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The new, several-mornings-after pill

Monday, August 16th, 2010

The FDA has just approved an emergency contraceptive that can prevent pregnancy if taken up to five days after intercourse.

The new drug, ulipristal acetate (ella), will be available by prescription only, unlike the so-called “morning-after pill,” levonorgestrel, which can be bought over-the-counter.

While ella is not the first emergency contraceptive to be approved, it gives women a wider window of opportunity to prevent pregnancy than previous emergency contraceptives such as levonorgestrel, which must be taken within 72 hours to be effective.

Although it’s been used in Europe for the past year, ella won’t be available here in the U.S. for another two to three months. And there are still risks and side-effects associated with it, as with all drugs. Still, the introduction of a new emergency alternative is good news for women and their doctors, in preventing unintended pregnancy.

- Yvonne S. Thornton, MD. MPH

Posted in Contraception (birth control), Fertility & Infertility, General health news, Women's health news | No Responses »
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Obesity and early puberty

Saturday, July 31st, 2010

A new study confirms what earlier studies have found: girls who are obese begin puberty earlier.

With childhood obesity approaching an epidemic, early puberty is becoming more common. There appears to be a critical weight for girls, above which the body starts its journey to womanhood with thelarche (breast buds), pubarche (pubic and axillary hair) and finally, menarche (onset of menses).   So, in general, the heavier a young girl is, the earlier the onset of her secondary sexual characteristics.

While we don’t know all the possible consequences of early puberty, we know that puberty is a time of emotional turmoil. For a younger child, that’s going to be more difficult.

We also know that youngsters have a great need to feel like they fit in and the combination of obesity and early puberty can punch a hole in a young girl’s self-esteem.

So, watch the eating habits of your whole family, and help your children make good choices –  just as you make healthier choices for yourself. As I’ve said before, when it comes to battling the bulge, I’ve been there, so I know it’s a struggle. But maintaining a healthy weight is essential, for everyone.

- Yvonne S. Thornton, MD, MPH

Posted in Menstruation, Women's health issues, Women's health news | No Responses »
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Overweight or Obese? Don’t Count On Your Birth Control Pills.

Wednesday, July 14th, 2010

Since the pill first appeared on the scene, about 50 years ago, women have felt secure knowing that they had an almost foolproof way to avoid unwanted pregnancies. And that’s been mostly true.

But maybe not for all women.

If you’re overweight or obese, recent studies suggest that birth control pills might not be as effective for you as they are for more slender women:

“In one study of oral contraceptive pills, women with a body mass index (BMI) in the overweight range (a BMI of 25 or more) had a higher risk of pregnancy that those in the normal weight range. In another study of contraceptive skin patches, higher body weight — not higher BMI — was associated with higher risks of pregnancy.”

In addition to the sobering news about the lessened effectiveness of hormonal birth control, these birth control methods are thought to slightly increase a woman’s risks of heart disease, high blood pressure and other conditions. When you consider that overweight and obese women are already at increased risk of heart disease, diabetes and other ills, and that pregnancy is a riskier venture, overall, for obese women and their babies, you have a new incentive for getting your weight down.

I know it isn’t easy. I’ve struggled with weight myself and can attest to the fact that it’s a constant battle. But it’s a battle we must fight – and win. And now, we have one more reason to do it.

- Yvonne S. Thornton, MD, MPH

Posted in Contraception (birth control), Fertility & Infertility, General health news, Pregnancy, Women's health issues, Women's health news | 1 Response »
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Pre-existing condition? No longer a problem.

Friday, July 9th, 2010

After all the hoopla, once healthcare reform was signed into law earlier this year, it didn’t immediately seem like much had changed. Most of the provisions of the new healthcare bill aren’t slated to take effect for a few years yet.

But there’s one provision, an all-important one for people who have been denied health insurance in the past, that could be a lifesaver.

And it takes effect this summer.

You can now get health insurance – good comprehensive coverage – if you’ve previously been turned down due to a pre-existing condition. Your new insurance will cover that pre-existing condition along with your other medical needs. Perhaps best of all, according to law, the premiums for this insurance must be affordable. You should pay about what anyone else your age pays, regardless of health.

Depending on the state where you live, the insurance plan will either be run by the state or federal government. Go here to find out about how to apply in your state.

So, if you have been denied insurance, or denied insurance for your pre-existing condition, and have been without any health insurance for six months or more, this is for you.

Take advantage. And here’s to your good health.

- Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | No Responses »
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Ready to Deliver and Morbidly Obese: One of My Most Challenging Cases

Wednesday, June 23rd, 2010

A recent article in The New York Times talked about how the obesity epidemic is affecting pregnant women and their babies:

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

New York City’s health department reported last Friday that half of the 161 women who died because of a problem with their pregnancy between 2001 and 2005 were obese. Black women were hit hardest, with a mortality rate seven times that of white women. While deaths are extremely rare in pregnancy, the city’s rate of 23.1 per every 100,000 births is twice the national average.

