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Endocrine Disrupters and Endometriosis: Is there a link? Warren G. Foster, Ph.D., Department of Obstetrics & Gynecology McMaster University 1.0 ABSTRACT Endometriosis is a common gynecologic disease of unknown cause affecting approximately 10-15% of women of reproductive age and 50% of infertile women. Estrogen dependence and immune modulation are established features of endometriosis but do not adequately explain the cause of this disease. In recent years, evidence that environmental contaminants possess estrogenic activity has led to the hypothesis that exposure to hormonally active environmental contaminants contributes to the pathobiology of endometriosis. However, hospital based case-control studies have failed to provide compelling evidence for or against an association between environmental contaminant exposure and endometriosis. Results of animal studies however, suggest that it is biologically plausible for environmental contaminants to affect the pathobiology of endometriosis. Specifically, animal experiments implicate dioxin and dioxin-like compounds in this disease. Herein the literature linking environmental contaminants with endometriosis is reviewed and the link with endocrine disruption discussed. 2.0 INTRODUCTION Endometriosis is an estrogen-dependent disease defined as the growth of endometrial glands and stroma at extra-uterine sites and is present in approximately 10% of reproductive-aged women (Wheeler, 1992). Although the cause of endometriosis is unknown, several mechanisms have been proposed to account for the implantation of endometrial cells outside of the uterus including coelomic metaplasia, vascular transport and retrograde menstruation of endometrial cells. Back-flow of menstrual contents into the pelvic cavity is thought to afford endometrial cells the opportunity to implant outside 2 of the uterus and is the most widely accepted theory for the cause of endometriosis (Sampson, 1922). A number of lines of evidence lend support to this theory. First, endometriosis is found more often in women with outflow defects of the uterine cavity (Olive and Henderson, 1987). Secondly, partial obstruction of the cervical os in baboons resulted in endometriosis induction rates of 100 % within 3 months (D'Hooghe et al., 1994). Although retrograde menstruation or bleeding into the peritoneal cavity during menstruation is widely accepted as a major contributing factor in the pathogenesis of this disease, it is a common phenomenon occurring in approximately 70 to 90 % of women (Halme et al., 1984). Hence, factors other than access of endometrial contents to the pelvis via retrograde menstruation are thought to contribute to the pathogenesis of endometriosis. Endometrial cells destined to become endometriotic implants are thought to be different from normal endometrial cells, a notion that is supported by a number of distinct observations. Endometrial cells from women with endometriosis survived transplantation in athymic nude mice longer than normal proliferative phase endometrium from women without endometriosis (Bruner et al., 1997) suggesting that these cells are functionally distinct. There are several important changes in endocrine regulation of the endometrium that are proposed to be important in the pathobiology of endometriosis. Aromatase gene expression levels have been demonstrated to be greater in endometriotic cells compared to eutopic endometrium from women with endometriosis, whereas expression was absent in the eutopic endometrium of disease-free women and non-endometriotic pelvic tissues from women with endometriosis (Noble et al., 1996). Aromatase is the rate-limiting 3 enzyme responsible for the conversion of androgens (e.g. testosterone and androstenedione) to estrogens. It has also been shown (Zamah et al., 1984) that the endometrium of women with endometriosis metabolize estrogen less readily due to lower levels of the enzyme 17β-HSD-II, the enzyme that converts estradiol to estrone, a less potent form of estrogen. Taken together, increased aromatase expression and lower levels of 17β-HSD-II are proposed to create a high local estrogen environment in the ectopic endometrium that favors the survival of endometrial stromal cells and potentially endometriosis. While the critical event(s) or biochemical change(s) that ultimately leads to establishment of endometriosis remains an enigma, dysregulation of estrogen metabolism or signaling in the endometrium is likely to play an important role. 3.0 EPIDEMIOLOGY OF ENDOMETRIOSIS: Although endometriosis is a common gynecologic problem, surprisingly little is known about the risk factors contributing to this disease. Associations between endometriosis and various factors including reproductive health, personal habits, body characteristics, immunological, and genetic factors have been described. Of the sociodemographic factors thought to be important in the development of endometriosis, age is the only characteristic for which a consistent positive relationship has been observed. This association peaks among women aged between 40-44 years (Vessey et al., 1993). There also appears to be an increased risk in individuals from higher socioeconomic stratas. This association can, however, be explained in part by selection bias since these individuals are more likely to seek medical attention and surgical management. Additionally, delayed child-bearing or nulliparity in this group of women may also account for the observed relationship between 4 endometriosis, age and socioeconomic status. Nevertheless, we propose that there are two key risk factors that are associated with endometriosis. Specifically, conditions that increase the opportunity for retrograde menstruation and increased circulating levels of estrogens will increase a woman's risk for endometriosis. For example, shorter cycle lengths, longer duration of flow, delayed childbearing, and reduced parity are all associated with an increased exposure to estrogen and therefore increased risk of endometriosis (Eskenazi and Warner, 1997). Furthermore, endometriosis is more likely to be found in women with increased peripheral body fat compared to women with central obesity. This is thought to occur because women with increased peripheral body fat have elevated estrogen levels due to peripheral conversion of androgens to estrogens (Eskenazi and Warner, 1997). In contrast, lifestyle habits that appear to decrease estrogen levels have been associated with a decreased risk of endometriosis. These include smoking and exercise, which are thought to increase estrogen turnover by the liver (Eskenazi and Warner, 1997). 3.1 Human Exposure to Environmental Contaminants and Endometriosis: A small number of hospital-based case-control studies have been designed to explore the association between endometriosis and exposure to environmental contaminants. Exposure to polychlorinated biphenyls (PCBs) and dioxins has been loosely linked with endometriosis (Gerhard and Runnebaum, 1992; Koninckx et al., 1994). In the former study (Gerhard and Runnebaum, 1992), serum levels of PCBs 138, 153 and 180 were elevated compared to women without endometriosis. A letter to the editor (Koninckx et al., 1994) noted that the levels of dioxins in Belgium are among the highest in the world 5 and the incidence of endometriosis is also higher in this country than elsewhere. A positive association between endometriosis and dioxin (2,3,7,8-tetrachlorodiebenzo-p- dioxin, TCDD) exposure was reported in a single case control study in which 44 women with endometriosis were compared with 35 age-matched women with tubal infertility (Mayani et al., 1997). In this study, one control subject had a detectable level of TCDD whereas 8 women of 44 had detectable levels. While an OR of 7.6 was obtained, the 95% CI included unity (0.87 - 169.7) and thus it cannot be concluded that dioxin exposure alone is associated with endometriosis. It is possible; however, other chemical contaminants that act through a common mechanistic pathway may be involved. A weakness of this study is the failure to control for obstetrical history. Since a full term pregnancy and breast-feeding are thought to decrease body burdens of lipophilic environmental contaminants, it is not possible to determine if prior pregnancies may have accounted for the low number of detections observed in this study. In another study (Eskenazi et al., 2000) the association between endometriosis and exposure to dioxin has been investigated in women living in Seveso, Italy. Results of the Seveso Women's Health Study (SWHS) reveal a non-significant doubling of risk. In another study, no association between endometriosis and PCB specific congeners and organochlorine pesticide concentrations could be found in a case-control study of 86 women with endometriosis and 70 controls matched for the indication of laparoscopy (Lebel et al., 1998). In this study, congener specific PCB analysis was conducted as a surrogate for TCDD, which is thought to co-migrate with the PCBs. While the exposure assessment taken in this study permitted a broader assessment of the exposures that could influence the pathogenesis of endometriosis, the absence of a truly 6 unexposed control population and sample size limitations are both factors that may have prevented detection of an association between endometriosis and exposure. Similarly, another team of investigators was unable to find an association between endometriosis and exposure to dioxins and furans in a study involving 15 control subjects and 15 cases (Boyd et al., 1995). In a recent study (Pauwels et al., 2001) the association between endometriosis and environmental contaminant exposure was evaluated using the CALUX assay to determine the level of dioxin-like activity of chemicals present in the serum. In this study serum samples were collected from 42 women compared to 29 women without endometriosis. However, as in the previous studies no relationship between endometriosis and dioxin- like activity was found. The authors however note that this was a pilot study and a minimum of 100 subjects in each group would be needed to detect a significant association. Hence, all of the case-control studies described in the literature to date are relatively small, and thus may not have the statistical power to detect differences if they were indeed present. Therefore, the human data at present neither confirm nor refute the hypothesis that environmental contaminants play a role in the pathobiology of endometriosis. 