The feminist appropriation of pregnancy testing in 1970s Britain

Jesse Olszynko-Gryn, Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK

Abstract

This article restores pregnancy testing to its significant position in the history of the women’s liberation movement in 1970s Britain. It shows how feminists appropriated the pregnancy test kit, a medical technology which then resembled a small chemistry set, and used it as a political tool for demystifying medicine, empowering women and providing a more accessible, less judgmental alternative to the N.H.S. While the majority of testees were young women hoping for a negative result, many others were older, menopausal women as well as those anxious to conceive. By following the practice of pregnancy testing, I show that, at the grassroots level, local women’s centres were in the vanguard of not only access to contraception and abortion rights, but also awareness about infertility and menopause.

… Many G.P.s also prescribed, on the N.H.S., Schering’s ‘Primodos,’ a ‘hormonal pregnancy test’ in tablet form that was less expensive and faster than ordering a urine test. The drug, which worked by inducing menstruation in non-pregnant women (a ‘negative’ result), was taken off the market in 1978 amidst concerns that it caused a variety of birth defects. Primodos Was a Revolutionary Oral Pregnancy Test: But Was It Safe?

  • … continue reading Jesse Olszynko-Gryn‘s full paper The feminist appropriation of pregnancy testing in 1970s Britain on tandfonline and/or download the PDF.
  • Featured image of the Pregnosticon Planotest credit tandfonline.

Care of girls and women with Turner syndrome

Beyond growth and hormones, 2017
A Guideline of the Turner Syndrome Study Group, 2009

Beyond growth and hormones

2017 Study Abstract

Turner syndrome (TS), although considered a rare disease, is the most common sex chromosome abnormality in women, with an incident of 1 in 2500 female births. TS is characterized by distinctive physical features such as short stature, ovarian dysgenesis, an increased risk for heart and renal defects as well as a specific cognitive and psychosocial phenotype. Given the complexity of the condition, patients face manifold difficulties which increase over the lifespan. Furthermore, failures during the transitional phase to adult care result in moderate health outcomes and decreased quality of life. Guidelines on the optimal screening procedures and medical treatment are easy to find. However, recommendations for the treatment of the incriminating psychosocial aspects in TS are scarce. In this work, we first reviewed the literature on the cognitive and psychosocial development of girls with TS compared with normal development, from disclosure to young adulthood, and then introduce a psychosocial approach to counseling and treating patients with TS, including recommendations for age-appropriate psychological diagnostics. With this work, we aim to facilitate the integration of emphasized psychosocial care in state-of-the-art treatment for girls and women with TS.

A Guideline of the Turner Syndrome Study Group

2009 Study Abstract

Objectives
The objective of this work is to provide updated guidelines for the evaluation and treatment of girls and women with Turner syndrome (TS).

Participants
The Turner Syndrome Consensus Study Group is a multidisciplinary panel of experts with relevant clinical and research experience with TS that met in Bethesda, Maryland, April 2006. The meeting was supported by the National Institute of Child Health and unrestricted educational grants from pharmaceutical companies.

Evidence
The study group used peer-reviewed published information to form its principal recommendations. Expert opinion was used where good evidence was lacking.

Consensus
The study group met for 3 d to discuss key issues. Breakout groups focused on genetic, cardiological, auxological, psychological, gynecological, and general medical concerns and drafted recommendations for presentation to the whole group. Draft reports were available for additional comment on the meeting web site. Synthesis of the section reports and final revisions were reviewed by e-mail and approved by whole-group consensus.

Conclusions
We suggest that parents receiving a prenatal diagnosis of TS be advised of the broad phenotypic spectrum and the good quality of life observed in TS in recent years. We recommend that magnetic resonance angiography be used in addition to echocardiography to evaluate the cardiovascular system and suggest that patients with defined cardiovascular defects be cautioned in regard to pregnancy and certain types of exercise. We recommend that puberty should not be delayed to promote statural growth. We suggest a comprehensive educational evaluation in early childhood to identify potential attention-deficit or nonverbal learning disorders. We suggest that caregivers address the prospect of premature ovarian failure in an open and sensitive manner and emphasize the critical importance of estrogen treatment for feminization and for bone health during the adult years. All individuals with TS require continued monitoring of hearing and thyroid function throughout the lifespan. We suggest that adults with TS be monitored for aortic enlargement, hypertension, diabetes, and dyslipidemia.

