7 Period Problems You Shouldn’t Ignore


Read this if your red tide wipes you out.
woman-lying-on-bed-period

There are some period problems that are unfortunately par for the course, like cramps, irritability, and bleeding more than you would like to be bleeding from your vagina.

But there are also some period problems that you should bring up to your doctor—just in case—because they’re a bit outside of what’s normally expected during menstruation. Here are some things to keep an eye out for.

1. You soak through a pad or tampon in an hour or less, your period lasts longer than seven days, or both.

The clinical term for an exceedingly heavy or long period is menorrhagia. These are basically horror movie-style periods, but some people don’t even realize this kind of bleeding is abnormal. “One of the biggest problems is someone being so used to heavy bleeding that she underplays the amount,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “She’ll come in and say her periods aren’t too bad, then say she has to change her tampon every hour.” Passing clots larger than a quarter is also a sign your bleeding is too heavy, according to the Centers for Disease Control and Prevention (CDC).

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It’s not just that bleeding way too much or for too long is messy and inconvenient. Losing more than the typical two to three tablespoons of blood during your period or bleeding for longer than seven days can lead to anemia, the CDC says. If you have anemia, you lack enough healthy red blood cells to get oxygen to all your tissues, so you may feel tired and weak, according to the Mayo Clinic.

Bleeding too much can also be a sign of various health issues, like uterine fibroids, which are benign growths in and on the uterus that can sometimes come along with problems like pelvic pain and frequent urination. Uterine polyps, which are growths on the inner lining of the uterus, can also cause heavy bleeding, as can cervical polyps, which are lumps that emerge from the cervix. Both types of polyps are typically non-cancerous but, in rare cases, may contain cancer cells.

The hormonal issue polycystic ovary syndrome (PCOS) can also cause heavy bleeding. Worse, this bleeding can strike after months of an MIA period. This gives your uterine lining a chance to build up over time, leading to an abnormally heavy period when it finally comes, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, tells SELF. PCOS can also cause symptoms like excess face and body hair or severe acne, thanks to high levels of male hormones.

Heavy menstrual bleeding could even be a sign of a disorder that causes you to lose too much blood, like idiopathic thrombocytopenic purpura (ITP). ITP usually comes along with other symptoms like easy and excessive bruising or a rash of reddish-purple dots on a person’s lower legs.

Clearly, figuring out what’s causing your heavy bleeding won’t be easy on your own, so you should see your doctor. They’ll typically ask about your other symptoms and perform exams to determine what exactly is going on, and treatment will depend on what you’re dealing with.

2. Your period brings days of pain that make it practically impossible to leave your bed.

Dr. Streicher’s rule is essentially that if you’re experiencing even an iota of period pain beyond what you’re fine with, it’s too much. The first step is typically to take nonsteroidal anti-inflammatory drugs, since they block hormone-like chemicals known as prostaglandins that cause uterine cramping. If that knocks out your cramps, you’re good to go. If you’re still curled up in the fetal position after a few hours, that’s a sign that you need evaluation, Dr. Streicher says. You’re dealing with dysmenorrhea (severe menstrual cramps), and doctors can help.

There are many different causes of overboard menstrual cramps. Fibroids are a common culprit. So is endometriosis, a condition many experts think happens when tissue lining the uterus travels outside of it and begins growing on other organs. (Other experts believe that tissue is actually different in that it can make its own estrogen, which can create painful inflammation in people with endometriosis.) In addition to causing extremely painful periods, endometriosis can lead to painful intercourse, occasional heavy periods, and infertility, according to the Mayo Clinic.

Adenomyosis, which happens when the endometrial tissue lining the uterus grows into the muscular walls of the organ, can also cause terrible menstrual pain, along with expelling big clots during your period and pain during intercourse.

3. You never know when your period is going to show up.

Pour one out for all the times you thought you’d have a period-free vacation, only for it to show up right as you hit the beach. Fun! Irregular periods could be due to a number of different things that are (at least somewhat) in your control, like stress and travel, Dr. Streicher says. But they can also happen because of various health conditions.

Take thyroid issues, for instance. Hypothyroidism, which is when your thyroid gland in your neck doesn’t produce enough hormones, can lead to an irregular period, according to the Mayo Clinic. It can also cause myriad other symptoms, like heavier than usual periods, fatigue, constipation, dry skin, weight gain, impaired memory, and more. Treatment typically involves taking medication that mimics the thyroid hormone.

On the flip side, hyperthyroidism, which is when your thyroid gland is overactive, can cause light or infrequent menstruation, along with issues like sudden weight loss, rapid heart rate, increased appetite, and more frequent bowel movements, according to the Mayo Clinic.

Irregular periods are also a sign of premature ovarian failure, which is when a person younger than 40 starts losing their normal ovarian function, according to the Mayo Clinic. It can also cause menopausal symptoms like hot flashes, night sweats, vaginal dryness, and difficulty conceiving. Doctors can offer estrogen therapy to relieve symptoms like hot flashes (typically in conjunction with progesterone to avoid the precancerous cells that may take hold if you take estrogen alone). They can also counsel you about the possibility of in vitro fertilization if you’d like to physically conceive and carry children in the future.

PCOS and uterine polyps be behind irregular bleeding, too.

