Planned Parenthood aids women’s care needs continued funding

It’s hard to believe that not a single state measures up when it comes to providing for women’s health care needs. But that’s the state of the union, according to a study released recently by the National Women’s Law Center.

The 10-year study from the National Women’s Law Center and Oregon Health Services University is called “Making the Grade on Women’s Health.” It ranks the states based on 26 measures of good health for women, established by the U.S. Department of Health and Human Services. Only two states ranked as high as a “satisfactory-minus.” Thirty-seven states, including Michigan, earned an “unsatisfactory.” Twelve states flunked.

Among the alarming trends nationally are a rise in the rates of chlamydia infections among women and a decline in the number of women getting Pap tests. Pap tests are one of the most basic tools for early detection of cervical cancer, yet, since 2007, Michigan showed a 5% drop in the number of women getting tested.

While Michigan’s overall grade was “unsatisfactory,” it scored even lower on a number of women’s health measures, including rates of obesity, diabetes, high blood pressure and maternal mortality.

The study points out the direct connection between economics and women’s health. Compared to men, women are poorer (on average), spend a greater portion of their incomes on health care (mostly because of reproductive health needs), have more difficulty accessing care, and are more likely to struggle with medical debt.

Equally alarming was the increase in the number of Michigan women who no longer have health insurance. The percentage of uninsured women rose from 13% in 2007 to 16% in 2010. A quarter of Hispanic women are uninsured, and nearly 22% of African Americans.

The fact that fewer Michigan women have health insurance is compounded by the fact that state family planning funding has been reduced by over 75% over the past two years, leaving 32,000 Michigan residents without services.

Women’s health centre closes

Women who used to go downtown to use the Women’s Health Care Centre services, such as eating-disorder and sexual-assault programs, now must go to the hospital.

The centre relocated from 157 Charlotte St. to the Peterborough Regional Health Centre (PRHC) on Tuesday as part of the plan to balance the PRHC budget by 2012, said hospital spokes-woman Alicia Doris.

The new centre is on the hospital’s fourth floor, near the main entrance. All services and the phone number (743-4132) remain the same, Doris said.

The centre saw patients down-t ow n until Friday and will reopen for patient care Jan. 4 because it’s typically closed between Christmas and New Year’s, Doris said.

An open house is being planned for January, she said.

Healthy Lifestyle Boosts Eye Health

MADISON, Wis.—Women who exercise and consume a healthy diet are significantly less likely to develop age-related macular degeneration (AMD), one of the most common causes of vision loss in the elderly, according to a new study published in the Archives of Ophthalmology.

Researchers at the University of Wisconsin, Madison reviewed data from the Carotenoids in Age-Related Eye Disease Study, an ancillary study of the Women’s Health Initiative (WHI) Observational Study. Data was included for 1,313 participants, ages 55 to 74; the women provided information on physical activity and lifetime smoking history, and were assigned a score on a modified 2005 Healthy Eating Index (HEI) based on responses to a food frequency questionnaire administered at baseline of the WHI study. The HEI is a measure of diet quality that assesses the nutrient adequacy of the diet based on the five major food groups of the original Food Pyramid, aspects of the diet that should be limited, and a measure of variety in food choices.

Six years later, researchers took stereoscopic fundus photographs to assess the presence and severity of AMD. A total of 202 women had AMD, 94 percent of whom had early AMD, the primary outcome. In multivariate models, women whose diets were in the highest quintile compared to the lowest quintile on the HEI were 46 percent less likely to have early AMD. Further, women in the highest quintile compared to the lowest quintile for physical activity had 54 percent lower odds for early AMD. Finally, while smoking was not independently associated with AMD, having a combination of the three healthy behaviors—not smoking, consuming a healthy diet and getting physical activity—was associated with 71 percent lower odds for AMD compared to women with high-risk scores.

Hormone Replacement Therapy: Clearing Up the Facts About Women’s Health

As a gynecologist, practicing for over 25 years and having treated thousands of women of all ages and stages of their lives, I am certain of the following: Unless and until we have all our facts — regarding all aspects of our health and health care — we cannot make informed decisions. Many women live paralyzed by fear, hearing misinformation regarding medical studies. Misrepresentation of the absolute risk of various choices has created mass confusion and and in some cases, the reactive discontinuation of potentially helpful medications. These fear-induced reactions create a dangerous schism between women and their care providers. When I’m not engaged in individualized patient care I’m advocating for women to get the facts that may save them unnecessary misery, lower their quality of life and increase their risks for many diseases of aging. With a steady stream of intelligent, clear, organized and useful evidence-based good information, a sense of a working knowledge of their basic biology and body science, women can understand their options — something the sensationalized style of medical reporting and conventional medicine keeps us from having.

We live in a paradoxical time with regard to women’s health care consciousness. How the generation of Baby Boomer feminists, the burners of the bra, the women who took control of their fertility with the pill, who fought for equality in their professions, could retreat so far into submission in fear is certainly puzzling. Case in point: the debate about hormone replacement therapy. It is clear that misrepresentation of the facts by journalists is frightening women from something that may benefit their health and certainly enhance their quality of life.

The single largest barrier to women taking estrogen/hormone therapy and allowing themselves to feel better after menopause is the fear of breast cancer. A powerful recent example is the New York Times, October 20th headline which read “Prempro Hormone Therapy Amplifies Breast Cancer Risks, Study Finds.”

The study released on October 20th regarding hormone replacement therapy (HRT) and breast cancer (from Women’s Health Initiative group Chlebowski et., al JAMA,) was met with fearful reactions by the news media, but aside from getting terrified by the reports, what can we actually learn from this study? For one thing, this study has absolutely no impact on women who are not taking Prempro, and for those who are, the absolute risk is exactly what we already knew. There is a .008 percent increase risk for a breast cancer diagnosis with an increase risk of death from breast cancer of .012 percent. These are very tiny individual risks of an increase of 8 cases per 10,000 women years of use. The reader was led to believe that there was a 29 percent increase in deaths from Prempro, with an absolute difference of 1.2 women in 10,000 years of use! Placing such data in perspective is a great service to aid women in placing risk in a meaningful context. Why are we not told this? What is to be gained from frightening us? Why can’t we know the truth? Women are competent to know these facts and figures as adults making long term self care choices.

The new information from the study published on October 20th in JAMA actually is in the details of breast cancer cell types associated with the particular progestin found in Prempro, and the incidence of higher death rates. The increase in the risk of death from breast cancer while taking Prempro compared to a placebo, in the new report, was one woman per 10,000 woman-years of use — a level described by the FDA as “extremely rare” — while the estrogen alone trial of the WHI study showed a 23 percent decreased risk of being diagnosed with breast cancer.

The detail of which hormones a woman takes is very important. We must help make women aware of news about different products that do not relate to their risk status. For example, we even have very reassuring data about estradiol and natural progesterone not statistically increasing risk for breast cancer (Breast Cancer Res Treat. 2008 Jan;107(1):103-11. Epub 2007 Feb 27) and also showing much better survival if one does get a breast cancer diagnosis if the woman is on estradiol at the time of diagnosis. Improved breast cancer survival among hormone replacement therapy users is durable after 5 years of additional followup, Christante D). (These are identical hormones to naturally produced estrogen and progesterone, also called Bioidentical hormones by some with FDA approved products available all across the U.S.)

The bottom line is there are many better options than Premarin or PremPro. Simply look at the estrogens delivered through the skin, all biologically identical to that which we naturally make in our bodies and for which nature selected over millions of “randomized blinded trial years” (the process of natural selection at its finest in my opinion). In all sorts of research, at cellular levels, as well as gene regulation and gene suppression/expression studies, estradiol is very positive in its effects on cell differentiation; in essence, keeping healthy breast cells healthy. That is the goal of ideal hormone support for every tissue we study: The enhancement of balanced, regulated cell growth and positive antioxidant effects of estradiol.

The truth is that after all the hullabaloo over the past nine years since the initial termination of the HT arm of the WHI, estrogen turns out to be quite safe, the MPA has a cloud of suspicion, and the future recommendation is for careful assessment on an individual basis for every women transiting menopause to determine health status, future risk for disease, and a decision based on a clear indication whether hormones are truly needed and recommended in her situation. If a woman chooses hormone support then current knowledge should be used to determine what dose, type and route of administration is best for her.

