Category: Reports

Company Size Affecting Your SEO STRATEGY

Both individuals and businesses alike, know that they need to have an effective SEO strategy in place, in order to compete more effectively. One of the reasons why it is important for companies to refine their SEO strategy is to streamline their marketing campaigns, increase their visibility and their reach.

The fact is that as each company optimizes their web content for online marketing and to appear higher on SERPS, it soon becomes evident that there are lots of tools, and ways to optimize the same. It can seem overwhelming which is why it makes sense for different companies to opt for various SEO strategies in order to compete more effectively.

The primary objective of most of these companies is to appear in the first two or three pages of SERPS, since that can result in online traffic getting bumped up, with more prospective leads.

But does the size of the company affect your SEO strategy?

In a nutshell, yes. To put it plainly, large corporations with enormous resources are able to spend more as far as their SEO strategies are concerned. Whereas when it comes to SEO strategies, different companies opt to adopt various SEO strategies depending on their current budget, cash inflows, cost, expenses etc. It depends on the size of the corporation as well.

Managing your company SEO strategyA two-person operation may not have to deal with big overheads, but they may not be able to match the marketing budget of some of the top companies. Their SEO strategy will vary depending on the size of the company as well as their current budget with smaller size companies opting for free tools.

Small companies:

If your organization is a small startup, then the chances are that your budget will be limited, and there will be a cash crunch. As a result, you may not be able to purchase all the SEO tools that may help level the ‘playing field’. Instead, you will have to opt for some of the lesser SEO tools and even free ones.

The good news is that as far as SEO strategies go, even those that depend on free tools entirely can help a company increase its profile.

You may want to focus on the core aspects of your business and concentrate on SEO strategies that are relevant and essential. For example, if your organization is a greeting card company, it makes very little sense to go in for directory marketing or for that matter, guest posting when you are better off with leveraging your content with the help of Social media platforms.

Mid-sized business:

If your organization is a medium sized business, then you can afford to increase your marketing budget and opt for specialized SEO tools, as relevant to your business to help market your products and services. For example, midsized businesses can afford to streamline their marketing strategies, concentrate on specialized SEO strategies, and build an online presence.

Furthermore, midsized companies can capitalize on the fact that they have the resources (even limited), to provide their audience with special offers and promos, as this can help them connect with various prospective leads. You can utilize various marketing channels from social media to print, to publicize your offers and generate a healthy interest in your product. Moreover, since you have the requisite budget, you can appoint a person in charge of marketing, to handle the SEO strategies for your organization.

Large companies:

It goes without saying that large-sized companies have the resources to integrate specialized SEO tools and to optimize their web content so that they rank higher on SERPs. More importantly, with large companies, often entire departments are often in charge of streamlining their current SEO strategy and to help make it more effective.

Recreating the brand is where the company seeks to increase its brand value by getting instantly recognized by most customers. Large scale companies often streamline their marketing and SEO efforts to expand their brand recognition which in turn can help companies identify easily with the brand in question.

Companies generally fall into two categories, B2B and B2C; if your organization is a B2B company, then you are better off concentrating on tech SEO, where you can use anything from content marketing to guest posting and social media, to help increase your profile.

And as your company has the required resources, you can streamline your current marketing and SEO strategies to target your key demographics more effectively with search engine optimization specialists in Manhattan for effective results.

Using SEO toolsSEO strategy can only be as effective as the content and functionality of your website. So, you need to ensure that your content is of informative, provides your prospective leads with good quality information along with the call to action, as this can help convert those leads to actual customers.

The right strategy for your business:

You need to determine which would be the most effective strategy for your business. Granted, that this is no easy task as there are multiple SEO tools that you can use for your business. You need to keep in mind the current size of your organization, your current marketing resources, and your current requirements. Once you do, you can opt for an SEO strategy that’s specific to the size of your business and your current resources.

As a growing company, you cannot ignore SEO as it forms one of the keystones of your current marketing strategies and can help your company grow further. But it is equally important that you choose an SEO strategy, one that is relevant to the size of your business.

You can always opt for premium SEO tools, later on, to further enhance your website and your current business profile. But at the moment, especially if your company is brand new and a small startup, you may want to opt for simple SEO strategies that involve everything from free tools to the rest.

You can also carry out an audit of your website, as it can help you determine what needs to be done. And you can then concentrate on these specific tasks, to further optimize your website.

