Heart disease is the leading cause of death among women, and evidence-based national guidelines promote the use of daily aspirin for women at increased risk for cardiovascular disease. However, less than half of the women who could benefit from aspirin are taking it, according to an article  available free online at the Journal of Women's Health website*.

"Based on this survey, it is evident that the majority of women for whom aspirin is recommended for prevention of cardiovascular disease are not following national guidelines," says Susan G. Kornstein, MD,  Executive Director of the Virginia Commonwealth University Institute for Women's Health.

Among more than 200,000 women participating in a web-based survey to assess their risk for cardiovascular disease, only 41%-48% of women for whom aspirin is recommended reported that they took an aspirin daily, according to the study authors, Cathleen Rivera, MD and Texas-based colleagues. The women were more likely to use aspirin if they had a family history of cardiovascular disease or had high cholesterol, as reported in the article "Underuse of Aspirin for Primary and Secondary Prevention of Cardiovascular Disease Events in Women." The authors conclude that improved educational programs are needed to increase awareness of the benefits of aspirin use to prevent heart disease among women.

References:
Mary Ann Liebert, Inc./Genetic Engineering News  "Should More Women Take A Daily Aspirin To Prevent Heart Disease?." Medical News Today. MediLexicon, Intl., 9 Apr. 2012. Web.
12 Apr. 2012.

A migraine is the most common type of headache that propels patients to seek care from their doctors. Roughly 30 million Americans suffer from migraine headaches, with women affected almost three times more often than men, according to statistics from the National Headache Foundation in Chicago. Today's blog incorporates  an article by Jennifer Wider, MD of the Society for Women's Health Research.

"Hormonal changes are a big contributor to the higher female incidence,” said Michael A. Moskowitz, MD, Professor of Neurology at Harvard Medical School at the Massachusetts General Hospital in Boston. “There are lines of evidence that support this from lab to clinical evidence and a decrease (although not abolished) incidence in post-menopausal females.”

Migraine headaches can vary from person to person, but they typically last from four hours up to 72 hours. Some people get them several times per month, while others experience them much less frequently. Many migraine sufferers report throbbing or pulsating pain on one side of the head, blurred vision, sensitivity to light and sound, nausea, and vomiting.  Roughly one in five migraine sufferers experience an aura, or visual or sensory disturbance, before the onset of the headache. Examples of an aura include: flashes of light, loss of vision, zig-zag lines, pins and needles in an arm or leg, and speech and language problems.

Several risk factors have been identified that increase a person’s chance of having migraines:

• Family history: A significant majority of migraine sufferers have a family history of migraine attacks. For a person who has one or more first-degree relatives with migraine headaches, the likelihood rises substantially.

• Age: Migraines typically affect people between the ages of 15-55. Most people have had their first attack by 40 years old.

• Gender: Women are more likely to suffer from migraines than men.

• Certain medical conditions: depression, anxiety, stroke, epilepsy, and high blood pressure are all associated with migraine headaches.

• Hormonal changes: Women who suffer from migraines often find that the headaches have a pattern of recurrence just before or shortly after the onset of menstruation. The headaches may also change during pregnancy and/or menopause.

Migraines are vascular headaches but the exact cause is not fully understood. Some researchers believe that migraines occur when there are abnormal changes in the brain. When these changes occur, inflammation causes blood vessels to swell and press on nerves, which can result in pain.

Researchers have learned that certain triggers can set off migraine attacks. These triggers vary from person to person and can include: sleep disturbances, stress, weather changes, low blood sugar, dehydration, bright lights and loud noises, hormonal changes, foods that contain aspartame, foods that contain tyramine (fava beans, aged cheeses, soy products, etc.), caffeine, and alcohol.

Unfortunately, migraines have no known cure, but they can be managed effectively with the help of a health care provider. A variety of drugs can be used for pain relief and for prevention. Lifestyle changes are often recommended to identify and eliminate possible triggers that can set off an attack.

“Until recently there have been no treatments available to treat people who suffer from chronic migraines,” said Moskowitz. However, she does mention that BOTOX has been helpful in some cases as was discussed in one of our earlier blogs. Chronic migraine sufferers have also found relief in certain vitamins and other homeopathic remedies. But patients should check with their doctors for proper treatment protocols.
Jennifer Wider, MD
SWHR, Contributing Writer

Spending time on a bicycle seat, which has been linked to erectile dysfunction in men, may also be a hazard to a woman’s sexual health, a new study shows.

