Improving Health for LGBT Patients

Feinberg School of Medicine faculty helped create the Association of American Medical Colleges’ (AAMC) first guidelines for medical schools on improving health care for people who are lesbian, gay, bisexual, transgender (LGBT), gendering nonconforming or born with differences of sex development (DSD).

“This resource guide is important because these populations have been historically disproportionately harmed or neglected in the medical system,” said Alice Dreger, PhD, professor of Clinical Medical Humanities and Bioethics at Northwestern University and member of the AAMC Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development. “By being a part of this committee I hope I am helping to seed a new generation of doctors who will know how to really help patients in these populations.”

The guide, “Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD,” provides information about the health needs of individuals from those populations, and about the role of academic medicine and the health care system in supporting them.

Click HERE to read the full release.

 

Fireworks fly when sperm fertilizes egg!

Sparks literally fly when a sperm and an egg hit it off. The fertilized mammalian egg releases from its surface billions of zinc atoms in “zinc sparks,” one wave after another, a Northwestern University-led interdisciplinary research team has found. Researchers at Northwestern developed technology that captured images of these fireworks.  According to Dr. Teresa Woodruff, PhD part of the team studying this phenomenon and director of the Women’s Health Research Institute at NU, “The amount of zinc released by an egg could be a great marker for  identifying a high-quality fertilized egg, something we haven’t been able to do.  Once we can, fewer embryos would need to be transferred during fertility treatments.”
View a WGN-TV segment on the new discovery HERE.
The study is publishing in the Dec. 15 by the journal Nature Chemistry.
Read more and view pictures HERE.

Medicine, Pregnancy and Breastfeeding

Some women need to take medicines during pregnancy for health problems like diabetes, depression, morning sickness or seizures. Always talk with your doctor, nurse, or pharmacist before taking any medicines, vitamins or herbs. Don’t stop taking your prescription medicines unless your health care provider says that it is OK.


Lots of women need to take medicines while they are pregnant. Learn how you can sign-up for a pregnancy registry to share your experience with medicines.

Use these resources to help you talk with your health care provider about the medicines you take during your pregnancy.

Prostate cancer treatment often ignores bone health

Men being treated with hormone therapy for prostate cancer are not  always getting bone-strengthening drugs they may need according to a Canadian study reported in a research letter in JAMA.  A potentially serious side effect of the androgen-deprivation therapy often prescribed to prostate cancer patients is an increased risk of bone loss and fracture. Several consensus guidelines recommend bisphosphonate therapy for men receiving hormones but the new study found that the bone strengthening treatment was underused even in men with osteoporosis.

Tips to eat, drink and still be “merry” during the holidays–the natural way.

Holiday celebrations lead to a bit of overindulgence but you can stay in good cheer with tips from Melinda Ring, M.D., medical director of the Osher Center for Integrative Medicine at Northwestern University.

  • Upset stomach: Ring’s favorite way to stave off the effects of overindulging: Dilute 1 to 2 teaspoons of unfiltered apple cider vinegar — known to aid digestion — in a glass of water and sip before you head to the party buffet.
  • Back pain: “Musculoskeletal tension in the shoulders and back is common during the holidays, thanks to the extra heel-wearing and package-lugging,” Dr. Ring says. Don’t carry too much at once; pick up a foam roller to release tight spots; and rock cute medium-high heels if you’ll be on your feet all night.
  • Insomnia: If never-ending to-dos are dancing in your head at bedtime, Ring suggests having a snack rich in tryptophan and complex carbs. Try a couple of slices of leftover turkey in a small whole-wheat wrap or a slice of cheese with whole-grain crackers.
  • Heartburn: “Rich treats like buttery cookies and greasy meats can relax your lower esophageal sphincter and cause acid reflux,” Dr. Ring says. “Try a marshmallow root or slippery elm supplement beforehand to coat and protect your GI tract.” (Check with your doc first if you’re pregnant, breast-feeding or taking other meds or supplements.)

Source:  Huffington Post

 

Study supports CVD timing hypothesis in menopause

Early results of the ELITE study find women who started hormone therapy early after menopause saw a significant slowing of atherosclerotic progression, whereas those who waited more than a decade saw no impact on vascular health, supporting the “timing hypothesis”.

“ELITE results are consistent with the majority of the literature that shows that women who are young and/or in close proximity to menopause when starting hormone therapy have reduced coronary heart disease and overall mortality,” according to study leader  Howard N. Hodis, MD, of the University of Southern California in Los Angeles, and colleagues.

The Women’s Health Initiative, aiming for cardiovascular prevention with menopausal hormone therapy, had raised major concerns about stroke and myocardial infarction (MI) in its somewhat older, later menopause population.  The KEEPS study subsequently showed that for a younger (ages 42 to 58) population, this may not be true.

ELITE was designed to directly test the hypothesis that timing makes all the difference in safety of hormone therapy after menopause.

“I think it’s important that clinicians not interpret this as you should start estrogen to try to prevent heart disease, but that the younger, newly menopausal woman who has menopausal symptoms should not be denied hormone therapy because of concerns about heart disease risk, as was seen in older women,” JoAnn E. Manson, MD, of Brigham and Women’s Hospital in Boston, told MedPage Today.

“There are other factors to take into consideration [such as risk of thrombosis],” she explained. “But because a newly menopausal woman is generally at low absolute risk of heart attack, stroke, thrombosis, all of those outcomes, it tends to be a favorable balance of benefit-to-risk.”

While suggestive that early hormone therapy wouldn’t have an impact on later heart disease risk, “this trial wasn’t large enough to look at clinical events,” Manson cautioned.

