What is Polycystic Ovary Syndrome (PCOS)?

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS), also known as Polycystic ovarian syndrome or Stein-Leventhal Syndrome, is a condition that affects a woman's ovaries. It is characterized by polycystic ovaries (cysts develop in the ovaries), irregular or no menstrual periods, irregular ovulation and high levels of androgens in the body. Androgens are male hormones. Women with PCOS usually have problems getting pregnant.

According to the Office on Women's Health, USA, polycystic ovary syndrome affects about 1 woman in every 10. It can even affect girls as young as 11 years of age.

The National Health Service, UK, estimates that 1 in every 5 women has polycystic ovaries, but most of them have no symptoms.

The PCOS Foundation refers to PCOS as the "Silent Killer" because it cannot be diagnosed with one simple test and many women are undiagnosed. Signs and symptoms vary from patient to patient.

PCOS has been associated with a higher risk of developing type 2 diabetes, insulin resistance, hypertension (high blood pressure), heart disease and high cholesterol. That is why early diagnosis is so important - the earlier it is treated, the better the outcome for the patient.

In PCOS, the ovaries produce excess male sex hormones. Small cysts form on the ovaries, which do not produce enough of a hormone that triggers ovulation. The ovarian follicles, which have filled with fluid in preparation for ovulation, remain as cysts when ovulation does not occur.

What are the signs and symptoms of polycystic ovary syndrome?

A symptom is something only the patient feels and describes, such as pain, while a sign is something others can identify, such as a lump or rash.

Signs and symptoms tend to emerge during late adolescence or early adulthood.

Some women do not have all the symptoms, and each one can range from mild to severe. In many cases, all the woman complains of is the inability to get pregnant or menstrual problems.

The most common signs and symptoms of PCOS are:

Irregular or no menstrual periods

Problems getting pregnant - this could be because there is no ovulation, or it is irregular

Hirsutism - excessive hair growth, usually on the buttocks, back, chest or face

Hair loss (from the head)

Acne

Pelvic pain

Patches of dark skin at the back of the neck, possibly some other areas of the body. This is caused by too much insulin.

Infertility

Polycystic ovary syndrome is a common cause of infertility among women. In fact, a large proportion of women do not know they have PCOS until they go and see their doctor because they are having problems getting pregnant.

A fertile woman should ovulate once during each menstrual cycle - an ovum (egg) should be released into the uterus. Women with PCOS either ovulate irregularly or not at all.

Polycystic ovaries

Polycystic ovaries are when the ovaries have a collection of little cysts that look like beads around their edge. The cysts do not cause any real problem, but they could be a sign of something else that is wrong.

Usually, when a woman ovulates during each menstrual cycle, a number of eggs develop in each ovary and eventually one, the "dominant" egg, is released during ovulation. The other eggs shrivel back down into the ovary. In PCOS, the bead-like cysts around the ovary are the remains of dominant eggs that were never released.

Although this may sound unlikely, polycystic ovaries alone do not necessarily mean the woman has PCOS. For a PCOS diagnosis the woman needs to have abnormal menstrual cycles and some sign(s) of androgen excess (acne, excessive hair, etc).

Some women with PCOS have "normal" ovaries with no apparent cysts, while others with polycystic ovaries may not have PCOS.

In January, 2013, the National Institutes of Health convened an independent panel to determine whether polycystic ovary syndrome is the right name for the common hormone disorder. The experts concluded that the current name, which focuses on a criterion - ovarian cysts - causes confusion and is a barrier to research progress and effective patient care.

Dr. Robert A. Rizza, panel member and professor of medicine at the Mayo Clinic in Rochester, Minnesota, said "The name PCOS is a distraction that impedes progress. It is time to assign a name that reflects the complex interactions that characterize the syndrome. The right name will enhance recognition of this issue and assist in expanding research support."

Researchers from Monash University in Australia found that new mothers with PCOS were more likely to be overweight and less likely to breastfeed.

What are the causes of polycystic ovary syndrome?

Experts are not sure what the causes of PCOS are. Most agree that hormone levels probably play a key role.

Insulin resistance - insulin resistance leads to higher levels of blood insulin, which in turn makes the ovaries produce too much testosterone hormone (androgens). This undermines the development of sacs in the ovaries where eggs develop (follicles), leading to abnormal or non-existent ovulation.