4.0 Biological plausibility: 4.1 Non-human primate studies – Endometriosis was accidentally discovered in a reproductive/developmental toxicology study, in which rhesus monkeys were treated with TCDD (Rier et al., 1993). The monkeys were treated with TCDD for four years and several years after the study was initiated several monkeys developed endometriosis. 7 Laparoscopies were performed approximately 6 years after the completion of TCDD treatment to investigate the potential relationship between TCDD treatment and endometriosis. A dose-dependent increase in the incidence and severity of endometriosis was found in this study. However, Rier and coworkers (Rier et al., 2001) have subsequently reported the results of residue analysis of the serum for TCDD and PCB specific congeners from the monkeys involved in the original endometriosis study (Rier et al., 1993). Residue analysis revealed that the incidence and severity of endometriosis was not correlated with serum TCDD levels. However, elevated serum levels of 3,3',4,4' tetrachlorobipehnyl (TCB), 3,3',4,4',5–pentachlorobiphenyl (PnCB) were associated with a higher prevalence of endometriosis whereas the severity of endometriosis was correlated with the serum concentration of 3,3',4,4'-TCB. Both of these coplanar PCBs are believed to act through the aryl hydrocarbon receptor (AhR). The majority of the toxic effects of TCDD are thought to be mediated through the AhR (Mimura and Fujii- Kuriyama, 2003). A recent study (Ohtake et al., 2003) has demonstrated that low concentrations of TCDD bound to the AhR can interact with estradiol and its receptor to induce an estrogen-mediated proliferative effect in the mouse uterus. Consequently, it is suggested that AhR ligands together with or in addition to TCDD can act via an endocrine pathway and are important in the pathophysiology of endometriosis. In another reproductive/developmental toxicology study, monkeys were exposed to a commercial PCB mixture, Arochlor 1254, over a five-year period. As in the Rier et al., (1993) study several monkeys developed endometriosis raising concern that treatments were inducing this disease. Therefore, the monkeys were examined either by laparoscopy (control and high dose monkeys) or necropsy for evidence of endometriosis 8 and adenomyosis (growth of endometrial epithelial and stromal cells in the muscle wall of the uterus). Rhesus monkeys treated with the commercial PCB mixture, however failed to show any relationship between the incidence and/or severity of endometriosis and PCB dose (Arnold et al., 1996). It is proposed that the PCB mixture used in this study (Arnold et al., 1996) possesses low dioxin like activity and thus would not be expected to have similar effects to TCDD. In another study (Yang et al., 2000) the effect of TCDD on surgically induced endometriosis was investigated. The doses of TCDD employed in this study were selected to be equivalent to those used by Rier and colleagues (Rier et al., 1993) and expanded to include one lower dose level. Interestingly, this study revealed a bimodal effect of TCDD on the maximum and minimum implant diameter. Maximal and minimum diameters of the lesions were significantly greater in the 25 ppt dose group compared to the controls and reduced in the 1 ppt group compared to controls. Over the course of the study implants were found to regress in all treatment groups but significant differences were not found until the completion of the study at one-year post implantation. Survival of ectopic endometrial implants was also affected by TCDD treatment with survival being significantly enhanced at the 5 and 25 ppt level compared to the controls. Consequently, this study supports and extends the findings of the earlier study in rhesus monkeys (Rier et al., 1993). Furthermore, these data suggest that duration of exposure to TCDD and by implication other AhR ligands must be lengthy before effects on endometrial implant survival and proliferation can be discerned. 9 4.1 Rodent studies: Surgical induction of endometriosis in rodents has been used to investigate the effect of environmental contaminants on the establishment of endometrial implants, survival of existing implants, and mechanism of contaminant action. In two separate studies (Cummings and Metcalf, 1995a,b) involving mice and rats autologous uterine implants were found to be estrogen dependent and responsive to an estrogenic contaminant methoxychlor. In another study ovariectomized mice with autotransplanted uterine strips were used to demonstrate that administration of 4-chlorodiphenyl ether, an estrogenic compound, could facilitate implant growth (Yang et al., 1997). The rodent studies therefore reveal that estrogenic contaminants affect the survival and proliferation of autologous uterine implants in rodent models making these suitable models for testing chemical contaminants for potential activity in this disease. Accordingly, these models have been used to explore the effect of TCDD on the growth of uterine implants which has been shown to enhance the growth of implants (Cummings et al., 1996). Administration of 0, 3 or 10 µg TCDD/Kg on gestational day 8 and then again three weeks before surgical induction of endometriosis in both the rat and the mouse resulted in an increase in implant size (Cummings et al., 1996). In another study (Johnson et al., 1997), endometriosis was surgically induced in mice and the animals were treated with 0, 1, 3 or 10 µg TCDD/Kg; 3 or 30 mg PCB 153; 100, 300 or 1000 µg PCB 126/Kg; 10, 30, 100 µg 4-PeCDF/Kg; or 2 or 20 mg 1,3,6,8-TCDD by gavage, five times 3 weeks apart. Following necropsy 3 weeks after the final dose, 2,3,7,8-TCDD and 4-PeCDF significantly enhanced the growth of endometrial lesions whereas PCB 126 and the highest dose of TCDD were without effect on growth of the endometrial lesions. Moreover, the non-dioxin-like compounds were without effect on lesion growth. These 10 data suggest therefore that it is the dioxin-like compounds that possess the ability to modulate the pathophysiology of endometriosis. In contrast to these findings ovariectomized and estrogen-replaced mice, treated with 10, 50 and 100 ng TCDD/Kg/day resulted in inhibited growth of previously established implants (Yang and Foster, 1997). Taken together these data suggest that the dose of TCDD and that the length of time that the implants are exposed to TCDD are also important. Rodent models of endometriosis are complicated by a number of significant limitations. The estrous cycle in rodents is significantly shorter than in humans and is characterized by endocrinological differences such as an abbreviated luteal phase compared to humans. Moreover, circulating levels of estradiol in rodents are markedly lower than in humans. Therefore, extrapolation of rodent study results to humans is difficult and fraught with uncertainty concerning differences in the physiology of rodent uterine tissue vs. human endometrium. 5.0 SUMMARY AND CONCLUSIONS: The findings from epidemiological studies are inconsistent and thus these studies neither support nor disprove the hypothesis that exposure to environmental contaminants are linked with an increased risk for endometriosis. However, the biological plausibility of the association between exposure to environmental contaminants and endometriosis is provided by several non-human primate and rodent studies. Unfortunately, the mechanism of action underlying the observed effects remains to be determined and an endocrine mechanism has yet to be demonstrated. Therefore, while the evidence linking exposure to environmental contaminants and endometriosis is weak at present, evidence of biological plausibility for the hypothesis is strong and thus further study of the association between exposure to 11 environmental contaminants and endometriosis together with investigation of underlying mechanisms is needed. 12 6.0 REFERENCES Arnold DL, Nera EA, Stapley R, Tolnai G, Claman P, Hayward S, Tryphonas H, Bryce F. 1996. Prevalence of endometriosis in rhesus (Macaca mulatta) monkeys ingesting PCB (Aroclor 1254): review and evaluation. Fund. Appl. Toxicol. 31:42-55. Boyd JA, Clark GC, Walmer DK, Patterson DG, Needham LL, Lucier GW. (1995) Endometriosis and the environment: biomarkers of toxin exposure. Conference on endometriosis 2000, May 15-17, 1995, Bethesda, National Institutes of Health, 1995. Bruner KL, Matrisian LM, Rodgers WH, Gorstein F, Osteen KG. (1997) Suppression of matrix metalloproteinases inhibits establishment of ectopic lesions by human endometrium in nude mice. J. Clin. Invest. 99:2851-7. Cummings AM, Metcalf JL. (1995a) Induction of endometriosis in mice: a new model sensitive to estrogen. Reprod. Toxicol. 9:233-8. Cummings AM, Metcalf JL. (1995b) Effects of estrogen, progesterone, and methoxychlor on surgically induced endometriosis in rats. Fund. Appl. Toxicol. 27:287-90. Cummings AM, Metcalf JL, Birnbaum L. (1996) Promotion of endometriosis by 2,3,7,8- tetrachlorodibenzo-p-dioxin in rats and mice: time-dose dependence and species comparison. Toxicol Appl. Pharmacol. 138:131-9. D'Hooghe TD, Bambra CS, Suleman MA, Dunselman GA, Evers HL, Koninckx PR. (1994) Development of a model of retrograde menstruation in baboons (Papio anubis). Fertil. Steril. 