The WHI has succeeded in adding valuable information showing that postmenopausal hormone therapy has clear rewards and very small risks when started in newly menopausal women. It remains a woman’s right to choose, not just a legal abortion, but to engage in a process of education and transparent explanation of the facts. Each of us can check these facts in a clear and unbiased way at the North American Menopause Society’s website.

Let’s think about why these studies are misinterpreted, over-inflated and misreported, an important question and one I will address in future posts.

Hospital Will Continue To Provide Life-Saving Care And Protect Women’s Health Despite Withdrawal Of Support From Catholic Diocese

NEW YORK–(ENEWSPF)–December 21, 2010. A religiously affiliated hospital announced today that it will continue to provide life-saving abortion care to its patients, despite being stripped of its affiliation with the Roman Catholic Diocese in Phoenix. In a statement today, St. Joseph’s Hospital in Phoenix said, “Morally, ethically, and legally we simply cannot stand by and let someone die whose life we might be able to save.”

“St. Joseph’s made the right decision to stand up for the rights and health of women in need of life-saving care,” said Alexa Kolbi-Molinas, staff attorney with the American Civil Liberties Union Reproductive Freedom Project. “A hospital’s first responsibility must be the needs of its patients. Any hospital that fails to provide emergency abortion care violates federal law. No woman should be afraid that she will be denied the care she needs when she goes to a hospital.”

St. Joseph’s Hospital provided a life-saving abortion to a young mother of four in November 2009, prompting the Bishop of Phoenix to remove his endorsement of the hospital today after hospital officials refused to “acknowledge in writing that the medical procedure that resulted in the abortion at St. Joseph’s Hospital was a violation” of the policy that governs all Catholic hospitals and “will never occur again at St. Joseph’s Hospital.”

The ACLU, citing the Arizona incident and other refusals of emergency care across the country, wrote to the Centers for Medicare and Medicaid Services in July alerting them to the potential violations of federal law by religiously affiliated hospitals that refuse to provide emergency abortions and requesting an investigation.

Women’s Health is Getting a Failing Grade

A new report from the Oregon Health and Science University gives the United States a failing grade in women’s health. This is the fifth in a series of reports that began in 2000, and it’s a look back at the progress and setbacks we are seeing in women’s health today. The only areas that saw improvement were an increase in screening for colorectal cancer and a drop in the number of women smoking cigarettes.

The bad news is that more women are suffering from obesity, diabetes, hypertension and sexually transmitted diseases linked to infertility. And the findings that are getting the most attention are an increase in the dangerous behavior of binge drinking (having 5 or more drinks at one time), and a considerable decline in the percentage of women getting pap smears (the primary test for detecting cervical cancer).

From the Oregon Health and Science University, U.S. Fails to Meet Women’s Health Goals (which were set by the government’s Healthy People 2010 Initiative)

Overall, the nation is so far from meeting the Healthy People and related goals that it receives a general grade of “Unsatisfactory.” Of the 26 health indicators that were graded, the country received a “Satisfactory” grade in only three and received a failing grade in half.

Do you want to know the specifics of the state you live in? Here is a link to the state-by-state interactive map for this report card.

A large part of the problem is directly related to the growing numbers of women without health insurance.
One in 5 women aged 18 to 64 is uninsured, representing a considerable increase since 2007, the highest rate since the Census Bureau began reporting such data.
No state meets the Healthy People 2010 goal of 100 percent of women having health insurance; Massachusetts comes the closest with 95 percent of women insured.
The disparities in insurance coverage between White women and women of color are alarming. Nationwide, 37.6 percent of Hispanic women, 32 percent of American Indian/Alaska Native women, and 23.4 percent of Black women do not have health insurance coverage, compared with 13.9 percent of White women.

More from the report on State Policies and Goals for the future:

In addition to health status indicators, the report also assesses 68 health and health-related policies. Of these, only two policy goals were met by all the states: Medicaid coverage for breast and cervical cancer treatment and participation in the Food Stamp Nutrition and Education Program.

Though most states have made only piecemeal progress in adopting policies to improve women’s health, many of the policy goals examined in the Report Card will be realized with the implementation of the new federal health care law, the Patient Protection and Affordable Care Act.

But can these goals be met with the Affordable Care Act in jeopardy from the new Congress? This is from MPR News:

The report expresses hope that the national Patient Protection and Affordable Care Act, signed into law in March, will slowly improve these grades.

There are, however, forces at work that appear determined to block any progress whatsoever on women’s health. Note, for example, the cries to repeal national health care reform. And note the cries to “defund” Planned Parenthood being issued by U.S. Reps. Mike Pence, R-Ind., and Michele Bachmann, R-Minn. Their bill, which is waiting in the wings for the new Congress, would deny federal funding for family planning services to any organization that offers abortion care.

There is a lot of information in this latest women’s health report card, and sadly, even the few areas that we are seeing some improvement, we are still far below goals. It’s not good news for women.

I have my own thoughts on one of the findings. I’ve been thinking about the possible reason for a drop in women getting Pap smears.

In the last few years there has been a huge push towards encouraging women (and even young girls) to get the HPV vaccine. Although it’s simply a vaccine to prevent the human papilloma virus, it has been touted as a “cancer” vaccine (but it’s NOT). Let’s face it, getting a pap test isn’t all sunshine and puppy dogs, they are actually something most of us women dread. So is it really that surprising that when we give a woman a vaccine and tell her it will prevent the same cancer that is detected by a pap smear, she is less likely to follow-up with continued cervical screening? [Yes, I know, women are being told to continue with pap tests, but it's not realistic to assume they will, and I think the findings in this report are just the first signs of the problem.]

It seems like a no-brainer and I’ve said as much in previous posts on Gardasil and the HPV vaccine. Anyway, what worries me even more than the decline in women getting routine pap screening, is the inevitable outcome of a rise in the incidence of cervical cancer (and cervical cancer deaths). At some point, once the pharmaceutical companies have made their billions scaring women into getting the HPV vaccine, someone is going to put two and two together and realize that since this vaccine hit the market, fewer women are getting pap tests and more women are developing cervical cancer.

What do you think? Are you surprised by the continued decline in women’s health in our country? Are you worried it may get even worse with the new congress? Do you think there is a correlation between fewer women getting pap smears and the push towards getting the HPV vaccine? Let us know your thoughts in comments.

Phoebe Sumter to open Womens health facility

AMERICUS, GA — On Monday Phoebe Sumter will open up a brand new women’s health facility. It’s the hospital’s first new building since the old campus was destroyed by a tornado two and a half years ago.

“This is just another step in the rebuilding process of our hospital that was completely devastated by the tornado,” said Americus Mayor Barry Blount.

While it was sad day for many who live in Sumter County, on Sunday they had something new to smile about.

Hundreds of came out to see Phoebe Sumter unveil a new medical facility, their Women’s and Family Health Center.

There was special ribbon cutting plus a tour of the halls of the building which still have the brand new smell.

“It’s kind of built for the sense of having convenience for women. They can get their appointments as well as bringing their kids in for immunizations and other tests. Kind of a one stop shopping for everybody,” said Marcus Johnson of Phoebe Sumter.

The new facility will house 24 exam rooms shared by three OB/GYNs and three family medicine physicians.

“It affords this region and our community access to medical services that we probably didn’t have before,” said Blount.

”When that tornado came and just blew us away we were lost and so was the community, and all our babies and we had to go down to Albany for deliveries and everything,” said Dorothy McCray, who lives in Sumter County.

Phoebe Sumter plans to open up another two health care facilities which will be satellites of this main hospital which is still under construction. They say they plan to have that open for patients around this time next year.

W.Va. flunks women’s health study

CHARLESTON, W.Va. — West Virginia ranks near the bottom nationally in obesity, smoking and diabetes, and has made limited strides to improve health-care policies, according to a national report that grades each state on various women’s health issues.

West Virginia ranked 47 out of 50 states and Washington, D.C., and was among 12 states given a failing grade in the report titled “Making the Grade on Women’s Health: a National and State-by-State Report Card.” The report comes from the Office of Women’s Health, part of the U.S. Department of Health and Human Services. It was updated by the National Women’s Law Center.