Insulin resistance can also make people put on weight, which makes PCOS symptoms worse.

Hormonal imbalance - an imbalance in certain hormones is common in women with PCOS, including:

High testosterone - although females produce small amounts of testosterone, it is a "male" hormone.

High luteinizing hormone (LH) - LH stimulates ovulation, but if levels are excessively high, the proper functioning of the ovaries may be disrupted.

Low SHBG (sex hormone binding globulin) levels - SHBG helps reduce the effects of testosterone.

High prolactin levels - prolactin stimulates the production of milk in the breast glands in pregnancy. High prolactin is present only in some patients with PCOS.

Nobody is sure why these hormonal problems emerge. Some say that the problem could originate in the ovary itself, part of the brain that controls hormonal production, or in other glands in the body. It is also possible that insulin resistance triggered these changes.

Genes - a woman is more likely to develop polycystic ovary syndrome if her mother, aunt or sister also has/had it.

Scientists at the Medical College of Georgia at Georgia Regents University reported in the journal Diabetes that high activity levels of a microRNA called miR-93 in fat cells hinders insulin's use of glucose, contributing to PCOS and also insulin resistance.

Scientists from the University of Oxford and Imperial College London found that a gene implicated in the development of obesity is also linked to susceptibility to PCOS.

Bisphenol A (BPA) - researchers at the University of Athens Medical School in Greece found higher BPA levels in women with PCOS compared to other women of the same age. They also found a significant positive association between male sex hormones and BPS in women with PCOS. This suggests that BPA probably has a role in ovarian dysfunction.

BPA is a common industrial compound used in dental materials, plastic consumer products, and food and drink packaging. Study leader, Evanthia Diamanti-Kandarakis, MD, PhD, said "These women should be alert to the potential risks and take care of themselves by avoiding excessive every-day consumption of food or drink from plastic containers."

Exposure to androgens in the womb - according to a study published in Human Reproduction Update in 2005, excessive exposure to androgens (male hormones) while in the womb may have a permanent effect on gene expression, making some genes not work in the way they are supposed to, leading to PCOS later on, as well as insulin resistance.

Diagnosing polycystic ovary syndrome

If you have some of the typical hallmark symptoms of PCOS you should see your doctor as soon as possible. You will be asked about your medical history, symptoms, menstrual periods, and weight changes.

The doctor will also carry out a physical exam, which will include checking your blood pressure.

Pelvic examination - the doctor will visually and manually check your reproductive organs.

The following diagnostic tests may be recommended:

Ultrasound scan - to determine whether you have polycystic ovaries.

Blood test - to determine hormone and cholesterol levels, and screen for diabetes.

According to the National Health Service, UK, for a diagnosis of PCOS to be made, other causes of the same symptoms need to be ruled out and the patient must meet at least two of the following criteria:

The patient has infrequent or irregular menstrual periods

According to blood tests, the patient has high levels of androgens, such as testosterone. In some cases, just the signs of excess androgen

Scans show the patient has polycystic ovaries.

What are the treatment options for polycystic ovary syndrome?

Polycystic ovary syndrome is incurable. However, there are several ways it can be treated. Treatment options depend on the symptoms, and may include:

Losing weight - obese or overweight women with PCOS who lose weight and adopt a healthy lifestyle can significantly reduce their risk of long-term health problems.

If you lose weight your insulin levels also drop, resulting in lower testosterone levels. Lower testosterone is a better environment for ovulation. Lower testosterone improves fertility, reduces excessive hair growth and acne.

The contraceptive pill - if you are not trying to get pregnant and are aiming for regular periods. This treatment will also reduce your long-term risk of developing endometrial cancer if you have no periods.

An article published in CMAJ (Canadian Medical Association Journal) reported that women with PCOS on combined oral contraceptives have double the risk of blood clots compared to women without PCOS taking the same combination.

Anti-male hormone medications - these reduce the masculine effects of testosterone, such as loss of hair from the head, and excess facial hair.

Clomifene - this medication fixes your hormone imbalance, increasing the likelihood that you ovulate, which in turn improves your fertility.

Gonadotrophins - may be recommended by your doctor if you have not responded to clomifene. There is a risk of multiple pregnancies (twins, triplets), because gonadotrophins might overstimulate the ovary.