62:635-38. Eskenazi B, Warres M. (1997) Epidemiology of endometriosis. Obstet. Gynecol. Clin. North Am. 24:235-58. Eskenazi B, Mocarelli P, Warner M, Samuels S, Vercellini P, Olive D, Needham L, Patterson D, Brambilla P. (2000) Seveso Women's health study: a study of the effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin on reproductive health. Chemosphere 40:1247-53. Gerhard I, Runnebaum B. (1992) Fertility disorders may result from heavy metal and pesticide contamination which limits effectiveness of hormone therapy. Zent. Bl. Gynakol. 114:593-602. Halme J, Hammond MG, Hulka JF. (1984) Retrograde menstruation in healthy women and in patients with endometriosis. Obstet. Gynecol. 64:151-4. Johnson KL, Cummings AM, Birnbaum LS. (1997) Promotion of endometriosis in mice by polychlorinated dibenzo-p-dixins, dibenzofurans and biphenyls. Environ. Hlth. Perspect. 105:750-5. 13 Koninckx PR, Braet P, Kennedy SH, Barlow DH. (1994) Dioxin pollution and endometriosis in Belgium. Hum. Reprod. 9:1001-2. Lebel G, Dodin S, Ayotte P, Marcoux S, Feron LA, DeWailly E. (1998) Organochlorine exposure and the risk of endometriosis. Fertil. Steril. 69:221-8. Mayani A, Barel S, Soback S, Almagor M. (1997) Dioxin concentration in women with endometriosis. Human Reprod. 12:373-5. Mimura J, Fujii-Kuriyama Y. (2003) Functional role of AhR in the expression of toxic effects by TCDD. Biochim.Biophys.Acta 1619 (3):263-8. Noble LS, Simpson ER, Johns A, Bulun SE. (1996) Aromatase expression in endometriosis. J. Clin. Endocrinol. Metab. 81:174-9. Ohtake F, Takeyama K, Matsumoto T, Kitagawa H, Yamamoto Y, Nohara K, Tohyama C, Kurst A, Mimura J, Chambon P, Yanagisawa J, Fuji-Kuriyama Y, Kato S. (2003) Modulation of oestrogen receptor signaling by association with the activated dioxin receptor. Nature. 423:545-50. Olive DL and Henderson DY (1987) Endometriosis and mullerian anomalies. Obstet. Gynecol. 69:412-5. Pauwels A, Schepens PJC, Hooghe TD, Delbeke L, Dhont M, Brouwer A, Weyler J. (2001) The risk if endometriosis and exposure to dioxins an dpolychlorinated biphenyls: a case-control study of infertile women. Hum. Reprod. 16:2050-5. Rier SE, Martin DC, Bowman RE, Dmowski WP, Becker JL.(1993) Endometriosis in rhesus monkeys (Macaca mulatta) following chronic exposure to tetrachlorodibenzo-p- dioxin. Fund. Appl. Toxicol. 21:433-41. Rier SE, Turner WE, Martin DC, Morris R, Lucier GW, Clark GC. (2001) Serum levels of TCDD and dioxin-like chemicals in rhesus monkeys chronically exposed to dioxin: Correlation of increased serum PCB levels with endometriosis. Toxicol. Sci. 59:147-59. Sampson JA. (1922) Intestinal adenomas of endometrial type. Arch. Surg. 5:217-80. Vessey MP, Villard-Mackintosh L, Painter R. (1993) Epidemiology of endometriosis in women attending family planning clinics. Br. Med. J. 306; 182-4. Wheeler JM. (1989) Epidemiology of endometriosis. Assoc. Infertility J. Rep. Med. 34:41-6. 14 Yang JZ, Foster WG. (1997) Continuous exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin inhibits the growth of surgically-induced endometriosis in the ovariectomized mouse treated with high dose estradiol. Toxicol. Indust. Health. 13:15-25. Yang JZ, Yagminas A, Foster WG. (1997) Stimulating effects of 4-chlorodiphenyl ether on surgically induced endometriosis in the mouse. Reprod. Toxicol. 11:69-75. Yang JZ, Agarwal SK, Foster WG. (2000) Subchronic exposure to 2,3,7,8- Tetrachlorodibenzo-p-Dioxin modulates the pathophysiology of endometriosis in the Cynomolgus monkey. Tox. Sci. 56:374-81. Zamah NM, Dodson MG, Stephens LC, Buttram VC, Besch PK, Kaufman RH. (1984) Transplantation of normal and ectopic human endometrial tissue into athymic nude mice. Am. J. Obstet. Gynecol. 149:591-7. 15
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Luck and the Irish, By RF Foster
Why Irish eyes are smiling
The transformation of Ireland in the past 20 years is one of the miracles of the modern economic age and already a subject for theses the world over. How did Europe's basket-case economy become, almost overnight, the most successful? Those who, like me, grew up in the Ireland of the Fifties, remember barefoot children, an all-powerful Catholic Church, endless poverty and mass emigration. We also remember happier aspects too: poetry, song and a respect and knowledge of age-old culture and mythology.
It has changed, not quite utterly, but certainly beyond easy recognition. The Ireland of today is bursting with prosperity and success, with the highest income per capita in Europe, and richer even than the US. A few years ago The Economist, somewhat dubiously, ranked it number one in the world for "quality of life". Foreign investment pours in and exports of high-value-added microelectronics and pharmaceuticals pour out. Emigration has reversed, although Ireland is probably the only country in the world whose population is less today than it was a century ago.
So how did the Irish pull it off? Roy Foster's answer is simple: they "got lucky". The boom was set off, and accompanied, by a series of what he calls "interconnected crises": scandal and corruption in government, a succession of political crises, planning blight, incompetent (and worse) leaders, and violence in the North. But it was also accompanied by the hugely successful creation of Brand Ireland, much copied by emerging countries from India to South Africa, by a low tax structure, EU money and, of course, enormous piles of foreign cash.
The cash won. But it was almost by accident. No one planned it, presided over it, chided it along or took responsibility for it. It just sort of happened – despite, rather than because of, everything those in power did to try to stop it.
Foster, professor of Irish history at Oxford, previously wrote a widely praised history of modern Ireland which stopped in 1972, the year of Bloody Sunday and the burning of the British embassy in Dublin. Luck and The Irish (note: not the hackneyed "Luck of the Irish") takes it up to the end of the millennium.
Except it doesn't. This book is more a collection of finely-drawn essays, loosely connected by the theme of modern Ireland, than it is a history. It doesn't seriously try to tackle the why, although the book is focused on the preconditions and the circumstances. The overwhelming evidence actually points to tax – hence Northern Ireland's attempts to persuade Gordon Brown to level the playing field and give them a corporate rate of 12.5 per cent. But no one understood the impact a 10 (now 12.5) per cent corporation tax rate would have when it was first introduced in the Republic. So luck will do just as well.
Charles Haughey gets an essay all to himself, and he thoroughly deserves it. Foster doesn't think much of him or his legacy and has a great deal of fun (there is a lot of fun in Foster's elegant writings) at his expense. Charlie is his big villain, his malign influence hanging over the whole period of modern Irish history.
Haughey's story is a truly amazing one: IRA gun-runner turned millionaire taoiseach (three times), collecting cash from friends and supporters and spending it on extravagant luxuries, including his own private island and an impressive collection of vintage wine. Thanks to the endless official inquiries and ongoing tribunals, we now know more than we want to know of Haughey's long, long trail of corruption, including the fact that he took payments equivalent to £30m between 1979 and 1996 and "granted favours in return".
Despite the volumes of evidence, we still don't know exactly what those favours were, and Haughey has taken his secrets to the grave. But we do know that they included approval for some of the most awful property developments ever seen in Ireland and the creation of a great deal of wealth for former bricklayers who became billionaires. Property developers have been the biggest beneficiary of the Irish boom.
That's the bad bit. There are good bits too – lots of them. Foster is much taken with the unexpected blossoming of the new Irish culture, which has gone global and which was born of this period of dislocation, crisis and change: the popular music of Bono, Geldof, Van Morrison and Enya (at one stage the most played musician in the world), inspiring an even larger number of second-generation Irish such as Shane MacGowan, Johnny Rotten (actually John Lydon), Liam and Noel Gallagher, and Elvis Costello. There was dance, too, with Riverdance; and the arrival of a new genre of novelist, notably John Banville, Colm Toibin, Anne Enright and Roddy Doyle, who have won more than their share of literary prizes.
Above them all, of course, is the towering figure of Seamus Heaney, with firm roots in the old Ireland but not to be left out of the new. All of these strut the world stage as the cultural output of no other European country does.
At the end of the day, Foster is not entirely certain whether the Celtic Tiger is a good or bad thing, and concludes, rather tentatively for such a self-assured historian, that it is probably a bit of both. It is a story, he says, citing the history of Haughey, of shade as well as light. And he is clearly tempted to conclude that the breakneck speed of change experienced by Ireland could mirror previous eras in Irish history, which "often ended in some great and traumatic upheaval".
Whenever he toys with that thought, however, he quickly draws back in the face of the sheer force of the change on every front in this period. The Catholic Church has been broken by a combination of women's emancipation and revelation after revelation of long-buried child abuse; there is peace in Northern Ireland, now the Mexico to the Republic's US; there are world-class businesses and economic numbers the rest of the developed world can only envy. So why not enjoy it? For centuries, Ireland had it so bad. Now, for the first time in centuries, it has never had it so good.
