Estrogen replacement therapy is the medical administration of estrogen; it may sometimes also include the use of progestins. ERT replaces hormones which the ovaries no longer produce, either through natural or surgical menopause, and provides relief from the unpleasant symptoms of menopause such as hot flashes and night sweats. The most common form of estrogen prescribed in the United States is conjugated estrogen, sold under the brand name of Premarin and not currently available in a generic form. Other types of estrogen available include the patch and estrogens made of singular estrogens rather than the triple estrogen of conjugated estrogens.

Some women are finding relief from menopausal symptoms with herbal remedies such as Black Cohosh, widely thought to help reduce the symptoms of menopause.

Although much controversy exists regarding the use of conjugated estrogens, their use is associated with significant reduction in the occurrence of heart disease and osteoporosis, including a reduction of approximately 10% in the occurrence of heart disease and stroke, over non estrogen users.

Conjugated estrogen, either alone or combined with progestins, has been found to reduce levels PA-1 by approximately 50%. PA-1 is an essential inhibitor of fibrinolysis which increases in women after menopause and may contribute to the risk of cardiovascular disease. This may help to explain the protective effect estrogen has in the reduction of heart disease in postmenopausal women.

An estimated 15- 20% of post- menopausal women currently use ERT. Many women have heard the risks of estrogens and are unaware that many of the substantial increases in risks occurred at much higher doses of conjugated estrogens than are recommended today.

In the past, conjugated estrogen was routinely prescribed doses of 1.25 mg to 2.5 mg per day; at todays recommended daily dose of .625 mg which is required to achieve the osteoporosis reduction benefit of estrogen, most of these risks are fairly small, although you must weigh the benefits against the risks of ERT and choose on an individual basis weather conjugated estrogen is for you.

Because of the potential risk factors involved with estrogen replacement therapy, a study was conducted to examine the relation of ERT and mortality. The study conducted between 1976 and 1994, included participants who were part of the Nurses’ Health Study; the women were between the age of 30 and 55 when the study began.

After adjusting the results for variables the study concluded, women who used estrogen replacement therapy had a lower mortality rate than the non- users; however the survival benefit of ERT decreased with long- term use and is lower for women already at risk for heart disease.

Another study reported in The New England Journal of Medicine to determine the effect of ERT on life expectancy in postmenopausal women with different risk factors for heart disease, breast cancer and hip fracture, concluded that the benefit of ERT in reducing the chance of heart disease appears to outweigh the risk of breast cancer for almost all women and supports the wide- spread use of estrogen replacement therapy.

A new report, released March 4, 1998, by the Journal of American Medicine concludes that plausible biological mechanisms exist by which ERT may lead to improved cognition, reduced risk of dementia, or improvement in the severity of dementia; however studies of women have produced conflicting results and larger placebo controlled studies are required to address the use of estrogen in the prevention of Alzheimers and other dementia related symptoms. Given the risks associated with estrogen, at this time estrogen use, solely to prevent dementia is not advised until adequate trials are completed.

Many children, when they get a cold, also develop a cough. This can be due to bronchitis, which is when the lining of the trachea and bronchi, becomes reddened and swollen, and there is more mucous.

What is bronchitis?

• Bronchitis is usually caused by a viral infection of the bronchi, causing swelling and more mucus than usual. This causes a cough, and sometimes pain which is felt in the throat or upper chest when the child coughs.
• It can occur as part of a cold, flu, whooping cough or measles.

Signs and symptoms of bronchitis

What you can do

From historical figures to celebrities to everyday people, there are many people with bipolar disorder.  Whether one hears of these people on television or in real life, the question often arises as to how they know they have bipolar disorder.  So, what are the symptoms of bipolar disorder?

Since there are two distinct parts of bipolar disorder, there are also two separate sets of symptoms of bipolar disorder.  These symptoms of bipolar disorder many times reflect opposites from the manic to the depressive sides of the illness.

The most obvious of the opposites in the symptoms of bipolar disorder is level of energy and activity.  In depression, the person will feel a loss of energy and suffer from fatigue.  That person may even appear to be slow.  On the other hand, the manic person will have an increased level of energy and much more than usual activity.

Degree of self-esteem is another of the symptoms of bipolar disorder.  A depressed person feels unworthy or is guilt-ridden.  A manic, though, is so full of him- or herself that he or she has unreasonable ideas of him- or herself or even delusions of grandeur.

This loss of self-esteem may be what leads the depressed person to be indecisive, and overblown self importance that urges the manic to become reckless.  Neither the depressed person  nor the manic one sees these decision-making processes as symptoms of bipolar disorder.  But that is exactly what they are.

