Category Archives: Women’s Health Week

An ancient imaging system proves to be an amazing cure for infertility!

Towards the end of the work week, Medical News Today revealed a story that looks like a miracle and something out of science fiction simultaneously. Infertility is a huge problem, with expensive, whose treatments are temperamental to say the least, fraught with emotional travails for families and other complicating issues.

And now, a single study appears to upend the problems and probably offer a simple, cost effective solution that will beat infertility right out of the cliched ball park! It is probably imprudent to get so excited, but it is hardly resistible.

Old techniques have gotten a second look in the past. Some of these techniques were trial and error prone, and many times the underlying science has not been understood. Renal Denervation is one such technique. With a surprising and incredible purchase of Ardian by Medtronic, it caused a frenzy, only to be let down by a poorly designed clinical trials. I have seen similar comebacks on old studies that controlled the Over Active Bladder condition. Therefore, one should look at any revivals of old techniques with ample caution.

Interesting Coincidences

Dr. Ben Mol, a Professor at Australia who spearheaded the study into an age old imaging technique as a possible treatment, appears to have been conceived as a result of this imaging treatment and has a younger brother! It seems remarkable that he started research intot his technique even before being made aware of his own history and relationship with the technique. Please refer to the MNT link below for more on this.

The Technique – Hysterosalpingography (HSG)

The technique, whose name is a mouthful, simply refers to imaging of the hystero, the uterus and salpingo, the fallopian tube. It was first carried out exactly 100 years ago, in 2017, just a few years after X-rays came into existence.

The procedure itself is a dye test, performed under X-ray. Water or oil are used to flush the Fallopian tubes. It is the flushing that appears to have aided fertility. In view of this notion, Dr. Ben Mol and others led a study with 1119 women, that produced interesting results.

The Study

The study, titled H2Oil was held in Netherlands, and as mentioned before, recruiting 1119 women, approximately half received HSG with oil, and as MNT put it, Lipidoil Ultra-Fluid, an iodized solution of fatty acids derived from poppy seeds.

The other half received HSG with water.

The Results

Nearly 40% of the women in the oil group, and 29% in the water group all conceived within 6 months. This is an amazing result. It shows immense promise.

Of course, more needs to be known, as I mentioned before. An underlying understanding of science, safety of flushing fallopian tubes and other important, fundamental considerations remain. However, for women and families struggling with infertility, this study shows great promise.

References: 

  1. The MNT Article: http://www.medicalnewstoday.com/articles/317532.php
  2. The NEJM Publication: http://www.nejm.org/doi/10.1056/NEJMoa1612337
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/close-up-of-hands-holding-baby-feet-325690/

Hand Osteoarthritis risk higher in women

Medscape reported on a study published on May 8 in the Journal, Arthritis and Rheumatology, that examined data collected from 1999 to 2010 to arrive at a risk prediction for women, with respect to osteoarthritis of the hand.

The Study

The study appears to be a retrospective evaluation of over 2000 people over the age of 45, in North Carolina. They used self-reports of arthritic symptoms and the participants’ X-ray imagery of the hands.

Results

For the overall population, the risk for osteoarthritis in at least one had by the age of 85, is about 39.8%

Caucasians had a higher risk of 41% and African Americans 29%. I assume here that the sub-populations were equivalent or adjusted for.

Obesity ups the risk to 47%, compared to 36% among the non-obese.

In women, the risk is 47% as opposed to men, where it is 25%.

Pain

Pain is one of the key effects of osteoarthritis. The more people use their hands, the more the pain related to osteoarthritis of the hand. This makes day to day activities challenging and a huge burden on Quality of Life.

Fighting Back

As the medscape article rightfully points out, physical therapy, occupational therapy and other precautions can help women (and men) in preparing themselves for this condition, as life spans increase and we await more permanent cures (such as gene therapies, etc).

References:

  1. The medscape article: http://www.medscape.com/viewarticle/879943
  2. The publication summary: http://onlinelibrary.wiley.com/doi/10.1002/art.40097/abstract
  3. The Arthritis Foundation on Osteoarthritis: http://www.arthritis.org/about-arthritis/types/osteoarthritis/
  4. Image Courtesy, Pexels: https://www.pexels.com/photo/silhouette-woman-hand-holding-heart-shape-against-orange-sky-256809/

GOC2: A PRO study on open vs. minimally invasive endometrial cancer surgeries

MDedge and MDLinx separately alerted me to a very interesting study based on GOC 2 (Gynecological Oncology), a Canadian research program. In this particular study (cost comparisons  apparently will be reported separately – MDedge has a video of an interview of the study lead), open surgery for Endometrial Cancer was compared to laparoscopic and robotic surgery techniques. The study was reported at the Society of Gynecologic Oncology 2017 Meeting.

