A Call to Action for Increased Funding for Endometriosis

An estimated 176 million women and girls throughout the world are affected by endometriosis, according to the World Endometriosis Society. I’m pleased to announce that ACOG, ASRM, and other organizations are co-sponsoring the worldwide Million Woman March for Endometriosis to raise awareness and advocate for increased funding for this common and often painful gynecologic condition. We believe that an internationally-coordinated campaign is absolutely necessary to effect change. So on March 13, we’ll be marching on the National Mall in Washington, DC, while similar events take place throughout the world.

Endometriosis affects 6–10% of all reproductive-age women. It’s a leading cause of chronic pelvic pain and a common cause of infertility. Unfortunately, we still don’t know what causes it. And the treatments that we have, while helpful, are not curative. According to the Endometriosis Foundation of America and the World Endometriosis Research Foundation, the health care costs of endometriosis are estimated to be $70–95 billion each year in the US alone. Although this is comparable to other chronic diseases, two-thirds of these costs are due to loss of productivity at work.

Our campaign goals include:

  • Empowering women and teens by encouraging them to unite with their supporters to take a stand against endometriosis.
  • Raising awareness about endometriosis and its effects on women and girls.
  • Educating and training the medical community to promote early detection and improved treatment.
  • Finding a cure for endometriosis and developing non-invasive diagnostic tests.
  • Working with Congress to allocate funding for endometriosis.

We won’t be marching alone in March. Awareness campaigns also will be occurring in dozens of capitals around the world—Amsterdam, Belfast, Berlin, Brasilia, Buenos Aires, Copenhagen, Dublin, Helsinki, Kingston, Lisbon, London, Madrid, Oslo, Reykjavik, Rome, and Stockholm, to name just a few.

Throughout my presidential term, I have advocated for well-woman health care and prevention. Wouldn’t it be wonderful to one day have endometriosis on the list of “preventable” conditions? That will only happen when our research discovers the cause.

Please plan to join us in Washington, DC, on March 13. For more information about supporting the Million Woman March for Endometriosis, go to www.millionwomanmarch2014.org.

Resource: Endometriosis Fact Sheet (PDF)

Then Comes the Baby Carriage…Or Maybe Not

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.

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Chlamydia and Gonorrhea Screening a Must for Women 25 and Younger

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.

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Understanding PCOS

Approximately 4% to 6% of women in the US have polycystic ovary syndrome (PCOS), a serious disorder that can make it hard to become pregnant and can lead to other severe health problems. The causes of PCOS are unknown, and many women may not recognize the seemingly unrelated symptoms—irregular periods, being overweight, and having extra facial hair—as signs of a serious health problem.

So what happens in women with PCOS? Unlike normally functioning ovaries which release a single mature egg every month, polycystic ovaries have many eggs that do not get released. This leads to a hormonal imbalance that can cause irregular menstruation and infertility. Women with PCOS also have higher than normal levels of male hormones (androgens). Excess androgens can disrupt ovulation and cause acne and hair growth on the face, the lower part of the abdomen, between the breasts, and on the inner thighs. Women with severe PCOS may experience balding and develop bigger muscles and a deeper voice.

Up to 80% of PCOS sufferers are obese, and they often have difficulty regulating blood sugar and insulin, the hormone that lowers blood sugar. These problems may lead to an increased risk of diabetes, high blood pressure, and heart disease.

Though PCOS cannot be cured, it can be treated, and its symptoms can be relieved. Overweight women benefit from exercising for at least 30 minutes a day and losing weight. Dropping even 10–15 pounds may improve symptoms such as menstrual irregularity, high levels of insulin and cholesterol, acne, and excess hair growth. Less insulin can stimulate ovulation and slow undesired hair growth. Birth control pills to regulate your menstrual cycle or medication to control insulin may also be prescribed. For those who want to become pregnant, medications can be used to induce ovulation.

For more information about PCOS, check out ACOG’s Patient FAQ.

