Latest news with #DrLeanaWen
CNN
5 hours ago
- Health
- CNN
Black box warning on menopause hormone therapies should be removed, experts say
All menopause treatments containing the hormone estrogen are mandated by the US Food and Drug Administration to carry a black box warning on the label, stating that the treatments could increase the risk of strokes, blood clots, dementia and breast cancer. Now, that advisory may be going away. Last week, a panel of experts convened by the FDA urged the federal agency to remove the cautionary language on at least some forms of hormone therapy. I wanted to understand more about why these warnings were first added and the arguments for and against removing them now. What are hormone therapies used for, and what are the different forms of treatment? What is the history behind adding black box warnings, and why are some experts pushing to remove them? What should women know about managing menopause symptoms? I turned to CNN wellness expert Dr. Leana Wen to answer these questions. Wen is an emergency physician and adjunct associate professor at George Washington University. She previously was Baltimore's health commissioner. CNN: When does menopause occur, and what kinds of symptoms do women experience during menopause? Dr. Leana Wen: Menopause is the stage in a woman's life when her menstrual periods permanently stop. It marks the end of fertility and is accompanied by a decline in reproductive hormones such as estrogen and progesterone. In the US, most women begin the menopause transition between ages 45 and 55, and the average age is 52. The definition of menopause is a full year without having a period. Except in situations where menopause is induced by surgery (for example, removal of ovaries) or specific medical conditions, this period is generally preceded by a stage called perimenopause, when women may have irregular periods and start experiencing menopause symptoms. Symptoms associated with menopause can include hot flashes and night sweats. Hot flashes are sudden sensations of heat, skin flushing and sweating that can significantly disrupt daily activities. About one-third of women have more than 10 hot flashes per day. When they occur at night, they can disrupt sleep and increase fatigue and irritability during the day. Menopausal declines in estrogen also may cause vaginal dryness, decreased libido and discomfort during intercourse. Some women experience other symptoms such as mood changes, anxiety, difficulty concentrating, dry skin and weight gain. Moreover, while this is not a symptom of menopause per se, the risk of developing chronic conditions such as cardiovascular disease and osteoporosis increases significantly after menopause. This rise in risk is thought to be linked to the decline in estrogen levels, as estrogen has a protective effect on maintaining healthy blood vessels and supporting bone density. CNN: What are hormone therapies used for? What are the different forms of treatment? Wen: Hormone therapies are prescription drugs that are used to treat menopause symptoms. They replace the hormones that decline during menopause. It's important to differentiate between two types of hormone therapy. The first is systemic therapy in which hormones are given in a way that is absorbed into the bloodstream. That could be through taking pills or using patches, sprays or gels. Systemic therapy is used to treat symptoms that affect the entire body, such as flashes and night sweats. The second type is low-dose vaginal estrogen therapy. This is a cream or suppository administered into the vagina to treat vaginal dryness and reduce tissue thinning. Unlike systemic therapy, this type of therapy works locally; its purpose is not to raise hormone levels throughout the body. CNN: What is the history behind adding black box warnings, and why are some experts pushing to remove them? Wen: For decades, hormone therapy was considered the standard of care for menopause-related symptoms. Then, in the early 2000s, a landmark study called the Women's Health Initiative was published that suggested hormone therapy increased the risk of breast cancer, heart disease and stroke. It concluded that the benefits of this therapy did not outweigh these risks, leading to the FDA adding the black box warning in 2003. Many researchers have since examined the methodological problems of the study. One significant issue was that the average age of participants was 63. The women studied were mostly postmenopausal, so the question answered was regarding the risks and benefits to postmenopausal women, not menopausal women. Last year, scientists — including some of the original researchers of the Women's Health Initiative — published an updated analysis in the journal JAMA. They concluded that, in fact, hormone treatment with a combination of estrogen and progesterone is safe and effective for treating hot flashes and other systemic symptoms if started before age 60 or within 10 years of starting menopause and if the woman does not have specific contraindications — for instance, an estrogen-sensitive breast cancer. This updated analysis is one reason cited by many advocates to remove the