Health experts are talking about…

why most women should avoid long-term hormone therapy. Women past menopause who hope to prevent certain chronic conditions shouldn’t turn to hormone replacement therapy (HRT) to do it, according to updated recommendations from the US Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine.

You may recall that long-term use of HRT was linked to increased risk of breast cancer as far back as 2002. However, some researchers thought it might reduce the risk of common, chronic conditions like heart disease and diabetes for women in the early stages of menopause. More recently, large studies found just the opposite: hormone therapy actually increases your risk of developing these diseases.

The task force concluded that use of HRT—either estrogen alone or an estrogen/progestin combination—heightens a woman’s probability of breast cancer, stroke, blood clots and gallbladder disease. HRT may also increase her chances of developing dementia or urinary incontinence. While combination HRT after menopause does help reduce the risk of fractures, the task force determined that the likely harms outweigh any potential benefits.

The recommendations against HRT don’t apply to short-term hormone therapy used to manage menopausal symptoms like hot flashes. They also don’t apply if you are younger than age 50 and have had a hysterectomy that resulted in menopause.

…what you should know about prediabetes. You may be at risk for diabetes and not even know it. About 84 million people in the United States have a condition called prediabetes. This happens when blood-sugar levels are higher than normal but are not yet high enough to be full-fledged, type 2 diabetes. About 90 percent of people with prediabetes are unaware they have it, says the Centers for Disease Control and Prevention (CDC). However, the kind of long-term health damage caused by diabetes, like heart and kidney problems, may already have begun.

Insulin is a hormone made by your pancreas, which feeds energy to your body’s cells. When you have prediabetes, your cells don’t react normally to insulin. The pancreas works harder to get the cells to react but eventually loses the fight. Your blood sugar rises, setting the stage for diabetes.

You can have prediabetes for years and not know it. That’s why it’s important to talk with your doctor and get tested, especially if you have risk factors like a family history of diabetes, are overweight, are over age 45 or don’t have a very active lifestyle. People who belong to certain ethnic groups, including African Americans, Hispanics/Latinos, Pacific Islanders and Native Americans, are also at higher risk of developing diabetes.

According to the Mayo Clinic, not everyone who has prediabetes progresses to the more serious form of the disease. There are many things you can do to control your blood sugar.

If you’re overweight, losing even five to seven percent of your total body weight—about 10 to 14 pounds for a 200-pound person—and exercising regularly for 30 minutes five times a week can reduce your risk of developing diabetes by as much as 58 percent. According to the American Diabetes Association, exercise helps your body use its insulin more efficiently and can lower your blood sugar levels for as long as 24 hours after a workout. Decreasing portion sizes, eating more lean protein like chicken and fish, cutting down on fats and consuming more fruits and vegetables can help you lose weight without giving up many of the foods you love.

The CDC’s National Diabetes Prevention Program can assist you in making some of these changes. Its lifestyle-change program has advice about improving physical activity, eating healthy (even when dining out), managing stress and staying motivated.

…strategies for managing chronic pain. Are you among the more than 50 million Americans who suffer from severe, chronic pain? While many believe recurring pain that lasts for months, or even years, is part of normal aging, that’s not so. And experts say that living with long-term pain isn’t inevitable. Good pain management can lead to a better quality of life.

More than one-third of Americans in their mid-50s and older report chronic neck, back, knee or leg pain, and more than one in five adults in their late 40s through late 80s have some other type of recurring pain. Underlying conditions such as diabetes or arthritis, or long-term effects from prior surgery or a sports injury, can result in chronic pain, which is defined as any continuous or recurring pain lasting longer than 12 weeks.

Whatever the cause, chronic-pain sufferers can wind up in a vicious cycle: limiting physical activity to avoid further pain can lead to weight gain. Extra pounds put more stress on knees, hips and backs, making existing pain worse. Some people may withdraw socially, leading to isolation, anxiety and depression. Sleep problems are also common. As many as 42 percent of adults with chronic pain have trouble falling or staying asleep. This causes ongoing fatigue, which reduces physical activity and further increases disability.

The goal of pain management isn’t necessarily to eliminate pain completely but rather to minimize discomfort and improve your ability to function. Treatment depends on your underlying condition and your body’s response to various approaches. The first line of treatment should be an over-the-counter pain reliever like acetaminophen (Tylenol), according to the American Chronic Pain Association. Older adults should use caution when taking anti-inflammatory drugs (NSAIDs) like ibuprofen, as they can cause serious side effects, like stomach bleeding and kidney or heart problems, or interfere with prescription medications you take.

Steroid injections can help relieve pain with few to no side effects and are especially effective for knee arthritis pain. However, they’re only a short-term solution, since the effect fades over time.

Your doctor may prescribe opioid therapy, although it should never be the first option, says the CDC. Opioid addiction is a major problem throughout the United States, and these drugs should only be used under a physician’s supervision. However, when prescribed according to medical guidelines and properly monitored to avoid misuse, opioids can be highly effective.

Physical, occupational and behavioral therapy are other routes to explore. Muscle strengthening exercises and low-impact activities like swimming, along with learning different ways to do ordinary tasks, may reduce pain and help avoid further injury. Some people find yoga or tai chi work well, as do complementary therapies like acupuncture, nerve-stimulation therapy or massage. Biofeedback, meditation or relaxation training may also be effective.

The American Chronic Pain Association offers a free resource guide to help you learn more about living as pain-free as possible.

…how to decrease falls among people with insomnia. If you have insomnia, you are already at a high risk for falls. But if you take prescription sleep medications, your likelihood of falling increases another 34 percent, compared with those taking no medication at all, say researchers at Penn State University.

Almost all of us have trouble falling asleep sometimes. Medications that are often very helpful in the short term usually aren’t meant for long-term use, according to health experts at the Mayo Clinic. Despite this, many insomniacs continue to take sleep aids long after they should. These medications often have lingering side effects that cause dizziness and problems with balance, memory and awareness of our surroundings. That can lead to falls and fractures or worse.

More than 30 percent of adults 60 and older who live on their own fall each year. Falls are the leading cause of fatal injury and the most common cause of nonfatal, trauma-related hospital admissions among older adults.

If not sleeping causes falls, and taking sleep meds causes more falls, what is the answer? The Penn State researchers think cognitive behavioral therapy (CBT) should be a doctor’s first recommendation. CBT helps change the way you approach sleep through lifestyle modifications, to help you doze off faster and stay asleep without relying on medication. Techniques may include keeping a sleep diary, curtailing daytime naps, using the bedroom only for sleep, avoiding caffeine, tobacco and alcohol before bed and developing a regular bedtime routine over the course of several weeks.

Sleep is important to a healthy life. If you have consistent trouble with falling asleep or staying asleep, make an appointment with your doctor to discuss a solution.

Freelance journalist Liz Seegert has been writing about health for nearly 30 years. Her work has appeared in Consumer Reports and Kaiser Health News, on the AARP and New America Media websites and on WBAI-FM/Pacifica Radio. She covers aging for the Association of Health Care Journalists. A native of Queens, NY, she loves to walk with her rescue dog, Duke. You can follow Liz on Twitter: @lseegert.

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