My new book, SOMETHING TO PROVE, is a personal memoir first, but because I’m a maternal-fetal medicine specialist and a surgeon, it also details a number of gripping moments in the operating room.

One of my most challenging cases involved a pregnant patient transferred to my care. When I walked into my new patient’s hospital room, I discovered she weighed more than 500 pounds and her baby was showing signs of distress on the fetal monitor.  The patient needed to be delivered. Let me give you a sense of the challenge with a brief excerpt:

…Many surgeons would begin their cut above her navel in an attempt to avoid that enormous layer of fat, while trying to find the uterus to get the baby out. …The area above the pubis, even in a morbidly obese woman, is usually flat and firm. Instead of a vertical incision from the navel down, I’d lift up the apron of fat and do a horizontal incision just above the pubis. That would allow me to get into the uterus and get the baby out. …We taped her massive belly to her chest, swabbed her with an antiseptic solution, and I went in. I was able to perform the cesarean quickly, without incident or excessive bleeding, and delivered the baby in only a few minutes.

The surgeon who handled the case recounted in The New York Times decided to cut through all the mother’s layers of fat, rather than using my technique of retracting and taping the massive layers of fat, which a colleague dubbed the “Thornton suspenders.” While there might have been excellent reasons for the physician’s decision, I hope more obstetricians learn to use the “Thornton suspenders” for such difficult deliveries in obese moms. Because, as the Times article explains:

… where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

- Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Promising Advances In Treating Breast Cancer

Wednesday, June 9th, 2010

As many as 12.7 percent of American women will be diagnosed with breast cancer at some point in their lives, according to the National Cancer Institute. The disease, if caught early, is very survivable. The big questions about treatment have included how aggressively to attack the tumors to keep cancer from recurring.

Two new studies, reported in The New York Times, suggest that a woman’s long-term survival doesn’t necessarily hinge on choosing the most aggressive treatment. And, if that conclusion is confirmed by further studies, it’s very good news, because treatment can come with significant side-effects.


“A new study has found that for certain women getting a lumpectomy, the standard treatment — an operation to remove underarm lymph nodes that can leave them with painfully swollen arms — may not be necessary. Compared with not removing the nodes, the surgery did not prolong survival or prevent recurrence of the cancer.

“And a second study found that a single dose of radiation, delivered directly to the site of the tumor right after a woman has a lumpectomy, was as effective as the six or so weeks of daily radiation treatments that most women now endure.”

Two notes of caution, however. The study on lumpectomy followed patients for five years; the study on radiation followed patients for four years. Breast cancer can recur after five years so we won’t know for sure that less aggressive treatment makes sense unless a longer term follow-up yields similarly promising results. But each study is cause for hope if not yet celebration.

- Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | No Responses »
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When New Moms – or New Dads – Get the Pregnancy Blues

Friday, May 21st, 2010

Most women are familiar with the term post-partum depression.  Start with all the stresses of adding a new member to the family – not just the financial burden, but the schedule upheaval, the sleep deprivation, and the demands of a tiny person who can only make his or her needs known by wailing. Add the wild surge of hormones flooding a woman’s body, and is it any wonder that she might not be the picture of serenity and assurance? Estimates vary on the prevalence but as many as 25 percent of new moms may experience some level of depression either before or after delivery.

That’s bad enough, but now a study suggests that new fathers, just like new mothers, can find themselves overwhelmed when baby makes three (or more).

“The study, published in the Journal of the American Medical Assn., found that 10.4% of men experienced serious depression at some point between his partner’s first trimester and one year after childbirth, more than double the depression rate for men in general. American men were more likely to experience prenatal or postpartum depression compared with men in other countries, 14.1% in the U.S. compared with 8.2% internationally.”

What can you do when the guy you depend upon to keep you sane is going through his own blue period?

Your most important step –the one you should take if either you or your partner starts to feel sadness, agitation or hopelessness – is to talk to your doctor. Don’t try to tough it out. Reach out for help at the first signs that something isn’t quite right. It’s possible that all you need to get back to your cheery old selves is a good night’s sleep, but sometimes, you need more. The good news is that help is available. But first, you have to be aware of the signs of depression.

Post-partum depression can be debilitating if you let it go, so take steps immediately to get yourself and your new family back into the swing of enjoying things together again.

- Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Women's health news | No Responses »
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Why do black women wait longer for breast cancer diagnosis and treatment than white women?

