WDDTY

WHAT DOCTORS DON’T TELL YOU

Women’s
Woman’s Health
Contents
Contraception, pregnancy and birth
2 Natural alternatives to the Pill
5 C-section aftershocks
9 Pregnancy pains
10 Postnatal depression: a bad case of the blues
13 Infertility and assisted reproduction

Female complaints
16 Urinary tract infections
19 Varicose veins
22 Uterine fibroids
23 Premenstrual syndrome

Menopause
24 HRT: the latest cancer risk
25 Menopausal symptoms
27 Nutritional support for women over 50
29 Osteoporosis: the brain-bone connection

Health and beauty

32 Saving face
35 Perfume: a whiff of danger
38 Hair - dyed and deadly
41 Minimizing the ‘orange peel’ look

Cancer
42 Mammograms: medicine’s false trail
46 Medicine has got it wrong about cancer, say experts
48 The scandal of mastectomy

Your questions answered

50 Help for period pain
51 Endometriosis
52 Preventing miscarriage
53 Amenorrhea
54 Vaginal dryness

WWW.WDDTY.COM
Contraception, pregnancy and birth

Natural alternatives to the Pill

You don’t have to risk the
adverse effects of
hormones, given the range
of effective alternatives

T he contraceptive pill is said

to be the most commonly used
drug of all. More than 300
million women worldwide have been
on ‘the Pill’ at some time or other, and
one hundred million-plus women are
currently taking it.
Its convenience and nearly 100-per-
cent rate of success are no doubt the
major draws. However, numerous
studies suggest there’s a high price to
pay for taking the Pill. Indeed,
thrombosis, stroke, cancer, brittle
bones and a reduced libido are just
some of the health risks associated
with these agents (Bennett J, Pope A. The
Pill: Are You Sure It’s For You? Crows Nest,
N.S.W., Australia: Allen & Unwin, 2008).
Happily, the Pill isn’t the only
option if you don’t want to become
pregnant. As well as the safer
conventional forms of contraception
(see box, page 3), there are also a
number of natural alternatives for
preventing pregnancy.

Other effective methods
Although most women know little
about them, there are a number of
device- and drug-free birth-control
methods—known as ‘fertility
awareness-based methods’, or
FABMs—that are both safe and
effective. These methods involve
learning to recognize the signs of
ovulation (when an egg is released
from the ovaries), and either
abstaining or using a barrier method
during such fertile times.
Ovulation signs include changes in
body temperature, the quality of
cervical mucus and position of the
cervix. There are also secondary signs,
such as ovulation pain and breast
tenderness, which may be helpful.
Each of these signs can be used on its
own—the Billings ovulation method,
for instance, relies upon the mucus
changes alone—or all together as a
cross-checking system, known as the
symptothermal method.
According to the scientific
literature, the following methods
compare favour-ably with the
conventional means of birth
control.
The Billings ovulation
method
Developed over 50 years ago by
Australian physicians Evelyn and
John Billings, this method relies
upon the changes in vaginal mucus
that occur regularly throughout
the menstrual cycle to identify
when a woman has released an egg
and is, therefore, fertile. In general,
fertile mucus is clear, wet, slippery,
stretchy and changeable in
quality—rather like raw egg
whites—while infertile mucus is
unchanging and usually dry, sticky,
cloudy and non-stretchy.
Studies carried out by the World
Health Organization (WHO) have
indicated that 93 per cent of
women, regardless of their level of
education, are capable of identifying
and distinguishing fertile from
infertile mucus. Moreover, when
used correctly, this method has a 98-
to 99-per-cent rate of effectiveness.
Typically, however, with this form
of birth control, around 10–20 per
cent of women will nevertheless
have an unintended pregnancy
within a year of following it. This is
mostly due to a conscious departure
from the method’s rules (J Am Board
Fam Med, 2009; 22: 147–57).
A variation of the Billings
method, known as the Creighton
model or NaProTechnology, is more
standardized in the way in which
cervical mucus is characterized
through the use of pictures and
precise words to describe the
changes. In a study of more than
1800 couples, efficacy rates for
avoiding pregnancy were between 96
and 99.5 per cent (J Reprod Med, 1998;

2 WDDTY Women’s health

 is “comparable to the method
Conventional alternatives to the pill effectiveness of modern cont-
raceptive methods like oral
contraceptives”.
Surprisingly, though, they also
found high rates of effectiveness
when barrier methods, such as
condoms, were used during the
fertile time rather than abstinence,
with 0.6 unintended pregnancies per
100 women per year, which works out
to an effectiveness rate of 99.4 per
cent.
In addition, the overall pregnancy
rate—in other words, the calculated
rate when all women were included,
As the following methods don’t use hormones to prevent pregnancy, they even those who didn’t always follow
may be safer to use. the rules (typical use)—was just 1.8
! Male and female condoms are 98-per-cent and 95-per-cent effective, per cent (98.2-per-cent effective) per
respectively, as barrier methods. year (Hum Reprod, 2007; 22: 1310–9). This
RISKS: The latex in condoms can cause allergic reactions in some figure is considerably lower than the
people, and the talc has been linked to an increased risk of ovarian cancer typical-use rate for the Pill, which is
(Eur J Cancer Prev, 2008; 17: 139–46). However, latex- and talc-free condoms around 8 per cent (or 92-per-cent
are available. effective). Nevertheless, previous
! Diaphragms and caps are 91- to 94-per-cent effective and more eco- studies have reported unplanned
friendly as barrier methods. They are used together with natural or pregnancy rates as high as 13–20 per
chemical spermicides. Natural spermicides include lactic acid, honey, and cent for typical users of the STM (J
aloe and lemon juice. Am Board Fam Med, 2009; 22: 147–57).
RISKS: They don’t protect against sexually transmitted infections (STIs) For more information on this
and, as with condoms, some people are allergic to latex diaphragms and method, visit www.ccli.org (The
caps. Couple to Couple League
! Intrauterine devices, or IUDs, are more than 99-per-cent effective. An International).
IUD, formerly known as the ‘coil’, is a plastic-and-copper device that has
to be inserted into the womb by a specially trained health professional. The Standard Days Method
Depending on the type of device, it can last for three to 10 years. Based on monitoring the days of a
RISKS: The device can come out (expulsion), and perforation (when the woman’s menstrual cycle, this is a
device punctures the wall of the uterus) and infection are potential modern user-friendly version of the
problems. IUDs can also cause painful periods, and about one in 20 so-called ‘rhythm method’, which was
pregnancies that occur in users are ectopic (when the egg becomes introduced in the 1920s before the
implanted outside of the uterus) (Prescrire Int, 2009; 18: 125–30). What’s more, availability of hormonal methods of
IUDs also don’t protect against STIs, and some people are allergic to contraception.
copper. This system is only appropriate for
women who have menstrual cycles
that generally last for between 26
43: 495–502). than one sign of ovulation, the and 32 days. With this method,
For more information about these woman will be more accurate in women are taught to avoid
methods, visit www.boma-usa.org predicting her ‘safe’ days. unprotected intercourse on
(The Billings Ovulation Method In a study in Germany that potentially fertile days—specifically,
Association) and www.aafcp.org included 900 women, researchers on days 8 through to 19 of their
(American Academy of FertilityCare found this method to be a “highly cycles—to avoid pregnancy. The
Professionals). effective” form of family planning. women can also use CycleBeads, a
The results showed that using the colour-coded string of beads that
The symptothermal method symptothermal method (STM) represents the menstrual cycle, to
This also relies upon observations of correctly, and abstaining from help keep track of their fertile and
cervical mucus but, in addition, it intercourse during the fertile time, infertile days.
also incorporates body-temperature led to a rate of 0.4 unintended Studies show that the Standard
readings (which rise after ovulation) pregnancies per 100 women per year Days Method is more than 95-per-
and historical cycle data to (99.6-per-cent effective). Thus, cent effective when correctly used,
determine fertility. This method is the researchers concluded that and 88-per-cent effective with typical
based on the idea that, by using more the successful use of the STM use (J Midwifery Womens Health, 2006; 51:

WDDTY Women’s health 3

Contraception, pregnancy and birth
471–7; J Am Board Fam Med, 2009; 22:
147–57).
For more information on this
method, see www.irh.org (George-
town University’s Institute for
Reproductive Health).
Lactational amenorrhoea
This short-term technique is based
on the natural effect of breastfeeding
on fertility. Breastfeeding—and, in
particular, exclusive breastfeeding—
suppresses the release of the
hormones that are necessary for
ovulation.
Provided that certain conditions
are met—the baby is exclusively
breastfed and is fed often, day and
night; the mother’s menses have not
returned; and the baby is less than 6
months old—this method is 98-per-
cent effective at preventing
pregnancy.
For working women, however, the
effectiveness rate drops to 95 per
cent, even if they express their milk
every 4 hours, suggesting that it is
the suckling of the infant that
contributes significantly to the
contraceptive effect of lactation (J Am
4 WDDTY Women’s health
Board Fam Med, 2009; 22: 147–57).
For further information, visit
www.irh.org (Georgetown Uni-
versity’s Institute for Reproductive
Health).
Benefits and risks
FABMs offer numerous benefits
besides a lack of pharmaceutical
side-effects. In one survey, couples
using natural methods reported
better communication and sexual
interactions as well as deeper
intimacy and respect for their
partners. FABMs are also
associated with lower divorce
rates—at least in the US (J Am Board
Fam Med, 2009; 22: 147–57).
Another major advantage is that
FABMs are immediately reversible.
As soon as the woman stops using
the method, she can fall
pregnant—unlike some hormonal
contraceptives after which fertility
can take quite a while
to return.
Moreover, she can use the
knowledge she’s gained about her
fertility to boost her chances of
conceiving.
But what are the drawbacks?
FABMs require a high level of
organization and commitment and,
so, are not for everyone. Clearly,
they also don’t offer any protection
against sexually transmitted
infections, which means that they
shouldn’t be used unless both
partners have been tested, or
condoms are used as well.
Another disadvantage is that
there’s a high risk of failure if the
woman’s fertility signs are not
correctly identified or calculated,
and this may depend on how well
the method was taught. Other
factors—for example, if the woman
is tired, stressed or ill—can also
make it difficult to interpret the
signs appropriately.
Another concern that’s often
raised about FABMs is the
potential for less-frequent sex.
However, in a comparative study
involving couples worldwide, the
monthly average for FABM users
was roughly the same as the
others’ (J Am Board Fam Med, 2009; 22:
147–57).
Joanna Evans
C-section aftershocks
Caesarean sections—delivering the baby via an abdominal
operation—are at an all-time high, and a growing number of
doctors and mothers-to-be elect for C-sections as a
convenient alternative to birth. However, new evidence shows
that C-section babies are almost three times as likely to die in
early infancy.
I
n late September of this year,
researchers in the US dropped a
bombshell onto the cosy world
of obstetrics.
After analyzing the records of
nearly six million births, they
advised that mothers should think
twice before choosing a caesarean
section (CS) over a natural birth.
Quite simply, an artificial
surgical delivery could be putting
the life of the newborn at risk. What
the stark American statistics
revealed was that caesarean babies
are almost three times more likely
to die within their first month of
life than naturally delivered babies
(Birth, 2006; 33: 175).
And yet, caesarean births (‘C-
sections’ in medico-speak) have
never been more popular. For an
increasing number of mothers-to-
be, the ready availability of CS has
meant that the trauma of giving
birth can be leapfrogged. The old
Biblical curse of having to endure a
painful labour is exorcisable—birth
can be as simple as having an
appendix removed.
Take this passage from a popular
American book on pregnancy: “With
a scheduled caesarean section, you
and your doctor have agreed to a
time at which you will enter the
hospital in a fairly calm and
leisurely fashion, and he or she will
extract your baby through a small
slit at the top of your pubic hair.
There are a lot of reasons to
schedule a C-section, [including] to
maintain the vaginal tone of a
teenager.” (Iovine V. The Girlfriends’ Guide
to Pregnancy. Pocket Books, 1995).
What is a caesarean? For
centuries, the classical CS
operation has involved a long
surgical incision made either
vertically or horizontally across the
centre of the abdomen, cutting
through to the womb below.
However, the operation is fraught
with complications—not least of
which is huge blood loss—and is
now rarely performed for this
reason. However, the modern CS
entails a much smaller incision (a
mere four to five inches across) low
down on the abdomen, just below
the top of the pubic hair—the
resulting scar thus conveniently
invisible even under a bikini.
The term ‘caesarean’ is popularly
thought to be named after the
Roman leader Julius Caesar who
was allegedly born that way.
However, doctors now think that
story is unlikely, as the operation
would almost certainly have killed
his mother (given the medicine
of the day)—and yet, historical
records show that she was still alive
after he reached adulthood.
A more plausible derivation is
from the term lex caesarea, a
Roman law passed during Caesar’s
reign decreeing that, if a mother
was dying during childbirth, the
baby could be surgically removed to
save its life.
In the US, 29.1 per cent of all
births are now delivered by CS,
according to 2004 statistics. And
the British figure is not far behind
at 21.6 per cent. Of these, almost
half (8.9 per cent) are ‘elective’—in
other words, chosen by the mother,
not by the doctor because of a
medical emergency (BMJ, 2004; 328:
1399). Why so many? After all, the
UK does not have the same financial
or litigious pressures as has the US.
The answer appears to be that
some women (anecdotally, the
British upper classes) consider
normal births too traumatic,
inconvenient, distasteful and
disfiguring to put up with—an
attitude memorably summarized as
‘too posh to push’.
There is some evidence for this.
A research group at Imperial
College in London recently collated
the UK’s CS data according to
social class, and found that elective
CS operations are not so much the
province of the top social classes,
but rather more a no-go area for
the lower classes—as they put it:
“not a case of too posh to push”,
but “too proletarian for a caesar-
ean” (BMJ, 2004; 328: 1399).
Although fear and distaste for
labour may play a part, another is
that doctors often pressgang
women into having ‘just-in-case’
caesareans for dubious reasons,
such as the fact that the baby is
large, is slightly overdue or in a
breech position (see box, page 6).
CS allows the doctor to do
‘daylight obstetrics’, obviating the
need to hang around for a woman to
deliver her baby, often in the middle
of the night (birth rates peak at
about 4 o’clock in the morning).
While labour can last for hours, a
typical CS is usually done and
dusted in less than 40 minutes.
Money’s a factor, too. In the
private American health system,
doctors and hospitals find CS more
profitable than natural births,
according to a World Health
Organization (WHO) report. “In the
WDDTY Women’s health 5
Contraception, pregnancy and birth

USA, the profit motive explains
hospital-specific CS rates that are
high even by US standards”
(Stephenson P. International Differences in
the Use of Obstetrical Interventions.
Copenhagen: WHO European Regional
Office, 1992).That report came out
15 years ago—and CS rates have
soared since then.
Another factor is litigation.
“Some caesareans are clear medical
necessities,” says Professor Joel
Evans of the Albert Einstein College
in New York, “but others lie in a
gray area, where there are other
possible medically appropriate
options. Now, more and more
physicians find it easier to follow
the growing trend of just go ahead
and do it, avoid a lawsuit.”
Advances in surgery and
anesthesia have made an operation
that was almost always fatal as
recently as the mid-19th century
a routine one 150 years later. And
yet, CS is still not to be undertaken
lightly. The most recent mortality
figures come from a huge study on
over 150,000 elective CS operations
in Britain, and shows that mothers
run nearly three times the risk of
dying from a CS than from a natural
delivery (Lancet, 1999; 354: 776).
Other risks to the mother
include the potential problems
associated with any major
abdominal surgery—anesthesia
accidents, damage to blood vessels,
and injury to the bladder, uterus or
other organs. Also, perhaps surpris-
ingly, CS comes with a much higher
risk of infection than natural birth
( Cochrane Database Syst Rev, 2002; 3:
CD000933). Other, longer-term risks
include possible decreased fertility,
ectopic pregnancy and miscarriage
(Lancet, 2003; 362: 1779–84).
But it’s the newly discovered risk
to the newborn child that has so
shocked obstetricians. The report
recently published in a peer-
reviewed journal was a four year
survey of all CS operations
performed in the US from 1998
to 2001. The researchers, led by Dr
Marian MacDorman of the Centers
for Disease Control and Prevention
(CDC), studied the records of
nearly 5.8 million live births and
almost 12,000 subsequent infant
deaths, and found a nearly three-
fold increase in the death rates
of elective CS babies within four
weeks of birth. The figures are
relatively small, but nevertheless
highly significant. While there were
only 62 deaths per 100,000 natural
births, a staggering 177 babies died
within a few weeks of CS surgery
(Birth, 2006; 33: 175).
Doctors have been anecdotally
aware of a higher risk with CS for
years, but have tended to explain
it away because CSs are usually an
emergency procedure, caused by a
problem with the birth anyway.
However, MacDorman’s study has
removed this confounding factor
by analyzing the records only of
women who had had no compli-
cations whatever with either kind

How to cope with a breech baby

Breech births are among the main reasons for doctors to
opt for a CS delivery.
Breeches are not that uncommon, being seen in about
3–4 per cent of women who are about to give birth. However,
just a few weeks earlier in the pregnancy, breech positions are
much more frequent. A month or so before birth, as many as
one in six women find that their baby is ‘the wrong way
round’. Nevertheless, more often than not, the baby will have
naturally repositioned itself by the time of delivery.
But what if it hasn’t? One solution is to try turning the
baby from the outside, using a technique called ‘external
cephalic version’ (ECV, or ‘outside head repositioning’). The
procedure involves manipulating the mother’s abdomen in an
attempt to push the fetus up and away from the pelvis,
gradually turning it upside-down while keeping its legs
bent. Crucial to its success are skill, experience and
patience—old-fashioned virtues that are at odds with the
hustle of modern high-tech machine-based medicine.
ECV is now decreasingly being practised in British and
American maternity units, although it’s still offered in
France, Belgium and Scandinavia, where it’s claimed to be
a successful and “safe procedure”. Even so, there are
risks. Nearly 6 per cent of babies develop transient heart
irregularities, and around 4 per cent require blood
transfusions. Not surprisingly, the overall infant death rate
is high—16 per 1000 births—and 0.4 per cent require
emergency CS, anyway (Acta Obstet Gynecol Scand, 2004; 83:
511–8).
There are other alternatives to ECV, however—mainly
drawn from unconventional medicine. Yoga, hypnosis and
chiropractic are claimed to have some success, but the most
clinically verified procedure is acupuncture. For centuries,
Chinese doctors, faced with a breech birth, have used
acupuncture plus moxibustion. This is where herbs—usually
mugwort—are burned on the tops of needles inserted into the
appropriate acupoints. Italian doctors recently tested this
traditional Chinese technique in a full-scale clinical
trial, and found that it works in roughly 50 per cent of cases
(J Matern Fetal Neonatal Med, 2004; 15: 247–52).
If the baby proves impossible to turn, it can still be
delivered naturally. National-birth pioneer Dr Michel Odent
has developed a tried-and-tested technique that works. It
involves no intervention during the first stage of labour,
leaving the woman free and ‘naturally active’. However, the
mother’s position becomes crucial when the time comes for
delivery. Odent scorns the traditional on-your-back position,
which he says is entirely for the doctor’s convenience, and
is the “least mechanically efficient method”. A much better
position is the ‘supported squatting position’. This reduces
the likelihood of having to pull the baby out, and minimizes
the delay between the appearance of the cord and the head.
As a result, the vast majority of Odent’s breech mothers
have had successful natural deliveries, with emergency CSs
generally only performed on those mothers who can’t get past
the first stage of labour (Odent M. Birth Reborn. Souvenir
Press, 1984).

6 WDDTY Women’s health

 Improving the odds of a natural birth
! Supplements. Take a general multivitamin/mineral
supplement and have levels of all nutrients, including
folic acid, checked to avoid congenital abnormalities;
abnormal babies are more likely to end up as breech
babies.
! Stay upright and mobile. Walking has no known side-
effects and is as effective as oxytocin for augmenting
labour (Am J Obstet Gynecol, 1981; 139: 669–72). Women who
walk, stand or sit upright during labour have shorter
labours, use less pain relief and less augmentation than
those who are supine and immobile (Enkin M et al. A Guide
to Effective Care In Pregnancy and Childbirth: A Synopsis. Oxford
University Press, 2000).
! Choose midwifery care. Studies show that midwifery
care equals low caesarean rates. One survey of 84 free-
standing birth centres in the US, staffed by midwives,
reported an overall caesarean rate of 4.4 per cent (N
Engl J Med, 1989; 321: 1804–11).
! Be patient. Some labours, especially first labours,
are simply long. Women who have had a previous
caesarean, especially one performed before a 4-cm
dilation, may have long labours comparable to those
of women having their first baby (Obstet Gynaecol, 1990;
75: 45–7).
! Opt for a doula (a midwife who cares for the mother
from conception to birth). A slew of clinical studies
have shown that they can reduce CS rates (J Womens
Health Gend Based Med, 1999; 8: 1257–64).
In addition, the presence of a doula (or trained birth
companion) has been shown to cut the average length
of labour by half—from 19.3 hours to just
8.8 hours (N Engl J Med, 1980; 303: 597–600).
! Consider having your baby at home—you’re much
more likely to then have a natural birth. Although
home is often best, according to Michel Odent, other
evidence show that even somewhere that’s ‘home-like’
can also prevent caesareans ( Cochrane Database Syst
Rev, 2005; 1: CD000012). Some hospitals offer this option,
often along with facilities such as birthing pools, which
also potentially promote natural birthing (Birth, 1996; 23:
136–43).
! Avoid having an epidural during labour, as CSs
are more common after administration of these
analgesics/anesthetics (Clin Nurs Res, 1999; 8: 119–34).

of delivery. This meant that the
difference in the babies’ death rates
could only have been due to the
delivery method itself.
In short, caesareans can be
lethal—but why?
The risk to the mother can be
explained by the fact that it’s a
major abdominal operation, but why
should the baby itself suffer any
harm? Well, there is evidence that
the baby may sustain “brachial
plexus injury, damage to soft
tissues, fractures, lacerations, and
entrapment of fetal head followed
by intracranial haemorrhage”
during CS (Cox JP. ICEA Review: Deliv-
ery Alternatives in the Term
Pregnancy. November, 1988).
But those
‘complications’ are relatively rare,
so it’s unlikely to be the whole
answer.
Natural birth benefits
Another way to explain the new
MacDorman data is to turn the
question on its head, and ask not
what’s wrong with CS, but what’s
so right about a natural birth?
One suggestion is that natural
vaginal delivery releases hormones
such as prolactin which promote
healthy lung functioning. In fact,
CS babies are known to have
impaired respiration compared with
non-CS babies (Arch Dis Child 1997; 77:
F237–8). Another factor may be the
sheer physical pressure on the baby
when being expelled through a
narrow opening. This, too, may
improve lung function by pushing
fluid from the lungs and preparing
the child for immediate air-
breathing.
Support for these theories has
come from studies that have found
a link between CS and later
respiratory disorders—in particular,
asthma. A recent German survey
discovered that CS-born children
have higher rates of asthma (and,
incidentally, more food allergies)
Breech up to age two than naturally born
babies (Pediatr Allergy Immunol, 2004; 15:
48–54 )—a pattern that continues
into adulthood. Astonishingly, even
as much as a whole generation
later, the long-term effects of CS
still show up. Finnish researchers
have found over three times more
cases of asthma in CS-delivered
31-year-olds ( J Allergy Clin Immunol,
2001; 107: 732–3).
Osteopaths believe natural
labour may have other, less quan-
tifiable effects. Some claim that the
compression of the baby’s body
down the birth canal helps kick-
start the natural maturation of
infant reflexes, allowing proper
neural development to take place.
On the other hand, compression of
the skull may also cause problems
such as colic and irritability.
Avant-garde gynaecologists such
as the famous water-birth pioneer
Dr Michel Odent are convinced
that natural labour has more
tangible benefits. Breastfeeding, for
example, is often easier after a
natural birth, says Odent, possibly
because of the better psychological
bonding between mother and child
after a natural delivery.
There may be two main reasons
for this. First, CS is a much more
medicalized procedure than a
natural birth and, as such, it
distances the mother from her
newborn. Second, the very act of
giving birth through the vagina
stimulates the production of
oxytocin—dubbed ‘the love hor-
mone’ by Odent. This hormone is
known to play a primary role
throughout the whole birthing
process, as it floods the mother’s
brain with powerful signals ‘telling
her’ to care for her infant (Odent M.
The Caesarean. London: Free Association
Books, 2004).
Once a Caesar . . .
Another frequently cited reason for
shunning a CS is to avoid another

WDDTY Women’s health 7

Contraception, pregnancy and birth
one for a later pregnancy. There’s
an old medical maxim that says
‘Once a Caesar, always a Caesar’
as, traditionally, it is believed that
a CS scar weakens the mother’s
abdomen, and so makes it more
vulnerable to the pressure of a
subsequent normal delivery.
This so-called VBAC (vaginal
birth after caesarean) issue remains
a hotly debated topic in obstetric
circles.
In the US, for example, over
300 hospitals have reportedly now
banned VBACs over fears of
malpractice suits. As a result, VBAC
rates have plummeted. However,
that trend is being challenged by a
few vociferous American women
pressure groups. They claim that
doctors who insist on repeat CSs
are denying women the right to
have a natural birth—which in any
case, they say, is just as safe as a
caesarean.
Which side is right? Unfor-
tunately, no one really knows. Two
exhaustive reviews of the clinical
data, one going back as far as 40
years, have proved inconclusive,
partly because good-quality data are
lacking (Aust NZ J Obstet Gynaecol, 2004;
44: 387–91; Oregon Health & Science
University Publication No 03-E018, March
2003). An older study of more than
5000 deliveries found not one
maternal death (Obstet Gynaecol, 1982;
59: 135).
Breech births
There is, however, one aspect of
the CS issue where there’s some-
what broader agreement. If labour
is difficult and the life of the
mother or child is immediately
8 WDDTY Women’s health
under threat, an emergency
caesarean is generally considered
the safest option.
The most common emergency
situation is with so-called breech
births—where the baby has its
bottom facing the birth canal
rather than being head downwards.
In the days before anesthesia and
surgery, all manner of complex
devices were invented to extract the
baby from this difficult position—
one that is potentially dangerous to
both the mother and infant. Some
doctors have also attempted to
solve the problem by developing
techniques of turning the baby in
the womb from the outside. More
recently, the trend in these cases
has been to perform a CS rather
than risk a natural delivery.
But here again, this issue has
divided the world of obstetrics, with
some arguing passionately that CS
is not necessarily the safer option
for breech-presenting babies.
In an effort to resolve the
controversy, Canadian researchers
set up a huge international trial,
involving over 2000 breech births
in 121 maternity units around the
world. Roughly half of the babies
were delivered naturally, with the
other half by CS. Although the
absolute risks to the infants were
relatively small in both cases, the
differences appeared to be clear-
cut: whereas 1.6 per cent of the
breech babies either died or were
damaged by the CS operation, that
figure leapt to 5 per cent for those
born without it. In both scenarios,
the mothers fared equally well
(Lancet, 2000; 356: 1375–83).
This result should have meant
‘case closed’ in favour of CS for
breech deliveries—but not so.
A few years later, South African
researchers collated fresh inter-
national birth data which showed
that the benefit of CS to the infant
had to be weighed against a modest
increase in danger to the mother
( Cochrane Database Syst Rev, 2003; 3:
CD000166).
This revised stance was again
confirmed by Dutch doctors who
agreed that CS was better for the
child, but not necessarily for the
mother (Br J Obstet Gynaecol, 2003; 110:
604–9).
And yet, that conclusion is flatly
contradicted by an earlier study from
the UK. In 1987, after reviewing 10
years of experience of both methods,
doctors at the Leeds University
Hospital concluded that CS is less
hazardous: “. . . vaginal delivery may
be the more dangerous maternal
option,” they reported (J Perinat Med,
1987; 15: 531–43).
Two very recent studies on the
subject have only served to fuel the
controversy.
Last January, an Israeli expert
published a stinging condemnation
of the original Canadian review,
complaining of “serious” flaws in its
design and methods—and, not
surprisingly, totally rubbishing its
conclusions (Am J Obstet Gynecol, 2006;
194: 20–5). Three months later, a
French report went further,
questioning the whole rationale for
opting for CS in breech births. In the
right hands, it said, the records
showed that natural breech births
are just as safe as CS deliveries (Am J
Obstet Gynecol, 2006; 194: 1002–11).
Tony Edwards
Pregnancy pains
U
p to 80 per cent of women
experience lower-back or pelvic
pain during pregnancy, usually
during the second or third trimester.
As drug treatment can harm a
developing fetus, pain management
options are limited.
In 2001, the World Health
Organization (WHO) published a
review of large controlled trials of
acupuncture that recognised it as
being effective in treating a variety of
pregnancy problems, including
inducing labour, low-back pain, a
breech presentation, morning
sickness, nausea and vomiting, and
postoperative pain. The report also
suggested that acupuncture seemed to
be effective for combating labour pain,
though further investigation was
needed.
So, if you’re pregnant, use
acupuncture to:
! reduce low back pain.
Other studies support that
acupuncture is a welcome
alternative treatment for women
with back and pelvic pain during
pregnancy. A Scandinavian study
comparing acupuncture and
physiotherapy found that
acupuncture relieved low-back pain
and reduced disability in pregnancy
better than physiotherapy did (Acta
Obstet Gynecol Scand, 2000; 79: 331–5).
A recent randomised study
compared acupuncture plus
standard treatment (consisting of a
pelvic belt, an at-home exercise
programme and patient education),
standard treatment alone and
standard treatment with additional
exercises for pelvic pain, and found
that acupuncture offered more
relief than the specific exercises
(BMJ, 2005; 330: 761).
Another acupuncture study
showed increased pain relief with
less pelvic and low-back pain, better
capacity to work, walk and perform
general daily tasks, and lower
reliance on paracetamol (Acupunct
Med, 2004; 22: 60–7).
! relieve labour pain.
In China, acupuncture is routinely
used instead of anaesthesia in 99
per cent of caesarean sections, and
sometimes for pain relief during
labour (J Nurse Midwifery, 1982; 27:
15–22).
The use of acupuncture appears
to cut down the need for
conventional pain relief. A
randomised, controlled trial of 90
birthing women found that women
having acupuncture required less
epidural analgesia and felt more
relaxed than those who had
conventional analgesia alone (Br J
Obstet Gynaecol, 2002; 109: 637–44).
A larger randomised, controlled
study the following year noted much
the same: meperidine, a narcotic
typically administered during
childbirth, was requested by just 11
per cent of those receiving
acupuncture, compared with more
than three times as much among
those not having acupuncture (Clin J
Pain, 2003; 19: 187–91).
Babies and mothers who used
acupuncture during pregnancy or
labour (most often for pain and
anxiety) have even been followed-up.
One such study concluded that it
was safe and effective, and without
significant side-effects (Ugeskr Laeger,
2003; 165: 1023–7).
Or try these alternatives:
! Water aerobics.
One high-quality study of low-
back and pelvic pain in pregnancy
reported that those who did water
gymnastics took significantly fewer
sick days during pregnancy than
those who did not (Acta Obstet Gynecol
Scand, 2003; 82: 983–90).
! Birthing pool.
A randomised, controlled trial of
found that those who used
birthpools required significantly less
analgesia and had fewer forceps
deliveries than standard bed
deliveries.
Kim Wallace

