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Birth Control Pills and
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 2142, 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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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 its 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 dont 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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