Ladies’ Home Journal

HOW MUCH DO YOU KNOW ABOUT WOMEN’S HEALTH RISKS?

By Michael Castleman

Based on the glare of recent media coverage, a woman might think she's at considerable risk for such conditions as mad cow disease, meningitis, or West Nile fever. Actually, the typical woman aged 35 to 45 is at remarkably LOW risk for these conditions and many others that grab headlines.

Unfortunately, many women are unsure about the real health risks they face. It's important to understand these risks. The knowledge provides perspective and encourages preventive efforts through healthy lifestyle choices. The time to commit to a healthy lifestyle is now, when you're still in your prime, and healthy living can add years to your life and life to your years.

How much do you know about the health risks you face? Ladies Home Journal worked closely with top experts at the National Institutes of Health (NIH) to develop this quiz. (All questions refer to U.S. women.)

Answers appear after the questions.

1. What is the leading cause of death for women of all ages?
(a) breast cancer (b) ovarian cancer (c) lung cancer (d) endometrial cancer
(e) heart disease (f) stroke

2. Which cancer kills the most women?
(a) breast cancer (b) ovarian cancer (c) lung cancer (d) endometrial cancer (e) colon cancer

3. What are the top three causes of death for women ages 25 to 45?
(a) cancer, suicide, and HIV infection (b) cancer, accidents, and heart
disease (c) heart disease, accidents, and liver disease (d) cancer, heart
disease, and suicide

4. Which cancer kills the most women from age 35 to 45?
(a) breast cancer (b) ovarian cancer (c) lung cancer (d) colorectal cancer (e) colon cancer.

5. Among the many risk factors for breast cancer, which is/are most important?
(a) age (b) a family history of the disease in one's mother or
sister (c) childlessness or a first birth after age 30 (d) being overweight (e) more than 2 alcoholic drinks a day (e) a,b,c (f) c,d,e.

6. Women diagnosed with breast cancer are at increased risk for which other
cancer?
(a) endometrial (uterine) cancer (b) cervical cancer (c) ovarian cancer (d)
vaginal cancer

7. Of the following, which does NOT help prevent heart disease?
(a) controlling blood pressure (b) controlling cholesterol (c) quitting smoking (d) regular exercise (e) getting eight hours of sleep a night (f) eating lots of fruits and vegetables (g) eating salmon

8. When adult women suffer chronic physical disabilities, which two conditions are the most likely causes?
(a) asthma and alcoholism (b) depression and arthritis (c) arthritis and low-back pain (d) diabetes and thyroid problems

9. To reduce risk of all major cancers, how many servings of fruits and
vegetables should women consume each day?
(a) 3 (b) 4 (c) 5 (d) at least 5, preferably 8 or 9

10. For general health benefits--cholesterol control, sound sleep, mood
elevation, diabetes prevention, mental sharpness, and feelings of vitality--how much exercise is sufficient?
(a) moderate physical activity (brisk walking, cycling, swimming) for at least 30 minutes daily (b) moderate physical activity (brisk walking, cycling, swimming) for 60 minutes daily (c) two 60-minute aerobics classes per week (d) three 60-minute aerobics
classes per week.

11. Approximately what proportion of women experience clinical depression at least once in their lives?
(a) 10 percent (b) 15 percent (c) 20 percent (d) 25 percent

12. Which of the following is NOT a risk factor for diabetes?
(a) being 20 percent heavier than your recommended weight (b) a physically inactive lifestyle (c) consuming more than 4 alcoholic beverages a week (d) Being African-American, American Indian, or Hispanic (e) having one or more family members with the disease (f) having had gestational diabetes while pregnant (g) giving birth to a baby weighing more than nine pounds.

13. To prevent osteoporosis, how much calcium should a woman consume each day?
(a) 500 mg (b) 500 to 750 mg (c) 750 to 1,000 mg (d) 1,000 to 1,500 mg (e)1,500-2,000 mg

14. Compared with men, what is women's risk of death from an asthma attack?
(a) less risk of death (b) about the same risk (c) a little greater risk (d)
considerably greater risk.

