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Global Health, HIV/AIDS, Women's Health

Preventing domestic violence and HIV in Uganda

Preventing domestic violence and HIV in Uganda

Ugandan dancers - 560

The woman was terrified, as she had just come from the hospital, where she discovered she was HIV-positive. It wasn’t so much the virus she feared, as the reaction from her husband. If he were to find out, he would surely beat her and throw her out of the house.

As predicted, the husband arrived home and seeing his wife in distress, forced her to confess what she had learned. “Either I cut you in two pieces and throw you in the ditch or leave the house,” he yelled, his arm raised in threat.

Fortunately, the wife wasn’t harmed, for the drama was merely that – a work of street theatre designed to break the traditional patterns of domestic violence and HIV in Uganda. The drama is one of the creative strategies being used by the nonprofit Center for Domestic Violence Prevention in Kampala, Uganda to effectively reduce incidents of domestic violence by more than 50 percent in the communities it serves.

In the process, group also aims to reduce the incidence of HIV, which affects 7.2 percent of adults in the East African nation, according to the latest figures from the United Nations Joint Programme on HIV/AIDS.

The organization works by mobilizing local men and women and training them in various interventions, like the street drama, address pervasive problem of violence among intimate partners. According to its figures, 59 percent of women between the ages of 15 and 49 say they have experienced physical or sexual violence by a husband or partner at some point in their lives.

“We are talking about an epidemic,” said Tina Musuya, a social worker and a women’s rights activist who directs the organization.

I was fortunate to see the street theatre program in action during a recent trip to Uganda with the American Jewish World Service, an international development organization that works to end poverty and promote human rights in the developing world. Fifteen of us, all Global Justice Fellows with the organization, visited CEDOVIP’s offices in Kampala and then fanned out to see the group’s work in action in the streets of Kampala one sunny afternoon.

A crowd had already begun to materialize by the time we arrived in one of the city’s poor neighborhoods, where three drummers had lured people from their homes with a lively beat. Two female dancers in colorful red outfits (pictured above) then entertained the crowd, whose curiosity was heightened by the presence of us five white foreigners. By the time the drama began, more than 100 people had gathered in the dirt road – youngsters who tugged at our hands, older women who sat on wooden stools to watch and groups of men who stood on the sidelines, quietly assessing the unfolding drama.

The story begins when the woman returns from the hospital to cry on a neighbor’s shoulder. The husband then arrives and suspects something is up. He falls into a rage on learning the wife’s news, threatening to “break her bones” and ordering her to leave the house. But the wife says she has nowhere to go. Besides, she tells him, she acquired the virus from him.

A narrator, dressed in an orange shirt, periodically freezes the drama, soliciting suggestions from the crowd on what the couple should do. One observer tells the woman to call the police. Another urges bystanders to intervene to help save the situation.

“We have so many instances of violence in our neighborhood,” the narrator concludes, speaking in Luganda while our host translates. “See what happens in violent situations when the woman becomes HIV-positive. Be supportive. Support the victims, but also support the man. Change the behavior. Break the silence.”

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Global Health, Sexual Health, Women's Health

Sex work in Uganda: Risky business

Sex work in Uganda: Risky business

We step across a sewage channel to enter an unmarked, tin-roof building, leaving the bright sunlight for the dark corridors of a 23-room inn in a busy commercial district in Kampala, Uganda. More than a dozen women huddle on the mud floor in a small rectangular courtyard whose walls are charcoal-black. We gradually come to realize that we’ve arrived at a brothel, the destination for our field tour with the Women’s Organization Network for Human Rights Advocacy, a prominent group that fights for the rights of Uganda’s sex workers.

One woman in her 30s, dressed in a black head scarf, does much of the talking for the women at the brothel, speaking in her native Luganda while the manager of the inn translates. The woman says she lost her husband and had no source of income to support herself and her children. “I almost committed suicide,” she says, but a friend encouraged her to try sex work to earn money. “My friend said, ‘I will show you what to do.’” Behind her, three wooden doors lead to squalid, closet-sized rooms where the women live and work their trade.

