Articles filed under 'WOMEN'S HEALTHCARE'
In our society, abstaining from alcohol can be difficult, especially during parties and family celebrations. But women who are pregnant or even just trying to get pregnant should stay away from alcohol entirely.
For the woman who is dependent upon or an abuser of this legal drug, it may be impossible to abstain from drinking without first undergoing effective treatment. Pregnant women with alcoholism should join an alcohol abuse rehabilitation program and be checked closely by a health care provider during their entire pregnancy.
Because alcohol use appears to be the most harmful during the first three months of pregnancy, serious harm can occur to the fetus before a woman even knows she is expecting. Few are even aware of the possible consequences of their drinking to the developing child, known as fetal alcohol syndrome (FAS).
Fetal alcohol exposure is the leading known cause of mental retardation in the Western world. In the U.S., FAS occurs as often as or even more frequently than Downs Syndrome or Spinal Bifida. Symptoms of FAS can include the following:
* Slowed intrauterine growth
* Poor growth in the fetus and newborn
* Possible failure to thrive after birth
* Delayed development and signs of mild-to-moderate mental retardation, with the average IQ in the mid 60s
* Irregularities of the face, including small head and upper jaw; a short, upturned nose; smooth groove in the upper lip; smooth and thin upper lip; narrow, small eyes with large folds above the eye; heart defects; abnormal joints in the hands and feet; tremors in the newborn; agitation and crying
* Abnormalities of the skeleton
Any woman who is pregnant should avoid consuming alcohol throughout her entire pregnancy, as permanent birth defects can occur during each of the trimesters. It is unknown whether the timing or any specific amount of alcohol consumption is safe for the developing baby. Alcohol crosses the placental barrier and can cause physical, mental, and behavioral problems that can persist for a lifetime.
Drinking alcohol during pregnancy can be the first sign of possible fetal alcohol damage. Infant ECG and echocardiogram are able to detect problems such as a heart murmur or other heart structural defects. Ultrasound of the fetus can show delayed intrauterine growth.
The primary effect of FAS is permanent central nervous system damage, especially to the brain. The resulting under-formed or malformed brain structures can create an array of primary cognitive and functional disabilities. Among them are poor memory, attention deficits, impulsive behavior, and poor cause-and-effect reasoning. Since the brain develops during the entire pregnancy, the risk of brain damage exists during each trimester. Mental health problems and drug addiction are secondary disabilities that can manifest themselves later in life and be due to FAS.
Many women are unfamiliar with the potential, permanent consequences of drinking while pregnant. The lifetime medical and social costs of each child born with FAS are estimated as just under a million U.S. dollars. The social costs to the family are inestimable. All women who go off their birth control in order to conceive are advised to drink NO alcohol (and take no harmful drugs). It may be difficult to stop drinking, but it is the best way to give a baby the best possible health and start in life.
Sources: Wikipedia and other Internet health-related articles
May 26th, 2008
Some women in their 40s can still get pregnant without assistance from fertility clinics. That’s good news for those who have postponed motherhood, but for women who have completed their family, continuing fertility can be problematic. Today, the Pill and the IUD (intra-uterine devices) are both considered good options for some women in their fourth decade. These two methods are much safer than, for example, in the 1960s and 1970s. In the past, most women over age 40 underwent a tubal ligation (a fallopian tube-tying procedure), or relied on condoms or vasectomy with their male partner.
Sterilization is now easier for women, thanks to a non-surgical method of tubal treatment called Essure. The new technique was approved by the U.S. government in 2002. No cutting of the abdomen or tying of the tubes is involved. Instead, the doctor works through the cervix, using a thin tube to insert small devices into the ends of the fallopian tubes. These “plugs” in about three months produce scarring to block the woman’s tubes, thus preventing ovulated eggs from reaching the uterus.
Women over 40 should continue to use birth control until well into menopause. This age group has been shown to have high abortion rates, similar to those of adolescents. Under certain conditions, the Pill is now safe for “older” women. The dosage of estrogen in today’s Pill is greatly reduced and considered by many physicians to be a good alternative for lean, healthy women over 40. The Pill has other benefits besides contraception for appropriate women. It can help to control irregular menstrual bleeding and hot flashes, reduce hip fractures and cases of ovarian cancer. Yet, some physicians urge caution even in lean and healthy women who are approaching menopause.
If a woman over 40 is significantly overweight, has high blood pressure or diabetes, the Pill would not be a good option. For them, the chances of dangerous blood clots rise sharply. Middle-aged women who are obese, who smoke, have migraine headaches or other identified risk factors might instead consider IUDs or progestin-only treatments termed “mini-pills.” Although higher breast cancer rates have been found in older women taking estrogen-progestin pills to control menopausal symptoms, women 35 and older taking oral contraceptives have not shown an increase in breast cancers.
