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Hormone therapy should be offered to more women with severe menopause: review

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More women suffering from “debilitating” symptoms of menopause should be presented with the option of hormonal therapy, according to a paper published in the Canadian Medical Association Journal (CMAJ) on Monday.

“There’s a whole constellation of menopausal and perimenopausal symptoms, some of which can be extremely debilitating, especially to what is relatively a young woman in our day and age,” said Dr. Iliana Lega, an endocrinologist at Women’s College Hospital in Toronto and the paper’s lead author.

“Every day we see how few women are asked about menopausal symptoms (and) are informed about the treatment options and we just feel there’s an ongoing need to improve education on this topic,” she said.

Women in their 40s and 50s are raising children and could be at the peak of their careers while trying to live with distressing symptoms, she said.

“Having disrupted sleep, having frequent hot flashes, having irritability and mood issues has a huge impact on their day-to-day,” Lega said.

Menopausal hormone therapy, also known as hormone replacement therapy, has been a controversial issue since the 1990s, when a major study found an association with higher rates of breast cancer and stroke.

But many experts now say that study overstated the risks, which were mainly associated with women over 60 — when the risks for those conditions would go up anyway due to age.

Lega and her co-authors reviewed more recent studies and found the risks are much lower for women in their 40s and 50s, especially if they use hormone therapy for five years or less.

For women between 50 and 59 years of age or who start hormone therapy within 10 years of their last period, “the additional risk of breast cancer is estimated at three additional cases for every 1,000 women who use combined menopausal hormone therapy for five years,” their review said.

“Combined” menopausal hormone therapy is a mix of estrogen and progestin.

The review also found that the risk of stroke for people under 60 using hormone therapy was very small.

“Certainly in women over the age of 60, the discussion is very different,” Lega said. “Usually that is not an age group (where) hormone therapy initiation is recommended.”

The review paper is not intended to suggest that all women should go on menopausal hormone therapy, but to give health-care providers the information they need to discuss the options with patients and weigh the risks and benefits on an individual basis, she said.

Dr. Iris Gorfinkel, a family physician in Toronto who was not involved with the paper, agreed.

“You place what the suffering is now on one side of the scale and on the other side of the scale has to go the potential for harm,” she said.

To assess potential for harm, Gorfinkel talks to patients about the possible presence of a BRCA gene mutation, which is associated with a higher risk for breast cancer, along with family history.

She does the same to assess the risk of heart disease or stroke, discussing family history and other factors such as smoking, diabetes and high blood pressure.

On the other side of the scale, it’s important not to underestimate the degree of suffering the patient is experiencing from menopausal symptoms, Gorfinkel said.

“The patient may be aware that this could be ‘change of life,’ but a lot of patients are not aware that the perimenopausal years can last a decade,” she said.

“I think medicine has long told women to ‘shut up and put up,'” Gorfinkel said. “The symptoms get worse and worse and worse and a lot of women just keep saying to themselves, ‘I should be used to this, I should be fine.'”

Menopausal hormone therapy is up to 90 per cent effective in treating hot flashes and improves sleep quality and mood disturbances, the review paper said.

It also helps prevent the loss of bone density.

That’s a significant benefit, Gorfinkel said, “because life changes on the dime when women or men fall and fracture a hip.”

Hormone therapy is taken in pill or patch form to manage those symptoms, she said.

But if someone only wants to treat a localized symptom, such as dry vagina, the hormone therapy can be taken through a topical lotion, which eliminates any increased risk of breast cancer, Gorfinkel said.

The Canadian Cancer Society urges caution when considering menopausal hormone therapy.

“The Canadian Cancer Society recommends that women avoid taking HRT (hormone replacement therapy) for any reason other than to relieve severe menopausal symptoms that have not responded to other treatment,” a statement on its website says.

“If you and your doctor decide that taking HRT is right for you, the lowest effective dose should be used for the shortest period of time possible.”

Dr. Melinda Wu, a general practitioner in oncology at Women’s College Hospital’s Breast Centre, said the cancer society’s position aligns with the review paper’s findings that not every woman should be on hormone replacement therapy, but they should be aware that it’s an option to discuss with their doctors.

“It always comes down to a risk-benefit discussion,” said Wu, who was not involved in the review paper.

“I do think the ‘less is more’ approach to medicine in general can be appreciated by many,” she said.

“We are treating something with (the) intention that we understand what benefits we’re looking to achieve and that we’re using the lowest effective possible dosing of menopausal hormone therapy to achieve that benefit.”

This report by The Canadian Press was first published May 15, 2023.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

 

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

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