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The Dialogue of Devdas. Bimal Roy's immortal Classic features the film's complete dialogue by Rajinder Singh Bedi, based on a screenplay by Nabendu Ghosh. and lyrics by Sahir Ludhianvi. Presented in a three-language format: Hindi. Urdu. Romanised Hindi/Urdu and an English translation, the book also includes an introduction by Nasreen Munni Kabir and comments by Banal Roy's family. The hugely popular 1917 Bengali novella "Devdas" by the celebrated author So-at Chandra Chattopadhyay has inspired numerous film versions made in various Indian languages. Iris, however, Bimal Roy's 1955 film with its excellent and subtle dialogue, fluid direction and sublime cast that instill widely considered the most important adaptation in Hindi/Urdu. Notes on translator: London-based documentary filmmaker and author. Nasreen Munni Kabir was the first so present Indian film dialogue in a three-language format. starting with Mughal-e-Azorn. and followed by Awoaro, Mother Indio and Pyaoso. AR. Rahman: The Spirit of Music (Om Books International, 2011) was her most recent publication. ISBN - 9789380069883
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Updated December 11, 2013
Getting Started
- 95 Pictures of Santorini
- Video: The Best of Santorini
- Map of Santorini – A simple but detailed map of the island
- Santorini with Kids – 11 Tips
- Athens Guide – Essential info for visiting Athens
The Ultimate Guide to Santorini
- The Best Villages on Santorini
- The Best Beaches on Santorini
- The Best Hotels on Santorini
- Booking Hotels
- Package Holidays
- Best Time to Visit
- Hotels in Fira
- Hotels in Oia
- Hotels in Imerovigli
- Hotels for Families
- Honeymoon Hotels
- Cave Suites
- Quiet & Secluded Hotels
- Affordable Hotels with Caldera Views
- Hotels with Swimming Pools
- Cheap (but Good) Hotels
- Renting Apartments
- Best Sunsets
- Getting to Santorini
- Flights to Santorini
- Santorini by Ferrry
- Ferry Schedules
- Advanced Ferry Tickets
- Best Tours of Santorini
- Airport Transportation
- Ferry Port Transportation
- Renting A Car or Scooter
- Best Wineries
- Best Things to Do
- Day Trips from Santorini
- Santorini with Kids
- Best Restaurants
- Non-touristy and Greek Restaurants
- Gluten Free Eating
- Hotels with Kitchens on Santorini
- Santorini on a Budget
- Hospitals on Santorini
- Travel Tips from Travelers
- Hotels – Tripadvisor Travelers' Choice Awards
Q. What village on Santorini should I stay in?
Here's how I would summarize the choices:
- Best nightlife: Fira
- Best beach: Perissa or Kamari
- Food and restaurants: Fira or Oia
- Solitude and quiet: Vedema Resort in Megalochori
- Best sunset: Imerovigli
- Best budget choice: Perissa
- Best for families: Fira, Kamari, or Perissa (which has a waterpark). Monolithos has the most kid-friendly beach.
Santorini is small and getting from one town or beach to the next is quick and easy so you don't have to feel limited by the place you pick. Obviously, if you're primarily looking to spend time on the beaches then stay there and commute to Fira and Oia for sunsets and dinner. If you're more interested in shopping, eating, and sightseeing then Fira, Oia, and Imerovigli are a better base. The beach towns are fun, full, and busy from June to September. Outside of these months they'll be very quiet and the weather usually isn't warm enough for swimming
If you're looking to save money then the beaches tend to offer better value hotels for the money. Restaurants in Oia, Imerovigli, and Fira are also quite expensive (though there are cheaper options away from the views of the caldera). The beaches will tend to have pub grub food that is not so pricey – though not as good either.
As for Oia or Fira, both towns are very touristy but in different ways. Oia is quieter, more romantic, generally has more expensive hotels, and higher-end restaurants. After the sunset, Oia gets very quiet. Fira has the nightlife and lively restaurants. Fira is also closer to most of the beaches.
Fira itself can get quite noisy so if you're looking for peace and quiet but still want to be near the nightlife then Firostefani and Imerovigli are good options.
Like the beach towns, if you're visiting outside of June to September then Oia will be very very quiet – with many shops and restaurants closing from November to March.
Q. What are the best beaches on Santorini?
back to topSantorini is not known for its beaches. They are good but not great – so don't be expecting those idyllic stretches of sand you've seen in pictures of Greece.
Most of Santorini's beaches are composed of dark volcanic sand that gets searingly hot in the mid-day sun. Beach sandals or water shoes are highly recommended for getting around on the sand.
But what the beaches lack in typical sandy splendor they make up for with breathtaking views and scenery. The cliffs that loom around some of the beaches and the nature of the sand itself make a surreal setting for swimming and sunning. And once in the sea the water is cool and refreshing.
These are the most popular beaches on Santorini:
Kamari – The most upscale and touristy of the beach towns. Package tourism is well represented here. Lots of places to eat and drink. Very close to the airport.
Perissa, Perivolos, Agios Georgios – These 3 beaches are essentially one very long beach that caters to the backpacker crowd and party scene. The beach becomes progressively quiet as you move south towards Agios Georgios.
Red Beach – The pebbly sand here is red and the backdrop is stunning. Quieter than Kamari and Perissa but still has a bevy of restaurants, beach umbrellas and chairs.
Monolithos – The nicest sand and most family-friendly beach on Santorini. Very quiet with a small collection of hotels and restaurants. The shallow slope of the seafloor make it better for kids than the steep drop-offs at Perissa and Kamari. Theres a small play area for the kids on the sand.
Amoudi – The best swimming spot on Santorini. Take the path down from Oia and jump from the rocks into beautiful blue water. There's a small island that you can swim out to that has glorious views of the caldera. The best swimming is at the end of a seawall that begins at the wharf. The walk from Oia takes about 15 to 20 minutes and can be tricky in spots.
More details on Santorini's best beaches (A great summary).
Q. What are the best hotels on Santorini?
Santorini is known for its fantastic boutique hotels and the best luxury hotels on Santorini are essentially boutiques. The towns along the caldera on the west side of the island (Fira, Oia, and Imerovigli) are where you'll find most of the five star hotels on Santorini.
The best hotels fill early – it's not unheard of for these places to be fully booked one year in advance.
- Oia Castle Hotel – Oia (Hotel phone: +30 22860 71831)
- The Belvedere Santorini – Firostefani (Hotel phone: +30 22860 25496)
- Enigma Apartments & Suites – Fira (Hotel phone: +30 22860 24024)
- Tsitouras Collection – Firostefani (Hotel phone: +30 22860 23747)
- Katikies Hotel – Oia (Hotel phone: +30 22860 71401)
- Canaves Oia Hotel – Oia (Hotel phone: +30 2286 071453)
- Chromata Hotel – Imerovigli (Hotel phone: +30 2286 024850)
- Cosmopolitan Suites Hotel – Fira (Hotel phone: +30 22860 25632)
- Vedema Resort – Megalochori (Hotel phone: +30 2286 081796)
- Ikies – Traditional Houses – Oia (Hotel phone: +30 22860 71311)
- Astra Suites – Imerovigli (Hotel phone: +30 2286 024763)
Q. What is the best website for booking hotels?
HotelsCombined.com/Santorini consistently finds the best deals and is very reliable (which is important).
I use it to find the hotels with the best rates and then phone or email them directly to see if they'll match the price I found on HotelsCombined. About half the time they'll offer the same rate. And even when they don't you can ask detailed questions about any concerns you might have which can be helpful if you're traveling with kids or a large group. Also, if you're a member of a hotel rewards program then you're more likely to get points if you book directly rather than through HotelsCombined (though whether that's worth paying a little more is obviously dependent on the details).
Booking your hotel is absolutely mandatory if you're visiting in July and August. It's recommended for June and September. You can get away with not booking for visits in May and October. On other islands showing up without a booking can be half the fun but that doesn't apply to Santorini which is packed with tourists from June to September.
If you do arrive on Santorini during high season take anything you can find for the first night and then look around for a better place once you've put down your bags. If there are hotel owners meeting your ferry at the port they're an easy way to get a place to stay and a free ride into town. Be aware if they say you're staying "right in Fira" you're still probably going to be outside the town a little way. If you're really concerned about location get them to point to the location on a map. Almost all of these hotel owners are legitimate and trustworthy, though, as I say, they will fudge a little on the true location of their hotel.
Q. What is the best company for booking a package holiday to Santorini?
Package holidays are not my favorite way to see Greece – traveling independently is a much more rewarding way to see the islands. But if you're short on time or only going to Santorini then package trips can provide very good value. Sunshine.co/Santorini is very reliable and has some incredible prices for flight and hotel packages.
Q. When is the best time to visit?
Weather Summary for Santorini
- July and August: Hot, sunny weather with lots of crowds. Prices are at their peak. Sea water at its warmest and best for swimming. Ferries and flights run with the greatest frequency.
- May and June, September and October: Great weather. Sunny and warm but not blazingly hot like the summer. Tourists are many but not overwhelming. Everything is open and ferries are running nearly all of their routes. The sea might not be warm enough for swimming in May and October.
- November to April: This is winter and that means gray skies, cool weather, and rain. Few hotels and restaurants are operating (but enough to get by). Ferries have very limited schedules though there'll be one a day going to all main destinations.
The best weather on Santorini is from June to September. July and August are the busiest months when hotels are full and restaurants are crowded. If you're more interested in sightseeing, hiking, and great views then May and October are great months to visit.
How long to visit? – You need 2 to 3 days minimum to get a feel for the island, see the top attractions, experience the sunset from a couple of different locations, and eat lots of great food. You could easily fill a week with long walks, swimming and sunbathing, and lots more eating, clubbing, and dancing. If you have more than a week in Greece then I'd encourage you to see a different island as there so many great places I think you'd experience more by seeing Naxos, Mykonos, Crete, or Rhodes than staying in Santorini for a second week.
