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Is the Pap Smear On the Way Out?
WebMD Health News
July 24, 2018 -- The FDA has approved elagolix (Orilissa), the first drug developed for the treatment of moderate to severe pain from endometriosis.
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The FDA approved elagolix under priority review. It is expected to be available in the U.S. next month.
Elagolix represents a "significant advancement for women with endometriosis and physicians who need more options for the medical management of this disease," Michael Severino, MD, chief scientific officer for AbbVie, the maker of elagolix, says in a news release.
Data from two studies of nearly 1,700 women with moderate to severe endometriosis pain supported the FDA's approval.
In the studies, elagolix reduced the three most common types of endometriosis pain: daily menstrual pelvic pain, nonmenstrual pelvic pain, and pain with sex, AbbVie says.
The company says that elagolix can reduce bone mineral density. Loss of bone mineral density is greater the longer the drug is used and may not be completely reversible after stopping treatment.
The drug should be taken by mouth at roughly the same time each day, with or without food.
"Endometriosis is often characterized by chronic pelvic pain that can impact women's daily activities," Hugh Taylor, MD, study investigator from Yale University School of Medicine in New Haven, CT, says in the release. "Women with endometriosis may undergo multiple medical treatments and surgical procedures seeking pain relief, and this approval gives physicians another option for treatment based on a woman's specific type and severity of endometriosis pain."
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Medscape: "FDA Clears Elagolix (Orilissa) for Endometriosis Pain."
©2018 WebMD, LLC. All Rights Reserved.
©2018 WebMD, LLC. All Rights Reserved.
Having More Kids Tied to Lower Odds of Alzheimer's in Women
By Dennis ThompsonHealthDay Reporter
MONDAY, July 23, 2018 (HealthDay News) -- A woman's fertility might help predict how likely she is to develop dementia later in life, two new studies suggest.
Women who were very fertile appeared to have some protection against dementia, a Kaiser Permanente study found.
This included women who had more children, more years of fertility, and menstruation that started earlier and ended later in their lives, explained lead researcher Paola Gilsanz. She is a staff scientist with the Kaiser Permanente Northern California division of research.
A second study, from the University of California, Los Angeles, found that women who experienced more months of pregnancy during their lives had a lower risk of Alzheimer's disease.
Both studies were to be presented Monday at the Alzheimer's Association annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal, and these studies did not prove that infertility causes dementia risk to rise.
There's been a lot of interest in sex-specific factors that could influence dementia risk, Gilsanz noted.
Almost two-thirds of Americans with Alzheimer's are women, according to the Alzheimer's Association.
"More women than men get dementia, and for a while it was thought because women were living longer. Now research is showing that's not the whole story," Gilsanz said. "Now we're asking, what is it about the biology of being a woman that could potentially modulate the risk of dementia?"
Kaiser Permanente researchers reviewed the health records of 14,595 women who were aged 40 to 55 between 1964 and 1973, to see if there were any associations between their reproductive history and dementia risk.
The investigators found that women with three or more children had a 12 percent lower risk of dementia than women with one child.
Further, the length of a woman's reproductive period -- the years during which she menstruates -- appeared to be tied to dementia risk:
- Women with reproductive periods of 21 to 30 years were at 33 percent elevated risk of dementia, compared to women who were fertile 38 to 44 years.
- Women who experienced their first menstrual period at age 16 or older were at 31 percent greater risk of dementia than those who reported their first menstrual period at age 13.
- Women who underwent natural menopause at age 45 or earlier were at 28 percent greater risk of dementia than those who had their last menstrual period later than age 45.
No one can say for certain why fertility is associated with decreased dementia risk, Gilsanz said.
"There's some promising research about estrogen and how it may play a role in dementia," Gilsanz noted. "Animal models have shown estrogen might play a protective role."
The second study, which looked at 133 elderly British women, found that those who spent more of their lives pregnant were less likely to develop Alzheimer's.
Women had a 5.5 percent decrease in Alzheimer's risk for every month they were pregnant, the researchers found.
In this case, the researchers hypothesized that the beneficial effects of pregnancy on the immune system could play some role in future brain health.
The study's lead researcher, Molly Fox, said, "We are intrigued by the possibility that pregnancy may reorganize the mother's body in ways that could protect her against developing Alzheimer's later in life." Fox is an assistant professor of anthropology and psychiatry & biobehavioral sciences at UCLA.
"These results also suggest that the story might not be so simple as being all about estrogen exposure, as previous researchers have suggested," Fox said in a statement.
According to Keith Fargo, director of scientific programs and outreach at the Alzheimer's Association, these two studies "really fit into a larger narrative we've seen developing in dementia research" involving lifelong factors that can help or harm brain health as people age.
"We used to think about dementia risk as something to worry about in old age," but now researchers are turning their attention to factors in middle age and younger that influence brain health, Fargo said.
Other studies have shown that high blood pressure in middle age could make you more prone to dementia, and that diabetes also might have a detrimental effect.
In the case of these new findings, a number of factors could influence risk, Fargo said -- the immune system, nutrition throughout the woman's life, nutrition during pregnancy, and natural estrogen levels.
Fargo noted that all these potential causes are "speculation."
"It really calls for additional research," Fargo said of the findings. "I think it's an important clue, but we don't have the mechanism worked out just yet."
Copyright © 2018 HealthDay. All rights reserved.
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SOURCES: Paola Gilsanz, Sc.D., staff scientist, Kaiser Permanente Northern California division of research, Oakland, Calif.; Keith Fargo, Ph.D., director, scientific programs and outreach, Alzheimer's Association; July 23, 2018, presentation, Alzheimer's Association annual meeting, Chicago
From 
Health Tip: Use Tampons Safely
(HealthDay News) -- Tampons -- cylindrical devices used to stem a woman's menstrual flow -- are regulated by the U.S. Food and Drug Administration as medical devices.
