December 12, 2011

Ovary Preservation: Know the Risks and Benefits

Helen Greco, MD

About 15 percent of premenopausal women with hysterectomy experienced ovarian failure after four years of follow-up, compared with eight percent of women who did not undergo the surgery, according to the journal Obstetrics and Gynecology. It is unclear whether these findings are attributable to the surgery or the underlying condition that led to it.

Keeping the ovaries intact when undergoing a hysterectomy is a very personal decision. What needs to be put in perspective is the risk of dying from ovarian cancer compared to heart disease or osteoporosis, which are basically caused by low levels of estrogen.

Significantly, postmenopausal ovaries still produce estrogen and testosterone (testosterone is converted into a weak estrogen in fat)--though at much lower levels. Younger women with the BRCA mutation for breast or ovarian cancer may benefit from oophorectomy (surgical removal of the ovaries). But those with average risk for these cancers have increased risk of heart disease and osteoporotic fractures upon removal of the ovaries.

In 2011, ovarian cancer caused 15,460 deaths in the US. But 42 million American women have heart disease or are at risk for it, and 432,709 die from it annually. One in three women over 50 suffer from an osteoporotic fracture. The lifetime risk of developing ovarian cancer is 2.1 percent after hysterectomy and 2.7 percent in the general population. Full Post - to Detail View

October 13, 2011

Folate Is Good for Neurodevelopment

Jill Rabin, MD

The latest edition of the Journal of the American Medical Association expands upon the accepted wisdom of the benefits of women taking folic acid (also called folate) before conception and during pregnancy.

Among a group of Norwegian mothers and children, the mothers’ use of folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at age 3 years. The study showed that the children of mothers who took folic acid before conception and in early pregnancy had a 45 percent lower risk of the language disability.

Obstetricians/gynecologists know that folate is good. This new study shows that there may be an additional benefit of folate supplementation in the pre and peri-conceptional period for early childhood language development, although additional studies are certainly needed. For now, there’s no reason for expectant mothers to change their current regimen—just keep taking your folate.

 

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July 05, 2011

IUDs: Effective for Most Women of Reproductive Age

Jill Rabin, MD

IUDs (intra-uterine devices) and hormonal implants are among the most effective reversible birth control available, according to a Practice Bulletin recently released by the American Congress of Obstetricians and Gynecologists.

ACOG reflects the experience of many practitioners, including myself: IUDs are safe for use by many reproductive-age women. The unwanted pregnancy rate associated with IUDs is extremely low, and contraception is the initial reason most women use them. IUDs are safe and efficacious, including in women who haven’t had children.

While copper IUDs can remain in place for up to 10 years and hormonal IUDs up to five, it’s important to know that any IUD can be removed at any time. Potential side effects of hormonal IUDs include mood changes, acne, headaches, breast tenderness, pelvic pain and nausea. Copper IUDs have the additional possible side effects of cramping and increased bleeding during menstruation.

The hormonal implant is a small, rod-shaped unit (about the length of a matchstick) that is inserted under the skin of the upper arm. It releases a progestin hormone which suppresses ovulation for up to three years. With a pregnancy rate of .5 percent, it is the most effective method of reversible contraception available today. It is also one of the most under-utilized. Full Post - to Detail View