15. If you have ever had a migraine, when are you most likely to experience another?
(a) after a high-fat meal (b) around the time of your menstrual period (c)
after strenuous exercise (d) when you are sleep-deprived

16. Women are two to three times more likely than men to suffer gallstones. Risk of gallstones is most closely related to
(a) heartburn (b) alcohol consumption (c) being overweight (d) emotional stress.

17. Risk of fibroids is most closely related to a woman's
(a) estrogen level (b) number of abnormal Pap tests (c) number of
pregnancies (d) use of an IUD

18. Compared with single, divorced, and widowed women, married women are:
(a) healthier and happier (b) about as healthy and happy (c) less healthy and happy (d) happier but less healthy

19. After a bad day when you're feeling frazzled and stressed, which of the following is the best way to calm down?
(a) venting your anger and frustration venting creates additional stress. (b) moderate or vigorous exercise (aerobics, yoga, brisk walking, sex) (c) Valium (d) a cocktail. (e) antidepressant medication

20. Which of the following is NOT a good way to fight germs?
(a) diluted bleech (b) soap and water (c) antibacterial cleaning products (d) cranberry juice (e) footwear in gym locker rooms

Answers:

1. e

If you answered (a) breast cancer, you're not alone. Many women feel most
threatened by breast cancer. But heart disease kills nine times as many
women--371,000 each year compared with 40,000 deaths annually from breast
cancer. Heart disease is rare in women until after menopause, but then it
hits hard. In fact, heart disease kills more women each year than all cancers
combined (260,000).

The good news is that since 1980, the heart-disease death rate has declined considerably--but more for men (28 percent) than for women (12 percent). "The reason," says Lawrence Freidman, M.D., a special assistant to the director of the NIH's National Heart Lung and Blood Institute (NHLBI), "has to do with a combination of preventive efforts and treatment advances. On the prevention side, smoking has declined (since 1985, about 6 percent in both men and women.) And some people have committed to a healthy lifestyle--regular exercise and low-fat diet. On the treatment side, our national efforts to detect and treat high cholesterol and high blood pressure are paying off, and we've seen good results from thrombolytic [clot-busting] treatment administered within an hour of so of a suspected heart attack. There's room for improvement, of course--many more people need to exercise more and lose weight. But the decline in heart-disease deaths shows that we've taken steps in the right direction."

Unfortunately, this good news is mixed with some bad: Compared with men,
women who suffer heart attacks are more like to die from them. Within one
year of a heart attack, 25 percent of men die. The figure for women is 38
percent. In addition, within six years of a heart attack, 18 percent of men
have another. The figure for women is 35 percent. Part of the reason for
these gender differences is that compared with men, women tend to have heart attacks 10 to 15 years later in life, when they are older and more frail, Dr. Friedman explains.

In addition, Maryanne Legato, M.D., a professor of clinical medicine at Columbia University and founder and director of the Partnership for Women's Health, cites three other reasons--gender prejudice, and the fact that women's symptoms of heart disease are often different than men's, and the fact that women don't appreciate their risk.

"Too many doctors still consider heart disease a man's disease," Dr. Legato explains. "They should know better, but they're uninformed. I was involved in a survey of 1000 women. Eighty-six percent said they had regular checkups but more than half said their doctor had never discussed their risk for heart disease with them. And once women develop heart disease, they are treated less aggressively than men."

"There is no question that women with chest pain are treated less aggressively than men," says Patrice Desvigne-Nickens, MD, director of cardiovascular medicine at NHLBI.

About 80 percent of women with heart disease exhibit the classic symptom, chest pain. "but 20 percent of women don't," Dr. Legato explains. "One woman in five experiences a heart attack as uppder abdominal pain, not chest pain, with profuse sweating and shortness of breath. In emergency rooms, instead of appropriate treatment, they often get an antacid for their abdominal pain and valium for hyperventillation. I know of cases where women whose heart attacks were misdiagnosed in this manner left the emergency room with antacids and valium--and dropped dead in the hospital parking lot."