The women, we learn, have turned to sex work as a matter of survival. Many have lost husbands or partners on whom they depended for income, and they lack the education or skills to find other jobs that pay a livable wage.

“If they turn away from sex work, how will they feed their children or pay their school fees?” one WONETHA official says.

But the work comes with a price. The women frequently face client abuse, beatings and harassment on the streets, even police brutality – including rape, beatings and extortion – and the ever-present risk of HIV.

“Sex workers are facing a health and human rights crisis in Uganda. Despite this, little is being done to protect the most basic human rights of sex workers,” declares a pink banner at WONETHA’s headquarters in central Kampala.

The largest organization of its kind in East Africa, the group works to provide the women with better access to medical care, legal and social services, job training and freedom from violence and arbitrary arrests.

I met with members of the nonprofit group in February as a Global Justice Fellow with American Jewish World Service, an international development organization that aims to end poverty and promote human rights in the developing world. I was among 15 fellows from the Bay Area who spent nine days in Uganda learning about the work of human rights organizations that advocate for women, girls and the LGBT community.

One of WONETHA’s goals is helping prevent HIV among the sex workers and obtain access to medical care for those who are infected with the virus. Sex workers are the greatest at-risk group in the country, with an infection rate of 37 percent in 2010, according to the Uganda AIDS Commission.  At the national level, Uganda was particularly hard-hit by AIDS early on, with the disease reaching epidemic proportions in the 1980s. Between 1992 and 2000, however, there was a dramatic decline in incidence – from an estimated high of about 18.5 percent to 5 percent. In recent years, the number of infections has begun to rise again in what many see as a disturbing trend; the infection rate reached 7.2 percent in 2012, according to the United Nations Joint Programme on HIV/AIDS.  Lax attitudes regarding safe sex and a lack of condom use are among the factors cited in the trend.

WONETHA distributes condoms to help protect sex workers against HIV and other sexually transmitted diseases. A dozen large boxes of Chinese-made condoms, supplied by the United Nations Population Fund, occupied a cool space in the group’s headquarters on the day of our visit – some 100,000 of them ready to be distributed to various locations around town.

But condom use, we are told, is not always guaranteed. Clients may resist using them or pay more for a condom-free encounter. A program manager with the group told me that even in marriages, many men resist use of condoms but continue to have multiple partners – putting their wives and the other partners at risk.

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Research, Stanford News

Researchers: Sea lions develop a form of epilepsy similar to that of humans

sea lionSea lions, those endearing creatures seen frolicking in San Francisco Bay area waters and beyond, are under threat from an unlikely source. The new foe is domoic acid, a neurotoxin that can cause memory loss, tremors, convulsions and death. The toxin is carried in algae that has been proliferating along the coast in recent years; sea lions ingest it by feeding on small, contaminated fish.

As a result of the exposure, the sea lions develop a form of epilepsy that is very similar to that in humans, according to a new Stanford-led study. The sea lions suffer brain damage in the hippocampus – the brain’s memory center – that mimics the damage in humans with temporal lobe epilepsy, said Paul Buckmaster, PhD, DVM, a Stanford veterinarian and expert in epilepsy in animals.

“We found there was a loss of neurons in specific patterns that closely matched what is found in people,” said Buckmaster, the study’s lead author. Moreover, the researchers noticed a pattern of rewiring in the brains of the animals that resembled that in humans with epilepsy, he said.

He said sea lions could serve as good models for studying the disease and developing much-needed treatments. Until now, scientists have been using rodent models for epilepsy, but rodent brains don’t exhibit the same kind of damage as that seen in sea lions and humans, he said.