Another birth control product called Implanon, FDA-approved in 2006, is a matchstick-sized plastic rod that is implanted under the skin of the upper arm. Implanon is similar to the earlier Norplant and can last up to three years.
Today’s IUDs are safer and more effective than those used by women in the 1970s. The earlier Dalkon Shield version resulted in a number of serious medical problems due to its defective design. A large class-action lawsuit was filed and millions in payouts were made over the years. American women and their physicians are again considering the IUD as a simple and effective method of birth control.
Women should discuss with their OB-GYN physician their preferences for contraception, the appropriateness for their age group and their individual health risks. New options in birth control methods and technologies greatly reduce the risk of an unwanted pregnancy.
San Francisco Chronicle, Mike Stobbe, AP story, April 5, 2008
http://www.msnbc.msn.com/id/23954260/
April 8th, 2008
A large study conducted over 24 years at Kaiser Permanente Medical Care Program in Oakland, California, concluded that having three or more alcoholic drinks a day can increase a woman’s risk of breast cancer by 30%. Those who drank one to two drinks per day had an increased breast cancer risk of 10%. Women who drank less than one drink per day showed no significant increased cancer risk. According to researchers at Kaiser, the risk of heavy drinking is roughly equivalent to smoking a pack of cigarettes a day or taking estrogenic hormones well beyond the menopause.
Of the 70,033 multi-ethnic women who supplied information during their health exams between 1978 and 1985, roughly 3,000 of them had been diagnosed with breast cancer by 2004. It mattered not what type of alcohol was consumed – wine (red or white), beer, or spirits – the end result was the same. Results were similar for all ages and ethnicities. Heavier drinking was related to breast cancer risk in each group (classified by the type of alcohol consumed).
Breast cancer is known to vary between populations, and only a small proportion of women are heavy drinkers. However, women who are heavy drinkers may translate to an extra 5% of all U.S. women developing breast cancer due to this lifestyle factor. The study provides more evidence to influence women who are heavy drinkers to cut back or quit. Those with a strong family history of breast cancer should consider eliminating alcohol entirely or drinking only on special occasions.
Source: Science Daily
September 28th, 2007
Although still very small, the risk of dying in childbirth is rising in the U.S. Between 2003 and 2004, maternal mortality rates rose from 12 deaths in 100,000 live births to 13 in 100,000 (Fewer than 600 American women giving birth in 2004 died in the process.) Infant mortality is actually more common than death of the mother. In 2004, the rate of infant deaths was 679 per 100,000.
Compared to a century ago, when about 1 in every 100 live births resulted in the mother’s death, the small rise may seem insignificant. But, with our modern technology and outstanding medical care, we should be concerned that the maternal mortality rate has risen at all.
Looking at possible causes for deaths related to childbirth, three factors may be at least partially responsible: the rising rates of Caesarean-section births (now accounting for about 29% of all births); increasing maternal obesity, and more women giving birth in their late 30s and into their 40s.
Today, C-section births are far higher than what public heath experts consider appropriate. As with other surgeries, Caesarean births carry risks from anesthesia, infection, and blood clots. Mothers with several previous C-sections may also be at risk of excessive bleeding or blood vessel blockages.
Women who are heavier can develop diabetes and other complications. In addition, they may have excess tissue. Generally, their babies are larger, making a vaginal birth more difficult. This factor, in turn, can lead to more C-sections.
More women are waiting longer to have their babies than even a few decades ago. Risks of complications to mother and baby are greater to a woman in her late-30s and 40s.
Studies show than at least 40% of maternal deaths could have been prevented had quality of care been better. Sometimes, despite excellent prenatal care and a healthy pregnancy, the mother dies for no apparent reason.
The woman’s race and economic status may also be factors. Maternal deaths are at least three times higher for Black women than for white women. Because they often do not get adequate prenatal care, Black women are more susceptible to complications such as high blood pressure.
Getting risk factor – especially diabetes, obesity and high blood pressure – under control before becoming pregnant and obtaining good prenatal care will help to ensure a healthy outcome for both mother and baby.
Source: Yahoo News
August 26th, 2007
Several decades ago, doctors routinely told their pregnant patients to gain about 25 pounds but no more than 35 pounds. Today, however, more expectant mothers may already be overweight or obese before conceiving. In these instances, weight gain guidelines should be reduced.