Even if women experience chest pain, Dr. Desvigne-Nickens explains. "it may not be the crushing chest pain men typically experience. Women are more likely to feel intermittent chest pain that's fairly tolerable. The result is that women are less likely to seek medical care for heart disease, and less likely to be treated within a few hours of a heart attack, when treatment is most likely to be life-saving."

Fortunately, Dr. Desvigne-Nickens says, physicians are becoming more
sensitive to the full range of possible signs of heart disease in women.

"It's equally important for women to understand these symptoms and their risk in general," dr. Legato says. "most women don't realize that they're at greater risk for heart disease than breast cancer. In our survey, 58 percent of the women said they were most likely to die of breast cancer, which is a major overestimate of risk. Meanwhile, 44 percent said that they were not likely to have a heart attack. Wrong again. Heart disease is the leading killer of women."

Dr. Desvigne-Nickens urges women to become sensitive to possible signs of heart attack, especially those who are at high risk. If you smoke, have a family history, are overweight, or have diabetes, high blood pressure, or high cholesterol--and you experience any persistent chest or upper abdominal discomfort or unusual shortness of breath, see your doctor promptly.

Fortunately, Dr. lLgato says, 80 percent of heart disease can be prevented. To prevent it, Dr. Friedman advises, Don't wait until menopause raises your risk. Start making heart-healthy lifestyle changes now. If you smoke, quit. Get more exercise. Reduce the fat in your diet by eating more fruits and vegetables. Maintain your recommended weight. Manage your stress. Get your cholesterol and blood pressure checked regularly, and treated if necessary. Also get your blood sugar checked. High blood sugar can be diabetes, which raises heart disease risk substantially.


2. c

Advertising for a certain cigarette pitched at women once said: "You've come a long way, baby." Women smokers have, indeed, come a long way--toward the grave. Breast cancer may be the cancer women fear most. But lung cancer kills 68 percent more women: 67,000 a year vs. 40,000. The cause of most lung cancer, smoking, has actually declined among women--about 6 percent since 1985. But about 20 percent of women continue to smoke, and among ex-smokers, lung cancer risk remains high for many years. "Most smokers have tried to quit, and failed," says medical onclogist Worta McCaskill-Stevens, M.D., a program director in the division of cancer prevention at the NIH's National Cancer Institute (NCI). "Past failures don't mean you can't do it. Talk with your doctor. We have more ways to help people quit smoking than ever. And, of course, if you don't smoke, don't start."


3. b

In premenopausal adult women, cancer is the leading cause of death. To reduce your risk, Dr. McCaskill-Stevens advises women to: Quit smoking. Eat a low-fat diet. Eat more fruits and vegetables. Get regular exercise. Maintain recommended weight. And limit alcohol consumption to no more than one drink a day, preferably fewer. In addition, to detect cancer early when it's most treatable, she urges women to: Perform breast self-exam monthly, have a Pap test and a professional breast exam annually, and have an annual mammogram after age 40, and regular colon cancer screening after age 50.

For women 25 to 45, accidents are the second leading cause of death. Motor vehicle accidents account for two-thirds of all accidental deaths. “We don't call them ‘accidents,’” explains Michael Goodman, Ph.D., chief of driver behavior research at the National Highway Traffic Safety Administration (NHTSA). “Crashes are not acts of God. Our studies show that up to 90 percent of motor vehicle crashes are the result of human error, usually distraction. Any moment of inattention increases risk of a crash: conversation, eating, using a cell phone, rolling down the window, changing the radio station--anything. The message is: Minimize distractions. Keep your eyes on the road.” In addition, Dr. Goodman advises: Always use seat belts. Maintain your vehicles properly, especially tires and brakes. And never drink and drive.

