New Guidelines for Depo-Provera®
Bone loss while using Depo-Provera is temporary and returns after injections are stopped.
The Society of Obstetricians and Gynaecologists of Canada (SOGC) has released new guidelines for healthcare professionals on the use of Depo-Provera® injectable contraceptive. The guidelines were created following concerns over the loss of bone mineral density (BMD) linked to the use of Depo-Provera®.
These concerns date back to November 2004, when the American Food and Drug Administration issued a “black box” warning for the labeling of Depo-Provera® (Depot Medroxyprogesterone Acetate [DMPA]) because of BMD concerns. Health Canada issued a similar warning in June of 2005.
Research has confirmed that Depo-Provera® use does reduce bone-mineral density in users, though there is evidence that most of this bone density loss is temporary, as bone mineral density returns once the contraceptive is stopped. This loss of bone mineral density has not been linked to an increase in adverse outcomes such as bone fractures or osteoporosis.
The new SOGC guidelines recommend that healthcare professionals carefully weigh the risks and benefits of Depo-Provera® before prescribing the medication, and that patients should be informed about the potential decrease in bone density. The guidelines also recommend that healthcare professionals counsel their patients on ways to improve their “bone health” such as by taking calcium and vitamin D supplements, or by quitting smoking. The guideline also states that current evidence does not support routine BMD testing for DMPA users.
Depo-Provera is a hormonal contraceptive given by injection by a healthcare professional every 12 to 13 weeks. Because it contains a progestin but not estrogen, it may be recommended for women who cannot take estrogen. It may also be recommended for smokers over 35 and women who have trouble adhering to the regular schedule or other birth control methods such as the birth control pill.
High Chlamydia Rates in Inuit Community
A recent article in the Ottawa Citizen revealed another health concern for Canada's Inuit population. Nursing professor Audrey Steenbeek recently examined the high rates of chlamydia within a small Inuit community as part of her PhD studies at the University of British Columbia.
Steenbeek interviewed 181 Inuit men and women, and also tested them for sexually transmitted infections (STIs). She found that, of the people tested, over 15% tested positive for chlamydia and that most of the infections occurred in adolescents and young women. Many of those tested had never heard of chlamydia ,, even though it is the most common of the bacterial STIs. There were no cases of gonorrhea diagnosed in this community.
It is very likely that such a high infection rate is not unique to this one community, but is in fact common among the majority of isolated northern communities. This may be related to several factors, including multiple sexual partners, unwanted intercourse, and reluctance to use barrier methods such as condoms for protection from STIs. Alcohol and substance abuse in the North may also contribute as risk factors for acquiring an STI.
The rate of chlamydia infection in the general Canadian population in 2004 was 197 cases per 100,000 people, while the rates in Northern Canada were from 638 to 1353 cases per 100,000 (Public Health Agency of Canada).
High rate of STD chlamydia in Inuit village raises concerns,
Margaret Munro
The Ottawa Citizen
Saturday, January 07, 2006
Pap Smear Registry – Should Ontario Join In?
Since 1949, the province of British Columbia has had a cervical cancer screening program. At present, all pap smears performed by health care providers are sent to a centralized lab where they are processed and stored. The results are sent to the primary care provider and are also kept on file at the lab. Recommendations for treatment (if needed) are sent as well. The organizers of the program have noticed a major decrease in the death rate from cervical cancer, and this is attributed to increased detection and earlier treatment of the disease. Since the 1960s, the number of cases of cervical cancer has dropped by 85%, and the number of deaths has dropped by 78%.
More recently, Saskatchewan, Alberta, and Nova Scotia have added cervical screening registries. Cancer Care Ontario has recently lobbied the government for funding to launch their own centralized registry. The benefits include: a central location for pap smear results allowing better follow-up of abnormal results; patient recall letters if pap smear screening is overdue; and reminders to health care providers when screening is due. A central registry would also decrease the number of duplicate tests performed. Registries such as this have been shown to decrease cancer rates in North America and Europe.
One of the biggest concerns is that there are many women who have never had a pap test. This may be due to a lack of knowledge about the importance of the test, fear of the test, or a lack of access to the test. Approximately half of women diagnosed with cervical cancer have never had a pap smear. By establishing a registry, all women in the province would be invited to participate in screening, which in turn may encourage all women to present for Pap smears during their lifetime.
Registry urged for Pap tests: Women would be called back in
Feb. 13, 2006. 04:56 AM
Tanya Talaga, Health Reporter
The Toronto Star
New anti-HIV vaginal gel may be available by 2010
An article recently released by the Associated Press News Service revealed that women may soon have a new option to protect themselves from acquiring HIV. Worldwide, several thousand women are involved in ongoing research investigating a vaginal gel that effectively kills the HIV virus that causes AIDS.
The majority of people infected with the HIV virus are in sub-Saharan Africa (25 million of the 45 million people infected worldwide). Up to 60% of the new infections in Africa are in heterosexual women who get it from their partners. This gel would give women an opportunity to protect themselves from the virus even when their partner is reluctant to use a condom.
Gita Ramjee, director of the HIV prevention research unit at South Africa's Medical Research Council, released the news at a conference on infectious diseases in Cape Town, South Africa. The final results from the research are expected in 2008, and a product could be on the market as early as 2010.
Much of the effort in stemming the spread of HIV has focused on anti-viral medications. However, these are expensive and difficult to take. The vaginal gel will potentially decrease the number of new infections, instead of just treating patients once they are infected.
Researchers foresee HIV-blocking gel for women
Barre Montpelier Times, Argus, VT - 24 Apr 2006
By Clare Nullis (Associated Press.)
Yes, it is. This IUD is made of two components, plastic and levonorgestrel (a progestin hormone). The levonorgestrel is released slowly from the IUD and causes the lining of the uterus to become very thin. When the Mirena is first inserted, before the lining becomes completely thinned out, women may have unpredictable spotting. Eventually, the lining becomes so thin that many women stop having their periods altogether. It should get better over the next few months. If that is not happening, see your health care provider to make sure there is not another cause for the bleeding.
