Long-acting contraceptives seem to be as safe as the pill when it comes to cancer risk
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Many women worry hormonal contraceptives have dangerous side-effects including increased cancer risk. But this perception is often out of proportion with the actual risks.
So, what does the research actually say about cancer risk for contraceptive users?
And is your cancer risk different if, instead of the pill, you use long-acting reversible contraceptives? These include intrauterine devices or IUDs (such as Mirena), implants under the skin (such as Implanon), and injections (such as Depo Provera).
Our new study, conducted by the University of Queensland and QIMR Berghofer Medical Research Institute and published by the Journal of the National Cancer Institute, looked at this question.
We found long-acting contraceptives seem to be as safe as the pill when it comes to cancer risk (which is good news) but not necessarily any safer than the pill.
How does the contraceptive pill affect cancer risk?
The International Agency for Research on Cancer, which compiles evidence on cancer causes, has concluded that oral contraceptives have mixed effects on cancer risk.
Using the oral contraceptive pill:
- slightly increases your risk of breast and cervical cancer in the short term, but
- substantially reduces your risk of cancers of the uterus and ovaries in the longer term.
Our earlier work showed the pill was responsible for preventing far more cancers overall than it contributed to.
In previous research we estimated that in 2010, oral contraceptive pill use prevented over 1,300 cases of endometrial and ovarian cancers in Australian women.
It also prevented almost 500 deaths from these cancers in 2013. This is a reduction of around 25% in the deaths that could have occurred that year if women hadn’t taken the pill.
In contrast, we calculated the pill may have contributed to around 15 deaths from breast cancer in 2013, which is less than 0.5% of all breast cancer deaths in that year.
What about long-acting reversible contraceptives and cancer risk?
Long-acting reversible contraceptives – which include intrauterine devices or IUDs, implants under the skin, and injections – release progesterone-like hormones.
These are very effective contraceptives that can last from a few months (injections) up to seven years (intrauterine devices).
Notably, they don’t contain the hormone oestrogen, which may be responsible for some of the side-effects of the pill (including perhaps contributing to a higher risk of breast cancer).
Use of these long-acting contraceptives has doubled over the past decade, while the use of the pill has declined. So it’s important to know whether this change could affect cancer risk for Australian women.
Our new study of more than 1 million Australian women investigated whether long-acting, reversible contraceptives affect risk of invasive cancers. We compared the results to the oral contraceptive pill.
We used de-identified health records for Australian women aged 55 and under in 2002.
Among this group, about 176,000 were diagnosed with cancer between 2004 and 2013 when the oldest women were aged 67. We compared hormonal contraceptive use among these women who got cancer to women without cancer.
We found that long-term users of all types of hormonal contraception had around a 70% lower risk of developing endometrial cancer in the years after use. In other words, the risk of developing endometrial cancer is substantially lower among women who took hormonal contraception compared to those who didn’t.
For ovarian cancer, we saw a 50% reduced risk (compared to those who took no hormonal contraception) for women who were long-term users of the hormone-containing IUD.
The risk reduction was not as marked for the implants or injections, however few long-term users of these products developed these cancers in our study.
As the risk of endometrial and ovarian cancers increases with age, it will be important to look at cancer risk in these women as they get older.
What about breast cancer risk?
Our findings suggest that the risk of breast cancer for current users of long-acting contraceptives is similar to users of the pill.
However, the contraceptive injection was only associated with an increase in breast cancer risk after five years of use and there was no longer a higher risk once women stopped using them.
Our results suggested that the risk of breast cancer also reduces after stopping use of the contraceptive implants.
We will need to follow-up the women for longer to determine whether this is also the case for the IUD.
It is worth emphasising that the breast cancer risk associated with all hormonal contraceptives is very small.
About 30 in every 100,000 women aged 20 to 39 years develop breast cancer each year, and any hormonal contraceptive use would only increase this to around 36 cases per 100,000.
What about other cancers?
Our study did not show any consistent relationships between contraceptive use and other cancers types. However, we only at looked at invasive cancers (meaning those that start at a primary site but have the potential to spread to other parts of the body).
A recent French study found that prolonged use of the contraceptive injection increased the risk of meningioma (a type of benign brain tumour).