warning. Another major reason is that the black box warning is currently on all types of hormone treatments, including vaginal therapies that deliver far lower doses and do not have the systemic effect of, say, an estrogen-containing pill. Advocates argue that putting all forms of hormone therapy under the same warning misrepresents risk and makes it harder for women to receive relief from troublesome symptoms. Women are still able to access the therapies despite the warning, but some may be more hesitant to use them after seeing the warnings. CNN: What are other arguments for and against this change? Wen: In his opening argument, FDA Commissioner Dr. Marty Makary remarked that systemic hormone therapy, when started within 10 years of the onset of menopause, can actually reduce cardiovascular disease. This finding is suggested by some recent studies, which also show a benefit for bone health. Not everyone agrees that hormone therapy should be taken for preventive purposes. There is also some controversy about process; specifically, the panelists who spoke at last week's FDA meeting were all selected by Makary and all favored hormone therapy. Some have said they would appreciate more balance by hearing from experts who have more nuanced views. In addition, there was no presentation by internal FDA scientists, who, in the past, have given their own analysis during these types of meetings. CNN: While the FDA is considering changing the warning label, what is your advice for women about managing menopause symptoms? Wen: The most important thing is that women who are experiencing significant symptoms during menopause don't need to suffer in silence. Effective treatments exist. Women should speak with their physicians about lifestyle measures that can help as well as hormonal and nonhormonal prescription therapies. They should also speak with their providers about preventive care to improve heart health and prevent bone loss. Those who want additional resources should look to the Menopause Society, which also has a searchable database of clinicians who are certified menopause practitioners and trained to guide women through this transition.
CNN
5 hours ago
- Health
- CNN
Black box warning on menopause hormone therapies should be removed, experts say
Women's health Federal agenciesFacebookTweetLink Follow All menopause treatments containing the hormone estrogen are mandated by the US Food and Drug Administration to carry a black box warning on the label, stating that the treatments could increase the risk of strokes, blood clots, dementia and breast cancer. Now, that advisory may be going away. Last week, a panel of experts convened by the FDA urged the federal agency to remove the cautionary language on at least some forms of hormone therapy. I wanted to understand more about why these warnings were first added and the arguments for and against removing them now. What are hormone therapies used for, and what are the different forms of treatment? What is the history behind adding black box warnings, and why are some experts pushing to remove them? What should women know about managing menopause symptoms? I turned to CNN wellness expert Dr. Leana Wen to answer these questions. Wen is an emergency physician and adjunct associate professor at George Washington University. She previously was Baltimore's health commissioner. CNN: When does menopause occur, and what kinds of symptoms do women experience during menopause? Dr. Leana Wen: Menopause is the stage in a woman's life when her menstrual periods permanently stop. It marks the end of fertility and is accompanied by a decline in reproductive hormones such as estrogen and progesterone. In the US, most women begin the menopause transition between ages 45 and 55, and the average age is 52. The definition of menopause is a full year without having a period. Except in situations where menopause is induced by surgery (for example, removal of ovaries) or specific medical conditions, this period is generally preceded by a stage called perimenopause, when women may have irregular periods and start experiencing menopause symptoms. Symptoms associated with menopause can include hot flashes and night sweats. Hot flashes are sudden sensations of heat, skin flushing and sweating that can significantly disrupt daily activities. About one-third of women have more than 10 hot flashes per day. When they occur at night, they can disrupt sleep and increase fatigue and irritability during the day. Menopausal declines in estrogen also may cause vaginal dryness, decreased libido and discomfort during intercourse. Some women experience other symptoms such as mood changes, anxiety, difficulty concentrating, dry skin and weight gain. Moreover, while this is not a symptom of menopause per se, the risk of developing chronic conditions such as cardiovascular disease and osteoporosis increases significantly after menopause. This rise in risk is thought to be linked to the decline in estrogen levels, as estrogen has a protective effect on maintaining healthy blood vessels and supporting bone density. CNN: What are hormone therapies used for? What are the different forms of treatment? Wen: Hormone therapies are prescription drugs that are used to treat menopause symptoms. They replace the hormones that decline during menopause. It's important to differentiate between two types of hormone therapy. The first is systemic therapy in which hormones are given in a way that is absorbed into the bloodstream. That could be through taking pills or using patches, sprays or gels. Systemic therapy is used to treat symptoms that affect the entire body, such as flashes and night sweats. The second type is low-dose vaginal estrogen therapy. This is a cream or suppository administered into the vagina to treat vaginal dryness and reduce tissue thinning. Unlike systemic therapy, this type of therapy works locally; its purpose is not to raise hormone levels throughout the body. CNN: What is the history behind adding black box warnings, and why are some experts pushing to remove them? Wen: For decades, hormone therapy was considered the standard of care for menopause-related symptoms. Then, in the early 2000s, a landmark study called the Women's Health Initiative was published that suggested hormone therapy increased the risk of breast cancer, heart disease and stroke. It concluded that the benefits of this therapy did not outweigh these risks, leading to the FDA adding the black box warning in 2003. Many researchers have since examined the methodological problems of the study. One significant issue was that the average age of participants was 63. The women studied were mostly postmenopausal, so the question answered was regarding the risks and benefits to postmenopausal women, not menopausal women. Last year, scientists — including some of the original researchers of the Women's Health Initiative — published an updated analysis in the journal JAMA. They concluded that, in fact, hormone treatment with a combination of estrogen and progesterone is safe and effective for treating hot flashes and other systemic symptoms if started before age 60 or within 10 years of starting menopause and if the woman does not have specific contraindications — for instance, an estrogen-sensitive breast cancer. This updated analysis is one reason cited by many advocates to remove the warning. Another major reason is that the black box warning is currently on all types of hormone treatments, including vaginal therapies that deliver far lower doses and do not have the systemic effect of, say, an estrogen-containing pill. Advocates argue that putting all forms of hormone therapy under the same warning misrepresents risk and makes it harder for women to receive relief from troublesome symptoms. Women are still able to access the therapies despite the warning, but some may be more hesitant to use them after seeing the warnings. CNN: What are other arguments for and against this change? Wen: In his opening argument, FDA Commissioner Dr. Marty Makary remarked that systemic hormone therapy, when started within 10 years of the onset of menopause, can actually reduce cardiovascular disease. This finding is suggested by some recent studies, which also show a benefit for bone health. Not everyone agrees that hormone therapy should be taken for preventive purposes. There is also some controversy about process; specifically, the panelists who spoke at last week's FDA meeting were all selected by Makary and all favored hormone therapy. Some have said they would appreciate more balance by hearing from experts who have more nuanced views. In addition, there was no presentation by internal FDA scientists, who, in the past, have given their own analysis during these types of meetings. CNN: While the FDA is considering changing the warning label, what is your advice for women about managing menopause symptoms? Wen: The most important thing is that women who are experiencing significant symptoms during menopause don't need to suffer in silence. Effective treatments exist. Women should speak with their physicians about lifestyle measures that can help as well as hormonal and nonhormonal prescription therapies. They should also speak with their providers about preventive care to improve heart health and prevent bone loss. Those who want additional resources should look to the Menopause Society, which also has a searchable database of clinicians who are certified menopause practitioners and trained to guide women through this transition.
CNN
6 days ago
- Health
- CNN
An Arizona resident has just died of the plague. What to know about this disease