4. Your period decides not to show up for a while.

While it’s true that you can sometimes randomly miss a period for reasons like stress, you shouldn’t just ignore a long-term missing period. Suddenly being period-free may feel blissful, but you’ll want to make sure there’s not a health issue going on, like PCOS, an eating disorder or excessive exercise affecting your menstruation…or, yes, pregnancy.

“If you’re menstruating normally then suddenly go months without a period, that’s not something to ignore,” Dr. Streicher says. If your period vanishes for three months or longer (this is known as amenorrhea), see your doctor for evaluation.

It’s worth noting that the use of some hormonal birth control methods—especially the hormonal IUD—can make your period basically disappear. Still, check with your doctor, just in case, when this happens.

5. You’re dealing with a lot of unexpected spotting between periods.

There are times when this is normal, like if you’ve just started a new type of birth control, or even if you’re pregnant (spotting can be totally fine during pregnancy), Dr. Minkin says. But if nothing in your life has changed and you start spotting between periods, call your doctor for an appointment.

It could be something that’s ultimately pretty harmless, like a benign uterine or cervical polyp that’s causing bleeding between periods. But spotting is also a hallmark of pelvic inflammatory disease (PID), which is the result of sexually transmitted bacteria from infections like chlamydia and gonorrhea spreading to reproductive organs like your uterus, fallopian tubes, and ovaries. In addition, pelvic inflammatory disease can cause issues like fever, strange vaginal discharge that smells bad, and burning when you pee.

If you have PID, your doctor will first address the STI in question with antibiotics, says the CDC, then treat your partner for an STI if necessary. Pelvic inflammatory disease is a leading cause of chronic pelvic pain and infertility in women, so if you suspect you have it, treatment is of the essence.

More rarely, spotting in between periods can be a sign of cervical cancer, according to the Mayo Clinic. Cervical cancer can come along with watery, bloody discharge that might have a bad odor and pelvic pain, including during intercourse. Even though this likely isn’t your issue, you’ll want to get checked out, just in case. Treatment for cervical cancer may involve a hysterectomy, radiation, or chemotherapy.

6. You experience debilitating mood issues before your period.

When your estrogen and progesterone drop before your period, you may experience the typical mood swings that mark premenstrual syndrome (PMS). (Bear in mind that this may not be as drastic if you’re on hormonal birth control, which stabilizes your hormones throughout your cycle.)

But if you deal with severe mood swings, irritability, anger, a lack of enjoyment in things you usually enjoy, and other symptoms that affect your life, you may have premenstrual dysphoric disorder (PMDD). PMDD happens when you experience these symptoms in the week before your period, then they start getting better in the first few days of bleeding, and disappear in the weeks after your period. It’s listed in the DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, for good reason: This psychological issue can completely turn your life upside down.

“If you suspect you have PMDD, the one thing I would encourage is keeping a daily record of the severity of your symptoms,” Dr. Minkin says. If these symptoms only rear their head the week before your period, PMDD might be your issue. If you realize you’re constantly dealing with them and your period just makes them worse, it might be premenstrual exacerbation, which is another way of saying you have a mental illness like depression that gets worse during your period.

Either way, a doctor can help. If you have PMDD, your doctor may have you take antidepressants in the timeframe when you usually experience symptoms, then stop once your period starts, Dr. Minkin says. (If you have premenstrual exacerbation, they may recommend staying on the antidepressants through the month and potentially upping your dosage in the week before your period.)

Or your doctor may suggest you go on birth control using a synthetic version of progesterone called drospirenone, Dr. Minin says, like Yaz and Beyaz. These are FDA-approved to treat PMDD. Though experts aren’t sure why they can be so successful in this arena, it may be because drospirenone reduces a person’s response to hormonal fluctuations. It’s also a diuretic, meaning it can flush out liquids that could otherwise cause fluid retention and contribute to annoying issues like bloating.

7. You have excruciating migraines before or during your period.

If migraines had any home training, they’d at least leave you alone when you’re about to get your period. Unfortunately, period migraines are indeed a thing.

It’s not that menstruation will just randomly cause migraines in unsuspecting people who have never had one, but women with a history of migraines may experience them before or during their periods, according to the Mayo Clinic, which adds that this may be due to estrogen fluctuations. “They tend to get the headache right as they go into their periods, and it seems to get better after they have had their menses for a day or two,” Dr. Minkin says.

If you’re dealing with this, your typical migraine medication may work for you. As you probably know if you’ve grappled with migraines, the treatment options are legion. They include pain-relieving medications to relieve symptoms ASAP and preventive drugs to ward off migraines altogether, according to the Mayo Clinic. In the former camp, you have choices like anti-nausea meds and triptans, which constrict swollen blood vessels and block pain pathways in the brain. In the latter, you’ve got meds like tricylic antidepressants, which affect brain chemicals like serotonin that may be implicated in migraines.

No matter what your period problem may be, you don’t have to suffer in silence.

You have no reason to feel embarrassed about your period—or the myriad problems that can come with it. After all, celebrities are out here talking about menstruation! Some pad commercials even—gasp—use red “blood,” these days! What a time to be alive.

If you’re having period problems, see your doctor for help. If they aren’t committed to relieving your symptoms, that’s a sign you should try to find a more sympathetic medical professional who can help you find the best treatment.

Mary Neal: Abortion decriminalisation and statutory rights of conscience.


