In the latest issue of the British Medical Journal Hannaford et. al. report on a data of a huge number of women followed for almost 40 years, and look at the death rates in women who have used birth control pills compared to women who never used birth control pills. In fact the overall death rates of pill users is lower in most categories that never users, even when controlled for other risk factors like smoking and socioeconomic status. They found not only do women who have used birth control pills have no increased overall risk of death overall, but that their rate of death is somewhat lower than never-users. The data is sliced and diced in innumerable ways, and the bottom line is that women do not need to worry that birth control pill use now or in the past will lead to a higher change of dying early of a pill related problem.
I like Hannaford’s comment, “I would never recommend that someone use the pill simply to reduce their risk of disease later in life,” he said. “However, if the choice is the pill, this decision does not increase a woman’s risk of long-term death. Indeed it may even have some benefits.”
Published 11 March 2010, doi:10.1136/bmj.c927
BMJ 2010;340:c927
My wife and I strongly believed that our daughter should learn to play on a team. We had her join the same type of youth soccer and baseball as our son. We thought that learning to play as a part of a team, to set goals, to win and lose, and to be coached were important life skills that girls in past generations often missed. We are glad we did, and here is data supporting out viewpoint. Tara Parker-Pope in the NY Times reports.
Almost four decades after the federal education law called Title IX opened the door for girls to participate in high school and college athletics, a crucial question has remained unanswered: Do sports make a long-term difference in a woman’s life?
A large body of research shows that sports are associated with all sorts of benefits, like lower teenage pregnancy rates, better grades and higher self-esteem. But until now, no one has determined whether those improvements are a direct result of athletic participation. It may be that the type of girl who is attracted to sports already has the social, personal and physical qualities — like ambition, strength and supportive parents — that will help her succeed in life.
Now, separate studies from two economists offer some answers, providing the strongest evidence yet that team sports can result in lifelong improvements to educational, work and health prospects.
Female athletes, especially basketball and soccer players have up to 6 times as many ACL tears as their male counterparts at similar competative levels. We are way past deciding if girls/women should be involved in sports like soccer, basketball, lacrosse, and other rigorous sports. What we need to recognize is that men’s bodies and women’s bodies are different in more ways that their reproductive organs. When my daughter, who was 13 at the time, had an ACL (anterior cruciate ligament) knee injury I was amazed to learn that this was extremely common.
One of the gynecology offices locally uses this as the headline on billboards in our area to market their endometrial ablation procedure. I hate the billboards, but do find many of my patients have found this or other endometrial ablation procedures very helpful. This is a procedure done where the endometrium is destroyed by one means or another; so that a woman’s bleeding each month is greatly reduced or eliminated.
In the 1950’s when birth control pills were first brought to market it was decided to use 21 days of hormone containing pills, and 7 days without the hormones to induce a withdrawal bleed mimicking a normal menstrual cycle. Today some women prefer to have less frequent bleeding and take extended cycle pills or use the pills continuously without cycling. Which is the better choice for an individual woman? That is a choice for each woman using birth control pills to make, but both ways are felt to be safe and effective. I believe the big issue is whether predictable monthly cycles is more important, or less frequent bleeding is more important. In women who have very bothersome symptoms around their menses from changes in hormones on cyclic use of the pill, continuous use may be better.
As I was thinking about a recent post on the concerns of using Depo-Provera I wondered about an alternative progesterone delivery technique and its effect on bone density. Implanon is an implantable cylinder containing etonogestrel, a different progestin hormone than is used in Depo-Provera. It was approved for use in the USA in 2006, but has been fairly slow to gain popularity, probably because of the problems that arose with the last implantable contraceptive rod device Norplant. Implanon is a single rod implanted just under the skin that slowly releases the hormone and gives up to 3 years of very effective contraception. It appears that Implanon use is not associated with bone mineral loss, as documented in several European studies. Implanon has been used in Europe for about 10 years. The Mayo Clinic patient education site has a good discussion of whether Implanon may be a good choice for you.
One good thing about both Depo-Provera and Implanon is that they avoid the reduction in effectiveness seen as well known side effects of many antibiotics. Reduced contraceptive efficacy is listed under Doxycycline side effects, Levaquin side effects as well as under the side effects of many other antibiotics.
We have known for some time that use of the injectable contraceptive Depo-Provera can lead to mineral loss in young women. Here is even more frightening information. Young women tend to feel this is a concern for old women, but I believe this contraceptive is a poor alternative to birth control pills, patches, or the nuva-ring intravaginal device for most young women. See the article by Roni Caryn Rabin in Friday’s NY Times.
If you have been using prednisone, you should be aware also that osteoporosis is one of the most common prednisone side effects with prolonged use.
Osteoporosis is a common problem in women and sometimes in men as we get older. Normally after menopause there is a gradual loss of calcium from the bones in women. There are a number of things you can do to reduce your risk of osteoporosis, and the fractures of the spine, hip and wrist that can happen in people with osteoporosis. Most important are getting good calcium intake as a young person to build strong bones up front by getting regular exercise, enough calcium in your diet, and not smoking. Dr. Oligario in Health Today outlines this pretty well. One thing some people don’t think of is that prolonged use of the injected contraceptive Depo-provera can lead to osteoporosis in young women, so that just when they should be adding bone mineral they are losing it. Any kind of long term corticosteroid use (prednisone or similar medications used for serious health problems like arthritis, lupus, and auto-immune disorders) is another common cause of bone mineral loss and osteoporosis. This is one of the well known prednisone side effects. If you think you are at risk for osteoporosis discuss this with your physician and consider a DEXA scan to test your bone density.
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