Conversación sobre la salud: Qué preguntas puede hacer a su médico si piensa que tiene fibromas uterinos

Este artículo se preparó en asociación con The White Dress Project.

La Dra. Kristen A. Matteson hizo la revisión médica de este artículo.

Los fibromas uterinos son la condición ginecológica más común para mujeres de edad reproductiva. El 80% de todas las mujeres habrán tenido fibromas para cuando hayan cumplido 50 años, los cuales son protuberancias no cancerosas (benignas) que aparecen dentro o fuera del útero de la mujer.

Mujeres que tienen fibromas pequeños o que no causan ningún síntoma podrían nunca darse cuenta de que los tienen, pero se estima que el 20% de mujeres con fibromas sufren de síntomas moderados y severos.

Le pedimos a la Dra. Kristen A. Matteson, una ginecóloga obstétrica de la facultad de medicina de Warren Alpert de Brown University y de Women and Infants Hospital, que nos proporcione algunas preguntas que las mujeres deberían hacer a sus médicos (HCP, por sus siglas en inglés) si sospechan que tienen fibromas o síntomas relacionados.

¿A qué señales y síntomas debería poner atención debido a sus implicaciones de fibromas?

Períodos menstruales con sangrado abundante, coágulos y brotes de sangre durante su período menstrual, y la sensación de presión o llenura en su pelvis son señales y síntomas comunes de fibromas uterinos. Es importante que hable con su médico si tiene síntomas tales como sangrado abundante entre sus períodos menstruales, dolor en la pelvis o en la parte inferior de su espalda, aumento de cólicos menstruales, aumento de la micción, dolor durante relaciones sexuales o períodos menstruales anormalmente largos pues dichos síntomas también podrían ser señales de otras condiciones médicas.

¿Cómo se diagnostican los fibromas?

Los síntomas asociados con fibromas uterinos, incluyendo sangrados abundantes durante los períodos menstruales, aumento de la micción y presión pélvica también pueden ser causados por otros problemas médicos. Si tiene esos síntomas, es importante que haga una cita con un médico.

¿Qué me pone en riesgo de tener fibromas?

Antecedentes familiares de fibromas uterinos, la obesidad y tener su primer período menstrual antes de los 11 años son factores que pueden incrementar su riesgo de desarrollar fibromas uterinos. La raza también puede ser un factor. Los fibromas uterinos son de dos a tres veces más comunes en las mujeres de raza negra que en las mujeres de raza blanca.

¿Hay alguna forma en la que pueda prevenir el desarrollo de fibromas?

No, los fibromas no se pueden prevenir. Los investigadores no saben porque algunas mujeres desarrollan fibromas y otras no. Sin embargo, se cree que factores genéticos y hormonales juegan un papel importante en su desarrollo. Pueden aumentar de tamaño con el embarazo y usualmente se encogen durante la menopausia cuando los niveles de estrógeno y progesterona disminuyen.

¿Existen tipos diferentes de fibromas?

Los fibromas son esferas hechas de células musculares lisas que crecen en el útero. Pueden describirse según su ubicación dentro y fuera del útero.

  • Fibromas submucosos: fibromas en la parte interior del útero
  • Fibromas intramurales: fibromas en la pared del útero
  • Fibromas subserosos: fibromas en la parte exterior del útero

El tiempo y la severidad de los síntomas dependen de la ubicación, el tamaño y el número de fibromas.

¿Pueden volverse cancerosos los fibromas? ¿Cómo puede distinguirse la diferencia entre un fibroma y un tumor canceroso?

Los fibromas uterinos son extremadamente comunes pues ocurren en el 70% de mujeres para cuando llegan a la menopausia. Por otro lado, el encontrar tumores cancerosos durante cirugías para remover fibromas es algo extremadamente raro. No hay pruebas disponibles mediante las cuales se pueda distinguir claramente entre un fibroma uterino benigno y un tumor canceroso antes de su remoción y biopsia, pero se están haciendo investigaciones para mejorar este proceso.

Este recurso se preparó con la asistencia de Myovant Sciences.

COVID-19 Could Cause Male Infertility and Sexual Dysfunction – but Vaccines Do Not


By Ranjith Ramasamy, University of Miami

Contrary to myths circulating on social media, COVID-19 vaccines do not cause erectile dysfunction and male infertility.

What is true: SARS-CoV-2, the virus that causes COVID-19, poses a risk for both disorders.

Until now, little research has been done on how the virus or the vaccines affect the male reproductive system. But recent investigations by physicians and researchers here at the University of Miami have shed new light on these questions.

The team, which includes me, has discovered potentially far-reaching implications for men of all ages – including younger and middle-aged men who want to have children.

What the team found

I am the director of the Reproductive Urology Program at the University of Miami’s Miller School of Medicine. My colleagues and I analyzed the autopsy tissues of the testicles of six men who died of COVID-19 infection.

The result: COVID-19 virus appeared in the tissues of one of the men; decreased numbers of sperm appeared in three.

Another patient – this one survived COVID-19 – had a testis biopsy about three months after his initial COVID-19 infection cleared up. The biopsy showed the coronavirus was still in his testicles.

Our team also discovered that COVID-19 affects the penis. An analysis of penile tissue from two men receiving penile implants showed the virus was present seven to nine months after their COVID-19 diagnosis. Both men had developed severe erectile dysfunction, probably because the infection caused reduced blood supply to the penis.

Notably, one of the men had only mild COVID-19 symptoms. The other had been hospitalized. This suggests that even those with a relatively light case of the virus can experience severe erectile dysfunction after recovery.

These findings are not entirely surprising. After all, scientists know other viruses invade the testicles and affect sperm production and fertility.

One example: Investigators studying testes tissues from six patients who died from the 2006 SARS-CoV virus found all of them had widespread cell destruction, with few to no sperm.

It is also known that mumps and Zika viruses can enter the testicles and cause inflammation. Up to 20% of men infected with these viruses will have impaired sperm production.