Many women who cycle or take spin classes are familiar with the numbness that sometimes can occur from sitting on a traditional bike seat. Bike seats are designed in such a way that body weight typically rests on the nose of the seat, which can compress nerves and blood vessels in the genital area. In men, this raises the risk of erectile dysfunction, something that has been documented in studies of male police officers on bicycle patrol.

But female cyclists have not been studied as closely. A study by Yale researchers in 2006 found that female cyclists had less genital sensation compared with a control group of female runners. As a result, some scientists believe that female cyclists probably are at similar risk for sexual problems as male riders.  In the latest study, the Yale researchers tried to determine whether there are specific factors that influence soreness and numbness among female riders. Forty-eight women took part in the study, each a consistent rider who cycled a minimum of 10 miles a week, but typically much more. The researchers mounted the women's bikes on a stationary machine in their lab and observed the women's biking positions.  It was the position of the handlebars that seemed to have the most effect. Women on bikes with handlebars positioned lower than their seats experienced more pressure in an area of soft tissue called the perineum, and had decreased sensation in the pelvic floor.

The researchers found that the lower the handlebars in relation to the saddle, the more a woman has to lean forward, forcing her to put a greater percentage of her body weight on the perineum. This problem is particularly likely to occur when a rider leans forward, flattens her back and puts her hands on the “drop bars” of a road or track bicycle for a more aerodynamic position.

“We’re basically showing that there may be modifiable risk factors associated with female riders,” said Dr. Marsha K. Guess, an author of the study and an assistant professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine. “This better positions us to educate riders on safe riding practices that may actually be beneficial to reduction of pressure and lost sensation in the pelvic floor.”

The findings, published online in The Journal of Sexual Medicine, help shed further light on the problems faced by female riders but more study is needed.

Women take longer to give birth today than did women 50 years ago, according to an analysis of nearly 140,000 deliveries conducted by researchers at the National Institutes of Health.

The researchers compared data on deliveries in the early 1960s to data gathered in the early 2000s. They found that the first stage of labor had increased by 2.6 hours for first-time mothers. For women who had previously given birth, this early stage of labor took two hours longer in recent years than for women in the 1960s. The first stage of labor is the stage during which the cervix dilates, before active pushing begins.

Infants born in the contemporary group vs those from the 1960s

• Tended to weigh more
• Were born 5 days earlier, on average

Women today vs the 1960s

• Weighed more
• Were, on average, four years older at the time of birth

The women in the contemporary cohort had an average pre-pregnancy Body Mass Index  of 24.9. A BMI of 25 is considered overweight. Overweight and obesity raise the risk of pregnancy complications for mother and baby. Women who are overweight or obese and who would like to become pregnant should speak with their health care provider about losing weight before becoming pregnant.“Older mothers tend to take longer to give birth than do younger mothers,” said the study's lead author, S. Katherine Laughon, M.D., of the National Institute of Child Health and Human Development (NICHD). “But when we take maternal age into account, it doesn't completely explain the difference in labor times.”

Changes in delivery practice the researchers found included an increase in the use of epidural anesthesia (half of recent deliveries, compared with 4 percent of deliveries in the 1960s.) Doctors in the early 2000s also administered the hormone oxytocin more frequently (in 31 percent of deliveries, compared with 12 percent in the 1960s), the researchers found. Oxytocin is given to speed up labor, often when contractions seem to have slowed. "Its use should be expected to shorten labor times, " Dr. Laughon explained, “ and without it, labor might even be longer in current obstetrics than what we found".

Other differences between the two groups reflect changes in later stage delivery practices. For example, in 1960s-era deliveries the use of episiotomy (surgical incision to enlarge the vaginal opening during delivery), and the use of forceps, surgical instruments used to extract the baby from the birth canal, was notably more common than they are today.

In current practice, doctors may intervene when labor fails to progress. This could happen if the dilation of the cervix slows or the active phase of labor stops for several hours, Dr. Laughon explained. In these cases, intervention can include administering oxytocin or performing a cesarean delivery.

In fact, the study found that the rate of cesarean delivery was four times higher today than it was 50 years ago (12 percent vs. 3 percent).

The authors note that while their study does not identify all the factors contributing to longer delivery times, the findings do indicate that current delivery practices may need to be re-evaluated.The study authors called for further research to determine whether modern delivery practices are contributing to the increase in labor duration.

Their analysis was published online in the American Journal of Obstetrics and Gynecology.