The Marine Mammal Center in Sausalito rescues a few hundred sea lions every year that have washed ashore in the throes of seizure as a result of domoic acid poisoning. About half are effectively treated with anti-convulsive therapy, but the other half are beyond help and have to be euthanized, said Frances Gulland, PhD, DVM, senior scientist and co-author on the recent paper. Many more sea lions, as well as other sea animals, are believed to die in the open ocean of untreated seizures, she said.

The hope is that the new findings will help lead to interventions to prevent seizures in the animals and lead to better treatments for them, as well as their human counterparts, Buckmaster said.

“What we need is an interventional treatment – both in humans and sea lions,” he said. “You’d give the treatment right after the brain injury, and that would prevent them from developing epilepsy. That’s the dream, but we are not there yet.”

The new study appears in the Journal of Comparative Neurology.

Photo courtesy of Marine Mammal Center

Global Health, HIV/AIDS, Infectious Disease, Stanford News

Stanford study: South Africa could save millions of lives through HIV prevention

Stanford study: South Africa could save millions of lives through HIV prevention

South Africa could save the lives of some 4.5 million people over the next 20 years by using a double-barreled approach to HIV prevention.

That’s the result of a new study by Stanford researchers who looked at two methods for helping contain the epidemic in South Africa. According to the latest figures from the United Nations Joint Programme on HIV/AIDS, South Africa is the world’s hardest-hit country with 6.1 million people infected with HIV and most new infections happening via heterosexual transmission.

Effectively targeting people who don’t use condoms and have many sexual partners would prevent many infections and avert the costs of having to treat people down the road

One way to prevent sexual transmission of the disease is to give antiretroviral therapy to individuals as soon as they are found to be HIV-positive, said Sabina Alistar, PhD, first author of the new study. The World Health Organization now recommends that people go on ARV treatment when their CD4 counts – a measure of their immune system function – fall below 500. But a landmark study, published in 2011, showed that if infected individuals are effectively taking ARV treatment, the chance of their passing on the virus falls by a staggering 96 percent. So the greater the number of infected people on treatment, the less the virus will spread through the population.

“It’s much more cost-effective to put people in treatment as you find them, regardless of how far along they’ve progressed, rather than wait until they get really sick and put them on treatment,” said Alistar, who did the study while a PhD candidate in Management Science and Engineering at Stanford.

That idea isn’t new, but in this latest study from Stanford, the researchers examined the benefits of combining that universal approach to therapy with another tool, creating a powerful, cost-effective strategy for preventing millions of infections over time. The added tool, known as pre-exposure prophylaxis, or PrEP, involves daily use of a pill containing an antiretroviral drug. The pill is taken by people who may be at risk for HIV but are not infected. A landmark 2010 trial found that PrEP, if used faithfully, can reduce the risk of acquiring the virus by up to 73 percent.

“If you could focus on getting PrEP to people who engage in risky behaviors, then you could get quite significant results,” Alistar said. “Effectively targeting people who do not use condoms and have many sexual partners would prevent many infections and avert the costs of having to treat people down the road.”

She and her colleagues calculated that combining the two strategies – universal therapy for all those with HIV and targeted PrEP therapy for uninfected, high-risk individuals – would cost $150 per quality-adjusted life year gained (a QALY is measure of how much health benefit is gained for every dollar invested). That is a highly valuable bargain for South Africa, she said, which has significant resources to invest in the epidemic.

Eran Bendavid, MD, an assistant professor of medicine at Stanford and senior author of the paper, said scientists are now developing an approach to PrEP that only requires an injection every three or four months, rather than a daily pill.

When that therapy becomes available, “That has the potential to become a game-changer, since the Achilles heel of PrEP is low adherence,” Bendavid said.

The paper appears online today in the journal BMC Medicine.