The state ranked last nationally in the percentage of women who are not physically active, a ranking that has gotten worse over the past three years.

In 2010, 36.8 percent of women had no leisure time and were not physically active, an increase from 31.3 percent in 2007.

“The magic bullet is being physically active,” said Jessica Wright, director of the state Division of Health Promotion and Chronic Disease.

Exercise and a healthy diet are simple and effect ways to reduce the rate of chronic disease and improve a person’s general health, Wright said.

“When it come to eating fruits and vegetables, West Virginia ranks so low that it’s embarrassing,” Wright said.

The number of women eating five servings of fruits and vegetables a day decreased from 22.9 percent in 2007 to 18.8 percent in 2010, ranking the state 48th in the nation.

The state and individual communities have done better at teaching residents how to eat well and encouraging residents to become more active, but they still has a long way to go, Wright said.

“When trying to address chronic disease as a whole, I don’t know if we will ever get enough programs out there that will really help improve our health,” Wright said. “West Virginia gets a lot of funding, but not enough to show incredible gains in the health across the state.”

West Virginia also has the nation’s highest rate of women with diabetes at about 13 percent, an increase from about 11 percent in 2007.

About 33 percent of West Virginia women are obese, an increase from 30.2 percent in 2007. The number of women with high blood pressure increased from 31.6 percent in 2007 to 36.3 percent in 2010.

U.S. Women Lag in Achieving Health Goals

December 15, 2010 – A new report finds that although fewer American women are dying of heart disease, stroke, and breast and lung cancer, and fewer are smoking, women as a group are not meeting most of the health goals set for them by the federal government. Obesity, high blood pressure, and diabetes are on the rise among women and fewer are being screened regularly for cervical cancer, for example, according the report by the National Women’s Law Center and Oregon Health Sciences University.

Several of the report’s findings echo a recent Institute of Medicine study that provided a progress report on women’s health research. Researchers’ efforts to boost study of women’s health over the last two decades has lessened the burden of disease and reduced deaths among women due to cardiovascular disease, breast cancer, and cervical cancer, the IOM study said. Less progress, although still significant, has been made in reducing the effects of depression, HIV/AIDS, and osteoporosis on women. However, several health issues important to women have seen little progress, including unintended pregnancy, autoimmune diseases, alcohol and drug addiction, lung cancer, and dementia. Overall, fewer gains have been made on chronic and debilitating conditions that have lower death rates but cause significant suffering, pointing to the need for researchers to give similar consideration to quality of life as to mortality.

Women’s Health in the U.S. Fails to Make the Grade

Women’s health initiatives in America are largely failing, according to the latest report card released by the National Women’s Law Center and Oregon Health and Science University.
Overall, the nation received a grade of Unsatisfactory, with 23 of the 26 goals outlined in the government’s Healthy People 2010 initiative — a decade-long effort to monitor the progress of the nation’s health objectives — remaining unmet.

This is the fifth and final report card for the decade, and its findings uncovered some troubling trends about the state of women’s health. Most notably, more women report binge drinking and fewer report being screened for cervical cancer than in 2007. On these two important indicators, the nation’s grade dropped to an F: the percentage of women who reported consuming five or more drinks at a time in the past month jumped more than 3% since 2007, to 10.6%, while the percentage of women who received annual pap smears dropped nearly 10% to 78% over the same time period. (More on Time.com: Health Check-Up: Women & Health)

Additionally, more women reported obesity, hypertension and diabetes than in 2007. And more have tested positive for chlamydia, a sexually transmitted infection that can cause infertility.

State-by-state findings reveal similar trends. Massachusetts and Vermont received the highest grades with an S- (Satisfactory minus), while 37 states scored a U (Unsatisfactory) and 12 states failed. Louisiana and Mississippi came in 50th and 51st, respectively. No states received the highest possible score of S, or satisfactory.

Dr. Michelle Berlin, associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine and associate director of the university’s Center for Women’s Health, told the New York Times that the findings were disappointing, given the length and comprehensiveness of the study. “The takeaway message is that we’re really not where we should be,” she said. (More on Time.com: Photos: A Brief History of Women in Power)

But despite this dismal picture, progress has been made in a few areas. One indicator — cholesterol screening — received a higher grade than in the previous report, moving from a U to an S-. Three benchmarks of the Healthy People 2010 initiative were met, including the percentage of women receiving regular mammograms, visiting the dentist and screening for colorectal cancer. Also notable is that the rate of smoking among women declined in 42 states, making that one of the most improved health status indicators.

The hope is that the passage of President Barack Obama’s health care legislation, the Patient Protection and Affordable Care Act, will help raise these grades over the next decade and help the country meet goals set by Healthy People 2020. The health-care act includes a significant focus on women’s health, including an expansion in Medicaid eligibility, that could prompt improvements on issues that have so far failed to be addressed. However, many of the services won’t go into effect until 2014, leaving women’s health in a state of uncertainty for at least a few more years.

Researcher: Estrogen-only therapy may prevent breast cancer in some women

Estrogen-only hormone replacement therapy may benefit younger postmenopausal women who do not have a uterus, a Canadian researcher said Thursday at the annual meeting of the San Antonio Breast Cancer Symposium.

Dr. Joseph Ragaz, an oncologist at the University of British Columbia, presented a re-analysis of the Women’s Health Initiative — which originally concluded that both long-term estrogen-only and estrogen-plus-progestin hormone replacement were too risky for most women.

But Ragaz said his take on the data suggests that using only estrogen — for women who do not have a uterus and do not need progestin — protects against breast cancer. He found that subsets of women, such as younger postmenopausal women and those with no strong family history of breast cancer or benign breast disease, had a lower risk of breast cancer after using estrogen-only therapy and reaped other health benefits, such as a lower risk of heart disease.

Ragaz says studies are needed to determine whether estrogen produced by the body, called endogenous estrogen and which is known to fuel cancer growth, and outside sources of estrogen (called exogenous) have different effects on breast-cancer risk.

“Our conclusion, which is potentially a new paradigm, is that we see a dual effect,” Ragaz said. “On a research level, we have to identify the mechanisms or biology that would distinguish exogenous-estrogen benefits from the carcinogenic effects of the endogenous estrogen.”

The study was called “provocative” by Dr. Judy Garber, an associate professor of medicine at the Dana-Farber Cancer Institute. But she said the idea called for further study and that the current guidelines for women regarding hormone therapy shouldn’t change.

Women Fail to Get Annual Mammograms as U.S. Physicians Debate Frequency

Half of U.S. women ages 40 or older failed to get an annual mammogram for breast cancer last year, said researchers concerned that women are confused by the debate about the effectiveness of the screenings.

The study, sponsored by Medco Health Solutions Inc., reviewed records for 1.56 million patients from January 2006 through December 2009. About 207,000 new cases of invasive breast cancer in women will be diagnosed and almost 40,000 women will die from the disease this year, according to the Atlanta- based American Cancer Society.

As death rates from the disease decreased over the last 10 years, the debate over how frequently to get a mammogram has grown. The cancer society recommends that women ages 40 or older get screened every year. In November 2009, the U.S. Preventive Services Task Force advised women 50 or older to undergo a mammogram only once every two years, and patients younger than 50 to get one only if they carry risk factors for the disease.

“As controversy becomes public and there’s so much back- and-forth, it becomes confusing for women,” said Milayna Subar, lead author of the study reported today at the San Antonio Breast Cancer Symposium, in a telephone interview. “This study shows the need to put programs in place to educate women and remind them to do it.”

Medco, based in Franklin Lakes, New Jersey, is the largest U.S. pharmacy benefit manager by number of prescriptions. Subar, a physician, heads the company’s Oncology Therapeutic Resource Center, which seeks ways to suggest health improvement for members of the health plans it serves.

Hormone Therapy

The mammogram research was among studies presented today including new findings on the use of hormone therapy, and on the risk of death for obese women with a type of breast cancer.

Mammography has been shown to reduce death rates 20 percent to 30 percent among women 40 or older, according to the National Quality Measures Clearinghouse, an agency under the U.S. Department of Health and Human Services. The decrease stemmed from earlier detection through screening and from improved treatment, the cancer society has said.