Q. What are the best hotels in Fira?
- Cosmopolitan Suites Hotel – An infinity pool perched right on the cliffs overlooking the caldera. This is one of the most praised hotels in Fira. Only 10 rooms here (individually furnished) so it's perfect for honeymooners – yet located in the heart of Fira. (Hotel phone: +30 22860 25632)
- Aria Suites – An amazing mix of luxury and friendliness, incredible views and exemplary service. Suites are beautifully decorated. The pool is one of the best in Fira and comes with views of the caldera. (Hotel phone: +30 2286 028650)
Q. What are the best hotels in Oia?
- Canaves Oia Hotel – A small intimate luxury hotel with few peers on the island. The view is absolutely stunning – perhaps the best hotel view on Santorini. Small pool with views of the caldera. Rooms are simple in a traditional Greek ambience. (Hotel phone: +30 2286 071453)
- Katikies Hotel – A larger resort than Canaves with 5 star everything. Incredible swimming pool, fantastic service, surreal architecture. All suites have their own plunge pool (honeymoon suite has a jacuzzi too). This is one of the best hotels in Greece. (Hotel phone: +30 22860 71401)
Q. What are the best hotels in Imerovigli?
- Astra Suites – A cliffside perch offers incredible views. Great pool, friendly staff, kitchenettes in all rooms. (Hotel phone: +30 2286 023641)
- Chromata Hotel – Fantastic in every way. Nice pool and wonderful service. (Hotel phone: +30 2286 024850)
Q. What are the best family hotels on Santorini?
On Santorini – for a family – a large hotel room probably means something around $150 to $200. Hotel rooms along the caldera (which include the towns of Fira, Imerovigli, Oia, and Firostefani) are priced at a premium. Families needing larger rooms or a bigger pool are better off at the beach resorts on the opposite side of the island. It's about 30 minutes by bus from Perissa or Kamari beaches to Fira.
Large rooms are rare and fill quickly. Book early!
- Pension George, Karterados – large rooms and a nice pool, 15 minute walk to Fira. (Hotel phone: +30 2286 022351)
- Smaragdi Hotel Perivolos, Perivolos – great pool near Perissa beach. (Hotel phone: +30 2286 082701)
- Aegean Plaza Hotel, Kamari – friendly staff, nice pool, minutes from the beach. (Hotel phone: +30 2286 028740)
- Vallas Apartments, Firostefani – for the location and amenities these are good value. (Hotel phone: +30 2286 022050)
- Caldera Butterfly Villas, Fira – great pool with caldera views, large family suites have kitchenettes. (Hotel phone: +30 22860 24856)
For more hotel and house recommendations for families go to Samkip.com/Santorini.
Q. What are the best hotels for a honeymoon on Santorini?
back to top
- Absolute Bliss Imerovigli Suites – Imerovigli
(Hotel phone: +30 2286 021310)- Chromata Hotel – Imerovigli
(Hotel phone: +30 2286 024850)- Canaves Oia Hotel – Oia
(Hotel phone: +30 2286 071453)- Vedema Resort – Megalochori
(Hotel phone: +30 2286 081796)- Zorzis Hotel Perissa – Perissa Beach
(Hotel phone: +30 2286 081104)
Q. What are the best cave hotels on Santorini?
Watch this video for a great introduction to Santorini and its cave hotels.
Cave hotels are very popular in Oia and are pretty much what they sound like – rooms and suites that are built into the cliffside to form a cave. They're usually decorated simply and sparsely, but when done right they're close to magical.
Two of the best cave hotels are Perivolas (+30 22860 71308) and Aris Caves (+30 2286 071511) – both of these are drop dead gorgeous. (The Perivolos is the hotel seen in the video above.)
If you're looking for a cave hotel that's a little "cheaper" then Lena's House (+30 22860 71910) and Delfini Villas (+ 30 22860 71600) are both great picks.
If you need a cave house then Dream Blue (+30 21080 02307) is a privately owned home that sleeps 6, has a fully equipped kitchen, a hot tub, 2 bathrooms, and free wi-fi. It's 350€ to 450€ a night (depending on season and number of guests) but it's an amazing house and worth it if you can afford it. The owner also rents a smaller house, My Blue, with traditional Santorini architecture. It sleeps up to 4 and costs between 290€ and 390€.
Q. What are the best hotels for quiet and solitude?
Three hotels stand out as providing a quiet and peaceful setting far from the crowds of Fira and Oia.
- Zannos Melathron Hotel – Pyrgos (Hotel phone: +30 22860 28220)
- Vedema Resort – Megalochori (Hotel phone: +30 2286 081796)
- Absolute Bliss Suites – Imerovigli (Hotel phone: +30 2286 021310)
Q. What affordable hotels have caldera views?
These hotels are not cheap but for budget-minded travelers that still want a caldera view they're the best hotels.
- Scirocco Apartments (Fira)
- Caldera Butterfly Villas (Fira)
- Theoxenia Hotel (Fira)
- Delfini Villas (Oia)
- Kallisti Villa (Oia)
- Aspa Villas (Oia)
- Gizis Hotel (Imerovigli)
- Sunset Hotel (Firostefani)
- Hotel Mylos (Firostefani)
- Villa Ilias (Firostefani)
- Blue Dolphins Traditional Apartments (Firostefani)
Q. What hotels on Santorini have swimming pools?
About half of the hotels on Santorini have swimming pools (here's a list from booking.com). Having a swimming pool can be worth it on Santorini as the beaches aren't the typical beautiful sandy types you find on most Greek islands. Try to see pictures of the swimming pool as many hotels will advertise their pool while it isn't much more than a large hot tub. Most pools on Santorini are heated by the sun so won't be terribly warm outside of June to September – and perhaps closed from November to April.
Q. What are some cheap hotels on Santorini?
If you're looking for a cheap room don't try to book specific hotels. Search for hotel discounts during your dates and go with the hotel that has the best mix of amenities you're looking for. Rates will vary depending on how many bookings the hotel currently has. And there are so many hotels in the budget and moderate price ranges it's really hard to narrow it down.
I have never stayed in a bad hotel in Santorini. Even the budget ones are clean and refreshingly simple.
Here are the best links for finding cheap hotels in Santorini:
- hotelscombined.com/santorini/Fira
- hotelscombined.com/santorini/Oia
- hotelscombined.com/santorini/Imerovigli
- hotelscombined.com/santorini/Firostefani
- hotelscombined.com/santorini/Kamari-Beach
- hotelscombined.com/santorini/Perissa-Beach
- hotelscombined.com/santorini/Perivolos-Beach
Generally, the hotels on the caldera (that is Fira, Imerovigli, and Oia) are much more expensive than the hotels on the east side of island (which is where all the beaches are located).
Of the towns near the caldera, the one that will have the least expensive hotels is Karterados. It's 1 mile from Fira and does not have views of the caldera but it's an easy walk into town and has much cheaper accommodations.
There is also a very good youth hostel in Oia with rates between €16 and €18 (Phone: +30 2286 071465) and a campsite near Fira (with private rooms, dorms, and a swimming pool).
Q. How can I rent an apartment on Santorini?
The best websites for renting apartments are:
- AirBnb.com – A great site for staying with (or near) locals and away from the really touristy areas.
- VRBO.com – The largest collection of villas and homes on the island.
Book very early in the year as the best places fill up more than 6 months in advance.
Q. What's the best town for sunsets on Santorini?
Imerovigli has the best sunsets of any town on Santorini. The hotels in Oia generally have either a view of the caldera or views of the sunset (this is a simplification as it also depends on the time of the year but for the most part it's true). Fira's sunset views are often blocked by the small island of Thirassia. Imerovigli has neither of the these problems and is perched high on a cliff with great views of the sunset and the caldera.
- The best hotels for sunset views in Imerovigli: Absolute Bliss Imerovigli Suites, Astra Suites, and Chromata Hotel.
- Many hotels in Oia do not have sunset views. The ones that do are: Oia Castle Hotel, Esperas Traditional Houses, Marizan Caves & Villas, Fanari Villas, and Golden Sunset Villas.
Q. What's the best way to get to Santorini?
Flying to Santorini is the quickest and easiest way. You can fly to Santorini from Athens or directly from cities in western Europe such as London, Manchester, Paris, and Amsterdam. There are few flights to Santorini from other Greek islands – though this can change from year to year and some summers will there will be flights from Heraklion (Crete) and Rhodes to Santorini.
If you're already in the Athens city center it can be easier to take a high speed ferry or catamaran from Piraeus (the Athens port) than to deal with getting to the airport and through security. But flying would still be a few hours faster.
The big advantage of flying to Santorini is that it's much easier to book flights in advance than to book ferries in advance (see below). But if you're on a flexible schedule or you're already in Greece (and can book the ferry at a travel agency) it's very easy to book ferry tickets. It's the booking in advance, figuring out routes and timetables from outside the country, that makes ferry travel difficult.
Arriving by ferry in Santorini is a great experience. The cliffs loom over your boat and it's a really awesome first impression of the island. (Less so if you arrive by hydrofoil as you're trapped inside, behind glass windows – but it's still impressive.)
A good compromise is to ferry to Santorini and then fly back. If you're island hopping Santorini has good connections with most of the other popular islands like Crete, Mykonos, Naxos, and Paros. Rhodes is more difficult (and a longer ferry ride) but still doable.
A 2nd class or "deck" ticket on one of the large (slow) ferries is the cheapest way to get to Santorini.