According to the March of Dimes, carrying too much weight while pregnant increases risks to mother and baby. These complications can include birth defects, problems with labor and delivery, death of the fetus, or delivery of very large babies. Overweight mothers are also more likely to produce babies who are too heavy as toddlers.
Setting appropriate pregnancy weight gain guidelines can be aided by referring to the woman’s body mass index (BMI) at the time she conceives. BMI is a combination of height and weight. Women with a “normal” body mass index are still encouraged to gain between 25 and 35 pounds. Women who are especially thin may be encouraged to gain up to 40 pounds. For those with a higher BMI (over 26), 15 pounds of weight gain may be more appropriate.
In 2003, about 1 in 4 expectant women in the U.S. gained more than 40 pounds during their pregnancy, up from 1 in 5 in 1990. Many women are putting on 50 or 60 pounds with their pregnancies, which can cause complications such as gestational diabetes. Obstetricians point out that an obese woman already has stored nutrients and does not need much additional weight to provide for her developing baby.
Women would do well to get their weight under control before becoming pregnant. Once conception has occurred, eating a healthy diet and engaging in moderate exercise are important for both mother and developing child.
Source: CNN.com
August 17th, 2007
A German study indicates that women at high-risk for breast cancer can benefit from magnetic resonance imaging (MRI) scans by detecting a nonmalignant tumor called ductal carcinoma in-situ (DCIS). If the pre-cancerous growth is discovered and removed before it becomes malignant, breast cancer could be prevented. Almost all malignant breast cancer is believed to begin with DCIS.
Because MRI is expensive, about $1,000 to $1,500 per scan, the technology does not yet make sense as a routine screening tool for all women. However, for women who have a strong family history of cancer or a genetic mutation found through testing, MRI can be especially effective. Apart from the expense, MRI has a high rate of false positives – often detecting lesions that are harmless. MRI scanning of breasts should always be paired with mammography, which finds things that MRI doesn’t.
The German study of 7,319 women took place over a five-year period. MRI scanning found DCIS in 90% of the 167 high-risk women discovered to have the condition, while mammograms detected only 56% of DCIS cases.
Two Dutch researchers involved with the study published their findings and recommendations in Lancet medical journal. They suggested that MRI be tested in more women to determine whether the technology should be used as a standard screening tool. They also noted that autopsy results show 9% of women have undetected DCIS.
The American Cancer Society recommends for women at high risk that MRI screening be performed annually in conjunction with mammography starting at age 30.
About 1.2 million cases of breast cancer are diagnosed annually, and each year 500,000 women (and a small percentage of men) die of the disease.
Source: Yahoo News
August 11th, 2007
This month the FDA approved the first birth-control pill designed to stop women’s menstrual periods indefinitely. Lybrel, expected to be on the market by July, is approved for continuous use to prevent pregnancies.
Lybrel can have troubling side effects for some women, especially in its first year of use. About half the women enrolled in the study of the new low-dose hormone pill did not continue in the study. Many dropped out due to irregular and unscheduled bleeding and spotting that can replace scheduled monthly periods.
In one test of Lybrel, 59% of women who stayed on the pill for a year had no spotting or breakthrough bleeding in the last month of the study. Because many women dropped out, only about one-third of women who originally entered the study experienced this result.
Women with especially difficult periods due to headaches, breast tenderness, cramps and nausea may be willing to put up with initial unscheduled bleeding and spotting that may last for a year. Some do not experience these side effects. In those who have no periods while on Lybrel, it may be difficult to know if they become pregnant.
With a lower-dose pill, its effectiveness can be reduced, although it is still able to prevent pregnancy approximately 96% of the time. Lower-dose pills have been developed to reduce the risk of serious side effects such as blood clots and stroke.
For many women, menstruation is a natural part of their experience. They may not want to treat a normal function as though it were a medical condition. Others may rejoice to be able to skip their menstrual periods indefinitely.
Another method of eliminating monthly periods is by receiving the hormonal contraceptive Depo-Provra by injection.
Other pills already on the market (Seasonale and Seasonique) can reduce the number of periods a woman has to three or four a year. Some nontraditional pills such as Yaz and Loestrin 24 are able to shorten monthly periods to three days or less.
Source: CNN.com
May 28th, 2007
While some women embrace the concept of eliminating their periods entirely, others are reluctant to take the new pill Lybrel that would in essence eliminate monthly menstrual bleeding entirely. Newer birth control pills already on the market (such as Seasonale) can enable women to have periods just once every three or every four months. Lybrel is expected to be FDA approved in May 2007.
