Sunday, July 31, 2005

Fertility Treatments, part 2

I took some time to think about the NPR story on older mothers a little more, and realized that something else bothered me about one of the arguments presented. One of the interviewees explained that they do not have an obligation to offer in vitro fertilization to post-menopausal women because infertility after menopause is natural, and not a disease state. Okay, that's sensible. It seems, though, that the medical profession offers all sort of procedures to those want and cannot afford them for things that have nothing to do with disease. I'm thinking Botox, breast implants, and many other plastic surgeries, all of which have risks to the woman involved. Some of these may have legitimate purposes for those who have congenital problems or for burn victims, for example, but it's hard to deny that these are often performed as elective procedures for those who just want to "look better." One might argue that those procedures only affect the individual woman, not a child as in the case of the older mother. I'll leave the implications of these procedures to society and women's self-respect overall to you to ponder.

Additionally, the interviewee stated that we wouldn't offer in vitro fertilization to a pre-menopausal, young girl, either. Again, sounds like a reasonable argument. However, issues of informed consent and responsibility would be much more problematic in, say, an 8-year-old. There are existing laws on voting, statutory rape, driving, criminal liability, etc. that inform how we as a society think about how able a young person is to be responsible, accountable, and able to understand or consent which do not apply to older women. It also ignores the differences in how developed women's bodies are at different ages.

Just something I'm pondering... I do try to avoid offering too many personal opinions on this blog, in favor of presenting informative resources and stories on current issues that are relevant to all women, regardless of their perspectives on hot topics. I think it's worthwhile, though, to examine and question the assumptions that inform health care decisions from time to time. Stay tuned.
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Friday, July 29, 2005

Who Gets to be a Parent? Who Decides?

I heard this story on All Things Considered tonight which addressed the ethics of providing in vitro fertilization to post-menopausal women who want to have a child. I was somewhat distrubed by some of the comments, so I thought I'd post and see what others think. I was surprised that at one institution, it went through two ethics committees to decide whether a couple could receive treatment. Some of the arguments bothered me, such as the assumption that an older mother (the debate is not about fathers, which is another issue) would necessarily die earlier or be unfit. I couldn't help thinking how many children lose parents through tragic events early in life - terrible, yes, but would they have been better off not being born? What about 2000 Census data showing that 2.4 million children are already being raised by their grandparents? Other arguments involve health risks to older women in pregnancy; I wonder why this is not simply an issue where the woman is informed, decides, and consents knowing the risks, rather than having the clinic make the decision on her behalf.

This made me think about what criteria fertility clinics are using to determine whether to assist individuals in conceiving children. A January 2005 article in Fertility and Sterility attempted to count just this type of information, asking assisted reproduction facilities about the information they gather and asking them to state whether they would care for certain types of hypothetical patients. Among the findings: more programs collect information on religion (34%) than criminal history (17%); 20% would be very or extremely likely to turn away an unmarried woman, 53% for an unmarried man; 18% would turn away a couple in which both partners were 43 years old. Big shockers to me: 5% would turn away a biracial couple, and 81% would turn away a couple in which the husband has been physically abusive to an existing child (why not all?).

This is a long post already, but here are a couple of links on the topic:
American Society of Reproductive Medicine's statement on oocyte donation to postmenopausal women
Debate on fertility treatment for older women from BMJ.
Commentary piece on bioethics.net
Another commentary

I'd love to hear what others think on this topic.
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Thursday, July 28, 2005

Health Guides by Decade

The National Women's Health Resource Center provides health guides by decade, with information for women in specific age ranges about questions to ask your health care professional, preventive health screenings you need, and other topics. The guides are for women in their 20s, 30s, 40s, 50s, 60s, and 70s. Each guide provides an easy-to-read overview of the health concerns facing women at that age.
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Wednesday, July 27, 2005

News Pieces on Problems with Contraceptive Patch

This is a little late, but a couple of articles have appeared online recently about dangers of Ortho Evra, the contraceptive patch. Here is one from MSNBC, and another from IntelliHealth. The MSNBC article provides a good summary of the risks of fatal blood clots for the patch vs birth control, and discussion of how alarmed women should be. Not sure where this one is going yet, stay tuned. Technorati Tags:

