But 55-percent of all strokes and 60-percent of stroke deaths occur in women.

About 100,000 women die annually of stroke, 40,000 more than the number of men who die from it. The fact that risk goes up with age and women live longer account for a large portion of that difference.

Strokes can affect younger women as well, including after childbirth when the blood is more likely to clot — probably an evolutionary adaptation so new mothers don’t bleed to death, says Dr. David Sherman, chief of neurology at the University of Texas Health Science Center.

And for women who have migraine headaches — about 18 percent of women do — and those who smoke and take oral contraceptives, there is more risk of stroke.

Twice as many women die from stroke every year than from breast cancer

That is why I’ve posted the following Harvard Medical report. LEARN the early warning signs of stroke. Inconvenient Women know their bodies and are proactive about their health. For more information go to ‘Stoke Facts In America‘

		September 23, 2008

3 warning signs of stroke You know the signs of a stroke. Or do you? You’d probably recognize the classic symptoms, such as sudden weakness on one side of the body or blurred vision, but often the signs are much less obvious. A crushing headache may come on without warning. Your face may feel numb. You may have inexplicable trouble speaking or following what people say. How to tell when someone’s having a stroke Crooked smile. Have the person smile or show his or her teeth. If one side doesn’t move as well as the other or seems to droop, that could be sign of a stroke. Arm drift. Have the person close his or her eyes and hold his or her arms straight out in front for about 10 seconds. If one arm does not move, or one arm winds up drifting down more than the other, they may be having a stroke. Slurred speech. Have the person say, “You can’t teach an old dog new tricks,” or some other simple, familiar saying. If the person slurs the words, gets some words wrong, or is unable to speak, that could be sign of a stroke. Knowing all the warning signs of a stroke may one day save your life and well-being. That’s because the faster you recognize the symptoms, the sooner you can get medical help. And prompt treatment is the key to shielding your brain from a stroke’s damage and sparing you serious disabilities such as paralysis, speech impairment, and dementia. Every 45 seconds, someone in the United States has a stroke. Stroke is the third leading cause of death in the United States and other industrial countries, trailing only heart disease and cancer. In the United States, about 700,000 people have a stroke each year. If you have a stroke, the risk of dying from it increases with age: 88% of deaths from stroke are in people 65 and older. About two-thirds of people who have a stroke have some resulting disability and require rehabilitation. The odds of having a stroke more than double for each decade after age 55. Two-thirds of strokes involve people over 65. Men and women are about equally likely to have a stroke, but women have a greater risk of dying from one. Race is another risk factor. African-Americans, for example, are almost twice as likely to suffer a stroke as are whites. Although you can’t change your age or race, you can take steps to reduce other risk factors for stroke, especially ischemic stroke. The most common risk factors for both ischemic stroke and TIAs (transient ischemic attacks, or “mini strokes”) are high blood pressure (hypertension), diabetes, unhealthy cholesterol levels, and obesity. All of these factors affect the health of your blood vessels — increasing the risk not only of stroke, but also of heart disease. That’s why medications and other steps you take to reduce the risk of an ischemic stroke will also benefit your heart. Some types of hemorrhagic strokes are more likely to occur in people with chronic high blood pressure. But other types of hemorrhagic strokes seemingly strike out of the blue. Although abnormal blood vessel conditions such as an aneurysm (a bubble in the blood vessel wall that could rupture) or an arteriovenous malformation (an abnormal tangle of blood vessels) increase the risk, these conditions may only be discovered inadvertently while you are undergoing testing for something else or may not be discovered until a stroke occurs. Fortunately, medicine has made considerable strides in understanding how to treat and prevent strokes. Medical imaging devices now enable medical teams to begin to diagnose a stroke accurately within minutes. Large studies have clarified which medications and other treatments are best for which patients. For those who need rehabilitation, experimental techniques are showing promise in helping patients make better progress than was possible even just a few years ago.

FEATURED CONTENT: What is a stroke? How the brain works Subtypes and causes of stroke Diagnosing a stroke Treating ischemic stroke Treating hemorrhagic stroke Stroke rehabilitation Preventing stroke Reprinted from Stroke: Preventing and treating “brain attack” — A Special Health Report from Harvard Medical School, Copyright © 2008 by Harvard University. All rights reserved.

