We have two courses scheduled for 2024

Cost: $675 (Canadian)

taught by Gloria Lemay

Jessica Austin, with a Doula client.

Jessica Austin, with a Doula client.

This course will give you the skills to assist women giving birth at home or in hospital. Doula services are in demand. There is a pre-reading requirement. Please email waterbirthinwoman@gmail.com for further information and to register for the course.

The course will be on Zoom and assignments and tests will be on Google Classroom.
12 Classes 2 and a half hours long. In 2024, this will be the next available course.

Course One: Wednesday evenings (Pacific Time)
Wednesday January 17 to April 3 7:00 p.m. to 9:30 p.m. (Pacific)

Course Two: Wednesday evenings (Pacific) September 4 to November 20 7:00 p.m. to 9:30 p.m. (Pacific)

Successful students will receive Wise Woman Way of Birth Doula Training certification.

Class 1: Introductions, birth “politics” and Language
Class 2: Preventing Problems before the Birth: Nutrition. Prenatal Screening
Class 3: Types of “support” in birth: Midwife, Dr, Obstetrician, Doula — what are the differences? Comparison of home and hospital choices. Assisting your client in making a clear Birth Plan for the chosen place of birth.
Class 4: Anatomy and fetal positions, introduce the concept of “pain” and normalizing birth sensations through knowing the anatomy. Introduction to the concept of breech and twins as variations of positions.
Class 5: Medical Birth Phases and the “real” phases of birth and how to recognize them.
Class 6: Breastfeeding and early days postpartum and newborn care / Doula Role in these.
Class 7: Common Interventions and the Intervention Cascade. (Fetal monitoring, ultrasound, epidurals, Caesarean, vacuum, forceps, etc.)
Class 8: Preventing Birth Derailment in common scenarios and special situations: Induction for Postdates, augmenting a “slow” birth, a diagnosis of Low or High Amniotic Fluid Levels, Meconium, premature release of the membranes, vaginal birth after cesarean (VBAC).
Class 9: “Informed Choice”: what it *really* means and how to use it as a tool for your client vs a tool for enabling the institutional model of birth, more work on creating a Birth Plan with a client
Class 10: Business Basics: Finances, record keeping, professional practices, client confidentiality, and effective advertising. Structuring a plan for working with clients from interview through to completion.
Class 11: Comfort Measures, supporting Long Births, Helpful things to say, Water Birth.
Class 12: Staying calm when the baby comes: what to do if things change quickly and the doula is the most knowledgeable person present.,
Write Exam. Goal setting for next steps, further Resources.

Postpartum Doula Certification(2024)


We have heard such positive feedback about our Postpartum Doula Certification Course. We have put together a great course that will launch participants into action in this career.

The Wise Woman Way of Birth Postpartum Doula Training will be taught primarily by Candice Johnson. Candice is the owner/operator of Cherish Childbirth in Vancouver, BC. She has built her business over the past 10 years and is the “go to” woman when families are having problems in the early days of parenting. She has a broad education in Massage, Breast Feeding, Childbirth Education and Infant Massage. Candice has trained many postpartum doulas and is active in the Vancouver birth community. She is the mother of two boys who were both born at home and breastfed into toddlerhood.
Website: https://www.cherishchildbirth.com/

6 live classes on Zoom, 2 and a half hours long.
Cost: $525 (Canadian)

Courses in 2024 dates:

Course 1: Saturday January 20th to February 24 10 a.m. to 12:30 p.m. (Pacific)

Course 2: Wednesday April 10 to May 15 7:00 p.m. to 9:30 p.m (Pacific)

Course 3: Saturday September 28 to November 2 10 a.m. to 12:30 p.m. (Pacific)