“Beyond the admonition not to drink and drive, don't drink and do ANYTHING," Dr. Goodman warns. Don't swim, ride a bike, go boating, or take walks while intoxicated. Studies by the NHTSA show that about one-third of pedestrians killed by motor vehicles were intoxicated. A recent study by Johns Hopkins University researchers shows that compared with sober bike riders, intoxicated bicyclists are almost six times more likely to be involved in a fatal accident. Other research shows that alcohol is a significant risk factor for every type of accidental injury.

Even though women suffer most of their heart attacks after menopause, those with several risk factors (a family history, smoking, overweight, high blood pressure, high cholesterol, and sedentary lifestyle) may fall victim to heart disease earlier in life. If you have any risk factor for heart disease, it's especially important to adopt the healthy lifestyle suggestions mentioned in the answer to Question #1.


4. a

There's a very good reason why women aged 35 to 45 fear breast cancer more than they fear lung cancer or heart disease. They're more likely to know a contemporary who has died of it. Heart disease and lung cancer tend to strike women after menopause. But breast cancer often develops earlier. In fact, breast cancer is the leading cause of women's cancer deaths from age 20 to 59, killing some 13,500 women a year. But as tragic as those deaths are, the numbers are small compared with the total number of breast cancer deaths, and very small compared with the total number of women killed by heart disease and lung cancer. For women of all ages, heart disease kills 371,000 a year, lung cancer 67,000, and breast cancer, 40,000. Breast cancer is the leading cancer cause of death among women 35 to 45, but the disease kills fewer than 10,000 women in this age group annually. Every one of these deaths is tragic, of course. But don't let fear of breast cancer blind you to your risk of heart disease and lung cancer, or your commitment to preventing them.

All women should do what they can to prevent breast cancer and detect it early when it's most treatable. In addition to the general cancer-prevention guidelines mentioned in the answer to Question 3, some studies have suggested that eating soy foods (tofu) and breast-feeding babies help prevent breast cancer. "The evidence in favor of these approaches is not very strong," Dr. McCaskill-Stevens says, "but there's certainly no reason not to eat soy foods, and breast-feeding is best for babies anyway."


5. e, that is a,b,c: (a) age (b) a family history of the disease in one's mother or sister, and (c) childlessness or a first birth after age 30

Age is very significant. "Many people forget that most breast cancer occurs in women over 50, and that risk increases steadily with age," Dr. McCaskill-Stevens explains.

Family history and childlessness or childbearing after 30 are also key risk factors. "Having a mother or sister with breast cancer approximately doubles your risk," says Louise Brinton, Ph.D., chief of the environmental epidemiology branch at the NCI. "But many women don't know that childlessness or having a first child after age 30 raises risk almost as much.

The other answers to this question also raise breast-cancer risk but not as much.


6. c

The same genetic mutations--BRCA1 on chromosome 17 and BRCA2 on chromosome 13--increase risk for both breast and ovarian cancer. As a result, women with these mutations who develop one of these cancers are at increased risk for the other. A woman can develop breast or ovarian cancer and not carry these mutations. But in families where several women develop either disease, University of Pennsylvania researchers estimate that about half the women who carry these mutations and are at increased risk for the other disease. Japanese researchers have found that women with a history of breast cancer have more than twice the general population's risk of ovarian cancer.

"A small group of women have many family members with breast or ovarian cancer, indicating a genetic predisposition," Dr. McCaskill-Stevens explains, "They should have the CA-125 blood test for that may be able to hint at early ovarian cancer." But this test is not a good screening test for the general population becuase many other conditions raise CA-125 level, among them: ovulation, endometriosis, and fibroids. For breast cancer survivors who don't have a strong genetic component--and for women in general--the best approach to ovarian cancer is early detection through an annual pelvic exam."

Women should also be aware of the symptoms of ovarian cancer, notably: feeeling full after eating a small amount, bloating, constipation, and abdominal pain.

