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Fifteen years ago, Dr. Naomi Rance was at work when she experienced her first hot flash. Rance, a physician and researcher at the University of Arizona College of Medicine — Tucson, took note.

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As it turns out, her basic scientific research on estrogen’s involvement with hot flashes may lead to a promising treatment for them.

Hot flashes can range from mild to severe and occur a few times a week to several times an hour.

Rance, also a UA professor of pathology and neurology, originally became interested in menopause during her neuropathology fellowship at Johns Hopkins University.

“I started off with a very straightforward project,” she explains. “I was going to examine the hypothalamus in women’s brains before and after the menopause. I found that a group of neurons got bigger in the brains of postmenopausal women and that was what was shocking at the time. Usually, with aging, things don’t get bigger, they get smaller.”

Rance knew from previous research that the enlarged neurons were in the hypothalamic area known as the arcuate nucleus, named for its arc shape. The tiny area contains a microscopic collection of neurons, which contain the neuropeptide, neurokinin B, and control reproduction.

Rance later discovered that those same neurons also influence how estrogen alters body temperature.

“That was really a sign that the reproductive axis is integrated with thermoregulation,” she says. “The two systems are intimately integrated.”

So much so that Rance was able to show through laboratory experiments on rodents that stimulation of the receptor for neurokinin B, called neurokinin 3, causes changes in body temperature similar to a hot flash, and that destruction of neurokinin B neurons alters thermoregulation.

These experiments led to a hypothesis that hot flashes occur when estrogen levels are diminished, causing increased release of neurokinin B into the brain areas that control body temperature. Theoretically, an antagonist could block this biological reaction by binding to the neurokinin 3 receptor and preventing the actions of neurokinin B.

Rance presented these findings at the 2012 Second World Conference on Kisspeptin in Japan.

As it happened, Dr. Waljit Dhillo, an endocrinologist and professor at Imperial College, London, was in the audience along with a few of his colleagues.

“Dhillo said that he and his colleagues heard the talk, and they realized that neurokinin 3 antagonists could be used as a treatment for hot flushes,” Rance says. “He took the idea to the clinical arena very fast. The first thing he did was infuse women with neurokinin B, and found that it caused hot flashes.”

Recently, Dr. Julia Prague, along with Dhillo and colleagues, tested the neurokinin 3 receptor antagonist (MLE4901) in a phase 2, randomized, double-blind clinical trial with 68 women. They found that the drug significantly reduced the total weekly number of hot flashes by 73 percent and was well tolerated.

If successful, the drug could be used as an alternative to estrogen, a development especially important to women with estrogen-dependent breast cancer.

Meanwhile, Rance is continuing to study more of the basic mechanisms that regulate hot flashes.

“People think everything you do has to be translational, but I want to emphasize that it was basic research that has driven me all the way along,” she says. “This would not have happened without the National Institutes of Health budget for basic research. You just don’t know if something is going have a clinical application when you start.”

source :  https://www.sciencedaily.com/releases/2017/06/170628172151.htm

Effect on the chance of subsequent pregnancy quantified for first time

Date:July 3, 2017

Source:European Society of Human Reproduction and Embryology

For the first time, a large population study has quantified the chance of pregnancy after treatment for cancer diagnosed in girls and women aged 39 or under. This landmark study, which linked all cancers diagnosed in Scotland between 1981 and 2012 to subsequent pregnancy, found that the cancer survivors were 38% less likely to achieve a pregnancy than women in the general population. This detrimental effect on fertility was evident in almost all types of cancer diagnosed.

“This analysis provides the first robust, population-based evidence of the effect of cancer and its treatment on subsequent pregnancy across the full reproductive age range,” said presenter Professor Richard Anderson from the MRC Centre for Reproductive Health, Queen’s Medical Research Institute at the University of Edinburgh, UK.

“The major impact on pregnancy after some common cancers highlights the need for enhanced strategies to preserve fertility in girls and young women.”

Professor Anderson will present the results of the study today at the Annual Meeting of ESHRE in Geneva.

The need for better access to fertility preservation has become more pressing in recent years for two reasons: first, the improved rates of survival in young women and girls diagnosed with cancer; and second, improvements in the techniques of freezing eggs and ovarian tissue to restore fertility.

This latest study, which cross-linked 23,201 female cancer survivors from the Scottish Cancer Registry with hospital discharge records, revealed 6627 pregnancies among the cancer survivors when nearly 11,000 would have been expected in a comparable matched control group from the general population.

For women who had not been pregnant before their cancer diagnosis, 20.6% of the cancer survivors achieved a first pregnancy after diagnosis (2114 first pregnancies in 10,271 women), compared with 38.7% in the control group. Thus, women with cancer were about half as likely to achieve a first pregnancy after diagnosis as were controls.

The analysis also found that the chance of pregnancy was reduced in all age groups, with substantial variations between different cancer diagnoses — notably, reduced pregnancy rates in women with cervical cancer, breast cancer and leukemia. However, those cancers diagnosed later within the study period (2005-2012) were associated with higher rates of pregnancy than those diagnosed earlier (1981-1988), suggesting that for some cancer treatments the impact on fertility has reduced.