Other ways to push your buttons

Several methods using acupuncture points have been studied and found to be useful for pain relief, including:
! Acupressure, which applies pressure to specific points along the energy meridians of the body. In a randomised,
controlled trial of 75 labouring women, the duration of labour and pain were both reduced by 30 minutes of acupressure
on the Spleen 6 (SP6) acupoint, located about 6 cm (just over 2 in) above the inside ankle, compared with just touching
the SP6 acupoint (controls) (J Altern Complement Med, 2004; 10: 959–65).
! Electroacupuncture, which uses low-voltage electricity on the acupuncture needles to produce bigger effects. although
a 1985 study only found “moderate results” with electroacupuncture for pain relief (Zentralbl Gynakol, 1985; 107: 532–8). A later
study using electroacupuncture during IVF egg retrieval concluded that it was an effective drug-free way to relieve pain
(Hum Reprod, 2005; 20: 728–35).
! Transcutaneous electrical nerve stimulation (TENS), which transmits electrical impulses via electrodes, brought about
pain relief in around 60 per cent of the 209 patients in one study, as well as significantly reduced the time to delivery
(Zentralbl Gynakol, 1985; 107: 532–8).

WDDTY Women’s health 9

Contraception, pregnancy and birth

Postnatal depression:
a bad case of the blues
Postnatal depression is a
crippling mood disorder
that can have long-lasting
effects for both mother
and baby. Happily, there
are a number of natural
ways to prevent and treat
it—from supplements to
massage therapy

N
ew evidence now suggests
that a simple supplement
could be the key to
preventing postnatal depression
(PND), a devastating condition
that affects 10 to 15 per cent of
women after having a baby.
Selenium—a trace mineral
found naturally in foods such as
Brazil nuts and fish—has
previously been shown to reduce
the risk of cancer, infertility and a
range of other conditions. Now,
researchers have found that taking
100 mcg/day of selenium during
pregnancy can effectively ward off
PND.
In a randomized, double-blind,
placebo-controlled trial (con-
sidered the ‘gold standard’ for
scientific evaluation), 166 women,
pregnant for the first time and in
their first trimester of pregnancy,
took either selenium or a dummy
pill every day until delivery. After
deliver y, the women were
monitored for symptoms of PND
over a period of eight weeks, using
the Edinburgh Postnatal Dep-
ression Scale.
The researchers found that the
women who had supplemented with
selenium had significantly higher
levels of the nutrient in their blood depression,” the researchers the mood disorder (J Nutr Environ
by the time they gave birth. More concluded (J Matern Fetal Neonatal Med, Med, 1992; 3: 35–42 ). In addition,
important, their ratings of depress- 2010 Jun 8; Epub ahead of print). other evidence suggests that
ion were significantly lower com- Although more research is inadequate intakes of vitamin B12
pared with the controls. needed to confirm these results, and folate, iron and calcium—
“These findings suggest that this study was not the first to commonly seen in pregnant women
supplementation with selenium suggest a link between nutrition who consume a typical Western
during pregnancy might be an and PND. Indeed, almost 20 years diet—could also be contributing to
effective approach for the ago, a UK study proposed that low PND ( J Am Diet Assoc, 2009; 109:
prevention of postpartum levels of zinc might play a role in 1566–75).

10 WDDTY Women’s health

 Most of the research, however,
has focused on omega-3 fatty acids.
Numerous studies have found a
correlation between low levels of
these essential fats—found in oily
fish and flaxseed—and a higher
incidence of maternal depression
(J Am Diet Assoc, 2009; 109: 1566–75).
In one study, Belgian
researchers compared 10 women
with PND and 38 women without
the condition. They found that
those with the disorder were more
likely to have low concentrations of
omega-3s, as well as a higher ratio
of omega-6 (found in vegetable
oils, mayonnaise, almonds, chicken
and turkey) to omega-3 fats (Life
Sci, 2003; 73: 3181–7).
Another study looked at fish
consumption during pregnancy
and found that women with the
lowest intakes were more likely to
be taking antidepressants for PND
(Am J Clin Nutr, 2009; 90: 149–55).
These studies suggest that
supplementing with omega-3
might be a simple way to prevent
and treat PND. In fact, a
preliminary trial showed that PND
symptoms were cut nearly in half
with eight-week supplementation
of eicosapentaenoic acid (EPA) and
docosapentaenoic acid (DHA) (Acta
Psychiatr Scand, 2006; 113: 31–5 ). Taking
a daily multivitamin/ mineral
supplement may also be beneficial.
Treatments that work
Good nutrition is not the only way
to counteract PND. Studies show a
variety of ways to deal with the
disorder without resorting to
dangerous antidepressants.
! Breastfeeding. According to a
recent review, breastfeeding is
one of the best ways to prevent
and treat PND, providing it does
not cause pain or other
problems. When breastfeeding
goes well, it protects mothers
against stress ( Int Breastfeed J,
2007; 2: 6). One US study found
that breastfeeding women had
lower perceived stress,
depression and anger, and
reported more positive life
events, than did formula-feeders
(Biol Res Nurs, 2005; 7: 106–17). In
another study, women with PND
were significantly less likely to
PND: an inflammatory response
Recent research has pinpointed inflammation as a key factor in depression.
One review, carried out by University of New Hampshire researcher Kathleen
Kendall-Tackett, noted that increased inflammation in the blood is not simply
a risk factor for depression, but is the risk factor that underlies all others. In
other words, inflammation is the mechanism by which previously identified
risk factors—such as psychological trauma, sleep problems, low income and
lack of social support—increase the risk of depression.
Postnatal women are particularly vulnerable because their inflammation
levels are naturally and inevitably elevated in the last trimester of pregnancy,
and this increase persists after giving birth. Moreover, the common
experiences of new motherhood, such as sleep disturbance, postnatal pain
and past or current psychological trauma, act as stressors to cause
inflammation levels to rise even further.
According to Kendall-Tackett, treatments that reduce inflammation and
lower maternal stress—such as breastfeeding, omega-3 supplements and
exercise—are particularly effective against PND. If left untreated, however, it
can persist for a year or more.
One new avenue of research would be to determine whether or not anti-
inflammatory approaches—used proactively—can stop depression from
arising in the first place (Int Breastfeed J, 2007; 2: 6).
be breastfeeding, and more can improve PND as well as
likely to report that they were mother–infant interactions ( J
suffering from greater life stress Affect Disord, 2008; 109: 189–92).
and anxiety ( Psychoneuro- Giving massage to mothers
endocrinology, 2007; 32: 133–9). may also have benefits. Mothers
! Exercise. Regular exercise is who received aromatherapy
known to have stress-reducing massage showed significant
and antidepressant effects (Prev improvements in both physical
Med, 2000; 30: 17–25 ). Indeed, and mental status compared
aerobic exercise proved to be with those who did not ( J
just as effective as the Midwifery Womens Health, 2006; 51:
antidepressant sertraline for e21–7 ). Also, pregnant women
major depressive disorder—and given two massage therapy
with lower rates of relapse sessions a week for 12 weeks by
(Psychosom Med, 2000; 62: 633–8). In their partner were less
new mothers, a programme of depressed than controls after
exercise and health-care giving birth, and also showed
education was found to improve lower levels of cortisol, the
postnatal wellbeing and cut the stress hormone. Their newborns
risk of developing PND by 50 per were also less likely to be born
cent (Phys Ther, 2010; 90: 348–55). prematurely and to have low
As it may be difficult for new birth weights ( Infant Behav Dev,
mothers to find the time to 2009; 32: 454–60).
exercise, joining a pram-walking ! Bright-light therapy. Intro-
group may be more feasible than duced to treat SAD (seasonal
joining a gym. One trial found affective disorder), photo-
that just such a pram-walking therapy may also help in PND.
programme was more effective Controlled trials are lacking,
than attending a social-support but the case studies of two
group for reducing symptoms of women with postpartum
PND. A bonus was that, as the depression showed significant
women’s fitness levels improved, reductions (by 75 per cent) in
so did their symptoms (Int J Nurs depression scores, using the
Pract, 2004; 10: 177–94). Hamilton Rating Scale for
! Massage. Studies show that Depression, after just four weeks
attending a baby-massage class of daily, 10,000-lux, bright-light
WDDTY Women’s health 11
Contraception, pregnancy and birth

therapy (Am J Psychiatry, 2000, 157: of depression during the

303–4).
! Transcranial magnetic stimula-
tion (TMS). This non-invasive
brain-stimulation technique was
recently tested on nine anti-
depressant-free women with
PND. After receiving
repetitive TMS sessions for four
weeks, the new mothers were
then assessed after 30 days,
three months and six months.
The results showed a signifi-
cant reduction in depression
symptoms by the end of the
second week of treatment. After
four weeks, eight out of nine
patients had complete remission
of symptoms and, at the six-
month follow-up, seven of these
patients were still depression-
free (Brain Stimul, 2010; 3: 36–41).
! Acupuncture. This can work just
as well as the proven
conventional treatments for
major depression ( Complement
Ther Med, 2001; 9: 216–8), and one
trial even found acupuncture to
be promising for the treatment
pregnancy (J Affect Disord, 2004; 83:
89–95).
! St John’s wort. This herb
(Hypericum perforatum) is a
well-known treatment for
depression. However, some
20 experts note that long-term
studies are needed to determine
its safety during breastfeeding
(Pharmacopsychiatry, 2002; 35: 29–30).
Nevertheless, in one Canadian
study with a follow-up period of
two years, the herb had no
adverse effects on either milk
production or infant growth (J
Clin Psychiatry, 2003; 64: 966–8).
! Cognitive therapy. Several
studies have found that ‘talking’
therapies can help women with
PND. Indeed, women who
received therapy focused on
interpersonal relationships and
role changes were more likely to
recover from their depressive
episodes than women not so
treated (44 per cent vs 14 per
cent, respectively) (BMJ, 2003; 327:
1003–4).
! Peer and midwife support. In

More than just the baby blues fact, just talking to someone who
has experienced PND and suc-
ceeded in overcoming it can be
Most women experience the ‘baby blues’ after giving birth, and such feelings effective in preventing it. A
can last from a few hours to a few weeks. Symptoms include mood swings, Canadian study found that
anxiety, sadness and irritability, but no treatment is generally necessary. women who spoke to volunteer
However, PND is a more severe form of depression that can eventually mothers over the phone were less
interfere with the new mother’s ability to care for her baby and manage other likely to be depressed after giving
everyday tasks. Untreated, it can persist for a year or more. The symptoms of birth compared with those who
PND may include: received the standard care (BMJ,
! loss of appetite 2009; 338: a3064).

! insomnia Midwives can also play a role in

reducing the risk of developing
! severe mood swings
PND. A British study compared
! intense irritability and anger conventional postnatal care—
! overwhelming fatigue regular visits by the midwife for
! loss of interest in sex the first two weeks, followed by
! lack of joy in life health-visitor checks and a GP
! feelings of shame, guilt or inadequacy appointment within six to eight
weeks—with midwife-led person-
! difficulty bonding with the baby
alized care for three months. The
! withdrawal from family and friends women receiving the midwife-led
! thoughts of self-harm or to the baby. care showed significantly better
Rarely, an extreme form of depression can develop after childbirth that is psychological wellbeing, with an
known as ‘postnatal psychosis’. As well as the symptoms of PND, mothers overall 40-per-cent reduction in
with this disorder may also suffer from delusions, hallucinations and irrational the risk of depression (Lancet,
or suicidal thoughts. 2002; 359: 370–1, 378–85).
Source: Mayo Clinic (www.mayoclinic.com) Joanna Evans

12 WDDTY Women’s health

Infertility
and assisted reproduction
Given the risks that can affect both the mothers and their infants with ART,
it’s worth considering more natural means of correcting infertility
B
abies born as a result of in-vitro
fertilization (IVF) are up to two
times more likely to have birth
defects than those born naturally, says
an alarming study from France.
The study—the largest of its kind
so far—looked at more than 15,000
children conceived through assisted
reproductive technology (ART), which
includes IVF and ICSI (intracyto-
plasmic sperm injection). Led by Dr
Géraldine Viot, a clinical geneticist at
a hospital in Paris, it found a major
congenital malformation in 4.24 per
cent of children vs the 2–3 per cent
reported in the general population.
This higher rate of birth defects
was due in part to an excess of heart
disease and malformations involving
the urinary tract and reproductive
organs. Also, among the minor mal-
formations, there was a fivefold higher
rate of angiomas, benign tumours
made up of small blood vessels lying
on or near the surface of the skin
(Proceedings of the Annual Conference of the
European Society of Human Genetics, 12–15
June 2010, Gothenburg, Sweden; Abstract no.
313).
Although more research is needed,
this is not the first time that infertility
treatments have been linked to birth
defects. Previous studies have reported
a rate of major malformations as
high as 11 per cent. Yet, according to
Dr Viot, couples considering ART are
often kept in the dark concerning the
associated risks. She’s now calling
on fertility clinics to routinely warn
prospective parents of the dangers,
regardless of whether or not such data
are specifically asked for.
A report last year by the US Centers
for Disease Control and Prevention
(CDC) came to the same conclusion.
After analyzing data from the National
Birth Defects Prevention Study, babies
conceived through ART were found to
be two to four times more likely to
have birth defects compared with
babies born naturally. Of pregnancies
resulting in a single birth, ART was
associated with twice the risk of heart
defects and more than twice the risk
of a cleft lip, with or without a cleft
palate, and more than four times the
risk of gastrointestinal defects.
Whether these malformations are
caused by ART or by infertility itself
is not clear. In any case, it’s believed
that it is important to inform couples
considering ART of all the potential
risks and benefits (Hum Reprod, 2009; 24:
360–6).
Other ART-ful risks
Sadly, it’s not only birth defects that
are linked to ART. A study presented
at this year’s International Meeting
for Autism Research in Philadelphia
revealed that children born through
IVF are more likely to be diagnosed
with autistic spectrum disorder (ASD).
The findings, based on 564 children
visiting an autism centre in Israel,
showed that 10.2 per cent of children
with ASD were conceived using IVF, a
significantly higher rate than the 3.5
per cent seen in the general Israeli
population (Proceedings of the 9th Annual
International Meeting for Autism Research, 20–22
May 2010, Philadelphia, PA; Abstract no.
103.004).
Although it’s too early to draw any
definitive conclusions, Dr Ditza
Zachor, lead author of the study,
suggests that ‘imprinting’ might
explain their findings. This refers to a
biochemical process that takes place
during cell division and determines
the genes to be selected or ‘expressed’
in the embryo. Epigenetic studies—of
changes in gene expression that occur
without changing the DNA sequence—
suggest that malformations may be
caused by imprinting abnormalities
introduced into the embryo while it’s
in the test-tube, says Dr Zachor. One
such disorder linked to IVF is the
Angelman syndrome, characterized by
severe learning difficulties, seizures
and jerky movements. Something
similar might be going on with autism.
The single biggest risk with ART is
for multiple births, which increases
the chances of stillbirths, neonatal
deaths and disability in the children
born. The UK’s Human Fertilisation
and Embryology Authority (see www.
hfea.gov.uk) says that, on average, one
in four IVF pregnancies are a multiple
pregnancy compared with one in 80
for women who conceive naturally.
Babies are also more likely to be
born prematurely and, so, are under-
weight at birth (Eur J Obstet Gynecol
Reprod Biol, 2009; 146: 138–48). This can
lead to a number of health problems
such as visual impairment and
cerebral palsy. Indeed, children born
through IVF are about twice as likely
to have cerebral palsy (Arch Pediatr
Adolesc Med, 2009; 163: 72–83).
There are also risks to the mother,
such as ectopic pregnancy and ovarian
hyperstimulation syndrome (OHSS), a
potentially dangerous overreaction to
the drugs used to stimulate egg pro-
duction. Even more worrying is that
ART might increase the risk of cancer
WDDTY Women’s health 13
Contraception, pregnancy and birth
(Int J Fertil Womens Med, 2005; 50: 259–66).
What to do instead
While many couples may believe that
assisted reproduction is their only
option for conception, in fact, there
are a number of natural ways to boost
fertility and pregnancy.
! Eat well. To raise levels of fertility
hormones, follow a varied whole-
food diet with high-quality proteins,
and plenty of fresh vegetables and
fruits, and drink only filtered or
glass-bottled water.
! Maintain a healthy weight. Being
either too overweight or under-
weight can contribute to infertility
(Fertil Steril, 1988; 50: 721–6).
! Stop smoking. A British study of
more than 17,000 women found
that the more cigarettes a woman
smokes per day, the less likely she is
to conceive (Br Med J (Clin Res Ed),
1985; 290: 1697–700). Smoking has a
negative impact on male fertility,
too (Acta Med Port, 2009; 22: 753–8).
! Avoid alcohol. Even moderate
drinking of alcohol (five or fewer
drinks per week) can contribute to
infertility in women (BMJ, 1998; 317:
505–10). Also, the risk of endometri-
osis, a common cause of infertility,
was around 50-per-cent higher in
women with any amount of alcohol
intake compared with teetotallers
(Am J Public Health, 1994; 84: 1429–32).
! Limit caffeine. In 104 healthy
women trying for a baby, those who
consumed a cup of coffee or more
a day were half as likely to become
pregnant, per cycle, as women who
drank less than that (Lancet, 1988; 2:
1453–6). Indeed, the more caffeine—
from any source (tea, cola drinks,
chocolate)—the lower the chances
of pregnancy (Reprod Toxicol, 1998; 12:
289–95). Caffeine also appears to
enhance the negative effects of
alcohol (Fertil Steril, 1998; 70: 632–7).
! Investigate allergies. Food allergies
such as coeliac disease may also
play a role in infertility (J Reprod Med,
2010; 55: 3–8). One case study was of
a woman with primary infertility
and coeliac disease. Eight months
after being put on a gluten-free
diet, she conceived. The researchers
concluded that “coeliac disease
should be checked in infertile
patients of unexplainable aetiology
with anaemia, as just changing
14 WDDTY Women’s health
Potential treatments for women
! Propolis. In a preliminary study of women with infertility and mild
endometriosis, supplementation with bee propolis (500 mg twice a day
for nine months) was associated with a pregnancy rate of 60 per cent
compared with only 20 per cent in those taking a placebo (Fertil Steril, 2003;
80 suppl 3: 32).
! Vitamin C may be useful for women with luteal phase defect (LPD), a
hormonal abnormality that commonly leads to infertility. In infertile women
with LPD, 750 mg/day of the vitamin taken for up to six months led to a
pregnancy rate of 25 per cent compared with 11 per cent in the untreated
control group (Fertil Steril, 2003; 80: 459–61).
! Multivitamins. Taking just a simple multivitamin was found to increase
female fertility in one trial. Compared with the placebo group, those
taking a multivitamin supplement took 5-per-cent less time to conceive (Int
J Vitam Nutr Res, 1996; 66: 55–8).
! L-Arginine (16 g/day) can improve fertilization rates in women with a
history of failed IVF attempts (Hum Reprod, 1999; 14: 1690–7). The amino acid
can also improve sperm counts and sperm motility in men, as can
carnitine, zinc, selenium and vitamin B12 (Altern Med Rev, 2000; 5: 28–38).
! Agnus castus. In one double-blind trial, more infertile women became
pregnant after taking a product containing this herb (30 drops twice a day
for three months) than did those who took a placebo ( Forsch
Komplementärmed, 1998; 5: 272–8).
! Acupuncture. In 104 women with unexplained infertility, a 60-per-cent
pregnancy rate for seen in those who underwent six months of treatment
with a standard therapeutic package of acupuncture plus moxibustion
and herbal medicine developed in a hospital in Seoul, Korea (J Altern
Complement Med, 2010; 16: 193–8
their diet can solve their fertility to poor sperm quality and infertility
problem” (Fertil Steril, 2010 May 25; Epub (Nutr Res, 2009; 29: 82–8).
ahead of print). ! Get yourself tested for infections.
! Consider nutritional deficiencies. Genital infection is a major cause
A study by Dr Stephen Davies, of of infertility worldwide (Enferm Infecc
the Biolab Medical Unit in London, Microbiol Clin, 2001; 19: 261–6).
showed that magnesium deficiency Chlamydia trachomatis infections
is associated with female infertility, are the most common, and their
increased miscarriage rates, and incidence has increased over the
increased incidences of premature past 10 years. When left untreated,
and low birth-weight babies. Mag- Chlamydia infection leads to a large
nesium supplements were given to proportion of cases of salpingitis
six magnesium-deficient women (inflammation of the fallopian
who had unexplained infertility. tubes), ectopic pregnancy and
After four months of treatment, all infertility (Clin Microbiol Infect, 2009; 15:
six conceived within the following 4–10).
eight months and produced normal ! Manage stress. Infertile couples
healthy babies. tend to be more stressed out than
Six other women with unexplain- fertile couples, which suggests that
ed infertility, whose magnesium stress might have adverse effects on
levels did not normalize after four reproductive health (Int J Fertil, 1986;
months of treatment, did so after a 31: 153–9). This also suggests that
further two months of magnesium relaxation techniques, such as
plus selenium supplementation. meditation and yoga, may well be
These women also conceived within beneficial (Fertil Steril, 2003; 80 Suppl 4:
the following eight months, and all 46–51).
gave birth to normal healthy babies ! Avoid environmental toxins.
(Magnes Res, 1994; 7: 49–57). In men, Infertility may be caused by
low levels of zinc have been linked commonly found contaminants in
the environment. Nowadays, we are
all bombarded by an ever-increasing
array of toxic chemicals—many of
which are hormone mimics or
disruptors—as we go about our
daily lives. The main chemicals of
concern for women include:
" perfluorinated chemicals (PFCs),
which are used in a variety of
consumer goods—from non-stick
cookware (Teflon) and carpets to
pesticides and personal-care items.
A recent study found that women
with high blood levels of two types
of PFCs took significantly longer
to become pregnant and were more
likely to be infertile (Hum Reprod,
2009; 24: 1200–5).
" bisphenol A (BPA), a plastics
chemical known to leach from food
and drink containers into the food
that we then eat. Blood levels of
BPA in women have been linked to
recurrent miscarriages, endo-
metrial hyperplasia (where the
lining of the womb becomes
abnormally thick) and polycystic
ovary syndrome (PCOS), one of the
most common causes of female
infertility (Hum Reprod, 2005; 20:
2325–9; Endocr J, 2004; 51: 595–600;
Endocr J, 2004; 51: 165–9).
" chlorinated hydrocarbons (or
CHCs), a class of persistent environ-
mental toxins such as dioxins,
polychlorinated biphenyls (PCBs)
and organochlorine pesticides. One
study found that women with
uterine fibroids, endometriosis,
miscarriages, persistent infertility
and hormonal disturbances had
higher than usual concentrations
of CHCs in their blood (Environ Res,
1999; 80: 299–310).
Although it’s impossible to avoid
all such dangerous chemicals, there
are ways to minimize your exposure
(see WDDTY vol 20 no 8) and to
detoxify your body (see WDDTY vol
20 no 10).
The Foresight programme
There’s a distinct lack of research on
the effect of preconception advice on
the chances of a live birth and other
fertility outcomes (Cochrane Database
Syst Rev, 2010; 4: CD008189).
However, the British charity
Foresight, the Association for the
Promotion of Preconceptual Care, has
managed to accumulate an impressive
success rate. Over 75 per cent of
couples who had problems with
infertility went on to have babies using
the Foresight programme—a method
that addresses all of the factors listed
above and more. Compare this with
the chances of success with IVF—
which, at best, is only 28.6 per cent
(see www.hfea.gov.uk/ivf-success-rate.
html). Among the minority that still
needs or wants IVF, Foresight can raise
the couple’s chances of success with
a 43.5-per-cent pregnancy rate.
To find out more about the
Foresight Fertility Programme, visit
www.foresight-preconception.org.uk
or call 01243 868 001.
One final option to consider is
adoption or fostering, as there’s no
shortage of foreign-born babies and
domestic children who are in need of
loving homes.
Joanna Evans
WDDTY Women’s health 15
Female complaints
Urinary tract
infections
UTIs are some of the most common infections in women,
but there’s a simple way to prevent them, according to
the latest evidence
I
f you’re one of the millions of
women plagued by recurrent
urinary tract infections (UTIs),
you’ve probably had your fair share
of antibiotics—the conventional
doctor’s only answer to this
common problem. But there’s a
much simpler and safer solution,
according to the latest research,
and you might even already have it
in your fridge.
Cranberry juice, that old folk
remedy often recommended for
cystitis and other UTIs, is now
finally getting the credit it
deserves from the scientific
community. In a study presented in
Boston, MA, at the 240th National
Meeting of the American Chemical
Society (ACS), it was revealed that
cranberr y juice can effectively
prevent UTIs by fighting the
Escherichia coli bacteria that
cause them.
The study involved growing
strains of E. coli—the most
common cause of UTIs—in urine
collected from healthy volunteers
before and after drinking
cranberry juice. The E. coli were
then tested for their ability to stick
together to form biofilms—thin,
slimy layers of these micro-
organisms, surrounded by their
own secretions, that provide an
ideal environment in which they
can thrive. E. coli bacteria that
don’t stick together are more
likely to be flushed out of the
urinary tract.
The results showed that
cranberry juice prevented E. coli
from sticking to either each other
or to the surface of a plastic petri
dish within just eight hours of
consumption. This suggests that
the beneficial active ingredients in
cranberry juice are quick to reach
the urinary tract and can prevent
an infection from developing in the
16 WDDTY Women’s health
first place ( www.sciencedaily.com/
releases/2010/08/ 100823183807.htm).
This research has important
implications, considering just how
big a problem UTIs are worldwide.
In the US alone, UTIs account for significantly reduce the incidence
around eight million medical visits of UTIs over a 12-month period,
each year, for a total annual cost of particularly in women who suffer
more than $1.6 billion (Dis Mon, from recurrent infections,
2003; 49: 53–70). What’s more, this compared with a placebo control
evidence confirms the results of ( Cochrane Database Syst Rev, 2008; 1:
recent controlled clinical trials— CD001321).
high-quality scientific studies However, as yet, there’s no
carried out in people—which found evidence to show that cranberry
that cranberries, in various forms, can be used to treat a UTI once
can reduce the incidence of UTIs in you’ve already got one (Drugs, 2009;
women who are prone to these 69: 775–807).
infections. The proanthocyanidins in
In one study, a year-long trial of cranberr y belong to a class of
150 sexually active women aged flavanols known as ‘condensed
21–72 years, participants were tannins’, and are thought to be
assigned to one of three groups responsible for its beneficial
and given either organic cranberry effects in the urinary tract. Other
juice plus placebo tablets, plant extracts also contain these
cranberr y tablets plus placebo proanthocyanidins, but it’s the
juice, or placebo tablets and specific structure of cranberr y
placebo juice. The juice dose was proanthocyanidins that makes
250 mL drunk three times daily, them particularly effective against
while the tablets were taken two UTI-causing bacteria (Altern Med Rev,
times a day. 2008; 13: 227–44).
Cranberry, in the form of either
juice or tablets, significantly
reduced the number of women who
went on to experience at least one
UTI per year (to only 20 per cent
and 18 per cent of women with
juice and tablets, respectively)
compared with the placebo (32 per
cent of women). Also, both
cranberry groups needed to take
fewer antibiotics during the course
of the year compared with the
placebo group (Can J Urol, 2002; 9:
1558–62).
Another review—this time, a
pooled meta-analysis carried out by
the prestigious Cochrane
Collaboration of the results of 10
trials—concluded that cranberry
products (juice and tablets) can
 What causes UTIs?
Urinary tract infections typically arise when bacteria enter
the urinary tract via the urethra and multiply in the
bladder. Women are especially susceptible because of
their anatomy—the close proximity of the urethra to the
anus, and the short distance from the urethral opening to
the bladder. Having sex can sometimes trigger UTIs in
women, as bacteria may then be pushed into the urethra.
Using a diaphragm can also lead to infections, as the
device can push against the urethra, making it harder to
completely void the bladder. Any urine that remains is
more likely to grow bacteria and cause infections. Here
are some tips that can help to prevent UTIs.
! Drink plenty of water, as this will flush the bacteria
away
! Don't hold your urine—always go when you feel you
need to
! Wipe yourself from front to back, as this helps to
prevent bacteria in the anal region from spreading to
the vagina and urethra
! Urinate after having sex to help eliminate bacteria
! Avoid potentially irritating feminine products, such as
deodorant sprays or powders
! Avoid using a diaphragm as a birth-control method if
you’re prone to UTIs.