6 Classes Live on Zoom, assignments and materials on Google Classroom.

Course Description:
This course will prepare you to be with families in the months after welcoming a baby. It includes all the aspects of the “fourth trimester” from practical feeding skills, to understanding the postpartum person’s body and how to support the family as a whole.
Our societal structures provide little care for new families. Having a trained eye and calm presence in a home in the early days is invaluable. Postpartum Doula care is proven to improve breastfeeding success, family bonding, and postpartum dis-ease disorders. Postpartum Doulas are in high demand!
The course will be on Zoom and assignments and tests will be on Google class room.
Successful students will receive Wise Woman Way of Birth Postpartum Doula Training certification.
Please email if you need more information or to register. waterbirthinwoman@gmail.com

Class ONE – The Fourth Trimester and the Role of the Postpartum Doula

Class TWO – Postpartum Healing – Physiology, Nutrition and Traditional Practice

Class THREE – Business for Postpartum Doulas and your Post Birth Bag

Class FOUR – Breastfeeding

Class FIVE – Alternative Feeding Methods, Twins/triplets, Newborn Intensive Care Unit

Class SIX – Newborn Care (including diapering and baby wearing).

Introducing Candice Johnson, the course instructor: Quote:
I have been living and breathing all things birth since I was asked to attend my first birth over 15 years ago. I feel a deep innate knowing of the undisturbed birth process. As an extension of my birth work I organically began supporting breastfeeding. I enjoyed my time with families postpartum but until I had my own babies I didn’t fully understand the importance of supporting someone through the postpartum period. Suddenly what I had always known, respected, and held space for I experienced first hand. This sparked a passion for serving new families. I hope by sharing my knowledge of how to support the “fourth trimester” through doula education, much needed support can be brought to communities everywhere.
Candice Johnson, Birth and Postpartum Doula, Childbirth Educator, Breastfeeding Counsellor
— on Bowen Island, British Columbia.

Breastfeeding Benefits

This is a good checklist of all the benefits that breastfeeding provides and the
risk of using any kind of subtitutes. Thanks to the California Dept of Health for
creating the poster. Gloria

Vaccines and babies in NICU

Journal of the American Medical Association

JAMA Original Investigation | June 01, 2015
Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants FREE ONLINE FIRST
Stephen D. DeMeo, DO1; Sudha R. Raman, PhD2; Christoph P. Hornik, MD, MPH1,2; Catherine C. Wilson, DNP, NNP-BC, FNP-BC3; Reese Clark, MD4; P. Brian Smith, MD, MPH, MHS1,2
[+] Author Affiliations
JAMA Pediatr. Published online June 01, 2015. doi:10.1001/jamapediatrics.2015.0418

Importance Immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events, including fever and apnea or bradycardia, in the immediate postimmunization period. These adverse events present a diagnostic dilemma for physicians, leading to the potential for immunization delay and sepsis evaluations.

Objective To compare the incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death among immunized ELBW infants in the 3 days before and after immunization.

Design, Setting, and Participants In this multicenter retrospective cohort study, we studied 13 926 ELBW infants born at 28 weeks’ gestation or less who were discharged from January 1, 2007, through December 31, 2012, from 348 NICUs managed by the Pediatrix Medical Group.

Exposures At least one immunization between the ages of 53 and 110 days.

Main Outcomes and Measures Incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death.

Results Most of the 13 926 infants (91.2%) received 3 or more immunizations. The incidence of sepsis evaluations increased from 5.4 per 1000 patient-days in the preimmunization period to 19.3 per 1000 patient-days in the postimmunization period (adjusted rate ratio [ARR], 3.7; 95% CI, 3.2-4.4). The need for increased respiratory support increased from 6.6 per 1000 patient-days in the preimmunization period to 14.0 per 1000 patient-days in the postimmunization period (ARR, 2.1; 95% CI, 1.9-2.5), and intubation increased from 2.0 per 1000 patient-days to 3.6 per 1000 patient-days (ARR, 1.7; 95% CI, 1.3-2.2). The postimmunization incidence of adverse events was similar across immunization types, including combination vaccines when compared with single-dose vaccines. Infants who were born at 23 to 24 weeks’ gestation had a higher risk of sepsis evaluation and intubation after immunization. A prior history of sepsis was associated with higher risk of sepsis evaluation after immunization.

