Though the legality of CBD is something of a grey area, products containing it are widely available in most states, as long as they don’t contain THC, the psychoactive component of marijuana responsible for a high. (Foria’s Relief product has both CBD and THC.)
According to Gerson, Foria’s products are effective because of what’s known as the “entourage effect” of the active compounds in marijuana.
“We now know that the minute you break this plant apart into its component parts, you lose some of the magic,” Gerson said. “And that sounds like hippie speak, but this is proven out again and again, in study after study, that the entourage effect as we understand it is real.”
Putting it to the test
Staci Gruber, a professor of psychiatry at Harvard Medical School and the director of the Cognitive and Clinical Neuroimaging Core and the Marijuana Investigations for Neuroscientific Discovery program at the McLean Hospital in Massachusetts, is using Foria’s marijuana suppository as part of the observational study.
“What we’re looking to do is take anecdotal information and turn it into data,” Gruber told Business Insider.
The observational study will survey participating women over a few months, asking them to record what their symptoms are like while using the suppository.
Gruber said she viewed the study as a first step, with the “holy grail” being a clinical trial that determines how a product like Foria’s compares with a placebo group in relieving menstrual symptoms.
Running a clinical trial, however, can be an expensive and difficult endeavour, especially because marijuana is considered a Schedule 1 drug.
First, researchers must go through a lengthy application process – which can take years – to obtain a permit to conduct a study. And all cannabis used for research must be purchased through the National Institute on Drug Abuse.
Many researchers have said the institute’s supply is of poor quality, with low concentrations of THC.
Gerson said he hoped the observational study would ultimately help the people who purchase Foria’s products.
“What actually made this market was empathy,” Gerson said. “We serve the plant, we serve our clients, and as a result, our investment community and the people that support our brand benefit from that.”
He added that the therapeutic potential of cannabis is “so profound.”
“If we lose sight of that,” he said, “it’s just a race to the lab to break this plant apart into its component parts so we can synthesise and patent it and put it in a bottle.”
Having a UTI is a huge pain. Literally. And if you’re a woman, you’re likely to get one at some point in your life.
You’ve probably heard that peeing after sex is a good way to keep one away. That’s true. Add to the list of to-dos: stay hydrated, pee when you have to go instead of holding it, wear breathable cotton underwear, and wipe front to back, Melissa Walsh, M.D., an ob/gyn in the department of obstetrics, gynecology, and women’s health at Montefiore Medical Center, tells SELF. What’s not true: All of the below.
When it comes to UTI do’s and don’ts, there’s a lot you’ll hear that’s better off ignored. Here are seven myths about UTIs you need to stop believing.
Myth #1: Getting a UTI means you have a hygiene problem.
The only way your hygiene can affect your risk of UTIs is if you wipe from back to front, Lisa Dabney, M.D., assistant professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai, tells SELF. Doing this can easily spread bacteria from the rectum to the vagina and urethra. Otherwise, over-cleaning can actually cause problems. “It is not helpful to clean the vagina with harsh soaps and chemicals because these will kill off the lactobacillus in the vagina,” aka the good bacteria that prevent the overgrowth of other bacteria that cause infections, she explains. If you get recurrent UTIs, getting cleaner isn’t the answer. Other health problems like kidney stones or urinary incontinence may be to blame, Walsh says. Or, you might just be one of the unlucky women who gets them for no apparent reason.
Myth #2: You can only get a UTI after sex.
Sex is frequently associated with UTIs—bacteria can easily get pushed into the urethra when you’re getting down—but you can absolutely get a UTI in other ways. Walsh notes that other common risk factors are: wiping from back to front, holding your urine, dehydration, and medical conditions like diabetes or immune-compromised states (e.g. an autoimmune disease).
Myth #3: Only women get UTIs.
Men can also get UTIs. It’s just not as likely, thanks to their anatomy. “Bacteria are less likely to travel a long distance and infect the urine in men versus the short urethral distance in women,” Walsh explains.
Myth #4: A UTI is an STI.
Although they can happen after intercourse, “UTIs are definitely not considered an STI!” Walsh says. The infection is a result of bacteria that’s already living on our skin being pushed up through the urethra where it doesn’t belong—sexual activity just gives bacteria an easy way to transport itself. They’re not contagious or transmittable, so you don’t have to worry about “catching” your partner’s UTI.
Myth #5: Drinking cranberry juice is an easy drug-free fix.
“Cranberry juice is not medically considered to be a ‘cure,'” Walsh says. “Several research trials have not been able to conclude this despite its common use.” One theory is that the cranberry juice makes it harder for bacteria to stick to the bladder wall. Another is that it makes urine more acidic and that prevents infection. However, Dabney says it could help prevent UTIs. The science is mixed, but it’s worth a try if you’re plagued with them often. Staying hydrated is a good prevention method, anyway: Peeing a lot and having a strong stream when you pee helps your body flush out bacteria in the urethra before it can travel further upward.
Myth #6: Irritation while peeing automatically means you have a UTI.
“I hear many patients say that they feel like they have a UTI simply because they’re experiencing irritation when urinating,” Walsh says. “Although this may be a symptom of a UTI, it could also be due to a vaginal infection or irritation from other common inflammatory conditions like yeast or a vaginitis.”
Myth #7: It’s just going to go away on its own.
“Women didn’t die of UTIs before antibiotics. They just had more pain,” Dabney notes. So yes, a mild UTI could potentially go away on its own. The problem is that UTIs have become harder to treat, thanks to increasing antibiotic-resistance of the most common bacteria that causes them, E. coli. Walsh recommends seeing your doctor to confirm it’s a UTI and get the right medications. A UTI left untreated can move further into your body and cause a deeper infection in the bladder. The last thing you want are the uncomfortable symptoms continuing any longer than they have to.
Women who use newer hormonal contraceptives, which often have lower oestrogen doses, have a significantly reduced risk of developing ovarian cancer versus never users, which becomes more pronounced over time, say UK and Danish researchers.
Previous studies had demonstrated that older products, with higher levels of oestrogen and older progestogen formulations, reduced ovarian cancer risk but this is believed to be the first time it has been shown in contemporary products in a large-scale prospective analysis.
