Brody continues that there are several treatments for fibroids but that many gynecologists are unfamiliar with the newer options and might not inform patients of possibilities other than hysterectomy. Hysterectomy is a major surgery that requires a two- or three-day hospital stay and a six week follow-up visit, "but is unquestionably effective at curing fibroid-caused symptoms," Brody writes. Hysterectomy usually is recommended for women who have completed childbearing.
One option for women who may wish to become pregnant is a myomectomy, in which the fibroids are removed and the uterus tract is left intact. However, there is a significant likelihood that the fibroids will grow back, according to Brody. Another less invasive option is medication, such as nonsteroidal anti-inflammatory drugs that can be taken on their own or with hormone medicines to reduce bleeding. An intrauterine device containing progesterone is another nonsurgical possibility that can provide temporary relief.
Women who do not wish to become pregnant might opt for embolization, a nonsurgical procedure that involves cutting off the blood supply to the fibroids by inserting tiny particles into the uterine arteries via a catheter. The process causes the fibroids to reduce in size, "though not necessarily disappear," according to Brody. The treatment duration is short, but the "fibroids can regrow or new ones can develop, and in clinical trials one-fifth to one-quarter of patients had to repeat the procedure or have a hysterectomy," Brody writes.
One of the newest treatment options is an MRI-guided ultrasound to "direct high-intensity ultrasound beams to the fibroids, heating them and destroying their outer layers," Brody says. She notes, however, that the procedure is not commonly covered by health insurance and could cost women as much as $10,000 (Brody, New York Times, 10/13).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
четверг, 29 декабря 2011 г.
New York Times Examines Alternatives To Hysterectomies For Treatment Of Fibroids
четверг, 22 декабря 2011 г.
Blogs Comment On Definitions Of Feminism, Supreme Court Nomination, Other Topics
~ "Sarah Palin Is No Susan B. Anthony," Ann Gordon/Lynn Sherr, Washington Post's "On Faith": The mission statement of the Susan B. Anthony List, a group that supports antiabortion-rights female candidates, "proclaims" that Anthony's antiabortion-rights stance is "untold history," according to Gordon, an editor of Anthony's papers, and Sherr, author of a biography on Anthony. They continue, "There's a good reason it's 'untold:' historians and good journalists rely on evidence. Of which there is none." According to Gordon and Sherr, the "only clear reference to abortion in [Anthony's] writings" was a remark in her diary about her sister-in-law's abortion. Although Anthony "[c]learly ... did not applaud her sister-in-law's action," the "notation is ambiguous" and "[a]t most, the quotation amounts to private disapproval within the family, unlikely to be voiced to her beloved relative," Gordon and Sherr write. There is "no hint that this is a social problem or a political matter," but the quote "was quickly fitted into the antiabortion narrative" nonetheless, they add. "Naming [a] lobby for Susan B. Anthony doesn't change her views any more than clicking your heels three times gets you back to Kansas," Gordon and Sherr say (Gordon/Sherr, "On Faith," Washington Post, 5/18).
~ "Susan B. Anthony: Pro-Life Feminist," Marjorie Dannenfelser, Washington Post's "On Faith": In a response to Gordon and Sherr's blog post, SBAL President Dannenfelser writes that their argument is "unfounded on many levels, but foremost, on the credibility issue." Dannenfelser writes that Anthony was "passionate and logical in her arguments against abortion," adding that although the "[l]ife cause isn't the issue that earned [Anthony] her stripes in American history books, historians would be wrong to conclude that Anthony was agnostic on the issue of abortion." She continues that "as one becomes familiar with Anthony's compatriots and their thoughts on the issue, it is clear and consistent that these early women leaders did not believe abortion was a good thing for women." According to Dannenfelser, "Over time, 'feminism' became the label adopted by activists preaching that women's rights and abortion rights were somehow one and the same." Recently, there has been "a shift back to the traditional roots of Susan B. Anthony feminism to give life even in the most difficult and unexpected circumstances," Dannenfelser contends (Dannenfelser, "On Faith," Washington Post, 5/20).
