women’s health


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% 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.

Continue reading

CDC Report Tracks The IUD Renaissance

You might call it the “Comeback Contraception.” In any case, it seems, IUD use is on the upswing.

This week’s CDC National Health Statistic Report highlights the surge: The number of women using long-acting reversible contraception (LARC) has almost doubled in recent years, and most of the increase is due to the growing popularity of IUDs.

From the report:

Among women currently using contraception, use of LARC increased from 6.0% for 2006–2010 to 11.6% for 2011–2013. Use of IUDs makes up the bulk of this category, with 10.3% of current contraceptors using an IUD during 2011–2013.

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

Intrauterine devices remain less popular than other forms of contraception, according to the report. The pill ranks as the most widely used method (it’s taken by 25.9 percent of women who use contraception, or 9.7 million women), followed by female sterilization (25.1 percent, or 9.4 million women) and the male condom (used by just over 15 percent, or 5.8 million women).

Still, LARC devices, including IUDs and contraceptive implants, were used by 11.6 percent or 4.4 million women, according to the report: “While the most commonly used methods — female sterilization, the pill, and the male condom — appear to remain consistent over time, an increase has been noted in the use of LARC methods, primarily the IUD.”

A confluence of events have contributed to the IUD’s renaissance, experts say, including an improved product, a drop in price and more promotion by doctors, including the American Academy of Pediatrics, and backing by the family of Warren Buffett.



What You Should Know About The New Breast Cancer Screening Guidelines

The American Cancer Society has issued newly revised guidelines on mammography and breast cancer screening. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

The American Cancer Society has issued newly revised guidelines on mammography and breast cancer screening. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

If you follow women’s health, there’s big news today from the American Cancer Society, which just issued newly revised (and frankly head-spinning) guidelines on mammography and breast cancer screening. Why all the fuss? Because breast cancer is the most common cancer among women worldwide; in the U.S., about 230,000 cases are expected to be diagnosed in 2015 with an estimated 40,300 deaths. And when such an influential organization changes its recommendations, it can radically shift the conversations between doctors and patients.

Here’s the crux of the news: In 2003, the ACS recommended annual mammography screening for all women starting at age 40 and continuing as long as women remain healthy. The group also recommended clinical breast exams (CBE), which is simply when your doctor examines your breasts, periodically for women in their 20s and 30s and every year for women 40 and up.

The new recommendations, published Tuesday in The Journal of the American Medical Association, change all of that, and come at a time of growing awareness about the potential downside of screening and the harms of over-diagnosis.

Here are the new guidelines from the report (my bold added):

The ACS recommends that women with an average risk of breast cancer [no family history, genetic predisposition, etc.] should undergo regular screening mammography starting at age 45 years (strong recommendation).

Women aged 45 to 54 years should be screened annually (qualified recommendation).

Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation).

Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation).

Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).

The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

Nancy Keating, professor of health care policy at Harvard Medical School and a primary care doctor at Brigham and Women’s Hospital in Boston, co-wrote an editorial accompanying the new guidelines.

In an interview, Keating described the four most striking aspects of new recommendations:

1) the more conservative starting age for mammography (45 vs. 40 years), which brings the ACS recommendations closer to the guidelines from another important advisory group, the U.S. Preventive Services Task Force (USPSTF), which endorse biennial screening for women aged 50 to 74 years;

2) the proposal for more frequent (annual) screening intervals among women aged 45 to 54 years;

3) the recommendation against routine screening CBE, a marked deviation from prior ACS guidelines and a stronger statement than that of the USPSTF, which in 2009 concluded that the evidence was insufficient to recommend for or against CBE;

4) the recommendation to stop screening among women with a life expectancy of less than 10 years.

Keating said that for some women, the new guidelines should make things easier because both the cancer society and the federal preventative task force basically line up on guidance. The big disagreement, Keating said, is over what to do for women age 45-54.

“This exemplifies the uncertainties of evidence,” Keating said. “Two really smart groups of people looked at the evidence and came up with different conclusions.”

Specifically, the cancer society included in its analysis findings from a large, observational study of mammography. That study concluded that for premenopausal (but not postmenopausal) women, annual mammograms were associated with smaller tumors.

“Smaller tumors should be better,” Keating said, “but we don’t have long-term data from that population. So we don’t know for sure if this leads to better outcomes.”

