil 200 mg 4-hourly, Hydrocortisone 100 mg intravenously 8-hourly. Antibiotics were stepped up to intravenous vancomycin 500 mg alternate days and meropenem 500 mg twice daily. The patient required high flow oxygen to maintain saturation; hence, it was not feasible to transport patient for thyroid scintigraphy or iodine uptake study. A thyroid fine needle aspiration cytology (FNAC) report revealed a thyroid abscess (Figures 1,2) and the culture report did not detect any organism.

Ultrasound-guided aspiration of thyroid abscess was performed, seropurulent pus was seen and thyroid drain was inserted, and the patientimproved symptomatically. A final diagnosis of acute suppurative thyroiditis and Lower respiratory tract infection (LRTI) with sepsis, acute on CKD was made. However, the patient developed severe respiratory distress with type 1 respiratory failure, and hypotension for which he was intubated, and noradrenaline infusion was started, subsequent chest imaging revealed multiple consolidations with cavitations suggestive of hospital-acquired pneumonia.Despite all efforts, the patient succumbed to death on day 22 of admission.

The term thyroiditis refers to inflammation of the thyroid gland. Thyroiditis can be broadly classified into infectious, De Quervains, autoimmune, Riedels, and miscellaneous [1]. The thyroid gland has rich vascularity and lymphatic drainage, has large amounts of iodine in the tissue, generates hydrogen peroxide, and is encapsulated. Owing to these factors, infection of the thyroid gland is rare. Acute suppurative thyroiditis is a rare life-threatening endocrine emergency. It has a reported incidence of 0.1%-0.7% and if untreated, the disease carries a high mortality rate of around 12% [2,3]. On the other hand, subacute thyroiditis is a spontaneously remitting condition that is much more common than acute suppurative thyroiditis. It may last for weeks to several months and tends to recur. It is also referred to as granulomatous or De Quervains thyroiditis [4,5].

Multiple factors predispose patients to the development of acute suppurative thyroiditis of which immunosuppression is the most common [6]. However, pyriform sinus fistula and third and fourth branchial arch abnormalities are also important, especially in children [7,8].The clinical features, laboratory findings, and radiological features of acute suppurative thyroiditis closely resemble those of subacute thyroiditis (Table 3).

Fine needle aspiration from the thyroid tissue provides the most accurate diagnosis and can be used to differentiate these two conditions. In acute suppurative thyroiditis, the FNAC aspirate is purulent with the presence of bacteria or fungi, whereas, in subacute thyroiditis, the FNAC aspirate shows lymphocytes and macrophages with some giant cells [9].

Although these conditions closely mimic each other, certain clinical features can be used as differentiating factors. Patients with acute suppurative thyroiditis are generally immunocompromised, sicker, with severe localized thyroid pain, an associated upper respiratory infection, and lymphadenopathy [1]. Thyrotoxic presentation is seen in only 8%-12% of patients with bacterial thyroiditis [3]. We reviewed some recent articles on patients with acute suppurative thyroiditis, the important studies have been shown in Table 4.

Differentiating these conditions is extremely important as their treatment differs. While antibiotics with or without surgery are required for patients with acute suppurative thyroiditis, patients with subacute thyroiditis require only analgesics and sometimes corticosteroids. For Emergency physicians, since the results of FNAC are often not available, it is prudent that a low threshold is maintained for initiating antibiotics in patients with painful thyroid swelling since untreated acute suppurative thyroiditis is life-threatening.For serious infections, parenteral antibiotics are necessary. Microscopic examination, staining, and culture of a fine-needle aspirate help determine the best agent. Thionamides are not necessary forindividuals with thyrotoxicosis from thyroiditis because there is no excessive thyroid hormone production; nevertheless, adjuvant medications such asbeta-blockers and cholestyramine may be used to reduce symptoms or more quickly restore euthyroidism. If a thyroid abscess is found, aspiration or surgical drainage should be tried [20].Open surgery with a complete, nearly entire, or hemithyroidectomy can be utilized to relieve pressure sensations in extreme circumstances, in individuals who do not respond to suitable antibiotic therapy and drainage. Ultimately, surgical removal of the damaged thyroid lobe may be required to treat the local source of infection and inflammation if systemic indications and symptoms do not improve with initial treatment [21].

Our patient was a young male who was diagnosed case of CKD, who had a mildly painful neck swelling along with symptoms of hyperthyroidism and uremia, and who was ultimately diagnosed to have bacterial suppurative thyroiditis. Although patients with CKD suffer from an altered immune response which includes both innate and acquired immunity [22]. Our patient was on no immunosuppressant drugs. Also, the clinical presentation of our patient was more suggestive of subacute thyroiditis as compared to acute suppurative thyroiditis. Thus, this was a rare presentation of acute suppurative thyroiditis.

Rare but potentially fatal, acute suppurative thyroiditis should never be ignored.Patients may experience acute symptoms or develop a more chronic course depending on the underlying organism. Its presentation strongly resembles that of subacute thyroiditis, which is a self-remitting illness; precise diagnosisis therefore challenging in the emergency room.Thyroid abscess can have a variety of complications, including thyroid storm, internal jugular vein thrombosis, airway obstruction, tracheal or esophageal perforation, necrotizing mediastinitis, sepsis, and even death.Therefore, all patients who report to the emergency room with painful neck swellings must receive careful attention. The most accurate diagnosis is achieved by fine needle aspiration from thyroid tissue; however, ultrasound is the preferred diagnostic method in the emergency room. Treatment options include intravenous antibiotics, abscess drainage, and possibly surgery.

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A Rare Case of Neck Swelling: Acute Suppurative Thyroiditis With End-Stage Renal Disease - Cureus

Anyone who's had a headache, which is nearly everyone, knows how quickly one can ruin your day and while the first reaction might be to grab a bottle of pain reliever, there's actually many other natural remedies to try. Headaches are one of the most common types of pain we experience and can be seriously debilitating, but before you reach for an over-the-counter medication, here's seven ways to help get rid of the throbbing pain, according to experts we spoke with. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Jacob Hascalovici MD, PhD as the Clearing Chief Medical Officer tells us, "Headaches can happen for quite a few different reasons. Stress, dehydration, genetics, illness, allergies, injuries, infections, hormone shifts, changes in the weather, certain medications, and even strong smells, among other things, can cause headaches."

Dr. Hascalovici says, "People should know that there are many different kinds of headaches, and that the various types may benefit from different treatments. With time and the right strategies, headaches usually fade away. If you have a headache after an injury, if a headache just keeps getting worse, if you have a stiff neck, and/or if you notice you can't remember things very well, can't seem to keep your thoughts straight, feel numb, slur your words, or have trouble seeing, you should seek medical attention."

Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies explains, "When you have a headache, the first thing you want to do is reach for some pain medication. But before you pop a pill, you may want to try reaching for a glass of water. That's because one of the most common causes of headaches is dehydration. When your body doesn't have enough fluids, it can cause your blood vessels to constrict, leading to pain. Drinking water helps to rehydrate your body and can often relieve headache pain. Plus, it's a natural and drug-free way to reduce pain. So next time you have a headache, reach for a glass of water before reaching for the medicine cabinet."

Dr. Mitchell says, "Headaches are a common albeit debilitating condition that various factors, including certain medications can cause. If these medications are missed or stopped abruptly, they can contribute to headaches. For example, beta-blockers and calcium channel blockers are used to prevent migraines, but if they are suddenly discontinued, they can cause rebound headaches. In addition, certain antidepressants and anti-seizure medications can also cause headaches if they are not tapered off gradually. As a result, it is important to take medications as prescribed and to consult with a physician before making any changes to one's medication regimen. By doing so, you can help to prevent the onset of headaches."

Dr. Hascalovici emphasizes, "That may sound odd, but just sitting still in a comfortable position in a dark, cool room may help drive your headache away. For additional help, you can try aromatherapy, which simply involves using candles, essential oils, or room diffusers that have therapeutic scents. Smells can have powerful effects on the body while they can trigger headaches, they can also ease them. Some people find relief from the smell of peppermint, lavender, eucalyptus, rosemary, or chamomile."

According to Dr. Hascalovici, "For some, a headache is connected to what they eat. The most frequent food culprits include chocolate, coffee, pizza, foods with MSG, foods preserved with nitrates (like lunch meats and pepperoni), and certain cheeses. Instead, try a salad, even if that doesn't sound as fun. The leafy greens can bring relief, as can nuts, hot peppers, pumpkin seeds, and cherries. Plenty of water and herbal tea is also good."

Dr. Mitchell shares, "This can trigger a headache if you are sensitive to certain scents or fragrances. Be aware of your environment. If you can leave the environment, great, or perhaps open the windows. However, if you cannot leave the environment, try to identify the source of the scent and avoid it if possible. For example, if you are sensitive to perfumes, ask people not to wear them around you. If you are sensitive to cleaning products, ask others not to use them when you are present. If you are sensitive to cigarette smoke, try to avoid smoking areas. By being aware of your surroundings and taking steps to avoid triggering scents, you can help reduce headaches."6254a4d1642c605c54bf1cab17d50f1e

Dr. Mitchell states, "Not getting enough sleep is a common cause of headaches. If you regularly work long hours or have trouble sleeping, you may be at risk for headaches. Sleep deprivation can trigger migraines and tension headaches. It can also make existing headaches worse. To help prevent headaches, it's essential to get enough sleep. Most adults need seven to eight hours of sleep per night. If you have difficulty sleeping, you can take steps to improve your sleep hygiene. Avoid caffeine and alcohol before bed, establish a regular sleep schedule, and create a relaxing bedtime routine. Getting enough sleep is essential for overall health and can help reduce your risk of headaches."

Dr. Mitchell says, "Most people have experienced being "hangry" at some point in their lives that feeling of irritability or irrational anger that seems to come out of nowhere. While it's often written off as a joke, the reality is that being hangry is a genuine phenomenon with a scientific explanation. Our blood sugar levels drop when we skip meals or go for extended periods without food. This can lead to feelings of dizziness, fatigue, and you guessed it headaches. So next time you're feeling hungry, try reaching for a snack instead of taking it out on the people around you. Chances are, it will do wonders for your headache and your mood."

