women’s health

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Yes, We’re Mammals, But Is It Wise These Days To Promote Breast-Feeding As ‘Natural’?

Public health officials should think twice about the unintended consequences of calling breast-feeding 'natural,' the authors of a new paper argue. (Michael Sawyer/AP)

Public health officials should think twice about the unintended consequences of calling breast-feeding ‘natural,’ the authors of a new paper argue. (Michael Sawyer/AP)

Hippos do it. So do orangutans. There’s no question that for us mammals, nursing is one of those defining behaviors in nature. The question is whether public health officials, in promoting breast-feeding among human mothers, should deploy the term “natural.”

Two academics pondering these and other linguistically charged questions sparked an online frenzy recently with a paper on the unintended consequences of promoting breast-feeding as a “natural” practice — and relating it to the anti-vaccine movement.

University of Pennsylvania ethicist Anne Barnhill and medical historian Jessica Martucci, writing last month in the journal Pediatrics, suggest that by using the word “natural” in campaigns endorsing breast-feeding, public health officials and medical professionals may be inadvertently fueling other groups that reject public health efforts — like anti-vaxxers. Continue reading

Opinion: A Call For Protecting The Health Of Women Who Donate Their Eggs

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

By Judy Norsigian and Dr. Timothy R.B. Johnson

The egg market is growing.

As couples and individuals continue to rely on assisted reproductive technology to overcome infertility, to make parenthood possible for gay couples and for other reasons, the demand for eggs is increasing swiftly. Between 2000 and 2010, the number of donor eggs used for in vitro fertilization increased about 70 percent per year, from 10,801 to 18,306, according to a report in the Journal of the American Medical Association.

And although there are no exact figures for how many young women engage in egg-retrieval-for-pay, the numbers are at least in the thousands. Many of these women are in their early 20s — often university students in need of cash to cover their tuition fees. But what most of these women, as well as the general public, don’t realize is that there are no good long-term safety data that would enable these young women to make truly informed choices.

Now, a number of women’s health and public interest advocacy organizations — including Our Bodies Ourselves, the Pro-Choice Alliance for Responsible Research and the Center for Genetics and Society — are studying women’s knowledge about egg retrieval and calling for more and better research about its risks.

Here’s an example:

One drug frequently used to suppress ovarian function (before the ovaries are “over-stimulated” to produce multiple eggs that can then be harvested and fertilized) is leuprolide acetate (Lupron). The U.S. Food and Drug Administration has not given approval for this particular use of the drug, and thus its use during egg retrieval protocols is “off label.”

In various surveys of younger women engaging in so-called egg “donation,” it appears that this fact about off-label use is rarely shared. Probably few, if any, of these young women know about the 300-page review of many Lupron studies that Dr. David Redwine submitted to the FDA in 2011. In this report, he documents a plethora of problems, some long term.

How can we encourage the collection of adequate long-term data about the extent and severity of egg retrieval risks? Given the strong anecdotal evidence of problems such as subsequent infertility, a possible link to certain cancers and more prevalent short-term problems with Ovarian Hyperstimulation Syndrome (OHSS) than previously reported in the literature, more well-done studies are needed.

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New Wellesley President, Dr. Paula Johnson: Advocate For Women’s Health, Access To Care And Beyond

Dr. Paula Johnson is a woman of breadth: she can give a speech calling for a new movement in health care comparable to the civil rights movement — with greater access to quality health care for all — and she can also deliver compassion in the clinic with her patients. (I know, she treated my mother years ago.)

Dr. Paula Johnson (Courtesy Wellesley College)

Dr. Paula Johnson (Courtesy Wellesley College)

Johnson runs the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, where she’s also the chief of women’s health. She’s also a professor at Harvard Medical School, and on Thursday she was named the new president of Wellesley College.

Johnson was a key driver behind a massive effort to end gender bias in medical research, starting with an exhaustive report on the problem (and a TED Talk that’s been viewed more than 1 million times). When the National Institutes of Health announced it would distribute more than $10 million in grants to help combat a persistent pattern of gender bias in science and medical research, Johnson called it “a significant step” but said much more needs to be done.

