Washington Post

For many women this college graduation season, the primary reason to see a doctor soon after graduation may be to get birth control.

They may want to stick with whatever they’ve been using, whether that’s the pill or the patch or the vaginal ring. Or they may want to consider a broad menu of options that vary with regard to ease of use, side effects and duration of protection.

The most popular kind of birth control on campus is condoms, with 61 percent of women reporting that they used that method the last time they had sex. The pill came in a close second, with 58 percent, followed by withdrawal at 33 percent, according to a 2016 report by the American College Health Association from a survey of 80,129 undergraduate students. (Survey respondents often reported more than one method used.)

And yet, these commonly used contraceptive methods have failure rates that may give one pause. For 100 women over the course of a year, there would be nine pregnancies with the pill, 18 with condom use and 22 with the withdrawal method.

The top two birth control options in terms of effectiveness are intrauterine devices (IUDs) and progestin implants. With these methods, the failure rate is less than one pregnancy per 100 women in a year.

These two methods have another advantage for users, which earns them the moniker long-acting reversible contraceptives, or LARCs. After a one-time procedure, women are protected from getting pregnant for at least three years or up to 10 years, depending on the product.

There are fewer or milder side effects with these long-acting methods, compared with birth control pills. Copper IUDs such as Paragard can increase menstrual pain and flow, especially in the first year of use. Hormone-releasing IUDs, such as Mirena and Skyla, can cause spotting or irregular bleeding, especially in the first six months of use.

The hormones released by IUDs stay locally in the uterus, says Kristyn Brandi, an OB/GYN at Boston University. “So you don’t get the same side effects as taking the pill, such as changes in mood and breast tenderness,” she says.

A birth control implant can cause spotting throughout the monthly cycle. And its slowly released hormone distributes through the whole body, so hormonal side effects can occur, but “less so than the pill,” Brandi says.

With implants and hormonal IUDs, often menstrual periods become much lighter and in some women disappear altogether — a side effect that many view as a benefit.

Why don’t more young women use these long-acting, super-effective methods? In that survey of college students, IUDs were reported to be used by 9 percent of females and implants by 6 percent.

One reason is lingering myths about their safety in young women. “It’s a myth that you can’t have an IUD if you haven’t had a child,” says Krishna Upadhya, a Johns Hopkins pediatrician who specializes in adolescent health.

Older versions of IUDs were thought to be too large for some young women, but that’s no longer a concern, says Joanne Brown, a nurse practitioner at the University of Kentucky’s health service. “The newer IUDs are very small.”

Another reason more young women don’t use IUDs or implants is access, particularly on campus. Whereas 98 percent of campus health services provide birth control pills, only 40 percent provide the implant or IUDs. “It can depend on the size of a college, how many providers or what level of services they have,” says Brown, who works with the American College Health Association on sexual health issues.

Implants and IUDs require a procedure, not just a consultation and a prescription.

Cost can be a barrier, as well. The Affordable Care Act required health insurers to cover birth control, but that doesn’t mean that every plan covers every birth control method. Getting an IUD can cost several hundred dollars and as high as $1,000, including a medical exam and insertion.

Even if you’re paying some of the cost, IUDs are the most cost-effective birth control method, Brandi says. The non-hormonal IUD Paragard is good for 10 years and cost-wise beats paying $20 per month for birth control pills.

A relatively new IUD called Liletta is made by a nonprofit company with the aim of making them cost-friendly. “It costs $50 for a clinic to use,” Brandi says.

Birth control implants, which last three years, are generally cheaper than IUDs, at a couple of hundred dollars, but can run as high as $800, including insertion.

Upadhya, who sees patients up to age 25, says she helps them explore all the options -- not just effectiveness and side effects, but how a particular option fits in with their lives. Comfort level can play a role, she says. “The pill is the thing that everyone has heard of. People are very comfortable with the idea of it.”

As Brandi puts it: “The most effective form of birth control is the one people practice. Some people are good pill takers.”

The bottom line is there are a lot of options: the LARCs, the pill, the patch, the ring and the shot. “Even if you’ve had a problem with other kinds of birth control, Brandi advises, “talk to you doctor; she’ll help you figure out how to find something that will work.”

Thank you to all who nominated their colleagues for an APAOG Award. It was a very competitive year! We are proud to announce the 2017 Award winners who will be recognized at the APAOG Banquet and Reception at the 2017 AAPA Conference in Las Vegas, NV.  