Dr. Mitchell says this "doesn't constitute medical advice and by no means are these answers meant to be comprehensive. Rather, it's to encourage discussions about health choices."

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This is How to Dissolve a Headache Fast Eat This Not That - Eat This, Not That

Robin Young has autism spectrum disorder, which, in his case, means he struggles to empathize and show love for someone else. The resident of Bodicote, England, is also a father.

This is something Ive always had. However, when I became a dad, I found that the love for my children was different, Young told Healthline. Not only was this strong feeling of love new, but it also enabled me to empathize better because I finally understood what others feel when they say they love someone.

Young the chief executive officer of workout supply company Fitness Savvy said he believes his outlook on life improved after having children and planning for their future.

People think that it is just your priorities that change when you become a parent, but it would make perfect sense that the brain goes through changes as well, Young said.

Hes likely correct, according to researchers from the University of Southern California (USC).

They say women arent the only ones who go through physical change when becoming parents. Mens brains undergo measurable changes after their babies arrive.

Thats right. They get dad brain.

Their study published in the journal Cerebral Cortex reports that some of those changes involve slight brain shrinkage. They add that brain changes in new fathers mostly affect areas linked to empathy and visual processing.

The scientists believe those changes contribute to neuroplasticity, which is the brains ability to create and form new synaptic connections to adapt to new experiences.

Becoming a parent entails changes to your lifestyle and your biology, said Darby Saxbe, the studys senior author and a professor of psychology at USCs Dornsife College of Letters, Arts, and Sciences, in a statement. And it requires new skills like being able to empathize with a nonverbal infant, so it makes sense but has not been proven that the brain would be particularly plastic during the transition to parenthood as well.

The study examined the brain scans of 40 expectant fathers 20 in the United States and 20 in Spain. Researchers also looked at a group of 17 childless fathers who were scanned in Spain.

The researchers identified that the most significant changes in the expectant fathers occurred in the cortex the brains outer layer managing attention, planning, and executive functioning.

Comparisons made before and after the babies were born showed changes where the brain processes visual information and areas that are part of the brains default mode network.

The childless men had no such changes.

This is such an important and neglected topic, Dr. Zishan Khan, a child, adolescent, and adult psychiatrist with Texas-based Mindpath Health, told Healthline.

This can be a very difficult transition for mothers and fathers, but fathers especially since they dont get the chance to carry the child during the course of pregnancy and it can sometimes take more time to truly feel connected, Khan explained. The psychological adjustment often involves having to manage the difficult sensory responses that occur when a child is crying, seemingly in pain or distress, or feeling ill.

Khan said theres a big shift in mindset for first-time parents.

Priorities must be shifted and you may not be able to find time to relax the same way you did after a long day at work or have the ability to go out with friends late into the night, Khan said. The lack of sleep can also further complicate this adjustment and fathers often experience irritability, impatience, and extreme exhaustion as a result.

Lauren Cook-McKay, a licensed marriage and family therapist as well as vice president of marketing for Connecticut-based Divorce Answers, told Healthline men go through their own hormone changes when they become fathers.

The mans cortisol and testosterone levels generally dip within the first few weeks of being a father, Cook-McKay said. This somehow makes fathers less aggressive, bringing them close to their children. New fathers also experience an increase in prolactin, oxytocin, and estradiol, which causes a man to exhibit nurturing behaviors.

The dad brain doesnt just happen overnight.

Parental psychological adjustment determines parental involvement, Cook-McKay said. Parents who have poor parental psychological adjustments tend to be less involved with their children. Engaging with an infant can help produce positive effects in terms of responsiveness and attentiveness.

Dr. Hayley Nelson is a neuroscientist, psychology professor, and founder of The Academy of Cognitive and Behavioral Neuroscience.

She told Healthline becoming a parent is a significant time for the brain, as it learns from new experiences.

Your life changes in the blink of an eye and you are now in charge of communicating with a non-verbal, seemingly helpless child, Nelson said. Its a perfect time for increased empathy, too.

Nelson said theres more research to be done on the brain effects of things such as fear, learning, and reward when becoming a father, which she said all affect mothers.

Future studies investigating brain changes in fatherhood considering hormonal changes, as well as effects from sleep deprivation and stress, could help further elucidate what is occurring in the brain after childbirth, Nelson said. Not only in the biological mother but also from the father or other caregivers, biological or not.

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'Dad Brain' and Why First-Time Fathers Develop It - Healthline

Hormone replacement therapy has a bad reputation because of potential risks to long-term health. A new look at the evidence could change our relationship with HRT - and the menopause

By Caroline Williams

Angus Greig

THE mood swings I could handle. Ditto the night sweats, irregular periods and alibido that swung between randy teenager and old maid. Then the menopause came for my brain and enough was enough. Ifageing naturally meant giving up the job I love because I could no longer think, I was out. Bring on the hormone replacement therapy.

Within weeks, I found energy reserves that I had forgotten I had. The urge to crawl into bed mid morning disappeared and was replaced with a clear head and renewed zest for life.

It was quite the transformation. So much sothat one of the first things I wanted to do with my new mental clarity was to dig in to thescience behind what was happening to me. Was I experiencing an age-related hormonal deficiency that I had, sensibly, nipped in the bud? Or was I guilty of jumping on the latest well-being bandwagon, making a big fuss about a natural life stage that would soon pass?And, importantly, am I protecting my long-term health by taking HRT or risking it?

These are questions that scientists have been grappling with for more than 80 years, ever since the first HRT was approved by the US Food and Drug Administration. Premarin, made from oestrogens extracted from the urine of pregnant horses, was licensed in the early 1940s for the treatment of hot flushes and night sweats, the most common menopausal symptoms. There are many others, ranging from heart palpitations and joint pain to brain fog, anxiety and depression.

These symptoms are eminently treatable with HRT. Yet its use has been controversial

Continue reading here:
Should you take HRT? Here's how to think clearly about the risks - New Scientist

Naturopathic Physician Dr. Michelle Sands transforms menopause and perimenopause care with a holistic approach to hormone replacement therapy and midlife menopause support. Dr. Sands believes all women deserve to feel amazing in their bodies and seeks to achieve this by providing affordable and accessible personalized care through her virtual health platform, Glow Natural Wellness.

Every woman will go through menopause, but Dr. Michelle Sands founded GLOW Natural Wellness because she believes that no woman should have to suffer through hot flashes, night sweats, intimate dryness, weight gain, and other change-of-life symptoms. These symptoms directly result from the dramatic drop in hormones such as estrogen, progesterone, and testosterone during the menopause transition.

Even more important is that women understand the importance of maintaining optimized hormone levels when it comes to protecting themselves from chronic disease. Without adequate estrogen levels, a womans risk of heart disease, diabetes, osteoporosis, Alzheimers, and all-cause mortality increases. Bioidentical Hormone Replacement, when dosed and delivered correctly, can reduce those risks and extend life. The problem is that this conversation is not happening in most doctors offices.

Studies show that when women seek medical care for the symptoms of menopause, 75 percent of them are sent home without treatment, Dr. Sands said. An estimated 1.3 million women enter menopause every year in the U.S. alone. Yet less than 20 percent of physicians, including OB/GYNs, are trained to treat them properly.

Dr. Sands, a licensed Naturopathic Physician, and Female Health and Hormone Expert, has created The Healthy Hormone Club to provide affordable and accessible testing, treatment, and education for this underserved demographic.

What is menopause

Menopause is a point in time 12 months after a woman's last period. The 10-15 years leading up to that point are called Perimenopause. During this period, women may have changes in their monthly cycles due to declining levels of estrogen and progesterone. By the time they reach menopause, estrogen and progesterone have plummeted to barely-there levels. Common symptoms include hot flashes, night sweats, mood swings, osteoporosis, fatigue, and more.

Menopause is one day, Dr. Sands said. The next day, you are postmenopausal for the rest of your life. Hormone replacement therapy is a great way to support the body through the menopause transition and throughout post-menopause.

Answering the most asked menopause and perimenopause questions

Hormone Harmony

Dr. Michelle Sands published a book, Hormone Harmony Over 35: A New, Natural, Whole-Body Approach to Limitless Female Health, to share her approach to optimal health with the public. She reveals her evidence-based 21-day plan to restore hormonal balance, reduce stress, and naturally detoxify the body.

A womans body can no longer make vital hormones once she is postmenopausal, and it can quickly affect her quality of life, Dr. Sands said. The GLOW Natural Wellness team helps clients understand their symptoms and how to navigate them using a personalized and holistic approach. A typical protocol will consider a patients health history, current symptoms, laboratory test results, and health goals. In addition to bioidentical hormone replacement therapy, a focus on nutrition, stress reduction, movement, nutraceuticals, and mindfulness is key for the best possible outcomes.

Conclusion

A mother herself, Dr. Michelle Sands, knows how draining life can be for women struggling with menopause symptoms. She is passionate about helping women harness the power of their DNA to elevate their genetic expression and live vibrantly, not just by optimizing health physically, but also mentally, emotionally, and spiritually.

Women experiencing menopause or perimenopause symptoms are encouraged to visit the GLOW Natural Wellness website to learn more about bioidentical hormone replacement therapy.

Glow Natural Wellness

Dr. Michelle Sands

United States

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Dr. Michelle Sands Treats Menopause Symptoms Through GLOW Natural Wellness Hormone Replacement Therapy - Benzinga

Primary hyperparathyroidism ( PHPT) primarily affects women after menopause.

Around 2-3 per cent of women develop a mild variant of the disease following menopause. PHPT is a disease that causes an increase in the level of calcium in the blood.

Calcium is an important mineral in the body, of which there should be neither too much nor too little. Those with mild PHPT only have a minor elevation of calcium levels and usually do not have any symptoms.