Avoiding the Agony of Urinary Tract Infection (UTI)

A UTI is a urinary tract infection. It can cause anything from a nuisance that goes away on its own, to a life-threatening kidney problem. Females have UTIs more often than men. Perhaps, it is due to the female anatomy. Women have shorter urinary passageways, so bacteria have less distance to travel.

A quick anatomy lesson will make the urinary system easy to understand. The urinary tract has only four parts:

  • the urethra, which goes from the outside opening into the bladder
  • the bladder, where urine is stored
  • the ureters, which transport the urine from the kidneys to the bladder
  • the kidneys, which are the filtering system of the urinary tract

Most women feel the agony of UTIRecognize Symptoms of a UTI

Early symptoms of a UTI are so vague that they are often overlooked. There may be a pain in the abdomen, back, or side. Some women complain that they just don’t feel well. Painful urination, frequent urination, and urinary urgency are three of the most common complaints that prompt women to see a doctor. As the infection progresses, a woman may notice the urine becomes cloudy or bloody. Sometimes, there are no symptoms.

See a Doctor if a UTI is Suspected

Left untreated, a bacterial infection usually grows. The infection can advance from the urethra, into the bladder, up the ureters, and invade the kidneys. The kidneys are the body’s filtering system. Since good kidney function is crucial to health, anything that interferes with kidney function can turn into a serious problem.

What Bacteria Causes a UTI?

Many bacteria cause UTIs. The doctor will usually order a urinalysis and a culture and sensitivity test to detect which bacteria is to blame. The doctor will probably ask for a clean caught specimen. This means the area around the urinary opening is to be cleaned and the patient will urinate in a specimen cup.

The complete results can take up to 72 hours to obtain because the culture needs time to grow. The doctor may start a broad spectrum antibiotic before the results are back. These antibiotics treat the usual causes of UTIs. They can keep the bacteria in check. Ideally, the doctor will wait for the results. The final report will list the medicines most effective for treating the specific bacteria causing the UTI. The results often list the most cost-effective treatments as well.

How to Treat a Urinary Tract Infection

Tell the doctor about any allergies before starting any medication. Antibiotics can have totally different names but cause the same allergic reaction. Once the doctor prescribes the proper treatment, it is up to the patient to follow through. Take antibiotics exactly as prescribed. If there’s a worrisome side effect, call the doctor.

Antibiotics often cause stomach and bowel problems. Some doctors have started ordering probiotics along with the antibiotics to lessen the chance of diarrhea. Duration of antibiotic treatment usually runs from one day to two weeks. But for persistent infections, doctors prescribe antibiotics indefinitely.

Recurrent Urinary Tract Infections

It is not unusual for urinary tract infections to recur. But if this happens, further testing is needed to find out the reason. There could be a blockage, an immune system problem, or some other contributing factor. There are many tests used to diagnose problems. Several are commonly ordered.

  1. IVP intravenous pyelogram, which takes pictures of the entire urinary system
  2. ultrasound, which uses sound waves to get pictures of the abdomen or pelvis
  3. cystoscopy, which provides a view of the urethra and bladder

Preventing Urinary Tract Infections

These prevention tips are simple. Nevertheless, women need reminders to take care of themselves. Many women admit to holding their urine until they are finished doing “something more important.”

  • Urinate as soon as the urge strikes. Holding urine increases the chances of bacterial growth.
  • Wipe from front to back after using the toilet. This keeps bacteria away.
  • Drink plenty of fluids. They wash bacteria out of the bladder.
  • Urinate and wash urethral areas before and after sex. It keeps bacteria from entering during sex.
  • Avoid scented douches and soaps. They can cause irritation which can lead to infection.

Some doctors recommend drinking cranberry juice if there is no history of kidney stones in the family. Drinking cranberry juice makes urine acidic and that discourages the growth of bacteria. So remember the basics and reduce the chances of getting a urinary tract infection.

What is the Cost of Endocrine Disorders?

Endocrine disorders are one of the greatest unappreciated causes of aging and disease in humans and animals. Disruption of the main hormones regulating sexual function, energy metabolism, brain function and immune response has widespread systemic effects. Impairments to these essential systems have been implicated in some of the most common physiological disorders including heart disease, diabetes, cancer, autoimmune disease, obesity and impaired intelligence. Perhaps even mental illness and crime can be attributed to them. The defense of San Francisco mayor George Moscone’s murderer centered on his blood sugar-insulin imbalance.
Are the rising rates of these problems related to man made or natural chemicals in our food or environment, and if so, is it possible to assign a cost to these challenges?

