5 Health Resolutions For Women To Keep In 2014

Dr. Enrique Jacome

For many women, the path to good health is not an easy one, with plenty of roadblocks along the way. Procrastination, family obligations, work demands, and lack of time and energy are a few culprits that can stop the best of health resolutions in their tracks. 

To help women in their quest for better living, here are five resolutions to improve physical and mental well-being. If you've made attempts at sounder mind and body before, don't get discouraged. This is just another wonderful chance for you to make it happen:

New Year's Resolution No. 1: Eat, but Don't Pig Out

When women resolve to lose weight, they are often black and white about it, says Bonnie Taub-Dix, spokeswoman for the American Dietetic Association. She says women tend to want to cut out major food groups, telling themselves they cannot have any candy, dessert, or carbohydrates.

"It's a setup for failure, because by the time mid-January comes around, those resolutions are already in line for the next new year," says Taub-Dix. "It would be a much wiser decision to say, for example, 'I'm going to cut back on desserts.' Maybe pick a Saturday to have dessert." Instead of deprivation, practice moderation during the holidays.

The reduction approach is much more realistic than the all-or-nothing technique, which labels foods as "good" or "bad." When people see certain edibles as "bad," they can end up obsessing about it. Or they may see dieting as punishment for a year of unhealthy eating. Concentrate on getting adequate servings of whole grains, calcium, fiber, fruits and vegetables. This can be as easy as having a high-fiber cereal with milk and a banana.

Slashing entire food groups from the diet often backfires, because food is good and is one of the pleasures in life, says Taub-Dix. "There's no reason why we shouldn't enjoy food just because we're over the weight that we should be."

"Don't wait until the new year to have better eating habits, says Taub-Dix. "It should be a whole year's resolution, not a New Year's resolution."

New Year's Resolution No. 2: Jump Outside the Box

Many women who resolve to become more physically active think of going to the gym. They tend to hit the aerobic machines or join group exercise classes. They may get discouraged easily because they don't achieve desired weight loss or muscle tone in a certain time frame. They may quit because of lack of time, energy, or money. Or, they may tire of the gym atmosphere.

There are dozens of reasons why the best of workout intentions fall by the wayside come February. Yet they don't have to end up that way if you're willing to step outside of a certain mode of thinking -- that exercise has to be done a certain way, at a certain place, at a certain time, and for a certain amount of time.

"Sometimes people have this 'all or none' mentality and they're so gung-ho and so excited when they set the resolution that they judge themselves too harshly if they don't perfectly adhere to what they've established," says Cedric Bryant, PhD, chief exercise physiologist for the American Council on Exercise.

He says many people make resolutions that are either unrealistic or too vague. A woman, for instance, may resolve to lose 10 pounds in two weeks. If she doesn't see desired results, she becomes discouraged and gives up.

It's better to set fitness goals that are realistic, achievable, and well defined. For example, a woman may strive to lose one to two pounds per week by exercising three to four times per week and holding off on seconds at the dinner table.

While the trend is changing, too many women don't do valuable resistance training, says Bryant. According to the Mayo Clinic, enhanced muscle mass can not only help better manage weight, it can also improve endurance, maintain the flexibility of joints, and reverse age-related declines in strength, bone density, and muscle mass.

Even very busy women can do resistance training and aerobic exercise, as they do not necessarily require a visit to a fitness center. "If you can't get to the gym, what can you do today to be more active?" asks Saralyn Mark, MD, senior medical adviser for the Office on Women's Health in the U.S. Department of Health and Human Services. "Can it be walking a little bit further in the parking lot, and using the stairs, or raking your leaves?"

"There's a lot you can do with just what is around you," says Mark. "The best part is that you don't have to get into a fancy gym outfit. You can be comfortable and you can do it while you're watching the news."

New Year's Resolution No. 3: Guard Against the Bone Thief 

"A lot of women feel that when they're not babies anymore, they don't have to worry about their bones, but it's quite the contrary," says Taub-Dix. "Watching calcium in your diet even as a young child or teen is very important, because that is the setup for what your bones may look like later on in life."

Osteoporosis, a bone-thinning disease, is major public health threat for 44 million Americans, 80% of whom are women, according to the National Institute of Health Osteoporosis and Related Bone Diseases. One out of every two women over 50 years old will have an osteoporosis-related fracture in her lifetime.

To help prevent osteoporosis, Taub-Dix suggests getting at least three servings of dairy a day. Healthy sources of dairy include skim milk, low-fat cheeses, and yogurt. There are also nondairy options for calcium, such as canned salmon with bones, dark green vegetables, dried beans, and calcium-fortified juices and cereals. Calcium supplements can also help women meet their recommended daily intake.

