Archive for November, 2018

On October 5, 2018 the FDA approved the use of the 9-valent HPV vaccine in women and men aged 27 through 45 years1. Although this approval opens the possibility for expanded protection against HPV disease in women and men, further review of the available data, including cost-effectiveness, is needed. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) is reviewing the available data, and ACOG is working closely with the CDC to determine if changes in clinical guidance and recommendations are appropriate.

In the meantime, members are advised that Committee Opinion 704, Human Papillomavirus Vaccination, remains in effect2. As outlined in the guidance, obstetrician-gynecologists and other health care providers are encouraged to welcome conversations with women older than 26 years who are interested in receiving the HPV vaccine2. In patients aged 27 to 45 years, their decision to be vaccinated should be individually based using shared decision making and clinical judgment based on those patients’ circumstances, preferences, and concerns. The vaccine is safe and is effective in preventing new infections with HPV in women aged 27-45 years3.

This Practice Advisory was developed by the American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group with Linda O’Neal Eckert, MD, and Kevin Ault, MD.


  1. Food and Drug Administration. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old [press release]. Silver Spring (MD): FDA; 2018. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm. Retrieved October 18, 2018.
  2. Human Papillomavirus Vaccination. Committee Opinion No. 704. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e173-8. Available at: https://journals.lww.com/greenjournal/fulltext/2017/06000/Committee_Opinion_No__704___Human_Papillomavirus.52.aspx. Retrieved October 18, 2018.
  3. Luna J, Plata M, Gonzalez M, Correa A, Maldonado I, Nossa C, et al. Long-term follow-up observation of the safety, immunogenicity, and effectiveness of Gardasil in adult women. PLoS One 2013;8:e83431. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083431. Retrieved October 18, 2018.

    Source: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-FDA-Approval-of-9-valent-HPV-Vaccine-for-Use-in-Women-and-Men-Age-27-to-45

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Premature birth, low birth weight and seizures are among the problems reported.

Babies of older fathers are at greater risk of premature birth, low birth weight and other neonatal problems, a new study reports.

Mothers may also be affected: Those with older partners were more likely to have gestational diabetes, probably because older paternity is associated with changes in the placenta.

The study, published in BMJ, used data gathered by the Centers for Disease Control and Prevention on more than 40 million live births between 2007 and 2016.

Compared with babies of fathers 25 to 34, those whose fathers were 45 to 54 had a 15 percent increased risk for premature birth, and an 18 percent increased risk for seizure. They were 14 percent more likely to be admitted to a neonatal intensive care unit, and 9 percent more likely to need antibiotics. Babies of fathers older than 55, although there were few in the study, were at even greater risk. The study controlled for maternal age and other factors.

The lead author, Dr. Michael L. Eisenberg, director of male reproductive medicine and surgery at Stanford, said that for the individual couple the effect is modest, and he would never tell a man he is too old to be a father.

Still, he said, “Men should no longer think their runway is unlimited. Now we know there are some risks that you should take into account when starting a family.”

A version of this article appears in print on , on Page D5 of the New York edition with the headline: Family: Woes for Babies of Older Fathers.
Source: https://www.nytimes.com/2018/11/07/well/family/older-fathers-more-likely-to-have-babies-with-health-problems.html

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We spend a lot of time and energy trying to pinpoint the toxic people in our lives, but how often do we look inwards during our search? The truth is, there are times when even the best of us exhibit toxic behaviors or patterns without realizing it.

Of course, there’s a difference between being toxic and acting toxic. The first is when it’s ingrained into our personality, and we activelyenjoy hurting others; the second corresponds to aspects of our behaviors. Sometimes without knowing it, these toxic behaviors can take us over. Think about it as a muscle that you’re unknowingly pumping metaphorical steroids and iron, and soon it looks like The Hulk.

The good new is, with a little self-reflection and asking for feedback from others, we can become aware of these habits and eradicate them so we can become better people. Here are a few of the most common behaviors that even good people can develop that might actually be hurting those around them—as well as how to change course for the better.

1. You’re always sarcastic.

The clever retort that’s accompanied by raucous laughter on a comedy—we’ve come to think that’s a good thing, and perhaps even aspire towards that. It’s gotten to the point that people who don’t know how to be “clever” believe they’re terrible, dull conversationalists. But the truth is, what’s funny on The Big Bang Theory isn’t necessarily funny in real life when you’re on the receiving end. It hurts.

It’s easy for this to be your default mode if you work in an industry that’s all about acting tough and masking emotions or if you grew up in a family where 99% of your conversations are sarcastic quips, “I told you so’s”, or remarks designed to one-up another person. Whilst I never advocate Pollyanna-esque naïveté, people who only look for the negative can be incredibly draining to be around in the long run; the teasing, even in good jest, will start to feel like carefully cloaked animosity.

