Most users of hormonal birth control have heard warnings that the drugs may increase risk of blood clots. Two new studies in the journal BMJ examine this risk, and attempt to characterize the amount of risk by how long women were on the drugs and the type of hormone. In general, they find the highest risk when women first start taking the pill, decreased risk with decreased dose, and a lower risk with levonorgestrel than with other progestagens.

The first, a case-control study conducted in the Netherlands, compared 1,524 pre-menopausal women who had experienced a deep vein thrombosis or pulmonary embolism with 712 women who had not (the control group). All of the participants completed a questionnaire on risk factors for venous thrombosis such as family history, pregnancy, and oral contraceptive use, and were further interviewed about their oral contraceptive use.

The researchers report a fivefold increase in risk for venous thrombosis associated with oral contraceptive use. The also found different levels of risk by the type of contraceptive in use – compared to women who did not use the drug, those using a contraceptive containing levonorgestrel (the most frequently used in the study) had an almost fourfold increase in risk (odds ratio 3.6). Risk also appeared to increase 5.6-fold for those containing gestodene, 6.3-fold for drospirenone, 6.8-fold for cyproterone acetate, and 7.3-fold for desogestrel. Risk seemed to increase with higher dosages, and to decrease over time – women had the greatest risk as new users in the first 3 months (odds ratio 12.6) which declined to the average 5-fold increased risk after one year.

The second is a cohort study using registry data to track Danish women over time for various types of thromboses and oral contraceptive use. The paper uses “woman years” as a measure of the participants and explains that the study covered 10.4 million woman years of observation (2 years of observation of 5 people, for example, would be 10 person-years). They report that “The overall absolute risk of venous thrombosis per 10,000 woman years in non-users of oral contraceptives was 3.01 and in current users was 6.29.”

These authors also found decreased risk over time, with the highest risk in the first year, a decreased risk with decreased estrogen dose, and a higher risk with contraceptives containing desogestrel, gestodene, or drospirenone were associated with a higher risk of venous thromboembolism than those containing levonorgestrel.

The BMJ issue also includes an editorial on the studies – which notes that while the absolute risk of blood clots is low, providers may need to consider these findings in selecting contraceptives with individual patients – and links to a recent review of different contraception options for women.

by Morgan Clark
Our Bodies Ourselves intern

The first day of my internship with Our Bodies Ourselves began with a fascinating web conference on reproductive and environmental health, organized by Reproductive Health Technologies Project. Presenters from Planned Parenthood of Connecticut, Asian Communities for Reproductive Justice, and MomsRising spoke about their organizations’ efforts in addressing “increasing evidence that industrial chemicals are linked to infertility and a host of negative health outcomes such as early puberty, miscarriage, and reproductive cancers.”

During this web conference I learned about a new report (pdf) published by the Oakland-based Asian Communities for Reproductive Justice (ACRJ). The latest volume in their Momentum Series, “Looking Both Ways: Women’s Lives at the Crossroads of Reproductive Justice and Climate Justice,” highlights the interconnectedness of reproductive health issues and the climate crisis.

The report offers an insightful framework for approaching issues that disproportionately affect vulnerable people, particularly women living in poverty and women of color. An example is the aftermath of Hurricane Katrina, which, among many of the disastrous outcomes, saw a rise in sexual abuse and a decline in access to reproductive health services.

The report finds that while Hurricane Katrina “brought shape to the emerging understanding of women and climate change in the United States, the scope of the climate crisis demands much more: that we not only address how women will be impacted— and how to protect their rights — but also how women’s lives are wrapped up in both the causes of, and potential solutions to, the climate crisis.”

Looking at how women’s lives are binded to some of the causes of the climate crisis, the paper also analyzes the effects of everyday workplace exposure to certain chemicals on women’s health and fertility. It underscores the importance of using Life Cycle Assessment (LCA) research to determine “the impact of the entire life cycle of a chemical or material on the environment or a particular aspect of the environment – such as energy consumption, greenhouse gas emissions, or water contamination.”

An LCA study generally looks at the following phases: raw material acquisition, materials manufacture, production, use/reuse/maintenance, and waste management. In other words, it is important to consider the environmental impacts of how a chemical was made, distributed and disposed of, as well as look at how a chemical’s use in a workplace affects the health of a worker. For more information, the EPA has a website on Life Cycle Assessment Research.

The nail salon industry in California is one of the examples cited, because it is a fast-growing industry that exposes workers to toxic chemicals, some unregulated, that contribute to global warming. The ACRJ’s POLISH program works with the nail care industry to improve the health of nail care workers and to reduce negative environmental impacts. Further,

[a] reproductive justice analysis of working conditions in nail salons directs improvements not only to making the nail salon environment one that is conducive to good health, but also to increasing wages, improving benefits, reducing working hours, reducing harassment and discrimination, and creating more educational opportunities for workers.

