HRT

	Hormone Replacement Therapies:

From being the magic potion that rescued women from the schizophrenia of hormonal imbalance, we now find that the physiological price for Hormone Replacement Therapy may be an impossible one.

Soy may take care of the hot flashes but it may even increase some of the more subtle signs of aging. Memory lapse, indecision, anger and anxiety are all part of the body's arsenal to get us to slow down. modern life does not facilitate such gentle change.

We are expected to function as we always have done. but to also compete with younger men and women who have acquired more familiarity from living through the technical advances rather than learning them as the need arises.

This is why women , whatever the risks, return to synthetic HRT. Often the results are predictable and we can continue with our lives putting the risks on the 'back burner ' for another time..

Hormone Replacement Therapy Alternatives
Due to the now well-known knowledge of the serious hormone replacement therapy side effects, post-menopausal women everywhere are wondering what hormone replacement therapy alternatives are available to treat their menopausal side effects. Women should visit their doctors to learn more about their treatment options that may include lifestyle changes, natural remedies, and possibly short-term hormone replacement therapy alternatives. Depending on the particular symptoms most often experienced by the individual woman, medications exist that may help relieve them and can be hormone replacement therapy alternatives.

Hot flashes and night sweats are often experienced by post-menopausal women and hormone replacement therapy claimed to treat this symptom. Women may wish to discuss with their doctors the possibility of taking a low-dose antidepressant as a hormone replacement therapy that has been shown to help some women with hot flashes. Antidepressants are known to impair sexual response and have other side effects as well so it may not be right for every woman.

Menopause also causes bone loss that hormone replacement therapy helped women to maintain. There are other medications available for bone loss, but all drugs have side effects and must be considered depending on the individual. For more information on hormone replacement therapy alternatives and your legal rights, please consult with your doctor, friends, relatives and any resource that can provide you with the information that can best suit your needs and your lifestyle.

Diindolylmethane (DIM) is an estrogen boosting supplement that is metabolized safely by the body, avoiding generation of the potentially damaging free radicals. It is also used for prostate health and pre-menstrual tension.

5-HTP: a natural alternative to some anti-depressants that work with the neurotransmitter serotonin. A precursor to L-tryptophan and serotonin. It is helpful for sleep, anxiety and as a 'mood smoother'. This should not be taken if you are on any other anti-depressant prescribed by your doctor.

Relora: used for stress, anxiety and weight balance.

Hylands: Calms Forte ~ homeopathic remedy for sleep, calm and stress. Hyland's Calms Forte™ provides natural relief of symptoms of simple nervous tension and sleeplessness. Hyland's Calms Forte™ is all natural and works without contraindications or side effects. Easy to swallow tablets are perfect for daytime or nighttime use. Like all homeopathic medicines, Hyland's Calms Forte™ will not interfere with other medications or alcohol.

Most Popular Traditional Medicines for Hormone Replacement Therapy Alternatives
For the six million American women that were using hormone replacement therapy at the time of the study's release, the doctors and medical groups were not prepared for the number of questions and concerned patients that unfolded because of the unanticipated event. Doctors were forced to take their phones off the hook because they themselves did not have the answers for what their patients should now do regarding hormone replacement therapy alternatives. Hormone replacement therapy had become such a common prescription that every year 70 million prescriptions were written for hormone replacement therapy that doctors encouraged almost every woman that had not had a hysterectomy to use when beginning menopause. The American College of Obstetricians has just issued guidelines on the most popular hormone replacement therapy alternatives to treat menopause:


Soy and Isoflavones (plant estrogens found in beans, particularly soybeans) - High isoflavone intake (about 50 grams of soy protein per day) may be a helpful hormone replacement therapy alternative in the short term (2 years or less) in relieving hot flashes and night sweats. Taken over the long term, it also may have beneficial effects on cholesterol and bones. While safe in dietary amounts, the consumption of extraordinary amounts of soy and isoflavone supplements may interact with estrogen and may be harmful to women with a history of estrogen-dependent breast cancer and possibly to other women as well.