News Roundup

Tuesday, July 26, 2005

House Hearing on Pharmacists/Contraception

On Monday, the House Small Business Committee heard testimony on the issue of whether pharmacists should be allowed to refuse to fill certain prescriptions (such as emergency contraception) based on their personal beliefs. Testimony from the hearing is available online, as is the committee chairman's press release, in which he suggests creating lists of pharmacists who will fill these prescriptions. The press release does not address the burden this may create for rural women or women with limited means of transportation who may be unable to reach an open, compliant pharmacy within the 72 hour window during which EC is most effective, or the administrative burden of producing such lists, keeping them up to date, and distributing them adequately.
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Monday, July 25, 2005

Event - for Nashville-Area Women

The Vanderbilt Women's Education and Lactation Center is hosting an open house on August 2nd (1-4pm) in celebration of World Breastfeeding Week. The event will take place on the 4th floor of the Medical Center East north tower in Room 4151. You will be able to meet the center's Lactation Consultants, register for door prizes, and view the Center's selection of breastfeeding supplies. Refreshments will be served.

Links:
List of the Center's other childbirth, breastfeeding, and parenting classes.
Map of VUMC with parking garages highlighted.
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Sunday, July 24, 2005

Panel Recommends HIV Testing for all Pregnant Women

A panel of authors looked at the existing data on "screening, risk factor assessment, accuracy of testing, follow-up testing, and efficacy of interventions." The authors conclude that, in part because there are now accurate HIV tests and effective treatments for reducing transmission to babies, and because many women underestimate their risk factors, all women should be tested during pregnancy. They cite data indicating that in 2000, 40% of HIV infected infants were born to women who did not know they had the infection prior to delivery.

The article is available here, and a CNN.com article summarizing the piece is available here.

Links to several web resources on HIV and pregnancy are provided at this MedlinePlus page.
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Friday, July 22, 2005

Vaginal Emergency Contraceptives

A study was released in the current issue of Fertility & Sterility that compares emergency contraceptives taken orally versus vaginally. The authors concluded that "vaginal route of administration of emergency contraception regimens may be as efficacious as the oral route." The abstract is available here, and MedlinePlus has a summary here.

The rationale for trying this is, in part, to reduce the nausea and vomiting many women experience when using emergency contraception. Notably, though, the study only involved 9 subjects, so more research would likely need to be done with a bigger study group. Oddly, women in the study "were asked to sit for four hours and restrict their physical activity for another four hours" after inserting the hormones. This seems like an inconvenience that could make oral medicines a better choice for some women.
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Wednesday, July 20, 2005

VAWA up for Reauthorization

The Violence Against Women Act is up for reauthorization in 2005. A summary from 2000 is available here. Lots of links to background information here. Also, full text of the 2005 legislation in the House and Senate.

VAWA addresses sexual assault, domestic violence, dating violence, and stalking, and provides for services, shelters, hotlines, etc. More info is available from the National Task Force to End Sexual and Domestic Violence Against Women and StopFamilyViolence.org. The task force site has a link for contacting your representatives.

Thanks to this blogger and this one for the reminders.
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More Cautions about Online Health Information

The Wall Street Journal published a piece yesterday by Dr. Benjamin Brewer called, "From Web-Savvy Patient to a 'Cyberchondriac,'" the main theme of which is summarized by the line, "As a physician, I'm not troubled by the autonomy of the informed patient. What troubles me is the proliferation of the partially informed patient and, frankly, the misinformed patient -- the patient who crosses the line from Internet-educated patient to cyberchondriac."

Brad King's Technology Review blog contains a commentary on the piece, stating, "However, when people use communication tools such as the Internet as the definite source of anything in their lives, there are bound to be -- well, unforeseen and unfortunate consequences."

There can never be too many reminders to 1) be cautious about automatically following any health advice you read online; 2) use any information you find in consultation with your health care provider. The web is a wonderful source for gaining new information, but Brad King says it well when he states, "The role of digital information has only made the information-gathering process easier; it hasn't fundamentally changed the ways in which we must process all of that information."
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More on Alternative Menstrual Products

Same info, but in a handy guide for teens.

The site itself, youngwomenshealth.org, provides information for teens on nutrition and fitness, sexuality and sexual health, general health and development, gynecology and reproductive health, and emotional health. A section is provided for parents, and the site also has a Spanish language version.