The diagnosis and treatment of female cancers are known to affect fertility for several reasons: some chemotherapy regimens can cause damage to the ovary, and this can occur at any age; radiotherapy can also compromise female fertility through effects on the ovary, uterus and potentially those brain centres which control the reproductive axis.

However, Professor Anderson stressed that the results of the study related only to subsequent pregnancy itself, and not to the incidence of infertility caused by cancer treatment. “Some women may have chosen not to have a pregnancy,” he explained. “Thus, while these results do show an expected reduction in the chance of pregnancy after chemotherapy and radiotherapy, having a pregnancy after cancer does involve a range of complex issues that we cannot address in this study.”

With rates of cancer survival increasing in both young male and females, fertility preservation ahead of treatment has an increasing role to play in fertility clinics. However, Professor Anderson described such services in all parts of the world, including the USA and Europe, as “very variable.” “Oocyte and embryo freezing are regarded as established,” he said, “but ovarian tissue cryopreservation is considered experimental, although it is the only option for prepubertal girls.”

He added that the results of this study would allow clinicians to advise girls and women more accurately about their future chance of pregnancy. “They emphasise the need to consider the possible effects on fertility in girls and women with a new cancer diagnosis. The implications of the diagnosis and planned treatment and, where appropriate, options for fertility preservation should be discussed with the patient and her family. Even for patients considered at low risk of infertility as a result of treatment, a fertility discussion is recommended before treatment begins.”

Over 22 million women in the United States have been raped in their lifetime. (National Intimate Partner and Sexual Violence Survey 2010) #keepwomenhealthy #rape #abuse #women

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https://www.facebook.com/keepwomenhealthy/Blue Band Aid Medical Logo(2)

Ask an American woman in her 20s or 30s to define an IUD, and she might tell you about a roadside bomb instead of one of the oldest forms of FDA-approved contraception.

In the late 1970s, this form of reversible contraception was used by nearly 10 percent of U.S. women on birth control. But today, IUDs are used by less than 2 percent of this U.S. market despite being wildly popular overseas, particularly in developing nations.

The intrauterine device is a small—roughly 1 inch—plastic “T” inserted into the uterus that hampers the interaction and implantation of the sperm and egg. It has to be placed by a trained gynecologist, midwife, or nurse practitioner, but once in, it’s a practically foolproof method of birth control—99 percent effective—that can last up to 10 years. * While daily or monthly forms of birth control can cost up to $60 a month, an IUD is a one-time cost between $300 and $500—though it’s often covered by insurance. There’s nothing to remember to take (unlike the pill), put in (unlike the NuvaRing), or take off (unlike the patch). And while efficacy studies suggest that the pill, patch, or ring are 99 percent effective in a clinical setting, real-life compliancy—like forgetting to take the pill at the same time every day—reduces its success rate. All that is a nonissue for the IUD: Once in, it requires no maintenance for the length of the device. Perhaps best of all, it can be hormone-free, which is better for the environment and ideal for women prone to some of the negative effects of hormonal birth control, like weight gain, mood swings, acne, or high blood pressure.

They seem like the perfect form of contraception: simple to use, long-lasting, reversible, hormone-free, economical. So why are American women so late to this party? Perhaps the better question is: Why did they leave the party to begin with?

That was my question when, after eight years and more than a dozen different incarnations of oral contraceptives, I decided to go back to the drawing board. I had never been good at taking the pill every day, and while my doctor suggested the patch and the ring, both were still under patent, making them more expensive than my monthly grocery bill. I needed something cheap, un-mess-up-able, and, ideally, hormone-free. So I did what any modern girl would do: I Googled. And thus began my research into the IUD and its mercurial history in the U.S. market.

“The major reason why women in the United States aren’t using IUDs and doctors aren’t recommending them is due to the erroneous belief that they’re highly dangerous,” says Dr. Katharine O’Connell, a gynecologist at Columbia University who specializes in contraception. Many in my mother’s generation remember the IUD’s heyday, when the contraceptive was linked to the horrors of pelvic infection, hysterectomy, and possible death. That negative rap stems from a particular device known as the Dalkon Shield. Heavily marketed in the early 1970s, it was the most popular model in the United States until a number of deaths from septic miscarriages caused the manufacturer to halt sales.

A study at the time linked the shield and other IUDs to pelvic inflammatory disease, and lawsuits were promptly filed. With the possibility of litigation of all IUDs on the table—and the terrible press at the time—the U.S. pharmaceutical industry abandoned the research and manufacture of IUDs in the mid-1980s, claiming the devices were no longer profitable. The result was a huge generational gap in knowledge about the IUD. Today, for women over 40, the thought of an IUD strikes terror into nether-regions; for those under 30, it’s a meaningless acronym, attached to a vaguely cautionary tale mentioned as an afterthought in high-school sex-ed class.

But while the United States panicked, other countries never took IUDs off the market, and they became only more popular. In France, they are used by 23 percent of women on birth control, and in China, 45 percent of married women use an IUD.