Sources

  • Care of girls and women with Turner syndrome: beyond growth and hormones, endocrine connections, 23 March 2017.
  • Care of Girls and Women with Turner Syndrome: A Guideline of the Turner Syndrome Study Group, press endocrine, January 14, 2009.
  • Image credit healthdarts.

Psychological and emotional concomitants of infertility diagnosis in women with diminished ovarian reserve or anatomical cause of infertility

Fertility and Sterility, Mental health, Volume 108, Issue 1, July 2017

2017 Study Abstract

Objective
To examine the magnitude and predictors of emotional reactions to an infertility diagnosis in two groups of women: those with diminished ovarian reserve (DOR), and those clinically diagnosed with an anatomical cause of infertility (ACI).

Design
Cross-sectional study.

Setting
Academic and private fertility clinics.

Patient(s)
Women diagnosed with DOR (n = 51) and women diagnosed with ACI (n = 51).

Main Outcome Measure(s)

Psychological and emotional concomitants of infertility diagnosis in women with diminished ovarian reserve or anatomical cause of infertility, Fertility and Sterility, Mental health, Volume 108, Issue 1, dx.doi.org/10.1016/j.fertnstert.2017.05.008, July 2017.

Image credit Petras Gagilas.

Fertility Problem Inventory (infertility distress), Rosenberg Self-Esteem Scale, Health Orientation Scale (emotional reactions to receiving a diagnosis).

Result(s)
Women with DOR had statistically significantly higher infertility distress scores than women with ACI and higher scores on subscales assessing distress from social concerns, sexual concerns, and a need for parenthood. In both groups, higher self-esteem was associated with lower infertility distress. Hierarchical multiple regression analyses revealed that for women with DOR and those with ACI lower infertility distress but not self-esteem predicted a more positive emotional reaction toward receiving a fertility diagnosis.

Conclusion(s)
Women diagnosed with DOR have greater infertility distress but similar self-esteem and emotional reactions to their diagnosis compared with women who have an anatomical cause of infertility. These results suggest that for both groups distress surrounding infertility itself may influence the way women respond to learning the cause of their infertility.

Age at Menopause : Do Chemical Exposures Play a Role ?

Environmental Health Perspectives, Charles W. Schmidt, June 2017

With its associated hot flashes, mood swings, and insomnia, menopause can be a challenging period in a woman’s life. But as much as it marks the end of her childbearing years, menopause—and more specifically the age at which it occurs—can also reflect on a woman’s overall health. An older age at menopause typically reflects good health overall, whereas early menopause—generally defined as occurring before age 40—can reflect poorer health and a greater likelihood of premature mortality.

Now, experts are taking a closer look at how environmental exposures may influence age at menopause and whether exposure-induced changes in menopausal timing put women at greater risk of associated health problems. These are early days in the field, but recent research suggesting a link between potential endocrine-disrupting compounds (EDCs) and early menopause has raised concerns over how exposures might accelerate hormonal processes involved in female aging.

“We know that going through menopause early increases the risk of osteoporosis, heart disease, and other disorders,
so the long-term health implications of early menopause are considerable.”

says Natalia Grindler, a reproductive and endocrinology fellow at the University of Colorado’s Advanced Reproductive Medicine Division.

There is still much to be learned about the toxicology underlying changes in age at menopause, and isolating chemical effects from the other varied influences that govern when a woman’s reproductive years come to an end is challenging. Nevertheless, this area of study provides a new window on population-level effects from chemical exposures that could have wide-ranging consequences.

continue reading Age at Menopause : Do Chemical Exposures Play a Role ? on Environmental Health Perspectives, by Charles W. Schmidt, 12 June 2017.