However, meningiomas are rare, especially in young women. There are around two cases in every 100,000 in women aged 20–39, so the extra number of cases linked to contraceptive injection use was small.
The French study found the hormonal IUD did not increase meningioma risk (and they did not investigate contraceptive implants).
Benefits and side-effects
There are benefits and side-effects for all medicines, including contraceptives, but it is important to know most very serious side-effects are rare.
A conversation with your doctor about the balance of benefits and side-effects for you is always a good place to start.
Susan Jordan, Professor of Epidemiology, The University of Queensland; Karen Tuesley, Postdoctoral Research Fellow, School of Public Health, The University of Queensland, and Penny Webb, Distinguished Scientist, Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Fatigue? Unexplained weight gain and dry skin? Could it be Hashimoto’s disease?
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Maybe you feel worn out. Perhaps you’re also having trouble losing weight. Generally, you just don’t feel 100%.
Could it be Hashimoto’s disease? This common autoimmune thyroid disorder is when your immune system (which fights off viruses and bacteria), mistakenly attacks a part of your body. In this case, it’s your thyroid – a gland located at the base of your neck – and can cause low thyroid hormones levels (hypothyroidism).
Hypothyroidism affects one in 33 Australians and Hashimoto’s is one of the most common thyroid conditions in first-world countries.
While symptoms can be subtle, untreated Hashimoto’s can cause long-term problems with your heart, memory and fertility. Here is what you need to know.
What happens when you have Hashimoto’s?
Your thyroid gland is a butterfly-shaped gland in the neck. It is essential in regulating things like muscle function, digestion, metabolism, the heart and lungs. In children, thyroid hormones are also needed for normal growth and development.
Hashimoto’s thyroid disease, named after the Japanese doctor who discovered it in 1912, is also known as Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis. The disease can cause the immune system to mistakenly produce proteins called antibodies (thyroid peroxidase and thyroglobulin). These can cause inflammation and long-term damage to the thyroid gland. Over time, as thyroid tissue is inflamed and/or destroyed, there can be a decrease in the production of thyroid hormones (hypothyroidism).
Hashimoto’s can present subtly at first. If you only have antibodies with no change in thyroid levels, it is likely you won’t have any symptoms.
However, as the disease progresses, you may experience fatigue, weight gain (or difficulty losing weight), increased sensitivity to the cold, constipation, dry skin, muscle aches, irregular or heavy menstrual cycles, enlarged thyroid (goitre) and occasionally hair loss, including at the ends of your eyebrows.
What causes Hashimoto’s thyroid disease?
Several risk factors can contribute to the development of Hashimoto’s including:
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genetic risk – your risk is higher if you have family members with Hashimoto’s
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gender – women are up to ten times more likely than men to develop the disease
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age – you are more likely to develop the disease from 30 to 50 years of age
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autoimmune condition – having another autoimmune condition like systemic lupus, Type 1 diabetes and celiac disease increases your risk
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excessive iodine intake and radiation exposure may also increase risk in people who are already genetically at greater risk.
What are the long-term risks?
Long-term, untreated Hashimoto’s thyroiditis can cause heart issues, higher cholesterol levels, nerve damage (peripheral neuropathy), reduced cognition and infertility.
In pregnancy, Hashimoto’s has a higher risk of pre-eclampsia (high blood pressure affecting several organs), premature birth, placental abruption (when the placenta separates from the inner wall of the uterus before birth) and, in severe cases, pregnancy loss.
The disease has also been linked with an increased risk (but low incidence) of the lymphocytes of the thyroid turning into cancer cells to cause thyroid lymphoma.
How is Hashimoto’s diagnosed?
Diagnosis can be confirmed with a blood test to check thyroid levels and antibodies.
Thyroid peroxidase antibodies are commonly present but about 5% of patients test antibody-negative. In those people, diagnosis depends on the thyroid levels, clinical presentation and ultrasound appearance of general inflammation. An ultrasound may not be required though, especially if the diagnosis is obvious.
Three hormone levels are tested to determine if you have Hashimoto’s.
Thyroid stimulating hormone (TSH) is produced by the brain to speak to the thyroid, telling it to produce two types of thyroid hormones – T3 and T4.
If you have either relative or absolute thyroid hormone deficiency, a test will show the stimulating hormones as high because the brain is trying to get the thyroid to work harder.