• Outstanding PA in Women's Health - Jacquetta Melvin, PA-C, MPH, North Carolina State University - Student Health Services, Raleign, NC
• Preceptor Award - Melinda Balzar, MHS, PA-C, Department of Community & Family Medicine, Duke University Medical Center, Durham, NC
• Student Award - Christina Saldanha, PA-S, High Point University, High Point, NC 

Congratulations to our 2017 award winners! View the APAOG award's page for the full announcement. 

Now Open – Apply Below

Over the years, the PA Foundation has awarded more than $2.25 million in scholarships to PA students, benefitting more than 1,400 future PAs. Scholarships are awarded based on the availability of funds provided through contributions from AAPA members, other individuals, and corporate partners.

Eligibility Requirements

Scholarship applicants must meet all of the following criteria:

• Be a student member of AAPA
• Attend an ARC-PA-accredited PA program
• Have successfully completed at least one term of PA studies (semester or quarter) and be in good academic standing
• Be enrolled in PA school at the time the application period closes (May 31, 2017)

2017 PA Student Scholarship Cycle

The 2017 scholarship cycle is now open! The following scholarships will be awarded for the 2017 cycle (click on the link under each to apply):

• PA Foundation Scholarship – 9 to be awarded @ $1,000 each
  Open to all applicants who meet the general eligibility criteria listed above.
  >>Apply for PA Foundation Scholarship
• AAPA Past Presidents Scholarship – 1 to be awarded @ $1,000
  Awarded to students who demonstrate service leadership through their PA program or through a community health organization/project.
  >>Apply for AAPA Past Presidents Scholarship
• NCCPA Endowed Scholarship – 2 to be awarded @ $2,000 each
  Awarded to underrepresented minority students and/or those who are economically and/or educationally disadvantaged (see definitions of these criteria here).
  >>Apply for NCCPA Endowed Scholarship
• AAPA Rural Health Caucus Scholarship and Ron Nelson Memorial Scholarship – 3 to be awarded @ $2,000 each
  Awarded to students from a rural area who are committed to serving a rural community.
  >>Apply for AAPA Rural Health Caucus Scholarship/Ron Nelson Memorial Scholarship
• Ron Pace Memorial Scholarship – 1 to be awarded @ $1,000
  Awarded to a Florida-based student who is a veteran or the child/dependent of a veteran. Named in memory of Ron Pace, a Florida Academy of Physician Assistants past president and AAPA Outstanding PA of the Year Award recipient, who served in the U.S. Navy for 20 years.
  >>Apply for Ron Pace Memorial Scholarship

PLEASE NOTE: You must click on the application link under the name/description of each scholarship in order to apply for that award. You will be prompted to create an account when you begin your first application, and will sign into that same account when completing the others; however, you still must click on each individual link on this page to apply for each award.

View the applicant instructional guide here.

Questions? Contact Caroline Pierce at cpierce@aapa.org or 571-319-4510.

Additional Financial Aid Resources

Information about additional financial aid resources for PA students is available in the Student Academy section of the AAPA website.

2016 PA Foundation Scholarship Recipients

Congratulations to the 16 PA students who were awarded scholarships during the 2016 application cycle.

By Steven Reinberg
HealthDay Reporter

THURSDAY, April 6, 2017 (HealthDay News) -- Nearly half of American men and women under 60 are infected with the human papillomavirus (HPV), putting them at risk for certain cancers, federal health officials reported Thursday.

More than 45 percent of men were infected with genital HPV in 2013-2014, while 25 percent were infected with high-risk genital HPV. At the same time, about 40 percent of women carried genital HPV, while almost 20 percent had high-risk genital HPV, according to the U.S. Centers for Disease Control and Prevention.

Some types of HPV can cause genital warts and are considered low risk, with a small chance for causing cancer, the CDC report said. Other types are believed to be high risk and can cause cancer in different parts of the body. Those areas include the cervix and vagina in women, the penis in men, and the anus and neck in both genders.

However, the HPV vaccine has the potential to reverse the epidemic and prevent thousands of cancers in the United States each year, the CDC researchers said. In fact, it's already having an effect, said Geraldine McQuillan, a senior epidemiologist at the CDC's National Center for Health Statistics (NCHS).

"After the introduction of the HPV vaccine in 2006, there has been a decrease in genital HPV in young adults -- this is a vaccine against cancer," she said.

In teenage girls, HPV infection has dropped 60 percent, and in young women it has dropped 34 percent, McQuillan said.

According to Fred Wyand, spokesman for the American Sexual Health Association, "These data are a further confirmation that HPV deserves its moniker as the 'common cold' of sexually transmitted infections."

Experts believe that most sexually active people have HPV at some point. "Fortunately, most of these infections do no great harm and will clear naturally by the immune system," Wyand said.

