You can reach her a lcarr@mjhlifesciences.com.

September Roundup: Top women's health stories

Let's review this month's top women's health stories.

Hormonal contraception’s effect on adolescent bone health 

The best clinical indicator of bone health is fracture history. Individuals with a history of fracture resulting from low-impact mechanisms of injury should raise concern for skeletal fragility and warrant a bone health evaluation.

A rising interest: Why obstetrics and gynecology is seeing an increase in applicants 

As the leaves begin to change, and our students consider their choices, I encourage you to reflect on your reasons to pursue obstetrics and gynecology, and on the field’s importance— not just for you, but for your patients and for their families—and reconnect with your passions.

Organizations should promote system-level solutions for retention and well-being. 

Articles

What's coming to Contemporary OBGYN this week? 

This week on Contemporary OBGYN: Sept 26 to Sept 30

Antitransgender discourse reinforces attacks on reproductive rights.

Improving contraceptive care for marginalized populations

Consider the needs of marginalized patients to promote equity

Nearly half (45%) of all pregnancies in the United States from 2015 to 2019 were unintended.

Reproductive health care for adolescents with disabilities requires special consideration

Despite a painful history, equitable care is imperative

Prenatal cannabis exposure increases risk of mental disorders

In a recent study, prenatal cannabis exposure was associated with greater risk of behavioral problems and mental health disorders in children.

Cesarean section increases risk of Crohn’s disease

In a recent study, offspring delivered through cesarean section were more likely to develop Crohn’s disease than those vaginally delivered.

Artificial sweetener consumption linked to increased cardiovascular disease risk

An analysis of data from more than 100,000 individuals living in Europe is providing insight into the risk of cardiovascular disease associated with consumption of artificial sweeteners.

Study: COVID-19 reduced contraceptive access

In a recent study, it was found that access to contraceptive services declined during the COVID-19 pandemic.

Phase 3 data show oral oteseconazole successful for treating vulvovaginal candidiasis and infections

The medication also performed comparably to vulvovaginal candidiasis (VVC) standard-of-care fluconazole for treating acute VVC infection.

Past traumas may worsen menopausal symptoms and wellbeing at midlife

Research in Menopause connects history of physical/sexual abuse, financial instability with worse menopausal symptoms and overall wellbeing at midlife.

Take a look at this month's top headlines. 

September roundup: Top women's health stories

AUGS Clinical Meeting 2022, Beyond Urogynecology: Pearls for Best Practice

Register for AUGS Clinical Meeting 2022, Beyond Urogynecology: Pearls for Best Practice! Join us in sunny Santa Monica, California, or virtually from the comfort of your home or office!

Child abuse and mandatory reporting policies decrease visits to prenatal care

Investigators found that women in states with child abuse or mandated reporting policies were less likely to visit prenatal care and postpartum health care.

SMFM Consult Series 61: Anticoagulation in pregnant patients with cardiac disease

View the latest recommendations from the Society for Maternal-Fetal Medicine on anticoagulation in pregnant patients with cardiac disease.

In case you missed it: Sept 19 to Sept 23

Physicians and their staff should beware a 

 that is targeting health care providers.

 was published Sept. 19 by the Health Sector Cybersecurity Coordination Center (HC3), within the U.S. Department of Health and Human Services. The campaign uses official-sounding language to convince recipients to click on a bogus download that is really a program that attempts to steal email credentials.

The sector alert stated: “The campaign has a subject of: “Data from (Victim Organization Abbreviation): "Important read about - Monkey Pox – (Victim Organization) (Reference Number) and utilizes an “Important read about Monkey Pox” theme.

“Inside of the email is a PDF with a malicious link which lures the recipient to a Lark Docs site. “The site is Adobe Doc cloud themed and offers a secure fax Monkey Pox PDF download.

"Clicking the download attempts to harvest Outlook, O365, or other mail credentials.”

HC3 recommends the following actions to help protect 

Protect each account with complex, unique passwords. Use a passphrase and/or a complex combination of letters, numbers, and symbols.

In general, avoid opening unsolicited emails from senders you do not know.

Do not open a link or an attachment in an email unless you’re confident it comes from a legitimate source.

Do not download or install programs if you do not have complete trust in the publisher.

Do not visit unsafe websites and do not click on pop-up windows that promise free programs that perform useful tasks.

This aricle originally appeared on Medcical Economics®.

Don’t click on links or attachments unless you’re sure they are legitimate.