The symptoms of bipolar disorder differ from the depressive to the manic mostly because the general themes are different.  In depression, everything is slow, dull, small, introverted, and hopeless.  In mania, things are overblown, huge, fast, outgoing, and full of impossible dreams.

Some symptoms of bipolar disorder seem, on the surface, to be similar.  For example,  The poor concentration of the depressed person may appear similar to the distraction of the manic person.  They both, in fact, have trouble holding a thought in their heads.  This happens for different reasons, though.  The depressed person has fewer thoughts but just cannot focus on any, while the manic person has excessive thought and goes rapidly from one to the next.

Sleep cycles vary in both depressed people and manic people.  This is one of the symptoms of bipolar disorder which cause trouble for both.  The depressed person may not care whether he or she sleeps or not, sometimes sleeping for long periods and sometimes not bothering to go to bed.  The manic person will most surely feel little or no need for sleep.  He or she may go without sleep for days.

The symptoms of bipolar disorder which vary the most from depressives to manics happen at the far ends of the spectrum.  A person who is extremely depressed is likely to think dark thoughts about death, suicide, and even plans to commit suicide.  The person who is manic enough can have strange thoughts such as delusions, and bizarre perceptions such as auditory and visual hallucinations.

If a person is truly bipolar, he or she will display some, if not all, of the symptoms of bipolar disorder on both the depressed and manic sides of the line.  Because this illness is so serious and can have life changing consequences for the person with it, it is important to recognize the symptoms of bipolar disorder.  

Bipolar disorder is a mental illness which causes mood swings and mood cycling.  Mood cycling is the transition between mania and depression.  Mania typically consists of feelings of elation and invincibility, and may cause disorientation, lack of sleep, and obsessive behaviours.  Depression, on the other hand, typically consists of feelings of overwhelming sadness and low self worth. 

Treatments for bipolar disorder, range from medications to therapy.  There are too many medications to be discussed here in depth.  There are also many forms therapy can take, and techniques that can be learned to assist the patient in gaining some control over their bipolar disorder.

Typically, bipolar disorder is treated with more than one medication.  This is due to the dual nature of bipolar disorder.  Many patients need at least two medications:  one to control depression and one to control mania.  The combination of these two types of medication works to obtain balance in moods and stop mood cycling.  Often, a third medication, called a mood stabilizer, is also prescribed.  The most common mood stabilizer is Topomax.

Popular medications for treatment of mania in bipolar patients include lithium, valproate (Depakote), carbamazepine (Tegretol), olanzapine (Zyprexa), and ziprasidone (Geodon).  Lithium has long been considered the miracle drug of bipolar disorder.  It is a sodium based medication that helps to balance the chemical imbalance in the brain that causes manic episodes in bipolar patients.

Valproate, or Depakote, was originally developed as a seizure medication.  However, its effects on bipolar patients who have rapid cycling bipolar (moods that cycle every few hours or days rather than weeks or months), it has been quite effective.  Carbamazepine, or Tegretol, is another anti-seizure medication.  While it appears to have similar effects on bipolar disorder as Depakote, it has not yet been approved by the Food and Drug Administration for use as a bipolar disorder treatment. 

Olanzapine, or Zyprexa, and Ziprasidone, or Geodon, are both anti-psychotic drugs, and are particularly effective for treatment of bipolar disorder in which mania becomes so severe that psychotic symptoms are present.

Medications for treatment of depression are called anti-depressants.  Common anti-depressants include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).  All of these medications have been proven to be successful treatments for depression, although Celexa and Prozac are the most commonly prescribed.

Usually, treatment of bipolar disorder includes a combination of medications and therapy, or counselling.  However, in some cases, medication may not be necessary for milder cases of bipolar disorder.  In other cases, medication may not be desired by the patient, and the patient may wish to seek out other alternatives to medication for treatment of their bipolar disorder.

For these patients, Cognitive Behavioural Therapy (CBT) can be quite effective.  CBT is a method of bipolar disorder treatment that involves teaching the patient techniques to recognize triggers and symptoms of their mood cycling, and use that information and recognition to prevent the triggers from occurring, or the mood cycling from being quite as severe.  Most of these techniques require the patient to develop cognitive thinking skills as well as critical thinking and problem solving capabilities.  If the bipolar disorder is severe to the point that the patient is unable to engage in these thinking abilities and skills, CBT may not be a viable form of treatment in and of itself.

Overall, there are many treatments available for bipolar disorder.  There are many options for the patient that can be discussed with the patient’s doctors.  If a patient is not satisfied with the form their treatment is taking, they should discuss it with their doctor, and not be afraid to change doctors in order to change treatment methods.  All in all, effective and successful treatment of bipolar disorder rests in the hands of the patient.