Conclusions and Relevance
All ELBW infants in the NICU had an increased incidence of sepsis evaluations and increased respiratory support and intubation after routine immunization. Our findings provide no evidence to suggest that physicians should not use combination vaccines in ELBW infants. Further studies are needed to determine whether timing or spacing of immunization administrations confers risk for
the developing adverse events and whether a prior history of sepsis confers risk for an altered immune response in ELBW infants. http://archpedi.jamanetwork.com/article.aspx?articleid=2300376&utm_source=silverchair+information+systems&utm_medium=email&utm_

Source: this blogpost http://www.jeffereyjaxen.com/

Cytotec (misoprostol) injuries or death? Medical records needed.

Hyper Stimulation of the Uterus cuts off Oxygen to fetus.

Hyper Stimulation of the Uterus cuts off Oxygen to fetus.

    From Jette Aaroe Clausen

I am engaged in the public discussion on induction of labor and misoprostol in Denmark. I and a colleague, Eva Rydahl, have addressed the Health committee in the Danish parliament. They have not banned cytotec but they have announced that they will do more monitoring of this and they issued a new circular making it mandatory for midwives and doctors to report side effects to off-label medication.

Eva and I strive to learn more about hyper stimulation and the way cytotec works. To do so we need patient records. We will of course treat them in confidence and not reveal any names. We will be grateful if we can be allowed to read any medical notes from patients (or their families) who have had adverse reactions to Cytotec (misoprostol). Fetal monitor tracings are especially useful to us. My colleague, Eva Rydahl (who is also on facebook), will also be happy to correspond with families. My e-mail address is jecl@phmetropol.dk I work at the Danish midwifery education in Copenhagen. I am an Assoc Prof of Midwifery and a researcher. Jette Aaroe Clausen, May 21, 2014

High Cesarean rates: all talk, no action

If we look at childbirth from the point of view of a game, the success or failure would be measured by the cesarean rate. When there is a 30% or higher rate of cesarean for first time mothers, there can be no excuse. . . those people playing the game are losing and losing badly. When there can be no denying that something is terribly wrong, what happens? The players get together and try to figure out what can be done to get a winning outcome. This has been done before by medical people with good results when action resulted. Unfortunately for women, it seems to be impossible to maintain positive results once the initial action plan is withdrawn. See my post.

There have been many statements, pledges, admonitions, expressions of concern, etc in the past 10 years about the impact on women’s health of all these major abdominal surgeries. See:
Cesareans Are Seriously Harming Women

Now we have a new statement put out by a team of people who are duly concerned in the USA. It mirrors other team reports. How many teams have to be gathered and how many over-educated people have to produce reports before a concerted program is instituted to stop the cesarean butchery of women in North America? We need action and we need it fast. Gloria Lemay, Feb. 12, 2014


Experts Identify Key to Reducing Cesarean Delivery Rate
News | February 05, 2014 | Pregnancy and Birth
By OBGYN.net Staff

Continued education on reducing unnecessary cesarean deliveries must include particular attention to preventing the first cesarean delivery, as well as tapping into the clinician’s ability to modify and mitigate factors that often contribute to the cesarean, leading experts suggested.

The article in which these suggestions are published is based on a workshop aimed at preventing first cesarean delivery.1 The workshop was a joint effort of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists.

“Given the risks associated with the initial cesarean and its implications in subsequent pregnancies, the most effective approach to reducing overall morbidities related to cesarean delivery is to avoid the first cesarean,” said George R. Saade, MD, of the division of maternal-fetal medicine, department of obstetrics and gynecology, University of Texas Medical Branch, Galveston and chair of the Society for Maternal-Fetal Medicine’s health policy committee. “The implications of a cesarean rate of 30% or more—since approximately 1 in 3 pregnancies are delivered by cesarean—have significant effects on the medical system as well as on the health of women and children. It is essential to embrace this concern and provide guidance on strategies to lower the primary cesarean rate.”