** Get your copy of Stroke: Preventing and treating “brain attack” Stroke: Preventing and treating “brain attack” provides up-to-the-minute information about stroke symptoms, diagnosis, stroke treatment, and rehabilitation. This report discusses stroke prevention and common signs of stroke. It also contains helpful illustrations, an extensive glossary, and an informative resource guide. Click here to read more or buy online. To order online, click one of the following links: Purchase printed version ($18.00) Purchase electronic download (PDF) ($18.00) Purchase print + electronic download (PDF) ($26.00) Or to order by mail, print and mail the order form below:

Harvard Medical School offers special reports on over 50 health topics. Visit our Web site at http://www.health.harvard.edu to find reports of interest to you and your family. Copyright 2008 by Harvard University.

©2012 An Inconvenient Woman. All Rights Reserved.

If you’re approaching the middle years of your life, it might be time to review your choice of contraceptives. But don’t be too hasty in putting them away for good.

Middle-age women and teenagers have the highest rates of unintended pregnancy and abortion in the United States, says physician Michele Curtis, an associate professor of obstetrics and gynecology at the University of Texas-Houston Medical School.

“Teenagers think they’re bulletproof,” she says. “Middle-age women think it’s too late. They say, ‘I’m 45, my fertility is dropping and I’m having hot flashes. What do you mean, I’m pregnant?’ ”

Misconceptions about the safety of birth-control methods contribute to the incidence of later-than-desired pregnancies, says physician Andrew Kaunitz, who reviewed contraceptive choices and their risks for women 35 and older for a study published in the March 20 issue of the New England Journal of Medicine.”Many women assume it becomes unsafe for them to use oral contraceptives or other hormonal contraceptives as they get older,” Kaunitz, a gynecologist at the University of Florida College of Medicine-Jacksonville, says by phone. “And that is true for women in their mid-30s and older if they’re smokers or grossly overweight or have high blood pressure, diabetes or migraines.”For them, the cardiovascular risks associated with combination estrogen-progestin oral contraceptives outweigh the benefits, he says.”But for healthy, non-smoking, lean women,” he says, “the pill remains safe for as long as they need birth control, up until the time of menopause.”The dangers associated with pregnancy when a woman is in her 40s are “considerably higher” than those linked to oral-contraceptive use, says Kaunitz, who reports receiving fees from contraceptive makers.

Denise Hanson, 45, of Mesa, in good health and a non-smoker, falls into the category of women for whom oral contraceptives usually are safe. But when she turned 40, she considered alternatives.

“I was a little concerned about still being on birth-control pills at that age,” she says.

Around the same time, her husband, Mark, was on a health kick, encouraging his family to choose unprocessed foods and vitamins over medicine when possible.

Denise went off the pill, and the couple began using condoms. Without the regulating effect of the pill, however, her menstrual periods became heavy and she needed an endometrial ablation to control the bleeding.

Because the Hansons’ family is complete – they have two kids, Alec, 16, and Haley, 10 – she underwent a non-surgical tubal ligation called Essure at the same time as the ablation, which destroys a thin layer of the uterine lining.

“It had taken me a long time to get pregnant with both my kids,” Denise says, “so I thought I might not even need birth control any longer.”

But she decided that wasn’t a chance she wanted to take in the years until menopause, which begins for many women at about 50.

In the Essure procedure she chose, doctors thread tiny springlike coils through the woman’s cervix and into her fallopian tubes, where scar tissue forms and blocks sperm from reaching the egg.

Approved by the federal Food and Drug Administration in 2002, Essure is one of the contraception choices boomers didn’t have when they began using birth control. Other contraceptives have since been improved.

“The pill certainly is safer than it was,” the University of Florida’s Kaunitz says, “and women who use it experience less nausea and breast tenderness than they used to.”

The oral contraceptives prescribed routinely today are low-dose, containing 20 to 35 micrograms of estrogen compared with 80 to 150 mcg when they became available in the early 1960s, he says.

Kaunitz says his review found that pill use does not increase risk for breast cancer, heart attack or stroke in healthy older women, and it may provide benefits beyond preventing pregnancy. These appear to include reductions in bone fractures and in ovarian, endometrial and colorectal cancers, he says.