Adequate intakes of calcium for women:

• From age 11 to 24, between 1,200 and 1,500 milligrams daily
• From age 25 to 50, 1,000 milligrams daily
• For postmenopausal women 1,000-1,500 milligrams daily if on menopausal hormone therapy
• For pregnant and breastfeeding women, 1,200-1,500 milligrams daily

Women also should be aware that without vitamin D, calcium absorption is reduced.  This vitamin is found in some foods sources including fatty fish, fish liver oil, and diary products that are fortified with vitamin D. An adequate intake of vitamin D for adults ranges from 200-600 international units a day.

Weight-bearing exercises, which use gravity to put pressure on the bones, can also help strengthen bones. Examples include walking, running, aerobics, and dancing. Resistance-training exercises are also valuable as they help enhance muscle mass and bone strength.

Be aware that certain foods and medications may help weaken bones. There is some evidence that soda drinking can contribute to bone loss, primarily because many soda drinkers tend not to drink milk. Research also shows nicotine can slow down bone cell production and cause faster bone loss.

"It's important that you talk with your doctor about how much calcium you get in your diet, whether you smoke cigarettes, your family history, whether you've been on Depo-Provera, or you've had a history of other diseases that have required you to be on steroids or thyroid medications," says Mark.

The FDA recently issued a strong warning about potential bone density loss with use of the contraceptive Depo-Provera. Use of steroids and an overactive thyroid have also been associated with weak and thinning bones.

New Year's Resolution No. 4: Take Health Exams and Get an "A" for Good Health

An osteoporosis screening test is ideal for all women aged 65 or older, or for younger women with one or more risk factor. It is also important to get tested if this problem runs in your family.

There are other important health exams for women, and the optimal benefits usually correspond with certain age groups. Mammograms, for example, screen for breast cancer, a disease with a risk that increases after age 40. Consequently, the Task Force recommends that mammograms be performed every one or two years beginning at 40.

Pap smears, which screen for cervical cancer, are recommended to start within three years of onset of sexual activity or at 21 years old, whichever comes first, and to continue screening at least every three years. Also, discuss with your doctor the new HPV vaccine, which helps reduce your risk of cervical cancer.

Starting at 50, testing for colorectal cancer is also important. The disease more often strikes older men and women.

Other important areas of screening for women include blood pressure, cholesterol, diabetes, depression, and sexually transmitted diseases.

There are risks to every exam, including the possibility of an inaccurate report. Overall, though, experts say they play an invaluable role in good health. "Screenings can't prevent anything, but they can make treatment more effective," says Cindy Pearson, executive director of the National Women's Health Network.

New Year's Resolution No. 5: Move Center Stage

Women are well-known caretakers and jugglers of several tasks at once. With responsibilities concerning home, work, and children, there just aren't enough hours to do all that needs done. The result: many women feel frazzled, frustrated, and forlorn.

The mere thought of taking time to take care of themselves sends ripples of guilt through many women. Where does one find the time for self-care?

Make the time, says Mark. Research shows stress can wreak havoc on health. It's not unusual for the stressed to have stomachaches, diarrhea, increased appetite, and weight gain. Constant stress can also compromise the immune system, making people more vulnerable to colds and other infections. The pressure can also aggravate illnesses, produce anxiety and depression, disrupt valuable sleep, decrease sex drive, and raise blood pressure.

The list of negative consequences goes on and on. But women do not have to be victims, or they can try to change unpleasant situations.

Peter A. Wish, PhD, a psychologist in Sarasota, Fla., suggests identifying stresses, prioritizing them according to importance, and then tackling them one at a time. He recommends starting with an easy objective, and then moving on to another minigoal. "It starts with something that you can be successful at, and nothing succeeds like success," he says. "It reinforces you to keep going."

If a woman is not able to accomplish everything on her list, Wish says not to fret. "The probability is that [women] won't be able to accomplish everything, and therefore, they shouldn't be too hard on themselves."

With the to-do list never ending, there's no better time than today to find time to do something for yourself, even if it's just for 10 minutes. The ideas vary with individual tastes, but some women have found doing simple things, such as walking, exercising, talking to a friend, soaking in the tub, or meditation to be highly enjoyable and relaxing.

So this new year, think of what's important to you, make your resolutions, and vow to make this the beginning of  If a woman is not able to accomplish everything on her list, Wish says not to fret. "The probability is that [women] won't be able to accomplish everything, and therefore, they shouldn't be too hard on themselves."

With the to-do list never ending, there's no better time than today to find time to do something for yourself, even if it's just for 10 minutes. The ideas vary with individual tastes, but some women have found doing simple things, such as walking, exercising, talking to a friend, soaking in the tub, or meditation to be highly enjoyable and relaxing.

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Research Shows Menstrual Cramping May Be Alleviated By Vaginally Administered Sildenafil Citrate

Dr. Enrique Jacome

Women with moderate to severe menstrual cramps may find relief in a class of erectile dysfunction drugs, according to a team of researchers led by Penn State College of Medicines Richard Legro.

