Women’s health issues

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When Did My Uterus Become Politicians’ Business?

Tuesday, May 1st, 2012

As a working mother, I have made many decisions over the years regarding my health and the health of my family.  Those decisions were always made after careful consideration that included years of education, the beliefs of my family, and my own personal needs.  Not once during those processes did I ever consult with or even consider that politicians should also be debating those decisions.  It is shocking how much interest the government is suddenly taking in women’s reproductive health.  What should be personal choices made by American women, have now become the focus of debates for men who are looking for political gains and who frankly don’t have the biological parts necessary to even consider these topics.

Because Rick Santorum felt the need to prove his belief in traditional family values, he mentioned that women who are the victims of rape, should, “make the best of a bad situation,” in regard to their unwanted pregnancies.  While this may have helped him get a few more conservatives on his side, it did nothing to stop the suffering of women who, if he had his way, would continue to live out their traumatic experience by carrying and delivering the children of their attackers.  Trying to prevent unintended pregnancies altogether is even too much for Committee Republicans to keep their hands off of these days.  They would like to eliminate $12 billion of healthcare funding that would otherwise go to preventive services.  This would reduce access not only to birth control, but also cancer screenings and other types of care and services, especially those used by low-income women.  Republican Candidate Mitt Romney would like to create tax cuts that would benefit millionaires, hoping to spur job growth, but those cuts would come at a cost to programs that help women.  Obama seems just as puzzled by this as many American women, saying, “These are folks who claim to believe in freedom from government interference and meddling. But it doesn’t seem to bother them when it comes to a woman’s health.” The absence of women in power has become very obvious because of these issues.  Hopefully, they will inspire more women to vote and maybe even to run for office.

No matter what her position, every woman has the right to make her own decisions regarding her health, including her reproductive health.  Pressure from politicians, employers, and religious organizations should have no influence on her decision.  It is up to each individual woman to decide what beliefs to follow.  That’s why it is so great to be American in the first place.  We have certain freedoms that allow us to live our lives the way we choose.  While talking points like women’s reproductive health can mean big business for bureaucrats, they’re interfering with the personal freedoms of women and decisions that are, frankly, none of their business.

— Yvonne S. Thornton, M. D., M. P. H.

Posted in Health care policy, Women's health issues, Women's health news | No Responses »
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Childhood Obesity Speeds the Onset of Puberty in Girls

Tuesday, April 24th, 2012

When I was young, even though my Dad wanted to “plump up” me and my sisters so that we would be less attractive to boys, for the most part, sitting down at the family table meant eating a well-balanced meal and reconnecting with each other after a busy day.  This time wasn’t just important for the bonding opportunity it provided, but for the proper nutrition it allowed my sisters and I to receive.  It was there that we learned what a balanced diet was and to appreciate the food we had.  Snacking throughout the day was a privilege and eating snacks between meals was a luxury a poor person could ill afford. Unfortunately now days, it seems that many parents don’t have time for traditional dinners or are unwilling to make time for time them.  Snacks are cheap, ubiquitous and filled with carbohydrates. With so many people reaching for the quickest, easiest foods, families are moving to a culture of convenience and their kids are paying the price.

Childhood obesity is on the rise and it’s having effects in some unexpected areas.  Studies are now suggesting that girls who are overweight start menstruation at much younger ages.  The average age of onset of menstruation (menarche) in the late 20th century was between 12.6 to 12.8 years.  Recently, that age has decreased to 12.43 years.   It has been argued that girls need to reach a critical weight (47.8 Kg) to initiate pubertal changes; it is more likely that what is needed is a shift of body composition, with an increase in the percentage of body fat. The percentage of body fat in children (16%) needs to rise to 23.5% to initiate puberty.  A 2011 study found that each 1 kg/m2 increase in childhood body-mass index (BMI) can be expected to result in a 6.5% higher absolute risk of early menarche (before age 12 years).

Normally, once a young woman reaches a particular body mass index, that tells her body she is of childbearing weight.  This starts the menstruation cycle.  If a young girl, say of about eight or nine, is overweight, she will reach this body mass index much sooner, triggering her body to go into early puberty.  While early childhood obesity is itself a problem, early puberty can also lead to a shortened growth span.  Most girls stop growing a few years after starting menstruation.  If they start this too soon, they will also stop growing much earlier than normal.  If childhood obesity continues to increase, the rise in early maturation is likely to follow.  In 1965, about 5% of kids were considered obese in the US.  Obesity in children has increased three-fold over the past 30 years.  In 1980 obesity in children, ages 6-11, was a mere 6.5% but by 2008 it increased to 19.6%.