On 13 March 2017, the House of Commons voted by 172 to 142 in favour of a second reading for the Reproductive Health (Access to Terminations) Bill. The bill, introduced by Diana Johnson MP, would decriminalise abortion until the end of the 24th week of pregnancy, meaning that abortion could be performed until the end of the 24th week of pregnancy without the need to satisfy any statutory grounds, or to obtain two doctors’ authorisation. Many campaigners see this bill as a first step toward the longer-term goal of fully decriminalising abortion. [1]

The prospect of decriminalisation raises a number of interesting and important issues, including an issue which has been neglected in the debates over decriminalisation so far, namely what any change in the law might mean for the right of health professionals to withdraw from participation in abortion on grounds of conscience, under section 4 of the Abortion Act 1967.

In the case of Greater Glasgow Health Board v Doogan, [2] the UK Supreme Court decided that section 4 only covered “direct” participation in the course of action which “begins with the administration of the drugs designed to induce labour and normally ends with the ending of the pregnancy by delivery of the foetus, placenta and membrane.” [3] Speculating about what “must” have been in Parliament’s contemplation at the time of the passing of the Act, the court held that there is no right to opt out of “indirect” participation (such as “delegation, supervision and support” in relation to abortion) on grounds of conscience. It also confirmed that the statutory conscience right offers no protection to general practitioners; what legal protection they have, they have under the terms of the GP contract with the NHS. Although this means that GPs conscience rights will be unaffected by any decriminalisation process, it also means that they have no statutory conscience rights at all and could be left without any protection were the terms of the GP contract to change.

There is ongoing academic debate about whether individual conscience should be accommodated at all in the healthcare context. [4] When the law does decide to provide for it, however (as it does in the case of abortion), the provision should be interpreted in a manner consistent with its purpose. The purpose of a conscience clause is to protect individuals from sharing in moral responsibility for an outcome that they regard as seriously immoral. Those who help to arrange for something to happen, or who support and facilitate it in necessary but “indirect” ways, share in the responsibility (credit or blame, depending on one’s view) for the outcome. Thus, a fit-for-purpose conscience clause must protect those who regard abortion as serious wrongdoing from participating in it indirectly (so it must cover senior midwives and GPs); restricting protection to those immediately involved defeats the purpose.

Weakened as it is by the Supreme Court’s decision, section 4 remains a vital lifeline for those whose roles it doescover. Moves to decriminalise abortion have the potential to restrict conscience rights much more severely, however. Section 4 provides that “no person shall be under any duty…to participate in any treatment authorised by this Act to which he has a conscientious objection” (my emphasis). In Doogan, the court held that “treatment authorised by this Act” means treatment “made lawful by” the Act. [5] If abortion were decriminalised, the 1967 Act would no longer be “making abortion lawful” (either at all, or until the end of the 24th week, depending on the scale of the decriminalisation), and it could be argued, following the reasoning in Doogan, that the section 4 conscience right no longer applied to recently-decriminalised abortion. If that argument succeeded, individual professionals could no longer rely on the protection of section 4 in the overwhelming majority of abortions (and perhaps even all abortions).

Influential supporters of decriminalisation, like Ann Furedi (CEO of Bpas) and Professor Sally Sheldon, have indicated their support for accommodating conscientious objection. [6,7] To ensure that any liberalisation of abortion law does not have the unintended side effect of depriving professionals of their conscience rights, it is imperative that a meaningful conscience provision be added to Johnson’s Bill if it progresses beyond the second reading, and to any subsequent bill seeking to decriminalise abortion. In my view, such a clause ought also to put GPs’ protection on a statutory footing.

Mary Neal is a senior lecturer in law at the University of Strathclyde in Glasgow, researching and teaching medical law and ethics with a particular focus on beginning and end of life issues and rights of conscientious objection. She is a current member of the BMA Medical Ethics Committee.

References:

[1] For example, the ‘We Trust Women’ campaign, which supports this Bill, seeks full decriminalisation: http://www.wetrustwomen.org.uk/about-the-campaign/ accessed on 20/03/2017

[2] [2014] UKSC 68

[3] [2014] UKSC 68, paragraph 34

[4] For a range of views, see the following special issues: Bioethics (Volume 28, Issue 1, January 2014); Medical Law Review (Volume 23 Issue 2, May 2015); Cambridge Quarterly of Healthcare Ethics (Volume 26 Issue 1, January 2017); and Journal of Medical Ethics (Volume 43 Issue 4, April 2017).

[5] Greater Glasgow Health Board v Doogan [2014] UKSC 68, paragraph 38

[6] A Furedi, ‘We support a woman’s choice of abortion: but should doctors have the right to choose too?Lawyers For Choice Blog, 25 July 2016, https://lawyersforchoice.wordpress.com/ accessed on 20/03/2017

[7] S Sheldon, ‘The Decriminalisation of Abortion: An Argument for Modernisation’, Oxford Journal of Legal Studies (2016) 36 (2): 334-365, 361  https://academic.oup.com/ojls/article-lookup/doi/10.1093/ojls/gqv026accessed on 20/03/2017

Source:http://blogs.bmj.com

 

Thyroid screening may benefit women with fertility problems


Screening for thyroid disease should be considered in women with fertility problems and recurrent early pregnancy loss, according to a review published in The Obstetrician & Gynaecologist.

“Abnormalities in thyroid function can have an adverse effect on reproductive health and result in reduced rates of conception, increased miscarriage risk and adverse pregnancy and neonatal outcomes,” Amanda Jefferys, BMBS, BMedSci, MRCOG, of the Bristol Center for Reproductive Medicine at Southmead Hospital in the United Kingdom, said in a press release. “However, with appropriate screening and prompt management, these risks can be significantly reduced.”