This study is another example where women were recruited across multiple sites, and they answered survey questions, and thus, is a Patient Reported Outcomes (PRO) study on Quality of Life (QOL) following procedures of varying invasiveness.

As a reference, Endometrial Cancer represents about 3.6% of all new cancer cases in the US, occurring as new cases in an estimated 61,380 women in 2017, with a projected mortality for about 10, 920 women. The 5 year survival rate is approximately 81.3%, making Quality of Life an important concern for survivors. An NCI link is available below if you wish to explore more.

The Current Study

Patients with confirmed stage I or stage II endometrial cancer  were recruited across 8 centers in Canada. 106 patients from the open surgery arm, and 414 from the minimally invasive surgery arm participated, with the breakdown amounting to 168 laparoscopic and 246 robotic surgery patients.

Approximately 80% of patients completed the QOL questionnaires. Only about 25 – 50% of the patients responded to the sexual-function questionnaires. Those responding were found to be young, pre-menopausal and sexually active.

The study itself was not randomized, but adjustments were made to accommodate this.

Also, quoting Dr. Ferguson from MDedge below, about sexual function:

Both of the surgical groups “met the clinical cutoff for sexual dysfunction” on the Female Sexual Function Index questionnaire, she said.

Results

The results can be viewed as three distinct sets:

  1. There was no statistical significance in QOL or sexual function, between laparoscopic and robotic procedures.
  2. At 3 weeks, patients in all groups fared better in terms of pain, but Quality of Life was worse for Open Surgery Patients. Novel to this study, this extended to the 3 month period as well, both clinically and statistically. (Please watch video on the MDedge link)
  3. While fewer patients responded to the questionnaires on sexual function, there was no significant difference between the open and minimally invasive surgery groups for up to 26 weeks. I am puzzled by this honestly. If you have reduced Quality of Life, your sexual function ought to be reduced. If it is not, then how would you have a significant difference in one case and not the other? The lower number of responses might be the confounding factor here, and honestly as the paper sits behind a paywall, there is only so much I can glean from reading articles and the abstract.

References:

  1. The MDedge Article (along with the video): http://www.mdedge.com/oncologypractice/article/134206/gynecologic-cancer/video-pain-and-impaired-qol-persist-after-open
  2. Abstract 51 from SGO: https://www.sgo.org/wp-content/uploads/2016/12/SGO-AM17-abstract_titles.pdf
  3. Some Endometrial Cancer Statistics: https://seer.cancer.gov/statfacts/html/corp.html
  4. Image Courtesy of Pexels: https://www.pexels.com/photo/woman-sitting-by-the-seashore-during-day-89820/

Total Body Fat Vs. Belly Fat in Breast Cancer Risk

I came across this very interesting study through a Medical News Today article (link below). The paper manuscript itself is free, but comes across as a little difficult to read on the downloadable PDF version , because of the way it appears to be output by the journal. However, it is always good to be able to access the full paper, and not simply the summary.

The premise

Among several risk factors, body fat is a breast cancer risk. There apparently have been contentions about where specific biomarkers that indicate breast cancer are produced, with some previous studies. This study has shown that overall weight loss is more beneficial in terms of breast cancer biomarker production reduction, rather than focusing on belly fat alone.

The current study

The current study is limited to post-menopausal women. Conducted in the Netherlands, 243 overweight women were recruited. They lost 5 – 6kg over a period of 16 weeks. A set of biomarkers, indicative of sex hormones, leptin and inflammation were compared before and after the weight loss. The fat changes themselves were measured using X-ray and MRI scans.

The latter appears to be important. The MNT article includes a statement that this study is different than previous ones that used waist measurements. I can see this being quite an important difference. X-rays and MRI scans definitely appear to be more fastidious methods of assessing fat changes, specific to a body region.

Results

Increased belly fat, according to Dr. Evelyn Monninkhof, the lead in the study indicates, increases the risk for several chronic diseases, independent of total body fat. She indicates however, that sex hormones, are more affected by total body fat and not just localized fat, as concluded from the study.