The fix: We all know how terrible it feels to be the target of such remarks, especially when we’re in a vulnerable time. So before you open your mouth, ask yourself, “How would I feel if I were sharing something about my life or thoughts, and someone gave me such a response?”

2. You deal with conflict in a roundabout way.

Conflict is uncomfortable. We don’t like to deal with tricky situations directly, and so we devise ways of getting around them. But if you’re always beating around the bush and then secreting hostility via sullen behavior, stubbornness, and subtle insults, it just amplifies the problem and turns a single conflict into a larger issue. No matter how logical our arguments or how upset we might be over what’s happening, passive-aggressiveness is painful and not helpful to anyone. It’s a cancer in relationships.

The fix: Know that difficult conversations are scarier in our heads than in reality—we simply haven’t had enough practice. The more you have these conversations, the easier they become. The rule-of-thumb you can subscribe to is to ask yourself, “How can I say this in a way that is kind and useful?”

3. Everything is a competition.

Telling someone how you went through a similar experience as they did is different from trying to show how you’ve had it worse. The first is where you show you resonate with the other person and use that empathy to connect. The second is a competition. I get that we’ve been conditioned to have some sort of seemingly-objective metric of what’s worse—we prioritize physical health ailments over mental health difficulties, and for anyone who appears to be living comfortably, we dismiss it with the label “first world problems” over someone who is in abject conditions. Sometimes we’re filled with indignation if we’ve been through “worse” and think “How dare they?” Or sometimes, we genuinely believe someone is being weak and should just “suck it up,” because we have done so ourselves.

Importantly, we need to be aware of these biases and to realize that pain isn’t a competition. Regardless of a person’s diagnosable condition or lifestyle, pain is pain. When we try to convince them their situation isn’t so bad, we are effectively invalidating their experiences and alienating them.

The fix: Be aware of why you feel the need to “compete”—is it because this is the only way you’ll feel validated for or feel some respite from your experiences? Sometimes, honesty is the best gift we can give ourselves, no matter how scary it is. This way, we can truly have empathy for ourselves and others.

If you find it hard to express compassion for someone else, perhaps ask yourself, “What would I want someone to say to me in my position?”

4. You turn everything into a joke.

We’ve all met that person who ends every line with “haha” and has to make a joke out of everything—even the most serious and saddest stuff. Maybe it’s because we don’t know how to deal with the situation, or we feel uncomfortable as it rips open old emotional wounds. So we try to escape via lightheartedness.

The fix: It’s okay. You don’t need to have the answer to everything right now. Simply say, “I feel a little uncomfortable and uncertain because I’m not used to this.” This is a lot more respectful than laughing and can help your loved one and you deepen your relationship as you navigate the complications of being human.

5. You want to fix everyone and everything.

Some of us are innately rescuers and fixers—maybe you’ve been trained to preempt and solve problems, or we unconsciously get drawn to similar relationships to fix a dynamic we were helpless in when we were younger. Or maybe you simply love to provide solutions. But this is a form of emotional labor, and as the work piles up, so do our distress and resentments. Put simply, other people aren’t our projects, and just because we can solve a problem doesn’t mean we should—the responsibility is squarely in the hands of the issue-holder, who may not even see it as a problem.

The fix: Here’s the deal. Sometimes people aren’t asking for solutions or even for a listening ear, but we unwittingly create trauma from nonexistent wounds by probing. What we can do instead is ask, “Do you want to talk about it?” If they say no, offer to be here if they change their minds. And if a person did not ask for advice, simply say, “I have a suggestion. Would you like to hear it?”

Additionally, recognize that you don’t need to fix everyone. Learn to accept people’s flaws, help them when asked, and if necessary, withdraw from those relationships where the person’s behaviors are seriously impacting you in a negative way. There’s no need for you to shoulder every single person’s problems and accompany them them all on their development journeys.

6. You secretly crave disaster because of the care you receive from it.

When we want to make a change, there are usually two sides of us in conflict. One side desires transformation, but the other doesn’t—because it has something to gain from the status quo. Much as we hate to admit it, a part of us may enjoy the attention from the drama and the subsequent pity parties we throw. Tough times happen, and we get stuck in a Groundhog Day rut.

A sign that we love the attention from pity parties is that we ask for solutions only to shoot them down. It’s a way of opening a conversation with someone else, bathing in their attention and care, and convincing ourselves we’re seeking help—but things never shift. While this might feel good for ourselves, it puts a lot of strain on our friends who need to continue picking up after us. We should of course feel free to lean on our network when we need help, but constantly injecting negativity into their lives just because we enjoy feeling the extent of their love is not fair to them.

