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Measuring how military service affects women’s longevity and overall health

Measuring how military service affects women's longevity and overall health

16044566446_77b89745de_zDespite the large numbers of women who serve in the military, there is a dearth of information about their postmenopausal health risks and how military service might impact their longevity. Now comes a study of more than 3,700 female veterans, led by a Stanford-affiliated psychologist, which is the first to examine the postmenopausal health of women veterans who participated in the Women’s Health Initiative (WHI) and who, given their ages, likely served in World War II or the Korean War.

The study, which appears online in the journal Women’s Health Issues, shows these women have higher all-cause mortality rates than non-veterans, even though their risks for heart disease, cancer, diabetes and hip fractures were found to be the same.

“The findings underscore the salience of previous military service as a critical factor in understanding women’s postmenopausal health and mortality risk, and the value of comparing women veterans to appropriately selected groups of non-veteran women, rather than benchmarking their health against that of the general public. It also reminds us of the importance of including women veterans in research,” said Julie Weitlauf, PhD, the study’s lead author and a clinical associate professor (affiliated) of psychiatry and behavioral sciences at the School of Medicine.

The Women’s Health Initiative is one of the most comprehensive research initiatives undertaken on the post-menopausal health of women, involving more than 160,000 women, including nearly 4,000 veterans.

Women can only serve in the military if they are deemed to be in good health, and military service stresses physical activity and many other elements of a healthy lifestyle, thus contributing to the concept of a “healthy soldier effect,” Weitlauf said. That explains why research typically shows that veterans, including women, have better health and lower mortality risk than non-veterans from the general public, she said. While the women in the study, most of whom who were likely military nurses, were probably very fit and healthy during their time of service, this effect may not be sustained throughout their lifetimes.

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Fertility, Pediatrics, Public Health, Research, Sexual Health, Stanford News, Women's Health

IUD is overlooked as excellent birth control for teens, Stanford expert says

IUD is overlooked as excellent birth control for teens, Stanford expert says


When teenagers think of birth control, the pill and condoms are likely the first to come to mind – and indeed the pill is the number one choice of contraceptive among adolescents. But according to Stanford ob/gyn expert Paula Hillard, MD, the IUD is a long-acting reversible contraception (LARC) excellently suited for adolescents. In an editorial published in the October issue of Journal of Adolescent Health, Hillard urges doctors to consider the benefits of LARCs for young women.

The IUD and other LARCs don’t require consistent, correct daily use, so they’re easier to use and less likely to fail. In addition to being extremely effective, IUDs have a high rate of satisfaction among adolescents. Some types of IUDs can also be used therapeutically for problems like heavy bleeding or cramping. LARCs are also cost-effective over time, and the initial investment is no longer a barrier in California due to the Family PACT program, which allows teens to confidentially access birth control at no cost. In addition, the Affordable Care Act mandates that contraceptive methods must be covered in most cases without a co-pay.

So what are the barriers to use? They include misconceptions and lack of information on the part of both teens and providers, as well as provider concerns about the insertion procedure in young women who haven’t given birth.

In an email, Hillard told me:

Many physicians and most adolescents are unaware that modern IUDs provide contraception that is 20 times more effective than birth control pills, the patch or the ring. IUDs are a method of birth control that is very safe, very effective, and “forgettable”.  IUDs are considered to be “top tier” contraceptive methods (along with subdermal implants and sterilization, which is not appropriate for typical adolescents) by the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics.

IUD use has increased from 0.5 percent to 2.5 percent among teens 15-19 years old over the past decade. Still, around 50 percent of obstetrician-gynecologists don’t consider an IUD as a first-line contraceptive for adolescents.

Hillard closes her piece with a discussion of the challenges and importance of counseling for adolescents. Proper counseling includes giving the most effective options priority, and discussing side-effects up front (which improves adherence to contraceptive regimens, including in adults). She writes:

It remains important for us as clinicians to fight for reproductive justice and contraceptive access for all women, with the elimination of barriers including costs. In our counseling, we need to honor principles of informed consent, be aware of power differences between ourselves and our patients, be certain that our counseling is not coercive, and carefully respect our patients’ choices.