In general, drinking 300–500
mL/ day of unsweetened cranberry
juice is recommended for UTI
prevention, or you could take 400
mg of concentrated cranberr y
extract twice a day.
Other natural approaches
Besides consuming cranberr y
products, there’s a variety of other
natural ways to prevent UTIs.
! Probiotics. As E. coli, the
primary pathogen involved in
UTIs, travels from the intestines
and/or vagina to inhabit the
normally sterile urinary tract,
improving either the gut or
vaginal flora can have a
beneficial impact on the urinary
tract ( Altern Med Rev, 2008; 13:
227–44). Indeed, clinical studies
show that certain probiotics—
whether taken orally or used as
vaginal suppositories—appear to
be effective in preventing UTIs.
In one preliminary trial of
nine women suffering from
recurrent UTIs, a vaginal
suppository containing Lacto-
bacillus crispatus, used every
other night for a year, led to a
marked reduction in recurrence
rates. Prior to treatment, the
women had an average of five
infections every year, but this
was reduced to only one bout of
infection during the year they
were treated with the probiotic
( Int J Antimicrob Agents, 2006;
28 Suppl 1: S30–4).
In another, larger-scale
placebo-controlled study, women
with UTIs were treated with
antibiotics for three days
(although recurrences were seen
in 29 per cent and 41 per cent of
those taking norfloxacin and
trimethoprim/sulphamethoxazo
le, respectively), which was
followed by a course of either
suppositories containing Lacto-
bacillus or a placebo. The results
showed that the recurrence rate
was 21 per cent in the probiotic
group compared with 47 per
cent in the placebo group (Clin
Ther, 1992; 14: 11–6).
Oral probiotics, such as L.
rhamnosus GG, have also been
shown to cut the incidence of
UTIs, although the evidence
mostly comes from studies in
children (Altern Med Rev, 2008; 13:
227–44).
! Vitamin C. In a study of more
than 100 pregnant women—who
are, as a group, particularly
prone to UTIs—half were given
200 mg of ferrous sulphate, 5
mg of folic acid and 100 mg of
vitamin C daily, while the other
half received only the ferrous
sulphate and folic acid. After
three months, the researchers
found that the occurrence of
UTIs was significantly lower (13
per cent) in those taking
vitamin C compared with those
not taking vitamin C (29 per
cent) ( Acta Obstet Gynecol Scand,
2007; 86: 783–7).
It’s thought that vitamin C
(ascorbic acid) may work by
acidif ying urine, thereby
creating an essentially
‘unfriendly’ environment for
infection-causing bacteria such
as E. coli ( Nitric Oxide, 2001; 5:
580–6). Alternatively, it could be
that the vitamin’s antioxidant
activity is responsible for the
beneficial effects ( Mediators
Inflamm, 2005; 2005: 242–4).
! Vitamin A. One small
randomized controlled trial has
suggested that vitamin A may be
helpful against recurrent UTIs.
A group of 24 sufferers were all
treated with antimicrobial
therapy, but half of them also
received a single dose of vitamin
A (200,000 IU), while the other
half were given a placebo. In the
follow-up a year later, the group
given vitamin A had suffered
significantly fewer UTIs
compared with the placebo
group. “Vitamin A supple-
mentation may have an adjuvant
effect on the treatment of
[recurrent UTIs],” the
researchers concluded (Pediatr Int,
2007; 49: 310–3).
! Uva ursi. Also known as
bearberr y (full name:
Arctostaphylos uva ursi), this
antimicrobial herb is commonly
used to prevent and treat UTIs.
However, no studies have ever
been conducted to confirm its
efficacy as a treatment,
although one clinical trial
suggests that it’s an effective
preventative.
This randomized controlled
trial of 57 women with chronic
cystitis showed that a
supplement containing stand-
ardized extracts of uva ursi leaf
as well as dandelion root and
leaf (the latter providing
diuretic effects), taken for one

WDDTY Women’s health 17

Female complaints

month, can effectively reduce

the rate of infection during the
following year. Indeed, a year
later, no one had suffered an
infection in the uva
ursi/dandelion group, whereas
five women in the placebo group
did (Curr Ther Res, 1993; 53: 441–3).
According to one review of
the literature, uva ursi is best
used at the first sign of an
infection or for short-term
prevention (Altern Med Rev, 2008; 13:
227–44). However, you should also
consult a qualified herbalist for
advice on the optimal dosage.
! D -Mannose. This simple sugar
appears to work in a way similar
to cranberry juice, preventing
certain bacterial strains from
adhering to the lining of the
urinary tract. In a mouse study,
alpha- D -mannose not only
prevented adhesion of E. coli, Bible for Women (London: heat and allow it to cool. Sip a
but also blocked its invasion Duncan Baird Publishers, 2010), cupful over the course of the
into bladder cells and its offers the following dietar y day.
subsequent biofilm formation advice for women prone to UTIs. Any leftover barley water can
(PLoS One, 2008; 3: e2040). " Avoid acidic foods and drinks be stored in an airtight
However, as clinical trials are such as tea, coffee, alcohol, container in the fridge for up to
lacking, we don’t yet know sugar, meat, spicy foods and 24 hours.
whether people who take oral D- undiluted citrus juices, all of " Eat garlic, which helps to
mannose would experience the which can trigger the problem. eliminate E. coli and the other
same effects. Keep a food diary to see if any bacteria in UTIs. Raw garlic is
Nevertheless, a few test-tube other type of food or drink more effective than cooked, so
studies have looked at the might be a trigger in your chop it up finely and sprinkle
impact of D -mannose in cells particular case. over salads or use it in dressings.
taken from both healthy women " Drink plenty of water. But if Alternatively, take garlic as a
and those with recurrent UTIs, you already have an infection, supplement (1000 mg/day of
and found that D-mannose can you can make barley water: aged garlic).
effectively inhibit nearly half of Bring 11/4 L (2 pints) of water to " Eat organic live plain yoghurt,
the E. coli strains found in the the boil, then add 40 g (11/2 oz) which contains beneficial
human urinary tract (Altern Med of whole barley and simmer for bacteria (probiotics) that help to
Rev, 2008; 13: 227–44). 20 minutes; add the juice of one recolonize your gastrointestinal
! Acupuncture. A controlled study lemon, and simmer for a further system with beneficial flora.
comparing real and fake 10 minutes; remove from the Joanna Evans
acupuncture, and no treatment,
in women with recurrent UTIs
found that, after six months, 85
per cent of those receiving the
Treating UTIs naturally
genuine acupuncture had
Urinary tract infections can spread from the bladder to the kidneys and may
suffered no UTI episodes
lead to permanent kidney damage, so it’s important to see a doctor at the
compared with 58 per cent in
first sign of infection. However, if you don’t want to take antibiotics to get rid
the sham group, and 36 per cent
of the infection, consider seeing a qualified homeopath or herbalist, who
in the untreated group (Scand J
can prescribe remedies according to your symptoms.
Prim Health Care, 1998; 16: 37–9). A
Herbal remedies may be especially useful, as many of these have a long
more recent trial also showed
history of success in the treatment of UTIs. These traditionally include
similar results (Am J Public Health,
Agrimonia eupatoria (agrimony), Althea officinalis (marshmallow), Apium
2002; 92: 1609–11).
graveolens (celery seed), Arctium lappa (burdock) and Zea mays (corn silk)
! Diet. Dr Marilyn Glenville, in
(Altern Med Rev, 2008; 13: 227–44).
her book The Natural Health