A new study on vaccine safety

Additional research by my team brought welcome news. A study of 45 men showed the Pfizer and Moderna mRNA vaccines appear safe for the male reproductive system.

This, then, is another reason to get the vaccinations – to preserve male fertility and sexual function.

Granted, the research is only a first step on how COVID-19 might affect male sexual health; the samples were small. Studies should continue.

Still, for men who have had COVID-19 and then experienced testicular pain, it is reasonable to consider that the virus has invaded testes tissue. Erectile dysfunction can be the result. Those men should see a urologist.

I also believe the research presents an urgent public health message to the U.S. regarding the COVID-19 vaccines.

For the millions of American men who remain unvaccinated, you may want to again consider the consequences if and when this highly aggressive virus finds you.

One reason for vaccine hesitancy is the perception among many that COVID-19 shots might affect male fertility. Our research shows the opposite. There is no evidence the vaccine harms a man’s reproductive system. But ignoring the vaccine and contracting COVID-19 very well could.

[Over 106,000 readers rely on The Conversation’s newsletter to understand the world. Sign up today.]The Conversation

Ranjith Ramasamy, Associate Professor of Urology, University of Miami

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Pain Gap: Why Women’s Pain Is Undertreated

When Karen Finney went into the hospital for brain surgery, she was well aware of the gender pain gap: women in pain are taken and treated less seriously than men in pain. Women of color are affected even more severely, and as a Black woman, Finney knew the hill to relief would be even steeper to climb.

When she woke up after surgery to remove her brain tumor, she was in excruciating pain. She was given painkillers every four hours but said she began to notice that the effects of the drugs would wear off 20 minutes before the four-hour mark — and then they would take another 20 minutes to kick in once they were dispensed again. “I was in this cycle [where] I was in so much pain and it was … up and down and up and down,” Finney recently recounted to HealthyWomen.

When a nurse asked her where her pain was on a scale of 1 to 10, Finney told her the truth: It was a 12. Despite the fact that she had just undergone brain surgery and had damage to her vocal chords that made it difficult to speak, Finney tried to advocate for herself. “I said, I understand some people have biases about Black people and our pain levels, but when I say I’m at a 12 out of 10, I’m not exaggerating.” The nurse told her she understood and wanted to take the issue seriously — then she offered Finney the opportunity to fill out a report about the experience.

Recounting this moment in her journey, Finney’s voice is clouded with pain and tears. She was in the hospital after brain surgery in horrific pain and all that was offered to her was paperwork.

Days after her surgery, she was finally given a morphine drip that she could control herself, but those couple of days of needless, intense suffering have stuck with her.

Women’s pain is often dismissed or not believed

It’s widely known that although women experience more chronic pain conditions than men — whether it’s fibromyalgia, endometriosis, or migraine — their pain is treated less seriously. In a 2019 HealthyWomen survey, 45% of respondents said they didn’t think their healthcare providers took their pain seriously. And there are facts behind those feelings: Women experiencing pain are more likely than men to receive a sedative prescription instead of a pain medication prescription.

The gender pain gap extends to the emergency room, where men wait an average of 49 minutes before receiving pain medication in instances of acute abdominal pain while women wait an average of 65 minutes in the same situation. Women are even half as likely as men to receive painkillers after a coronary bypass surgery.

In the paper, “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” Diane Hoffman and Anita Tarzian found that “women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively.” But what is it about women in pain that is so easily shrugged off by healthcare providers?

Dr. Sharon Allison-Ottey, an internal medicine physician and a member of HealthyWomen’s Women’s Health Advisory Council (WHAC), says women are often considered histrionic when they complain of pain. “They’re not taken as seriously, whether that’s chest pain and they’re having a myocardial infarction or they’ve just broken a bone,” Allison-Ottey said.

“There is the perception of the big, strong male who says he’s in pain being taken more seriously by healthcare professionals and therefore acted upon [rather] than the weak little woman in the corner who is complaining about pain, and she’s just had major surgery as well. She’s often thought of as weak and not being able to tolerate pain or overstating her pain level.”

Another member of the WHAC, Dr. Daihnia Dunkley, whose background is in maternal child health and labor and delivery, said it’s been disturbing to see how differently female pain is perceived — and underprescribed. “There’s an implicit bias there between the two sexes when it comes to pain management,” Dunkley said.

The pain gap is even worse for Black women

In a 2016 study, half of medical students and residents believed one of the three erroneous beliefs: “Black people’s nerve endings are less sensitive than white people’s”; “Black people’s skin is thicker than white people’s”; “Black people’s blood coagulates more quickly than white people’s.” These kinds of false perceptions, Dunkley said, need to be addressed during medical education and training so they aren’t perpetuated further.

According to Allison-Ottey, the change in treatment between Black women and white women can sometimes be understood by implicit bias. It may not be that a doctor or healthcare provider is racist, but they’re surrounded by the stigma of the Black patient coming into the emergency room with drug-seeking behavior. “Really, they’re in excruciating pain and you want to give them extra strength tylenol, but that same person in the next room who’s white is getting hydrocodone,” Allison-Ottey said.

If she were to advise other women, Finney said she would tell them to talk to their doctors and anesthesiologist and create a plan for pain management before heading into surgery. If possible, she says, it’s best to bring someone with you who can understand the plan and advocate for you because it can be difficult, and sometimes impossible, to advocate for yourself when you’ve just undergone surgery. And, she said, don’t be afraid to use your voice.

“Remember it is your right to ask as many questions as you need because you deserve to feel comfortable with the plan,” Finney said. “I think sometimes any of us can get intimidated and think the doctors and nurses know best. It’s your right to ask questions. It’s their job to answer those questions.”

June Policy Roundup

1. The Affordable Care Act Lives to Fight Another Day

On June 17, 2021, the United States Supreme Court rejected a lawsuit that would have made the Affordable Care Act (ACA) unconstitutional. The argument, brought by several Republican state attorneys general, was that Congress had effectively undone the individual mandate by making the tax penalty for not having health insurance $0. As a result, they claimed, the whole law should fall. The Supreme Court voted seven to two that the states and the individual plaintiffs did not have standing to bring the lawsuit, which means they didn’t show that they’d been directly harmed by the law. The justices did not weigh in on the merits of the arguments, and the net effect is that the ACA remains intact.

