Women's Newsletter
February 6, 2017
When we are no longer able to change a situation, we are challenged to change ourselves.
                                                            -- Viktor Frankl
In this Issue
• 2.5 Million U.S. Women Have Condition That Can Cause Infertility
• Many Breast Cancer Survivors Don't Get Life-Extending Therapy
• Heart Risks May Boost Women's Colon Cancer Risk, Too
• Better Sleep Could Mean Better Sex for Older Women



2.5 Million U.S. Women Have Condition That Can Cause Infertility

Pelvic inflammatory disease often caused by sexually transmitted infections, CDC experts say

FRIDAY, Feb. 3, 2017 (HealthDay News) -- About 2.5 million American women have had pelvic inflammatory disease, an often-symptomless infection of the reproductive tract that can cause infertility and lasting abdominal pain, a new U.S. government report shows.

Scientists also found that those who had 10 or more male sex partners experienced pelvic inflammatory disease three times as often as women with a single partner.

The culprits in most cases of pelvic inflammatory disease, or PID, are the sexually transmitted diseases (STDs) chlamydia and gonorrhea, researchers said. Overall, about 4.4 percent of American women said they'd been diagnosed with PID.

Pelvic inflammatory disease tends to be a later "complication of having a prior sexually transmitted infection, and given that there are such high numbers of chlamydia and gonorrhea infections in the U.S., it means a lot of women are at risk," said study author Kristen Kreisel. She's an epidemiologist with the Division of STD Prevention at the U.S. Centers for Disease Control and Prevention.

"Pelvic inflammatory disease can be treated, as well as the STD that caused it, but the structural damage that occurs because of PID is often irreversible," Kreisel said. "That's why it's important to stay on top of it."

Chlamydia and gonorrhea are the most commonly reported STDs in the United States. About 1.5 million chlamydia and 400,000 gonorrhea infections were reported in 2015. These infections often don't cause symptoms and may go undiagnosed and untreated, according to the study.

When symptoms do appear, they may include abnormal vaginal discharge or a burning sensation during urination.

Pelvic inflammatory disease symptoms may include persistent abdominal pain, fever, abnormal vaginal discharge, or pain or bleeding during sexual intercourse, Kreisel said.

PID poses long-term hazards such as infertility, chronic pelvic pain and ectopic pregnancy. Ectopic pregnancies occur when an embryo implants in the fallopian tube instead of the uterus.

No single test can diagnose PID, so doctors often rely on symptom reporting. But PID often doesn't cause symptoms, Kreisel explained. "That's one of the scariest things because you may not know it's even happening," she said.

The researchers used information from the U.S. National Health and Nutrition Examination Survey from 2013 to 2014. This survey included nearly 1,200 women between the ages of 18 and 44.

The study didn't find any significant differences in PID prevalence by age, race, ethnicity or socioeconomic factors.

Pelvic inflammatory disease prevalence, however, was significantly higher among women whose sexual behaviors placed them at greater risk for contracting STDs. These behaviors included having sex with multiple partners and not using condoms.

Dr. Matthew Hoffman is chair of obstetrics and gynecology at Christiana Care Health System in Wilmington, Del.

Hoffman said that, in addition to using condoms, progesterone-containing birth control pills or intrauterine devices (IUDs) can also help reduce the risk of developing pelvic inflammatory disease. He wasn't involved in the study.

Hoffman explained that progesterone-containing birth control pills or IUDs can help thicken cervical mucus, hindering bacteria from moving further into the reproductive tract.

Kreisel and Hoffman agreed that sexually active women under age 25 should be screened annually for STDs. That process usually involves a vaginal swab or a urine test. Treatment for gonorrhea and chlamydia typically includes antibiotics.

"There's some data that if symptoms are treated early, it may result in better fertility outcomes," Hoffman added.

The study findings was published Jan. 27 in the CDC's Morbidity and Mortality Weekly Report.

More information

The U.S. National Library of Medicine offers more information about pelvic inflammatory disease, or PID.

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Many Breast Cancer Survivors Don't Get Life-Extending Therapy

Study estimates nearly 15,000 lives saved over decade if all who needed hormone treatment got it

THURSDAY, Feb. 2, 2017 (HealthDay News) -- Hormonal therapies such as tamoxifen, or a class of drugs called aromatase inhibitors, can reduce the likelihood that women diagnosed with certain breast cancers will experience a recurrence of their disease.

However, a new study finds these treatments -- used in breast cancers that are responsive to hormones such as estrogen -- are too seldom utilized or often used incorrectly.