Some endocrine related disorders have been rising over the past several decades. By some estimates, the incidence of diabetes has gone up 49% since 1990 and is now estimated to cost Americans $98 billion a year, according to the American Diabetes Association. Could many of these current cases have been caused or exacerbated by chemicals in the environment and our foods or is it simply bad culinary choices?

Some economists have stepped forward to place a cost on environmentally related disorders, which if correct, is massive. Muir et al. have estimated that the total costs of just four environmentally related diseases: diabetes, Parkinson’s disease, neurodevelopmental effects and hypothyroidism, and deficits in IQ cost an estimated $568-$792 billion each year in Canada and the US. They expect 10%-50% of this cost could be environmentally induced, implying that environmental factors could be costing $57-$392 billion dollars for just these four diseases.6 Tom Muir, a senior economist with Environment Canada, told E/E Letter than many cost factors were left out of this analysis for simplicity and that the real costs could be even higher than these estimates. [6]

Muir said, “These diseases are likely candidates for environmental causation. They are finding more mechanisms by which these environmental pollutants can lead to things like Parkinson’s, but it is over an extended period of time and low-level exposure to very many substances. The EPA did not regulate chemicals on anything other than cancer risk and based on animal models and little or nothing else They are starting to look at other things now, but there is no real effort to look at neurodevelopmental effects of the endocrine disruptors. They are mainly looking at estrogenic effects. There is a whole suite of things that can be messed up by these compounds not just acting as estrogens.”

A Mount Sinai Study found that pediatric related diseases related to environmental toxins cost Americans cost an estimated $54.9 billion annually. The study, which was supported by a grant from the now-defunct W. Alton Jones Foundation broke environmental diseases into four causes: lead poisoning ($43.4 billion), neurobehavioral disorders ($9.2 billion), asthma ($2 billion), and childhood cancer ($.3 billion). [1]

The authors noted, “This estimate is likely low because it considers only four categories of illness, incorporates conservative assumptions, ignores costs of pain and suffering, and does not include late complications for which etiologic associations are poorly quantified.”

It would be disingenuous to suggest that removing a single chemical from circulation or telling people not to smoke would eliminate this problem. On the other hand, by establishing a surveillance system for tracking these issues, we may discover relatively simple preventive measures that significantly reduce our risk of disease.
Identifying and remediating environmental factors with a role in disease can provide significant benefit. For example, one study conducted by the Center for Disease Control estimates that the campaign to reduce lead in the 1970s could result in a $110 billion to $319 billion economic gain over the lifetime of children born recently with lower levels of lead exposure compared to children born before the 1970s. [2]

One way of looking at this is as overlapping circles identifying the domains of these issues. One circle, the largest, defines the field of all endocrine related disorders. A second specifies the area of research related to chemicals and other environmental factors that cause disease. Some evidence indicates there are some areas of apparent overlap between the two regions. But the great unknown is how much overlap exists.

One tool used by epidemiologists is the Environmentally Attributed Fraction (EAF), which is a model that assumes that some percentage of a disorder can be attributable to environmental causes. For example, a recent study by Landrigan et al. defined the EAF for lead pollution as 100%, neurobehavioral disorders as 10%, childhood cancer at 5%, and asthma as 30% .[3]

A Hormonally Attributed Fraction (HAF) could provide a tool for estimating the relative impact of hormone imbalances on other diseases. For example, estrogen variations have been shown to affect HDL/LDL levels in heart disease, the progression of certain cancers, and autoimmune disorders. The HAF for multiple sclerosis for example, which has been shown to improve with high levels of estrogen, could enable us to calculate the relative cost of estrogen imbalances on this disease. However, some conditions might be affected by multiple hormonal pathways, in which case calculating the HAF would be more complicated.

Many might write off this issue as a normal function of our genes or the cost of living a longer, satisfying life. However, the rapid and steady growth in the occurrence of chronic diseases such as diabetes, cancer, heart disease, and mental disorders suggests that environmental factors of some kind are involved.

There appears to be a tendency among scientists, government regulators, and lay people to pin the root cause of these disorders on some key factor, such as an industrial chemical. The history of the debate around endocrine disruptors is punctuated by the effects of the chemical de jour: bisphenol-A, phthalates, PCB, dioxin, or phytoestrogens. Unfortunately, this kind of myopic approach masks our ability to find more complex underlying patterns that may play a more significant role in creating these disorders.