This month, the Centers for Medicare and Medicaid Services (CMS) also announced that it will provide $80 million in funding for navigators, individuals and organizations trained to help consumers choose Marketplace health insurance, to support 2022 enrollment in states that use the federal ACA health insurance marketplace. This increased funding comes after the prior administration had cut navigator funding to just $10 million nationwide.

2. Medicaid Enrolls 9 Million More People During the Pandemic

The economic havoc brought on by Covid-19 led to millions of additional Americans qualifying for Medicaid, according to a new analysis by the Kaiser Family Foundation. Medicaid enrollment grew nationwide from 71.3 million enrollees in February 2020 to 80.5 million in January 2021. Federal requirements that states could not disenroll Medicaid members until after the national emergency ends also contributed to growing Medicaid enrollment.

3. New Approaches to Treating Breast and Ovarian Cancers Offer New Hope

New research released by the American Society of Clinical Oncology before its annual meeting and published in the New England Journal of Medicine showed that a drug initially approved for ovarian cancer also effectively reduces the risk of breast cancer recurrence or death among patients with the BRCA1 and BRCA2 genetic variants. The results may affect how some aggressive breast cancer is treated.

Another promising development emerged this month when researchers at the Dana-Farber Cancer Institute published data that suggests an antibiotic developed in the 1950s effectively kills tumor cells with damaged BRCA1 and BRCA2 genes. These genetic defects are commonly found in breast, ovarian, prostate and pancreatic cancers. The new findings, which need to be studied further in clinical trials, point to a potential new approach in hard-to-treat cancers.

4. The Gender Gap Holds Back Innovations for Women’s Health

A new paper published this month in Science suggests the world is likely missing out on a lot of innovation aimed at improving women’s health. Women are more likely to create biomedical inventions that solve health problems for women and men are more likely to invent solutions for men. But since women hold just 16% of biomedical patents, the paper suggests that technological advancement for women’s health is likely suppressed as a result of gender disparities in the biomedical field. If women had patented inventions at the same rate as men between 1976 and 2010 (the period covered in the study), there likely would have been approximately 6,500 more inventions focused on women

5. New Moms Are More Likely to Seek Mental Health Care During Pandemic, New Study Shows

More than half (56%) of postpartum women in a recent study in Couple and Family Psychology: Research and Practice reported symptoms of postpartum depression during Covid-19. The study documented the impact of Covid-19 on women and suggests the pandemic has had adverse effects on women during perinatal care. To meet the health needs, including mental health, of postpartum women, the American Rescue Plan Act of 2021 (ARPA) gave states the option to extend Medicaid benefits to postpartum women for up to 12 months following delivery, up from just 60 days. Medicaid currently covers approximately half of all U.S. births.

Several U.S. states are expanding postpartum Medicaid coverage as allowed by ARPA. According to the Kaiser Family Foundation, Illinois, Missouri and Georgia have already extended Medicaid coverage for women during the postpartum period, and several more states are awaiting federal approval to do so. Other states are also working on efforts to improve access to care for postpartum women. Rep. Ayanna Pressley of Massachusetts has introduced the Safe Birthing Act to make extended postpartum coverage mandatory, but that bill has yet to make its way through the legislative process.

6. Vaccinating Pregnant Women Against the Flu Did Not Harm Babies

A new study in the Journal of the American Medical Association showed that infants whose mothers got the flu shot during pregnancy did not have any greater likelihood of negative health outcomes than babies who were not exposed to the vaccine in utero. Despite there being no increased health risks to the babies, only 36% of women had had the flu vaccine during their pregnancy, suggesting there may be lingering hesitancy about flu vaccines.

7. Biosimilars May Be the Key to Lower Drug Prices

A study published this month in Health Affairs looked at how quickly biosimilars — lower-cost versions of biologic drugs — have taken off in the United States. Though early biosimilars were relatively slow to gain popularity, more recent products have grown more quickly, suggesting that adoption of biosimilars is accelerating. This trend is good for patients and the health system, as biosimilars work as well as their reference products but at a much lower cost. These lower costs help offset the overall trend toward rising biologic price increases, according to the study.

8. Biden Administration Extends Title IX Protections to LGBTQ Students

This month, the U.S. Department of Education announced that it will enforce the application of Title IX prohibitions against discrimination on the basis of sex for LGBTQ students as well. Title IX bans educational programs or institutions that get federal funding from denying students access to activities or benefits on the basis of the student’s sex. The Biden Administration policy is based on a 2020 U.S. Supreme Court decision that expanded workplace protections from sex discrimination to LGBTQ people. The new guidance reverses a Trump-era policy, issued late in his last term, that took the opposite interpretation of the Supreme Court’s decision.

Contraception Is Free to Women, Except When It’s Not

By Michelle Andrews, Kaiser Health News

For Stephanie Force, finding a birth control method that she likes and can get without paying out-of-pocket has been a struggle, despite the Affordable Care Act’s promise of free contraceptives for women and adolescent girls in most health plans.

The 27-year-old physician recruiter in Roanoke, Virginia, was perfectly happy with the NuvaRing, a flexible vaginal ring that women insert monthly to release hormones to prevent pregnancy. But her insurer, Anthem, stopped covering the branded product and switched her to a generic version in early 2020. Force said the new product left her with headaches and feeling irritable and short-tempered.

After talking to her OB-GYN, Force tried an IUD. But that made her feel worse: She had bad cramps, gained 10 pounds and developed severe hormonal acne. Plus, she was charged $248 for an ultrasound her provider used to guide the insertion of the device, a charge she successfully fought.

Force also considered a couple of birth control products approved in recent years: a non-hormonal vaginal gel called Phexxi and a vaginal ring called Annovera that can be used for a year. But Phexxi isn’t covered by her employer health plan, and she would owe a $45 copayment for Annovera.

