The following information is taken from the 20^th edition of Contraceptive Technology:

Intrauterine Contraceptives by Gillian Dean, MD, MPH and Eleanor Bimla Schwarz, MD, MS

Cancer Protection

Both IUCs are associated with a reduction in the risk of endometrial cancer.  Although the mechanism of action in the copper IUC is unknown, it may relate to alterations in the endometrium.  Similarly, progestin-releasing intrauterine contraception has also been shown to protect against endometrial cancer, as is true of contraceptives that deliver a progestin systemically.  Indeed, the LNg IUC has been used to prevent development of endometrial hyperplasia in women using estrogen therapy in the peri-and postmenopause.  While the TCu380A is generally preferred for women with recent breast cancer, the LNg IUC is used at times for women treated with tamoxifen to protect the endometrium.  Moreover, the LNg IUC has been used for the treatment of nonatypical endometrial hyperplasia.  It may also be effective for atypical hyperplasic and grade 1 endometrial cancer.                           

Non-contraceptive Health Benefits of the LNg IUC Topical delivery of progestin to the uterine cavity has exciting therapeutic uses aside from contraception. Some are well established and approved indications, while others are still being explored. The LNg IUC reduces dysmenorrhea and menstrual blood loss from a variety of causes. Overall blood loss drops about 90%, and at least 20% of women stop bleeding altogether. This translates into clinically important increases in hemoglobin and iron stores. The reduction in menstrual blood loss occurs both in women with normal coagulation parameters and in those with bleeding diatheses, including those using anticoagulant therapy. Some evidence supports a benefit in treating heavy bleeding associated with adenomyosis and leiomyomas with the LNg IUC. Trials have compared this approach to treatment with an oral progestin, a nonsteroidal anti-inflammatory drug, or mefenamic acid (which is not available in the United States) and found the LNg IUC superior to the other alternatives. In addition, the LNg IUC is an acceptable and cost effective alternative to endometrial ablation or hysterectomy. The LNg IUC may also decrease the risk of pelvic inflammatory disease (PID), similar to other progestin-containing contraceptives. By thickening cervical mucus, progestin may provide a barrier to ascending infection. 

IUDs May Protect Against Cervical Cancer

By NICHOLAS BAKALAR Published: September 19, 2011

Intrauterine devices may offer some protection against cervical cancer, a large review of studies has found.

Related

·         Health Guide: Cervical Cancer

·         More Vital Signs Columns

The studies were conducted from 1985 to 2007 in Europe, Asia and South America and involved nearly 20,000 women. After controlling for many health and behavioral factors, the researchers found that using an IUD reduced the risk of cervical cancer by 45 percent, compared with never using one. The review, published online last week in Lancet Oncology, said the protective effect was apparent in the first year of use and continued for as many as 10 years.

Women who choose to have IUDs inserted are more likely to have been screened for cervical cancer, but the researchers found that screening was not a factor in the reduced risk. And women with IUDs were no more or less likely than women without them to be infected with human papillomavirus, the main cause of cervical cancer. Rather, the researchers suggest, the insertion of an IUD might provoke an immune response to HPV.

The data underscore two important points, according to the lead author, Dr. Xavier Castellsagué, an epidemiologist at the Catalan Institute of Oncology in Barcelona, Spain. First, having an IUD does not change the risk for HPV infection. And second, IUD use is associated with a reduction of almost 50 percent in the risk for cervical cancer.

Robert A. Hatcher MD, MPH

Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, GA 

Reference:

Dean G, Schwarz EB. Intrauterine contraceptives (IUCs) IN Hatcher RA, Trussell J, Nelson AL, Cates Jr. W, Kowal D, Policar MS. et al Contraceptive Technology 20^th edition, pages 152 and 153: Ardent Media Inc. 2011

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What is your body telling you?

One day a good friend and colleague walked me out to the parking area next to the building where we both worked. It was across the street from Grady Memorial Hospital where I have worked since 1963 save for two years of active duty in the Public Health Service and one year at the University of California in Berkeley.

I was seated in the driver’s seat and had rolled down the window.  Our conversation went on for about five minutes. My friend was standing right next to the open window.

Then without raising her voice and in the exactly the same matter of fact tone in which she had been speaking, she said “Oh, Bob, I just ovulated in my right ovary.”