Previously: U.S. AIDS Czar tells Stanford audience that witnessing death is a powerful motivatorTask force recommends HIV screening for all people aged 15 to 65International AIDS conference ends on an optimistic note and Using family planning counseling to reduce number of HIV-positive children in Africa

Global Health, Health Disparities

In Uganda, offering support for those born with indeterminate sex

Kaggwa - smallWhen most adolescent boys in his Ugandan village were lobbing soccer balls, Julius Kaggwa was sidelined by an unusual phenomenon: He began to develop the breasts of a girl. His mother took this as a sign from the spirits that young Julius was intended to be female and she began to send him to school in girls’ dresses. The boy was mortified and became afraid to show his face in public. Life became so unbearable that he contemplated suicide.

Today, Kaggwa, 44, is the founder and director of Support Initiative for People with Congenital Disorders, the first group of its kind in East Africa to serve the intersex population. Intersex individuals are those born with indeterminate sex because of hormonal, physiologic or other medical anomalies.

In Uganda, where children are cherished and celebrated by the community in the month after birth, he said the arrival of an intersex child is a mother’s “nightmare.”

“Our work starts in the delivery ward where children are mutilated or their lives are terminated,” he said. The mother may be reviled by the community: “There are people who will say, ‘What is the use of this woman?’ So the mother will kill that child to avoid the stigma.”

I met Kaggwa in February at the group’s headquarters in Kampala, Uganda’s bustling capital city. I had traveled to the East African country as a Global Justice Fellow with the American Jewish World Service, an international organization that aims to end poverty and support human rights in the developing world. Fifteen of us fellows spent nine days in Uganda last month meeting with organizations that support women, girls and members of the LGBTI community.

We headed down a long dirt road to the headquarters for SIPD, located in a building that remained unidentified for security reasons. Since the Ugandan Parliament passed a harsh anti-gay law in December, there had been a rise in arrests, beatings and public assaults on members of the LGBTI community, and there were concerns that the anti-gay sentiment would spill over into the organization.

The group focuses on changing cultural attitudes so that intersex children are more accepted in the community. SIPD also facilitates referrals to a hospital in Kampala where they can receive appropriate medical treatment, the only site in Uganda where physicians are equipped to deal with their specialized medical problems, Kaggwa said.

The group also does educational outreach in schools so that intersex youngsters don’t experience the kind of stigma and emotional trauma that he did.

“So they don’t have to kill themselves, drop out of school or sell their souls to seek asylum in other countries,” he said.

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Cardiovascular Medicine, Chronic Disease, Stanford News

Born with high cholesterol

high cholesterol illustrationOn a Friday morning last October, I drove to the East Bay to meet with a fellow who I had been told had quite a story to tell. I met Scott Radabaugh in a coffee shop in San Ramon – a tall, dark-haired man with a weightlifter’s physique and an eagerness to unburden himself of the many troubles he’d suffered as a result of his genetic predisposition to high cholesterol. This was no garden-variety high cholesterol, but the kind of numbers that put people at serious risk of heart attack at a relatively young age.

We talked for more than 2 ½ hours as Radabaugh, 46, detailed his surgeries – his quadruple bypass and the surgery to clear a clogged vessel in his neck – as well as his ongoing anxiety about when the next heart event might strike.

“I’m on hyper alert,” he told me for a story that appears in Stanford Medicine magazine’s new issue. “Once I have chest pains, it may be time…What’s scary is that I don’t go anywhere without nitroglycerin or aspirin [to help defuse a blood clot or heart attack]. I think about my own mortality many times a day.”

Radabaugh had learned just three years ago that he had inherited a gene for high cholesterol, a condition known as familial hypercholesterolemia (FH). People with FH are born with high cholesterol – yes, babies can suffer from high cholesterol. And the harmful substance begins building up in the arteries from that time forward.