She was out front as a cheerleader of the benefits for women from President Obama’s Affordable Care Act; and she was passionate about the importance of the HPV vaccine for both women and men, in particular, when it comes to head and neck cancers.

I asked Johnson, who is also a cardiologist, for a list of her top 10 medical accomplishments, and here, lightly edited, is what her people sent over: Continue reading

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For Menopause-Related Sleep Problems, Study Suggests Trying Acupuncture

If you’ve reached menopause and just can’t sleep like you used to, you might want to learn about a special spot on your body. No, not that one. It’s the Sanyinjiao acupoint, or Spleen 6 — a small area just above the ankle on the inside of the leg. New research suggests that for women with menopause-related sleep problems, acupuncture, particularly on that point, may offer relief.

(Fairy heart/Flickr)

(Fairy heart/Flickr)

Among the myriad discomforts that afflict menopausal women, sleep problems may not get as much attention as hot flashes. But all manner of sleep disturbances — from waking up at the crack of dawn unable to fall back asleep to full blown insomnia — are pervasive among this demographic.

Researchers report that the prevalence of menopause-related sleep disturbances ranges from 8.4 to 56.6 percent. Estrogen deficiency contributes to the problem; nocturnal hot flashes are also sometimes a factor.

In the new review, a meta-analysis of more than 30 clinical trials involving 2,433 participants published in the journal Obstetrics and Gynecology, researchers in China found a “substantial association” between acupuncture and improved sleep in peri-menopausal and post-menopausal women. Specifically, the researchers say they demonstrated “that the association of reduction in menopause-related sleep disturbance and acupuncture was correlated with changes in serum estradiol levels particularly when the Sanyinjiao acupoint was stimulated.” (Estradiol is the estrogen mostly produced from the ovaries, and can also be used to treat peri-menopausal symptoms.)

The researchers theorize that the elevated serum estradiol levels may be the key to why acupuncture could help alleviate the sleep disturbances.

There are caveats: the researchers report an association only between acupuncture and a decrease in sleep disturbances; also, sleep quality assessments were mostly based on patients perceptions; in addition, the researchers report that their analysis only looked at articles in English and Chinese, which might limit the generalizability of the review.

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Why To Exercise Today: Minimizing ‘Menopause Misery’

(pennstatelive/Flickr)

(pennstatelive/Flickr)

A new report suggests a path toward reducing “menopause misery”: Give up your sedentary lifestyle.

A paper — titled “Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity,” and published online in the journal Menopause — looks at more than 6,000 women across Latin America ages 40-59. Researchers found that compared to active women, sedentary women (who made up about 63 percent of participants) reported more “severe” menopause symptoms, including hot flashes, joint pain, depressed mood and anxiety and other symptoms like sex problems, vaginal dryness and bladder problems.

Sedentary lifestyle was self-reported (always a possible red flag in a study like this) as less than three 30-minute sessions of physical activity per week; activities included walking, biking, running, jogging, swimming or working out.

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FDA Reclassifies Vaginal Mesh, Device Used For Prolapse, As ‘High Risk’

The U.S.Food and Drug Administration has moved to strengthen regulations on vaginal mesh, a controversial medical device used to treat pelvic organ prolapse, a condition that can occur after childbirth as a result of weakened pelvic muscles.

Following reports of thousands of injuries related to the devices, FDA issued two orders this week: It reclassified the devices from Class II, generally considered to be a moderate-risk, to Class III, considered high-risk. Additionally, the agency will now require vaginal mesh manufacturers to submit “a premarket approval (PMA) application to support the safety and effectiveness of surgical mesh for the transvaginal repair of” pelvic organ prolapse.

From the FDA statement:

The orders will require manufacturers to address safety concerns, including severe pelvic pain and organ perforation, through a rigorous PMA pathway to demonstrate safety and effectiveness. The actions apply only to mesh devices marketed for the transvaginal repair of POP. These orders do not apply to surgical mesh for other indications, like stress urinary incontinence (SUI) or abdominal repair of POP.