St. John's Wort - May be helpful as a hormone replacement therapy alternative in the short-term (2 years or less) to treat mild to moderate depression in women (when given in doses of less than 1.2 milligrams a day.) A recent study showed it is not effective in treating severe depression. It also can increase skin sensitivity to the sun and may interfere with prescription antidepressants.

Black Cohosh - May be helpful as a hormone replacement therapy alternative in the short term (6 months or less) to treat hot flashes and night sweats. It seems to be extremely safe, although studies have been small and brief, none longer than six months.

Chasteberry (also known as monk's pepper, Indian spice, sage tree hemp, and tree wild pepper) - This may inhibit prolactin, a natural hormone that acts on the breast. It is touted for breast pain and premenstrual syndrome. There are very few studies in menopausal women as used as a hormone replacement therapy alternative. A study of women with premenstrual syndrome found they reported improvements in mood, anger, headache, breast fullness, but not bloating and other symptoms.

Evening Primrose - This plant produces seeds rich in gamma-linolenic acid, which some experts believe is the nutritionally perfect fatty acid for humans. Although evening primrose capsules are taken for breast pain, bladder symptoms and menopausal symptoms, there is little or no evidence that they work as hormone replacement therapy alternatives. The one high quality study of effects on hot flashes found that evening primrose was no better than placebo.

Dong Quai - A study aimed at reducing hot flashes found that dong quai as a hormone replacement therapy alternative was not better than placebo - although the 4.5-gram dose used in the study was lower than that typically given in Chinese medicine. The herb is potentially toxic. It contains compounds that can thin the blood, causing excessive bleeding, and make the skin more sensitive to sun, possibly increasing skin cancer risk.

Valerian Root - This has traditionally been used as a tranquilizer and sleeping aid, which can be used as a hormone replacement therapy alternative. But the U.S. Pharmacopoeia, which sets manufacturing standards for medicines, does not support its use, and there have been reports of heart problems and delirium attributed to sudden withdrawal from valerian.

Ginseng - Most of the many types of ginseng (including Siberian, Korean, and American, white and red), are promoted for relieving stress and boosting immunity. A study of menopausal women by the leading ginseng manufacturer found the product did not relieve hot flashes but did improve women's sense of well being if used as a hormone replacement therapy alternative. Analyses of ginseng products have found a troubling lack of quality control: some contained little or no ginseng, contained large amounts of caffeine, or were tainted by pesticides or lead.

Wild and Mexican Yam - There are no published reports that show wild and Mexican yam cream as a hormone replacement therapy alternative is effective in helping menopausal symptoms. The hormones in wild and Mexican yam do not have any estrogenic or progestational properties, so they are not expected to help women with these symptoms

No money has been exchanged or favors given for any content on this site or page. Please seek information and professional help before using these suggestions.

Prevention of Infection

Are there any preventive measures I can take?

1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. There is no need or efficacy in using anti-bacterial soap. In fact using these products strengthens the bacterium. The action of friction of rubbing/scrubbing the skin for 20 seconds is the most efficient protection.
2. Keep cuts and scrapes clean and covered with a bandage until healed. Cough into your elbow not your hand. Use strong paper handkerchiefs to avoid droplet transmission. Wash surfaces with alcohol or chlorine bleach. Use diluted chlorine bleach in laundry.
3. Avoid contact with other people’s wounds, handkerchiefs, dirty dishcloths, unwashed food or bandages.
4. In professional settings wear the right clothing and change into street clothes when you leave. Many hospitals now use fast-acting, special antiseptic solutions, like alcohol rubs or gels - you may find dispensers placed by patient’s beds and at the entrance to clinical areas for use by staff and visitors.
5. The most important type of isolation required for any potentially resistant medical infection is what is called Contact Isolation. This type of isolation requires everyone in contact with the patient to be very careful about hand washing after touching either the patient or anything in contact with the patient. If the organism is in the nose or lungs it may also be necessary to have the patient in a room to prevent spread to others by droplet spread. Because dust and surfaces can become contaminated with the organism, cleaning of surfaces are also important.
6. DO NOT USE SOMEONE ELSE'S TOWEL OR STORE/KEEP DAMP SPORTS EQUIPMENT/CLOTHES AROUND. LAUNDER FREQUENTLY AND DRY THOROUGHLY.

