Medical Advances for Women

12 breakthroughs that keep women’s well-being front and center.
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Early Cancer Detection: Pap Smears

For most of us, the Pap smear – an early-detection screening for cervical cancer that dates back to 1931- is just one in the litany of procedures we dread during our annual GYN exams. But a little respect, please: Mostly because of these screenings, the death rate from cervical cancer in 2006 was less than one-third of its 1970 rate. Now the most common cancer-screening procedure, the Pap smear detects cervical cancer very early by looking for pre-cancerous cells in samples collected from the cervix with a swab. Recent changes in recommendations suggest that women over 30 wait three years between smears if they’ve had three consecutive normal results. And with the advent of testing for the human papilloma virus (HPV), which can cause cervical cancer, the question going forward will be how Pap smears, HPV tests, and the HPV vaccine should coincide.

A Support Network: Sports Bras

They bounce, they jiggle, they fly around – let’s face it, breasts aren’t the ideal exercise accessory. Thank goodness the sports bra debuted in 1977 (as the "Jogbra"— a pair of jock straps sewn together) to help women control their assets. Sports bras are a marvel of engineering: They lift and compress the breasts to prevent movement. The undergarments now come with a variety of options, and are available in various sizes, materials, sports-impact levels and strap designs. Some bras even have specs for specific sports, such as yoga and distance running. And some are so attractive exercisers wear them as tops instead of hiding them under T-shirts.

Sex Gets Simpler: The Pill

When it came on the market in 1957, the oral contraceptive presented not just a medical breakthrough, but also a paradigm shift. For the first time, women could control their fertility in a highly reliable way; sex became fun and largely disentangled from worries about unintended pregnancy. Yet it became clear early on that the Pill’s first incarnations were too strong. The initial version, Enovid, delivered a 10 mg dose of progesterone; three years later, that dose dropped to between 2.5 and 5 mg. Women who took the Pill in its early form risked a range of side effects from milder ones like weight gain and nausea to problems as severe as blood clots and stroke. Even the most recent versions still carry risks, particularly in women who smoke, and the Pill’s health effects have been the subject of decades of controversy. But it remains one of the most used form of birth control in the U.S. and several European countries. In the last decade, "extended-cycle" contraceptive pills have taken the phenomenon of control a step further, reducing bleeding from a monthly to a quarterly event or doing away with it entirely. Take that, Mother Nature.

Wisdom Upended: Heart Attack Warning Signs for Women

We all grew up knowing the classic warning signs of a heart attack: tightness, pressure or squeezing in the chest, dizziness, sweating, pain radiating down the left arm. But that template was developed by centuries of science focused on male patients. Recent studies have found that in women, the warning signs may be markedly different — so different that they’re often missed by both doctors and women alike. In women, warning signs can include unusual fatigue, shortness of breath, sleep disturbances, jaw/neck pain, shoulder pain, abdominal pain or heartburn, nausea or vomiting, lightheadedness or dizziness, sweating, and weakness in the arms —- and any or all may happen without chest pain. While chest pain is still considered the most important warning sign in both men and women, less than 30 percent of women in an NIH study felt chest pain before they had a heart attack, and 43 percent had no chest pain at any time during the attack. The timing may be different, too: While some women do experience sudden-onset pain and pressure, in other women less obvious symptoms can persist for up to a month before an attack, and many women delay seeing their doctors about those subtler symptoms. So, listen to your body, know the signs, and don’t dismiss them, even if they "could be anything"—your life may depend on it.

Lightening the Load: Breast Reduction Surgery

Did you know that it’s possible to buy a bra with a G, HH, or JJ cup? For women with extremely large breasts, these measurements — and the specialty stores that are often their only source of lingerie — are as familiar as back pain, posture problems, and grooves or bruises at the tops of the shoulders where bra straps have dug into the skin. In some women, disproportionate breast size can also cause skin rashes, numbness in the breasts, or breathing problems. First developed in the late 1800s and modernized in the 1960s, breast reduction surgery has made it possible for women uncomfortable with their breast size to live with less pain, discomfort, and self-consciousness. The surgery typically keeps the nipple and areola intact to preserve sensation; some women may lose the ability to breastfeed, but the advantages – particularly in terms of back, shoulder, and neck health – often outweigh the disadvantages. Insurance plans may cover the surgery with documentation that it is being performed to relieve physical problems. Added perk: Exercise is easier at a smaller cup size, and that can contribute to lifelong improvements in health and well-being.