Hashimoto’s thyroiditis under the microscope. Antibodies against thyroid peroxidase and thyroglobulin were elevated.
Patho/Wikimedia Commons, CC BY-SACan it be treated?
The management of Hashimoto’s depends on the severity of the thyroid levels. Up to 20% of the population can have antibodies but normal thyroid levels. This is still Hashimoto’s thyroid disease, but it is very mild and does not require treatment. There is no current treatment to reduce antibody levels alone.
Because thyroid peroxidase antibodies increase the risk of abnormal thyroid levels in the future, regular thyroid testing is recommended.
When the thyroid stimulating hormone is high with normal thyroid hormone levels it is termed “subclinical hypothyroidism”. When it is paired with low hormone levels it is called “overt hypothyroidism”. The first is a mild form of the disease and treatment depends on the degree of stimulating hormone elevation.
Overt hypothyroidism warrants treatment. The main form of this is thyroid hormone replacement therapy (levothyroxine) with the dose of the drug adjusted until thyroid levels are within the normal range. This is usually a lifelong treatment but, once the dose is optimised, hormone levels usually remain relatively stable.
In some people with very enlarged thyroid glands causing compressive symptoms (such as difficulty swallowing or breathing), thyroidectomy (surgical removal of the thyroid) is considered.
Hashimoto’s thyroiditis is a common condition caused by your body’s immune system incorrectly damaging to your thyroid and can go undetected. Long-term, untreated, it can cause issues with your heart, cognition, and fertility. It can be diagnosed with a simple blood test. Speak to your doctor if you have any concerns as early diagnosis and treatment can help prevent complications.
Aakansha Zala, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Build a Body That Lasts – by Adam Richardson
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This book is written on a premise, and that premise is: “your age doesn’t define your mobility; your mobility defines your age”.
To this end, we are treated to 328 pages of why and how to improve our mobility (mostly how; just enough on the “why” to keep the motivation flowing).
Importantly, Richardson doesn’t expect that every reader is a regular gym-bunny or about to become one, doesn’t expect you to have several times your bodyweight in iron to life at home, and doesn’t expect that you’ll be doing the vertical splits against a wall any time soon.
Rather, he expects that we’d like to not dislocate a shoulder while putting the groceries away, would like to not slip a disk while being greeted by the neighbor’s dog, and would like to not need a 7-step plan for putting our socks on.
What follows is a guide to “on the good end of normal” mobility that is sustainable for life. The idea is that you might not be winning Olympic gymnastics gold medals in your 90s, but you will be able to get in and out of a car door as comfortably as you did when you were 20, for example.
Bottom line: if you want to be a superathlete, then you might need something more than this book; if you want to be on the healthy end of average when it comes to mobility, and maintain that for the rest of your life, then this is the book for you.
Click here to check out How To Build A Body That Lasts, and build a body that lasts!
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Night School – by Dr. Richard Wiseman
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Sleep is a largely neglected part of health for most people. Compared to factors like food and exercise, it’s something that experientially we’re mostly not present for! Little wonder then that we also often feel like it’s outside of our control.
While Dr. Wiseman does cover the usual advices with regard to getting good sleep, this book has a lot more than that.
Assuming that they go beyond the above, resources about sleep can usually be divided into one of two categories:
- Hard science: lots about brainwaves, sleep phases, circadian rhythms, melatonin production, etc… But nothing very inspiring!
- Fantastical whimsy: lots about dreams, spiritualism, and not a scientific source to be found… Nothing very concrete!
This book does better.
We get the science and the wonder. When it comes to lucid dreaming, sleep-learning, sleep hypnosis, or a miraculously reduced need for sleep, everything comes with copious scientific sources or not at all. Dr. Wiseman is well-known in his field for brining scientific skepticism to paranormal claims, by the way—so it’s nice to read how he can do this without losing his sense of wonder. Think of him as the Carl Sagan of sleep, perhaps.
Style-wise, the book is pop-science and easy-reading. Unsurprising, for a professional public educator and science-popularizer.
Structurally, the main part of the book is divided into lessons. Each of these come with background science and principles first, then a problem that we might want to solve, then exercises to do, to get the thing we want. It’s at once a textbook and an instruction manual.