The context of all this is a greater awareness of the harms of false positive mammograms and the the real harm of over-diagnosis, which basically is when you’re diagnosed with a cancer that would never become “clinically evident” in your lifetime except for the fact that you underwent screening. This over-diagnosis, of course, can lead to the real harm of treatment for a cancer that you may never have needed to deal with. Continue reading

Sad After Sex? New Study Suggests ‘Postcoital Dysphoria’ Is Widespread

A new study finds that 46 percent of women reported experiencing symptoms of postcoital dysphoria, or PCD, at least once in their lifetime, with 5.1 percent experiencing symptoms of the condition a few times within the past four weeks. (Peter Kelly/Flickr)

A new study finds that 46 percent of women reported experiencing symptoms of postcoital dysphoria, or PCD, at least once in their lifetime, with 5.1 percent experiencing symptoms of the condition a few times within the past four weeks. (Peter Kelly/Flickr)

For Kim, a 30-year-old teacher in North Carolina, it happens pretty much every time she has an orgasm: a feeling of profound sadness washes over her and she experiences a sense of regret. “It’s not that I don’t like sex,” she said in an interview. “I enjoy sex, I like to have orgasms, but after an orgasm, I feel this wave of sadness. It only lasts around a minute, but I’m just like, ‘Ugh, that doesn’t feel good.’ ”

For Kim’s sister, Rachel, 27, it’s even worse. She says that since she was a young adolescent, around 12 or 13, after an orgasm darkness and despair descends on her for 10 to 15 minutes. “It’s just really sad,” she said. “Almost like a feeling of homesickness, but I’m home. It happens every single time.”

Kim and Rachel (both happily married, they say, and both asking that their last names be omitted) had shared their intimate distress in the past — the topic came up when they both had a similar sadness breast-feeding their babies; a condition, they discovered, that’s known as dysphoric milk ejection reflex, or D-MER. But they didn’t fully realize their post sex sadness was “a thing” until they came across a Facebook post about a new study that called it by its official name: postcoital dysphoria, or PCD.

Also called “postcoital tristesse,” literally “sadness” in French, it’s a condition marked by feelings of melancholy, agitation, anxiety or sadness after intercourse that can last between five minutes and two hours. Sometimes there are tears.

If you look it up on Wikipedia you’ll learn “the phenomenon is traced to the Greek doctor Galen, who wrote, ‘Every animal is sad after coitus except the human female and the rooster.’ ”

Not true, according to the new study, published in the journal Sexual Medicine and led by researchers in Australia. They found that 46 percent of women reported experiencing PCD symptoms at least once in their lifetime with 5.1 percent experiencing symptoms of the condition a few times within the past four weeks.

There are big caveats. Data for the study were collected through an online questionnaire; female students over 18 who reported being sexually active were recruited via email at Australian universities and through Facebook. Ultimately, the total sample included 195 heterosexual, mostly white women, the study notes, and so the results can’t necessarily be generalized to the broader population. (Earlier estimates of the condition vary.)

“We go through life with our defenses up, and after sex, with that release, sometimes the feelings just flood in.”

– Psychologist and sex therapist Judy Silverstein

There are a number of theories on what’s behind PCD, and clearly more research is needed. Some say it’s hormones, others suggest the intense emotional release after sex let’s loose other deep emotions. Past sexual abuse may play a role in some cases, but this particular study suggests it’s not the main driver.

Judy Silverstein, a psychologist and sex therapist in Needham, Massachusetts, says she’s worked with many women who have tears or sadness after sex. She said she believes that biology, in addition to psychology, could be a factor.

“When orgasm occurs … there is a physiological release — after a buildup of sexual tension — which may lead to tears (or laughter) not accounted for by psychological variables,” she said. Continue reading

Women’s Health World Abuzz On ‘Pink Viagra’ Approval, But Are Expectations Realistic?

In this June 22 photo, a tablet of Flibanserin sits on a brochure for Sprout Pharmaceuticals in the company's Raleigh, N.C., headquarters. (Allen G. Breed/AP)

In this June 22 photo, a tablet of Flibanserin sits on a brochure for Sprout Pharmaceuticals in the company’s Raleigh, N.C., headquarters. (Allen G. Breed/AP)

Everyone, it seems, has an opinion on the FDA’s approval this week of the drug Flibanserin, aka “pink Viagra,” to boost women’s sexual desire.

“This is the biggest breakthrough for women’s sexual health since the pill,” Sally Greenberg, executive director of the National Consumers League, told The New York Times.

Others have their doubts. Cindy Pearson, of the National Women’s Health Network, told NPR that approval of the drug “is a triumph of marketing over science” and added: “To have any chance of benefit from this drug they’re going to have to take it every day for months on end, years…We just don’t know what the long-term effects will be of changing brain chemistry in this way.”

Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research (CDER), said the approval “provides women distressed by their low sexual desire with an approved treatment option…The FDA strives to protect and advance the health of women, and we are committed to supporting the development of safe and effective treatments for female sexual dysfunction.”