Where the common cold is concerned, the best preventive action that works is avoidance of the virus. Because cold viruses are transmitted by droplets or respiratory secretion, therefore handwashing is probably one of the most effective ways of keeping the cold at bay. When in the company of someone who has a cold⁴, avoid touching your eyes or nose - there might be infective droplets on your hands - and if possible, clean possibly contaminated surfaces with a virus-killing disinfectant. Avoid sharing easily contaminated things with an infected person⁵, and keep you personal hygiene items far away - or make sure they can be cleaned properly. (These are all just common sense measures) Maintenance of a healthy immune system is also important if you are to avoid a cold. There is currently no vaccine for the common cold because there are just too many viruses to target, and the said viruses have a tendency to evolve over a short period of time.
Studies have shown that viruses can survive on human hands for several hours and that they can be spread by direct contact. As well as through coughs and sneezes, a person may pick up the virus on their fingers by touching an infected object or person.

MRSA, SARS, FLU, AVIAN FLU, TB, MENINGITIS, COMMON COLD, HIV, & Super bugs of every hue ……….

In 1918 the schoolgirls in America jumped rope to a new chant:

I had a little bird
And its name was Enza
I opened the window
And in-flew-Enza

Is there a vaccine effective against Avian or Bird Flu H5N1 in humans?

No. Currently available vaccines will not protect against disease caused by the H5N1 strain in humans. WHO is urgently working together with laboratories in the WHO Global Influenza Surveillance Network to develop a prototype H5N1 virus for use by leading vaccine manufacturers.

An available vaccine prototype virus, developed using the 2003 strain of H5N1 (which caused the two human cases in Hong Kong), cannot be used to expedite vaccine development. Initial analysis of the 2004 virus, conducted by laboratories in the WHO network, indicates that the virus has mutated significantly.

In the 20th century, the great influenza pandemic of 1918-1919, a form of Avian Flu, which caused an estimated 40 to 50 million deaths worldwide, was followed by pandemics in 1957-1958 and 1968-1969

~Are there drugs available for prevention and treatment?

Yes. Two classes of drugs are available. These are the M2 inhibitors (amantadine and rimantadine) and the neuraminidase inhibitors (oseltamivir and zanimivir). http://www.tamiflu.com/ These drugs have been licensed for the prevention and treatment of human influenza in some countries, and are thought to be effective regardless of the causative strain.

Thirteen grams (0.46 ounces) of star anise are required to produce the equivalent of 10 Tamiflu capsules prescribed to treat one person contaminated with avian flu.

That means that the effective dose for avian flu could be 12 capsules a day at 75mg a capsule, use for 10days. Start the first day of symptoms - fever and severe chest pain. PLEASE seek the advice of a professional first. This is theory - not fact.

But, prevention is always better.

Are there any preventive measures I can take?

1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. There is no need or efficacy in using anti-bacterial soap. In fact using these products strengthens the bacterium. The action of friction of rubbing/scrubbing the skin for 20 seconds is the most efficient protection.
2. Keep cuts and scrapes clean and covered with a bandage until healed. Cough into your elbow not your hand. Use strong paper handkerchiefs to avoid droplet transmission. Wash surfaces with alcohol or chlorine bleach. Use diluted chlorine bleach in laundry.
3. Avoid contact with other people’s wounds, handkerchiefs, dirty dishcloths, unwashed food or bandages.
4. In professional settings wear the right clothing and change into street clothes when you leave. Many hospitals now use fast-acting, special antiseptic solutions, like alcohol rubs or gels - you may find dispensers placed by patient’s beds and at the entrance to clinical areas for use by staff and visitors.
5. The most important type of isolation required for any potentially resistant medical infection is what is called Contact Isolation. This type of isolation requires everyone in contact with the patient to be very careful about hand washing after touching either the patient or anything in contact with the patient. If the organism is in the nose or lungs it may also be necessary to have the patient in a room to prevent spread to others by droplet spread. Because dust and surfaces can become contaminated with the organism, cleaning of surfaces are also important.