Mild PHPT is a relatively common condition in women who have gone through menopause. Unfortunately, it is often overlooked in routine health examinations, says Jens Bollerslev, adjunct professor at the Institute of Clinical Medicine at the University of Oslo and senior physician at Oslo University Hospital.

Now, however, he and his colleagues have good news for PHPT patients.

Four small glands in the neck, called parathyroid, regulate the level of calcium in the blood. In people who have PHPT, one or more of these glands are overactive.

Common treatment of PHPT has been to remove overactive glands through surgery. The aim has been to reduce the risk of early death and of potentially developing other diseases because of the elevated calcium levels.

However, researchers in Norway, Sweden and Denmark have found that it is not necessary to perform surgery on patients who have the mild variant of the disease, where the calcium level is only slightly higher than usual.

Our study suggests that it is safe not to remove the overactive glands in patients with mild PHPT, at least over a ten-year perspective, Mikkel Pretorius says.

He is a PhD candidate at the Institute of Clinical Medicine at the University of Oslo (UiO) and senior physician at the Department of Endocrinology, Morbid Obesity and Preventive Medicine at Oslo University Hospital.

From left: Ansgar Heck, Jens Bollerslev, Kristin Godang and Mikkel Pretorius. (Photo: Oslo University Hospital)

In the study, Pretorius and colleagues found out that the vast majority of people with mild PHPT had good health over a ten-year period, regardless of whether or not the overactive gland had been removed.

A few patients with mild PHPT developed other diseases and complications, and a few died during the 10-year duration of the study. This, however, seems unrelated to whether or not the patients underwent surgery. There were no differences on these measures between the two groups.

Our study shows that the health of patients who did not have surgery was just as good as the health of patients who did have surgery, Jens Bollerslev, who led the study, says.

Ansgar Heck, researcher and senior physician at the Section for Special Endocrinology at Oslo University Hospital, puts it like this:

This study allows us to give better advice to patients. Patients will also be able to base their choice between surgery and a wait-and-see attitude on more information."

Visual abstract: Annals of Internal Medicine. (Image: Pretorius et al.)

The parathyroid glands secrete the parathyroid hormone PTH. This hormone ensures that calcium is moved from the skeleton to the bloodstream. An overactive gland secretes too much of the hormone, which leads to higher calcium levels.

Researchers and professionals in the medical field assume that the disorder in the parathyroid gland and the disease PHPT increases the risk of developing other diseases such as cardiovascular disease, kidney disease and osteoporosis.

Osteoporosis is the same as bone fragility. The disease makes the skeleton weaker and more prone to bone fractures.

The assumed increased risk of getting other diseases is the reason why common treatment has been to remove the overactive gland. Nevertheless, there is a lack of research documenting the risk.

In real terms, we do not know whether the assumption of increased morbidity and death is true for people with mild PHPT, Bollerslev explains. We also do not know whether the development of disease is connected with the higher calcium levels or the higher levels of the hormone PTH, or both.

Although patients who have the mild variant of the disease do not appear to need surgery, the healthcare system should ensure that this patient group is followed-up.

It is important to follow the development of the calcium level and the potential development of other diseases annually. If patients develop osteoporosis, one must decide whether surgery or other treatment is necessary after all, Bollerslev says.

The slightly higher level of calcium in the blood is often discovered by chance during a blood test.

If we see a higher level of calcium, it is important to examine the patient further to find out whether the patient also has higher levels of the hormone PTH. Because it may be that there is another reason for the higher calcium level, Heck says.

PHPT is much less common among men and among people under the age of 50. There is currently little research on how the disease affects these groups.

We do not know whether men and younger people who have the disease also have an increased risk of getting other diseases, Bollerslev says.

Another unanswered question is whether there is a smooth transition between what is considered mild PHPT and what is considered severe PHPT.

In severe PHPT, the level of calcium in the blood is much higher and patients usually have symptoms or complications. Surgery is then recommended.

191 patients with mild PHPT participated in the study. All participants were over 50 years of age and had a slightly elevated level of calcium in their blood. The patients had no symptoms or other diseases that could be directly linked to PHPT.

The patients were randomly divided into two groups, where one group underwent surgery and the other group was observed without surgery.

The researchers then followed up the patients in the two groups over a ten-year period in order to compare their state of health and any development of other disease with and without surgery.

This is the largest and longest lasting randomised study on this common disease. The study also shows that with good Scandinavian cooperation we can answer research questions that are relevant to the rest of the world, Pretorius states.

Reference:

Pretorius et al. Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation, Annals of Internal Medicine, 2022. DOI: 10.7326/M21-4416 Abstract.

Summary for Patients: Mortality and Morbidity in Mild Primary Hyperparathyroidism, Annals of Internal Medicine, 2022.

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Hormone disease that mostly affects menopausal women should not lead to surgery in mild cases - Sciencenorway.no

Posted By: Jan Larson McLaughlinAugust 31, 2022

Teal ribbons adorn downtown Bowling Green and other communities across the U.S. as part of a nationwide campaign during the month of September, which is Ovarian Cancer Awareness Month.

Locally, the campaign is spearheaded by the Ovarian Cancer Connection, a non-profit organization serving northwest Ohio and southeast Michigan.

Ovarian cancer impacts 21,000 more women each year.

Turn the Towns Teal is a national campaign in all 50 states, with the mission of raising awareness of the symptoms of ovarian cancer. Knowing the symptoms and risk factors of the cancer can lead to early detection with a 90-95% success rate.

Although the primary mission is to raise awareness to the symptoms of ovarian cancer, the national campaign also promotes support for survivors.

Potential symptoms may include:

If any symptom persists for 10 days to two weeks, consult your gynecologist or physician.

Risk factors for ovarian cancer may include genetic predisposition, family history, hormone replacement therapy, increasing age or reproductive history and infertility.

Do not ignore the risk factors and symptoms of ovarian cancer. If something does not feel right, contact your local physician or gynecologist.

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'Turn the Towns Teal' ribbons raise awareness of ovarian cancer BG Independent News - BG Independent Media

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Twenty-five years ago, when I was a young medical student on one of my first hospital rotations, the soft-spoken senior physician leading our team asked us one day on rounds, "what is all medication?" Met with blank stares, he then answered for us: "Poison. All medication is poison." He didnt mean that the drugs we were giving our patients were killing them, but that we had a responsibility to be cautious when using them, as they also have the potential to harm.

Its a lesson many of my physician colleagues are ignoring in their opposition to burgeoning legislation in several states that would prohibit "gender-affirming" therapies for children with gender dysphoria, including Ohio HB 454, currently the subject of contentious debate in my home state. Those therapies include hormones to stop puberty and change external sexual characteristics, and surgeries to alter anatomy to that of the opposite sex. As a doctor and a father, I have watched the role many in my profession have played in this debate with increasing concern and dismay. Physician involvement in this kind of therapy for children is horribly irresponsible and worthy of contempt.

The standard in medicine is that the onus is on those proposing any treatment to reliably demonstrate that treatment is safe and effective. In the case of children with gender dysphoria, the medical evidence for hormone therapy and surgery is weak and conflicting, with poor quality studies that are riddled with shortcomings and bias. Moreover, data supporting the safety of long-term hormone treatment in these children is largely nonexistent.

BOSTON CHILDREN'S HOSPITAL DELETES REFERENCES TO VAGINOPLASTIES FOR 17-YEAR-OLDS AMID ONLINE FUROR

Infertility is common after hormone therapy, and bone and cardiovascular health are at risk as well. Crucially, there is also data to show that those who undergo surgical therapy are vastly more likely to suffer lifelong mental unrest and even commit suicide, and that those consequences may not surface until a decade or more after surgery. In recent years, an increasing number of accounts of children who "transitioned," then subsequently "detransitioned" in adulthood, have illustrated the difficulty of reversing the effects that hormones and surgery have on young bodies and minds.

"I'm Not a Girl" is written by Maddox Lyons and Jessica Verdi about a transgender child. (YouTube/Screenshot)

Sadly, in a pattern that has become all too common in the COVID-19 era, U.S. physician advocates for these kinds of treatments have vastly overstated the results of their studies, downplayed any potential side effects, declared the issue "settled science," and then used that declaration as a cudgel to attack anyone who disagrees. In contrast, many of our European counterparts, including the United Kingdom, France, Sweden, and Finland, have recently hit the brakes on such therapy for children, recognizing that the data is poor and the long-term side effects are unclear.

Whats more, the ability of children to assent to any medical treatment is limited by the state of their brain development. Its long been known that the prefrontal cortex, the area of the brain that is responsible for planning and making impulse-free decisions, is not fully developed until about age 25. Thats why we dont let 10-year-olds eat ice cream all day long, why we dont let 16-year-olds buy alcohol, and why rental car companies charge 21-year-olds a young renters fee. Physicians who treat children with gender dysphoria know this well, but many inexplicably suspend that knowledge when it comes to life-altering hormonal and surgical therapy. In doing so, theyre betraying the trust of the vulnerable children and parents who have come to them for help.

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There is even an increasing chorus of voices within the transgender community itself who, unlike my ostensibly judicious colleagues, recognize these issues with childhood decision-making, and have spoken against such therapies for children.

More fundamentally, the very notion of chemically and surgically altering a child because they feel like they are the opposite sex runs counter to some basic truths that humanity has traditionally taught its children. Namely, that their feelings sometimes dont reflect objective reality, that there are some absolute constants in the world (one of them being their biologic sex), and that their physical existence is not a mistake. The idea that their body is somehow "wrong" is a message that should never be given to a child.

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Like all who seek out medical care, children with gender dysphoria and their families deserve compassion and honesty from their physicians. What many are getting instead are misleading, ideologically driven recommendations, resulting in physical and psychological mutilation that is difficult or impossible to reverse. Thats true poison to our profession, and it needs to stop.

LeRoy Essig, M.D. is a pulmonary, critical care, and sleep medicine physician practicing in Columbus, Ohio. He is a graduate of Princeton University and The Ohio State University College of Medicine.