The fix: If you feel a part of your life has become a consistently deteriorating train wreck, where the majority of your interactions are centered around getting this attention, it’s time to get it together. Commit to stop managing the problem and its symptoms and to instead start actually mastering the situation by mastering yourself. Think about a time when things were good, when you were in control, and when you liked who you were—your integrity and your energy. Tap into how that feels, and use that energy to propel your momentum and strategy towards finding that person again.

7. You think pointing out someone’s flaws will help them to change.

One of the most mortifying situations is when someone well-intentioned gathers others to shame you for a flaw, thinking this will whip you into action. We hear of such stories in families, where the flaw may be a mental health difficulty, weight gain, or bad skin. If you do this, know that it’s hurtful and alienating. Most of us are aware when we’re a shadow of our old selves, and if it is sliding in the wrong direction, we are busy trying to adjust or even mourn the loss of our old selves. Adding salt to the wound only triggers more shame and anxiety.

The fix: What you could say instead would be something like, “I’ve noticed this change in you, and I’m here for you if you ever want to talk.” Then leave the ball in their court.

8. You tell everyone to “just change their mindset.”

Someone told my friend Karla to “just be more proactive” when her professor had forgotten the deadline for her scholarship application, even though Karla had repeatedly reminded the professor for months. Karla was frantic and sad, and then furious with said friend. We often tell each other to just “cheer up,” “stop thinking that,” or “be logical’’—effectively applying cognitive photoshop on our “negative” emotions because these feelings are uncomfortable or socially unpalatable. But it is irrational to put a rational filter over everything.

The fix: The only way to master your emotions and difficult situations is to feel them. We must wholly acknowledge their part in our lives as signals and sources of wisdom, rather than to “just suck it up.” Unfortunate situations happen, and they don’t just get reset by the push of a mental button or a mindset transplanted into our heads. Instead of telling someone to simply change the way they’re thinking, just sit down with them and be a source of emotional comfort. Let them earnestly convey their emotions out loud to you without judgment. Sometimes this is all that’s needed for them to regain some semblance of emotional equilibrium so they can set out to tackle their problems.

9. You push your truth on others.

When we discover a solution, especially after feeling stuck for a long time, we want to shout it from the mountaintops. Whether it’s the secret to weight loss or finding spiritual salvation, we hope our loved ones will reap those benefits. And then there’s also another deeper subconscious drive that spiritual author Paulo Coelho writes about: We believe that an extra person subscribing to our truth makes it more valid.

Especially if we’re watching our friends’ lives deteriorate or worried about the afterlives of our loved one, we feel compelled to proselytize. But this backfires in the end: forcing our truths down someone else’s throat feels just as uncomfortable and invasive as the metaphor suggests. Moreover, just because something’s worked for you doesn’t mean it’ll work for someone else— solutions must be tailored to someone’s personality, experience, and situation for maximum success.

The fix: Remember that you’re their loved one, not their doctor or coach—your role isn’t to heal or save them. Simply be the best example for them—live your life the way you’d like someone else to have been your role model. When they are ready and start asking you, you can gently open the conversation.

As you start to detox, take pride in your growth.

We’re fundamentally copycats—we learn behaviors by modelling others, and sometimes we have the wrong role models. At other times, we run into a bad spate in life, get jaded, and see the world through a pessimistic lens. And so our toxic behaviors grow.

But having them in one chapter of our lives doesn’t mean we’re condemned to them forever. Instead, pinpointing the root and committing to personal growth can help us to find our old selves again or create a new self that is stronger, having integrated the wisdom of a difficult chapter in our lives.

Just because we’ve had some bad behaviors isn’t cause for shame. Rather, knowing that we’ve transcended them is actually cause for pride. Understanding our own toxic behavior develops empathy for why we do the things we do, hones our self-awareness, and helps us to become better people. Acknowledgment is the first step down that journey.

Source: https://www.mindbodygreen.com/articles/toxic-relationships-are-you-the-toxic-person-in-your-life

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The true culprit is actually a lot easier to fix.

It’s easy to say that neck and back pain is due to our slouching, hunching-over culture—too easy, says Eric Robertson, associate professor of clinical physical therapy at the University of Southern California. “Actually, if you hunch a while, that’s fine,” he says. “You can see people who have all sorts of funky postures and positions and they don’t experience pain. I think it’s convenient, when somebody does have pain, to point at their posture and say, ‘oh look, that’s why.’” Robertson also points out that there aren’t studies that show a link between pain and posture.

So why are you in such pain? It’s simple: you probably aren’t moving enough.