Despite the ACA’s guarantees of free contraception coverage, Force’s experience illustrates that even for women whose health plans are subject to the law’s requirements, obtaining the right product at no cost can be onerous. New types of contraceptives aren’t automatically incorporated into the federal list of required methods that insurers use to guide coverage decisions. In addition, some health plans continue to discourage use of even long-established methods like IUDs by requiring providers to get approval from the plan before prescribing them.

Consumer advocates who have studied the issue say a process is spelled out in federal rules for women to get the contraceptive they need, but far too few people know that is an option.

Ultimately, Force went back to the generic version of the NuvaRing, despite the side effects she continues to experience. She’d prefer to be on the branded NuvaRing, which didn’t give her problems, and the ping-ponging from method to method has left her exhausted and furious.

“I cannot believe what hoops I have had to jump through between September 2020 and June 2021,” Force said, “between switching from the generic NuvaRing to the IUD and then back, fighting my insurance and OB-GYN’s office on the ultrasound charge.”

In a statement, Anthem said, “Anthem health plans cover 222 contraceptive products at $0 cost share on our ACA Preventive List. We cover at least one product” in each of 18 categories of contraception methods approved by the FDA.

Contraception is a very personal choice, and what meets one woman’s needs may not meet another’s. If avoiding pregnancy is a woman’s top priority, a virtually fail-safe method like an IUD may be the right solution. But for someone who’s considering getting pregnant soon, a readily reversible method like a birth control pill might be the best option. Side effects are important to consider as well, since women respond differently to the hormones in various birth control products.

Before the ACA required no-cost birth control coverage, researchers estimate, up to 44% of women’s out-of-pocket health care spending went toward contraceptives. The ACA required most commercial health plans to cover a comprehensive list of FDA-approved methods without charging women anything. Church plans and religious nonprofits as well as employers and schools that object to contraception are exempt from the coverage requirements. Plans that were grandfathered under the law are also exempt. Uninsured women don’t benefit from the mandate either.

But the federal rules do not require health plans to cover every contraceptive. After the ACA passed in 2010, the federal Health Resources & Services Administration developed guidelines for women’s preventive services. Those guidelines say women should have access without cost sharing to a list that covers the 18 FDA-approved methods, including oral contraceptives, vaginal rings and cervical caps, IUDs, implantable rods and sterilization. Under federal rules, health plans must cover at least one product in each category.

But neither the HRSA guidelines nor a birth control chart published by the FDA addresses newer methods, including the gel Phexxi, which regulates vaginal acidity to reduce the odds a sperm reaches an egg. It was approved by the FDA last year.

Nor do they incorporate fertility-awareness mobile apps the FDA approved in recent years such as Natural Cycles, which tracks a woman’s temperature and menstrual cycle to avoid pregnancy.

“There’s a real need for new guidance that keeps up with new methods,” said Mara Gandal-Powers, director of birth control access at the National Women’s Law Center.

Many insurers have balked at covering Phexxi, said Rameshwari Gupta, director of strategic markets for Evofem Biosciences, which markets Phexxi. A box of 12 single-use applicators — consumers use one before having sex — costs $267.50 without insurance, she said.

“When I started talking to payers, they all said, ‘Where are you on this FDA chart?'” she said.

According to an FDA spokesperson, the birth control chart is for consumer education purposes only and “was not created with the intent of driving coverage decisions.” The agency is in the process of updating it.

In a statement, HRSA said it is reviewing the evidence on contraceptives and expects to complete its review late this year. If it opts to make revisions, it will publish draft recommendations to update the women’s preventive services guidelines. These will be finalized after a public comment period and become effective a year later.

At this point, health plans consider Phexxi a spermicide and are required to cover only one type of spermicide without cost sharing, said Kristine Grow, a senior vice president at AHIP, a health insurance trade organization.

“If Phexxi is indeed considered a new ‘method’ of contraception, both the FDA and HRSA would need to make this clear,” she added.

The vaginal ring Annovera, approved by the FDA in 2018, is typically covered by health plans, according to Grow, though it may not be available without cost sharing. The average retail price is $2,457 a year, according to GoodRx.

One way plans have made it difficult for women to access certain contraceptives, even those on the list of approved methods, is by requiring that their providers get approval from the insurer first, often by providing documentation that the product is medically necessary.

Under UnitedHealthcare’s coverage policy for Phexxi, for example, before coverage will be authorized, members must have documented reasons that they are unable to use eight other contraceptive methods, including oral contraceptives, the contraceptive patch, a vaginal ring, injections and spermicides. Providers also must attest that they have counseled patients that Phexxi is less effective at preventing pregnancy than some other methods.

In a statement, UHC said it covers “a broad array” of generic and brand-name options, and it follows scientific evidence to develop its list.

Yet consumers have a way to get the specific drug that is most appropriate for them, according to a report by the National Women’s Law Center.

Under federal rules, if a doctor or other health care provider determines that a patient needs a particular contraceptive, even if it’s not on the list of approved products for the patient’s plan, the insurer is required to have an expedient process for the patient to seek a waiver.

“It’s not up to the insurance company whether to cover that method; it’s up to the provider,” said Adam Sonfield, executive editor for policy analysis at the Guttmacher Institute, a research and advocacy organization focused on women’s reproductive health.

But according to the National Women’s Law Center report, many insurers, patients and their providers aren’t aware of the requirement, and state agencies don’t enforce these so-called exceptions policies.

If patients run into trouble getting the method they want, “we typically recommend filing an appeal with their insurance provider,” said Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center.

Stephanie Force said she was unaware of any process she could have used to get the NuvaRing covered without cost sharing. Neither her health care provider nor the insurer mentioned the possibility.

She recently had an appointment with a new provider, who she hopes will be a better advocate for her.

Subscribe to KHN’s free Morning Briefing.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Using for Two

Jen Simon tried many times to quit using the opioids she first started taking to help with painful periods, and then, to ease her anxiety and depression. But, she just couldn’t seem to stop — until she found out she was pregnant with her second son.

“It was much easier to quit for someone else,” Simon said.