In addition, some studies suggest the ovarian cancer risk can be reduced by: eating more fruits and vegetables, eating less meat, and taking birth control pills. "A diet high in fruits and vegetables is protective not just for ovarian cancer, but for all cancers and many other illnesses," says Daniela Seminara, Ph.D., a program director for the genetic epidemiology program at the NCI. "As for birth control pills, some studies suggest a protective effect, but we need more research before we'll really know."


7. e

"There are many good reasons to get eight hours of sleep a night," Dr. Friedman says, "but heart-disease prevention is not one of them." All the other answers have been shown to help prevent heart disease.

In addition, some studies have suggested that taking hormone replacement therapy after menopause reduces heart-disease risk, but Dr. Friedman explains that recent studies have not shown this. "There's no question that hormone replacement helps treat hot flashes. But in my opinion, it's premature to recommend it for prevention of heart disease." Some studies have suggested that one alcoholic drink a day, especially red wine, helps prevent heart disease. But Dr. Friedman doesn't recommend it: "Alcohol causes so much harm that I think it's irresponsible for public health officials to recommend it for heart-disease prevention. There are plenty of good ways to prevent heart disease without drinking."


8. c

According to the federal Centers for Disease Control and Prevention, 22 percent of women complain of joint pain, and 17 percent report back problems. The most common form of arthritis is osteoarthritis, also known as degenerative joint disease. It usually results from decades of wear and tear on the joints, but may also be caused by joint injury. Joints are lined with cartilage, the tough, flexible, shock-absorbing material that keeps the bones from grinding into one another. In osteoarthritis, cartilage breaks down, and the bones develop little outgrowths (spurs). If you’re a woman with osteoarthritis in your fingers, you may also develop bony bulges in the joint nearest your nails (Heberden nodes).

"Osteoarthritis used to be considered inevitable with aging--but not any more," explains Gregory Dennis, M.D., director of clinical care and training at the NIH's National Institute of Arthritis and Muskuloskeletal and Skin Diseases. "Now we know that weight control and regular, moderate exercise helps prevent it, particularly exercise that moves the major joints through their full range of motion, for example, walking, swimming, gardening, and yoga."

Recent studies also show that in those with early osteoarthritis, supplementation with glucosamine and chondroitin can help prevent progression to more pain. Dr. Dennis calls the supplements "very promising," but notes, "they have not been studied well enough for long enough to make any blanket recommendations."

To prevent back problems, Dr. Dennis recommends maintaining recommended weight, cultivating good posture, lifting with the legs, not the back, and stretching and other range-of-motion exercises. One effective form of back-healthy exercise, he says, is yoga. "Yoga develops flexibility and strength in low back, which helps prevent back injuries. It's not for everyone, but if you like it, it helps."


9. d

Linda Nebeling, Ph.D., R.D. is the chief of the health promotion research branch of the NCI, and a nutritionist with the Institute's "5 A Day" program. "Our name is a little misleading," she explains. "To prevent cancer, Americans should eat at least five servings of fruits and vegetables a day, preferably eight or nine. Fruits and vegetables are our main sources of antioxidant nutrients, for example, vitamins A, C, and E, all of which help prevent the cell damage at the root of cancer." Unfortunately, according to the latest NCI research, only 20 percent of American men and 31 percent of women eat the healthy minimum of five daily servings of fruits and vegetables. "It's not difficult to eat at least five daily servings of fruits and vegetables," Nebeling explains. "Have some fruit with breakfast, a salad, and vegetable at lunch and dinner, and a few fruit or vegetable snacks each day."

According to the nci, one serving is one medium-size piece of fruit (apple, organge, banana, etc.), A half-cup of cut-up fruit, three-quarters of a cup of 100 percent fruit juice, one-quarter cup of dried fruit, one-half cup of raw or cooked vegetables, one cup of raw leafy vegetables (lettuce, spinach, etc.), Or one-half cup of cooked beans or peas.


10. a

In 1995, a panel of experts from the NIH's Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine announced that "every U.S. adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week." The following year, the U.S. Surgeon General endorsed this recommendation.