For the study, Lisa Iversen, PhD, research fellow, Institute of Applied Health Sciences, University of Aberdeen, examined prospective data on almost 1.9 million Danish women aged 15–49 years.
They found that women who were current or former users of hormonal contraceptives had a 34% reduced risk of developing any form of ovarian cancer, rising to a 74% reduced risk after more than 10 years of use.
The research, which was published in the BMJ on September 26th, suggested that, across the whole study population, hormonal contraceptive use had prevented 21% of ovarian cancers.
The team says that their findings indicate that “contemporary combined hormonal contraceptives are still associated with a reduced risk of ovarian cancer in women of reproductive age, with patterns similar to those seen with older combined oral products”.
They note, however, that while the beneficial effect appears to continue after stopping them, “it is not known how long for”.
The authors add: “It has been suggested that recent downward trends in ovarian cancer mortality rates in North America and Europe can be partly attributed to the use of combined oral contraceptives.
“We found a population prevented fraction of 21% with use of hormonal contraception, which supports the notion that these ovarian cancer mortality benefits are likely to continue.”
Previous studies have demonstrated that women who use combined contraceptives have a reduced risk of developing ovarian cancer, and the effect persists many years after stopping use.
However, the majority of the evidence refers to older and higher dose oestrogen preparations that contain older progestogens, and there have been “substantial changes” in hormonal contraception in recent years, the team notes.
These include combined formulations with lower oestrogen doses, the introduction of newer progestogens, alterations in the patterns of administration, the introduction of non-oral administration, and the increased use of progestogen-only preparations.
To examine the association between contemporary combined hormonal contraceptives and rates of ovarian cancer, the researchers conducted a prospective study of all Danish women aged 15–49 who were enrolled on the Danish Sex Hormone Register Study between 1995 and 2014.
After excluding women who had cancer or venous thrombosis or who were treated for fertility before study entry, the final population was 1,879,227 women.
The women were categorised as never users of contraceptive, current or recent users (defined as ≤1 year after stopping use), and former users (defined as >1 year since stopping use).
During the study period, 1249 women developed incident ovarian cancer during more than 21.4 million person-years of observation, or an average of 11.4 years of follow-up per woman.
Among women who had ever used hormonal contraceptives, 478 ovarian cancers were diagnosed during approximately 13.3 million person-years of follow-up. A further 771 ovarian cancers were diagnosed during approximately 8.2 million person-years of follow-up among never users.
The median age at ovarian cancer diagnosis was 44.4 years.
Adjusting for a range of factors, including parity, age group, education, polycystic ovary syndrome, and family history of breast or ovarian cancer, the team found that, overall, ever hormonal contraceptive users had a reduced risk of ovarian cancer versus never users, at a relative risk of 0.66.
This translated into a reduction in the age standardised absolute rate of ovarian cancer from 7.5 per 100,000 person years with never use to 3.2 per 100,000 years with ever use.
For current or recent users of hormonal contraceptives, the relative risk of developing ovarian cancer versus never users was 0.58, while that for former users was 0.77.
The risk of ovarian cancer decreased with increasing hormonal contraceptive use, from a relative risk of 0.82 with ≤1 year of use to 0.62 for >1 to ≤5 years, 0.57 for <5 to ≤10 years, and 0.26 for >10 years of use (p<0.001 for trend).
Analysis indicated that the results were similar when restricting the population to the period up to the first switch in contraceptive type, and there was little evidence of a substantial difference in risk by tumour type or progestogen content in the contraceptive.
However, the team found that progestogen-only hormonal contraceptives were not associated with a reduction in the risk of ovarian cancer, although relatively few women used these products exclusively.
The team calculates that, overall, the use of hormonal contraception, whether current or former, was associated with a 21% reduction in the incidence of ovarian cancer versus never use.
Noting the similar effect across ovarian cancer types, they write: “Recent understanding suggests that although ovarian cancer is clinically considered to be one disease, it is in fact a heterogeneous group of neoplasms with different pathogenesis pathways.
“Combined hormonal contraceptives suppress ovulation so protection against neoplastic development is feasible, but the exact mechanisms by which hormonal contraceptives reduce ovarian cancer risk are unclear.
“Whatever the biological mechanisms, the epidemiological evidence suggests a long-lasting protection against most types of ovarian cancer from combined oral contraception.”
Diagnosis of polycystic ovary syndrome (PCOS) is challenging, and there should be no rush to label an adolescent as having the condition before a thorough evaluation of symptoms, according to a leading endocrinologist who was speaking at the RCOG World Congress 2018 in Singapore.
“Common features of PCOS such as hirsutism, acne, and obesity are often present in otherwise ‘normal’ adolescents,” said Dr Veronique Celine Viardot-Foucault from the KK Women’s and Children’s Hospital, Singapore, adding that these features may not necessarily be indicative of PCOS.
Appropriate diagnosis of PCOS in adolescents should involve careful evaluation of symptoms such as menstrual irregularities, hyperandrogenism, and polycystic ovarian morphology, she said. Menstrual irregularities—including secondary amenorrhoea and oligomenorrhoea in girls beyond 2 years after menarche, or primary amenorrhoea in those who have completed puberty—may be indicative of androgen excess. [Horm Res Paediatr 2017;88:371-395]
As symptom such as acne is common in adolescence and usually transient, it may not be indicative of hyperandrogenism, said Viardot-Foucault. Also, isolated cases of acne and/or alopecia should not be considered as diagnostic criteria for PCOS in adolescence, but moderate or severe inflammatory acne that is unresponsive to topical therapy may require investigation of androgen excess. [Horm Res Paediatr 2017;88:371-395]
Another feature commonly seen with PCOS is hirsutism, which can be evaluated using the modified Ferriman–Gallwey (FG) scoring system. “However, the FG scoring system is not applicable to younger, perimenarchal patients [younger than 15 years old],” she advised, pointing out that biochemical evidence of hyperandrogenism is preferred in this group.