That’s because most pain comes from weak or stiff muscles. “Imagine if you woke up one day and you never turned your head. Well, at the end of the day you wouldn’t be very good at turning your head left or right. It would feel stiff and uncomfortable,” Robertson says. That’s what happens when we sit in a car or at a desk. It’s not the hunching or leaning forward itself—it’s that that’s all we’re doing.

The solution: Take your joints through their full range of motion every day. “All joints have a built-in range that they can go through, and they like to visit those ranges often,” he says. “Think of something like yoga that’s been around for eons. One of the things it does is take people through a very wide range of motions.”

Next time you’re starting to feel a twinge in your back or neck, give your head, shoulders, and back a good twist and turn, and you’ll stave off increasing pain. Better yet, start a regular stretching routine. The benefits of stretching are well-known; try these stretches for your lower backhipsgroin, and neck.

For pain that lingers, Robertson suggests seeing a physical therapist. “The care is individualized, so the intensity of the solution matches the intensity of the problem,” he says. “Working with providers that empower you as a partner—rather than give you passive interventions—is a really important factor in your success.”

Source: https://www.prevention.com/health/a24791641/bad-posture-back-pain/

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Researchers announced last month that thanks to a compulsory vaccine program, Australia is on track to eradicate cervical cancer. This is due to almost universal vaccination against human papillomavirus (HPV), a virus which is responsible for 90 percent of cervical cancers. The vaccine itself is a medical breakthrough and has only been available for use since 2006. In just 12 short years, cervical cancer is becoming a rarity in Australia and will eventually be eliminated, saving thousands of Australians’ lives.

According to the Center for Disease Control and Prevention (CDC), each year HPV causes cancer in 33,700 men and women in the U.S. alone. Cervical cancer is not the only cancer caused by HPV; 70 percent of oropharynx cancers, for example, which were previously attributed only to alcohol and tobacco use, are caused by HPV.

In Australia in 2016, 78.6 percent of females and 72.9 percent of males had completed the HPV vaccine series. By comparison, the CDC reports only 49 percent of U.S. adolescents completed the series in 2017. So why is Australia so much closer to eradicating cervical cancer than the United States?

Anti-vaxxers and conservative attitudes on sex

One reason is the anti-vaccine movement, pushed into the mainstream by the former physician and con man Andrew Wakefield, who falsified research results linking autism to vaccines and planned to make millions of dollars selling a scam diagnostic test, and promoted by the likes of Jenny McCarthy, the celebrity anti-vaxxer who wrongly claimed vaccines caused her son to develop autism. McCarthy was denounced by medical scientists, but that didn’t keep her from spreading her erroneous views to millions of Americans thanks to regular television appearances on “Oprah” and “The View.”

Conservative attitudes about sex, especially as it relates to young people, have also kept many American parents from having their children vaccinated against HPV.  But we need to talk about healthy sexual behaviors, as current movements like #MeToo have shown us. We need to discuss with our children ways they can remain healthy when choosing to participate in sexual activity.

This includes removing the stigma surrounding sex that causes unintended pregnancies and sexually-transmitted infections to spread because adolescents and young adults are too embarrassed to seek out contraception. Religious leaders have suggested the HPV vaccine encourages promiscuity, a claim that has been exhaustively disproven in medical research.Suggesting that protecting oneself against cancer is something to be ashamed of is an irresponsible and nefarious assertion.

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As a nurse, I am still amazed that we have the ability to prevent cancer from occurring and save tens of thousands of people’s lives, just through a vaccine. Yet so many of my patients still wrongly believe that vaccines are dangerous, despite my assurances. Anti-vaccine groups have gone so far as to spread false claims regarding the safety of the vaccine. The World Health Organization, the Food and Drug Administration and the CDC have all determined the HPV vaccine is safe. And the only common side effects that have been proven are ones that can occur with any vaccine, like dizziness and a reaction at the injection site.

It strikes me that my patients accept my recommendations with almost every other health decision they have to make. Why do my patients trust me when I prescribe antibiotics or anti-hypertensives, but not when I recommend the HPV vaccine? Why is Jenny McCarthy’s medical opinion valued over mine?

HPV vaccine should be required for school

For the Unites States to eradicate cervical cancer as Australia is on pace to do, we must include the HPV vaccine in the regular childhood vaccine schedule, and it should be required for enrollment in school.

The HPV vaccine is recommended in childhood for two reasons.  First, the vaccine works best at the beginning of adolescence when one’s body can make stronger antibodies that are required to prevent infection. Second, a child must be vaccinated before he or she has been exposed to the virus itself.

Making the choice to protect your children against cancer is the same as making them wear a seat belt or a helmet. You hope they will never need it, you hope they won’t be exposed to the virus, but if they are, they will be covered. No one should die because of myths and misconceptions. We have the power to stop this virus in its tracks and protect generations of Americans from an early death. Don’t American children deserve to have lives as long and healthy as those in Australia?