Today, about 25 million children are either overweight or obese.  Researchers are finding that increases in the number of girls hitting puberty early seems to be in keeping with these obesity statistics.  The First Lady is even promoting a change in our habits that affect childhood obesity.

Although convenient, fattening foods have flooded the markets; there are still plenty of healthy foods out there.  Parents cannot expect their kids to make smart choices about their diets, especially at such young ages.  It’s up to them to teach their children how to eat, so they can grow up to make good choices for themselves and their own families.  There’s something to be said for those traditional sit-down dinners, because they truly benefit the health of our children in more ways than one.

— Yvonne S. Thornton, M. D., M. P. H.

Sources:

http://children.webmd.com/features/obesity

http://www.helium.com/items/1249193-delayed-puberty

 

 

 

Posted in Fertility & Infertility, General health news, Menstruation, Women's health issues | No Responses »
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No Breastfeeding; No Guilt

Thursday, April 19th, 2012

I was raised in an era when children were fed Karo Syrup and evaporated milk, and nobody gave my mother a guilt-trip for doing so.  As with many low-income families, she spent much of her time working to provide for our family and would not have been able to stay home to breastfeed.  Somehow though, we all grew up to be healthy, happy adults.  In fact, two of my sisters are doctors and the other is a lawyer and Ph. D., so I’d say we turned out pretty well.  The American Academy of Pediatrics (AAP) though, would like moms to believe otherwise.

When an organization like the AAP recommends breastfeeding, new moms are likely to trust in their expertise and follow suit, assuming the organization has conducted years of research and found conclusive results in favor of breastfeeding.  Unfortunately, that just isn’t the case.  That hasn’t stopped them from publishing an executive summary of their recommendations though.

In their most recent Executive Summary on Breastfeeding and the Use of Human Milk, the AAP cited, “a variety of government data sets, including the Centers for Disease Control and Prevention (CDC) National Immunization Survey, the NHANES, and Maternity Practices in Infant Nutrition and Care.”  These studies merely show how many people are breastfeeding in developed countries, not whether or not this has been beneficial for the children involved.

In fact, there has so far only been one scientific study performed and this is where all of their data is coming from.  Also, the study itself admits that, “Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.”  In other words, they gathered their information from other reports and performed a scientific analysis, but did not do any controlled experiments themselves, so they can’t be certain that the relationship between the health of children and the rate of breastfeeding are actually related.  Even more shocking is the AAP’s blatant disregard for some of the findings in the study.  The AAP Summary reports that, “Adjusted outcomes for intelligence scores and teacher’s ratings are significantly greater in breastfed infants.”  While the study they are citing actually says, “There was no relationship between breastfeeding in term infants and cognitive performance.”  Human breast milk is deficient in iron and Vitamin D; yet, those deficiencies are rarely mentioned when it comes to comparing breastfeeding and formula feeding.  Moreover, the touted immunity conferred to the newborn from breastfeeding has not resulted in better outcomes for breastfed infants.

So why are they so adamant about it?  It turns out; they have spent the past several years urging the Senate to carry out a $15 million campaign to promote breastfeeding at maternity care practices, community-based organizations, and hospitals.  In other words, wherever mothers might be giving birth or receiving pediatric care, their physicians are flooded with propaganda pushing the importance of breastfeeding.  This has led to a lot of pressure on moms who have chosen not to breastfeed, and consequently, a lot of unnecessary guilt.  Mothers have the right to choose the method they feel most comfortable with, and shouldn’t have to feel guilty for that choice.

— Yvonne S. Thornton, M. D., M. P. H.

Sources:

http://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf

http://www.usbreastfeeding.org/Portals/0/Letters-Comments/2011-03-07-Joint-Letter-BF-Approp.pdf

 

Posted in General health news, Pregnancy, Women's health issues, Your newborn baby | No Responses »
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Uterine Artery Embolization for Fibroids (Myoma)

Friday, April 6th, 2012

I have been asked many times the best approach to the treatment of myoma (the correct term for the common term “fibroid”. There are many approaches, most include surgery, i.e., hysterectomy or myomectomy. Recently, a less invasive management has been offered and should be considered prior to surgery. It is Uterine Artery Embolization.

Uterine Artery Embolization (UAE) as another alternative treatment for fibroids (myoma): This latest less radical approach to reducing myoma (fibroids) was first tried in France and has been available in the United States for over a decade.