As there is no clear cut-off of testosterone levels for adolescents, biochemical hyperandrogenism should be defined based on the methodology used, informed Viardot-Foucault. “Ideally, to establish the existence of androgen excess, assaying for free testosterone levels is the gold standard as it is more sensitive than measuring the total testosterone levels,” she said. “But a downside of this is that it requires equilibrium dialysis techniques which are costly and not widely available.”
However, most commercial laboratories use direct analogue radio-immunoassay, which is notoriously inaccurate for measuring free testosterone, cautioned Viardot-Foucault. “If uncertain regarding the quality of the free testosterone assay, it is preferable to rely on calculated free testosterone, which has a good concordance and correlation with free testosterone levels measured by equilibrium dialysis methods,” she suggested. [J Clin Endocrinol Metab 1999;84:3666-3672]
Also, the value of measuring other androgens besides free testosterone in patients with PCOS is relatively low, although increased levels of dehydroepiandrosterone sulphate (DHEAS) have been observed in 30–35 percent of PCOS patients. [Ann N Y Acad Sci 2006;1092:130-137]
“Transabdominal pelvic ultrasound has a lower diagnostic accuracy,” said Viardot-Foucault. “The presence of polycystic ovarian morphology [on ultrasound] in an adolescent who does not have hyperandrogenism or oligo-anovulation does not indicate a diagnosis of PCOS.”
When menstrual irregularities are concerned, the first-line treatment should be cyclical progestogens when contraception is not required and there are no signs of hyperandrogenism, according to Viardot-Foucault. If there is clinical hyperandrogenism or a need for contraception in those sexually active, third-generation oral contraceptives such as ethinyl estradiol 30 µg can be considered.
“There is room for local treatment of hirsutism such as laser [hair removal, but only for patients beyond] 16 years old and [who are] at least 2 years post-menarche,” she said. “If there are metabolic complications, [patients should be referred] to the endocrinologist.”
Two treatments and a placebo yield similar relief for postmenopausal vaginal discomfort
A clinical trial comparing two common treatments for postmenopausal vaginal discomfort to placebo treatment found that both low-dose vaginal estrogen and a vaginal moisturizer produced symptom improvements similar to those associated with placebo after 12 weeks of treatment.
The authors note that better understanding of the causes of postmenopausal symptoms could lead to more effective treatment options for this bothersome problem.
“The fact that all three treatments—vaginal estradiol tablets, a vaginal moisturizer and the lubricating gel we used as a placebo—were able to reduce symptoms is great news for women, since it means that regular use of any of these treatments is likely to have benefit, whether the cost is $20 or $200,” said corresponding author Caroline Mitchell, HMS assistant professor of obstetrics, gynecology and reproductive biology at Massachusetts General Hospital.
“The significant impact of vaginal discomfort on the lives of women is reflected by how quickly we were able to enroll more than 300 participants in less than a year. Women are desperate for some kind of intervention for these symptoms,” Mitchell said.
The authors, from seven research centers across the country, note that symptoms such as vaginal dryness, itching and pain during sexual intercourse affect around half of postmenopausal women and can have negative quality-of-life effects similar to those of chronic conditions like arthritis or irritable bowel syndrome.
But more than half of affected women use no medical treatments. Available nonprescription products, such as vaginal lubricants and moisturizers, can be messy; and prescription hormonal treatments in the form of creams, vaginal tablets and oral pills can be expensive and may raise concerns about safety.
The current trial was designed to assess the effectiveness of the two most commonly recommended treatments—low-dose estrogen vaginal tablets and a nonhormonal vaginal moisturizer.
The study enrolled 302 women, most between the ages of 55 and 64, who reported moderate to severe symptoms of vaginal itching, dryness, irritation or pain with sexual activity.
Participants were randomly divided into three groups, one receiving a low-dose vaginal estrogen tablet and a placebo vaginal gel, one receiving a placebo vaginal tablet and a nonprescription vaginal moisturizer and one receiving both placebo tablets and placebo gel.
Participants were instructed to administer the vaginal tablet once a day for 2 weeks and then twice a week for the remaining 10 weeks of the study period. The moisturizing gels were to be applied every three days throughout the study period. Neither participants nor study staff knew to which group individual participants were assigned.
At the end of the study period all three groups had similar decreases in the severity of their most bothersome symptom. A similar proportion of women in each group had at least a 50 percent decrease in overall symptom severity.
Improvement in sexual function and overall treatment satisfaction were also similar across all three groups. There was a significantly higher positive response to the question, “Did you have a meaningful benefit from the treatment?” among those receiving the vaginal estrogen tablet than among those receiving placebos.
Mitchell notes that, while most studies of treatments for vaginal discomfort show a significant placebo effect, the size of the response to placebo treatments in this trial was surprising.
“It’s hard to say whether the properties of the placebo gel itself, which is an excellent lubricant, are responsible, but our results suggest that regular use of any one of these products may be helpful,” she said.
“During the 12 weeks of the trial, more than 90 percent of women used the medication regularly, but prior studies suggest that many women do not continue use of this type of treatment beyond six months. A remaining question is whether women find the benefits of the treatment worthwhile enough to continue regular use,” Mitchell said.
Co-author Susan Reed, of the University of Washington, added, “It was notable that the overwhelming majority of women in our study were bothered by pain with sexual activity and earnestly wanted to help find a treatment for the many women bothered by this problem. More couples are remaining sexually intimate despite aging, and better therapies for vaginal discomfort need to be developed.”
A high Menopause Rating Scale (MRS) score supports the decision to treat bothersome climacteric symptoms, researchers from Chile report.
“There was no previous study that objectively indicated the need for treatment of climacteric symptoms,” Dr. Juan Enrique Blumel of Universidad de Chile, in Santiago, told Reuters Health by email. “Our study indicates that a score of 14 or more on the MRS questionnaire marks the need for treatment.”
The MRS has been validated in several languages and is the most commonly used instrument for evaluating the severity of symptoms associated with menopause. A total score of 17 indicates “severe symptomatology,” but no cutoff score has been determined to be an objective indication of the need for treatment.
Dr. Blumel and colleagues used MRS data from 500 healthy women aged 40 to 59 years to establish a cutoff score that would allow better decisions regarding the need to start treatment of menopausal symptoms.