Aerobic exercise is fine if you enjoy it. But vigorous exercise is not necessary to obtain important health benefits, such as longevity and cholesterol and weight control. Health-promoting activities include: walking, washing windows or floors, raking leaves, gardening, biking, and swimming. Unfortunately, according to the CDC's latest report, only about one-quarter of Americans get 30 minutes of exercise a day.


11. c

Different studies have come up with different estimates, but most place women's lifetime risk at around 20 percent, or one woman in five. "There are three main risk factors for depression," says Mary Blehar, Ph.D. director of women's mental health programs at the NIH's National Institute of Mental Health, "being a woman, a previous episode of depression, and a family history of the disease." Other factors associated with some increased risk include: a history of sexual abuse, less than a high school education, not working outside the home, having young children at home, and chronic marital problems. Anyone who is depressed is at risk for suicide, which, for women aged 25 to 44, is the fourth leading cause of death (tied with HIV infection). "Depression is a disease," Dr. Blehar says. "It's not a personal failure. The good news is that depression can be effectively treated. Medication, psychotherapy, and exercise all help. If you feel depressed--and especially if you've had any thoughts of suicide--consult your physician immediately."


12. c

Mention diabetes, and most people think of children who must inject insulin because they can't produce it themselves. That's Type 1 diabetes--but it accounts for only about 10 percent of cases of the disease. The other 90 percent are Type 2 diabetes, an illness related to the risk factors listed above, particularly obesity.

Compared with men, women are more likely to develop diabetes. Currently, according to the CDC, 3.8 million men have diabetes and 4.7 million women.

Insulin is necessary to move blood sugar (glucose) from the bloodstream into the cells, where it's the body's main fuel. When glucose can't enter the cells, it remains in the bloodstream and causes many serious complications, among them: heart disease, kidney disease, and eye and nerve damage. .In Type 2 diabetes, the body can't use the insulin it produces. The reason: As body weight rises, cells become "insulin resistant."

Many studies show that weight loss through a low-fat diet and regular exercise (e.g. walking) reduces risk of Type 2 diabetes, and helps treat the condition in those who have it. "Risk of developing Type 2 diabetes can be substantially reduced through a combination of weight loss and increased exercise," says Judith Fradkin, M.D., director of diabetes, endocrine, and metabolic diseases research at the NIH's National Institute of Diabetes and Digestive and Kidney Diseases. "These are basic good-health recommendations. They're also the keys to reducing diabetes risk."


13. d

An expert panel convened by the National Institutes of Health in 1994 concluded that osteoporosis could best be prevented if women consume 1,000 to 1,500 mg of calcium a day. Specifically, the panel recommended:

* Women age 25 through menopause: 1,000 mg a day
* Pregnant and lactating women: 1,200 mg
* Postmenopausal women taking hormone replacement therapy: 1,000 mg
* Postmenopausal women not taking hormone replacement: 1,500 mg
* Women over age 65: 1,500 mg.

"Those are still the guidelines," Dr. Dennis says. "The typical woman aged 35 to 45 should consume about 1,500 mg of calcium a day. But that recommendation assumes that women get 500 mg a day from food, so they should supplement on the order of 1,000 mg a day. I would advise against taking any more because at higher levels of supplementation, calcium can be deposited in the kidneys and other soft tissues and cause harm."

Here’s how much calcium can be obtained from common foods:

* Plain nonfat yogurt. 8 oz. 452 mg
* Canned sardines. 3.75 oz. 382 mg
* Nonfat dry milk. 1/4 cup. 377 mg
* Part-skim ricotta cheese. 1/2 cup. 337 mg
* Parmesan cheese. 1 oz. 336 mg
* Lowfat fruit yogurt. 8 oz. 314 mg
* Skim milk. 1 cup. 302 mg
* Cheddar cheese. 1 oz. 204 mg
* Mozzarella cheese. 1 oz. 147 mg
* Feta cheese. 1 oz. 140 mg
* Poppy seeds. 1 tablespoon. 127 mg
* Broccoli, cooked. 1/2 cup. 89 mg


14. d

According to the NIH's Centers for Disease Control and Prevention, compared with men, women's risk of death from asthma is 40 percent greater. Asthma is the unknown women's health issue. Compared with men, women are considerably more likely to develop asthma, seek medical treatment, and die from it.