Previously: Research supports IUD use for teens, Will more women begin opting for an IUD?, Study shows women may overestimate the effectiveness of common contraceptives and Study: IUDs are a good contraceptive option for teens
Photo by Liz Henry

In the News, Medicine and Society, Nutrition, Parenting, Research, Women's Health

Research elaborates on how moms can protect their daughters’ body image

Research elaborates on how moms can protect their daughters' body image

6945839301_9d61091329_zIt’s been my experience that women struggle with their body image at some point on the way from girlhood to womanhood – this may be brief and exploratory, or get tangled with eating disorders and other destructive behaviors. When I had a period of bulimia in my early 20s, I reflected on (among other things) my mother’s relationship with food and body image, and so some new research from Ben-Gurion University in Israel struck a chord.

Maia Maor, PhD, a sociologist, and Julie Cwikel, PhD, a professor of social work and director of the Center for Women’s Health Studies and Promotion, invited adult mother-daughter pairs to reflect on various strategies the mothers used to instill resilience about body image in their daughters. The researchers identified five methods commonly used to resist or reject negative and oppressive messages about body image:

  1. Filtering: being cautious and sensitive regarding body image issues 
  2. Transmitting awareness of the dangers of eating disorders, which can cause illness and death
  3. Positive reinforcement, using affirmative language in regard to their daughters’ bodies
  4. Discussion: providing tools for criticism of dominant body-related messages
  5. Positivity: shifting the focus of food and body-related discussions away from weight loss and towards health and taking pleasure in food. 

In a press release from last week, Maor explained that “the focus on protective strategies was intended to achieve two goals: to emphasize the positive in mother-daughter relationships and to identify a repertoire of strategies available to parents and allied health professionals who wish to help their daughters or young women build a stable, positive body image.”

Feelings about food and bodies have long chains of intergenerational transmission. According to the release, “some of the mothers in the study recalled how their own mothers’ negative comments to them about eating too much led them to associate food with guilt and bad feelings. They raised their own daughters by instead talking about the quality of food, importance of food choices and its relationship to developing respect for their own bodies.”

The study appears in the journal Feminism & Psychology.

Previously: Incorporating the family in helping teens overcome eating disorders, Stanford study investigates how to prevent moms from passing on their eating disorders, Promoting healthy eating and a positive body image on college campuses, What a teenager wishes her parents knew about eating disorders, and Social website shown to boost teen girls’ body image
Photo by Thanasus Anastasiou

Cardiovascular Medicine, Chronic Disease, Women's Health

Surviving a betrayal of the heart

Surviving a betrayal of the heart

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; this month’s column comes from a patient with spontaneous coronary artery dissection (SCAD).

2259323415_ab113de5bc_zThis is a story about a betrayal of the heart — an actual heart. Girl has heart, girl treats heart well, heart gets torn up and girl figures out how to recover from this betrayal by her own body.

Last summer, I participated in my second sprint triathlon. The first part was a half-mile swim in a cold lake. I’d been swimming this distance for months and had done this same triathlon before. Yet, I couldn’t catch my breath, my chest hurt and swimming was appallingly hard for me. But I persevered and finished the biking and running events just fine.

Two weeks later, unnerved by my unsuccessful swim, I steeled myself for a similar swim across a lake in Idaho. Almost halfway through my swim, I started struggling to breathe and felt a band of pain and searing cold across my sternum. I felt weak and cold and couldn’t swim anymore.  Fortunately, my husband was on a paddleboard close by. I called him over, climbed on the board and hung onto his ankles for dear life (vomiting occasionally) as he paddled us to shore.

In retrospect, I had many of the typical symptoms women experience when having heart attack, but it took a while before it dawned on us that I was suffering from one. I don’t fit the profile: I was 53, nearly vegetarian, slim, fit with a mild addiction to kale smoothies. However, I had just gone through menopause and was on a low dose of HRT.

Fortunately, the ER doctor in Idaho did an EKG and figured out I was having a heart attack. The next day, an angiogram found a tear in the innermost wall of my coronary artery called a spontaneous coronary artery dissection (SCAD). This tear causes blood to flow between the layers of the arterial wall, blocking blood flow and causing a heart attack. SCADs are rare, yet, nearly 80-90 percent of SCAD patients are women in their early 40s with no additional risk factors.

It’s not yet known what causes SCADs. So, I am left with a lot of unanswered questions, and I’ve had to slowly rebuild trust in my own body and abilities, knowing my condition is rare and poorly understood.

