Women on the Pill have less menstrual pain

NEW YORK (Reuters Health) - Young women on birth control pills tend to have less painful menstrual periods than those not on the contraceptives, a new study finds.

Swedish researchers found that of 2,100 women followed from age 19 to 24, those on the combined birth control pill (estrogen and progestin) had less-severe menstrual pain over time.

It's already common practice for doctors to recommend the Pill to women with dysmenorrhea -- menstrual cramps, back pain and other symptoms that are severe enough to disrupt a woman's life.

Birth control pills are not specifically approved for that purpose, but doctors can prescribe them for dysmenorrhea on an "off-label" basis. However, it has not been clear how effective the pills are against period pain.

The new findings are not conclusive, but still caused excitement among some researchers.

"Our study provides evidence for the effective relief of painful periods with combined oral contraceptives," said Dr. Ingela Lindh of Gothenburg University in Sweden, who led the study.

Both Lindh and one of her co-researchers have financial ties to companies that make hormonal contraceptives, although the new research was not supported by drugmakers.

Menstrual pains typically fade as a woman gets older, and they often lessen after childbirth. But even when age and childbirth were taken into account, Pill users had less painful periods in the new study, Lindh told Reuters Health in an email.

The study, published in the journal Human Reproduction, does not prove that the Pill eases dysmenorrhea.

It's an observational study that looked at the relationship between women's Pill use and dysmenorrhea risk. Clinical trials -- where people are randomly assigned to take a drug or a placebo -- are considered the "gold standard" for proving cause-and-effect.

And a 2009 review of 10 clinical trials concluded that there was "limited evidence" that the Pill improved menstrual pain.

Still, the trials in that review varied in their methods and their quality, so it's hard to draw firm conclusions, according to Dr. Michele Curtis of the University of Texas Medical School at Houston, who was not involved in the current study.

She told Reuters Health the new study isn't definite, but "makes a strong case" that the Pill is effective against menstrual pain.

"I think combined oral contraceptives really do help women with primary dysmenorrhea," said Curtis, who has received speaking fees from drugmaker GlaxoSmithKline, according to ProPublica's database Dollars for Docs.

Primary dysmenorrhea refers to menstrual pain that is not caused by underlying medical conditions such as endometriosis, a disorder of the uterine lining, or non-cancerous uterine growths called fibroids. When a medical condition is the cause, it's known as secondary dysmenorrhea.

A weakness of the current study, Curtis said, is that it did not determine whether women had primary or secondary dysmenorrhea. In some cases of secondary dysmenorrhea, she said, birth control pills might help, but in other cases will do nothing.

The study included three groups of young women who were 19 years old in either 1981, 1991 or 2001. They all completed a standard questionnaire on menstrual symptoms, then repeated the survey five years later.

Dysmenorrhea was common, the study found. Of the 1981 group, 37 percent had at least moderate menstrual pain that disrupted their daily activities; in the 2001 group, that figure was 47 percent.

But Pill users had less pain over the next five years. Overall, Pill use was linked to a reduction of 0.3 units on the pain scale. That means every third woman on the Pill went "one step down" on the scale -- from severe pain to moderate pain, for example -- according to Lindh.

The researchers also looked at subgroups of women who were using the Pill at the age of 19, but not at age 24. On average, their menstrual pain increased over time. In contrast, pain decreased among women who were not on the Pill at age 19, but were at age 24.

There are biological reasons that the Pill would help with dysmenorrhea, both Lindh and Curtis said.

Menstruation causes increased muscle activity in the uterus, which lessens blood flow to the uterus. And that's believed to be the root of menstrual pain.

Hormone-like compounds called prostaglandins help churn up that extra muscle activity. Since birth control pills lower the body's prostaglandin production, Lindh explained, it makes sense that they would ease dysmenorrhea.

Birth control pills, which cost anywhere from $15 to $50 a month, are not the only treatment for dysmenorrhea.

Some women can find enough relief from nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, according to Curtis. NSAIDs also block prostaglandin production.

What's more, vitamin B1 and magnesium, exercise, relaxation techniques and acupuncture have all been advocated for dysmenorrhea.

"Clearly, our evidence base is smaller for those things," Curtis said. But she also said that if a woman does not want birth control or NSAIDs, she could try an alternative.

Birth control pills can have side effects like breast tenderness, nausea and vomiting, and spotting between periods. Pill users also have a slightly higher-than-average risk of blood clots, particularly if they smoke or are age 35 or older.

But most women with primary dysmenorrhea are younger. In fact, Curtis said, if you start having painful periods for the first time when you are 30, it's unlikely that it's primary dysmenorrhea. A secondary cause is probably at work.

The new study was funded by grants from the Gothenburg Medical Society and other groups.

SOURCE: http://bit.ly/zTpZa5 Human Reproduction, online.

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Study links sleep apnea and sudden deafness

NEW YORK (Reuters Health) - Sudden hearing loss might be tied to an underlying sleep disorder that interrupts breathing, suggests a new study from Taiwan.