Sixty-five percent of the study’s 708,290 women ages 50 to 64 — considered the “must-do group” — had a mammogram at least twice during the four-year period, Subar said.

“That still leaves 35 percent not getting mammograms even every other year,” she said. Fifty-seven percent of the 406,746 women ages 40 to 49 had a mammogram on average at least twice during the four-year period, and 47 percent had one screening on average every year.

Estrogen and Cancer

In a second study presented today at the San Antonio symposium, researchers reported that giving estrogen alone to older women who don’t have a uterus may reduce rather than increase their risk of breast cancer.

The study found a 20 percent reduction in breast cancer for older women who took estrogen alone, compared with a placebo, for postmenopausal hormone therapy. The study, from scientists who re-examined data from the Women’s Health Initiative trial, looked only at women who didn’t have a uterus.

Millions of patients had already stopped taking hormone replacement therapy after 2002 when the Women’s Health Initiative found a higher risk of breast cancer in postmenopausal women getting hormone treatment with both estrogen and progestin. The trend of avoiding estrogen-only treatment needs to be reversed, said Joseph Ragaz, the lead researcher for the new analysis.

Thousands of Lives

“We will be saving thousands of lives every year if we use hormone replacement therapy for menopause,” said Ragaz, a medical oncologist and a clinical professor at the University of British Columbia in Vancouver. “Women will not only have quality of life improvement by handling menopause more easily, they will also have substantial benefits on bone fractures, colon cancer and now breast cancer.”

Ragaz said estrogen-alone therapy should be given only to women who don’t have a uterus, because the hormone raises the risk of uterine cancer. Women who have undergone surgery to remove their uterus, called a hysterectomy, are typically candidates for estrogen-only therapy.

Ragaz and other researchers looked at 10,739 women without a uterus who were part of the estrogen-only trial of the Women’s Health Initiative. Half received a placebo and the other half, the drug Premarin, made by Pfizer Inc.’s Wyeth unit.

While women getting estrogen showed a 20 percent lower risk of breast cancer, the reduction was 30 percent to 40 percent in patients who had a low risk at the start of the study, Ragaz said. Those included women with no strong family history of breast malignancy.

Adds to Research

The analysis adds to research suggesting estrogen alone can lower breast cancer risk and that the hormone may have a place for treating menopausal symptoms, said JoAnn Manson, a principal investigator for the Women’s Health Initiative, a 15-year program organized by the U.S. National Institutes of Health.

“Estrogen still has a clinical role in the management of moderate to severe hot flashes and other menopause symptoms, especially in women who are closer to the onset of menopause,” said Manson, chief of the Division of Preventive Medicine at Brigham & Women’s Hospital in Boston and a professor at Harvard University.

Another study presented today at the San Antonio meeting found that women who are obese and have a type of breast cancer fueled by estrogen are more likely to die of the disease than their slimmer peers.

Obesity Risk

Adult women with body mass indexes of 30 or above are 42 percent more likely to die of estrogen-receptor positive/HER-2 negative disease, the study found. Two-thirds of all breast cancers are fed by estrogen, according to the National Institutes of Health.

Today’s study suggests that breast cancer patients who are already overweight or obese should make an effort to avoid further weight gain, said study author Joseph Sparano, the associate chairman of the oncology department at Montefiore Medical Center.

“We may need to pay greater attention to nutrition, and include a nutritional evaluation for someone who has breast cancer,” said Sparano, who is also a professor of medicine at the Albert Einstein College of Medicine, in a telephone interview.

Body mass index, or BMI, is a measure of weight and height, with a 5-foot 4-inch woman weighing 175 pounds having a BMI of 30. BMI of 30 or more is considered obese, while a BMI of 25 to 29.9 is considered overweight, according to the National Institutes of Health.

Third of Population

About a third of the U.S. adult population is obese, according to the Atlanta-based Centers for Disease Control and Prevention.

The study examined 3,484 people, of which 2,115 had breast cancer that was hormone-receptor positive, HER2-negative. HER2- negative cancer doesn’t produce a protein called HER2, which is a sign of a type of aggressive breast cancer generally treated with Roche Holding AG’s Herceptin.

It may be that obese women have more estrogen, since fat cells play a role in synthesizing it, Sparano said. It may also be related to insulin levels, since higher levels of the hormone have also been associated with increased breast cancer risk, he said.

The rise of binge drinking women

As a nation, when it comes to booze and women, we’ve failed. I’m not being judgey here, I mean we literally received a big fat “F” in that category on the latest women’s health report card. The culprit is binge drinking: The percentage of women who have “had five or more drinks on at least one occasion during the past month” has gone from 7.3 percent in 2007 to 10.6 percent this year, according to the National Women’s Law Center’s annual report, “Making the Grade on Women’s Health.”

No surprise here. We’ve been following the rumblings over the trend of lady bingers for some time now, and the question often seems to be, as a 2008 New York magazine article put it: “should gender equality extend to drinking?” My answer is: yes and no. I’m more likely to order a beer and a shot of whiskey than a cosmo. I like to go against stereotypes like that. It is cocky and perhaps foolish — but, then again, the same can be said for my male friends when it comes to drinking. I might be driven by some vaguely third-wave feminist desire to “keep up with the boys” — but plenty of “the boys” are driven to keep up with each other, lest they appear unmanly. This is binge culture, and it isn’t strictly male or female anymore. We’re all full of bluster and far too much booze.

That doesn’t mean the impact is equal, though. A female friend wrote to me in an e-mail, “I’m of the opinion that, yes, gender equality means you get to drink however the eff you want and you don’t have to be confined to ‘dainty’ drinks and expected to drive the boys home or whatever. But with great binge-drinking comes great responsibility, you know? I’ve had to do a serious gut check in the past year about this because excess drinking affects women differently.” It’s true: Women’s bodies are not only generally smaller than men’s but they also metabolize alcohol differently. I’ve boasted that I could drink my male friends under the table, and I have at times through sheer force of will. Not even my iron will can force my liver to process booze differently, though.

Of course, it isn’t just physiological sex differences that raise concern here, it’s also sex, as in sex. The researchers find binge drinking troubling for many reasons, but especially so because hard-boozing women experience “more sexual-assault problems,” Michelle Berlin, an associate professor at the Oregon Health and Science University School of Medicine, tells the New York Times. These are the unfun facts: Alcohol is processed differently by women’s bodies, and it’s associated with higher rates of sexual assault. We should be able to be real about this without blaming women who are raped while intoxicated. (Unfortunately, this continues to be a really tough concept for some to grasp.) We should also be able to acknowledge the simple fact that women, like men, can make dumb sexual decisions while drunk.

If we must talk about binge-drinking in terms of feminism, it seems to me that a real victory would mean recognizing the impact hardcore boozing has on both sexes, and with a little more perspective. After all, binge drinking is much higher among men than women. Men are more likely to drive drunk (although young women are increasingly driving under the influence). Boozing college-age males are more likely than women to: land in the hospital, be physically assaulted, be involved in an accident where someone is injured, and break the law, according to a U.K. study. As I wrote in response to the New York magazine piece a couple of years back, “young women’s sometimes confused struggle for equality in their day-to-day lives … can result in their acting the part of stereotypical men, in ways that don’t seem particularly halthy for either sex.”

High-Dose HRT Still Prevalent

Eight years after the Women’s Health Initiative trial found that traditional hormone replacement therapy carried serious health risks for postmenopausal women, doctors continue to write prescriptions for it by the millions, researchers said.

According to data from a large, continuous survey of physicians, about 3.1 million visits in the U.S. in 2009 resulted in prescriptions for standard-dose estrogen therapy, alone or in combination with other hormones, according to a study published online in Menopause.

About one million of those prescriptions were for women 60 and older, the population most at risk for the cardiovascular and cancer risks identified in the Women’s Health Initiative study, noted Sandra A. Tsai, MD, MPH, of Stanford University in California, and colleagues.

“Despite reduced use, standard-dose oral menopausal hormone therapy remains the dominant formulation,” they wrote.