In 1995, the total rate of cesarean deliveries was 20.8%, and the rate of primary cesarean deliveries was 15.5%.2 The rise in the rate of cesarean delivery compared with these 1995 rates is due in part to an increase in the frequency of primary cesareans, the authors noted, but it is also because attempts at labor after cesarean have declined.

Workshop participants developed a set of guidelines for preventing first cesarean delivery. They included the appropriate ways to identify failed induction, arrest of labor progress, and non-reassuring fetal status. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed, as long as the maternal and fetal conditions permit, they noted. The experts also determined that the adequate time for each stage appears to be longer than traditionally thought.

Other key points included:

Accepting operative vaginal delivery as a birth method when indicated. Given its declining use, training and experience in operative vaginal delivery must be facilitated and encouraged.
Counseling pregnant women about the effect of cesarean delivery on future reproductive health.
If cesarean deliveries are conducted for non-medical indications, the gestational age should be at least 39 weeks and the cervix should be favorable, especially in the nulliparous patient.

The complete study is available here.

1. Spong CY, Berghella V, Wenstrom KD, et al. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists workshop. Accessed January 31, 2013. Available here.

2. Curtin SC, Kozak LJ. Cesarean delivery rates in 1995 continue to decline in the United States. Birth. 1997;24:194-196.

Source http://www.obgyn.net/news/experts-identify-key-reducing-cesarean-delivery-rate?cid=newsletter#sthash.UuS7x6rD.dpuf

Vitamin K

Routine procedures in neonatal care are questioned by parents and rightly so.  The first question is “does the benefit outweigh the risk?”  The next question is “is there really a problem?” and the third question is “Who is making a big money profit from this routine?”  Anytime we are giving a system-wide medication, there’s big money to be made.

A newborn baby has as much blood volume as can be contained in a soda pop can.  This is why the umbilical cord must be securely clamped after cutting because it wouldn’t take much to lose the whole blood supply.  It’s also a reason why many baby boys have died after circumcision–they can lose most of their blood volume into a diaper.  What are other ways that the baby can lose blood?  The most common is internal bleeding due to severe bruising.  When a baby is hauled out of the mother by forceps, vacuum extractor or through a cesarean (and, yes, many cesareans also involve forceps on the head or a vacuum extractor in addition to rough handling) the bruises on the baby can be so massive that  blood pools in those internal bruised areas and is not available for the function of vital organs. Giving the baby Vitamin K in order to boost the body’s ability to clot and stop that internal bleeding could be prudent.

What does this mean for the baby who is born without bruising and trauma?  It could mean that the baby is in even more danger of a medication error (giving the wrong drug, giving the drug in the wrong way, other human error) or sepsis from the skin protection being broken.  The preservatives in the Vitamin K could be causing harm as well.

gently born at home and kept intact

gently born at home and kept intact

Someone who has done some thinking and research about the Vitamin K subject is Michel Odent, a physician originally from France who now resides in Britain.

Michel Odent, M. D.

Question: What are the risks/benefits to letting your baby have a shot of vitamin K after birth?

Today there are many reasons to de-dramatize the topic and to reassure at the same time the parents who are inclined to refuse the shot and also those who prefer to do it.

To the parents who refuse the injection, we can say that they don’t take a great risk, since the chances of their breastfed baby having a hemorrhagic disease related to vitamin K deficiency is in the region of one in 15,000. It is even probable that the risks are still lower if the birth and the initiation of lactation were undisturbed. My view is that vitamin K deficiency of breastfed babies is probably no more physiological than the weight loss in newborn babies. After thousands of years of culturally controlled childbirth and lactation, we usually underestimate the amount of ‘colostral milk’, and therefore of vitamin K, a human baby has been programmed to consume during the first days following birth.