FacebookTweetLinkA person died from pneumonic plague in Arizona last week, the first death from the disease in this region in nearly two decades. This death might bring to mind the bubonic plague, the form of the plague that killed millions during the Middle Ages. This latest case is not the same form, and treatments have certainly advanced since that time. That said, I wanted to know what pneumonic plague is, how it's spread and what its symptoms are. How is it diagnosed, and what treatments are available? What can people do to reduce the risk of contracting the disease? And how much should people be worried about plague? To help with these questions, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously was Baltimore's health commissioner. CNN: What is pneumonic plague? Dr. Leana Wen: Pneumonic plague is one of three types of plagues that are caused by the bacterium Yersinia pestis. The type of plague someone has is classified based on where the bacteria are concentrated. Bubonic plague infects lymph nodes. Septicemic plague is when the bacteria cause a whole-body infection through the bloodstream, and pneumonic plague affects the lungs. CNN: How does someone contract plague? Can it be spread from person to person? Wen: It depends on the type of plague. Bubonic plague is typically caused by the bite of an infected rodent flea. It can progress to septicemic plague, which can also arise as a result of handling infected animals such as rats and cats. Cats and other animals can contract the plague through eating rodents or through the bite of fleas. Pneumonic plague develops when the bacteria spread to the lungs in someone who started out with bubonic or septicemic plague. It can also occur when the bacteria are directly transmitted through airborne droplets — if someone inhales droplets containing the Yersinia bacteria that are coughed by an infected person or animal. This is the only form of the plague that can be spread from person to person. CNN: What are the symptoms of the three types of plague? Wen: People infected with all three forms develop common infectious symptoms including fever, headache, chills and weakness. Those with bubonic plague have one or more swollen and painful lymph nodes, also called buboes. In septicemic plague, the seeding of bacteria to other parts of the body can cause multi-organ failure and total body shock. Pneumonic plague is characterized by a rapidly progressing pneumonia with symptoms of shortness of breath, cough and chest pain. CNN: Is plague common? Wen: No. There are an average of seven human plague cases reported each year in the United States, according to the US Centers for Disease Control and Prevention. Over 80% of cases are bubonic plague. Most human cases have occurred in two regions: northern Arizona, northern New Mexico and southern Colorado; and California, southern Oregon and far western Nevada. Plague has also been reported in various parts of the world. According to the World Health Organization, most human cases since the 1990s have occurred on the African continent. The three countries where plague is the most endemic are the Democratic Republic of Congo, Madagascar and the South American country of Peru. CNN: How worried should people be about pneumonic plague, if it would be transmitted person to person? Wen: In Arizona, there was only one person diagnosed with pneumonic plague. There have not been reports of other infected individuals. Health experts there reiterate that the 'risk to the public of exposure to plague remains low.' CNN: How is plague diagnosed? Wen: Diagnosis is made through laboratory testing of blood, sputum and parts of a swollen lymph node. Because the disease progresses very quickly and effective antibiotic therapies exist, prompt recognition is crucial. In cases where there is a high level of suspicion, antibiotics are often started in advance of confirmatory testing. CNN: What treatments are available? Wen: The good news is that there are accessible and effective therapies. Several antibiotics are effective against Yersinia pestis. In the US, gentamicin and fluoroquinolones are first-line treatments. It's crucial that antibiotic therapies are promptly started. If left untreated, the case fatality rate can be as high as 30% to 100%. CNN: Is there a vaccine against plague? Wen: A vaccine against plague had been authorized for individuals at high risk of exposure, but this vaccine is no longer available in the United States, in part due to how rare this disease has become. Some potential vaccine candidates are under development. CNN: What can people do to reduce the risk of contracting the plague? Wen: Most Americans do not live in areas where plague can be found. For those in Western US states where plague has occurred, there are several actions they can take to reduce their potential exposure. First, avoid contact with wild animals. Do not handle wild rodents. Do not touch sick or dead animals. Second, because most cases are associated with rodents, people should prevent rodent infestation by storing pet food in rodent-proof containers and removing brush and trash around homes. Third, avoid fleabites. Wear long sleeves and use insect repellent containing DEET if you are hiking, camping or working outdoors. Keep fleas away from household pets by using veterinarian-approved flea control products. Fourth, keep pets out of areas known to be inhabited by wild rodents. Be on the outlook for illnesses in domestic animals, especially indoor-outdoor cats, and seek prompt veterinary care. All of this said, I think it's important to be reminded of how uncommon plague is. People who live in areas where plague has been found should take preventive measures, and clinicians should ask about travel history to these areas. Most Americans, though, do not need to be concerned about plague based on this single recent case in Arizona.
