A Lesson In Breasts, Starring Angelina Jolie

Posted on by
Reply

Sometimes, public interest in the lives of celebrities helps us in medicine. For years, I have wished that a celebrity would champion the importance of contraception, planned pregnancies, and reproductive choices. Someone to share that planning for a pregnancy, optimizing health, taking preconception folic acid, and making healthy choices was fashionable. Alas, I’m still waiting for this to happen.

But this week, Angelina Jolie did a great service by bringing attention to the very difficult choices women face in the complex world of breast cancer, screening, prevention, and genetics. It was almost 40 years ago when First Lady Betty Ford openly discussed her breast cancer, mastectomy (surgical removal of the breast), and the importance of a screening mammogram. There was a surge in screening mammography after her revelations, and she personally helped Nancy Brinker get the Susan G. Komen Foundation started. It’s a great example of a well-known individual making a big impact on women’s health.

Hopefully, Ms. Jolie’s announcement will have a similar effect. She has taken the key message of preventive health, and used a very important term, “empowerment.” Clearly, her decision to have a double mastectomy in order to lower her cancer risk was not made lightly—it was made with a collaborative team that factored in her family history, risk factors, and the individual options available to her. In describing her experience, Ms. Jolie addressed the concerns many women have about their family support, family impact, and perception of self. She discussed how rare BRCA gene mutations increase a woman’s risk of developing cancer and the health disparities that stand in the way of more screening and treatment for women with these inherited risk factors. These are the issues our ACOG Fellows face daily—determining which patients need a comprehensive screening approach, providing the appropriate care, and having a team well-versed in genetics and risks to tailor the care to the individual.

Quite frankly, we as ob-gyns can’t know it all, but we sure can get a team that collectively does! We need to be knowledgeable in the appropriate screening protocol (ACOG recommends routine screening for hereditary breast and ovarian cancer). We also need to be prepared to counsel patients with elevated risk, and to call on the expertise of geneticists, surgeons, oncologists, and radiologists to collaboratively manage a patient’s care. It is up to us to be aware of risks for our patients and develop the best available system to help them make personal decisions.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

Finally, Women’s Health Gets Its Due

Posted on by
Reply

It is an amazing time for women in the US. The recent passage of the Affordable Care Act (ACA) shows that women’s health has been embraced as a national priority. Implementation of this landmark legislation will improve and expand health care for millions of women. From yearly well-woman visits to cancer screenings and domestic violence screening and counseling, to breastfeeding support and contraceptive coverage, more women’s health services will be accessible and affordable than ever before.

It’s with this backdrop that I take the reins as president of The American Congress of Obstetricians and Gynecologists, and I couldn’t be more excited. As a nation, we’re finally recognizing that health care is about more than solving accute health crises. It’s about promoting wellness to prevent disease. For ob-gyns, providing top-notch health care includes having meaningful interactions with women and providing them tools not only to maintain their physical health, but to improve their physical, mental, and emotional health, too.

Ob-gyns will be greatly affected by the new law, but we’ll also have a chance to make a great impact. We will be gaining new patients and collaborating with colleagues to optimize their health. We should strive to make the most of these patient-doctor visits and encourage women to put their health first—take advantage of the services ACA offers; get preexisting health conditions under control; make time for eating right, exercise, and the stress-relieving activities that they enjoy. These are fundamental health reminders that we must convey to every woman, every time.

As an ob-gyn, I believe that no medical specialty knows women’s health better than we do. We have a duty to speak up in the best interest of women’s health. During my year as ACOG president, I plan to take every opportunity to advocate for women. I challenge ACOG Fellows to let your voices be heard as well. Talk to your legislators and your community about women’s health, but most of all, talk to your patients. Working with them one-on-one to build the foundation for a healthier future is where we can make the biggest difference.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

Time Flies When You’re Having Fun

Posted on by

What a ride this past year has been! As I wind down my time as ACOG president, I’m proud of our accomplishments—we remained a strong and vocal supporter of women’s reproductive rights, made strides in standardization of care and patient safety, and moved forward in communication and technology, including the introduction of the new ACOG app for ob-gyns.

Two main themes during my presidential year have been the essentialness of contraceptive access for all women and the importance of having women in leadership roles. For the “grand finale” of my presidency—the President’s Program on May 6 at ACOG’s Annual Clinical Meeting (ACM) in New Orleans—I’ve assembled a roster of phenomenal speakers that will offer their unique spin on these topics.

I’m happy to welcome Malcolm Potts, MD, chair of population and family planning at the University of California Berkeley’s School of Public Health. Dr. Potts has studied extensively the positive societal changes that come when women can make their own reproductive health choices. In a recent speech, Dr. Potts said “If you’re working in cancer or orthopedics or pediatrics, you make people healthier by trying to relieve pain and suffering. What we’ve done in gynecology is change civilization.” His lecture “Sex, Ideology, and Religion: How Family Planning Frees Women and Changes the World” is one not to be missed.