A well-constructed Japanese study showed that babies who consume 350 ml of breast milk in the first three days following birth are protected against vitamin K deficiency. Let us also remember that vitamin K deficiency is unheard of among formula fed babies.

Some parents who accepted the injection might feel guilty or anxious afterwards when hearing about two British studies suggesting that vitamin K injected at birth (not vitamin K given orally) is a risk factor for cancer in childhood. These parents must be reassured as well because the British findings have not been confirmed by other studies, particularly a huge authoritative Swedish study involving more than one million children. However one cannot hide the fact that the routine injection of 1 mg of vitamin K at birth is always associated with the injection of 10 mg propylene glycol and 5 mg phenol, the effects of which are unknown.

Source:  UPDATE ON DEC 30, 2013 The quoted material by Dr Odent was taken (by me) from a website called “Ways of Wise Woman” which has since been taken down. I’m happy that I was able to copy some of the information here before that happened. For more reading on the dangers of Vitamin K and links to the studies mentioned by Dr. Odent see this website http://legaljustice4john.com/jaundiceVitKshotNewborns.htm

UPDATE ON DEC 31, 2013. Dr. Odent has sent me this explanatory letter about the breastfeeding optimization which leads to Vitamin K natural coverage. Quote: “Since 1967 it is well accepted that breastfeeding is a ‘necessary factor’ in the pathogenesis of the hemorrhagic disease of the newborn (Sutherland JM, et al. Hemorrhagic disease of the newborn: Breastfeeding as a necessary factor in the pathogenesis. Am J Dis Child 1967; 113: 524-530).
My point of view is that that the vitamin K deficiency of breastfed babies is not more physiological than the weight loss of the newborn baby. In fact I wrote about the newborn weight loss in Mothering (Odent M. Newborn weight loss. Mothering. Winter 1989: 72-73). When a woman gave birth at home, in complete privacy, without feeling observed or guided (in conditions with make a ‘fetus ejection reflex’ possible), when the first contact between mother and baby in a very warm place has been undisturbed by distractions (such as somebody observing, guiding, talking or cutting the cord), and when mother and baby could maintain a quasi continuous day and night skin-to-skin contact during the first two days, one third of babies do not lose weight at all. In other words we usually underestimate the amount of colostral milk a human baby has been programmed to consume. All human cultural milieus routinely disturb the physiological processes. Most breastfed babies are not correctly breastfed.
These are important considerations when taking account a Japanese study which found that babies who consume 350 ml of breast milk during the first three days are protected against vitamin K deficiency (Motohara K, et al. Relationship of milk intake and vitamin K supplementation to vitamin K status in newborn. Pediatrics 1989; 84: 90-93). The Japanese researchers used a biological marker in order to detect vitamin K deficiencies without clinical expression. I summarized my point of view in the summer 1997 of the Primal Health Research newsletter (vol 5. no1).
In conclusion the vitamin K deficiency of breastfed babies might be an effect of culturally controlled childbirth and lactation. All societies have disturbed the physiological processes and particularly the first hour following birth via beliefs (e.g. the colostrum is harmful) or rituals. For that reason we have not known for a long time that the human baby is as if programmed to find the breast during the hour following birth. When I said that 25 years ago obstetricians and pediatricians could not believe me (Odent M. The early expression of the rooting reflex. Proceedings of the 5th International Congress of Psychosomatic Obstetrics and Gynecology, Rome 1977. London: Academic Press 1977: 1117-19). Today we must readjust all our observations and interpretations by taking account the usual deviations from the physiological model.

