Archive for the ‘Menopause’ Category

July 31, 2012

The Women’s Health Initiative Studies, Ten Years Later

Although the Women’s Health Initiative trials, which studied different aspects of postmenopausal women’s health, began in 1991, the real game-changing results from the trials happened 10 years ago, in 2002, when the trial of estrogen plus progestin hormone therapy was stopped early. The trial was stopped because those responsible for monitoring trial safety found an increased risk of breast cancer, along with risks for heart attacks, strokes and blood clots to the lungs and legs.

This was major news at the time, because many, many women had been prescribed this combination hormone therapy under the assumption that it might actually protect them from heart disease, cancer, and stroke.

Today, both consumer advocate organizations like the National Women’s Health Network and the federal U.S. Preventive Services Task Force seem to agree that hormone therapy should not be used for the prevention of these diseases.

Earlier this month, in honor of the 10 year anniversary of the halting of the trials, the National Women’s Health Network hosted a blog carnival about hormone therapy. Among the posts:

  • Dr. Sharima Rasanayagam of the Breast Cancer Fund writes about hormone therapy, chemical exposures, and breast cancer risk. (full post here)
  • Karuna Jaggar of Breast Cancer Action on the importance of independently funded research, including the WHI (full post here)
  • Cindy Pearson, Executive Director of the National Women’s Health Network, on the importance of the WHI and the need for ongoing research and “protections against misleading promotion of unproven and unsafe drugs.”
  • Amy Allina, also of NWHN, writes about “challenging unproven medicine and saving lives.”
  • Also, an interview with Dr. Vivian Pinn, former Director of the NIH’s Office of Research on Women’s Health, NIH, on the importance and impact of the WHI trials.

You can find these and other posts on NWHN’s blog.

The NWHN is also collecting stories from women took or were offered hormone therapy before the WHI; who refused it because of the study’s findings; were involved in the study as researchers or participants; and other health care providers, advocates, and individuals affected by the WHI.


June 5, 2012

Hormone Therapy and Chronic Disease Prevention

This month, the U.S. Preventive Services Task Force released a new report which is informing their updated recommendations on hormone therapy for chronic disease prevention in menopausal women. Bone fractures, dementia, stroke, and urinary incontinence were among the chronic conditions they examined.

In the 2005 recommendations, USPSTF recommended against routine use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women, and against estrogen alone for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. The new research looked at 9 newer studies – mostly from the Women’s Health Initiative – in order to review and update those recommendations.

Based on their review of the evidence, the authors concluded that both regimens – estrogen plus progestin, and estrogen alone – decrease risk of bone fracture but increase risk for stroke, thromboembolic events (blood clots in the legs or lungs), gallbladder disease, and urinary incontinence. Estrogen plus progestin was found to increase risk for breast cancer and probably dementia, while estrogen alone may slightly decrease risk for breast cancer.

The draft new recommendations are very similar to the 2005 ones. The USPSTF “concludes with high certainty that there is zero to negative net benefit for the use of combined estrogen and progestin therapy for the prevention of chronic conditions, and concludes with moderate certainty that there is no net benefit for the use of estrogen alone.” They also explain that the recommendations do not apply to women younger than age 50 who have undergone surgical menopause, and they don’t address use of hormone therapy for the management of menopausal symptoms like hot flashes or vaginal dryness.

There were some limitations of this research described by the authors, like the small number of new studies, variations in the studies that make it hard to combine their findings, and lots of study participants who dropped out before the trials were finished. In addition, most of the women in the studies were 60 to 69 years old. Additional research is needed that looks at women who are transitioning through menopause or immediately postmenopausal.

A Washington Post article puts the findings in context, explaining:

One form of hormone replacement therapy — estrogen alone — did appear to slightly reduce the incidence of breast cancer. Invasive breast cancer looms large as a concern to many women, but affects just 11 percent of them past menopause.

That possible protective effect became less consequential when weighed against hormone therapy’s impact on far more likely risks to women’s health…It fails to reduce the risk of heart disease, which will affect 30 percent of women who live past menopause. It slightly increased the likelihood of dementia, which will affect 22 percent of all post-menopausal women. It was linked to a higher likelihood of stroke, affecting 21 percent of these women.

 


May 15, 2012

Long-term Use of Bisphosphonates Not Helpful for Most Women

Last week, the U.S. Food & Drug Administration (FDA) published a perspective piece on the long-term use of bisphosphonates for reducing bone fracture risk in the New England Journal of Medicine, describing findings from the agency’s September 2011 review of these drugs. The agency had reviewed data from a few studies on longer term (>3 years) use of the drugs, including whether they increased bone mineral density and decreased bone fractures.

We wrote about that review in more detail here. Essentially, the agency reported that long-term safety of these drugs was still something of a mystery, but there was concern about rare but serious complications – jaw osteonecrosis, atypical femoral fractures, and esophageal cancer. The agency has also previously stated that there was no apparent benefit of continuing the drug beyond 5 years for fracture prevention.

In the NEJM piece, agency authors reiterated both these concerns and the reality that more research and information is still needed on questions such as how long most people really should take the drugs, whether certain groups of patients are more likely to benefit from longer term use of the drugs, how long benefits of the drugs last after stopping them, and whether there are reliable measures to help make that decision in individual patients. While they don’t focus on it, there is also considerable concern and controversy about whether women who do not actually have osteoporosis (or who are classified as having “osteopenia”) should be getting these drugs in an attempt to prevent it.

The NEJM piece is likely to draw more attention to this issue than the previous FDA documents alone, and bolster advocates’ push to reconsider practices and get the information gaps filled. The National Women’s Health Network, a longtime advocate of looking closely at these issues, writes in response:

NWHN agrees with the FDA that long-term use of bisphosphonates isn’t helpful for most women, and urges women and their clinicians to seriously consider stopping these drugs after 3-5 years. Are there some women who should continue bisphosphonates beyond 3-5 years?…We will advocate for more studies to answer this important question.