Source: https://eu.usatoday.com/story/opinion/2018/11/12/eradicate-cervical-cancer-require-hpv-vaccine-like-australia-column/1850760002/

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Older women who lose weight may have a lower risk of developing invasive breast cancer than those who maintain or gain weight, a large U.S. study suggests.

While obesity has long been linked to an increased risk of breast cancer, previous research has offered a mixed picture of the potential for weight loss to help reduce that risk. For the current study, researchers assessed weight and height to calculate body mass index (BMI) for more than 61,000 women twice, three years apart.

Then, researchers followed women for an average of 11.4 more years. During this time 3,061 women developed invasive breast cancer.

Compared with women who had stable weight during the initial three years of the study, women who lost at least 5 percent of their body weight during those first three years were 12 percent less likely to develop breast cancer over the next decade or so.

“Our results are consistent with a woman being able to lower their cancer risk, even if they remain overweight or obese after losing some weight, since almost none of the women in our current cohort analysis lost sufficient weight to achieve normal weight,” said lead study author Dr. Rowan Chlebowski of the City of Hope National Medical Center in Duarte, California.

“That should be an encouraging result for women since modest sustained weight loss can be achievable by many, while weight loss sufficient to return to a non-obese or overweight category is quite difficult,” Chlebowski said by email.

All of the women in the study had gone through menopause, when menstruation stops and production of the hormone estrogen drops. After menopause, women’s main source of estrogen is fat tissue; being overweight or obese can increase the risk of cancer because estrogen can help tumors grow.

“Women who are overweight or obese likely have an increased risk of postmenopausal breast cancer due to increased hormone levels associated with fat cells,” said Dr. Daniel Schauer of the University of Cincinnati College of Medicine, who wasn’t involved in the study.

“These hormones, especially estrogen, can promote the development of postmenopausal breast cancer,” Schauer told Reuters Health by email. “Losing weight decreases the levels of circulating hormones.”

Among the roughly 41,000 women in the study who had a stable weight during the initial three years, participants had an average BMI of 26.7, which is considered overweight.

The 12,000 women who gained weight during the study also started out with an average BMI of 26.7.

Women who lost weight started out heavier.

The roughly 3,300 women who lost weight unintentionally started out with a BMI of 27.9 and half of them lost more than 17 pounds. Women who lost weight intentionally began with an average BMI of 29.9, just shy of the cutoff BMI of 30 to be considered obese, and half of them lost more than 20 pounds.

Weight gain of 5 percent or more was not associated with an increased risk of breast cancer overall, the researchers report in the journal Cancer. But this amount of weight gain was associated with a 54 percent higher risk of developing “triple negative” breast cancer, an aggressive and difficult to treat type of cancer.

The study wasn’t a controlled experiment designed to prove whether or how weight changes over time might directly impact women’s risk of developing or dying from breast cancer.

Researchers only measured women’s weight twice, at the start of the study and again three years later, and any changes in weight women reported after that were not verified by medical exams.

For most people, weight creeps up over time, said Dr. Graham Colditz of the Washington University School of Medicine in St. Louis, who wasn’t involved in the study.

“So, the first realistic goals is to work to stop gaining. There are health benefits to that, even if you’re overweight,” Colditz said by email.

“After that, sensibly and slowly losing weight is a good goal,” Colditz added. “Five to 10 pounds is a great start that’s more easily maintained over time.”

SOURCE: bit.ly/2AreUsz Cancer, online October 8, 2018.

Source: https://www.reuters.com/article/us-health-breastcancer-weightloss/weight-loss-after-menopause-tied-to-lower-breast-cancer-risk-idUSKCN1NF01B

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Women fed soy-based formula as babies were more likely to have severe menstrual pain as adults.

Consuming soy-based formula during infancy may be linked to severe menstrual pain in adulthood, researchers report.

study published in Human Reproduction included 1,553 African-American women ages 23 to 35 with information on soy formula feeding gathered by questionnaires. To determine menstrual pain, they asked women whether they had ever taken prescription or over-the-counter medication to prevent menstrual cramps or pelvic pain.

About 13 percent of the women reported being fed soy formula as babies. They were significantly more likely than those who had not been fed soy formulas to have used hormonal contraception for menstrual pain, especially in the first five years after menarche.

The precise mechanism is unknown, but soy contains phytoestrogens that have been shown in animal studies to affect uterine development and adult uterine function.

The study relied on the subjects’ recall, and there was no data on the reasons for formula feeding or on the feeding of solid foods during infancy. The lead author, Kristen Upson, a researcher at the National Institutes of Health, said the observational study shows an association, not cause and effect.

