Womens Health

Medline Articles on Womens Health

• A combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: A preliminary estimate of dose and efficacy.
  Hains G, Hains F. Private practice of chiropractic, Trois-Rivieres,Quebec, Canada.
  J Manipulative Physiol Ther 2000 May;23(4):225-30
  
  OBJECTIVES: To provide preliminary information on whether a regimen of 30 chiropractic treatments that combines ischemic compression and spinal manipulation effectively reduces the intensity of pain, sleep disturbance, and fatigue associated with fibromyalgia. In addition, to study the dose-response relation and identify the baseline characteristics that may serve as predictors of outcome. DESIGN: Subjects were assessed with self-administered questionnaires taken at baseline, after 15 and 30 treatments, and 1 month after the end of the treatment trial. SETTING: Private practice. METHODS: Participating subjects were adult members of a regional Fibromyalgia Association. Participating subjects had fibromyalgia for more than 3 months. They received 30 treatments including ischemic compression and spinal manipulation. The 3 outcomes being evaluated were pain intensity, fatigue level, and sleep quality. A minimum 50 improvement in pain intensity from baseline to the end of the treatment trial was needed to include the patient in the respondent category. RESULTS: Fifteen women (mean age 51.1 years) completed the trial. A total of 9 (60) patients were classified as respondents. A statistically significant lessening of pain intensity and corresponding improvement in quality of sleep and fatigue level were observed after 15 and 30 treatments. After 30 treatments, the respondents showed an average lessening of 77.2 (standard deviation = 12.3) in pain intensity and an improvement of 63.5 (standard deviation = 31.6) in sleep quality and 74.8 (standard deviation = 23. 1) in fatigue level. The improvement in the 3 outcome measures was maintained after 1 month without treatment. Subjects with less than 35 improvement after 15 treatments did not show a satisfactory response after 30 treatments. A trend, determined as not statistically significant, suggests that older subjects with severe and more chronic pain and a greater number of tender points respond more poorly to treatment. CONCLUSION: This study suggests a potential role for chiropractic care in the management of fibromyalgia. A randomized clinical trial should be conducted to test this hypothesis.
  
  
• The effectiveness of chiropractic management of fibromyalgia patients: a pilot study.
  Blunt KL, Rajwani MH, Guerriero RC. Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
  J Manipulative Physiol Ther 1997 Jul-Aug;20(6):389-99
  
  OBJECTIVE: To demonstrate the effectiveness of chiropractic management for fibromyalgia patients using reported pain levels, cervical and lumbar ranges of motion, strength, flexibility, tender points, myalgic score and perceived functional ability as outcome measures. DESIGN: A. Preliminary randomized control crossover trial. B. Before and after design. PATIENTS: Twenty-one rheumatology patients (25-70 yr). CHIROPRACTIC INTERVENTIONS: Treatment consisted of 4 wk of spinal manipulation, soft tissue therapy and passive stretching at the chiropractors' discretion. CONTROL INTERVENTION: Chiropractic management withheld for 4 wk with continuation of prescribed medication. MAIN OUTCOME MEASURES: Changes in scores on the Oswestry Pain Disability Index, Neck Disability Index, Visual Analogue Scale, straight leg raise and lumbar and cervical ranges of motion were observed. RESULTS: Chiropractic management improved patients' cervical and lumbar ranges of motion, straight leg raise and reported pain levels. These changes were judged to be clinically important within the confines of our sample only. CONCLUSIONS: Further study with a sample size of 81 (for 80% power at alpha < or = .05) is recommended to determine if these findings are generalizable to the target population of fibromyalgia suffers.
  
  
• Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives.
  Allaire AD, Moos MK, Wells SR. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, USA.
  Obstet Gynecol 2000 Jan;95(1):19-23
  
  OBJECTIVE: To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. METHODS: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients. RESULTS: Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. CONCLUSION: Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.
  
  
• Water-gymnastics reduced the intensity of back/low back pain in pregnant women.
  Kihlstrand M, Stenman B, Nilsson S, Axelsson O. Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden.
  Acta Obstet Gynecol Scand 1999 Mar;78(3):180-5
  
  OBJECTIVE: To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave. METHODS: A prospective, randomized study. One hundred and twenty-nine women were randomized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were randomized to a control group. The women in both groups filled in questionnaires in gestational weeks 18, 34 and within the first postpartum week. Every day from week 18 to labor they assessed the intensity of back/low back pain. RESULTS: Back pain intensity increased during pregnancy. No excess risk for the pregnancy associated with water-gymnastics was observed. The women participating in water-gymnastics recorded a lower intensity of back/low back pain. The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group (124 women) compared with 1484 in the control group (120 women). After weeks 32 33, seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain (p=0.031). CONCLUSIONS: Intensity of back/low back pain increased with advancing pregnancy. There was no excess risk for urinary or vaginal infections associated with water-gymnastics. Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain. Water-gymnastics decreased the number of women on sick-leave because of back/low back pain. Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave.
  