Now that the FDA has acknowledged the problems of long-term use of these drugs, it should take the next step and address the important question – Which women should start taking bisphosphonates in the first place? We have urged the agency to change its recommendations to end the practice of prescribing bisphosphonates to healthy women for prevention. Too many women are handed a prescription for bisphosphonates after getting a bone density scan that shows normal age-related bone loss, even though they have no other risk factors for fracture. Those women are very unlikely to have a serious fracture in the next few years – and taking bisphosphonates isn’t likely to do them any good.

The NWHN has also recently sent a letter to FDA Commissioner Margaret Hamburg urging the agency “to remove the prevention indication for bisphosphonates and to take steps to alert women and their health care providers that these drugs are no longer recommended for prevention of osteoporosis.”

See also: our previous posts on bisphosphonates and osteoporosis.


May 4, 2012

Progesterone-Alone for Hot Flashes and Night Sweats?

Many women going through perimenopause and in menopause either don’t have have flashes and night sweats that bother them or are able to ease them with self-help approaches.  However, between 7 and 9 percent of women have symptoms severe enough to interfere with their quality of life.

In the past, the primary treatment for hot flashes and night sweats (called vasomotor symptoms) was estrogen-plus-progestin or estrogen-alone hormone therapy—both effective therapies. But as the Women’s Health Initiative (WHI) trials demonstrated, these hormone regimens unfortunately increase the risk of heart disease, stroke, blood clots and breast cancer.

Because of these risks, new treatment options for vasomotor symptoms are needed. A new study published in the journal Menopause by the Centre for Menstrual Cycle and Ovulation Research looks at the safety and effectiveness of progesterone-only therapy for alleviating hot flashes and night sweats. (Progesterone is a hormone produced in the body, while progestin, which was used in the WHI, is a synthetic form of progesterone).

In this trial, the researchers randomized 133 healthy, postmenopausal women with vasomotor symptoms to Prometrium, a brand of oral micronized progesterone, or placebo, and had them report on the frequency and severity of their night sweats and hot flashes over three months.

The researchers (one of whom, Jerilynn Prior, co-wrote the menopause chapter in the 2011 edition of Our Bodies, Ourselves) found that symptoms improved in both the progesterone and placebo groups over the course of the study. Scores, however, improved significantly more in the progesterone group, suggesting that the hormone provided greater relief of symptoms than placebo. There were few adverse effects reported in this brief trial, none of which were considered serious.

It is not clear what the breast cancer implications of progesterone-alone therapy might be – the Women’s Health Initiative trials found an increased risk of breast cancer with estrogen-plus-progestin therapy but not with estrogen-alone. In their article, the authors briefly address this issue, noting varying findings in other studies and remarking that:

Although there is reason to believe that progesterone has a more favorable safety profile than medroxyprogesterone [used in the WHI study], large safety trials of progesterone as postmenopausal monotherapy are lacking.

OBOS contacted researcher Jerilynn Prior to ask her if she had any additional comments about the potential increased risk of breast cancer. Prior answered that a large observational study in France called E3N found that estrogen with progesterone was not associated with increased breast cancer risk, while estrogen alone and estrogen with progestin were. “This suggests that progesterone alone would be safe in terms of breast cancer risk,” Prior noted.

In the published study, the researchers address certain limitations of their work, including the racial/ethnic makeup of their study population (primarily white), and participants being overall leaner and healthier than the general population. Additionally, while the placebo was identical to the active drug and neither the researchers or women could guess by the look or feel of the pill which they were taking, over time 54% of those receiving progesterone and 60% of those getting placebo were able to correctly guess their group assignment. In correspondence with OBOS, Prior said that this was likely due to the fact that many of those taking progesterone experienced improvement in their sleep.

The researchers also note that their population were postmenopausal, having not menstruated for 1-10 years, so their findings are not applicable to women transitioning into menopause.

The bottom line is that progesterone-alone may be a useful treatment for relieving hot flash and night sweat symptoms of menopause, although more investigation is needed. Many of the benefit and harms of hormone therapy may turn out to depend on the type of hormone, who’s using it, in what form, when and for how long. I hope to see more studies on this in coming years.


December 23, 2009

Bone Density Loss and Depo: Who’s at Risk?

The current issue of the journal Obstetrics & Gynecology includes an article on the risk of bone mineral density loss in users of contraceptive shots (DPMA, or brand name Depo Provera). As we mentioned in a previous post, the drug comes with a box warning that “Women who use Depo-Provera Contraceptive Injection may lose significant bone mineral density. Bone loss is greater with increasing duration of use and may not be completely reversible.”

The current study compared women who used DMPA for at least 24 months and had less than 5% vs. at least 5% bone loss to attempt to identify any characteristics that might be associated with a higher risk of bone loss.

The authors report that being a current smoker was associated with higher bone loss, while higher calcium intake (at least 600 mg/day) and having ever delivered a child were associated with lower levels of bone loss. Age, race or ethnicity, previous contraceptive use, and body mass index did not appear to be associated with higher bone mineral density loss.

Although only the abstract of the article is freely available, ScienceDaily provides an additional summary.

In other bone-related news, NPR published a piece this week, “How A Bone Disease Grew To Fit The Prescription,” which describes Merck’s approach to marketing the drug Fosamax, including its efforts to push smaller, cheaper machines to perform bone density scans (and for Medicare payment for the scans) and to expand the “osteopenia” diagnosis.

However, as the piece notes, “There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50s and continue treatment long-term in the hopes of preventing old-age fractures. And none are planned.”

The story and accompanying transcript provide a fascinating look at the marketing of a drug, from the perspective of a former Merck rep who believed he was helping save women from fractures through his marketing efforts, to criticisms of that work as “a plot to misdiagnose American women,” and the debate over whether women with slightly decreased bone density should be medicated at all.


November 25, 2009

Courts Find in Favor of Women Claiming Prempro Caused Breast Cancer

Courts in Philadephia recently ruled in favor of two plaintiffs who sued Pfizer because they believed their breast cancer was caused by taking Prempro, an estrogen plus progestin combined hormone replacement therapy (formerly sold by Wyeth).

More than $100 million was awarded by juries between those two cases, although news reports indicate that Pfizer will appeal and damages awarded are likely to be reduced; a Pfizer spokesperson said the company does not believe the verdicts “were supported by the evidence or the law.” About 10,000 similar cases are apparently pending at this time.