According to the research team, if all U.S. breast cancer survivors who needed them followed recommendations for hormone therapy, that could mean almost 15,000 lives saved over a decade.

Unfortunately, these drugs are "still underused, and in some cases, misused -- offered to patients who lack [estrogen] hormone receptors" on their tumor cells, explained study senior author Dr. Dezheng Huo. He's associate professor of public health sciences at the University of Chicago.

As the researchers explained, hormonal therapies are associated with a 29 percent lower risk of death for women with hormone receptor-positive breast cancer.

The treatment involves drugs such as tamoxifen or aromatase inhibitors that block hormones and prevent cancer from coming back. These drugs work by slowing or stopping the growth of tumors that feed on certain hormones. Patients are encouraged to take these pills daily for at least 10 years.

The study involved nearly one million women with hormone-sensitive breast cancers who were included in a nationwide cancer registry. Of these women, one out of six who should have had post-surgical hormonal treatments never received them.

The study authors estimated that 14,630 women who did not get the recommended hormone therapy went on to die from a recurrence of their cancer between 2004 and 2013. These deaths could have been prevented, Huo's team suggested.

There was some good news, however: During the study period, adherence to guidelines on the use of the drugs did improve, the investigators found.

Their use "slowly gained popularity over this time," Huo said in a university news release. "It improved after 2004, rising from 70 percent in 2004 to almost 84 percent in 2011. Then it declined slightly to 82 percent in 2013, when the study ended."

Still, 18 percent of women who could have benefited from this treatment were not receiving it by the end of the study, the researchers noted. Also, about 3 percent of women received the therapies inappropriately, where they might not have been indicated for their particular breast cancer type.

There are some downsides to hormonal treatments, the researchers noted. The drugs may cause unpleasant side effects, such as nausea or hot flashes, which may help explain why they are underused.

Other risks vary by the type of drug. For example, patients taking tamoxifen are at greater risk for stroke, while those on aromatase inhibitors are more likely to develop osteoporosis, Huo's group noted.

The researchers also stressed that the long-term survival benefits of hormonal therapy after breast surgery are tough for the average patient to recognize -- the benefits aren't immediate and noticeable. That might also influence women's decisions on whether to continue the therapy.

Some women are also more likely than others to adhere to the therapy, the study found. Those groups include women who underwent breast surgery, or those treated at a large hospital. Asian and white women were also more likely than black or Hispanic women to continue their therapy, the research showed.

The findings were published Feb. 2 in JAMA Oncology.

More information

The U.S. National Cancer Institute has more on hormone therapy and cancer.

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Heart Risks May Boost Women's Colon Cancer Risk, Too

This was true even in normal-weight women, study suggests

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- Even normal-weight women may be at greater risk for colon cancer if they have certain traits, such as elevated levels of blood fat, high blood sugar, high blood pressure and low levels of good cholesterol, a new study suggests.

Among older women of normal weight, those with so-called metabolic risk factors had a 49 percent increased risk for cancers of the colon, rectum and sigmoid colon (the lower part of the intestine connecting the rectum and colon) compared with healthy counterparts.

Current guidelines recommend colon cancer screening primarily based on a person's age. But identifying at-risk individuals by their metabolic type could help prevent these cancers and catch them at an earlier stage, saving more lives, the study authors concluded.

The takeaway: "Know your own metabolic health, even if your weight is normal," said Juhua Luo, the study's senior author. She's an associate professor of epidemiology and biostatistics at Indiana University Bloomington's School of Public Health.

Candyce Kroenke, a research scientist at Kaiser Permanente Northern California and a study co-author, said the findings "further point to the need for better measures than BMI [body mass index] to assess health risks." Body mass index is a rough estimate of a person's body fat based on height and weight measurements.

The study involved normal-weight postmenopausal women, aged 50 to 79.

It's reasonable to suspect that the findings may apply to men or younger women, too, Luo said. "But we would need additional study to answer this for sure," she added.

Dr. Andrew Chan is a gastroenterologist and associate professor of medicine at Harvard Medical School in Boston. He agreed that the findings suggest that other factors beyond weight may be independently associated with colon cancer.

"It's really hard to prove cause and effect with this type of study, but it does raise some interesting questions," said Chan, who wasn't involved in the research.

Excluding skin cancers, colon cancer is the third most common cancer diagnosed in women and men in the United States, the American Cancer Society says.

The "absolute" risk of developing colon cancer over a specified period of time varies by age, sex and other risk factors. The U.S. Centers for Disease Control and Prevention says a 50-year-old woman has a 2 to 3 percent chance of having colon cancer over the next 30 years. A 60-year-old male has a 4 percent chance of developing it over the same three-decade period.