Feds warn of monkeypox-themed malicious email campaign targeting health care providers

The Society for Maternal-Fetal Medicine supports the clinical practice of maternal-fetal medicine by providing education, promoting research, and engaging in advocacy to optimize the health of high-risk pregnant women and their babies.

Lifelong therapeutic anticoagulation is a principal component of the medical management of mechanical heart valves to prevent valve thrombosis. 

Anticoagulation regimens indicated outside of pregnancy for patients with mechanical valves should be continued during pregnancy with the possibility of modifications based on the type of valve, the trimester of pregnancy, individual risk tolerance, and circumstances around the time of delivery. The purpose of this document is to provide recommendations regarding the management of anticoagulation for common cardiac conditions complicating pregnancy, including mechanical heart valves, atrial fibrillation, systolic heart failure, and congenital heart disease.

Society for Maternal-Fetal Medicine Consult Series #61: Anticoagulation in pregnant patients with cardiac disease

American Journal of Obstetrics & Gynecology]

View the latest recommendations from the Society for Maternal-Fetal Medicine on anticoagulation in pregnant patients with cardiac disease. 

 of published literature also indicates that using more data collection methods, analyses and definitions for these unmet needs would enable a clearer understanding of health inequality.

Five databases were searched for studies published between 2010 and 2021 that described quantitative measurement of unmet need within sexual and/or reproductive health: PubMed, Web of Science, Scopus, the Cumulative Index to Nursing and Allied Health Literature and Health Management and Policy Database.

The review consisted of 216 studies, of which 190 were analyses of unmet need in reproductive health. Of those 190 studies, 179 collected information via questionnaires.

Among the 190 studies in reproductive health, 137 analyzed trends in populations living in low or lower-middle income countries, compared to only 51 studies that comprised populations from upper-middle and high-income countries. The 2 remaining studies were global comparisons.

Half of the reproductive health studies extrapolated at the national or multinational level, while the other half focused on the regional level.

Six of these 190 studies considered the contraceptive needs of men. The other 184 studies were limited to unmet need in women, of which 89 analyzed women of reproductive age only. A significant majority of studies also restricted analysis to married women or who were in a union similar to marriage.

Overall, 165 of the 216 studies used the Demographic and Health Surveys definition of unmet need. “According to this definition, women are considered to have unmet need if they report being fecund and sexually active, would like to stop or postpone childbearing, and are not currently using a modern contraceptive method,” wrote the authors.

The authors noted that “unmet need for family planning” is a key indicator of the United Nations, without much discourse of unmet need in other areas of sexual and reproductive health. It is also easier to define and measure unmet need for contraception than for sexual health because of the defined endpoint for contraception: unplanned pregnancy.

By contrast, measuring unmet need in sexual health is much more difficult, due to the lack of data from people not receiving care.

Because there remains a large and under-treated global burden of morbidity in sexual health, the conceptualization and measurement of unmet need in sexual health should be a research priority, according to the authors.

There is also a need for data collection using a range of methods that reflect regional patterns, sub-group trends and can begin to determine the causes of unmet need.

“If these gaps are not addressed, we run the risk of repeatedly measuring unmet need within sexual and reproductive health but not collecting the data that will allow us to make significant and sustainable change,” wrote the authors.

Solomon D, Cabecinha M, Gibbs J, et al. How do we measure unmet need within sexual and reproductive health? A systematic review. 

. Published online September 20, 2022. doi:10.1177/17579139221118778

A systematic review on measuring unmet need in sexual and reproductive health has concluded that the emphasis is on contraception for women in low-income countries, while unmet need for sexual health in general, especially among men, and unmet reproductive health need in high-income settings lack much evidence. 

Measuring the unmet need of sexual and reproductive health

Podcasts

Tune into this valuable discussion with host Scott Kober and experts Rachel Pope, MD, MPH, and Sheryl Kingsberg, PhD, as they highlight the overall impact of vaginismus and discuss strategies to combat its effects on women who are diagnosed the condition.

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

COVID-19 vaccination has been associated with an increase in menstrual cycle length of less than 1 day, based on a large international study.

The study, which was funded by the National Institutes of Health and published in the 

, gathered data from almost 20,000 people across the world who had received any of the 9 different COVID-19 vaccinations. In most participants, menstrual cycle length saw an increase after the vaccine was administered.

“These findings provide additional information for counseling women on what to expect after vaccination,” said Diana Bianchi, MD, director of National Institute of Child Health and Human Development. “Changes following vaccination appear to be small, within the normal range of variation, and temporary.”