In 2002, the Women’s Health Initiative study was released results indicating that women taking estrogen plus progestin hormone replacement (such as Prempro) were more likely to develop breast cancer than women taking placebo, and their cancers were more likely to be more advanced. The trial was stopped early that year after it became clear to investigators that the risks of combination hormone therapy outweighed the reported benefits.

As a result of WHI findings, in 2003 the FDA required the addition of a black box warning to the drug’s label to state that estrogen and estrogen plus progestin therapies should not be used for the prevention of cardiovascular disease, and to warn of increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women taking the estrogen/progestin combo.


September 24, 2009

How Does Hormone Replacement Therapy Affect Lung Cancer?

A new study in The Lancet looks at hormone replacement therapy, and concludes that while the combination of estrogen and progestin doesn’t increase women’s risk of lung cancer, it increases their risk of dying from the disease. This finding has generated a fair bit of media coverage, but – although the issue of HRT and lung cancer is an important one – the study itself is perhaps not as definitive as that coverage might suggest.

The authors analyzed data from the Women’s Health Initiative study, a trial of estrogen plus progestin hormone therapy in postmenopausal women that was stopped early when the associated health risks (including cardiovascular disease and breast cancer) were found to exceed the benefits. For this analysis, they looked at data on the incidence and mortality rates of all lung cancer, small-cell lung cancer, and non-small-cell lung cancer.

They found:

78 women in the combined hormone therapy group who had received a diagnosis of lung cancer died during follow-up, compared with 49 in the placebo group (0·12% vs 0·08%; HR 1·50, 1·05—2·14, p=0·03). Of these deaths, 73 (94%) in the combined hormone therapy group and 40 (82%) in the placebo group were directly attributed to lung cancer by chart review (HR 1·71, 1·16—2·52, p=0·01).

The impact of the study is limited, as the authors acknowledge, because of the unplanned post-hoc analysis (a statistically weak method), and because of the small number of lung cancers in the population (fewer thank 130 out of more than 16,000 women studied) and the absence of information on treatment after diagnosis. An accompanying commentary in the journal explains that “data on the effect of oestrogens on both the incidence of lung cancer and outcomes from lung cancer are controversial,” with conflicting findings and limited study designs.

Due to its limitations, the new Lancet paper does not provide strong evidence on whether hormone replacement therapy significantly raises the risk of death from lung cancer, but it may encourage future research and suggest something that should, as the authors conclude, “be considered before the initiation or continuation of combined hormone therapy in postmenopausal women, especially those with a high risk of lung cancer, such as current smokers or long-term past smokers.”

Related: The National Cancer Institute provides information on hormone replacement therapy and risks for breast, ovarian, colorectal, and endometrial cancer and related issues here.


September 11, 2009

Guide to Osteoporosis Treatments Now Available in Spanish

Here’s news to share with women’s health groups: The Agency for Healthcare Research and Quality (AHRQ) has released the Spanish language version of Osteoporosis Treatments that Help Prevent Broken Bones: A Guide for Women After Menopause. The information is available online and in pdf format. For a free print copy, call the AHRQ Publications Clearinghouse: (800) 358-9295

The guide covers prescription drugs available to treat osteoporosis, along with their potential side effects and risks. Our Bodies Ourselves Executive Director Judy Norsigian reviewed the content for the English language version, which was released in June 2008.

Osteoporosis is more likely to affect women after menopause, mostly because the body has less estrogen. Smaller and thinner women are more at risk, as are women who have family members who had osteoporosis and broke a bone. Certain medicines, such as thyroid medicine or steroids, are also risk factors.

Earlier this summer, AHRQ, which is the health services research arm of the U.S. Department of Health and Human Services, released a statistical brief concerning U.S. hospitalizations due to osteoporosis and injury. Between 1995 and 2006, there was a 55 percent increase in the rate of patients hospitalized for treatment of hip, pelvis and other fractures associated with osteoporosis. The more than 254,000 hospital stays totaled $2.4 billion in costs in 2006.

Other highlights from the brief:

  • Injuries were noted in one-fourth of all stays with an osteoporosis diagnosis. Pathological fractures (i.e., spontaneous and stress fractures), hip fractures, and fractures of the vertebrae, ribs, and pelvis were the most frequently occurring injuries among these patients.
  • Nearly 90 percent of stays involving an injury likely due to osteoporosis occurred among patients 65 years and older; 37 percent occurred among patients 85 and older.
  • Females accounted for nearly 89 percent of injurious osteoporosis stays and had hospitalization rates that were more than six times higher than males.
  • The Midwest had the highest rate of injurious osteoporosis hospitalizations (107 stays per 100,000 population), while the West had the lowest rate (68 stays per 100,000 population).
  • Treatments of hip and leg fractures and dislocations were performed in 16.4 percent of all injurious osteoporosis stays, and 8.1 percent of these stays noted a hip replacement.

Our Bodies Ourselves has posted clinical recommendations (pdf) for when women should be screened, who should consider screening, and what kind of prevention and treatments can be effective. The guidelines were written by the Harvard Vanguard Medical Associates. OBOS has a very comprehensive section on menopause and recommends these sites for further reading about osteoporosis.

In related news, The New York Times this week looks at the dispute over how to address osteopenia, bone density that is below what is considered normal, but not low enough to be considered osteoporosis. Kate Murphy writes:

Millions of people worldwide, most of them women, have been told they have osteopenia and should take drugs to inhibit bone loss. But the drugs carry risks, so many public-health experts say the diagnosis often does more harm than good.

Now the World Health Organization has developed an online tool meant to help doctors and patients determine when treatment for deteriorating bones is appropriate.

A preliminary version of the tool, called FRAX, was released last year and can be found at www.shef.ac.uk/FRAX/index.htm. A revised version is to be released later this year.

But FRAX is proving almost as controversial as the diagnosis of osteopenia. While some experts applaud it for taking factors besides bone density into account, others say that the formula on which the tool is based is faulty and that the advised threshold for medication is too low.

“FRAX is coming from the same people who came up with osteopenia in the first place,” said Dr. Nelson Watts, director of Bone Health and Osteoporosis Center at the University of Cincinnati, who said the diagnosis unnecessarily frightened women and should be abolished.