Metformin (Glucophage) - a medication used for treating diabetes can increase ovulation in patients with PCOS. Metformin may also minimize the health problems caused by insulin resistance, as well as regulating excessively high levels of male hormones. Metformin can be taken together with clomifene.

Swedish researchers found that metformin in combination with liraglutide led to more weight loss than administering either drug alone.

Eflornithine - a cream that is applied to the skin to slow down the growth of facial hair. Eflornithine does not remove hair. Electrolysis or laser hair removal are permanent hair removal options.

Surgery - laparoscopic ovarian drilling (LOD) involves surgically treating the ovaries using laser or heat. This procedure destroys the tissue that produces androgens.

LOD corrects the hormone imbalance in women with PCOS, thus restoring normal function of the ovaries. LOD lowers levels of luteinising hormone and testosterone and raises levels of follicle-stimulating hormone.

Doctors may recommend surgery if the patient has not responded to clomifene.

What are the complications of polycystic ovary syndrome?

Women with PCOS have a higher risk of developing the following conditions or diseases, especially if they are obese/overweight:

Abnormal bleeding from the uterus

Blood cholesterol and lipid abnormalities

Endometrial cancer - cancer of the lining of the uterus

Gestational diabetes - diabetes during pregnancy

High levels of C-reactive protein, a disease marker for cardiovascular diseases

Hypertension (high blood pressure)

Metabolic syndrome

Pregnancy induced hypertension

Severe liver inflammation (nonalcoholic steatohepatitis)

Sleep apnea - women with PCOS who also have obstructive sleep apnea have a much higher risk of pre-diabetes, researchers from the University of Chicago Center for PCOS reported

Type 2 diabetes

Researchers from the Karolinska Institute, Sweden, reported in the BMJ (British Medical Journal) in October, 2011, that women with polycystic ovary syndrome have a higher risk of complications during pregnancy, including diabetes, pre-eclampsia and giving birth prematurely.

Video - Dr. Ruman discusses PCOS

Dr. Jane Ruman, Infertility Specialist at RMA of New York, discusses polycystic ovarian syndrome, its causes, symptoms, treatment options and getting pregnant with PCOS.

Written by Christian Nordqvist

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Risk of kidney stones in women appears to be increasing, along with related ER visits

Risk of kidney stones in women appears to be increasing, along with related ER visits

The risk of women developing kidney stones is rising, as is the number of cases being seen in U.S. emergency departments, while the rate of hospitalization for the disorder has remained stable.

Those are among the findings of a new study led by Henry Ford Hospital researchers that set out to look at trends in visits, hospitalization and charges during a four-year period for patients who went to U.S. hospital emergency departments for treatment of kidney stones.

"While the number of patients visiting the emergency department had increased over that time period, it was women who had the greatest increase in visits," says Khurshid R. Ghani, M.D., of Henry Ford's Vattikuti Urology Institute and lead author of the study.

The study is published online in the Journal of Urology.

Citing recent population-based studies that have shown an increase in kidney stones among women, Dr. Ghani says his team's findings in the ER provide further evidence that the risk of stones in women appears to be increasing.

"Women are becoming more and more obese. Obesity is a major risk factor for developing a kidney stone. And one fascinating thing about women versus men is obese women are more likely to develop a stone than an obese man," says Dr. Ghani.

Drawing raw data from the Nationwide Emergency Department Sample (NEDS), the research team looked for related emergency room visits from 2006 - 2009. They found a total of more than 3.6 million visits for upper urinary tract stones.

During the study period, the incidence of the disorder rose from 289 to 306 per 100,000 people. Among the study group, 12 percent were hospitalized as a result of their visits and rates remained stable during the study period.

"I think in the last 10 years, the way urologists manage kidney stone patients in the ER has changed dramatically," says Dr. Ghani. "Today, the emergency room physician and urologist have access to better diagnostic tools that allow for a more precise diagnosis. We use a CT scan, which is a quick test that allows for an immediate diagnosis and is available in every emergency department.

"Better diagnosis may be contributing to our findings that patients are not being admitted to the hospital as frequently as they had in the past.

Also, medication can help with the spontaneous passage of these stones. As a result, some of these patients may be safely managed through the outpatient system with follow-up visits."