Where the common cold is concerned, the best preventive action that works is avoidance of the virus. Because cold viruses are transmitted by droplets or respiratory secretion, therefore handwashing is probably one of the most effective ways of keeping the cold at bay. When in the company of someone who has a cold⁴, avoid touching your eyes or nose - there might be infective droplets on your hands - and if possible, clean possibly contaminated surfaces with a virus-killing disinfectant. Avoid sharing easily contaminated things with an infected person⁵, and keep you personal hygiene items far away - or make sure they can be cleaned properly. (These are all just common sense measures) Maintenance of a healthy immune system is also important if you are to avoid a cold. There is currently no vaccine for the common cold because there are just too many viruses to target, and the said viruses have a tendency to evolve over a short period of time.

Studies have shown that viruses can survive on human hands for several hours and that they can be spread by direct contact. As well as through coughs and sneezes, a person may pick up the virus on their fingers by touching an infected object or person.

MRSA stands for Methicillin Resistant Staphylococcus Aureus or Multiply Resistant Staphylococcus Aureus (S aureus).

MRSA is created by antibiotic usage. Contrary to news reports, many of the patients with MRSA in hospital have brought the bug in with them; this has been proven by swabbing patients on admission. MRSA is endemic in nursing homes. MRSA rates are more related to overuse of antibiotics than poor hospital hygiene - the USA has a massive problem with resistant bacteria (vancomycin-resistant enterococci as well as MRSA).

S aureus is of course not the only bacterium to have gained drug resistance; it is merely the most famous. Drug resistant tuberculosis is also well known and this is indeed deadly. Some patients in New York have recently (at the time of writing) been effectively imprisoned in order to ensure they complete their course of antibiotics and limit the spread of drug resistance in this lethal bacterium. Streptococcus pneumoniae - responsible for many throat and lung infections - has also been reported to be gaining drug resistance and again there are more.

Symptoms	Common cold	Influenza
Nose	Drips like a leaky faucet; nose often gets clogged up with discharge; bad attack of sneezing. Sinus membranes are usually inflamed	Not affected
Cough	Yes; hacking cough	Yes; dry cough (no phlegm)
Sore throat	Sometimes	Common
Fever	Usually slight; may reach 102°F in infants, young children	May reach 104°F, but subsides after two to three days
Headache	Localized	Prominent; nonlocalised
Body aches	Rare; slight	Common (head, back, arms and legs)
Nausea	No	Yes
Other symptoms	May lead to complications such as middle ear or sinus infections	Burning eyes, loss of appetite; patient may suffer chills and debilitating weakness
How long it lasts	Two to 14 days	May last longer than the common cold

So what Can We Do about This?

There are a number of ways around the problem of drug resistance. Some have been already been applied and used with a mixed level of success, while some are still in the realms of theory. Just a few of the possibilities are mentioned here:

§ Limit the use of antibiotics - In the past antibiotics were overused and this is one of the causes of the rapid spread of drug resistance. They were formerly given routinely in hospitals mainly to prevent the outbreak of dangerous infections in already sick patients. Also, in farming, some antibiotics were put into animal feed to again prevent disease among animals. The drawbacks have clearly outweighed the benefits on this issue and so the overuse of antibiotics is now frowned upon. There is a growing trend to use them only when a clear bacterial infection has taken place and this should slow the spread of resistance.

§ Development of new drugs - The oldest of the methods and the most often used. If bacteria become resistant to our current array of antibiotics, simply make some more. The development of methicillin to get around ß-lacatamase-based resistance is the most famous case of this.

Unfortunately, this is more easily said than done. To develop and make a new drug is an expensive and long drawn out process as well as being of high financial risk. A pharmaceutical company typically has to put a drug through 5-10 years of trials before it is given a safety certificate to go on the market. A drug can fail at any stage of this process and more importantly, drug resistance now tends to develop more quickly than this. Bacteria can be resistant to a drug before it is available on the market.

Pharmaceutical companies are still researching into new antibiotics, however. The financial rewards of finding a new 'penicillin' with no resistance yet in place are potentially enormous.