August 17, 2009

Double Dose, Part 2: Clinton Focuses on Elevating Women; Whole Foods Fight; Our Genders, Our Rights; The Gender Politics of “Mad Men”

Clinton Prioritizes Women’s Rights: “Clinton intends to press governments on abuses of women’s rights and make women more central in U.S. aid programs,” writes Mary Beth Sheridan at the Washington Post. “But her efforts go beyond the marble halls of government and show how she is redefining the role of secretary of state. Her trips are packed with town-hall meetings and visits to micro-credit projects and women’s dinners. Ever the politician, Clinton is using her star power to boost women who could be her allies.”

“It’s just a constant effort to elevate people who, in their societies, may not even be known by their own leaders,” Clinton told WaPo. “My coming gives them a platform, which then gives us the chance to try and change the priorities of the governments.”

Whole Foods Fight: I’ll be posting a more studious healthcare round-up, but for the moment: The New York Times Opinionator blog did a nice job pulling together comments from around the web about the anti-government healthcare reform op-ed written by Whole Foods CEO John Mackey that has some shoppers calling for a boycott.

One commenter recalls a food boycott from years ago that was more win-win: “I *loved* the Domino’s boycott way back when. Pro-choice cred PLUS I don’t have to eat cardboard pizza!”

feminism_and_sexismOur Genders, Our Rights: The summer edition of On The Issues Magazine discusses a topic that the editors describe as “both utterly fundamental and wildly revolutionary: gender norms and gender identity.”

Among the many offerings: “How a Feminist Found Her Sexism,” by Helen Boyd (with image at left by Gavin Rouille); “Trans Health Care Is A Life and Death Matter,” by Eleanor J. Bader; and “Virtual Switching, or Playing Games?” by Georgia Kral.

The Gender Politics of “Mad Men”: Cheers to Feministing for making Mondays that much better with a weekly feminist analysis of the popular AMC series “Mad Men,” and to RH Reality Check for hosting an ongoing “Mad Men” salon. And don’t miss Crystal Merritt’s insider perspective, as an ad woman and feminist.

New Column, Great Advice: Jaclyn Friedman is one of our favorite people for many reasons. She runs the annual Women, Action & Media conference as part of her role at Center for New Words; she co-edited, with Jessica Valenti, “Yes Means Yes: Visions of Female Sexual Power and a World Without Rape“; and now she’s writing a weekly column for Amplify Your Voice, a project of Advocates for Youth.

Read Friedman’s “Open Letter to Miley Cyrus,” which should be shared with all 16-year-olds.

Ovarian Cancer Surgery and Fertility: According to a new study published in the journal Cancer, five-year survival rates for stage 1 ovarian cancer patients were the same for patients who had both ovaries removed and women who had only the cancerous ovary removed, reports the L.A. Times. Though ovarian cancer occurs most often in postmenopausal women, up to 17% of ovarian cancers occur in women 40 or younger and that rate is believed to be rising.

Plus: Chicago Tribune health columnist Julie Deardoff writes: ”One of every 1,000 pregnant women in the U.S. has cancer, a relatively rare but stark convergence of life and death. For these women, treatment is possible. But it comes with a host of terrifying decisions for the family.”  The story focuses on Sarah Joanis, who was diagnosed with ovarian cancer at age 26.

“Menopause, the Musical”: “This isn’t retro; it’s just old,” Anita Gates writes in The New York Times of the eight-year-old musical that, despite corny songs and stereotypes, has been produced in 14 countries and in more than 200 American cities. “Who calls menopause the change of life? Edith Bunker, maybe, on the 1970s sitcom ‘All in the Family.’ And she would have been in her 80s by now. Women who read ‘Our Bodies, Ourselves’ in their youth don’t use euphemisms.”

The musical is underway at the South Orange Performing Arts Center, and while Gates is clearly not enamored with the premise, she is a fan of the current staging and cast: ”And thanks to a shift from self-deprecation to self-actualization (and a few nice costume changes), by the end, against all odds, the show is actually exhilarating.”


July 6, 2009

Double Dose: Fat is Not a Death Sentence; Google AdWords Prohibits Abortion Ads; Survey: Sex After Kids; What Would Buffy Do?

Excess Pounds, Longer Life?: It wasn’t so long ago that we heard calorie restriction was linked to longevity. Now it seems the scales have shifted: A new report, published online in the journal Obesity, found that people who are moderately overweight live longer.

“[W]hy is it so hard to believe, even in the face of such evidence, that being fat’s not exactly a death sentence?” asks Washington Post columnist Jennifer LaRue Huget.

On another note, looking at the journal’s website, I wish access wasn’t restricted to an article touted on the homepage as an “important review” of weight discrimination and the stigma of obesity.  The “comprehensive update” features “sections on stigma-reduction research and legal initiatives to combat weight discrimination”; alas, only the citation is available without charge.

Plus: Also see Huget’s column on locally grown food. Miriam at Feministing has more on food politics.

Google AdWords Won’t Advertise Abortion: Lori Adelman of the International Women’s Health Coalition writes that as a result of policy changes, Google AdWords, the search engines’s advertising network, now prohibits ads for abortion services in more than a dozen countries, including Brazil, France, Mexico, Poland, and Taiwan.

“Google’s rationale behind disallowing ads in these particular countries, whose abortion laws range from conservative (Argentina, Brazil ) to more liberal by comparison (France, Italy), is shrouded in mystery: the spokeswoman deftly avoided answering my question about how the countries were chosen,” writes Adelman at Feministing. She includes an email exchange she had with a Google representative.

IWHC has an action alert over at its blog that encourages emailing Google.

Plus: Frances Kissling, a visiting scholar at the Center for Bioethics at the University of Pennsylvania and the former president of Catholics for a Free Choice, wrote a provocative piece at Salon last month that asks whether it’s ever appropriate to say “no” to a woman seeking an abortion.

Nurse Stereotypes Are Bad for Health: Theresa Brown, an oncology nurse, writes about how popular culture misrepresents nurses and the work that they do. She recommends a new book — “Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,” by Sandy Summers and Harry Jacobs Summers.

