Yes, it’s true: Not all women need a Pap smear

By Dr. Diana Sarmiento, The Blogging Doc | Yahoo! SHE

If you’ve ever had a Pap smear, you know that the experience of lying on a cold examining bed half-naked can be very unpleasant.

With your genital area exposed, a doctor inserts an instrument called a speculum in your vagina and scrapes off some cells from the cervix. These cells are sent to the laboratory to screen for the earliest sign of cervical cancer, the third leading cause of death in women.

Introduced 60 years ago, the Pap smear remains the mainstay when it comes to the early diagnosis of the disease.

If you are one of those women who have been putting off your doctor's visit because you dread the pap smear, the October 17, 2011 issue of the Annals of Internal Medicine suggests that women younger than 20 and older than 65 do not need a Pap smear.

A review of multiple studies and trials showed that there is no improvement in detecting cervical cancer for the mentioned age groups. In addition, the incidence of cancer in women under 20 is rare.

Risk Of Postpartum Depression Higher For Latinas Victimized By Domestic Violence

Latinas who endure violence at the hands of a partner during or within a year of pregnancy are five times more likely to suffer postpartum depression than women who have not experienced such violence, according to a new study by researchers at the UCLA Center for Culture, Trauma and Mental Health Disparities.

The study, published in the current issue of Archives of Women's Mental Health, suggests that recent exposure to intimate partner violence, or IPV, is a much stronger prenatal predictor of postpartum depression than even prenatal depression, which is generally considered the most significant predictor.

In addition, recent partner violence has a stronger effect on postpartum depression than prior episodes of trauma from either partners or non-partners, the researchers said.

The authors suggest that pregnant women be screened for both prenatal depression and IPV.

Postpartum Depression and Difficulty Breast-Feeding May Go Hand in Hand

By BONNIE ROCHMAN | @brochman

Breast-feeding may be natural but that doesn’t mean it comes easily to every new mom. A new study in the August edition of the journal Obstetrics & Gynecology finds that women who struggle to breast-feed in the first two weeks after giving birth are more prone to postpartum depression.

The study was not able to determine whether depressed moms were more likely to have trouble breast-feeding or whether difficulty breast-feeding sparked depression, but the paper’s authors, from the University of North Carolina at Chapel Hill (UNC), recommend a two-pronged holistic approach: screen women with breast-feeding difficulties for depression and assess how breast-feeding is going for depressed mothers.

“Clearly all women who have pain breast-feeding are not depressed, but the message for clinicians is to look not just at baby’s mouth and the boob but to also look at mom’s brain,” says Dr. Alison Stuebe, the study’s senior author and an assistant professor in the department of obstetrics and gynecology in the UNC School of Medicine. “The mind has to be part of the evaluation.”

To reach their conclusions, the researchers relied on data from 2,586 women in the government-funded Infant Feeding and Practices Study II, which assessed issues of feeding and depression. Nine percent of the women fell into the category of “major depression.”

MORE: Pediatricians Should Start Screening for Postpartum Depression

Women who reported dissatisfaction with breast-feeding early on were 42% more likely to have postpartum depression two months after delivery compared with women who enjoyed breast-feeding. Mothers who initially experienced severe breast pain initially and at two weeks postpartum were twice as likely to be depressed as pain-free women. Depression, in general, has been linked to increased pain sensitivity, which may explain why depressed women have more pain while breast-feeding.

The association is unlikely to be coincidental. In a pilot study Stuebe is conducting, she’s found that new moms who report feeling anxious have lower levels of oxytocin — the feel-good hormone that courses through the body while nursing — during feeding. “Is there something hormonal in women who are depressed that makes breast-feeding less enjoyable?” she says.

Stuebe first began wondering about a possible correlation when she was a medical resident in Boston. Lactation consultants in the community would tell her that patients who needed help breast-feeding frequently seemed depressed. When she came to UNC, she suggested administering the Edinburgh Postnatal Depression Scale, a 10-question screen that is widely used to gauge depression in new mothers, to women who had problems breast-feeding. (The questions include: “I have been able to laugh and see the funny side of things” and “I have been so unhappy that I have been crying.”) She found an “impressive” number of women were both depressed and having difficulty breast-feeding.

MORE: Child’s Play: What’s So Bad About ‘The Breast Milk Baby’?

Though women are urged to breast-feed for the health benefits it conveys to both mom and baby, a single-minded focus on nursing as the only acceptable choice — without the accompanying support necessary for breast-feeding success — may be putting too much pressure on some mothers.

“We have seen a really positive shift in the attitude of public-health experts away from ‘mothers have to breast-feed, or else’ to ‘we need systems to support mothers in their breast-feeding goals,’” says Stuebe. In January, the U.S. Surgeon General issued a Call to Action to Support Breastfeeding that urged communities, relatives, employers and health providers to pitch in to help women attain their breast-feeding goals.

