FDA panel recommends approval of 5-day 'morning after' pill

A Food and Drug Administration advisory panel Thursday recommended that the agency approve a "morning after" pill that is effective for five days after unprotected sex, providing an alternative to existing drugs that can be used only for three days. The agency is not required to follow the advice of its advisory panels, but usually does.

The new drug, whose proposed brand name is ella, is already marketed in Europe as ellaOne. It blocks the effect of progesterone, a female hormone that spurs ovulation. There has been spirited debate about whether the drug simply blocks ovulation or, because it is related to the abortion drug RU-486, whether it actually produces an abortion. The Washington Post and the New York Times have outlined the parameters of the debate.

The agency has set no timetable for a decision. The drug will most likely be available only by prescription, at least initially.

-- Thomas H. Maugh II

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Book Review: 'The Strong Women's Guide to Total Health' by Miriam E. Nelson and Jennifer Ackerman

Although men may have more heart attacks, more women die as a result of them. Women have stronger immune responses  --  with increased resistance to many infections -- but are much more likely than men to develop autoimmune diseases. Men are more likely to have schizophrenia and alcohol and drug addiction, whereas women have more depression, anxiety and eating disorders. 

Those are just some of the ways women's health differs from men's, according to Miriam E. Nelson and Jennifer Ackerman, authors of "The Strong Women's Guide to Total Health."

"Our gender affects everything from the makeup of our bones and the architecture of our joints, to our skin's response to sunlight and aging, to how we experience pain, react to drugs, and cope with stress," they write.

Until fairly recently, medical researchers considered men's bodies the prototype for both genders. But today women are more than half of participants in health studies, and researchers are looking closely at illnesses affecting mostly them, Nelson and Ackerman write. 

In fact, there is so much health information available to women -- much of it contradictory -- that it can get confusing.

That's where "Strong Women's Guide" comes in. The book aims to summarize the latest thinking on women's health and offer "basic, reliable guidelines for staying well in body, mind and spirit."

And it appears to do so remarkably well considering the range of topics it covers, including reproductive and sexual health; skin, teeth, hair and nails; body weight and metabolism; muscles, bones and joints; the heart and lungs; cancer and disease; vision and hearing; and mental health.

Nelson -- the director of the John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention and an associate professor of nutrition at Tufts University -- has gained a following with earlier "Strong Women" books on topics such as weight control and bone health. Ackerman is a science and health writer and the author of several other books, including "Sex Sleep Eat Drink Dream."

Their new book is not the place you would go for in-depth coverage of a specific health topic, but it offers solid overviews, useful advice and quite a bit of up-to-date detail. 

The section on birth control, for example, looks at the varied oral contraceptives available today, including a spearmint-flavored chewable pill, the three-month combination pill, the mini-pill, the "no more period" pill and other hormonal options such as a skin patch and injections. The chapter on menopause sorts through recent research findings on hormone therapy and summarizes the options for easing symptoms. A discussion of heart disease details the symptoms unique to women and tells what to look for in cholesterol, triglyceride and blood pressure screenings.

The writing is intelligent, accessible and sometimes personal; amid the matter-of-fact health discussions are anecdotes such as one in the sexuality chapter that describes a nervous first-time trip to a sex-toy boutique. A chapter on changing habits includes a story about how a colleague once chastised Nelson for not practicing what she preached about exercise -- a comment that prompted her to start running regularly to train for the Boston Marathon.

"Strong Women's Guide" is as much a how-to health book as it is a medical reference work. It starts with a health self-assessment section that looks at everything from body mass index to joy quotient. Sprinkled throughout the book are checklists of ways to protect or improve health. The book ends with chapters on managing stress and sleeping well, eating and exercising right and getting the proper screenings, tests and vaccines at every age.

-- Anne Colby

Photo: "The Strong Women's Guide to Total Health," Miriam E. Nelson and Jennifer Ackerman, Rodale Books, $27.99 

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Emergency contraception might offer peace of mind, doesn't change big picture

Women with a stash of emergency contraceptives likely would have lower pregnancy rates, one might think, as they wouldn't be faced with the sometimes overly daunting task of trying to find the medications when time is of the essence. Those same women also might be more likely to engage in unprotected sex, similar thinking might hold, as they wouldn't have to worry about at least one reason for using condoms.

But such thoughts would be incorrect, says a featured research review from the Cochrane Library.