~ "How Webcams Expand Abortion Access in Rural Iowa," Roxann MtJoy, Change's "Women's Rights": As part of an "innovative, high-tech solution to the lack of abortion access in rural Iowa," Planned Parenthood of the Heartland has "set up a system wherein doctors videoconference with their patients and abortion drugs can be prescribed via remote control," MtJoy writes. The technology "could impact thousands of women's lives," she continues, noting that 86% of U.S. counties do not have an abortion provider. "Of course, more women having access to safe abortions early in their pregnancies has its critics," including Operation Rescue President Troy Newman, who "thinks that it puts the patient's life at risk, though he offers nothing in the way of proof to support that claim," MtJoy continues. "Telemedicine has been used for years in a variety of medical fields," she writes, adding, "Yet, only when this technology is expanded to women's reproductive health are people crying foul." MtJoy "applaud[s] Planned Parenthood's efforts to make sure that all women, not just those in urban areas, have access to safe abortion care" (MtJoy, "Women's Rights," Change, 5/20).
~ "Is Sarah Palin Really a Feminist?" Tracy Clark-Flory, Salon's "Broadsheet": Clark-Flory notes that when former Alaska Gov. and 2008 Republican vice presidential candidate Sarah Palin referenced feminism during a recent speech at a SBAL fundraiser, "she was talking about 'the pioneering spirit of our foremothers, who went in wagon trains across the wilderness, and they settled in homesteads,'" Clark-Flory writes, "When Palin talks about gender equality, she's really talking about the equal importance of men's and women's traditional gender roles. The emphasis isn't on personal freedoms, but how mothers are just as important as fathers." Clark-Flory continues that Palin "sees pro-choice activism as denying women's capacity to have it all and fancies herself a supporter of women's rights -- to a family and a career -- by shunning abortion." However, the "label ['feminism'] doesn't belong to me any more than it does to Palin," Clark-Flory writes, adding, "Besides, I'm less concerned with labels than I am with actual arguments about what is truly best and just for all women." She concludes, "I say, let Palin hide behind her favorite new buzzword; we all know she's better with catch phrases than actual policy" (Clark-Flory, "Broadsheet," Salon, 5/20).
~ "Elena Kagan: Aggressive and Abrasive?" Christine Mathias, Salon's "Broadsheet": "It always comes back to choice of words when discussing powerful women," a "point [that] was driven home" by a recent Associated Press article on Supreme Court nominee Elena Kagan's management style during her time as dean of Harvard Law School, Mathias writes. She continues, "Women tend to use different descriptors than men when evaluating other women, so we might have been spared the series of painfully stereotypical comments unleashed by law professor Detlev Vagts," who describe Kagan as "aggressive," "abrasive" and "dismissive." Mathias adds, "The reason Vagts' comments stick in my craw so profoundly ... is the simple fact that he went on record with a legitimate news source to slag off his former boss in terms that befit a pissy child who was sent to bed without dessert" (Mathias, "Broadsheet," Salon, 5/20).
~ "Ten Better Things To Do With $30,000 Than Hire Bristol Palin To Speak," Patrick Malone, RH Reality Check: According to news reports this week, Bristol Palin, the daughter of Sarah Palin, "is now available for speaking events such as 'conferences, fundraisers, special events and holidays, as well as women's, youth, abstinence and pro-life programs' for the low, low price of $30,000 a pop," Malone writes. "Bristol is famous, of course, for becoming pregnant and having a baby as a teenager," Malone notes. Malone questions whether $30,000 is a worthwhile fee to hire Palin as a speaker, determining that the "answer is an unqualified and unmitigated 'no.'" He adds, "There is no reason to think that listening to Bristol Palin's story is going to inform, educate, enrich or stimulate" audiences in any way. Malone proposes 10 alternate ways to spend $30,000 -- including investing in a local community, donating to a state organization or paying for 30 teen mothers to travel to Congress to speak with lawmakers about their experiences (Malone, RH Reality Check, 5/20).