The percentage of women who felt they required treatment increased along with their MRS scores and reached 90% in those who considered at least one of their symptoms to be very severe, the researchers report in Maturitas, online February 15.
Symptoms most commonly deemed to require treatment when rated very severe included physical and mental exhaustion, muscle and joint discomfort, and bladder problems, whereas sexual problems, anxiety, and heart discomfort were least frequently considered to require treatment.
ROC curve analysis identified an MRS total score of 14 or more as the optimal cutoff score for defining the need for treatment. This cutoff had a sensitivity of 76.5% and a specificity of 83.6%; 97.1% of women who consider that they require treatment for at least one of their symptoms would be treated on the basis of this cutoff score.
“The presence of a single climacteric symptom with a very severe intensity is associated in almost all women with a score of 14 or more points in the MRS questionnaire, a score that indicates the need for treatment,” Dr. Blumel said.
“Physicians should ask women not only for the classic vasomotor symptoms, but also for the other symptoms that are included in the MRS scale,” he said. “Hot flushes are not the most frequent symptoms in climacteric women; we and other researchers have shown that musculoskeletal discomfort and fatigability are much more frequent and are rarely considered climacteric symptoms.”
Dr. Stephanie S. Faubion from Mayo Clinic’s Office of Women’s Health in Rochester, Minnesota, told Reuters Health by email, “Midlife women in the community have bothersome menopause-related symptoms that are not being addressed. It is also clear that women will say they need treatment when symptoms are severe if we ask them. Asking about these symptoms (hot flashes, night sweats, sleep and mood disturbances, sexual symptoms, vaginal dryness) should be routine for clinicians caring for midlife women.”
“These questions aren’t validated individually (only the total score), so if this is used, the total score should be used,” she said. “It’s interesting that the mood-related scores are more highly correlated with total MRS scores over 14. We have also noted that mood seems to be a strong driver of perceptions about menopause.”
Dr. Faubion added, “We do actually use the MRS in our clinical practice, though I’m in a tertiary care setting in a specialty menopause practice. I do find it useful, but women will tell you when they need treatment if you ask them, which was demonstrated clearly in this study. I don’t think the MRS will make or break decision making for the clinician who is in front of a patient. For research purposes, the MRS is useful for assessing bothersome (clinically meaningful as demonstrated in this study) menopause-related symptoms and for monitoring response to therapies.”
Plus, the lowdown on when it’s normal to miss a cycle.
You’d think that after getting your period month after month for a decade or two, you’d know it intimately well. And yet, there are still things about our own menstrual cycles that elude us. Part of the problem is that no one ever really talks about periods, which makes it harder to know what’s normal and what’s not. So we often cobble together information from our friends and some Google searches, but that can still leave some gaps in our knowledge about our own bodies.
Considering that, on average, women have about 450 periods in their lifetime, according to the Association of Reproductive Health Professionals, it’s worth getting to know your cycle and how it works. So we tapped top experts to address some common period myths and misconceptions.
Let’s clear up some confusion, shall we?
1. Figuring out the first day of your cycle isn’t as complicated as you might think.
For some reason, there’s a lot of confusion surrounding what exactly counts as the first day of a woman’s menstrual cycle. The good news: Pinpointing when your cycle officially starts is simple: “The first day of your cycle is the first day you start bleeding,” Leah Millheiser, M.D., clinical assistant professor of obstetrics and gynecology and director of the Female Sexual Medicine Program at Stanford University Medical Center, tells SELF. “That is cycle day one.” (This video shows your entire menstrual cycle in two minutes.)
2. Ovulation, on the other hand, is a bit trickier to nail down.
In general, women with regular cycles who are not on hormonal contraceptives (since you don’t ovulate while on most types of oral contraceptives) ovulate between day 10 and day 14 of their cycle. As we’ve already established, day one is the first day that you bleed, so you can do the easy math from there.
That said, “women are not machines, so it can vary,” Fahimeh Sasan, D.O., an assistant professor of obstetrics, gynecology, and reproductive science at Icahn School of Medicine at Mount Sinai, tells SELF. “You may not ovulate exactly on the 10th day every single month. That’s why when women are trying to conceive we don’t tell them to only have sex on days 10 through 14. Instead, have sex three to four times per week [around the ovulation period] because sometimes it can vary.”
3. Your cycle doesn’t have to be exactly 28 days long.
That’s the number that’s often touted as “normal” because a 28-day cycle is the average—meaning, 28 days from the first day of your period to the first day of your next period. But there’s actually a range when it comes to what’s considered a normal, healthy menstrual cycle: anywhere from 21 days to 35 days in adults (and 21 to 45 days in teens), per the U.S. Department of Health and Human Services. So anything that falls within that span is A-OK.
Also, most periods last three to five days, notes Millheiser, but as little as two days and up to seven days is also considered normal. If your periods are consistently longer than seven days, though, you should get checked out by a gynecologist. Longer bleeding days can be a sign of fibroids, uterine polyps, or adenomyosis, which is when endometrial tissue grows into the muscular wall of the uterus and can cause painful, heavy periods, according to the Mayo Clinic. “That’s certainly something we want to treat,” says Sasan.
4. And even if your cycle is 28 days, it may not always stay that way.
Yes, it can be a little disconcerting if your period tends to show up like clockwork and then there’s a slight delay, but your cycle isn’t set in stone. “Everyone assumes that if their period is exactly 28 days for the last 10 years and now it’s every 30 days that something is wrong,” says Millheiser. But you’re probably fine: “Period cycles fluctuate, depending on the environment, diet, stressors, and hormonal changes,” she explains.
5. It’s not unusual to skip a month once in a while—but get it checked out anyway.
Although pregnancy is the most likely reason why a period is MIA if you’re sexually active, high levels of stress—such as a big breakup, getting laid off, or moving—can also suppress reproductive hormones, causing secondary amenorrhea. In fact, a 2014 study of more than 370 couples that was published in the journal Human Reproduction found that psychological stress makes it harder to get pregnant.