§ Combination therapy - Another method that has already been successfully employed - although again, bacteria have found ways around it. There are a class of molecules known that prevent the action of ß-lactamase enzymes. If such a drug (clavulanic acid is a well known example of this type of drug - a ß-lactamase inhibitor) is used in combination with a penicillin then the ß-lactamase inhibitor stops the ß-lactamase enzyme from destroying the penicillin which can then get on with its job of killing the bacterium freely. Unfortunately, some bacteria can simply pump out clavulanic acid and this means that the penicillin may be destroyed. Other combination therapies may also be of use however.

§ Let some antibiotics lie 'fallow' - It has been observed that when the selective pressure to become drug resistant is removed, some bacteria will lose the DNA that leads to drug resistance. In other words they return to a more native state. It has therefore been proposed that it might be possible to use a rotating regime of antibiotics. Some antibiotics will be used for a period of time while others are not used at all. Hopefully, the bacteria would become resistant to those in use but would lose their resistance to those not in use. One could then switch the therapy and the situation would reverse, the bacteria would gain resistance to the new drug but would lose it to the old one. The cycle could then start again. This is analogous to the old three-field system in farming.

While possible in theory, this has yet to be tested in practice. Also, it is known that under certain conditions, bacteria can form spores and these spores can lie dormant for thousands to millions of years. Bacillus 2,9,3 is an example illustrating this. This allows the possibility that a bacterium that is multi-drug resistant could resurface at any time, rendering this method useless.

§ Use of Bacteriophages - Bacteriophages are viruses that specifically attack bacteria. It is proposed to use these as a way of killing drug resistant bacteria. These viruses have probably been around for as long as bacteria (billions of years) and so are excellent at their exploitation of them. Bacteriophages are specialized in invading bacterial cells only and so cannot affect our own cells. This is potentially, therefore, an exceptionally safe therapy for us.

The word bacteriophage literally means "to eat bacteria".

Once the phage has entered the body, it attaches itself to the bacteria causing the infection, and shoots in its own DNA to make the bacteria start producing bacteriophages. Within 30 minutes, up to 200 new phage are created, according to Dr Dixon, and in the process the bacteria die.

The job done, the phage automatically start to disappear.

And if the bacteria become resistant to the phage, as they have done to antibiotics, a new phage matched to the new bacteria can be developed. In order to inhibit resistance, a cocktail of phages would most likely be used in treatment.

The great escape: Ending period pain

26 September 2007

• NewScientist.com news service
• 26 September 2007
• Hannah Hoag

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• Lybrel
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• No Period.com

Playing the system

THEY are a rite of passage for young women and a sign of likely fertility and health. For some women they are welcome proof that they are not pregnant. But generally speaking periods aren't much fun. What with radical mood swings, migraines, cramps, bloating and nausea, at best they are an irritation, at worst they require medication.

Now, though, women can choose to opt out entirely. In July, pharmacies in the US began stocking a new oral contraceptive designed for women "interested in putting their menstrual cycle on hold". The pills can be taken 365 days a year with no need to break for a monthly bleed. Other forms of hormonal contraception are on the cards too. Researchers are experimenting with ways to keep periods at bay by blocking the body's own progesterone.

All of this has reignited the debate over whether it is healthy for women to disrupt their monthly cycle and even stop having periods altogether. Some say that the rate at which the average western woman menstruates could actually be bad for her health - causing an increased risk of ovarian cancer and many other disorders. Others argue that long-term exposure to the hormones in birth control pills could be harmful, that it's wrong to medicalise menstruation and that not having periods could mask signs of infertility until it's too late.

The regular contraceptive pill has changed very little since it was first licensed in the 1960s. Today's pills contain a much lower dose of hormones than they did back then, but the concept remains the same. Most are made of synthetic versions of the key reproductive hormones oestrogen and progesterone, which prevent pregnancy by stopping the ovaries from releasing an egg. They also thicken the cervical mucus, making it nearly impossible for sperm to pass into the uterus.

The pill was designed to be taken for 21 days in a row, followed by a week of either placebo pills or no pills at all. Over the first 21 days, the endometrium - the lining of the uterus - reinforces itself, building up tissue into a lush nourishing environment in anticipation of a fertilised egg, which of course will never arrive. When the pills run out, the drop in progesterone triggers the expulsion of this blood vessel-rich tissue, mimicking a period.

