What Every Woman Needs to Know About the IUD

Great news: The intrauterine device, or IUD, is probably a lot safer than you think. IUDs do not cause pelvic inflammatory disease, according to a joint study led by researchers at the University of California, San Francisco and Kaiser Permanente Northern California Division of Research.

Researchers looked at medical data from nearly 60,000 women over four and a half years, from January 2005 to August 2009. They found that women with IUDs didn’t experience any higher rates of pelvic inflammatory disease (PID) than women without IUDs. This in spite of the widely held belief that IUDs put you at greater risk of the fertility-crushing disease.

So why the common misconception? “In the 1970s and 1980’s, an IUD called the Dalkon Shield was found to increase the risk of women developing PID,” explains study author Carolyn B. Sufrin, MD, MA, of UCSF’s Bixby Center for Global Reproductive Health. “Even though the IUDs on the market now are very different devices, that misperception continued to exist among practitioners and patients. Our study disproves the link and reaffirms there is an extremely low risk of developing PID from an IUD.”

And, contrary to a long-held misperception, an IUD can be inserted in women who haven’t been pregnant before. “I recommend the IUD for any woman who wants a reliable, long-lasting, reversible birth control option,” says Deborah Ottenheimer, MD, an ob/gyn in private practice at Ottenheimer Health Care in New York City. Here’s why it’s worth it to consider and discuss with your doc at your next gynecologist appointment.

Forgetting about it is a good thing. There’s nothing worse than the stomach-sinking feeling when you realize you forgot a pill. But you don’t need to do anything about the IUD after insertion. “If you or your partner feel anything, that may be a sign that it’s not in the right place,” says Ottenheimer. The IUD is checked for proper placement at your annual gynecologist appointment, but other than that, you can leave it alone.

It doesn’t disrupt your cycle. “Unlike the pill, which creates an artificial cycle, both hormonal and non-hormonal IUDs allow you to cycle naturally,” explains Ottenheimer. What this means: It’s easy to pinpoint any period abnormalities that could clue you in to a potential problem.

It’s super effective. “Studies show an IUD is 99 percent effective at preventing unplanned pregnancy,” explains Ottenheimer. This stat is superior to other methods of birth control like the Pill, which, in practice, has about 92 percent efficacy.

It’s financially smart. In the past, spotty coverage meant that the IUD often had to be paid for out of pocket—and, at $ 700 to $ 800 for insertion, it wasn’t exactly cheap. Now that the Affordable Care Act ensures that birth control is covered, an IUD can end up less expensive over time than the equivalent cost of years of co-pays for the Pill. Since most women consider birth control an economic issue, the cost angle is hard to overlook.

It lasts a long time. “Many patients are put off by the potential pain of insertion,” says Ottenheimer. The truth: Yes, it can be crampy, but the actual procedure only takes a few minutes, your doctor will give you before-and-after meds to minimize pain, and once it’s in, it’s there for a long time. “Mirena (the hormonal option) lasts for five years and Paragard (the non-hormonal option) lasts for ten,” says Ottenheimer.

… But you can get pregnant as soon as you take it out. Even if you’re planning to start a family in the next year or two, an IUD may be the ideal for-now option. “Removal only takes a quick office visit, and it’s possible to get pregnant within twenty-four hours of having it removed,” says Ottenheimer.

photo: Photodisc/Thinkstock

More from WH:
Will Birth Control Be OTC Soon?
Which Birth Control is Right For You?
Birth Control is an Economic Issue


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NEED TO KNOW: New Pap Test Guidelines

New guidelines say you may need fewer pap tests if you’re healthy. But that doesn’t mean you should stop seeing your gyno regularly.

The American College of Obstetricians and Gynecologists have released new guidelines surrounding pap and HPV (human papillomavirus) testing. Their recommendations:

– Women under age 21 are advised to postpone their first pap test until age 21.

-Women ages 21 to 29 that have had a healthy pap test at their last exam can wait three years before their next test.

-Women ages 30 to 65 are advised to request a pap test, as well as a test for the cancer-causing HPV virus. If both of those test results show no signs of trouble, it is recommended they wait five years for their next screening.

During your pap test, a doctor takes a sample of cells from the cervix, which is then sent to a lab for examination. If the sample is abnormal, your doctor may call you back for further testing. Abnormal cells may simply signify a small change in the cervix, but they could also be sign of pre-cancer, caused by a strain of HPV. If left untreated, pre-cancerous cells can develop into cervical cancer.