However, using the pill contributes to the formation of blood clots, even in younger women, Kaunitz says. The likelihood of developing a clot remains small, he says, but being overweight or older than 35 multiplies the odds. Women with those risk factors should consider non-estrogen contraception, such as injections, in-arm implants or intrauterine devices.

Curtis, the Houston doctor, recommends the low-dose pill as the best choice for healthy women who want to prevent both pregnancy and the abnormal bleeding that often accompanies their premenopausal years.

But for those who can’t or don’t want to use the pill, an IUD that releases the hormone progestin in the uterus offers similar hormonal control over inconvenient and unpredictable menstrual periods, she says. It doesn’t get into the bloodstream and affect the rest of the body as oral contraceptives do.

Women who have had a blood clot, have a family history of a blood disorder or have a breast mass that has not been checked out are not good candidates for oral contraceptives, Curtis says. If they have well-controlled high blood pressure or diabetes, they should talk with their doctor about whether the low-dose pill would be safe for them.

The one thing a sexually active woman should do is use condoms, unless she’s in a long-term, monogamous relationship.

“Every woman, I don’t care if she’s 75, has to be aware of sexually transmitted infections and the need to use a condom,” Curtis says. “And as far as birth control goes, if a condom is used every time and used properly, particularly with a spermicide, it’s pretty effective.

“The problem is people assume men are born knowing how to use a condom.”

Medical guidelines for age, contraceptive use

If you’re 35 or older and have any of the following risk factors, combination estrogen-progestin contraceptives may not be safe for you. Guidelines are from the American College of Obstetricians and Gynecologists and the World Health Organization.

OBESITY

ACOG guidelines: Progestin-only or intrauterine contraception may be safer than combination estrogen-progestin contraception.*

WHO guidelines: Benefit usually outweighs risks.**

SMOKING

ACOG guidelines: Progestin-only or intrauterine contraception should be used.*

WHO guidelines: Risk unacceptable.

HIGH BLOOD PRESSURE

ACOG guidelines: Progestin-only or intrauterine contraception should be used.*

WHO guidelines: Risk unacceptable.

DIABETES

ACOG guidelines: Progestin-only or intrauterine contraception should be used.*

WHO guidelines: Risk unacceptable.

MIGRAINES

ACOG guidelines: Progestin-only or intrauterine contraception should be used.*

WHO guidelines: Risk unacceptable.

NONE OF THE ABOVE RISKS

ACOG guidelines: Healthy women who are non-smokers and doing well with combination contraceptive can continue this method until 50 to 55, after weighing risks and benefits.

WHO guidelines: For women 40 or older, risk of cardiovascular disease increases with age and may also increase with combined hormonal contraceptive use; in absence of other adverse clinical conditions, combined hormonal contraceptives can be used until menopause.

*This category includes progestin-only oral contraceptives, depot medroxyprogesterone acetate, contraceptive implants, and copper and progestin-releasing intrauterine devices.

**Obesity in women 35 and older not specifically addressed.

Common contraceptives for women in later years

Next to tubal ligations (or their partners’ vasectomies), these are common birth-control choices for women 35 and older, says gynecologist Andrew Kaunitz of the University of Florida College of Medicine-Jacksonville.

ESTROGEN-CONTAINING

• Low-dose oral contraceptives (“the pill”).

• Transdermal patch (Ortho Evra).

• Vaginal ring (NuvaRing).

NON-ESTROGEN

• Intrauterine devices, progestin-releasing (Mirena) or copper (ParaGard).

• Injectable progestin (Depo-Provera).

• Implant (Implanon).

Source: Connie Midey – The Arizona Republic

©2012 An Inconvenient Woman. All Rights Reserved.

An analysis of case-control studies has found that use of oral contraceptives for ≥ 5 years in women with human papillomavirus (HPV) infection is associated with an increased risk of cervical cancer.  This confirms existing knowledge and emphasises the need for regular cervical screening of all women aged 20-69 years who have ever been sexually active.