Primary dysmenorrhea, also called PD, is the most common cause of pelvic pain in women. The current treatment is non-steroidal anti-inflammatory drugs, such as ibuprofen. However, ibuprofen does not work well for all women, and can be associated with ulcers and kidney damage when used chronically.

Sildenafil citrate, sold under the brand name Viagra, may help with pelvic pain because it can lead to dilation of the blood vessels. Previous research shows that taking it orally can alleviate pelvic pain, but the incidence of side effects -- often headaches -- may be too high for routine use.

The researchers looked at administering sildenafil citrate vaginally, which had not yet been tried, to treat PD. They compared pain relief from use of sildenafil vaginally with that of a placebo. Results were published in Human Reproduction.

Penn State College of Medicine researchers worked with researchers at Nova Gradiska General Hospital in Croatia. They recruited women 18 to 35 years old who suffered from moderate to severe PD. Of the 29 women screened for the study, 25 were randomized to receive either sildenafil or a placebo drug.

Patients rated their pain over four consecutive hours. Sildenafil citrate administered vaginally alleviates acute menstrual pain with no reported side effects. Researchers hypothesized that the drug would alleviate pain, which it does, but also that is does so by increasing blood flow. However, because uterine blood flow increased from both sildenafil and the placebo, the reason it alleviates pain is not yet known.

"If future studies confirm these findings, sildenafil may become a treatment option for patients with PD," said Legro, professor of obstetrics and gynecology and public health sciences. "Since PD is a condition that most women suffer from and seek treatment for at some points in their lives, the quest for new medication is justified."

Larger studies must be completed to validate the small sample of this study, and additional research is needed to see whether sildenafil changes the menstrual bleeding pattern.

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Great Holiday Health Tips For Women

Dr. Enrique Jacome

Indulge Without Overindulging

Relax. You won’t gain 10 pounds.It’s a misconception that you’ll need to go up a pant size in January. The average person gains only about a pound during the weeks between Thanksgiving and New Year’s. That’s no excuse to eat with abandon, though. (After all, gaining one pound every year can add up in the long run.) But a study published in the Journal of Social and Clinical Psychologynotes that people who had an attitude of forgiveness and self-compassion after one high-calorie setback were less likely to give up and keep bingeing.

Don’t skip meals. It seems logical: Forgo lunch; leave more room for pigs in blankets at the office party later. But arriving starved may result in overeating, and drinking on an empty stomach will give you a quicker buzz, which is more likely to lead to mindless munching. Eat normally during the day, and be strategic at the buffet. Don’t bother with things you don’t absolutely love. Splurge on something special (hint: It’s not those cubes of Cheddar), then stop.

Count your bites. “A lot of appetizers are about 60 calories a bite,” says Karen Diaz, a registered dietitian in Wyckoff, New Jersey. Just five bites is around 300 calories. “That’s about half of what you might eat for dinner,” says Diaz. Keep a mental tab—or fill a small plate, once—so you don’t go overboard.

Turn down Aunt Jan’s pie. “It’s better to sit with a little guilt than to overeat just to please loved ones,” says Diaz. If you can’t say no to Jan’s face, try “Maybe later,” then hope she forgets.

Give yourself a break from the gym. According to a Gallup poll, the percentage of people who exercise regularly is lower in December than at any other time of the year. So don’t beat yourself up—you’re not the only one who’s too busy for Spinning class. But try to stay active in other ways. Speed-walking with shopping bags counts. So does cleaning, says Mark Macdonald, the author of Body Confidence. Add some toning by tightening your core muscles as you vacuum or reach for scattered toys (imagine trying to get your belly button to touch your spine). And most important: Get back into your regular exercise routine once the holidays end.

Weigh yourself every day. Or try on a pair of snug-fitting jeans to gauge those subtle ups and…OK, just ups. The point isn’t to get obsessive and berate yourself over every ounce gained; it’s to prevent yourself from completely letting go of good habits. “Breaking the rhythm of healthy behaviors that you’ve built up is the real danger. You don’t want to have to start from scratch on January 1,” says Macdonald.

Drink Responsibly

Practice moderation (really). Drinking too much may not just mean a terrible hangover. Around this time of year, doctors report seeing a spike in erratic heartbeats—dubbed “holiday heart syndrome.” It is more common among people who usually aren’t heavy drinkers but drink in excess for a short time. “Alcohol may be toxic to enough cardiac cells that it disrupts the coordination required to maintain a normal heart rate,” says Kenneth Mukamal, an internist at Beth Israel Deaconess Medical Center, in Boston. “Women should have no more than three drinks on any occasion and seven per week,” says Michael Weaver, an associate professor of internal medicine at Virginia Commonwealth University School of Medicine, in Richmond. “So a woman can have up to three drinks in a night and go out two nights, but that’s it for the week—or else the chances of problems go way up.”