Warmest regards
Michel Odent” end of quote

The reference for the large Japanese study mentioned by Dr. Odent is:
Motohara K, et al. Relationship of milk intake and vitamin K supplementation to vitamin K status in newborn. Pediatrics 1989; 84:

Added April 2015: Pharmaceutical information on Vitamin K with precautions http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20%28General%20Monographs-%20V%29/VITAMIN%20K.html

Birthing the Placenta in the early days of Canada

I’m a little hesitant to post the following because of the undertones of colonial disdain but I’m going to go ahead because this is the source of my conviction about the 30 Minute Third Stage. If this story can be used as a cautionary tale for midwives and physicians, I think it’s important to share it. Please read it with a sympathetic view to the time and place.

From CBC Radio “Ideas” program “Doctoring the Family
By David Cayley and Jutta Mason

(beginning of excerpt) David Cayley (announcer): It is clear that pre-medical birth cultures, both Native and non-Native, had many resources to deal with difficulties, but the picture is naturally not without its shadows and isolated cases of shocking cases of incompetence are easy enough to find. Rita Dobois, for example, recalls that although native midwives were usually very cautious about manual extraction of the placenta, she did encounter one very striking exception.

Rita Dobois: The placenta, they didn’t like to pull on it. Now, there was another case here in Manitoba that one of my friends went to and they did a terrible job there. Now, that midwife was known in the community as not being a very good midwife, and she did a delivery on a young woman, a woman who was about 19-20 years old and it was her first baby, and the placenta did not come away fast enough for her liking, and she went in after the placenta. It was very strange, I was quite surprised that she apparently took the placenta and whatever she got and put it into a cloth and put it on the lady’s abdomen and sent the patient in to Norway House, to the doctor, because she was still bleeding. When the doctor opened the cloth, he almost died of shock because there was the uterus, the cervix, the bladder and part of the bowel. She had taken everything out. She had yanked it all out—everything. And that was something that we could not understand, because we had never seen this happen.

So, this nurse said that she was sent in there for the next period. It was freeze up in the fall. She said there were two babies delivered and this midwife insisted that she do the delivery. So she thought well, I’m going to be there, I’m going to see this thing. And so she was there for the delivery and she said it was really an amazing thing because she had never heard a midwife or seen a midwife do this. As soon as the baby was born, I mean just as fast as a wink, her hand was going in to pull out the placenta because the woman was going to die if the placenta wasn’t out. And at one point, the nurse said to her, if you don’t take your hands away from there I’m going to hit you over the head right now and knock you out, because you’re going to kill this lady. And this woman got really upset because she thought that what she was doing was really the right thing to do. And so they got a clock and they sat there and watched the clock. And this nurse kept saying to her, take your hands away, it’s not 30 minutes yet, it’s not 30 minutes. And so finally in 30 minutes, the placenta separated and delivered by itself, and this woman was absolutely amazed.

So, when the nurse asked around the community, you know, how much experience this woman had, they said not a lot, but they thought that she wasn’t that bad. So then when they had the second delivery, Lenore said to this woman, well, you’re going to do the delivery, but there’s the clock and I’m telling you, if you touch that woman before 30 minutes I’m going to really sock you a good one. And so she said the woman just sat there and waited and watched the clock and watched the nurse for fear that she was going to get a clobbering. And in 30 minutes, the placenta separated and came away nicely, and this woman was amazed. She said, you’ve got magical powers. She said no, but she said I bought this clock and it’s yours, and you watch it. And she said, the next time there’s a delivery, even if I’m not here, you expect me to clobber you if you touch her before 30 minutes. And this woman was really amazed, she just couldn’t believe that 30 minutes was like a magic number. Because to her, as soon as the feet were out, you had to go in there and pull out the placenta, right away, quick. . . There was this terrible fear of losing the patient to hemorrhage. We’ve never seen that anywhere else. (end of excerpt)

Related link: 30 Minute Third Stage

Hormone Replacement Therapy? just say “no”

Many parents are appalled at the number of vaccines that are recommended by the medical/pharmaceutical industry for little children.

The number of drugs and hormones that are given to women during the birth process are alarming to those who understand the health costs of interference in a normal, healthy bodily process.