Unfortunately, Radabaugh had passed the gene on to his three children, and he felt some guilt in that. All of the children, as well as Radabaugh himself, are taking medication to help prevent heart problems and are careful in their eating habits. The disease, I learned, is relatively common in the U.S. population, though few people are aware it. As an advocate with the FH Foundation, a nonprofit patient organization, Radabaugh is hoping to change that – and to help others avoid some of the heartache he’s experienced himself.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions and Hope for patients with familial hypercholesterolemia
Illustration, which originally appeared in Stanford Medicine magazine, by Lincoln Agnew

Chronic Disease, Health Costs, Patient Care, Stanford News

Stanford Coordinated Care: A team approach to taming chronic illness

Stanford Coordinated Care: A team approach to taming chronic illness

team handsNearly two years ago, Stanford began an experiment in medical care, a novel way to bring down the extravagant costs of health care while improving people’s health and their experience with the system. If you ask Shelly Reynolds, RN, one of the first patients to benefit, she will tell you it’s been a wild success.

“They hold me accountable for my own health, which is great,” she told me for my recently published Inside Stanford Medicine story. “Physically and emotionally, I’m healthier than I was before.”

And the experiment is costing less, according to initial figures.

The experiment is called Stanford Coordinated Care, a clinic aimed at helping those who consume the lion’s share of health care dollars. These are patients with chronic illnesses, like diabetes or asthma, who often wind up in emergency rooms or in the hospital because their conditions aren’t being well-managed.

The clinic helps them gain control over their health through a personalized approach by a team of caregivers who are available day or night and who give them the tools and support to manage their conditions at home. It focuses on the patients’ goals and what is important to them.

“It’s easy to make a diagnosis of diabetes, but it can be hard for a person to manage day by day,” Ann Lindsay, MD, one of the clinic co-directors, commented. “We help patients in developing a plan. We support it, and we empower them along the way.”

The clinic is the brainchild of Arnold Milstein, MD, a professor of medicine at Stanford and nationally known health care innovator. He developed a model, called the “ambulatory caring ICU,” which was tested successfully in several major pilot sites around the country. He wanted to bring the model to Stanford and recruited the husband-and-wife team of Alan Glaseroff, MD, now a professor of medicine at Stanford, and Lindsay, who had led one of the sites in California’s Humboldt County.

The clinic now has more than 200 patients, all employees and their families at Stanford University and Stanford Hospital & Clinics. Glaseroff calculates that among the first 27 patients treated in the first six months of the clinic’s opening in May 2012, it saved about $420,000, a 39 percent decline in costs from the previous six months, when patients were receiving care elsewhere. He said the numbers are still small and that research is under way to determine if the model is effective in reducing costs, improving outcomes and promoting patient satisfaction.

Initial findings show patient satisfaction at 100 percent. Reynolds is a good example: Working with Lindsay, she has developed a plan to effectively manage her asthma and her back pain and keep her out of the emergency room. She no longer feels like “a number” in the health care system and says having support from Lindsay has made all the difference: “For the first time in a long time,” she told me, “I felt that someone was looking out for me, advocating for me. It was such a relief.”

Previously: Focusing on the whole person to treat chronic disease – and cut costs, At-home program aimed at helping patients with chronic illness and Innovative Stanford clinic to support chronic care patients
Photo (modified from original) by bibendum84

Cancer, Stanford News, Stem Cells

Stanford among the beneficiaries of major gift from Ludwig Cancer Research

Stanford among the beneficiaries of major gift from Ludwig Cancer Research

Daniel K. Ludwig was a reclusive, self-made billionaire and a friend of President Richard Nixon who took the president’s “War on Cancer” to heart. In his will, Ludwig left his entire fortune to cancer research. Now, the New York-based Ludwig Cancer Research is announcing one of the largest gifts ever made to cancer by an individual donor: $540 million to be shared by six leading cancer centers nationwide.

The beneficiaries include the Ludwig Center for Cancer Stem Cell Research and Medicine at Stanford, which will receive $90 million to spur its innovative work on cancer stem cells, which are believed to drive the growth of many cancers. The center, founded in 2006, has received $150 million from Ludwig Cancer Research to date.