Still, she said, menstrual pain is common, and “our findings point to the need for a greater understanding of exposure, even those that occur earlier in life.”

Source: https://www.nytimes.com/2018/11/09/well/family/soy-baby-formulas-tied-to-menstrual-pain.html

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Women who breastfeed their babies for the recommended six months may also be lowering their own risk of developing endometrial cancer, a new study suggests.

A mother and baby attend a breastfeeding contest organized by Peru’s Health Ministry in Lima, Peru, August 26, 2016. REUTERS/Mariana Bazo

In the analysis of data from 17 past studies, researchers found that women who had ever breastfed their children were 11 percent less likely than women who had children but didn’t breastfeed to be diagnosed with endometrial cancer.

Longer breastfeeding seemed to further lower endometrial cancer risk, though there was little extra benefit past 6-9 months of breastfeeding, the study team reports in Obstetrics and Gynecology.

“Cancer of the uterus is becoming more common and we need to try to prevent it,” said lead author Susan Jordan of the QIMR Berghofer Medical Research Institute in Brisbane, Australia.

Endometrial cancer is the fourth most common cancer in women in high-income countries such as the United States, Canada and Australia, according to the International Agency for Research on Cancer.

“The more women know about the things they can do to reduce their risks of future cancer diagnoses, the better,” Jordan said by email. “Although this piece of evidence by itself may not convince women to breastfeed, it contributes to the overall picture of health gains that can come from breastfeeding.”

The World Health Organization recommends that women exclusively breastfeed for the first six months of their baby’s life, then continue breastfeeding even after beginning to introduce solid foods.

The researchers analyzed pooled data from studies participating in the Epidemiology of Endometrial Cancer Consortium, including 10 from the United States and others from Canada, Europe, China and Australia. They looked at more than 26,000 women who had ever had a child, whether they breastfed, and for how long. This included about 9,000 women with endometrial cancer.

After accounting for other factors that can influence endometrial cancer risk, including age, race, education, oral contraceptive use, menopausal status, years since last pregnancy and body mass index (BMI), researchers found the apparent protective effect of breastfeeding remained.

Notably, the risk reduction linked to breastfeeding was 28 percent among women born after 1950, but negligible among those born before 1950, which may reflect differences in breastfeeding practices, they study authors note. In the United States in the 1950s and 1960s, for example, breastfeeding rates were much lower than in recent decades, the authors note.

The study doesn’t prove that breastfeeding helps to protect against endometrial cancer, but it’s plausible, the authors write, because the growth of this type of cancer is stimulated by estrogen, which is suppressed during breastfeeding.

“The message is not only relevant for women making decisions about breastfeeding but also for society to understand the benefits so we can support women to breastfeed for reasonably long periods of time,” Jordan told Reuters Health. “However, it’s not always possible for women to breastfeed, so it should also be noted that just because a woman chooses not to or can’t breastfeed, it doesn’t mean she’ll go on to develop cancer.”

“Breastfeeding seems to significantly reduce the risk, but further studies originating in other countries are required to assess the association,” said Lianlian Wang of The Fourth Affiliated Hospital of China Medical University in Shenyang, China, who was not involved with the study.

For instance, the most recent endometrial cancer report produced by the World Cancer Research Fund and American Institute for Cancer Research in 2013 classified the evidence for a benefit from breastfeeding as “limited-no conclusion.”

Jordan and colleagues are working with international collaborators to investigate the effects of breastfeeding on ovarian cancer risk. They’re also researching other factors that may influence the risk of endometrial cancer, including specific medications.

“Breastfeeding has consistently been found to be associated with reduced risk of breast cancer,” Jordan pointed out. “This provides evidence of another long-term health benefit for women who breastfeed for more than six months.”

SOURCE: bit.ly/2rFNGeL Obstetrics and Gynecology, June 1, 2017.

Source: https://www.reuters.com/article/us-health-breastfeeding-endometrial-canc-idUSKBN18S64K

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About half of menopausal women suffer from vaginal dryness and painful intercourse. Yet less than half of those women seek help.

At a cocktail party at my home a few months ago, I started chatting with a few middle-aged women, including a few I barely knew. After brief introductions, the conversation quickly turned to a topic that’s become typical banter among women of my age: menopause. But this time, it bypassed hot flashes and went right to sex.

It wasn’t until one of the male guests sauntered over and asked what we were discussing that the conversation came into sharper focus.

“Uh, dry vaginas,” said a friend. He didn’t leave.

About half of menopausal women suffer from vaginal dryness and painful intercourse. Yet less than half of those women seek help. For many women, the discomfort arrives so insidiously that they don’t link it to the hormone changes of menopause, doctors said.