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Mental Health, Parenting, Pediatrics, Pregnancy, Public Health, Research, Women's Health

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

Sleep-deprivation and stress among factors contributing to smoking relapse after childbirth

2473235415_0584b78298_zSmoking can make it more difficult to get pregnant and it can contribute to complications after conception and endanger the health of babies as they grow. For these reasons, many women quit smoking when they are trying to conceive and during pregnancy. But an estimated 40 percent of women in the United States who kick the nicotine habit for the health of their unborn child relapse within six months after delivery.

New research published in the journal Addiction suggests that the stress of becoming a parent could be a significant factor in why some moms resume smoking after childbirth. In the study, British researchers interviewed 1,000 mothers about factors that influenced their relapse or contributed to them staying smoke-free. Lead researcher Caitlin Notley, PhD, discussed the findings in a PsychCentral article:

One of the most striking things that we found is that women’s beliefs about smoking are a major barrier to remaining smoke-free. Many felt that smoking after the birth of their child was acceptable provided they protected their babies from secondhand smoke.

Their focus is, admirably, on the health of the baby, but they often do not think about the long-term health consequences for themselves as mothers.

We also found that women who saw smoking as a way of coping with stress were more likely to relapse. And that feeling low, lonely, tired, and coping with things like persistent crying were also triggers. Women reported that cravings for nicotine, which had lessened or stopped during pregnancy, returned.

The majority of women who had successfully remained smoke free said that the support of their partner was a strong factor. Partners who gave up smoking, or altered their own smoking behaviors, were a particularly good influence. And those who helped ease the stress of childcare were also praised by women who had resisted the urge to light up

In addition to receiving help from their partners, moms said support from health professionals was another positive contributor to them being able to resist urges to smoke and manage stress.

Previously: Study shows mothers receiving fertility treatments may have an elevated risk of depression, Examining how fathers’ postpartum depression affects toddlers, A telephone lifeline for moms with postpartum depression, What other cultures can teach us about managing postpartum sleep deprivation and Is postpartum depression more of an urban problem?
Photo by Samantha Webber

Genetics, In the News, Pregnancy, Research, Science, Women's Health

Maternal-fetal “chimera” cells: What do they actually do?

Maternal-fetal "chimera" cells: What do they actually do?

1292733380_3e6815a6d1_zAfter a woman is pregnant, fetal cells linger in her body long after her baby is brought out into the world. They cross the placenta and congregate in her thyroid, breasts, brain, scars… and elsewhere. The phenomenon is called “fetal microchimerism,” a reference to the hybrid monster of Greek mythology that strikes me as both whimsical and menacing.

But what do these cells do? An entertaining and informative National Geographic blog post highlights a recent review study published in BioEssays that seeks to answer this question. The evidence we have so far is contradictory and messy, not yielding much in the way of patterns: Sometimes cells collect more in diseased tissues, other times in healthy ones. But when viewed through an evolutionary lens, things start to make sense, argue the paper’s authors. These cells allow a baby to inadvertently influence her mother’s body in her own interest, which is sometimes – but not always – in the mother’s interest, too.

Writer Ed Yong explains:

Some of those changes, like faster healing, benefit the mother too. Others may not. For example, foetal cells could stimulate the breast to make more milk, either by releasing certain chemical signals or by transforming into glandular cells themselves. That’s good for the baby but perhaps not for the mother, given that milk takes a lot of energy to make—mothers literally dissolve their own bodies to create it. And if the foetal cells start dividing too rapidly in the breast, they might increase the risk of cancer.

Similarly, the thyroid gland produces hormones that control body temperature. If foetal cells integrate there and start dividing, they could ramp up a mother’s body heat, to a degree that benefits her baby but also drains valuable energy. And again, if they divide uncontrollably, they might increase the risk of cancer. Indeed, thyroid cancer is one of the only types that’s more common in women than men, but is not a reproductive organ like the ovaries or breasts.

Such influences would have developed gradually over hundreds of millions of years in a subtle evolutionary contest between mother and fetus – it is in the mother’s interest for the fetus to do well, but not to monopolize all her resources, so it’s not unlikely that mothers evolved counter-measures. The paper authors don’t have any conclusions yet, but their point is that within this evolutionary framework, it makes sense that fetal cells both help and harm the mother.