In addition, low body weight, because of major weight loss, anorexia, or exercising rigorously (think: marathon running), can affect the hypothalamus, which helps regulate a woman’s menstrual cycle, leading to skipped periods, notes Millheiser.
While one missed period followed by your cycle going back on track is nothing to worry about, if you’re missing more than one period in a row, see your doctor. (The exception: If you’re adjusting your contraception to purposefully miss your period—more on that below.) missed periods signal that there’s likely a health issue at play, such as polycystic ovarian syndrome (PCOS), which is a hormonal imbalance—namely, high levels of androgens, a male hormone—that causes irregular cycles, such as only getting your period three or four times a year, or no periods at all. PCOS affects one in 10 women of childbearing age, according to the U.S. Department of Health and Human Services. Here’s some information on how to know if you have PCOS, endometriosis, or both that may be helpful.
If you’re over 40 and you’re skipping two to three periods in a row followed by a heavy period (thanks to a uterine lining that’s been building up for months)—especially if that’s joined by mood swings, night sweats or hot flashes—you’re experiencing the telltale signs of perimenopause, notes Millheiser.
But don’t panic thinking you’re going into full-blown menopause right away. “Perimenopause can go on for one to five years—you’re not going to go into menopause tomorrow,” Millheiser notes. “Menopause is one full year without a period.”
6. Once and for all, it’s usually perfectly safe to use the Pill to skip your period.
And more young women are doing just that. A 2013 study published in the journal Conception found that many college-age women are choosing to skip their periods by taking the hormonal pills in the pack back-to-back (and skipping the sugar pills) or using other hormonal contraceptives like the vaginal ring continuously. Of the more than 1,300 women in the study using combined hormonal contraception currently or recently, about 17 percent deviated from package instructions to alter their scheduled periods. Half of these women said they delayed or skipped their period for convenience’s sake.
“Is it safe for you to not have your period [by choice]? Absolutely,” says Millheiser. “The progesterone in your birth control pills is keeping the uterine lining thin. Often women will choose to have their periods two to three times per year.” If you have a health condition that affects your reproductive system, such as PCOS or endometriosis, check with your ob/gyn before you decide to skip periods.
Keep in mind that if you do continuous birth control pills, except some breakthrough bleeding eventually. The spotting is caused by hormonal fluctuations that cause some of the uterine lining to slough off, notes Millheiser.
7. And yes, you can get pregnant while on your period.
One of the most persistent period myths is that it’s impossible to get pregnant while you’re menstruating. It’s not common, but getting pregnant while on your period can definitely happen. Sperm can last in the cervical mucous and uterus for up to five days. If a woman has a short menstrual cycle, such as 24 days, and has unprotected sex on the last day of her period and ovulates three days later, it’s possible for the egg and sperm to meet, resulting in a pregnancy. The chances are slim, notes Millheiser, but is a possibility. This is especially true if a woman’s cycle is short and her period lasts six or seven days. Adds Sasan: “It’s very unlikely for a woman who is actively menstruating to get pregnant. However, with every rule there’s an exception, and women should not use their period as a form of contraception.”
Another risk is thinking you’re on your period while you’re actually ovulating. Here’s why: In some cases, when a woman is spotting during her cycle, that can be mistaken for a period when it can actually be a sign of ovulation. “It’s very common for a woman to spot during ovulation,” notes Millheiser. “One day—typically mid-cycle—a woman might notice a couple of drops of light red or dark brown spotting, not usually bleeding. It’s just hormonal changes during ovulation—it causes this little shedding. It’s nothing concerning. In fact, for women trying to get pregnant, it’s a really good sign that you can get pregnant now.” So some women might mistake the spotting for their actual period and, thinking they can’t get pregnant during their period, have unprotected sex when they’re actually at their most fertile. The misconception can lead to a pregnancy outcome.
8. Painful cramping isn’t something you have to put up with.
When you’re having your period, hormones called prostaglandins cause the uterus to contract to help shed the uterine lining. As almost anyone with a period knows, those contractions can be uncomfortable and even downright painful. Over-the-counter pain relievers, as well as birth control pills, can help. “For some women, being on birth control pills can help make periods less painful,” says Sasan, because birth control pills reduce the amount of prostaglandins produced by the body. “Even in someone who is not using it for contraception purposes, we often prescribe it since it can be used specially for dysmenorrhea, which is painful periods.”
If your periods are predictable and your doctor gives you the green light, Sasan recommends taking an anti-inflammatory prophylactically the day before you expect your period. That way, the medication is already in your system. “Unless there are contraindications, start taking Advil or Motrin the day before every six hours,” she says. “Most people report painful periods for the first day or two, so continue to take the medication every six hours or for however many painful days you typically experience.” Sasan recommends Advil and Motrin since they’re anti-inflammatory and suggests taking the meds with food so they don’t upset your stomach.
But if your periods are very painful and nothing seems to help (or they weren’t painful and now are), don’t dismiss it, says Sasan. “No one should put up with pain,” she says. “If you’re in pain, you should definitely talk to your doctor and have a thorough exam.” In some cases, painful periods can be a sign of a cyst, fibroids, or endometriosis that should be evaluated and treated by a doctor.
There are three sources of variability in fertility – genetics, the family environment and the individual environment.
Genetic profiling could help determine whether an embryo created through in-vitro fertilisation (IVF) is likely to successfully transfer to the womb, increasing the success rate of the procedure.
It’s part of a field of work looking at the role of genetics in fertility.
‘Understanding why some people do not have children, and developing treatments for them is extremely important,’ said Joris Vermeesch, professor of molecular cytogenetics and genome research at KU Leuven in Belgium. ‘People sometimes spend years of their life trying to get pregnant, and it doesn’t work.’
Despite advances in IVF, its success for each cycle – counted via the so-called baby take-home rate – is only 30%. But a project called SARM, led by Prof. Vermeesch, aimed to improve that figure by looking at ways to identify which embryos were unlikely to survive in the womb.
Already, in 2009, scientists at KU Leuven had discovered that most early IVF embryos were unstable — at high risk of having the wrong number of chromosomes or loss or gain of chromosomal fragments. This made them much less likely to develop properly, leading to failed embryo transfers — and frustration for prospective parents.