  
• A randomized, placebo-controlled clinical trial on the efficacy of chiropractic therapy on premenstrual syndrome.
  Walsh MJ, Polus BI. Department of Chiropractic, Osteopathy and Complementary Medicine, RMIT, Melbourne, Australia.
  J Manipulative Physiol Ther 1999 Nov-Dec;22(9):582-5
  
  OBJECTIVE: To evaluate the efficacy of chiropractic therapy on the treatment of symptoms associated with premenstrual syndrome. DESIGN: A prospective, randomized, placebo-controlled, crossover clinical trial. SETTING: Multicenter private clinics. SUBJECTS: Twenty-five subjects with diagnosed premenstrual syndrome (with a Moos premenstrual syndrome questionnaire plus daily symptom monitoring). INTERVENTION: After randomization, 16 of the subjects received high-velocity, low-amplitude spinal manipulation plus soft tissue therapy 2 to 3 times in the week before menses for at least 3 cycles. The remaining 9 subjects received a placebo treatment with a spring-loaded adjusting instrument wound down for minimum force. After a 1-cycle washout, the 2 groups changed over. OUTCOME MEASURE: Daily rating of symptom level, comparing total scores for premenstrual week with baseline for treatment and placebo phases. DATA ANALYSIS: The data were analyzed with paired Student t tests and Wilcoxon signed rank tests, with the statistical significance set at P < .05. RESULTS: There was a significant decrease in scores after treatment compared with baseline scores (P = .00001) and a statistically significant decrease in scores for the treatment phase compared with the placebo (P = .006). For group 1 (n = 16), there was a significant decrease in scores after treatment compared with baseline scores (P = .0001) and a statistically significant decrease in scores for the treatment phase compared with the placebo (P = .041). For group 2 (n = 9), there was a significant decrease in scores during treatment compared with the baseline (P = .01); however, there was no difference at the P = .05 level between treatment and placebo scores. CONCLUSIONS: Within the limitations of the study, the results support the hypothesis that the symptoms associated with PMS can generally be reduced by chiropractic treatment consisting of adjustments and soft-tissue therapy. However, the role of a placebo effect needs further elucidation, given that the group receiving the placebo first, although improving over the baseline, showed no further improvement when they had actual treatment.
  
  
• The frequency of positive common spinal clinical examination findings in a sample of premenstrual syndrome sufferers.
  Walsh MJ, Polus BI. Department of Chiropractic, Osteopathy & Complementary Medicine, RMIT, Melbourne, Australia.
  J Manipulative Physiol Ther 1999 May;22(4):216-20
  
  OBJECTIVE: As part of a randomized clinical trial to determine the efficacy of chiropractic therapy on premenstrual syndrome (PMS), subjects were evaluated for initial underlying spinal dysfunction. SUBJECTS: Fifty-four subjects with diagnosed PMS (using a Moos PMS questionnaire plus daily symptom monitoring) and 30 subjects with no diagnosable PMS were recruited by newspaper advertising and referrals. DESIGN: All subjects underwent a full history and physical and chiropractic examination carried out by 1 of 2 fully qualified and registered chiropractors, each with a minimum of 10 years experience. The results of the assessment for the PMS group were compared with those of the non-PMS group. SETTING: RMIT teaching clinics. DATA ANALYSIS: The data collected were entered into a spread sheet and contingency tables were created. The data were analyzed by use of chi-squared tests, with the statistical significance being set at P < .05. RESULTS: The PMS group had a higher percentage of positive responses for each of 12 measured spinal dysfunction indexes except for range of motion of the low back. The indexes where the increase was statistically significant (P < .05) were cervical, thoracic, and low back tenderness, low back orthopedic testing, low back muscle weakness, and the neck disability index. An average of 5.4 of the 12 indexes were positive for the PMS group compared with 3.0 for the non-PMS group. CONCLUSIONS: A relatively high incidence of spinal dysfunction exists in PMS sufferers compared with a comparable group of non-PMS sufferers. This is suggestive that spinal dysfunction could be a causative factor in PMS and that chiropractic manipulative therapy may offer an alternative therapeutic approach for PMS sufferers.
  