She also points that their next steps is to look at how to reduce levels of total fat and abdominal fat. This said, it appears that women, especially those postmenopausal and those approaching menopause can benefit from exercise and nutritional changes that lead to total fat loss, and hopefully, abdominal fat loss along the way. It is always important to contact licensed medical and/or nutritional professionals when considering exercise and/or dietary changes.

References:

  1. The MNT Article: http://www.medicalnewstoday.com/releases/317498.php
  2. The Endocrinology Paper: http://erc.endocrinology-journals.org/content/early/2017/05/16/ERC-16-0490.abstract?sid=9f3c9977-0e81-4583-bdf5-07b3f182f911
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/woman-with-umbrella-on-beach-247304/

Early Menopause and lack of child birth increase risks for Heart Failure

Heart Health in Women has many risk factors associated with it. A new study, another retrospective one, examined 28,516 women, who were enrolled as part of the Women’s Health Initiative (link below), a great effort that is now providing invaluable statistics that can be used to identify root causes and create awareness.

Eliminating all other known factors, such as BMI, smoking etc., two new factors popped up:

  1. Early Menopause
  2. Lack of pregnancy

They also identified that for every year’s worth of delay in menopause initiation, a woman’s heart failure rate drops by 1%. The other risk is caused by nulliparity, or lack of pregnancy. I am quoting directly here:

The latest study also found that women who had never given birth were 2.75 times more likely to have diastolic heart failure than women who had children.

The study authors did not establish a direct causal link, but they were able to identify a statistical link. The lead author did mention that polycystic ovary syndrome (a blog post for another day) has been known to increase cardiovascular risk. Diastolic Heart Failure happens when the heart is not able to pump enough blood to the body.

Study Limitations

Retrospective studies, especially ones based on efforts such as the Women’s Health Initiative, where large amount of data can be a treasure trove of information, just as this study has been. However, there are limitations. The current study only shows an association, not a causation, and no clues on the actual causation.

Such limitations however can be overcome by future studies, that focus on trying to identify causes.

Mitigating Circumstances

The more causes that are identified for the risk of heart failure, the better. Instead of considering these things in a negative light, women and doctors can better prepare ahead, taking precautionary measures ensuring a long and fruitful lifespan. It is also true that women in this century, prefer to make their life choices and therefore, knowing that avoiding pregnancy means a need to plan and prepare ahead for optimal health is always very good!

References:

  1. The study (sits behind a paywall): http://www.sciencedirect.com/science/article/pii/S0735109717367694
  2. The Guardian Article summarizing the study: https://www.theguardian.com/science/2017/may/15/earlier-menopause-puts-women-at-greater-risk-of-heart-failure-study-shows
  3. The Women’s Health Initiative: https://www.nhlbi.nih.gov/whi/
  4. Nulliparity: http://medical-dictionary.thefreedictionary.com/nulliparity
  5. A simple review of early menopausehttp://www.webmd.com/menopause/guide/premature-menopause-symptoms#1
  6. Diastolic Heart Failure: http://www.webmd.com/heart-disease/heart-failure/tc/diastolic-heart-failure-topic-overview#1
  7. Image Courtesy, Pexelshttps://www.pexels.com/photo/sunset-hands-love-woman-5390/

Obesity is a risk factor for IUD Expulsions

This is National Women’s Health Week. I am trying to highlight key health-related news all week. This night’s post also comes from the latest ACOG 2017 meeting from last week.

Obesity

Obesity is already a risk factor for various health conditions, such as diabetes, cardiovascular diseases and so on. For long term, reversible contraception, it is recommended that obese women opt for IUD over oral pills or patches, as the chances of venous thromboembolism is higher in obese and overweight women, than in women of normal weight. Please see referenced link below. It is an earlier paper by the same lead author/group as the current one, coming from Hawaii.

Weight classification, takes women and men from underweight to normal weight, overweight and obese. Within obesity, depending on waist size, the classification goes from Class I to Class III, representing extreme obesity. I have attached an NIH reference for your convenience.

It appears that in women with Class III obesity, IUDs can shift inside the uterus, also commonly termed IUD expulsion, at a higher rate than in women of other weight classes. This was the focus of the presentation at ACOG last week.