Jefferys and colleagues conducted the review to gather information on the effect of thyroid disorders on reproductive health. The researchers also sought to gather information on how to optimize thyroid function in order to improve reproductive outcomes.

There can be adverse effects on reproductive health, decreased conception rates, increased early pregnancy loss, and adverse pregnancy and neonatal outcomes with abnormalities in thyroid function, including hyperthyroidism and hypothyroidism.

Compared with 1.5% of women in the general population, 2.3% with fertility problems have hyperthyroidism. Menstrual irregularity has been linked to hyperthyroidism. Preterm delivery, preeclampsia, growth restriction, heart failure and stillbirth are all possible adverse outcomes of pregnancy in women with hyperthyroidism.

Less than 1% of women of reproductive age have hypothyroidism, which can cause a delay in reaching sexual maturity during childhood and adolescence as well as menstrual problems in adulthood.

Currently, national guidelines do not recommend screening for asymptomatic women with problems conceiving.

“Thyroid disease can have significant effects on reproduction from conception to birth; however, with appropriate screening, a high index of suspicion and prompt management, risks can be significantly reduced if not ameliorated,” the researchers wrote. “The benefits of [levothyroxine] replacement in euthyroid women and with [autoimmune thyroid disease] both preconceptually and during pregnancy remain a grey area and further research is needed to confirm benefit.”

EFFECT OF THYROID DISORDERS ON REPRODUCTIVE HEALTH


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Thyroid disease can have significant effects on a woman’s reproductive health and screening for women presenting with fertility problems and recurrent early pregnancy loss should be considered, suggests a new review published today (23 January) inThe Obstetrician & Gynaecologist (TOG).

The review examines the effect of thyroid disorders on reproductive health and reviews the current evidence on how to optimise thyroid function to improve reproductive outcomes.

Thyroid hormones control the metabolism via the production of two hormones triiodothyronine and thyroxine. These hormones also have key roles in growth and development, particularly brain development. Changes in thyroid function can impact greatly on reproductive function before, during and after conception.

Thyroid disease is divided into hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid), and the causes of the diseases are numerous.

The review highlights that hyperthyroidism is found in approximately 2.3% of women presenting with fertility problems, compared with 1.5% of women in the general population. The condition is linked with menstrual irregularity. Hypothyroidism affects around 0.5% of women of reproductive age. Hypothyroidism in childhood and adolescence is associated with a delay in reaching sexual maturity, and in adulthood is associated with menstrual problems and in some cases a lack of ovulation, state the authors.

The authors note that thyroid disease has long been associated with fertility problems, however, national guidance does not currently recommend routine measurement of thyroid function in asymptomatic women presenting with problems conceiving.

Additionally, the authors of the review note that miscarriage is common, affecting approximately one in five pregnancies and recurrent miscarriage, defined as three consecutive miscarriages, affects 1% of couples. Given that thyroid hormone plays an important part in embryonic development, thyroid disease has long been associated with an increased risk of miscarriage.

Thyroid disease, in particular hyperthyroidism, can also have a significant effect on pregnancy, the authors of the review state. Adverse outcomes can include preterm delivery, pre-eclampsia, growth restriction, heart failure and stillbirth.

The authors conclude that screening for thyroid disease should be considered in women presenting with fertility problems and recurrent pregnancy loss. Additionally, the authors highlight that there is evidence to suggest that routine screening of the general population for thyroid dysfunction at the start of pregnancy may be beneficial.

Furthermore, women diagnosed with thyroid disease should continue on anti-thyroid medication throughout pregnancy and receive close monitoring, emphasise the authors.

Amanda Jefferys, from the Bristol Centre for Reproductive Medicine, Southmead Hospital, Bristol, and co-author of the study said:

“Abnormalities in thyroid function can have an adverse effect on reproductive health and result in reduced rates of conception, increased miscarriage risk and adverse pregnancy and neonatal outcomes.

“However, with appropriate screening and prompt management, these risks can be significantly reduced.”

Jason Waugh, TOG Editor-in-chief, added:

“Thyroid disease is common in the reproductive medicine setting, in fact, it is the most common endocrine condition affecting women of reproductive age.

“This paper highlights how thyroid disorders can affect fertility and pregnancy and makes a case for universal screening.”

Why male birth control is a million disasters waiting to happen.


It was 100 degrees out but I couldn’t stop shivering. I wore two shirts, jeans, and a heavy hoody but was still colder than I had ever been in my life.

Several months prior to the chills I started to have trouble sleeping. The urge to urinate woke me up about every two hours. I woke up about four times a night to take a piss. Each time hardly anything would actually come out.

At first I wrote it off.

Maybe I’m drinking too much water before bed, I thought. After all, I did drink tons of water throughout the day.

Then I started having problems urinating during the day. I’d whip it out to piss and then…nothing. Sometimes it’d be a full minute until I could actually get a stream going.

The pain started a few weeks later. It felt like a burning-hot screwdriver was being shoved up my phallus every time I tried to pee. There was pain even when I didn’t go to the bathroom. The sensation was as if everything beneath my stomach was crammed into a blender, torn apart, and then lit on fire. There was also pain in my sides. I don’t have quite as dramatic an explanation for that pain. If you’ve ever been punched before, imagine that but coming from the inside.