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As a doctor and dad, I am ashamed by how horribly my field mistreats kids with 'gender-affirming' therapies - Fox News

Diabetesis a common condition that affects one in 10 people, that's over 37 million Americans, according to the Centers for Disease Control and Prevention While that's an alarming number, there are ways to help lower the risk. Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies tells us, "Diabetes is a serious medical condition that can lead to several health complications, including heart disease, kidney damage, and blindness. Fortunately, there are several things that people can do to reduce their chance of developing diabetes. Here are five lifestyle changes that can help to prevent diabetes. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell says, "Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. When blood sugar levels are too high, it can strain the organs and lead to complications such as heart disease, stroke, kidney disease, and vision problems. There are two main types of diabetes: type 1 and type 2. Type 1 diabetes usually develops in childhood or adolescence and is caused by an autoimmune reaction that destroys the beta cells in the pancreas that produce insulin. Type 2 diabetes usually develops in adulthood and is characterized by insulin resistance, when the body cannot effectively use the insulin it produces. Diabetes can be managed through lifestyle changes such as diet, exercise, and medication.

According to the Centers for Disease Control and Prevention (CDC), more than 30 million people in the United States have diabetes. However, it is estimated that one in four is undiagnosed and unaware of the condition. This is particularly concerning because diabetes can lead to several serious health complications, including heart disease, stroke, kidney disease, and blindness. That is why it is so important to get screened for diabetes if you think you may be at risk. If you have a family history of diabetes, your doctor might recommend getting screened at an earlier age. There are several ways to test for diabetes, but the most common is the A1C test. This test measures your average blood sugar levels over two to three months and can be done at your doctor's office or a local clinic. If you have diabetes, it is essential to work with your healthcare team to manage your condition and prevent complications. People with diabetes can live long and healthy lives with proper treatment and care."

Dr. Mitchell explains, "Being overweight or obese is the number one risk factor for type 2 diabetes. About 80 percent of people with this form of diabetes are overweight or obese. There are several reasons why carrying extra weight increases your risk of developing diabetes. First, excess body fat makes it difficult for the body to use insulin effectively. When the body can't use insulin properly, blood sugar levels rise. This is known as insulin resistance. Insulin resistance is a major cause of type 2 diabetes. In addition, carrying extra weight puts extra strain on the body's organs and systems, including the pancreas, which produces insulin. Over time, this can lead to damage and dysfunction. Finally, fat tissue produces hormones contributing to insulin resistance and high blood sugar levels. For all these reasons, people who carry extra weight are at a much higher risk of developing diabetes than those of a healthy weight."6254a4d1642c605c54bf1cab17d50f1e

According to the Centers for Disease Control and Prevention, "Not getting enough physical activity can raise a person's risk of developing type 2 diabetes. Physical activity helps control blood sugar (glucose), weight, and blood pressure and helps raise "good" cholesterol and lower "bad" cholesterol. Adequate physical activity can also help reduce the risk of heart disease and nerve damage, which are often problems for people with diabetes."

Dr. Mitchell reminds us, "Eating a healthy diet is essential for many reasons. It can help you maintain a healthy weight, have more energy, and avoid heart disease, stroke, and diabetes. Diabetes is a condition that affects how your body uses blood sugar. If you have diabetes, your body either doesn't make enough insulin or can't use it as well as it should. This causes blood sugar levels to rise. Over time, high blood sugar levels can lead to serious health problems, such as heart disease, kidney disease, nerve damage, and eye problems. Eating a healthy diet is one of the best ways to prevent or delay type 2 diabetes. A healthy diet includes fruits, vegetables, whole grains, and lean proteins. Limiting sugar, saturated fat, and trans fat is also essential. If you already have diabetes, eating a healthy diet can help you control your blood sugar levels. It can also help you prevent or delay complications of the disease."

Dr. Mitchell says, "Smoking is a leading cause of preventable death in the United States and a significant risk factor for developing diabetes. Smokers are more likely to develop type 2 diabetes than non-smokers, and the risk increases with the number of cigarettes smoked daily. Quitting smoking not only lowers your risk of developing diabetes but also helps to improve blood sugar control if you already have the disease. In addition, quitting smoking decreases your chances of developing other serious health problems, such as heart disease, stroke, and cancer. If you smoke, quitting is one of the best things you can do for your health. Talk to your doctor about ways to help you quit smoking for good."

Dr. Mitchell shares, "Monitoring blood sugar is essential in preventing diabetes because it allows people to see how their diet and lifestyle choices affect their blood sugar levels. For example, if someone eats many sugary foods, they might see a spike in their blood sugar levels. By monitoring their blood sugar, they can change their diet or lifestyle to help prevent their blood sugar from reaching diabetic levels. In addition, monitoring blood sugar can also help people with diabetes to keep their condition under control. They can adjust their insulin doses accordingly by knowing their blood sugar levels. Thus, monitoring blood sugar is an essential tool in both preventing and managing diabetes."

Heather Newgen

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The #1 Root Cause of Diabetes, Say Physicians Eat This Not That - Eat This, Not That

Every year, more than one million women in the United States enter menopause when a woman stops menstruating and hasnt had her period for 12 months in a row. When you think of menopause, hot flashes, insomnia, mood changes, and night sweats may come to mind. But heart disease the No. 1 killer of women, causing 1 in 3 deaths a year, according to the American Heart Association (AHA) should also be high on your list of menopause related health concerns.

Heart disease risk increases with age for both men and women. But there are heart disease risk factors especially associated with ovarian aging, says Chrisandra Shufelt MD, associate director of the Mayo Clinic Center for Womens Health in Jacksonville, Florida, which is the complex process marked by changes in hormone levels that occurs, ending with menopause. Aging ovaries produce less estrogen and follicle-stimulating hormone; a drop in these hormones is linked to heart disease risk.

Heres a rundown of the risks associated with heart disease in women in menopause and what you can do to lower the risk.

Menopause drives detrimental changes in your cholesterol and blood fats, which can lead to artery-clogging atherosclerosis.

According to an AHA Scientific Statement published in Circulation in December 2020 about menopause and cardiovascular disease risk, your total cholesterol and your bad cholesterol (LDL-C and apolipoprotein B levels) may go up and your good cholesterol (HDL) is likely to go down, which is bad news since we need HDL to move out extra cholesterol that our body doesnt need. Having too much cholesterol in your blood can cause the formation of plaque (hardened deposits) in your arteries, and can ultimately lead to a heart attack or stroke.

After age 40, women are more likely to pack on the pounds, especially around the midsection. What changes in menopause that puts our hearts at risk is the shift of where we start to lay down fat, Dr. Shufelt says. Fat around the midsection and vital organs, such as the liver, can increase your risk of heart disease, even if youre at a healthy body weight, according to astudy published in 2021 in Circulation.

Want to know if youre at risk? Get a tape measure. Research shows that postmenopausal women with a body mass index (BMI) estimates body fat by weight and height within normal range and a waist circumference of more than 35 inches are at increased risk of dying from heart disease, compared with women with a normal BMI without midsection body fat. If your waist circumference is more than 35 inches, talk to your doctor about how to optimize this number, which may include diet, exercise, or weight loss surgery, according to the AHA.

In menopause, or even in late premenopause or perimenopause when periods start to skip women are more likely to develop metabolic syndrome, which is a combination of conditions, including excess belly fat, high cholesterol, and elevated blood sugar, according to the AHA statement. In other words, menopause is linked to an increased risk of metabolic syndrome, which puts you at a higher risk for heart disease, diabetes, and stroke.

Depression can take its toll on your heart. Stress and anxiety can reduce blood flow to the heart, causing your heart rate and blood pressure to rise, as well as increase stress hormone levels, like cortisol, which can up your risk for heart disease, according to the American Heart Association.

A landmarkstudy published in 2019 in Menopause, known as the Study of Womens Health Across the Nation (SWAN), which enrolled 3,302 women between age 42 and 52 and followed them for 23 years, reported that depressive symptoms were higher during late peri- and postmenopause than premenopause. In a subset study, the SWAN Mental Health study, women were 2 to 4 times as likely to experience a major depressive episode in menopause or early postmenopause compared with premenopausal women. Still, women who have had a bout of depression before menopause may be more susceptible to having depression again in menopause. According to a study published in 2017 in Medicine & Science in Sports & Exercise, women with a history of depression are 5 times more likely to a have major bout of depression in menopause.

Its important to discuss depression at the time of perimenopause and menopause, Shufelt says. Talk to your doctor if youre feeling persistently sad, anxious, hopeless, irritable, or fatigued. Dont ignore depression symptoms, she cautions. Many effective treatment options are available, including medications and psychotherapy.

Restless sleep is often one of the first symptoms of menopause and perimenopause. Chronic disrupted sleep can be a risk factor for heart disease. When youre sleeping, your blood pressure naturally takes a dip. If you dont get enough sleep, your blood pressure can stay higher for a longer period, according to the Centers for Disease Control and Prevention. High blood pressure above 130/80 mmHg can increase your risk of heart disease and stroke.

Menopause may be the reason for your disrupted sleep, or it could be sleep apnea, the risk of which also rises during menopause and is associated with heart disease risk. If women are having high blood pressure changes, we dont want to say, Oh, this is just menopause. We want to also think about things like sleep apnea, Shufelt says. While having hypertension doesn't necessarily mean you have sleep apnea, it could be worth screening. Talk to your doctor about being evaluated for sleep apnea, especially if your blood pressure is on the rise.

If youre waking up often due to menopause symptoms, such as hot flashes, you should also talk to your doctor about hormone replacement therapy. We dont use estrogen replacement to prevent heart disease, but we do use it to manage bothersome symptoms, Shufelt says. If you cant sleep through the night because youre having night sweats all night, thats also a disruptive symptom. Estrogen patches, in which a low dose of estrogen is applied through the skin, may help ease menopausal symptoms, including disrupted sleep.