Keep it on the rocks. Melting ice dilutes a cocktail and creates more liquid. So order your drink on the rocks to try to avoid a quick buzz—and to sip longer before a refill. Use soda water as a mixer for liquor (a cocktail with liquor and club soda is only about 100 calories), and don’t be ashamed to add ice cubes to bubbly. In France, it’s called a piscine. Très chic.

Put a cork in it early. Alcohol may help you to conk out quickly; the problem comes when it starts to wear off. The period in which your body is metabolizing the alcohol is when sleep is disrupted. You may wake up frequently in the middle of the night (even if you don’t remember doing so) and miss out on restorative rest. The best strategy is to allow time for the alcohol levels in your body to drop before going to sleep; at the very least, retire your flute several hours before bedtime.

Fight Off Sleep Deprivation

Don’t let late nights make you fat. “People who sleep less over time tend to be heavier,” says Lawrence Epstein, the chief medical officer of the Sleep Health Centers, in Brighton, Massachusetts. But it doesn’t take long for the cycle to start. “If you pull one all-nighter or miss a few hours each night over a week, your body releases hormones that prompt eating and weight gain,” says Epstein.

Use the weekend to catch up. Most of us have sleep debt: the difference between the number of hours we need every night (which varies per person) and how many we get. If you feel best after seven hours a night and you get five for three nights in a row during a busy week, you have a sleep debt of six hours (two missing hours for three nights). Erasing that debt requires you to get six extra hours over the course of a few days, but they don’t have to be consecutive, says Epstein. David F. Dinges, Ph.D., the chief of the division of sleep and chronobiology at the University of Pennsylvania School of Medicine, conducted a study in which participants were restricted to about four hours of sleep for five consecutive nights, then allowed to sleep for 10 hours or more on the sixth night. The researchers found that after the recovery night, participants regained some of their previous levels of alertness and ability to concentrate. So while you should focus on eliminating your sleep debt completely, just one good snooze (a few hours more than you normally need) can give you a fresher start.

Watch out for hidden caffeine. Think hot cocoa is a soothing way to end a winter’s night? Hold on to your marshmallows. Chocolate, even the powdered kind, contains caffeine, as do many over-the-counter pain medicines that you might pop at night to get a head start on a hangover. Excedrin Extra-Strength Caplets, for example, contain 65 milligrams of caffeine; by comparison, the average cup of coffee contains 50 to 100.

Skip the sliders. Foods that are high in fat or protein require your body to work harder at digestion. When your body is busy breaking down mini hamburgers, your sleep is more likely to be hampered. Watch the clock; an early cocktail party is the perfect time to snack on something more substantial. As the night wears on, taper off. Or, if you’re still hungry, have some complex carbohydrates, like whole-wheat crackers or a handful of crudités.

Beat the Blues

Don’t assume that this is the most depressing time of the year.Contrary to popular belief, depression isn’t more common during the holidays. In fact, suicide rates in the United States are actually lowest in December, according to the Centers for Disease Control and Prevention. “This may be a result of more social interaction, which has been found to enhance happiness,” says Caroline Adams Miller, the author of Creating Your Best Life. But that doesn’t mean that you’re immune to the holiday blues, especially when you’re missing a family member or stressed-out by the in-laws. Make plans with friends if your family is far away—or, on the flip side, opt out of events if your schedule is overwhelming. “You don’t have to be a type E personality—everything to everyone,” says Ronald Nathan, a psychologist in Albany.

Consider a supplement. Is there a magic pill that will cure the blues? Of course not. But some research shows that omega-3 fatty acids may relieve depression; other research has found that vitamin D may improve mood. Add a daily supplement of omega-3 or vitamin D to your diet. Or increase your intake of vitamin D–fortified milk or foods rich in omega-3s, such as fish, flaxseed, and walnuts.

Take Facebook with a grain of salt. You’ve seen the status updates: “Hope Santa can find us in ARUBA!” or “Mmm, homemade cider, kids making cookies, life is good.” And you know what? Those people have bad days, too. Remember: Most people put their best self forward on Facebook and Twitter. Don’t compare your life with those dreamy-sounding posts.

Make plans for January. “If you have social events coming up with people you like, you’ll be upbeat about what’s to come,” says Alison Ratner, a clinical social worker in Atlanta. Plan a weekend getaway or an Oscar-nominated–movie marathon. Or, ahem, if you did gain that holiday pound, might we suggest a jogging club? Happy New Year!

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Research Shows Glaucoma Risk Double For Long-Term Oral Contraceptive Users

Dr. Enrique Jacome

Research presented at the 117th Annual Meeting of the American Academy of Ophthalmology in New Orleans, has found that women who have taken oral contraceptives for three or more years are twice as likely to suffer from glaucoma, one of the leading causes of blindness which affects nearly 60 million worldwide. The researchers caution gynecologists and ophthalmologists to be aware of the fact that oral contraceptives might play a role in glaucomatous diseases, and inform patients to have their eyes screened for glaucoma if they also have other risk factors.

