TIME Reproductive Health

Morning-After Pill May Not Be Affected By Body Weight

Morning-after pill
Jacques LOIC—Getty Images/Photononstop RM

Recent studies raised questions about the effectiveness of the contraceptive method among heavier women.

But after an investigation, the European Medicines Agency (EMA) says that emergency contraceptives are effective for women of all weights.

Last year, the agency requested a warning on the label of Norlevo, the European equivalent of Plan B containing levonorgestrel, indicating that it might not be as effective in preventing pregnancy for women with a body mass index (BMI) greater than 25. This decision was based on a 2011 study that showed heavier women who took products containing levonorgestrel—which prevents pregnancy after intercourse—were four times as likely to become pregnant as those with lower BMIs.

After that recommendation, the regulatory agency conducted a review of other emergency contraceptives containing levonorgestrel or ulipristal acetate, and found that the data in the earlier studies was limited and not substantial enough to conclude that the contraceptives’ effect was decreased with increased body weight. That doesn’t mean that weight may not play a role in the drugs’ effectiveness, but for now, the EMA’s Committee for Medicinal Products for Human Use (CHMP) recommends that Norlevo remove the current warnings from its label. It also said emergency contraceptives should continue to include on their product inserts some study results showing potentially reduced effects in heavier women.

While the European health authorities took action on Norlevo last year, the U.S. Food and Drug Administration has not issued any similar warnings for Plan B. “I don’t necessarily think it’s inevitable that the FDA would act on this,” Dr. Carolyn Westhoff, professor of obstetrics and gynecology and public health at Columbia University and senior medical adviser at Planned Parenthood Federation of America, told TIME in November 2013 regarding the data at the time. “People in the field have been scratching their heads since [the 2011 study] was published, saying what sorts of studies could we do to get more data to help us understand this better. To my knowledge, nobody has done those additional studies.”

EMA also admits that such data isn’t available yet, but says that there isn’t enough data to support the previous warning to women about weight.

TIME Sex

Stress Degrades Sperm and Fertility, Study Finds

Men who feel stressed have fewer, slower sperm

Psychological stress may degrade sperm quality and sperm fertility, according to a study published today in the journal Fertility and Sterility.

“Men who feel stressed are more likely to have lower concentrations of sperm in their ejaculate, and the sperm they have are more likely to be misshapen or have impaired motility,” said researcher Pam Factor-Litvak, an epidemiologist at Columbia’s Mailman School of Public Health, in a statement. “These deficits could be associated with fertility problems.”

Researchers studied 193 men ages 38 to 49, who rated how stressed they felt and shared the life events that led to said stress. Life stress degraded the quality of semen even when the scientists accounted for other factors, such as health concerns or previous issues with fertility.

Even though life stress affected the caliber of the sperm, workplace stress did not. However, job strain did lower testosterone levels and therefore could still hurt reproductive health. Unemployed men also had lower sperm quality than employed men, regardless of other stressors.

Scientists don’t know how exactly emotional strain affects semen, but this adds to a body of research examining the many ways emotional stress can take a toll on the body.

TIME Reproductive Health

FDA Panel Recommends Test That Would Replace Pap Smears

An FDA advisory committee unanimously agreed that a DNA test developed by Roche should be approved by the FDA as a primary screening tool for HPV.

Currently, women are tested for human papillomavirus (HPV) during a Pap test or after a Pap smear shows abnormal changes on their cervix. But the new test from Roche identifies screening HPV DNA as a superior source for detecting abnormalities. HPV screening is important since it is the most common cause of cervical cancer. The committee–made up of experts in the field–green lighted it as an initial test for women starting at age 25.

According to the New York Times, it’s highly unlikely that the Roche test will replace the pap smear, especially since many physicians will take a long time to incorporate it into their practice. However, in Roche’s trials, it showed that the test was better than the Pap in areas like detecting cancerous lesions.

The primary concern for HPV testing is that it could lead to unnecessary invasive procedures. Most people get infected with HPV in their younger sexual years, and the majority will the clear the virus naturally. HPV testing could mean that young women may be sent in for biopsies and examinations that aren’t necessary, since their infection would have likely gone away on its own. Joint HPV testing and Pap testing is thus recommended for women between the ages of 30 and 65 every five years, while women between the ages of 21 through 30 are recommended to receive Pap testing every three years.

[The New York Times]

TIME Reproductive Health

UN Sets Guidelines for How Developing Countries Should Teach Puberty

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Forest Woodward—Getty Images/Vetta

Educating boys and girls about menstruation and sex sets up a path to greater gender equality

Many girls—especially those in low-income countries—start their periods without a clue as to what’s happening to them.