Bottom line: this is a very inspiring book with a lot of science. Whether you’re looking to measurably boost your working memory or heal trauma through dreams, this book has everything.
Click here to check out Night School and learn what your brain can do!
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Get Ahead (Healthwise) This Winter
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Tomorrow will be December the first.
A month later, it’ll be January the first, and very many people will be quite briefly making a concerted effort to get healthier.
So, let’s get a head start, so that we can hit January already in great health!
December’s traps to plan around
In North America at least, common calendar-specific health problems associated with December are:
- Infectious diseases (seasonal flu and similar unpleasantries)
- Inactivity (seasonal weather)
- Slower metabolism (seasonal eating and drinking, plus seasonal weather)
- Alcohol (seasonal drinking)
- Stress (seasonal burdens)
So, let’s plan around those!
But first, sleep
Nothing will go well if we are not well-rested. There are six dimensions of sleep, but the ones that matter the most are regularity and duration, so plan for those and the rest should fall into place:
Calculate (And Enjoy) The Perfect Night’s Sleep
Skip those viruses
If you’re doing the rest of what we advise, your immune system will probably be in good shape, unless you have some chronic disease that means you are immunocompromised, in which case the next things will be extra important:
- Avoid enclosed spaces with lots of people where possible
- Ventilation is your friend (as is air filtration)
- Masks don’t protect against everything, but they do protect against a lot
- Wash your hands more often than you think is necessary (invest in luxurious soap, to make it a more pleasant experience, then you’re more likely to do it often!)
- Breathe through your nose, not your mouth (nostril hairs attract floating particles by static charge, and then dispose of intruders via mucus)
See also: The Pathogens That Came In From The Cold
Plan your movement
But, realistically. Let’s face it, unless you already have such a habit, you’re not going to be hitting the gym at 6am every day, or be out pounding pavement.
The weather often makes us more reluctant to exercise, so if that sound like you, plan something low-key but sustainable that will set you in good stead ready for the new year. Here are two approaches; you can do both if you like, but picking at least one is a good idea:
- Commit to just a few minutes of high-intensity exercise each day. If you don’t have equipment, then bodyweight squats are a great option.
- Commit to gentle exercises each day—pick some stretches and mobility drills you like, and focus on getting supple for the new year.
See also: How To Keep On Keeping On, When Motivation Isn’t High ← this isn’t a motivational pep talk; it’s tricks and hacks to make life easier while still getting good results!
Fuel in the tank
It’s fine if you eat more in winter. We even evolved to put on a few pounds around this time of year. However, to avoid sabotaging your health, it’s good to do things mindfully. Pick one main dietary consideration to focus on, for example “anti-inflammatory” or “antidiabetic” or “nutrient-dense”.
Those focused ways of eating will, by the way, have a huge amount of overlap. But by picking one specific factor to focus on, it simplifies food choices at a time of year when supermarkets are deliberately overwhelming us with choices.
If you’re having a hard time picking just one thing to focus on, then we recommend:
What Matters Most For Your Heart?
About that festive spirit…
Alcohol consumption goes up around this time of year, partly for social reasons, partly for “it’s cold and the marketing says alcohol warms us up” reasons, and partly for stress-related reasons. We’re sure you know it sabotages your health, so choose your path:
How To Reduce Or Quit Alcohol, or
How To Reduce The Harm Of Festive Drinking (Without Abstaining)
Relax and unwind, often
There’s a lot going on in December: consumerism is running high, everyone wants to sell you something, finances can be stressful, social/familial obligations can be challenging sometimes too, and Seasonal Affective Disorder is at its worst.
Make sure to regularly take some time out to take care of yourself, and make sure you’re doing the things you want to do or really have to do, not just things you feel you’re expected to do.
Different people can have very different challenges at this time of year, so it’s hard to give a “one size fits all” solution here (and we don’t have the room to cover every possible thing today). You know your life best, so think what you’re most likely to want/need for you this month, and make sure you get it.
At the very least, most of us will benefit from taking a few minutes to consciously relax, and often, so something that is almost always a good idea for that is:
No-Frills, Evidence Based Mindfulness
…but if you’re feeling in a more playful mood, consider:
Meditation Games You’ll Actually Enjoy!
Take care!