I roared! She told me that occasionally she could feel a slight twinge of pain as she ovulated.  This is what had happened that afternoon.  About 15% of women occasionally do feel something in the pelvic area as ovulation happens.  It can happen on the right or the left as ovulation can occur in either ovary.  When there is any discomfort from rupture of an egg out of the ovary it usually happens about 2 weeks after the first day of the previous menstrual period. This month my friend’s ovulation happened in the right ovary. 

Sometimes the pain of ovulation is quite severe (and must be distinguished from pain associated with pain from appendicitis and other causes). In the vast majority of women ovulation causes no symptoms at all.

Since my friend and I were working in the area of fertility control a recurrent symptom right at the time of ovulation, we realized, could have interesting implications for a woman both in terms of trying to become pregnant and trying to avoid pregnancy.

Well, those are probably more details about ovulation than you expected to hear about from reading today’s issue of the Clayton Tribune!

Next month when I am lecturing to 100 students at a women’s health course at the University of Michigan in Ann Arbor, I will have to tell them of this happening some 30 years ago and go into more details about the implications of that little moment of slight pain in the 15% of them who have experienced it.

So what does this moment of my life some 40 years ago possibly mean to the average reader of this paper? It reminds us that our bodies are speaking to us all the time and that if we are aware and attentive we can pick up signals that could be helpful to us.

Each of us is the captain of his or her own health team.  And it is my strong belief that each of us must be listening and looking for clues as to how our bodies are functioning.  This means looking closely at our habits as well as at the ways our bodies are responding to life and to our habits.

The challenge is to be interested and involved detectives without becoming paranoid or overly self-absorbed. 

Here a suggestion: take a few very, very deep breaths right now. It feels good, doesn’t it?  Now if you haven’t felt this good feeling recently take a number of deep breaths in the day ahead. Deep breathing is such a stress reducer and nothing is better for our health than stress reduction!

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia

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Come back with exactly the same question!

At 6:15 AM on the Wednesday 2 ½ weeks before Christmas last year a woman asked me if I was all set for Christmas. She was a complete stranger and we were walking along a corridor at the Emory Midtown Hospital. I said briefly how plans were progressing for Maggie and me and then turned her question around and asked her: “How about your plans?”

“I am having 82 people to our house in Hayesville this weekend” she said.  “Last year we had 84. Things are pretty well lined up, she said. Then she outlined a number of the details necessary to pull off the huge affair.  I am convinced that she actively wanted to tell me about the throng of people expected at her house. It was on her mind and in her heart and I feel quite sure that a number of others she would be with that Wednesday would hear about this gala affair!  I told her WOW! And wished her the very best. 

          If someone asks you as question, it may be telling you what he or she wants you to ask in return.  That initial question may be asked almost as an invitation to you to ask the same question of the person standing opposite you.

Often we ask about another person’s children and this tends to be genuinely appreciated.  In some cases we are hoping that this will lead to a question about our own children, and if this does not happen we may be disappointed.

          Another example: recently I heard a person ask another person: “Do you have any great grandchildren.”  The answer was “Yes, and it was just recently. This is my first.” He turned the question around and asked,  “And what about you?”

“Oh yes, I now I have three great grandchildren!” came back the enthusiastic reply.

The next time someone asks you a question, answer it and then consider coming right back to him or her with exactly the same query.

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia

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Hello Dr. Hatcher & Team!

My question is in regards to the rule of “taking your pill at the same time every day”.

Due to a medical condition, I have to take my Ocella at bedtime.  I do take my pills RELIGIOUSLY every day, but my bedtime also varies everyday.  It is usually never more than a 4 hour window – meaning I take them between 10:30pm – 2:30am… everyday. 

Reading through your posts, I noticed that there is quite some leeway when it comes to pill-taking.  But, considering my pill-taking habit, am I still getting the full pregnancy protection from the pill or should I consider another method of birth control? 

As always, your advice and assistance is most highly appreciated!

Warm Regards & Happy Holidays

A:        Not a problem.

Her email reply on 12-6: “A million thanks again for all your help!  You and your team are truly a beacon of truth in the fog that is contraceptive management!    

Happy Holidays to you all!”

Happy New Year and thank you for such nice words.