In fact, wrote Stuebe earlier this year in a blog for the Academy of Breastfeeding Medicine, it’s time to recognize that breast is not necessarily best for every woman:

We should not change the public health message that breast-feeding is the physiologic norm. Soft-pedaling medical advice because we might hurt someone’s feelings is patronizing at best, and unethical at worst. Further, backing away from evidence-based medical recommendations for 6 months of exclusive breastfeeding gives policy makers permission to cut back support for mothers and families.

In so many cases, a terrible breast-feeding experience is the downstream effect of subpar maternity care, unsupportive family and friends, poor medical advice and unrealistic expectations of motherhood.

But there is a major difference between a public health message on a billboard and a conversation between a struggling mother and her medical provider.

In routine care, we need to ask each mother how she feels about how feeding is going, and then we need to take time to listen to her response. And if, for this mother, and this baby, extracting milk and delivering it to her infant have overshadowed all other aspects of their relationship, it may be that exclusive breast-feeding is not best for them – in fact, it may not even be good for them.

Says Stuebe: “A lot of the pain that women experience with breast-feeding reflects the now-outdated concept that moms have to power through, no matter what. It is helpful to have a more honest, realistic expectation of motherhood as a whole.”

Breast-feeding may be natural but that doesn’t mean it comes easily to every new mom. A new study in the August edition of the journal Obstetrics & Gynecology finds that women who struggle to breast-feed in the first two weeks after giving birth are more prone to postpartum depression.

The study was not able to determine whether depressed moms were more likely to have trouble breast-feeding or whether difficulty breast-feeding sparked depression, but the paper’s authors, from the University of North Carolina at Chapel Hill (UNC), recommend a two-pronged holistic approach: screen women with breast-feeding difficulties for depression and assess how breast-feeding is going for depressed mothers.

“Clearly all women who have pain breast-feeding are not depressed, but the message for clinicians is to look not just at baby’s mouth and the boob but to also look at mom’s brain,” says Dr. Alison Stuebe, the study’s senior author and an assistant professor in the department of obstetrics and gynecology in the UNC School of Medicine. “The mind has to be part of the evaluation.”

To reach their conclusions, the researchers relied on data from 2,586 women in the government-funded Infant Feeding and Practices Study II, which assessed issues of feeding and depression. Nine percent of the women fell into the category of “major depression.”

MORE: Pediatricians Should Start Screening for Postpartum Depression

Women who reported dissatisfaction with breast-feeding early on were 42% more likely to have postpartum depression two months after delivery compared with women who enjoyed breast-feeding. Mothers who initially experienced severe breast pain initially and at two weeks postpartum were twice as likely to be depressed as pain-free women. Depression, in general, has been linked to increased pain sensitivity, which may explain why depressed women have more pain while breast-feeding.

The association is unlikely to be coincidental. In a pilot study Stuebe is conducting, she’s found that new moms who report feeling anxious have lower levels of oxytocin — the feel-good hormone that courses through the body while nursing — during feeding. “Is there something hormonal in women who are depressed that makes breast-feeding less enjoyable?” she says.

Stuebe first began wondering about a possible correlation when she was a medical resident in Boston. Lactation consultants in the community would tell her that patients who needed help breast-feeding frequently seemed depressed. When she came to UNC, she suggested administering the Edinburgh Postnatal Depression Scale, a 10-question screen that is widely used to gauge depression in new mothers, to women who had problems breast-feeding. (The questions include: “I have been able to laugh and see the funny side of things” and “I have been so unhappy that I have been crying.”) She found an “impressive” number of women were both depressed and having difficulty breast-feeding.

MORE: Child’s Play: What’s So Bad About ‘The Breast Milk Baby’?

Though women are urged to breast-feed for the health benefits it conveys to both mom and baby, a single-minded focus on nursing as the only acceptable choice — without the accompanying support necessary for breast-feeding success — may be putting too much pressure on some mothers.

“We have seen a really positive shift in the attitude of public-health experts away from ‘mothers have to breast-feed, or else’ to ‘we need systems to support mothers in their breast-feeding goals,’” says Stuebe. In January, the U.S. Surgeon General issued a Call to Action to Support Breastfeeding that urged communities, relatives, employers and health providers to pitch in to help women attain their breast-feeding goals.

In fact, wrote Stuebe earlier this year in a blog for the Academy of Breastfeeding Medicine, it’s time to recognize that breast is not necessarily best for every woman:

We should not change the public health message that breast-feeding is the physiologic norm. Soft-pedaling medical advice because we might hurt someone’s feelings is patronizing at best, and unethical at worst. Further, backing away from evidence-based medical recommendations for 6 months of exclusive breastfeeding gives policy makers permission to cut back support for mothers and families.