Bye-bye Hysterectomies: Non-invasive Fibroid Removal

Uterine fibroids – benign growths in the wall of the uterus— typically appear in women of childbearing age, and one in four women over 40 has them. African-American women are more likely to have fibroids than women of other races. Their fibroids are tend to be larger and to occur at younger ages. Generally, fibroids are harmless. But in some women, fibroids become very large, very deep, or grow outside the uterus; these women can experience pain and unusually heavy menstrual bleeding, making them anemic. Hysterectomy used to be the only treatment available – a devastating option for those who still wanted to give birth. Now, less invasive procedures are allowing many women to lose the fibroids, but keep the uteruses. Laparoscopic or hysteroscopic surgery allows surgeons to remove fibroids with few or no incisions. A procedure called uterine artery embolization destroys fibroids by cutting off their blood supply rather than by excising them. And in some women, hormonal treatments alone can shrink fibroids to the point at which they no longer cause problems.

Breast Cancer Breakthrough: Herceptin Boosts Survival

Some 20 percent of women diagnosed with breast cancer have tumors with a marker called HER2, which used to mean that their cancer was very likely to recur or spread. But in 1998, a drug called Herceptin changed the landscape for these women. The medicine targets HER2-positive tumors by disabling the mechanism through which those tumors continue to grow. Because its action is so limited, it produces few side effects. In studies, Herceptin has cut recurrence rates by up to half in women with HER2-positive tumors. It doesn’t work for everyone, and it doesn’t replace chemo or radiation. But patients who once had one of the worst breast cancer prognoses may now have one of the best —- as long as either they or their insurance companies can pay for it. The $50,000- to $100,000-a-year price tag, not yet covered by all plans, is still Herceptin’s toughest side effect.

Old-fashioned Childbirth: Midwives and Doulas

Female birth attendants – first called "midwives" in the 14th century — ruled the realm of childbirth before it began to be subsumed under the mantle of male-run medical practice starting in the mid-1700s. In recent decades, midwifery has made a comeback, offering a woman-centered alternative to the obstetrical establishment and reframing the birth process itself as a primarily non-medical event. Yet we know how suddenly childbirth can, in fact, transform into a medical event. And in the U.S., midwives become accredited and they often have quick access to operating rooms and other hospital facilities should medical intervention be needed for either mother or baby. Doulas, from the ancient Greek for "women who serve," have re-emerged along with midwives to provide multiple levels of support to laboring and post-partum women. In developed countries like the U.S., where extended families often live hundreds or thousands of miles apart, doulas can help take the place of the "village" that would care for a laboring and post-partum woman in some traditional societies, allowing her to rest, recuperate, and learn how to nurse and care for her infant. Doulas are licensed for birth and/or post-partum support, and post-partum doulas can work with new families for anywhere from a day to a few months after a baby arrives.

Pictures of Health: Breast Imaging

It all started with the mammogram – the uncomfortable but mercifully brief annual x-ray that has become the gold standard in early detection of breast cancer since it was first made widely available in the late 1960s. Death rates from breast cancer in the U.S. have fallen more or less steadily since 1990 (though the drop has been steeper for white women than black women), and that decline has been attributed to a combination of early detection — courtesy of mammography — and improvements in treatment. Now breast imaging has become multi-faceted: Ultrasound is sometimes used at annual screenings to spot things that mammograms don’t always see, and breast MRIs are used both to screen high-risk women starting at the age of 30 and to monitor breast cancer survivors for possible recurrence. Last year, the U.S. Preventive Services Task Force created a firestorm by coming out against the long-established recommendation that women begin annual screening mammograms at age 40. To minimize overtreatment, the Task Force said, average-risk women aged 40 to 49 should talk with their doctors about the pros and cons of mammography rather than considering it an annual mandate, then have regular mammograms every two years starting at age 50. The outcry was loud and immediate, reaching all the way to the Obama administration, the American Cancer Society, and the American College of Radiology, which all stated that they would stick with the recommendations already in place and keep encouraging women to start annual screening at 40.