This change in cycle is under 8 days, making it fit within the normal range of variation. While not concerning from a professional standpoint, the study authors noted that even minor changes in bodily function surrounding fertility may cause concern and increase vaccine hesitancy.

Data was gathered from a fertility tracking app called Natural Cycles, where women voluntarily provided information on menstrual cycles and body temperature. Over 19,000 individuals participated, with almost 15,000 being vaccinated against COVID-19 while over 4500 were not.

Over 30% of participants were from the United Kingdom, while about 30% were from the United States and Canada, and almost 35% from Europe. Participants were included if they had received any of the following vaccinations: Pfizer-BioNTech, Moderna, AstraZeneca, Covishield, Janssen/Johnson & Johnson, Sputnik, Covaxin, Sinopharm, and Sinovac.

The study period lasted at least 4 consecutive cycles, with at least 3 before vaccination and at least 1 after vaccination being studied. In the cycle after vaccination, vaccinated individuals experienced an average increase of less than 1 day, increasing by about 70% of a day after the first dose and about 55% after the second dose.

Over 1300 participants experienced an increase in cycle length greater than 8 days, making up 6.2% of those vaccinated and 5% of those unvaccinated. This increase was mostly likely in younger woman who had experienced longer circle length prior to vaccination.

The authors recommended further studies to observe other potential physical changes, along with the reasons these changes occur.

Study confirms link between COVID-19 vaccination and temporary increase in menstrual cycle length. National Institutes of Health. September 27, 2022. Accessed September 27, 2022. 

https://www.nih.gov/news-events/news-releases/study-confirms-link-between-covid-19-vaccination-temporary-increase-menstrual-cycle-length

In a recent study, participants who had received a COVID-19 vaccine saw an average increase in menstrual cycle length of less than 1 day.

COVID-19 vaccine associated with increased menstrual cycle length

An analysis of the landmark EMPEROR-Preserved trial is providing new insights into the effects of the SGLT2 inhibitor on heart failure outcomes based on patient sex in 

heart failure with preserved ejection fraction (HFpEF)

With women representing 44.7% of the enrolled population in the phase 3 trial, investigators determined empagliflozin contributed to a similar degree of risk reduction for cardiovascular death or hospitalization for heart failure among female patients as was seen in their male counterparts, with these results consistent for the primary outcome, KCCQ-CSS, and other secondary outcomes.

“Sex did not influence the effect of empagliflozin on reducing the risk of cardiovascular death or HF hospitalization or on health status as assessed by KCCQ scores, and there was no significant treatment–by–sex–by–fraction interaction on the primary endpoints. These findings stand in contrast to the striking influence of sex on the response to neprilysin inhibition,” wrote investigators.

With women representing the majority of HFpEF patients in contemporary settings, an international team of investigators led by Stefan Anker, MD, PhD, with the specific intent of assessing the specific influence of sex on the effects of empagliflozin among patients with HFpEF. To do so, investigators designed their analysis using patient data from the EMPEROR-Preserved trial to estimate effects of empagliflozin on the study’s primary and secondary outcomes, with subgroup analyses planned to further estimate effects based on baseline ejection fraction.

EMPEROR-Preserved randomized 5988 patients to either 10 mg empagliflozin or placebo therapy. With a median follow-up of 26.2 months, results indicated a total of 926 primary outcome events among the overall study cohort, including 415 among 2997 patients randomized to empagliflozin and 511 among 2991 patients randomized to placebo therapy (HR, 0.79; 95% CI, 0.69-0.90; 

In the present analysis, initial results indicated women in the placebo arm tended to have a lower risk for adverse outcomes, including a lower risk of all-cause mortality (HR, 0.69 [95% CI, 0.56-0.84]). For the primary composite outcome, use of empagliflozin was associated with a similar degree of risk reduction for cardiovascular death or hospitalization for heart failure in both men (HR, 0.81 [95% CI, 0.69-0.96]) and women (HR, 0.75 [95% CI, 0.61-0.92]) (

 for interaction=.54). Further analysis indicated sex did not modify the relationship between empagliflozin and outcomes based on baseline ejection fraction.

Additionally, investigators pointed out similar trends were observed for secondary outcomes and physiological measures. When assessing KCCQ scores, results suggested empagliflozin was associated with similar improvements in the KCCQ-CSS (men: 1.38 vs women: 1.63; 

 for interaction=.77) at 52 weeks, as well as for KCCQ-OS and KCCQ-TSS.