However, not all women follow this schedule. Some choose to take the pill every day, skipping the seven-day break or placebo pills and avoiding any bleeding. Women have been doing this ever since the pill was formulated. Some did it for convenience, others to rid themselves of unwanted symptoms. Patricia Sulak, an obstetrician at Texas A&M University Health Science Center College of Medicine in Temple, is among the many physicians - and women - who challenged the idea of the seven-day break early on. "I did my medical residency in the early 80s. Many of us were on continuous pills then, and we have been recommending it to many of our patients since," she says.

Now, after more than 20 years of clandestine menstrual suppression continuous contraception is becoming mainstream and the standard pill regime is beginning to look a bit passé. In recent years, some pharmaceutical companies have repackaged their pills into products that allow women who take them to have just four periods a year. One, Seasonale, was approved by the FDA in September 2003, while Seasonique was approved in May 2006.

Yearly cycle

Lybrel, manufactured by the pharmaceutical giant Wyeth, is the first oral contraceptive to be approved for continuous use. The drug, to be marketed as Anya in Canada and the European Union, is taken daily, turning that time of the month into that time of the year - and only then if a woman chooses to stop taking the pills. David Archer, director of the Clinical Research Center at the Eastern Virginia Medical School in Norfolk, oversaw some of the clinical trials for Lybrel. He says there's no real reason to stop after a year. "If you have done well the first year, why not go on for a second?" he says.

Sulak is among a growing group of medics who feel that having fewer periods is a good thing and that a monthly period may even be bad for a woman's health. Richard Anderson of the Centre for Reproductive Biology at the University of Edinburgh, UK, agrees. He says he can think of no medical reason why women need to experience a monthly bleed. "It really just reflects that you haven't got pregnant and that there is no embryo trying to implant into the uterus," he says.

In fact, bleeding every month is not necessarily the norm. Anthropological studies of women in contemporary hunter-gatherer societies show that they have far fewer periods than western women and suggest that women in pre-industrial times had far fewer periods than women today. In the 1980s, Beverly Strassmann, now at the University of Michigan in Ann Arbor, spent more than two years living among the Dogon people of Mali in west Africa. She found that menstruation was a relatively rare event: between the ages of 20 and 24, women had on average just two periods a year. Strassmann calculated that a Dogon woman has only around 110 periods in her lifetime. The rest of the time she is pre-pubescent, pregnant, lactating or post-menopausal. In contrast, the average woman in New York, London or Toronto has 350 to 400 periods between menarche and menopause. Her first period arrives earlier, she bears children later, has fewer of them, and doesn't breastfeed for as long.

“Having a monthly period is not necessarily the norm. It may even be bad for a woman's health”

All these factors lead to almost incessant ovulation and menstruation. Sulak reels off a list of problems that may be associated with or worsened by uninterrupted menstrual cycles: ovarian cancer, increased risk of endometriosis, anaemia, uterine fibroids, premenstrual syndrome (PMS) and premenstrual dysphoric disorder - a severe, disabling form of PMS. "We weren't designed to have decades of periods," she says.

But while taking the pill continuously might reduce your risk of developing some of these conditions, the pill brings health concerns of its own. Few long-term studies have addressed potential risks to breast, bone and cardiovascular health, but there have been high profile scares. For example, since 2004, the FDA has required that Depo-Provera, a long-term injectable contraceptive, include a warning about how it may lead to reduced bone density.

More generally, women with a history of cardiovascular disease, or who are obese, those with high cholesterol levels, and smokers over the age of 35 face a greater risk of blood clots that could lead to pulmonary embolisms, strokes or heart attacks when taking any contraceptive pill. Some studies have shown that the pill may bring an increased risk of cervical cancer.

As well as health concerns, long-term use of oral contraceptives can have unwanted side effects. Unpredictable bleeding is a common reason for women to stop taking the pill and Lybrel is no exception. During a phase III clinical trial more than half of the 2134 women who took part dropped out, many of whom cited bleeding as the cause. Of those that remained in the study, 40 per cent still experienced irregular bleeding after 12 months.