18 WDDTY Women’s health

Varicose veins
Varicose veins affect nearly a third of us and rarely go
away on their own so, thankfully, there’s a range of
herbs and supplements that can help
V
aricose veins are veins that
have become twisted and
swollen because blood isn’t
flowing through them properly.
They can develop anywhere in the
body, but the veins in the legs are
the most commonly affected, as
they have to move blood along
against gravity. Increased blood
pressure and hormonal changes
during pregnancy can also trigger
the problem, which helps to explain
the higher incidence of varicose
veins in women than in men
( Cochrane Database Syst Rev, 2007; 1:
CD001066).
For many sufferers, varicose
veins are simply a cosmetic
concern. Others, however, may
experience aching, throbbing,
itching or burning sensations,
which usually worsen with pro-
longed standing.
Rarely, varicose veins can lead
to more serious problems such as
infection, leg ulcers and thrombo-
sis ( Am Fam Physician, 2008; 78:
1289–94).
Treating varicose veins
Conventional treatment of varicose
veins includes a range of options—
from compression stockings to
surger y and laser treatments.
Compression stockings, which
steadily squeeze the legs to
improve blood flow, are usually the
first course of action, but studies
conclude that they are no more
effective than simply resting
( Cochrane Database Syst Rev, 2007; 1:
CD001066).
Surgery, on the other hand, can
effectively get rid of these unsightly
veins and help to relieve symptoms.
However, varicose veins may
gradually recur through a process
of ‘neovascularization’—regrowth
and enlargement of veins—even
after successful surgery, or they
may simply develop elsewhere in
the legs ( BMJ, 2006; 333: 287–92 ).
Other possible complications
include bleeding, bruising, infec-
tion, scarring and nerve damage.
There is also evidence that
suggests that surgery for varicose
veins might even increase the risk
of thrombosis (blood clots) (BMJ,
1996; 312: 1158).
Two newer treatments are
radiofrequency ablation and laser
treatment, which use heat to seal
off varicose veins. These less
invasive techniques appear to be
at least as effective as surgery,
but with fewer risks (J Vasc Surg,
2009; 49: 230–9).
Nevertheless, we still don’t
know how safe and effective these
treatments are in the long term.
Yet another option is sclero- vascularization remains
therapy, in which chemicals are high. There are also
injected into varicose veins to concerns over the development of
cause their walls to collapse. This deep vein thrombosis (DVT), visual
can be effective for smaller varicose disturbances and stroke (Am Fam
veins, but the risk of neo- Physician, 2008; 78: 1289–94; J Neurol
Tips for prevention
The following self-care methods may help to prevent varicose veins or, at
least, stop them from getting worse.
! Exercise regularly to aid your circulation. Walking or anything that gets
the legs moving is ideal.
! Reduce leg strain by avoiding prolonged standing and excessive heavy
lifting.
! Elevate the legs. To improve leg circulation, take a few short breaks
daily to raise your legs to above the level of your heart by, for example,
lying down with your legs propped up on three or four pillows.
! Don’t cross your legs when sitting, as this can slow the upward flow of
blood back to the heart and increase pressure on the leg veins.
! Try massage and other therapies that increase circulation.
! Watch your weight, as overweight and obesity are known to contribute
to the development of varicose veins (Am Fam Physician, 2008; 78: 1289–94).
! Avoid high heels. Low-heeled shoes work the calf muscles more, which
is better for venous blood flow.
! Avoid wearing tight clothing around your waist, legs and groin, as this
can reduce blood flow.
! Consider your diet. Hard stools and constipation can lead to varicose
veins as straining increases pressure in the abdomen that, in turn,
increases pressure on the lower legs. So, it’s important to consume good
amounts of water-soluble fibre and liquids. Foods that are especially
helpful for varicose veins include berries, cherries, grapes, buckwheat
and onions.
WDDTY Women’s health 19
Female complaints
Neurosurg Psychiatry, 2010; 81: 582–3).
Happily, there are a number of
natural ways to treat varicose veins.
Natural remedies
! Supplements. Among the most
useful supplements are those
that contain flavonoids, some of
which have anti-inflammator y
effects and can help to
strengthen the blood vessels.
" Hydroxyethylrutoside (HR), a
type of flavonoid derived from
rutin (found in buckwheat and
asparagus), improved varicose
veins in a controlled trial of
pregnant women (Zentralbl Gynakol,
1995; 117: 190–7). Typically, the HR
dose is 1000 mg/day, but its
efficacy may be increased by
combining the supplement with
topical HR gel, applied two to
three times a day (Angiology, 2008;
59 Suppl 1: 7S–13S).
" Proanthocyanidins, flavonoids
found naturally in apples, pine
bark, grapeseed, bilberry and
some red wines, have also been
successfully used to treat
varicose veins. A single dose of
proanthocyanidins (150 mg)
improved leg-vein function in
people with widespread varicose
veins (Sem Hop, 1981; 57: 2009–13).
" Daflon, a combination of the
flavonoids diosmin and hesperi-
din, has been shown to be
effective for chronic venous
insufficiency (CVI; pooling of
blood in the legs), a condition
commonly associated with
varicose veins. According to one
review, its comprehensive mode
of action on the veins, lymphatic
vessels and microcirculation
makes it the treatment of choice
not only for the early stages of
CVI, but also for the more severe
stages, too (Angiology, 2001; 52 Suppl
1: S49–56).
" Pycnogenol (maritime pine-
bark extract) may be even more
effective than Daflon, according
to one study. Italian researchers
found that, after eight weeks,
CVI patients taking 150 or 300
mg/day of Pycnogenol improved
more than those taking 1000
mg/day of Daflon (Clin Appl Thromb
Hemost, 2006; 12: 205–12).
20 WDDTY Women’s health
Spider veins
Also known as ‘telangiectasias’ or ‘sunburst varicosities’, so-called spider
veins are a smaller, milder form of varicose veins. Although they are
harmless and generally cause no pain or discomfort, many people hate
the way they look.
Sclerotherapy is the usual treatment for spider veins but, as already
mentioned (see main text), it’s been associated with serious side-effects
such as stroke and deep vein thrombosis (DVT). More commonly,
sclerotherapy causes hyperpigmentation, or darkening of the skin, along
the course of the treated vein. This side-effect is reported in up to 30 per
cent of patients treated for spider/varicose veins. In most cases, it
disappears within 6–24 months but, for some, the discoloration may
persist for five or more years (J Dermatol Surg Oncol, 1987; 13: 547–50).
Fortunately, the natural remedies and preventative tips for varicose
veins can benefit spider veins, too. In addition, vitamin K cream is claimed
to be an effective natural treatment. Topical vitamin K was able to reduce
laser-induced bruising and purpura (red/purple discolorations due to
bleeding under the skin) (J Am Acad Dermatol, 2002; 47: 241–4; Dermatol Surg,
1999; 25: 942–4). However, WDDTY could find no published studies showing
that vitamin K can reduce or eliminate spider veins themselves.
Nevertheless, an unpublished study reported in WDDTY’s sister
publication PROOF! (vol 4 no 3) tested the efficacy of a 5-per-cent pharma-
ceutical-grade vitamin K product (Dermal-K) on 50 women. Among these
women after six months, three saw significant reduction or complete
healing of their spider veins within 8–14 days, 17 saw significant reduction
or complete healing in 15–30 days, 26 achieved significant reduction
within 31–46 days, two had a significant reduction within 47–120 days and
two showed no effects at all. There was no improvement in 50 women who
used an aloe vera skin cream as a comparison.
So, vitamin K cream may be worth a try, but proceed with caution as the
long-term safety of this treatment remains unknown.
Another option is to mask spider veins with makeup. Indeed, there are
long-lasting (and some waterproof) body makeups specially formulated to
camouflage spider veins and other skin blemishes. In the UK, the British
Red Cross runs a free treatment service at centres across the country,
used by patients with birthmarks, burns, scars and spider veins (see
www.redcross.org.uk).
! Herbs. Plant remedies are a as early in the condition as
popular treatment for varicose possible ( BMC Cardiovasc
veins, and the following appear Disord, 2001; 1: 5; doi:
to be especially useful. 10.1186/1471-2261-1-5).
" Horse chestnut (Aesculus " Gotu kola (Centella
hippocastanum). Extracts from asiatica). This appears to
the seeds of this plant (HCSE) have a beneficial effect on
have traditionally been used to the connective tissues in
treat patients with CVI and to varicose veins ( Int J Clin
alleviate its associated symp- Pharmacol Res, 1990; 10: 229–33).
toms. Four clinical trials in In a randomized placebo-
patients with CVI and one study controlled trial—the ‘gold
in patients with varicose veins standard’ of scientific
showed that HCSE—taken either evaluation—a titrated
as an oral tincture or tablets (20 extract of gotu kola (60 or
mg or 50 mg), or applied as a 120 mg/day) was effective
topical gel—can reduce leg pain for reducing leg swelling
and swelling as well as heaviness and leg heaviness in
and itching ( Adv Ther, 2006; 23: patients with CVI (Angiology,
179–90). For best results, take it 1987; 38: 46–50).
" Butcher’s broom (Ruscus
aculeatus). Taken orally, this
herb can improve venous tone
and poor circulation (Fortschr Med,
1989; 107: 52, 55–8). In a placebo-
controlled trial of 148 women
with CVI, those taking butcher’s
broom extract saw significant
improvements in leg swelling as
well as in heaviness, tension and
tingling (Arzneimittelforschung, 2002;
52: 243–50). Dosage for capsules
standardized for ruscogenins is
7–11 mg, although some experts
recommend higher dosages of
16.5–33 mg of total ruscogenins
three times a day (Altern Med Rev,
2001; 6: 608–12).
" Witch hazel (Hamamelis
virginiana). This herb is famous
for its astringent and anti-
inflammatory properties ( Altern
Med Rev, 2001; 6: 608–12), and, in
the form of an ointment, it is
recommended by the German
Commission E for varicose veins.
Note, however, that the
ointment may need to be applied
three or more times a day for
several weeks before there is any
noticeable improvement.
" Red vine leaf (Folia vitis
viniferae) extract. A source of
flavonoids, this herb was able to
reduce calf swelling in patients
with CVI ( Arzneimittelforschung,
2000; 50: 109–17). Another study
concluded that red vine leaf
extract shows “a fast onset of
action and an excellent efficacy”
in the treatment of CVI (Praxis
[Bern 1994], 2006; 95: 187–90). The
usual dose is 360–720 mg/day.
! Hydrotherapy. The use of water
to treat illness appears to work
for varicose veins. In a study of
61 patients, three and a half
weeks of hydrotherapy reduced
leg swelling and other symptoms
of varicose veins (Vasa, 1991; 20:
147–52 ). In another study,
thermal hydromassage therapy
was also effective for patients
with CVI (Minerva Cardioangiol, 2008;
56: 401–8).
! Reflexology. This form of foot
massage reduced symptoms in a
study of 55 women with varicose
veins and leg swelling (Cochrane
Database Syst Rev, 2007; 1: CD001066 ).
! Homeopathy. According to
WDDTY columnist Dr Harald
Gaier, there are several effective
homeopathic remedies for
varicose veins, including H.
virginiana (witch hazel),
Aristolochia clematis, Paeonia
officinalis, Viburnum opulus and
Ruta graveolens. For best
results, see a qualified
homeopath, who can prescribe a
remedy based on your individual
symptoms.
Joanna Evans
WDDTY Women’s health 21
Female complaints
Uterine fibroids
Harald Gaier covers the best natural treatments for
fibroids—from homeopathy to herbs
T
hese generally symptomless
benign tumours—known as
‘fibroleiomyoma’ or ‘uterine
fibromyoma’—are painless, although
other signs may raise the suspicion of
their presence. Shorter menstrual
cycles and heavy bleeding
(hypermenorrhoea), sometimes with
discomfort, are often associated with
them, as are a difficulty in conceiving
and a tendency to miscarry.
Most uterine fibroids (or myomata)
are found on routine abdominal or
gynaecological examination, during
surgery, on an ultrasound scan or post
mortem. Small fibroids are left un-
treated, while large ones are surgically
removed either by full hysterectomy—
unnecessarily in the vast majority of
cases and often because the operation
is easier for the surgeon—or by
myomectomy, where only the fibroid
is removed. This allows the patient to
still have children, although fibroids
do frequently recur.
Happily, alternative medicine offers
a variety of promising, non-surgical,
approaches to the problem of fibroids.
! Homeopathy. Experiments over
the past five decades have shown
that parathyroid hormone
(Parathyroidinum) and Cobaltum
Nitricum are both effective for
uterine fibromyoma (Allg Homöop
Zeitung, 1958; 203: 419–35; Arch Homéop
Normandie, 1962; 25: 30–53; Cahiers de
Biothérapie, 1971; 29: 1–14).
! Oriental Medicine. According to
Taoist philosophy, fibroids usually
correspond to Stagnation of Damp
Phlegm, Chi or Blood, caused by
emotional stagnation, overcon-
sumption of cow’s milk products or
sexual intercourse at too-early an
age (before 18 years, when the
body’s energies are not considered
mature), or emotional imbalance
during the teenage years (Gascoigne
S. The Manual of Conventional Medicine for
Alternative Practitioners, vol II. Dorking, UK:
Jigme Press, 1994: 415).
! Keishi-bukuryo-gan (KBG; kuei-
chih-fu-ling-wan). This traditional
Chinese herbal remedy is common-
22 WDDTY Women’s health
ly used to treat gynaecological
disorders such as hypermenor-
rhoea, dysmenorrhoea (painful
menstruation) and sterility. The
herbal remedy comprises five
herbs: Cinnamomum cassia Bl
(Lauraceae); Paeonia lactiflora Pall
(Paeoniaceae); Prunus persica
Batsch (or var davidiana Maxim;
Rosaceae); Poria cocos Wolf (Poly-
poraceae); and Paeonia suffruti-
cosa Andr (Paeoniaceae).
KBG has also been shown to act
as an antagonist of luteinizing
hormone-releasing factor (LH-RF)
and as a weak antioestrogen in
uterine DNA synthesis. In a study
involving 110 premenopausal
patients with uterine fibroids, both
hypermenorrhoea and dysmenor-
rhoea were improved in more than
90 per cent of cases, with shrinking
of the fibroids in 60 per cent (Am J
Chin Med, 1992; 20: 313–7).
Fibroids are found in some women
who have abnormally heavy or
prolonged menstruation, frequent
periods, persistent bleeding outside of
periods, or breast pain with marked
nipple tenderness, especially in the
week before a period. Also, myomatous
or cystic changes can be found in
ovaries that may be either small or
normal in size. Furthermore, there’s a
definite link between ovarian cysts and
later fibroid development; indeed, such
cysts, if ignored, may become a
‘seeding’ site of later myomata.
Myomata can be diagnosed non-
invasively by ultrasound, preferably
performed transvaginally by an
experienced sonographer, along with
laboratory blood tests to exclude any
other possible diagnosis.
In my own clinical experience, a
tried-and-true alternative therapy,
which has been thoroughly researched
for more than 40 years, is Vitex agnus-
castus (chasteberry), a shrub that
grows around the Mediterranean.
Historically used to correct disorders
of the female reproductive system, the
plant is mentioned in the medical
writings of Hippocrates, Plinius,
Dioscorides
Galen. An extract
and
made from its fruit
(extract of agnus
castus: EAC) is said
to possess corpus
luteum-like effects
( p ro v i d i n g
hormonal support
for pregnancy) (Hippokrates, 1954; 25:
717–9). This has been confirmed by
histological examination of the
endometrium, basal-temperature
measurement and cellular examination
of vaginal secretions (Deutsche Med
Wochenschr, 1954; 79: 1271).
EAC also lowers the production of
follicle-stimulating hormone (FSH) in
the pituitary while gently increasing
secretion of luteinizing hormone (LH)
and prolactin, effects that can be
achieved with therapeutic doses and
which are clearly dose-dependent. EAC
doesn’t replace LH but, acting via
central nervous system pathways,
regulates the production of ovarian
hormones.
In cases of polycystic or myomatous
ovaries detected by ultrasound, the
typical excessive bleeding, overly
frequent periods, persistent acyclic
haemorrhages and similar menstrual
disorders can be brought under control
by using 30 drops of EAC in water once
a day (Deutsche Med Wochenschr, 1955; 80:
936).
The response of the cysts needs to be
carefully monitored by ultrasound.
However, premenstrual syndromes,
breast tenderness and quick-
temperedness may all be improved by
the next menstrual cycle (Zeitschr Allg
Med, 1981; 56: 295).
By promoting the secretion of LH,
EAC contributes to progesterone
synthesis (Selecta, 1977; 19: 3688), which
also makes it of value in the successful
treatment of endometriosis. My own
experience is that uterine fibroids
within the smooth muscle walls of the
womb will cease to grow and, in fact,
shrink (as confirmed by regular
ultrasound scans) with daily doses of
EAC taken for at least seven months.
Harald Gaier
Harald Gaier, a registered naturopath,
osteopath, homeopath and herbalist,
practises at The Allergy and Nutrition Clinic,
22 Harley Street, London (e-mail:
admin@drgaier.com).
Premenstrual syndrome
P
remenstrual syndrome (PMS),
the bugbear of most modern
women, is a catch-all term for the
mixture of different physical and
emotional symptoms that occur in the
10 days or so before menstruation.
Physical symptoms include fluid
retention, breast tenderness, headache
and backache, and emotional
symptoms include tension, fatigue,
irritability and depression. It’s often
seen as the bane of women’s lives, and
affects more than 90 per cent of fertile
women at some time or other. In some
women the effects of PMS disrupt their
social and work lives, but there are
many natural ways to relieve the
symptoms.
PMS, also called premenstrual
tension (PMT), is a syndrome of
oedema (which can cause temporary
weight gain), nervous tension,
headache, breast pain, dysphoria
(depressive anguish) and some loss of
coordination that occurs during the
last few days of the menstrual cycle
before the onset of menstruation. Some
well-controlled successful clinical
studies have shown that seven different
non-orthodox therapeutic approaches
can help alleviate PMS:
# Reflexology (in nine weekly
treatments) has been shown to
improve both physiological and
emotional PMS symptoms when
compared with sham reflexology
treatments (Obstetr Gynaecol, 1993; 82: 906-
7).
# Biofeedback (in 12 weekly sessions of
vaginal temperature feedback) has
been reported to alleviate both somatic
and psychological symptoms (Int J
Psychosom, 1994; 41: 53-60).
# Homoeopathy was shown to be highly
effective in controlling PMS symptoms.
In a study that included 105 patients
monitored for three months, symptom
scores were significantly reduced in the
homoeopathy group. The treatment
group also reported lower use of
analgesics and tranquillizers and
considerably fewer work days lost than
in the placebo group (Proceedings Annual
Conference: International Homoeopathic League,
Budapest, Hungary, May 2000). beneficial in the
treatment of PMS.
# Chiropractic manipulative therapy In a double-blind,
(two to three times premenstrually for placebo-controlled,
three months) reported superior trial, 165 women
results to sham chiropractic therapy in between the ages of
a well-controlled study that involved 25 18 and 45 years were selected who
patients (J Manip Physiol Ther, 1999; 22: 582- experienced congestive symptoms of
5). PMS. These symptoms—consisted of
oedema (water retention) of the
# Nutritional supplementation with extremities, pain in the breasts and
1200 mg calcium per day for three abdominal and pelvic distension plus
months has been shown to be highly such emotional problems as irritability
effective, compared to placebo for most and aggression—were present in all the
PMS symptoms, according to an patients during seven days of the cycle.
impressive trial in terms of size (466 Treatment with Ginkgo biloba
patients) and its absolute rigor (Am J extract or placebo was administered to
Obstet Gynaecol, 1998; 179: 444-52). the women for two menstrual cycles,
In my own practice I have found and initiated from day 16 of the first
calcium supplementation to be more cycle until day five of the next.
reliable than other supplements that Asignificant difference was found in the
have had less convincing, though Ginkgo group in terms of alleviating or
successful, studies published. These completely ameliorating symptoms,
include the standard anti-PMS compared with the placebo group.
nutrients, such as vitamin B6, The best results occurred with breast
magnesium or potassium. tenderness and pain and water
retention in the extremities. Those in
# Autogenic relaxation training, the treatment group also reported
carried out twice weekly for three significant improvements in their bad
months and aimed primarily at muscle moods and aggression.
relaxation, can alleviated physical Ginkgo also proved to be easy to
symptoms of PMS. In a well-controlled take. Those given the Ginkgo were
trial autogenic training worked better mostly able to tolerate the herb without
than the control interventions, in which side effects (Rev Fr Gynécol Obstét, 1993; 88:
women were simply told to chart 447-57).
symptoms. For those women with
severe symptoms, improvements in Harald Gaier
their emotional mood swings were also Harald Gaier, a registered naturopath,
reported (Obstet Gynaecol, 1990; 75: 649-55). osteopath, homeopath and herbalist,
practises at The Allergy and Nutrition Clinic,
# Herbal medicine: 80 mg of Ginkgo 22 Harley Street, London (e-mail:
biloba extract twice daily can be admin@drgaier.com).
The herbal standby
An extract of Vitex agnus castus fruit, also known as chasteberry, can
reduce the symptoms associated with premenstrual syndrome (PMS) by at
least 50 per cent, according to one study.
Researchers studied 170 women who took 20 mg daily of V. agnus castus
in tablet form for three consecutive menstrual cycles, and compared them
with a group taking a placebo. In the herbal group, five of six common
symptoms—irritability, mood alteration, anger, headache and breast
fullness—improved significantly. Bloating was unaffected by the treatment.
At least a 50 per cent reduction in symptoms was reported by 52 per cent
of the treated women, compared with 24 per cent with the placebo (BMJ,
2001; 322: 134-7).
WDDTY Women’s health 23
Menopause
HRT: the latest cancer risk
Just when it looks as if it couldn’t get any worse for
HRT, a new study shows that it causes lung cancer
A
nyone with shares in hormone
replacement therapy (HRT) is in
the doldrums. HRT was touted
as the modern-day equivalent of the
fountain of youth—until 2002, when
the US Women’s Health Initiative
(WHI) study, one of the largest-ever
studies of these drugs, discovered that
women taking HRT were more likely to
have breast cancer, ovarian cancer,
stroke and heart disease.
And now, new evidence from the
WHI data shows that the use of HRT
during the menopause increases lung
cancer by 60 per cent after five years.
Dr Rowan Chlebowski, a medical
oncologist at Harbor-UCLA Medical
Center in Los Angeles, CA, analyzed
the WHI statistics, and found a link
between prolonged HRT use and non-
small cell (NSC) lung cancer.
Although most of the adverse
publicity after the WHI study focused
on the breast cancer risk, this is the
first time that a link between HRT and
lung cancer has been identified. It also
happens that NSC lung cancer is the
leading cause of death in women.
The most vulnerable women were
smokers using HRT, who accounted for
slightly more than half of all cases of
NSC lung cancer. In the WHI study, the
researchers found one extra
death from this for every 100 women
using Prempro, Wyeth’s combination
oestrogen–progestin HRT drug.
Ovarian cancer risk
This announcement, made at the
annual meeting of the American
Society of Clinical Oncology in May,
coincided with the release of the
findings from a large-scale, long-term
Danish study showing that women who
take HRT increase their risk of ovarian
cancer by 38 per cent (JAMA, 2009; 302:
298–305).
The study, which included more than
900,000 women aged 50–79, found
that the current use of hormones
accounted for a 38-per-cent greater
chance of ovarian cancer. This
translates to one extra case every year
for every 8300 women using HRT, or
140 extra cases during the eight-year
24 WDDTY Women’s health
follow-up, accounting for 5 per cent of
all cases of the cancer.
The risk of having the disease were
the same regardless of how long the
drug was taken, which formulation was
used, how much oestrogen was
included in the mix and what sort of
delivery method was chosen.
As ovarian cancer is difficult to
detect and is often fatal, such a risk
should not be brushed aside, the
Copenhagen researchers noted.
HRT to blame
Up to now, medicine has tended to
blame a familial ‘predisposition’—that
is, a family history of breast cancer and
the presence of certain predisposing
genes—on many incidences of breast
cancer, particularly in women using
HRT. Nevertheless, the latest trawl
through the WHI data shows that HRT
shoulders much of the blame.
Epidemiologists from the University
of Rochester Medical Center, in New
York, followed-up the more than 16,000
postmenopausal women given either
HRT or a placebo during the five-year
WHI study, which was abruptly
abandoned when the health risks
emerged. When they evaluated the 349
women who’d developed breast cancer,
they could find no link with a family
history.
The researchers concluded that a
family history and hormones have
“independent and non-interacting
effects”—in other words, the cases of
cancer were most likely entirely caused
by HRT (Epidemiology, 2009; 15 May: doi:
The current risks of HRT
According to the US Women’s Health Initiative study, hormone therapy
increases your chances of developing the following diseases by these
percentages:
! Coronary heart disease-related events, 29 per cent
! Stroke, 41 per cent
! Deep vein thrombosis, 200 per cent
! Blood clot in lungs, more than 200 per cent
! Invasive breast cancer, 24 per cent
! All cancers among previous users, 86 per cent
! Ovarian cancer, 38 per cent
! Lung cancer, 60 per cent.
10.1097/EDE. 0b013e3181a71279).
Fewer cases after the facts
Following the disclosures of the WHI
trial, breast cancer rates fell by 13 per
cent among more affluent women in
California, but only by 7 per cent in
rural areas. When researchers from the
Northern California Cancer Center
investigated the discrepancy, they
found that women in the more rural
areas had not heard about the link
between HRT and cancer, and so had
continued taking the drugs—which
would again tend to point the finger at
HRT (BMC Med, 2009; in press).
After the WHI results were reported,
Wyeth’s products took a hammering,
and their use declined
by 50 per cent. Nevertheless, sales of
the oestrogen-only drug Premarin and
various cream formulations still
constitute a business totalling up to
one billion dollars per year.
Last month, the US Food and Drug
Administration added a final nail in the
HRT coffin with a boxed warning for
Prometrium, a progesterone drug,
warning of the WHI’s results showing
increased risks of heart attack, stroke,
invasive breast cancer, blood clots and
deep vein thrombosis, and a greater risk
of dementia, among those taking
combined oestrogens and progesto-
gens of any variety.
Lynne McTaggart
Menopausal symptoms
We now know that the risks of HRT far outweigh the benefits, so
what alternatives are there to help women through the menopause?
N
ow that hormone replacement
therapy (HRT) has been largely
discredited, millions of women
embarking on the menopause are
turning to alternative medicine to
manage their symptoms. In fact, only
10–25 per cent of women experiencing
menopausal symptoms seek treatment
from a traditional healthcare provider,
according to a recent report, and many
of them are dissatisfied with
conventional medical recomm-
endations (J Womens Health [Larchmt], 2005;
14: 634–49).
However, finding a safe and effective
alternative treatment is no easy task.
One of the favourites is so-called
‘natural’ progesterone, championed by
the late Dr John Lee. But, as WDDTY
reported in 2006, it is far from natural
and might even cause cancer, just like
hormone replacement treatment (HRT;
see WDDTY vol 17 no 2). Similar
concerns have been raised about soy
and isoflavone supplements (see
WDDTY vol 16 no 8), which are also
among the more popular alternative
remedies for menopause. So what’s a
girl to do?
Happily, research shows that there
are a number of simple, safe steps you
can take to help make the transition
into menopause a smooth one.
! Exercise regularly. Growing
evidence suggests that being
physically active is one of the best
things you can do to keep
menopausal symptoms under
control. A recent study of 336
menopausal women found that those
who were the most physically active
had less severe symptoms and
generally felt better than their less-
active counterparts (Climacteric, 2010;
13: 355–61). In another study, 36
postmenopausal women were split
into two groups: an aerobic-exercise
group; and a resistance-exercise
group. Both groups exercised three
times a week for eight weeks under
the supervision of a physiotherapist.
At the end of the study, both types of
exercise were found to have positive
effects on the symptoms of
menopause, although aerobic
postmenopausal women (Gynecol
Obstet Invest, 2007; 64: 204–70). Previous
research suggests that vitamin E
may also help with mood swings and
vaginal dryness (NY State Med; 1952; 52:
1289).
exercise had a slightly greater ! Consider aromatherapy. This form
impact. Nevertheless, both exercise of treatment uses essential oils
groups saw improvements in extracted from the flowers, leaves,
psychological health, depression and fruit, bark and roots of medicinal
quality of life (Obstet Gynecol Int, 2010; plants. Aromatherapy massage
2010. pii: 274261). works on the nervous system
Regular exercise can also reduce through the senses of both smell and
the risk of postmenopausal breast touch. In a small study carried out in
cancer, osteoporosis and cardio- Japan, 15 women with menopausal
vascular disease, an important symptoms were examined by a
consideration, as the risk of gynaecologist before receiving a 30-
developing these diseases increases minute aromatherapy session,
after menopause (Arch Intern Med, 2010; involving a consultation, massage
170: 1758–64; Aust J Public Health, 1993; 17: and home-massage guidance. After
23–6). Aim for at least 30 minutes of one month of at-home care and a
moderate-intensity physical activity second aromatherapy session, all
on most days. reported significant improvements
! Take omega-3 fats. A new study has in their symptoms (J Altern Complement
found that omega-3 fatty-acid Med, 2005; 11: 491–4).
supplements can help fight Intriguingly, another study
depression and hot flushes in women discovered that aromatherapy
going through the menopause. The massage, with an additional focus on
study involved 20 women with major the abdomen, can reduce abdominal
depressive disorder given 2 g/day of fat and improve body image in
eicosapentaenoic acid (EPA) and postmenopausal women (Taehan
docosahexaenoic acid (DHA) for Kanho Hakhoe Chi, 2007; 37: 603–12).
eight weeks. The results showed that ! Take up yoga. A systematic review of
70 per cent of the women saw a 18 clinical trials from six countries
reduction of at least 50 per cent in found that yoga-based and certain
their Montgomery–Asberg Dep- other mind–body therapies can be
ression Rating Scale (MADRS) beneficial by alleviating a range of
scores. Moreover, hot flushes menopausal symptoms. Eight out of
decreased in both number and nine studies of yoga, tai chi and
severity (Menopause, 2010 Oct 27; Epub meditation-based programmes rep-
ahead of print). orted improvement in overall
Like exercise, omega-3 supp- menopausal and vasomotor
lements can also help to prevent symptoms (such as hot flushes and
postmenopausal osteoporosis, breast night sweats); six of seven trials
cancer and heart disease (Obstet using yoga-based programmes
Gynecol Surv, 2004; 59: 722–30). indicated improvement in mood and
! Take vitamin E. A randomized sleep, and four studies reported
controlled trial found that daily reduced musculoskeletal pain.
doses of vitamin E (400 IU) Results from the other trials suggest
significantly reduced the frequency that breath-control-based and other
and severity of hot flushes in relaxation therapies are also
Signs of menopause
Officially, you’re not in the menopause until it’s been a whole year since your
last menstrual period. However, the signs and symptoms of menopause may
often appear long before that. These include:
! hot flushes ! impaired memory or
! night sweats concentration
! irritability ! loss of libido
! mood swings ! vaginal dryness
! depression ! increased abdominal fat
! insomnia
WDDTY Women’s health 25
Menopause
promising for relieving menopausal
symptoms (Maturitas, 2010; 66: 135–49).
! Consider acupuncture. One small
Swiss study showed that acup-
uncture was able to significantly
reduce vasomotor symptoms and
physical disturbances in menopausal
women. What’s more, the effects
were still evident three months after
the last session (J Altern Complement
Med, 2001; 7: 651–8).
More recently, a randomized
controlled trial of 175 women
reported that acupuncture, in
addition to the usual care, was
associated with marked clinical
improvement in hot flushes and
other menopause-related symptoms
(Menopause, 2010; 17: 269–80).
! Try the herbal supplement Femal.
This “unique blend of pollen extracts
from seven organically cultivated
flowers grown in . . . Sweden” also
contains vitamin E. In one Danish
study, 54 menopausal women were
randomly given either two Femal
tablets each morning, or two
identical placebo tablets, for three
months. The results showed that 65
per cent of the Femal group enjoyed
a reduction in hot flushes compared
with 38 per cent in the placebo
group. When the researchers looked
at 15 other menopausal “quality-of-
life” symptoms, Femal again came
out on top (Climacteric, 2005; 8: 162–70).
Femal is available from Boots and
independent chemists.
! Lose weight. If you’re overweight or
obese, losing weight may help to
keep hot flushes under control.
University of California at San
Francisco researchers studied 338
overweight or obese women and
found that those who followed an
intensive weight-loss programme
showed greater improvements in
bothersome hot flushes compared
with those following a structured
health-education programme (con-
trols) (Arch Intern Med, 2010; 170: 1161–7).
! Stop smoking. One study suggests
that women who suffer from hot
flushes are more likely to be smokers
(J Womens Health, 1998; 7: 1149–55).
Another study found that women
taking HRT for relief of menopausal
symptoms were more likely to be
current smokers. “This relation
between HRT use and smoking could
result from an anti-oestrogen effect
26 WDDTY Women’s health
of smoking, intensifying menopausal
symptoms,” the researchers said (J
Epidemiol Community Health, 1987; 41:
26–9).
! Investigate allergies. According to
Dr Ellen Grant, author of The Bitter
Pill and Sexual Chemistry, hot
flushes could be due to an allergic
reaction to common foods or
chemicals. In her study of 60
migraine sufferers, a variety of foods
and drinks, including wheat, eggs,
sugar, tea and coffee, commonly
caused vascular reactions such as
flushing, headaches, and pulse or
blood pressure increases. The most
common chemical allergens were
cigarette smoke and domestic gas
(Lancet, 1979; 313: 966–9; WDDTY vol 17 no
2). So, if you suffer from hot flushes,
keep a food diary to try to pinpoint
your possible triggers.
! Consider black cohosh. This herb
has a long history of traditional use
for a variety of ‘female complaints’,
including menstrual problems and
childbirth. Scientific studies have
found it to be a safe and effective
remedy for a number of menopausal
symptoms, but mainly hot flushes
and mood swings. Indeed, the
German governmental regulatory
agency Commission E has approved
the use of 40 mg/day of black
cohosh (sold as Remifemin) for six
months for the relief of such
symptoms.
Although early studies suggested
that the herb has oestrogenic
effects, more recent evidence shows
that black cohosh does not have an
oestrogenic mechanism of action
but, instead, acts on serotonin
receptors to relieve menopausal
symptoms (J Womens Health [Larchmt],
2005; 14: 634–49). Nevertheless, there
have been concerns (from animal
studies, which may not apply to
humans) as to its potential to
increase the spread breast cancer, so
it’s generally not recommended for
patients or women with a family
history of the disease (Cancer Res,
2008; 68: 8377–83). If you wish to try
black cohosh, do so only under the
supervision of a registered
naturopath or medical herbalist.
! Give Ginkgo a go. Several studies
show that Ginkgo biloba may help to
boost memory and concentration,
which can suffer during menopause.
One study found that 120 mg/day
for one week significantly improved
memory and attention compared
with placebo in postmenopausal
women (Pharmacol Biochem Behav, 2003;
75: 711–20).
When combined with other herbs,
Ginkgo may also boost the libido. A
herbal formulation (Herbal vX) of
Ginkgo and Muira puama was
assessed in 202 healthy pre- and
postmenopausal women comp-
laining of a low sex drive. After one
month of treatment, statistically
significant improvement was found
in frequency of sexual desire, sexual
intercourse and sexual fantasies, as
well as in satisfaction with sex life in
general, intensity of sexual desires,
excitement of fantasies, ability to
reach orgasm and intensity of
orgasm (Adv Ther, 2000; 17: 255–62).
However, as the trial was
uncontrolled, we don’t know to what
extent the results are down to the
‘placebo effect’.
In another study, this time a
double-blind, placebo-controlled
trial, a supplement (ArginMax)
containing Ginkgo, as well as L-
arginine, ginseng, damiana,
multivitamins and minerals, was
tested in just over 100 women, aged
22–73 years, who reported a lack of
sexual desire. In those going through
the menopause, the supplement
increased frequency of intercourse,
satisfaction with the sexual
relationship and vaginal dryness. In
postmenopausal women, half
reported increased sexual desire
compared with only 8 per cent
taking the placebo. Moreover, the
formulation has been shown to
exhibit no oestrogenic activity (J Sex
Marital Ther, 2006; 32: 369–78).
! Eat healthily. Keeping to a balanced
diet that includes a variety of fruit
and vegetables can protect against
bone loss, cancer and premature
death (Am J Clin Nutr, 2000; 71: 142–51;
Cancer Epidemiol Biomarkers Prev, 2004; 13:
1485–94; JAMA, 2000; 283: 2109–15).
Nutrients especially important for
menopausal women include
calcium, vitamins D, C and the Bs, as
well as potassium, zinc, copper and
magnesium. Aim to get these
nutrients from your diet and
supplement when necessary.
Joanna Evans
Nutritional support for women over 50
Harald Gaier lists some of the helpful herbs that women can take as they go through
the menopause and after
A
s women grow older and reach
the menopause and beyond, the
inevitable changes that occur in
their bodies due to age and hormones
may require lifestyle changes, including
a new look at nutritional requirements.
The following herbs have all been
proven to help.
Black cohosh (Actaea
racemosa)
This is good for menopausal symptoms,
but needs a prescription from a
registered naturopath or medical
herbalist (McKenna DJ et al. Botanical
Medicines: The Desk Reference for Major Herbal
Supplements, 2nd edn. London, Oxford & NY: The
Haworth Press, 2002: 41–3).The herb can
also help with postoperative functional
deficits following ovariectomy or a full
hysterectomy.
Contraindications: Pregnancy; lac-
tation; oestrogen-dependent tumours,
including some breast cancers due to
its potential oestrogenic actions; and
salicylate hypersensitivity, as this is a
salicylate-containing plant.
Drug interactions: Hormone
replacement therapy (HRT), as this
herb may lead to oestrogen excess.
In studies using a fluid extract of this
herb, up to 890 mg/day has been
given—with no toxic effects (Brinker F.
Herb Contraindications & Drug Interactions, 3rd
edn. Sandy, OR: Eclectic Medical Publications,
2001: 40–1; also www.eclecticherb. com/emp),
although the usual dose of an ethanolic
extract is only 8 mg/day.
Evening primrose oil (EPO)
Postmenopausal women often suffer
from dry skin (eczema-like), hair loss,
breast pain and poor wound-healing
due to depleted oestrogen. However,
EPO (Oenothera biennis) can help to
reverse these conditions (McKenna op.cit.,
327–35).
Contraindications: Epilepsy; and
mania.
Drug interactions: Phenothiazines:
induces seizures and hallucinations;
tamoxifen: speeds up clinical response;
cyclosporine: less kidney damage; and
anticoagulants: may enhance blood-
thinning effects.
The highest dose generally
recommended is 0.1 mL/kg/day, so
someone weighing 55 kg (8.5 stone)
should take 5.5 mL/day (Brinker op. cit.,
92–3; see also www.eclecticherb.com/emp).
Garlic (Allium sativum)
It is well established that garlic lowers
blood pressure, blood glucose, blood
lipids and cholesterol, but it also
prevents blood clots, and is mildly
antibiotic, antifungal, anticancer,
antioxidant, immunomodulatory and
liver-protective (McKenna op. cit., pp
375–96).
Contraindications: Gastritis; early
pregnancy; hypothyroidism; and oeso-
phageal reflux.
Drug interactions: Warfarin or other
blood-thinners: because it enhances
anticoagulation; indomethacin; dypiri-
damole; paracetamol/ acetaminophen:
it may prevent liver toxicity; and insulin
(as it lowers blood glucose, insulin
doses may need adjusting).
A dose of 4 g/day of fresh garlic, or 8
mg of essential oil of garlic as support
therapy, is typically prescribed to
reduce blood lipids, and to prevent age-
dependent vascular changes (Brinker, op.
cit., pp 99–101).
Ginkgo biloba (maidenhair
tree)
Ginkgo helps to prevent memory loss,
loss of mental alertness, dementia,
stroke, free-radical damage in
traumatic brain injury and Alzheimer’s
(Arch Phys Med Rehabil, 2000; 81: 668–78).
Contraindications: Bleeding dis-
orders, especially those with reduced
blood-clotting, so it may contribute to
haemorrhage if used for a lengthy
period prior to surgery.
Drug interactions: Aspirin (when
used chronically to prevent blood
clots), anticoagulants, heparin, other
non-steroidal anti-inflammatory drugs
(NSAIDs), ticlopidine, thiazide,
trazodone, cyclosporine and papaver-
ine; it may enhance meclofenoxate,
used to treat senile dementia and
Alzheimer’s, and the effects of
monoamine oxidase inhibitors
(MAOIs), a class of antidepressant
drugs.
In a study of 33 women taking an
average dose of 209 mg/day, Ginkgo
leaf extract counteracted the sexual
dysfunction associated with anti-
depressants, mostly SSRIs (selective
serotonin reuptake inhibitors), but also
phenelzine (an MAOI), vivactil
(protriptyline, a tricyclic), and ven-
lafaxine, nefazodone and bupropion
(serotonin–norepinephrine reuptake
inhibitors, SNRIs) .
It is also thought that Ginkgo may
reduce the efficacy of anticonvulsants
such as carbamazepine (Brinker op. cit., pp
103–7).
Ginkgo is usually given as a total
daily dose of 120–240 mg of the
standardized extract [containing at
least 24-per-cent ginkgo flavone
glycosides and 6-per-cent terpene
lactones (ginkgolides and bilobalides)]
for at least eight weeks to treat chronic
conditions, and a review of its benefits
is typically carried out before it
is taken for more than three months.
Arnica montana (wolfsbane)
Never use Arnica internally unless
it’s dispensed in a homeopathic
potency, as it has toxic effects on
the liver and kidneys. It can also
cause gastrointestinal irritation if
taken undiluted ( Brinker F. Herb
Contraindications & Drug Interactions, 3rd
edn. Sandy, OR: Eclectic Medical
Publications, 2001: 31–2; see also
www.eclecticherb. com/emp ).
The
Arnica tablets sold over-the-
counter (OTC) at many
pharmacies come from man-
ufacturing pharmacies such as
Nelsons or Weleda, and have
undergone processes to have such
toxicity removed, so they can safely
be taken as advised by the
packaging, without the guidance of
a homeopath. There should be no
side-effects or contraindications.
WDDTY Women’s health 27
Menopause
Arnica tablets can reduce
bruises and contusions, as can
suitably diluted Arnica creams
[ Schilcher H, Kammerer S. Leitfaden
Phytotherapie, 3 aufl (Guide to Phytotherapy,
3rd edn). Munich, Jena: Urban & Fischer
Verlag, 2010: 30–2]. Indeed, virtually
every cosmetic and plastic surgeon
in London’s Harley Street
recommends taking Arnica before
and after surgery by their middle-
aged patients to minimize the
severe bruising that is inevitable
after such surgery.
Hawthorn (Crataegus
oxyacantha)
With the reduced oestrogen in
postmenopausal women comes an
increased risk of heart problems.
Women aged over 50 then suddenly
run the same risks of athero-
sclerosis, hypertension and
congestive heart failure as do men.
However, hawthorn has proved
to have numerous beneficial
actions on the heart and cardio-
vascular system. It can regulate
heart rhythm through its anti-
arrhythmia actions, and dilate the
coronar y arteries, thereby
reducing the chances of heart
attack. It can also increase the
blood supply to the heart.
Furthermore, hawthorn can lower
systolic pressure (the first number
in a blood pressure reading), which
is especially beneficial in people
over 50, who have the highest risk
of isolated systolic hypertension
(ISH). If left untreated, ISH can
lead to heart disease, stroke and
dementia.
The herb also improves low
blood pressure, which can lead to
dangerous sudden fainting
episodes (McKenna DJ et al. Botanical
Medicines: The Desk Reference for Major
Herbal Supplements, 2nd edn. London,
Oxford & NY: The Haworth Press, 2002:
659–70).
However, those taking beta-
blockers for blood pressure should
know that hawthorn may cause a
slight rise in diastolic blood
pressure (the second number in a
blood pressure reading).
Hawthorn used with garlic
powder protects the heart, liver
and pancreas against damage from
28 WDDTY Women’s health
isoprenaline, a bronchodilator
known to have a powerful
stimulant effect on the heart and
cardiovascular system. Taken with
adenylic acid, the herb enhances
the action of digoxin, prescribed
for cardiac and coronary insuffic-
iencies. When used as an alcoholic
extract (4:1 ratio), it inhibits the
arterial contractions induced by
phenylephrine ( Brinker, op. cit., pp
118).
St John’s wort
(Hypericum perforatum)
This herb has been in continuous
recorded use as a natural medicine
since the days before Hippocrates
(ca. 460–ca. 370 BC).
Although best known nowadays
for its antidepressant effects, it’s
also known to promote wound-
healing, and can inhibit protein
kinase C, which has the beneficial
effect of preventing the usual
diabetic vascular complications of
nephropathy, retinopathy and
neuropathy.
In addition, St John’s wort has
antiviral activity, coronar y
vasodilator y effects, painkilling
(analgesic) and liver-protective
effects, and can help against sleep
disturbances by boosting
melatonin synthesis (McKenna,
op. cit., pp 923–71).
However, this herb
should not be used in
pregnancy, prior to sun exposure
or solarium therapy, or ultraviolet
light therapy, or in those with
endogenous (genetic) depres-
sion—especially in those cases
with psychotic symptoms or high
suicidal risk.
St John’s wort can have
interactions with nefazodone,
sertraline, trazodone, fluoxetine,
paroxetine, indinavir, warfarin,
phenoprocoumon, reserpine, pro-
tease inhibitors, theophylline
(requires a 250-per-cent increase
in the daily dose of St John’s wort
to maintain effectiveness),
monoamine oxidase inhibitors
(MAOIs), midazolam and naloxone,
as well as with photosensitizers
(causing light sensitivity) such as
piroxicam and tetracycline. Prior
to surger y, it may interact
adversely with anaesthetics (so the
anaesthetist should always be
informed when St John’s wort has
been taken) ( Brinker, op. cit., pp
178–84).
For mild-to-moderate dep-
ression, therapeutic doses of the
herb extract are 300–900 mg/day,
and up to 1800 mg/day for more
severely depressed patients. The
extract should be standardized at
0.3-per-cent hypericin.
Harald Gaier
Harald Gaier is a registered naturopath,
osteopath, homeopath and herbalist,
and practises at The Allergy and
Nutrition Clinic, 22 Harley Street,
London (e-mail: admin@drgaier.com).
Osteoporosis: the
brain–bone connection
New research has revealed an intriguing link between
osteoporosis and depression

O
steoporosis, a leading cause
of bone fractures, is the
most widespread deg-
enerative disease in the West,
affecting around three million
people in the UK and 10 million in
the US. Women are most at risk,
with one in six Western women
expected to suffer a hip fracture at
some point in their lives.
Our genes, age, diet and lifestyle
are all known to have an influence
on our bone health. Now, it appears
that our mental health may also
have a significant part to play.
Indeed, intriguing new research
has found that depression, a
condition that afflicts more than
120 million people worldwide,
could be an important risk factor
for osteoporosis—and especially in
women.