For those who do get admitted to the hospital, the study showed that the highest likelihood was related to sepsis, or blood infection, which can sometimes occur when the stone causes a blockage and urinary tract infection.

Most notably, in 2009, the charges for emergency department visits rose to $5 billion in 2009 from $3.8 billion dollars in 2006.

"One of the possible reasons for the increase in charges is the use of a CT scan to diagnose a kidney stone," Dr. Ghani says.

"Fifteen years ago, around 5-10 percent of patients visiting the emergency department for a kidney stone would get a CT scan. Today, 70 percent of patients who visit the emergency department get a scan. While they're wonderful tools of technology that allow an accurate diagnosis, they are expensive," says Dr. Ghani.

New research sheds light on previously under-researched area of study - females with autism

New research sheds light on previously under-researched area of study - females with autism

Autism affects different parts of the brain in females with autism than males with autism, a new study reveals. The research is published in the journal Brain as an open-access article.

Scientists at the Autism Research Centre at the University of Cambridge used magnetic resonance imaging to examine whether autism affects the brain of males and females in a similar or different way. They found that the anatomy of the brain of someone with autism substantially depends on whether an individual is male or female, with brain areas that were atypical in adult females with autism being similar to areas that differ between typically developing males and females. This was not seen in men with autism.

"One of our new findings is that females with autism show neuroanatomical 'masculinization'," said Professor Simon Baron-Cohen, senior author of the paper. "This may implicate physiological mechanisms that drive sexual dimorphism, such as prenatal sex hormones and sex-linked genetic mechanisms."

Autism affects 1% of the general population and is more prevalent in males. Most studies have therefore focused on male-dominant samples. As a result, our understanding of the neurobiology of autism is male-biased.

"This is one of the largest brain imaging studies of sex/gender differences yet conducted in autism. Females with autism have long been under-recognized and probably misunderstood," said Dr Meng-Chuan Lai, who led the research project. "The findings suggest that we should not blindly assume that everything found in males with autism applies to females. This is an important example of the diversity within the 'spectrum'."

Dr Michael Lombardo, who co-led the study, added that although autism manifests itself in many different ways, grouping by gender may help provide a better understanding of this condition.

He said: "Autism as a whole is complex and vastly diverse, or heterogeneous, and this new study indicates that there are ways to subgroup the autism spectrum, such as whether an individual is male or female. Reducing heterogeneity via subgrouping will allow research to make significant progress towards understanding the mechanisms that cause autism."

A new mother's personality may affect her decision to breastfeed

A new mother's personality may affect her decision to breastfeed

A new analysis has found that mothers who are more extroverted and less anxious are more likely to breastfeed and to continue to breastfeed than mothers who are introverted or anxious. Published early online in the Journal of Advanced Nursing, the study indicates that new mothers with certain personalities may need additional support and education to help them feel confident, self assured, and knowledgeable about breastfeeding.

Breastfeeding is important for the health of both mother and baby: breastfed babies have lower levels of infections and allergies and are less likely to be overweight, while mothers who breastfeed are less likely to develop certain cancers.

Many factors can affect whether a mother breastfeeds, but mothers who have lots of support, feel confident, and know how to overcome problems are more likely to breastfeed for longer. Understanding what makes a mother feel confident and supported is important to increasing breastfeeding rates. Many studies have looked at the role of mothers' education, age, and relationships, but the link between breastfeeding and a mother's personality has not been explored.

To investigate, Amy Brown, PhD, of Swansea University in the United Kingdom, surveyed 602 mothers with infants aged six to 12 months old. The questionnaire examined the mothers' personalities, how long they breastfed, and their attitudes and experiences of breastfeeding. Data were collected between March and June 2009.

Mothers who indicated that they were extroverts and were emotionally stable were significantly more likely to initiate and continue breastfeeding for a longer duration. Mothers who were introverted or anxious were more likely to use formula milk or only breastfeed for a short while.

Dr. Brown believes that the findings can be explained by the link between mothers' personalities and their attitudes and experiences of breastfeeding. Mothers who were introverted felt more self-conscious about breastfeeding in front of others and were more likely to formula feed because other people wanted them to. Meanwhile mothers who were anxious found breastfeeding was more difficult and felt that they couldn't get the support they needed. These factors are known to be linked to low breastfeeding rates.