Faced with these problems, researchers are now looking at different forms of contraception altogether. Rather than using synthetic oestrogen and progestin to control the menstrual cycle, they are using antiprogestins to block the body's own progesterone. This is the hormone responsible for the build-up of blood vessels in the uterus, so if this can be prevented, there is no lining to shed and no period. Antiprogestins would also suppress ovulation, making them potential contraceptives.

The first antiprogestin was synthesised in 1980. Since then more than 400 others have been identified, but only a handful have been tested in humans. Some say antiprogestins herald a revolution in reproductive science, offering control of menstruation without the need for long-term exposure to oestrogen and progestin. "You won't get a contraceptive that is more effective than current methods and intrauterine devices, but you can get one that has added health benefits," says David Baird, a reproductive biologist at the University of Edinburgh.

Baird and his colleagues have been studying the contraceptive properties of the antiprogestin mifepristone for many years. In early clinical trials the hormone has lived up to its potential as an extended-use contraceptive. Most recently the team compared it with the progestin-only pill - also called the mini-pill - in a trial with 97 volunteers. More than 80 per cent of the women who took mifepristone daily for six months did not experience any bleeding or spotting, or had less than two days of bleeding or spotting per month (Human Reproduction, vol 22, p 2428).

Another study published in June demonstrated an alternative approach. Researchers at the Oregon National Primate Research Center in Beaverton tested an intrauterine device (IUD, also known as a coil) that released an antiprogestin called ZK 230211 directly into the uterus of macaques. Robert Brenner, who led the study, found that although there was extended bleeding immediately after the IUD was fitted, the longer it was in place, the less likely the macaques were to experience bleeding or spotting. And although the study did not directly test the device as a contraceptive, Brenner believes such a device could potentially offer a long-term, reversible option with minimal breakthrough bleeding and few side effects (Contraception, vol 75, p S104).

"There is no doubt that antiprogestins can suppress bleeding," Brenner says. "The question is what is the best drug and the best way to deliver that drug?" To him, an IUD makes sense, because the actions of the antiprogestins remain largely localised, minimising any unwanted effects elsewhere in the body.

Body blocking

As well as acting on the endometrium, progesterone affects the ovaries, breast tissue and brain. If the antiprogestin is swallowed, as it is in Baird's trials, it will distribute itself throughout the body and may be more likely to cause side effects. Although Baird reported no major adverse effects in his study (minor side effects included abdominal pain, headaches and mood swings), a phase III trial of a larger number of women would give a better idea.

One particular concern is the fact that the body would be constantly exposed to oestrogen without the inhibitory effects of progesterone. Since endometrial cancer is often linked to exposure to excessive oestrogen, some researchers are concerned that blocking progesterone might make endometrial cancer more likely. In Baird's trial, almost half of the women had some changes to their uterus, although none had over-proliferation of the endometrial lining that could be the early signs of endometrial cancer.

In the west, IUD uptake has lagged behind that of the pill, but Sulak and Anderson say they have recently become more popular, particularly the new hormone-containing coils such as Mirena, which slowly releases a progestin called levonorgestrel over five years. According to its manufacturer Bayer, 90 per cent of women who use Mirena can expect less menstrual bleeding and 20 per cent have no periods after a year. However, many women find the amount of breakthrough bleeding that occurs in the first three months unacceptable, Brenner says, which is why he began testing the antiprogestin IUD.

Antiprogestins seem to have great potential for contraception and the suppression of periods, but their use is controversial. In 1980, soon after researchers at the French pharmaceutical company Roussel Uclaf discovered mifepristone, also called RU-486, the drug was found to be able to abort pregnancies. Since then mifepristone has been widely used in Europe and the US in combination with another drug, misoprostol, for medical abortions.

This fact has dogged the development of antiprogestins as contraceptives, say Brenner, Baird and others. "It has made it anathema among those opposed to abortion, especially in the US. Many drug companies have shied away from developing this class of drug because of the controversy associated with its use in medical abortions," Brenner says.