Prof. Vermeesch led that initial research. As part of SARM he and his team wanted to find a better a way to detect those imbalances, a method they could apply in IVF to boost its chances of success.
Experiments in human fertility are constrained by ethical boundaries. The scientists worked with cow embryos because bovine reproductive systems mirror those of humans at this stage of embryonic development.
Using a technique called haplotyping, which determines which gene sets come from which parents, the researchers succeeded in analysing the genetic make-up of an embryo’s cells. This new technique allowed them to determine which embryos are chromosomally unstable and which are more likely to thrive.
The same technology can identify whether an embryo is affected by genetic disease. To reduce the risk of transmission, clinics can simply decide not to transfer those embryos.
‘If we can do these tests on all IVF embryos it’s possible and likely that the success rate of IVF will increase,’ Prof. Vermeesch said. ‘You eliminate those embryos with chromosomal abnormalities and you only transfer those with fewer or no abnormalities.’
Infertility affects 10% of couples in the world, a growing demographic challenge with a human cost. Embarking on having a family later in life is one clear cause, poor lifestyles another, but reproductive health isn’t just about age or wellbeing — some of it is also in our genes.
Scientists exploring the role of genetics in these trends have found that heritability plays a significant part, which is not yet well understood.
‘If we can do these tests on all IVF embryos it’s possible and likely that the success rate of IVF will increase.’
Joris Vermeesch, KU Leuven, Belgium
If there are few environmental constraints and a population cohort follows certain social norms — taking the pill and living through the era of sexual liberation, or postponing childbearing because of pressures in the job or housing market — then genetic factors become more of a factor in the differences in reproductive fertility.
Some problems, like endometriosis, polycystic ovary syndrome or premature menopause, are highly genetic, says Dr Nicola Barban from the Institute for Social and Economic Research at the University of Essex, UK.
Dr Barban is a scientific collaborator on Sociogenome, a project run by Professor Melinda Mills at the University of Oxford, UK, that looks at how infertility is influenced by genetics and environment. It’s the first study to look at these two factors together.
‘What we know is that some women can conceive when they’re in their 40s or late 40s, and some women have problems much earlier in time,’ he explained. ‘We are (investigating) the end of the reproductive window where there’s more variability due to genetics.’
One strand of the project looked at the role of genetics compared with environment and individual choice and studied differences between identical twins, who share 100% of their genome, and fraternal twins, who share 50% of their genomes. The research found that genes make up 15-45% of the factors that determine the number of children a person ends up having, depending on the sample.
Dr Barban stresses that the methods could not be used to predict when an individual might have children because other factors are also involved. ‘Think of three possible sources of variability,’ he said. ‘Genetics, the family environment, the individual environment.’
Next, the Sociogenome researchers wanted to analyse the genome itself. To create their bank of data, the team persuaded 250 other scientists to share their records and formed a massive data pool — roughly 251,000 participants of European ancestry for age at first birth and 343,000 for number of children ever born.
They focused on demographic traits that both men and women share. While fertility research has traditionally focused on the female patient, researchers on Sociogenome wanted to look at both men and women.
‘Much of the research on infertility is on women only but we think that both men and women should be studied,’ Dr Barban said.
This strand of the project probed which parts of individual genes affect child-bearing. It identified 12 genetic loci, or parts of the gene, that can explain around 1% of variation in the age at which a person has their first baby — which may not seem like a lot. But although the results don’t say much about individual fertility at a population level they’re significant, Dr Barban says, because understanding 1% of the genetic predisposition of thousands of people builds a picture of a population’s fertility.
The next phase, with 800,000 participants, aims to show which parts of the gene are expressed in hormones, brain activity and other biological processes — shedding further light on why some people are more fertile than others.
All this doesn’t yet answer the tricky questions of why a particular individual is infertile but it lays the ground for a more sophisticated understanding of the causes of infertility.
‘I think finding the genes that are connected with some of these biological mechanisms could be a very first step towards drug development,’ Dr Barban said.
The causes of suicide attempts and suicide are hard to investigate, but there is strong evidence for the importance of depression, which in itself has been linked with a wide range of possible hormonal abnormalities across many studies. Now a team of investigators from the University of Copenhagen, Denmark, have undertaken a study to assess the relative risk of suicide attempt and suicide in users of hormonal contraception. Using national Danish registers, the investigators followed nearly half a million women with a mean age of 21 years on average for 8.3 years (3.9 million person-years). They identified 6999 first suicide attempts and 71 suicides and found that, compared with women who never used hormonal contraceptives, the relative risk among current and recent users was 1.97 for suicide attempt and 3.08 for suicide. They concluded that use of hormonal contraception was positively associated with subsequent suicide attempt and suicide, that adolescents had the highest relative risk, and that the association between hormonal contraceptive use and a first suicide attempt peaked after 2 months of use.
So, what is the clinical significance of these associations? First, there is no evidence from this study of a causative link between hormonal contraception and suicidal behavior, but it does seem that we should be screening for suicidal ideation in any woman, especially adolescents, who are starting hormonal contraceptives for the first time. Not surprisingly, this may be a stressful developmental time for such individuals, in terms of new relationships and sexual activities, and is potentially a time of increased risk for victimization and abuse, which may be the drivers of suicidal behavior, with the need for contraceptives being the potential identifying marker. More studies to examine this link between hormonal contraception and suicide are certainly needed.
Despite having the highest health care expenditures in the world, U.S. rates of premature births have risen two years in a row, hitting 9.8 percent in 2016 — a 2 percent increase from 2015
Underweight births in the U.S. have also increased since 2014, and increases a child’s risk of infections and brain bleeds during infancy, and chronic health problems such as obesity, diabetes and heart disease later in life
Racial disparities are pronounced. African-Americans have a 13 percent low birth weight rate compared to 8 percent for Asian and Native Americans and 7 percent for Hispanics and Caucasians
Research shows vitamin D optimization could prevent 60 percent of premature births. Among African-Americans, up to 75 percent of all preterm births could be prevented by raising vitamin D levels to 40 ng/mL by the third trimester
The Organic & Natural Health Association will be submitting a health claim petition for vitamin D’s ability to lower premature birth to the FDA
By Dr. Mercola
Despite having the highest health care expenditures in the world, U.S. rates of premature births are on the rise, especially among African-Americans. Preterm birth (which is responsible for 28 percent of newborn deaths during the first month of life) is defined as a baby being born before 37 weeks of gestation,1 and preterm birth rates have risen two years in a row, hitting 9.8 percent in 2016 — a 2 percent increase from the year prior.2
That means nearly 1 in 10 babies is now born prematurely in the U.S. Prevalence of low birth weight is also rising. Any newborn weighing less than 5 pounds, 8 ounces is considered underweight. While the most common reason for low birth weight is premature birth, poor maternal nutrition also plays a role.