ACRJ’s important work, with POLISH and its other programs, makes “clear that the preservation of the planet remains intimately connected to protecting the reproductive capacities and self-determination of marginalized communities.”

I found the ACRJ’s report enlightening. I appreciated its broad perspective on reproductive health and the causes and effects of climate change. As someone concerned with the rapid decline of our environment, and its effects on our health, I appreciate the efforts of the ACRJ and the other organizations that presented during the web conference in addressing these issues.

Morgan Clark is a PhD student in public policy at the University of Massachusetts, Boston.

The Centers for Disease Control and Prevention has released a new report on the sexual and reproductive health of people ages 10-24 in the United States. The agency compiled data from its various surveillance and survey systems for the period of 2002-2007 in an attempt to answer questions about how many young people engage in “sexual risk behaviors” and the related health outcomes, and to compare the findings with historical data.

While the report includes a number of details on rates of sexual intercourse, sexual violence, use of contraception, pregnancy, births, abortion, sexually transmitted infections, and HIV/AIDS (all of which are freely available for viewing online), perhaps most interesting are the information on health disparities and changes over time.

In a press release on the report, the CDC notes signs that progress in sexual and reproductive health of young people may have slowed over the report period. They explain:

Among the signs that progress has halted in some areas:

• Teen birth rates increased in 2006 and 2007, following large declines from 1991-2005.
• Rates of AIDS cases among males aged 15-24 years increased during 1997-2006 (AIDS data reflects people with HIV who have already progressed to AIDS.)
• Syphilis cases among teens and young adults aged 15-19 and 20-24 years have increased in both males and females in recent years.

Additionally, a lack of change in the rates of some items isn’t necessarily a positive outcome. For example, the prevalence of dating violence was “stable overall” and did not decrease, as was the prevalence of ever having been physically forced to have sexual intercourse (except among 10th grade males, whose rates declined). Rates of “nonfatal sexual assault injuries” were also “relatively stable.”

The authors also note that “noticeable disparities exist in the sexual and reproductive health of young persons in the United States.” For example:

• Pregnancy rates for female Hispanic and non-Hispanic black adolescents aged 15–19 years are much higher (132.8 and 128.0 per 1,000 population) than their non-Hispanic white peers (45.2 per 1,000 population).
• Non-Hispanic black young persons are more likely to be affected by AIDS.
• In 2006, among young persons aged 10–24 years, rates for chlamydia, gonorrhea, and syphilis were highest among non-Hispanic blacks for all age groups.
• The southern states tend to have the highest rates of negative sexual and reproductive health outcomes, including early pregnancy and STDs.

For more resources on adolescent and young women’s health, see our collection of web links on this topic.

A study in the current issue of JAMA attempts to assess the risk of ovarian cancer in women taking hormone replacement therapy (HRT, or “HT” in this study). The study (see abstract) adds to a growing body of literature suggesting that HRT may increase the risk of ovarian cancer.

Data for the current study comes from Danish Sex Hormone Register Study, which “follows a national cohort of Danish women aged 15 through 79 years to explore the influence of sex hormones on the risk of cardiovascular diseases and different female cancers.” That data was studied in conjunction with other national registries on cancers, hospital discharge and surgical data, demographics, and other details.

The final analysis included almost 910 thousand women who were 50 or older in 1995, had no previous cancers, and had not had their ovaries removed. The women were followed over time and those who had never used hormone replacement therapy were compared to those who had various types of HRT for ovarian cancer outcomes (previous research had suggested different outcomes depending on factors such as duration and type of HRT).

The findings are presented in terms of relative risk, meaning that the “RR” figures for those who used HRT reflect the amount of risk of ovarian cancer relative to those who never used HRT. The authors found that current users of hormone therapy had an increased relative risk of ovarian cancer of 1.38 (95% CI, 1.26-1.51) – or 1.38 times the risk of never-users. Risk for epithelial ovarian cancer (the most common type, which begins on the surface of the ovary) was increased for up to 2 years after ending hormone use, and declined to a similar level of risk as nonusers thereafter.

The authors did not find a significant difference in the rate of increased risk between estrogen-only or estrogen-plus-progestin users, between cyclic or continuous regimens, between oral vs. transdermal administration, or between different lengths of duration of use.

The authors note that their finding is somewhat different from previous similar studies, in that it “contrasts some prior studies that were not able to detect increased risk with HT of less than 5 years” and “no consistent association was found between increasing dose of ET (estrogen therapy) and the risk of ovarian cancer.”