American parents barely mastered the discomfort of talking about the birds and bees with their kids, but this inadequacy takes on a particular urgency for other parts of the world. Ninety-five percent of girls in Ghana reported missing school because of their period. In Ethiopia, 39% of girls reported poor performance in school during menstruation.

That’s why, for the first time, UNESCO (United Nations Educational, Scientific & Cultural Organization)—in partnership with sanitary product maker Procter & Gamble—is releasing a publication setting out guidelines for puberty education. The goal is to provide developing countries with a framework of programs that promote access to hygiene products for girls, safe sanitation facilities in schools, and better puberty knowledge and skills for both boys and girls beginning at age 10.

There are 650 million primary school-age kids worldwide, although 57 million of them do not attend school. Still, that leaves nearly 600 million kids that can be reached through school-based programs. And that’s where boys and girls should be set on a path of positive sexual health and relationships, body image, and gender equality, UNESCO argues.

“[Primary school] is where we have school dropouts of girls, [which leads to] early marriages and pregnancies,” says Irina Bokova, the director-general of UNESCO. “Keeping girls in school is the most important investment we can make as a development community.”

Puberty education is also an important factor in breaking down gender roles. Menstruation is typically regarded as something young woman need to handle, and privately. Male puberty, on the other hand, is viewed as the beginning of sexual desire and “power” to be enjoyed, says UNESCO. This biological view of puberty also confines women to the role of mothers. If, instead, puberty education talked about pleasure as a normal part of what both boys and girls will experience, it would expand conceptions beyond reproduction and work towards balancing the issue.

Puberty education might seem a less urgent issue for young women in the developing world. After all, they face much more serious obstacles when it comes to family planning measures, with many getting pregnant too young and dropping out of school. Child marriage is also unfortunately all to common in many countries, causing similar damages to young women’s health and futures. But while birth control remains taboo for many cultures, puberty happens to everyone—boys included.

“A lot of countries haven’t stepped up to the plate as much as they should,” says Christopher Castle, UNESCO’s chief of HIV and Health Education. “We need Ministers of Education to integrate puberty education into primary education.”

Keeping young people—especially girls—in school may be the greatest contribution of quality puberty education. “No one needs persuasion that girls need to be in school anymore. We won that battle,” says Castle. “Now we need to make sure that when they are in school, they’re in a safe environment. Puberty education is important for that and gender equality.”

TIME Reproductive Health

Women Who Stand By Their NuvaRing

Reproductive Health Convention Showcases Newest Contraceptives
The NuvaRing is monthly vaginal insert that slowly releases Estrogen. Sandy Huffaker—Getty Images

Prescription drug company Merck is being forced to shell out big bucks to settle a lawsuit over health problems with the contraceptive, but some are finding it difficult to dump the convenience of the device

There’s the 24-year-old who stopped breathing, had two heart attacks, and died on life support. There’s the mother whose two-year-old son watched her go into a seizure. And there’s the college student who started spitting up blood while having lunch with her dad.

The accounts of women experiencing the negative side effects of the NuvaRing contraceptive are gruesome, and their stories are part of the evidence that led to the $100 million settlement last week with NuvaRing maker Merck & Co. The pharmaceutical company agreed to hand over $100 million for liability lawsuits claiming the ring caused blood clots that sometimes led to heart attacks and even death, although Merck denied fault. The women argued they were not adequately warned about these side effects, and about 3,800 of them are eligible to partake in the settlement.

Despite the well-publicized risks, some women are finding it difficult to ditch a contraceptive that has provided them with consistency and convenience. Oftentimes, finding the right birth control takes years of trial and error, and side effects range from weight gain to decreased libido. For this reason, when women find the right contraceptive, they tend to develop a certain loyalty to it.

Sarah, 26, a graduate student in New York City, struggled with finding the right birth control since she was 20 years old. During the year she was on the pill, she put on weight and was constantly having mood swings. She’d feel depressed one day and highly irritable the next. She switched to the NuvaRing five years ago after a friend suffering similar effects made the swap, and it has been smooth sailing ever since. “I hated the whole contraceptive experience, but with the NuvaRing I don’t experience any of that,” she says.

The NuvaRing ring is a flexible ring that women insert inside their vagina and remove for the week of their period. Like an oral contraceptive, it releases the hormones progestin and estrogen (though at lower levels), preventing ovulation and sperm from reaching the egg, but you don’t have to remember to take a pill every morning. Women prefer it for its convenience, the localized hormones, and the fact that there’s less accountability. In 2012, there were about 5.2 million prescriptions in the U.S. for the NuvaRing, according to IMS Health, a healthcare technology and information company.