  
• Chiropractic care for women with chronic pelvic pain: a prospective single-group intervention study.
  Hawk C, Long C, Azad A. Palmer Center for Chiropractic Research, Davenport, Iowa 52803, USA.
  J Manipulative Physiol Ther 1997 Feb;20(2):73-9
  
  OBJECTIVE: To assess the role of chiropractic care for women with chronic pelvic pain (CPP) as a first step in designing a randomized clinical trial. DESIGN: Prospective single-group intervention study. SETTING: Chiropractic Research Center. SUBJECTS: Nineteen volunteer female subjects meeting inclusion/exclusion criteria for chiropractic treatment of chronic pelvic pain. INTERVENTIONS: Chiropractic treatment consisting of flexion/distraction and trigger point techniques administered by faculty clinician over a period of 6 wk. MAIN OUTCOME MEASURES: Pain Disability Index (PDI) was the primary measure; secondary outcome measures were Visual Analog Scale for pain (VAS), RAND-36 Health Survey and Beck Depression Inventory (BDI). All were administered at baseline and at 6 wk. RESULTS: Eighteen subjects completed the study, with an attrition rate of 5%. The mean improvement in the PDI score was 13.0 points (p = .001); in the VAS it was 4.0 cm (p = .001); and in the BDI it was 6.1 points (p < .001). All eight subscales of the RAND-36 Health Survey increased post-intervention, with the largest differences in role function limitations because of physical problems (45.8%), emotional problems (44.4%) and pain (40.6%). CONCLUSION: The chiropractic treatment used in this study had positive short-term effects. These results will be used to design a randomized clinical trial to investigate the efficacy of chiropractic care in the treatment of CPP.
  
  
• The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea.
  Kokjohn K, Schmid DM, Triano JJ, Brennan PC. Research Department, National College of Chiropractic, Lombard, IL 60148-4583.
  J Manipulative Physiol Ther 1992 Jun;15(5):279-85
  
  OBJECTIVE: The primary objectives of this study were to compare the effect of spinal manipulation vs. sham manipulation on a) circulating plasma levels of the prostaglandin F2a metabolite, 15-keto-13,14-dihydroprostaglandin (KDPGF2a), b) perceived abdominal and back pain and c) perceived menstrual distress in women with primary dysmenorrhea. DESIGN: This randomized clinical pilot study investigated the outcome measures before and after either a spinal manipulation treatment (SMT) or a sham manipulation. SETTING: All subjects were treated at the National College Chiropractic clinic, a private chiropractic clinic in the suburban Chicago area. PARTICIPANTS: Forty-five women with a history of primary dysmenorrhea were recruited from the local community. The volunteers ranged in age from 20-49 (mean age = 30.3 yr), and were entered into the study between April 1990 and January 1991. Twenty-four were randomly assigned to the spinal manipulation group and 21 were assigned to the sham group. INTERVENTIONS: Subjects treated with spinal manipulation were placed in a side-lying position with the bottom leg straight and the top leg flexed at the knee and hip. They received a high-velocity, short lever, low-amplitude thrust to all clinically relevant vertebral levels within T10 and L5-S1 and the sacroiliac joints. In the sham manipulation, subjects were placed in a side-lying position with both hips and knees flexed. Their manipulation consisted of a similar thrust administered to the midline base of the sacrum. OUTCOME MEASURES: Perceived abdominal and back pain were measured with a visual analog scale, and menstrual distress was measured with the Menstrual Distress Questionnaire. Both were administered 15 min before and 60 min after treatment. Blood samples were collected by venipuncture for the determination of plasma levels of KDPGF2a at the same times. The plasma was then assayed for KDPGF2a by radioimmunoassay. RESULTS: Analysis of covariance and paired Student's t tests were used for the statistical evaluation. Immediately after treatment, the perception of pain and the level of menstrual distress were significantly reduced by SMT. This reduction was associated with a significant reduction in plasma levels of KDGPF2a in the SMT group. A significant and similar reduction in plasma KDPGF2a also occurred in the sham group, indicating that a placebo effect was associated with a single sham intervention. CONCLUSIONS: This randomized pilot study suggests that SMT may be an effective and safe nonpharmacological alternative for relieving the pain and distress of primary dysmenorrhea. However, the large change in KDPGF2a observed in both treatment groups clearly indicates that further studies with more subjects, studied over a longer time frame, are needed to resolve the question of a placebo effect.
  