Yahoo
11-07-2025
- Health
- Yahoo
The diseases that could return as vaccination rates decline — and why you should care
Measles have surged to a record high, with more cases reported this year than any year since the disease was declared eliminated in the United States in 2000. This disappointing record comes amid falling childhood vaccination rates: Coverage against measles, mumps, rubella, chickenpox, polio and pertussis is declining in more than 30 states, according to data from the US Centers for Disease Control and Prevention. Some people may believe that if they're personally vaccinated, they have nothing to worry about. But is individual protection enough when contagious illnesses start multiplying? How will falling vaccination rates result in the return of previously eliminated diseases? Will only children be affected, or could adults see an impact as well? Who would be at highest risk if there is lower population-wide immunity? And what can be done to prevent this possibility? To get some answers, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously was Baltimore's health commissioner. CNN: Can falling vaccination rates result in the return of diseases that have been eliminated? Dr. Leana Wen: Yes. There are numerous examples around the world. Countries that were once polio-free have had polio outbreaks due to interruptions in childhood immunization programs caused by war and conflict. Measles outbreaks have occurred in countries where measles had been eliminated, due to falling vaccine coverage. This, in fact, is what we are seeing now in the US. In Texas, 753 measles cases have been confirmed since January. According to the Texas Department of State Health Services, 98 of these patients have been hospitalized, and two people, both children, have died. This outbreak is believed to have originated in communities with low vaccination rates. What could happen if childhood vaccination rates declined further? A recent study published in JAMA predicted that a 10% decline in measles-mumps-rubella (MMR) vaccine coverage could result in more than 11 million measles infections over 25 years. A 50% decline in routine childhood vaccinations could result in 51 million measles cases, 9.9 million rubella cases and 4.3 million polio cases. The projections also included the number of people affected by severe consequences of these diseases: As many as 10.3 million people in the US could be hospitalized, 159,200 could die, 5,400 could experience paralysis from polio, and 51,200 could have neurological consequences from measles. CNN: Is that only unvaccinated people? If someone is vaccinated, do they need to worry if others are unvaccinated? Wen: They should still worry for three main reasons. First, while many vaccinations provide excellent protection against disease, there is still a chance of breakthrough infections — meaning that the vaccine doesn't provide 100% protection. Two doses of the MMR vaccine are 97% protective against measles infection, which is an outstanding level of protection. But it's not 100%, so if someone is exposed to measles, there is still a chance they could become infected. However, vaccination substantially reduces the likelihood of infection and also of having severe disease if they were to become infected. The more disease there is in the community, the higher the likelihood of exposure and infection. Second, there may be some waning of vaccine effectiveness over time. For instance, according to the CDC, immunity to pertussis — also known as whooping cough — starts to wane after a few years following vaccination. Older adults who received childhood vaccinations many years ago may become susceptible if previously controlled childhood diseases make a comeback. Third, there are people who are unable to receive the benefit of vaccination directly themselves. Some people are unable to receive certain vaccines because of specific medical conditions. For instance, someone who has a weakened immune system may not be able to get the MMR vaccine because it contains a live, weakened form of the virus. Also, some people may have medical conditions that render vaccines less effective at protecting them. These individuals depend on the rest of society — those who can receive the vaccine — to do so and try to prevent these diseases from spreading. CNN: What about pregnant people? Are there also some vaccines they cannot get? Wen: This is another good point. Take rubella, or German measles. Pregnant individuals cannot receive the MMR vaccine because it contains live virus. But rubella can be especially dangerous during pregnancy. In addition to increasing the risk of miscarriage and stillbirth, rubella can lead to a condition called congenital rubella syndrome that can cause numerous birth defects including heart problems, brain damage, deafness, and lung, liver, eye and thyroid ailments. According to the World Health Organization, before the introduction of the vaccine, as many as 4 babies in every 1,000 live births were born with this condition. Rubella remains the leading cause of vaccine-preventable birth defects. Pregnant patients should not receive other live-attenuated vaccines either. Varicella, the vaccine against chickenpox, is another one of these vaccines. People should receive the vaccines before they are pregnant, ideally as part of their routine childhood immunizations. And other people can help to reduce disease in the community by getting vaccinated themselves. CNN: Who would be at highest risk if there is lower population-wide immunity? Wen: There are three groups I would be the most worried about. First are newborns who are too young to be vaccinated. They are also among the most medically fragile; something that is a mild cold for an older child or healthy adult could send them to the hospital. Second are immunocompromised people. This is a large group and includes patients receiving cancer treatments, transplant patients and individuals taking immunosuppressant medications. These individuals are more likely to become severely ill if exposed to disease. Vaccines may also not protect them as well, or they may be ineligible to receive certain vaccines as we discussed earlier. Third are the elderly. As we discussed many times in reference to Covid-19, these are individuals whose age and underlying medical conditions make them more susceptible to severe illness. That, in combination with possible waning immunity from certain vaccines, could put them at higher risk if there is more disease in the community because of lower vaccine coverage. CNN: What can be done to prevent this possibility? Wen: Everyone should speak with their primary care provider to verify that they are up to date on recommended vaccines. Parents with young children should do this with their family's pediatrician, and adults should also be sure to speak with their family physician or internist as well. The reason to do this is primarily to ensure that you are well-protected. If you are eligible for additional booster doses, you may consider getting them, or, if you are more susceptible to certain illnesses because you are not eligible for some vaccines, you should also know this and take precautions accordingly. There's another reason: The entire concept of population immunity depends on all of us doing our part to keep diseases at bay. That protects us — and others around us, including those who are especially vulnerable to severe illness and death.
