For many women, the side effects of menopause don't call it a day when they do.

Between 40 and 60 percent of women in perimenopause and early menopause face issues with sleep because of this physical change. The majority also report hot flashes and night sweats, which can be disruptive to falling and staying asleep.

A new study published in Menopause: The Journal of The North American Menopause Society has found that low-dose hormone therapy may be effective in easing sleep issues in this population. The goal of the study was twofold: find out how two forms of hormone therapy affect sleep quality and assess the ties between hot flashes, sleep quality and hormone therapy.

"Poor sleep quality over time affects more than just mood," says Virginia Miller, Ph.D., director of Mayo Clinic's Women's Health Research Center and the study's corresponding author. "Sleep deprivation can lead to cardiovascular disease, among other health risks. There can be serious consequences -- mental and physical -- if you're not getting quality sleep over a long period of time."

The study looked at two forms of hormone therapy -- oral estrogen (conjugated equine estrogen) and a patch (17 beta-estradiol) -- to find out how their use affected sleep quality. The participants were part of the Kronos Early Estrogen Prevention Study, and all were recently menopausal women. The women self-reported on the quality of their sleep using the Pittsburgh Sleep Quality Index. They also recorded the intensity of hot flashes and night sweats during this time.

The women were found to have improved sleep quality over four years when using low-dose hormone therapy -- twice the improvement of those in the placebo group.

Researchers also found that sleep quality improved with changes in hot flashes and night sweats, but Dr. Miller says it remains difficult to determine if the low sleep quality is caused by these symptoms or if they are a consequence of poor sleep.

"Menopause affects such a large portion of the population, so it is important to keep researching how we can best promote a woman's overall health during this phase in her life," says Dr. Miller.

Source:

https://newsnetwork.mayoclinic.org/discussion/study-finds-hormone-therapy-improves-sleep-quality-for-recently-menopausal-women/

(Reuters Health) - For women, greater access to primary care providers may be linked to a lower risk of sexually transmitted infections (STIs), a U.S. study suggests.

“A lack of health care access can translate to more people with undiagnosed and untreated STIs,” said lead study author Danielle Haley of the University of North Carolina at Chapel Hill.

“Regular screening can help ensure that people who have an STI are aware of the infection and get proper treatment,” Haley said by email. “Screening also helps identify and treat sex partners who may also have STIs.”

Haley’s team examined data on 666 women in five southern states (Alabama, Florida, Georgia, Mississippi and North Carolina) who joined a study about HIV.

Overall, these women typically lived in communities where about 74% of residents had primary care providers, the study team reports in Sexually Transmitted Diseases, online August 2.

Women were 43 years old on average, and 71% were HIV-positive when they joined the study between 2013 and 2015; the vast majority were black.

Overall, about 11% of the women had at least one STI confirmed in lab tests.

After accounting for insurance and individual patient characteristics, each four-percentage-point increase in neighborhood residents with primary care providers was associated with 39% lower odds that women would have an STI.

Researchers didn’t find an association between women’s odds of having a STI and the proportion of residents in their communities who had health insurance.

Access to primary care influenced the odds of STIs regardless of socioeconomic status, the study also found.

One limitation of the study is that it was too small to tell how access to care influenced the odds of specific STIs, only the overall chances that women might get at least one STI, the authors note. Because so many of the participants were HIV-positive and had agreed to be part of a long-term study, their odds of STIs also might not be the same as those of other women.

Even so, the findings underscore the importance of routine checkups, said Dr. William Miller, a public health researcher at the Ohio State University in Columbus who wasn’t involved in the study.

“They should see their physician regularly and talk about their sex life with the physician, even if the physician doesn’t bring it up,” Miller said by email.

Women still have options if they lack insurance or a primary care provider, Miller added. Many county and city health departments provide STI screenings and treatment, as do nonprofit clinics.

And they shouldn’t forget prevention.

“To protect themselves, it’s still all about condoms, a message that has been lost a bit in recent years,” Miller said.

Each year, an estimated 20 million new STIs occur in the U.S. alone, half among young people ages 15 to 24, according to the Centers for Disease Control and Prevention.

SOURCE: bit.ly/2vgvpCF

Sex Transm Dis 2017.

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60.4 percent received one or more doses in 2016, but many not completing series

FRIDAY, Aug. 25, 2017 (HealthDay News) -- Six out of 10 U.S. teens ages 13 to 17 received one or more doses of a human papillomavirus (HPV) vaccine in 2016, but many are still not completing the vaccination series, according to research published in the Aug. 25 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. In its new report, the CDC said 60.4 percent of teens aged 13 to 17 received one or more doses of HPV vaccine in 2016 -- an increase of 4.3 percentage points from 2015. And the report found that HPV vaccination is becoming more common among boys. An estimated 65.1 percent of girls received their first dose of HPV vaccine in 2016, compared to 56.0 percent of boys. That represents a 6.2 percentage point increase for boys from 2015. Rates for girls were about the same as 2015, the CDC said. But agency officials said they're concerned because, while most teens have received the first dose of HPV vaccine, only 43.4 percent are up to date on all recommended doses. Vaccination rates tend to be lower in rural and less urban areas compared to more urban areas, the CDC said. The CDC recommends two doses of HPV vaccine for children at ages 11 or 12. Teens who get the first vaccine dose before their 15th birthday need two doses to be protected. Teens and young adults who start the vaccine series between ages 15 through 26 need three doses, according to the agency. Abstract/Full Text