Q. What airlines fly to Santorini?
Direct Flights from Europe to Santorini
A great way to see more than one island is to fly into one island (e.g. Santorini), take a ferry to another island (e.g. Mykonos), and then fly home from there. You save the time, hassle, and cost of returning to your initial destination.
Many airlines fly to Santorini from large cities in Western and Northern Europe. Here are some of them though the list is constantly changing:
- EasyJet – Flights from Rome, Milan, London Gatwick, and Manchester to Santorini. Also has flights from Western Europe to Athens, Mykonos, Crete, Rhodes, and several other islands.
- Air Berlin – Flights from Berlin, Frankfurt, Hamburg, many more German cities, Paris, and Copenhagen to Santorini and many other Greek Islands.
- FlyThomasCook – Flights from Manchester, London Gatwick, and Birmingham to Santorini. Also flights between the UK and Rhodes and Heraklion, Crete.
- Thomson Flights – Flights from Manchester, Birmingham, and London Gatwick to Santorini. Flights from many UK cities to Rhodes, Crete, and Mykonos. Also, if you're traveling to Turkey there are flights from Bodrum, Dalaman, and Antalya to the UK.
- Lauda Air – Flights from Vienna to Santorini.
- NIKI – Flights from London, Paris, Copenhagen, Munich, Berlin, Milan, Rome, and Vienna to Santorini. Flights between Europe and Rhodes, Crete, Athens, Samos, Kos, Lesvos, and Corfu. One of the few airlines to offer flights from Barcelona to Mykonos.
- Germanwings – Flights from Bonn/Cologne to Santorini. Flights from Crete and Rhodes to many European cities as well as Crete to Izmir which could be handy if you're traveling to Turkey.
- TUI Fly – Flights from many German cities and Vienna to Santorini, Crete, Karpathos, Rhodes, and Kos, as well as several cities in Turkey.
- Transavia – Flights from Paris and Amsterdam to Santorini. Also flights from many European cities to many Greek islands including flights to and from Chania which could be of interest to travelers who want to see Crete.
- Norwegian – Flights from Stockholm, Oslo, and Copenhagen to Santorini. Connecting flights to New York City.
- Meridiana – Flights from Rome, Milan, Verona, and Bologna to Santorini and Mykonos.
- Condor Air – Flights from Dussledorf, Hamburg, Bonn/Cologne, Frankfurt, and Munich.
- Jetairfly – Flights from Brussels to Santorini. Also flights from Brussels to Chania, Heraklion, Rhodes, Kos, Samos, and Mykonos.
- Edelweiss Air – Flights from Zurich to Santorini. Flights from Zurich to Mykonos. And flights from Zurich and Geneva to Heraklion, Crete.
- Air Baltic – Flights to Athens and Santorini from Riga and other European capitals (though as of spring 2013 not showing many flights).
- AtlasJet – No direct flights to Santorini but does have flights from Istanbul to Mykonos making it the most direct way from Turkey to Santorini.
Flights from Athens to Santorini
- Olympic Air – 4 to 6 flights a day from Athens to Santorini.
- Aegean Airlines – 3 flights per day from Athens to Santorini. 1 flight per day from Thessaloniki to Santorini for June 26 to September 13, 2013.
- SkyExpress has a route map that is always changing but will sometimes have flights from Crete to Santorini and Rhodes to Santorini. (Update April, 2013: It does not appear that SkyExpress is flying to Santorini for the summer of 2013. There are flights from Crete to Rhodes that might be of interest to visitors to Santorini.)
- Astra Airlines – In summers past has run flights from Thessaloniki to Santorini but as of Spring 2013 nothing planned. They were, however, advertising flights on May 3 and May 6 from Thessaloniki to Mykonos and Santorini.
- AirSeaLines has ceased operations so if you read they have flights from Santorini to Athens, Crete, and Rhodes this is no longer the case.
- Athens Airways ceased operations in the fall of 2012.
Q. How do I get to Santorini by ferry?
Up to 8 ferries a day sail the route from the Athen's port (Piraeus) to Santorini. The ferry from Piraeus to Santorini takes 4.5 hours by high speed ferry or catamaran (cost: 60 euros) and 9 hours by the slower car ferries (cost: 34 euros).
The large car ferries and the high speed ferries provided a much smoother ride than the catamarans. If you're sensitive to seasickness then avoid the catamarans.
Buying tickets a few days in advance should be enough to secure a space for 2nd class (airplane style seating). Book several weeks in advance if you want a cabin or need to take a vehicle.
Buying tickets online in advance is a pain (routes aren't published until 2 or 3 weeks before the date, the websites are confusing, and you need to visit 3 or more websites to see all the available ferries) – but you'll sometimes need to book in advance (or want to for peace of mind). You'll rarely, if ever, need advance tickets for ferries to Santorini from other Cycladic islands so just purchase these a day or 2 before sailing at a travel agent on whatever island you happen to be on. When you do need to buy tickets in advance these are the most useful websites:
- Amphitrion Holidays – If you need help from a travel agency to book your ferry tickets then Amphitrion can do it for you (with added fees). Then pick up your tickets after you arrive. They have offices in Santorini, Athens, the Athens airport, Mykonos, and Crete.
- Greek Travel Pages – This is the single best page for finding routes and timetables for all Greek ferries – but it is still challenging to use.
- Hellenic Seaways – The fastest ferries to Santorini from Piraeus but only one departure a day, usually in the early morning. Also have ferries from Santorini to Heraklion, Paros, and Ios and the only service between Mykonos and Santorini.
- Anek Ferries – Multiple departures a day from Piraeus. Also ferries from Heraklion, Crete and Rhodes to Santorini.
- Blue Star Ferries – Multiple departures a day from Piraeus. Also ferries from Santorini to Naxos and Santorini to Rhodes.
- SeaJets – Runs from Santorini to Crete and several Cycladic islands. These are the smaller catamarans and the route to Crete can be especially rough.
Q. How often do ferries arrive and depart?
The most important ferries to and from Santorini are:
- Blue Star – Daily ferries to Santorini from Piraeus, Naxos, Paros, and Ios. And from Santorini to Ios, Paros, Naxos, Piraeus and Rhodes (summer only). If you're prone to seasickness this is the best ferry to and from Santorini.
- Flying Cat 4 – From Heraklion (Crete) to Santorini continuing on to Paros and Mykonos.
- Sea Jets – High speed catamarans between Santorini and Heraklion, Ios, Paros, Naxos, and Mykonos.
- Anek Ferries – The only year-round ferry from Santorini to Rhodes. Also service to Heraklion, Karpathos, and Piraeus.
Ferry schedules do not come out until a few weeks before sailings so the schedules linked to above could are not set in stone. But while the times and departures might change, the general routes are fairly consistent and you can be pretty sure about the following connections from the Athinios port (Santorini's main port) during summer months:
Heraklion (on Crete): 1 ferry, 1 catamaran daily.
Kos: 2 ferries weekly.
Milos: 2 ferries weekly, 1 catamaran daily.
Mykonos: 2 catamarans daily.
Ios, Naxos and Paros: 2 ferries daily, 1 to 2 catamarans daily
Piraeus (Athens): 5 ferries daily, 3 catamarans daily.
Rethymno (on Crete): 3 ferries daily.
Rhodes: 1 to 2 ferries daily.
Serifos and Sifnos: 2 ferries weekly.
Sikinos: 1 to 4 ferries daily, 1 catamarans weekly.
Syros: 2 ferries weekly.
Thessaloniki: 4 ferries weekly.Catamarans or high speed ferries are about twice as fast as conventional car ferries and cost about twice as much. During rough seas catamarans are canceled much more frequently than the slower car ferries. When they do run during rough or windy conditions life on board can be brutal for those prone to seasickness.
If you want to avoid taking a catamaran between Santorini and Mykonos take the Blue Star ferry to Paros and then switch to a high speed ferry for the rest of the way to Mykonos.
Q. Should I book my ferry ticket in advance?
If you have a car and need a spot on the ferry for your vehicle then yes, you need to book your ferry in advance.
If you are traveling overnight to Rhodes, Crete, or Athens and want a cabin then yes, booking in advance is a good idea as well.
Otherwise, the large ferries almost never sell out. Occasionally the high speed ferries will sell out but usually buying a day or 2 in advance is fine. Purchasing ferry tickets from outside the country is a pain and if you can avoid doing so you should.
Once again (repeating myself here), booking ferry tickets in advance from outside the country is head-bangingly difficult. But in-person, and in-country, it's pretty easy. Ferries rarely sell out so if you can buy a day or two in advance you'll be fine most of the time. On the popular routes there will be more than one ferry a day (e.g. Athens to Santorini) so even if a ferry did sell out, as long as you have a flexible schedule, you can jump on a later ferry, or at worse, one the next day.
Oh, and ferries can be cancelled due to rough seas, high winds, and strikes. (It's always a good idea to arrive in Athens a full day before your flight home to allow for any ferry cancellations.)
But, all in all, traveling by ferry is fun and an authentic way of seeing the country. Just be flexible and patient.