You could spend roughly 30 years of your life or more living with menopause, so its important to take hold of your heart health, notes Shufelt. Heres what you can do:

See your doctor regularly. After 50, every woman should have an annual checkup, Shufelt says. Yearly appointments can help you keep track of your numbers like your cholesterol, weight, blood pressure, and blood sugar, and keep those numbers within a healthy range to reduce your heart disease risk.

If youre at high risk for heart disease because of high cholesterol or weight gain, or if heart disease runs in your family, your doctor may recommend more screening tests. People with a family history of heart disease are at higher than average risk of heart disease. For those people, we might use tools to assess their risk, such as a coronary calcium scan, Shufelt says.

In women at higher than average risk for heart disease due to family history, the coronary artery calcium (CAC) test offers a more precise assessment to help guide treatment and medication decisions. The CAC test is an X-ray that takes images of your heart and helps detect and measure calcium-containing plaque in your arteries, which can increase your risk for a heart attack. The scan is a good tool to virtually look at your heart, Shufelt says.

Consider hormone replacement therapy. We dont use estrogen replacement to prevent heart disease, but we do use it in low doses for bothersome menopausal symptoms, such as having night sweats that prevent you from sleeping, Shufelt says.

The latest hormone therapy guidelines from the North American Menopause Society,published in 2022 in Menopause Shufelt was a coauthor no longer recommend using the lowest dose of supplemental hormones for the shortest time for menopause symptom relief. The guidelines now state the appropriate amount of time, Shufelt says, which varies per person. Theres a certain percentage of women who will have troublesome menopausal symptoms for years. Every woman is different, Shufelt says.

If you enter menopause before age 45 (because of chemotherapy, hysterectomy, or premature ovarian insufficiency, a type of early menopause in younger women), hormone replacement therapy is also recommended by the North American Menopause Society. Premature menopause (before age 40) or early menopause (before age 45) without hormone replacement therapy can accelerate your risk of heart disease, Shufelt says.

When you enter menopause at an earlier age, its important to get a dose of estrogen in an amount your body would otherwise naturally produce at this time. These are women who should have estrogen naturally in their bodies, Shufelt says. If youre in premature or early menopause and youre eligible, Shufelt recommends using a dose of estrogen and progesterone through the time of natural menopause, at age 52, to replace what your body would naturally produce.

Keep up the good work (-out). Exercise can lower the risk of heart disease as you age. According to the study from 2017 in Medicine & Sports Science in Sports and Exercise, the lifetime risk of heart disease in women who exercise was about 12 percent lower from age 45 to 85, compared with women in that age group who werent physically active.

The American Heart Association recommends that men and women get moderate exercise 150 minutes or more per week in addition to not smoking, eating a healthy diet, losing weight if you need to, and managing blood pressure, cholesterol and blood sugar. Menopause is an opportunity to know your numbers and look at your lifestyle because exercise and diet are the backbone and the cornerstone of cardiovascular disease prevention, Shufelt says.

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5 Signs Your Heart Is Changing During Menopause - Everyday Health

By The ASCO Post StaffPosted: 8/30/2022 3:05:00 PM Last Updated: 8/30/2022 2:21:19 PM

Women with a breast cancer diagnosis undergoing procedures for fertility preservation are not at an increased risk for recurrence of the disease or disease-specific mortality, according to the results of a study from the Karolinska Institutet in Sweden that followed participants for 5 years on average. The findings were published by Marklund et al in JAMA Oncology.

Almost 1 in 10 women affected by breast cancer are of childbearing age and are at risk of becoming infertile from chemotherapy treatment. With the hope of being able to have children after completing cancer treatment, many women choose to undergo procedures for fertility preservation with or without hormonal stimulation. These methods include cryopreservationthe freezing of embryos, female gametes (oocytes), and ovarian tissue.

It is not unusual that women with hormone-positive breast cancer or their treating doctors opt out of the procedures for fertility preservation because of the fear that these procedures will increase the risk of cancer recurrence or death. In some cases, women are also advised to wait 5 to 10 years before trying to conceive, and with increasing age, fecundity in all women decreases. More knowledge is therefore needed about the safety of procedures for fertility preservation at the time of a breast cancer diagnosis, said the studys first author, Anna Marklund, MD, PhD, a researcher in the Department of Oncology-Pathology at the Karolinska Institutet.

Study Details

In this study, researchers at the Karolinska Institutet and Karolinska University Hospital investigated whether procedures for fertility preservation in connection with a breast cancer diagnosis entail an increased risk of disease recurrence or death. The study followed the women for 5 years on average.

The registry study covered 1,275 women of childbearing age who were treated for breast cancer between 1994 and 2017 in Sweden. Of these, 425 underwent procedures for fertility preservation with or without hormonal stimulation. The control group of 850 women were treated for breast cancer but did not undergo procedures for fertility preservation.

The women who underwent procedures for fertility preservation and the women in the control group were matched on age at diagnosis, calendar period at diagnosis, and health-care region. The statistical data were taken from both nationwide health-care registers and population registers with data on outcomes, disease- and treatment-related variables, and socioeconomic characteristics.

Results

The proportion of women without relapse over the 5 years was 89% among those who underwent hormonal stimulation of the ovaries, 83% among women with ovarian tissue freezing, and 82% among women who did not undergo procedures for fertility preservation.

Five years after treatment for breast cancer, the survival rate was 96% in the group that underwent hormonal stimulation to freeze eggs or embryos, 93% in the group that underwent procedures for fertility preservation who did not undergo hormone stimulation, and 90% in the group that did not undergo procedures for fertility preservation.

We did not see any increased risk of relapse or mortality when procedures for fertility preservation were undertaken, compared to the women who did not undergo procedures for fertility preservation. This is valuable information that can contribute to changed care routines when it comes to young women with breast cancer who want to preserve their fertility, said senior study author Kenny Rodriguez-Wallberg, MD, PhD, Adjunct Professor and Research Group Leader in the Department of Oncology-Pathology, Karolinska Institutet, and Chief Physician at Karolinska University Hospital.

The researchers plan to follow up on the results after another 5 years.

Disclosure: The study was funded by the Swedish Cancer Society, Radiumhemmet's Research Funds, the Breast Cancer Association, Region Stockholm, and Karolinska Institutet. For full disclosures of the study authors, visit jamanetwork.com.

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Fertility Preservation Measures Do Not Appear to Increase the Risk of Breast Cancer Recurrence - The ASCO Post

If you want to brighten your mood, you have options: You could get your happy hormones (aka, endorphins) pumping with some exercise, call a friend who always makes you laugh, or snuggle up with a cheesy Netflix movie. What you maynotknow is that the contents of your fridge can also lift your spiritsso long as you look out for an internal medicine doctor's three essential mood-boosting nutrients.

As health professionals, internal medicine doctors pride themselves on having a more personal approach to medicine because they tend to work with people who suffer from chronic, often severe, illnesses. They also look at their patient's health through a holistic lens in order to determine the root of their health issues. And thus, these MDs tend to have some compelling insight when it comes to how, say, your diet affects your mood.

"Our brains are a reflection of what we put into our bodies, and one of the most important ways that we influence them is the quality of what we eat," says internal medicine doctor Austin Perlmutter, MD, author and Senior Director of Science and Clinical Innovation at Big Bold Health. "A brain-nutrient rich dietof which the Mediterranean diet is a great examplemay help support the brain and specifically mental health through pathways that range from neurotransmitters to inflammation to the gut-brain axis."

Look, things get a little complicated when you whip out the term "gut-brain axis," but the TL; DR is this: A growing body of research suggests that since about 95 percent of your serotonin (a happiness hormone) is produced in your gut,andyour gut is lined with nerves and neurons, what goes in your belly may affect the quality of your mood. And thus, when you're feeding your belly, you're also feeding your brain. I know, I know: Science is cool.

Ready to start priming your brain for a better outlook on life? Ahead, Dr. Perlmutter name drops the big three nutrients you need to boost your mood (and includes a grocery shopping list to help you check out with your brain in mind). Ready to eat?

You may already know that omega-3 fatty acids are basically the prom queen of fatty acids. And according to Dr. Perlmutter, incorporating more of them into your diet can seriously pep up your brain.

"Omega-3 fats can be found in plant foods like nuts and seeds, but the omega-3s that have been best studied for their link to mental health are docosahexaenoic acid (DHA) and especially eicosapentaenoic acid (EPA)which are primarily found in higher concentrations in cold-water fish like salmon, sardines, mackerel, herring and anchovies, as well as in supplement forms," says Dr. Perlmutter.

There's also evidencethat omega-3s can help reduce clinical anxiety and could ease symptoms of depression, although more research is needed. And beyond the brain, omega-3s also boost blood flow, improve skin health, and contribute to the overall health of cell membranes.

Learn more about the benefits of omega-3s:

"Polyphenols are a large groupthink thousandsof plant molecules. Eating certain types of antioxidant-rich polyphenols has been linkedto lower risk for depression, while otherresearchsuggests that eating more polyphenols overall may be helpful for overall mental status andbrain protectionagainst certain types of dementia," says Dr. Perlmutter.

Polyphenols are commonly found in fruits and veggies (particularly in berries, red onions, and tempeh), as well as coffee, tea, dark chocolate, and spices like turmeric and cloves.

Relatively new to the field of scientific research, probiotics are on the rise as a nutrient that may be majorly beneficial to your brain. "A myriad of recent studies have suggested that one of the biggest ways we can influence our brains is through the health of our gut, including the microbes that live there.Thats in part because our gut is where the majority of our immune system is located, and these immune cells may affect what gets into our bloodstream and therefore influences our brains," says Dr. Perlmutter.

While more studies need to be conducted on probiotics, Dr. Perlmutter notes that you can try promoting a healthy gut-brain connection by eating more prebiotic foods, or foods that feed the good bacteria in the gut. "For those who can tolerate it without significant GI issues, eating more leafy greens, whole grains may be a good place to start, and if you want to get specific, dandelion greens, Jerusalem artichoke, garlic, onions and leeks are thought to be excellent sources of prebiotic fiber," he says.