Overall, systemic hormone therapy for menopause symptoms has fallen by nearly two-thirds since 2001, Tsai and colleagues found, from about 16.3 million prescriptions to 6.1 million in 2009.

But low-dose oral preparations and vaginal and transdermal formulations — believed to carry less risk of adverse effects — still accounted for a minority of prescriptions.

“Greater recognition of distinctions based on menopausal hormone therapy dose, route of administration, need for concomitant progestogens, and woman’s age may move clinical practice into better alignment with available evidence,” the researchers concluded.

The study used data from 2001 to 2009 in the National Disease and Therapeutic Index, an ongoing survey of about 1,800 physicians who provide quarterly reports on their management of patients evaluated on two recent, randomly assigned workdays.

The reports list diagnoses and prescriptions written (as well as OTC products recommended) for each patient seen on those days. Consequently, the data is detailed enough to identify hormonal preparations prescribed for menopause symptoms.

In 2009, according to Tsai and colleagues, the database included about 341,000 patient encounters. The researchers extrapolated the results to the entire U.S. physician population to yield estimates of national hormone therapy prescription numbers.

Between the release of the Women’s Health Initiative results and 2009, the number of oral estrogen-only hormone prescriptions at standard doses declined 71%. Estrogen combined with other hormones at standard doses fell 83%.

Use of vaginal hormone formulations rose steadily from an estimated 2 million to 2.5 million prescriptions, whereas transdermal hormone prescriptions declined slightly, from 1.7 million to 1.5 million.

Tsai and colleagues identified differences in prescribing patterns according to physician specialty. Ob/gyns showed smaller declines over time in the percentage of visits that included menopausal hormone therapy prescriptions (46% from 2001 to 2009) compared with all other specialties (69%).

Of all visits resulting in a menopausal hormone therapy prescription, 72% were written by ob/gyns.

One of the most remarkable study findings, Tsai and colleagues suggested, was that low-dose oral therapy prescriptions did not make greater inroads into overall use of oral formulations during the study period.

Low-dose formulations, which have been found to be effective for controlling unwanted menopause symptoms, did increase from 700,000 to 1.3 million in 2009.

But this was still only 29% of all oral menopausal hormone therapy prescriptions, the researchers noted.

Moreover, use of low-dose products has been declining since hitting a peak of 1.5 million prescriptions.

“Current recommendations to use the lowest dose … effective for symptom relief should receive greater consideration,” they wrote.

They also expressed surprise that transdermal formulations have not gained in popularity during the study period.

Tsai and colleagues identified several limitations to the study. The survey excludes physicians in publicly funded practices, where lower income patients are more likely to be seen. Patients seen by respondent physicians may also not be representative of the general female population and their hormone therapy use.

In addition, information on symptoms and responses to previous therapies is sparse in the database.

As a result, the researchers noted, “there are inherent limitations in commenting on the appropriateness of current practice patterns.”

Study Adds Uterine Fibroids to Meningioma Risk Factors

MONTREAL – Meningiomas in postmenopausal women are associated with an increased rate of uterine fibroids, low levels of physical activity, and greater height and body mass index, according to an analysis of the Iowa Women’s Health Study.

The link with uterine fibroids is a novel finding, “probably due to shared risk factors,” commented Dr. Derek R. Johnson of the Mayo Clinic, Rochester, Minn. “I’m certainly not suggesting it’s causal,” he said at the annual meeting of the Society for Neuro-Oncology.

The Iowa Women’s Health study is a prospective cohort of women followed since 1986. Dr. Johnson’s analysis included 27,791 of these women who had completed a follow-up self-report survey in 1993, had no history of cancer, and were enrolled in Medicare.

The mean age of the women was 70 years (in 1993), and their mean body mass index (BMI) at the time of first enrollment was 27 kg/m2.

The analysis found 125 incident meningiomas reported over 291,021 person-years of follow-up, for an overall incidence of 43/100,000 person-years.

BMI was the strongest of the self-reported risk factors for meningioma, with a relative risk (RR) of 2.14 for BMIs greater than 30 compared with BMIs in the normal range of 19.5-24.5 kg/m2. BMI at age 50 and age 40 was positively associated with the risk of meningioma, but BMI at younger ages was not.

Height was the second strongest risk factor for meningioma, with a relative risk of 2.04 for height above 66 inches compared with height of 62 inches or shorter.

Physical activity was protective against meningioma. Compared with a low rate of physical activity, medium and high levels were associated with decreased risk (RR, 0.57 and 0.61).

A history of uterine fibroids carried a relative risk of 1.78, but no other reproductive factors seemed to be correlated. “Fibrocystic breast disease, endometriosis, and some other reproductive covariates have not shown any association, so, with uterine fibroids being so strongly associated, I think it’s not simply a coincidence,” Dr. Johnson said.

The associations were significant after adjustment for “current” BMI (1993).

The data raise the hypothesis that a metabolic environment associated with greater growth in adolescence, and greater weight later in life, may play a role in the etiology of meningiomas, he said.

“Potentially the key unifying factor in the things we found in meningioma risk is the influence of circulating sex hormones and insulin resistance,” Dr. Johnson said.

Meningiomas occur at twice the rate in women as in men, and the incidence is increasing, he added.

When asked for his opinion on the findings, Dr. Fred Barker of the department of neurosurgery at Massachusetts General Hospital, Boston, said the association with uterine fibroids was intriguing. “It is biologically plausible that the same mechanism of exposure to hormones could explain the association, but it may also be some genetic predisposition, or it may be that women who seek out imaging have both of these things found with relatively minor symptoms.”

Many meningiomas in elderly people are small and asymptomatic and are discovered only incidentally or on autopsy, he said in an interview. “As with fibroids, it could just be that certain patient behaviors lead to imaging being done.”

Can depression be a menopause-associated risk?

There is little doubt that women experience a heightened psychiatric morbidity compared to men. A growing body of evidence suggests that, for some women, the menopausal transition and early postmenopausal years may represent a period of vulnerability associated with an increased risk of experiencing symptoms of depression, or for the development of an episode of major depressive disorder.

Recent research has begun to shed some light on potential mechanisms that influence this vulnerability. At the same time, a number of studies and clinical trials conducted over the past decade have provided important data regarding efficacy and safety of preventative measures and treatment strategies for midlife women; some of these studies have caused a shift in the current thinking of how menopausal symptoms should be appropriately managed.Essentially, most women will progress from premenopausal into postmenopausal years without developing significant depressive symptoms.

However, those with prior history of depression may face a re-emergence of depression during this transition while others may experience a first episode of depression in their lives. Here I provide an overview of what is known about risk factors for depression and the risk posed by the menopausal transition, its associated symptoms, and the underlying changes in the reproductive hormonal milieu, discussing the evidence for the occurrence of mood symptoms in midlife women and the challenges that face clinicians and health professionals who care for this population.

Tropical Moments and Other Joys of Menopause

Menopause is one of those strange times when the body takes over and does its own thing beyond our control. Deb knows the ups and downs of menopause from years of sleepless nights spent flinging off the bed covers, feeling bloated like a beached whale and getting bitchy for no reason.

We recently talked with Dr. Mache Seibel, director of the Complicated Menopause Program at the University of Massachusetts Medical School, who said:
Menopause is a window of time, like puberty backward. Puberty is when there are great body changes, hormonal changes, raging feelings and things that are going on that you don’t understand, and menopause is when there are raging feelings and body changes, emotions and things that you don’t understand. Women spend at least 10 years in menopause, but the benefits last for years to come: no need for contraception, no fear of pregnancy, children are leaving or have left home so there can be greater spontaneity and freedom. In other words, women can go from making babies to making love!

As a seasoned veteran, Deb has meditated her way through the changes: Meditation is the most important thing she ever did for herself, over and above all the Chinese herbs, yam creams or other remedies. One of the difficulties with having hot flashes, for instance, is the incredible longing to get away from the heat, whether by flinging open windows or running outside in the snow, but often such activity just increases the heat. Very simply, hot sweats increase with stress and decrease with deep relaxation. Being or sitting still releases all resistance and enables the body to cool down more quickly. Meditation also shows us how all things do pass, including such intense physical discomfort.