It also helped Simon to know that her abstinence had a deadline. Once she stopped breastfeeding, she planned to start using drugs again. She stockpiled pills throughout her pregnancy and left the hospital with a large supply of opioid pain relievers. At no time, did anyone talk to her about the risk of opioid dependence.

What began as an appropriate use of prescription opioids turned into misuse — using drugs differently than prescribed — and ultimately into opioid use disorder (OUD).

Before she knew it, Simon had joined the 1.3 million adults in the United States, many of whom are women, who are addicted to opioids.

The opioid epidemic affects all kinds of people from all walks of life, but there is some evidence that women are more likely to misuse or abuse opioids than men, perhaps because women are more likely to experience chronic pain and other mental health conditions.

In a 2019 survey from the Centers for Disease Control and Prevention (CDC), 7% of pregnant women reported using prescription opioids during pregnancy and 21% of those reported misusing them. Nearly one-third (32%) of pregnant women who used opioids got no counseling about how opioids could affect their baby.

Talking about opioids

It’s important for pregnant women who misuse opioids to be able to openly discuss their challenges and get information about their options, but too often, they face stigma, judgment and compelling reasons not to come forward for help.

To raise awareness about opioid use during pregnancy, HealthyWomen recently brought together clinical and legal experts for our webinar, “Healthy Pregnancy, Healthy Mom: Reducing Barriers to Treatment for Opioid Use Disorder,” to shed light on the unique challenges and barriers to care that pregnant women with OUD face.

One of the biggest issues addressed during the webinar is that the baby will experience withdrawal, known as neonatal abstinence syndrome (NAS), a condition that increased dramatically between 2004 and 2014.

Concern for babies often overshadows concern for mothers, a phenomenon that dates back to the 1980s crack cocaine epidemic, according to Nancy Wolf, CEO of Libertae, a Pennsylvania drug treatment facility for pregnant and parenting women.

“We were focused on the effects of the maternal substance use on the children to the detriment of the moms,” Wolf said on the webinar. “We didn’t really concern ourselves with the moms that were facing addiction.”

But women who abuse opioids during pregnancy need attention for their own health, too, partly because they’re more likely than other women to have complications or die during childbirth.

Barriers to care

Despite the importance of pregnancy care and treatment for addiction, many women don’t seek care for themselves or their babies.

On the webinar, Shruti Kulkarni, Esq., counsel to Aimed Alliance, a nonprofit advocacy organization that works to improve health care in the United States, explained that women have reason to fear legal consequences if they disclose drug use during pregnancy. As a result, many women hesitate to seek treatment for fear of losing custody of their children or having to give up their children as a condition of treatment, despite evidence that punishing women doesn’t stop them from using drugs.

Kulkarni also cited data from the Guttmacher Institute which shows that substance use during pregnancy is considered child abuse in 23 states and Washington, D.C. More than half the states and D.C. require healthcare providers (HCPs) to report suspected prenatal drug use to authorities.

Disclosure rules also vary by hospital and sit outside of HIPAA protections for patients’ privacy, according to Dr. Mishka Terplan, a board-certified OB-GYN and addiction medicine doctor.

As a maternal health nurse, Beth Battaglino, RN-C, who is also CEO of HealthyWomen, has seen firsthand how these policies dampen women’s willingness to seek care.

“Patients … that are trying to keep [drug use] a secret are not going for prenatal visits,” Battaglino said during the webinar. “They’re just getting pregnant and then coming to deliver the baby.”

But disclosing drug use may be well worth the risk of child welfare authorities getting involved. Experts on the webinar explained that seeking help can reflect positively on women for at least trying to get better, and that getting prenatal care is vital to delivering healthy babies even if the mother uses drugs during pregnancy.

“I have yet to meet the person who’s pregnant who uses drugs who doesn’t care about her health or the health of her baby-to-be and isn’t actually seeking information about how to be more healthy in her pregnancy,” Terplan said in the webinar.

Support for pregnant women with OUD

Concerns about the baby can be a powerful motivator for pregnant women with OUD.

“Pregnancy is actually a very promising time for people to make progress with substance use disorders,” said Dr. David Gunther, a board-certified family physician and addiction medicine specialist at Column Health, who spoke with HealthyWomen but did not participate in the webinar.

Nineteen states have drug treatment programs for people who are pregnant, and 17 states give pregnant people priority for state-funded drug treatment programs.

“When people are pregnant, doors open,” Terplan said in the webinar. After delivery, though, women are at greater risk of relapse.

To support people in recovery, Terplan said HCPs should be welcoming and nonjudgemental. He and Kulkarni both called for decriminalizing drug use in pregnancy so women can get the care they need without fear of legal consequences.

Too much to lose

It took Simon two years to get treatment after her baby was born. Using multiple drugs and deeply depressed, she faced a choice: double down on drug use or ask for help.

“I was at the crossroads, and the other side really scared me,” Simon said.

She found a psychiatrist who specializes in addiction, went to therapy and started taking an opioid blocker to reduce her physical and emotional opioid cravings.

Today, it would be hard for Simon to spontaneously take drugs. She’d have to let the opioid blockers out of her system, find new pill sources and be prepared to disappoint a lot of people — including her kids, now ages 8 and 11.

That’s a price Simon desperately doesn’t want to pay.

Should Fully Immunized People Wear Masks Indoors? An Infectious Disease Physician Weighs In



By Peter Chin-Hong, University of California, San Francisco

With the highly infectious delta coronavirus variant spreading at an alarming rate, the World Health Organization in late June 2021 urged people to again wear masks indoors – even those who are fully vaccinated. And on July 15, Los Angeles County, California, announced that it would again require masking up in public indoor spaces, regardless of vaccination status. This was followed by a recommendation – though not a mandate – from seven Bay Area counties for all to again don masks in public indoor settings.

Notably, the U.S. Centers for Disease Control and Prevention has not yet taken a similar stance. On July 12, National Nurses United, the nation’s largest professional association for registered nurses, called on the CDC to reconsider in light of the spike in new infections and hospitalizations across the country. The Conversation asked Peter Chin-Hong, a physician who specializes in infectious diseases at the University of California, San Francisco, to help put into context the science behind these seemingly mixed messages.

