Women over 40 have more options for birth control - 04/05/08

(04-05) 04:00 PDT Atlanta --

Birth control choices are wider these days for women 40 and older - a group that once viewed its options as pretty much limited to tube-tying surgery and condoms.

For them, the Pill is back. So is the IUD. Both are safer than they used to be. There's even a nonsurgical method of tube-tying.

Traditionally, women 40 and older are the least likely to use birth control. Along with adolescents, they have the highest rates of abortion. At the same time, these women are more experienced at using contraception and follow instructions better.

When it comes to contraceptives for women 40 and older, "one size definitely does not fit all," said Dr. Vanessa Cullins, vice president for medical affairs at the Planned Parenthood Federation of America.

A review of the current science of contraception and women 40 and older was published recently in the New England Journal of Medicine. The author, University of Florida gynecologist Dr. Andrew Kaunitz, noted that the risk of dangerous blood clots rises sharply at age 40 for women who take birth control pills containing estrogen. The risk is even greater for overweight women, who also are more likely to have high blood pressure and diabetes.

But the dosage of estrogen in current birth control pills has been dramatically reduced. The Pill is now considered a safe alternative for lean, healthy older women, Kaunitz and other experts said.

"It may not be well known that the current low-dose formulations are a reasonable option for healthy women in their 40s," said Dr. JoAnn Manson, a Harvard endocrinologist who wrote a book on menopausal hormone therapy.

The Pill may be preferable for some women, because it can help control irregular menstrual bleeding and hot flashes and has been shown to reduce hip fractures and ovarian cancer, wrote Kaunitz. He has received fees or grants from several companies that make oral contraceptives.

But middle-aged women who are obese, smoke, or have migraines, high blood pressure or certain other risk factors should be steered toward IUDs or progestin-only treatments like "mini-pills," experts said.

Higher breast cancer rates have been reported in older women who took estrogen-progestin pills for menopause. However, studies did not find an increased breast cancer risk in women 35 and older who took oral contraceptives.

The most common form of contraception for women 40 and older continues to be sterilization - a category that counts tubal ligations (tube-tying) in women as well as vasectomies in their male partners.

Increasingly, gynecologists are offering a newer type of tubal ligation that is nonsurgical. The procedure, called Essure, was approved by the government in 2002. Instead of cutting through the abdomen to cut and tie the fallopian tubes, a doctor works through the cervix, using a thin tube to thread small devices into each fallopian tube. These cause scarring, which in about three months plugs the tubes, stopping eggs from the ovaries from reaching the uterus.

Also relatively new is a product called Implanon, approved by the government in 2006. It's a matchstick-size plastic rod, placed under the skin of the upper arm, that is a more modern cousin of Norplant and can last about three years.

"Things have definitely changed. There are a lot more options for older women than there used to be," said Dr. Erika Banks, director of gynecology at New York City's Montefiore Medical Center.

HPV not just a threat to women - 04/02/08

While men are not typically at risk of dying or developing cancer after contracting the human papillomavirus, it is a sexually transmitted infection that demands some attention.

In 2008, about 11,070 U.S. women will be diagnosed with invasive cervical cancer, according to the American Cancer Society Web site.

"I think men are often left out of the HPV talk," said Devora Lomas, health educator for Planned Parenthood Shasta-Diablo.

HPV can not only lead to cervical cancer in women, but certain strains cause genital warts in both men and women, she said.

Lomas thinks both men and women are becoming more aware of what HPV is and the side effects, but there is still work to do, she said.

Sophomore R.J. Osborne remembers learning in high school that HPV can cause genital warts, he said. But most of his friends probably don't know what HPV is.

Because so many men and women in college have HPV, it's important for students to be informed and protect themselves, Osborne said.

"You have to wrap that shit up," he said.

But condoms aren't perfect.

Using condoms correctly can help decrease the spread of HPV, but a condom is only effective on the part of the penis that is covered, said Dr. Jeff Thomas, the Student Health Center's chief of clinical medicine.

HPV is spread through skin-to-skin contact, Thomas said. And because men can have warts not just on the penis, but in the areas above and surrounding the penis as well, condoms won't always protect against infection.

Most men and women who have HPV are not aware of it, which also contributes to the spread, he said. People usually go undiagnosed unless there are obvious signs, like external warts.

Warts can appear externally on the penis and surrounding areas, as well as both internally and externally on and around the anus and vagina, Thomas said. In extremely rare cases, usually in individuals with compromised immune systems, HPV infections can be oral.

In men with compromised immune systems, HPV can in rare cases cause penile and anal cancers, Thomas said. However, this usually occurs in men who have diseases such as HIV.

Most men and women with healthy immune systems will overcome HPV, and the infection will go away, he said. The problem is there are so many strands of HPV that it is easy to become infected again with a new sexual partner.

The Health Center saw 429 men and 641 women with genital warts from fall 2006 to spring 2007, Thomas said.

Sophomore Jesse Jansen didn't know what HPV was until he was interviewed. But he's glad he knows about it now, he said.

"They should make men more aware about HPV, just as much as with any other STD," Jansen said.

Thomas thinks most of his male patients who come in for STI exams or who are diagnosed with genital warts are knowledgeable about STIs and want to be informed, he said.

"But then again, I'm only seeing the students that come in," he said. "I don't know how much general knowledge there is out there in the student body."

Even though HPV in men is mostly manifested as genital warts, which typically go away, there is the potential of passing it to a partner, Thomas said.

It is a personal health issue for men just as much as it is a relationship issue, he said.

"It's showing a sign of respect for your partner to protect yourself and in the process protect your partner," Thomas said.

Gardasil, the same HPV vaccine available for women, is being tested on men by the Food and Drug Administration, Thomas said.

"You could come up with a good argument that since women get HPV from their partners, it would make sense if men were vaccinated, too," he said.

So far the trials are showing that Gardasil is just as effective on men as it is on women, he said. But whether the drug will be approved for men by the FDA is still up in the air.

The Health Center saw 18,011 students for STI screening tests from fall 2006 to spring 2007, Thomas said, who encourages students with questions or concerns about HPV and other STIs to visit the Health Center for more information.

"These are equal opportunity infections," Thomas said. "They don't care whether it's a man or a woman - both sexes can be infected."

Nicole Williams can be reached at
nwilliams@theorion.com

Both Planned Parenthood and the Student Health Center are resources for students who want STI screening, treatment or just have questions. Students can call the health center at 898-5241 or visit their site for further information.