Doctors generally express no concern about extra risks with the complete elimination of the menses. About two-thirds of women surveyed showed interest in taking Lybrel, as they believe they are “too busy” to bother with monthly bleeding. At this point, however, there have been no long-term studies. It is yet unknown whether adverse unintended consequences might occur after having no periods for 30 or 40 years of a woman’s life.
Some women express concerns that menstrual cycles may involve complex interactions with the brain, bones and skin. Others are emotionally attached to their symbol of fertility when monthly bleeding does occur, or they may feel relief to have evidence that they are not pregnant.
Women on any type of birth control pill are not having real periods, as the hormones they are taking stop the monthly release of an egg and the buildup of the uterine lining. For that reason, the new pill is not offering a drastically different option, just more convenience for women.
Women who have difficult, painful periods that cause them to miss work and keep a low profile for several days may welcome the addition of Lybrel to choices they can make for contraception.
Source: New York Times
May 4th, 2007
This spring, new information came out about breast cancer screening, much of it perplexing to women. Past guidelines for annual mammograms included women in their 40s. Now, a major medical group disputes the need to screen women between the ages of 40 and 49.
The American College of Physicians has issued new and controversial guidelines. Their rationale is that for every 10,000 women screened in their 40s, perhaps six might avoid death from breast cancer. In addition, a high percentage of false positives could lead to unnecessary biopsies, increased costs, and potential for injury. Younger women receiving annual screenings might also incur a tiny risk of cancer developing from radiation used in mammograms.
All medical groups and experts agree that women 50 and over should get regular annual mammograms. Some women are known to have a very high risk of developing breast cancer — based on a strong family history or genetic testing showing defective BRCA1 and BRCA2 genes. The American Cancer Society recommends screening mammograms and MRI imaging for these women, beginning at age 30. Sonograms are also used for more definitive imaging in high-risk young women whose breasts are quite dense.
Recently, a new study found that MRI scans can detect tumors mammograms missed in about 3% of women. This sensitive technology, not available in all hospitals, often picks up suspicious but harmless growths that need to be biopsied. The result can be costly procedures that might cause unnecessary alarm in women. For those few in whom cancer is found at an early stage, MRI can prove valuable and, hopefully, life-saving.
Another controversial subject is a computer-assisted program designed to help radiologists identify small cancers on mammograms. This system has proved to be no more effective than traditional mammography read by an experienced radiologist. The technology also has led to many false alarms requiring needless biopsies. About 30% of mammography centers use computer-assisted technology, and no clear medical benefits have been found. Government and private insurers may be re-evaluating whether these expensive systems are worth the price.
The best advice in the screening controversy is to assess your risks carefully with your physician and determine what is right for you. If you are very high risk for breast cancer, use all available technologies at an early age. Early detection is still the best strategy.
Source: New York Times
April 7th, 2007
For women with very dense breasts or a strong family history of breast or ovarian cancer, MRI can yield much greater detail than mammography. MRI is so sensitive that it can reveal many types of suspicious growths in the breast. For this reason, there may be more false-positive findings leading to some unnecessary biopsies and additional scans. But for women at high risk for the disease, MRI can find tumors when they are most treatable.
Breast MRI requires special equipment, software and trained radiologists, and the expense can be 10 times the cost of mammography. In addition, breast MRI may not be available outside large cities.
Women at high risk are defined as having at least a 20 to 25% chance of developing breast cancer over their lifetime. Most U.S. women have about a 9% lifetime risk. Those who inherited defective BRCA1 or BRCA2 genes – a condition involved in only 10 percent of breast cancers – have a lifetime risk ranging from 36 to 85% of getting the disease. Especially at risk are those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested.
Using MRI for breast scans is especially useful for women who have been diagnosed with cancer in one breast and who need to know the status of the other breast. This sensitive technology can find tiny tumors that mammograms have missed. If an early cancer is detected in the other breast, both can be treated at the same time. Studies have shown that 10% of women with cancer in one breast over time will also develop it in the second breast.
MRI scans are most useful in younger women with cancer diagnosed in one breast and those with dense tissue that mammograms do not clearly image. Older, post-menopausal women with early tumors and clear mammograms are less likely to need MRI imaging.
Breast MRI can cost between $1,000 and $2,000. It may not always be covered by medical insurance. Figuring out just who needs MRI scans in addition to mammography can be difficult and much will depend on having a knowledgeable referring physician. A simple risk calculator is available online at http://www.cancer.gov/bcrisktool/. Genetic counseling can also be valuable in determining a woman’s level of risk.
Sources: New York Times ; MSNBC
March 31st, 2007
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