Robert A. Hatcher MD, MPH

Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, GA

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I used the QuickStart method with the pill and my period was in about 12 days.  After my first pill, I started bleeding and after 10 days of bleeding I decided to get the Depo injection.  I will be seeing my boyfriend in 12 days.  Should I worry about getting pregnant?  Can I use an emergency contraceptive just to make doubly sure this does not happen?

Good morning!

 Her email reply on 1-12: “Yes, I took my pill at 9:00 PM every night and not even 24 hours after my last pill, I received my first Depo shot.   

Thank you so much for the quick response!  I tried many other sites and this is the first reply I received.  This is definitely the place to get the right answers!” 

To learn more about the advantages and disadvantages of birth control pills and Depo-Provera injections, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?

Robert A. Hatcher MD, MPH

Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, GA

January 11, 2012, January 12, 2012, January 18, 2012

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Amelia, Josh and Harry Potter

Bob Hatcher

December 27, 2011

          This story started a year ago when my son-in-law, Josh, read his 9 year old daughter, Amelia, about 50 pages of Harry Potter and the Sorcerer’s Stone.  It stopped within days when it was deemed by Amelia’s mom, Carrie, and her dad that the story was just a bit too scary.  What happened was that as it turned dark and bedtime rolled around the frightening nature of some of the characters interrupted Amelia’s calm bedtime routine. The decision to stop was definitely Amelia’s parents, not hers!

          Then just over 3 months ago third grader, Amelia, known by all who know her well, as a rather tenacious, persistent, strong young girl, kept after her dad and mom to relent and let her get back into Harry Potter.  It happened and very quickly Josh had read Amelia the entire first book (several times she read several pages on her own).  Book 1 was finished in a few days. Josh had already read all the Harry Potter books and had seen the first 6 Harry Potter movies.

          And then there was book 2, Harry Potter and the Chamber of Secrets.  Most of book 2 was read by Josh to Amelia and parts she read herself.  It took several weeks.

          Books 3 and 4 of Harry Potter were read almost entirely by Amelia and each was completed in several weeks.

When Maggie and I arrived in Ann Arbor on Christmas day, Amelia was avidly reading the beginning of book 5. She was up to page 358 of the 5^th book 2 days later.  She will be done with this 870 page book in 2 to 3 days, I’m sure.

So now, in less than 4 months Amelia herself has read about 1500 pages of Harry Potter and reading these books has been causing her no difficulty getting to sleep or staying asleep.

So what can parents of young children learn from Amelia, Josh and Carrie?

• It is amazing how focused a young girl can be. Try to talk to Amelia while she’s reading!!!
• It has been fun for Amelia because she loves the magic.  She just likes it.  Lots!
• In the course of an average month Amelia and her brother, Elijah, spend about zero (0) hours watching television. Reading seems to be more exciting for Amelia and her 7 year old brother than television is for many other children.
• Exposing a young person to magnificent adventures through reading causes joy, independence and is fun to share with one’s children.
• There is no rush either to start reading or to read specific books. There is an attitude of hurrying up in our society that extends to education and entertainment.  Let these learning experiences unfold naturally.

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia

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Bucket Lists and Dreams

November 25 and 27, 2011

One way of visualizing one’s possible futures was described marvelously by Morgan Freeman and Jack Nicholson in the movie called Bucket List.

Lying in adjacent hospital beds these two men, both of whom were close to death, compiled lists of what each would like to have happen in the remainder of his life.  The rest of the movie is a usually hilarious and sometimes poignant description of two wonderful actors going for their dreams with enthusiasm.  If you haven’t seen this movie, definitely do rent it. 

If you are open to dreaming impossible dreams this movie may inspire you to make up a Bucket List that could keep you occupied for years.

So what is on your bucket list? What are the incredible possibilities you might want to explore.  Your list might include sights and places, people, books, courses of study, purchases, events or conversations. Your list might include things you want to shed in an effort to simplify your life.  It might include a book you want to read or even write or it could include a religion you want to study in depth.

You awakened this morning. It is without question the very first day of the rest of your life. So today might be the very day to spend an hour of reflection thinking about possibilities for your personal Bucket List. This could be an hour that will cause ripples that will go on and on through the years of your life.