They indicate that their findings are in accordance with some past studies (specifically the the Million Women Study and the Nurses’ Health Study) in that “past users users had only a slightly increased risk of ovarian cancer, and the excess risk was not apparent 2 years after cessation.” The authors also note that although the absolute risk increase is small, “ovarian cancer remains highly fatal, so accordingly this risk warrants consideration when deciding whether to use HT.”

We’ve mentioned in previous posts that comparative effectiveness research (research that directly compares the effectiveness of different treatments for the same illness) received funding in the stimulus bill, and that the Institute of Medicine was gathering public input in order to inform a report providing specific recommendations to Congress for prioritizing the expenditure of the funds. On Tuesday, the IOM released that report, “Initial National Priorities for Comparative Effectiveness Research“, which includes a list of 100 top topics (out of 1,268 unique suggestions) that the authoring committee believes should be prioritized for funding.

The committee writes that the list of priorities was determined not just by which conditions affect the largest number of people, but with balance in mind. The full report notes that rare diseases and conditions that disproportionately affect specific segments of the population were also considered. They also explain that while comparative effectiveness research often focuses on comparing drug A to drug B, the committee felt it was important to include a diversity of interventions and different types of therapies, and they also considered where the gaps are in existing research.

The priority list includes several childbirth related topics, including this: “Compare the effectiveness of birthing care in freestanding birth centers and usual care of childbearing women at low and moderate risk.” The report doesn’t specify what “usual care” is, so we can only assume that it means birth in a hospital with an ob/gyn. The list also doesn’t include details on how the effectiveness of birthing care will be judged, but we’ll certainly keep an eye out for more information!

Several other topics that are at least partially specific to women’s health made it into the top 25 priorities (the list of 100 was further broken down into quartiles). They include:

• Genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist.
• Interventions to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
• Clinical interventions (e.g., prenatal care, nutritional counseling, smoking cessation, substance abuse treatment, and combinations of these interventions) to reduce incidences of infant mortality, pre-term births, and low birth rates, especially among African American women.
• Innovative strategies for preventing unintended pregnancies (e.g., over-the-counter access to oral contraceptives or other hormonal methods, expanding access to long-acting methods for young women, providing contraceptive methods at public clinics, pharmacies, or other locations).

Other relevant topics include comparison of weight-bearing exercises and bisphosophonates for preventing fractures in older women with osteoporosis, film screen or digital mammography and mammography plus MRI for breast cancer screening in high risk women, outcomes with and without the use of obstetric ultrasound in normal pregnancies, and “strategies for promoting breastfeeding among low-income African American women.”

Kaiser Family Foundation has released an important package of resources that shines a spotlight on health disparities between white women and women of color in all 50 states and Washington, D.C.,

The report (pdf), “Putting Women’s Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level,” takes into account 25 indicators, including rates of diseases such as diabetes, heart disease, AIDS and cancer, and access to health insurance and health screenings.

The states with the largest rate of disparities were Arkansas, Indiana, Louisiana, Mississippi, Montana and South Dakota. States such as Virginia, Maryland, Georgia and Hawaii showed relatively smaller disparities between women of color and white women on health outcomes and health care access.

The reports also notes that white women and minority women were doing similarly well in Maine — and similarly poorly in Kentucky and West Virginia.

This introductory page includes links to the full report and numerous documents that look closely at health status, access to health care, social determinants and workforce statistics.

Among the key findings:

Disparities existed in every state on most measures. Women of color fared worse than White women across a broad range of measures in almost every state, and in some states these disparities were quite stark. Some of the largest disparities were in the rates of new AIDS cases, late or no prenatal care, no insurance coverage, and lack of a high school diploma.

In states where disparities appeared to be smaller, this difference was often due to the fact that both White women and women of color were doing poorly. It is important to also recognize that in many states (e.g. West Virginia and Kentucky) all women, including White women, faced significant challenges and may need assistance.

Few states had consistently high or low disparities across all three dimensions. Virginia, Maryland, Georgia, and Hawaii all scored better than average on all three dimensions. At the other end of the spectrum, Montana, South Dakota, Indiana, and several states in the South Central region of the country (Arkansas, Louisiana, and Mississippi) were far below average on all dimensions.

States with small disparities in access to care were not necessarily the same states with small disparities in health status or social determinants. While access to care and social factors are critical components of health status, our report indicates that they are not the only critical components. For example, in the District of Columbia disparities in access to care were better than average, but the District had the highest disparity scores for many indicators of health and social determinants.