Regular visits to the gynecologist are essentially a must for a woman. While this has to suck, the upshot is that it forces them to understand their sexual health and reproductive health better than any man understands their own. It also, presumably, makes them less afraid of invasive tests since they have to endure them on a semi-regular basis. That’s why I put off going to the urologist for so long, because I was afraid of getting a tube put in my dick. Eventually, I couldn’t stand the pain and constant chills anymore, and I saw the doctor.

The doctor said I had a severe bacterial kidney infection that spread to the bladder and prostate—so basically a kidney infection, a urinary tract infection, and prostatitis.

I took the most powerful antibiotics they’re allowed to prescribe and after a while the pain went away…but the nocturia (getting up to pee a lot during the night) and the long delay before urinating. I went back to the doctor and he said the bladder muscle had become spastic and overactive as a result of the prolonged infection.

He prescribed a medicine to help me with my symptoms. I can’t remember the name, but I know it belonged to a class of medicines calledAlpha Blockers.

“One thing about this medicine,” the doctor said as he typed the prescription into the computer. “There’s a chance it can cause retrograde ejaculation.”

“Um…what?” I asked. I obviously knew what ejaculation meant but “retrograde” could’ve meant anything.

“Dry orgasms. No seminal fluid,” he said. In more specific terms, retrograde ejaculation is when semen gets sent into the bladder rather than out into a sock, condom, or, if you’re lucky, a crevasse belonging to your significant other.

I was weirded out but he said there was only a chance, right? So that meant there was a chance it didn’t cause retrograde ejaculation.

This pathetic bit of self delusion lasted until my first jerk-off session on the medicine. I felt the familiar build-up of pleasure and tension (I call it plension) and then… nothing. Not only was there no semen, there was no electric rush, no hip-bucking, and no release.

After about a month of this, I asked to switch to a different medicine. As far as I knew, that’d be the last time I’d ever have to think or hear about dry orgasms and retrograde ejaculation.

I was wrong.

Male birth control is swift becoming a highly discussed issue among social justice circles and the Internet in general.

One proposed method of male birth control is the use of alpha blockers to intentionally cause dry orgasms. Another, more recently publicizedstrategy is using gel to block the vas deferens—the tube sperm travels through—thereby preventing sperm from ever coming out of the penis (forgive the pun). The latter product could be available in three years.

The Daily Beast’s Samantha Allen, who is also a frequent contributor at the Daily Dot, noted that male birth control could have a multitude of wondrous impacts on society, and would greatly aid women since they would no longer be subject to the deleterious affects of The Pill.

Allen’s interpretation of the facts is accurate, but it paints too rosy a picture. The coming wave of male birth control will make conversations about reproductive health more vitriolic and hateful, not less.

First, insertion of gel into the vas deferens is an invasive procedure—far more invasive than popping a pill every day. A significant percentage of America’s 150 million-plus men will not go for it no matter how economical it is or how beneficial to society it is. American culture is too patriarchal and while #NotAllMen are this selfish, most are.

The bigger concern, however, isn’t the procedure but the dry orgasm.

“Dry orgasm” is a misnomer. Yeah it’s dry, but calling it an orgasm is just wrong. My dry “orgasms” felt like being 12 again—old enough to get a boner looking at porn illegally downloaded from Napster but not actually old enough for your member to spew forth any precious fluids.

I’m not alone in realizing that dry orgasms remove pleasure from sex. Astudy performed in 2009 found that “a strong decline in ejaculatory volume is associated with reduced sexual pleasure” when they gave men alpha blockers. The study noted the men were “greatly dissatisfied with the ejaculatory dysfunction” from the alpha blockers.

I lost all sex drive almost immediately once I started having dry orgasms. I didn’t even respond to a “booty call” I got while I was on the alpha blockers because I just didn’t care. What was the point of having sex if I knew I was incapable of enjoying it?

Cynics and jokesters would say “Well, if male birth control reduces libido then mission accomplished: No kids!”

Birth control isn’t just a preventative measure; it enables people to fully enjoy sex while avoiding the grave biological and financial consequences of sex. Male birth control, however, prevents pleasure as well as pregnancy.

Look, I’m not a men’s rights activist. I’m not trying to say women should be subjugated and forced to take the pill for as long as they live. I’m just saying that male birth control is highly imperfect. If you’re expecting it to take the world by storm in 2017, don’t. Once the first crop of men feel what a dry orgasm is like, it’ll start a new culture war. Imagine the GIF vs. JIF debate, but 10,000 times worse because it’ll be filled with more hate and it’ll be an issue that actually matters.

I guarantee you there will be a contingent of men comparing male birth control to female circumcision in that it robs both groups of pleasure. The web will be inundated with articles just like this one explaining just how awful male birth control is for men’s sexual health. And maybe we don’t deserve sexual health for all the atrocities we’ve committed against females, but good luck convincing America of that.

This birth control innovation isn’t a solution, it’s 150 million problems waiting to happen.

Scans show premature-baby brain arrested development.


Premature birth may interrupt vital brain development processes, medical scans reveal.

Researchers at King’s College London scanned 55 premature infants and 10 babies born at full term, using a novel type of MRI scan.

Premature baby in hospital

The brain scans showed arrested development in the premature babies at a key stage of maturation.

Experts say the work, in PNAS, could further understanding, but that parents should not be alarmed by the findings.

