Medical Monday: Breaking News from the World of Obstetrics and Gynecology

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As reported last week, many States are starting to push back against the defunding of teen pregnancy prevention programs in their states. The latest such example is Minnesota, where in Hennepin County, HHS (Department of Health and Human Services) terminated a $214 million teen pregnancy prevention program. The grant had originally been obtained to last through 2020 and was cut as of 2018, and the suit filed asks that it be reinstated until 2020 again. Texas’ Teen Pregnancy Prevention Program is called Healthy Futures of Texas, and its Title X funds are slated to be cut. However, This organization and other Texas grant recipients are filing lawsuits to discontinue the termination of their grants. 

Title X is a federal grant program dedicated solely to providing funds for birth control and family planning. The Trump administration governs the awarding of such grant money. Of late, they have shifted their funding criteria to favor those organizations which promote abstinence rather than evidence based birth control. Several chapters of Planned Parenthood and the National Family Planning and Reproductive Health Association have filed suit against the Trump administration alleging that this strategy violates the mission statement of Title X. 

During the recent years of the Trump administration, the number of uninsured Americans rose by 4 million. These are those who slip through the cracks between the Affordable Care Act plans and private insurance, with a single income of $30,000 and a joint family income of about $61,000. The data comes from the Commonwealth Fund who warned that this trend is likely to continue. 


We have known for some time now that women have been concerned about contraceptive access ever since Trump was elected. Long acting reversible contraceptives (LARCs) have been the strategy for many women. In one particular study out of UCLA David Geffen School of Medicine, uptake of LARCs nearly doubled in the two weeks following the election. 

All kinds of stereotypes exist about older people. Some have to do with sexual activity. A new study has shown that 40% of people ages 65-80 are sexually active, and of those, 73% are satisfied with their sex lives. In the subgroup of those with spouses or partners, a little over half are sexually active. Caregivers need to continue to bear all this in mind. 

ACOG (American College of Obstetricians and Gynecologists) recently held its annual meeting. One presenter there highlighted the medical benefits of vibrators, and called upon Gynecologists to identify patients who might benefit from them, and initiate discussions which normalize their use. 

ACOG president Dr. Hal Lawrence has termed the current health care climate a “battle” and “ one that is not going to end anytime soon”. They have called it a “fight to protect women’s health care”. The ACOG president has highlight the advocacy efforts of the organization this past year, along with like minded others, the “Gang of Six” consisting of  internists, pediatricians, family doctors, psychiatrists, ob/gyns, and osteopaths. 

Menopause. It is the cessation of ovarian function and all that results from that. We cease to ovulate and become infertile. Then our hormone production quits, and we may have symptoms of estrogen deprivation, like hot flashes and vaginal dryness. The average age of menopause is 51, but the range is considerable and it takes about two years to get completely through. A new study has highlighted a little know fact, that women with a poor diet, i.e. diets high in refined carbohydrates, get menopause much sooner than those with high quality diets, such as those with lots of whole foods and fish. 

The postpartum period or so called fourth trimester, is getting some much needed attention. A new study has illuminated the prevalence of perinatal depression. Turns out it affects 1 in 7 women. Indeed, a related study found that maternal suicide takes more women than hemorrhage and hypertensive disorders combined, and accounts for 1 in 5 postpartum deaths. The study has also shown that only about a fourth of postpartum moms suffering from depression get treatment. Both the US Preventive Services Task Force and ACOG recommend mental health screening during pregnancy. Pregnant moms take note: Your postpartum visit should cover mood, emotions, infant care, sexuality , contraception, sleep, and health maintenance, to name a few. 

The opioid crisis has brought many problems for pregnant women and their children. However, one such problem can go under the radar: Hepatitis C.The opioid epidemic is driving an increase in Hepatitis C among mothers and children and neither the screening protocols for mothers or infants has kept up. Hepatitis C is transmitted by blood, and thus by needles, and infrequently, from mother to child. There is no vaccine, but just recently, there is a fairly good treatment. 

Stay tuned for more news from the intense world of Obstetrics and Gynecology, here, next week, on Medical Monday. 

Medical Monday: Menopause, A Philosophical Introduction

It's cool to be hot in menopause. 

It's cool to be hot in menopause. 

The average lifespan in the United States in the year 1900 was about 51, and in 1800 it was 39. The average age of menopause is about 51. Thus, in all of human history, menopause is a relatively new life stage. Most women simply did not live long enough to reach it, and those that did , did not spend much time in it. 

Currently, the average lifespan for a women in the United States is 81. It is interesting to think about what may explain this. I think we have nutrition and health care to thank. As we were, before the modern age, we were able to reproduce for the majority of our lifespan. Could it be that we are outliving our design ? Or could it be that our nutrition and health have unlocked heretofore unexpressed genetic potential for long life? Either way, a modern woman will spend nearly 40% of her life in menopause, and this percentage will only increase as lifespan increases. Moreover, the number of people in menopause will increase as the population ages. 

In the developed world, we can now eat a scientifically based, nutritionally optimal meal 365 days per year. We can do evidence based physical activities that counteract the physical deteriorations of age, such as fat deposition, bone density loss, and muscle loss.

Menopause is no longer a thing to be dreaded. Menopause is life cycle phase like adolescence and pregnancy, and people deserve support during such times. As an Ob/Gyn, I rely on a constantly improving body of data and recommendations about the care of menopausal women. They involve increased surveillance in the form of mammograms, bloodwork, bone scans, colonoscopy and the like. We evaluate and make recommendations about enhanced nutrition, specialized supplements, tailored fitness training, and yes, medications including hormones, all in the service of optimal health. 

Older women should take note, and see that they are up to date on their health care. Younger women should picture themselves how they would like to be in menopause. 

Stay tuned as we devote a few Medical Mondays to menopause, an increasingly important topic.