The Power of Names: PMS and PMDD Get Recognized

For centuries, women were stigmatized as unbalanced, hysterical, or enslaved by their physiology because of the often disabling emotional and physical symptoms they experienced just before their menstrual periods. But in 1994, pre-menstrual syndrome (PMS) and the more severe pre-menstrual dysphoric disorder (PMDD) entered the lexicon — in the Diagnostic and Statistical Manual, the handbook of behavioral-health diagnoses – and became legit. PMS and PMDD share some symptoms – mood problems such as irritability and aggression, and physical problems like bloating and fatigue – and both syndromes are thought to be caused by the hormonal fluctuations that occur just before menstruation. But PMDD is a more severe form of PMS—it interferes with a woman’s work, relationships, and daily routine. In mental-health circles, controversy continues about whether making PMDD an established psychiatric disorder helps women by recognizing the severity of their symptoms or hurts us by implying that we’re technically crazy once a month. But for the 3 to 9 percent of women who have PMDD or the one-third of women who live with PMS, the pertinent questions are more about how soon relief can come, and how effective it is. Remember; the average woman menstruates every month for nearly four decades. Nothing that happens to us that often and for that long should have to be a debilitating experience.

Advance Notice: BRCA Testing

With all we’ve learned about breast cancer, we still know precious little about what actually causes it – except in one group of women. Inherited genetic mutations that cause breast cancer, on genes dubbed BRCA1 and BRCA2, were isolated in 1994 and 1995. The mutations occur disproportionately, though not exclusively, in women of Eastern-European (Ashkenazi) Jewish ancestry. Inherited mutations account for only 5 to 10 percent of breast cancers in the U.S., but women who do have the mutations face serious odds. While the average woman has a 12 percent chance of developing breast cancer in her lifetime, in women with BRCA mutations, the risk spikes to 60 percent, with an additional 15 to 40 percent risk of developing ovarian cancer. Genetic testing for BRCA mutations is typically offered to women who have breast cancer or have a family history of it, especially if they are of Ashkenazi heritage and if the family history includes people diagnosed before the age of 40. More recent evidence also indicates that women of African descent may be at a higher risk for BRCA mutations. And while discovering that you are positive for BRCA mutations isn’t what any woman wants to hear, the test can lead to preventive options, such as mastectomy and/or removal of the ovaries to try to protect against both breast and ovarian cancer. For women at the highest risk, forewarned is forearmed.

DIY: Dermatology

Once upon a time, there was a strong line between the kind of skin care you could make happen at home-cleansing, exfoliating, toning, moisturizing-and the kind that required an appointment at the dermatologist’s-peels, microdermabrasion, scar removal. But in the last 10 years, cosmetic dermatology has leaped over the counter, with a wide range of procedures now available in packaged form at your local drugstore. Peels combine an exfoliating scrub with a cleanser that activates fruit acids to remove the top layer of skin cells. A welter of different kits offer at-home microdermabrasion, complete with handheld resurfacing tools. Topical wrinkle treatments-while not equal to Botox, fillers, or plastic surgery-have become sophisticated enough to dissuade many from more invasive procedures. And as if that weren’t enough, a shelf full of peripherals help reduce under-eye darkness and puffiness, even out dark spots from light scarring or sun damage, and replenish the look and feel of skin on the chest, arms, and hands. But no matter how much you take on at home, the most important skin-care procedure-a mole check every year to screen for skin cancer-is still something that only your dermatologist can do. NEXT: 12 Great Herbal Supplements Worth a Look

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