The study - conducted by researchers at University of California, San Francisco, Duke University School of Medicine and Third Affiliated Hospital of Nanchang University, Nanchang, China - is the first to establish an increased risk of glaucoma in women who have used oral contraceptives for three or more years. The researchers utilized 2005-2008 data from the National Health and Nutrition Examination Survey (NHANES), administered by the Centers for Disease Control, which included 3,406 female participants aged 40 years or older from across the United States who completed the survey's vision and reproductive health questionnaire and underwent eye exams. It found that females who had used oral contraceptives, no matter which kind, for longer than three years are 2.05 times more likely to also report that they have the diagnosis of glaucoma.

Although the results of the study do not speak directly to the causative effect of oral contraceptives on the development of glaucoma, it indicates that long-term use of oral contraceptives might be a potential risk factor for glaucoma, and may be considered as part of the risk profile for a patient together with other existing risk factors. These include factors such as African American- ethnicity, family history of glaucoma, history of increased eye pressure or existing visual field defects. Previous studies in the field have shown that estrogen may play a significant role in the pathogenesis of glaucoma.

"This study should be an impetus for future research to prove the cause and effect of oral contraceptives and glaucoma," said Shan Lin, M.D., lead researcher and professor of clinical ophthalmology at the University of California San Francisco. "At this point, women who have taken oral contraceptives for three or more years should be screened for glaucoma and followed closely by an ophthalmologist, especially if they have any other existing risk factors."

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New Study Shows That Womb Cancer Can Be Detected Early Using Easily Accessible Body Fluids

Dr. Enrique Jacome

A new study, funded by The Eve Appeal and published this week in the open access journal PLOS Medicine^[i], has the potential to change the cancer landscape by being able to accurately identify individuals with early stage womb cancer using easily accessible body fluids.

By collecting swabs from the entrance to the womb genetic material can be easily analysed for pre-cancer/cancer without the need for an invasive womb biopsy.

How does this work?

Epigenetic^[ii] changes to the HAND2 gene have, for the first time by the team of researchers, been shown to play a critical role in the development of womb cancer. HAND2 is active in the healthy womb lining where it prevents the growth-inducing effects of oestrogen. By contrast, in more than 90% of womb cancers, the HAND2 gene has undergone epigenetic changes - that effectively turns it off - leading to cancer-prone tissue.

These epigenetic changes offer the opportunity to detect endometrial cancer much easier and potentially also earlier. Worryingly, womb cancer is the most common gynaecological cancer, particularly in the wake of the current ageing and obesity epidemics.

The researchers suggest - after additional trials have confirmed these results - that this technique can be used as a test, or to screen women for womb cancer. Early detection will save lives. 

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Pelvic Pain In Women Often Goes Underreported, Untreated

Dr. Enrique Jacome

Although many women experience pelvic pain in their late teens and early 20s, a new University of Florida Health study indicates that only a small fraction of these women report their symptoms to their doctors and seek treatment, leaving some health problems unresolved.

Up to 72 percent of the women who responded to the survey reported experiencing pelvic pain in the past year, yet nearly three-quarters of them did not seek treatment from a physician. The study was published in the November issue of the Journal of Minimally Invasive Gynecology and was presented at the Society of Laparoendoscopic Surgeons meeting in August.

Led by Nash Moawad, M.D., the researchers surveyed 2,000 women and received nearly 400 responses. Almost 80 percent of respondents had reported painful periods, nearly one-third reported painful sexual encounters and one-fifth reported pain in external genitalia.

Some of the reasons women reported not talking to their doctors about the pain included embarrassment, difficulty with insurance or making appointments, or a lack of empathy and understanding from physicians.

"But a big part of the problem is that women often don't realize their pain is abnormal," said Moawad, the director of the Center of Excellence for Minimally Invasive Gynecology at UF Health.

"There is a significant lack of awareness about pelvic pain in general," Moawad said. "Some women thought their pain was normal. They think that is how periods are supposed to be. But if you are missing days from school or work or have to cancel activities, that is striking. No pain should ever be that severe. If a woman has to take narcotics for pain, or if she has had to drop out of classes, that is not normal. She should see a physician."

Aside from painful periods, other examples of conditions that cause pelvic pain include endometriosis, which occurs when the uterine lining begins to grow outside the uterus, usually on the ovaries or bowels; ovarian cysts; interstitial cystitis; irritable bowel syndrome and urinary tract infections.

Endometriosis, for example, is often described as an extremely painful condition, yet it typically takes women five to 15 years to receive a diagnosis for it, Moawad said.

It's important that women get treatment for pain, because aside from the obvious effects, pain also affects women's overall health and how they feel about themselves. The researchers found that women who reported higher levels of pain also reported having a lower overall quality of health. They reported a greater number of sad days and had more irregular sleep patterns, too.