“These stronger clinical requirements will help to address the significant risks associated with surgical mesh for repair of pelvic organ prolapse,” said William Maisel, M.D., M.P.H., deputy director of science and chief scientist for the FDA’s Center for Devices and Radiological Health. “We intend to continue monitoring how women with this device are faring months and years after surgery through continued postmarket surveillance measures.”

Surgical mesh has been used by surgeons since the 1950s to repair abdominal hernias; in the 1970s, gynecologists began implanting surgical mesh for the abdominal repair of POP and, in the 1990s, for the transvaginal repair of POP. In 2002, the first mesh device with this indication was cleared for use as a class II moderate-risk device, and there are five manufacturers who are currently marketing this product.Over the past several years, the FDA has seen a significant increase in the number of reported adverse events associated with the use of surgical mesh for transvaginal POP repair, and an advisory panel of experts recommended in 2011 that more data is needed to establish the safety of the device. The FDA has since taken several actions to warn doctors and patients about the use of surgical mesh for transvaginal POP repair.

Manufacturers of surgical mesh to treat POP transvaginally will have 30 months, as required by federal law, to submit a PMA for devices that are already on the market. Manufacturers of new devices must submit a PMA before those devices can be approved for marketing.

Prolapse occurs when pelvic muscles become stretched, torn or weakened, making it difficult to support the bladder, bowel or uterus; these organs can then drop and bulge into the vagina.

“While not a life-threatening condition, women with POP often experience low back pain or pelvic pressure, painful intercourse, constipation or urinary problems such as leakage or a chronic urge to urinate,” according to the FDA.

This week’s move follows a series of actions by the FDA warning of potential dangers of vaginal mesh. Notably, the agency’s latest orders relates specifically to transvaginal surgery for prolapse, and not other conditions, such as stress urinary incontinence, which has also been treated with vaginal mesh.

For reaction, I reached out to several doctors and a woman who suffered from complications related to vaginal mesh.

Amy Gezon, who testified before an FDA advisory panel about her experience back in 2011, sent me this email: “I am disappointed that the FDA did not reclassify mesh kits for the treatment of [stress urinary incontinence]. The apparent disregard of the serious complications experienced by myself and countless other women is truly disheartening.” Continue reading

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Opinion: ‘Lactivism’ Has Trump-Like Appeal For Breastfeeding Backlash, But Science Is Off

A baby sleeps in the arms of his mother after breastfeeding. (Nikolas Giakoumidis/AP)

A baby sleeps in the arms of his mother after breastfeeding. (Nikolas Giakoumidis/AP)

By Melissa Bartick, M.D.

Judging from the hype around Courtney Jung’s new book “Lactivism,” breastfeeding backlash is alive and kicking. In fact, if Donald Trump suddenly jumped into the breastfeeding fray, he might sound a bit like Jung: In her world, breastfeeding advocates are nearly always “lactivists,” self-righteous extremists preying on innocent mothers in the name of science and good parenting.

Jung, a professor in the Department of Political Science at University of Toronto, conjures a villain (or villains) everyone can rally against, as evidenced in the book’s subtitle: “How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy.”

If only some of the glowing book reviews mentioned Jung’s sloppy reading of the scientific literature, her absurd claims about the breastfeeding industrial complex and her misplaced theories of breastfeeding class warfare.

Let’s be clear: There is no place for shaming any mother about how she feeds her infant. There are indeed people out there who deserve our ire, who shame and pressure women instead of listening and educating. But Jung lumps nearly all breastfeeding advocates into this camp, stoking hatred of an entire group where only some are guilty.

Perhaps the book is popular for the same reason Trump is popular. It taps into mothers’ collective anxiety, anger and fears over a highly emotional topic, and then hold up twin “culprits”: breastfeeding zealots and bad science. The only problem is, the actual zealots are few (though offensive), and the science is not as Jung states.

Here are some facts: Breastfeeding mothers still get harassed in public and at work, and formula feeding mothers are subject to shame as well. For decades, formula feeding has been the norm in this country, and for much of our society it’s still the norm. CDC data show low-income women and African-American women have lower breastfeeding rates than middle class white women.