Consulting a large health insurance database, researchers found that people who'd suffered sudden deafness were more likely to have a previous diagnosis of sleep apnea than a comparison group without hearing loss.

The absolute difference was small: 1.7 percent of those with hearing loss had sleep apnea, compared to 1.2 percent without hearing trouble.

"If there is sudden hearing loss, I would investigate the presence of apnea as well, given that it's easy to diagnose and it's easy to treat," said Dr. Seva Polotsky, a sleep apnea researcher from Johns Hopkins University School of Medicine in Baltimore who wasn't involved in the new study.

"Obviously we don't know from this paper whether treating apnea will reduce hearing loss," or the chance of having hearing problems in the first place.

For now, he said, "There are more questions than answers."

Polotsky added, it's possible that sleep apnea, which is known to increase the buildup of plaque in blood vessels, could affect vessels in areas of the brain that control hearing, or vessels that feed the nerves responsible for hearing.

But he said more research will be needed to find out what could be behind this link -- or whether something besides the apnea, itself, might explain an increased risk of deafness.

There are about 4,000 new cases of sudden deafness each year in the United States, according to the National Institutes of Health, and there are many possible causes, including infections and head injuries.

Typically the deafness only occurs in one ear, and most people regain their hearing over a period of weeks, sometimes aided by steroid treatment. But occasionally the hearing loss becomes more serious.

Looking at health records of one million Taiwanese, researchers led by Dr. Jau-Jiuan Sheu, of Taipei Medical University Hospital, found almost 3,200 had been diagnosed with sudden deafness between 2000 and 2008. For each of those people, they picked out another five of the same age and sex without hearing loss to serve as a comparison.

Out of those 19,000 people in total, 240 had been diagnosed with sleep apnea before the episode of sudden deafness occurred.

When researchers took into account health and lifestyle factors that may be related to both sleep problems and hearing loss -- such as obesity and heart disease -- they found that men with sudden deafness were 48 percent more likely to have a previous sleep apnea diagnosis than men without hearing loss.

The association for women was less clear, the researchers reported in the Archives of Otolaryngology-Head & Neck Surgery.

Sleep apnea is characterized by closing off of the airways during sleep, leading to repeated drops in oxygen levels in the blood and frequent short wake-ups, along with snoring. It's often treated with a mask and breathing device, called continuous positive airway pressure, or CPAP, but one of the most effective treatments is weight loss.

The new study doesn't prove that sleep apnea causes sudden hearing loss. The researchers couldn't account for people's smoking and drinking, for example, which may affect the risk of both conditions.

Sheu and colleagues speculated, however, that inflammation and changes in blood vessels linked to sleep apnea could contribute to the risk of deafness.

Tinnitus, the sensation of ringing in the ears, has been linked to circulatory disorders, for example.

Polotsky added that most of the complications associated with sleep apnea, which include high blood pressure and diabetes, are thought to result from frequent oxygen fluctuations during the night.

And sudden hearing loss could fit into that category, he told Reuters Health.

But the current study, Polotsky said, "doesn't really establish that. It just shows us a new potential area to research."

SOURCE: http://bit.ly/AgF7gE Archives of Otolaryngology-Head & Neck Surgery.

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Neuroscience Suggest Three Distinct Systems for Love

Helen Fisher, an evolutionary biologist from Rutgers University, hypothesized that there are three distinct yet intersecting brain systems that correspond to sex, romantic love, and long-term attachment (like a mother-child bond or the comfortable relationship you might see in a couple who have been married for sixty years). These three separate systems, she argued, could cover all facets of love: romantic, parental, filial, platonic, and that old bugger, lust.

Scientists have long known that the seat of the sex drive is the hypothalamus. When it is removed, folks lose all interest in sex, as well as the ability to perform sexually. This almond-size brain area is linked to the pituitary gland, which produces the hormones necessary to fuel the desire to “get it on.” Humans are more than just their sex drives, however. With romantic love, Fisher and her colleagues observed brain activity in areas outside the hypothalamus, including the right ventral tegmental area (VTA) and the right caudate nucleus. These are both part of the basal ganglia, a brain area connected to both the cerebral cortex and the brain stem. The basal ganglia, along with the hypothalamus and amygdala, is implicated in reward processing and learning. It’s a little like bribery: when we experience something that feels good, such as satiating our hunger, having a sexy romp, or spending time with the object of our affections, these areas of the brain give us a little extra boost to encourage us to do it again. If we are talking about deep emotional attachment, the ventral pallidum, a different part of the basal ganglia circuitry, is activated. All these areas are very sensitive to the neurochemicals dopamine, oxytocin, and vasopressin, which are thought to be pleasure-inducing and critical to forming pair-bonds in socially monogamous animals like prairie voles and Titi monkeys. But they each work a little differently.