The drug, which will be sold under the brand name Addyi, is expected to go on sale Oct. 17, according to its maker, Sprout Pharmaceuticals. And along with the potential to ignite a low (or non-existent) libido among some women, the drug comes with a boxed warning, the strongest kind, on contraindications and potential side effects, including low blood pressure, fainting, nausea, dizziness and sleepiness.

Here’s more on the site Throb, about how the drug actually works.

Still others have extreme doubts.

Emily Nagoski, a feminist sex educator and author of the book “Come As You Are,” wrote a smart, thoughtful piece on the site Medium about why Flibanserin isn’t addressing the true nature of women’s sexual desires. Here’s a bit of that piece, called: “Pleasure is the Measure:”

I believe that the folks at Sprout Pharmaceuticals — the company that owns Flibanserin, the so-called “pink viagra” — have good intentions. I believe that they want to help women who are struggling with sexual desire.

And I believe that they feel sure — as most people do— that lack of spontaneous, out-of-the-blue desire for sex is a problem. A disease.

They are wrong — as you now know.

It’s not their fault, really, that they’re wrong. Cindy Whitehead, Sprout CEO, isn’t a sex researcher, educator, or therapist. She’s a marketing professional, and she’s darn good at her job. But why would she believe anything except what mainstream culture taught her?

In fact the drug is designed — they’ve said explicitly — as though responsive desire were a disease, as though spontaneous desire were the only “normal” way to experience desire.

And that’s a problem. Continue reading


Where Does Life Begin, And Other Tough Abortion Questions For Doctors In Training

Our recent post on how residents training to be OB-GYNs think about providing abortions (or not providing them) went viral earlier this month and triggered a broader conversation among readers. The topic was also featured on Radio Boston and WBUR’s All Things Considered.

I asked Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, and the person who organized the initial discussion among the residents, to follow up. She, in turn, ​asked Jennifer Villavicencio, a third-year resident​, to lead a discussion digging even more deeply into the topic.

Two of the residents ​in the discussion ​perform abortions, two have chosen not to do so. ​But they are colleagues and friends who have found a way to talk about this divisive issue in a respectful and productive way. ​Here, edited, is ​a transcript of ​their discussion, which gets to the heart of a particularly fraught question: When does life truly begin? ​Three of the residents have asked that their names not be included, for fear of hostility or violence aimed at abortion providers.

Jennifer Villavicencio (Resident 3): Let’s talk about a woman who comes in, has broken her water and is about 20 to 21 weeks pregnant and after counseling from both her obstetricians and the neonatologist [a special pediatrician who takes care of very sick newborns] has opted for an abortion. Let’s talk about how we each approach these patients.

Resident 2: As a non-abortion provider I will start just by saying that a patient of this nature in some ways is on one extreme of the spectrum. As an obstetrician, I view the loss of her pregnancy as an inevitability. I think we would all agree with that. So, taking part in the termination [another word for abortion] of her pregnancy is different to me than doing that for someone whose pregnancy, but for my involvement, would continue in a healthy and normal fashion.

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

JV: Would your opinion change if she were 22 or 23 weeks and theoretically could make it to viability [the concept that a fetus could survive outside of the mother. Currently, in the U.S., the generally accepted definition of viability is 24 weeks gestation or approximately six months pregnant]?

Resident 2: Personally, it wouldn’t, because I feel there is a very slim chance of an intact survival [refers to an infant not having significant mental or disabilities] of an infant. If she were 22 or 23 weeks gestation and could potentially make it to the point of a survivable child, that likelihood is so rare. But for my involvement, she will still lose this pregnancy. My point is, if I help terminate this pregnancy, I am not playing an integral role in the loss of this pregnancy. I feel that supporting her in proceeding in the safest possible way, protecting her while accepting the loss of her pregnancy, is my job.

Future Health Of The Child

JV: Does the future health of the child really play a role in it for you?

Continue reading

Calcium, Vitamin D For Osteoporosis: Are Recommendations Skewed By Conflicts Of Interest?

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

By Marina Renton
CommonHealth Intern

Might commercial influences be driving the widespread recommendation of calcium and vitamin D supplementation for the prevention and treatment of osteoporosis?

That’s the conclusion of an analysis published in the journal BMJ, written by Andrew Grey and Mark Bolland, endocrinologists and associate professors at the University of Auckland.

The analysis — strongly refuted by organizations that advocate for osteoporosis research — further complicates the already contentious issue of whether it’s a good idea to take the supplements and if so, at what dosage.

The Supplement Conundrum

Women over 50 are most likely to develop osteoporosis, a bone disease affecting millions of Americans that results in bone weakness and increased risk of fracture. Calcium and vitamin D supplements are widely recommended to prevent and treat the condition.

“But as we point out, the considerable body of randomized trial evidence doesn’t support that practice,” Grey, the study’s co-author, wrote in an email.  “We wondered why practice hasn’t changed to reflect the evidence.”