I think I will do just that, myself. Today, right now, the day after Thanksgiving, as I enjoy a day in beautiful Blue Mounds, Wisconsin, I am going to address this joyful task and see what happens.  Here are the thoughts that come to my mind this day. Here is my Day-After-Thanksgiving, 2011 Bucket List:

1.   I am going to continue to see my weight plummet as I go to Weight Watchers and lose the final 11 pounds (of 35 pounds), so that I weigh a pound or so less than the weight at which I wrestled and played football and ran track at Williams College in 1955. Would this ever bring a smile to my face!

2.   I am going to read several books, listen to several tapes, and or go to several seminars so that I understand better the essence of Buddhism. In the process I will learn about mindfulness, an important concept in psychology and neuroscience today.

3.   I am going to think differently about the loss of water in the pond in front of our house and see if it can become something more beautiful.  The lake is beautiful today. But brown areas from the current shoreline to the current grass could possibly be transformed by a new acre of vibrant green grass or by some Siberian irises or by some cypresses than can thrive with wet feet.

4.   I want to revisit the novel I started to write and worked on fairly diligently several years ago, but haven’t looked at for a single minute in the past three years.

5.   I do want very much to see Monet’s pond at Giverny outside Paris

So, what is on your wish list? Where do your dreams take you this day?

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia

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To folks joining us on www.managingcontraception.com   I meet weekly with women who have been emotionally, physically and/or sexually abused. The Penn State revelations have been about boys and young men who have been abused.  But don’t think for a minute than women have escaped sexual abuse, violence and emotional trauma related to athletics on college campuses.  Here are my thoughts about

Big time athletics and predatory sexual abuse 

Bob Hatcher

November 14, 2011 

The Penn State disgrace is on our lips, but then we should also remember the John Woodens and Dean Smiths of college sports. 

This past week has been tough for those of us who truly believe that there are many, many good things young and old can learn from sports. The first part of this article is derived from one I wrote months ago.  I feel it is important to repeat these words in view of the culture of athletics on college and university campuses revolving around money, money, money and the sad events at Penn State.

John Wooden coached basketball teams. And they did very, very well.  He lived to right at 100 years of age and perhaps you are thinking:  “Just why” should I be interested in this old man’s three rules?”

Well, John Wooden wasn’t just another successful coach.  He was THE WINNER of all big time athletic winners. His success exceeded that of any other coach over the last 100 years. His basketball teams had four perfect 30-0 seasons and he was named ESPN’s greatest coach of the 20th century.

His UCLA basketball teams won 10 National Championships. You know, the tournament we are all talking about each spring called March Madness. Well, he won THAT tournament 12 times!

Here were his rules for his players:

1. Get to every meeting, practice and game on time

2. Not one swear word

3. Never criticize one of your teammates

          Almost all of John Wooden’s players graduated from college. He was known for his impeccable record of sportsmanship. He was even named California Father (and later, Grandfather) of the Year.

          If I didn’t quite win you over with those three rules for his team, let me tell you what he said was his daily rule for himself.  But first think about what daily rule would best characterize your approach to life.  Think about that for one minute and then after one minute of deep reflection read this last paragraph.

Here is what John Wooden encouraged each of us to do:

“Make each day your masterpiece.”

     Now we are hearing of the evil, selfish, sexually depraved acts of a man, Jerry Sandusky, who was twice named the best assistant football coach in the entire country.  His teams did what successful teams are supposed to do, WIN AND MAKE MONEY. The words used to describe him and Penn State coaches and administrators are strong and angry. They have dominated both sports news and national news this past week.

          You have heard the following words and phrases. They are NOT my words:

          “Predatory, child rape, an outrageous tragedy, perversion of power in college sports, the biggest story on college sports ever, negative visceral outrage and perhaps most often, unbelievable.”

          But wait there’s more!

          “It took a victim’s mother to notify the police because it was more important to protect the system, to protect the football team, than to protect the boys. It was a conspiracy of silence for 13 years. There was a psychopathic lack of concern for the effects of these sexual crimes on young boys.”

           As we hear more, and I am certain we will be hearing much more, it might be well to remember that there are high school and college coaches (and I think that this is the case for most of them) who are far more like John Wooden and Dean Smith than like  Jerry Sandusky.  

A resident of Tiger, Georgia, Robert A. Hatcher MD,

Is a professor of gynecology and obstetrics at the Emory University School of Medicine

He meets weekly with the women and staff at Fight Abuse In The Home (FAITH) in Clayton, Georgia

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Come join us!

