Researchers have found that hormone replacement therapy in young women with primary ovarian insufficiency (POI) led to increases in their bone mineral density, restoring levels to normal.

The findings provide important treatment information for women with POI and their physicians.  Researchers at the NIH examined scans of the hip and lower spine to determine the effects of hormone treatment on bone mineral density of women with primary ovarian insufficiency.

Spontaneous POI, which affects 1 in 100 women by age 40, occurs when the ovaries stop producing sufficient estrogen in the absence of a known cause, such as anorexia, chromosome abnormality, or chemotherapy. It is typically characterized by irregular or absent menstrual cycles, hot flashes, and fertility problems. Women with POI have abnormally low levels of reproductive hormones, including estradiol, a type of estrogen produced by the ovary, as well as testosterone, a predominantly male hormone, but also produced by women in smaller amounts. They also have reduced bone mineral density, which can lead to osteoporosis and bone fractures.

“Bone mineral density is an important measure of bone health. This study showed that not only could hormone treatment reduce the rate at which women with POI lose bone mineral density, but it could actually restore bone density to normal levels,” said Dr. Lawrence M. Nelson, study author and investigator in the Program on Reproductive and Adult Endocrinology at NICHD.
The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health.

The findings were published online in the Journal of Clinical Endocrinology & Metabolism. To reach more, click HERE.

The FDA and the EPA are revising their joint fish consumption Advice and Questions & Answers to encourage pregnant women, those who may become pregnant, breastfeeding mothers, and young children to eat more fish and to eat a variety of fish from choices that are lower in mercury. This is a DRAFT for which you may provide comment. Once finalized, it will replace the current advice which was issued in 2004.

The Food and Drug Administration and the Environmental Protection Agency are issuing this advice to encourage women to eat recommended amounts and types of fish. Recent reports show many pregnant women in the United States are not consuming fish in amounts recommended by the Dietary Guidelines for Americans 2010. This advice is being issued now to encourage women who are pregnant (or may become pregnant) or breastfeeding and young children to eat more fish and to eat a variety of fish from choices that are lower in mercury. The Dietary Guidelines for Americans 2010, the federal government’s evidence-based nutritional guidance to promote healthy eating, now recommends that “women who are pregnant or breastfeeding consume at least 8 and up to 12 ounces of a variety of seafood per week, from choices lower in methyl mercury.”

There is longstanding evidence of the nutritional value of fish in the diet. Fish contain high quality protein, many vitamins and minerals, omega-3 fatty acids, are mostly low in saturated fat, and some fish even contain vitamin D. The nutritional value of fish is especially important during growth and development before birth, in early infancy for breastfed infants, and in childhood.

Download in PDF (276KB) to learn details such as what fish is safer.

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Despite the fact that fertilization requires mutual, active participation by both eggs and sperm, gender roles are often projected onto reproductive biology, leading to the portrayal of eggs as passive and sperm as active. For example, the opening credits in the 1989 movie Look Who’s Talking portray a common perception of fertilization. As the Beach Boys’ song “I Get Around” plays in the background, we see sperm inside a women’s reproductive tract moving toward her egg. The scene is narrated by one of the sperm, though we can hear some of the other sperm talking. The narrating sperm tells the others, “Ok, follow me … I know where we’re going … I’ve got the map. Follow me kids, keep up.” Upon seeing the egg, the sperm says “I think I see something … this is it, this is definitely it … jackpot!” to which another sperm relies “Yee haw!” We then see a bunch of sperm on the outside of the egg, seeking entrance through the egg membrane – a difficult task as evidenced by the lead sperm stating, “kinda tough here.” The egg then envelopes one sperm as it cries “Ohhh, ohh, I’m in, I’m in.” In this scene, the egg is portrayed as passive, merely drifting along waiting to be discovered by the sperm, whereas the sperm is active, strong, and on a mission to reach the egg.

A colleague and I were interested in seeing if this misperception of fertilization is limited to the media or if it is also seen in scientific writing. We analyzed science textbooks from the middle school to the medical school level to determine if fertilization in human reproduction is described in gender biased language regarding the sentence structure, amount of information provided for female and male processes/parts, and neutrality in describing female and male processes/parts.

Unfortunately, we found that scientific textbooks tend to present the egg and sperm in ways that align with dominant gender norms. Indeed, many textbook accounts of fertilization read like a fairy tale—specifically like a courtship or romance—with the sperm as the “knight in shining armor” and the egg as the “damsel in distress.”  We were surprised to find that gendered language was just as common at the higher levels (college and medical school) as the lower levels. In almost all textbooks, we encountered passive language to describe the egg (e.g. “the egg is fertilized” and “the egg is swept”). In contrast, sperm’s activities, including their death, were typically presented in active and often anthropomorphic terms. For example, the word “survive” was almost exclusively used for sperm, whereas the death of eggs was depicted in more scientific terms, such as “degenerate” and “disintegrate.”

At all educational levels, we found shorter explanations, fewer facts, and more misrepresentations about the female reproductive system than the male reproductive system. In particular, most textbooks had minimal information about the active role the egg plays in fertilization and limited or no information about female sexuality even when male sexuality was covered. Even those textbooks that spent more time discussing the female reproductive system often portrayed the female body negatively by selectively omitting certain facts. For instance, the majority of textbooks that described how the acidity of the vagina can deleteriously affect sperm failed to point out the ways the female body can help sperm (e.g. cervical mucus and vaginal lubrication aid in sperm transport). Additionally, the male reproductive system was subtly elevated in many textbooks by the consistent placement of male terms before female ones (e.g. “the sperm and egg” rather than “the egg and sperm”).

Endowing gametes with gendered personalities reifies gender norms, making them appear “natural” and innate. Sexist language in scientific textbooks undermines teachers’ ability to teach in an accurate and gender-neutral way. Furthermore, presenting science in a gendered way can deter girls and women from enjoying and considering a degree and/or career as a scientist. Overt sexist language and images in textbooks have been shown to have deleterious effects on both girls/women and boys/men and may reinforce the stereotype that science is just not for girls/women. In contrast, gender-neutral language in science textbooks, especially for reproductive biology, will encourage girls and women to partake in and develop an affinity for science.

Guest Blogger:  Lisa Campo-Engelstein, Ph.D.
Assistant Professor
Alden March Bioethics Institute & Department of OBGYN
Albany Medical College

Why should drugs be tested in both males and females?   Because physiological differences between males and females affect drug activity. Factors like body weight, GI motility,  intestinal enzyme activity, and kidney clearance rate affect how drugs move through the body and affect the absorption, excretion, distribution and metabolism of a drug in men and women differently.  A drug's mechanism of action may also impact men and women differently.   For example, men and women react differently to many antidepressants, antipsychotic agents, and pain killers.  Sometimes the fix is a simple change in dosage (like the FDA recommended for Ambien recently).  In other cases, the cause may be more complex due to hormonal differences, gene expression or metabolism.

In the past, even after years of testing, it was not until a drug actually got into circulation that we found out if there were sex differences (when patients reported adverse effects!).  But we hope that process will soon change.  Early this month, the NIH announced that all researchers must included both male and female cells or animals in preclinical research.   The expectation is that sex differences (or lack of differences) will be identified early in the discovery pipeline---before the drug is used in humans.  Most drugs used today were studied predominately in males.   In the long run, finding differences early will not only be cheaper, it will reduce the number of potential adverse effects in humans.

We have two standards for shoe sizing in men and women in the US and some other countries,  should we do the same for drugs???