Includes:

  • Mechanisms of Menopause
  • Variations on Normal
  • Assessing the Evidence
  • A Search for Mechanisms

Download the full PDFImage credit © V. Benakis.

Postdischarge Opioid Use After Cesarean Delivery

Too Many Opioids After Cesarean Delivery

Doctors may be overprescribing opioids to women who have had cesarean sections, a new study found, and it’s not so simple as ‘just use less’, the lead author said:

”About a quarter of the women used all their pills and still reported they had pain”

2017 Study Abstract

OBJECTIVE
To characterize postdischarge opioid use and examine factors associated with variation in opioid prescribing and consumption.

METHODS
We conducted a prospective observational cohort study by recruiting all women undergoing cesarean delivery during an 8-week period, excluding those with major postoperative morbidities or chronic opioid use. Starting on postoperative day 14, women were queried weekly regarding number of opioid pills used, amount remaining, and their pain experience until they had stopped opioid medication. Demographic and delivery information and in-hospital opioid use were recorded. The state Substance Monitoring Program was accessed to ascertain prescription-filling details. Morphine milligram equivalents were calculated to perform opioid use comparisons. Women in the highest quartile of opioid use (top opioid quartile use) were compared with those in the lowest three quartiles (average opioid use).

RESULTS
Of 251 eligible patients, 246 (98%) agreed to participate. Complete follow-up data were available for 179 (71% of eligible). Most women (83%) used opioids after discharge for a median of 8 days (interquartile range 6-13 days). Of women who filled their prescriptions (165 [92%]), 75% had unused tablets (median per person 75 morphine milligram equivalents, interquartile range 0-187, maximum 630) and the majority (63%) stored tablets in an unlocked location. This amounts to an equivalent of 2,540 unused 5-mg oxycodone tablets over our study period. Women who used all prescribed opioids (n=40 [22%]) were more likely to report that they received too few tablets than women who used some (n=109 [61%]) or none (n=30 [17%]) of the prescribed opioids (33% compared with 4% compared with 5%, P<.001). The top quartile was more likely to be smokers than average users and consumed more opioid morphine milligram equivalents per hour of inpatient stay than average opioid users (1.6, interquartile range 1.1-2.3 compared with 1.0, interquartile range 0.5-1.4, P<.001).

CONCLUSION
Most women-especially those with normal in-hospital opioid use-are prescribed opioids in excess of the amount needed.

More Information
  • Postdischarge Opioid Use After Cesarean Delivery, The American College of Obstetricians and Gynecologists, doi: 10.1097/AOG.0000000000002095, June 06, 2017.
  • Too Many Opioids After Cesarean Delivery, nytimes, JUNE 14, 2017.

Phthalates and Thyroid Function in Preschool Age Children: Sex Specific Associations

Household Chemicals May Impair Thyroid in Young Girls

Early childhood exposures to specific phthalates are associated with depressed thyroid function in girls at age 3, according to a May 2017 study conducted by scientists at Columbia University’s Mailman School of Public Health. Image credit columbia.edu.

Highlights

  • In a study of inner-city mothers and their children, we measured metabolites of several phthalates in maternal prenatal urine and child urine collected at age 3.
  • We also measured serum free thyroxine and thyroid stimulating hormone in the children at age 3.
  • We found inverse and sex specific associations between specific phthalate metabolites measured in children at age 3 and free thyroxine.
  • The associations were limited to girls.
  • Maternal prenatal urine concentrations of MEHP, a metabolite of DEHP, were associated with increases in free thyroxine in children at age 3.
  • No associations were found between phthalate metabolites and thyroid stimulating hormone.

Abstract

Background
Research relating either prenatal or concurrent measures of phthalate exposure to thyroid function in preschool children is inconclusive.