Bob Hatcher

          There is a long narrow table (about 15 feet by 3 feet) at the new restaurant in Clayton called the UNIVERSAL JOINT.  UNIVERSAL JOINT is on North Main Street next door to the Clayton Post Office.  There are 13 seats around this covered table that is outside. You can sit at any of the outside tables and watch the world go by.

          One evening in the middle of August Maggie and I were sitting at one end of the large outdoor table with 3 to 4 other people.  One of them was Peter McIntosh, the superb photographer who also writes movie introductions that Robert Osborne and Ben Mankiewicz read prior to classical movies shown on TCM (Turner Classic Movies). Through his photography he supports numerous charities and conservation groups.

At the other end of the table sat a woman and Peter, saw that she was alone. He called over to her with a friendly voice: “Come join us.” She did and we enjoyed learning about her in the course of the next 2 hours. 

          Little things can mean a lot. This was such a simple, thoughtful thing to do. The kind of thing that is very easy to do, takes almost no time, costs nothing, and may make someone else’s day a whole lot more fun. Thank you, Peter McIntosh! It is so easy to have a generous spirit and our county is made a better place by the generous spirit of Peter McIntosh.

          Come join us! Including someone else at a meal is something middle and high school students can do at a time in their lives when being included is so important, and being excluded is so painful.

          Come join us! Asking someone to participate in a volunteer activity is an easy way to include a new person in town in some worthwhile effort.

Come join us! If you haven’t yet been to the UNIVERSAL JOINT, do try it. The hamburgers, sandwiches, and salads are wonderful. There is a television that keeps you up on the latest football, basketball or baseball game. And if you are lucky you might get Becky or Ruth as your waitress.  They will almost certainly bring a smile to your face.  

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia

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Doubt is Helpful

Certainty is Dangerous

Bob Hatcher

November 12, 2011

 Doubt is helpful: TRUE or FALSE?

Certainty is dangerous: TRUE or FALSE?

Perhaps the best answer is that both statements can be either true or false.

We have a tendency to look suspiciously at ourselves or others who move slowly, with caution or only after checking and rechecking all the possibilities.  Doubt, one might think, is a sign of weakness or fear.

At lunch recently, one of my Rabun County heroes, Pierce Cline, came to Grapes and Beans with several handwritten thoughts and phrases he wanted us to discuss.  One was the wisdom or folly of these six words: “Doubt is helpful. Certainty is dangerous.”

Pierce decided at age 60 to climb the Appalachian Trail from Springer Mountain, Georgia to Mount Katahdin, Maine.  He did not have much doubt but that he could accomplish this remarkable objective. He planned to hike the entire 2,178 miles in sections. He would do this over a number of years.  Along the way, he would pass through Georgia, North Carolina, Tennessee, Virginia, West Virginia, Maryland, Pennsylvania, New Jersey, New York, Connecticut, Massachusetts, Vermont, New Hampshire, and Maine.

Along the way Pierce learned over and over again that he was really rich. “On the trail I have learned that everything I truly need I can carry on my back.”

Prior to climbing the Appalachian trail Piece had hiked all over the world for decades with a group of close friends.  This in part explains why he was fairly certain that in time he would be successful in accomplishing his remarkable new goal.  Just a bit of doubt crept into the picture when he needed cardiac bypass surgery several years later. That derailed him for a year, but then he returned cautiously to the trail and he accomplished his goal.

For a long while now the phrase “sometimes wrong but never in doubt” has had primarily negative connotations to me. But not always.

Perhaps, in parallel with the words in Ecclesiastes, we might suggest that there is a time for doubt and a time for putting aside one’s doubts.  There is a time for certainty and a time to make decisions slowly.

Some examples of certainty carried to dangerous and evil extremes are the lives of Adolf Hitler, Mao, Joseph Stalin, and members of “the family” in Washington. If you haven’t read the book, “The Family” I recommend it highly.

So life presents us with this very difficult challenge: while it is important to have in mind what we want to accomplish, what we believe in and what we think is right, at the same time we must always be aware of the fact that we may need to tweak our perception of what is the best course of action to follow.

Who ever, ever, ever said that life was going to be easy? 

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia

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