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The Big 3 Nutrients Known To Help Boost Your Mood, According to an Internal Medicine Physician - Well+Good

There's more than 100 different types of cancers and pancreatic canceris considered one of the deadliest because there's oftentimes no early warning signs. It's not diagnosed until a later stage, which makes treatment challenging. Dr. Tomi Mitchell, a Board-Certified Family Physician with Holistic Wellness Strategies tells us, "Pancreatic cancer is one of the most aggressive and difficult-to-treat forms of cancer. Unfortunately, it is also one of the most common types of cancer, with over 60, 000 new cases diagnosed each year in the United States alone. While many risk factors for pancreatic cancer, some lifestyle choices can increase the likelihood of developing the disease. Here are five lifestyle choices that have been linked to an increased risk of pancreatic cancer." Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Mitchell says, "Pancreatic cancer is a type of cancer that starts in the pancreas. The pancreas is a gland located in the abdomen, behind the stomach. The pancreas has two main functions: to produce enzymes that help digest food and hormones, such as insulin, that regulate blood sugar levels. Pancreatic cancer usually starts in the cells lining the pancreas' ducts. These cells are called exocrine cells. Less often, pancreatic cancer begins in the hormone-producing cells of the pancreas, called islet cells. When pancreatic cancer begins in the exocrine cells, it is called exocrine pancreatic cancer. When it starts in the islet cells, it is called an islet cell tumor or neuroendocrine tumor. Most pancreatic cancers are exocrine tumors."6254a4d1642c605c54bf1cab17d50f1e

Dr. Mitchell states, "Pancreatic cancer is a very aggressive form of cancer and is difficult to treat. It seldom causes symptoms in its early stages, so it is often not discovered until it has spread to other body parts. By the time most people are diagnosed with pancreatic cancer, the disease has already spread beyond the pancreas and cannot be cured. However, treatment may help people live longer and improve their quality of life. Pancreatic cancer is one of the few cancers for which there is no widely available screening test, so it is essential to be aware of the signs and symptoms of the disease. If you have any concerns, please consult your doctor. Early diagnosis and treatment of pancreatic cancer can improve survival rates."

"According to the American Cancer Society, smokers are two to three times more likely than nonsmokers to develop pancreatic cancer," Dr. Mitchell shares. "Smoking is thought to be responsible for approximately 25% of all pancreatic cancers. The link between smoking and pancreatic cancer is thought to be due to the many harmful chemicals found in tobacco smoke. These chemicals damage DNA, leading to the development of cancerous cells. Smoking damages the pancreas, making it more difficult for this vital organ to function correctly. This can lead to chronic inflammation, which further increases the risk of pancreatic cancer. Quitting smoking is the best way to reduce the risk of developing this deadly disease."

Dr. Mitchell emphasizes, "Obesity is a major risk factor for pancreatic cancer. Obese people are nearly twice as likely to develop pancreatic cancer as those of average weight. There are several ways in which obesity increases the risk of pancreatic cancer. First, excess fat tissue produces hormones that can promote the growth of cancer cells. Second, obesity increases inflammation throughout the body, which is known to play a role in cancer development. Finally, obesity makes it more difficult for the body to process sugar, leading to insulin resistance and an increased risk of pancreatic cancer. By maintaining a healthy weight, you can help reduce your risk of this deadly disease."

"There is a strong link between diabetes and pancreatic cancer," Dr. Mitchell explains. "People with diabetes have a two- to three-fold higher risk of developing pancreatic cancer than those without diabetes. The link between diabetes and pancreatic cancer is likely due to the high levels of blood sugar associated with diabetes. High blood sugar levels can damage cells and lead to inflammation, both of which can increase the risk of cancer. Pancreatic cancer is also more common in people with type 2 diabetes, the most common form of the disease. This may be because type 2 diabetes is often associated with obesity, another risk factor for pancreatic cancer. If you have diabetes, it's important to control your blood sugar levels and maintain a healthy weight to lower your risk of pancreatic cancer."

Dr. Mitchell says, "A healthy diet is essential for many reasons, including reducing your risk of developing pancreatic cancer. Pancreatic cancer is more common in people who are overweight or obese, and those who consume a diet high in sugar and fat are also at an increased risk. While the exact cause of pancreatic cancer is unknown, it is thought that excess insulin production may play a role. Insulin is a hormone that helps to regulate blood sugar levels, and when blood sugar levels are constantly high, it can damage cells and lead to cancer. A diet high in sugar and fat raises blood sugar levels, increasing pancreatic cancer risk. Additionally, eating a lot of red and processed meats has also been linked to an increased risk of pancreatic cancer. So, if you want to reduce your risk of this disease, it's essential to maintain a healthy weight and eat a balanced diet low in sugar, fat, and red meat."

"A sedentary lifestyle has been linked to an increased risk of pancreatic cancer," Dr. Mitchell tells us. This is likely because a sedentary lifestyle leads to obesity, a known risk factor for pancreatic cancer. In addition, a sedentary lifestyle can lead to inflammation, which is also a risk factor for pancreatic cancer. Finally, a sedentary lifestyle can lead to insulin resistance, another known risk factor for pancreatic cancer. While other factors can contribute to the development of pancreatic cancer, a sedentary lifestyle is considered one of the most important. Therefore, it is essential to stay active and avoid sitting for long periods in order to reduce your risk of pancreatic cancer."

Dr. Mitchell says this "doesn't constitute medical advice and by no means are these answers meant to be comprehensive. Rather, it's to encourage discussions about health choices."

Heather Newgen

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Habits Increasing Your Pancreatic Cancer Risk, Say Medical Experts Eat This Not That - Eat This, Not That

Sophie Jackson, 26, might not be here today if she had listened to her doctor. She noticed a large lump on her right breast, so she decided to have it checked out by her general physician. But the provider told her it was likely due to her menstrual cycle and that they would have to wait another four weeks to see if anything had changed before they could do anything.

But the lump turned out to be anything but ordinary. She was diagnosed with invasive ductal carcinoma, an aggressive form of cancer, a short while later.

I cried my eyes out and first asked if I was going to die and second if I was going to lose all my hair, Jackson said. Other than the lump I had no other symptoms whatsoever. It felt completely random, and the diagnosis was such a shock.

Jackson is no stranger to cancer. She works as an oncology nurse as part of the U.K.s National Health Service (NHS). Given her experience with the issue, she decided to get a second opinion and pushed for a referral to a breast cancer clinic.

She said she was disappointed by her GPs initial reaction.

I felt let down. The doctors initially thought it was nothing purely based on age, she explained. I feel frustrated on the guidance out there with the stereotypical lumps to look for such as being hard or non-moveable as mine met all the criteria to be what they classed as nothing.

She sought the advice of a specialist, who diagnosed her with breast cancer after running a few tests. They caught it late, and Jackson knew she was in for a long, arduous road to recovery. Since being diagnosed in November, she has been through ten rounds of radiotherapy and underwent surgery to remove the tumor.

Jackson is now cancer-free thanks to her quick thinking. She recently returned to work at University Hospitals Dorset and said the experience has left her with a better understanding of what her cancer patients are going through.

Unfortunately, doctors told her that the tumor is likely to return within the next two years considering the aggressive nature of her disease.

While she is happy to be back at work, Jackson is also mourning the chance to be a mother because she went through medically induced menopause during treatment. She now takes regular injections to reduce the amount of estrogen in her body. High levels of the female sex hormone can increase the risk of breast cancer tumors growing.

Jackson is now on a mission to spread the word about her experience. She encourages women of all ages to get checked for breast cancer and to seek a referral if they need a second opinion.

If Id left it four weeks like the GP suggested, it may have spread in that time and Id have been looking at an incurable diagnosis.

Breast cancer is the second most prevalent cancer in the U.S., with 288,000 diagnoses a year. It accounts for 30% of all female cancers in the country.

Jackson also admitted that she was frustrated throughout the experience because she already knew how the process works.

When I was diagnosed it was extremely overwhelming usually you drip feed patient information as it is way too much to take on at once. I didnt have that luxury and instead was instantly aware of facing surgery, chemo, losing my hair and becoming infertile at such a young age. I think my job did help in a way as I didnt have the expected anxieties about chemo, she added.

I knew what would happen, I knew the drugs, and I knew and trusted the people giving it to me which saved a lot of worrying. It felt really strange receiving chemotherapy drugs Id given to other patients before, like an out of body experience. I was also in disbelief seeing my name on the chemo bag and having my details checked when it was usually me on the other side.

She also learned more about what it was like for her patients to lose their hair. Jackson eventually lost all the hair on her head and started wearing scarves instead.

Coming back to work has forced Jackson to face her fears of her cancer coming back, but she is doing her part to help others advocate for proper medical care.

Id just love to spread awareness that cancer can affect you at a young age even with no family history, no genetics, no risk factors other than taking the contraceptive pill, she said. Early detection has saved my life so its so important to check monthly and push to get things checked out. You are never wasting anyones time.

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Oncology Nurse Diagnosed with Cancer After Her Physician Dismissed Her Lump as Probably Nothing - Scrubs Magazine

Putting on weight is one of the easiest things to do, especially during the last couple of years when our lives were completely disrupted. The 'Quarantine 15' is real and John Morton, MD, MPH, MHA, medical director of bariatric surgery at Yale New Haven Health System says, "We are definitely seeing weight gain," Dr. Morton says. "You can put on 30 pounds really quicklyyou can do it in three months." That said, it's time to get back into shape and drop the excess weight. Eat This, Not That! Health spoke with Dr. Hector Perez, a board-certified general and bariatric surgeon with Bariatric Journal who shares how much belly fat is too much for men and how to lose it. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Perez explains, "A common way people use to judge if they have too much abdominal fat is to measure their waistline with a tape measure. Men are considered to have too much abdominal fat if they have a waist measurement of more than 40 inches, while women are considered to have too much abdominal fat if they have a waist measurement of more than 35 inches. Having these measurements is generally considered unhealthy and puts you at greater risk for various health conditions.

