Sexuality

• Birth Control Pills and Breast Cancer
• Timing of pregnancy tests affects accuracy
• Birth Control Patch
• New IUD
• Symptomless Genital Herpes Infections

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Birth Control Pills and Breast Cancer

Good news for women who take the Pill — a new study, published in the June 27, 2002, issue of the New England Journal of Medicine, shows that current or former use of oral contraceptives does not increase the risk of breast cancer later in life.

Previous research indicated women who use or had used oral contraceptives in the past ten years were at an increased risk for breast cancer compared to women who had never used the Pill or had used it less recently. The new study was necessary now because the first generation of women to use the Pill at a younger age is reaching the period in their lives when the risk for breast cancer is greatest.

The study, conducted in Atlanta, Detroit, Los Angeles, Philadelphia, and Seattle, involved 4,575 women with breast cancer and 4,682 without. Study participants were between the ages of 35 and 64. Seventy-seven percent of the women with breast cancer and 79% of the women with no personal history of breast cancer had used oral contraceptives in their lives. The results were analyzed according to race, age, family history of breast cancer, and type of oral contraceptive used.

According to the results, women who took the Pill were as likely to have breast cancer as those who had never taken it. The results also showed the risk for breast cancer did not increase with longer periods of use or with higher doses of estrogen. Age, race, weight, and family history did not affect the risk of breast cancer in women using the Pill compared to women who did not.

Researchers interviewed only Caucasian and African American women. They also evaluated the risk of breast cancer in relation to a family history in first-degree relatives only (not including grandmothers, aunts, and cousins). Regardless, the results of this study should allay the fear that breast cancer may be related to use of the Pill.

August 2002 Update

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Timing of pregnancy tests affects accuracy

Pregnancy test instructions routinely approve testing "as early as the first day of the missed period." However, a recent study suggests such guidance could lead to inaccurate results.

Researchers in North Carolina evaluated the number of pregnancies that were actually detectable on the first day of a woman's missed period. The participants, women ages 21–42, were planning to conceive. Of the pregnancies conceived during the five-year study, 10% of the fertilized eggs had not yet implanted in the woman's uterus on the day a period was expected. Even one week after the first day of the missed period, the test was only accurate 97% of the time.

In addition, due to natural fluctuation in the schedule of ovulation, implantation does not necessarily occur before a woman's regular period should. The timing of implantation varies widely in its relation to the expected period. Many women will test positive a week or more before their period is expected, while some will test positive only a week or more afterward. As a result, women should avoid substances known to harm a fetus (cigarette smoke, large quantities of alcohol) if they are trying to conceive, even if a pregnancy test comes back negative on the first day of a missed period.
March 2002 Update

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Birth Control Patch

The first skin patch approved for birth control by the U.S. Food and Drug Administration will be available by prescription in 2002. Ortho Evra works by slowly releasing progestin and estrogen, the same hormones used in birth control pills, into the bloodstream. Its efficacy lies in the prevention of ovulation and the thickening of the cervical mucus, which makes it harder for sperm to enter the uterus.

Ortho Evra is 99% effective in preventing pregnancy. However, the side effects include an increased risk of blood clots, heart attack, and stroke. This risk is even higher for cigarette smokers. In three clinical trials involving over 3,000 women taking Ortho Evra, 5% of participants had at least one patch that detached from their skin and 2% withdrew from the trial due to skin irritation. Also, the patch appeared to be less effective in women weighing more than 198 pounds.

The regimen is similar to that of birth control pills. The patch is changed once a week for three weeks. The patch-free fourth week allows for a menstrual period. The small (less than two square inches) and paper-thin design makes Ortho Evra easy to hide beneath clothing. It can be applied to the buttocks, abdomen, upper torso (front or back), and the upper outer arm, and be worn in a different place each week.
February 2002 Update

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New IUD

Women have a new choice for birth control. Late last year the FDA approved the intrauterine device (IUD) Mirena. Mirena is a T-shaped plastic device placed in the uterus by a physician that releases small amounts of the hormone levonorgesterel to block conception. Although not the first hormonal IUD, Mirena only needs to be replaced once every five years. The others, in contrast, must be changed yearly. The manufacturer, Berlex Laboratories, reports less than 1% of women become pregnant while using Mirena.
Physicians can easily remove the IUD. And once it’s extracted, a woman can again become pregnant. According to Berlex, eight out of ten women who are trying to conceive will become pregnant within the first year after Mirena is removed.

Mirena is not for everyone, however. Women with a history of pelvic inflammatory disease or a previous ectopic pregnancy (when the embryo grows outside the uterus) should not use IUDs. Furthermore, they don’t protect against sexually transmitted diseases. Possible side effects include spotting or missed periods.
June 2001 Update

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Symptomless Genital Herpes Infections

Recent research tested a potential vaccine against genital herpes only to find it ineffective. But study investigators did learn something very important about this infection. During the course of the trial, 63% of study volunteers who developed antibodies to the virus (indicating exposure) never developed symptoms. Women were about equally likely to develop symptoms or not.

Perhaps the most important message here is that while a newly acquired genital herpes infection may cause no symptoms, new symptoms of genital herpes may in fact result from an old infection. If you or your sexual partner develop symptoms of genital herpes, it is very possible that this is ancient history coming to light in the context of a new relationship.

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