“Saving Lives” is an important book because it so clearly delineates how ubiquitous negative portrayals of nursing are in today’s media, particularly three common stereotypes of nurses — the “Naughty Nurse,” the “Angel” and the “Battle Axe.” They argue that these images of nursing degrade the profession by portraying nurses as either vixens, saints or harridans, not college-educated health care workers with life and death responsibilities.

There’s a media advocacy website connected with the book: TruthAboutNursing.org.

Sex, Kids & Reality: Amy Richards and Jennifer Baumgardner’s new book-in-progress — “The Family Bed: Is There Sex After Kids?” — focuses on the sex lives of parents after having children. As research for the book, they’re looking for folks to complete this survey on sex and parenthood.

When Wives Don’t Know: The New York Times Room for Debate Club brought together an all-female panel to discuss modern marriage. The central issue? Political wives who said they didn’t know about their spouses’ infidelities and Ruth Madoff, who said she didn’t know her husband of 50 years was practicing massive fraud.

Sales Outpace Data in Rush for Natural Remedies: “In 2002, when the initial findings of a National Institutes of Health study — known as the Women’s Health Initiative project — suggested that women on conventional hormone therapy were at greater risk for heart disease, cancer, stroke and blood clotting, the market for alternative treatments soared,” writes Camille Sweeney at The New York Times.

“There are now more than 500 products that purport to relieve symptoms associated with menopause, including capsules, tablets, teas, gels and creams. In the United States, the dietary supplement market associated with menopause has grown to $337 million in 2007 (the last year tabulated) from $211 million in 1999, according to the Nutrition Business Journal, a trade publication.”

“Beauty” Aces Talent at Wimbledon: Anyone else watch women’s tennis at Wimbledon last week? Read how looks came under consideration in determining which matches were played in the premiere Centre Court. Slender white women with long hair clearly had the advantage.

What Would Buffy Do?: See what happens when our favorite heroine takes on Edward from “Twilight” in a mash-up not to be missed.

“My re-imagined story was specifically constructed as a response to Edward, and what his behavior represents in our larger social context for both men and women,” creator Jonathan McIntosh explains in a blog post at Women in Media & News. He continues:

More than just a showdown between The Slayer and the Sparkly Vampire, it’s also a humorous visualization of the metaphorical battle between two opposing visions of gender roles in the 21ist century. [...]

In the end the only reasonable response was to have Buffy stake Edward — not because she didn’t find him sexy, not because he was too sensitive or too eager to share his feelings — but simply because he was possessive, manipulative, and stalkery.


February 4, 2009

Reiterating the Lack of Evidence Behind “Bioidentical” Hormones

Ever since the Women’s Health Initiative study found that women taking supplemental hormones had an increased risk of breast cancer, heart disease, and stroke, women struggling with menopausal symptoms have searched for safer alternatives. Companies that make bioidentical hormones (also called natural or compounded hormones) have been quick to jump into the void, often claiming that their products are safer and more effective than traditional “synthetic” hormones.

Unfortunately, there is no evidence to suggest that this is true. Yesterday, the American College of Obstetricians and Gynecologists (ACOG) issued a press release on such hormones.

ACOG expressed concern about the lack of testing of these products and also criticized the salivary testing that is often done in bioidentical hormone users under the assumption that it provides information needed for selecting a dosage:

“Despite celebrity testimonials touting scientifically unfounded benefits of compounded bioidentical hormones, the bottom line is that most have not undergone rigorous clinical testing for safety or efficacy, nor are they approved by the FDA. ACOG also stresses that salivary testing of a woman’s hormone levels is not useful because they vary within each woman depending on her diet, time of day, the specific hormone being tested, and other variables. Although monitoring salivary hormone levels is promoted by some as a means of ‘tailoring’ a hormone treatment to an individual, hormone therapy does not require customized dosing. “

The organization previously released a committee opinion in 2005 stating that “There is no scientific evidence to support claims of increased efficacy or safety for individualized estrogen or progesterone regimens prepared by compounding pharmacies,” but indicated that recent media attention to the topic led to yesterday’s statement.

The FDA has also set up a page for consumers of myths vs. facts about compounded “bioidentical” hormones, and expressed concern that “claims like these [about the effects of the hormones] mislead women and health care professionals, giving them a false sense of assurance about using potentially dangerous hormone products.”

Related Posts: Outrage Over FDA Crackdown on Biodentical Hormones? Not So Fast, says National Women’s Health Network

OBOS Web Content: Natural Products: Phytoestrogens and Bioidentical Hormones; The Medicalization of Menopause


January 1, 2009

A New Year Review of Women’s Health Heroes

Among the many luminaries who died in 2008 are women who made significant contributions in the areas of women’s health and hospice care. Please add names and links we might have missed in the comments.

Pamela Morgan | b. 1949
In November, Our Bodies Ourselves lost one its founders, Pamela Morgan. A writer, editor and administrative manager of the organization in its early days, Morgan was “one of these extraordinarily multitalented individuals, and as a dancer, everything she did was with élan and flair,” said Judy Norsigian, executive director of OBOS.

Remembrances by other OBOS co-founders who had the privilege of working closely with Pamela can be read here.

Barbara Seaman | b. 1935
Barbara Seaman, a self-described muckraker, co-founded the National Women’s Health Network in 1975. A tireless advocate, she is credited with helping to create the concept of patients’ rights, particularly “informed consent,” and is well-known for her writings on women’s health. Her first book, “The Doctors’ Case Against the Pill” (1969), led to congressional hearings on the safety of oral contraceptives. “The Greatest Experiment Ever Performed on Women” (2003) was an expose of hormone replacement therapy.

OBOS co-founder Norma Swenson wrote wrote a rememberance of Barbara Seaman focusing on their involvement in the early women’s health movement.

Edwina Froelich | b. 1915
In the 1950s, Edwina Froelich was part of a group of suburban Chicago moms who met at each other’s homes to help new mothers with breastfeeding. The seven women, all Catholic housewives, founded the La Leche League.

“In those days you didn’t mention ‘breast’ in print,” Froehlich once said. “We knew that if we were ever going to get anything in the paper we would have to find a name that wouldn’t actually tell people what our organization was about.”