Q. How do I get from the airport to Fira and the rest of the island?
- Taxi – The easiest and quickest way to get into Fira and to the rest of the island is by taxi. There will always be taxis available at the airport though it can involve a long wait (especially if 2 flights arrive at the same time). It costs about 15 euros to Fira and 20 to 25 euros to go to the rest of the island. Taxi rates and reservation info. Taxi phone number: 22860-22555.
- Bus – In high season (roughly June to September) buses run every hour between Fira and the airport. Most of these buses are running the Fira to Monolithos route and make a stop at the airport – although there might be a few additional buses each day that do only the Fira to airport run. There are fewer buses on the weekend and also fewer buses during the low season. It takes about 15 minutes to get from the airport to Fira by bus and costs about 2 euros. Plan to have small change available so that you don't need to ask for change from a 50 euro note. If you want to go anywhere else other than Fira (or Monolithos) you'll need to change buses in Fira (which is easy enough, but time consuming). Santorini bus schedule.
- Minivan/Airport Transfer – This is a good choice for singles going anywhere or couples going to a town other than Fira (if there are no buses or you don't want to take a bus). But for 3 or more it's cheaper to take a taxi as the fare is about 9 euros/per person. Contact Santorini Transfers to arrange pick up at the airport or your hotel.
- Hotel Pickup – If your hotel offers free pickup and dropoff be sure to take advantage. Most do charge but as long as it's close to the taxi rate it's a good choice.
Q. How do I get to and from the ferry port in Santorini?
All ferries arrive at Athinios port (transportation info below). If you're arriving by cruise ship you'll be tendered in a small boat from the ship to the a wharf directly below Fira. From there you can either climb the steps (a lot of them) or take a cable car (which will probably involve waiting some time in a line). There are also donkey rides up the path you walk but many find their use offensive so be prepared for some dirty looks by people who don't think donkeys should be used (abused) in this manner.
- Bus – A bus leaves from Fira to the ferry port about 1 hour before every ferry departure and arrival. There should always be a bus waiting as your ferry arrives at the port. If you're staying in a town other than Fira you'll need to get to Fira first and then switch buses there. The cost form the port to Fira is about 2 euros. The bus from the port to Fira takes about 20 minutes and drops you at the bus station in the middle of Fira. The bus, like all buses on Santorini, is air conditioned and has plenty of room for luggage.
- Taxi – There will usually be taxis waiting as ferries arrive but if it's late at night you might want to arrange pickup in advance. It costs about 15 euros from the ferry port to Fira, 25 euros from the ferry port to Oia, and somewhere in-between to go anywhere else on the island. A taxi ride from the port to Fira takes about 15 minutes. Taxi phone number: 22860-22555.
Q. What are the best tours in Santorini?
There are 2 main types of tours in Santorini: boat and bus tours.
- Bus tours visit the following attractions: Akrotiri, Ancient Thira, different wineries, Oia, Pyrgos and potentially a few other sites. If you're able to rent a car you're probably better doing it yourself but if you're short on time, don't feel like driving, or want a quick sprint around the highlights they're a good choice.
- Dakoutros Bros has the glass bottomed Calypso boat that visits the nearby islands in the Santorini caldera. There are full and half day tours that take in Thirassia, Nea Kameni (where you climb the volcano and swim in a hot spring), and Red Beach. (There are also sunset boat tours as well.) Tours will leave from both Amoudi Bay (near Oia) and Athinios (near Fira) with bus connections from both towns included. Tickets are available from any travel agent in Santorini so don't bother booking in advance unless you're on a very tight schedule. Tickets coast between 20 euros and 40 euros. This is a cheap way to do a boat tour but be warned you could be on a boat with up to 50 other guests and this can turn some people off.
- For a much more intimate (and costly) tour of the same attractions you can do a semi-private boat tour with Captain George or Captain Ted. These are on smaller yachts or catamarans with 6 to 12 guests. You can charter the whole boat too if you're willing to pay a bit more. Per person these tours run about 150 euros or 600 to 1000 euros for a private charter.
Q. Where and how do I rent a car or scooter?
There are rental offices all over the island that will rent a car or scooter to you. Two that are reliable are Vazeos in Oia and Spiridakos (which offers free pickup at the port, airport, or your hotel).
Booking in advance is not absolutely necessary but if you require an automatic transmission during July and August then it's probably best (most cars are standard).
If you have a child it's recommended to bring a car seat from home – some rental agencies do have a few but they tend to be older and not up to British or American standards (though they'll do in a pinch).
EU drivers licenses are perfectly acceptable for renting a car. But if you're not from the EU be sure to get an International Drivers permit before leaving home. It's possible to rent a car, motorbike, scooter, or ATV by showing your passport and a current drivers license from your home country. But this is not advised even when allowed.
If you get into an accident your insurance will be not be valid because you will have been driving illegally. If you don't have the International Drivers Permit the Greek police will have a lot of questions too. Greek Law requires an IDP and if you don't have it, you could be detained until you pay for repairs to the damaged vehicles.
Q. What are the best wineries to tour on Santorini?
Santorini is famous for its wine and many wineries offer well-regarded tours. Most wineries are closed on Sunday so check their schedules online before visiting.
- Koutsoyannopoulos Wine Museum, Kamari – A 300 meter long cellar (8 meters underground) that hosts a wine museum. The museum presents the history of Greek wine and the life of vine-growers in Santorini since the 1600s.
- Santo Wines, Pyrgos – The most comprehensive tours of any winery. It has a large shop filled with wines and local food specialties. Fantastic views of the cliffs and caldera.
- Boutari, Megalohori – Taste 8 high quality wines for 8 euros from Santorini's largest winery.
- Sigalas, Oia – A small winery a short walk from a bus stop on the Fira-Oia bus route. It has wine tastings with appetizers from April to October.
Q. What are the best things to do on Santorini?
- Archeological Museum – Fira
- Museum of Prehistoric Thira – Fira
- Megaro Gyzi Museum – Fira
- Petros M Nomikos Conference Centre – Fira
- Folklore Museum of Santorini – Fira
- Ancient Thira
- Ancient Akrotiri
- The beaches
- Wineries
- Boat tour of the caldera, Nea Kameni, and Thirassia
Q. What islands have day trips from Santorini
Santorini does not have any nearby islands making day trips impractical for most visitors. (The tiny island of Thirassia just across the caldera, of course, offers many day trip possibilities.) Most ferries are based on other islands or back in Athens and thus it's usually mid-day before they even arrive in Santorini. If you really want to make a day trip to another Greek island your best bet is to wait until you've arrived in Santorini. Then visit a travel agency and enquire about the ferry schedule to and from Santorini's neighboring islands. If it seems like the amount of time you'll get on the island is worth the journey then book the ticket. If not, then don't. Ferry schedules are always changing and rarely are released more than a few weeks in advance. A day trip requires fairly precise timing to pull off so it's best to wait to arrange until you're in Greece and can be certain of the schedule. Ferries on these short routes from Santorini will almost never sell out so don't worry about finding a spot onboard.
The most likely candidate for a day trip from Santorini is Ios. It has fantastic beaches and a young and fun party vibe – though the clubbing doesn't get going until late at night so day-trippers won't encounter anything too hedonistic. With a little luck you could have 6 or 7 hours on the island making the 35 minute boat trip from Santorini worth the effort. Mylopotas Beach (one of the best in Greece) and the Chora (the main town up a steep cliff from the port) are well connected to the harbor by a short bus ride. The ferry from Santorini to Ios is €20 one way.
Naxos and Paros are both (just) possible but even with the best possible ferry connections you'd have little more than 2 or 3 hours to explore the island. Except in rare circumstances a day trip to Mykonos is not possible from Santorini. The journey from Santorini to Mykonos is more than 2 hours and 30 minutes and there are rarely returning boats that make the trip doable in a day. A day trip from Crete to Santorini is sometimes possible with Hellenic Seaways from Heraklion. But a trip going from Santorini to Crete does not work with the ferry timetable. Anafi is another island that would seem to allow for a day trip but since ferries run to Santorini in the morning and back to Anafi in the afternoon any visit would require staying a night on Anafi.
Q. What are the best things to do with kids?
Santorini is not on my list of the 5 best Greek islands for kids – but there's still lots to do to keep kids busy. There's a water park in Perissa, the boat tours around the caldera are great for kids and feature plenty of activity (including swimming and hiking), and, of course, swimming at the beaches is always fun (Monolithos has a kids' play area, nice sand, and a shallow slope to the water).
Read 11 Tips for visiting Santorini with kids for a full rundown.
Q. What are the best restaurants on Santorini?
Selene in Pyrgos (10 minutes from Fira) is widely considered the best restaurant in Santorini and one of the top in Greece. Reservations are (almost) mandatory in summer and must be made at least 48 hours in advance – though I would reserve as soon as you have a date in mind. The restaurant also offers one and three day cooking courses for traditional Greek food.
For a romantic dinner with cliffside views of the caldera Ambrosia in Oia is one of the best on Santorini.
In Fira, the best restaurant is likely Koukoumavlos. Housed in a former sea captain's house and with good views, wonderful service, and inventive local food. Reservations recommended.