Methods
In a study of inner-city mothers and their children, metabolites of di-n-butyl phthalate, butylbenzyl phthalate, di-isobutyl phthalate, di(2-ethylhexyl) phthalate, and diethyl phthalate were measured in a spot urine sample collected from women in late pregnancy and from their children at age 3 years. We measured children’s serum free thyroxine (FT4) and thyroid stimulating hormone (TSH) at age 3. Linear regression models were used to investigate the associations between phthalate metabolites, measured in maternal urine during late pregnancy and measured in child urine at age 3 and thyroid function measured at age 3.

Results
Mean concentrations (ranges) were 1.42 ng/dL (1.02–2.24) for FT4, and 2.62 uIU/mL (0.61–11.67) for TSH. In the children at age 3, among girls, FT4 decreased with increasing loge mono-n-butyl phthalate [estimated b = − 0.06; 95% CI: (− 0.09, − 0.02)], loge mono-isobutyl phthalate [b = − 0.05; 95% CI: (− 0.09, − 0.01)], loge monoethyl phthalate [b = − 0.04; 95% CI: (− 0.07, − 0.01)], and loge mono(2-ethyl-5-hydroxyhexyl) phthalate [b = − 0.04; 95% CI: (− 0.07, − 0.003)] and loge mono(2-ethyl-5-oxy-hexyl) phthalate [b = − 0.04; 95% CI: (− 0.07, − 0.004)]. In contrast, among boys, we observed no associations between FT4 and child phthalate metabolites at age 3. On the other hand, in late gestation, FT4 increased with increasing loge mono-(2-ethylhexyl) phthalate [estimated b = 0.04; 95% CI: (0.02, 0.06)] and no sex difference was observed. We found no associations between phthalate biomarkers measured in either the child or prenatal samples and TSH at age 3.

Conclusions
The data show inverse and sex specific associations between specific phthalate metabolites measured in children at age 3 and thyroid function in preschool children. These results may provide evidence for the hypothesis that reductions in thyroid hormones mediate associations between early life phthalate exposure and child cognitive outcomes.

Environmental dioxins and endometriosis

Period activists want pads and tampon makers to disclose ingredients

Who knows what chemicals and other ingredients are in (your) tampons? Many sanitary pads don’t list any ingredients at all on the package…

One longtime concern about menstrual products has been whether the process of purifying or bleaching cotton and rayon with chlorine compounds may leave worrisome traces of toxic dioxins behind. Some research in nonhuman primates has linked exposure to dioxins to endometriosis.

Abstract

Endometriosis is a common gynecologic problem of unknown etiology. Estrogen dependence and immune modulation are established features of this disease, and environmental contaminants have been suggested to play a role in the pathobiology of this disease as well.

Previous work in nonhuman primates has shown that exposure to the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is associated with an increased prevalence and severity of endometriosis. Further animal experiments have implicated dioxin and dioxin-like compounds in this disease. Rodent studies support the plausibility of a role of environmental contaminants in the pathophysiology of endometriosis, although a convincing mechanistic hypothesis has yet to be advanced.

Small hospital-based case-control studies have failed to provide compelling evidence for or against an association of environmental contaminants and endometriosis. Herein we review evidence that dioxin and dioxin-like compounds are potent modulators of immune and endocrine function critical to the pathobiology of endometriosis.

Furthermore, perspectives on the potential mechanism(s) of dioxin and dioxin-like compound-induced toxicity in endometriosis, important knowledge needs, potential animal models for endometriosis studies, and considerations integral to future human case-control studies are discussed.

Sources and Press Release
  • Environmental dioxins and endometriosis, Semin Reprod Med 2003; 21(2): 145-154, DOI: 10.1055/s-2003-41321.
  • Period Activists Want Tampon Makers to Disclose Ingredients, nytimes, MAY 24, 2017.
  • Image credit Al Drago/The New York Times – Representative Grace Meng, Democrat of New York, spoke Tuesday at a rally in Washington calling for makers of feminine hygiene products to disclose the ingredients used to make tampons and pads.

Can (Non-Ruptured) Breast Implants Give You Cancer ?

Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) — is a cancer that has affected a tiny proportion of the women who have received implants. Nearly all the cases have been linked to implants with a textured or slightly roughened surface, rather than a smooth covering. Texturing may cause inflammation that leads to cancer.

Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants

January 2011 Preliminary FDA Findings and Analyses

Executive Summary

Reports in the scientific community have suggested a possible association between anaplastic large cell lymphoma (ALCL) and breast implants. In this document we summarize the scientific data the FDA used to assess the possible association. It represents our current understanding, based on the published scientific literature on ALCL in women with breast implants and information gathered through the FDA’s contact with other regulatory authorities, scientific experts, and breast implant manufacturers. The document includes the FDA’s analyses of the data and steps we plan to take to better understand and characterize the possible association.

Although ALCL is extremely rare, the FDA believes that women with breast implants may have a very small but increased risk of developing this disease in the scar capsule adjacent to the implant. Based on available information, it is not possible to confirm with statistical certainty that breast implants cause ALCL. At this time, data appear to indicate that the incidence of ALCL is very low, even in breast implant patients. Currently it is not possible to identify a type of implant (silicone versus saline) or a reason for implant (reconstruction versus aesthetic augmentation) associated with a smaller or greater risk.

The FDA is interested in learning more about the actual incidence of ALCL in women with breast implants, the characteristics of breast implants that might increase the risk of ALCL, and the pathological characteristics and clinical features of ALCL in women with breast implants. To this end, FDA is collaborating with the American Society of Plastic Surgeons to establish a registry of cases of women with breast implants who have been diagnosed with ALCL.

Health care providers should be aware ALCL in women with breast implants is a very rare condition; when it occurs, it has been identified most frequently in patients undergoing implant revision operations for late onset, persistent seroma. The FDA does not recommend prophylactic breast implant removal in patients without symptoms or other abnormalities. Current recommendations are described below. As we learn more about ALCL in women with breast implants, these recommendations may change.

  • Consider the possibility of ALCL when you have a patient with late onset, persistent peri-implant seroma. In some cases, patients presented with capsular contracture or masses adjacent to the breast implant. If you have a patient with suspected ALCL, refer her to an appropriate specialist for evaluation. When testing for ALCL, collect fresh seroma fluid and representative portions of the capsule and send for pathology tests to rule out ALCL. Diagnostic evaluation should include cytological evaluation of seroma fluid with Wright Giemsa stained smears and cell block immunohistochemistry testing for cluster of differentiation (CD) and Anaplastic Lymphoma Kinase (ALK) markers.
  • Report all confirmed cases of ALCL in women with breast implants to the FDA. In some cases, the FDA may contact you for additional information. The FDA will keep the reporter’s and the patient’s identity confidential.
  • Develop an individualized treatment plan in coordination with the patient’s multi-disciplinary care team. Because of the small number of cases worldwide and variety of available treatment options, there is no single defined consensus treatment regimen.

Some researchers have suggested that breast implant-associated ALCL may represent a new clinically entity with less-aggressive (indolent) behavior (Li, 2010; Miranda et al, 2009; Thompson et al, 2010). Because of the small number of cases and the short median duration of follow-up, the FDA believes it is premature to draw conclusions regarding the prognosis of ALCL in women with breast implants.

Because the risk of ALCL appears very small, FDA believes that the totality of evidence continues to support a reasonable assurance that FDA-approved breast implants are safe and effective when used as labeled.

More Information
  • A Shocking Diagnosis: Breast Implants ‘Gave Me Cancer’, NYtimes, MAY 14, 2017.
  • Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants: Preliminary FDA Findings and Analyses, FDA, January 2011.
  • Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), FDA, Last Updated: 03/23/2017.
  • Questions and Answers about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), FDA, Last Updated: 03/21/2017.

Can hormone replacement therapy increase the risk of hearing loss ?

The link between menopausal age, the use of oral hormonal therapy, and hearing loss

New research suggests that hormone therapy increases the risk of hearing loss among menopausal and postmenopausal women.