In addition to the chemical factors that play a role in communication imbalances, other factors could be in play. These include biological elements (viruses, bacteria, protozoa, and fungi) electromagnetic radiation and fields (i.e., sunlight, cell phones, power lines, CAT scans, and magnetic resonance imaging, and combinations again), rhythms (i.e., when we sleep, exercise, eat, or are exposed to sunlight), and stress.

Some interesting data points relating to the costs of endocrine disorders and health care in general:

Overall Personal and Economic Costs

Spending for health services and supplies reached $1.3 trillion in 2000, almost three times the 1987 spending level of $477.8 billion.[4]


Diabetes is now estimated to cost Americans $98 billion a year, and 17.0 million people have the condition in the US according to the American Diabetes Association.[5] Tom Muir et al. has estimated the annual cost of diabetes at $128 billion per year in the US and Canada. [6]

Pituitary Disorders

An analysis of the literature by a team of pituitary researchers suggests that 1/5 of all adults have a tumor of the pituitary gland and that at least 1/3 of these are clinically significant.[7] This could affect a wide variety of other hormonally related endpoints. There is no evidence to suggest this phenomenon is growing.


Muir, et al estimates cost of Neurodevelopmental Effects and Hypothyroidism at between $81.5 and $167 billion per year in the US and Canada.[6]

The American Thyroid Association estimates that over 14 million Americans have thyroid disorders.


44 million US men and women age 50 and over have Osteoporosis and low bone mass.

The direct medical costs for osteoporosis and the 1.5 million associated fractures is $14 billion ($38 million each day) – and the cost is expected to increase to more than $60 billion by 2020 if nothing is done. By the year 2010, it is estimated that over 52 million women and men in this same age category will be affected and, if current trends continue, the figure will climb to over 61 million by 2020.[8]

A Call to Action, prepared by International Osteoporosis Foundation indicates that osteoporotic fractures in Europe have increased by some 25% since a 1998 European Union report was issued, but government action has been “disappointing” and has not stopped significant suffering resulting from the disease. Dr. Juliet Compston of the University of Cambridge noted that in the past three years the cost of osteoporosis has increased some 33% and now costs more than Euro 4.8 billion annually in European Community hospital healthcare alone. [9]


Could natural and human-made chemicals and other factors modulate hormone systems such as ghrelin, contributing to the massive epidemic of obesity in America or is it just a lack of exercise? For example, recent work by Masuno et al. suggests that bisphenol A induced more and bigger fat cells in cell culture studies.[10]

Although this new evidence is suggestive as the whole population is exposed to Bisphenol A and it has been detected in human tissues, there are other obvious risk factors, such as couch potato-ing, and gluttony. The causes are not certain, but it is clear that obesity is on the rise. According to the CDC, in the last ten years, obesity rates have increased by more than 60% among adults. Approximately 45 million adults, or 25% of the adult population, are obese. Since 1980, obesity rates have doubled among children and tripled among adolescents. Almost 15% of our children and adolescents—about 8 million young people—are overweight.

Among children and adolescents, annual hospital costs related to obesity were $127 million during 1997–1999 (in 2001 constant U.S. dollars), up from $35 million during 1979–1981. In 1995, obesity among U.S. adults cost $99.2 billion, of which $51.6 billion was for direct medical costs. Among U.S. adults in 1996, $31 billion of treatment costs (in the year 2000 dollars)—17% of direct medical costs—for cardiovascular disease were related to overweight and obesity. [11]

A University of Michigan Study even found that heavier women tend to be worth less financially. After analyzing the financial data over more than 7,000 males and females, a high statistical correlation was noted between the female’s weight and their net worth. Obese women tended to have a net worth that was 60% lower than the slimmer ones. No such correlation was noted for the men.[12]
Muir said some evidence suggests that obesity could be involved with other health and endocrine related problems associated with an increased body burden of fat soluble chemicals like PCBs and dioxins.

Sexual Dysfunction/Infertility

  • Number of Women ages 15-44 With Impaired Ability to Have Children: 6.1 million
  • Number of Women Who’ve Used Infertility Services: 9 million
  • Percent of Births That Are “Unwanted”: 10% (1995) Number of Infertile Married Couples: 2.1 million
  • Number of Women Using Infertility Services: 9.3 million

Source: Vital and Health Statistics Series 23, No. 19 based on 1995 data  [13]

According to the American Society for Reproductive Medicine, infertility affects 6.1 million American women and their partners, about 10% of the reproductive age population. Infertility is a disease of the reproductive system that affects the male or female with almost equal frequency.  [14]

Results from a national survey of people aged 18 to 59 years reported in the February 10, 1999, issue of The Journal of the American Medical Association indicate that sexual dysfunction was common among women (43 percent) and men (31 percent). [15]


The National Institutes of Health estimate overall costs for cancer in the year 2000 at $180.2 billion: $60 billion for direct medical costs (total of all health expenditures).