Follow all directions on the product's label.The FDA offers these tips for safe tampon use:
- Wash hands before and after use.
- Only use tampons during the menstrual period.
- Change a tampon every 4-to-8 hours.
- Use the lowest-absorbency tampon for your needs.
- Beware of pain or any other unusual symptoms as a result of using a tampon. Toxic shock syndrome is a dangerous possible side effect of tampon use. It's symptoms typically include sudden fever, vomiting, diarrhea, feeling faint, dizziness or a sunburn-like rash.
Copyright © 2018 HealthDay. All rights reserved.
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Heart Risks Tied to Transwomen's Hormone Therapy
The term transwoman refers to a woman who is designated male at birth. Some undergo hormone therapy to minimize their male characteristics and maximize female traits.TUESDAY, July 10, 2018 (HealthDay News) -- Transwomen who undergo hormone therapy may face higher chances of blood clots, stroke and heart attack, a new study suggests.
"While our study confirmed elevated risks of certain vascular events related to hormone therapy, these risks need to be weighed against the important benefits of treatment," Dr. Michael Goodman, a professor of epidemiology at Emory University in Atlanta, said in a school news release.
The researchers compared nearly 4,700 transgender and gender non-conforming people with more than 97,000 men and women whose gender identity matches their assigned sex at birth. The term for this is cisgender.
Blood clots in the veins (venous thromboembolism) were nearly two times higher in transwomen. Rates of stroke and heart attack among transwomen were 80 to 90 percent higher than those in women without gender issues, but similar to the rates in cisgender men.
The higher rates of blood clots and stroke among transwomen were more noticeable several years after they began estrogen therapy, according to the study, which did not prove a cause-and-effect link.
Further research is needed to learn more about how specific hormone formulations, doses, drug combinations and types of administration may affect heart risks in transwomen, the study authors noted.
The findings were published July 9 in Annals of Internal Medicine.
-- Robert Preidt
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SOURCE: Emory University, news release, July 9, 2018
Is the Pap Smear On the Way Out?
By Steven ReinbergHealthDay Reporter
Latest Womens Health News
TUESDAY, July 3, 2018 (HealthDay News) -- The Pap test, used for over 50 years to spot the early signs of cervical cancer, may soon become a thing of the past, new research suggests.
Its replacement? The human papillomavirus (HPV) test. Nearly all cervical cancercases are linked to HPVinfection, and HPV testing detected pre-cancers earlier and more accurately than the Pap test among the 19,000 women in the Canadian study.
The HPV test also seemed better at predicting who'd stay cancer-free, the investigators found. Women whose HPV test showed they didn't have the infection were less apt to develop a pre-cancerous lesion over the next four years, compared to women who'd gotten the Pap test alone.
"All women of childbearing age should be screened for cervical cancer," said lead researcher Dr. Gina Ogilvie, a professor in the School of Population and Public Health at the University of British Columbia, in Vancouver.
Thousands of women's lives have been saved because the Pap test detected cervical cancer in its earliest stages. But the newer, more accurate HPV test may replace the Pap smear as the preferred screening test, Ogilvie said.
U.S. guidelines call for both HPV and Pap tests, but studies have shown that the real benefit comes from the HPV test, she added.
According to the American College of Obstetricians and Gynecologists, women aged 21 to 29 should have a Pap test alone every three years.
Women 30 to 65 years should have a Pap test and an HPV test every five years or a Pap test alone every three years.
A new draft guideline from the U.S. Preventive Services Task Force, however, says HPV testing can replace Pap tests, Ogilvie said.
Specifically, the task force is recommending either screening every three years with a Pap test alone or every five years with an HPV test alone for women aged 29 to 65.
For women under 25, the Pap test is still the standard because many young women are infected with HPV, Ogilvie said.
Cervical cancer is very rare in younger women, and an HPV test might send many women for unnecessary treatment, she explained.
For the study, the researchers randomly assigned more than 19,000 women aged 25 and older to either Pap testing alone or HPV testing alone. After four years, nearly six women in 1,000 who had Pap tests had pre-cancerous lesions, compared with just two in 1,000 women who had HPV tests alone.
The findings were published July 3 in the Journal of the American Medical Association.
One expert expects to see the end of Pap tests in favor of HPV tests.
"Pap testing is going away," said Dr. L. Stewart Massad, a professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis.
This trial showed that screening with HPV testing leads to earlier diagnosis of cervical pre-cancer and picks up cases that Pap testing missed, he said.
"Look for changes to screening guidelines to favor HPV testing over Pap testing, and expect a shift to longer intervals between screens," said Massad, who wrote an editorial accompanying the study.
But Dr. Jason Wright, chief of gynecologic oncology at NewYork-Presbyterian/Columbia University Medical Center in New York City, isn't ready to opt for HPV testing alone.
"This is one study," he said. The Pap smear has been around for 50 years, so co-testing remains a viable option, Wright said.
"But we will gradually move to more HPV testing for primary screening," he said. "It will probably be a slow process."
Women should discuss the risks and benefits of each test with their doctor, Wright said.
Copyright © 2018 HealthDay. All rights reserved.
SOURCES: Gina Ogilvie, M.D., Dr.P.H., professor, School of Population and Public Health, University of British Columbia, Vancouver, Canada; L. Stewart Massad, M.D., professor, obstetrics and gynecology, Washington University School of Medicine, St. Louis; Jason Wright, M.D., chief, gynecologic oncology, NewYork-Presbyterian/Columbia University Medical Center, New York City; July 3, 2018, Journal of the American Medical Association
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