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The morning-after pill may help shrink painful fibroids and relieve excessive bleeding, new research indicates.Fibroids are benign tumors that form on the wall of a woman’s uterus; as many as 80 percent of all women may have fibroids. Many cause no symptoms, but one in four women experiences symptoms that are severe enough to require treatment, according to the National Uterine Fibroids Foundation. Symptoms may include heavy periods, anemia, bloating, constipation, infertility and miscarriage. Treatment may involve surgery to remove the uterus and/or hormone treatments such as Lupron (leuprolide) or oral contraceptives.Now, two new studies in the New England Journal of Medicine suggest that the ‘morning-after’ pill Ella (ulipristal) works just as well as Lupron in treating fibroid-linked uterine bleeding, with less risk of hot flashes. The new studies were funded by PregLem, which markets a form of ulipristal acetate called Esmya.The drug, used as an emergency contraceptive to prevent pregnancy when taken within five days of unprotected sex, lowers levels of the hormone progesterone, which feeds fibroids.In one study, women with fibroids who took 5 milligrams (mg) or 10 mg of Ella for 13 weeks had less bleeding and their fibroid shrank when compared to women who took a placebo. A second study showed that women who took either dose of Ella were less likely to have hot flashes than women who received injections of Lupron. Both studies were conducted by researchers from the Cliniques Universitaires Saint-Luc Catholic University of Louvain, in Brussels.”Clearly women with fibroids need more alternatives to hysterectomy, especially as they pursue educations and working and not having children until after they have developed fibroids,” said Dr. Elizabeth Stewart, a reproductive endocrinologist at the Mayo Clinic in Rochester, Minn. who wrote an editorial accompanying the new studies. “Surgical solutions are not ideal, so we need more medical treatments. This study suggested that these drugs work equivalently to our standard medical treatment for fibroids and what I am hoping is that future studies will confirm this. Women could then take a drug like this for three months and then come off.”One of the concerns with Ella was that the medication caused worrisome, potentially precancerous changes in the lining of the uterus. These changes appear to be reversible, Stewart said. “If you can reverse these changes and keep your symptoms under control, this treatment can be used in the long term.”Dr. Micheline Chu, director of the recurrent pregnancy loss program at the Center for Human Reproduction at North Shore University Hospital in Manhasset, N.Y., said there may be a role for this pill in certain women with fibroids. Lupron puts people in to a premature medical menopause, can’t be taken indefinitely due to side effects, and when you stop talking it, the fibroids grow back. Chu often prescribes Lupron to women to reduce the size of their fibroid before surgery. “This pill is better for the type of person who is done having kids and is bothered by fibroids or bleeding,” she said. “It can offer a long-term fix for these women.”Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital in New York City, said that a new way to treat fibroids is needed. “A lot of our prescription medications don’t work so well for fibroids, so I see a great role for this medication,” she said. “It is a potential long-term treatment for women who want to avoid surgery.”
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The German chemical and pharmaceutical company Bayer faces a US lawsuit on behalf of a teenager who died from a blood clot allegedly linked to its YAZ contraceptive.
Michelle Pfleger, an 18-year-old college student in North Carolina, died of cardiac arrest last September after taking YAZ, also known as Yasmin or Ocella, to treat acne, according to the complaint filed on Tuesday.
“One day she was a freshman at college so full of hope and promise and the next she was gone,” Pfleger’s mother, Joan Cummins said.
“I can only hope that by publicizing what happened to Michelle, I can keep another family from having to go through this.”
The family’s attorney, Wendy Fleishman called YAZ a “a dangerous prescription drug sold without adequate warnings about the risks of serious and fatal injuries.”
“Bayer failed to warn doctors and patients that YAZ poses a greater risk of serious side effects than previous generations of oral contraceptives,” she added.
Last month two studies in the British Medical Journal found that drugs like YAZ and Yasmin — which contain the hormone drospirenone — increase the risk of serious blood clots three-fold or two-fold compared to earlier-generation oral contraceptives.
Bayer criticized the results of the studies at the time, insisting that side effects were rare.
The official YAZ website says the drug is associated with “increased risks of several serious side effects, including blood clots, stroke, and heart attack.”
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LONDON – For men with fertility problems, some doctors are prescribing a very conventional way to have a baby: more sex.
In a study of 118 Australian men with damaged sperm, doctors found that having sex every day for a week significantly reduced the amount of DNA damage in their patients’ sperm. Previous studies have linked better sperm quality to higher pregnancy rates.
The research was announced Tuesday at a meeting of the European Society of Human Reproduction and Embryology in Amsterdam.
Dr. David Greening of Sydney IVF, a private fertility clinic in Australia, and colleagues looked at 118 men who had damaged sperm. Greening and colleagues told the men to have sex every day for a week. After seven days, the doctors found that in 81 percent of the men, there was a 12 percent decrease in the amount of damaged sperm.
Many fertility experts suggest men abstain from sex before their partners have in-vitro fertilization, to try to elevate their sperm counts.
Sperm quality can also be improved if men don’t smoke, drink moderately, exercise, or get more antioxidants.
Since concluding the study, Greening says he now instructs all couples seeking fertility advice to start by having more sex. “Some of the older men look a little concerned,” he said. “But the younger ones seem quite happy about it.”
Experts think sex helps reduce the DNA damage in sperm by getting it out of the body quickly; if sperm is in the body for too long, it has a higher chance of getting damaged.
Some experts said that while Greening’s research is promising, it doesn’t prove that daily sex for men with fertility problems will actually produce more babies.
Greening said he and his colleagues are still analyzing the study data to determine how many women got pregnant.
“Looking at sperm DNA is just one part of the puzzle,” said Bill Ledger, a professor of obstetrics and gynecology at the University of Sheffield, who was not connected to the research. “Maybe this will improve pregnancy rates, but we still need to do more studies.”
Ledger said instructing couples with infertility problems to have more sex could stress their relationship. “This may add even more anxiety and do more harm than good,” he said. He said couples shouldn’t feel pressured to adjust their sex lives just for the sake of having a baby.
Greening said the study’s findings were ultimately very intuitive. “If you want to have a baby, our advice is to do it often.”
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NEW YORK (Reuters Health) – Women who suffer from depression after giving birth can often be helped with antidepressants, and when treatment is successful it usually improves sexual problems.
In the Journal of Clinical Psychiatry, Dr. Katherine L. Wisner, of the University of Pittsburgh Medical Center, Pennsylvania, and colleagues report their assessment of sexual problems in women diagnosed with postpartum depression. The information was drawn from an 8-week study comparing the antidepressants nortriptyline (for example, Sensoval, Aventyl) and sertraline (Zoloft, Lustral) for postpartum depression in 70 women.
At the start of the study, 73 percent of women reported problems in at least three areas of sexual function. By week 8, this number had fallen to 37 percent, and women whose depression resolved were more likely to report fewer concerns about sex drive, sexual arousal, and reaching orgasm than those whose depression did not remit, regardless of which antidepressant they received, according to the researchers.
The investigators point out that for new mothers with depression and sexual problems, prior research has shown that recovery depends not only on relieving the depression but also on the time it takes for tissues around the vagina to recover from the stress of childbirth.
In the current study, however, the decrease in sexual concerns was specifically linked with improvements in depression rather than with the passage of time, according to the article.
The lack of a specific association with either nortriptyline or sertraline suggests that it does not matter how the depression is addressed, only that it is relieved, the authors note.
SOURCE: Journal of Clinical Psychiatry, March 2009.
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