$15 billion for indirect morbidity costs (cost of lost productivity due to illness); and, $105.2 billion for indirect mortality costs (cost of lost productivity due to premature death).

Type of cancer # Cases Deaths in 2001
Breast 193,700 40,600
Genital system 286,800 58,500
Prostate (subset of genital) 198,100 31,500

Heart Disease

In some cases, hormone replacement therapy has been shown to alleviate heart disease If this is the case, could endocrine disorders and endocrine disrupting agents play a role in heart disease? Muir said there is evidence that air pollution contributes, and that aromatic hydrocarbons, such as PCBs, induce an oxidative stress attack on the endothelium of the blood vessels, including the coronary arteries, causing arteriosclerosis. Heart disease is a leading cause of death. According to the US Center for Disease Control,

About 57 million Americans live with some form of cardiovascular disease, which causes more than 40% of all deaths in the United States; 950,000 Americans every year. Heart disease and stroke cost the nation almost $260 billion annually. Cardiovascular disease is the leading cause of death for older Americans and is the primary cause of death for all Americans age 35 and older. Coronary heart disease (CHD), also known as ischemic heart disease, is the most frequent cause of death in the United States — accounting for 481,458 deaths in 1994. Death rates from CHD decreased dramatically during the 1960s and 1970s, with slower declines occurring during the 1980s. The recent data for the 1990s indicate that the rate of decline in CHD deaths is continuing to slow down. [16]


The brain’s performance can be adversely affected by changes in the neurotransmitter balance, structural damage, and the buildup of plaques and other waste products. Some of the problems, which may occur from brain imbalances, include impaired intelligence and anti-social behavior (crime) Muir said, “Our paper covers the increase in the prison population, and this reflects violence. Also, the neuro developmental stuff also has a factor for a greater tendency to violence in it.”

According to statistics collated by the Stanley Medical Research Institute, the rate of people committed to psychiatric hospitals grew nearly 8-times between 1860 and 1955 from about .04% of the population to about .34% of the individuals in the US. In the book, “The Invisible Plague: The Rise of Mental Illness from 1750 to the Present,” Dr. E Fuller Torrey argues that this increase may be attributable to biological infectious agents, changes in diet, and toxins.

On the other hand, critics such as Dr. Kenneth S. Piver, dismiss these statistics. He noted on June 26, 2002, Journal of the American Medical Association that Torrey’s attempt to lump together data from different centuries seems akin to comparing apples and oranges.

Muir, et al. estimates loss of 5 IQ points costs about $30 billion a year in Canada and about 275 to $376 billion in the US annually and the hypothetical dynamic impacts of these costs another $19-$92 billion per year. 6 Data from the US CDC suggests that the per capita costs of mental disorders more than quadrupled between 1975 and 1994 from $31 per person to $128. [17]


CDC research has indicated a significant increase in the occurrence of hypospadias. One study found that rates increased almost twofold in metropolitan Atlanta from 1968 to1993, from around 18 per 10,000 births to approximately 40 per 10,000 births. Similarly, rates increased approximately twofold in a national congenital disabilities surveillance system based on hospital discharge data between 1970 and 1993to about 80 per 10,000 male births. [18]

[1] “Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities.” Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, Schwartz J. Environ Health Perspect 2002 Jul;110(7):721-8

[2] “Economic Gains Resulting from the Reduction in Children’s Exposure to Lead in the United States,” Scott D. Grosse, Thomas D. Matte, Joel Schwartz, and Richard J. Jackson, Environmental Health Perspectives Volume 110, Number 6, June 2002

[3] “Environmental Pollutants and Disease in American Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities,” Philip J. Landrigan, Clyde B. Schechter, Jeffrey M. Lipton, Marianne C. Fahs, and Joel Schwartz, Environmental Health Perspectives Volume 110, Number 7, July 2002

[4] Cathy A. Cowan, Patricia A. McDonnell, Katharine R. Levit, and Mark A. Zezza
Burden of Health Care Costs: Businesses, Households, and Governments, 1987-2000


[6] “Societal Costs of Exposure to Toxic Substances: Economic and Health Costs of Four Case Studies That Are Candidates for Environmental Causation,” Tom Muir and Mike Zegarac. Environmental Health Perspectives Volume 109, Supplement 6, December 2001

[7] 10th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists presentation by Keith Friend, Dr. Keith Friend, formerly University of Texas at MD Anderson Cancer Center (Now at Pharmacia, Upjohn),
Dr. Shereen Ezzat, MD, Professor of Medicine at University of Toronto,
Dr. William Couldwell, Professor of Neurosurgery at University of Utah,
Dr. Ian McCutcheon, MD Anderson Cancer Center in Houston Texas.