“We don’t stop enough in life; there is rarely a pause button we can push,” says Mache. He adds:
Music would not be pretty if there weren’t some rests in between the notes, and meditation gives us that spaciousness. Menopause is one phase of life while meditation transcends all phases of life. It realigns and regroups the cells, atoms are aligned, molecules re-ordered. People should try meditation for three minutes, then for five or six, until they find a space that fits their day.

Most especially, menopause is when we can drop all the labels and come into our own sense of who we are. It is a time for us to emerge! We may want to start dancing or rock climbing, become a poet, write a book or work for the homeless — whatever it may be, now is the time to just do it!

Menopause Symptoms And Diet

Menopause is a state of women health during which her periods stop and she is no more fertile. Like in puberty during this time also women go through a lot of hormonal changes which also result in health disorders. Menopause is an important part of a woman’s life and needs immense care as her body mental and physical self become weak.

Symptoms Of Menopause

1.Irregular Periods – A woman might skip periods for several months and then have in in gap of a weeks time. The number of days of periods also get restricted to one or two days.

2.Low Fertility – During menopause, the estrogen level drops and she will have very less chance of getting pregnant.

3.Hot Flashes – A women might suddenly feel heat on her upper body, which gradually spreads to the stomach. Her skin might turn red and patchy.

4.Urinary Problems – Infections in urinary tract might happen. She might also have the tendency to urinate frequently.

5.Mood Swings – Due to hormonal changes, woman might have a lot of mood swings.

6.Osteoporosis – As the estrogen level decreases in the body, bone mass is lost, thus making the bones brittle. They are so brittle that in very little amount of pressure they can break. This is called Osteoporosis. This is one of the major symptom of menopause.

These are some of the basic symptoms of menopause. These symptoms of menopause become all the more chronic as the time approaches but if proper care is taken then it also subsides with time.

Menopause Diet

1.Menopause diet of a woman should include a minimum of 1200 to 1500 mg of calcium. Thus it is important to add yogurt, green leafy vegetables, milk and cheese in her diet.

2.Woman going through this phase tend to store cholesterol, which increases the risk of heart attack. Thus one should include sources of Omega-3 fatty acids in his diet. Food rich in Omega-3 include fish and other sea food.

3.Include fruits in your diet as they are rich in Vitamins, which a woman requires at this time. Sources of Vitamin B and B-12 should be included in her diet.

4.Menopause diet should include fiber rich food. Food rich in fiber are whole wheat, fruits, cereals etc. This will help her digest food, thus, cutting down the amount of cholesterol, prevent constipation and maintain the blood glucose level.

5.Soy is a very good source to meet menopause symptoms. Soy contains Phytoestrogen. This treats menopause symptoms like hot flashes, calcium deficiency etc. This also provides energy to the body.

Many women ‘unaware they have a weight problem’

When a woman asks: “Does my bum look big in this?” she has some insight that her derriere may appear larger than desirable.

But ask a woman if she thinks she is overweight and you may be surprised by the answer you get.

When US researchers asked 2,000 women this question, many were unable to give a correct answer.

A quarter of those who were overweight were unaware that they had a weight problem and perceived their size to be “average”, even though they clearly were not.

In fact 1,000 of the women in the survey were found to be clinically obese or overweight.

Like this latest work in Obstetrics and Gynecology journal, UK researchers have also found many Brits have a skewed perception of what is fat.
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Everybody is getting heavier and, as a result, people think ‘I’m not so heavy – look at her’ and then fail to realise they themselves have a problem”
Tam Fry
National Obesity Forum
Obese the new “norm”

A YouGov poll of 2,000, carried out last year with Slimming World, found three in four obese people in the UK were unaware of their weight problem.

This survey found only 7% of people believed their weight was significant enough for them to be classified as obese, despite over a quarter of those interviewed fitting into this category.

Experts say part of the problem is that obesity is becoming normalised by society.

With two-thirds of UK adults now overweight or obese, the average size is no longer average.

Tam Fry of the National Obesity Forum says obesity is now so common-placed that we no longer see it.

“Everybody is getting heavier and, as a result, people think ‘I’m not so heavy – look at her’ and then fail to realise they themselves have a problem.”

Dr Shahrad Taheri, lead clinician in obesity at Birmingham’s Heartlands Hospital, says it is the environment that we live in that makes it hard for people to both recognise and tackle weight issues.

Our love of convenience – fast food, motorised transport and sofa-based hobbies – is making obesity inevitable.

And as clothes are being supersized to fit our plumper bodies, we may not be alerted to our growing girth.

And, typically, when obesity is covered in the media, it is the extreme cases of massively overweight people stuck in their houses that grab the headlines. Hardly an accurate barometer.

Dr Taheri said: “Our environment is designed to trick us into eating fast food and doing little exercise.

“In the UK we have the biggest obesity problem in Europe, yet we continue to have this difficulty with perception.

“It may be easy to spot those people who are very overweight, but it’s the middle of the road people that are missed.

“Experience shows that even many parents are not aware when their children have a weight problem.”

But this blinkered perspective is dangerous say the US experts who carried out the latest survey.
Society’s problem

The team from the Center for Interdisciplinary Research in Women’s Health found people who failed to realise they were overweight were far less likely to concern themselves with adopting lifestyle changes to maintain a healthy weight.

Lead researcher Dr Abbey Berenson said: “These patients are at risk for cardiovascular disease, type 2 diabetes and other serious problems.”

Dr Tony Goldstone, an obesity expert at London’s Hammersmith Hospital, explains what fat is

Official statistics suggest an obese person dies on average nine years earlier than somebody of normal weight, while a very obese person’s life is cut short by an average of 13 years.

Tam Fry believes GPs should take charge and do more weighing of their patients.

“If people themselves can see that they have a weight problem then the medical profession has to be much more observant.”

But Dr Jacquie Lavin, head of nutrition at Slimming World, said it should be up to individuals themselves to take responsibility.

“If people take responsibility themselves they are more likely to succeed in keeping weight off.

“It is easy enough to jump on a set of scales and work out your own BMI.”

She believes it is important to get back to a time where a healthy weight is again the “norm”.

“As a society, we need to offer more opportunities for people to be more active and to make healthier food choices.

“The figures suggest we seem to be making some headway with tackling childhood obesity. But for adults, we are certainly not over the worst of it yet.”

Women seeking birth control get unneeded pelvic exams

Many doctors and other health care workers require that women have pelvic exams before they can get prescriptions for birth control pills, despite guidelines saying that the step is unnecessary, a new study finds.

In a survey of 1,200 U.S. doctors and advanced practice nurses, researchers found that one-third said they always required women to have a pelvic exam before they would write a prescription for birth control pills.

An even higher percentage — 44 percent — said they “usually” required one, according to findings published in the journal Obstetrics & Gynecology.

The number of practitioners requiring a pelvic exam is disappointingly high, researchers say, considering the fact that the World Health Organization and the American College of Obstetricians and Gynecologists (ACOG) advise that birth control pills can safely be prescribed without the exam.

“We were surprised, and we were certainly hoping that the numbers would be lower,” Dr. George F. Sawaya, one of the researchers on the study, told Reuters Health.

Unnecessary hurdle
The key problem with mandatory pelvic exams is that it puts up an unnecessary hurdle to women seeking effective birth control, according to Sawaya and his colleagues at the University of California, San Francisco.

Women have to wait until their provider can fit the exam into his or her schedule; some may be turned off by the requirement altogether and opt for less-reliable forms of contraception, like condoms.

Birth control pills are the most popular form of reversible contraception in the U.S., used by 28 percent of women using contraceptives, the authors note.

“In my view, we should have as few barriers as possible to women trying to get effective birth control,” Sawaya said.

Dr. Andrew M. Kaunitz, an ob-gyn not involved in the study, agreed.

Pelvic exams, which can find potential signs of sexually transmitted infections, ovarian cysts, cancer or other disorders, are an important part of women’s routine healthcare, said Kaunitz, a professor and associate chairman of obstetrics and gynecology at the University of Florida College of Medicine-Jacksonville.

“But pelvic exams should not be linked to oral contraception in a mandated fashion,” he told Reuters Health.