To estimate the prevalence of HPV infection among U.S. adults aged 18 to 59, the researchers used data from the National Health and Nutrition Examination Survey from 2011 to 2014.

The investigators found that during that time period, the prevalence of oral HPV for adults of both genders stood at just over 7 percent, while 4 percent of men and women had high-risk oral HPV.

The prevalence of oral HPV was lowest among Asian adults and highest among black adults. And more men than women were infected with oral HPV, the findings showed.

As for genital HPV, Asians had the lowest rate of infection, while black adults had the highest rate.

Although the HPV vaccine prevents about 70 percent of all cervical cancers, too few girls and boys are getting it, McQuillan said.

According to a 2015 report, six out of 10 girls have started the HPV vaccine series, as have five of 10 boys. All girls and boys aged 11 or 12 should get the recommended two-dose series of HPV vaccine, the CDC advises.

"The vaccine is targeted to very young kids because you have to catch them before they are sexually active," McQuillan explained.

As more people are vaccinated, further declines in HPV and the cancers it causes will be seen, she said.

Wyand added that "HPV immunization is a sparkling triumph of public health. It works very well and has been shown to block virtually all infections and diseases related to the HPV types it covers."

Electra Paskett, a cancer control researcher at the Ohio State University Comprehensive Cancer Center, pointed out that there's still a lack of urgency among parents to get their children vaccinated.

In addition, she said, "the vaccine is not strongly and routinely recommended by physicians."

Paskett believes the vaccine should be a regular part of a child's vaccine program and not singled out as something special. It's up to doctors to include the vaccine in the usual vaccine schedule, she said.

"The vaccine is a part of cancer prevention," Paskett said. "This vaccine has the potential to prevent 30,000 cases of cancer each year and is woefully underused."

The report was published April 6 in the CDC's NCHS Data Brief.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on the human papillomavirus.

SOURCES: Geraldine McQuillan, Ph.D., epidemiologist, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention; Fred Wyand, spokesman, American Sexual Health Association; Electra Paskett, Ph.D., cancer control researcher, Ohio State University Comprehensive Cancer Center, Columbus; April 6, 2017, CDC's National Center for Health Statistics NCHS Data Brief

Last Updated: Apr 6, 2017

Copyright © 2017 HealthDay. All rights reserved.

By Lisa Rapaport

(Reuters Health) - - After menopause, women who take estrogen therapy may be less likely to develop severe oral health problems than peers who don’t take hormones or other treatments for age-related bone damage, a recent study suggests.

During menopause and afterward, the body slows production of new bone tissue and women face an increased risk of osteoporosis. Falling levels of the hormone estrogen around menopause can contribute to fragile, brittle bones associated with both osteoporosis and periodontal disease, or infections around the teeth and gums.

For the current study, researchers examined data on 492 women in Bahia, Brazil, who had gone through menopause and had bone density scans between 2009 and 2011. The group included 113 women treating osteoporosis with calcium and vitamin D supplements, or with estrogen alone or in combination with the hormone progestin.

Overall, the rate of severe periodontitis - when the inner layer of gums pull away from the teeth - was 44 percent lower among the women taking estrogen for osteoporosis, the study found.

“I imagine that a patient who forgoes osteoporosis treatment with estrogen because of its risks is unlikely to change her mind after learning there is a potential connection to periodontal disease,” said Natalia Chalmers, director of analytics at the DentaQuest Institute in Westborough, Massachusetts.

“But if she is already predisposed to severe periodontitis, it is important for her to know how osteoporosis may make her condition worse,” Chalmers, who wasn’t involved in the study, said by email.

Risks of estrogen therapy can include increased odds of heart disease and breast cancer, Johelle de S. Passos-Soares of the Federal University of Bahia in Brazil and colleagues note in the Journal Menopause. Passos-Soares didn’t respond to requests for comment on the study.

Periodontitis is a leading cause of tooth loss in older adults. As gums pull away from the teeth, debris collects in the mouth that can become infected and plaque can spread below the gum line. In severe cases so much gum tissue and bone are destroyed that teeth become loose and fall out.

Women in the study were 61 years old on average, and ranged in age from 50 to 87. They typically when through menopause when they were around 47 years old.

Women treating osteoporosis averaged about 9 missing teeth, 8 decayed teeth and 2 teeth with fillings or restorations. They were also more likely than women not treating osteoporosis to have visited a dentist within the past two years.

With estrogen treatments, fewer women had periodontal disease, which researchers defined as gaps at least 5 millimeters deep between the gums and the jaw around at least 30 percent of teeth. But the difference from women not using estrogen was too small to rule out the possibility that it was due to chance.