The site is run by the Center for Young Women's Health at the Children's Hospital of Boston.
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Tuesday, July 19, 2005

Breastfeeding Rights by State

La Leche League has summaries of breastfeeding legislation for each of the 50 states. Topics addressed in the laws include women's rights to breastfeed in public and workplace rights, depending on the state. Details of proposed laws are also provided by state.
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Sunday, July 17, 2005

Emergency Contraception, part 3

An article in today's New York Times indicates that the FDA will decide by September 1 whether to allow Plan B, an emergency contraceptive, to be sold over-the-counter in the US. The article provides a nice overview of the opposing and supporting arguments. Basically, supporters want OTC access in part b/c the drug must be taken within 72 hours to be effective, the earlier the better. With waits for doctor's appointments, this can be a real problem. Opponents think OTC access will increase risky sexual activity in younger women (nothing about younger men here - they've been able to get OTC condoms all along).

If you don't have a NYTimes login, you can register for free or borrow one from BugMeNot.

The FDA/CDER letter initially declining OTC status can be found here (PDF).
I have not yet found anything new on the proposed 9/1/05 deadline on the FDA website; will update if I do.

Note: you will sometimes see emergency contraception referred to as the "morning after" pill. This is something of a misnomer, because it can be taken for up to 72 hours after unprotected sex, and consists of more than one pill.

Also, this page provides a chart of which regular oral contraceptives can be used for emergency contraception, and the proper dosages. You may want to speak to your women's health provider about this.
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Saturday, July 16, 2005

Emergency Contraception, part 2

Here's a page explaining how EC works - basically, it prevents a pregnancy by stopping ovulation, fertilization of the egg, or the implantation in the uterus necessary for pregnancy. It is intended for use on occassions when a woman has had unprotected sex, such as in rape, or when a condom breaks.

Not-2-late.com is a Princeton website that explains EC, and includes a searchable directory of where EC can be obtained in the US and Canada.

This page from the National Conference of State Legislatures provides a 50 States Summary of Emergency Contraception Legislation," which summarizes laws in the states. There is also a page explaining the laws in each state regarding whether pharmacists can refuse to fill EC prescriptions.

Here's the FDA's statement on why EC wasn't approved for over-the-counter status, which has been the subject of much debate. This press release is a response from the American College of Obstetricians and Gynecologists.

Back up Your Birth Control is an advocacy group; its website provides info on EC access.

Click here to run a PubMed search for research and other professional articles on emergency contraception.
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Study on Emergency Contraception in BMJ

BMJ published a study this week that presents the results of a survey of British women on their use of contraceptives. In particular, it looks at whether emergency contraception use went up after it was made an over-the-counter drug in 2001. Women were asked about the types of contraception they used, and where they obtained it. The rates of use before and after EC became available without a prescription were very similar. 91.6% of women said they didn't use EC in 2000, vs. 92.2% and 92.8% in 2001 and 2002. The authors suggest that this detracts from the argument that over-the-counter availability would increase the use of emergency contraception. The biggest change they say was in where women obtained EC, with more women getting it from pharmacies in 2002, although most (48.8%) still went through their general practitioner.

One thing of note is that this study's results are based on women's responses to a survey. The results may be somewhat inaccurate, as the authors rely on this self-reporting. A more accurate study might result from tracking how much EC was actually dispensed and where, although that might not give you the individual usage counts. It also only looked at women over 16; in the U.S. a big part of the debate has been about whether younger women will use the drug.

Get the abstract of the article
The full text of the article can also be downloaded for free (as a PDF).
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Tuesday, July 12, 2005

Your State's Sexual Health Laws - for teens

The Sex, Etc. website provides an easy to use guide to each state's sexual health laws, intended for a teenage audience. Just click on your state to view information about rights to abortion and birth control, access to pregnancy testing, condoms, and emergency contraception, testing and confidentiality for HIV and STI's, rights to sex ed in schools, and anti-discrimination policies to protect gay, lesbian, bisexual and transgender teens.

The Sex, Etc. site also provides additional resources for teens, including personal stories on numerous topics, information on sexual and emotional health concerns, a glossary, body diagrams, and answers to frequently asked questions. The site is very frank about sexual health topics. Unfortunately, it does not provide author names, references, or the date topics were updated for the FAQ topics, so should be taken with a grain of salt. I'm not singling this site out - I think it's very interesting and I wish it had been around in my early teens - just reminding you to be cautious about which websites you rely on for health information.
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Sunday, July 10, 2005

Appeals court finds "partial birth abortion" ban unconstitutional

The 8th Circuit Court of Appeals in St. Louis ruled that the ban is unconstitutional because, although it allows the procedure to save the life of the woman, it does not provide exceptions for protecting the health of the woman. The New York Times has a clear summary here; registration is required, but you may borrow one from BugMeNot. The Court's opinion is available here, as a PDF file.