According to the American College of Obstetricians and Gynecologists (ACOG)–the medical authority on all things related to baby-making–NuvaRing leads to a slight increased risk of deep vein thrombosis, heart attack, and stroke. And, as highlighted in a safety warning on NuvaRing’s website, the danger is higher for some women, like those over 35 who smoke more than 15 cigarettes a day or women who have multiple risk factors for heart disease. Its typical use failure rate is 9%, the equivalent of an oral contraceptive, according to the CDC.

Following the settlement Friday, Merck issued a statement saying, “We stand behind the research that supported the approval of NuvaRing, and our continued work to monitor the safety of the medicine.”

Though the side effects of the NuvaRing are very real, for many women it bears no complications. “I am extremely busy with very irregular hours and travel for my job,” says Julie*, 27, who works for a film production company in Los Angeles, California, “so the NuvaRing is the ideal fit for my lifestyle. I have virtually no side effects, so I plan to remain on it for the foreseeable future.”

Other women simply shrug off the dangers. “Every drug you take comes with risks, from Asprin to birth control to allergy medicine,” says Ricci Ellis, 31, a respiratory therapist in Little Rock, Arkansas, who switched from the pill after consistently forgetting to take it. “For me, the benefits of NuvaRing far outweigh the risks.” Because she’s not not a smoker and leads an active and healthy lifestyle, Ellis considers herself relatively safe from the risks of blood clots, strokes, and sudden death.

“It is absolutely essential that people are aware of the risks associated with each method of contraception,” says Bill Albert, the chief program officer at The National Campaign to Prevent Teen and Unplanned Pregnancy. The American Heart Association (AHA) recently recommended that women considering birth control get screened for high blood pressure, which can put them at a greater risk for clots and stroke. “Equally important, however, is how such risks compare to those of other methods, and to pregnancy as well.”

According to Albert, the side effects need to be placed in a broader context so that they are neither dismissed nor viewed with disproportionate alarm. “One of the highest risk of blood clots comes with pregnancy. Consequently, if an individual is having sex and doesn’t want to get pregnant, skipping birth control altogether for fear of blood clots is not the best way to protect your health,” says Albert. “This is not meant to be cavalier, but the doubling of a rare risk is still rare.”

Medical experts are careful to not trivialize the risks, but Dr. Eve Espey, the chair of ACOG’s Committee on Health Care for Underserved Women and a professor in the Department of Ob-Gyn at the University of New Mexico’s School of Medicine, says the NuvaRing settlement hasn’t changed how she counsels her patients. “It’s always tragic and horrible when a woman has a bad outcome or dies from a blood clot. But to then label that method as dangerous often translates into more unintended pregnancies with a higher risk than using the method,” says Dr. Espey. Though popular for its convenience, the NuvaRing isn’t the most effective form of birth control out there. And neither is the pill. The intrauterine device (IUD) and the implant are considered the two safest and most effective forms of birth control available, with a typical use failure rate of 0.8% and 0.05% respectively.

When asked if women currently using NuvaRing should talk to their doctors about other options, Dr. Espey said, “How do you prepare for the event that’s so rare?”

But it’s making Sarah think twice. “I’m definitely concerned about the risks,” she says. “I am making an appointment with my gynecologist to discuss options.”

*Name has been changed for privacy.

TIME Women's Health

First Stroke Guidelines for Women Created

Strokes are the third leading cause of death for women in the U.S.
Strokes are the third leading cause of death for women in the U.S. Jaime Monfort—Getty Images

Hormonal changes caused by pregnancy or birth control are factors in the third leading cause of death for females, the American Heart Association reports

The American Heart Association outlined Thursday its first ever guidelines for primary care provider sand OBGYNs developed specifically to prevent women’s strokes, the third leading cause of death for U.S. women, and the fifth leading cause for men.

Stroke risk factors for both men and women include high blood pressure, high cholesterol, and smoking, but certain hormonal changes can reportedly increase a woman’s risk.

“If you are a woman…your risk is also influenced by hormones, reproductive health, pregnancy, childbirth and other sex-related factors,” said Cheryl Bushnell, M.D., M.H.S., author of the new scientific statement published in the American Heart Association journal Stroke.

According to the guidelines, women with a history of high blood pressure before pregnancy are at risk for preeclampsia, a blood pressure disorder that occurs during pregnancy. Preeclampsia doubles the risk for stroke and increases the risk for high blood pressure four-fold, according to the guidelines.

The combination of high blood pressure and birth control use can also raise a woman’s risk for stroke. Migraines with aura, diabetes, depression, and emotional stress, which occur more frequently among women, are also contributing factors.

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