"The important message from the findings is that some mothers may face more challenges with breastfeeding based on their wider personality. Although they may want to breastfeed, more introverted or anxious mothers may need further support in boosting their confidence and learning about how to solve problems, and they may need encouragement to make sure they access the breastfeeding support services that are available," said. Dr. Brown.

Data collection is hiding the truth about the health of ethnic minorities

Data collection is hiding the truth about the health of ethnic minorities

A new report calling for health data to be broken down by ethnicity has been published by international development organisation Health Poverty Action, ahead of the International Day of the World's Indigenous People this Friday.

Health Poverty Action is calling for the measurement of any new goals on health and wider development to be broken down by ethnicity in the run up to the UN high level meeting on the new framework for international development in September. In May the High Level Panel report, which will inform the UN's deliberations, called for a 'data revolution,' but it failed to make a clear call for data to be disaggregated by ethnicity.

Working in 13 countries across Africa, Asia and Latin America, Health Poverty Action works in partnership with marginalised communities struggling for health. These communities are often indigenous and ethnic minorities. They face many barriers to health care and experience significantly worse health outcomes than the majority of the population, but this is hidden in most countries because health data is not broken down by ethnicity.

This report states that to improve global health we must disaggregate data by ethnicity and shine a light on the true health status of ethnic and cultural minority groups.

The report is part of the Mothers on the Margins campaign and has a focus on maternal health amongst ethnic and cultural minority groups.

The report covers:

Why it is vital that major health surveys and governments disaggregate health data by ethnicity.

An analysis of current practices in the collection of health data.

Recommendations for overcoming the barriers to obtaining and using ethnically disaggregated data including analysis of proxy indicators such as language or geographical region.

Examples from Ethiopia, Laos, Namibia and Guatemala that illustrate the vast differences in health outcomes experienced by ethnic minority groups and majority group populations.

Sarah Edwards, Head of Policy and Campaigns at Health Poverty Action, comments:

"Around the world there are marginalised communities that experience extreme poverty and poor health, and we must use every tool we have to end this, including disaggregating data by ethnicity.

"When it comes to improving maternal health the world has achieved a lot but many ethnic minority communities have been left behind; in some countries, indigenous women can be twice as likely to die from pregnancy-related causes than women from the majority population.

"If we continue to ignore this we are effectively turning our back on the most marginalised communities on our planet. We have the capacity to identify the different health statuses of minority groups. To improve health policies and ultimately, save lives, we must do it."

The full report can be downloaded here.

Long-term calcium-channel blocker use for hypertension associated with higher breast cancer risk

Long-term calcium-channel blocker use for hypertension associated with higher breast cancer risk

Long-term use of a calcium-channel blocker to treat hypertension (high blood pressure) is associated with higher breast cancer risk, according to a report published by JAMA Internal Medicine, a JAMA Network publication.

Antihypertensive medications are the most commonly prescribed class of drugs in the United States and in 2010 totaled an estimated 678 million filled prescriptions, Christopher I. Li, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and colleagues write in the study background.

"Evidence regarding the relationship between different types of antihypertensives and breast cancer risk is sparse and inconsistent, and prior studies have lacked the capacity to assess impacts of long-term use," the study notes.

The population-based study in the three-county Seattle-Puget Sound metropolitan area included women ages 55 to 74 years: 880 of the women had invasive ductal breast cancer, 1,027 had invasive lobular breast cancer and 856 of them had no cancer and served as the control group. Researchers measured the risk of breast cancer and examined the recency and duration of use of antihypertensive medications.

According to the results, current use of calcium-channel blockers for 10 or more years was associated with higher risks of ductal breast cancer (odds ratio [OR], 2.4) and lobular breast cancer (OR, 2.6). The relationship did not vary much based on the type of calcium-channel blockers used (short-acting vs. long-acting or dihydropyridines vs. non-dihydropyridines). Other antihypertensive medications - diuretics, -blockers and angiotensin II antagonists - were not associated with increased breast cancer risk, the results indicate.

"While some studies have suggested a positive association between calcium-channel blocker use and breast cancer risk, this is the first study to observe that long-term current use of calcium-channel blockers in particular are associated with breast cancer risk. Additional research is needed to confirm this finding and to evaluate potential underlying biological mechanisms," the study concludes.