In so many cases, a terrible breast-feeding experience is the downstream effect of subpar maternity care, unsupportive family and friends, poor medical advice and unrealistic expectations of motherhood.

But there is a major difference between a public health message on a billboard and a conversation between a struggling mother and her medical provider.

In routine care, we need to ask each mother how she feels about how feeding is going, and then we need to take time to listen to her response. And if, for this mother, and this baby, extracting milk and delivering it to her infant have overshadowed all other aspects of their relationship, it may be that exclusive breast-feeding is not best for them – in fact, it may not even be good for them.

Says Stuebe: “A lot of the pain that women experience with breast-feeding reflects the now-outdated concept that moms have to power through, no matter what. It is helpful to have a more honest, realistic expectation of motherhood as a whole.”

Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME‘s Facebook page and on Twitter at @TIME.

http://healthland.time.com/2011/08/05/do-depression-and-difficulty-breast-feeding-go-hand-in-hand/ 

Pregnancy Increases Heart Attack Risk

By ABC News | ABC News Blogs

Ike S. Okwuosa, MD reports:

CHICAGO -  Heart attacks are often linked to high blood pressure, diabetes and smoking. But a new study suggests pregnancy can also increase the risk.

"There are significant hormonal changes that occur during pregnancy that affect the coronary arteries," said study author Dr. Uri Elkayam, professor of medicine, cardiology, and obstetrics and gynecology at the University of Southern California.

Those pregnancy-related hormonal changes,  Elkayam said, leave women "susceptible to clots."

Elkayam and colleagues reviewed 150 cases of heart attack during pregnancy between 2005 and 2011. They presented their findings today at the 61 st conference of the American College of Cardiology in Chicago.

Heart attacks are usually triggered by  atherosclerosis - a build-up of plaque that narrows the arteries and makes it harder for blood to flow.  But only a third of heart attacks that occur during pregnancy are caused by atherosclerosis, Elkayam said. Rather the vast majority are caused by a tear of one of the three layers that make up a blood vessel known as a dissection.

Seventy percent of spontaneous coronary dissections occur in women and 30 percent of those occur during pregnancy or immediately after, according to Dr. Sharon Hayes, a cardiologist at the Mayo clinic in Rochester, Minn. who was not involved in the study. "We have known for decades that young women with heart attack have higher mortality than men at the same age and also have very different cardiovascular disease risk factors," she said.

Heart attacks are usually treated with clot-busting drugs and balloons or stents that open up the narrowed artery. But for pregnant women with dissections, typical treatments can make the situation significantly worse.

Elkayam found that "performing a coronary angiogram, in which you inflate a balloon and place a stent, in 5 percent of the patients made things worse… In patients who are stable, we advise to evaluate the patient non-invasively, and only the high risk patient should undergo a cardiac catherization," he said.

A heart attack occurring in a young, previously healthy young woman is very unusual, with a reported incidence of 1/16,000. Elkayam emphasized that "women should not be afraid to become pregnant because the incidence of a heart attack is very small."

Dr. Okwuosa is an internal medicine resident Northwestern Memorial Hospital's Feinberg School of Medicine.

http://news.yahoo.com/blogs/abc-blogs/pregnancy-increases-heart-attack-risk-192805072--abc-news.html;

Down-There News You Need Right Now

Four crucial updates you've just gotta have before your next gyno visit

Rennie Solis

 

Your yearly visit to the gynecologist is critical to your health—period. What's also key: going in with a list of specific questions, so your gyno can tailor her recommendations to your needs, says Jill Maura Rabin, MD, a spokeswoman for the American Congress of Obstetricians and Gynecologists. To get more out of your time in the stirrups, consider discussing these important findings with your doc.

Update #1: New relief for heavy periods

If you have menorrhagia—periods so heavy and painful they interfere with daily life—your gyno may have suggested going on the Pill or taking some other hormonal medication. If that didn't work, your only other option was surgery, from endometrial ablation (which destroys the uterine lining) to a hysterectomy (total removal of the uterus). Now there's a new nonhormonal way to lighten the flow: tranexamic acid, a prescription drug that works by stabilizing a protein that helps blood to clot. While the drug does carry a risk of side effects, such as unwanted clotting, Dr. Rabin says it's "a great option for women who can't or don't want to take hormonal treatments."

Update #2: A surprise upside to hormone therapy

Talk about confusing: First, hormone replacement therapy (HRT) was hailed as a miracle drug that might not only ease menopause symptoms, such as hot flashes and insomnia, but also reduce the risk of osteoporosis and heart disease. Then the landmark Women's Health Initiative (WHI) study found that an HRT treatment of estrogen plus progestin increased the stroke and breast cancer risk in some women. But in April, a WHI report yielded some good news: For one group—postmenopausal women in their 50s who'd had a hysterectomy—taking an estrogen-only form of HRT for up to six years lowered the rate of breast cancer without increasing any other risks. If you're seeking relief from menopause, talk to your doctor about HRT's pros and cons—whether you still have your uterus or not.