The brain–bone link

Two recent meta-analyses—pooling
the results of several previous
studies—have found a clear
connection between depression
and low bone mineral density
(BMD), an indicator of
osteoporosis and fracture risk. The
latest, an international study
carried out by scientists at the
Hebrew University of Jerusalem,
assessed data from 23 research
projects in eight countries,
comparing bone density in 2327
people suffering from depression
with that of 21,141 non-depressed
individuals.
The researchers found that the
depressed had substantially lower
BMD than the non-depressed, and
that depression was also associated
with markedly greater activity of
osteoclasts, the cells that break
down bone.
What’s more, the connection
between depression and bone loss
was particularly strong in
premenopausal women with
clinical depression diagnosed by a
psychiatrist.
The scientists concluded that
“all individuals psychiatrically
diagnosed with major depression
are at risk for developing
osteoporosis, with depressed young
women showing the highest risk”
(Biol Psychiatry, 2009; 66: 423–32).
The other meta-analysis came to
much the same conclusion. On
reviewing data from more than
10,000 people from 14 separate
studies, US researchers from the
Mayo Clinic in Arizona reported
that depression was associated
with a significant decrease in BMD
of the spine and hip, especially in
depressed women and in those with
clinical depression. “Depression
should be considered as an
important risk factor for
osteoporosis,” the researchers
concluded ( Osteoporos Int, 2009; 20:
1309–20).
So, is depression the cause of
the bone loss or does some other
factor explain this novel link?
According to one study, it may
not be depression per se that’s the
problem, but the drugs used to
treat it. In 5000 people aged 50
years and over, Canadian
researchers found that those
regularly taking the anti-
depressants known as ‘selective
serotonin-reuptake inhibitors’, or
SSRIs, had a twofold increased risk
of bone fractures. SSRI use was
also dose-dependently associated
with greater odds of falling, and
lower BMD of the hip and spine
(Arch Intern Med, 2007; 167: 188–94). A
review of the scientific literature
reached a similar conclusion (Eur

WDDTY Women’s health 29

Menopause

Neuropsychopharmacol, 2009; 19: 683–92).
Nevertheless, there’s also
evidence that depression itself
could be causing bone loss. Hebrew
University of Jerusalem
researchers have found that
depression sets off the sympathetic
nervous system—connecting the
brain to the internal organs and
skeleton—which is primarily
aroused by stress. Its activation
causes secretion within the bone of
‘noradrenaline’ (‘norepinephrine’),
which has a detrimental effect on
bone-building cells. The Israeli
researchers were able to show that
chronic treatment with a drug that
blocked noradrenaline in the bone
also blocked the effects of
depression on bone (Proc Natl Acad
Sci USA, 2006; 103: 16876–81; Ann NY Acad
Sci, 2010; 1192: 170–5).
Although more studies are
needed in this field—dubbed
‘neuro-psychoosteology ’—some
scientists are already calling for
depression to be officially
recognized as a risk factor for
osteoporosis. Indeed, the findings
suggest that dealing with
depression may be an important
means of keeping bones strong and
preventing fractures (see WDDTY
vol 18 no 12, or www.wddty.com/
how-you-beat-depression, for more
information on how to treat
depression naturally).
Other risk factors
Besides depression, other factors
can increase the risk of
osteoporosis. Some, such as being
female, getting older and having a
family history of the condition,
can’t be changed. But there are
other things we can do something
about.
! Sedentary lifestyle. People who
spend a lot of time sitting are more
likely to develop osteoporosis. As
Marilyn Glenville explains in The
Natural Health Bible for Women
(Duncan Baird, 2010), bone
strength depends on supply and
demand. “If you demand lots from
it, it will supply the bone density to
accommodate your demands; if you
make few demands on it, your bone
density will reduce proport-
ionately.”
Studies show that regular
weight-bearing exercise is
important for building and
maintaining bone strength. Low-
impact activities such as walking
and gentle aerobics can prevent
bone loss, while high-impact
exercise like running and weight-
training can increase bone density
( Postgrad Med J, 2003; 79: 320–3 ).
Football is a helpful activity. A 14-
week study of women, aged 20–47
years, who played football twice a
week showed significantly
increased bone density in the
shins. Surprisingly, similar female
runners who trained for the same
amount of time didn’t see such
dramatic effects (Scand J Med Sci
Sports, 2010; Mar 4; Epub ahead of print).
For the less mobile, whole-body

Bone-building alternatives
A variety of drugs can prevent and treat osteoporosis, but
they all come with a raft of undesirable side-effects.
Bisphosphonates, for instance, stop bone breakdown, but
are linked with severe bone pain, oesophageal cancer,
heart-rhythm irregularities and osteonecrosis of the jaw
(ONJ), where bone tissue fails to heal after even minor
trauma, such as tooth extraction (Curr Opin Rheumatol, 2009;
21: 363–8). Happily, a combination of vitamins and minerals
such as strontium and magnesium offer an alternative.
! Calcium is important for bone health although, says
Annemarie Colbin, too much emphasis is placed on
this mineral alone. Indeed, there’s evidence that too
much calcium can even increase the risk of broken
bones (Am J Epidemiol, 1997; 145: 926–34). Healthy bones
require many nutrients—magnesium, phosphorus,
boron, copper, manganese and zinc, plus vitamins C,
D, K, B6 and folic acid—all working together. We also
need sufficient amounts of protein for healthy collagen,
and healthy fats for vitamin D uptake and protection
against bone-destroying free radicals (for more
information on calcium, see WDDTY vol 20 no 3).
! Vitamin D is essential for strong bones and calcium
absorption, and not having enough D has been linked
to osteoporosis and low bone mineral density (BMD) in
women aged over 50 (Joint Bone Spine, 2008; 75: 567–72).
You can get D from food (fish, liver, eggs), but the best
source is the sun. Just 15 minutes of sunshine on your
skin every day should produce all the vitamin D you
need. In winter, you may need to take supplements.
Studies show a 30-per-cent decrease in non-spinal
fractures among seniors taking 800 IU/day of vitamin D
(Ann Med, 2005; 37: 278–85).
! Vitamin K is not just important for blood-clotting, but
also plays a major role in bone metabolism. In a three-
year study of nearly 200 women aged 50–60 years,
those taking vitamin K1 (phylloquinone; 1 mg/day) with
a mineral+vitamin D supplement lost less bone than
those taking a placebo or the mineral+vitamin D
alone (Calcif Tissue Int, 2003; 73: 21–6). Vitamin K2 (mena-
tetrenone; 45 mg/day) boosted BMD and reduced
spinal fractures in osteoporosis sufferers almost as
effectively as etidronate, but without the side-effects
of the bisphosphonate (J Orthop Sci, 2001; 6: 487–92).
However, due to its blood-coagulating properties,
vitamin K should never be taken with warfarin.
Good food sources of vitamin K include leafy green
vegetables and fermented products such as natto.
! Strontium appears to have the dual effect of increasing
bone formation while decreasing bone breakdown
(Bone, 2008; 42: 129–38). In a three-year study of 1649
postmenopausal women with osteoporosis, 2 g/day of
oral strontium ranelate (a prescription drug) increased
BMD and reduced fracture risk by more than 40 per
cent vs a placebo (N Engl J Med, 2004; 350: 459–68).
However, side-effects included diarrhoea, nausea
and even memory loss with long-term treatment (Drugs,
2010; 70: 733–59). Natural sources of strontium include
wholegrains, parsley, fish, Brazil nuts and lettuce.

30 WDDTY Women’s health

vibration training (WBVT), which
involves standing, sitting or lying
on a vibrating platform to
stimulate muscle contractions, is a
good option. Postmenopausal
women having WBVT three times a
week for six months saw significant
increases in hip BMD, as well as in
strength and balance (J Bone Miner
Res, 2004; 19: 352–9 ). WBVT also
prevented bone loss in the spine
and femur (thigh bone) compared
with a placebo (J Bone Miner Res, 2004;
19: 343–51).
If you already have osteoporosis,
exercise that improves balance and
coordination, such as Tai Chi or
step aerobics, can help to prevent
falls and fractures (BMC Geriatr, 2006;
6: 6).
! Acidic diet. While some foods
supply us with essential bone-
building nutrients such as calcium,
others can be detrimental to bone
health.
Says Annemarie Colbin, author
of The Whole-Food Guide to Strong
Bones: A Holistic Approach
(Oakland, CA: New Harbinger
Publications, 2009), watch out for
acid-forming foods—such as meat
and sugar—as excess intakes drain
calcium and other minerals from
the bones. Studies in mice show
that acidosis—a tilt towards an
acidic blood pH—encourages bone
loss and inhibits bone formation
(Curr Opin Nephrol Hypertens, 2004; 13:
423–36). This may explain why older
women who eat chocolate (high in
sugar) every day have less bone
density and strength (Am J Clin Nutr,
2008; 87: 175–80), and why certain
drinks are linked to osteoporosis
(see below).
The best diet for better bones
includes acid-forming and
alkalizing foods such as leafy green
vegetables (kale, collard and
mustard greens, watercress,
arugula), roots (carrots, turnips,
parsnips, radishes), broccoli and
squash (for more information, see
WDDTY vol 19 no 12).
! Coffee and alcohol. Caffeine
increases urinary loss of calcium
and magnesium (J Nutr, 1993; 123:
1611–4), and four or more cups of
coffee a day is linked to a higher
risk of fractures, particularly in
women with low calcium intakes
(Osteoporos Int, 2006; 17: 1055–64). In
contrast, tea appears to be bone-
protective (Am J Clin Nutr, 2007; 86:
1243–7 ), as it contains other
healthful ingredients such as
flavonoids.
Heavy alcohol consumption is
also implicated in osteoporosis
(Alcohol Clin Exp Res, 2010; Feb 24; Epub
ahead of print ), but a moderate
consumption (1–2 drinks/day) may
be beneficial to bone in men and in
postmenopausal women (Am J Clin
Nutr, 2009; 89: 1188–96).
! Smoking. Cigarettes are a
known risk factor for low BMD and
osteoporosis ( J Cross Cult Gerontol,
2005; 20: 109–25 ). Smoking more
than a pack a day is associated with
a 60-per-cent greater risk of
osteoporosis ( Bone, 2010; Mar 31;
Epublication ahead of print ). Also,
Japanese researchers have
discovered changes such as fewer
marrow cells and osteoblasts
(bone-making cells) in the bones
of smoke-exposed rats. Although
these findings may not apply to
humans, they suggest that even
passive smoking may adversely
affect bones (Orthopedics, 2010; 33:
90–5).
! Changes in weight. Studies have
shown that those who have
successfully lost weight also had
greater bone loss compared with
those who didn’t lose weight (J Clin
Endocrinol Metab, 2007; 92: 3809–15). So,
if you’re on a weight-loss diet, be
sure to increase your physical
activity (preferably with high-
impact exercise) and ensure that
your intake of bone-building
nutrients is adequate (see box,
page 30).
! Certain medications. Long-
term use of corticosteroid
medications such as prednisone
and cortisone can lead to
osteoporosis ( Presse Med, 2006; 35:
1571–7). Other drugs that have been
linked to brittle bones include
aromatase inhibitors, used to treat
breast cancer (Bratisl Lek Listy, 2010;
111: 27–32 ), and acid-blocking
proton pump inhibitors ( Curr
Gastroenterol Rep, 2010; Apr 24;
Epublication ahead of print).
Prevention is the key
Ultimately, as osteoporosis is a
‘silent’ condition—it’s usually
asymptomatic until a bone fracture
occurs—understanding what
causes it is our best weapon
against it. Indeed, research
suggests that making simple
changes to our diet and lifestyle
now can have a big impact on our
bones for years to come.
Joanna Evans
WDDTY Women’s health 31
Health and beauty
Saving face
Research shows that you can keep wrinkles at
bay without resorting to botox or surgery
S
kin changes such as wrinkles
and sagging are among the
most visible signs of ageing.
To an extent, such changes are an
inevitable part of growing old—the
result of ‘intrinsic’ (internal)
factors beyond our control that
include genes and changes in
hormone levels over time.
However, research shows that
the vast majority of skin ageing is
due to ‘extrinsic’ (external)
factors, such as sun exposure,
smoking, poor nutrition,
environmental pollution and
stress. These are factors that we
can do something about and,
ultimately, our understanding of
them is the key to keeping our skin
young- and healthy-looking for
longer.
Sun exposure
Although sunlight is undoubtedly
good for us, when it comes to our
skin, overexposure to the sun is its
number-one enemy. Ultraviolet
(UV) radiation from the sun is by
far the most important factor in
skin ageing, especially its
premature ageing. In fact,
‘photoageing’, as it’s known, is
estimated to account for up to 90
per cent of all visible skin-ageing
(Int J Cosmet Sci, 2008; 30: 87–95).
Both ultraviolet A (UVA) and B
(UVB) radiation are responsible,
but UVA penetrates more deeply
into the skin and, thus, is able to
damage both the epidermis—the
outermost layer, made up of skin
cells, pigment and proteins—and
the dermis—the next layer in,
made up of collagen and elastin
fibres (Acta Dermatovenerol Alp Panonica
Adriat, 2008; 17: 47–54).
The tell-tale signs of
photoageing include wrinkles,
sagging, dry or rough skin, age
spots, spider veins and actinic
keratoses—thickened wart-like,
rough, reddish-brown to blackish
patches of skin (Coll Antropol, 2008; 32
32 WDDTY Women’s health
Suppl 2: 177–80). Most at risk are
those of us who live in sunny
climates, spend a lot of time
outdoors and have fair skin (Arch
Dermatol, 2002; 138: 1462–70).
The most obvious plan of action
is to protect the skin with a
sunscreen. Indeed, UV filters are
now found in numerous everyday
cosmetic products such as
makeup, moisturizers and hand
creams. However, several sun-
screen chemicals are linked to
adverse effects, such as hormone
disruption and allergic reactions
(see WDDTY vol 19 no 3).
A safer option is to use products
that contain physical filters, such
as zinc oxide and titanium dioxide,
rather that chemical filters. These
agents are capable of reflecting
both UVA and UVB rays and, as
they don’t penetrate into the skin,
they are unlikely to have
toxic/allergic effects ( Acta
Dermatovenerol Alp Panonica Adriat, 2008;
17: 47–54).
Even better, look for products
that contain antioxidants such as
vitamins C and E, and coenzyme
Q10, as these natural free-radical
fighters play an important role in
protecting the skin against UV-
induced damage (Curr Probl Dermatol,
2001; 29: 157–64). One 16-week study
found that twice-daily application
of a cream containing antioxidants
provided protection against UVB-
induced oxidative stress in the
epidermis, a crucial factor in skin
ageing ( Photodermatol Photoimmunol
Photomed, 1999; 15: 115–9). Another
revealed that the topical
application of coenzyme Q10 was
effective against UVA-induced
oxidative stress in the skin,
concluding that “CoQ10 has the
efficacy to prevent many of the
detrimental effects of photoaging”
(Biofactors, 1999; 9: 371–8).
Antioxidants taken internally
may also be beneficial. Taking
supplements, or including plenty
of antioxidant-rich foods in your
diet, can bolster the skin’s natural
defences against sunlight (see
below).
Other ways to protect yourself
against the sun include avoiding
exposure between 11am and 3pm,
when the sun’s rays are strongest,
and wearing protective clothing,
such as a wide-brimmed hat and
long sleeves, when you’re outdoors
during the day. Also, be sure to
avoid indoor tanning devices,
which are another source of UV
radiation.
Dietary factors
Nutrition is one of the most
important factors involved in skin
health and its condition. If the skin
is not sufficiently nourished, it
won’t be able to defend itself
against external insults, such as
the sun’s rays, that contribute to
the signs of ageing ( Dermat-
oendocrinol, 2009; 1: 271–4).
Indeed, an international study
conducted in 2001 confirmed that
the foods we eat can have a
significant impact on the state of
our skin ( J Am Coll Nutr, 2001; 20:
71–80). Researchers at Melbourne’s
Monash University studied 453
people living in Australia, Greece
and Sweden to determine whether
or not food and nutrient intakes
were related to wrinkling of the
skin in sun-exposed areas.
What they discovered was that a
high intake of vegetables, legumes
and olive oil appeared to be
protective against developing
wrinkles, while a high intake of
meat, dairy and butter had the
opposite effect. In particular, full-
fat milk (rather than skimmed
milk, cheese and yoghurt), red
meat (especially processed meat),
potatoes, soft drinks/cordials and
cakes/pastries were all associated
with extensive skin-wrinkling.
Protective foods included leaf y
green vegetables, broad beans,
lima beans, nuts, olives, dried
fruit/prunes, cherries, grapes,
apples and tea.
According to the researchers,
these protective foods may have
contributed to less skin-wrinkling
because of their high contents of
antioxidant vitamins and
phytochemicals. Indeed, previous
studies found that certain
antioxidants and plant ingredients
can protect the skin against UV
radiation when taken as
supplements, so high intakes of
these nutrients would tend to lead
to less wrinkling at sun-exposed
sites. The antioxidant vitamins C
and E, the carotenoids beta-
carotene and lycopene, and the
proanthocyanidins, a group of
flavonoids found in grape seeds
and other plant sources, are just
some of the nutrients that appear
to have photoprotective effects
(see WDDTY vol 19 no 3).
The Monash researchers also
noted that sugar and sugar
products can contribute to poor
skin health through the
‘glycosylation of proteins’—when a
sugar molecule attaches itself to a
protein molecule—in the skin.
This, in turn, can contribute to
skin-wrinkling and photoageing,
and might explain why foods such
as soft drinks and cakes/pastries
are associated with more wrinkling
of the skin (J Am Coll Nutr, 2001; 20:
71–80).
A more recent study also
reported a link between diet and
skin-ageing. Using data from the
first National Health and Nutrition
Examination Survey, UK
researchers examined the asso-
ciations between nutrient intakes
and ‘skin-ageing appearance’ in
more than 4000 American women
aged 40–74 years. They found that
having higher dietary intakes of
vitamin C (from orange juice,
citrus fruits, fruit juices and
tomatoes) and linoleic acid (found
in oils such as rapeseed and
soybean oils, and in foods such as
green leafy vegetables and nuts),
and lower intakes of fats and
carbohydrates, were associated
with better skin-ageing app-
earances.
In fact, higher vitamin C intakes
were associated with fewer
wrinkles and less senile dryness
(dry skin as a result of ageing);
higher linoleic-acid intakes were
associated with less of a likelihood
of senile dr yness and thinning
skin; and higher fat and
carbohydrate intakes were linked
with a more wrinkled and thinning
skin. These associations were
independent of age, race,
education, sunlight exposure,
income, menopausal status, body
mass index, supplement use,
physical activity and energy intake
(Am J Clin Nutr, 2007; 86: 1225–31).
In general, the evidence
suggests that including plenty of
antioxidant-rich fruit and
vegetables in your diet is one of the
best things you can do to save your
skin.
Smoking and pollution
Cigarette-smoking is another
important causal factor in skin
ageing; so, if you need yet another
reason to quit the habit, think of
your skin. Smoking increases the
quantities of matrix metallo-
proteinases (MMPs)—enzymes that
break down the collagen, elastin
fibres and connective tissue in the
skin (J Dermatol Sci, 2007; 48: 169–75).
These enzymes also cause oxidative
stress, which impairs collagen
production (J Investig Dermatol Symp
Proc, 2009; 14: 53–5). The result of
this double whammy is skin that’s
old before it’s time. Indeed,
studies show that the longer you
continue to smoke, the older you’ll

Natural wrinkle fighters

! Coenzyme Q10. Topical application of this antioxidant
not only protects against sun damage, but also appears
to improve the appearance of wrinkles. A clinical trial
showed that the use of a 1-per-cent CoQ10 cream for
five months significantly reduced wrinkles, as rated by a
dermatologist (Biofactors, 2008; 32: 237–43).
! Vitamin C. In one placebo-controlled trial, a topically
applied cream containing 5-per-cent vitamin C led to a
“clinically apparent improvement” of sun-damaged skin
after six months. In particular, deep furrows and skin
elasticity were improved (Exp Dermatol, 2003; 12: 237–44).
! Niacinamide. According to clinical testing, applying
5-per-cent niacinamide (vitamin B3) in a moisturizer to
the face can improve various signs of ageing, including
hyperpigmentation, fine lines and wrinkles, redness/
blotchiness, yellowing (sallowness) and elasticity (Int J
Cosmet Sci, 2004; 26: 231–8; Dermatol Surg, 2005; 31: 860–5).
! Alpha-lipoic acid (ALA). In a trial of 33 women, aged
40–75 years, each treated half her face with a cream
containing 5-per-cent ALA, and the other half of her face
with a placebo cream, twice daily for 12 weeks.
The results showed significant improvement in the
signs of photoageing on the ALA-treated side of the
face. Specifically, laser profilometry—which measures
the surface of the skin with extreme accuracy—revealed
an average decrease in skin roughness of 51 per cent
compared with 41 per cent on the placebo-treated side
(Br J Dermatol, 2003; 149: 841–9).

WDDTY Women’s health 33

Health and beauty

Hope in a jar?
Of the countless creams on the market claiming to erase
wrinkles and stop sagging, few have undergone rigorous
scientific trials to prove their effectiveness. One exception is
No 7 Protect & Perfect Intense Beauty Serum, made by
Boots, which was tested last year in a double-blind,
randomized controlled trial. After one year, the researchers
found “significant clinical improvement in facial wrinkles”,
which they believed was due to the increased production
of fibrillin-1 in the skin, a protein that promotes skin
elasticity. Bear in mind, however, that the study was funded
by Boots (Br J Dermatol, 2009; 161: 419–26).
Nevertheless, for those who might be looking for a more
natural solution (the Boots serum contains a raft of harsh
chemicals), your best bet is to look for products with high
levels of antioxidants such as vitamin C and E, and co-
enzyme Q10.
Weleda’s new Pomegranate Firming Face Serum, for
example, contains antioxidant-rich pomegranate juice and,
according to the website, dermatological tests have shown
that, after 28 days of use, the depth of wrinkles was
reduced by 29 per cent while skin moisture levels
increased by 39 per cent (www.weleda.co.uk).

look ( Plast Reconstr Surg, 2009; 123:
1321–31).
Fortunately, just stopping
smoking can have a rejuvenating
effect on the skin. In a study of 64
women who took part in a nine-
month stop-smoking programme,
the results suggested that kicking
the habit can dramatically reduce
the biological age of your skin.
The women’s skin was assessed
before and after the programme in
terms of lines, pigmentation,
elasticity, brightness and texture
to establish its biological age. At
the end of the programme, an
average reduction of about 13
years in the biological age of the
women’s skin was found whereas,
at the beginning of the study, their
skin had an average biological age
of nine years older than their
actual, chronological age (Skinmed,
2010; 8: 23–9). These results suggest
that stopping smoking is an
important way to prevent and even
reverse the signs of skin-ageing.
Besides tobacco smoke, the air
pollution from road traffic and
other sources can also have a
negative impact on the skin.
A recent German study of 400
elderly women found that air-
pollution exposure was
significantly linked to extrinsic
signs of skin ageing and, in
particular, pigment spots. An
increased exposure to soot and
particles from traffic was
associated with 20-per-cent more
pigment spots on the forehead and
cheeks. Background particle
pollution that was not directly
attributable to traffic was also
positively associated with pigment
spots on the face (J Invest Dermatol,
2010 Jul 22; Epub ahead of print).
While it’s impossible to
completely avoid air pollution,
increasing antioxidant intake
can boost the skin’s natural
defences.
Also, keep tabs on the
air pollution in your area
by contacting your local air-quality
monitoring service (in the
UK: www.airquality.co.uk/index.
php; in the US: www.epa.gov/oar/
airpolldata.html). When pollution
levels are high, avoid spending a
lot of time outdoors if possible. For
further advice on how to minimize
your exposure to air pollution, see
WDDTY vol 18 no 5.
Other face-saving factors
Clearly, wrinkles, sagging and the
other signs of skin ageing are not
simply the inevitable consequence
of getting old. The sun, tobacco
smoke and outdoor air pollution
can all have a negative impact on
our skin, and what we eat can
determine how well our skin
responds to these insults.
In addition, severe physical and
psychological stress can both take
their toll on the appearance of
yourskin ( Acta Dermatovenerol Alp
Panonica Adriat, 2008; 17: 47–54 ), so
consider stress management the same way every night can lead
techniques such as meditation and to wrinkles known as ‘sleep lines’
yoga as part of your anti-ageing (Scand J Plast Reconstr Surg Hand Surg,
regime. 2004; 38: 244–7).
Also, it may help to get into the Finally, don’t forget to drink
habit of sleeping on your back plenty of water to keep your skin
rather than on your side, as years hydrated and smooth-looking.
of resting your face on the pillow in Joanna Evans