Next, I’ve invited two exceptional leaders, colleagues, and ACOG vice presidents, Sandra A. Carson, MD, and Barbara S. Levy, MD, to present “Your Personal Path to Leadership: The Road Less Traveled.” They’ll discuss their own not-so-traditional journeys to becoming leaders in our field and the need for diversity in leadership.

Rounding out the program, Gary Chapman, PhD, author of The Five Love Languages, will present his speech “The Five Languages of Apology.” His insightful presentation will discuss the importance of apology in developing, maintaining, and repairing relationships.

Though my year as ACOG president is coming to a close, my involvement will continue. I’m looking forward to supporting our new president, Jeanne A. Conry, MD, PhD, in her endeavors and continuing to be an outspoken advocate for women. I’m also looking forward to more time for family and mountain biking in Nevada! Many thanks to ACOG Fellows and staff for your support and friendship throughout this amazing year.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

 

Guest Blog: How ACOG Sections Can Increase Member Advocacy

Posted on by
Holly S. Puritz, MD

Holly S. Puritz, MD

As women’s health continues to come under attack at the federal and state level the importance of advocacy cannot be overstated. We need educated voices to weigh in on key issues. It is only through continued advocacy that we can protect our patients’ access to care and preserve the sanctity of the physician-patient relationship.

Ob-gyns are getting the message: More than 330 ob-gyns attended ACOG’s annual Congressional Leadership Conference (CLC) in March—our highest attendance yet. During the CLC, we have the opportunity to meet with congressional leaders to call attention to key ob-gyn issues. We also learn about the importance of women’s health advocacy on the state level, where many laws that affect how we care for our patients are passed. Often, our expert testimony can be very meaningful when bills are still in committee.

In Virginia, we were struggling to find a way to have physicians available for these committee sessions, but we believe we’ve found a good solution. Each year, the Virginia Section sponsors approximately six members to attend the CLC. This year, to encourage state advocacy, we adopted a “pay it forward” approach to this sponsorship. We now expect our sponsored members to spend one full day during the legislative session in Richmond, ready to speak to lawmakers.

The Virginia General Assembly meets every year from January to March. The key committees meet on Tuesdays and Thursdays, and bills often come up without warning. Our lobbyist can testify on our behalf, but the message is always better received when delivered by a physician. In 2013, we aimed to have at least one ACOG Fellow or Junior Fellow attend each Tuesday and Thursday of the legislative session.

By implementing this new system, as bills came up, there was always someone who could testify. Our lobbyist knew she would have coverage, and we knew our voices would be heard. On days when testimony was not needed, the ob-gyn would accompany our lobbyist on “rounds” of key legislators to discuss women’s health issues from our perspective.

Our CLC group wasn’t large enough to cover every Tuesday and Thursday during the session, so we also asked other ob-gyns to volunteer, offering to reimburse them for mileage and lunch. Our ob-gyn representatives enjoyed their one-on-one experience and are looking to build on the relationships they formed in the off-season so that we can continue to be strong advocates for women’s health.

We found this new process to be a very effective way to encourage state advocacy, and we hope to expand participation in 2014 by increasing volunteer outreach at our annual section meeting. I invite other ACOG sections to give this formula a try. More voices in more states speaking up for women is a goal that we should all strive to achieve.

Holly S. Puritz, MD is chair of ACOG’s Virginia Section.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

Then Comes the Baby Carriage…Or Maybe Not

Posted on by

Infertility—the inability to conceive after six months to a year of unprotected sex—is a common problem in the US. More than 7 million people struggle to have a baby, often facing frustration and confusion along the way. Fortunately, many people who are treated for fertility problems are able to conceive after therapy.

Infertility affects men and women nearly equally. About one-third of cases can be attributed to the male partner, one-third are related to the female partner, and the remainder are caused by a combination of problems with both partners or by unknown factors.

In women, increasing age, irregular ovulation (release of eggs from the ovaries), abnormal anatomy, or scarring or blockages in the fallopian tubes are the main causes of infertility. Gynecologic conditions, such as polycystic ovary syndrome, endometriosis, and fibroids, can also make it difficult for a woman to conceive. Lifestyle factors, such as smoking, eating a poor diet, or being underweight, overweight, or obese, may also make it harder to get pregnant.

Male fertility also declines with age, but at a slower rate. Infertility in men usually involves problems with the sperm. Sexually transmitted diseases (STDs) or an injury to the testicles, such as overheating (from spending too much time in a hot tub, for example) or a reaction to medication, can lead to short-term fertility issues.

If you are having trouble getting pregnant, see your ob-gyn. Your doctor may order tests to understand what is causing the problem. You may also be referred to a doctor who specializes in infertility (reproductive endocrinologist) or to other counselors and specialists.

