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Tag: gynecology

  • Birth Control Over the Counter Recommended by OB/GYNs

    The American College of Obstetricians and Gynecologists (ACOG) recently recommended that oral contraceptives be sold over the counter in drugstores, without the need for a doctor’s prescription. The group’s recommendation will be published in the December 2012 issue of the journal Obstetrics & Gynecology.

    No oral contraceptives are currently over the counter in the U.S. ACOG cites cost, access, and convenience as factors in why women don’t use contraception. The group believes that easier access to birth control will help lower the unintended pregnancy rate in the U.S., which they estimate costs taxpayers $11 billion annually.

    Though ACOG states that no drug is risk-free, it also states that the overall consensus is that oral contraceptives are safe. The group points to aspirin and acetaminophen as medications available over the counter that also have health risks. ACOG admits that while there is an “extremely low” risk of blood clots with oral contraceptive use, the risk is significantly lower than the risk of blood clots during pregnancy or after giving birth.

    ACOG cited studies showing that women are able to self-screen for health risk using check lists before using oral contraceptives, and that women continue seeing their doctor for preventive services when allowed access to over the counter oral contraceptives as grounds for their recommendation. The group also pointed to a study that shows women who receive more than one month’s worth of oral contraceptives at a time have higher continuation rates for birth control.

    The new recommendation is one of several that will be published in the upcoming Obstetrics & Gynecology. Other recommendations include the optimal timing of umbilical cord clamping after a birth (30 to 60 seconds), and health care services offered to women in the military.

  • Hormone Therapy Declining Among Older Women

    A study published this week in the journal Obstetrics & Gynecology shows that hormone use among postmenopausal women has been declining for at least the past decade. The study, which examined data from the National Health and Nutrition Examination Survey, found that less than 5% of postmenopausal women used hormone therapy in 2009. In contrast, that number was just over 22% in 1999.

    The study found that hormone therapy use among white women sharply declined starting in 2003. The same decline followed for black and Hispanic women starting in 2005. Not coincidentally, the Women’s Health Initiative announced in 2002 that combined estrogen/progestin hormone therapy can raise certain health risks for women.

    Reuters quotes the lead author of the study, Brian Sprague of the University of Vermont, as stating that he is unable to say definitively why the change is occurring, though he does speculate that fears of the health risks of hormone therapy from doctors and patients is likely the cause.

    The Woman’s Health Initiative is a health initiative created by the U.S. National Institutes of Health to conduct research into the health issues that concern older women. In it’s 2002 study, it found that estrogen plus progestin hormone therapy increases the risk of heart attack, stroke, blood clots, and breast cancer. The initiative did not, however, suggest that women not use hormone therapy to alleviate symptoms of menopause. Instead, it recommended that women follow the Food and Drug Administration’s advice on hormone therapy, which suggests taking the lowest dose for the least amount of time necessary.

  • Cervical Screenings to Occur Less Often: Good News for Women Aged 30-65

    New guidelines indicate that women who have had normal HPV and pap test results in the 30-65 year old age bracket will only need to be tested every five years. This revision was put into place after physicians found that “combining a Pap test with a human papillomavirus (HPV) test can safely extend the interval between cervical cancer screenings from three years to five years” in this age group.

    Cervical screenings can be very uncomfortable and even painful so this may come as a pleasant surprise for women with no abnormal test histories in the past ten years.

    Women who opt for the Pap test alone, are advised to get screened every three years.

    It is also believed that if women undergo unnecessary screenings they could be putting themselves at greater risks; the authors of the guidelines explain: “The harms of more frequent screening — such as a greater chance of abnormal test results can lead to further, sometimes invasive testing — outweigh the benefits of early detection of slow-growing precancerous changes in the cervix. Often, those precancerous changes resolve without any treatment. Persistent infection with certain types of HPV can lead to cervical cancer.”

    Older guidelines suggested that women be screened within three years of becoming sexually active. While the average age that women experience their sexual debut is 17 race, socio-economic status, and geographic location skew the averages. The median ages by race are as follows: White (16.6), Black (15.8), Hispanic (17), Asian American (18), and other (17.4). This means that in the past, the majority of American women should have been screened between the ages of 15-20.

    In its new update, though, the task force says it found little evidence that sexual history should affect the age at which women begin to get screened. And, the guidelines note, there is no evidence that screening women younger than 21 reduces diagnoses of or deaths from cervical cancer.

    Other Changes with the New Guidelines

    HPV testing is not recommended for women in their 20s because people in that age group can have HPV infections that resolve without treatment.

    Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or at least two negative HPV tests within the previous 10 years. The guidelines do not apply to women with a history of cervical cancer or prenatal exposure to the drug diethylstilbestrol (DES) or to women whose immune systems aren’t functioning normally, such as those with HIV. Such women may need more intensive screening.

    Cervical Cancer Deaths Plummet

    As a result of cervical cancer screening, death rates from cervical cancer in developed countries have decreased significantly. This year, the American Cancer Society estimates that more than 12,000 women will be diagnosed with the disease and more than 4,200 will die. A majority of cases occur in women who hadn’t been screened in more than five years, if ever.

    Some people are skeptical of the new guidelines and decided to tweet:

    (image)@PGRDresses
    PrettyGirlsRockDress    Ladies don’t fall for the hype. PLEASE continue to get your annuals. If you don’t please START this year! http://t.co/sk4voLCk(image) 19 hours ago via Facebook ·  Reply ·  Retweet ·  Favorite · powered by @socialditto

    (image)@greenphillyblog
    greenphillyblog    WTF?! Please explain how cancer is detected if you’re reducing the # of tests?!? http://t.co/wY4DzQdd cc: @cnnhealth #cervicalcancer(image) 19 hours ago via TweetDeck ·  Reply ·  Retweet ·  Favorite · powered by @socialditto

    And doctors like Howard W. Jones III, MD, director of gynecological cancer at the Vanderbilt-Ingram Cancer Center, agree: “Just because they don’t need a Pap test doesn’t mean women should go years without seeing a doctor. After all, Jones says, high cholesterol, high blood pressure, and diabetes can go undetected for years in people who aren’t screened for them.”

    Could this just be one more way for insurance companies to increase their profit margins?