"There is a big difference between those with pain and those without pain and their perception of their own health and how it affects their daily activities," Moawad said.

The study was the first of its type and examined pelvic pain and health in a group of college-educated women, a group that typically has access to medical care and is in good health. Studies examining how pelvic pain affects women in lower socioeconomic groups, who typically have less access to medical care, could reveal that pelvic pain is even more problematic for women, Moawad said.

"Women need to understand they do not need to wait so long to get help," Moawad said. "There are ways to diagnose and treat these conditions."

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Pesticide Exposure Linked To Increased Endometriosis Risk

Dr. Enrique Jacome

Endometriosis is a common condition that affects around 10% of women in their reproductive years. New research has found that two organochlorine pesticides - once widely used in the US for pest control and agriculture but now banned - are linked to an increased risk of the chronic condition.

Researchers from Fred Hutchinson Cancer Research Center in Seattle, WA, published the results of their study inEnvironmental Health Perspectives, a journal of the National Institute of Environmental Health Sciences (NIEHS).

They note that though endometriosis is noncancerous, it is characterized by tissue - which normally lines the inside of the uterus or womb - growing outside and attaching to other areas or organs, affecting the ovaries, fallopian tubes and lining of the pelvic cavity.

Common symptoms typically include painful menstrual periods, pelvic pain and infertility.

Kristen Upson, PhD, a study author who is now a postdoctoral fellow at the Epidemiology Branch of the NIEHS, says:

"For many women, the symptoms of endometriosis can be chronic and debilitating, negatively affecting health-related quality of life, personal relationships and work productivity."

Because endometriosis is a condition led by estrogen, Upson notes that they "were interested in investigating the role of environmental chemicals that have estrogenic properties, such as organochlorine pesticides, on the risk of the disease."

Pesticides raise endometriosis risk to 30-70%

In the US, certain pesticides that are no longer in use are still in blood samples of women today, and this recent study links the chemicals to an increased risk of endometriosis.

According to the US Geological Survey (USGS), organochlorine pesticides are man-made chemicals that were used in the recent past for agricultural and household pest problems.

Dichlorodiphenyltrichloroethane (DDT) is one of the most well-known organochlorines, and it was "heavily applied in agricultural regions," says the USGS. Although these types of pesticides are no longer used in the US, the organization notes that they are still present in the environment.

To conduct their study, the researchers used data from the Women's Risk of Endometriosis study, which is a population-based case-control study of endometriosis in women aged 18- to 49-years-old.

There were 248 women who had recently been diagnosed with endometriosis and 538 women without the condition who served as controls.

Results of the research showed that women who had higher exposures to two organochlorine pesticides - beta-hexachlorocyclohexane and mirex - had a 30-70% increased risk of endometriosis.

The study authors say they found it interesting that these types of chemicals were found in the blood samples of women from the study, despite the fact that organochlorine pesticides have been banned in the US for several decades.

"The take-home message from our study," says Upson, "is that the persistent environmental chemicals, even those used in the past, may affect the health of the current generation of reproductive-age women with regard to a hormonally driven disease."

'Another piece of the puzzle'

This research is important, say the authors, because the medical community still does not entirely understand why some women develop endometriosis while others do not.

Study co-author Prof. Victoria Holt adds that their study "provides another piece of the puzzle."

They point to other lab studies of human tissue that have shown organochlorine pesticides display "estrogenic properties" and "adverse reproductive effects," which can alter the uterus, ovaries and hormone production.

"Given these actions," says Upson, "it's plausible that organochlorine pesticides could increase the risk of an estrogen-driven disease such as endometriosis."

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New Survey Show Fibroid Sufferers Delay Seeking Treatment

Dr. Enrique Jacome

A newly published survey of nearly 1,000 US women with uterine fibroids shows that fear and lack of knowledge about treatment options may be preventing them from seeking treatment.

Uterine fibroids are common, non-cancerous tumors of the uterine muscle (myometrium) consisting of smooth muscle cells and connective tissue. A woman may have one fibroid or groups of several fibroids, and they can range in size from less than 1 inch to more than 8 inches across.

The study, conducted by leading fibroid experts from the Mayo Clinic, the Cleveland Clinic and the University of North Carolina, sheds new light on the impact, prevalence and treatment concerns related to uterine leiomyomas (fibroids).

The large-scale, racially diverse survey of symptomatic US women aged 29 to 59 - spanning childbearing age to menopause - is the first of its kind.  

Dr. Elizabeth A. Stewart, lead author of the study, said:

"Our study shows that women suffer too long before seeking treatment. This can narrow their range of effective options. Women are concerned about missing work and not reaching their career potential due to their symptoms, and they strongly desire noninvasive treatment options that preserve the uterus and fertility."

Leading cause of hysterectomy

Uterine fibroids are benign tumors in the uterus, which affect up to 80% of women by the age of 50. They are the leading cause of hysterectomy in the US - nearly half of the 600,000 hysterectomies performed each year in the US are for uterine fibroids and abnormal bleeding. 