Irving Weissman, MD, the center’s director, said Ludwig was willing to invest in cancer stem cells at a time when there was great controversy in the medical community about the role of these cells – and whether they existed at all.

“The Ludwig was absolutely critical to taking this very high-risk research into a real and rapid understanding of cancer cells,” said Weissman, the Virginia and D.K. Ludwig Professor for Clinical Investigation in Cancer Research at Stanford. As a result of the Ludwig support, he said, “We have taken many of our understandings of cancer stem cells into potential therapeutics.”

Weissman and his colleagues at the Ludwig center have discovered that virtually all human cancers express a protein known as CD47, which functions as a “don’t-eat-me-signal” to fend off potential attacks from the immune system. They have developed an antibody against CD47 which has been shown to attack a wide range of solid tumors. The scientists plan to begin a clinical trial in early 2014. They also plan to test it in combination with other antibodies to see if there is a synergy that will make it even more effective, Weissman said.

With Ludwig support, Weissman is also moving forward with clinical trials with a therapy that could dramatically improve survival rates for women with metastatic breast cancer. The innovative approach was tested more than 15 years ago in a small group of women, 33 percent of whom are still alive and well. With the standard treatment, the survival rate after 15 years is just 7 percent, Weissman said. The trial was discontinued by the sponsoring company but with Ludwig support, Weissman and his colleague, Judith Shizuru, MD, an associate professor of medicine, have obtained the rights to the process and plan a larger trial in 2014. “We need urgently to take this forward,” he said.

Previously: Single antibody shrinks or eliminates human tumors in mice at Stanford and Cancer stem cell researchers are feeling the need for speed
Photo of Irving Weissman in featured entry box by Flynn Larsen

Neuroscience, Stanford News

Stanford Nobelist receives hero’s welcome home

Stanford Nobelist receives hero’s welcome home

Sudhof surprise party - 560

Three days after winning the Nobel Prize in Physiology or Medicine, neuroscientist Thomas Südhof, MD, flew back to Stanford late last week to a hero’s welcome, with cheers and applause from about 60 fellow scientists, including many of his postdocs and graduate students who gathered outside his office. Südhof entered on a plastic red carpet into a hallway adorned with fuchsia streamers and red and yellow balloons. He surveyed the cheering crowd, speechless.

“Can I go to work now?” he said, grinning.

But his lab mates at the Lorry I. Lokey Stem Cell Research Building were not about to let him off that easily. There were champagne toasts in plastic cups, cameras flashing and postdocs and grad students angling to get a shot of themselves with their now-famous mentor. They had gone to some lengths for the celebration, even using red balloons on a whiteboard to create a mock presynaptic terminal, part of the brain’s communication system and the focus of Südhof’s award-winning research.

Südhof, a neuroscientist and professor of molecular and cellular physiology, had been on the road to a conference in a small hilltop town in Spain Oct. 7 when he first heard the news of the award from the Nobel’s communications officer. He had flown in the night before to Madrid and had been driving for more than four hours, in search of the town of Baeza, where he was due to deliver a lecture that afternoon on the synapses in the brain, which help neurons communicate the messages that underlie our thoughts, emotions and activities.

“I was exhausted and it was a little frustrating because Google Maps said it would take three hours, and I had been driving four hours already, so I thought it was my colleague calling asking me where I was.” But when the Swedish-accented voice of Adam Smith delivered the Nobel news, “It wasn’t exactly something I expected,” he told the crowd.

His lab members draped him in a red feather boa and gold paper crown and presented him with giant red cup and a bottle of Dom Pérignon. They called him a “superstar.”

“I’m just the administrator,” he said. “You guys are the superstars.”

Later that afternoon, Südhof was feted by several hundred colleagues who gathered in the Beckman Center lobby on the med school campus in his honor. His colleague Brian Kobilka, MD, winner of the 2012 Nobel Prize in Chemistry, warned him about the after-effects of Nobel-hood.