So why the call for fewer paps? Jennifer Ashton, MD, a New-Jersey based board-certified OBGYN and Fellow of the American College of Obstetricians and Gynecologists, says these new guidelines stem from doctors’ increased understanding of how HPV impacts the body. While virtually all cervical cancer is caused by HPV, the process can take many years to develop. In most cases, the body can clear up the HPV virus on it’s own, and extra testing can put the patient at risk medically, emotionally and financially.

The recommendation for women under age 21 to skip pap tests is due to a high probability of false alarms, Ashton says. Because of the significant incidence of HPV in the teenage population, many of those early pap tests can come out abnormal. As a result, patients are subjected to extra testing, as well as unnecessary extra stress, even though a very small percentage of those abnormalities progress to pre-cancer of the cervix, she says. The same logic applies to the recommendation for fewer tests for women in their 20s.

Women in the 30 to 65 age group need to request an HPV test, because if infected at an early age, the virus has had more time to advance, says Ashton. More importantly, Ashton says women should request the high-risk test specifically. “More than 50 percent of doctors do low-risk HPV testing, which is unjustified, a waste of money, and potentially harmful to the patient,” she says. While pap tests look specifically at the cells of the cervix, high-risk HPV tests look at sign of infection in your DNA, says Ashton. For those reasons, women should make sure they receive both, she says.

Healthy and HPV-free? No need to cancel your gyno appointments just yet. If your lady doc is also your primary care physician, there are still reasons to schedule a yearly visit, says Ashton. “Your doctor can screen for other STDs, make sure you don’t have any problems with your period, check your blood pressure, and monitor breast health,” she says.

Get overwhelmed in the waiting room? Here’s how to get the most out of your next check up.

photo: altrendo images/Stockbyte/Thinkstock

More from WH:
Gyno 101: Prep for Your Next Visit
Everything You Need to Know About HPV
Can You Get HPV from Oral Sex?
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Major Breast Cancer News: What You Need to Know

 
Amazing research alert: There are four genetically distinct classes of breast cancers, according to an article published in the journal Nature. These findings will impact how doctors approach cancer treatment going forward.

“Knowing about the different classes of tumors means doctors can tailor a patient’s therapy so that it’s more individualized,” says Alyssa Gillego, M.D., breast surgeon at Beth Israel Comprehensive Cancer Center in New York City. That means better targeted—read: more accurate, less risky—approaches, depending on your tumor type. (One harmless way to stay on top of your breast health? Take the Touch Yourself Challenge.)

For instance, one class of cancer cells is called Basal-like, or triple-negative. The researchers determined that it genetically resembles a certain type of ovarian cancer. Currently, it’s commonly treated with a class of chemotherapy drugs called Anthracyclines, which are associated with increased risk of heart disease. But knowing that Basal-like cells resemble ovarian cancer cells, which aren’t typically treated with Anthracyclines, researchers can begin to study whether there are alternative ways (with fewer side effects) to treat basal-type cancers.

All that being said, the four genetic differences between breast cancer tumors aren’t exactly breaking news to most cancer specialists. “Women are treated based on these four categories already,” says Gillego.

What makes this study newsworthy, then, isn’t so much the nitty-gritty findings, but that it serves as further evidence to support the need for personalized medicine, an increasingly popular philosophy in patient care. While many doctors now support this philosophy, some still exist who aren’t as up-to-date and prefer to treat patients wholesale, rather than as individuals.

For example, traditionally tumor size has dictated whether a patient receives chemotherapy, says Gillego. “If the tumor was a centimeter in diameter, you automatically got chemotherapy, regardless of genetics. There are people in other parts of the world, and even some parts of this country, who still practice like that.” The problem with this approach, as supported by the study findings, is that chemotherapy doesn’t actually work on all tumors. Some need hormone therapy. Some just need surgery. Some need a combination of all or some of the above. The bottom line, though, is that one size does not fit all when it comes to cancer treatments. And ultimately, the more research that exists that supports the need for genetics-based, individualized treatments, the better for the future of cancer care.

In the meantime, if you find yourself facing a breast cancer diagnosis, Gillego recommends seeking treatment from a breast cancer specialist at a cancer center. Cancer centers tend to have integrated teams, where oncologists, radiologist, surgeons, and other specialists all work together closely. “Integrated teams are better set up to provide patient-centered therapy,” she says. Just what the doctor ordered.

photo: Hemera/Thinkstock

 
More from WH:
7 Ways to Keep Your Breasts Healthy
Should You Get a Mammogram?
18 Self Checks Every Woman Should Do

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Everything You Need to Know About Soy

If you bypass tofu at salad bars, skip the meatless dishes at Chinese restaurants, and avoid edamame when you’re out for sushi, well, it’s time to give soy-based foods a second look. “Whole soy foods are a great substitute for meat,”says Christine Gerbstadt, MD, a spokesperson for the Academy of Nutrition and Dietetics. Their healthy protein content makes them a good option even if you’re not one of the growing number of people going “flexitarian,”or opting to eat less meat. Here’s your guide to making this legume a regular and great-tasting part of your diet.