The medical name for a "partial birth" abortion is dilation and extraction.

As a side note, I had a very hard time finding information, especially consumer-friendly info, on this procedure that was not from a political website (left and right). MedlinePlus (a government consumer health site w/ info on hundreds of topics) doesn't cover it, although they do cover D & C and abortion in general.MedlinePlus also has a section on women's health that omits the topic of abortion entirely. If this omission bothers you, you can send the MedlinePlus team a message here.

Here's an overview of several surgical abortion procedures.
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Saturday, July 09, 2005

Kaiser Women's Health Survey - results

The Kaiser Family Foundation has published the results of a 2004 national telephone survey in which 2,766 women ages 18 and up were asked about healthcare-related issues. It's probably no surprise that women without health insurance reported lower rates of being screened for breast cancer, cholesterol, high blood pressure, and other conditions. Of note is that 17% of women with private health coverage and 32% of women with Medicaid "stated that they postponed or went without needed health services in the past year because they could not afford it."

Other highlights (or lowlights...):
-14% of women reported skipping doses or taking smaller doses of medicine in the past year to make them last longer.
-23% of women on Medicaid said they were turned away from a physician because the doctor was not accepting new patients
-21% report having concerns about the quality of care they have received in the past year
-19% of women have changed physicians in the past 5 years because they were not satisfied with the care they received

The full report provides additional details on how frequently women discussed issues such as sexual health, domestic violence, drug abuse, nutrition, and other topics with a health care provider, as well as other details on women's responses to questions about health care costs and coverage, family health, and access to care.
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Monday, July 04, 2005

Alternative Menstrual Products

I've been woefully neglectful of this blog recently, but here it is, finally - the period post. I thought I'd take a moment and do a little rundown of the menstrual products available in addition to traditional pads and tampons, because I'm always surprised that more women haven't heard about these options.

There are a number of reasons you might choose products aside from store-bought pads and tampons. A couple of the big ones:

The environment - traditional pads and tampons go through a bleaching process, releasing toxins into the environment. There are non-bleached, organic tampons and pads on the market now, avoiding some of the chemicals normally used, although these may be pricier. There is also a lot of waste involved - think about how many applicators, wrappers, cardboard boxes you throw out each month, in addition to the used product itself.

Cost - many alternative products are reusable, saving money over a lifetime. For example, say you spend $3 a month on tampons. Over 10 years, that's $360. A Keeper (my favorite) costs $30, and is reusable for that same 10 years - $330 saved.

Obviously, the choice must be made by each woman regarding what is right for her. Here are some options, though:
  • The Keeper: a reusable soft natural rubber cup, which collects menstrual fluid (rather than absorbing it). Empty, rinse, repeat. Tip: trim the stem. This is particularly handy for scenarios where frequent tampon-changing may be inconvenient. In my experience, the Keeper has leaked once, after willful neglect on my part.

  • The Diva Cup: Same thing as The Keeper, but silicone instead of rubber, for those with latex allergies.
    This and the Keeper supposedly have a lesser risk of TSS. They also don't absorb your natural vaginal fluid, making removal more comfortable than with tampons for some women.

  • Washable cloth menstrual pads: for the environmentally-conscious woman who prefers pads
    Lunapads - order online
    GladRags - order online, also sells the Keeper, organic tampons, and sea sponges
    Pattern and instructions for making your own

  • Sea sponges: Resuable, used as a sort of tampon replacement. I've never been sure about these, not knowing the TSS risk or whether ocean pollution is an issue.

  • Instead SoftCup: another fluid collection device, hypoallergenic. You can have sex with this in, but it does NOT provide any birth control. Comes in only one size - this did not work for me. Ask and I'll tell you why.

  • Organic and/or unbleached pads and tampons: Normal products, but without as many chemicals being released into the environment. Still have that pesky waste problem.
    Natracare - order online

    There are probably options I haven't mentioned here. Check around, see what works for you!

    For the young, activist menstruator: Tampaction - a campaign to encourage healthier, more sustainable menstrual product options

    Next time: I'll report on any studies I find assessing the health effects or benefits of these products
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