The procedure entails inserting a catheter (long hollow tube) in the major arteries of the thigh (femoral artery) and threading the catheter to the area of the fibroids. Using an inert material (polyvinyl alcohol) in the form of beads or particles, this material essentially cuts off the blood supply to the growing myoma (fibroid) resulting in shrinkage of the fibroid. Interventional radiologists have promoted this procedure as opposed to gynecologists who have proceeded with much more caution. The known side-effects have been serious systemic infection, excessive bleeding from the catheter insertion site, chronic pelvic pain after the procedure and, in some patients, early onset of menopause. Uterine artery embolization has been associated with decreased fertility.

In August, 2010, the conclusion of a 5-year outcome study from the embolization versus hysterectomy randomized clinical trial (EMMY) was that UAE is a well-established alternative to hysterectomy about which patients should be counseled.

So, if you are a candidate for myomectomy or hysterectomy because of myoma, perhaps a discussion about UAE would be helpful.

——Yvonne S. Thornton, MD, MPH

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In came Beyoncé and the security guards. Out went the hospital’s common sense—and common decency.

Friday, January 13th, 2012

As an OB-GYN who has delivered thousands of babies—including several with rich and famous parents—I’m scratching my head over the insanity at Lenox Hill Hospital in New York City surrounding the birth of Beyoncé’s baby.

Here’s a sampling of what went on, according to The New York Times:

The familiar area outside the neonatal unit had been transformed: partitions had been put up, the maternity ward windows were completely covered, and even the hospitals’ security cameras had been taped over with paper. Guards with Secret Service-style earpieces roamed the floor.

“We were told we could walk no further,” Ms. Nash-Coulon said Monday. And when she and her husband, Neil, demanded an explanation, she added, the guard claimed, unconvincingly, “ ‘Well, they’re handling hazardous materials,’ ” even as a large group of people screened from view were passing through the main hallway he had declared off-limits.

Let me make this perfectly clear: The hospital had no right to bar other patients from having free access to their babies.  Worse, from a safety perspective, doctors were prevented from visiting their own patients on rounds, because of this so-called “security.”

Someone in the hospital decided that the celebrity of a hip-hop artist was sufficient to ignore medical necessity and common decency. Not a good message to send to sick people.

Beyond that, I’m alarmed to learn that the baby was born by Cesarean, as so many celebrity babies are today. I could be mistaken, but I doubt that Beyoncé’s OB-GYN warned her of the risks before treating little Blue Ivy’s birth like just another item on the to-do list. The risks are real: a dramatic increase in maternal deaths due to hemorrhage and infection; more babies ending up in the neonatal intensive care units after Cesarean births because of respiratory distress.

If she’d been my patient, I’d have told her what I tell other mothers-to-be: if God wanted women to have Cesareans, he would have put a zipper in the pubic area.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Women's health issues | 1 Response »
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Baby’s tastebuds mirror Mom’s food choices?

Wednesday, November 30th, 2011

You’ve probably heard the claim that exposing a baby in the womb to Mozart will increase his or her IQ. Despite the hype, the research doesn’t support major leaps in smarts (but, if nothing else, it might improve your child’s musical taste, later on).

Now, there’s some evidence showing that you may be able to shape a yet-to-be-born child’s taste in food.

“The flavor and odors of what mothers eat show up in the amniotic fluid, which is swallowed by the fetus, and in breast milk. There is evidence that fetal taste buds are mature in utero by 13 to 15 weeks, with taste receptor cells appearing at 16 weeks, according to researchers.

“’With flavor learning, you can train a baby’s palate with repetitive exposure,” said Kim Trout, director of the nurse midwifery/women’s health nurse practitioner program at Georgetown University.

“Trout recently co-authored a paper that reviews the evidence on prenatal flavor learning and its implications for controlling childhood obesity and diabetes, among the country’s most pressing health problems…”

 

Although I’m just as skeptical of this claim as I am about the one for baby-and-Mozart, I see real benefit in giving this a try, whether it makes your baby want broccoli or not. That’s because, in my practice, I see too many women gaining too much weight during pregnancy, which can not only cause complications for mother and baby, but can be almost impossible to shed once your baby is born.

So, bring on the Brussels sprouts, and eschew the Twinkies. Pass by the apple pie and bite into a nice juicy apple instead. Whether it does a thing to change your baby’s mind about what tastes good later in life, it will do a world of good for you both right now.

– Yvonne S. Thornton, MD, MPH

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Should you be worried about the blot clot risk with newer birth control pills?

Monday, November 21st, 2011

You might have read the news that YAZ and Yasmin, two newer birth control pills, are riskier to take than older contraceptives due to higher potential for blood clot formation.

But it’s important to put this into perspective. No matter what birth control pill you use, blood clots are a possibility, if an uncommon one. What you might not know is that blood clots are even more common in pregnancy. Fortunately, the vast majority of the millions of women who get pregnant and give birth each year don’t suffer blood clots. Just as millions of women take birth control pills with no such side effects.