African-American Women Are Disproportionately Affected
According to the “2018 County Health Rankings Key Findings Report”3 produced by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation, underweight births in the U.S. have increased since 2014, and as noted in Mother Jones,4 “Low birth weight is associated with a range of health problems, from infections and brain bleeds in infancy to a higher risk of obesity, diabetes and heart disease later in life.”
Because of its health implications for both mother and child, birth weight is a good indicator of public health in general. Interestingly, Southeast and Southwest states are disproportionately affected by low birth weight rates. Racial disparities are also pronounced, with African-Americans having a 13 percent low birth weight rate compared to 8 percent for Asian and Native Americans and 7 percent for Hispanics and Caucasians. African-American women are also four times more likely to die during childbirth.
Vitamin D Optimization Can Prevent 60 Percent of Premature Births
Research shows vitamin D optimization could prevent 60 percent of premature births. Among African-American and Hispanic populations, as much as 70 to 75 percent of all preterm births might be prevented. Many other benefits could also be achieved by making vitamin D testing and optimization part of standard prenatal care. For example:
Women with a vitamin D level of above 40 nanograms per milliliter (ng/mL) have a 25 percent lower risk of infections, including respiratory and vaginal infections,5 which in turn lowers their risk of pregnancy complications
Comorbidities of pregnancy are 30 percent lower in women who achieve a vitamin D level of at least 40 ng/mL, including diabetes, high blood pressure and pre-eclampsia — a potentially deadly increase in blood pressure and fluid accompanied by low platelets
A mother’s vitamin D status during pregnancy can have lifelong ramifications for her child. Vitamin D deficiency in pregnancy has been linked to higher rates of childhood allergies, asthma,6,7 colds and flu, dental cavities, diabetes, and even strokes and cardiovascular disease later in life8,9
According to Julie A. Willems Van Dijk, a public health scientist at the University of Wisconsin and a lead researcher on the featured report, “the right kind of action” will be necessary to close the racial gap, and this includes not just medical care but also societal issues such as reducing segregation and improving access to healthy food and employment.10 What she failed to mention was vitamin D optimization — one of the least expensive and quickest acting remedial actions available!
Organic Trade Association to Submit Petition for Vitamin D Health Claim
It’s quite remarkable that at a time when there’s so much research data supporting the use of vitamin D to dramatically improve pregnancy outcomes, lower preterm birth rates and improve the long-term health of both mother and child, health authorities still make no mention of it whatsoever.
In an effort to break the silence, the Organic & Natural Health Association, which is committed to “empowering conscious consumer choice,”11 will be submitting a health claim petition for vitamin D to the U.S. Food and Drug Administration.
In a press release, executive director and CEO Karen Howard noted “The petition will assert there is a well-established body of research, including that of GrassrootsHealth and its results12 at the Medical University of South Carolina, documenting vitamin D levels of 40 ng/ml or higher reduces the rate of preterm birth by 60 percent.”
The petition is being prepared for submission during a planned April 12 meeting at Capitol Hill, where the association will be sharing the message with key legislators and staff. The key message is that vitamin D supplementation “directly impacts health outcomes and is changing the standards of care, in this case, for pregnant women and a generation of children.”
40 ng/mL Is the ‘Magic’ Minimum Number for Reducing Preterm Birth Rates
According to findings by Grassrootshealth, there’s a clear and definitive correlation between vitamin D levels and time of gestation — up to 40 ng/mL, where the impact plateaus.13 Overall, evidence shows pregnant women with a vitamin D level between 40 and 60 ng/mL have 46 percent lower preterm birth rate than the general population, while those with a vitamin D level at or above 40 ng/mL by their third trimester have a 59 percent lower risk for premature birth compared to those with levels below 20 ng/mL.14
Among non-Caucasian women (among whom vitamin D deficiency is far more common) the reduction in risk is even more significant. In this group, those who achieved a vitamin D level of 40 ng/mL by their second vitamin D test had a 78 percent lower preterm birth rate — reducing the preterm birth rate from 18 percent to 4 percent! To ignore this astounding improvement in preterm birth rate among African-American would be foolhardy in the extreme.
As noted in a 2015 press release announcing the findings:15“The March of Dimes estimates that the annual cost of preterm births in the United States as $12 billion (for 455,918 children). If approximately 50 percent of preterm births could be prevented in the general population, as this analysis suggests is possible, there could be $6 billion available for other services, and more than 225,000 children and families spared this trauma.”
Researchers Call for Vitamin D Testing as Part of Standard of Prenatal Care
As a result of these findings, the Medical University of South Carolina (MUSC) updated its standard of care for prenatal patients to include vitamin D testing and, if necessary, vitamin D3 supplementation. Pregnant women are typically given 4,000 IU of vitamin D3 per day to start. Regular testing then helps determine whether this dose is sufficient, or how much more might be needed to reach a serum level of at least 40 ng/mL by the third trimester.
MUSC is clearly a frontrunner in this regard, and it’s a great start, but it’s quite clear vitamin D testing and optimization needs to be expanded across the nation, and there’s absolutely no reason not to. It’s simple, inexpensive and profoundly effective.
To speed up this change, physicians across the U.S. are encouraged to enroll their pregnant patients in the Protect Our Children NOW! project, which seeks to resolve vitamin D deficiency among pregnant women and children, and raise global awareness about the health risks associated with vitamin D deficiency.