When we first wrote about her death in June, it sparked a discussion about La Leche and feminism. In an essay about Froelich published in The New York Times Magazine last week, Emily Bazelon addresses the history of the organization and its attitude toward working mothers.

Florence Wald | b. 1917
Here’s a hero we haven’t yet mentioned. In the 1960s, after attending a lecture by a British physician about opening the world’s first hospice, Florence Wald resigned her position as dean of the Yale School of Nursing to focus on developing a hospice care center in the United States.

“In those days, terminally ill patients went through hell, and the family was never involved,” she said. “No one accepted that life cannot go on ad infinitum.”

In 1974, Connecticut Hospice, the nation’s first home-care program for the terminally ill, opened its doors. A 44-patient hospice opened six years later. From The New York Times:

“This hospice became a model for hospice care in the United States and abroad,” the publication Yale Nursing Matters said this week, adding that Mrs. Wald’s role “in reshaping nursing education to focus on patients and their families has changed the perception of care for the dying in this country.”

There are now more than 3,000 hospice programs in the United States, serving about 900,000 patients a year.

In recent years, Mrs. Wald had concentrated on extending the hospice care model to dying prison inmates.

“People on the outside don’t understand this world at all,” Mrs. Wald told The New York Times in 1998. “Most people in prison have had a rough time in life and haven’t had any kind of education in how to take care of their health.”

Rosetta Reitz | b. 1924
Rosetta Reitz is best known for her support of women involved in early jazz and blues — stars who were overlooked in the shadow of male performers. With $10,000 borrowed from friends, Reitz created Rosetta Records, releasing 17 albums of lost music. But as The New York Times notes, music history was just one of Reitz’s accomplishments:

Ms. Reitz was at different times a stockbroker, a bookstore proprietor and the owner of a greeting card business. She was a food columnist for The Village Voice, a professor, a classified-advertising manager and author of a book on mushrooms. She was a founding member of Older Women’s Liberation. She reared three daughters as a single parent.

Ms. Reitz also wrote “Menopause: A Positive Approach” (1977), considered one of the first books to look at menopause from the viewpoint of women and not doctors. She listened to her recordings of women while she wrote the book, many of them celebrating the strength of women rather than treating them as victims.

“I was so alone and needed to be nurtured, and I found I was getting it from them,” she told The Los Angeles Times in 1992.


December 11, 2008

Osteopororsis Medicine: National Women’s Health Network Urges Women to Consider the Risks

National Women’s Health Network has posted a health alert concerning FDA oversight of bisphosphonates, such as Fosamax, and is urging women to carefully evaluate whether they should be on the drugs:

After two bisphosphonate studies showed problems with heart damage, the FDA examined the effect of these drugs on the heart and found that women taking zoledronic acid (Reclast) and alendronate [Fosamax] were more likely to have dangerous irregular heart beats (atrial fibrillation). After examining all the available data, the FDA wasn’t able to confirm that the drugs cause the irregular heart rhythms, but it can’t rule it out, either. The FDA says it will do further studies of this issue, but in the meantime it has alerted women about the possible problem.

The FDA advised women currently taking bisphosphonates not to stop. However, NWHN believes there may be many women taking the drugs for whom the benefits don’t outweigh the risks, and we urge women and prescribers to carefully evaluate whether they should be on the drugs. For example, healthy middle-aged women whose only reason for taking the drug is that a test showed some loss of bone density may decide they don’t want to increase their risk for heart problems to ward off a bone fracture that might or might not happen. (For more on the over-use of bone density screening tests, see the NWHN Osteoporosis fact sheet.)

Read the full alert, which also discusses the FDA announcement that it has put off deciding whether to approve another osteoporosis drug, lasofoxifene (Fablyn). Cindy Pearson, NWHN’s executive director, had urged the FDA not to approve the drug until there was more long-term safety data.


July 18, 2008

Double Dose: A Wacky Week for the White House on Abortion; “Hypersegregation” and Racial Disparities in Preterm Birth; Blogging While Brown Conference; Hot Flash Fan on Exhibit; AIDS Conference Coverage …

White House Defines Contraception as Abortion: You know you’re counting down the remaining hours of the Bush presidency when you read that the administration “wants to require all recipients of aid under federal health programs to certify that they will not refuse to hire nurses and other providers who object to abortion and even certain types of birth control,” as reported in The New York Times.

Under the draft of a proposed rule, hospitals, clinics, researchers and medical schools would have to sign “written certifications” as a prerequisite to getting money under any program run by the Department of Health and Human Services. Such certification would also be required of state and local governments, forbidden to discriminate, in areas like grant-making, against hospitals and other institutions that have policies against providing abortion.

And the kicker:

The proposal defines abortion as follows: “any of the various procedures — including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action — that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation.”

Check out the full memo (PDF). Reuters has reaction from family planning groups. NARAL created a letter you can send to members of Congress.

For more reading, see Allison Stevens; Susan Wood; and Christina Page, who notes:

Up until now, the federal government followed the definition of pregnancy accepted by the American Medical Association and our nation’s pregnancy experts, the American College of Obstetricians and Gynecologists, which is: pregnancy begins at implantation. With this proposal, however, HHS is dismissing medical experts and opting instead to accept a definition of pregnancy based on polling data. It now claims that pregnancy begins at some biologically unknowable moment (there’s no test to determine if a woman’s egg has been fertilized). Under these new standards there would be no way for a woman to prove she’s not pregnant. Thus, any woman could be denied contraception under HHS’ new science.

Senate Passes PEPFAR: Scott Swenson of RH Reality Check has the live blog on the 80-16 vote to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $50 billion global initiative to combat HIV/AIDS, tuberculosis and malaria.

SEICUS, International Women’s Health Coalition, and other groups issued a response to the vote, noting in part that “policymakers failed to address critical shortfalls in the bill that would have ensured effective use of scarce public funds and a sustainable response to the pandemic.” It continues:

One key change that should have been made in the PEPFAR bill was the abolishment of arbitrary funding guidelines that determine how money can be distributed on the ground. The Senate bill calls for spending at least fifty percent of prevention funds designed to halt the sexual transmission of HIV, in countries with generalized epidemics, only on abstinence and faithfulness programs. PEPFAR recipients that do not meet this requirement must justify their programmatic decisions through an onerous reporting requirement to Congress, potentially facing defunding. [...]