[10] Masuno, H, T Kidani, K Sekiya, K Sakayama, T Shiosaka, H Yamamoto and K Honda. 2002. Bisphenol A in combination with insulin can accelerate the conversion of 3T3-L1 fibroblasts to adipocytes. Journal of Lipid Research 3:676-684.



Raw U Mich Data supporting this story:






[18] Paulozzi LJ, Erickson JD, Jackson RJ. Hypospadias trends in two US surveillance systems. Pediatrics. 1997 Nov;100(5):831-4.

Hormone Treatments Magnifies the Risks of Breast Cancer

Three clinical trials have changed the way postmenopausal hormone treatment is viewed. One of the trials was ended because of increases in breast cancer risk related to the treatment. Further, the decrease in the risk of heart and blood vessel disease, which was expected, was not found in any of these trials. Major health organizations have responded and suggested that use of this type of therapy be discontinued for health promotion and most disease prevention purposes. The decision to use birth control pills is difficult. Use of birth control pills has been associated with a small increase in breast cancer risk during the time that the pills are taken. Birth control pills also have other potential risks and benefits, beyond preventing pregnancy.

1) Hormone Treatment after Menopause and the Risk of Breast Cancer

What is menopause, and what physical symptoms are associated with this period of a woman’s life?

Women over 50 experience menopauseMenopause is the time in a woman’s life when she stops having menstrual periods completely. The average age of menopause in North American and European women is about 51 years old. Both her health and the society she lives in affect how a woman deals with menopause. At midlife, women experience a number of the physical effects of getting older, and some symptoms often associated with menopause are simply the result of aging, not menopause itself.

Symptoms that women experience at menopause vary among cultures. North American and European women often have hot flashes, night sweats, and vaginal dryness. Hot flashes cause problems for many but not all women. The number of hot flashes increases during the time leading up to menopause. They are most frequent at about the time of menopause and then decline rapidly afterward. Symptoms that women have that may or may not be connected with menopause are incontinence (leaking urine when sneezing or laughing), forgetfulness, depression, a decrease in sexual desire, and joint pains.

How do hormone levels change during a woman’s transition to menopause?

The levels of hormones that are necessary for childbearing change at this period of a woman’s life. Hormone levels typically change during a woman’s menstrual periods, but during the time before menopause, the changes become more frequent. After menopause, the levels of a number of hormones change in both directions. Estrogen and progesterone levels are greatly decreased, but the levels of other reproductive hormones are increased or may decrease. After menopause, women’s fat tissues become the primary source of estrogen and may affect estrogen levels.

Do the hormone changes at menopause carry health risks?

Lower levels of estrogen in women after menopause contribute to one type of osteoporosis (brittle bones) and may play a role in heart disease. The relationship between estrogen and osteoporosis and heart disease is discussed below. Changes in the levels of the other reproductive hormones have not been directly linked to adverse health effects. On the other hand, a woman’s lifetime exposure to estrogen is thought to be related to her risk of breast cancer and an earlier age at menopause and loss of estrogen are associated with lower breast cancer risk.

What is postmenopausal hormone treatment and why is it used?

Symptoms of MenopausePostmenopausal hormone treatment (hormone replacement therapy) is the use of estrogen alone or together with progesterone after menopause.

Postmenopausal hormone treatment has typically been prescribed to women for three purposes:

1) to limit the symptoms of menopause;

2) to reduce bone loss in women with or at risk for osteoporosis;

3) to potentially decrease the possibility of heart disease in postmenopausal women.

Estrogen may be given alone if a woman has had her uterus surgically removed (hysterectomy). Hormone treatment is also given to women whose ovaries have been removed surgically for medical reasons (ovariectomy, oophorectomy). Estrogen, if given alone, increases the risk of uterine (endometrial) cancer. Adding progesterone to the treatment limits the adverse effects of estrogen on the uterus, so women, with a uterus, are given progesterone with estrogen. Progesterone must be given along with estrogen treatment for at least ten days of a monthly cycle of treatment. Epidemiological studies indicate no increase in the risk of uterine cancer among women who use postmenopausal hormone treatment with estrogen and continuous progesterone, but this is not yet known for certain. Hormone treatment may also be used over the short term to control some of the symptoms of menopause.