Each racial and ethnic group faced its own particular set of health and health care challenges.
The enormous health and socioeconomic challenges that many American Indian and Alaska Native women faced was striking. American Indian and Alaska Native women had higher rates of health and access challenges than women in other racial and ethnic groups on several indicators, often twice as high as White women. Even on indicators that had relatively low levels of disparity for all groups, such as number of days that women reported their health was “not good,” the rate was markedly higher among American Indian and Alaska Native women.

Plus: Kaiser also put together a video companion to the report. Filmed at the Arlington (Va.) Free Clinic, the video looks at the challenges that uninsured women face.

In 1970, Kay Zakariasen sought treatment for a bladder infection. The resulting diagnosis (a too narrow urethra) and treatment (surgical dilation) set her on a course of pain and frustration for the next three decades.

In an article published at the National Women’s Health Network and at Our Bodies Ourselves, Zakariasen describes what it was like living with the constellation of bladder and pelvic pain symptoms that is often referred to as interstitial cystitis.  And she laments the lack of effective, evidence-based treatments:

Studies touting the effectiveness of surgeries such as hydrodistention and instillations often fail to follow basic practices of good scientific research. Almost no published reports on IC are randomized, controlled clinical studies in which both researchers and patients were “blinded” about the subjects’ conditions and the treatment being tested to ensure objectivity. Most studies also failed to include control groups, which compare a group getting the treatment being investigated with a control group receiving only a placebo. When higher quality scientific studies have been done, they often fail to support the initial positive results. As a result, experts suggest that the reported high success rates for IC treatments should be reduced by 35% to factor in the placebo effect, and by as much as 50% to address spontaneous remission of the patient’s symptoms. It’s likely that many women, if informed about these low success rates, would decide not to have invasive treatments.

Zakariasen found some relief for severe intestinal bloating — which many IC patients have, and which started for her about the same time as urological treatment with antibiotics and dilation — when a holistic internist treated her for food sensitivities and intestinal candida. But she did not get significant help for chronic bladder urgency and frequency until years later, when she was treated for “intestinal bacterial overgrowth.”

The experiences left Zackariasen frustrated by the dearth of evidence-based information about surgical outcomes and alternative treatments.

In  2003, with the help of Dr. Elizabeth Kavaler, a urologist, Zakariasen created a patient survey — www.cystitispatientsurvey.com — for women who had been treated for IC. Most of the respondents said surgeries either worsened or had no effect on their symptoms. More than 1,300 patients have completed the survey, and four physicians who analyzed some of the data published an article in the January 2008 issue of the journal Urology. Our Bodies Ourselves and the National Women’s Health Network contributed letters of support to the survey.

The survey is still open for women to share their experiences, and Zakariesen is seeking volunteer statisticians to help analyze more data.

Zakariasen is currently writing a book on her experiences and the history of treatments for interstitial cystitis. She asks readers who are willing to share their medical experiences to contact her at zakariasen@verizon.net.

In the article posted at OBOS, Zakariasen makes the case for more patient involvement in the treatment of IC, but her statement applies to all aspects of women’s health:

Despite the principle that patients should be the primary decision-makers regarding their own treatment and care, it is clear that many women are not given all of the information they need to make a truly informed decision. Patients have a right to know — for every treatment a doctor offers — the nature of the procedure, the quality of evidence supporting it, its benefits and risks, and any alternatives to that treatment.

Finding “Common Ground” on Abortion – How’s That Working?:  “President Obama has accomplished a lot in his first 100 days in office, but one campaign promise he’s been unable to keep is a vow to make peace in one of the most polarizing issues in all of American politics: abortion,” reports NPR.

Lines in the Sand: Speaking of the elusive common ground, On the Issues magazine chose “lines in the sand” as the theme for its current issue.

An email to readers said the choice was “provoked by today’s too-prevalent sentiment to compromise principles in the interests of seeking ‘common ground’ and reconciliation with opposing views. In these articles we explore the feminist and progressive values that must be held tightly, the ‘lines in the sand’ that we refuse to erase.”

Publisher and Editor-in-Chief Merle Hoffman says reproductive freedom is “the front line, the bottom line and the everlasting line in the sand,” in her editorial “Higher Ground, Not Common Ground.”

Also look for essays by Gloria Feldt, Loretta Ross and many more writers and artists.

Economics, Race and Pollution: A study by researchers at the University of Massachusetts and the University of Southern California tracking toxic emissions from factories confirms what we already know: poor, minority communities are disproportionately affected by harmful pollution. The Milwaukee Journal Sentinel reports on the findings. View the full report (PDF) here.

Public Attitudes Toward HIV/AIDS as a Health Issue: Kaiser Family Foundation has released its 2009 Survey of Americans on HIV/AIDS. In the United States, the sense of urgency about HIV/AIDS as a national health issue has decreased significantly. Residents’ concerns about the disease as a personal risk also has declined, even among some high-risk groups. This press release summarizes the findings. The study comes less than a year after the CDC  announced that there were 40 percent more new HIV infections each year than previously believed.

