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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