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08/24/2017

August 24, 2017 – The U.S. Preventive Services Task Force posted today a final research plan on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer. The draft research plan for this topic was posted for public comment from March 16, 2017 to April 12, 2017. The Task Force reviewed all of the comments that were submitted and took them into consideration as it finalized the research plan. To view the final research plan, please go to https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing1.

The American Reproductive Health Professionals is offering APAOG two FREE webinars and two FREE clinical minutes about psoriasis and sexual health. 

About 20% of American women have psoriasis, and 30% of those get psoriasis on their genitals. The AHRP offerings help healthcare professionals communicate with their patients about the physical and emotional challenges of living with psoriasis, the latest treatment options, and how your members can help support the sexual and psychosocial health of women living with psoriasis. Available live Aug. 23 and 31 or online on demand until January 2018, these offering provide your members with FREE CME credits.

The links below will provide you with additional information: 

Webinar 1: More than Skin Deep: Improving the Diagnosis and Therapeutic Management of Psoriasis in Female Patients
Aug. 23, 2-3 PM EDT

http://bit.ly/2wh1pun

Webinar 2:  
More Than Skin Deep: Managing Psoriasis in Females Across the Reproductive Lifespan

AUG. 31, 2-3 PM EDT

http://bit.ly/2uYl7LH

Learn Even More On Your Schedule With Our "Clinical Minute" Videos

15-Minute Activities that Award More Free CME/CE Credits

Clinical Minute 1: 
Diagnosing and Managing Psoriasis in Female Patients

CLICK HERE for More Information/To View

Clinical Minute 2: Psoriasis in People of Color
CLICK HERE for More Information/To View

Recommendations for breast cancer screening in average risk women have been included in the Practice Bulletins for the  American Congress of Obstetricians and Gynecologists. The recommendations for screening mammography state the following: "Updated recommendations include that average-risk women be offered screening at age 40, or no later than 50 years. Screening should be continued every one or two years until at least age 75." ACOG encourages shared decision making for all about breast cancer screening decisions. A comparison of breast cancer screening recommendations in average risk women as developed by several recommending bodies can be found here: https://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Breast-Cancer-Risk-Assessment-and-Screening-in-Average-Risk-Women

The U.S. Preventative Services Task Force issues a statement in July recommending against ovarian cancer screening in women without symptoms, stating that clinicians "should not screen for ovarian cancer in women who have no signs or symptoms of the disease". This reaffirms their statement from 2012. This recommendation does not apply to women with BRCA I/II mutations. 

Improve safety, quality, and access in women's healthcare
AAPA

AAPA seeks a volunteer to represent AAPA on a Facility Standards Development Initiative of the American College of Obstetricians and Gynecologists (ACOG). Potential candidates must be available to attend an in-person meeting at ACOG headquarters in Washington, D.C., on Wednesday, Dec. 13 (10 a.m. –5 p.m.), and Thursday, Dec. 14 (8:30 a.m.–2 p.m.). Representatives also would be expected to review draft documents and supporting materials prior to the meeting and remain engaged as ACOG staff revises drafts based on discussions at the December meeting. Applications are due Aug. 18.

Learn More

Significant reduction in postmenstrual spotting, dysmenorrhea, and discomfort related to spotting 

TUESDAY, Aug. 1, 2017 (HealthDay News) -- Laparoscopic niche resection is associated with improvement in niche-related symptoms and/or fertility-related problems in women with a large niche (residual myometrium [RM] <3 mm) in the uterine cesarean scar, according to a study published online July 13 in BJOG: An International Journal of Obstetrics and Gynaecology. Anke Vervoort, M.D., from the VU University Medical Center in Amsterdam, and colleagues conducted a prospective cohort study involving women with a large niche and complaints of postmenstrual spotting, dysmenorrhea, intrauterine fluid accumulation, and/or difficulties with embryo transfer due to distorted anatomy. The researchers found that in 79.2 percent of the 101 women who underwent a laparoscopic niche resection, the main problem was improved or resolved. There was a significant reduction in postmenstrual spotting by seven days at six-month follow-up compared with baseline. Significant reductions were also seen in dysmenorrhea and discomfort related to spotting. At follow-up, there was a significant increase in RM. For 86.9 percent of the women with intrauterine fluid at baseline, the intrauterine fluid was resolved. Overall, 83.3 percent of women reported being (very) satisfied. There was an increase in the physical component of quality of life, while no change was seen in the mental component. "A laparoscopic niche resection reduced postmenstrual spotting, discomfort due to spotting, dysmenorrhea, and the presence of intrauterine fluid in the majority of women and increased the RM," the authors write. Abstract Full Text Editorial (subscription or payment may be required)

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Adapted Media Release

A new test is the best-to-date in differentiating Zika virus infections from infections caused by similar viruses. The antibody-based assay, developed by researchers at UC Berkeley and Humabs BioMed, a private biotechnology company, is a simple, cost-effective way to determine if a person's infection is from the Zika virus or another virus of the same family, such as dengue and West Nile viruses.