The current study

A retrospective cohort study, in Hawaii, with access to a diverse population including approximately a third each of Asian women and Native Pacific Islanders, has shown that obese women with Class III obesity have a risk, that is 3.06 times other women. Read other details in the paper summary and the article linked below.

Theories

The study itself was only performed, retrospectively to titrate risks. Some theories have been presented by the authors.

Placement itself might pose difficulties because of obesity.

Another risk of obesity is heavy menstrual bleeding, and therefore, IUD expulsions might be encouraged.

The authors however continue to encourage the use of IUDs in all women, regardless of body weight, as the benefits outweigh risks.

Conclusion

While on one end, further studies are needed, and will likelihood indicate why IUD expulsions occur at a higher rate in obese women, women should not stop opting for IUDs.

Additional studies that describe the causes for IUD expulsion might indicate that it is solely not a function of obesity, and it has already been shown that obesity is but one risk factor for expulsion.

Knowing why IUDs dislodge or move would make for better IUD design! 

Until the reasons are known and designs could be potentially improved, for the long term, women should focus on efforts that help them lose weight, in a healthy and practical manner.

References:

  1. ACOG Presentation Summary: http://mobile.journals.lww.com/greenjournal/Abstract/2017/05001/Levonorgestrel_Intrauterine_Device_Complications.235.aspx
  2. A previous article by the same group: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642497/
  3. The mdedge article http://www.mdedge.com/clinicalendocrinologynews/article/137744/gynecology/beware-hormonal-iud-expulsion-obese-women?channel=261&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
  4. NIH Weight Classification: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_dis.htm
  5. Some information on IUD Expulsion and what to do: http://www.healthline.com/health/birth-control/iud-fell-out#5
  6. Retrospective Cohort Studies: https://en.wikipedia.org/wiki/Retrospective_cohort_study
  7. Image Courtesy, Pexels: https://www.pexels.com/photo/backlit-beach-dawn-dusk-227674/

Delay in Breast Cancer Diagnosis and Increase in Mortality

In the United States, it is National Women’s Health Week. I am going to try to post about a different and key area of Women’s Health through this week.

Today, I am going to point you to the summary of some important results from a very interesting paper on breast cancer diagnosis delays. I only have the summary to offer as the paper itself sits behind a pay wall. Still, even the summary should give one pause and suggestions of key demographics to aim at, in trying to bring up the diagnosis.

Study Limitation

This study, like the one mentioned in yesterday’s blog is also an ecological study and therefore, does not have the strength and rigor of a prospective, clinical study. However, the study results are still very valuable and informative.

Summary of Key Findings (Quoted)

Delays in diagnosis could possibly affect survival as well. While it is possible to quote from the summary, the mdedge article that originally pointed me to the paper has a nice summary, and I am going to quote it here. The article itself is linked below:

  • Women who received Medicaid or were uninsured were more than twice as likely to be diagnosed at a later stage, vs those with commercial insurance.
  • Blacks were 18% more likely than whites to experience such.
  • Unmarried women were 25% more likely than their married counterparts to be diagnosed later.
  • Younger patients were 25% more likely than older individuals to experience delayed diagnosis.
  • Compared with commercially insured patients, death rates from breast cancer in Medicaid and uninsured women were 40% and ~60% higher, respectively.
  • This rate was nearly 40% higher in blacks vs whites, and nearly 20% higher in unmarried vs married women.

Conclusion

As you can see, social status, insurance, and even marital status as well as age make significant contributions to delay in diagnosis. Similar issues exist with survival and mortality. As the authors state in the study, it is important to explore these demographic and social status differences further. When separated by sex, Breast Cancer is the leading cause of cancer based mortality among women in the United States. Every effort must be made to ensure increased awareness, early diagnosis and treatment of breast cancer!

References: 

  1. Summary of the Study: http://onlinelibrary.wiley.com/doi/10.1002/cncr.30722/full
  2. The mdedge article: http://www.mdedge.com/oncologypractice/clinical-edge/summary/practice-management/these-factors-impact-breast-cancer?group_type=2-month&topic=278&utm_source=News_Power_eNL-B_051417&utm_medium=email&utm_content=ClinicalEdge%20Top%2010:%20Editor%27s%20Picks%20for%20May
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/woman-in-black-tank-top-holding-an-umbrella-in-front-of-yellow-concrete-wall-57851/