Not all HPV infection is persistent or leads to cancer

The presence of human papillomavirus (HPV) infection is known to play the major causative role in cervical cancer.  However, the development of such cancer is multi-factorial and HPV infection alone is not thought to be sufficient.[1,2]  More than 30 HPV types infect the genital tract, and these have been classified as either low or high risk types according to the potential of infected cells to progress to carcinoma.[3]  Many sexually active women have HPV present at some time in their lives, and in most cases it disappears after a time with no resultant problems. It is the persistence of HPV, in particular a high risk type, that contributes to the development of cervical intraepithelial neoplasia and invasive cancer.  Women with persistent HPV on smear tests are usually referred for colposcopy.[4]

Increase in cervical cancer with OC use for ≥ 5 years in HPV-positive women

A pooled analysis of eight case-control studies looking at the effect of oral contraceptives (OCs) on the risk of cervical cancer was published in March 2002 in the Lancet.[1]  The International Agency for Research on Cancer (IARC) conducted the original studies in Spain, South America, Asia and Africa, between 1985 and 1997. The IARC analysis[1] looked only at women who were HPV-positive.

The results showed that women with HPV, who used oral contraceptives for less than five years, had no increase in risk of squamous-cell cervical cancer, compared to women with HPV who had never used OCs. In contrast, a duration of OC use of 5-9 years was associated with an almost three-fold increase in risk, compared with never-users, and a four-fold increase for usage of 10 years or longer.  These estimates of risk were higher than those reported in most other studies.[2]  Further research is needed to determine how long these risks persist after stopping OC use.  The questionnaire used in the studies[1] did not specifically ask about type of hormonal contraceptive but from independent surveys and country usage data it is likely that the majority were taking a combined OC.

Analysis of only HPV-positive women reduces confounding

The IARC paper[1] eliminates a potential source of confounding present in earlier studies by analysing the effect of combined OC use in HPV-positive women.  It was previously difficult to assess the influence of OC use on cervical cancer risk due to possible confounding by differences in sexual behaviour and HPV infection rates that may have been associated with use of OCs.

No association was found between presence of HPV and use of OCs among the controls.[1]  This suggests that the increase in risk of cervical cancer from OCs is due to an effect on progression (from HPV infection to cancer), rather than affecting susceptibility or persistence of HPV infection.[2]

Regular cervical screening likely to offset increase in cancer risk

It is important to note that these case-control studies[1] were mostly in countries without a cervical screening programme.  The Medicines Adverse Reactions Committee (MARC) has reviewed the IARC paper[1] and believes that the increase in cervical cancer risk in long-term users of OCs found in this study would be greatly reduced by the cervical screening programme in place in New Zealand.[4]  The MARC did not recommend that women with abnormal smears should stop taking OCs.  The findings must be considered in light of the benefits of combined OCs (such as control of fertility and reduction in risk of uterine and ovarian cancer), and add further to our knowledge about the risks and benefits of hormonal contraception.  The IARC paper[1] emphasises the importance of regular cervical screening in all women with a history of sexual activity, whether on OCs or not.

Correspondence to Dr Natasha Rafter, Division of Community Health, Auckland University, Private Bag 92019, Auckland. E-mail: n.rafter@auckland.ac.nz

References

[1.] Moreno V, Bosch FX, Muñoz N, et al, for the International Agency for Research on Cancer (IARC) Multicentric Cervical Cancer Study Group. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 2002;359:1085-1092.

[2.] Skegg DCG. Oral contraceptives, parity, and cervical cancer [Commentary]. Lancet 2002;359:1080-1081.

[3.] Galloway DA. Biology of genital human papillomaviruses. In Holmes KK, Mårdh P-A, Sparling PF et al (Eds). Sexually Transmitted Diseases 3rd Edn. 1999:McGraw Hill, USA, p335-348.

[4.] National Cervical Screening Programme. http://www.healthywomen.org.nz/ncsp/default.asp

Source: Medsafe is the New Zealand Medicines and Medical Devices Safety Authority. It is a business unit of the Ministry of Health and is the authority responsible for the regulation of therapeutic products in New Zealand.Medsafe’s mission is to enhance the health of New Zealanders by regulating medicines and medical devices to maximise safety and benefit.

Medsafe has around 60 staff operating out of two offices, with centralised administrative functions, product approval and standard setting based at the head office in Wellington.

©2012 An Inconvenient Woman. All Rights Reserved.