Even if you didn't have asthma as a child, you can develop it as an adult," says Calman Prussin, M.D., head of the clinical allergy and immunology unit of the NIH's National Institute of Allergy and Infectious Diseases. The symptoms are usually wheezing and tightness in the chest, particularly after strenuous exercise, or an upper respiratory infection, or exposure to things that trigger allergies, for example, cats or dust. "But some people don't wheeze," Dr. Prussin explains. "Their main symptoms is coughing, especially at night."

Doctors don't fully understand the cause of asthma, but the condition is often linked to respiratory allergies (hayfever). Common triggers of asthma attacks include: animal dander, feathers, pollen, smoke, air pollutants, and certain medications, notably aspirin. Learn your triggers and take steps to avoid them, Dr. Prussin advises. In addition, some studies suggest that low levels of vitamin C also contribute to asthma risk.

If you have a persistent cough or any difficulty breathing, see your doctor. Once diagnosed, asthma can be effectively treated, Dr. Prussin says, notably with inhaled corticosteroids (Flovent, Pulocort, Azmacort, Vanceril, etc.)


15. b

In about two-thirds of women who suffer migraines, attacks are related to the menstrual cycle. "My wife is a migraine sufferer," says John Marler, M.D., associate director of clinical trials at the NIH's National Institute of Neurological Disorders and Stroke, "but she only gets them at certain times during her cycle." The reasons for the migraine-menstrual connection are biochemically complicated, but have to do with the fact that estrogen level falls after ovulation and before menstruation. The change in estrogen level leads to the blood vessels in the brain opening (dilating) and then constricting. This action triggers migraines. The good news is that as menopause approaches and menstruation fades away, so do menstrual migraines.

In addition, migraines are often triggered by certain foods and/or drugs: milk, wheat products, fatty meats, chocolate, eggs, oranges and other citrus fruits, alcohol (especially red wine), cheeses, birth control pills, MSG (monosodium glutamate), Tagamet, and certain pain medications. "Many neurologists have lists of possible food and triggers they hand out to people with migraines," Dr. Marler explains. "Eliminating them often helps." Scientists don't understand exactly why these foods--and other--plus certain drugs trigger migraines, but presumably, Dr. Marler says, they trigger blood vessel dilation and constriction to which migraine sufferers are particularly sensitive.

In addition to standard medication, Dr. Marler says biofeedback and other relaxation therapies may help prevent migraines. Some studies suggest that the medicinal herb feverfew also helps prevent them.


16. c

"Obesity is the main risk factor for gallstones," says Frank Hamilton, M.D., director of gastrointestinal diseases research at the NIH's National Institute of Diabetes and Digestive and Kidney Diseases. Anything that promotes weight gain is a risk factor, chief among them a diet high in refined sugar, and fat, especially saturated (animal) fats found in meats and whole-milk diary foods. In addition, a sedentary lifestyle is also a gallstones risk factor because of its relationship to weight gain. But if you're heavy, don't go on a crash diet, Dr. Hamilton warns: Rapid weight loss is also a risk factor for gallstones. Other risk factors include: advancing age (especially being over 69), a family history, use or hormonal medication (including birth control pills), and having two or more children.

To prevent gallstones, Dr. Hamilton recommends eating a low-fat diet with plenty of fruits and vegetables, getting regular exercise, and avoiding crash dieting. If you take birth control pills, you might discuss ask your doctor about switching contraceptive methods. Finally, some studies suggest that vitamin C supplements and coffee drinking also protect against gallstones.