To get more accurate results, however, you can get a CT, MRI, or DEXA scan to measure your abdominal fat. These are generally considered more accurate methods, but they're also more expensive and not as readily available. Doctors will usually only recommend these tests if they suspect you have a serious health condition related to your abdominal fat."

Dr. Perez tells us, "Carrying too much abdominal fat is generally considered unhealthy because it's associated with a greater risk of developing various health conditions. These include heart disease, stroke, type 2 diabetes, and certain types of cancer. Abdominal fat also produces hormones and substances that can contribute to inflammation, which has been linked to a variety of health problems."

Dr. Perez reminds us, "Fixing your diet is one of the most effective ways to lose abdominal fat. Eating a diet that's high in whole foods, including plenty of fruits, vegetables, and lean protein, and low in processed foods can help you shed pounds all over, including from your belly. Make sure to also limit refined carbs, sugary drinks, and excessive alcohol intake, as these can all contribute to excess abdominal fat.

"A healthy diet alone isn't enough to lose abdominal fat," Dr. Perez emphasizes. "You'll also need to incorporate regular exercise into your routine. Aim for at least 30 minutes of moderate-intensity cardio per day, and include strength training a few days per week as well. These activities help burn calories and can lead to overall weight loss, which will reduce the amount of fat stored in your abdomen."

According to Dr. Perez, "One of the most important but often overlooked aspects of losing abdominal fat is getting enough sleep. Most adults need around 7-8 hours of sleep per night, but many people get far less than that. When you're tired or have low energy levels, you're more likely to make poor food choices and be less active, both of which can contribute to weight gain. So make sure you're getting enough shut-eye each night to help support your weight loss efforts."6254a4d1642c605c54bf1cab17d50f1e

Dr. Perez says, "Experiencing high levels of stress can also lead to weight gain. When you're stressed, your body releases cortisol, a stress hormone that can trigger your appetite. This is why people often turn to food for comfort when they're feeling stressed. Find ways to manage your stress levels through relaxation techniques like yoga or meditation, and make an effort to reduce the amount of stress in your life."

Heather Newgen

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Are You a Man With "Too Much" Abdominal Fat? Here's How to Lose it Eat This Not That - Eat This, Not That

-- Progression-Free Survival Efficacy of Trodelvy Consistent with That Observed in the TROPiCS-02 Intention-to-Treat Population --

-- Results Presented at ESMO 2022 Highlight Trodelvy as a Potential Treatment Option in HR+/HER2-Low and IHC0 Status Metastatic Breast Cancer --

FOSTER CITY, Calif.--(BUSINESS WIRE)--Gilead Sciences, Inc. (Nasdaq: GILD) today announced new data from a post hoc subgroup analysis from the Phase 3 TROPiCS-02 study evaluating Trodelvy (sacituzumab govitecan-hziy) versus comparator chemotherapies (physicians choice of chemotherapy, TPC) in patients with HR+/HER2- metastatic breast cancer who progressed on endocrine-based therapies and at least two chemotherapies. The analysis examined progression-free survival (PFS) in the intention-to-treat population by HER2-immunohistochemistry (IHC) status, and the results demonstrated that Trodelvy improved median PFS vs. TPC in both HER2-low (IHC1+ and IHC2+/ISH-negative) and IHC0 groups.

Summary of results:

HER2-low

IHC0

ITT

Trodelvy arm(n=149)

TPC arm(n=134)

Trodelvy arm(n=101)

TPC arm(n=116)

Trodelvy arm(n=272)

TPC arm(n=271)

Median PFS(months)

6.4

4.2

5.0

3.4

5.5

4.0

Hazard ratio(95% confidenceinterval)p-value

0.58(0.42-0.79)

0.72(0.51-1.00)

0.66(0.53 0.83)p=0.0003

Detailed findings will be presented at a mini-oral session (Abstract #1362) during the European Society for Medical Oncology (ESMO) Congress 2022 in the vry Auditorium, Paris Expo Porte de Versailles, on September 10.

These data demonstrate Trodelvys efficacy across HER2-low and IHC0 status in pre-treated metastatic breast cancer patients in the TROPiCS-02 trial, said Professor Peter Schmid, Professor of Cancer Medicine; Centre Lead, Centre of Experimental Cancer Medicine; Director, Barts Breast Cancer Centre. Once patients have developed resistance to endocrine-based therapies, their prognosis is extremely poor. The results highlight the potential for Trodelvy as a treatment option for people living with pre-treated HR+/HER2- metastatic breast cancer, regardless of their HER2-negative status.

These results show Trodelvy improved progression-free survival regardless of HER2 status in this pre-treated patient population and reinforce the strength of clinical activity in a population where need is highest, said Bill Grossman, MD, PhD, Senior Vice President, Therapeutic Area Head, Gilead Oncology. Trodelvy is already transforming the standard of care in second-line metastatic triple-negative breast cancer, and were excited about its potential in other breast cancers where there is significant need for new treatment options.

In the study, HER2 negativity was defined per American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) criteria as immunohistochemistry (IHC) score of 0, IHC 1+ or IHC 2+ with a negative in-situ hybridization (ISH) test.

Trodelvy has not been approved by any regulatory agency for the treatment of HR+/HER2- metastatic breast cancer. Its safety and efficacy have not been established for this indication. Gilead has submitted a supplemental Biologics License Application (sBLA) to the U.S. Food and Drug Administration (FDA) based on data from TROPiCS-02; these data will also be shared with health authorities outside the U.S.

Sacituzumab govitecan is currently included in the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines)i. This includes a Category 1 recommendation for use in adult patients with second-line metastatic triple-negative breast cancer (defined as those who received at least two prior therapies, with at least one line for metastatic disease). It also has a Category 2A preferred recommendation for investigational use in HR+/HER2- advanced breast cancer after prior treatment including endocrine therapy, a CDK4/6 inhibitor and at least two lines of chemotherapy.

Trodelvy has a Boxed Warning for severe or life-threatening neutropenia and severe diarrhea; please see below for additional Important Safety Information.

About HR+/HER2- Breast Cancer

Hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer is the most common type of breast cancer and accounts for approximately 70% of all new cases, or nearly 400,000 diagnoses worldwide each year. Almost one in three cases of early-stage breast cancer eventually become metastatic, and among patients with HR+/HER2- metastatic disease, the five-year relative survival rate is 30%. As patients with HR+/HER2- metastatic breast cancer become resistant to endocrine-based therapy, their primary treatment option is limited to single-agent chemotherapy. In this setting, it is common to receive multiple lines of chemotherapy regimens over the course of treatment, and the prognosis remains poor.

About the TROPiCS-02 Study

The TROPiCS-02 study is a global, multicenter, open-label, Phase 3 study, randomized 1:1 to evaluate Trodelvy versus physicians choice of chemotherapy (eribulin, capecitabine, gemcitabine, or vinorelbine) in 543 patients with HR+/HER2- metastatic breast cancer who were previously treated with endocrine therapy, CDK4/6 inhibitors and two to four lines of chemotherapy for metastatic disease. The primary endpoint is progression-free survival per Response Evaluation Criteria in Solid Tumors (RECIST 1.1) as assessed by blinded independent central review (BICR) for participants treated with Trodelvy compared to those treated with chemotherapy. Secondary endpoints include overall survival, overall response rate, clinical benefit rate and duration of response, as well as assessment of safety and tolerability and quality of life measures. More information about TROPiCS-02 is available at https://clinicaltrials.gov/ct2/show/NCT03901339.

About Trodelvy

Trodelvy (sacituzumab govitecan-hziy) is a first-in-class Trop-2 directed antibody-drug conjugate. Trop-2 is a cell surface antigen highly expressed in multiple tumor types, including in more than 90% of breast and bladder cancers. Trodelvy is intentionally designed with a proprietary hydrolyzable linker attached to SN-38, a topoisomerase I inhibitor payload. This unique combination delivers potent activity to both Trop-2 expressing cells and the microenvironment.

Trodelvy is approved in more than 35 countries, with multiple additional regulatory reviews underway worldwide, for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) who have received two or more prior systemic therapies, at least one of them for metastatic disease. Trodelvy is also approved in the U.S. under the accelerated approval pathway for the treatment of adult patients with locally advanced or metastatic urothelial cancer (UC) who have previously received a platinum-containing chemotherapy and either programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor.

Trodelvy is also being developed for potential investigational use in other TNBC and metastatic UC populations, as well as a range of tumor types where Trop-2 is highly expressed, including hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer, metastatic non-small cell lung cancer (NSCLC), metastatic small cell lung cancer (SCLC), head and neck cancer, and endometrial cancer.

U.S. Indications for Trodelvy

In the United States, Trodelvy is indicated for the treatment of:

U.S. Important Safety Information for Trodelvy

BOXED WARNING: NEUTROPENIA AND DIARRHEA

CONTRAINDICATIONS

WARNINGS AND PRECAUTIONS

Neutropenia: Severe, life-threatening, or fatal neutropenia can occur and may require dose modification. Neutropenia occurred in 61% of patients treated with Trodelvy. Grade 3-4 neutropenia occurred in 47% of patients. Febrile neutropenia occurred in 7%. Withhold Trodelvy for absolute neutrophil count below 1500/mm3 on Day 1 of any cycle or neutrophil count below 1000/mm3 on Day 8 of any cycle. Withhold Trodelvy for neutropenic fever.

Diarrhea: Diarrhea occurred in 65% of all patients treated with Trodelvy. Grade 3-4 diarrhea occurred in 12% of patients. One patient had intestinal perforation following diarrhea. Neutropenic colitis occurred in 0.5% of patients. Withhold Trodelvy for Grade 3-4 diarrhea and resume when resolved to Grade 1. At onset, evaluate for infectious causes and if negative, promptly initiate loperamide, 4 mg initially followed by 2 mg with every episode of diarrhea for a maximum of 16 mg daily. Discontinue loperamide 12 hours after diarrhea resolves. Additional supportive measures (e.g., fluid and electrolyte substitution) may also be employed as clinically indicated. Patients who exhibit an excessive cholinergic response to treatment can receive appropriate premedication (e.g., atropine) for subsequent treatments.