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Creatine’s Brain Benefits Increase With Age
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Creatine is generally thought of as a body-building supplement, and for most young people, that’s all it is. But with extra years come extra advantages, and creatine starts to confer cognitive benefits. Dr. Brad Stanfield shares the science:
What the science says
Although 95% of creatine is stored in muscles, 5% is found in the brain, where it helps produce energy needed for brain processes (and that’s a lot of energy—about 20% of our body’s metabolic base rate is accounted for by our brain).
In this video, Dr. Stanfield shares studies showing creatine improving memory, especially in older adults—and also in vegetarians/vegans, since creatine is found in meat (just like in our own bodies, which are also made of meat) and not in plants. On the meta-analysis level, a systematic review concluded that creatine supplementation indeed improves memory, with stronger effects observed in older adults.
Dr. Stanfield also addresses the safety concerns about creatine, which, on balance, are not actually supported by the science (of course, always consult your own doctor to be sure, as your case could vary).
As for dosage, 5g/day is recommended. For more on all of this plus links to the studies cited, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Creatine: Very Different For Young & Old People
Take care!
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Uric Acid’s Extensive Health Impact (And How To Lower It)
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Uric Acid’s Extensive Health Impact (And How To Lower It)
This is Dr. David Perlmutter. He’s a medical doctor, and a Fellow of the American College of Nutrition. He’s a member of the Editorial Board for the Journal of Alzheimer’s Disease, and has been widely published in many other peer-reviewed journals.
What does he want us to know?
He wants us to know about the health risks of uric acid (not something popularly talked about so much!), and how to reduce it.
First: what is it? Uric acid is a substance we make in our own body. However, unlike most substances we make in our body, we have negligible use for it—it’s largely a waste product, usually excreted in urine.
However, if we get too much, it can build up (and crystallize), becoming such things as kidney stones, or causing painful inflammation if it shows up in the joints, as in gout.
More seriously (unpleasant as kidney stones and gout may be), this inflammation can have a knock-on effect triggering (or worsening) other inflammatory conditions, ranging from non-alcoholic fatty liver disease, to arthritis, to dementia, and even heart problems. See for example:
- David Perlmutter | Uric Acid and Cognitive Decline
- American Heart Association | Uric acid linked to later risk for irregular heart rhythm
- World Journal of Gastroenterology | The role of uric acid in non-alcoholic steatohepatitis development
How can we reduce our uric acid levels?
Uric acid is produced when we metabolize purine nucleotides, which are found in many kinds of food. We can therefore reduce our uric acid levels by reducing our purine intake, as well as things that mess up our liver’s ability to detoxify things. Offsetting the values for confounding variables (such as fiber content, or phytochemicals that mitigate the harm), the worst offenders include…
Liver-debilitating things:
- Alcohol (especially beer)
- High-fructose corn syrup (and other fructose-containing things that aren’t actual fruit)
- Other refined sugars
- Wheat / white flour products (this is why beer is worse than wine, for example; it’s a double-vector hit)
Purine-rich things:
- Red meats and game
- Organ meats
- Oily fish, and seafood (great for some things; not great for this)
Some beans and legumes are also high in purines, but much like real fruit has a neutral or positive effect on blood sugar health despite its fructose content, the beans and legumes that are high in purines, also contain phytochemicals that help lower uric acid levels, so have a beneficial effect.
Eggs (consumed in moderation) and tart cherries have a uric-acid lowering effect.
Water is important for all aspects of health, and doubly important for this.
Hydrate well!
Lifestyle matters beyond diet
The main key here is metabolic health, so Dr. Perlmutter advises the uncontroversial lifestyle choices of moderate exercise and good sleep, as well as (more critically) intermittent fasting. We wrote previously on other things that can benefit liver health:
…in this case, that means the liver gets a break to recuperate (something it’s very good at, but does need to get a chance to do), which means that while you’re not giving it something new to do, it can quickly catch up on any backlog, and then tackle any new things fresh, next time you start eating.
Want to know more about this from Dr. Perlmutter?
You might like his article:
An Integrated Plan for Lowering Uric Acid ← more than we had room for here; he also talks about extra things to include in your diet/supplementation regime for beneficial effects!
And/or his book:
…on which much of today’s main feature was based.
Take care!
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