There is no established medical need for women to have the exam before receiving a prescription for birth control pills, Sawaya said. It’s just that, traditionally, pelvic exams have been coupled with contraceptive prescriptions; in many cases, it may have simply been convenient for women to have a pelvic exam as part of their routine healthcare at the same time they were seeking a birth-control prescription.

“The two just became linked,” Kaunitz agreed. But while there is nothing wrong with that, he said, “women also deserve the option of un-linking those two services.”

The current findings are based on a survey sent to a national sample of 1,196 ob-gyns, family doctors and advanced-practice nurses specializing in either women’s health or family medicine.

Overall, 29 percent of ob-gyns and 33 percent of family doctors said they always required a pelvic exam for women seeking birth control pills. In addition, half of ob-gyns and about 45 percent of family doctors said they usually required the exam.

Nurses least likely to require exams
Advanced-practice nurses specializing in women’s health were the least likely to require a pelvic exam, with 16 percent saying they always did so. In contrast, nurses specializing in family medicine were more likely than all other providers to always require a pelvic exam; 45 percent said they did.

The reasons for the high rates are not clear from the study. But simple tradition could be at work, according to both Sawaya and Kaunitz. “I think old habits die hard,” Kaunitz said.

He also pointed out that among all providers in the study, those working in private practice were twice as likely as those in community and family-planning clinics to require a pelvic exam — suggesting that the clinic providers are more aware of current guidelines.

It’s also possible that some doctors require a pelvic exam in order to get the insurance reimbursement, Sawaya and his colleagues note in their report.

Medicare pays doctors about $75 for a screening pelvic exam and, depending on geography, private insurers may pay more. Contraceptive counseling, on the other hand, may not always fall into a clearly defined reimbursement category, the authors note.

“In the absence of adequate financial incentives for contraceptive counseling as an important clinical activity in its own right,” the researchers write, “providers are incentivized to conduct a physical exam with a well-reimbursed billing code.

Exams raise risks of more unnecessary tests
Along with added costs, unneeded pelvic exams also open women up to the possibility of having an abnormal finding that, upon further testing, turns out to be nothing. “Any (test) we do with an asymptomatic person has a chance of resulting in a false-positive,” Sawaya pointed out.

As for how often women should have a routine pelvic exam in the absence of any problems, there is no specific guideline. There are guidelines, however, for how often women should get a Pap test to screen for cervical cancer, which is often done in conjunction with a pelvic exam.

According to ACOG, women should begin having Pap tests at age 21, with screening repeated every two years until age 30. Women age 30 and older who have had three consecutive negative Pap tests can be screened every three years.

For women who are only seeking a birth control prescription and are told they need to schedule a pelvic exam, Sawaya suggested they ask their provider why the exam is necessary.

But he said the real message of the survey results is for practitioners, who, based on these findings, need better awareness of current guidelines on birth control prescription.

Women’s Preventive Services Needed in Health Insurance

The process of implementing the new health care law continued last week as a panel of independent experts meet to begin to develop evidence-based preventive health guidelines for women that will be used to determine what preventive services will be covered in all new health insurance plans and provided with no cost-sharing.

Under a part of the new health care law that went into effect in September, all new insurance plans are required to cover certain preventive measures like mammograms, pap smears, smoking cessation therapy and folic acid and provide them to patients at no cost. To supplement these new rules, the Institute of Medicine has been tasked with addressing serious gaps in the definition of preventive care for women and ensuring that this landmark protection meets the full range of women’s health needs. This week the Institute of Medicine’s panel of women’s health experts is holding its first meeting to begin the process of making preventive care more accessible and affordable for women.

As a part of this meeting, I testified before the panel and discussed general barriers to care that women face and recommended five services that the panel should be sure to include in their final recommendations to Department of Health and Human Services (HHS).

Women seeking affordable health care face significant and unique barriers. Women generally make less than men. With women making on average just 78 cents for every dollar a man earns, women have less money to spend on their health care. It is then not hard to imagine why more women than men have faced economic hardship due to health care needs. Women are also more likely to delay or avoid seeking care, including preventive care, due to cost. Evidence also suggests that even moderate co-pays can cause individuals, especially those with low and moderate incomes, to forgo needed preventive care.

As NWLC has shown, before the Affordable Care Act, the individual insurance market routinely failed women, making access to affordable health care even more challenging. Women obtaining identical plans to men oftentimes pay higher premiums. To add insult to injury, maternity care is rarely included in basic individual plans, and as a result women must purchase a supplemental policy to cover pregnancy. These riders can be prohibitively expensive. Women who obtain coverage through an employer are partially protected from these barriers due to federal and state employment discrimination laws, but cost and coverage challenges continue to exist.

The National Women’s Law Center also proposed five additional services to be included in the final list:

Family Planning Counseling and All FDA- Approved Prescription Contraceptive Drugs and Devices- Nearly all American women use contraceptives during their reproductive years. Family planning counseling and supplies allow women to control the spacing, timing and number of births, which leads to improved health and mortality outcomes for women and their children. The ability to plan a pregnancy can prevent a range of pregnancy related complications that can endanger a woman’s health, and allows women to the take the necessary steps to ensure her own health is adequate to undergo pregnancy and childbirth.

A wealth of information supports the recommendation that reversible and permanent forms of contraception be covered by health insurance.

A consensus study by a panel convened by the IOM in 1995 to address unintended pregnancy recommended that financial barriers to contraception be reduced by “increasing the proportion of all health insurance policies that cover contraceptive services and supplies…with no copayments or other cost-sharing requirements, as for other selected preventive health services.”

The Centers for Disease Control and Prevention named family planning one of the ten most important public health achievements of the 20th century because of its contribution to “the better health of infants, children, and women.”

Contraceptive use is one of the cornerstones of Healthy People 2010, the nation’s agenda for promoting health and preventing disease.

The National Business Group on Health, a non-profit organization representing large employers’ perspectives on national health policy issues, conducted a comprehensive review of available evidence and recommends a clinical preventive service benefit design that includes all FDA-approved prescription contraceptive methods at no cost-sharing.

Including family planning counseling and supplies in the final recommendations would also build on key federal protections in place for millions of women. For almost 40 years, Medicaid has covered family planning services and supplies and provided them without co-payments for millions of low-income women.

Because the only FDA-approved prescription contraceptives available today are for women, and pregnancy is a condition unique to women, the panel has the opportunity to rectify a long-standing inequity for women. Failure to cover contraceptives forces women to bear higher out-of-pocket health costs, totaling approximately $9,000 over her lifetime. Nearly ten years ago, the Equal Employment Opportunity Commission issued an interpretation of the federal civil rights law that prohibits discrimination in employment, stating that it is sex discrimination for employer-sponsored health insurance plans to provide coverage of other prescription drugs and preventive services, but fail to provide coverage of contraception.

Screening for Intimate Partner Violence- Three women are murdered each day by their husbands or boyfriends, and two million injuries result from domestic violence each year. We should be using every tool at our disposal to identify and help victims of intimate partner violence and we believe routine behavioral assessment for intimate partner violence could help reduce these numbers.

Screening for Cervical Cancer- Cervical cancer was once the leading cause of cancer death for American women, but screening and early intervention has greatly reduced the number of deaths each year. It has been a several years since the United States Preventive Service Task Force (USPSTF) has updated its recommendations. We urge the panel to review relevant evidence to ensure women are receiving the appropriate care.

Breast Pump Equipment- Studies have shown that breastfeeding provides important long-term health benefits for mothers. Lactation supplies, including breast pumps, are critical for mothers to sustain breastfeeding and receive the preventive health benefits that lactation affords.

Physician-Recommended Preventive Services- Many of the services that are provided in a routine preventive visit are included among USPSTF recommendations, yet the Task Force does not recommend the actual visit itself, and women are often charged co-payments at the time of service. We urge the panel to consider covering all well-woman and preconception care visits. When a doctor recommends a preventive health visit, a woman’s decision about whether to comply should not turn on her ability to afford the care.

A number of organizations, including the U.S. Conference of Catholic Bishops, decried the possibility that contraception may be included among the preventive health services covered, but this extreme position is without merit and harmful to women. Sound science should trump ideology, and we’re confident that the Institute of Medicine panelists will not let the religious views of some interfere with their expert review of the scientific and medical evidence and the needs of American women.