Not everyone can breastfeed and not everyone wants to breastfeed, but data show 68 percent of women who want to exclusively breastfeed do not meet their own goals.

To be fair, Jung does a few things right. For instance, a 2007 report from the Agency for Health Research and Quality (AHRQ) found that exclusively breastfeeding for three months cuts the risk of ear infections in half. To her credit, Jung highlights the same data from a different perspective, illustrating that six babies would need to be exclusively breastfed for three months to prevent one ear infection. And, also to her credit, she highlights fairly recent data showing little if any link between breastfeeding and lower risk of asthma, eczema and type 1 diabetes.

But overall, Jung’s grasp on the medical research is poor. Scientific papers are peer reviewed by other researchers who are experts in the same field and must pass rigorous standards before publication. Jung is not a medical researcher. While I don’t know if Jung’s book was reviewed by any medical authority, as a reviewer myself I can say it never would have made it past the first stage of the peer review process. It was reviewed by editors whose goal is to sell books.

She misstates so much of the medical literature, one wonders if she did more than just skim through these papers. Here are a few examples of inaccuracies:

• The rate of HIV transmission from mothers to their 6-month-old infants via breast milk is 4 percent among those exclusively breastfed, according to a study in The Lancet; Jung wrongly puts that number at 22 percent. Continue reading

Childbirth As An Extreme Sport — And Why Its Injuries Can Take So Long To Heal

A study finds some childbirth-related injuries are surprisingly like sports injuries. (popularpatty/Flickr)

A study finds some childbirth-related injuries are surprisingly like sports injuries. (popularpatty/Flickr)

Childbirth, as anyone who’s been through it knows, can feel very much like an extreme sport. And, it turns out, some childbirth-related injuries are surprisingly like sports injuries, including the very long time they need to heal.

That’s the conclusion of a recent study that tracked 68 pregnant women at risk for pelvic injuries and followed up using diagnostic imaging techniques more typically used in sports medicine.

The report by a team of researchers at the University of Michigan found that some women sustain long-lasting pelvic injuries after childbirth — and these aren’t the kinds of injuries that Kegel exercises alone can fix. (For the uninitiated, Kegels are pelvic floor strengthening exercises that involve squeezing and releasing certain muscles.) The research team also found that some childbirth-related injuries may take longer to heal, but ultimately do.

Janis Miller, an associate professor at Michigan’s School of Nursing, and the study’s lead author, says just like elite athletes, new mothers should acknowledge what their bodies have been through.

“If you’ve just run a marathon, it may take longer to heal than if you’ve just run a mile,” Miller said in an interview. “Some women’s birthing experiences are more strenuous than others, so one of the main points is to let women know their bodies will recover…but it can take a long time.”

And while many doctors give new moms the green light to resume normal activities — from sex to exercise — after the standard six-week postpartum exam, the reality is that it can take far longer to feel “normal” again. (I remember dragging my still-sore, depleted body in to that six week follow-up exam, and feeling I was decidedly not good to go.)

Indeed Miller calls the six-week marker for postpartum recovery “arbitrary.” “There is no rationale for that six-week time frame in terms of the body’s responses and healing,” she said.

The study, published earlier this year in the American Journal of Obstetrics and Gynecology, concludes that a clinical examination alone may not be able to detect the range of pelvic injuries from childbirth; and in certain women, specialized MRI scans may be warranted if there is “unexplained or prolonged pain after delivery,” or other complications, Miller says.

One surprising new finding was related to the types of injuries sustained by the women, who were all at higher risk for pelvic muscle tears because they had a long pushing phase during delivery or they were older women.

Miller said that the conventional wisdom at the start of the study was that postpartum pelvic injuries were primarily nerve-to-muscle or muscle-stretch related, but the researchers discovered that in this higher risk group of women, “one-quarter of them showed fluid in the pubic bone marrow or sustained fractures similar to a sports-related stress fracture, and two-thirds showed excess fluid in the muscle, which indicates injury similar to a severe muscle strain. Forty-one percent sustained pelvic muscle tears, with the muscle detaching partially or fully from the pubic bone.” Continue reading

As If PMS Weren’t Bad Enough, Study Links It To Later High Blood Pressure

(Newton Free Library/Flickr Creative Commons)

(Newton Free Library/Flickr Creative Commons)

By Dr. David Scales

As if the symptoms of PMS itself weren’t bad enough — the hot flashes, dizziness, cramping, trouble sleeping — now researchers have found a possible link to high blood pressure.