The project was initiated by Carole Baggerly of GrassrootsHealth16 in 2015, and has a panel of 42 vitamin D researchers that provide scientific advice. If you are 12 to 17 weeks pregnant, at least 18 years of age, and currently reside in the U.S., this fully sponsored study is available at no cost to you. Participation in the program includes:
Free vitamin D blood tests, which you can do from the comfort of your own home
Your and your newborn’s new questionnaire entries
Reporting of results directly to you
Free vitamin D supplements
If you are planning a pregnancy, or are more than 17 weeks pregnant, you can still take control of your and your child’s health by using the D*Action test kit. It’s one of the most cost-effective ways to monitor your vitamin D status. Again, the minimum vitamin D level you’re aiming for is 40 ng/mL, while additional research suggests a level between 60 and 80 ng/mL provides the greatest health benefits and widest protection against chronic disease.
Vitamin D Status Is Strongly Correlated With Cancer Risk
For example, mounting evidence suggests that optimizing your vitamin D level may significantly reduce your risk of cancer, including breast cancer. Most recently, a Japanese study17 published in The BMJ concluded higher vitamin D levels do in fact provide cancer protection, as indicated by many other studies. As reported by Technology Networks:18
“As vitamin D concentrations and metabolism can vary by ethnicity, it is important to find out whether similar effects would be seen in non-Caucasian populations. So an international research team, based in Japan, set out to assess whether vitamin D was associated with the risk of total and site specific cancer. They analyzed data from the Japan Public Health Center-based Prospective Study, involving 33,736 male and female participants aged between 40 to 69 years …
After accounting for … seasonal variation, samples were split into four groups, ranging from the lowest to highest levels of vitamin D. Participants were then monitored for an average of 16 years …
After adjusting for several known cancer risk factors … the researchers found that a higher level of vitamin D was associated with a lower (around 20 percent) relative risk of overall cancer in both men and women … [N]one of the cancers examined showed an increased risk associated with higher vitamin D levels.”
As mentioned, the link between vitamin D status and cancer risk has been assessed in many studies, including the following, which found that:
Having a serum vitamin D level of at least 40 ng/mL reduces your risk for cancer by 67 percent, compared to having a level of 20 ng/ml or less.19,20 Most cancers occur in people with a vitamin D blood level between 10 and 40 ng/mL, and the optimal level for cancer protection was identified as being between 40 and 60 ng/mL
Women with vitamin D concentrations of at least 30 ng/mL have a 55 percent lower risk of colorectal cancer than those who had a blood level below 18 ng/mL21
Women with vitamin D levels above 60 ng/mL have an 83 percent lower risk of breast cancer than those with levels below 20 ng/mL22
Women over 55 who raised their average serum level to 38 ng/mL lowered their risk of all invasive cancers, including breast cancer, by 77 percent23
Vitamin D also increases your chances of surviving cancer if you do get it,24,25 and this includes melanoma26,27 and breast cancer. In the case of the latter, breast cancer patients with high vitamin D levels are twice as likely to survive than those with low levels.28 Higher vitamin D levels are also associated with a lower risk of severe peripheral neuropathy in cancer patients29
Additional studies can be found on GrassrootHealth’s vitamin D*Action breast cancer page,30 where you can also enroll in the D*Action Breast Cancer Prevention project, which now includes both vitamin D and omega-3 testing. Besides cancer protection, vitamin D sufficiency also lowers your mortality risk from all causes.31,32
It even lowers your risk of Type 2 diabetes by about 60 percent, as evidenced by a GrassrootsHealth analysis.33 Here, those with a median vitamin D level of 41 ng/mL had a diabetes rate of 3.7 per 1,000, compared to a rate of 9.3 per 1,000 among those with a median serum level of 22 ng/mL.
Be Mindful of the Interplay of Vitamins D and K2, Calcium and Magnesium
The best way to optimize your vitamin D level is through sensible sun exposure, but for many, oral supplementation will be necessary to achieve an optimal level, especially if you’re pregnant during the winter. Remember, the only way to accurately assess your need for supplementation is to measure your vitamin D level. It’s a simple, relatively inexpensive blood test. Considering the extreme cost of pregnancy complications and preterm birth, the cost of vitamin D testing and supplementation is negligible.
Just keep in mind that if you take high-dose vitamin D, you may also need to increase your intake of calcium, magnesium and vitamin K2 as well, as these four nutrients work in tandem and rely on sufficient amounts of each to work properly. Importantly, excessive vitamin D in combination with lack of vitamin K2 may cause overabsorption of calcium, which in turn may result in calcium deposits in your heart and kidneys.
Maintaining an appropriate calcium-to-magnesium ratio34 is also important, as magnesium helps keep calcium in your cells so they can function better. A ratio of 1-to-1 appears to be ideal. Magnesium is also required for the activation of vitamin D. Without sufficient magnesium, taking a vitamin D supplement may be ineffective, essentially making it appear you need unnecessarily high amounts. Magnesium and vitamin K2 also complement each other.
Preterm Birth Rate Can Be Significantly and Immediately Slashed
At this point, there’s simply no doubt that maintaining a vitamin D level of 40 to 60 ng/mL during pregnancy is one of the most important strategies you can implement, both for your own health and for the health of your child. The science is done and the results are in. It just needs to be put into practice. I cannot think of any other measure that can reduce pregnancy complications, deaths, and future health problems for less money, and be as safe and risk free.35
If you’re planning a pregnancy or are already pregnant, please, get your vitamin D tested, and if you’re below 40 ng/mL, take a vitamin D3 supplement (and make sure you’re getting sufficient amounts of vitamin K2, magnesium and calcium as well). One in 10 children is born prematurely in the U.S., and there’s simply no reason for this tragedy to continue. This rate can be cut by at least 60 percent simply by making vitamin D optimization a standard part of prenatal care.
Again, if you’re between 12 and 17 weeks pregnant, you can enroll for free in the Protect Our Children NOW! study. If you’re planning a pregnancy, or have passed the 17-week mark, enrolling in the D*Action study is a cost-effective way to get regular testing done. The D*Action study is also open to non-pregnant women, as well as men and children.