Egypt’s FGM Ban, One Year Later: In the year since Egypt outlawed female genital mutilation, the government hasn’t prosecuted a single case, Iman Azzi writes at Women’s eNews. Still, some activists say the law is a tool, among others, for gradually dismantling an ancient tradition.

Legalization – The “X” Factor: On May 1, thousands of activists took to the streets in favor of expanding immigrants rights. Suman Raghunathan, an immigration and public policy analyst, describes what immigrant women, particularly those who are undocumented, need: “A legalization program that’s broad, fair and workable for both immigrants and immigration officials.”

Raghunathan goes on to note that current federal immigration policy leaves it up to states to decide whether to provide free or low-cost health care to their undocumented residents. Several states, including New York, have expanded prenatal and neonatal care to undocumented women and children.

“Legal status,” she writes, “would mean that undocumented women are no longer left to the mercy of state legislatures and no longer denied appropriate nursing and doctoring.”

Plus: The L.A. Times reports on how some California counties are eliminating non-emergency health services for undocumented immigrants.

“We are mortgaging the future to scrape through the present,” said David Hayes-Bautista, professor of medicine and director of UCLA’s Center for the Study of Latino Health and Culture.

HRT and Heart Health: A study in the May issue of the journal Medical Care (abstract) looks at whether the decreased use of HRT has affected the rate of cardiovascular health outcomes, according to this release. The number of heart attacks in menopausal women has decreased, though it’s not conclusive that there’s a link. Researchers did not find a difference in the rate of strokes.

Before 2002, physicians believed HRT reduced the risk of coronary heart disease by up to 50 percent in menopausal women. As a result, physicians prescribed it broadly to treat many of the symptoms of menopause, as well as to protect women against cardiovascular disease. However, a report by the Women’s Health Initiative in 2002 revealed that HRT actually had the opposite effect — it increased the risk of heart attack in these women.

“After the 2002 report, the use of HRT in women aged 50 to 69 declined from more than 30 percent to less than 15 percent,” said lead study author Kanaka Shetty, M.D.

For many years, women who underwent hysterectomies also routinely had their ovaries removed, in order to prevent them from developing ovarian cancer in the future. A new study that will appear in the May 2009 issue of Obstetrics and Gynecology calls this practice into question.

The study, “Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses’ Health Study,” examines the long-term survival rates of women of women who have had hysterectomies (removal of the uterus) because of non-cancerous reproductive disease. It compares the medical outcomes of women who had their uterus and ovaries removed with women who had only their uterus removed. The study used the database from the Nurses’ Health Study, which included 122,700 registered nurses in 1976 when it began.

The study found that women who had their ovaries removed had a higher risk of death from any cause, primarily from heart disease and lung cancer. Removing the ovaries at any age did not improve life-span for this group of women.

One of the studies lead authors, William Parker, MD, a clinical professor at the UCLA School of Medicine, has written a summary of the study and its findings that was published at Our Bodies Ourselves:

Women often have their healthy ovaries removed when they are having a hysterectomy in order to prevent ovarian cancer from developing in the future. About 50% of women who have a hysterectomy between ages 40-44 have their ovaries removed, and 78% of women between ages 45-64 undergoing a hysterectomy have their ovaries removed. All together, about 300,000 American women have their healthy ovaries removed every year.

If the ovaries are removed before menopause, a sudden decrease in the hormones made by the ovaries, including estrogen, testosterone and androstenedione, results. Even after a woman enters menopause, her ovaries continue to make considerable amounts of testosterone and androstenedione, which are then changed into estrogen by other cells in the body.

Some studies had already show that women who keep their ovaries have a lower risk of heart disease. While ovarian cancer accounts for 14,700 deaths per year in the U.S., heart disease causes 326,900 deaths, and stroke causes 86,900 deaths each year. If a woman is not at high risk for ovarian cancer, then keeping the ovaries might benefit her overall health and survival.

We designed a study to see whether it was better for women who needed a hysterectomy to keep their ovaries or have them removed during the surgery to remove the uterus.

Continue reading Parker’s summary.

The ACLU has taken an interest in gene patents, which allow human genetic sequences and gene tests to be patented,  expressing concern that “While the purpose of the patent system is to encourage innovation, the high licensing and diagnostic testing fees that some biotech companies charge for use of ‘their’ genes are inhibiting biomedical research and interfering with patient care.”

Although somewhat technical, this Human Genome Project Information page from the Oak Ridge National Laboratory provides an overview of the topic, including some of the arguments for and against gene patenting, with lots of links to related information.