Commentary: Calcium-Channel Blockers and Breast Cancer

In a related commentary, Patricia F. Coogan, Sc.D., of the Slone Epidemiology Center at Boston University, writes: "Given these results, should the use of CCBs [calcium-channel blockers] be discontinued once a patient has taken them for 9.9 years? The answer is no, because these data are from an observational study, which cannot prove causality and by itself cannot make a case for change in clinical practice."

"Should the results be dismissed as random noise emanating from an observational study? The answer is no, because the data make a convincing case that the hypothesis that long-term CCB use increases the risk of breast cancer is worthy of being pursued," Coogan continues.

"In conclusion, the present study provides valid evidence supporting the hypothesis that long-term CCB use increases the risk of breast cancer. If true, the hypothesis has significant clinical and public health implications," Coogan concludes.

Prevent Osteoporosis With Bioidentical Hormone Therapy

Osteoporosis occurs when the bones in the body start to lose density and become brittle. This can be caused by poor nutrition and a lack of exercise. Causes that are more common include age, disease or changes in hormonal levels. Women who have gone through menopause and older men both have decreased hormonal levels in the body. The reduction of hormones like estrogens takes away the body's ability to regulate the normal cycles that would maintain bone density and bone health. Several treatments for osteoporosis exist although some have serious side effects. Bioidentical hormone therapy is a safe and effective treatment that can help to prevent osteoporosis.

Bone Remodeling

Osteoporosis develops because of issues with the process known as bone remodeling. Bone remodeling is the natural cycle where bone tissue is absorbed by the body and replaced with new tissue. This maintains bone density as well as flexibility and strength. The bone marrow creates cells called osteoclasts that absorb bone tissue. Other cells called osteoblasts then create new tissue to replace what was absorbed. These cells are regulated by a collection of estrogen hormones in women. Decreased levels after menopause result in a disruption where more bone tissue is absorbed and less or none is produced to replace it.

A bioidentical hormone is a special combination of the different hormones and other natural chemicals that are deficient in the body. A saliva or blood test is given to a person in order to determine the current production levels of the important hormones. The bioidentical hormone is created by compounding the amount of each hormone that is missing from the body. Bioidentical therapy might involve taking a pill, taking an injection or applying a cream to the skin. This therapy will compensate for the reduced hormone levels in the body and will eventually start to have several positive effects including the prevention of osteoporosis.

The behavior of osteoclasts and osteoblasts start to change as the levels of estrogens and other hormones start to rise. Restoring the proper balance can help to reduce the rate of absorption of the bone. This gives osteoblasts the opportunity to deposit new tissue at the same rate or slightly faster than it is reabsorbed. This stops the loss of bone density and the development of fractures, broken bones and other serious problems. The level of hormones in the body is re-tested at regular intervals in order to determine if the bioidentical compound needs to be adjusted due to increases or reductions in natural hormone production.

Anyone who is starting bioidentical hormone therapy should understand that it is also very helpful to begin eating a balanced diet that is high in vitamins C, D and K. Weight-bearing exercise can actually increase the production of new bone tissue. Combining these lifestyle changes with bioidentical hormone therapy will reduce the chances of developing full osteoporosis for many people.

Female deaths much less likely to be reported to coroner in England and Wales, UK

Female deaths much less likely to be reported to coroner in England and Wales, UK

Doctors in England and Wales are much less likely to report a woman's death to a coroner than they are a man's, reveals research published online in the Journal of Clinical Pathology.

Furthermore, women's deaths are less likely to proceed to an inquest, and those that do are less likely to result in a verdict of "unnatural" death than men's, with some coroners particularly likely to favour a verdict according to the sex of the deceased, the research shows.

The authors analysed figures from the Ministry of Justice on the numbers and proportions of deaths reported to all 98 coroners, in each of the 114 jurisdictions in England and Wales, between 2001 and 2010.

These figures were then set in the context of official national statistics on the number of deaths registered in England and Wales over the same period.

Doctors are not obliged to report a death to a coroner, and the legal duty to hold an inquest resides with the coroner, usually prompted by a death in unnatural or violent circumstances, or when the death is sudden, of unknown cause, or happens in prison.

The analysis of the figures showed that coroner reporting rates varied widely across England and Wales.