In recent decades there have been big advances in caring for premature babies, which mean most can go on to live a healthy life.

“Start Quote

Most premature babies are unaffected by their early arrival and families of these babies should not be unduly concerned”

Andy Cole Bliss

The researchers say the new type of imaging – which tracks the movement of water in the brain – will enable them to explore how the disruption of key processes might cause conditions such as autism.

It could also be used to monitor possible treatments to prevent brain damage.

Interrupted development

The scans showed cortical development was reduced in the preterm babies compared with those born at full term, with the greatest effect in the most premature infants – those born at about 27 weeks.

The brain regions affected govern social and emotional processing, as well as memory.

The same children were assessed at two years of age and those who had been born prematurely performed less well on neurodevelopmental tests, which the researchers say suggests the weeks a baby loses in the womb may matter.

Lead investigator Prof David Edwards said: “The number of babies born prematurely is increasing, so it has never been more important to improve our understanding of how preterm birth affects brain development and causes brain damage.

“We know that prematurity is extremely stressful for an infant, but by using a new technique we are able to track brain maturation in babies to pinpoint the exact processes that might be affected by premature birth.”

Andy Cole, chief executive of the premature baby charity Bliss, said: “It is very exciting that this ground-breaking research is being driven forward here in the UK.

“A better understanding of the way that preterm babies’ brains develop is an important step for doctors to help identify improvements in care that will benefit the 60,000 preterm children born every year.

“It is important to mention that most premature babies are unaffected by their early arrival and families of these babies should not be unduly concerned.”

Antithyroid drug use in early pregnancy increased birth defect risk.


The treatment of hyperthyroidism during pregnancy with both methimazole/carbimazole and propylthiouracil was linked to birth defects, but the type of malformations differed, according to recent study findings.

The prevalence of birth defects was greater among children exposed to antithyroid drugsduring early pregnancy (propylthiouracil, 8%; methimazole/carbimazole, 9.1%; methimazole/carbimazole and propylthiouracil, 10.1%; P<.001), according to data. Researchers did not see an increased risk for birth defects in infants born to mothers treated with antithyroid drugs before or after pregnancy (no antithyroid drugs, 5.4%; nonexposed, 5.7%;P<.001).

“It is imperative to treat overt hyperthyroidism in pregnant women, but the use of [antithyroid drugs] in early pregnancy should be limited when possible,” the researchers said. “For the present, it may be optimal to shift women planning pregnancy from [methimazole/carbimazole] to [propylthiouracil] before pregnancy.”

The researchers used the Danish nationwide register-based cohort study, including 817,093 children live-born from 1996 to 2008 to determine how the use of antithyroid drugs used in early pregnancy increased the prevalence of birth defects.

Patients were assigned to the following groups:

  • Propylthiouracil (n=564);
  • Methimazole/carbimazole (n=1,097);
  • Methimazole/carbimazole and propylthiouracil (n=159);
  • No antithyroid drugs during pregnancy, but taken before or after pregnancy (n=3,543); and
  • Nonexposed females (n=811,730).

Data indicate that mothers who were assigned both methimazole/carbimazole (adjusted OR=1.66; 95% CI 1.35-2.04) and propylthiouracil (OR=1.41; 95% CI, 1.03-1.92) with maternal shift between methimazole/carbimazole and propylthiouracil during early pregnancy (OR=1.82; 95% CI, 1.08-3.07) demonstrated an increased prevalence of birth defects, researchers wrote.

In particular, methimazole/carbimazole and propylthiouracil were associated with urinary system malformation, and propylthiouracil with malformations in the face and neck region.

Moreover, choanal atresia, esophageal atresia, omphalocele, omphalomesenteric duct anomalies and aplasia cutis were common in methimazole/carbimazole-exposed children (combined, adjusted OR=21.8; 95% CI, 13.4-35.4), according to data.

Further studies are warranted to confirm these results, researchers wrote.

PERSPECTIVE
  • There is concern over whether carbimazole/methimazole or propylthiouracil is the most appropriate antithyroid drug to use when treating hyperthyroidism in pregnant women. Traditionally, propylthiouracil has been preferred, as it was felt to be associated with a lower risk for congenital abnormalities. However, concerns regarding propylthiouracil use have arisen owing to the rare complication of propylthiouracil-induced hepatitis in pregnancy, which can have catastrophic consequences.

    This study is very important, as it substantially adds to our current knowledge of birth defects associated with antithyroid drug exposure for carbimazole/methimazole and propylthiouracil. This study crucially highlighted that both carbimazole/methimazole and propylthiouracil were associated with an increased risk for birth defects. However the birth defects associated with propylthiouracil may be less common and severe than those associated with carbimazole/methimazole. Of particular note was that, in the small number of women who switched from carbimazole/methimazole to propylthiouracil during the first trimester, there was no obvious amelioration in the risk for birth defects. This implies switching to propylthiouracil during the first trimester may be too late to prevent carbimazole/methimazole-associated abnormalities. This would support the argument that in women considering pregnancy, propylthiouracil should be used instead of carbimazole/methimazole, as swapping in the first trimester may be too late. However, further studies are needed.

    The use of robust national registry data provided the very large population required to identify rare but clinically important outcomes and also protected against differential recall of exposure between carbimazole/methimazole and propylthiouracil-treated pregnancies. This is a particular strength as traditional reporting methods may be biased by clinicians’ preconceptions regarding these antithyroid drugs.