Overcoming Disparity – Women’s health damaged by increased city living

Today’s urban cities are suffering from a dramatic rise in a disproportionate health crisis coming from its poorest citizens, finds WHO (World Health Organisation)/UN-HABITAT report, Hidden Cities – Unmasking and Overcoming Health Inequities in Urban Settings. Women suffering under poverty are especially sensitive to impacts of urbanisation as statistics show women in densely populated areas have a 1.5 times higher rate of HIV/Aids than men. Women in cities also face higher dangers of contracting Aids, a figure almost twice as high as their rural sisters.

On the edge of the global economic shakedown, as numerous cities and urban areas suffer from rising population, women who suffer from poverty experience greater encounters with overcrowded substandard housing, infectious diseases, food and water safety issues, inadequate sanitation and increasing solid waste disposal problems.

“In 2010, more than half (the world’s population) live in cities, and by 2050, 7 out of every 10 people will live in urban areas,” outlines the new report. “Most of this explosive growth is occurring in developing countries, where municipalities and other government authorities are often overwhelmed by the rapid population boom.”

With the transfer of both men and women from rural to urban regions steadily increasing at a rate of 60 million per year, globalisation is reaching a tight squeeze creating a real possibility that massive problems in overcrowding will overshadow our next century. Urban city dwellers will most assuredly face failures with services and infrastructure creating dire consequences that may outlive generations.

For the very first time in history, a majority of the world’s populations are living in cities. And this figure is rising. Ultimately, the problems of urbanisation will affect the life and health of rich and poor alike, but the poorest populations will suffer much more from inequities.

Developing nations, spurred by increasing problems of climate change, are also growing the world’s largest slums, as the rural poor break with generations of steady work in agricultural endeavors to move to cities under mythological promises of better employment.

“Urban poverty has become highly feminised,” says the new WHO/UN-HABITAT report. Women, who have worked in farming agri-industries, find that upon their arrival to urban areas they are often quickly and sharply excluded from jobs, denied training programs and placed in situations that bring ongoing and demeaning exclusions.

While cities offer rural women new experiences and opportunities to create larger support networks, they also face heightened struggles toward empowerment. With urban environments come increased dangers of violence to women due to domestic and economic struggles at home. Rape too is an ominous urban threat.

“In many cities, the urban poor face challenges in accessing health services due to their inability to pay out-of-pocket expenses for services,” says the 2010 report on urban health inequities from WHO/UN-HABITAT. “This is in contrast to rural settings, where the main access issue facing residents is that health facilities are far from their homes and communities.”

In Bangladesh, surprisingly the number of women who have diabetes increases as the nation becomes more developed and more urbanised as wealthier women, 45yrs and older, outnumber poor women who have the disease. But care, for those with less money who do suffer from diabetes, is markedly unequal.

“Many urban dwellers at some point will face a dire choice: either to go without essential treatment, or to seek treatment and go into poverty,” continues the WHO/UN-HABITAT report.

Health equity, for urban and non urban women, is an issue that relates across the board stating that all woman must have fair and equal access to health management and programs.

“Opportunities to put health at the heart of the urban policy agenda exists, and it is time for all sectors to work together toward innovative and effective solutions that mitigate health risks and increase health benefits,” says Margaret Chan, director of WHO.

“Of the many risks to health that are linked to rapid urbanization, none is more compelling than urban poverty,” adds Inga Björk-Klevby, assistant secretary general of the UN and officer in charge of UN-HABITAT.

“These unfair health gaps are growing in spite of unprecedented global wealth, knowledge and health awareness,” continues the UN assistant secretary general.

Hazards: Work Stress Raises Women’s Heart Risk, Study Says

Women who are stressed at work are more likely than other working women to have a heart attack or other forms of heart disease, a new study suggests.

The findings, presented Monday at an American Heart Association meeting in Chicago, were based on data from 17,415 otherwise healthy middle-aged women who took part in the Women’s Health Study, sponsored by the National Heart, Lung and Blood Institute.

The researchers found that women who reported high job strain faced a 40 percent increase in cardiovascular disease over all, and an 88 percent increase in risk for heart attacks alone. (“Strain” was defined as demanding work with little decision-making authority or ability to use one’s creativity and skills.)

Women who were worried about losing a job did not experience an increase in heart ailments, but they were more likely than women with high job security to be overweight or to have high blood pressure or high cholesterol, all risk factors for heart disease.

Earlier studies on chronic job stress and heart disease in women have had mixed results, though studies of mostly male subjects have found a clear association between the two, said the study’s senior author, Dr. Michelle A. Albert, a cardiologist at Brigham and Women’s Hospital in Boston and an associate professor at Harvard Medical School.

“You can’t get rid of stress, but you can manage it,” Dr. Albert said, adding that she recommends getting more exercise and maintaining contacts with friends and family. In addition, she said, “try to keep work at work.”

“If you have to work when you’re home, since we are all living in an electronic age,” she went on, “limit your time on e-mail. Otherwise you never leave work.”

Hormone therapy may prevent – or contribute to – dementia risk

Hormone therapy appears to affect the brain differently depending on the age of the woman when she receives it, researchers reported Thursday.

Hormone-replacement therapy for women has been the subject of considerable debate. Studies have shown both pros and cons. But hormone use has declined in the last decade because a major study on the issue, the Women’s Health Initiative, found that the risks of taking hormones appeared to outweigh significantly the benefits in older postmenopausal women. Among the findings was that beginning hormone therapy in women ages 65 and older led to a twofold higher risk of dementia.

Questions remain about the affect of hormones if taken at a younger age — among perimenopausal (the phase before menopause when hormones decline and fluctuate) or menopausal women in their early 50s. The new study, published in the Annals of Neurology, supports the idea that hormones can affect dementia risk differently depending on the age of the woman when she takes them.

Kaiser Permanente researchers examined data from members in Northern California from 1964 to 1973, among women 40 to 55 years old. The study examined whether hormones were used at midlife — defined in this study by the average age of 48.7 — or in late life, defined as age 76. Compared to women who never used hormones, those taking hormones only at midlife had a 26% decreased risk of dementia. This link held true even when the researchers controlled for other factors that contribute to dementia, such as high cholesterol and stroke.

However, taking hormones in late life may counteract whatever benefits are seen by taking hormones at midlife, the authors said. Women taking hormone therapy only in late life had a 48% increase in dementia. Women using hormones at both midlife and late life did not differ in their dementia risk from women who didn’t take hormones.

“The reduced risk of dementia associated with midlife hormone therapy use only lends support to the notion that it is not only early postmenopausal use of hormone therapy that is protective, but that use should also be limited to a few years,” the authors wrote.

Animal studies suggest that estrogen benefits brain health, and observational studies have shown that women who take hormones are less likely to develop dementia later in life. But studies such as the Women’s Health Initiative dashed hopes that hormones protected against cognitive impairment. Research now is focusing on whether there is a “critical window” for use — a specific time of life when hormones would do more good than harm.

High-stress jobs a health risk to women?

NEW YORK – Women with high-stress jobs face about 88 per cent more risk of a heart attack than if they had low workplace strain, according to Harvard researchers.

The scientists defined the stressful positions as those with demanding tasks and little authority or creativity.

Those jobs were also associated with a 40-per-cent greater chance of getting any kind of cardiovascular disease, according to a study presented yesterday in Chicago at the American Heart Association’s Scientific Sessions.

Job strain, social isolation and some personality traits have been recognised as raising risks in both men and women, according to the Dallas-based heart association.

Past studies that focused on men, the traditional breadwinners, found that higher job stress raised heart risks.

This is the longest major one to look at stress in women, who now make up nearly half of the workforce in the United States.

“The big thing is, what’s happening to you now in terms of mental tension has long-term effects on your health,” said the study’s senior author, Assistant Professor Michelle Albert of the Harvard Medical School, who is also a cardiologist at the Brigham and Women’s Hospital, both located in Boston.

The study analysed job strain in 17,415 participants from the Women’s Health Study, a US project that began in 1991 and ended last year, with funding from the National Institutes of Health, based in Bethesda, Maryland. Bloomberg