Currently, doctors are naturally aware of Premenstrual Syndrome, but are not thinking about it as a warning sign that a patient is at risk for developing health problems down the line. A new study by Dr. Elizabeth Bertone-Johnson, an epidemiologist at UMass, and her colleagues may soon change that.

They studied over 1,200 women — all part of a well-known and long-followed group called the Nurses’ Health Study — who developed at least moderate PMS. The researchers matched them to twice the number of women without PMS symptoms and looked for links to the diagnosis of high blood pressure.

Their analysis, published this week in the Journal of Epidemiology, found women with moderate-to-severe PMS had a 40 percent higher risk of developing high blood pressure over the next 20 years than the control group that experienced few PMS symptoms.

The researchers took into account factors we already know lead to hypertension, such as obesity, smoking or a lack of exercise.

Still, the study had a number of limitations, so it will need to be repeated to make sure the link between PMS and high blood pressure holds up to scrutiny.

Dr. Bertone-Johnson and her colleagues are also looking into ways to prevent the symptoms of PMS. So far, they have found that high dietary intake of certain vitamins like thiamine, riboflavin or vitamin D as well as calcium can lower the risk of developing PMS. Another study by Bertone-Johnson’s group suggested increased iron and zinc intake may be protective.

These studies are preliminary, though, so I wouldn’t go out and load up on vitamins, iron and zinc –- but they do suggest that PMS may be treatable, and that treatment might help prevent some of its potentially harmful downstream consequences.

Study: Risk Of Hidden Cancer In Gynecologic Surgery Higher Than Previously Thought

Undetected cancer among women undergoing a type of minimally invasive hysterectomy or fibroid removal surgery is more common than previously thought, a new study finds. Researchers at Boston Medical Center report that the risk of such hidden cancer is about 1 in 352 women.

The upshot: these women may have had the undetected cancer spread within their bodies inadvertently through a technique that has fallen out of favor called “power morcellation,” which was typically used in these types of surgeries. The technique involves cutting the woman’s uterus or fibroids into small pieces to make them easier to remove during the less invasive laparoscopic procedure.

The new findings (which looked at the cases of more than 19,000 women) support a 2014 estimate by the U.S. Food and Drug Administration that approximately 1 in 350 women undergoing this type of surgery face the risk of hidden cancer. But earlier conventional wisdom was that the risk of undetected cancer for women undergoing this kind of surgery was closer to 1 in nearly 5,000 or more.

“The take-home message of the study is that the true risk of an undetected cancer at the time of gynecologic surgery for what was assumed to be benign disease is about 1 in 352 women,” says Dr. Rebecca Perkins, a practicing gynecologist at BMC and lead author of the new study.

This kind of minimally invasive surgery had “increased greatly” over the past decade, researchers report, because the procedures involved less pain and shorter recoveries, among other benefits.

But power morcellation came under public and regulatory scrutiny a few years ago (in large part due to excellent reporting by Jennifer Levitz at The Wall Street Journal). In 2014, the FDA issued a series of warnings against the use of laparoscopic power morcellators in the majority of women undergoing these types of gynecologic surgeries because of the risk of spreading unsuspected cancer.

At that time, regulators estimated the risk of hidden cancer this way:

Based on an FDA analysis of currently available data, we estimate that approximately 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of fibroids is found to have an unsuspected uterine sarcoma, a type of uterine cancer that includes leiomyosarcoma. At this time, there is no reliable method for predicting or testing whether a woman with fibroids may have a uterine sarcoma.

If laparoscopic power morcellation is performed in women with unsuspected uterine sarcoma, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s long-term survival. While the specific estimate of this risk may not be known with certainty, the FDA believes that the risk is higher than previously understood.

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