Women's Health Archive

The synthetic estrogen diethylstilbestrol (DES) was widely prescribed in the 1940s, '50s, and '60s to prevent miscarriage and premature delivery. Its dangers were first revealed in the early 1970s, when Harvard-affiliated researchers linked the drug to a rare cancer of the vagina and cervix in the daughters of women who took DES while pregnant. In 1971, the FDA issued a warning against its use by pregnant women, but five to 10 million pregnant women and their babies had already been exposed. In the following decades, many other health problems were discovered among DES daughters. A report from the DES Follow-up Study, published in The New England Journal of Medicine (Oct. 6, 2011), documents the health risks for these women.

The study. In 1992, researchers contacted women who had participated in one of three studies of DES daughters undertaken in the 1970s. They recruited 4,653 women who had been exposed to DES in utero for a follow-up study, along with a control group of 1,927 women who had not been exposed. Using questionnaires, phone interviews, and medical records, the researchers assessed the cumulative risk for 12 health problems linked to DES exposure in earlier studies.

Q. Should I have my magnesium level checked regularly to make sure I'm getting enough for my bones?

A. You need adequate magnesium, and not just for bone health. It's central to hundreds of biochemical reactions throughout the body and essential for proper nerve, muscle, heart rhythm, and immune function. It also helps regulate blood sugar levels and promotes healthy blood pressure. We get most of the magnesium we need in food (good sources are whole grains, legumes, and dark-green leafy vegetables). Most multivitamins also contain some magnesium.

Q. Do vaginal estrogens that are used for vaginal dryness have the same risks as estrogens taken orally or by skin patch?

A. Hormone therapy (HT) — estrogen given alone or with progesterone or a progestin (to protect the uterine lining, or endometrium) — is the most effective treatment for postmenopausal hot flashes and vaginal symptoms. However, systemic HT, which acts throughout the body and is measurable in the blood, is associated with increased risk for heart disease, stroke, blood clots, breast cancer, and gallbladder disease, although we don't know the exact relationship between these risks and differences in dosage, timing, modes of administration, and factors such as age. The main types of systemic HT are oral and transdermal, such as a skin patch or gel. A vaginal ring called Femring also delivers estrogen at a dose high enough to have systemic effects.

As many as 32 million American women and men have some degree of incontinence—the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. The most common causes of incontinence are childbirth and aging in women; prostate disorders and their treatment in men. Treatments include exercises to strengthen the pelvic floor, fluid management, medications, and surgery. For people with urinary incontinence, fluid management is an easy place to start, explains Better Bladder and Bowel Control, a new Special Health Report from Harvard Medical School. This involves drinking only when you are thirsty, limiting your fluid intake from all sources to six to eight 8-ounce cups of fluid per day from all sources, and minimizing caffeinated and carbonated drinks, as well as alcohol.

A 28-year study of 106,000 women found that moderate alcohol slightly increases a woman’s risk of developing breast cancer. Women who had the equivalent of three to six drinks a week had a modest increase in their risk of breast cancer (15%) compared to women who never drank alcohol. That would translate into an extra 3 cases of breast cancer per 1,000 women per year. The risks were the same for wine, beer, and spirits. Because moderate drinking appears to prevent some types of heart disease—which affects more women than breast cancer does—it’s important for women to think about alcohol in light of their own personal health situation.

Some lifesaving cancer therapies can harm the heart and arteries (Harvard Heart Letter, March 2010). Trastuzumab (Herceptin), a drug used to treat one type of breast cancer, has improved survival for women, but it can also weaken the left ventricle, the heart's main pumping chamber.

One study suggests that the problem may be more common than researchers had initially suspected, especially among older women. A team of researchers from Vall d'Hebron University Hospital in Barcelona, Spain, reviewed the medical records of 45 women ages 70 and older who were treated with trastuzumab. Four developed heart failure, and another eight had declines in a measure called left ventricular ejection fraction, indicating a problem in the left ventricle. Eleven of the women recovered after stopping trastuzumab, though recovery sometimes took as long as 21 weeks. In one woman, heart failure persisted (Annals of Oncology, published online Aug. 9, 2011).

Screening guidelines often change after age 75. If you're in that age group, how do you decide which tests you need?

If you're close to age 75, you may have followed the same schedule for mammograms, Pap smears, and other screening tests for decades. And if you're like many women, you may be surprised that your physician is suggesting fewer tests or longer intervals between them. The practice seems to fly in the face of conventional wisdom. After all, the risk for many degenerative diseases increases with age, so shouldn't older women be monitored even more closely? The answer is, "It depends on the woman."

Physical activity confers important health benefits, reducing the risk for many chronic conditions, including heart disease. Federal guidelines recommend that we get at least 150 minutes (2.5 hours) of moderately intense physical activity such as brisk walking each week, with greater benefits if we do even more. But even 2.5 hours a week is too much for some people, including those who are strapped for time. They'll be glad to hear that, according to a study, you can significantly lower your risk for heart disease by getting as little as 15 minutes of exercise most days of the week.

The study, led by researchers at Harvard School of Public Health, is the first to quantify just how much exercise is needed to reduce the risk of heart disease. It found, as expected, that you can lower the risk more by exercising longer. Interestingly, the effect was stronger for women than for men. Results were published in Circulation: Journal of the American Heart Association (Aug. 16, 2011).

More than half of adults ages 65 and over have sleep apnea, a disorder characterized by abnormal pauses in breathing during sleep. Chronic sleep apnea is associated with many health risks, including high blood pressure, heart disease, and stroke. It's also been linked to deficiencies in memory and attention in children and middle-aged adults, but studies of older adults have produced conflicting results. Now, a well-designed study has concluded that older women with sleep apnea are more likely to develop cognitive problems and dementia. The findings were published in The Journal of the American Medical Association (Aug. 10, 2011).

The study. At the start of the study, 298 healthy women, average age 82, completed tests of cognitive function and underwent overnight sleep testing that monitored changes in respiration, heart rate, blood oxygen levels, brain activity, and other measures. Sleep apnea was defined as 15 or more "sleep-disordered breathing events" — pauses in breathing or shallow breathing — per hour. Five years later, the women were given further cognitive tests.

Q. I'm looking for information on Prolia and Reclast as alternatives to Boniva.

A. All of the drugs you mention are used to treat postmenopausal women with osteoporosis, although they're in different drug classes. Ibandronate (Boniva) and zoledronic acid (Reclast, Zometa) are bisphosphonates; denosumab (Prolia) is a monoclonal antibody. Bisphosphonates interfere with the activity of osteoclasts, bone cells that are involved in normal remodeling. Osteoclasts break down (resorb) old bone. Bisphosphonates work by reducing the rate of resorption. Denosumab also reduces bone resorption but does so by inhibiting the formation of osteoclasts rather than their activity.