A freely available article from Nature Reviews Genetics, Patenting human genetic material: refocusing the debate, also provides good background reading on this issue, including a discussion of concerns about patenting from “adversely affecting the research environment to hampering the distribution of useful technologies.” A number of other articles on this topic are also freely available through PubMed Central.

The ACLU is specifically focused on patents related to the BRCA1 and BRCA2 genes relevant to breast and ovarian cancer, explaining that:

“…the Utah-based company Myriad Genetics has patented two genes – BRCA1 and BRCA2 – and certain mutations along these genes that have been associated with an increased risk of certain forms of breast and ovarian cancer. The high licensing and diagnostic testing fees charged by Myriad have forced some researchers to discontinue research on breast cancer and have prevented women from having access to screening for mutations.”

The organization is currently conducting a survey to gather information on women’s experiences with BRCA testing:

We are interested in hearing from you if you have been advised to get the BRCA genetic test and fall into one of the following categories:

1) You were tested, and had problems with or concerns about the testing process (for example, your results were uncertain or incorrect, or you were advised you needed to be tested a second time); or

2) You were tested, and want to be tested again through another lab for verification; or

3) You wanted to be tested, but had financial problems getting the test (for example, you could not afford it or your insurance did not cover it); or

4) You want to determine the BRCA status of a deceased relative.

If your answer is YES to even one of these questions, please take the ACLU’s survey: www.aclu.org/brcasurvey. The ACLU is looking into the legality of patenting human genes, including the BRCA1 and BRCA2 genes, and the effects of gene patenting on research and testing.

For additional information on genetic testing and breast cancer in general, see our related content and this page from the National Cancer Institute.

Time magazine has a story about growing concerns over the long-term health effects of donating eggs, especially cancer and infertility.

The issue has become more urgent as more women are showing an interest in egg donation as a way to make ends meet. Some fertility clinics say that the number of applicants has increased as much as 55 percent in the past four months compared to the same period last year.

Catherine Elton writes:

Doctors say there is no biological reason that donating eggs would cause infertility, but they also cannot say for sure that it doesn’t. The long-term health effects of egg donation have never actually been studied, in large part because the high cost of studies doesn’t “seem justified in terms of what the possible risks [of the procedure] might be,” according to Sean Tipton, spokesman for the American Society for Reproductive Medicine (ASRM). He points out that egg donors undergo the same drug treatment as IVF patients — hormone injections and other drugs that stimulate follicles, promote egg maturation and prevent the release of eggs before they can be retrieved — and that studies of the latter population show it is safe.

But some women’s health advocates say that evidence isn’t strong enough, calling for further study and a national, trackable registry of egg donors. While the Centers for Disease Control and Prevention (CDC) logs the number of donated eggs transferred to infertile women each year — there were some 15,500 in 2006, the most recent year for which data are available — no one knows how many individual donors those eggs came from, who they were or whether they were exceeding industry guidelines of six donations in a lifetime. (The guidelines are intended to limit the number of offspring from a particular donor and to prevent overexposure to fertility drugs, but they are not based on scientific data.)

“Right now egg donors are treated like vendors, not as patients. Patients need to be followed up,” says internist Jennifer Schneider, who has been advocating for the government to track egg donors since 2007, a few years after her daughter, a three-time egg donor, died of colon cancer at age 31. “After the first few days of being discharged from the IVF clinic and seeing that there were no immediate consequences, they are never contacted again.”

Short-term risks include ovarian hyperstimulation syndrome, ovarian torsion or ruptured ovarian cysts. Our Bodies Ourselves Executive Director Judy Norsigian, who also supports a national registry of egg donors, tells Time that women she speaks to on college campuses are generally uninformed about the risks. Elton writes:

A recent study of past donors seems to support Norsigian’s impressions. In an article published in Fertility and Sterility in November 2008, researchers found, for example, that 34% of former egg donors didn’t recall being aware at the time of donation of the risk of ovarian hyperstimulation syndrome, the most common side effect. The majority of donors experience at least the mild or moderate form of this syndrome, which involves discomfort, bloating or nausea and usually resolves itself on its own. The severe version of this syndrome is rare — only 100 to 200 for every 100,000 women — but its consequences can include kidney failure and death. And then there are other side effects, such as bleeding, infection and death, which are associated with any surgery performed under general anesthesia. But fully 20% of the 80 donors interviewed said they didn’t know there were any physical risks to egg donation at all.

“There is a clear problem about informed consent here,” Norsigian says.

It’s a comprehensive story that raises a number of important issues — please share it.