“From the very first day, my e-mail hit above 1,000 and I’ve never caught up since,” Kobilka said. “Unfortunately I have the compulsion to answer.”

Then there were the autograph seekers everywhere, trailing his limo in Sweden and besieging him with phone and email requests. One graduate student sent him a lumpy Fed-Ex envelope with two baseballs, asking him to autograph them, though Kobilka knows nothing about the sport. “I signed them and sent them back,” he shrugged.

“It’s going to be an amazing, crazy experience,” Kobilka told Südhof. “You deserve it. It might throw you off balance for a while, but I’m confident it won’t be for long.”

Previously: For award-winning scientist, a finished experiment is like a piece of completed art, The lure of research: How Nobel winner Thomas Südhof came to work in the basic sciences, Celebrate good (Nobel) times – come on!, Discussing the brain in Spain: Nobel Laureate Thomas Südhof addresses the media, Stanford’s Thomas Südhof wins 2013 Nobel Prize in MedicineStanford’s Thomas Südhof wins 2013 Nobel Prize in Medicine and Stanford’s Brian Kobilka wins 2012 Nobel Prize in Chemistry
Photo by Nathan Huang

Chronic Disease, Public Health, Research, Stanford News, Women's Health

Large federal analysis: Hormone therapy shouldn’t be used for chronic-disease prevention

Large federal analysis: Hormone therapy shouldn't be used for chronic-disease prevention

woman in windowFor years, women were misled into believing that menopausal hormone therapy was a fountain of youth, a way to counter the chronic diseases of aging, such as heart disease and dementia. But after 15 years of trials and follow-up, the Women’s Health Initiative has delivered the final blow to use of the therapy for disease prevention.

A synthesis of all WHI studies, involving more than 27,000 women, reinforces previous findings that there are many risks in taking hormone therapy and precious few benefits. The new report, published in today’s Journal of the American Medical Association, included women with a uterus who were given estrogen with progesterone, as well as those without a uterus who were given estrogen alone. The women were between the ages of 50 and 79 at the start of the study.

Among women in the estrogen-progestin group, the risks were higher for coronary heart disease, breast cancer, stroke, pulmonary embolism, gallbladder disease, urinary incontinence, and in those 65 or older, dementia. The benefits included decreased hip fractures, diabetes and reduced menopausal symptoms such as night sweats and hot flashes. In the estrogen-only group, the risks and benefits were more balanced, with increased risks of stroke and blood clots, and dementia in women aged 65+, and reduced risk of hip and other fractures.

“What we found initially has not changed, despite more than a decade of new analyses which have taken into consideration questions and controversial issues raised by individual scientists and professional organizations that continue to believe menopausal hormone therapy is good for women - particularly younger women,” Marcia Stefanick, PhD, a professor of medicine at Stanford and one of the study’s co-authors, told me.

She said it is clear menopausal hormone therapy should not be used to prevent diseases of aging. Younger, healthy women in early menopause may still opt to use the therapy to manage their symptoms but shouldn’t look to it as a disease prevention tool, she and her colleagues conclude.

Stefanick has been a leader in the NIH-funded initiative since its outset in 1994. She said it’s important to include women in NIH-funded clinical trials to ensure that there is enough evidence to prescribe any kind of drug that is widely used, whether it is hormones or other treatment. Earlier this year, Stefanick co-founded a School of Medicine-wide center known as the Stanford WSDM Center (Center for Health Research on Women & Sex Differences in Medicine), which encourages study of sex differences in cells, tissues, animal models and human health outcomes, with an emphasis on women’s health.

Previously: No long-term cognitive effects seen in younger post-menopausal women on hormone therapyA call to advance research on women’s health issuesNew findings on aspirin and melanoma: Another outcome of the Women’s Health Initiative, Exploring sex differences in the brain and Women underrepresented in heart studies 
Photo by Alfonso Jimenez

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