Eventually, stateside science caught up to the IUD witch hunt. In the early 1990s, a study inthe Journal of Clinical Epidemiologychallenged the validity of the research that had condemned the IUD. It’s now generally understood that the problems in the 1970s were due largely to the Dalkon Shield’s faulty design, which made users more susceptible to infection, as well as a lack of testing for sexually transmitted diseases before insertion, says O’Connell.

Now the IUD is being remarketed in the States, where there are two major IUDs: Mirena (FDA-approved since 2001) and ParaGard (one of the only IUDs that remained continuously available, though scarcely promoted, since the early 1980s). Mirena is made of a soft plastic and releases a steady amount of hormone directly in the uterus, comparable to taking a birth control pill or three a week. ParaGard is also made of plastic, but instead of releasing hormones, copper wire is wrapped around the device; the wire interferes with sperm transport and fertilization. Both IUDs also create a mild inflammation, which prevents sperm from fertilizing eggs and blocks fertilized eggs from implanting on the uterus.

Mirena’s advertising pitches the device to mothers, which might be why, despite being pretty well-informed about birth control, the IUD was still new to me when I discovered it this year. The same was true for my friend Daniela, who stuck with the pill—even though it made her “unbearably emotional”—until she graduated college and her pill bills, which had been partially subsidized by her student health care plan, rose from $7 to $50 monthly. On a trip to Brazil, she learned about the IUD from local friends, and had the ParaGard inserted on her return to the States.

Patients aren’t the only ones who don’t know much about IUDs. A recent study published in the medical journal Contraception surveyed premedical students in the United States and Canada. It found that 96 percent of education on contraception focused on oral contraceptive pills; 76 percent of those surveyed were taught about IUDs. Many medical schools limit their classes on contraception to one lecture, says O’Connell, leaving insertion and removal of an IUD to be taught during rotation, if it’s taught at all.

This lack of training can leave many doctors feeling uncomfortable recommending the once-controversial devices to their patients, which might explain why only 58 percent of family-planning clinics in the United States offer the IUD. Certain doctors who do know how to insert and remove an IUD still refuse to recommend it to childless patients because of the device’s checkered history. I experienced this with the first two doctors I visited. Though recent scholarship shows that the risk of an IUD creating infertility is almost nonexistent, some doctors prefer to insert them in patients already known to be fertile—so the IUD (and the doctor) can’t be blamed for any future infertility.

It took me four months, three doctors, and a $40 co-pay to get my IUD, and it was worth every minute, visit, and nickel. Despite how thrilled I am with my new birth control, I still have a hard time convincing women how great it is. Daniela has the same problem and thinks that many women in the United States are dissuaded from the IUD because of the high upfront cost and the invasiveness of the procedure. Though the insertion hurt and her periods were heavier and more crampy for a few months afterward, she describes it as a “very small price to pay for the peace of mind, money, and time” she saves with the IUD.

IUDs are still a contraception aberration in the United States, but if there’s one thing that creates change in America, it’s consumer demand. With Mirena advertising on television, the downturn in the economy forcing people to economize, and more women concerned about the long-term effects hormones have on their bodies, perhaps the IUD’s stigma will finally become a thing of the past.

Correction, Aug. 6, 2009: This article originally and incorrectly stated that an IUD has to be placed by a gynecologist. It can be placed by a trained gynecologist, midwife, or nurse practitioner. (Return  to the corrected sentence.)

 

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Source:http://www.slate.com/articles/health_and_science/medical_examiner/2009/07/the_best_birth_control.html

Looking for an IUD?

The other day I was talking to a friend of mine who runs a clinic in the Midwest.  As always, I asked how things are going and he said “the number of women asking for the IUD is going through the roof.”  A few days later I saw a report confirming that women are looking for the IUD in record numbers.

Many say that the numbers are going up because women are concerned that when/if the Congress repeals Obamacare, then their birth control will not be covered by insurance.  Worse, they are concerned that Congress and Mr. Trump will outlaw birth control altogether – an unlikely event but enough to make some women nervous.  So, they are looking for the IUD to cover themselves as it is a form of birth control that can last for many years.

In timely fashion, the website www.IUD.com has reappeared on the scene.  This site is the only website that is a directory of doctor’s offices that offer the IUD.  It’s a simple website – you just go in and enter your zip code and up come the offices that are near you that offer the device.  The manager of the site is now devoting a lot of time to increasing its visibility, using all kinds of Search Engine Optimization techniques that have already had great results.  This is great news for women out there who don’t have a regular Ob-Gyn and are looking for the IUD.

Check it out.  Spread the word!

As of yesterday, because of the Affordable Health Care Act, every new health insurance policy must include FDA-approved contraceptives without any co-pays or deductibles.

In addition, all new insurance policies must cover women’s preventive care without co-pays or deductibles, including:

An annual well woman preventive care visit with your doctor.
Screening for:
Gestational diabetes
STIs
HIV/AIDS
HPV
Screening and counseling for domestic violence
Breastfeeding support, supplies, and counseling

Remember these advanced when you vote in November!