    • Peter N. Taylor, MRCP
    • Welsh clinical academic trainee in diabetes and endocrinology
      Thyroid Research Group
      Institute of Molecular and Experimental Medicine
      Cardiff University School of Medicine

The Quest for a Male Contraceptive.


John Amory, a doctor at the University of Washington, has been developing a male contraceptive for 15 years. Turns out, it’s harder than it sounds. We spoke with him to find out why.

PopSci: Why is it taking so long to produce a birth-control pill for men?

John Amory: Women make one egg a month, but men make 1,000 sperm every second of every day, from puberty until the day they die. Turning that off is difficult.

PS: How does hormone contraception work?

JA: If you give a man enough testosterone, the brain will shut down the secretion of gonadotropins, which are the hormones that signal the testes to make sperm. This is why most bodybuilders are infertile, by the way. But it doesn’t work in all men.

PS: How many men does testosterone work for?

JA: We have never been able to get more than 95 percent effectiveness. It’s possible to identify who testosterone won’t work for, but it involves getting a lot of sperm counts. It would be much nicer if you could just say, “Take this and it will work.” Women don’t have to undergo ovulation detections and testing to see if the Pill is going to work for them.

PS: The World Health Organization funded a study across eight countries for hormone-based contraception, but last year, it shut down the study early. What happened?

JA: There were side effects, including severe depression. Some men don’t take hormonal shifts very well.

PS: What other approaches might work?

JA: Sperm have a pretty daunting mission. There’s a lot that can go wrong. Researchers have injected monkeys with eppin, a protein that coats sperm so they can’t swim. There’s also the process by which sperm make energy. If you can block that, you’d get tired sperm. Also, the testes need vitamin A to produce sperm, and there’s an enzyme that converts vitamin A to its active metabolite, retinoic acid. No retinoic acid, no sperm. I’m developing drug inhibitors that stop retinoic-acid production in the testes. I’m hopeful that we’ll have something approved in five years.

PS: Do you expect much demand for the male pill?

JA: Yes. Men are interested in having sex. Most of the time they’re not as interested in fathering a pregnancy.

http://www.popsci.com

Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial.


Summary

Background

Fetal lower urinary tract obstruction (LUTO) is associated with high perinatal and long-term childhood mortality and morbidity. We aimed to assess the effectiveness of vesicoamniotic shunting for treatment of LUTO.

Methods

In a randomised trial in the UK, Ireland, and the Netherlands, women whose pregnancies with a male fetus were complicated by isolated LUTO were randomly assigned by a central telephone and web-based randomisation service to receive either the intervention (placement of vesicoamniotic shunt) or conservative management. Allocation could not be masked from clinicians or participants because of the invasive nature of the intervention. Diagnosis was by prenatal ultrasound. The primary outcome was survival of the baby to 28 days postnatally. All primary analyses were done on an intention-to-treat basis, but these results were compared with those of an as-treated analysis to investigate the effect of a fairly large proportion of crossovers. We used Bayesian methods to estimate the posterior probability distribution of the effectiveness of vesicoamniotic shunting at 28 days. The study is registered with the ISRCTN Register, number ISRCTN53328556.

Findings

31 women with singleton pregnancies complicated by LUTO were included in the trial and main analysis, with 16 allocated to the vesicoamniotic shunt group and 15 to the conservative management group. The study closed early because of poor recruitment. There were 12 livebirths in each group. In the vesicoamniotic shunt group one intrauterine death occurred and three pregnancies were terminated. In the conservative management group one intrauterine death occurred and two pregnancies were terminated. Of the 16 pregnancies randomly assigned to vesicoamniotic shunting, eight neonates survived to 28 days, compared with four from the 15 pregnancies assigned to conservative management (intention-to-treat relative risk [RR] 1·88, 95% CI 0·71—4·96; p=0·27). Analysis based on treatment received showed a larger effect (3·20, 1·06—9·62; p=0·03). All 12 deaths were caused by pulmonary hypoplasia in the early neonatal period. Sensitivity analysis in which non-treatment-related terminations of pregnancy were excluded made some slight changes to point estimates only. Bayesian analysis in which the trial data were combined with elicited priors from experts suggested an 86% probability that vesicoamniotic shunting increased survival at 28 days and a 25% probability that it had a large, clinically important effect (defined as a relative increase of 55% or more in the proportion of neonates who survived). There was substantial short-term and long-term morbidity in both groups, including poor renal function—only two babies (both in the shunt group) survived to 2 years with normal renal function. Seven complications occurred in six fetuses from the shunt group, including spontaneous ruptured membranes, shunt blockage, and dislodgement. These complications resulted in four pregnancy losses.

Interpretation

Survival seemed to be higher in the fetuses receiving vesicoamniotic shunting, but the size and direction of the effect remained uncertain, such that benefit could not be conclusively proven. Our results suggest that the chance of newborn babies surviving with normal renal function is very low irrespective of whether or not vesicoamniotic shunting is done.

Source: Lancet

Regulatory approval opens the way for European launch of new single-size contraceptive diaphragm.


The device is safe, comfortable, and easy to use, expanding nonhormonal contraceptive options for women

Seattle, June 20, 2013—Soon, women in Europe may be taking a new look at one of the world’s oldest forms of contraception. European regulators have granted the single-size SILCS Diaphragm a CE marking, allowing the product to be sold throughout Europe. The launch is also an important step toward expanding nonhormonal contraception options for women worldwide.