Soy 101
All soy products are made from soybeans, mostly grown here in the United States. You can buy whole soybeans dried or canned, or in the produce section or freezer aisle as edamame, the common name for soybeans picked before they’re fully mature. (Edamame can be purchased either in pods or shelled.)

Beyond whole beans, soy takes on a number of different guises. Roasted soybeans are sold as soy nuts or ground into soy nut butter. Soybeans can be
soaked in water, cooked, and filtered to
make soy milk and soy yogurt. Adding a coagulant to soy milk curdles it, producing tofu, which ranges in texture from “silken”(very soft) to “extra firm,”depending on how
much liquid is removed. Soybeans can also be
fermented into a paste called miso (the base for miso soup) or a cake
or patty called tempeh, which is often used in place of meat in sandwiches or grilled
and eaten on its own. Finally, soy can be found in many packaged foods—such as frozen meatless burgers, cereals, and energy bars—often in the form of “soy protein isolate,”meaning it’s mostly the protein from soybeans you’re getting.

The power of soy
Soy’s biggest nutritional claim to fame is its complete protein, one of the only plant proteins that contains all nine essential amino acids our bodies need from our diets to function properly. This makes it an ideal substitute for meat, poultry, and eggs. In fact, a half cup of cooked soybeans supplies about one-third of your necessary daily protein, for a mere 149 calories (versus about 230 for one serving of cooked ground beef). That protein and the fiber it contains make it incredibly filling. Plus, soybeans are cholesterol-free and lower in heart-unhealthy saturated fat than meat and dairy.


Soy also packs a number of phytochemicals, including isoflavones, which may work together to help fight conditions like cardiovascular disease, osteoporosis, and breast cancer. (Though you might have heard that women with a history of breast cancer should avoid soy, recent research suggests that’s probably not necessary, says Karen Collins, RD, nutrition adviser to the American Institute for Cancer Research.) To score soy’s benefits, get up to three servings a day, mostly from less processed forms like soybeans, soy milk, soy nuts, and tofu. “When soybeans are eaten close to their original state, you get more of their good-for-you attributes,”says Dawn Jackson Blatner, RD, author of The Flexitarian Diet.

You may get slightly more nutrients from fermented soy foods like miso and tempeh, since the fermentation process can make those nutrients more absorbable by the body, says Blatner, but all forms of the legume deserve a place on your plate. Two exceptions: First, avoid soy isoflavone supplement pills and powders. Research hasn’t yet determined how much of it’s safe to take, says Collins. Plus, unlike whole soy foods, they don’t give you the full range of phytochemicals and other nutrients,
such as B vitamins, which help with bodily processes like metabolism and keep your DNA healthy. And though foods made with soy protein isolate (like soy burgers and soy dogs) do usually pack less saturated fat than their meat counterparts, they also tend to be loaded with sodium and additives, so don’t make them a staple.

Easy ways to eat soy
Look for simple places to swap soy in for other foods and drinks. Snack on soy nuts instead of cheese; use soy nut butter instead of peanut butter for a change of pace (you may not be able to tell the difference!). Soy milk is a great alternative for the lactose intolerant (just avoid sweetened ones, which pack extra sugars). Soybeans and tofu take a bit more prep, but not much. Here’s how to make them taste great, fast:

• Steam or boil edamame for 3 to 5 minutes. You can puree them into hummus instead of chickpeas, or just sprinkle the pods with sea salt, chili powder, Chinese five-spice powder, or any other spice you like, and squeeze the beans into your mouth.

• Because it’s so soft, “silken”tofu works well as a thickener for sauces, dips, and smoothies (try our Blueberry-Tofu Smoothie recipe). The denser texture of “firm”or “extra firm”tofu works best for stir-frying, grilling, or baking. Just remove extra moisture first so it’s not mushy: Lay a clean kitchen towel on a cutting board and place tofu on top. Cover with another clean towel and cutting board, then place a heavy pot on top. Allow it to rest for about 1 hour. Cut into cubes or strips and cook. Tofu will soak up the flavor of any dish it’s in; you can also marinate it as you would meat and poultry.

• Prepare whole soybeans the same way you would other beans: Cooked into soups or chili, added to Mexican dishes, or tossed cold in salads, they bring new flavor to your favorite dishes.


Eating – Health.com