Standard fertility testing for women includes a physical exam and a health history survey that focuses on menstrual function and a woman’s history of pregnancy, STDs, and birth control use. Blood and urine samples may be analyzed to confirm that normal ovulation is taking place. X-rays or ultrasounds may be used to view and inspect the reproductive organs for any abnormalities. To test for male fertility, a semen sample will be checked for the number, shape, and movement of the sperm and for signs of infection.

Infertility can be treated in a variety of ways depending on the cause. If you are overweight or obese, losing weight may improve your chances of getting pregnant. Medications that stimulate the ovaries or regulate blood insulin levels (which can interfere with ovulation) may be prescribed. Your doctor can also help you decide if surgery or assisted reproductive therapies, such as in vitro fertilization, are right for you.

National Infertility Awareness Week is April 21–27, 2013. Learn more.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

Chlamydia and Gonorrhea Screening a Must for Women 25 and Younger

Posted on by

Each year, approximately 19 million Americans contract a sexually transmitted disease (STD). STDs are infections spread from one person to another during sexual activity. Chlamydia and gonorrhea are the most commonly reported STDs.

There are an estimated 2.8 million new cases of chlamydia and 700,000 cases of gonorrhea in the US each year. Both infections are most common in young women and both pose a serious risk to women’s reproductive health. If left untreated, gonorrhea and chlamydia can cause pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, and other parts of the pelvis. PID may cause chills, fever, pelvic pain, infertility, and ectopic pregnancy.

Many women may never know they have an STD—the symptoms can be vague. Within two days to three weeks of infection, women may experience a yellow vaginal discharge; painful or frequent urination; vaginal burning or itching; redness, swelling, or soreness on the outside of the vagina (vulva); pain in the pelvis or abdomen during sex; abnormal vaginal bleeding; and rectal bleeding, discharge, or pain. Many women and men will experience no symptoms at all.

ACOG and the US Centers for Disease Control and Prevention (CDC) recommend that all sexually active women age 25 and younger be regularly screened for chlamydia and gonorrhea. Women over 26 should be screened for chlamydia and gonorrhea annually if they have multiple sexual partners or if their partner has multiple sexual contacts. Despite these recommendations, the CDC recently reported that only 38% of young sexually active women are screened for chlamydia and that more than 20% who test positive become reinfected within six months.

ACOG urges ob-gyns to talk to their patients about STDs and screen those at high risk of infection. Chlamydia and gonorrhea can be treated with antibiotics. To lower the risk of reinfection, ACOG suggests that ob-gyns write a prescription both for their patient and her sexual partner, who may be unlikely or unable to get treatment on his or her own. It is important that both partners are treated and take all of their medicine before resuming sexual activity.

Using a male or female condom correctly every time you have sex can also help reduce transmission of STDs. Practice abstinence or monogamy, or limit your number of sexual partners. And be up front: it’s better to have a frank conversation with your partner about your sexual histories beforehand than to be unpleasantly surprised down the road.

April is STD Awareness Month. For more information, check out the CDC’s STD Awareness Month page.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.

Gynecologic Oncologist = Women’s Cancer Specialist

Posted on by

For many women, ob-gyns are their primary health care provider. It’s not uncommon for women to see their ob-gyn at least annually, and for good reason. Ob-gyns receive a comprehensive education in caring for women from adolescence through childbearing and into menopause. Our training includes care of both pregnant and non-pregnant women, surgery, pharmacology, and more.

Because we see our patients regularly, especially during their reproductive years, ob-gyns have the opportunity to build and maintain a strong patient-doctor relationship. We can observe patients when they’re healthy, establish a baseline of what’s normal, and potentially spot suspicious changes or health problems when they are most treatable.

When a patient reports out-of-the-ordinary changes and symptoms, an ob-gyn can perform diagnostic exams and tests to confirm the problem. He or she can treat changes that may lead to cancer and prevent cancer from ever developing. When invasive cancers of the female reproductive organs—cervix, ovary, uterus, vagina, or vulva—are diagnosed, ob-gyns will often consult with other ob-gyns with advanced training and experience, such as gynecologic oncologists. This can be especially helpful for cases that are thought to be more advanced.

Gynecologic oncologists are ob-gyns who have completed several additional years of training in surgery, treatment, and research on women’s cancers and received board certification in gynecologic oncology. They see patients with these cancers every day. Following diagnosis, gynecologic oncologists can perform the sometimes complicated surgical procedures (staging) necessary to improve a woman’s chances of controlling and beating cancer. They are experts in the timing and order of treatment and can also serve as the “traffic controllers” overseeing the coordination of nurses, primary care physicians, radiologists, and other health care professionals who will be involved in all aspects of the patient’s care.

Today, there are more than 1,000 board-certified gynecologic oncologists in the US. To learn more about these cancer specialists, visit the Society for Gynecologic Oncology website.

Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.