What’s the science behind the WHO recommendation?

There is clear and mounting evidence that – though rarebreakthrough COVID-19 infections can occur, even in the fully vaccinated. This is particularly true with emerging variants of concern.

The CDC has been following these data closely. By mid-July 2021, nearly 60% of the U.S. population age 18 or older had been fully vaccinated. Infections in those who are fully vaccinated are rare, and serious outcomes from COVID-19 in that population are even rarer – though they do still occur. However, the CDC stopped tracking nonhospitalized cases of COVID-19 for people with and without symptoms among fully vaccinated individuals on May 1, 2021.

The risk of infection leading to serious illness and death, however, differs starkly between vaccinated and unvaccinated people.

Are breakthrough infections more likely with the delta variant?

Maybe. Preliminary data suggests that the rise of variants like delta may increase the chance of breakthrough infections in people who received only their first vaccine dose. For instance, one not-yet peer-reviewed study found that a single dose of the Pfizer vaccine had an effectiveness of just 34% against the delta variant, compared with 51% against the older alpha variant in terms of warding off symptomatic disease.

But the data is more reassuring for those who have been fully vaccinated. After two doses, the Pfizer vaccine still provides strong protection against the delta variant, according to real-world data from Scotland and a variety of other countries; and in preliminary studies out of Canada and England, researchers noted only a “modest” decrease in effectiveness against symptomatic disease from 93% for the alpha variant to 88% for delta.

One recent preliminary report from Israel is sobering, however. Before the delta variant became widespread, from January to April 2021, Israel reported that the Pfizer vaccine was 97% effective in preventing symptomatic disease. However, since June 6, with the delta variant circulating more widely, the Pfizer vaccine has been 64% effective in preventing symptomatic disease, according to preliminary data reported by Israel’s Ministry of Health in early July.

And in another new report that is not yet peer-reviewed, researchers compared blood serum antibodies from people vaccinated with Pfizer, Moderna and J&J vaccines and found that the J&J vaccine lent much lower protection against delta, beta and other variants, compared with the mRNA-based vaccines. As a result, the researchers suggest that J&J vaccine recipients would benefit from booster immunizations, ideally with one of the mRNA vaccines. However, this is a limited laboratory study that doesn’t look at whether real people got sick, and contradicts a peer-reviewed study that found the J&J vaccine was protective against delta eight months after vaccination.

In all reports and studies, however, vaccine efficacy is still very high against the delta variant in preventing hospitalizations and severe disease – arguably the outcomes we most care about.

All of this emerging data supports the WHO recommendation that even fully vaccinated individuals continue to wear masks. Most of the world still has low vaccination rates, uses a range of vaccines with variable efficacy at preventing infection and has different burdens of circulating SARS-CoV-2 virus. In this context, it makes sense that the WHO would give a conservative recommendation to mask up for all.

Who’s actually protected by masking recommendations?

The WHO’s latest call for fully vaccinated people to continue wearing masks is primarily intended to protect the unvaccinated – which includes kids under age 12 who are not yet eligible for vaccines in the U.S. Unvaccinated people are at a substantially higher risk of getting infected with and transmitting SARS-CoV-2, and of developing complications from COVID-19.

And, again, there is still a low risk of infection for vaccinated people, but this risk differs regionally. In areas of highly circulating virus and poor vaccination rates, and with highly transmissible variants, there is a higher probability of infection in vaccinated individuals compared with people living in areas with lower levels of virus in the community.

Does the US situation warrant masking up (again)?

I suspect the CDC is unlikely to pursue a universal U.S. recommendation to wear masks at this time. With an overall high countrywide vaccination rate and a low overall COVID-19 hospitalization and death burden, the U.S. has a COVID-19 landscape very different from most of the world.

Some experts also worry that sending an official message that the vaccinated should don masks may dissuade unvaccinated individuals from seeking vaccines.

What changes would signal it’s time for the US to mask up again?

There are emotional red flags and then there are more realistic red flags that may bring about a nationwide call for masking indoors for fully vaccinated people.

Having more than 100 cases of infection per 100,000 people per week is defined as “high” community transmission, the worst category, by the CDC. Los Angeles County, for example, has already surpassed that mark, with more than 10,000 coronavirus cases per week.

A more pragmatic measure for masking is the number of hospitalizations, because it is directly related to use of health care resources. Some researchers have proposed a threshold of five COVID-19 cases – averaged over several days – hospitalized per 100,000 people, which would potentially be a more ominous signal than infection rates. Los Angeles County has also surpassed that as well.

Surges will likely be a regional phenomenon based on how many people are fully vaccinated in an area. As long as hospitalizations and deaths remain generally manageable nationally, and with hospital capacity intact, the U.S. as a whole may not need to return to masking indoors for the fully immunized.

[The Conversation’s most important coronavirus headlines, weekly in a science newsletter]The Conversation

Peter Chin-Hong, Associate Dean for Regional Campuses, University of California, San Francisco

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Living With Fibroids

Did you know the vast majority of American women will probably get uterine fibroids by age 50? But despite being common, there’s not a lot of talk about fibroids in the national conversation on women’s health.

Women trying to understand their fibroid diagnosis and treatment and management options often get incorrect information, which contributes to stigma about fibroids and can keep people who have them from reaching out for help.

That’s why we’re excited to have joined forces with The White Dress Project to help women living with fibroids feel supported and empowered during their journey. As a nonprofit organization primarily made up of women who’ve traveled through fibroid journeys of their own, The White Dress Project is uniquely positioned to partner with us to educate, empower and support people who are managing life with fibroids.

Through our collective work, we’ve developed resources to illustrate life with fibroids, educate the community, encourage self-advocacy and strengthen the patient-healthcare provider relationship and interaction.

We invite you to explore our inspiring and educational content below.

The program is funded by Myovant Sciences and Pfizer.