  
• Back pain during pregnancy and labor.
  Diakow PR, Gadsby TA, Gadsby JB, Gleddie JG, Leprich DJ, Scales AM. Division of Chiropractic Science, Canadian Memorial Chiropractic College, Toronto.
  J Manipulative Physiol Ther 1991 Feb;14(2):116-8
  
  A retrospective study of 400 pregnancies and deliveries was undertaken by interview of 170 consecutive female patients presenting to five chiropractic offices in the Niagara Peninsula. Back pain was reported during 42.5% (170) of the pregnancies and 44.7% (179) of the deliveries. There was a statistically significant association between back pain during the two events (p less than .001). Of the 170 pregnancies with reported back pain, 72% (122) also reported back labor. A subsample of 170 painful pregnancies was divided into those that had received manual manipulation and those that had not. The treated group experienced less pain during labor (p less than .001).
  
  
• A chiropractic approach to the treatment of dysmenorrhea.
  Liebl NA, Butler LM
  J Manipulative Physiol Ther 1990 Feb;13(2):101-6
  
  This time-series case study was designed to determine whether manipulating the spine can be an effective method of relief from dysmenorrhea. A patient suffering from dysmenorrhea monitored her monthly menstrual cramps by using pain diaries. She rated her pain levels during 4 months of a baseline phase and 3 months of treatment. The treatment phase consisted of manual chiropractic adjustments and soft tissue therapy. The patient realized fewer episodes of pain as well as lower pain ratings during the treatment phase. There was no significant change in the duration of the menstrual flow.
  
  
• The effect of low-dose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women. A randomized, controlled trial.
  Recker RR, Davies KM, Dowd RM, Heaney RP. Osteoporosis Research Center, School of Medicine, Creighton University, Omaha, Nebraska 68131, USA.
  Ann Intern Med 1999 Jun 1;130(11):897-904
  
  BACKGROUND: Hormone replacement therapy (HRT), the mainstay of osteoporosis prevention, is limited because of dose-related risks, side effects, and patient acceptance. The bone-sparing efficacy and tolerability of the lowest available doses of HRT have not been adequately studied in elderly women. OBJECTIVE: To determine the bone-sparing effect of continuous low-dose HRT in elderly women. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: University osteoporosis research and clinical center. PATIENTS: 128 healthy white women (age > 65 years) with low bone mass recruited by word of mouth and by local advertisement. The principal eligibility criterion was spinal bone mineral density of 0.90 g/cm2 or less. INTERVENTION: Continuous therapy with conjugated equine estrogen, 0.3 mg/d, and medroxyprogesterone, 2.5 mg/d, or matching placebo. Sufficient calcium supplementation was given to bring all calcium intakes above 1000 mg/d in both groups; supplemental oral 25-hydroxyvitamin D was given to maintain serum 25-hydroxyvitamin D levels of at least 75 nmol/L in both groups. MEASUREMENTS: Bone mineral density of the spine, hip, total body, and forearm; serum total alkaline phosphatase and serum osteocalcin levels at 6-month intervals; and 24-hour urine creatinine and hydroxyproline excretion at baseline, 12 months, and 42 months. RESULTS: During 3.5 years of observation, spinal bone mineral density increased by 3.5%(P < 0.001) in an intention-to-treat analysis and by 5.2% among patients with greater than 90% adherence to therapy. Significant increases were seen in total-body and forearm bone density (P < 0.01). Symptoms related to HRT (breast tenderness, spotting, pelvic discomfort, and mood changes) were mild and short-lived. CONCLUSIONS: Continuous low-dose HRT with conjugated equine estrogen and oral medroxyprogesterone combined with adequate calcium and vitamin D provides a bone-sparing effect that is similar or superior to that provided by other, higher-dose HRT regimens in elderly women. This combination is well tolerated by most patients.
  
  
• A prospective study of recreational physical activity and breast cancer risk.
  Rockhill B, Willett WC, Hunter DJ, Manson JE, Hankinson SE, Colditz GA. Channing Laboratory, Boston, MA
  Arch Intern Med 1999 Oct 25;159(19):2290-6
  