Does postmenopausal hormone treatment increase the risk of breast cancer?

Premenopausal and Postmenopausal risksWomen who use postmenopausal hormone therapy have a higher risk of breast cancer compared with women who do not use hormone treatment. In the past, hormone treatment used estrogen alone, and the effects of this treatment have been studied more extensively. These early studies saw breast cancer risk increase the longer the length of the estrogen treatment. Breast cancer risk among women who used hormone treatment, increased about 2% for each year of use compared to women who did not use hormones. When hormone treatment is stopped, the risk falls to previous levels over a period of five years.

Today, most women who receive postmenopausal hormone treatment use estrogen combined with progesterone. Some recent studies indicate a higher risk of breast cancer is associated with this form of hormone treatment. These studies found that estrogen with progesterone treatment increased breast cancer risk by 6% to 8% for each year of use. Confirming these results, a large clinical trial examining estrogen with progesterone treatment in healthy women, the Women’s Health Initiative, was recently ended prematurely because of an association of excessive breast cancer risk with this treatment. Trials of this type are the ‘gold standard’ for examining drug effects, and this early termination result raises strong concern about the use of estrogen with progesterone as a beneficial treatment for healthy women after menopause.

Does postmenopausal hormone treatment prevent or help control heart and blood vessel disease?

It is unlikely that postmenopausal hormone treatment can prevent or help control existing heart disease. Early studies had found benefits of hormone treatment for reducing the risk of heart and blood vessel disease in women. The results of these early studies were limited because they compared women who chose to use hormone treatment to women who did not. Women in these studies who decided to use hormones may have differed from women who did not participate in meaningful ways that would have affected their heart disease risks such as diet or exercise.

A more definite way to determine how hormone treatment affected heart disease is through a clinical trial. In these studies, individuals are randomly assigned to receive an active or inactive (placebo) treatment, and which treatment a person receives is unknown until the study is ended. Recent clinical trials have examined the effect of postmenopausal hormone treatment for the treatment of women who already have heart disease. Two trials examined the effect postmenopausal hormone treatment in women with existing heart and blood vessel disease. The results of both studies surprised researchers by showing no benefit of hormone treatment for women who already had heart disease.

These studies have questioned the idea that postmenopausal hormone treatment could help control heart disease. This question was answered by The Women’s Health Initiative, the large clinical trial examining estrogen with progesterone for potential benefits including those to the heart and blood vessels. Although this study had to be terminated early, it indicated that it was unlikely that estrogen with progesterone treatment would be of benefit for heart and blood vessel disease. Both the National Heart, Lung and Blood Institute and the American Heart Association have recommended that use of this type of therapy for women with existing disease or prevention of heart and blood vessel disease be discontinued.

Does postmenopausal hormone treatment reduce the risk of osteoporosis?

Continuous postmenopausal hormone treatment will minimize the risk of osteoporosis and is one treatment that can be used for this disease. Osteoporosis happens when bones lose calcium and other minerals, making them more fragile and easily broken. Osteoporosis is a serious problem; broken bones can lead to pain, infection, limited ability to get around, and even death. Whether a woman develops osteoporosis as she gets older depends on how much bone she has built up by about age 30 and how quickly she loses calcium from her bones as she gets older. While some bone loss occurs in everyone with aging, some women are more likely to get osteoporosis. The risk for osteoporosis depends on a woman’s family history, her estrogen levels, her diet, the amount of exercise she gets, and whether she smokes or drinks alcohol. The loss of estrogens at menopause is considered to be responsible for a short period of quick bone loss during this life period. Significant osteoporosis is seen in about a third of postmenopausal women in the United States. Prevention of osteoporosis does not necessarily require hormone treatment. Successful risk reduction has also been reported using calcium and vitamin D supplements and exercise. The best prevention is adequate calcium and vitamin D intake and physical activity in childhood and adolescence. The Women’s Health Initiative (the clinical study described above) is also studying calcium and vitamin D supplements as treatments to prevent osteoporosis in postmenopausal women.

Are there other health risks associated with postmenopausal hormone treatment?

Other studies have indicated that women who used postmenopausal hormone treatment may have higher rates of ovarian cancer, gall bladder disease, and problems associated with increased blood clotting compared to women who did not use hormone treatment. Postmenopausal hormone treatment is associated with, at most, a small increase in ovarian cancer risk. Women who use hormone therapies containing estrogen had two to four times the amount of gall bladder disease compared to women who did not use hormone treatment.