Wednesday, April 28th, 2010

Among pundits, there is a tendency to proclaim that we live in a post-racial society. We’ve had laws on the books banning racial discrimination for decades now. In 2008, we elected our first African-American president. Perhaps the most popular talk show host of our time is a black woman.

While all these signs of progress are encouraging, they are still only steps along the road to equality; we haven’t yet reached our destination. That reality becomes painfully evident in the results of a recent study about the disparities in diagnosis and treatment of breast cancer between white and black women.

In a five-year study, using initial screening data that reached back 12 years, researchers at The GW Cancer Institute examined the effect of race and health insurance status on the diagnosis and treatment of breast cancer. What they found was startling:

• insured black women and uninsured white women waited more than twice as long to reach their definitive diagnosis than insured white women;

• lack of health insurance decreased the speed of diagnosis in white women, but having insurance did not increase the speed of diagnosis in black women; and

• overall, black women waited twice as long as white women for treatment initiation following definitive diagnosis.


The researchers had, quite reasonably, expected to find that any insured woman, of any color, would get diagnosed and treated earlier than any woman of any color without insurance.

What do we make of the data that suggest that being black is as great a barrier to treatment as being uninsured?

It’s a question without an answer but it shows that we have a long way to go on this journey. For those quick to proclaim the “post-racial” era has arrived, this is a call, first for introspection but most urgently, for action. Neither insurance status nor race should get in the way of life-saving treatment.

- Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | No Responses »
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A court says that genes can’t be patented – and why that’s good news for women

Wednesday, March 31st, 2010

For many years, corporations have been filing patents to claim ownership of the genes that researchers have discovered. Nevermind that these genes exist in our bodies and were designed, not by scientists, but by nature. Once a corporation or other institution gets a gene patent, that gene becomes its property.

Those who control the genes get to decide whether to allow other researchers to use the gene in further research. The gene’s “owners” also get to corner the market in potentially life-saving tests involving the gene.

That’s led to some pretty significant price-gouging of women whose genetics put them at risk for certain breast and ovarian cancers. Myriad Genetics controls the patents for the genes that are associated with about 10 percent of breast and ovarian cancers. So if your doctor told you that you needed a test to see whether you carry a gene that makes you more susceptible to these cancers, you could get hit with a bill from Myriad for a whopping $3,000.

But that’s about to change.

This week, a federal court ruled, in a lawsuit against Myriad Genetics, that its gene patents were invalid because genes occur naturally. From an article about the court’s ruling that appeared in The New York Times:

Judge Sweet… said that many critics of gene patents considered the idea that isolating a gene made it patentable “a ‘lawyer’s trick’ that circumvents the prohibition on the direct patenting of the DNA in our bodies but which, in practice, reaches the same result.”

The case could have far-reaching implications. About 20 percent of human genes have been patented, and multibillion-dollar industries have been built atop the intellectual property rights that the patents grant.

“If a decision like this were upheld, it would have a pretty significant impact on the future of medicine,” said Kenneth Chahine, a visiting law professor at the University of Utah who filed an amicus brief on the side of Myriad. He said that medicine was becoming more personalized, with genetic tests used not only to diagnose diseases but to determine which medicine was best for which patient.

Mr. Chahine, who once ran a biotechnology company, said the decision could also make it harder for young companies to raise money from investors. “The industry is going to have to get more creative about how to retain exclusivity and attract capital in the face of potentially weaker patent protection,” he said.

I take issue with anyone who claims that denying patents on what nature creates will thwart research. And I am in total agreement with the court’s decision to invalidate these patents on genes. Patenting genes invites a type of commercial perversion of what is a natural occurrence. As a researcher myself, I disagree that invalidating gene patents removes incentives for future research. There will always be research. However, the results of that research will have checks and balances rather than the current focus on the “bottom line” of profit, that takes advantage of patients and the medical community.

- Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | No Responses »
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Pregnant or new mom and feeling depressed? Get help now.

Tuesday, March 9th, 2010

Pregnancy and childbirth alter the hormonal balance, which may explain why depression is so common at this stage of women’s lives. Up to 23 percent of pregnant women experience symptoms of depression and that figure rises to up to 25 percent among new mothers.

Many women decide to simply suffer through it without seeking help, but that could be a big mistake. According to the American College of Obstetricians and Gynecologists:

“… untreated maternal depression negatively affects an infant’s cognitive, neurologic, and motor skill development. A mother’s untreated depression can also negatively impact older children’s mental health and behavior.”

Everyone feels sad some of the time. It’s normal to have a bad day. But if your bad day stretches into weeks, for your own sake and the sake of your baby, you need to get help. If you don’t have a therapist, ask your ob-gyn for a referral if you experience feelings of hopelessness, sadness or despair. Don’t suffer needlessly. Help is available.

- Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Women's health issues, Women's health news, Your newborn baby | No Responses »
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