Here's the summary. It notes that women with emergency contraception on hand are more likely to use the drugs, yes, but widespread effects are hard to find.

In another featured research review: Antidepressants can effectively treat depression in physically ill people.

Duh, you say?

Maybe. The point is, in analyzing the data, sometimes researchers get expected results; sometimes they get unexpected results. The risk comes from assumptions beforehand. The Cochrane Reviews help separate assumptions from evidence.

Read more about the reviews here. Then take a spin through the library. You never know what assumption-busting results you may find.

-- Tami Dennis

Photo: Emergency contraception, shown here in one of its forms, can be hard to get when women most need it. 

Credit: AFP / Getty Images

Emergency contraception is more varied than you might think

Making headlines today is a new study in the Lancet comparing the emergency contraceptives ulipristal acetate and levonorgestrel. Note, however, that the former is approved in the United Kingdom, but not in the U.S. The latter is a form of the hormone progestin, which is approved here.

 

Here's the summary from the medical journal. And here's a nice analysis of the study from the Guardian in the U.K. 

 

The study serves as a reminder that emergency contraception is not just the "morning-after pill," often sold as Plan B. It can take a variety of medication forms.

 

Here's a comparison of the drugs used in this country -- and elsewhere around the globe -- for emergency contraception. Many of them are also prescribed for routine contraceptive purposes. Here's a specific explanation of how those pills are used. The information is from the Office of Population Research at Princeton University.

 

-- Tami Dennis

 

 

Can condoms combat climate change?

Yes, and they should, argues an editorial in the new issue of the medical journal the Lancet.

In addition to boosting the health, standard of living and human rights of women, encouraging the use of contraception also will help save the planet, the journal argues. The calculus is simple: preventing unwanted pregnancies -- especially in the developing world -- translates into reduced demand for increasingly scarce and energy-intensive resources like food, water and shelter.

More than 200 million women around the world would like access to modern contraception, and their lack of it leads to 76 million unintended pregnancies each year, according to Lancet.

Thomas Wire, a postgraduate student at the London School of Economics, came to essentially the same conclusion last week. In a report titled “Fewer Emitters, Lower Emissions, Less Cost,” Wire calculated that if present trends continue, the planet is on track to have 338 billion “people-years” lived between 2020 and 2050. But if contraception were available to every woman who wanted it, so many pregnancies would be averted that the number of people-years would fall to 326 billion.

That reduction of 12 billion people-years would save 34 gigatons of carbon dioxide that would otherwise cost at least $220 billion to produce. In other words, each $7 invested in contraception would buy more than 1 ton of carbon dioxide emissions.

Among the first 40 developing countries to submit global warming adaptation plans to the U.N.  Framework Convention on Climate Change, 37 linked population growth to global warming. But only six of those countries incorporated contraception into their plans, according to Lancet. That should change, the editorial says.

“It is time for the sexual and reproductive health community to use the climate change agenda to gain the traction women’s health deserves,” Lancet says.

-- Karen Kaplan

Photo: A powerful weapon in the fight against global warming. Credit: Bryan Chan / Los Angeles Times

Birth control pill decreases urinary incontinence

Premenopausal women who take oral contraceptives have lower rates of urinary incontinence compared with women who use other forms of contraception, according to a study published in the new issue of Fertility and Sterility, the journal of the American Society for Reproductive Medicine.

The study suggests that the hormones in the pill have a positive influence on vaginal connective tissues, blood flow and skin thickness. Previous studies, such as the Women's Health Initiative, have found that hormones worsen symptoms of urinary incontinence. But, this study suggests, younger women react differently to hormone exposure.

The study, from Sweden, examined the relationship between oral contraceptive use and urinary incontinence while controlling for other factors such as body mass index, age and history of pregnancy. Though the pill was helpful in preventing symptoms, the study found that women who use a hormone-releasing intrauterine device did not have lower rates of incontinence compared with women who don't use hormonal contraceptives.

Doctors should consider the pill to treat premenopausal women with urinary incontinence, although more studies are needed on just how much effect hormones might have on the disorder, the authors said.

"With so many women using oral contraceptives, it is vital that we continue to fully understand their non-contraceptive effects, both positive and negative," Dr. Dale McClure, president of the American Society for Reproductive Medicine, said in a news release.

-- Shari Roan

Photo: Associated Press