The PEPFAR bill passed by the Senate also failed to fully increase protection for women and young people, two groups increasingly vulnerable to new infections in nearly every region of the world. Women and young people are most likely to use family planning and other reproductive health services, and would benefit greatly from a strategy that integrated HIV prevention and treatment with family planning. Recent studies suggest that upwards of 90 percent of HIV-positive pregnant women in countries such as Uganda and South Africa have unmet need for integrated family planning and HIV services. However, the bill passed by the Senate fails to call for, or even acknowledge, the need to strengthen critical linkages between family planning and reproductive health services and HIV prevention efforts.

Regional “Hypersegregation” May Contribute to Racial Disparity in Preterm Births: Where a mother lives may account for some of the striking racial disparities in preterm birth, according to a new study described in this release and published in the American Journal of Epidemiology.

Written by Northeastern University professor Theresa Osypuk, the study found that regional hypersegregation (residential racial segregation across four or more dimensions*) may contribute to the higher rate of preterm births among black women. Prior research has shown that infants born to Black women in the U.S. are 50% more likely to be preterm than infants born to White women, although the causes remain poorly understood. [...]

“The complexity of residential segregation and its impact on preterm births and related health outcomes has been overlooked by health literature,” said Dr. Osypuk, Assistant Professor in Northeastern’s Bouve College of Health Sciences. “We believe that the association between residential segregation and higher risk of preterm birth is related to the neighborhood environments in which black women live, including neighborhoods characterized by high levels of poverty, violent crime, and worse housing stock.”

Are Breast Self-Exams Worth It?: Kate Harding breaks down a new study by the Cochrane Collaboration.

Blogging While Brown (and Female): “People consider me the 411 on what goes wrong with black women in America,” Gina McCauley, founder of www.whataboutourdaughters.blogspot.com,” tells Kristal Brent Zook in this article on how women bloggers of color are getting their messages out without having to first get approval through a male power structure.

Plus: The first ever “Blogging While Brown” conference takes place July 25-27 in Atlanta.

Return of the C-Word for Departing Trib Editor: From Romenesko: “In 2004, Ann Marie Lipinski had her Chicago Tribune staff manually pull 600,000 copies of the WomenNews section out of preprinted packages because of the headline, “You c_nt say that.” (The story explored usage of the vulgar term for a woman’s anatomy.) On Thursday, the departing editor showed the newsroom a reader’s e-mail that said, “You C_nt Leave.”

Dissecting the Diets: I caught a frustratingly superficial TV news segment on a long-term Atkins Foundation-funded study (published in the New England Journal of Medicine) that concluded participants on the Atkins Diet lost more weight compared to people on low-fat or Mediterranean diets. Tara Parker-Pope notes, however, that none of the diets resulted in much weight loss (though there were other health benefits), and she takes a closer look at what eating low-carb meant for the purpose of this study — while some commenters discuss whether the low-fat diet was low enough to be effective. Parker-Pope’s most concise critique of the study may be found here.

AIDS Conference Coverage: Kaisernetwork.org will provide daily coverage of AIDS 2008 from Mexico City, Aug. 3-8. Coverage will include live and tape-delayed webcasts and transcripts of each day’s sessions, including the opening and closing sessions, all plenary sessions, and selected other sessions and press conferences; English- and Spanish-language audio podcasts of select sessions; slide presentations from select conference sessions; a daily update email with links to the latest coverage; and more.

Plus: Here’s information on how you can syndicate Kaiser’s coverage on your own website.

Hot Flash Fan Heats Up Exhibit: Lucinda Marshall points to an exhibit at the Huff Gallery at Spalding University in Louisville: “The Hot Flash Fan, Then and Now: Celebrating 160 Years of Feminism.” The Hot Flash Fan, an 8’ x 16’ wall hanging, was created by Ann Stewart Anderson in collaboration with more than 50 women artists. From the exhibit website:

The Hot Flash Fan was created in 1985 and facilitated by renowned feminist artist, Judy Chicago. The Hot Flash Fan, an immense wall hanging, encompasses various media and materials including: elaborate knotting, roping, beading and stitching. In addition, the piece is swathed in vibrant colors, which enhances the viewer’s image of the realities and experiences of menopause.

This specific piece has particular historical significance because it was one of the first artworks to ever visualize the subject of menopause. Through its vivid colors and intricate detailing the Hot Flash Fan depicts the various myths, stereotypes, as well as lived experiences of women transitioning through the multiple phases of menopause. Though historically, representations of menopause have largely focused on the decaying of women’s bodies, as the piece indicates, there are also many reasons to celebrate menopause as one of the important phases in women’s lives.

Check it out:

hot_flash_fan.jpg


June 28, 2008

Double Dose: Planned Parenthood Expands Reach; Pack Journalism in Search of a Pregnancy “Pact” in Gloucester; Teen Pregnancies at 30-Year Low; Mandating Insurance Coverage for Anorexia; Will Women Give Hormone Maker a Second Chance? …

Planned Parenthood Expands its Reach: “Flush with cash, Planned Parenthood affiliates nationwide are aggressively expanding their reach, seeking to woo more affluent patients with a network of suburban clinics and huge new health centers that project a decidedly upscale image,” reports the Wall Street Journal.

Unfortunately the full story is available to subscribers only, but the WSJ health blog has a summary that includes these remarks:

Despite some critiques to the contrary, Planned Parenthood insists it’s not compromising is long-held focus on serving the poor with birth control, sexual-health care and abortions. Officials there say they take a loss of nearly $1 on each packet of birth-control pills distributed to poor women under a federal program that funds reproductive care. But they make a profit of nearly $22 on each month of pills sold to an adult who can afford to pay full price. That money helps subsidize other operations, including care for the poor as well as pursuing Planned Parenthood’s political agenda.