Related: Egg Donation for IVF and Stem Cell Research: Time to Weigh the Risks to Women’s Health

This week, we learned of the Overlapping Conditions Alliance, a group of nonprofit organizations “seeking to advance the scientific, medical and policy needs of individuals affected by medical conditions that frequently overlap.”

The conditions – chronic fatigue syndrome, endometriosis, interstitial cystitis, irritable bowel syndrome, temporomandibular joint disorders (TMJ), and vulvodynia – disproportionately or solely affect women.  All are poorly understood, and many who suffer from these conditions are misdiagnosed and receive inappropriate treatment.

While the OCA website does not yet have a lot of detail, the partnered organizations are:

• Chronic Fatigue and Immune Dysfunction Syndrome Association of America
• Endometriosis Association
• Interstitial Cystitis Association
• International Foundation for Functional Gastrointestinal Disorders
• TMJ Association
• National Vulvodynia Association

The Overlapping Conditions Alliance will advocate for funding to research the common underlying mechanisms and risk factors for these conditions, so that preventive strategies and more effective treatments can be developed.

Reading List: Anna Clark interviews Michelle Goldberg, author of “The Means of Reproduction: Sex, Power, and the Future of the World,” at Bitch magazine (and happy birthday to Anna’s blog, Isak!).

Kathryn Joyce, author of “Quiverfull: Inside the Christian Patriarchy Movement,”  talks with Religion Dispatches. An excerpt of her book can be read here.

Planting a Future: Melissa Harris Lacewell digs through the meaning of Michelle Obama planting the new White House vegetable garden. More historians, authors and gardeners weigh in at the Washington Post.

Plus: Sharkfu on nutrition, cost and Alice Waters; Mark Bittman on eating healthy, organic or not.

Dealing with the Recession: Over at Writes Like She Talks, Jill Miller Zimon put together a list of articles that provide perspective on the recession, job loss and the economic impact on women. At Women’s eNews, Mimi Abramovitz explains three new rules about jobless benefits in the stimulus package that will help women and correct a major gender bias.

Pregnant? Here’s a Pink Slip: “Last year the number of pregnancy-based discrimination charges filed with the E.E.O.C. was up nearly 50 percent from a decade earlier, to a total of 6,285. That number seems likely to rise even higher this year,” writes Lesley Alerman in The New York Times.

“Some employers are using the economy as a pretense for laying off just one person,” said Elizabeth Grossman, a lawyer for the Equal Employment Opportunity Commission. “And very often that person is pregnant or the oldest employee on staff. The economy may be the legitimate cause — or there may be discrimination.”

Tenn. Senate Passes Abortion Amendment: The Tennessee Senate passed a constitutional amendment that states in part, “nothing in Constitution of Tennessee secures or protects right to abortion or requires the funding of an abortion.”

Rachel writes: “Supporters keep insisting that the bill does not make abortion illegal, while not addressing the fact that if this ultimately succeeds (there are several more steps for this Constitutional amendment), it makes room for the numerous restrictions often supported by anti-choice folks — such as waiting periods, forced ultrasounds, required ‘informed consent’ scripts that are not medically accurate, and so on. It also makes room for an abortion ban in the event that national protections vanish.”

Meanwhile, “Illinois could be on the verge of passing one of the most progressive reproductive health bills, the Reproductive Health and Access Act, any state has seen in a long time,” writes Veronica Arreoloa. Here are the groups supporting  the bill. If you’re a resident of Illinois, contact your legislator and voice your support.

Cost of Domestic Abuse: Women who are abused by their partners spent 42 percent more on healthcare per year than non-abused women, according to a long-term study of more than 3,000 women published online in the journal Health Services Research.  The study, summarized in this press release, also found that the increased costs don’t end when the abuse does. Women who suffered physical abuse five or more years earlier still spent 19 percent more per year on health care than women who were never abused.

Recognition for the Rights of Persons with Disabilities: “We are living in a new era for persons with disabilities,’ writes Myra Kovary at On the Issues Magazine. The story details the Convention on the Rights of Persons with Disabilities, which was adopted by the General Assembly of the United Nations and has been signed by 50 nations so far.  The U.S. has yet to sign it, but President Barack Obama has said he will do so.

Facts of Life: Sarah Seltzer praises “the sex talk” on one of my favorite television shows, “Friday Night Lights,” and compares it to a conversation from over a decade ago on “My So-Called Life.”

More than half of the 48 baby shampoos, bubble baths and baby lotions analyzed in a recent laboratory test were found to contain formaldehyde and/or 1,4-dioxane, chemicals that have been linked to allergies and skin cancer.