Through the years, we’ve learned that birth control pills have been a giant human experiment gone wrong. Who is accountable when things that are foisted on the general population without careful scrutiny are, later, shown to be massively harmful while also being massive money-makers for a very few?

Even at the end of life, there’s a profit to be made by “correcting” what is perceived to be the problems of the maturing female. Millions of women have been prescribed hormones to prevent problems that could have been far better managed with good lifestyle advice (yes, diet and exercise). If you can read between the lines of this notice just sent out to gynecologists, you will see that there are women all over North America who are insane, incontinent, have heart attacks, and cancer from the hormones which doctors recommended to them. Careful research was not done before this mass selling job that physicians did on behalf of the pharmaceutical companies. Perhaps it will be a warning to some that there is no one out there in government or industry that is watching out for your health and the health of your family. YOU are the only one who can do that. Read it and weep.

More on HRT: Draft Recommendations Released
By Jamie Habib | June 15, 2012
The U.S. Preventive Services Task Force (USPSTF) has issued draft recommendations for
postmenopausal hormone therapy for the primary prevention of chronic conditions, such as heart
disease, stroke, dementia, hip fracture, and breast cancer.1 These recommendations were based on findings from a new study of 9 randomized, placebo-controlled trials conducted since 2002 that
retrospectively analyzed the role of hormone therapy for the prevention of chronic conditions.2
Most of the data used in the analysis came from the Women’s Health Initiative study.3

Combined estrogen and progestin is not recommended for the prevention of chronic
conditions in postmenopausal women aged 50 years and older, according to the USPSTF.1 In
addition, the use of estrogen alone for the prevention of chronic conditions in postmenopausal
women who have had a hysterectomy is not recommended. These draft recommendations are for
the average-risk population. After menopause, the average life expectancy for women is 30 years.
During this time, a woman’s estimated risk for a chronic condition developing is 30% for
coronary heart disease, 22% for dementia, 21% for stroke, 15% for hip fracture, and 11% for
breast cancer.1
The use of combined estrogen and progestin decreases the risk of fracture in
postmenopausal women (46 fractures prevented for every 10,000 person-years), but the net
benefit does not outweigh the increased risk of stroke, invasive breast cancer, dementia,
gallbladder disease, deep vein thrombosis, and pulmonary embolism that are associated with
combination hormone replacement therapy (HRT).2 Use of estrogen alone also is associated with
a decreased risk of fracture in postmenopausal women (56 fractures prevented for every 10,000
person-years).2 However, HRT with estrogen alone can increase the risk of stroke, deep vein
thrombosis, and gallbladder disease. Both types of HRTs have been associated with an increase
in urinary incontinence in previously asymptomatic women after 1 year; however, this finding
was based on data gathered through a self-administered questionnaire and needs further study.

These draft recommendations come on the heels of another re-analysis of the WHI, which
found that there are some modest benefits to HRT but that its use should be limited to specific
patient populations.4
Pertinent Points:
– Estrogen with progestin and estrogen alone decrease risk of fractures but increases risk of
stroke, thromboembolic events, gallbladder disease, and urinary incontinence.
– Estrogen plus progestin increases risk of breast cancer and probable dementia.
– Estrogen alone decreases risk of breast cancer.

Protect your mother and grandmother

References 1. U.S. Preventive Services Task Force. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement (Draft). Available at: http://www.uspreventiveservicestaskforce.org/draftrec.htm. Accessed June 7, 2012. 2. Nelson HD, Walker M, Zakher B, Mitchell J. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the U.S. Preventive Services Task Force Recommendations. Ann Intern Med. May 28, 2012. [Epub ahead of print.] 3. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321-333. 4. Special edition on Women’s Health Initiative and HRT. Climacteric. 2012;15:205-293. Source http://hcp.obgyn.net/menopause/content/article/1760982/2083455

Related post on this site: http://www.glorialemay.com/blog/?p=176