Plymouth and South West Devon topped the league table, with 87% of registered deaths reported to the coroner between 2001 and 2010, while Stamford in Lincolnshire came bottom, with only 12% of deaths reported to the coroner.

There were no obvious explanations to account for such wide differences, which remained stable throughout the decade, suggesting that local demographics or medico-legal practice had a part to play, say the authors.

Similarly, coroners varied widely in their use of verdicts, which again remained consistent over time, the analysis showed. This is likely to reflect the personal decision making style of the coroner rather than any local patterns in deaths, say the authors.

But when they looked at reporting rates according to the sex of the dead person, a striking gender divide emerged.

While jurisdictions with high reporting rates for men also had high reporting rates for women, and vice versa, male deaths were 26% more likely to be reported to the coroner than female deaths.

Higher reporting rates for men were common across all jurisdictions in England and Wales, and in some areas male deaths were 48% more likely to be reported.

Not only were female deaths less likely to be reported, but they were also less likely to proceed to an inquest.

Female deaths were half as likely to proceed to an inquest as men's, with just 8% going to this stage compared with 16% of all male deaths. And even when female deaths did get an inquest, they were more likely to be given a verdict of natural causes than men (28% compared with 22%).

Among verdicts of unnatural deaths, men were overrepresented in occupational diseases and suicide while women were overrepresented in narrative verdicts - where cause of death is given in the form of a narrative rather than as a single "short form" definition - and accidents, implying that sex of the deceased influences the verdict, say the authors.

Furthermore, some coroners were "gendered," in their approach to inquest verdicts, and more likely to favour a particular verdict when dealing with a death, according to the gender of the deceased.

The government is currently reforming the death certification process in a bid to strengthen arrangements and improve the quality and accuracy of causes of death, but there are some concerns that the move will prompt a fall in deaths reported to the coroner from the present national average of 46% to around 35%, say the authors.

Personalized risk calculator for women's cancers

Personalized risk calculator for women's cancers

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Researchers have discovered a new way of predicting whether a woman is at risk of cancer of the breast, ovaries, or uterus, according to a study published in the journal PLoS Medicine.

Researchers from the National Cancer Institute and colleagues from other US medical institutes developed "absolute risk prediction models" that could help women predict their chances of developing breast, ovarian or endometrial cancer.

The researchers say that these models could help with clinical decision-making for patients.

To create the models, the researchers analyzed common cancer risk factors in women involved in two large US studies - the National Institutes of Health-AARP Diet and Health Study (NIH-AARP) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).

The studies included white, non-Hispanic women aged over 50 years.

Some of the common risk factors included were:

Parity (the number of children a woman had delivered)

Body mass index

Use of oral contraceptives

Menopausal status

Use of menopausal hormone therapy.

The study authors say their research gave absolute risk prediction models that were able to predict women's individual risks of each of the three cancers.

The individual risk of endometrial cancer, for example, ranged from 0.5% to 29.5% over the next 20 years - with each woman's results depending on their exposure to certain risk factors.

The study authors say their findings show that breast, ovarian and endometrial cancer can all be predicted using easily-obtainable information on known risk factors.

They add: "We developed and assessed models that project the probabilities of developing breast, endometrial, or ovarian cancer among white, non-Hispanic women aged over 50 years."

The authors say:

"These models might improve the ability to identify potential participants for research studies and assist in clinical decision-making related to the risks of these cancers."

The models are not always applicable though, the researchers warn. They will not predict a cancer risk for women who already have a previous diagnosis of the particular condition, or who are already known to be at a much higher risk.

They explain: "Our models are not intended to predict the probability of the three cancers among women known to be at much higher than average risk. For example, women with a mutation in BRCA1 or BRCA2 or with hereditary non-polyposis colorectal cancer (HNPCC)."

The calculations can, however, predict a woman's risk of a type of cancer that is different from one she has already suffered.

"Each model is applicable to women without a prior diagnosis of that particular cancer, and thus in principle the breast cancer model can be applied to predict breast cancer risk for women with a prior diagnosis of any other cancer, including endometrial cancer."

Since the prediction models were developed from studies involving white, non-Hispanic women, the researchers caution that they may not be accurate for women of other ethnicities.