Hysterectomies involve permanent removal of the uterus, which prevents fibroid recurrence but also results in loss of reproductive potential and many possible side effects, including early menopause and urination and defecation disorders.

Dr. Stewart, Professor of Obstetrics and Gynecology and Chair of the Division of Reproductive Endocrinology at the Mayo Clinic, added:

"Many people are unaware that the vast majority of women will experience uterine fibroids in their lifetime. This condition can cause significant morbidity for those who are symptomatic"

Assessing the results

The survey assessed diagnosis, information-seeking behaviors, attitudes about fertility, impact on work and treatment preferences among women living with uterine fibroids for an average of nearly 9 years. 

Key findings of the survey include:

• The mean amount of time women delayed seeking treatment was 3.6 years, with 32% of women waiting more than 5 years
• Most reported fears associated with their fibroids, including being afraid that they will grow (79%) and that they will need a hysterectomy (55%), as well as fears regarding relationships, sexual function, body image, loss of control and hopelessness
• Two-thirds (66%) of women were concerned about missed days from work due to their symptoms, and 24% of employed respondents felt that their symptoms prevented them from reaching their career potential
• The vast majority said they prefer a minimally invasive treatment option that preserves the uterus.

Justine Atkinson, Executive Director of Fibroid Relief, said:

"We were alarmed to find that this survey demonstrates a dangerous delay in diagnosis that may unnecessarily advance women's fibroid growth and rob them of less invasive treatment choices."

When presented with treatment descriptions, the majority of women surveyed (60%) rated focused ultrasound as their top treatment choice.

Focused ultrasound treatment, which has been available to US fibroid patients since 2004 and is the first noninvasive treatment option for this condition, uses high intensity sound waves to heat and destroy uterine fibroid cells while leaving surrounding tissue intact. It is an outpatient procedure that involves no incisions and enables many women to return to normal activity in 1 or 2 days.

Other treatment options include hormone therapy and myomectomy where the fibroids are surgically removed from the uterine wall.   

African-American women sub-study

A sub-study of 268 African-American women, published in the Journal of Women's Health this month, found that they have more severe symptoms, unique concerns and different information-seeking behavior for fibroids.

   Key findings of the sub-study include:

• African-American women were significantly more likely to have severe or very severe symptoms, including heavy or prolonged menses and anemia
• They more often reported that fibroids interfered with physical activities and relationships, and were more likely to miss days from work 
• One-third (32%) of black women waited more than 5 years before seeking treatment for their fibroids, compared with only 17% of white women; similarly, while 43% of white women say they sought treatment within 1 year or less, only 20% of African-American women did the same
• Concerns for future fertility and pregnancy were key concerns for black women; 71% said preserving the uterus was very important or important, versus 41% of white women.

Dr. Linda Bradley, Professor of Surgery at the Cleveland Clinic, said:

"This study has shown us that the burden of uterine fibroids is even more extensive for black women compared to white women than previously reported. In addition, we were alarmed to find that African-American women, despite their far more severe symptoms, report significant delays in seeking treatment compared to white women. The real-world consequences of these findings cannot be ignored."

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Finnish Study Finds Association Between Eating Disorders And Reproductive Health Problems

Dr. Enrique Jacome

According to a Finnish study, women with eating disorders are less likely to have children than others in their age group. The discrepancy is the most apparent in anorexia sufferers. In this group, the number of pregnancies was less than half of that of the control group.

The likelihood of abortion was more than double for bulimics than for others in the same age group. Meanwhile, the likelihood for miscarriage was more than triple forbinge-eating disorder (BED) sufferers. For women who had been in treatment for BED, nearly half of their pregnancies ended in miscarriage.

"Early recognition, effective care and sufficiently long follow-up periods for eating disorders are crucial in the prevention of reproductive health problems," states researcher Milla Linna from the University of Helsinki, Hjelt Institute.

Eating disorders are common in Western countries, particularly among girls and young women. It has been estimated that 5-10% of all young women in developed countries suffer from an eating disorder at some point in their lives.

Conducted jointly by the University of Helsinki and the National Institute for Health and Welfare, the 15-year register-based study examined the reproductive health of patients treated at the eating disorder clinic of the Helsinki University Central Hospital in 1995-2010 and a control group. Members of the control group were of the same age and gender and from the same region as the patients. More than 11,000 women participated in the study, of which 2,257 were patients of the eating disorder clinic and 9,028 were control group members.

"This study does not provide an explanation for the reproductive health problems observed in women with eating disorders. Based on previous research, however, it seems likely that the problems can at least partially be attributed to the eating disorder. Both being underweight and obese are known to be associated with the increased risk of infertility and miscarriage. Eating disorders also often involve menstrual irregularities or the absence of menstruation, which may lead to neglecting contraception and ultimately to unwanted pregnancies," hypothesises Linna.