Previous research on microchimerism has only asked about such cells’ presence, not their function. The paper’s authors hope to organize a workshop to test some of the hypotheses they proposed, which means gathering microchimeric fetal cells and sequencing their genes, then working out which of the mother’s genes they are activating and whether these correlate with any traits like milk production or temperature. The possibilities for further research are immense:

And then, there’s the matter of cells that travel in the other direction—from the mother to the foetus. What do they do in their new homes? These paths can get even more complicated. It’s possible that the cells from one foetus can travel into its mother, hide out, and then into a sibling during a later pregnancy. “At one point, we started trying to draw family trees, and trying to work out where all the microchimerc cells could be going,” says [co-author Athena Aktipis, PhD]. “It got really messy.”

Previously: How a child’s cells may affect a mother’s long term health
Related: The yin-yang factor
Photo by Simone Tagliaferri

In the News, Parenting, Patient Care, Pregnancy, Public Health, Women's Health

Low-tech yet essential: Why parents are vital members of care teams for premature babies

Low-tech yet essential: Why parents are vital members of care teams for premature babies

3297657033_081d4f3630_zThanks to recent advances in medicine, technology and research, most premature babies born in the United States face better odds of surviving than ever before. Yet, the number of premature births in the U.S. remains relatively high, with a rate that’s on par with that of Somalia, Thailand and Turkey.

For the parents of a premature baby, an early birth can transform what was supposed to be a happy event into a stressful one, says Henry Lee, MD, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford. In a recent U.S. News & World Report article penned by Lee, he discusses why it’s important for parents, and beneficial for the baby, when parents are active members of the child’s medical team:

Giving birth to a preemie, especially when it’s unexpected, leaves many parents feeling unprepared and helpless. But we make it clear very early. “You, the parent, are a critical part of our medical team.” That’s right. Even in the heart of Silicon Valley where we’re located, two of our biggest assets are decidedly low-tech workers: the baby’s mom and dad.

Including parents in the care of preemies is a standard that was unheard of in the early days of neonatology, but is now used in leading NICUs for one critical reason: It works.

Here’s an example of how parents contribute. Studies have shown that skin-to-skin care, also known as kangaroo care, can have beneficial effects on preterm neonates, including improved temperature and heart rate stability. In many NICUs, you will see babies – clad only in a diaper and covered by a blanket – placed prone position on the chest of either the mother or the father. This intimate method of care provides a preterm baby a natural environment for rest, growth and healing.

No matter when a baby is born, term or preterm, families know their children best. A parent’s contribution is critical to treating these most vulnerable of newborns.

Previously: How Stanford researchers are working to understand the complexities of preterm birthNew research center aims to understand premature birth and A look at the world’s smallest preterm babies
Photo by Sarah Hopkins

Genetics, Pediatrics, Transplants, Women's Health

Rare African genes might reduce risks to pregnant women and their infants

Rare African genes might reduce risks to pregnant women and their infants

Khoe-SanWhen Hugo Hilton began working at Stanford as a young researcher several years ago, his supervisor set him to work on a minor problem so he could practice some standard lab techniques. His results, however, were anything but standard. His supervisor — senior research scientist Paul Norman — told him to do the work over, convinced the new guy had made a mistake. But Hilton, got the same result the second time, so Norman made him do it over again. And then again.

“This was Hugo’s first PCR reaction in our lab and I gave him the DNA,” recalled Norman, “and the very first one he did, he pulled out this mutation. I was convinced that he’d made a mistake.” Norman even quietly redid the work himself. But the gene variant was real.

Norman and colleagues had been studying the same group of immune genes for decades and he knew them like the back of his hand. Yet he was astonished by what Hilton had stumbled on — a mutation that switched a molecular receptor from one protein target to another. It would be as if you bent your house key ever so slightly and discovered it now opened the door to your neighbor’s apartment — but not yours.

And the mutation, far from causing some illness, might contribute to healthier mothers and babies. Parallel research at another institution suggests the odd gene most likely changes the placenta during early pregnancy, leading to better-nourished babies and a reduced risk of pre-eclampsia, a major cause of maternal death.

The surprising finding grew out of a long-term effort to understand how immune system genes make us reject organ transplants. A big part of that puzzle is understanding how much immune genes can vary. On the surfaces of ordinary cells are proteins called HLAs. Combinations of these proteins mark cells in a way that makes each person’s cells so nearly unique that the immune system can recognize cells as either self or not self. When a surgeon transplants a kidney, the recipient’s immune system can tell that the kidney is someone else’s — just from its cell surface HLA proteins. The patient’s immune system then signals its natural killer cells to attack the transplanted kidney. The key to all that specificity is the huge variation in the genes for the HLA proteins.