Clinically Speaking: What to Ask Your Healthcare Provider If You Think You Have Uterine Fibroids

Clinically Speaking: What Are My Options Following a Fibroid Diagnosis?

Clinically Speaking: Talking to Patients About Uterine Fibroids

Fibroids Resource List

Fibroids are abnormal growths that develop in or on a woman’s uterus. In some cases, no signs or symptoms are present, but if the tumors become extremely enlarged, women can experience severe abdominal pain and heavy periods. Although the cause of fibroids is still unknown, up to 80% of women experience fibroids by the age of 50 and African American women suffer from fibroids 2 to 3 times more than white women at a younger age and often more severely. For more information on fibroids, contact your healthcare provider and visit the resources provided below.

The White Dress Project and HealthyWomen Resources

Additional Resources

Being Pregnant Was Wonderful. And Overwhelming.

As told to Shannon Shelton Miller

Every time I visited the doctor during my pregnancy, I’d take a test or undergo a screening to make sure my baby was all right. My healthcare providers (HCPs) checked my vitals too, giving me a clean bill of physical health each time.

But no one asked how I was feeling. While protecting my baby’s health was a top priority, my own mental health was neglected.

Like many women, I was worried at first about how my husband and I would fit a pregnancy into our busy lives, but we were thrilled to be expecting. Being excited about the new baby didn’t prevent me from feeling overwhelmed by the physical and mental changes I experienced as my pregnancy progressed.

Feeling nauseated forced me to slow down, and I was exhausted for much of my first trimester. Researching information about pregnancy created anxiety about what could go wrong during pregnancy and birth for mom and baby, and I began growing fearful of any and every symptom that felt off.

Internet searches made me think every unusual symptom I was experiencing was a sign of miscarriage, and I had a constant fear of losing my baby after I learned that spotting and cramping were the biggest red flags. I’m a fitness instructor and because I was still teaching classes, I cramped and experienced a small amount of spotting a few times. I had to keep telling myself that I was OK, that my baby was OK, and that I wasn’t miscarrying.

At doctor’s appointments, pregnant women are told they need multiple screenings to make sure their children are healthy. HCPs check the mom for gestational diabetes and other conditions that could affect a pregnancy. They’re doing the right thing, of course, but I was constantly worried there was a chance something was wrong, and it made me feel stressed, and then I worried that the stress could lead to other complications.

Going through this during a pandemic, I was cut off from people who could have been my support system. I was trying to hold everything in and deal with my feelings alone, figuring that I should just be able to handle it all by myself.

After waking up yet another morning to a bizarre dream, feeling off and just kind of grumpy with my husband, I realized I needed to get everything off my chest. Anxiety wasn’t healthy for the baby or for me. I hit a breaking point where I admitted that everything wasn’t all right, that I was feeling vulnerable and needed help.

I leaned on my mama, my friends and my sister, who has two young children and works as a doula. My sister helped me understand everything I was going through was to be expected. That’s the message I needed to hear — everything I was feeling was normal, even if it didn’t feel that way in the moment. It was important to give myself permission to express all of my feelings about pregnancy and impending motherhood, even if they weren’t always positive in the moment.

I was also really honest with my partner about everything I was feeling. Just opening that dialogue with him — even if he couldn’t totally understand what was going on — did help. It was freeing when I could tell my husband how I was feeling.

I also decided to go against one of the biggest societal expectations about pregnancy — that you don’t announce your pregnancy until you’re past your first trimester. It’s incredibly difficult when you’re struggling with your pregnancy but feel you can’t tell anyone you’re pregnant because you might miscarry. I decided I wanted the people close to me to know that I was pregnant. That way, if I did end up miscarrying, I’d be able to turn to them for support.

I started prenatal yoga, which taught me to tune into my body and helped me feel more connected to the baby. I scheduled sessions with holistic healers who gave me a safe forum where I felt free to speak what was on my mind.

Even little things at home helped lift my mood, like watching Netflix shows and listening to audiobooks about new moms experiencing motherhood. When I was just sitting on the couch, I’d light a candle nearby. Anything that can make a difference when you’re stressed can be part of self-care. I realized I didn’t need to push myself to be perfect — pregnancy is a time to rest, honor yourself and your baby.

I turned a corner once I got things off my chest and opened up to my close friends and family. I was able to get through the rest of my pregnancy, labor and delivery and the postpartum period with better mental health because I leaned on people around me. I felt less resistant to stepping into motherhood.

I remember telling one of my mama friends I was crying every single day after giving birth. She told me she went through it too, and that it’s normal because of that mix of hormonal changes, the identity shifts you’re experiencing and the love you feel for your new baby. You’re allowed to feel it’s all really hard and still be an amazing mom and partner. Once, I finally opened up, having friends and family to check on me during my pregnancy and postpartum period made such a difference.

My daughter, Mylo, is now 6 months old, and my experience led me to a second career coaching women about reducing stress around conception, pregnancy and the postpartum period. I’m passionate about reminding pregnant women that they’re going into a courageous and beautiful chapter of their lives, but it can still be scary — and they’re not alone if they need support.

Before Shark Week and ‘Jaws,’ World War II Spawned America’s Shark Obsession


By Janet M. Davis, The University of Texas at Austin College of Liberal Arts

Every summer on the Discovery Channel, “Shark Week” inundates its eager audiences with spectacular documentary footage of sharks hunting, feeding and leaping.

Debuting in 1988, the television event was an instant hit. Its financial success wildly exceeded the expectations of its creators, who had been inspired by the profitability of the 1975 blockbuster film “Jaws,” the first movie to earn US$100 million at the box office.

Thirty-three years later, the enduring popularity of the longest-running programming event in cable TV history is a testament to a nation terrified and fascinated by sharks.

Journalists and scholars often credit “Jaws” as the source of America’s obsession with sharks.

Yet as a historian analyzing human and shark entanglements across the centuries, I argue that the temporal depths of “sharkmania” run much deeper.