To promote bone health, over half of older Americans take calcium and vitamin D supplements, which can be prescribed by a doctor or purchased over the counter, the authors write.

The Institute of Medicine (IOM) recommends adults take in 1,000 mg of calcium per day (1,200 for adults 70+ and women 51-70) and 600 IU (international units) of vitamin D — 800 IU for the 70+ set.

As of 2013, the U.S. Preventive Services Task Force does not recommend daily calcium and vitamin D supplementation for non-institutionalized postmenopausal women to prevent fractures. This, they note, is not necessarily inconsistent with the IOM’s recommendations, which do not specifically discuss fracture prevention.

The supplements have been standard clinical practice in preventing or treating osteoporosis in older adults since the early 2000s. Since then, however, studies have emerged to contest their effectiveness, according to the paper. Continue reading

Doctor: You Should Not Need Prescription To Treat Urinary Tract Infection

Cranberry juice is often recommended to help with UTIs. (Woo Woo/Flickr Creative Commons)

Cranberry juice is often recommended to help with UTIs. (Woo Woo/Flickr Creative Commons)

My friend was looking peaked and pained the other day. Today, she was vastly better.

“UTI,” she said, and I nodded knowingly. Urinary tract infections are so common that up to half of all women get them at some point. There are many wonderful things about being a woman; cystitis is not one of them.

It was no big deal. She called her doctor and the prescription was phoned over to her pharmacy. But a recent editorial in the British medical journal BMJ argues for an even simpler solution: She should have been able to just diagnose herself and pick up the treatment over the counter.

Dr. Kyle Knox, a general practitioner, writes that letting women treat UTIs without a prescription could cut 3 million unnecessary visits to the doctor each year in the United Kingdom. From the BMJ press release:

Acute uncomplicated urinary tract infections (AUUTIs) such as cystitis are the most common bacterial infections in women. Cystitis affects around half of women at least once in their lifetime and is coded as the reason for 1% of the 300 million GP consultations held annually in the UK.

Management of cystitis is straightforward – a short course of the antibiotic nitrofurantoin and symptoms usually start to improve after a day or two.

“Therefore, in an era of ready access to information, increasing patient autonomy, and overstretched primary care services, it would seem a good idea for women to be able to access safe and effective treatment without the costs and delays associated with consulting a clinician to obtain a prescription,” suggests Knox. Continue reading

Are Skinny Jeans Bad For Your Health?

(James Mitch/Flickr)

(James Mitch/Flickr)

This is the kind of headline that can trigger a snarky response even in the most compassionate person: “Squatting in ‘skinny jeans’ can damage nerve and muscle fibres in legs and feet.”

Yes, it’s true: A case report published this week in the British Journal of Neurology, Neurosurgery and Psychiatry describes a 35-year-old woman who suffered serious muscle damage, swelling and nerve blockage after squatting in her super tight skinny jeans. (The jeans were so tight, in fact, that doctors had to cut them off to treat her.)

Here’s the top of the report (my bold added):

A 35-year-old woman presented with severe weakness of both ankles.

On the day prior to presentation, she had been helping a family member move house. This involved many hours of squatting while emptying cupboards. She had been wearing ‘skinny jeans’, and recalled that her jeans had felt increasingly tight and uncomfortable during the day. Later that evening, while walking home, she noticed bilateral foot drop and foot numbness, which caused her to trip and fall. She spent several hours lying on the ground before she was found.

On examination, her lower legs were markedly oedematous bilaterally, worse on the right side, and her jeans could only be removed by cutting them off. There was bilateral, severe global weakness of ankle and toe movements, somewhat more marked on the right… Sensation was impaired over the lateral aspects of both lower legs, and the dorsum and sole of both feet…Nerve conduction studies showed conduction block in both common peroneal nerves between the popliteal fossa and fibular head…

The story of the skinny jean medical emergency went viral, with fashionistas and feminists weighing in on whether the era of super-tight jeans is over. The New York Times did a piece headlined “Why You Shouldn’t Throw Out Your Skinny Jeans,” and interviewed the paper’s fashion director, who declared:

Not all skinny jeans are created equal, and it would be alarmism to jump to the conclusion that one pair of skinny jeans created health issues, ergo all skinny jeans are bad. I think the takeaway is skinny jeans are one thing, jeans that actually inhibit movement something else. Maybe we should call them straitjacket jeans. Those should be avoided.

Still, after reading the study, it’s hard not to feel a little empathy. Who among us hasn’t worn a heel just a bit too uncomfortably high, or a pair of movement-limiting pants (and don’t even get me started about thong underwear) in an attempt to feel better/younger/sexier? Continue reading