Hypersensitivity and Infusion-Related Reactions: Serious hypersensitivity reactions including life-threatening anaphylactic reactions have occurred with Trodelvy. Severe signs and symptoms included cardiac arrest, hypotension, wheezing, angioedema, swelling, pneumonitis, and skin reactions. Hypersensitivity reactions within 24 hours of dosing occurred in 37% of patients. Grade 3-4 hypersensitivity occurred in 2% of patients. The incidence of hypersensitivity reactions leading to permanent discontinuation of Trodelvy was 0.3%. The incidence of anaphylactic reactions was 0.3%. Pre-infusion medication is recommended. Observe patients closely for hypersensitivity and infusion-related reactions during each infusion and for at least 30 minutes after completion of each infusion. Medication to treat such reactions, as well as emergency equipment, should be available for immediate use. Permanently discontinue Trodelvy for Grade 4 infusion-related reactions.

Nausea and Vomiting: Nausea occurred in 66% of all patients treated with Trodelvy and Grade 3 nausea occurred in 4% of these patients. Vomiting occurred in 39% of patients and Grade 3-4 vomiting occurred in 3% of these patients. Premedicate with a two or three drug combination regimen (e.g., dexamethasone with either a 5-HT3 receptor antagonist or an NK1 receptor antagonist as well as other drugs as indicated) for prevention of chemotherapy-induced nausea and vomiting (CINV). Withhold Trodelvy doses for Grade 3 nausea or Grade 3-4 vomiting and resume with additional supportive measures when resolved to Grade 1. Additional antiemetics and other supportive measures may also be employed as clinically indicated. All patients should be given take-home medications with clear instructions for prevention and treatment of nausea and vomiting.

Increased Risk of Adverse Reactions in Patients with Reduced UGT1A1 Activity: Patients homozygous for the uridine diphosphate-glucuronosyl transferase 1A1 (UGT1A1)*28 allele are at increased risk for neutropenia, febrile neutropenia, and anemia and may be at increased risk for other adverse reactions with Trodelvy. The incidence of Grade 3-4 neutropenia was 67% in patients homozygous for the UGT1A1*28, 46% in patients heterozygous for the UGT1A1*28 allele and 46% in patients homozygous for the wild-type allele. The incidence of Grade 3-4 anemia was 25% in patients homozygous for the UGT1A1*28 allele, 10% in patients heterozygous for the UGT1A1*28 allele, and 11% in patients homozygous for the wild-type allele. Closely monitor patients with known reduced UGT1A1 activity for adverse reactions. Withhold or permanently discontinue Trodelvy based on clinical assessment of the onset, duration and severity of the observed adverse reactions in patients with evidence of acute early-onset or unusually severe adverse reactions, which may indicate reduced UGT1A1 function.

Embryo-Fetal Toxicity: Based on its mechanism of action, Trodelvy can cause teratogenicity and/or embryo-fetal lethality when administered to a pregnant woman. Trodelvy contains a genotoxic component, SN-38, and targets rapidly dividing cells. Advise pregnant women and females of reproductive potential of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with Trodelvy and for 6 months after the last dose. Advise male patients with female partners of reproductive potential to use effective contraception during treatment with Trodelvy and for 3 months after the last dose.

ADVERSE REACTIONS

In the ASCENT study (IMMU-132-05), the most common adverse reactions (incidence 25%) were fatigue, neutropenia, diarrhea, nausea, alopecia, anemia, constipation, vomiting, abdominal pain, and decreased appetite. The most frequent serious adverse reactions (SAR) (>1%) were neutropenia (7%), diarrhea (4%), and pneumonia (3%). SAR were reported in 27% of patients, and 5% discontinued therapy due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence 25%) in the ASCENT study were reduced neutrophils, leukocytes, and lymphocytes.

In the TROPHY study (IMMU-132-06), the most common adverse reactions (incidence 25%) were diarrhea, fatigue, neutropenia, nausea, any infection, alopecia, anemia, decreased appetite, constipation, vomiting, abdominal pain, and rash. The most frequent serious adverse reactions (SAR) (5%) were infection (18%), neutropenia (12%, including febrile neutropenia in 10%), acute kidney injury (6%), urinary tract infection (6%), and sepsis or bacteremia (5%). SAR were reported in 44% of patients, and 10% discontinued due to adverse reactions. The most common Grade 3-4 lab abnormalities (incidence 25%) in the TROPHY study were reduced neutrophils, leukocytes, and lymphocytes.

DRUG INTERACTIONS

UGT1A1 Inhibitors: Concomitant administration of Trodelvy with inhibitors of UGT1A1 may increase the incidence of adverse reactions due to potential increase in systemic exposure to SN-38. Avoid administering UGT1A1 inhibitors with Trodelvy.

UGT1A1 Inducers: Exposure to SN-38 may be substantially reduced in patients concomitantly receiving UGT1A1 enzyme inducers. Avoid administering UGT1A1 inducers with Trodelvy.

Please see full Prescribing Information , including BOXED WARNING.

About Gilead Sciences

Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis and cancer. Gilead operates in more than 35 countries worldwide, with headquarters in Foster City, California.

Forward-Looking Statements

This press release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that are subject to risks, uncertainties and other factors, including Gileads ability to initiate, progress or complete clinical trials within currently anticipated timelines or at all, and the possibility of unfavorable results from ongoing or additional clinical trials, including those involving Trodelvy; uncertainties relating to regulatory applications for Trodelvy and related filing and approval timelines, including with respect to the pending sBLA for Trodelvy, and pending or potential applications for the treatment of metastatic TNBC, mUC, HR+/HER2- breast cancer, NSCLC, SCLC, head and neck cancer, and endometrial cancer, in the currently anticipated timelines or at all; Gileads ability to receive regulatory approvals for such indications in a timely manner or at all, and the risk that any such approvals may be subject to significant limitations on use; the possibility that Gilead may make a strategic decision to discontinue development of Trodelvy for such indications and as a result, Trodelvy may never be commercialized for these indications; and any assumptions underlying any of the foregoing. These and other risks, uncertainties and other factors are described in detail in Gileads Quarterly Report on Form 10-Q for the quarter ended June 30, 2022, as filed with the U.S. Securities and Exchange Commission. These risks, uncertainties and other factors could cause actual results to differ materially from those referred to in the forward-looking statements. All statements other than statements of historical fact are statements that could be deemed forward-looking statements. The reader is cautioned that any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, and is cautioned not to place undue reliance on these forward-looking statements. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation and disclaims any intent to update any such forward-looking statements.

U.S. Prescribing Information for Trodelvy including BOXED WARNING, is available at http://www.gilead.com.

Trodelvy, Gilead and the Gilead logo are trademarks of Gilead Sciences, Inc., or its related companies.

For more information about Gilead, please visit the companys website at http://www.gilead.com, follow Gilead on Twitter (@GileadSciences) or call Gilead Public Affairs at 1-800-GILEAD-5 or 1-650-574-3000.

i Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer Version 4.2022. National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed August 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

View source version on businesswire.com: https://www.businesswire.com/news/home/20220902005309/en/

Jacquie Ross, Investorsinvestor_relations@gilead.com

Nathan Kaiser, MediaNathan.kaiser@gilead.com

Source: Gilead Sciences, Inc.

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New TROPiCS-02 Data in HR+/HER2- Metastatic Breast Cancer Patients Demonstrates Progression-Free Survival Benefit of Trodelvy Regardless of Their HER2...

Newswise A new paper inFamily Practice,published by Oxford University Press, indicates that overweight patients are more inclined to disagree with their healthcare providers on advice on weight loss and lifestyle.

The World Health Organization estimates obesity nearly tripled between 1975 and 2016. General practitioners have a key role in medical care targeting weight loss and obesity. The quality of information, mutual comprehension, and agreement between doctors and patients affect a patients health status, compliance, satisfaction, and confidence towards his or her doctor. Previous research has shown patients and doctors often have dissimilar attitudes about weight. Patients tend to attribute excess weight to factors that they cannot control (e.g. genetics, hormones), whereas physicians tend to attribute it to behavioral, and thus controllable, factors (e.g. nutrition, physical activity). While many factors contribute to patients weight and health, these differences in perception of weight could degrade doctor-patient interaction.

This study aimed to analyze whether the interaction between patients and their doctors, as measured by their disagreement on information and advice given during the consultation, varied according to the patients body mass index.

Twenty-seven general practitioners and 585 patients from three regions in France participated in the quantitative phase of the project in September and October of 2007 and answered questionnaires collecting both general practitioners and patients perceptions of information and advice given at the end of the consultation.

Researchers here explored differences concerning the patients and doctors declarations about actions, information, and advice during the same visit, the patients health status, and the perceived quality of their relationship. For example, the questions about weight loss were: Did your doctor advise you to lose weight during the consultation? (Answered by patients) and its mirror Did you advise this patient to lose weight during the consultation? (Answered by doctors). Differences in answers given by doctors and their patients were used to define disagreement.

Agreement between patients and doctors was weak (20 to 40 percent agreement) or moderate (40 to 60 percent agreement) for most of the questions, including questions about actions, information, advice, and patients health status discussed during the doctors appointment. Agreement was very weak (less than 20 percent agreement) for questions about the perceived quality of the patient-doctor relationship.

Researchers also found that there was more doctor-patient disagreement the more overweight the patient was. Disagreement was particularly pronounced for advice given by doctors on weight and lifestyle issues. Compared to patients with a normal BMI, overweight patients were more likely to disagree with their doctors regarding advice given on weight loss, advice given on doing more physical activity, and advice about nutrition.

An exploration of the patient's representations and difficulties related to weight could be offered by the general practitioners as a basis for discussion and appropriate support, said the studys lead author, Latitia Gimenez.

The paper, Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey, is available at:https://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmac086.

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Overweight patients more likely to disagree with their doctors - Newswise