SILCS is the first new cervical barrier method to receive regulatory approval and enter the market in more than a decade. It was designed through a unique collaboration between PATH, a Seattle, Washington-based global health nonprofit; CONRAD, a reproductive health product development organization operated through the Eastern Virginia Medical School in Norfolk, Virginia; the United States Agency for International Development (USAID); and other partners. In 2010, PATH licensed the SILCS design to Kessel Marketing & Vertriebs GmbH (Kessel), a private-sector company in Frankfurt, Germany, to accelerate women’s access to the technology.

This June, Kessel will launch SILCS in six European countries. The product, marketed as the Caya™ contoured diaphragm and sold through health providers and pharmacies, will later be expanded to additional markets.

“PATH has more than 35 years of expertise developing and introducing new and overlooked approaches to global health challenges, so we knew that a well-designed and marketed diaphragm could have real health benefits for women worldwide,” said Steve Davis, president and CEO of PATH. “This multiyear process has taken the persistence and dedication of a remarkable group of public- and private-sector partners. Our work is by no means over, but this launch moves us one step closer to expanding women’s options for contraception.”

Worldwide, many women who don’t want to become pregnant aren’t using existing contraceptive methods for a number of reasons, including concerns about the side effects of hormonal contraception; wanting a method that can be used only when they need protection; or finding it difficult to negotiate condom use with their partners. Often, women have difficulty reaching a health care provider to discuss, initiate, or maintain other methods. The SILCS Diaphragm could help address the needs of these women.

Women and their partners in the Dominican Republic, South Africa, Thailand, and the United States validated the design of SILCS through user acceptability studies. CONRAD validated the safety, acceptability, and effectiveness of SILCS in clinical studies for safety and effectiveness. “[Our] pivotal study showed that the SILCS Diaphragm used with contraceptive gel is as effective as the traditional diaphragm used with contraceptive gel,” said Marianne Callahan, deputy director of clinical research at CONRAD. “The advantage of SILCS is that women do not need a pelvic exam to determine their diaphragm size, which can be an obstacle to access. Studies also show that this single-size device fits most women.” CONRAD has a long history of collaborating with organizations like PATH to create new methods of contraception and HIV prevention for women.

Together, these improved features have the potential to make SILCS a valuable option not only in Europe but for the estimated 222 million women worldwide who still have an unmet need for modern family planning. Introducing the method in developed countries, where traditional diaphragms are still available as part of family planning programs, will inform future introduction in low-resource settings where diaphragms have not been available in recent decades. A single-size device, rather than a diaphragm that comes in multiple sizes, will be easier to supply and provide.

These efforts, and continuing work to expand SILCS, have been funded primarily by USAID. “This woman-initiated, nonhormonal contraceptive barrier method has great potential to improve women’s reproductive health options by addressing several of the reasons for unmet contraceptive need,” said Judy Manning, team lead for contraceptive research and development at the agency. Manning added that the device may fill another needed role by “serving as a delivery method for gels that help protect against HIV and other sexually transmitted infections—it could be our first true multipurpose prevention product.”

The next step for the SILCS team is regulatory submission to the United States Food and Drug Administration for market approval in the United States. “It is vitally important to expand access in the United States to methods that improve women’s pregnancy and STI prevention options,” said Wayne C. Shields, president and CEO at the Association of Reproductive Health Professionals (ARHP). “ARHP supports the availability of as many safe, effective prevention options as possible, since each woman’s sexual and reproductive health needs are unique and vary over her life span.”

PATH and its research partners in Uganda, India, and South Africa are also gathering information on opportunities and challenges for introducing SILCS in low-resource settings. Marleen Temmerman, director of the Department of Reproductive Health and Research at the World Health Organization (WHO), noted the promise of these efforts: “The SILCS barrier method has the potential to avert health outcomes from unintended pregnancies, particularly for women in resource-poor settings, and will form part of the WHO’s strong commitment to achieving universal access to reproductive health through expanding choice and method mix.”

The European regulatory approval and launch announced this week mark important progress toward these goals.

About PATH

PATH is an international nonprofit organization that transforms global health through innovation. PATH takes an entrepreneurial approach to developing and delivering high-impact, low-cost solutions, from lifesaving vaccines, drugs, and devices to collaborative programs with communities. Through our work in more than 70 countries, PATH and our partners empower people to achieve their full potential.

About CONRAD

CONRAD was established in 1986 and is a Division of the Department of Obstetrics and Gynecology at Eastern Virginia Medical School (EVMS) in Norfolk, VA, where it has laboratories and a clinical research center. The main office is located in Arlington, VA, with additional offices in West Chester, PA, and collaborators around the world. CONRAD is committed to improving reproductive health by researching and developing new contraceptive options and products to prevent HIV and STI infections. www.conrad.org

About KESSEL

KESSEL was established in 1987 as the Sales Division of the German Familia Planning Organization PRO FAMILIA. Today, KESSEL is a small private entity and certified producer of medical devises for contraception and sexual healthcare products based at Frankfurt/Germany.

About USAID

President John. F. Kennedy created the United States Agency for International Development by executive order in 1961 to further America’s interests while improving lives in the developing world. USAID is the largest supporter of the development of safe, effective and acceptable contraceptives and multipurpose prevention technologies designed specifically for provision and use in low resource settings. www.usaid.gov

Source:PATH

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