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Frequently Asked Questions.

What women would like men to do.

The off plan for outsmart female fat: inactivity.

Block the estrogen receptor for breast cancer prevention: raloxifene.

Menopause and hormone replacement therapy (hrt): possible side effects of progestogens used in hrt.

The menopause gateway: help is on the way.

Controlling our reproductive destiny: legal principles - t + 1.

Premenstrual syndrome: how to help yourself - diet.

Fwomens problems: when the egg is not fertilized.

Alexander procedures for pregnancy and labour: the monkey.

Getting pregnant: unexpected labor events.

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Presently, 10,000 women worldwide are enrolled in a raloxifene study designed to evaluate its role in preventing cardiovascular disease and breast cancer. At an open FDA meeting in November 1997, researchers presented interim data showing a stunning 77 percent decreased risk of breast cancer for women who have been on the drug only 18 months. Doctors inside the clinical trials report to us that the 30-month data are even better, approaching 90 percent. Dr. Brian Walsh of Harvard says that the final results will bring us to the cusp of an explosion in breast cancer prevention. What about side effects and risks?

Raloxifene does not increase the risk of cancer of the uterus even after 39 months of use. The reason is that raloxifene is a "selective" estrogen that blocks the effect of estrogen in the uterus as well as the breast yet has a positive effect on the heart and bones. The major risk of raloxifene is that of blood clots, but this risk is equivalent to what women who take hormone replacement therapy would expect.

You might well ask, if raloxifene is so good, why has tamoxifen generated all the excitement? When the National Cancer Institute began its trial, tamoxifen was the only estrogen receptor blocker available. Most researchers say that if the trials were begun today, a newer estrogen receptor blocker, in all likelihood raloxifene, would have been chosen. Gynecologists like NYU s Dr. Steven Goldstein are amazed at all the attention tamoxifen is getting, given that newer drugs are so superior. Who should take raloxifene? Postmenopausal women who are at high risk of breast cancer and for osteoporosis and who do not want to risk taking hormone replacement therapy should consider raloxifene and could start taking it today. They'll enjoy the FDA-approved benefit, prevention of osteoporosis, and an added secondary benefit, decreased risk of breast cancer. A University of California at San Francisco study has shown that it is safe in younger women, but the FDA cautions that raloxifene is not approved for use in younger women.

This is a terribly exciting time and we can expect to learn lots more about the use of these drugs. Until it's determined which drug is best for you, the safest bet is to stick with food-based estrogen blockers that have stood the test of time, unless you are at very high risk for breast cancer. In that case, you "should consider enrolling in a clinical study at a major cancer center.

One last question is, gee, if estrogen blocker drugs work so well, why bother with the diet? First, estrogen blocker drugs are too toxic for many women. Second, even for those women who do take them, they don't eliminate breast cancer risk. They intercept only a single point in the estrogen pathway. The recommendations in the rest of this book will allow you to intercept multiple critical points in the estrogen pathway to reduce your risk even further and to make the effect of estrogen blocker drugs far more powerful.

Recommendation

Include 35 to 60 grams of soy protein or 25 grams of flaxseed in your daily diet once you and your doctor agree on the appropriateness of the estrogen receptor blocker strategy for you. For women at very high risk, an estrogen blocker pill may be appropriate. You'll find more on these drugs in Part Three: "Breast Cancer Prevention Plans." Even for those women who take a breast cancer prevention pill, the features of this diet, found in the following chapters, add powerful synergistic effects.

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Women’s health