So, is there a unique problem with YAZ? Yes, but not the one identified in the headlines. The problem is in the marketing.

YAZ was promoted to women as a pill for bloating and acne in addition to its contraceptive effects. While that might be a good marketing strategy, it’s not a good medical one. Contraceptives are for birth control, and the best one for you, based on your medical history, might have nothing to do with acne. People shouldn’t pick their birth control the way they pick their toothpaste—on the basis of consumer advertising. You should consult your doctor who will look at your history and decide what form of contraception meets your needs. If your family has a history of strokes, blood clots, or thrombophlebitis (a blood clot that causes swelling in a vein), your doctor will almost certainly order advanced testing due to the possibility that any birth control pill—YAZ, Yasmin, or older medicines—might be inappropriate for your condition.

But if your doctor has already determined that YAZ or Yasmin is a safe bet, and you’re on one of these now? Keep taking it unless your doctor says otherwise. The alternative could be unintended pregnancy. And pregnancy, ironically enough, is more likely to cause a blood clot than your birth control pills.

– Yvonne S. Thornton, MD, MPH

Posted in Contraception (birth control), Fertility & Infertility, General health news, Pregnancy, Women's health issues, Women's health news | No Responses »
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HPV infections usually resolve on their own

Thursday, October 27th, 2011

It’s become common practice among some OB-GYNs to test for HPV, the human papilloma virus, due to the association of some strains of this sexually transmitted infection (STI) with cervical cancer.

But testing of women under the age of 30 is inadvisable. Because, although at least half of all sexually active men and women will get genital HPV at some point in their lives, the immune system will fight off and remove most of these infections from the body with no treatment. Seventy percent are gone within a year and 90 percent within two years.

It’s that 10 percent of cases we have to watch for. Some of those will lead to precancerous lesions in the cervix which, if left untreated, can develop into cervical cancer. But this process takes from 15 to 20 years. So, testing women under 30 for HPV leads to false positives, more testing, and perhaps invasive procedures in women who are at little or no risk of developing cervical cancer from HPV.

The American College of Obstetricians and Gynecologists (ACOG) therefore recommends that women under 30 not be tested for this STI, and I agree. If a woman under 30 has one of the high risk types of HPV, and if it persists, there will be ample time to find it and treat it. If she has one of the lower risk strains, it will probably be gone with no intervention within a year or two.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | 2 Responses »
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There’s much more to an annual pelvic exam than a Pap smear

Tuesday, October 25th, 2011

You might have read that the U.S. Preventive Services Task Force now recommends that most women have Pap smears just once every three years instead of once per year.

Does that mean you can skip the OB-GYN appointment until 2014?

No, no, no, and no.

You must have a pelvic exam every year. Pelvic examinations save lives. A Pap smear, which can help identify cervical cancer, is just one part of that examination. Your OB-GYN does much more during your annual. She also looks for any evidence of ovarian cancer, vaginal cancer, myoma (fibroids) and other abnormalities of the reproductive tract.

And while it’s true that cervical cancer is typically a slow-growing cancer that takes an average 10 years to spread, sometimes these cancers “don’t read the books” and spread in a shorter period of time.

In my new health book, INSIDE INFORMATION FOR WOMEN, I tell you in greater detail what to expect when you have a gynecologic examination.

Don’t take risks with your health. Your “annual” is called that for a reason. Make sure you see your OB-GYN for your pelvic examination every year.

– Yvonne S. Thornton, MD, MPH

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You are what you eat…and so is your baby

Thursday, October 20th, 2011

We’ve all been told how important it is to eat well in order to stay healthy. Now, new research shows that what you eat when you’re pregnant can be as important for your baby as it is for you.

A study published in the Archives of Pediatrics and Adolescent Medicine shows that when mothers-to-be ate healthful foods, such as those that make up the so-called Mediterranean diet, their babies had fewer birth defects such as cleft palates and neural tube defects.

The Mediterranean diet focuses on vegetables, beans, fruits, grains and fish, and is lower in meat, dairy and “empty” carbs.

Before you panic if you’re reading this while gorging on burgers and fries, no, your baby isn’t going to be born with birth defects just because you’re taking a vacation from your diet. The birth defects researchers looked at in the study are quite rare to begin with. It’s just that they are rarer still among women who eat well.

But the study does hint at something we know: your baby’s development depends, in part, on the nutrients you consume. So, give your little one a head-start on a good future. You’ll be doing a favor for both of you.

– Yvonne S. Thornton, MD, MPH

Posted in Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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