However, osteoporosis treatment was associated with fewer cases of severe periodontitis and significantly fewer teeth that had gaps at least 4 millimeters deep between the gums and the teeth.

The study isn’t a controlled experiment designed to show whether estrogen treatment after menopause directly prevents gum disease or severe periodontitis.

Limitations of the study include the fact that researchers looked at women at a single point in time, so they couldn’t determine when the women developed oral health problems relative to when they went through menopause or started estrogen treatments. Women in the study were also recruited from a health center, making it possible the findings might be different in a broader population of patients, researchers note.

It’s also possible that women who seek routine care for one aspect of their health may be more likely to get treatment for other health issues, Chalmers said. That means the connection between osteoporosis treatment and women seeking more preventive care in general might explain a lower risk of periodontal disease.

“The link between osteoporosis and periodontal disease is not clear, and more studies are needed to fully assess this connection,” Chalmers said. “However, we can say that patients affected by each condition share risk factors such as age, smoking, hormonal change and genetics, as well as calcium and vitamin D deficiency.”

SOURCE: bit.ly/2oykoJb Menopause, online February 22, 2017.

APAOG Events at AAPA

According to new data, almost three-quarters of PAs (72 percent) who responded to a survey express support for the full practice authority and responsibility (FPAR) proposal drafted by the Joint Task Force on the Future of PA Practice Authority.

Issued in December 2016, the proposal includes four components for the profession on which the Joint Task Force was seeking comment: Team-Based Practice; Elimination of Supervisory Agreement Requirements in Law/Regulation; Creation of Autonomous State PA Boards; and PA Eligibility for Direct Reimbursement.

Read the full report here. 

Dorothy L. Tengler      

Hysterectomy is one of the most commonly performed surgeries in women. Approximately 600,000 hysterectomies are performed each year in the United States, second only to cesarean sections.

According to the Centers for Disease Control and Prevention (CDC), 11.7 percent of women between the ages of 40-44 had a hysterectomy from 2006-2010. By the age of 60, more than one-third of all women have had a hysterectomy.

Although surgeons may suggest removing the ovaries to prevent possible ovarian cancer, this is not always medically necessary and may contribute to increased risk of cardiovascular disease, other cancers and higher overall mortality, according to recent research. A study in the British Medical Journal compared cases in which both ovaries were removed with those in which some ovarian tissue was conserved.

The study, led by Richard Lilford, professor of obstetrics and gynecology and chair in public health at the University of Warwick's Warwick Medical School, examined a national database of hospital admissions and linked them to the national register of deaths. Unlike the previous, smaller Nurses' Health Study, the study was conducted on a countrywide basis rather than in a sample and examined associations between operation type and subsequent hospital admissions, as well as mortality.

More than 113,679 hysterectomy cases were studied; the ovaries were removed in a third of these. The women were between the age of 35 and 45 (mean age, 41 years), the upper limit ensuring that the great majority of cases would be premenopausal. Women with a history of reproductive cancer, including breast cancer, were excluded. Outcomes included mortality, mortality resulting from ischemic heart disease and hospital admission for ischemic heart disease, cancer (all cancers, ovarian cancer, breast cancer), and suicide.

Patients in the ovarian conservation group were less likely to be admitted for ischemic heart disease after hysterectomy than were those in the bilateral removal group. They were also less likely to have a cancer related post-hysterectomy admission.

Fewer women who retained one or both ovaries compared to those who had both removed died within the study period (0.6 percent compared to 1.01 percent). Mortality was lower when ovarian tissue was conserved than when all ovarian tissue was removed, with a statistically significant difference of 0.41 percentage points. This amounts to one death in about 240 operations over 10 years, which is clinically significant.

Researchers also found that there was a slow decline in the number of hysterectomies performed. Nearly 9,000 women had a hysterectomy for a benign condition in the target age range in 2014 compared to almost 13,000 in the 2004-05 group.

Many premenopausal women with no specific risk factors have both ovaries removed during hysterectomy to protect them from the possible development of ovarian cancer. However, removing the ovaries may have long-term harmful effects that should be weighed against the potential benefit. A decrease in endogenous estrogen may increase the risk of cardiovascular disease or all cause mortality, but little empirical evidence for this exists.     

About the Author

Dorothy L. Tengler, MA, is a freelance medical writer/communication specialist with nearly 20 years of experience in the pharmaceutical and medical communication industries. She has developed educational and medical marketing materials, including monographs, slide kits, health articles, prima