17. a

The cause of uterine fibroids remains a mystery, but most experts believe they are related to estrogen. They are rare before puberty when estrogen levels are low, Phyllis Leppert, M.D., Ph.D. chief of the reproductive sciences branch of the NIH's National Institute of Child Health and Human Development, explains. They develop in an estimated 25 percent of all women during thier reproductive years when estrogen levels are high. And they shrink after menopause when estrogen levels decline.

"Fibroids are a leading cause of hysterectomy," Dr. Leppert says, "but it's always a mistake to rush into surgery. Treatment depends on the woman's symptoms. In many cases, pain medication and waiting until menopause, when fibroids shrink, is all that's necessary. But if fibroids become large and cause heavy bleeding, then surgery--either myomectomy, removal of just the fibroids, or hysterectomy--become reasonable options. But before a woman opts for surgery, she should get several medical opinions. She may not need surgery."


18. a

The myth is that marriage is good for men, but bad for women. "Marriage contributes more to men's health and happiness than women's, but marriage is still good for women's health and happiness," says Linda Waite, Ph.D., coauthor (with Maggie Gallagher) of The Case for Marriage (Random House, 2000). Waite is a professor of sociology at the University of Chicago. Gallagher is the director of the Marriage Program at the Institute of American Values in New York City. Waite and Gallagher cite an enormous amount of research to show that marriage benefits women in many ways. "Compared with single, cohabitating, divorced, and widowed women, married women live longer, healthier lives,” Dr. Waite explains. Married women are also less likely to engage in risky, possibly life-threatening behaviors such as binge drinking, and they enjoy a death rate 50 percent lower than the unmarried. Married women are less likely to commit suicide, or suffer depression, anxiety, and other mental health problems. They are more sexually active. And they have higher incomes, giving them greater access to health insurance, and better homes in safer neighborhoods. Finally, married women are the group most likely to describe themselves as "happy." Only 15 percent of those who are separated call themselves happy, Dr. Waite explains. For the divorced, the figure is 18 percent, and for those who are single, cohabitating, or widowed, it's about 25 percent. But for those who are married, 40 percent say they are happy.

19. b

"Exercise is one of the best ways to deal with stress," says Allen Elkin, Ph.D. author of Stress Managment for Dummies (1999) and director of the Stress Management Counseling Center in New York City. "It encourages deep breathing, which is relaxing. It uses up energy you might otherwise use obesssing about your problems. It's mood elevating. And it's tiring, so you sleep better." Exercise is one of Dr. Elkin's personal strategies for dealing with stress. He works out a gym near his office for 90 minutes four times a week.

Dr. Elkin discourages venting. "There's good research to show that venting doesn't provide relief. It often makes things feel worse."

He also discourages alcohol. "Using alcohol to cope with stress is a step on the road to alcoholism."

Finally, while Valium and antidepressants have a legitimate place in treatment of significant anxiety and major depression, for everyday stress, Dr. Elkin says, "skills are better than pills." In addition to exercise, he advocates activities that provide perspective. "When you take a step back from the problems that cause you stress, you usually realize that most stressors are annoyances not catastrophes." Activities that help provide perspective include: talking with friends, journal writing, and volunteer work helping those less fortunate than you are.

20. c

Antibacterial household cleaning products are "at best, a marketing gimmick," according to Jeffrey Duchin, M.D., chief of the communicable disease control, epidemiology, and immunization section of the Seattle and King County public health department, "and at worst, potentially problematic. They increase the likelihood that the bacteria in your home will become resistant to antibiotics." For household washing and bathing, Dr. Duchin says "plain old soap and water are fine." And for cleaning and disinfection in the the kitchen and bathroom, he urges the use of bleech diluted with water. "Bleech is the best household disinfectant. It kills everything you want to kill."

Cranberry juice can help prevent urinary tract infections, according to several studies.

Footwear--flip-flops or sandals--in gym locker rooms helps protect against athlete's foot.