CNN
04-07-2025
- Lifestyle
- CNN
American food trivia, four-day workweek, how much to exercise: Catch up on the day's stories
👋 Welcome to 5 Things PM! The Fourth of July is officially upon us, and no country knows how to celebrate its birthday quite like the US. Whether you're feasting on barbecue fixings, watching fireworks by the lake or taking a road trip, find out just how much — or little — your holiday weekend could cost. Here's what else you might have missed during your busy day. Switching to a four-day workweek can be good for the bottom line — and it isn't only workers who reap the benefits, according to the results of a new trial in the UK. Some organizations recorded an increase in revenue and fewer sick days compared with the same year-ago period. Mass evacuations are underway after an out-of-control wildfire in Crete — Greece's largest island and a popular tourist spot — broke out following high temperatures and strong winds. More than 200 firefighters, along with 46 vehicles and 10 helicopters, have been deployed to fight the blaze, according to officials. The US job market continues to strengthen despite heightened uncertainty following President Donald Trump's tariff policies. 147,000 jobs were added in June, and the unemployment rate fell to 4.1%. But this job growth is only within a few industries. Regular exercise has long been known to help reduce the risk of chronic diseases such as diabetes and heart disease — and a new study suggests working out could help people fighting cancer. CNN wellness expert Dr. Leana Wen explains what you need to know. The Fourth of July is a time to celebrate our country's diversity of people, perspectives and palettes — but how well do Americans know their food? Put your knowledge to the test by matching these 50 regional dishes with the US states that love them. Get '5 things' in your inbox If your day doesn't start until you're up to speed on the latest headlines, then let us introduce you to your new favorite morning fix. Sign up here for the '5 Things' newsletter.☕ A new 'third place': Starbucks is trying to win back customers looking to sit down for a cup of coffee by renovating select stores with comfy chairs, couches, tables and power outlets in the next year — a stark change from its grab-and-go concept. Will it work? Liverpool star Diogo Jota dies at 28 in car crash in Spain A tropical storm is brewing just in time to ruin July 4th weekend Congress passes Trump's sweeping domestic policy bill 🪖 That's how many troops North Korea may be sending to Russia in the coming months to bolster its front line with Ukraine, adding to the 11,000 deployed last November in a shroud of secrecy. 🏭 Finding surreal beauty: The same photographer who captured China's factories with seemingly inexhaustible human labor revisited the country 20 years later to an eerily different workplace: no people. 'Ultimately, I knew that I didn't want to say on my deathbed, 'I always wanted to move to France but didn't.'' Mary Jane Wilkie, an octogenarian expat 🥐 Oui can do it: George Gershwin's score is the only thing that's missing from this modern fairytale. After falling in love with Paris in her 20s, the American finally relocated to the French capital at the age of 79 — and has absolutely no regrets. 🍕 New York may have America's top pizza, but which city is at its heels, according to Italian judges?A. ChicagoB. NewarkC. Los AngelesD. New Orleans⬇️ Scroll down for the answer. 🌭 Relishing tradition: Champion eater Joey Chestnut will soon grace the Coney Island stage again at its annual Nathan's Famous Hot Dog Eating Contest. The quintessential American tradition is expected to attract thousands, as Chestnut works to break his world record of 76 hot dogs and buns in 10 minutes. 🧠 Quiz answer: C. Pizzeria Sei, the No. 2 pizzeria in the US, is run by William Joo in Los Angeles.📧 Check out all of CNN's newsletters. Today's edition of 5 Things PM was edited and produced by CNN's Kimberly Richardson and Chris Good.