“It is high time we follow the population,” said Sarah Stoesz, who heads Planned Parenthood operations in three Midwest states. She recently opened three express centers in wealthy Minnesota suburbs, “in shopping centers and malls, places where women are already doing their grocery shopping, picking up their Starbucks, living their daily lives,” she said.

Pregnant in Gloucester: Concerning the 18 high school students pregnant in Gloucester, Mass, that have received national news coverage for supposedly choosing to get pregnant and raise their children together, Kelly McBride, who covers media ethics for Poynter Institute, has an excellent piece on pack journalism in search of a “pact..” Meanwhile, the high school principal who first said their was evidence of a pact defends his comments and his memory.

Plus: Courtney Macavinta of Respect RX discusses her own sex “pact” at age 15 and the cycle of disrespect that leads girls who don’t value themselves to make choices “in which the fine print (that life is about to get even harder) is written in invisible ink.”

Teen Pregnancies at 30-Year Low: Writing in the Chicago Tribune, Lisa Anderson reports on the latest pregnancy statistics released by the Guttmacher Institute.

Pregnancies — whether they end in birth, miscarriage or abortion — among women age 15 to 19 dropped to 72.2 per 1,000 women in 2004, down from a peak of 117 per 1,000 women in 1990 [...]

While some 700,000 women age 15 to 19 become pregnant every year, the rate has declined 36 percent since it peaked in 1990. The rate of abortions among teens also plummeted, to 19.8 per 1,000 women in 2004 from a high of 43.5 per 1,000 in 1988.

But researchers are keeping a close eye on the numbers, as there are some signs that the drop may be reversing:

Despite decades of improvement and for reasons yet unknown, there is statistical evidence that the drop in pregnancy rates, the age of first sexual activity and contraceptive use among teens stalled after 2001.

The exception may be in the teen birthrate. After a 14-year decline, the birthrate, meaning the number of live births, among women age 15 to 19 rose 3 percent in 2006 to 41.9 per 1,000 women from 40.5 per 1,000 women in 2005, according to the U.S. Centers for Disease Control and Prevention. Until more data are compiled, it is unclear whether the 2006 uptick in births was an isolated blip or the harbinger of a more significant and negative change on the teen reproductive landscape, according to David Landry, a senior research associate at the Guttmacher Institute.

Mandating Insurance Coverage for Psychiatric Ailments: Illinois will become the 17th state to mandate insurance coverage for treatment of anorexia and bulimia, assuming the governor signs a bill recently approved by the state Legislature.

Bonnie Miller Rubin and Ashley Wiehle of the Chicago Tribune write:

The measure is part of a larger national debate about addressing inequities in insurance coverage between psychiatric and physical ailments.

More than 12 million Americans, mostly young women, have eating disorders in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders. The organization ranked risk of death as higher with anorexia than with any other mental illness. Among patients with anorexia, almost half of all deaths are suicides, according to ANAD. Yet many insurers balk at covering the tab, which can run as high as $2,500 a day.

“I’ve met so many parents who have had to refinance their homes,” said Rep. Fred Crespo (D-Hoffman Estates), one of the bill’s sponsors.

But others cite the financial cost of such a law. Richard Cauchi, health program director for the National Conference of State Legislatures, said Illinois has taken “an unusual action” for 2008, when the trend is to move away from mandates on business and governments.

“There’s more pressure now to repeal and restrict mandates than to enact new ones,” he said..

“Neglected Infections of Poverty”: “Despite plummeting mortality rates for most infectious diseases over the last century, a group of largely overlooked bacterial, viral and parasitic infections is still plaguing the nation’s poor, according to a report released this week,” writes Wendy Hansen in the L.A. Times.

“Many of the diseases are typically associated with tropical developing countries but are surprisingly common in poor regions of the United States, according to the analysis, published in the Public Library of Science journal PLoS Neglected Tropical Diseases.”

The study’s author, Dr. Peter Hotez, chairman of George Washington University’s department of microbiology, immunology and tropical disease, says there are 24 diseases affecting at least 300,000 Americans, and possibly millions. Poverty-stricken regions, including Appalachia, inner cities, the Mississippi Delta and the border with Mexico, are the areas most severely affected.

Will Women Give Hormone Maker a Second Chance?: “Can Wyeth win back the 40 million Premarin and Prempro users it’s lost since 2002 — along with $1 billion a year in profits — with a new menopause drug? Or will the once-bitten women who have filed more than 5,000 lawsuits claiming the hormones gave them cancer feel fooled twice?” asks Martha Rosenberg at AlterNet.org, in this look at Wyeth’s hope of marketing Pristiq as the first nonhormonal treatment for menopause symptoms.

Don’t Ask, Don’t Tell Affects Women More: “The Army and Air Force discharged a disproportionate number of women in 2007 under the “don’t ask, don’t tell” policy that prohibits openly gay people from serving in the military, according to Pentagon statistics gathered by an advocacy group,” reports The New York Times.

While women make up 14 percent of Army personnel, 46 percent of those discharged under the policy last year were women. And while 20 percent of Air Force personnel are women, 49 percent of its discharges under the policy last year were women. By comparison for 2006, about 35 percent of the Army’s discharges and 36 percent of the Air Force’s were women, according to the statistics.

The information was gathered under a Freedom of Information Act request by the Servicemembers Legal Defense Network, a policy advocacy organization.

Gardasil Not Approved for Older Women: “U.S. regulators have told Merck & Co they cannot yet approve Merck’s application to expand marketing of its cervical cancer vaccine Gardasil to an older group of women, the drugmaker said on Wednesday,” reports Reuters.

“Merck had applied for the use of Gardasil in women ages 27 through 45. The U.S. Food and Drug Administration said in a letter regarding the application that it has completed its review and there are ‘issues’ that preclude approval within the expected review time frame, Merck said.”

Exercise as a Tonic for Aging: The New York Times reports on an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine, which are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

“Contrary to what many active adults seem to believe, physical fitness does not end with aerobics,” writes Jane Brody. “Strength training has long been advocated by the National Institute on Aging, and the heart association has finally recognized the added value of muscle strength to reduce stress on joints, bones and soft tissues; enhance stability and reduce the risk of falls; and increase the ability to meet the demands of daily life, like rising from a chair, climbing stairs and opening jars.”