When estrogen plummets during menopause, the vaginal lining thins. In addition to vaginal cells, estrogen influences cells that line the urethra, bladder and vulva, said Dr. Stacy Lindau, a professor of obstetrics and gynecology at the University of Chicago and director of WomanLab, a website that addresses issues of women’s sexual health. “When estrogen is doing its job, it improves blood flow and maintains the elasticity of the vagina,” she said.

The hormone shifts also alter the kinds of “good” bacteria that reside within the vaginal lining, changing the acidity level as well. The upshot is an internal environment that is drier and stiffer. And unlike hot flashes, which subside within a few years for some 80 percent of menopausal women, vaginal dryness tends to get worse.

While doctors can assess the appearance of the vaginal lining and measure blood flow and acidity, test results may not correlate with symptoms. Some patients who seem to have a vagina that would cause pain are not in discomfort, whereas others with a healthy exam report distress.

“Symptoms should be the be-all and end-all of what we care about,” said Dr. Caroline Mitchell, the director of the vulvovaginal disorders program at Massachusetts General Hospital. “The good news is that there are a lot of things that can help, and for most people, things will get better.” She added that, unfortunately, most women will not get 100 percent relief.

Treatment choices include lubricants, applied just before intercourse to reduce the sand-papery feeling in the vagina; moisturizers, used about three times a week to keep the vagina moist; and estrogen that plumps the vaginal wall lining. The estrogen is either in systemic doses — taken as an oral pill, a patch or a gel. Or it is formulated to give a dose that mainly stays in the vagina — as a vaginal tablet, a cream or a ring.

The Food and Drug Administration recently approved Intrarosa, a vaginal suppository containing DHEA, short for dehydroepiandrosterone, a hormone that is converted into estrogen inside cells and that may reduce pain, said Dr. Mary Jane Minkin, an obstetrician-gynecologist at Yale University.

A recent 12-week study in JAMA Internal Medicine of 302 postmenopausal women found that estrogen (in the form of Vagifem, a vaginal tablet) was about as effective as a vaginal moisturizer (Replens) or a placebo tablet or gel in providing relief.

“Estrogen is not some sort of miracle for everyone,” though for some, “I think it’s great,” said Dr. Mitchell, who led the study. Dr. Lindau said of the treatments that were tested, “the point isn’t that they all did nothing, but they all did something.”

Alternative therapies are popular, but there is no proof they work. Eating yogurt rich in probiotics, for instance, is a common remedy, but it does not change vaginal flora. “It sounds like a good idea,” said Dr. Mitchell, “but the bacteria are not the same ones in the vagina, so that isn’t going to help.”

Websites sell marijuana douches or topical cannabinoids, the active ingredient in marijuana, that claim to lubricate the vagina. But no studies show they alter the vaginal microbiome or are effective, though high doses may get into the bloodstream and provide some relaxation, Dr. Mitchell said.

The MonaLisa Touch, a laser therapy, has been offered as a hormone-free way to reverse vaginal dryness, but there are no long-term randomized studies proving its efficacy for this purpose. “We haven’t reviewed or approved these devices for use in such procedures,” said Dr. Scott Gottlieb, the F.D.A. commissioner, in a recent statement.

Dr. Lindau added that painful intercourse may not always be a result of hormonal changes. Some women are dry from using too much soap. “This hyper hygiene activity — too much washing and wiping — there is no good reason to use soaps, certainly not in the vagina or in the vulva,” Dr. Lindau said.

Other women may have pain limited to the opening of the vagina that can be eased with a lidocaine ointment, a numbing cream. Painful intercourse may also be caused by spasms on the opening of the vagina or abnormal growths.

One 78-year-old woman was surprised to find the ease of intercourse improved after her recent hip replacement surgery. What she thought were vaginal issues was discomfort from her hip pain.

Sexual problems can also arise, of course, from relationship issues.

“I don’t want the knee-jerk reaction to be that every vaginal complaint needs to be treated with estrogen, though low estrogen is a common cause of itchiness and dryness.” Dr. Lindau said.

She suggests trying existing therapies — and giving each one a good shot.

To be sure, it wasn’t that long ago that women broke the taboo of menopause talk and began sharing experiences about hot flashes along with the pros and cons of hormone therapy. Now that menopausal woman are more open to talking about vaginal dryness, they are seeking help — but often not soon enough. Then what began as a hormonal problem can turn into a relationship issue, too.

“Women have been led to believe that if they were just nicer to their partners or a little less anxious, their vaginal dryness would go away,” Dr. Lindau said. “But more often it’s the physical changes of menopause that are driving these issues — and they are treatable.”

Randi Hutter Epstein is the Writer in Residence at Yale Medical School, an adjunct professor at Columbia University Graduate School of Journalism and the author of “Aroused: The History of Hormones and How They Control Just About Everything.”