“Because the clinical benefits of empagliflozin in patients with HFpEF are consistent in both women and men, the decision about the use of empagliflozin in patients with HFpEF should be made independently of the patient’s sex,” investigators added.

Effects of Empagliflozin in Women and Men with Heart Failure and Preserved Ejection Fraction

This article was initially published by our sister publication Practical Cardiology.

An analysis of the landmark EMPEROR-Preserved trial is providing new insights into the effects of the SGLT2 inhibitor on heart failure outcomes based on patient sex in heart failure with preserved ejection fraction (HFpEF).

In HFpEF, empagliflozin provides similar benefit for men and women

Our sister publication, Rheumatology Network,

 interviewed Bonnie L Bermas, MD, to discuss the ways in which the Supreme Court decision to overturn Roe v Wade, a ruling that had guaranteed the right to abortion in the United States since 1973, will change the way rheumatologists are able to care for their patients. She emphasizes the negative effects this legislation will have on marginalized populations, explains how the ruling will impact pregnancy in patients with rheumatic disease, and what rheumatologists need to know moving forward. Bermas, Professor in the Department of Internal Medicine at UTSouthwestern Medical Center, co-authored the article “Overturning Roe v. Wade: Toppling the Practice of Rheumatology,” published in 

 What was the motivation for you and your team to want to address the recent decision to overturn Roe v Wade?

 We as rheumatologists, and in particular this collection of rheumatologists, amongst many other rheumatologists, have an interest in reproductive issues in our rheumatic disease patients. We think about this a lot because we care for a lot of patients who are in their reproductive health years. This ruling has tremendous impact on our patients. Our motivation was the impact it has in our patients.

 Overturning Roe v Wade will obviously affect patients with a constellation of rheumatic diseases. However, it might disproportionately affect women with lupus, who are often diagnosed in their reproductive years. What are your thoughts on how this decision might impact this particular patient population and pregnancy in general?

 We know that lupus pregnancies are high risk pregnancies, and they have a higher incidence of adverse pregnancy outcomes both amongst the mothers and the developing fetus and infant. One of the crucial things in controlling those or preventing adverse pregnancy outcomes, which can be progression of disease or an adverse pregnancy outcome in the fetus, is that the disease really needs to be under good control. And, as you know, no contraception is perfect. Inadvertent pregnancies do occur, or people will get pregnant when their disease is active. And that can be really detrimental and dangerous. The maternal mortality rate for lupus patients is during pregnancy is significantly higher than in general population.

Our patients are frequently treated with medications that can cause birth defects. And so that is another issue in terms of this rule. Also, lupus disproportionately impacts minoritized patient populations. Those patient populations, unfortunately, often live in the states that have the most restrictive abortion laws, and some of these patients may not have the resources to travel out of state if they need to have a pregnancy termination.

 What are some of the potential outcomes of this legislation on the practice of rheumatology in terms of prescribing medications and treating patients?

 That's a really important point. The first thing is that we try to encourage rheumatologists to tell their patients up front about the risks of unplanned pregnancies and emphasize the importance of contraception in women who are sexually active. We need to make sure that we're discussing this a lot with our patients.

The second thing is there are going to be providers who are possibly reticent to prescribe teratogenic medications to their patients. The 2 most common medicines that would fall under that category would be methotrexate and Mycophenolate Mofetil. Methotrexate is the first drug of choice for the treatment of inflammatory arthritis issues such as juvenile idiopathic arthritis and rheumatoid arthritis. Mycophenolate Mofetil is one of our key medications in treating lupus and lupus kidney disease. You can imagine that there will be some hesitancy in prescribing these medications. Potentially, we're talking about rheumatologists not prescribing the best medication for their patients.

 What do rheumatologists need to know moving forward?

 They need to know that pregnancy across all rheumatic diseases does best when pregnancies are planned. So that means really ramping up our understanding of what the most effective contraceptive methods are. And it is also about asking if patients are sexually active, if they're planning to get pregnant, and referring them appropriately for contraception if they're not already on contraception. Providers also need to understand which medications are teratogenic.

 Is there anything else that you would like to add before we wrap up?

 What really motivated us to write this is that this ruling is not good for patient care and it's not good for our patients. Like the vast majority of providers, we care about our patients and their wellbeing. So, it's pretty devastating to feel that there's been a politicized ruling that is going to negatively impact our ability to provide our patients with the best care.

Bonnie L Bermas, MD, emphasizes the negative effects this legislation will have on marginalized populations and explains how the ruling will impact pregnancy in patients with rheumatic disease.