34 WDDTY Women’s health

Perfume:
a whiff of danger
It’s time for a change in labelling laws to help consumers
avoid the symptoms of toxic fragrance cocktails
A
cocktail of hidden hazardous
chemicals could be lurking
in your favourite perfume,
says a new report from the US. The
Campaign for Safe Cosmetics
(CSC)—a non-profit partly funded
by the Breast Cancer Fund—in
partnership with the non-profit
research and advocacy organiza-
tion Environmental Working Group
(EWG), have revealed that many
top-selling fragrance products—
from Calvin Klein’s Eternity to
Britney Spears’ Curious—contain a
dozen or more ‘secret’ chemicals
not listed on the labels.
Among these chemicals are
those associated with allergic
reactions and hormone disruption,
and other agents with troubling
hazardous properties.
The CSC commissioned tests of
17 fragranced products, such as
perfumes, colognes and body
sprays, by an independent lab,
while the EWG was responsible for
analyzing the data.
All 17 products contained at
least seven chemicals
that weren’t indicated
on labels; indeed, a
total of 38 secret
chemicals were det-
ected. On
average, the
products had
nearly equal numbers of hidden
and listed ingredients, with 14
chemicals kept secret but found
through testing, and 15 disclosed
on the labels.
“This complex mix of
clandestine compounds in popular
colognes and perfumes makes it
impossible for consumers to make
informed decisions about the
products they consider buying” the
report says ( www.safecosmetics.org/
notsosexy).
Secret scents
So, are these companies breaking
the law by not disclosing precisely
what is in their products? Sadly,
no. As the CSC report points out,
fragrance secrecy is legal due to a
giant loophole in the US Federal
Fair Packaging and Labeling Act of
1973. It requires that companies
list cosmetics ingredients on the
product labels, but specifically
exempts fragrance. This means
that manufacturers disclose some
chemical constituents on
ingredients lists, but lump others
together as ‘fragrance’. Yet,
fragrances are typically a complex
cocktail of dozens—sometimes
even hundreds—of different
chemicals.
In Europe, recent changes in
labelling laws mean that cosmetics
makers have to list any of the 24
fragrance chemicals (and two
botanicals) that the EU’s Scientific
Committee on Cosmetic Products
and Non-Food
Products (SCCNFP)
has identified as
contact allergens, or
‘sensitizers’. A are lurking in your favourite
recent Danish study
of over 100 such
sufferers found that
45 per cent had
found scented prod-
ucts they could tolerate, usually by
reading ingredient labels (Contact
Dermatitis, 2009; 61: 320–4).
In the US, shoppers have no way
to know—short of sending the item
to a lab for testing—precisely
what is hiding in a perfume or
beauty product, thus increasing
the chances of allergic reactions,
including headaches, chest
tightness, wheezing, asthma,
sense-organ irritation and skin
rashes.
Sniffing out toxicity
Sensitizers are not the only
chemicals of concern, however. The
CSC report also revealed a host of
other potentially harmful
ingredients in high-end products,
some of which have been linked to
hormone disruption, reproductive
toxicity and even cancer.
Although EU labelling laws
require common sensitizers to be
declared on the label, other
ingredients that make up the
fragrance can simply be listed as
‘parfum’—so you won’t know which
product.
The main ingredients of concern
are phthalates and synthetic
musks, which the CSC found in
nearly ever y product tested.
WDDTY Women’s health 35
Health and beauty

Similarly, a 2005 investigation by
environmental group Greenpeace
International found these
chemicals in virtually all of the 36
name-brand perfume products they
analyzed ( www.greenpeace.org/inter
national/en/publications/reports/perfume-
an-investigation-of/).
The most prevalent phthalate
chemical was diethyl phthalate
(DEP), used in cosmetics and other
personal-care products as a solvent
and vehicle for fragrances, and also
as an alcohol denaturant (making
the alcohol unfit to drink). The
Greenpeace study found DEP in 94
per cent of the products tested,
while 70 per cent of the items
contained the chemical in the CSC
report. Most worrying, however,
is that not one of the 12 products
containing DEP in the CSC study
disclosed its presence on the label.
Recent epidemiological studies
have linked DEP and other
phthalates to a range of human
health effects, which make for
alarming reading.
! Findings from the US-based
Study for Future Families found
a strong link between exposure
to DEP and other phthalates
during pregnancy and changes
in the development of genitals
in baby boys ( Environ Health
Perspect, 2005; 113: 1056–61).
! In 130 Danish and Finnish
infants, there was correlation
between levels of DEP
metabolites in breast milk and
alterations in levels of male sex
hormones in baby boys (Environ
Health Perspect, 2006; 114: 270–6).
! In 379 men attending an
infertility clinic, exposure to
DEP and DEHP [Di(2-ethylhexyl)
phthalate] was associated with
DNA damage in sperm ( Hum
Reprod, 2007; 22: 688–95).
! A Mexican study found a
relation-ship between high levels
of urinary DEP and an increased
risk of breast cancer ( Environ
Health Perspect, 2010; 118: 539–44).
! A study of children aged four to
nine years noted a link between
behav-ioural problems such as
ADHD and greater maternal
exposure to low-molecular-
weight phthalates such as DEP
( Environ Health Perspect, 2010; 118:
565–71).
These findings are even more
worr ying as phthalates—
particularly DEP—are pervasive. A
US population study found these
chemicals in every person tested
( Environ Health Perspect, 2004; 112:
331–8).
Although DEP doesn’t
accumulate in the body, when
applied to the skin, it rapidly
penetrates it to become widely
distributed in the body. DEP
metab-olites have been detected in
human urine at levels up to 32
times higher than any other
phthalates ( Environ Health Perspect,
2003; 111: 1164–9). The highest levels
are found in women (Environ Health
Perspect, 2004; 112: 331–8), and those
who regularly wear perfume have
more than twice the levels of DEP
in their urine than in non-wearers
(J Expo Sci Environ Epidemiol, 2010 Mar
31; Epub ahead of print).
The other hazardous chemicals
pinpointed by both the CSC and
Greenpeace are synthetic musks,
used in perfumes, aftershaves,
cosmetics and skincare products,
as well as in cleaning products and
detergents. The CSC found
synthetic musks in all 17 products
tested, but not one listed the
chemicals on the label.
Synthetic musks accumulate in
the body in fatty tissue, and have
been found in blood samples and even

Safer scents make good sense

BRAND PRICE RANGE

Aroma Sciences From £25.50 Wide range of 100-per-cent natural perfumes; high-quality,
www.aromasciences.com but can cost as much as £500 for 30 mL of a specially
Tel: 01445 731 618 crafted individual scent

Aveda From £20 A range of natural essences; available as sprays, rollerballs

www.aveda.com and splashes
Tel: 0800 054 2979

Burren Perfumery From !35.50 Limited range of natural parfums, colognes and eaux de
www.burrenperfumery.com toilette
Tel: +(353) 65 708 9102

Clarins From £27 Eau Dynamisante and Eau Ressourçante combine aromatic
http://uk.clarins.com essential oils with non-fragrant extracts of plants with
healing properties; available as a spray or splash

Nature’s Gift From $6 A range of single essential oils diluted in perfumer’s alcohol
www.naturesgift.com
Tel: +(615) 612 4270

Profumo From !30 A wide range of intriguing blended scents from Italy,
www.profumo.it (without VAT) produced exclusively with natural essential oils and
Tel: +39 (0) 541 86 30 13 absolutes

36 WDDTY Women’s health


breast milk (Chemosphere, 2005; 59:
487–92; Chemosphere, 1996; 33: 2033–43).
The available research suggests that
certain musks—including those in
perfumes—can disrupt hormone
systems (Environ Sci Technol, 2004; 38:
997–1002), trigger skin sensitization
when exposed to ultraviolet (UV)
light (Contact Dermatitis, 1986; 14: 103–9)
and worsen the effects
of exposure to other toxic
chemicals ( Environ Health Perspect,
2005; 113: 17–24). Some musks have
even significantly increased the
growth of human breast cancer
cells in test-tube studies ( Arch
Environ Contam Toxicol, 2002; 43: 257–64).
In addition these agents, the
CSC identified a laundry list of
other secret chemicals in the 17
products analyzed, many of which
could pose health risks.
Myrcene, for example, was found
in all but one product, and showed
carcinogenic activity in a two-year
animal study [National Toxicology Panel
technical report on the toxicology and
carcinogenesis studies of beta-myrcene
(CAS no. 123-35-3) in F344/n rats and
B6C3F1 mice (gavage studies), 2009;
http://ntp.niehs.nih.gov/index.cfm?objectid
=F44C400D-F1F6-975E-7058AFF96
EAA63E2 ]. Another animal study
showed that inhaling the
hydrocarbon compound p-cymene,
found in 11 of the 17 products, is
toxic to the nervous system
(Pharmacol Toxicol, 1996; 79: 225–30).
A change in the air?
The CSC and EWG are both calling
for urgent changes to cosmetics
laws to protect consumers. Says
Lisa Archer, national coordinator of
the CSC, “We urgently need
updated laws that require full
disclosure of cosmetic ingredients
so consumers can make informed
choices about what they are being
exposed to.”
But the fragrance industry says
this is unrealistic. Says John Bailey,
chief scientist for the Washington-
based Personal Care Products
Council, there wouldn’t be enough
room on labels to include all the
ingredients used to create a
fragrance, and the information
would be meaningless to
consumers anyway.
Other industr y groups cite
fragrance counter-feiting as the
reason why companies don’t declare
the exact ‘recipe’ of a product on
the bottle.
However, a growing number of
companies are fully disclosing their
ingredients—including fragrance—
on labels as part of their
commitment to the Compact for
Safe Cosmetics, a pledge for safety
and transparency (see
www.safecosmetics.org/notsosexy
Appendix F for a full list of
companies).
Others, such as Boots and The
Body Shop, have agreed not to use
synthetic musks and phthalates,
which is certainly a step in the
right direction.
Nevertheless, the vast majority
of fragrance products on the
market are likely to continue to use
hidden toxic chemicals. But even
those disclosed on the label can
pose risks. Sunscreen chemicals,
often added to perfumes and
colognes to increase stability and
shelf life, are hormone disruptors
and toxic to fetuses—at least in
rats (Toxicology, 2004; 205: 113–22). Of
the CSC’s 17 products, 13
contained at least one sunscreen
chemical.
So, whether listed on the label or
not, most perfumes and scented
products invariably contain a
cocktail of potentially harmful
chemicals. Although regulator y
and standard-setting agencies
insist fragrances are perfectly safe,
as the CSC points out, they “do not
often consider the risk to human
health of cumulative exposures to
the same chemical from multiple
sources, nor do they consider the
exposures to multiple chemicals
from multiple sources”.
Indeed, one-time use of
fragrances may not cause harm, but
we don’t know what effect repeated
use has—especially in conjunction
with other toxin-laden consumer
products.
Good scents
Although it may be difficult to find
a truly natural scent, as words like
‘hypoallergenic’, ‘natural’ and
‘floral’ don’t necessarily mean you
can trust the product behind the
labelling, safer alternatives are
available (see box, page 36).
Another option is to make your
own unique scent using natural
essential oils such as jasmine,
lemon, sandalwood and ylang-ylang.
As few of these oils are safe to use
neat on the skin, they should be
mixed with a base oil (such as sweet
almond, apricot kernel, safflower,
hazelnut or even sunflower oil). Use
no more than 1 drop of essential oil
to 1 mL of base oil, and be aware
that some people are allergic to
essential oils.
Another option is to forgo
fragrance altogether. Indeed, in a
world where synthetic fragrances
are nearly ubiquitous, perhaps the
ultimate scent is ‘fragrance-free’.
Joanna Evans
WDDTY Women’s health 37
Health and beauty
Hair – dyed and deadly
Millions of women regularly colour their hair without giving it a second
thought, yet the evidence is mounting that hair dye may be responsible
for a host of serious health problems—from liver disease to cancer
I
f you are one of the millions
of people everywhere who
routinely dyes their hair, you
could be increasing your
chances of developing a Aminophenol has been shown to
progressive—and ultimately
fatal—liver disease, according
to an alarming new study.
This latest research involved
more than 5000 people in the
UK with and without primary
biliary cirrhosis (PBC), an early
stage of liver cirrhosis. Using
detailed postal questionnaires,
the study found that around 1
per cent of men, and more than
50 per cent of women, used hair
dye, and that this was
associated with a 37-per-cent
increased risk of PBC.
Smoking was also linked to
the disease but, surprisingly,
drinking was not (Gut, 2010; 59:
508–12).
Although the findings aren’t
proof that hair dye causes PBC,
the authors suspect that
octynoic acid—a chemical
found in hair dye, nail polish
and other cosmetics—could be
responsible for the connection.
Indeed, there’s convincing
evidence from both animal and
test-tube studies to
substantiate such an hypothesis
( J Autoimmun, 2006; 27: 7–16; J
Immunol, 2005; 174: 5874–83 ). In
humans, there’s also a study
linking PBC with frequent use
of nail polish (Hepatology, 2005; 42:
1194–202).
Other hair-dye chemicals—
including toluidine and p-
aminophenol—are also
plausible causes of liver damage
(Chin Med J [Engl], 2009; 122: 875–7).
In a Japanese study of 15
factory workers who handled
toluidine from three to 20
38 WDDTY Women’s health
times, seven showed signs of liver
damage, and three were
hospitalized because of acute liver
dysfunction (Gut, 2002; 50: 266–70). p-
cause liver damage in mice ( J
Biochem Mol Toxicol, 2001; 15: 34–40).
While more studies are needed,
there’s already considerable
evidence to suggest that using hair
dye on a regular basis could be
contributing to liver disease,
especially in women.
Cancer risk
If that’s not enough to put you off
colouring your hair, there’s also
evidence linking hair-dye use to
cancer, including rare cancers
such as non-Hodgkin’s lymphoma
(NHL).
A possible connection was first
noted in the 1970s, when several
studies found links between hair
dyes—particularly the black, dark-
brown and red shades—and breast
cancer (NY State J Med, 1976; 76: 394–6;
J Natl Cancer Inst, 1979; 62: 277–83 ).
What’s more, women who had
started dyeing their hair in their
20s had twice the risk of the 40-
year-olds. However, the users who
were at greatest risk were those
aged 50–79 years who had been
dyeing their hair for years.
Moreover, compared with women
who had never coloured their hair,
those who dyed their hair five or
more times a year had twice the
risk of developing ovarian cancer
(Int J Cancer, 1993; 55: 408–10).
It was also discovered that
people who had worked
for 10 or more years as
hairdressers or barbers had a
fivefold greater risk of bladder
cancer than the general population
(Int J Cancer, 2001; 91: 575–9). More
recently, a meta-analysis, which
pooled the results of 247 studies,
similarly concluded that
hairdressers have a greater overall
risk of cancer—in particular, lung,
larynx and bladder cancers, and
multiple myeloma—than the rest
of the population (Int J Epidemiol,
2009; 38: 1512–31).
However, it’s the link with
otherwise unusual cancers that
provides the most compelling
evidence of hair-dye toxicity.
Dyeing your hair can increase the
risk of NHL and multiple myeloma
from two to four times over a non-
user’s risk (Am J Public Health, 1988; 78:
570–1; J Natl Cancer Inst, 1994; 86: 210–5).
Indeed, hair dyes may account for
as much as 20 per cent of all cases
of NHL in women (Cancer Res, 1992;
52 [19 Suppl]: 496s–500s).
Nevertheless, there are studies
that dispute the cancer connection
with hair dyes. Indeed, as a 1993
report by the International Agency
for Research on Cancer (IARC)
concluded, “There is inadequate
evidence that personal use of hair
colorants entails exposures that
are carcinogenic”. However, the
report also stated that being a
hairdresser or barber entails
exposures that are “probably
carcinogenic”, suggesting that
hair dyes may well lead to cancer.
The problem may lie with the
older hair-dye formulations, which
were considerably more toxic than
the newer compounds used these
days. One study found an increased
risk for NHL in women who used
hair dye—particularly the darker,
permanent types—before 1980,
but no risk for those who began
colouring their hair after that time
(Am J Epidemiol, 2004; 159: 148–54).
However, the researchers admit
that this finding may also be
because “recent users are still in
their induction and latent
periods”. Indeed, chemically
induced cancers typically take
more than 20 years to develop (Crit
Rev Toxicol, 2007; 37: 521–36). So, it
may not be that the new dyes don’t
cause cancer, but just that it’s too
soon to tell.
Another factor that might
explain the inconsistent findings is
genes. Genomics—the new branch
of genetics that studies gene
mapping and DNA sequencing—
has revealed that some individuals
have variations (known as
‘polymorphisms’) within genes
that encode for certain
detoxification enzymes. This
means that they have greater
difficulty clearing environmental
toxins from the body (see WDDTY
vol 20 no 10), and might also
explain why some people may be at
greater risk of cancer from using
hair dye.
In fact, two recent studies of
hair-dye use have found an
increased risk of NHL only among
women with specific genetic
polymorphisms (Am J Epidemiol, 2009;
170: 1222–30; Carcinogenesis, 2007; 28:
1759–64 ). It’s possible, therefore,
that a genetic inability to
adequately remove toxic hair-dye
chemicals from the body could lead
to cancer.
Safer formulas?
Happily, a number of ingredients
commonly used in hair dye are now
under restricted use and—at least
in Europe—some agents have even
been banned completely. However,
the current formulations may still
be hazardous to health.
One chemical of concern is a
component of permanent hair dyes
called paraphenylenediamine, or
PPD. It’s still found in more than
two-thirds of hair dyes on the
market, including many of the top-
selling brands. PPD is an effective
colorant because its low molecular
weight enhances its ability to
penetrate the hair shaft and
follicle, and it also has a strong
protein-binding capacity. However,
these properties also make PPD an
ideal contact allergen—and, in
fact, it’s among the most potent of
such allergens around. hairdressers) PPD allergy whereas,
Over the past few decades, recently, that figure has grown to
allergic reactions to PPD have more than 40 cases annually.
become such a serious problem Indeed, it’s a trend that has also
that the chemical has been banned been observed in other countries
completely from hair dyes in (BMJ, 2007; 334: 220).
Germany, France and Sweden. A patient with contact allergy to
Nevertheless, the current hair dye often presents with a
European legislation allows PPD to simple rash on the face or around
comprise up to 6 per cent of the the hairline. But severe reactions
constituents of personal-use hair may also occur. One consumer
dyes. complaint-based study in Denmark
In addition, despite its identified 55 cases of severe acute
restricted use, dermatologists contact dermatitis caused by hair
continue to report increasing dye, with gross swelling of the face,
numbers of cases of PPD-induced scalp and ears. These cases were
contact dermatitis. A 2007 survey responsible for 75 visits to the
of adults in a London clinic found health service and five admissions
that cases have doubled since to hospital, leading the researchers
2001, and it’s likely that the to conclude that PPD, at its
increased personal use of hair dye current concentrations in hair dye,
is to blame. The same clinic “presents a significant health risk
confirmed that, during the for the population” ( Contact
1965–1975 decade, it saw up to 11 Dermatitis, 2002; 47: 299–303). Severe
patients a year with non- hair-dye reactions among children
occupational (they weren’t have also been reported (Contact
Safer hair colouring
! Always do a patch test first, as both natural and conventional hair dyes
contain a range of ingredients that can trigger allergic reactions. Hair-dye
manufacturers maintain that allergic reactions can be avoided if
instructions are carefully followed and if a skin-sensitivity test is carried out
48 hours before product use. Bear in mind, though, that patch-testing is
not 100-per-cent reliable (Br J Dermatol, 2007; 157: 1017–20).
! Choose safer products. Go to www.safecosmetics.org for a list of
companies that have pledged not to use chemicals that are known, or
strongly suspected, to cause cancer, mutations or birth defects in their
products. One such company is Aubrey Organics (www.aubrey-
organics.com; tel: 0800-0851-697), which makes a herbal, chemical-free
permanent hair colour called Color Me Natural (available in mahogany and
dark brown). For a wider colour range, try the German company Logona,
which makes products that are free of ammonia, peroxides, PPD and other
aggressive ingredients (www.logona.co.uk; tel: 0800-027-1102).
! Always read the labels. Many supposedly natural products often contain
the same chemicals found in conventional products, so always check the
list of ingredients. Avoid products that contain phenylenediamines such as
PPD, and look out for words like ‘amino’ and ‘nitro’, and names of colours
starting with the letters ‘HC’ (a clue that it’s not natural). Check out
www.cosmeticsdatabase.com, compiled by the US-based consumer
watchdog Environmental Working Group (EWG), as it can help you figure
out which ingredients and products to avoid.
! Don’t dye your hair too often. If you do use chemical-based formulas,
make an effort to go for the maximum amount of time between colour
applications. To reduce the health risks even further, only apply dye to hair,
and not the scalp. You can now buy hair-dye applicators, which look like
hollow combs or brushes, that allow you to smooth the dye onto the hair
to minimize contact with the scalp. Also, leave hair dyes on the head for the
minimum required time.
WDDTY Women’s health 39
Health and beauty
Dermatitis, 2006; 54: 87–91).
Even hair dyes containing
relatively small concentrations of
PPD can be a problem, as the
chemical accumulates in skin over
time. This means that intermittent
exposure to lower levels of PPD,
such as from regular hair-
colouring, could elicit the same
reaction as a one-off exposure to a
higher concentration ( Contact
Dermatitis, 2007; 56: 262–5).
Another problem with PPD is
cross-sensitization. This means
that once you have reacted to PPD,
you may become sensitive to its
chemical cousins. These are
commonly used in other sorts of
hair dyes, textile dyes, pen ink,
food dyes, medication dyes,
preservatives (parabens) and some
drugs (such as benzocaine,
procaine and sulphonamides). So,
an allergy to PPD can be a long-
term problem (Frosch PJ et al., eds.
Contact Dermatitis, 4th edn. Heidelberg,
Germany: Springer-Verlag, 2006: 479).
Sensitization to PPD has also
been seen in connection with its
use as black ‘henna’ skin paint for
temp-orar y tattoos ( J Cosmet
Dermatol, 2003; 2: 126–30 ). Int-
erestingly, PPD is not permitted for
this type of use. As the US Food
40 WDDTY Women’s health
and Drug Administration (FDA)
states, it is not approved for direct
application to the skin
( www.cfsan.fda.gov/~dms/cos-tatt.html ).
Be that as it may, when hair dye is
applied, it inevitably comes into
direct contact with the scalp and
skin on the forehead and around
the ears. So, the fact that it
triggers allergic reactions in some
people is hardly surprising.
Chemical cocktails
In addition to PPD, a host of other
potentially dangerous chemicals—
many of which rapidly penetrate
the skin—can be found in the hair-
dye products currently on the
market. It appears that octynoic
acid may well be a cause of the
progressive liver disease primary
biliar y cirrhosis, and 4- has now emerged that is devoted to
aminophenol (an alternative name hair-colouring alternatives. How-
for p-aminophenol), another ever, many so-called natural
current hair-colouring ingredient, products may still contain as many
is “a recognized human urinary toxic agents as conventional
bladder carcinogen” ( Chem Res brands, which means that it’s up to
Toxicol, 2003; 16: 1162–73). the consumer to be vigilant and to
This means that, so far, we can choose the safest products
only guess at what effects the available (see box, page 39).
combination of chemicals used in Alternatively, perhaps it’s time to
hair dyes will ultimately have on embrace your natural look or to
our health. consider growing grey gracefully.
Fortunately, an entire industry Joanna Evans
Minimizing the ‘orange-peel’ look
L
ooking good on the beach
occupies many women’s minds at
this time of year. Diet and
exercise are usually the first port of call
in preparation for a bikini-friendly body,
but what about those distressing body
complaints that healthy eating and
regular gym sessions just won’t shift?
Excess weight is one thing, but
cellulite, stretch marks and scars can
seriously affect the body confidence of
even the slimmest of women. While we
can’t always eliminate the problem
completely, there are a number of
natural remedies that can help.
Cellulite
Cellulite is a naturally occurring
condition in women that causes hips,
thighs and buttocks to take on an
unsightly ‘orange-peel’ appearance.
Even thin women can get it, so eating
right and exercising doesn’t always
mean you’ll be dimple-free. So what
can be done?
According to one study, the first step
in cellulite treatment is “stimulation of
microcirculation and the removal of
accumulated fluids and toxic elements”
(Int J Cosmet Sci, 2006, 28, 191–206). This
could mean daily dry skin brushing and
courses of lymphatic massage. Both
methods are considered excellent ways
to stimulate the lymphatic system,
encouraging improved circulation and
detoxification. While there is no
research on skin brushing, manual
lymphatic drainage has been much
studied as a therapy for oedema (fluid
retention) (Rev Prat, 2000; 50: 1199–203).
Other research suggests directing
therapeutic attempts at the connective
tissue. In theory, agents or physical
manipulations that increase the
integrity of connective tissue between
adipose tissue and the dermis may lead
to a reduction or elimination of
cellulite (Plast Reconstr Surg, 1998; 101:
1934–9).
In this respect, an extract of Centella
asiatica (Gotu kola or Indian
pennywort) has demonstrated
impressive clinical results when taken
orally. Several experimental studies
show this remedy to have a normalizing
action on connective tissue metabolism
by stimulating manufacture of
glycosaminoglycans (GAGs)—the
major components of the ground
substance in which collagen fibres are
embedded (Clin Therap, 1981; 99: 507–13;
Minerva-Cardioangiol, 1982; 30: 201–7). The
outcome is stronger connective tissue,
without excessive collagen synthesis or
cell growth (Ital J Biochem, 1988; 37: 69–77).
Another helpful herb is horse
chestnut, specifically, an extract from
its seed called aescin, which is reported
to be useful in improving micro-
circulation and oedema (Altern Med Rev,
2001; 6: 126–40), and, as an astringent,
can also tone and tighten tissues
(Arzneim-Forsch, 1979; 29: 672–5). In the case
of cellulite, it decreases capillary
permeability by reducing the number
and size of tiny pores in the capillary
walls (Clin Terap, 1965; 32: 297–328; Arzneim-
Forsch, 1964; 14: 892).
In addition to herbs, certain
nutritional supplements currently
being investigated for weight manag-
ement (hydroxycitrate, epigall-
ocatechin gallate, conjugated linoleic
acid (CLA), etc.) may be beneficial for
treating cellulite (Int J Cosmet Sci, 2006;
28: 175). CLA has shown particular
promise (Adv Ther, 2001; 18: 225-9).
Stretch marks
These purple or silvery lines on the skin
can occur during puberty, pregnancy or
when we lose or gain weight. They’re
notoriously difficult, but not
impossible, to treat—at least with
natural substances.
Italian researchers discovered that a
compound containing a mix of
Alchemilla vulgaris (Lady’s mantle),
Hedera helix (Ivy leaf) and Equisetum
arvense (Field horsetail) can help
improve stretch marks, especially when
given to younger women. Fifty-one
patients with striae cutis distensae
(stretch marks) applied the herbal
mixture to their skin twice a day for 40
days. Although the marks did not
disappear in any of the patients, there
was a little improvement in 55.5 per
cent of cases and a greater
improvement in 24.4 per cent. The
group of patients with the lower
average age and with more recent
marks had the best results (G Ital Dermatol
Venereol, 1993; 128: 619–24).
Centella asiatica extract has also
been used effectively in the reduction of
stretch marks (Phytomedicine, 2000; 7:
427–48).
Surgical scars
Terpenoids extracted from the Centella
asiatica plant—including asiatic acid,
madecassic acid and asiaticoside—have
been documented to aid wound healing
in a large number of scientific reports.
Plastic surgeons now routinely use
topical Centella to speed up scar tissue
healing as it promotes collagen and
reduces inflammation, thus making
scars less noticeable (Aesth Plast Surg,
2000; 24: 227–34). Extract of Centella
taken orally at doses of 60–90 mg daily
for 2–18 months has also been used
effectively to treat scars (Ann Plast Surg,
1979; 3: 13–21).
Oil of Rosa mosqueta seed, or rose
hip oil, may also help. Italian doctors
have found the oil—which comprises
linoleic, linolenic and arachidonic fatty
acids—is beneficial in healing surgical
scars and those caused by accidents (J
Med Cutan Ibero Latin Am, 1994; 22: 23–30).
Several anecdotal reports claim
topical vitamin E is valuable for
speeding up wound healing and
improving the cosmetic outcome of
burns and surgical scars, but clinical
research remains inconclusive.
In one study, vitamin E oil actually
made some surgical scars worse and
provoked contact dermatitis (Dermatol
Surg, 1999; 25: 311–15).
Joanna Evans
WDDTY Women’s health 41
Cancer
Mammograms:
medicine’s false trail
Routine mammogram
screening risks outweigh any
benefits, despite what our
health guardians tell us
R
outine mammogram screening
for early-stage breast cancer may
well be one of the great false
trails of modern medicine. Despite the
general belief that mammograms are a
life saver, the astonishing truth is that
the risks of such screening outweigh
any benefits. Indeed, on balance, most
women are better off not having regular
mammograms.
But it’s a message that isn’t being
communicated to the women aged over
50 who are being urged to begin regular
mammogram screening. Instead, they
are being told that mammogram
screening is safe, reliable and saves
lives, ‘facts’ that are so often repeated
by health experts in the West that most
women accept them without question.
Screening is promoted as one of the
few defences we have against a disease
that most women fear more than any
other. Every year, another one million
women worldwide are diagnosed with
the disease and, each year, it claims the
lives of around 54,000 women in the UK
and US alone, according to Cancer
Research UK, a major independent
fund-raiser for cancer research in
Europe (visit www.cancerresearch
uk.org).
Doctors and health officials reckon
that routine mammogram screening is
saving the lives of around 1400 women
in the UK and 26,000 women in the US
annually by picking up the earliest signs
of breast cancer—which are not
detectable by self-examination—at a
time when it is easier to treat. But such
claims are dubious. Most of the cancers
detected by mammography are slow-
growing and not life-threatening
whereas, paradoxically, the X-rays
cannot detect the fast-growing and
aggressive cancers that invariably prove
to be fatal. This suggests that most
42 WDDTY Women’s health
women are being ‘saved’ from cancers
that, in any case, wouldn’t have killed
them.
Yet, because women are told that the
procedure saves lives, around 37 million
Americans and 1.7 million Britons are
submitting themselves to a routine
mammogram every year, including
some for the first time. In fact, Britons
are so convinced of the merits of
mammography that, in 2008, around
two million women were routinely
screened, the highest figure ever
recorded by the UK’s National Health
Service.
Nevertheless, a damning report from
the Cochrane Collaboration—an
independent, and prestigious,
international research organization—
reveals that women are being seriously
misled by health officials, who are
dramatically downplaying the risks of
mammography X-rays while overstating
the benefits. Even the prevailing view
that mammograms save lives is based
on shoddy and biased science.
The report’s lead researcher,
Professor Peter Gotzche, from the
Nordic Cochrane Centre that carried
out the research, says that the official
information leaflet on mammograms
issued to women in the UK
“exaggerates the benefit, omits the
harm, and looks like propaganda aimed
at persuasion . . . There is no convincing
evidence that screening saves lives” (J R
Soc Med, 2010; 103: 14–20).
However, propaganda dressed up as
impartial medical advice isn’t the sole
preserve of the UK health authorities.
Researchers from the University of
Dusseldorf discovered that brochures
on mammography screening in
Germany, Italy, Spain and France
“conceal information from women that
is essential when making an informed
decision” (Eur J Pub Health, 2009; doi:
10.1093/eurpub/ ckp174).
What’s more, the government-
funded websites are no better. When
Cochrane researchers explored 27 sites
run by health agencies or patient
groups that are funded by government,
they found that the sites played down
the risks and even made light of the
procedure itself, which is often very
painful as it involves compressing the
breast between two plates. The
American Cancer Society and the
Cancer Research UK sites both claim
that patients “should not feel pain” (yet
they invariably do), while a
Scandinavian site reported that the
experience was so satisfactory that
women were recommending it to their
“fellow sisters” (BMJ, 2004; 328: 148–51).
Such overselling and playing fast and
loose with the facts could be being
driven by politicians who see universal
and routine screening as a vote-winner
among women, says the Health Services
Research Unit (HSRU), part of the
Department of Public Health, based at
the University of Oxford, UK.
As breast cancer is clearly an
emotive issue among women,
politicians are putting more resources
into a screening programme that
medical evidence tells them isn’t
working. After carefully reviewing 35
years of research, Jane Wells of the
HSRU concluded that screening
neither raises the detection rate of
aggressive cancers nor lowers the
mortality rate for breast cancer. In
addition, she found that it fails to make
a significant difference in the mortality
rate among the over-50s, the group that
is supposed to derive the most benefit
from breast-cancer screening (BMJ, 1998;
317: 1224–9).
A group of cancer specialists in the
 The cancers that just go away
Every woman diagnosed with breast cancer—and every
oncologist handing out the diagnosis—wants to begin
treatment straightaway. This is because, as everyone
knows, the earlier you begin treatment, the greater your
chances of success.
But what would happen if you were to do nothing at all?
It’s a course that almost no one has followed, and doctors
are professionally bound not to do so unless the cancer
is in its very last stages, when treatment would clearly
worsen the patient’s quality of life during her final weeks.
Yet, researchers from the Veterans Affairs Medical Center
in Vermont found the answer when they tracked two
groups of women in Norway from 1996, when the country
introduced its routine and twice-yearly mammogram
screening programmes. They think that the cancers just
went away.
In fact, this astonishing discovery was made by
accident. The objective of the study was to demonstrate
just how effective mammograms are. To do this, the
researchers recruited two groups of women—all aged
between 50 and 64 years, and with similar profiles. One
group had undergone three mammograms between 1996
and 2001, while the other, control group had not been
screened during the six years prior to the study period
and were screened only once, at end of the study.
The cumulative rate of breast cancer was, of course,
much higher in the screened group throughout the study
period. But the unexpected result came at the end of the
trial when both groups were finally screened: the breast
cancer rate in the regularly screened group was still 22
per cent higher than that of the controls.
As the profiles of the two patient groups were similar,
this finding suggests that, during the six years of the trial,
the unscreened group developed breast tumours that, of
their own accord, also simply went away.
The researchers also pointed out that some cancers,
such as metastatic melanoma and metastatic renal cell
carcinoma, do spontaneously regress, and this might
explain the cancers that went away in the unscreened
group (Arch Intern Med, 2008; 168: 2311–6).
In an earlier study, scientists from the Finnish Cancer
Registry made a similar observation, and concluded that
it was because cancers are dynamic and constantly
changing. In this study of women mostly aged between
50 and 64 years, those who were screened had three
times more preclinical tumours than those who were not
screened, although this ratio fell to only twice the rate by
the time these same women reached the age of 70 (Eur
J Cancer, 2004; 40: 2116–25).
The researchers believe that mammograms are picking
up benign tumours that will spontaneously go into
remission, which suggests that only women who are
considerably older should be screened, or that a period
of watchful-waiting may be the wisest course of action.