Source: https://www.nytimes.com/2018/09/03/well/live/menopause-sex-vagina-vaginal-dryness-pain-treatment-estrogen-hormones.html

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NEW YORK (Reuters) – General Electric Co (GE.N) and other large companies are trying to chip away at rising childbirth costs for U.S. employees, working directly with hospitals to reduce cesarean sections and related complications.

The efforts are in very early stages, with few details on their impact outside of cost savings of a few million dollars so far. But they illustrate yet another path companies are taking to bring down U.S. medical costs by working with doctors and hospitals to set health goals.

GE’s maternity strategy is designed to steer its employees to hospitals that are believed to provide better care and less likely to recommend unnecessary and costly interventions, company officials told Reuters.

U.S. employer spending on maternity care rose 50 percent in the last decade, fueled by a jump in C-section rates despite years of efforts to curb the practice, according to research firm Truven Health Analytics. For a graphic, see: tmsnrt.rs/2P1MPRs

“Maternity is one of the main drivers of high cost claims,” for employers, said Ellen Kelsay, chief strategy officer at the National Business Group on Health. Avoiding unnecessary C-sections and minimizing complications “decreases turnover in the workforce following the birth of a child,” she said.

General Motors Co (GM.N) said it has included maternity goals, including reducing C-sections, in a new contract with a Detroit-area hospital. Dow Chemical demanded explanations from hospitals that care for its employees when its C-section rate hit 44 percent several years ago. Now part of the merged company DowDuPont Inc (DWDP.N), it is working on new payment agreements with doctors and administrators.

“We went to them and said how do you explain this?” said Steve Morgenstern, Dow Chemical’s North American Health and Insurance Plan Leader, who called the rate “unacceptable.”


GE launched its Maternity Care Select Program in Cincinnati, Ohio, home to its aviation business, where nearly 300 babies are born to employee families every year.

Local hospital system TriHealth agreed to a single “bundled” payment rate to care for low and moderate-risk mothers from the start of pregnancy until 90 days after the baby is born, rather than charge for each visit and delivery separately. That typically removes the financial upside for C-sections, which cost nearly 60 percent more, on average, than a regular delivery.

Adam Malinoski, GE’s manager of health services, said none of the company’s health insurers offered bundled payments on maternity care when it designed its program, so it decided to work directly with providers.

GE pays the out-of-pocket costs for women who enroll, saving them up to several thousand dollars. TriHealth and GE would not disclose the bundled payment rates or how they compare with other hospital rates.

New deliveries under GE’s program began in 2016, when only 78 pregnant women enrolled. In 2017, 136 women enrolled, TriHealth told Reuters. C-section rates for first-time, low-risk deliveries, which represent a small group within the program, dropped to about 6 percent in 2017 from 24 percent in 2016. That comes in well below the U.S. rate of 26 percent for low-risk births.

TriHealth would not disclose the C-section rate for the total group.

GE expanded the program to hospitals in Wisconsin, South Carolina and Massachusetts in 2017 and announced a fifth location in New York in August, but says it is too early to provide data for other locations.

GE executives said the program so far has saved the company nearly $2 million because of lower negotiated fees for maternity care. It represents a fraction of its spending on the 113,000 employees and family members enrolled in the GE health insurance plan, but a step in the right direction, they added.


The rise of C-sections has been fueled in part by fears about malpractice litigation, as well as expecting mothers with health issues or who are older, which raise the risk of complications.

Hospitals say that makes them reluctant to set maternity goals. The Stanford Health Care medical system works directly with employers on health targets, such as diabetes care, but has so far refused to set specific goals on C-sections.

In such higher risk cases, “it’s entirely appropriate and (there’s) no way to determine upfront” who will need a cesarean, said John Jackson, who handles corporate health partnerships at Stanford Health Care.

Suzanne Delbanco, executive director of the nonprofit Catalyst for Payment Reform, has worked with large employers seeking to reduce C-section rates. But some companies “are still leery about wading in too much,” she said. “They don’t want to alienate people, they don’t want to be accused of being Big Brother.”

GM is taking its own shot at lowering costs and improving care with a new health program, announced in August, that was created directly with Henry Ford Health System in Michigan . Three of the program’s 19 health metrics involve maternity care such as lowering C-section rates, the company told Reuters.

The automaker’s total C-section rates vary widely, from about 40 percent in the Dallas/Fort Worth area to 30 percent or lower in Detroit.

“We were shocked,” said Sheila Savageau, U.S. health care leader for GM. “We have to change the system.”

Source: https://www.reuters.com/article/us-world-work-maternity/u-s-companies-team-up-with-hospitals-to-reduce-employee-maternity-costs-idUSKCN1NC1EQ

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