How can women weigh the benefits and the risks of hormone treatment for themselves?

Women, with their health care providers, should decide whether to use postmenopausal hormonal treatment based on their current health, the severity of their menopausal symptoms, and their medical history. Risk factors that should be considered are a family or personal history of breast cancer and other reproductive cancers, a personal history of blood clotting problems, existing heart and blood vessel disease, and a personal history of gall bladder disease. Women with a family history of heart and blood vessel disease or women at risk for osteoporosis may benefit from hormone treatment. It should also be noted that other medications and lifestyle changes could be used to control these diseases, as well as the symptoms of menopause.

Should breast cancer survivors consider hormone treatment?

Hormone treatment is not recommended for breast cancer survivors. Known or suspected breast cancer is currently considered a contraindication for hormone treatment. Investigators have suggested the need for randomized clinical trials, to assure safety, before breast cancer survivors use hormone therapy.

2) Use of Birth Control Pills and the Risk of Breast Cancer

What hormones are used in birth control pills and how do they work?

The birth control pills used today contain an estrogen and a progesterone. Birth control pills are thought to prevent conception by acting on the reproductive system in four complementary ways:

1) they prevent ovulation, the release of an egg;
2) they interfere with movement of the egg to the sites for fertilization and then growth;
3) they hamper preparation of the uterus (womb) to receive the fertilized egg;
4) they change the consistency of cervical mucus, making it difficult for sperm to reach and fertilize the egg.

Birth control pills are very effective. Used properly they prevent pregnancy in 97% to 98% of menstrual cycles.

Is the use of birth control pills associated with increased breast cancer risk?

birth control pills may trigger breast cancerWomen who are currently taking birth control pills have a small increase in their risk of breast cancer relative to women who had never taken birth control. This finding is the result of the co-operative reanalysis of 54 studies (53,000 women with breast cancer and 100,000 women as controls) that examined the relationship between birth control pills and breast cancer risk. Ten years after women had stopped using birth control pills their risk for breast cancer was back to normal. How long birth control pills were used, the dose of hormone or the type of the hormone used did not affect breast cancer risk. However, women who began using birth control pills before age 20 may have a greater risk of premenopausal breast cancer than women who started birth control use later in life. It is currently unclear if women with a family history of breast cancer may increase their risk of breast cancer if they use birth control pills. More studies are needed examining women who began birth control pill use early in life and women with a family history of breast cancer.One of the limits to understanding how birth control pills affect breast cancer risk is that their hormone composition has changed several times since the time they were first released. Birth control pills in use today use lower hormone doses than those used in the past. These lower dose pills have not been in use long enough to have been included in many of these studies. More studies are needed to determine if the lower dose of hormones in currently used birth control pills has changed their effect on breast cancer risk.

Is birth control pill use associated with other health risks?

Three other groups of health risks have been associated with birth control pill use. First, their use is linked with an increased risk of blood clots, especially in women older than 35 who smoke. Second, their use is potentially associated with an increase in the risk of some other cancers, such as liver and cervical cancer. Third, their use is related to other changes in body systems and hormone levels. For example, birth control pills increase one’s risk of gall bladder disease.

Are there health benefits associated with birth control pill use?

The use of birth control pills containing estrogen and progesterone has been associated with decreased risk of ovarian and uterine cancers. In general, the risk of both these cancers was reduced by approximately 50%.

The health risks for women during pregnancy are greater than those seen among women who use birth control pills. For instance, the risk of increased blood clotting during pregnancy is higher than that observed during birth control use. Nonetheless, it should be kept in mind that many other safe and effective methods of birth control also exist.

Should breast cancer survivors use birth control pills?

It is not recommended that women who are survivors of breast cancer to use birth control pills. As with hormone therapy, known or suspected breast cancer is a contraindication for using these drugs.

What can women do now?
  • Maintain a healthy heart and bones by getting plenty of exercise.
  • Maintain a healthy body weight, neither too fat nor too thin.
  • Eat plenty of calcium rich foods such as low fat dairy products, leafy greens and hard tofu and make sure that their calcium intake is a least 1000 mg daily before menopause and 1200 mg daily after menopause.
  • Do not smoke.
  • Choose a diet low in fat, especially saturated fats from meat and dairy products.
  • Choose a diet high in fiber from whole grains, vegetables, and fruits.