The two regions that seemed most important to romantic love in Fisher’s research were the caudate nucleus and the VTA. These areas reside in what is called the “reptilian brain”—a cluster of subcortical regions near the brain stem that have existed since before we evolved to walk upright—and are strongly implicated in both reward processing and euphoric feelings. They are also part of an important dopamine-fueled circuit called the mesocortical limbic system, a pathway critical to motivational systems; unsurprisingly it’s a circuit that has been implicated in addiction. These study results led Fisher and her colleauges Arthur Aron, and Lucy Brown to conclude that romantic love is not an emotion, but a drive. According to Brown,“Love is there to help fuel reproduction, to help us psychologically by connecting with others. It is distinct, yet related to lust and attachment.”

Think of it this way: Lust may be the simplest of the three hypothesized systems, an almost reflex-like process that keeps us getting busy. Certainly if it were a more involved process, we would not find ourselves so interested in individuals like Pamela Anderson in all her glory or, like one of my girlfriends who is too embarrassed to be named, totally hot for the ’s resident Lothario, Mike “The Situation” Sorrentino, right? At the same time we also have a system for attachment. Feeling connected to someone is a rewarding behavior, hence that ventral pallidum activation; it is nice to have someone to come home to, even if you are no longer inclined to jump his or her bones 24/7. Somewhere in the middle is the romantic love system, connected to both lust and attachment. It hits on areas involved in attachment and lust, as well as those implicated in reward processing and learning. It is no surprise that romantic love feels good and helps us to bond with another person (and consequently promotes procreation).

“These brain systems often work together, but I think it’s fair to say they often don’t work together too,” Fisher told me when I asked whether these three systems overlapped in other ways. “One might feel deep attachment for one partner, be in romantic love with another partner, and then be sexually attracted to many others. There’s overlap, but like a kaleidoscope, the patterns are different.”

It is also possible that these systems work on a bit of a continuum: one’s physical attraction for a person can develop over time into romantic love and then into a deep-seated attachment. It might even work the other way: a good friend to whom you are deeply attached may one day, inexplicably, seem physically irresistible. A quick flick of the wrist, a change in circumstance or age, and that love kaleidoscope may offer you a completely different configuration.

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Docs more likely to suspect abuse in poor kids

NEW YORK (Reuters Health) - When a toddler has a broken bone, pediatricians may be more likely to suspect abuse if the family is lower-income, a new study finds.

Researchers found that pediatricians who read a fictional case report of a toddler with a leg fracture were more likely to suspect abuse if the child was described as coming from a lower-income family.

The hypothetical child's race, on the other hand, did not appear to influence doctors' opinions.

The second finding is somewhat surprising, according to the researchers. Studies looking at real-world cases have found that minority children are more likely to be evaluated for abuse than white children are.

And it's well known that the child welfare system in the U.S. has a disproportionate number of minority kids.

"There's very strong evidence of a racial difference in how patients are handled," said lead researcher Dr. Antoinette L. Laskey, a pediatrician at the Indiana University School of Medicine in Indianapolis.

But, she told Reuters Health, the reasons for that have not been clear -- including whether doctors may act based on unconscious racial stereotypes.

The current results suggest "there's more than race involved," Laskey said.

She was also quick to say, however, that the study doesn't mean pediatricians are consciously "classist" or otherwise biased when evaluating children's injuries.

The study, reported in the Journal of Pediatrics, included 2,100 U.S. pediatricians who responded to a survey that described one of four hypothetical cases.

All cases included an 18-month-old with an "ambiguous" leg fracture -- a type that can be caused by abuse or an accident.

But the cases varied by the child's race (black or white) and the family's economic situation; parents were described as having either professional jobs (accountant and bank manager) or working-class jobs (grocery clerk and factory worker).

Race had little effect on the doctors' responses. The study found that when the child was black, 45 percent of doctors believed there had "possibly" or "almost certainly" been abuse; another 32 percent were "unsure." If the child was white, 46 percent of pediatricians suspected abuse, with 28 percent saying they were unsure.

In contrast, there was evidence that parents' job descriptions swayed doctors' opinions.

When the child's family was lower-income, 48 percent of pediatricians thought there'd been abuse, versus 43 percent when the family was higher-income.

It's hard to know whether doctors' responses to a fictional case would be the same in real life.

And it's not clear, according to Laskey, whether attitudes about socioeconomic status might explain some of the racial differences in child abuse reporting seen in earlier studies.

She also stressed that she does not think pediatricians are consciously basing their diagnoses on parents' job titles. But in general, unconscious stereotypes can influence anyone's thinking.

"People tend to think that child abuse, or domestic violence, doesn't happen in upper-middle-class families, but of course it does," Laskey said.

It's important, she said, for doctors to be aware that unconscious generalizations could get in the way of diagnosing child abuse -- either missing it in kids from affluent families, or over-diagnosing it in children from poorer or minority families.

"My big take-home message for doctors is that we need to rely on the objective data," Laskey said.

It is true that studies have found children in poorer families to be at greater risk of abuse. But the poverty, itself, is not a "causative factor," Laskey said.

"Race and socioeconomic status shouldn't be things used in a diagnosis of abuse," she said.

SOURCE: http://bit.ly/wVlYrX Journal of Pediatrics, online.

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