Written by Honor Whiteman

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

BPA may be linked to infertility in women

BPA may be linked to infertility in women

A new study from Brigham and Women's Hospital (BWH) recently analyzed the effects of Bisphenol-A (BPA) on human eggs, and it may reveal why some couples are unable to conceive.

The study, published recently online in the journal Human Reproduction, is the first of its kind to show the direct effects of BPA on egg maturation in humans.

BPA is a chemical that is used to make certain plastics and resins, and it can be found in some water bottles, food cans, bottle tops or water supply lines.

The experiment was led by Dr. Catherine Racowsky, director of the Assisted Reproductive Technologies Laboratory at BWH. She and her team conducted a randomized trial using 352 discarded eggs from 121 patients, who were undergoing in vitro fertilization (IVF) at the hospital from 2011 to 2012.

Subjects' eggs were exposed to varying levels of BPA in the laboratory, but an egg from each patient was held aside and not exposed to BPA to serve as the control.

After being exposed to BPA, researchers examined the eggs and found the following results:

Percentage of eggs that matured decreased

Proportion that degenerated fell

Percentage of eggs that underwent spontaneous activation increased

Genetic parts of eggs exposed to BPA (images B, C, D, E) compared with unexposed eggs (A). In green: spindles. Red: chromosomes. Right: combination of both. Courtesy of Brigham and Women's Hospital

(Spontaneous activation is an abnormal process in which an unfertilized egg acts as if it has been fertilized.)

Researchers also noticed with eggs that did mature, they tended not to have bipolar spindles and aligned chromosomes, as unaffected eggs do.

Dr. Racowsky says:

"Our data show that BPA exposure can dramatically inhibit egg maturation and adds to a growing body of evidence about the impact of BPA on human health.

I would encourage further research to gain a greater understanding of the role BPA plays in infertility."

The researchers note that the prevalence of BPA in our society is such that the general population is exposed to it on a regular basis. They also say that BPA has been detected in human follicular fluid.

Katherine Zeratsky from the Mayo Clinic notes that although the Food and Drug Administration (FDA) says BPA is safe at very low levels, the organization is continuing to review BPA and supports ongoing research.

She makes a few recommendations for those consumers who are concerned about BPA, including:

Use BPA-free products

Cut back on cans

Avoid microwaving or dishwashing plastics.

Researchers from the recent study note that though they "used sibling oocytes (eggs) to overcome potential confounders, such as infertility diagnosis and maternal age, additional studies with a larger number of oocytes are required to confirm present results."

Written by Marie Ellis

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

New study explores the pathways that lead to jail time for women

New study explores the pathways that lead to jail time for women

How do pathways to jail vary for females who are victims of specific types of trauma? New research published in Psychology of Women Quarterly, a SAGE journal, pinpoints the types of trauma such as caregiver violence, witnessing violence, and intimate partner violence, that lead to specific types of offending later in life and offers explanations based on real experiences.

Researchers Dana DeHart, Shannon Lynch, Joanne Belknap, and Bonnie Green conducted life-history interviews with 115 female inmates from five U.S. states and found the following patterns:

Intimate partner violence increased women's risks for property crimes, drug offending, and commercial sex work. These relationships often related to intimate involvement with violent men who fluctuated between roles as the women's co-offenders, drug dealers, and pimps.

Witnessing violence increased risks for property crimes, fighting, and use of weapons. These relationships often stemmed from affiliation with criminal networks, and often women's use of weapons or aggression arose from efforts to protect themselves or others.

Experiences of caregiver violence increased risk of running away as a teen. Runaway youth often enact this behavior as a means of escaping intolerable maltreatment at home.

The researchers wrote, "The research is critical to development of gender-responsive programming, alternatives to incarceration, and problem-solving court initiatives that address girls' and women's specific needs."

The researchers also found that the women they interviewed had high rates of mental health disorders, especially serious mental illnesses (50%) such as major depression, bipolar disorders, or psychotic spectrum disorders, posttraumatic stress disorder (51%), and/or substance use disorder (85%).

"Existing studies note that many offenders with serious mental illness are not identified as mentally ill upon entry into the system," the authors wrote. "Given that mental health problems in offenders are linked to greater likelihood of violent crimes, longer sentences, rule violations, and physical assaults in the corrections environment, greater knowledge and understanding of these offenders and their needs is critical for the success of behavioral health treatment programs, jail management, and correctional staff safety."