  BACKGROUND: Increased physical activity has been hypothesized to prevent breast cancer, largely by reducing cumulative lifetime exposure to circulating ovarian hormones. However, epidemiologic findings are inconsistent, and there is no consensus on the best way to quantify physical activity. We thus examined this issue in a large cohort of women, using several different measures of adult physical activity. METHODS: We analyzed data from the Nurses' Health Study, a prospective study of women aged 30 to 55 years in 1976. In 1980 and on subsequent surveys, women were asked about the average number of hours per week spent in various moderate and vigorous recreational physical activity during the past year. We computed a "baseline-only" (1980) measure of hours per week of physical activity, as well as a cumulative average measure that used updated reports on physical activity. During 16 years of follow-up, we identified 3137 cases of invasive breast cancer (1036 premenopausal and 2101 postmenopausal women). Data were analyzed by use of multivariate pooled logistic regression to produce relative risks of breast cancer, and the associated confidence intervals. RESULTS: Women who were more physically active in adulthood had a lower risk of breast cancer than those who were less physically active. Comparing those who reported engaging in moderate or vigorous physical activity for 7 or more hours per week with those who engaged in such physical activity for less than 1 hour per week, the relative risk was 0.82 (95% confidence interval, 0.70-0.97), using the cumulative average updating. The dose-response trend was statistically significant (P = .004). Using the baseline-only measure of physical activity produced slightly weaker relative risks. CONCLUSION: These results contribute to the body of evidence suggesting that higher levels of adult physical activity afford modest protection against breast cancer.
  
  
• A prospective study of folate intake and the risk of breast cancer.
  Zhang S, Hunter DJ, Hankinson SE, Giovannucci EL, Rosner BA, Colditz GA, Speizer FE, Willett WC. Department of Epidemiology, Harvard School of Public Health, Boston, Mass
  JAMA 1999 May 5;281(17):1632-7
  
  CONTEXT: Folate is involved in DNA synthesis and methylation and may reduce breast cancer risk, particularly among women with greater alcohol consumption. OBJECTIVES: To assess the association between folate intake and risk of breast cancer and whether higher folate intake may reduce excess risk among women who consume alcohol. DESIGN: Prospective cohort study performed in 1980, with 16 years of follow-up. SETTING AND PARTICIPANTS: A total of 88818 women who completed the dietary questionnaire section of the Nurses' Health Study in 1980. MAIN OUTCOME MEASURE: Incidence of invasive breast cancer by levels of folate and alcohol intake. RESULTS: A total of 3483 cases of breast cancer were documented. Total folate intake was not associated with overall risk of breast cancer. However, among women who consumed at least 15 g/d of alcohol, the risk of breast cancer was highest among those with low folate intake. For total folate intake of at least 600 microg/d compared with 150 to 299 microg/d, the multivariate relative risk (RR) was 0.55 (95% confidence interval [CI], 0.39-0.76; P for trend = .001). This association was only slightly attenuated after additional adjustment for intake of beta carotene, lutein/zeaxanthin, preformed vitamin A, and total vitamins C and E. The risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 microg/d (for alcohol intake > or =15 g/d vs <15 g/d, multivariate RR, 1.32; 95% CI, 1.15-1.50). For women who consumed at least 300 microg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol vs less than 15 g/d was 1.05 (95% CI, 0.92-1.20). Current use of multivitamin supplements, the major source of folate, was associated with lower breast cancer risk among women who consumed at least 15 g/d of alcohol (for current users of supplements vs never users, RR, 0.74; 95% CI, 0.59-0.93). CONCLUSIONS: Our findings suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced by adequate folate intake.
  
  
• Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk.
  Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R. National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD
  JAMA 2000 Jan 26;283(4):485-91
  
  CONTEXT: Whether menopausal hormone replacement therapy using a combined estrogen-progestin regimen increases risk of breast cancer beyond that associated with estrogen alone is unknown. OBJECTIVE: To determine whether increases in risk associated with the estrogen-progestin regimen are greater than those associated with estrogen alone. DESIGN: Cohort study of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program. SETTING: Twenty-nine screening centers throughout the United States. PARTICIPANTS: A total of 46355 postmenopausal women (mean age at start of follow-up, 58 years). MAIN OUTCOME MEASURE: Incident breast cancers by recency, duration, and type of hormone use. RESULTS: During follow-up, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years (relative risk [RR], 1.2 [95% confidence interval [CI], 1.0-1.4] and 1.4 [95% CI, 1.1-1.8], respectively); the relative risk increased by 0.01 (95% CI, 0.002-0.03) with each year of estrogen-only use and by 0.08 (95% CI, 0.02-0.16) with each year of estrogen-progestin-only use among recent users, after adjustment for mammographic screening, age at menopause, body mass index (BMI), education, and age. The P value associated with the test of homogeneity of these estimates was .02. Among women with a BMI of 24.4 kg/m2 or less, increases in RR with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 (95% CI, 0.01-0.06) and 0.12 (95% CI, 0.02-0.25), respectively. These associations were evident for the majority of invasive tumors with ductal histology and regardless of extent of invasive disease. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only. CONCLUSION: Our data suggest that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.