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Mental Health, Pregnancy, Research, Women's Health

Study shows mothers receiving fertility treatments may have an elevated risk of depression

Study shows mothers receiving fertility treatments may have an elevated risk of depression

5088785288_9f7a23f17a_zAn estimated one in four couples in developing countries encounter difficulties trying to conceive. In the United States, more than 7 million women have undergone fertility treatments and, as a result, millions of babies have been born through in-vitro fertilization.

While many may assume that failed fertility treatments would increase a woman’s risk of depression more than successful attempts that resulted in a live birth, research recently published in the journal ACTA Obstetricia et Gynecologica Scandinavica shows that the opposite may be true.

In the study, researchers from the University of Copenhagen analyzed data on 41,000 Danish women who had undergone fertility treatments. PsychCentral reports that “investigators discovered women who give birth after receiving fertility treatment are five times more likely to develop depression compared to women who don’t give birth.”

Lead author Camilla Sandal Sejbaek, PhD, discusses the results in the story:

The new results are surprising because we had assumed it was actually quite the opposite. However, our study clearly shows that women who become mothers following fertility treatment have an increased risk of developing depression in the first six weeks after birth compared to women who did not have a child.

Our study has not looked at why the depression occurs, but other studies indicate that it could be caused by hormonal changes or mental factors, but we cannot say for sure. We did not find any correlation between the number of fertility treatments and the subsequent risk of depression.

Previously: Stanford-developed fertility treatment deemed a “top medical breakthrough” of the year, Ask Stanford Med: Expert in reproductive medicine responds to questions on infertility, Image of the Week: Baby born after mom receives Stanford-developed fertility treatment and NIH study suggests progestin in infertility treatment for women with PCOS may be counterproductive
Photo by Big D2112

FDA, Media, Research, Science Policy, Sexual Health, Women's Health

“A historic moment for women”: FDA approves the first drug to treat hypoactive sexual desire disorder

"A historic moment for women": FDA approves the first drug to treat hypoactive sexual desire disorder

20705116491_5351758c67_zRoughly 16 million women over the age of 50 suffer from low sex drive. Yet, until recently, there were no FDA-approved medications to treat the lack of sexual thoughts and desire experienced by women with hypoactive sexual desire disorder (HSDD).

That’s why the U.S. Food and Drug Administration’s recent approval of the drug flibanserin (sold under the brand name Addyi™) to treat women with HSDD, is such big news.

“It’s a historic moment for women,” said Leah Millheiser, MD, director of Stanford’s Female Sexual Medicine Program, in a story published today in the San Francisco Chronicle. HSDD, Millheiser explains, is more than the occasional loss of sexual desire that can result from changes in hormones, stress and discontent in a relationship. “These are women who want to have sex with their partner, they’re attracted to their partner and used to love having sex,” Millheiser said. “It’s as if someone turned off the lightbulb.”

It’s tempting to equate flibanserin to Viagra (the drug approved to treat erectile disfunction in men), but this is clinically inaccurate. As explained in the article, Viagra treats erectile dysfunction by increasing blood flow to the penis, while flibanserin works on the brain.

From the story:

The drug [flibanserin] was first developed as an antidepressant. Like other antidepressants, it works on the brain’s serotonin levels, but researchers say it works on different serotonin receptors than other similar antidepressants.

It didn’t work to relieve depression, as it turned out, but patients reported increased sexual desire.

In clinical trials, researchers said 53 percent of women who took the drug reported an increased desire for sex and 29 percent said the drug decreased their level of distress over their condition. In the trials, the number of “satisfying sexual events” reported by participants essentially doubled from an average of 2.5 per month before they received flibanserin to five while taking it.

Millheiser credits Viagra for helping to pave the way for this new approved treatment for HSDD.  “As a result of Viagra, there was an explosion in research and understanding into what sexual dysfunction is and how we treat it,” she said. “It took 17 years to … get to this day,” she said.

Previously: When hormonal issues interfere with mental healthFemale sexual health expert responds to delay in approval for “Viagra for women and Speaking up about female sexual dysfunction
Photo by Day Donaldson

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