A follow-up study is currently underway, focusing on the course of the pregnancies and deliveries of women who have had eating disorders.

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Insertable Ring Could Prevent HIV In Women

Dr. Enrique Jacome

Scientists from Northwestern University have developed a new intravaginal ring that they say could help prevent women from being infected with HIV. The device is easily inserted and remains in place for 28 days, delivering a measured amount of the anti-retroviral tenofovir directly to the site of transmission.

HIV affects an estimated 34 million people around the world. In 2011, 2.5 million people were newly diagnosed, and in sub-Saharan Africa, women make up 60% of people living with HIV/AIDS.

Preventative drugs do exist, but many have proved ineffective, especially in developing countries where financial and cultural barriers interrupt their use.

Previous studies have shown that antiviral drugs can prevent HIV infection, but existing delivery methods often fall short: pills need to be taken daily and in high doses, while vaginal gels have to be applied before each sex act, making them inconvenient.

However, the researchers from Northwestern University believe they have found an answer with their new device.

Visiting associate professor Patrick Kiser, an expert in intravaginal drug delivery, claims the ring is easy to use, long-lasting and extremely effective. He says:

"After 10 years of work, we have created an intravaginal ring that can prevent against multiple HIV exposures over an extended period of time, with consistent prevention levels throughout the menstrual cycle."

Unique construction

The ring has a unique polymer construction, which allows its elastomer to swell in the presence of fluid, delivering up to 1,000 times more of the drug than current intravaginal devices. 

Based on its success in preventing transmission of simian immunodeficiency virus (SIV) in macaques, the ring - known as a TDF-IVR (tenofovir disoproxil fumarate intravaginal ring) - will be tested in a clinical trial at the Albert Einstein College of Medicine in New York in November.

Sixty women will be fitted with the ring, and the trial will assess its safety and measure how much of the drug is used.

Other drugs could be integrated in the TDF-IVR, such as contraceptives and antiviral drugs, to prevent other sexually transmitted diseases, which Kiser believes could increase user rates.

"The flexibility to engineer this system to deliver multiple drugs and change release rates is extraordinary and could have a significant impact on women's health," he says.

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Clinical Trial Strives To Provide Optimal Care During High-Risk Pregnancies With Smaller Than Normal Babies

Dr. Enrique Jacome

Researchers are conducting a clinical trial to help determine the best timing of delivery in preterm pregnancies complicated by poor fetal growth. Preliminary results from the trial, which are published early online in Ultrasound in Obstetrics & Gynecology, demonstrate better than expected health outcomes in this high-risk group of fetuses.

Doctors are faced with a dilemma when deciding about the timing of delivery of a baby who does not grow adequately as a fetus, a condition called fetal growth restriction. To deliver early potentially exposes the baby to risks associated with being born immature, but to deliver late risks allowing other serious problems to develop due to a lack of nourishment and oxygen in the womb.

Doctors usually decide on the timing of delivery for a small baby in a high-risk pregnancy based on what they feel might be best for the baby, but without a solid basis in scientific facts.

Researchers designed a study - called the Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE) - in an attempt to help determine the best timing of delivery in preterm pregnancies complicated by fetal growth restriction. The study compares three groups of patients. In one group, the timing of delivery was based on monitoring the baby's heart rate. In the other two groups, timing was based on changes in the Doppler ultrasound measurement of one of the baby's blood vessels. A standardized prenatal monitoring and delivery protocol was used for all women in the trial. Ultimately, the investigators hope to determine which monitoring practice is best for safeguarding development by measuring babies' neurological health at age two years.

In the meantime, the researchers now report early results from TRUFFLE performed in 20 European centers. The analysis includes 503 women who were pregnant for less than 32 weeks and whose babies were smaller than would be expected. The results revealed better health outcomes for the babies compared with recent reports: deaths were uncommon (8%), and most of the babies (70%) survived without severe health problems. Women withhypertension were at increased risk of having babies who died before or after birth or who had health issues.

"Although the effects of the different fetal monitoring practices on long-term neurodevelopment are not yet known, these management protocols would help effect a reduction in perinatal mortality and short term morbidity in pregnancies complicated by severe, early-onset fetal growth restriction," said lead investigator Chistoph Lees, MD of Queen Charlotte's & Chelsea Hospital, London. "This is the largest prospective study of outcomes in pregnancies complicated by severe, early-onset fetal growth restriction showing that, at least in part, a standardized antenatal management protocol was responsible for the improved neonatal outcomes," said co-author Basky Thilaganathan, MD, PhD, and Editor-in-Chief of Ultrasound in Obstetrics & Gynecology.

Dr. Lees noted that the two-year outcomes of the babies in the study will be available in 2014, which may provide clues about what management and monitoring strategy is best to optimize long term neurodevelopmental outcome.

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