2017 Study Abstract

Objective

Menopause and postmenopausal hormone therapy and risk of hearing loss, menopause journal, doi: 10.1097/GME.0000000000000878, May 8, 2017.

medical news today,  articles/317387, May 10, 2017.

Image credit anthonymedicalcare.

Menopause may be a risk factor for hearing loss, and postmenopausal hormone therapy (HT) has been proposed to slow hearing decline; however, there are no large prospective studies. We prospectively examined the independent relations between menopause and postmenopausal HT and risk of self-reported hearing loss.

Methods
Prospective cohort study among 80,972 women in the Nurses’ Health Study II, baseline age 27 to 44 years, followed from 1991 to 2013. Baseline and updated information was obtained from detailed validated biennial questionnaires. Cox proportional-hazards regression models were used to examine independent associations between menopausal status and postmenopausal HT and risk of hearing loss.

Results
After 1,410,928 person-years of follow-up, 18,558 cases of hearing loss were reported. There was no significant overall association between menopausal status, natural or surgical, and risk of hearing loss. Older age at natural menopause was associated with higher risk. The multivariable-adjusted relative risk of hearing loss among women who underwent natural menopause at age 50+ years compared with those aged less than 50 years was 1.10 (95% confidence interval [CI] 1.03, 1.17). Among postmenopausal women, oral HT (estrogen therapy or estrogen plus progestogen therapy) was associated with higher risk of hearing loss, and longer duration of use was associated with higher risk (P trend < 0.001). Compared with women who never used HT, the multivariable-adjusted relative risk of hearing loss among women who used oral HT for 5 to 9.9 years was 1.15 (95% CI 1.06, 1.24) and for 10+ years was 1.21 (95% CI 1.07, 1.37).

Conclusions
Older age at menopause and longer duration of postmenopausal HT are associated with higher risk of hearing loss.

Could Birth Control Pills Make You Feel Bad ?

It’s Not in Your Head: Your Birth Control Pills Might Be Making You Feel Crappy

A new study found that oral contraceptives lowered women’s quality of life. The average decrease was small, but for certain women the effects could be significant, researchers say.

2017 Study Abstract

Objective
To determine whether there is a causal effect of oral contraceptive (OC) treatment on general well-being and depressed mood in healthy women.

Design
Double-blind, randomized, and placebo-controlled trial.

Setting
University hospital.

Patient(s)
Three hundred and forty healthy women aged 18–35 years randomized to treatment, of whom 332 completed the data collection at follow-up evaluation.

Intervention(s)
A combined OC (150 μg levonorgestrel and 30 μg ethinylestradiol) or placebo for 3 months of treatment.

Main Outcome Measure(s)
Primary outcome measures: global score of Psychological General Well-Being Index (PGWBI) and the Beck Depression Inventory (BDI); secondary outcome measures: six separate dimensions of the PGWBI.

A responsible physician should warn their patients that some women generally don’t feel well on the pill and, if this turns out to be the case, alternatives are available.

Result(s)
The OC treatment statistically significantly decreased general well-being compared with placebo −4.12 (95% CI, −7.18 to −1.06). Furthermore, OC decreased the following PGWBI dimensions compared with placebo: positive well-being −3.90 (95% CI, −7.78 to −0.01), self-control −6.63 (95% CI, −11.20 to −2.06), and vitality −6.84 (95% CI, −10.80 to −2.88). The effect of OC on depressive symptoms and on the PGWBI dimension depressed mood were not statistically significant.

Conclusion(s)
This study demonstrates a statistically significant reduction in general well-being by a first-choice OC in comparison with placebo in healthy women. We found no statistically significant effects on depressive symptoms. A reduction in general well-being should be of clinical importance.

Sources and Press Releases
  • A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial, Fertility and Sterility, dx.doi.org/10.1016/j.fertnstert.2017.02.120, April 19, 2017.
  • It’s Not in Your Head: Your Birth Control Pills Might Be Making You Feel Crappy, health, April 20, 2017.
  • The Pill image credit Sarah C.