~ "Abstinence-Only Congressman Can't Keep it in His Pants," Mike Larsen, Huffington Post blogs: "[O]ne sure tip-off that a married congressman is getting some on the side is that he can't stop talking about family values," comedian, writer and former congressional staffer Larsen writes. He notes that Rep. Mark Souder (R-Ind.) -- "Congress' leading advocate of abstinence-only sex education" -- resigned recently after admitting an extramarital affair with an aide. "Souder made a name for himself as an evangelical Christian who embraces family values, such as fighting AIDS prevention programs that include information on safe sex," Larsen says, adding that he considers it "wonderfully ironic that a man who preached abstinence-only for AIDS prevention was brought down by his inability to abstain from his aide." Souder also appeared in a video with the staffer to promote abstinence-only education programs, despite the fact that their "effectiveness was unproven, at best," Larsen writes. He asks, "[D]o we all get it now that the moralists are not to be trusted?" (Larsen, Huffington Post, 5/21).
~ "Male Birth Control: Not Sex Standing Up," Alex DiBranco, Change's "Women's Rights": Change editor DiBranco highlights a new public service announcement from the National Campaign To Prevent Teen and Unplanned Pregnancy that aims to dismantle the myth that having sex standing up is an effective form of contraception. According to DiBranco, one in five men ages 18 through 29 believe having sex standing up will prevent pregnancy. She writes, "I guess this is what happens with abstinence-only education and a refusal to provide youth with proper comprehensive sex education," adding that "if this is what men think of as good birth control, no wonder we have such high rates of youth pregnancy." DiBranco says there is "some good news" about men and contraception, as "progress is being made on research to use ultrasound waves or testosterone gels to temporarily stop the production of pregnancy-producing sperm." She concludes, "Until then, if you're having sex -- standing up, lying down, or any other position out of the Kama Sutra -- the best form of male birth control is a condom. Suit up" (DiBranco, "Women's Rights," Change, 5/18).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.
© 2010 National Partnership for Women & Families. All rights reserved.
четверг, 15 декабря 2011 г.
Fertility & IVF Experts: Don't Bet All On Late Motherhood
for becoming the world's oldest mother, fertility experts are encouraged by
recent research showing that older moms are as capable of good parenting as
younger women -- but are increasingly concerned about women naively
postponing pregnancy till later in life.
"Thanks to technology and the improved health of today's 40- and
50-year-olds, it is more possible than ever to facilitate their desires for
pregnancy," said Dr. Ramie Hinckley of Reproductive Science Center of the
Bay Area, in vitro fertilization (IVF) specialist. "But no one should take
that as reason enough to put off giving birth past the normal reproductive
years."
Women's focus on career development -- combined with advances in
fertility medicine -- has produced higher-than-ever increases in the birth
rates for older mothers. The birth rate for American women aged 40-44 years
has more than doubled in the last 25 years, according to the Centers for
Disease Control, a greater increase than in any other age group.
But there is a down side, Dr. Hinckley said: "The media spotlight on
women giving birth in their 50s and 60s, especially among celebrities, can
create the fallacy that there is no ticking clock and ultimately create
heartache for women who wait too long to try to conceive."
In December, a 67-year-old Spanish woman became the world's oldest
mother, after having undergone IVF in the United States. Meanwhile, results
of a study announced in October by University of Southern California
researchers showed that women in their 50s and 60s are just as capable of
being good parents as women in their 30s and 40s. The research was based on
the mental and physical health of 150 women, a third of whom had become
parents in their 50s after receiving IVF with donor eggs.