Zika is a mosquito-borne disease and is linked to severe congenital birth defects. Assays already exist to detect Zika virus infection, but they either work only shortly after infection or are poor at differentiating Zika from other flaviviruses. The limited ability of assays to detect Zika virus has led to difficulty in determining the prevalence of Zika virus infections, the incidence of congenital Zika syndrome and the frequency of neurological complications associated with Zika virus infections.

The new assay has very high sensitivity (91.8 percent) and specificity (95.9 percent) for identifying Zika virus infections. The assay is currently in the licensing process and researchers hope it will be available to the medical community soon.

"The whole world has been in urgent need of a serological method to distinguish dengue virus from Zika virus infections, and this the first to have such high sensitivity and specificity in dengue-endemic regions," said Eva Harris, study co-author and UC Berkeley professor in the Division of Infectious Diseases and Vaccinology at the School of Public Health.

The article will be published online in the journal Proceedings of the National Academy of Sciences. The research was supported, in part, by grants from National Institutes of Health.

Utilizing its proprietary CellClone discovery technology, Humabs generated a new human antibody to the Zika virus, which the company then used to develop the assay. The assay is based on a well-established approach to detecting viral infections, but the new antibody and protocol give the assay superior sensitivity and specificity, two key assay metrics.

The assay was implemented in five countries and tested using a large number of clinical samples from travelers and patients living in areas with a high level of exposure to Zika virus and other flaviviruses. The new assay was highly sensitive, specific and robust, according to the study data. When the assay was run on patients infected with Zika virus and also on a control group of 540 patients infected by other flaviviruses or other viruses, plus healthy donors, the specificity was 95.9 percent.

The assay was developed using detailed patient samples from Harris's collaborative studies in Nicaragua, a large step forward over previous studies. These samples included multiple, longitudinal samples from Zika patients, with or without prior exposure to dengue virus, and samples from dengue patients infected either once or more than once with different types of the dengue virus. The samples were obtained from a 14-year study of a cohort of children whose previous viral infection histories were well documented. These samples were key to the research, because prior dengue virus infections can cross-react and confound many current Zika antibody-based assays; having a thoroughly analyzed pool of patient samples helped the research team characterize and avoid this cross-reactivity.

"These results support that the antibody-based assay that we have developed is highly effective in detecting both recent and past Zika virus infections and in discriminating Zika from other flavivirus infections," said Davide Corti, senior vice president and chief scientific officer of Humabs BioMed. "This novel assay has the potential to become an effective, simple and low-cost solution for Zika surveillance programs, prevalence studies and clinical intervention trials in flavivirus-endemic areas."

The assay is cost effective and easy to use, the researchers say, and additional studies are ongoing to further simplify the assay protocol.

Article: Antibody-based assay discriminates Zika virus infection from other flaviviruses, Davide Corti et al., Proceedings of the National Academy of Sciences, doi: 10.1073/pnas.1704984114, published online 17 July 2017.

Case report describes 51-year-old man who primarily presented with multiple nodules on his scalp 

WEDNESDAY, July 19, 2017 (HealthDay News) -- A rare case of secondary syphilis which primarily presented with multiple nodules on the scalp has been detailed in a case report published online July 17 in the Journal of Dermatology. Fan Li, from Sichuan University in Chengdu, China, and colleagues reported the case of a 51-year-old man who presented with a two-month history of multiple nodules on his scalp. The skin lesions had initially developed as groups of small nodules over the parietal area; in the following weeks, they increased in size and number. According to the authors, multiple, rounded yellow-red to dull-red non-tender nodules and masses measuring 0.5 to 3 cm in diameter were observed scattered over the patient's scalp; some of these were scaly and some were crusted due to scratching. A well-defined, firm painless subcutaneous mass was seen on the left cervical region. The results of routine blood, urine, and stool samples and of chest computed tomography and abdominal and pelvic cavity ultrasound were normal. An enlarged lymph node was identified with normal structure in the left neck; the diagnosis remained indefinite. The patient was referred one month later with papillary nodules at his right nasolabial fold and bilateral nasal vestibules, with condyloma lata around the anus. Nodular secondary syphilis was eventually diagnosed. "Secondary syphilis, also termed the 'great imitator,' has extremely diverse manifestations, with cutaneous involvement in most cases," the authors write. "Clinicians must be aware of syphilis because of its prevalence and diversity of clinical manifestation." Abstract Full Text (subscription or payment may be required)

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