Update #3: Beat fibroids without surgery

Rennie Solis

Fibroids—or benign tumors in the uterus—don't always cause symptoms. But for an unlucky minority, they can lead to heavy bleeding, pain, and even infertility. Hysterectomy is a traditional treatment for the condition, but a recent study shows that two less-invasive options preferred by patients can help them just as much. One, called uterine artery embolization, involves injecting particles into the arteries supplying blood to the fibroids to block them. The other, a focused ultrasound, heats and kills fibroid cells. "Though all treatments may not be suitable for all patients, they all lead to a significantly improved quality of life," says lead author Fiona Fennessy, MD, a radiologist at Brigham and Women's Hospital.

Update #4: You may need even more folic acid

Sure, you know you need folic acid right before and during pregnancy to help prevent neural-tube defects, such as spina bifida. Since 1996, many common foods, like breads and pastas, have been fortified with this B vitamin. But you still may not be getting enough. While fortification has cut spina bifida rates in half, "many women now miss out on fortified foods because they're cutting back on carbs," says OB-GYN Diana Ramos, MD, consultant to the March of Dimes. Even if you're a carb addict, she says, not all the folic acid from food is absorbed by your body—and you need it in your system at least a month before you conceive to reap the benefits. Play it safe by taking a multivitamin with at least 400 milligrams of folic acid even if you're not pregnant or trying (half of all pregnancies are unplanned!); bump it up to 600 milligrams if you are.

http://www.health.com/health/condition-article/0,,20489182_2,00.html

Gravity and Its Effects on Women

By Amy S. D. Lee, MS, WHCRNP, Nurse Practitioner

When I start thinking about how the force of gravity tugs and pulls on the female body, I usually reflect on the various parts of me that I can see have begun to sag!

Unfortunately, gravity can cause some of our organs, such as the uterus, to fall down or slip out of place. But there are ways to handle this condition, which we in medicine commonly refer to by the catchall term, prolapse. Prolapse literally means "to fall out of place," and it affects the vagina and the bladder as well.

What is prolapse?

Prolapse is a condition in which the pelvic organs begin to sag into, and even out of, the vagina. There are varying degrees of severity of prolapse, and the severity of the symptoms a woman will experience are usually related to the degree or extent of the prolapse.

Women who have never had children may have prolapse, but it's more common in women who have had vaginal deliveries. Other factors contributing to prolapse include

• older age
• heavier weight
• constipation
• prolonged cough
• pelvic tumors (like heavy uterine fibroids)
• perhaps a genetic predisposition

Common Symptoms of Prolapse

• pelvic pressure
• feeling of vaginal fullness
• leakage of urine
• pain with sex
• constipation (both a cause and a symptom)

Diagnosis

Diagnosis of mild prolapse can be made during a pelvic exam at your GYN visit. A more severe prolapse sometimes will become evident when the pelvic organs can be seen or felt protruding from the vagina. Your healthcare provider should then confirm the diagnosis with a pelvic exam.

While it can be quite alarming to discover that you have prolapse, it’s usually a pretty benign condition that can be corrected.

Treatment

Treatment of a prolapse often depends on the severity of both the prolapse and the symptoms. Mild prolapse can often be treated with vaginal topical estrogen andvaginal exercises (Kegel exercises), both of which strengthen the vaginal walls. Other tactics for treating milder prolapses include avoiding heavy lifting and avoiding caffeine (which acts as a diuretic).

More severe prolapse can be treated with a device called a pessary. Pessaries come in a variety of designs and are fitted by your healthcare provider. They stay in the vagina and lift the organs back into normal position. (No, you can't feel them.)

Last, the most severe cases of prolapse can be addressed with surgery. Severe uterine prolapse may require a hysterectomy, followed by repair of the vaginal muscles to lift the bladder back into position. There are also surgical procedures that can be done to suspend the bladder to or from other parts of the abdomen. Women who do not plan to ever be sexually active again may choose to have a procedure that closes the vagina, thereby lifting the organs into place and preventing them from falling back down.

What if you think you have prolapse?

The first thing ALL women should be doing--whether they have a prolapse condition or not--is the Kegel exercises. We should start doing them early (even as teens and young adults) to keep the vaginal muscles strong. Practice by squeezing the vaginal muscles (like starting and stopping the stream of urine) 10 times at least 10 times per day. If you are concerned that you have prolapse, or are at risk of prolapse, discuss your situation with your healthcare provider. Early intervention is an important part of prevention.

http://health.yahoo.net/experts/womentoday/gravity-and-its-effects-women

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