In accordance with American Society for Reproductive Medicine
guidelines, the age limit for women who seek fertility treatment at RSC is
currently 51 (52 for a gestational carrier). Fertility decline begins at
age 28. Although women older than 35 run greater risk of complications
during pregnancy and delivery, the study clearly states that once their
children are born, older women are just as good at raising them.
The study also reinforces the use of assisted reproductive technology
such as egg freezing for those who wish to begin parenting later in life.
In just the last year, scientists at RSC have begun offering such "egg
banking" to qualified patients for fertility preservation.
About Reproductive Science Center
Established in 1983, the Reproductive Science Center of the San
Francisco Bay Area was one of the earliest IVF facilities in the United
States, begun just two years after the nation's first successful IVF
treatment. RSC was among the first in the United States to report a
successful pregnancy from an egg donated from one woman to another for
gestation and delivery, and was also responsible for the nation's second
successful transfer of a previously frozen embryo into a mother's uterus.
Today, RSC boasts a staff of six infertility physicians with a collective
85 years' experience with offices in San Ramon, Orinda, San Jose, Fremont,
Modesto, Brentwood, and Monterey. RSC is a member of IntegraMed, a national
network of 30 fertility centers in 95 locations across the United States.
One of every five IVF procedures in the United States is performed in an
IntegraMed practice. For more information, visit rscbayarea.
Reproductive Science Center of the Bay Area
rscbayarea
четверг, 8 декабря 2011 г.
Horseback Riding: Impact On Sexual Dysfunction And Lower Urinary Tract Symptoms In Men And Women
UroToday - Bicycle riding has been reported to be related to male sexual dysfunction. Dr. Shaheen Alanee and colleagues from Minneapolis hypothesized that similar force impacts might be seen in equestrian sports. They sought to evaluate the effect of horseback riding on urinary symptoms and sexual dysfunction in men and women. Swimmers were used as a control group.
Twelve hundred and fifty surveys were sent to equestrian clubs and 750 surveys were sent to swim clubs and over 300 questionnaires were distributed by hand. Responders (15% by direct mail and 31% from manual distribution) filled out the American Urologic Association Symptom Index, the abridged International Inventory of Erectile Dysfunction, and a sexual questionnaire developed by the authors for women.
Horseback riding was not significantly associated with sexual dysfunction in males. Age and the years of bicycling were significantly associated with sexual function in males. Age was another factor affecting the incidence of sexual function in males. In women, horseback riding was not associated with urinary symptoms, though greater age increased the risk and marriage seemed to decrease the risk of LUTS. No aspect of female sexual dysfunction was associated with horseback riding.
Based on this study, one can surmise that horseback riding need not be contraindicated in patients with BPS nor is it likely to be a risk factor based on current available information.
Alanee S, Heiner J, Liu N, Monga M
Urology. 2008 Oct 22. Epub ahead of print.
doi:10.1016/j.urology.2008.07.058
UroToday Contributing Editor Philip M. Hanno, MD, MPH
UroToday - the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.
To access the latest urology news releases from UroToday, go to:
www.urotoday
Copyright © 2008 - UroToday
четверг, 1 декабря 2011 г.
How Cow Warts, Clergy Sex Surveys Moved Along Cancer Vaccine
At the University of Rochester Medical Center, the initial research more than 20 years ago included visits to veterinarians and meat-packaging plants in Upstate New York to collect scrapings from "prized" cow warts, and surveys of people unlikely to be infected with a sexually transmitted disease - priests and nuns who had taken a vow of celibacy.
The work with the cows, the warts, the nuns and the priests illustrates how basic research can pay off in big and unexpected ways. The research by a trio of University of Rochester virologists - William Bonnez, M.D., Richard Reichman, M.D., and Robert Rose, Ph.D. - helped bring about the cervical cancer vaccine, poised to prevent cancer in thousands of people. The University is one of several institutions in whose laboratories work on an HPV vaccine blossomed. Rochester's contribution is recognized with a patent issued by the European Patent Office and by royalty agreements with the companies commercializing the vaccine.