World War II played a pivotal role in fomenting the nation’s obsession with sharks. The monumental wartime mobilization of millions of people placed more Americans into contact with sharks than at any prior time in history, spreading seeds of intrigue and fear toward the marine predators.

America on the move

Before World War II, travel across state and county lines was uncommon. But during the war, the nation was on the move.

Out of a population of 132.2 million people, per the 1940 U.S. Census, 16 million Americans served in the armed forces, many of whom fought in the Pacific. Meanwhile, 15 million civilians crossed county lines to work in the defense industries, many of which were in coastal cities, such as Mobile, Alabama; Galveston, Texas; Los Angeles; and Honolulu.

Local newspapers across the country transfixed civilians and servicemen alike with frequent stories of bombed ships and aircraft in the open ocean. Journalists consistently described imperiled servicemen who were rescued or dying in “shark-infested waters.”

Whether sharks were visibly present or not, these news articles magnified a growing cultural anxiety of ubiquitous monsters lurking and poised to kill.

The naval officer and marine scientist H. David Baldridge reported that fear of sharks was a leading cause of poor morale among servicemen in the Pacific theater. General George Kenney enthusiastically supported the adoption of the P-38 fighter plane in the Pacific because its twin engines and long range diminished the chances of a single-engine aircraft failure or an empty fuel tank: “You look down from the cockpit and you can see schools of sharks swimming around. They never look healthy to a man flying over them.”

‘Hold tight and hang on’

American servicemen became so squeamish about the specter of being eaten during long oceanic campaigns that U.S. Army and Navy intelligence operations engaged in a publicity campaign to combat fear of sharks.

Published in 1942, “Castaway’s Baedeker to the South Seas” was a “travel” survival guide, of sorts, for servicemen stranded on Pacific islands. The book emphasized the critical importance of conquering such “bogies of the imagination” as “If you are forced down at sea, a shark is sure to amputate your leg.”

Cover depicting a cartoon shark about to attack someone stranded in the ocean.

‘Shark Sense’ sought to prepare troops for encounters with the marine predators.

Navy Archives

Similarly, the Navy’s 1944 pamphlet titled “Shark Sense” advised wounded servicemen stranded at sea to “staunch the flow of blood as soon as you disengage the parachute” to thwart hungry sharks. The pamphlet helpfully noted that hitting an aggressive shark on the nose might stop an attack, as would grabbing a ride on the pectoral fin: “Hold tight and hang on as long as you can without drowning yourself.”

The Department of the Navy also worked with the Office of Strategic Services, the wartime precursor to the Central Intelligence Agency, to develop a shark repellent.

Office of Strategic Services executive assistant and future chef Julia Child worked on the project, which tested various recipes of clove oil, horse urine, nicotine, rotting shark muscle and asparagus in hopes of preventing shark attacks. The project culminated in 1945, when the Navy introduced “Shark Chaser,” a pink pill of copper acetate that produced a black inky dye when released in the water – the idea being that it would obscure a serviceman from sharks.

Nonetheless, the U.S. military’s morale-boosting campaign was unable to vanquish the glaring reality of wartime carnage at sea. Military media correctly observed that sharks rarely attack healthy swimmers. Indeed, malaria and other infectious diseases took a far greater toll on U.S. servicemen than sharks.

But the same publications also acknowledged that an injured person was vulnerable in the water. With the frequent bombing of airplanes and ships during World War II, thousands of injured and dying servicemen bobbed helplessly in the ocean.

One of the worst wartime disasters at sea occurred on July 30, 1945, when pelagic sharks swarmed the site of the shipwrecked USS Indianapolis. The heavy cruiser, which had just successfully delivered the components of the Hiroshima atomic bomb to Tinian Island in a top-secret mission, was torpedoed by a Japanese submarine. Out of a crew of 1,196 men, 300 died immediately in the blast, and the rest landed in the water. As they struggled to stay afloat, men watched in terror as sharks feasted on their dead and wounded shipmates.

Only 316 men survived the five days in the open ocean.

‘Jaws’ has an eager audience

World War II veterans possessed searing lifelong memories of sharks – either from direct experience or from the shark stories of others. This made them an especially receptive audience for Peter Benchley’s taut shark-centered thriller “Jaws,” which he published in 1974.

Don Plotz, a Navy sailor, immediately wrote to Benchley: “I couldn’t put it down until I had finished it. For I have rather a personal interest in sharks.”

In vivid detail, Plotz recounted his experiences on a search and rescue mission in the Bahamas, where a hurricane had sunk the USS Warrington on Sept. 13, 1944. Of the original crew of 321, only 73 survived.

“We picked up two survivors who had been in the water twenty-four hours, and fighting off sharks,” Plotz wrote. “Then we spent all day picking up the carcasses of those we could find, identifying them and burying. Sometime only rib cages … an arm or leg or a hip. Sharks were all around the ship.”

Benchley’s novel paid little attention to World War II, but the war anchored one of the movie’s most memorable moments. In the haunting, penultimate scene, one of the shark hunters, Quint, quietly reveals that he is a survivor of the USS Indianapolis disaster.

“Sometimes the sharks look right into your eyes,” he says. “You know the thing about a shark, he’s got lifeless eyes, black eyes, like a doll’s eyes. He comes at you, he doesn’t seem to be living until he bites you.”

The power of Quint’s soliloquy drew upon the collective memory of the most massive wartime mobilization in American history. The oceanic reach of World War II placed greater numbers of people into contact with sharks under the dire circumstances of war. Veterans bore intimate witness to the inevitable violence of battle, compounded by the trauma of seeing sharks circle and feed opportunistically on their dead and dying comrades.

Their horrifying experiences played a pivotal role in creating an enduring cultural figure: the shark as a mindless, spectral terror that can strike at any moment, a haunting artifact of World War II that primed Americans for the era of “Jaws” and “Shark Week.”

[Get the best of The Conversation, every weekend. Sign up for our weekly newsletter.]The Conversation

Janet M. Davis, University Distinguished Teaching Professor of American Studies, The University of Texas at Austin College of Liberal Arts

This article is republished from The Conversation under a Creative Commons license. Read the original article.