US agree with her. The National Cancer
Institute’s Physician Data Query (PDQ)
advisory board has concluded—as did
the Cochrane researchers—that
mammograms don’t save lives. In line
with what other researchers have found,
the PDQ advisors pointed out that
mammograms are picking up only
those cancers that are slow-growing or
benign, and missing the life-
threatening tumours (BMJ, 2002; 324: 432;
doi: 10.1136/bmj. 324.7334.432).
Despite this, some doctors and
organizations based in the US—which
already operates one of the world’s
most aggressive screening
programmes, targetting women as
young as under age 40—want to lower
the age even further to include all
women in their 30s.
However, it’s now more than likely
that the US will fall in line with other
national screening programmes and
raise the screening age to 50 for all
women who don’t have a genetic
profile, or family history, of breast
cancer. The US Preventive Services Task
Force (USPSTF)—which sets the gold
standard for medical care in that
country—recently recommend-ed
raising the age threshold, thereby
causing a major furore, so embedded is
the idea that mammography is a life
saver. One woman writing on a web blog
said she hoped she would never again
have to hear the voice of one of the
researchers, who had been interviewed
on American TV about the new
recommendations.
Dr Karla Kerlikowske, another of the
USPSTF researchers, wrote in an
editorial that accompanied the study:
“Usually when we go to do something,
we want the benefits to outweigh the
risks. In this particular case, it is kind of
a toss-up.” Overall, the study found that
there was not enough evidence to
suggest that shifting the age for a first
screening from 40 to 50 years would
put any lives at risk (Arch Intern Med, 2009;
151: 716–26).
The true risks and benefits
The Cochrane researchers came to the
same conclusions: the evidence just
isn’t there to support the official line
being promoted by doctors and
government health agencies that
mammograms are safe, reliable and
effective, and that they save lives.
The scientists based their contro-
versial findings on seven studies—
which monitored a total of around
600,000 women—that they had
adjudged to be truly scientific and
unbiased. Many other studies had to be
discarded because they were biased in
favour of screening, including several
that had even misinterpreted the
causes of death (Cochrane Database Syst
Rev, 2009; 4: CD001877; doi:
10.1002/14651858.CD001877. pub3).
What follows is a summary of their
ground-breaking report.
! Mammograms save lives. The
Cochrane researchers say it is
“likely” that screening saves lives,
but it is impossible to assess just how
many. It certainly appears to be far
fewer than is suggested by the
official figures, and could even be as
low as 0.05 per cent of the women
who are screened, say the
researchers. This means that

WDDTY Women’s health 43

Cancer

mammography can save one life out
of every 2000 women screened, or
half the official number that is so
often repeated by doctors in the UK,
and 14 times lower than the
estimates reported by Cancer
Research UK, which claims that
mammograms can detect seven
cancers in every 1000 women
screened and that, as the cancer is
detected at an early stage, almost
every case is successfully treated
(www.cancerhelp.org.uk).
! Mammograms can cause cancer.
Although this was not touched upon
by the Cochrane researchers,
mammograms are carcinogenic.
This is because they use X-ray
technology, and it’s estimated that
a mammogram can cause breast
cancer in one out of every 25,000
women screened (www.cancerhelp.
org.uk). This suggests that the
procedure can trigger 80 new cases
of breast cancer in the UK, and
around 1480 new cases in the US,
every year. What’s more, a
computer model has drawn an even
bleaker picture: it has predicted
that radiation levels can cause one
death from breast cancer for every
eight it detects. If this is so, then
mammography will be responsible
for 93 new cases of breast cancer
each year in the UK alone (J Med
Screen, 1998; 5: 81–7).
! Mammograms cause unnecessary
worry. Mammograms are only as
good as the radiologist who
interprets the image. The Coch-
rane researchers reckon that
mammograms lead to 10 times the
number of false-positive results—
seeing cancer that isn’t there—
compared with true positives.
So, if a mammogram is picking
up one new case of breast cancer
out of every 2000 women screened,
it is also ‘seeing’ 10 cases of cancer
that aren’t actually there. This
means that, every year, around
7500 women in the UK and
185,000 women in the US are
going through months of worry and
stress, and being subjected to
invasive tests, such as biopsies, and
ultrasound examinations for a
cancer that they don’t have.
In another study, which tracked
2400 women aged 40–69 years,
researchers discovered that the
rate of false positives increased
with the number of times a woman
was screened—such that, by the
time a woman had undergone 10
mammograms, the rate of false
positives is as high as 64 per cent
(N Engl J Med, 1998; 338: 1089–96).
! Mammograms don’t always detect
cancer. Screening can also come
up with false-negatives results—in
other words, failing to see cancers
that truly are there.
Overall, mammograms miss
around 20 per cent of cancers in
the breast. Tragically, according to
the US National Cancer Institute
(see www.cancer.gov), the missed
cancers are invariably those that
are fast-growing and aggressive,
and so more likely to be a threat
to life. A false-negative reading is
also more likely in younger women
as their breast tissue is denser.
Instead, mammograms detect
the slow-growing tumours that
don’t kill the patient. Neverthe-
less, once detected, the patient is
immediately subjected to debilita-
ting chemotherapy or surgery,
procedures that are probably
unnecessary, as a watchful-waiting
approach is now considered to be
more appropriate (Arch Intern Med,
2009; 151: 716–26).
Mammograms also pick up
tissue abnormalities such as DCIS
(ductal carcinoma in situ) which,
despite the name, is invariably
benign. Around one in three cases
of DCIS progresses to true cancer,
says Cancer Research UK (www.
cancerhelp.org.uk) and, in most cases,
the patient is treated by surgery in
yet another example of

The myth of the ‘cancer type’

Mammography screening targets women who fall into
one of three categories: they are older than 50 years of
age; they have a family history of breast cancer; or they
have a genetic predisposition for the cancer. If a woman
falls into either of the two latter categories, she may begin
being screened from the age of 30 or so.
But now, there’s growing evidence to suggest that a
family history of cancer doesn’t necessarily mean that
you’re at any greater risk than the rest of the population.
Researchers at the Imperial Cancer Research Fund’s
Cancer Epidemiology Unit at the University of Oxford,
UK, say that most women with a family history of breast
cancer will never go on to develop the disease while,
conversely, women who do have breast cancer don’t
have a close relative with the disease.
Indeed, this was what the researchers found when they
reviewed 52 studies involving 58,209 women with breast
cancer and 101,986 healthy women. They discovered that
four out of five women who had a mother or sister with
breast cancer never developed the disease themselves,
whereas eight out of nine women diagnosed with breast
cancer did not have a mother, sister or daughter who
went on to develop the disease (Lancet, 2001; 358: 1389–99).
US researchers at the University of California at
Berkeley have also found that cancer is not a genetic
disease. It is, instead, a disease that is brought about by
external factors such as chemicals, radiation, stress and
diet (Biochem J, 2000; 348: 497–506). However, as this was a
laboratory-based mouse study, the results may not
necessarily apply to humans.
Nevertheless, if cancer is, indeed, not a disease that
is predetermined by our genes or family history, it would
explain the many cases of spontaneous remission that
have been observed by researchers, including the
Institute of Noetic Sciences, which has tracked at least
1000 cases of cancer that inexplicably disappeared
(O’Regan B, Hirshberg C. Spontaneous Remission: An Annotated
Bibliography. Sausalito, CA: Institute of Noetic Sciences, 1993).

44 WDDTY Women’s health

 mammography leading to un-
necessary treatment.
Furthermore, until only recent-
ly, this treatment often involved
radical mastectomy—complete
removal of the breast—for a
condition that, in 66 per cent of
cases, is harmless, according to the
US National Cancer Institute
(www.cancer.gov).
Danish researchers estimate
that 25 per cent of the supposed
cancers detected by mammograms
are either benign lesions or cases of
DCIS, and they estimate that
cancer ‘overdiagnosis’—in other
words, detection of breast
abnormalities that are not life-
threatening—is far worse in
countries that have more
aggressive and popular screening
programmes (BMC Women’s Health,
2009; 9: 34; doi:10.1186/1472-6874-9-34).
In an earlier study, Cochrane
researchers had estimated that
overdiagnosis could be affecting as
many as one in every three
‘cancers’ picked up by mam-
mography screening (BMJ, 2009; 339:
b2587; doi: 10.1136/bmj.b2587).
! Mammograms are expensive. The
most conservative estimates put
the cost of a single mammogram at
around $100, or £65, which
translates into an annual expen-
diture of $3.7bn in the US, and
around £130m in the UK.
Nevertheless, patients in the US are
being billed around $700 per
procedure, according to the price-
checker website (www.costhelper.
com). Added to this pricetag, there
are also the additional costs of the
further tests subsequent to a false-
positive reading, as well as the
surgery and drug therapies, many
of which are, again, probably
unnecessary.
What’s the alternative?
Those women who don’t want to
give up completely on the idea of
mammography may choose to use it
more judiciously instead. Despite the
current threshold age of 50 years for
beginning routine screening, there is
scant evidence to demonstrate that
women aged between 50 and 55 years
derive much benefit from it. However,
any benefits there may be do become
more apparent in older women aged
between 60 and 69 years. In a study of
129,750 women who were 55 years or
older, screening reduced the death
rate from breast cancer by 21 per cent
compared with a similar group of
117,260 unscreened women (Lancet,
2002; 359: 909–19).
Mammograms are also more
accurate if the woman was screened
during the first part of her menstrual
cycle. Breast density fluctuates
throughout the cycle, and the best
time to screen is within the first two
weeks before menstruation, when
breast tissue is less dense (J Natl Cancer
Inst, 1998; 90: 906–10).
Regular self-examination is still a
reliable way to detect signs of breast
cancer, especially if it is complement-
ed by occasional clinical examina-
tions by a nurse or doctor. Indeed,
in one study, self-examination was
found to be more reliable than
mammograms (N Engl J Med, 1998; 339:
1089–96).
Thermography, now a virtually
forgotten screening tool, is a non-
invasive technology that uses infrared
thermal imaging to visualize breast
tumours. First introduced in 1956, it
lost ground after a study in 1977
concluded that it was inferior to, and
less sensitive than, mammog-raphy.
Since then, few radiologists have used
it. However, the computer technology
has advanced so much in the past 30
years that it now has an undisputedly
important role to play in cancer
diagnosis, including its use as a
complement to mammography, say
researchers from the Canadian
College of Naturopathic Medicine
(Integr Cancer Ther, 2009; 8: 9–16).
This view has also been borne out
by a study of 92 patients who had been
recommended for breast biopsy after
having had a positive mammogram. In
the event, 60 of these cases were
malignant, and thermography
screening correctly identified 58 of
them. This was a far more accurate
assessment than that achieved by
mammography, which had produced
32 false positives (Am J Surg, 2008; 196:
523–6).
Ultrasound is another useful—and
non-invasive—screening tool, as it can
pick up abnormalities that
mammograms can’t. Also, as it’s not
an X-ray, it may well be safer than
mammography. However, as with
mammograms, its accuracy is often
dependent on the skill of the operator.
Most practitioners see it as a
complement to mammography,
although the more skillful are able to
use it as a first-line screening tool.
Finally, if radiation from mammo-
graphy X-rays is a major concern, you
might ask for digital mammography
instead. Standard mammograms use
X-ray film, but researchers have
discovered that capturing the image
digitally reduces radiation exposure
by 22 per cent and may be more
sensitive, too. One study involving
49,528 women found that digital
mammography also detected 28-per-
cent more cases of cancer than did
conventional mammography. In the
US, more than 60 per cent of the
dedicated breast-imaging facilities
offers digital mammography (Am J
Roentgenol, 2010; 194: 362–9).
What women want?
Not every case of breast cancer is
a death sentence and, if screening has
detected a tumour, it most likely isn’t
one: mammograms are apparently
able to only detect either benign
tumours or slow-growing ones that
don’t threaten the life of the patient,
while tending to miss those that truly
endanger life.
This makes mammography an
extremely poor first line of defence
against a disease that most women
probably fear more than any other.
However, as there is so much emotion
attached to breast cancer, women
naturally want to believe that the
mammogram stands between them
and a potentially disfiguring and life-
threatening disease—and politicians
and, by association, government
health agencies want us to believe
that they have the solution. These
separate but overlapping agendas
mean that the truth is easily
overlooked.
It is evident that more invest-ment
and research are needed into other
technologies. But that will only be
possible when we all face up to the
truth about mammography—that it is
truly one of medicine’s great false
hopes.
Bryan Hubbard
WDDTY Women’s health 45
Cancer
F
ive of the world’s leading
cancer experts say that the
current medical model of
cancer—that it’s an ongoing
aggressive disease—is wrong. As a
result, it may be that conventional
therapies—and especially sur-
gery—are doing more harm than
good.
Most oncologists accept the
prevailing theory that cancer is the
result of “invading alien enemies
that must be completely destroyed
in order to achieve the cure”, say
Michael Retsky, from the Harvard
School of Public Health, and
Michael Baum, from the Royal Free
Hospital and UCL Medical School
in London, along with three other
cancer specialists.
However, there is virtually no
evidence to support the theory,
which has been the accepted model
since the 1890s. Instead, there’s a
great deal of evidence—such as
mammography screening results,
and the outcomes of
chemotherapy, surgery and radio-
therapy—to suggest that the
disease is chaotic. It also has long
periods when it lies dormant, say
the experts in their landmark, 32-
page review (Cancers, 2010; 2: 305–37).
Breast cancer surgery is usually
performed—unwittingly—during
the disease’s dormant period. The
intervention then often reactivates
the cancer, causing it to suddenly
spread rapidly—and often fatally.
46 WDDTY Women’s health
Medicine has got
it wrong about
cancer, say
experts
In general, this is a common
outcome, as it follows more than
half of all surgical procedures for
breast tumours.
“Millions of healthy women have
been screened for cancer and
cancer patients have been treated
by interventions based on the
continuous growth assumption,”
says the report.
Yet, even DCIS (ductal
carcinoma in situ), often
considered an early marker of
breast cancer, rarely becomes
cancer, even though its detection
by mammography invariably
triggers early, and aggressive,
treatment.
“The DCIS conundrum is rarely
disclosed in public since it is
thought that, if women were told
this, they might not opt for
mammography. Getting women
screened . . . is a major goal of
some organizations so this
information is withheld as its
release will be contrar y to
achieving their goal. This is highly
patronizing to women. It has been
described as ‘Mummy knows
best’,” they write.
First, do nothing
The DCIS paradox is just one
example that confounds the
continuous-growth concept of
cancer. Another one is the cancer
patient who is never treated. While
it is rare to find such a case, one
study carried out between 1938
and 1956 in Ontario, Canada, did
succeed in tracking untreated
cancer patients. Out of nearly
10,000 cancer patients,
researchers found 145 who had
received no treatment whatsoever.
While the continuous-growth
model of cancer suggests that the
untreated patients would
inevitably die, 35 per cent of these
patients were still alive five years
later, and their average survival
rate was 47 months, nearly four
years. In addition, 70 per cent of
those whose cancer did not spread
were still living five years later. By
way of comparison, the overall
survival rate among women was
around 45 per cent and, in men, 36
per cent (Can Med Assoc J, 1965; 92:
647–51).
Cancer surgery
Astonishingly, doing nothing at all
has a better survival rate than the
use of conventional therapies.
Radical surger y—removing the
tumour ‘with its roots’, including
the lymph nodes—has a 25-per-
cent survival rate (Cancer, 1983; 51:
1941–3). This procedure has given
way to a gentler, systemic treat-
ment based on the hypothesis that
cancer is spreading through the
bloodstream even before it is
detected. However, systemic
therapy has a similarly poor
outcome, reducing the rate of
breast cancer deaths by only
8 per cent (Lancet, 1992; 339: 1–15,
71–85).
Radiotherapy
Radiotherapy reduces the breast
cancer death rate by 3 per cent—
but any good that it does is
counteracted by the harm from
radiation to the heart.
Similar numbers who survive the
cancer go on to die instead of
heart problems due to radiation,
especially if the cancer was in the
left breast (N Engl J Med, 1997; 337:
949–55).
Chemotherapy
Earlier trials suggested that
chemotherapy was the way forward
with cancer treatment, but later
studies were far more modest. One
report found an “absolute survival
benefit”of 11 per cent in women
aged under 50 vs 3 per cent in
women aged 50 to 69 with node-
involving breast cancer (Oncology,
2000; 14: 1267–88).
Faced with such disappointing out-
comes, oncologists adopted a
response similar to that taken by
surgeons a few decades earlier: if a
little doesn’t work, try a lot.
However, according to Retsky et al.,
“High-dose chemotherapy with bone
marrow rescue was a failure, and the
least said about this sorry episode in
the history of breast cancer the
better.”
How cancer develops
The failure of conventional therapies
suggests that the idea of cancer as
aggressive and ongoing abnormal
cell growth is faulty. Close
observation of the disease shows
periods of growth and dormancy. In
patients with breast cancer,
researchers saw a growth spurt at 18
months, followed by a dormant stage
peaking at 50 months. This was
followed by further growth that
peaked at 60 months that finally
ended with a long tail-off of almost no
growth lasting for up to 20 years in
untreated patients (Ann Oncol, 1997; 8:
1075–80).
However, this pattern is disturbed
by treatment, especially surgery. In
studies of breast cancer detected by
mammography, death rates peaked in
the third year in women aged under
50 who had been operated on within
a year of diagnosis. However, deaths
in women aged 50 and older with no
surgery did not rise at any time
(Lancet, 2002; 359: 909–19). This suggests
that the surgery was responsible for
the higher death rates in those
women.
A new model
Retsky and his co-authors are
calling for the adoption of a new
model of cancer that, in turn,
would change the way it is
managed and treated.
“Cancer is a process,” they
argue. “Individual cancers, while
likely to originate from single
cells, are constantly adapting to
the local environment.”
Their new model also
acknowledges cancer’s various
phases of growth and dormancy.
The dormant phase often ends
because of a signal—from surgery
or perhaps an adverse life event—
that triggers a period of rapid
growth. “The act of wounding the
patient creates a favourable
environment for the sudden
transfer . . . from a latent to an
active phase,” they say.
According to the new model, sur-
gery and other interventions would
not be performed as a matter of
urgency following diagnosis, as the
timing of such interventions would
be determined by the phase of the
cancer. Surger y would be
performed only during the cancer’s
active phase and, even then,
procedures would be in place to
prevent flooding the body with
angiogenic (stimulating blood-
vessel growth) signals. Any positive
effects of cancer drugs such as
tamoxifen and chemotherapy
might be because they have anti-
angiogenic effects rather than
because of any direct effect on the
cancer cells themselves.
Bryan Hubbard
WDDTY Women’s health 47
Cancer
The scandal of
mastectomy
Girls as young as 15 are having their breasts
removed—and they don’t even have cancer
T
he rate of total mastectomy—
complete surgical removal of
the breast—has increased by 37
per cent over the past decade in the
UK, and this traumatic procedure has
even been done in girls 15 years of
age.
Tragically, leading oncologists are
now saying that half these women had
their breasts removed unnecessarily,
as many mastectomies are carried out
on women who don’t have breast
cancer at all. Instead, they have DCIS
(ductal carcinoma in situ), a precan-
cerous and non-invasive condition of
the milk ducts around the breast.
More than 60,000 new cases of
DCIS are detected by mammography
every year in the US alone, yet less
than 5 per cent become breast cancer,
says Dr Laura Esserman, from the Uni-
versity of California at San Francisco
(UCSF). UK cancer expert Professor
Michael Baum thinks the figure is
slightly higher, but accepts that at
least 80 per cent of DCIS cases never
become cancer (Breast J, 2000; 6: 331–4).
Esserman’s colleague at UCSF,
Virginia Ernster, a cancer statistician,
reviewed the records of 7000 women
who had been diagnosed with DCIS
before and after the introduction of
mass mammography. Before the
advent of such national screening
programmes, around 3.4 per cent of
the women died from breast cancer,
and this ratio dropped only slightly to
1.8 per cent after screening was
introduced. In either case, the risk
was low, said Ernster (Arch Intern Med,
2000; 160: 953–8).
Despite these established facts,
DCIS is treated as aggressively as if it
were full-blown breast cancer with
mastectomy, lumpectomy—where
only part of the breast is removed—or
chemo- and radiotherapy. Indeed, half
of all breast cancer diagnoses every
year are, in fact, DCIS.
Esserman is now heading a
campaign calling for a radical change
48 WDDTY Women’s health
in the way DCIS is seen and treated.
One of the keys is to rename the
condition and remove ‘carcinoma’
from the name. “Minimal-risk lesions
(such as DCIS) should not be called
cancer,” she says. “Methods exist to
identify low- and high-risk cancers.
Tests for prognosis and prediction of
breast cancer are available and
provide better discriminatory
information than clinical features
alone” (JAMA, 2009; 302: 1685–92).
She is joined in her campaign by
oncologist Dr Carmen Allegra, chief of
hematology and oncology at the
Shands Cancer Center, University of
Florida, in Gainesville. Allegra agrees
that DCIS needs a new name, and also
advocates the watchful-waiting
approach, as is done with prostate
cancer (J Natl Cancer Inst, 2010; 102: 6-8;
doi:10.1093/jnci/djp497).
More controversially, Baum and
others believe that the real problem is
mass mammography screening, which
he wants to see scrapped. Before
mammograms became part of the
national health regime, few women
knew they had DCIS, which can’t be
palpated. Before the widespread use
of mammography, in 1983, around
4900 cases of DCIS were diagnosed in
the US; by 2002, this had risen to
48,000 new cases, and now the
technique is detecting 60,000 cases
each year in the US alone.
Baum points out that detection
triggers an expensive and invasive
series of treatments for a problem
that is rarely cancerous. In a contro-
versial speech to the Royal Society of
Medicine in London, Baum called for
the scrapping of the national mammo-
gram screening programme even
though he himself was instrumental
in creating the £50-million-per-year
service in the first place (The Evening
Standard, 10 December, 2002).
In fact, DCIS can be considered a
byproduct of mammography, which is
designed to detect malign tumours in
breast tissue. As Esserman points out,
the detection of DCIS was never part
of the screening programme, and she
believes it should be entirely removed
from the agenda. Radiologists who
detect low- and intermediate-grade
DCIS should merely take note of their
presence, but should then take no
immediate action.
Unfortunately, both oncologists
and women immediately press the
panic button when the C word is used,
and no one appears to be willing to
adopt the watchful-waiting strategy.
However, to encourage such an
approach, Esserman is leading a UCSF
pilot study to develop a surveillance
protocol that would identify those few
cases of DCIS that might turn into
cancer. She is currently working with
40 women diagnosed with DCIS (BMC
Cancer, 2009; 9: 285; doi:10.1186/1471-2407-
9-285). Ultimately, she wants to find
non-surgical ways to stop DCIS pro-
gression to cancer and preserve the
breast (J Natl Cancer Inst, 2008; 100: 228–9).
Esserman is bucking against a
trend in medicine that has seen more
mastectomies being performed than
ever. The UK’s National Mastectomy
and Breast Reconstruction Audit
reports that the 37-per-cent increase
rate from 1997 to 2006 would be
rising even more rapidly if sufficient
resources could be found. Yet,
according to the No More Breast
Cancer campaign, the mastectomy
rate is already higher than the official
figures indicate. When researchers
were able to obtain the unpublished
statistics, they found that the rate has
actually increased by 44 per cent
overall in the UK, and by 41 per cent
among younger women aged between
15 and 44 years (Hospital Episode Statistics,
1990–2005. London: HMSO).
“We are regularly told that breast
cancer is solely due to certain risk
factors. In fact, fewer than 50 per cent
of breast cancer cases can be
explained by these risks, and many are
due to unknown factors,” says the
campaign’s Clare Dimmer, a breast-
cancer survivor. Tragically, these
unknown factors include cases of
DCIS.
Bryan Hubbard
What to do if you’re diagnosed
So-called ‘watchful-waiting’ may be the best strategy if you’ve been diagnosed
with DCIS (ductal carcinoma in situ), but you can also help yourself, as
suggested by the international non-profit public-interest group People Against
Cancer (www.peopleagainstcancer.com), which recommends:
! a strict wholefood, non-processed diet (with no sugary and fatty foods,
dairy or wheat);
! an intensive nutritional programme, including high-dose vitamin C, beta-
carotene, vitamin B, selenium, zinc, coenzyme Q10, fish oils and vitamin B17
(apricot kernels);
! an intensive detox programme, including elimination of mercury from
amalgam fillings;
! coffee enemas; and
! heat therapy, as temperatures of 44 degrees C and over can kill cancer cells.
WDDTY Women’s health 49
Your questions answered
Help for period pain
Q
I am aged 36, and am increasingly
experiencing a very high level of pain and
discomfort with each period. I have breast pain
for a week before, and then excruci-ating pain
on the day of my period, along with vomiting and
diarrhoea. I have no children and I’m also having difficultly
conceiving. I have tried quite a few alternative therapies to
no avail, so any advice would be much appreciated.—D.S.,
via e-mail
A
Period pain—or dysmenorrhoea, in medical-
speak—affects up to 95 per cent of menstru-
ating women (Nurs Times, 2004; 100: 40–3).
Cramping lower abdominal pain is common,
but the pain can also extend to the lower back and thighs,
and lead to nausea, vomiting, diarrhoea and fatigue (Aust
Fam Physician, 2006; 35: 842–4, 846–9).
But period pain doesn’t have to be simply endured,
particularly if it’s impacting on your lifestyle and daily
activities. But before starting any treatment, you need to
establish whether you are suffering from primary or
secondary dysmenorrhoea. Primary dysmenorrhoea is
menstrual pain without pelvic disease; secondary
dysmenorrhoea is pain associated with an identifiable
condition, usually endometriosis, fibroids or pelvic
inflammatory disease (BMJ, 2006; 332: 1134–8).
As you are over 25 and having trouble conceiving,
secondary dysmenorrhoea is a possibility, so you may wish
to see your doctor for a diagnosis.
Treating the cause of the pain is more effective than
treating just the pain itself. Conventional treatments
usually involve non-steroidal anti-inflammatory drugs
(NSAIDs) or oral contraceptives, but these have various
adverse effects and may not work in up to 25 per cent of
sufferers (Cochrane Database Syst Rev, 2004; 3: CD002119).
Fortunately for you, there is a variety of alternative
treatments, many with good evidence of success.
! Dietary changes and supplements. Taking 100 mg/ day
of thiamine (vitamin B1) may be effective: 87 per cent
of patients were cured after three months of treatment
and remained pain-free two months later (Indian J Med
Res, 1996; 103: 227–31). Other helpful supplements are
pyridoxine (vitamin B6), magnesium, vitamin E and fish
oil, particularly Neptune Krill Oil (BMJ, 2006; 332: 1134–8;
Altern Med Rev, 2003; 8: 171–9).
Changing your diet may also bring relief. Endo-
metriosis and dysmenorrhoea are known to be related
to a low intake of vegetables and fruit, and a high intake
of vegetarian polyunsaturated fat, ham, beef and other
red meat (Eur J Obstet Gynecol Reprod Biol, 2007; 132: 140–7).
Another study found a significant improvement in
menstrual pain and PMS symptoms with a low-fat
vegetarian diet (Obstet Gynecol, 2000; 95: 245–50).
! Herbs. A Japanese herbal formulation known as Toki-
shakuyaku-san—a blend of six herbs, including angelica
and peony root—reduced menstrual pain (Am J Chin Med,
50 WDDTY Women’s health
1997; 25: 205–12). Together with another remedy called
Shakuyaku-kanzo-to (including peony and liquorice), this
combination may also help women with secondary
dysmenorrhoea to conceive (Clin Exp Obstet Gynecol, 2003; 30:
95–8).
! Acupuncture. When 649 women with dysmenorrhoea
received acupuncture (15 sessions over three months) in
addition to their usual medical care, they saw significant
improvements in pain and quality of life compared with
those receiving only the usual care (Am J Obstet Gynecol, 2008;
198: 166).
Other trials have also been positive, although one trial
found that acupuncture worked well for primary
dysmenorrhoea but was only “satisfactory” for cases of
secondary dysmenorrhoea (Akush Ginekol [Sofiia], 1996; 35:
24–5).
! Transcutaneous electrical nerve stimulation (TENS). This
involves stimulation of the skin using currents at various
pulse frequencies and intensities to relieve pain. A number
of small studies found high-frequency TENS to be effective
for dysmenorrhoea (Cochrane Database Syst Rev, 2002; 1:
CD002123). In one trial, 42–60 per cent of patients achieved
at least moderate relief, and required the use of fewer
additional analgesics (BMJ, 2006; 332: 1134–8).
! Heat. A randomized, controlled trial found that a heat
patch (at 39° C) used for 12 hours a day was as effective as
ibuprofen (400 mg three times a day) and more effective
than placebo in reducing pain (Obstet Gynecol, 2001; 97: 343–9).
Another study found that a heat wrap was better than
paracetamol (acetaminophen) for pain relief over an eight-
hour time period (J Reprod Med, 2004; 49: 739–45).
! Magnets. A 2700-gauss static magnet attached over the
pelvic area significantly reduced menstrual pain and
irritability compared with a placebo (140-gauss) magnet (J
Altern Complement Med, 2005; 11: 681–7).
! Aromatherapy and massage. In a trial of 67 college
students, aromatherapy (topically applied lavender, clary
sage and rose) eased the severity of menstrual cramps (J
Altern Complement Med, 2006; 12: 535–41). Combining
aromatherapy with massage is also a good idea, as a Korean
study found that women receiving abdominal meridian
(Kyongrak) massage had significantly less menstrual pain
than the control group (Taehan Kanho Hakhoe Chi, 2005; 35:
1325–32).
! Biofeedback. A study of nine women suggested that
thermal biofeedback may be effective for painful periods
(Biofeedback Self Regul, 1982; 7: 499–520). Another study
reported that thermal biofeedback may be a promising
treatment for menstrual pain and other symptoms related
to endometriosis (Appl Psychophysiol Biofeedback, 2003; 28:
279–89).
! Relaxation techniques. High levels of stress can greatly
increase dysmenorrhoea (BMJ, 2006; 332: 1134– 8), but a review
of the literature suggests that relaxation techniques may
help to relieve symptoms (Cochrane Database Syst Rev, 2007; 3:
CD002248).
Endometriosis
Q
I’ve just been diagnosed
with endometriosis, and I
am having difficulty finding
information on effective
alternative treatments. Can you help?—
C.C., via e-mail
A
Endometriosis is a gynae-
cological condition where
cells of the mucous mem-
brane lining the womb
become deposited elsewhere in the
body. It affects around 10 per cent of
women of reproductive age, causing
symptoms such as painful, heavy or
irregular periods, bowel and bladder
problems, tiredness, insomnia and
depression. However, some cases have
no symptoms at all.
Endometrial deposits are most
commonly found on the ovaries,
fallopian tubes and peritoneum. But
other sites may be involved—even, in
rare cases, the eye. The cells then
behave just as they do in the womb,
bleeding during menstruation, caus-
ing inflammation and often forming
fibrous adhesions that make organs
stick to each other. Inflammation or
scarring of the reproductive organs,
particularly the fallopian tubes, can
result in infertility.
No one knows exactly what causes
endometriosis or how to cure it, so the
goals of conventional medicine are
pain relief, slowing its progression and
relieving infertility, if present. However,
the treatments prescribed—
painkillers, hormonal drugs and
surgery—all come with high rates of
recurrence and significant risks (Coch-
rane Database Syst Rev, 2009; 3: CD006568).
Gonadotropin-releasing hormone
(GnRH) agonists, for example, among
the most popular drugs for the
condition, can induce a ‘pseudo-
menopause’, complete with hot
flushes, vaginal atrophy, mood swings
and osteoporosis (Aust Fam Physician, 2006;
35: 864–7). Happily, there are safer ways
to manage the condition.
Alternative approaches
Although more research is needed, the
evidence so far suggests that the
following may be helpful for women
with endometriosis.
! Avoid toxic chemicals. Certain
environmental pollutants, such as
dioxins and polychlorinated
biphenyls (PCBs), may play a role in
endometriosis (Environ Health Perspect,
2009; 117: 1070–5). Experts believe that
over 90 per cent of human
exposures to these chemicals comes
from food, mainly animal fat, so
eating an organic, wholefood diet
low in animal fats may be beneficial.
! Limit caffeine. Caffeine intake may
be related to endometriosis and
infertility. Women who consumed
more than 5 g/month of caffeine
(about 1.5 cups of coffee a day) were
nearly twice as likely to have
endometriosis and be infertile as a
result (Am J Epidemiol, 1993; 137:
1353–60).
! Eat more fruit & veg. In more than
1000 women in northern Italy, those
with low intakes of fresh fruit and
green vegetables had a signifi-cantly
higher risk of endometriosis. Those
who ate a lot of beef and red meat
were also more likely to have the
disease (Hum Reprod, 2004; 19: 1755–9).
! Exercise. This may influence the
risk of endometriosis. Women who
reported frequent, high-intensity,
physical activity had a 76-per-cent
lower risk than those who did not
engage in any such physical activity
(Am J Epidemiol, 2003; 158: 156–64).
! Increase antioxidants. Endometri-
osis sufferers were found to have a
lower intake of antioxidants (vita-
mins A, C and E, zinc and copper)
than women without the disease.
Consuming more of these nutrients
through either diet or supplements
may help (Reprod Biol Endocrinol, 2009; 7:
54). Indeed, in women with pelvic
pain possibly due to endometriosis,
taking vitamins E (1200 IU/day)
and C (1000 mg/day) for two
months led to improvement in pain
in 43 per cent of cases. In contrast,
none of the women taking a place-
bo reported pain relief (Townsend Lett,
2004; 253/254: 36).
! Boost omega-3 fats. Animal and
test-tube experiments show that
omega-3s can help by reducing
inflammation (Fertil Steril, 2008; 90 [4
Suppl]: 1496–502; Fertil Steril, 2001; 76:
717–22), although whether supple-
ments will benefit women in real life
remains to be seen. However, a daily
dose of omega-3 (1080 mg of
eicosapentaenoic acid and 720 mg
of docosahexaenoic acid) plus
1.5 mg of vitamin E improved
symptoms of dysmenorrhoea (pain-
ful menstruation), which may be
related to endometriosis (Am J Obstet
Gynecol, 1996; 174: 1335–8).
! Take Chinese herbs. A review of all
randomized controlled trials found
that Chinese herbals were just as
effective as the hormone drugs
gestrinone and danazol for
symptom relief—with fewer side-
effects (Cochrane Database Syst Rev,
2009; 3: CD006568). A variety of herbs
can be used, so be sure to consult
a qualified practitioner for advice.
! Consider curcumin. Derived from
the popular Indian spice turmeric,
curcumin has properties that
suggest benefit for endometriosis.
A study in mice showed significant
antiendometriosis effects, alth-
ough these results may not
necessarily apply to humans (Indian
J Biochem Biophys, 2009; 46: 59–65).
! Try acupuncture. This well-known
pain treatment was both safe and
effective for endometriosis-related
pelvic pain in adolescents (J Pediatr
Adolesc Gynecol, 2008; 21: 247–57), and
was just as effective, if not more
so, than the drug danazol in
relieving symptoms—and again,
with far fewer side-effects
(Zhongguo Zhen Jiu, 2006; 26: 863–5).
! Use biofeedback. A small study of
five women reported that thermal
biofeedback helped to improve the
pain and other symptoms of endo-
metriosis (Appl Psychophysiol Biofeed-
back, 2003; 28: 279–89). Other mind–
body techniques, such as hypnosis
and meditation, may also help to
control endometriosis-related pain
(see Special Report, pp 6–9).
! Join a support group. Sharing
with other sufferers may also help
in coping with the condition.
When women had a chance to
speak with other endometriosis
patients and to meet with a
counsellor, they all reported being
highly satisfied with their overall
care (J Psychosom Obstet Gynaecol, 1997;
18: 255–8).
WDDTY Women’s health 51
Your questions answered