The research project in Rochester began with an effort to develop a blood test to detect infection by a class of viruses known as human papillomaviruses or HPV, which cause warts as well as cervical cancer. To do so, the researchers needed large amounts of papillomavirus - and while there are plenty of warts in this world, finding people willing to collect and analyze them is quite a different story. So as a starting point the team turned to bovine papillomavirus or BPV in cows, and Bonnez found himself visiting veterinarians and others with access to cows with warts, seeking samples.
In the world of warts, cows offer a particularly plentiful lode of papillomavirus, Bonnez said, because they are particularly rich in viral particles. Many other warts, such as genital warts in humans, don't provide enough viral particles.
The trips to the countryside were successful - Bonnez ultimately collected enough cow warts and still keeps a stash in his laboratory freezer - and the research moved ahead. The next step involved assessing the test, and doctors needed a large control group of adults who were unlikely to have been infected with genital HPV. So the group turned to area nuns and priests who allowed themselves to be polled about their sex lives and who donated blood samples. (Clergy have been crucial to other Rochester research projects as well; several have volunteered to test HIV vaccines, for instance.)
A few years into the project, the scientists faced difficulty improving their blood test using BPV, so they scrapped the cow warts and learned to grow human HPV in the laboratory. Soon after that they discovered that the three-dimensional outer shell of the virus was crucial to creating an immune response that could prevent infection.
The scientists then turned their attention to determining how to make a safe, non-infectious form of the viral coating, and that led them to figure out how to make harmless virus-like particles (VLPs) to trigger the same immune response. They did this by putting an HPV gene into insect cells using a virus called baculovirus, which infects insects; the HPV gene then produces VLPs that mimic the shape of real HPV particles. The team made VLPs of the specific cancer-causing strains of HPV and showed that they protected against the disease. VLPs are crucial to the vaccine approved today by the FDA, as well as another cervical cancer vaccine in development; both protect against multiple strains of the virus.
The new vaccine is given as a series of three shots administered a few months apart. Most doctors say the vaccine needs to be given before a person becomes sexually active to do the most good.
HPV causes about 9,700 new cases of cervical cancer in women in the United States annually, and about 3,900 women in the nation die of the disease every year. The toll is much worse in other parts of the world, where Pap smears to detect the disease in its earliest stages are not widely available. In some parts of the world, cervical cancer is the leading cause of death by cancer in women - doctors estimate that more than 230,000 women around the globe every year die from the disease.
In the United States, more than 15,000 people every day, or about 5.5 million people a year, get sexually transmitted HPV infections from their partners. About three out of every four sexually active people will get an HPV infection at some point during their lifetime; in some age groups, such as sexually active men and women under the age of 30, doctors estimate that 40 percent of people are currently infected.
Most people fight off the virus and never even know they were infected. Others have warts or abnormal cell growth known as dysplasias. In the most serious cases, it progresses to cervical cancer. Two types of HPV, type 16 and type 18, cause about 70 percent of cervical cancers, and those are the types that the new vaccine is designed to prevent.
While the new vaccine is certainly great news, there are still millions of people infected with the virus. That's why Reichman, Rose, Bonnez and many other researchers continue to do research on HPV. Bonnez, for instance, is part of a federally funded network of research centers that tests drugs against viruses. In the last 15 years he has evaluated more than two dozens drugs to treat HPV. Rose is exploring new methods to treat a person once he or she is infected.
The Rochester team, based in the Infectious Diseases Division of the Department of Medicine, makes up one of several laboratories whose work helped bring about such a vaccine. In addition to pharmaceutical giant Merck, which received approval from FDA to market its vaccine product, GlaxoSmithKline also has a product in development. Other institutions that have contributed include the National Institutes of Health, Georgetown University, and the University of Queensland in Australia.
Contact: Tom Rickey
University of Rochester Medical Center