Baird has no further plans to study the hormone as a contraceptive. "It has reached a stage where we can't take it any further until a commercial company takes it on for phase III development," he says. "You're talking about an investment of between $5 million and $8 million. The companies are convinced there is a market for it, but it is a question about whether they want to get into this area."

It's hard to say whether or not antiprogestins will make it to the clinic. The pill is approaching its 50th birthday, and while there are many more choices available for women today, there is still no sign of the perfect contraceptive. Let's hope it arrives well before it reaches 100.

Hannah Hoag is a freelance science writer based in Montreal, Canada

From issue 2623 of New Scientist magazine, 26 September 2007, page 40-43

Philosophy

Moderation Management

When you have made the healthy decision to drink less, and you stay within moderate limits, you should not experience any health, personal, family, social, job-related, financial, or legal problems due to alcohol. The suggested guidelines below allow for a degree of individual interpretation, because moderation is a flexible principle and is not the same for everyone. The suggested limits, however, are more definite.

A Moderate Drinker:

• considers an occasional drink to be a small, though enjoyable, part of life.
• has hobbies, interests, and other ways to relax and enjoy life that do not involve alcohol.
• usually has friends who are moderate drinkers or nondrinkers.
• generally has something to eat before, during, or soon after drinking.
• usually does not drink for longer than an hour or two on any particular occasion.
• usually does not drink faster than one drink per half-hour.
• usually does not exceed the .055% BAC moderate drinking limit. (see Note 1 below)
• feels comfortable with his or her use of alcohol (never drinks secretly and does not spend a lot of time thinking about drinking or planning to drink).

The MM Limits:

• Strictly obey local laws regarding drinking and driving.
• Do not drink in situations that would endanger yourself or others.
• Do not drink every day. MM suggests that you abstain from drinking alcohol at least 3 or 4 days per week.
• Women who drink more than 3 drinks on any day, and more than 9 drinks per week, may be drinking at harmful levels.
(See Note 2 below for definition of a "standard" drink)

• Men who drink more than 4 drinks on any day, and more than 14 drinks per week, may be drinking at harmful levels.

  Notes:

  Standard drink: one 12 oz-beer (5% alcohol), one 5-oz glass wine (12% alcohol), or 1 and 1/2 oz of 80-proof liquor (40% alcohol).

These "number of drinks" limits are LIMITS and not TARGETS. Blood Alcohol Concentration (BAC) charts are more accurate than number of drink limits because they take into account weight, sex, and rate of drinking. If you are very light in weight use the BAC upper limit of .O55%. Some researchers advise a limit of one drink per day for older adults (55+).

The limits used by MM are based on research published in 1995 in the American Journal of Public Health, by Dr. Martha Sanchez-Craig, Addiction Research Foundation, Toronto, Canada and other published limits.

PLEASE CHECK WITH FAMILY AND FRIENDS WHETHER OR NOT THIS PROGRAM IS SUITABLE FOR YOUR INDIVIDUAL SITUATION. Consider consulting a trained Drug and Alcohol Treatment Program/Counsellor or AA.

Coeliac Disease Diet

Treatment

The only treatment for CD/DH is the lifelong adherence to a gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves. Medication is not normally required. Because osteoporosis is common and may be profound in patients with newly diagnosed CD, bone density should be measured at or shortly after diagnosis. Consult your physician regarding specific nutritional supplementation to correct any deficiencies. The diagnosed celiac should have medical follow-up to monitor the clinical response to the gluten-free diet. Dietary compliance increases the quality of life and decreases the likelihood of osteoporosis, intestinal lymphoma and other associated illnesses.

Adapting to the gluten-free diet requires some lifestyle changes. It is essential to read labels which are often imprecise, and to learn how to identify ingredients that may contain hidden gluten.

Be aware that hidden gluten can be found in some unlikely foods such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans.

Gluten may also be used as a binder in some pharmaceutical products. Request clarification from food and drug manufacturers when necessary.

Potential harmful ingredients include:

• unidentified starch
• modified food starch
• hydrolyzed vegetable protein - HVP
• hydrolyzed plant protein - HPP
• texturized vegetable protein - TVP
• binders
• fillers
• excipients
• extenders
• malt