While being overweight or obese is a known risk factor, few studies have examined colon cancer risk among people with unhealthy metabolic factors, especially in normal-weight individuals, the study authors noted.

Having "metabolic syndrome" means you have three or more of these traits: high blood pressure, high triglycerides (a type of blood fat), high blood sugar, low levels of good HDL cholesterol and a large waist measurement.

Thirty percent of normal-weight adults worldwide are believed to be metabolically unhealthy, according to lead study author Dr. Xiaoyun Liang of Beijing Normal University in China.

The research team's analysis involved more than 5,000 women enrolled in the Women's Health Initiative, a 15-year study led by the U.S. National Institutes of Health.

Women with a body mass index of 18.5 to less than 25 are considered normal weight. Someone who's 5 feet 6 inches tall and weighs 142 pounds would have a BMI of about 23, according to the CDC.

One-third of the women in the study were deemed metabolically unhealthy, meaning they had two or more risk factors of metabolic syndrome. The researchers didn't include waist measurement as one of the factors.

After adjusting for factors that affect cancer risks, women with metabolic syndrome had more than a twofold higher risk of colon and rectal cancers compared with metabolically healthy women, the findings showed.

Why these women seem at higher risk isn't clear. It's possible that poor metabolic health may promote inflammation in the body that boosts cancer risk, the study authors suggested.

Chan said it's becoming clear that risk factors for heart disease may overlap with risk factors for many types of cancer. "So I think that gives people an additional reason for really thinking about trying to maintain a healthy lifestyle," he said.

More information

Learn more about metabolic syndrome from the U.S. National Institutes of Health.

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Better Sleep Could Mean Better Sex for Older Women

Study found links between too little shuteye and less sexual satisfaction, especially around menopause

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- A more satisfying sex life may be only a good night's sleep away for women over 50, new research finds.

Researchers led by Dr. Juliana Kling of the Mayo Clinic in Scottsdale, Ariz., tracked data from nearly 94,000 women aged 50 to 79.

The investigators found that 31 percent had insomnia, and a little more than half (56 percent) said they were somewhat or very satisfied with their sex life.

But too little sleep -- fewer than seven to eight hours a night -- was linked with a lower likelihood of sexual satisfaction, the findings showed.

"This is a very important study since it examines a question which has tremendous potential impact on women's lives," said Dr. Jill Rabin, who reviewed the findings. She's co-chief of the Women's Health Program at Northwell Health in New Hyde Park, N.Y.

Age played a key role in outcomes. For example, the study found that older women were less likely than younger women to be sexually active if they slept fewer than seven to eight hours per night.

Among women older than 70, those who slept fewer than five hours a night were 30 percent less likely to be sexually active than women sleeping seven to eight hours, Kling's team found.

The findings highlight how crucial sleep is to many aspects of women's health, medical experts said.

"Seven hours of sleep per night will improve sexual satisfaction and has been shown to increase sexual responsiveness," said Dr. JoAnn Pinkerton, executive director of The North American Menopause Society.

Besides putting a damper on sex lives, she said, poor sleep is also tied to an array of health issues, such as "sleep apnea, restless legs syndrome, stress and anxiety." Other health problems linked to insomnia include "heart disease, hypertension [high blood pressure], arthritis, fibromyalgia, diabetes, depression and neurological disorders," Pinkerton added.

Dr. Steven Feinsilver directs sleep medicine at Lenox Hill Hospital in New York City. He reviewed the new findings and stressed that they can't prove cause and effect. "It certainly could be possible that many underlying problems -- for example, illness, depression -- could be causing both worsened sleep and worsened sex," he noted.

Rabin agreed, but said there's been "a paucity of studies" looking into links between sleep and sexual health, especially during menopause.

"We know that obstructive sleep apnea and sexual dysfunction are positively correlated," she said. "Other factors which may lead to a decreased sleep quality include: a woman's general health; various life events, which may contribute to her stress; chronic disease; medication; and degree and presence of social supports, just to name a few," Rabin explained.

And, "in menopause, and due to the hormonal transition, women may experience various symptoms which may impact the duration and quality of their sleep patterns," Rabin added.

"We and our patients need to know that quality sleep is necessary for overall optimum functioning and health, including sexual satisfaction, and that there are effective treatment options -- including hormone therapy -- which are available for symptomatic women," she said.

The study was published online Feb. 1 in the journal Menopause.

More information

The U.S. National Institute on Aging has more about sexuality later in life.

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