Preventing miscarriage

Q
I have just had my first
child at the age of 35 and
I’m keen to start trying
for another baby as soon
as possible. However, I have mis-
carried in the past, and I’m terrified
about it happening again. What can I
do to improve my chances of having
a successful pregnancy?—J.D., via
e-mail
caffeine, both before and during
pregnancy, comes with an increased
risk of miscarriage (JAMA, 1993; 270:
2940–3). So, err on the side of caution
and avoid it altogether. And don’t
think about switching to decaffein-
ated coffee as this, too, is linked to
a higher risk of miscarriage (Epidemiol-
ogy, 1997; 8: 515–23).
You should also think twice before
(Am J Epidemiol, 2003; 158: 931–7).
A better idea is to join a yoga class.
Not only can this lower stress, but it
can also improve birth weights, and
reduce preterm labour and other
complications, when practised by
pregnant women for one hour a day
(J Alt Complement Med, 2005; 11: 237–44).
Other factors that may contribute
to miscarriage include hormonal

A
Miscarriage affects about
one in four pregnancies,
and a previous miscarriage
has a higher risk of
another in the future, although a
second miscarriage is generally seen
in only 1 per cent of women.
However, in your case, the fact that
your last pregnancy was successful
means that your chances
of giving birth to a healthy baby the
next time round are excellent (BMJ,
1989; 299: 541–5).
Nevertheless, trying to conceive
again too soon can affect your
chances. Women who have only a
short interval (less than six months)
between pregnancies have a greater
risk of stillbirth, miscarriage and
other complications (BMJ, 2003; 327:
313; BJOG, 2007; 114: 1079–87). However,
it’s also important not to wait too
long, as the risk of pregnancy loss
dramatically increases for women
over 40—from 15 per cent to about
40 per cent—mostly due to genetic
abnormalities (WDDTY vol 11 no 3).
One US study concluded that the
optimal time to wait before con-
ceiving again after giving birth is
between 18 and 23 months (N Engl J
Med, 1999; 340: 589–94).
Apart from choosing the best time
to have your second baby, you may
also wish to re-think your lifestyle. If
you or your partner smoke, drink or
use recreational drugs, stop, as these
cause harm to your genetic material.
Caffeine—found in coffee, black tea,
cocoa, colas and chocolate—may also
be a threat to your baby. One study
found that the equivalent of five or
more cups of coffee a day doubled the
risk of miscarriage in early pregnancy
(N Engl J Med, 2000; 343: 1839–45).
Even a moderate consumption of
you pop a pill for that headache. problems, infections and maternal
Taking non-steroidal anti-inflamma- health problems such as poorly
tory drugs (NSAIDs) like ibuprofen or controlled diabetes, lupus or thyroid
aspirin—but not paracetamol— disease. Indeed, women with a vaginal
during pregnancy can raise the risk infection (bacterial vaginosis) were
of miscarriage by 80 per cent (BMJ, nine times more likely to miscarry
2003; 327: 368). So, check with your than non-infected women (Am J Obstet
doctor before taking any Gynecol, 2003; 189: 139–47).
medications, and seek non- This means that before you embark
pharmaceutical alternatives wherever on trying to conceive, go for a check-
possible. up to determine whether or not you
Avoid stress, too, as less stress and have an illness that could cause a
more attention to emotional well- miscarriage, and get treated first.
being are associated with a lowered Finally, examine your environment.
risk of miscarriage (BJOG, 2007; 114: Use natural cleaning products around
170–86). the house, and limit your use of hair
But don’t be tempted to use a hot dye, perfume and other chemically
tub to relax in. One study found that laden toiletries.
using a hot tub or whirlpool bath For more information about mis-
during early pregnancy came with a carriage, including a preconception
twofold greater risk of pregnancy loss plan, see WDDTY vol 11 no 3.
Getting healthy beforehand
Healthy eating is a crucial part of getting your body ready for a baby. But
much of our food is tainted with toxic chemicals, so choose organic whenever
possible, and read labels to avoid additives and preservatives getting into
your body. Eat a wide variety of fruit and vegetables every day, and cut out
unpasteurized soft cheeses, lightly cooked eggs and meat, as these have
high levels of microbes that could interfere with your reproductive health and
pregnancy. Also, avoid fish, such as tuna, that are likely to contain high amounts
of mercury and other contaminants (see WDDTY vol 17 no 10, pages 20–22, for
more information).
If possible, visit a nutritional therapist who has experience in fertility, and have
your vitamin and mineral levels assessed. The therapist should also screen for
high levels of toxic heavy metals such as aluminium, lead, mercury and
cadmium—all of which have been associated with infertility, miscarriage,
premature birth, and malformed and underweight babies. Have the therapist
custom-design a supplement programme just for you and your partner to
correct any deficiencies, and minimize your levels of toxic chemicals.
Useful supplements include calcium, magnesium, iron, zinc, selenium, and
vitamins C, B1 and B12. Taking a multivitamin/mineral that is designed for
pregnancy can also help. Folic acid is also recommended, but it’s best to take
it as part of a general B-complex or multivitamin pill.
For more advice on nutrition and preconceptual care, including how to avoid
miscarriage, go online to www.foresight-preconception.org.

52 WDDTY Women’s health

Amenorrhoea
Q
I am 20 years old and
haven’t had a period for
over a year now. My GP
suspected that my weight
loss was the trigger (I lost 7 kg when I
went to live abroad last year) and put
me on a balanced diet. However, after
six months, I still have no periods and
seem to be unable to put on weight. Can
you offer any advice?—H.S., via e-mail
A
lthough the absence of
periods (known medically as
‘amenorrhoea’) usually
indicates pregnancy or
menopause, there are a number of
other reasons why a woman may stop
menstruating. As your doctor has
explained, weight loss is one of them,
although thyroid dysfunction,
polycystic ovarian syndrome, excessive
exercise, stress and certain drugs (such
as oral contraceptives and anti-
depressants) are also known to cause
the condition (Am Fam Physician, 2006; 73:
1374–82).
If your doctor has ruled out drugs
and any underlying condition, the
following self-care steps may be helpful.
! Consume enough calories. The
reproductive system is closely linked
to nutritional status, so any energy
deficit—either because of dietary
restriction, intense physical exercise,
or both—can, over time, lead to a
loss of menstrual periods (Hum Reprod
Update, 2006; 12: 193–207; Endocrinol Metab
Clin North Am, 2001; 30: 611–29). Simply
eating more—or exercising less—
may be all that’s needed for you to
resume normal menstruation, but
the process can take up to a year
(BMJ, 1978; 1: 321).
For quicker results, try adding a
daily high-calorie nutritional drink
to your diet. This proved to be
beneficial for some athletes with
amenorrhoea (Int J Sport Nutr, 1999; 9:
70–88; Int J Sport Nutr, 1996; 6: 24–40).
It may also be worth keeping a
food diary to record the amount of
calories you are consuming each day.
Use an online calorie counter, such
as found at http://nutrition.
about.com/library/bl_nutrition_gui
de.htm.
! Increase your fat intake.
Amenorrhoeic women—even those
with normal body weight—tend to
have lower intakes of dietary fat than
women who menstruate regularly (J
Soc Gynecol Investig, 1994; 1: 84–8; Clin
Endocrinol [Oxf], 1999; 50: 229–35). So,
consuming more fat—from healthy
sources such as nuts and seeds, oily
fish (or fish-oil supplements, to avoid
mercury), olive oil and avocados—
may help your period return to
normal. The above-mentioned
calorie counter can also tell you how
much fat you need, as well as your
protein and carbohydrate require-
ments.
! Find out your metabolic type. Make
sure you are eating right for your
biochemistry (see WDDTY vol 20 no
1). Also, consider the glycaemic
index (GI) of foods. Eating healthy,
non-processed high-GI foods,
provided that they match your
metabolic type, may help you to gain
weight.
! Consider supplements. The amino-
acid acetyl-L-carnitine (ALC) has
been shown to be promising in the
treatment of amenorrhoea. In a
study of 20 amenorrhoeic women
taking 2 g/day of ALC, hormone
levels improved and around half the
women resumed their menstrual
periods within three to six months of
starting the therapy (Acta Obstet
Gynecol Scand, 1991; 70: 487–92).
Vitamins C and B6 (pyridoxine) as
supplements may also help in some
cases (Int J Fertil, 1977; 22: 168–73; J Clin
Endocrinol Metab, 1976; 42: 1192–5).
! Look after your bones. Amen-
orrhoeic women are at an increased
risk of bone mineral loss (BMJ, 1990;
301: 790–3), so make sure you’re
High-calorie, but healthy
Consuming more of the following foods may help you put on weight:
" nuts
" seeds
" wholegrains
" bananas
" pure fruit juices and smoothies
" avocados
" raisins
" dark chocolate.
eating the right foods for strong
healthy bones (see WDDTY vol 19 no
12 for ‘The best diet for better
bones’, page 10). Calcium and
vitamin D supplements may also
prove useful.
! Reduce stress. Several studies have
found a link between high cortisol
levels—the hormonal response to
too much stress—and amenorrhoea
(Eur J Endocrinol, 2000; 142: 280–5; Am J
Obstet Gynecol, 2000; 182: 776–81). So,
stress-reducing techniques such as
yoga or meditation could be worth
your while.
! If you smoke, quit. According to a
study of 2544 teenage girls, you’re
nearly twice as likely to suffer from
amenorrhoea if you smoke one or
more packs of cigarettes a day (Am J
Public Health, 1992; 82: 47–54).
! Try acupuncture. Some studies
suggest that acupuncture can have
a positive effect on amenorrhoea
(Wien Med Wochenschr, 1981; 131: 123–6).
It appears to work by regulating
hormone levels, thereby stimulating
ovulation (J Tradit Chin Med, 1993; 13:
115–9).
! Consider herbs. Vitex agnus castus
(chasteberry) has been traditionally
used to treat a number of female
conditions, including amenorrhoea,
and is approved by Gemany’s
Commission E (Drug Saf, 2005; 28:
319–32). In clinical trials, the herb
was able to normalize certain
hormones related to menstrual loss,
including prolactin and luteinizing
hormone (Arzneimittelforschung, 1993;
43: 752–6; Phytomedicine, 2003; 10:
348–57). Blue cohosh, motherwort
and yarrow are other traditional
herbal remedies for absent
menstruation, but consult a
qualified herbal practitioner to get
an individualized prescription.
WDDTY Women’s health 53
Your questions answered

Vaginal dryness

Q
I am in my late 60s, and
since coming off HRT which
I was on for 10 years, I
have had vaginal dry-
ness—very itchy, and soreness both
external and internal. My GP has
prescribed Canesten and Vagifen
(pessary) which did little to help. I have
seen a gynaecologist who could find
nothing sinister, and prescribed Estring
Vaginal Rings, and Aqueous cream. The
cream is good for external use, but not
internal. Also the rings, which I have
been using for two years, produce side
effects—headaches, sweatiness, and
vaginal discharge. Needless to say, sex
is out of the question. Are there any
alternative treatments that would help?
—SJS, Swindon

A
Vaginal dryness can be a
particular problem after
the menopause, because
the body is producing less
oestrogen, and oestrogen is the
hormone largely responsible for normal
vaginal function: it helps keep the
lining of the vagina plump and elastic,
and it controls the production of
moisture from the cervix. This means
that there is normally a very slow flow of
moisture through the vagina, helping to
keep it clean by gently flushing dead
cells and other debris to the outside. So
a slight discharge is normal—roughly 2
grams of dead cells and 3 grams of
mucus a day. This whole process is put
at risk after the menopause.
Oestrogen also controls the glands
that lubricate the vagina during sexual
arousal. The American sex researchers
Masters and Johnson found that young
women may become sufficiently
aroused for penetrative sex in just a few
seconds, but menopausal women may
take as much as 5 minutes or more.
Given all this, it’s hardly surprising
that dryness is a fairly common
problem after the menopause, affecting
at least one in four women. Worse,
dryness itself can also set up a vicious
circle within the vagina. Because there
is less moisture, there are fewer of the
‘friendly’ bacteria that help to keep the
vagina acidic. When the vagina
becomes less acidic, infections such as
thrush can take hold, which cause
further irritation and discomfort.
Hormone replacement therapy (HRT)
may increase vaginal lubrication, but,
as WDDTY readers will know only too
well, it has serious risks.
So what are the alternatives? Some
doctors prescribe Estradiol Vaginal
Rings—marketed as “Estrings” or
“Femrings”. Placed inside the vagina,
these gradually release oestrogen, and
are claimed to have a local effect on
vaginal moisture. They have to be
replaced every three months, and are
not recommended to be used for more
than two years.
In addition to the side effects you
mention, there are fears oestrogen
may enter the bloodstream, making
Estrings no different from HRT in
terms of potential health risks, such
as endometrial and breast cancer.
Fortunately, there is a range of
things you can do that are harmless
and may help. First, prevention. Do
not use ‘intimate’ deodorants. Avoid
bubble bath preparations, drying
soaps and perfumed bath products in
your bath water. Do not shampoo
your hair under the shower, in case it
gets trapped in the vagina. Wear
cotton panties, and wash them in
detergents designed “for sensitive
skin”. Avoid wearing trousers. If you
have to wear tights during the day,
compensate by wearing a nightgown
in the evening without panties to let
your body breathe.
Try some of the many vaginal
lubricants. Go for water-based ones,
as those with petroleum (e.g.,
Vaseline) may interfere with natural
secretions and possibly harbour
infection. Besides KY Jelly, there are
now many more sophisticated ones
such as Replens (0870-7202027) or
Senselle (www.westonshealth.co.uk).
An interesting possibility is Sylk
(0870-9506004), derived from kiwi
fruit, with a non-sticky texture similar
to natural secretions. Astroglide
(www.astro-glide.com) is another
heavily marketed lubricant, but it
contains parabens which may be
carcinogenic. Zestra (www.zestra.
co.uk) is marketed as an all-natural
arousal oil.
For vaginal itching (pruritis), try
tea tree oil suppositories such as
Femigel (www.garden.co.uk). Femigel
is claimed “to recreate the natural
fungal/bacterial culture and
moisture levels in the vagina,
relieving irritations.” Tea tree oil has
been found to be “highly efficacious”
in getting rid of candida in the vagina
(albeit in rats) (J Antimicrob Chemother,
2003, 5:1223-9). If the problem persists,
check out whether you may be
suffering from Lichen sclerosus, a
poorly recognized chronic inflam-
matory skin disorder which mainly
affects the vulval and perianal area.

54 WDDTY Women’s health