To learn more about this study, click HERE.   To learn more about Menopause, click HERE.


Primary source: American Heart Association
Source reference: Hodis HN, et al “Testing the menopausal hormone therapy timing hypothesis: The early versus late intervention trial with estradiol” AHA 2014; Abstract 13283.

New drug data finds sex/race inclusion lacking

In response to the call for more sex inclusion data in drug studies, the FDA has developed  Drug Trials Snapshot a pilot project to provide information about the sex, age, race and ethnicity of clinical trial participants for a small group of recently approved drugs. In addition to information about who participates in the trial, each Snapshot also includes information on how the study was designed, results of the efficacy and safety studies and, if known, differences in efficacy and side effects among sex, race and age (referred to as subgroups).

While this is certainly an important step toward inclusion, the recently posted six examples reinforce the lack of racial minorities in all studies and the lack of women in many studies.   These drugs were approved over a two month period in 2014.  In summary, of the six examples provided:

  • All studies, except one, had more males than females in the clinical pool
  • All studies except one, reported that the drug achieved the desired response (efficacy) in both in men and women (one study showed the the drug trended in favor of females though only 23% of the study subjects were female)
  • Four studies indicated the side effect (safety) profile was similar in both sexes; one study did not evaluate safety; and one study found increased risk for women even though only 24% of the study subjects were female).
  • All studies showed a considerable lack of minority race/ethnic participants .

“‘This new report provides a clarion call to action for the scientific, medical and regulatory communities to ensure representational science, medicine and the approval process. By taking strong, decisive action today, we can be assured a healthier tomorrow for all people.” says Teresa K. Woodruff, PhD, director, Women’s Health Research Institute and a national leader in the movement toward sex equity in science.

 

Tactics to slow cognitive decline due to Alzheimer’s

The cognitive decline associated with Alzheimer’s Disease (AD) may be related to the particular pathology of this disease which researchers continue to study.  One study at Stanford suggests that if you slow the pathology (biologic)  progression it could slow the path to full dementia.   In other words, if you stay healthier, you may slow the biological process that causes the progression of dementia.  Some suggested tactics:

  • Improve brain health by reducing cardiovascular risks caused by hypertension, diabetes, smoking, and high cholesterol
  • Enhance cognitive reserve through mental stimulation (working, leisure activities and social engagement)
  • Reduce the burden of AD pathology with regular aerobic exercise.

While we haven’t found a “cure” for AD yet, it makes sense to try whatever possible to “slow” its devastating effects.   All of these activities have many health benefits, so why not???

Source:  Henderson VW.  Climacteric 2013:17(suppl 2) 38-46.

 

Menopause hormone therapy: what do we know today?

Today, Many women live beyond age 80 and as a result may be postmenopausal for over 30 years. Each woman has a unique range of symptoms.  Hormone therapy has been widely prescribed since the early 60s despite limited research to relieve unpleasant menopausal symptoms.  However,  alarms were raised in the 1990′s that have led to a whole battery of new research on hormone therapy that continues to this day.

So what is the current status of hormonal therapy as a treatment option?   Researchers now know that the timing, dosage, path of metabolism, mode of delivery, drug combination, and years of use all matter and need to be measured against each woman’s risk profile.   New genetic and molecular tools enable us to determine how  individuals may respond differently to  the same medications and hormones.     Doctors have better ways to determine risks for the chronic conditions of aging and how they may be impacted when estrogen drops during menopause.   Non-hormonal options are slowly coming on the market, but these, too, may need the test-of-time to determine if they work without side effects and are not always a better alternative.

Doctors do know much more today that they did when hormone therapy was first used and have begun “personalizing” the treatment approach to relieving menopause symptoms as new findings are published.  Individualization is key, and research continues as new diagnostic tools for efficacy and risk are discovered.   In the meantime, women should realize that ALL medicines we take—from aspirin to antibiotics to cold medicine–carry different levels of risk for each person. In fact, many medications beyond hormone therapy, have been studied primarily in males!

In many cases, hormone therapy,  is a relatively safe and effective drug for some women who are experiencing severe symptoms. Learn all you can about your own risk profiles, assess the severity of your symptoms, and find a clinician who keeps up on the latest research to discuss options.    An excellent on-line tool to help you assess your risk and explore the latest interventions can be found at  menopausenu.org

 

 

 

Global Female Condom Day

This year, September 16 marked Global Female Condom Day. Compared to other forms of birth control, female condoms are not widely known about, although they have many advantages. The most important aspect about female condoms is that they are the only woman-initiated birth control product that protects women from both pregnancy and STI’s. While male condoms protect against both of these conditions, a woman does not have complete control over their use as she does with a female condom.

Other benefits of female condoms include:

  • They are non-hormonal for women unable to use hormonal birth control
  • They are latex-free for those with latex allergies

  • There are a variety of brands sold over-the-counter

  • Their design allows for pleasure enhancement for men and women during intercourse

Female condoms have the potential to prevent unwanted pregnancy, especially in countries and regions where prescription birth control and other forms of women-initiated birth control, like IUDs, are not readily available. Additionally, they could be instrumental in reducing HIV/AIDS and other STI rates by giving women more control over protection during intercourse.

The first step to achieving more widespread use of the female condom is education and awareness. For more information on the female condom, click here.

Sources:

Widsom, Phylisa. “It’s Global Female Condom Day! 6 Reasons why the Female Condom is Worth Reconsidering (Hint: It’s not that Scary).”  Bustle.com. 16 September 2014. 

National Female Condom Coalition.