The study was sponsored by the Campaign for Safe Cosmetics, a national coalition of nonprofit organizations focused on health and the environment. The full report, “No More Toxic Tub” (pdf), is available online. Among the findings:

• 17 out of 28 products tested – 61 percent – contained both formaldehyde and 1,4-dioxane.
• 23 out of 28 products – 82 percent – contained formaldehyde at levels ranging from 54 to 610 parts per million (ppm).
• 32 out of 48 products – 67 percent – contained 1,4-dioxane at levels ranging from 0.27 to 35 ppm.

Though the levels found were relatively low, the Campaign for Safe Cosmetics notes in this release “that babies may be exposed to several products at bath time, several times a week, in addition to other chemical exposures in the home and environment. Those small exposures add up and may contribute to later-life disease.”

Product labels do not disclose the chemicals because they’re contaminants (byproducts of the manufacturing process), not ingredients, and therefore are exempt from labeling laws.

Many of the products on the study list are  manufactured by Johnson & Johnson. The company released a statement, published in the Washington Post, noting that their “products meet or exceed the regulatory requirements in every country where they are sold.”

The European Union has banned 1,4-dioxane in personal care products, but the U.S. Food & Drug Administration has determined that trace amounts found in personal care products do not pose a threat. Health advocates are pushing for increased FDA regulation.

“The fact that we are bathing our kids in products contaminated with carcinogens shows how woefully out of date our cosmetics laws are and how urgently they need to be updated,” Rep. Jan Schakowsky (D-IL) told the Post. “The science has moved forward; now the FDA needs to catch up and be given the authority to protect the health of Americans.”

Sen. Dianne Feinstein (D-CA) said she will introduce legislation requiring stronger oversight of the cosmetics industry.

In an online discussion about safety limits on commercial products, Stacy Malkan, the study’s co-author and author of ” Not Just a Pretty Face: The Ugly Side of the Beauty Industry,” stressed that the purpose of the study was not to cause alarm but to point out that products advertised as “gentle” and “pure” may still contain contaminants.

Many companies are already reformulating products for markets with stricter regulation outside the United States. Our own safety standards need to be updated, said Malkan.

Current cosmetics laws in the U.S. were created in 1938 — they’re a bit outdated, to say the least! Scientists have learned a lot over the past few decades about the health risks of low dose chemical exposures, and the special vulnerabilities of children. Companies have also learned a lot about how to make high performance products without carcinogenic chemicals. I believe that shifting to cleaner product formulations will benefit the beauty industry in the long run, making them more competitive globally.

To get there, we need a smarter regulatory system that requires companies to remove chemicals that are known or highly suspected of causing cancer, reproductive harm or other health problems, and also requires them to fully disclose the ingredients in their products. In other words, we need a regulatory system that keeps companies honest and rewards the companies that are doing the best job of making the safest products. This will take an act of Congress. FDA currently does not have the authority to properly regulate cosmetics.

Plus: If you want to look up the products you use, the Environmental Working Group maintains a Skin Deep database with toxicity information on more than 42,000 products.

The March issue of the Guttmacher Institute’s journal, Perspectives on Sexual and Reproductive Health, includes a study on access to abortion [PDF] for incarcerated women in the United States, and found considerable variability in women’s access to these services.

The researchers sent surveys to correctional health providers across the country and asked questions about access to abortion, contraceptive counseling, and other women’s health issues, such as vaccine updates, STI screening, and mammography.

They received 286 responses; among the findings:

• 68% of respondents indicated women at their facility were allowed to obtain an elective abortion if they requested one.
• 54% percent of respondents who said yes reported that they also assist women in arranging an appointment for an abortion, and 88% replied that their facility arranges transportation for women seeking an elective abortion.
• 71% of providers counseled women about contraceptive options at some point during their incarceration.

The authors also note, perhaps unsurprisingly, that “By all of the measures we assessed, abortion appears to be more accessible to incarcerated women in states with predominantly Democratic or bipartisan legislatures than in states with Republican-controlled legislatures.”

A commentary [PDF] in the same issue of the journal by Diana Kasden of the ACLU Reproductive Freedom Project, points out that “even among respondents who indicated that their facilities do allow access to abortion, many said that women receive little or no logistical assistance in arranging, paying for and getting to the appointment,” and discusses the findings and related Constitutional issues.

Thanks to RaceWire for pointing to the study; author Michelle Chen comments on the study’s discussion of the obstacles incarcerated women have often faced in obtaining health care in their communities as well:

“Prison should not be a woman’s first opportunity to obtain quality medical care, though neither should it replicate the systemic problems that limited her opportunities on the outside. President Obama recently started redirecting federal family planning resources toward comprehensive clinical services and away from abstinence-only sex education programs. It remains to be seen whether some of the country’s least free women will see brighter prospects for reproductive freedom under the new administration.”