Q. What are some good traditional restaurants on Santorini?
All restaurants receive tourists but some that have a more Greek feel (and might be less expensive) are:
Q. Is gluten free food available at restaurants and grocery stores?
Finding gluten free food is relatively easy in Santorini. Fresh fruit, vegetables, meat, and seafood are readily available and form the basis of traditional Greek cooking. Grocery store sell some gluten free items but not as many as you'll find in Athens or Western Europe. Most restaurants cook from scratch which makes it easier to derive the ingredients of different dishes. Most servers and cooks on Santorini will have heard of gluten free diets (this might not apply if you're traveling to other smaller Greek Islands). If you're ordering a meal without bread you might also want to say no pita as your server might not equate the two.
Print or bookmark this glossary of eating, cooking, and food terms in Greek and this card which explains gluten free dietary requirements in Greek (here's the english version).
Q. What hotels on Santorini have kitchens?
These hotels have fully equipped kitchens with cutlery, dishes, and some cookware. (Almost every hotel on Santorini will have a fridge and coffee maker.)
- Astra Suites (Imerovigli, luxury)
- Caldera Butterfly Villas (Fira, mid-range)
- Atalos Villas (Kamari, mid-range)
- Villa Aretousa (Perissa, mid-range)
- Rhapsody Traditional Apartments (Imerovigli, mid-range)
- Enplo Apartments (near Oia, budget)
- Kykladonisia Hostel (Fira, budget).
Q. How do I see Santorini on a budget?
4 tips for saving money while visiting Santorini.
- Search for hotel deals on Hotelscombined.com/Santorini – This is the best way to find discounts, rather than looking at specific hotels.
- Get a room without a view – If you're staying at any of the towns along the caldera having a view will cost a premium. Many restaurants have views of the caldera and there are great walks along the caldera edge – so it's not as if you're foregoing the enjoyment of the Santorini cliffside.
- Eat where the locals eat – Santorini is mainly geared around the tourist trade but there is still a vibrant local community that has its favorite restaurants. If a restaurant has a touristy feel (which will of course include the restaurants along the caldera) then you'll be paying more for food. Look away from the touristy areas for less-trendy local eateries that will be less than half the price of the touristy restaurants.
- Get a hotel with kitchenette – Eating in for one or two meals a day is a great way to save a lot of money. (Breakfast is an especially easy meal to prepare in a hotel.) Grocery stores and fresh produce markets are easy to find. See above for a list of hotels with kitchenettes.
Q. Is there a hospital on Santorini?
The Central Clinic of Santorini is a small medical clinic located in Fira, near the bus station. It's open 24 hours a day, 7 days a week (although serious medical issues will need to be evacuated to Athens). Map of clinic. Emergency phone number: +30 22860 21728. Email: email@example.com
Recommendations from Travelers
- Suggestions for a Hotel with an Infinity Pool (Aug 02, 2013)
Check Perivolas Villas, Kirini Suites, and Katikies Hotel, all in the most beautiful village and all with infinity pools.- Trip report on Santorini and Perivolos in October (Oct 18, 2009)
VILLAGE TOUR – Because we were on a budget (and reliant on the local bus), we decided to book this at a local tour agency for 20 euros each. We found it to be good value and cheaper than going to these places independently.
VOLCANO, HOT SPRINGS, AND SUNSET IN OIA TOUR – Booked locally, this cost us 25 euros each. The boats are quaint, have a bar, and are well equipped. However, we found this tour tough, and dissapointing.
OIA – A lovely place, but, not somewhere I would like to spend my whole holiday. I think that staying in Perivolos, or Perissa offers you a better opportunity to experience all that Santorini has to offer on a budget.
ILIADA STUDIOS – Great location, near bus stop to Fira, the beach, the local shop and tour company. Accessable to a cheap supermarket (towards Emporio), Vlichada Marina, Perissa and Ancient Thera. The Iliada Studios are basic, but very clean appartments.- Trip Report Kamari and Beyond (July 20, 2011)
We found one of the nicest places to watch the sunset was at Senor Zorbas which is a Mexican restaurant outside of Fira, yes it was more expensive than Kamari but the food was outstanding. The view is stunning.- Cruise Ship Transfers from Fira Dockside (May 8, 2013)
Booked and paid for Satorini Planet transfers to Oia but it never eventuated. Arrived for the 9.30am transfer as booked but after a few queries, raised eye brows and phone calls was told there would be no transfer to Oia that morning due to insufficient numbers. They need around 15 people before they are willing to operate the service. Although my money was refunded it was incredibly disappointing.- Best View in Oia (Aug 28, 2013)
I've stayed in both Aspaki and Oia Castle Hotel (Art Maisons) and the views from both are spectacular.- Accommodation with a view in Oia? (Sept 6, 2013)
Fotinos Houses – I stayed there with my family last summer and it was wonderful. It's a real gem in a spectacular spot that has much lower rates than many of the cave houses in Oia.- Airport to Port by taxi (Aug 26, 2013)
In June we were charged 25 euro from airport to port with taxi from the rank outside the airport,we had 2 cases and 2 small hand luggage for 2 of us.
Tripadvisor Traveler's Choice Awards
back to topTop 25 Luxury Hotels in Greece
- #3 Katikies Hotel, Oia
- #6 Canaves Oia Hotel, Oia
- #7 Andronis Luxury Suites, Oia
- #8 Oia Castle Hotel, Oia
- #9 Aigialos Hotel, Fira
Top 25 Small Hotels in Greece
- #1 Anastasis Apartments, Imerovigli
- #3 Enigma Apartments & Suites, Fira
- #5 Ikies – Traditional Houses, Oia
- #6 Mill Houses Studios & Suites, Firostefani
- #10 Anassa Deluxe Suites, Kamari
- #13 Atrina Traditional Houses, Oia
- #15 Petit Palace Suites Hotel, Fira
- #16 Kapari Hotel Imerovigli, Imerovigli
- #17 Oia Castle Hotel, Oia
- #18 Andronis Luxury Suites, Oia
- #19 Afroessa Hotel, Imerovigli
- #20 Aria Suites, Fira
- #22 Aigialos Hotel, Fira
- #23 Chromata Hotel, Imerovigli
- #24 Altana Traditional Houses, Imerovigli
Top 25 Bargain Hotels in Greece
- #2 Antonia Hotel Santorini, Fira
- #7 Artemis Villas, Imerovigli
- #10 Atalos Villas, Kamari
Best Island in Greece Travelers' Choice
- #1 Santorini


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Doppio: Issue 20
Doppio 20 lives the high life with the USA Pro Cycling Challenge, featuring a map of the seven-stage race, a glimpse into its history and information on where spectators can find free espresso each day at the Mobile Cycle Club.
There's also a look at the difficult history of the under-rated Eneco Tour, and some good news for Rapha-Condor-JLT in advance of their home Tour in September.
The Doppio is available in all Cycle Clubs – San Francisco, London, Osaka, and the newly opened Sydney – and can be downloaded as a PDF here each week.
Best enjoyed with an espresso or two.
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Hyperrealistic Pencil-Drawn Portraits by Olga Larionova
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Google, Southwest employees have better 401(k) than you
Updated On: Sep 06 2013 09:58:23 AM CDT
Lawyers, tech workers and airline pilots have some of the best 401(k) plans in the country, often carrying low fees and high account balances that will give employees a much better shot at a secure retirement, according to a report released Friday.
But those working in retail or food services may want to start saving some extra pennies. These workers have plans that are among the worst in the nation, according to Brightscope, which gathers 401(k) data for tens of thousands of company plans.
Brightscope ranked company 401(k) plans on hundreds of factors, including fees, participation rates, investment options and the level of employer and employee contributions. They then calculated industry averages based on all company plans with at least $100 million in assets.
Savers in the top 25 tech company plans, for example, received average employer contributions of $5,708 a year, while those in the top 25 airline plans received nearly $10,000 annually.
Within these top industries, Google and IBM and pilot-specific plans for Southwest Airlines and United Airlines were among the most generous.
Average savers in these companies' plans are more likely to reach what Brightscope dubs the "retirement goal line" -- basically the ability to grow a big enough nest egg to afford a comfortable retirement, said Brooks Herman, head of data and research at Brightscope.
Industries where employees earn higher pay dominated the top of the list since workers can afford to sock away significant savings. Meanwhile, industries at the bottom of the list -- including hotels, casinos, food services and retail -- tend to have many lower-paid workers with higher turnover, both of which keep 401(k) balances low.
"Saving for a retirement isn't a priority when you have to make car payments, rent payments and everything else," Herman said.
Savers in retailer The Gap's 401(k) plan, for example, had an average account balance of only $15,000, compared to roughly $70,000 for the Google's plan, according to Brightscope. Participants in the Southwest pilots' plan, meanwhile, had already saved, on average, more than $300,000.
Perks like low fees or a generous company match helped push up a plan's ranking, but plan participation rates were also key, Herman said.
On average, more than 90 percent of employees at legal firms participated in their 401(k) plans, Brightscope found. In contrast, only 54 percent of those in the hospitality industry actively participated in their employer's 401(k) offerings.
"(It) is really the global check of, 'Not only can employers provide but do people understand it's important?'" he said.
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