What You Need to Know about Fibroids

Have you ever heard of fibroids? If you’re a woman, especially in your 30s or 40s, it’s important that you know what they are. An estimated 70–80% of women in the US have these non-cancerous growths that form in, on, or around the uterus. They may vary in shape, location, and size—some fibroids are roughly the size of a pea while others can grow large enough to fill a woman’s pelvis or abdomen.

Fibroids do not always cause symptoms, so many women may never know they’re there. If symptoms do occur, they may include menstrual changes such as heavier, longer, or more frequent periods; vaginal bleeding at times other than during menstruation; pain during menstruation or sex; lower abdominal or pelvic pain or abdominal cramps; difficult or frequent urination; constipation, rectal pain, or difficult bowel movements; an enlarged uterus and abdomen; or miscarriages or infertility.

Today, there are more options than ever available to treat fibroids. If symptoms are mild, medication, such as birth control pills to control heavy bleeding and painful periods, may help. Older women may decide to forgo treatment because fibroids generally shrink after menopause. Some women, regardless of age, decide to skip treatment altogether.

Surgery or other non-surgical procedures to remove fibroids may be necessary when fibroids cause severe discomfort, excessive bleeding, fibroid-related infertility, or when it is unclear whether the growth is a fibroid or another type of tumor (such as ovarian cancer). More information about treatment options is available on the ACOG website.

Women who experience symptoms should report them to their doctor. If fibroids are to blame, an appropriate treatment plan can be developed. When considering treatment possibilities, it’s important to weigh the severity of the symptoms, plans for having children in the future, age, and whether a surgical or non-surgical approach is preferred.

Double Take: Where’d All These Twins Come From?

If you’ve been noticing more twins around lately, it’s not just double vision. New data from the Centers for Disease Control and Prevention confirm that more twins are being born today than ever before. In fact, one in every 30 babies born in the US in 2009 was a twin.

Contrary to what some have said, oral contraceptive use is not a factor in the twin boom. The two main reasons for the increase: age of mother and fertility drugs. Women in their 30s—particularly those from 35 to 39—are more likely to ovulate more than one egg at a time, leading to historically higher rates of naturally conceived twins. With more than one-third of all US births occurring among women age 30 and older, the math adds up to more twins. Additionally, more couples of all ages are pursuing assisted reproductive technologies such as fertility drugs or in vitro fertilization, which increase the odds of a twin pregnancy.

While having twins can be twice as nice, there are some very real health concerns that come with carrying two or more embryos. Preterm labor is more common among twin pregnancies and frequently results in preterm birth. Roughly half of twins are delivered early, sometimes before they have fully developed. When compared to singleton babies, twins are more likely to be born small and require more hospitalization. Women carrying twins also have a higher likelihood of developing high blood pressure, preeclampsia, anemia, and other conditions. Efforts are ongoing to improve infertility treatments to avoid multiple gestation pregnancies.

With proper prenatal care and monitoring, it is possible to deliver a healthy pair of babies. However, women should be aware of the risks of carrying twins and work closely with their doctors to ensure a healthy pregnancy and delivery of two bundles of joy.

Increased Health Risks for DES-exposed Women

Back in the 1940s and until 1971, women took a synthetic estrogen called diethylstilbestrol (DES) to prevent miscarriages and other pregnancy complications. As a result, millions of babies were exposed to DES in utero with profound health consequences.

Now, a new study in the New England Journal of Medicine quantifies the magnitude of that impact. Government researchers analyzed data from three studies that began in the 1970s, looking at 12 health risks in 4,600 women who were exposed to DES in utero and compared them to 1,900 women who were not.

Investigators found that exposed women had higher rates of infertility (33% vs. 16%), miscarriage (50% vs. 39%) and premature delivery (53% vs. 18%) than unexposed women. In addition, they were more likely to develop preeclampsia (26% vs. 14%), miscarry in the second trimester (16% vs. 2%), and experience early menopause (5% vs. 2%). DES daughters also had a slightly higher risk for breast cancer after age 40 (4% vs. 2%).

Little can be done now to undo this public health disaster. Researchers plan to follow these women through menopause and study their daughters to see whether the impact will affect future generations.