The Health Blog

WOMEN AND AIDS: SOME SERIOUS FACTSNow there is increasing realization that HIV is not an infection that certain groups get because of inherent group characteristics but rather an equal-opportunity pathogen that can attack anyone who engages in certain high-risk behaviors. If you engage in these high-risk behaviors, it doesn’t matter who you are, what your race or socioeconomic status group may be, or what your sexual orientation is.With this realization, the focus has finally turned to the 51 percent of the population that was long ignored: women. These are a few of the facts that have emerged:- From 1985 through 1997, the proportion of AIDS cases among American women increased from 7 percent to 22 percent. In 2000, over 43 percent of all AIDS cases in the United States were among women.- In rural America, HIV/AIDS due to heterosexual sexual transmission is increasing faster than in any other part of the country. Women most at risk are ethnic minorities and the economically disadvantaged. Among sexually active heterosexual teenagers, college students, and health care workers, nearly 60 percent of HIV cases are women.- Women in the age group of 13- to 24-year-olds accounted for 44 percent of new HIV cases in 1997.- Most women with AIDS were infected through heterosexual exposure to HIV, followed by injection drug use (sharing needles).- Women of color are disproportionately affected by HIV; African American and Hispanic women together account for 76 percent of AIDS cases among women in the United States, though comprising less than 25 percent of all U.S. women.- Of all AIDS cases among women, 61 percent were reported from five states: New York (26 percent), Florida (13 percent), New Jersey (10 percent), California (7 percent), and Texas (5 percent).- AIDS is the leading cause of death among African American women ages 25 to 44, and it is the fourth leading cause of death among all American women in this age group.Compounding the problems of women with HIV are serious deficiencies in our health and social service systems, including inadequate treatment for women addicts and lack of access to child care, health care, and social services for families headed by single women. Women with HIV/AIDS are of special interest because they are the major source of infection in infants. Virtually all new HIV infections among children in the United States are attributable to perinatal transmission of HIV.*44/277/5*

The health care costs of abdominal, vaginal and laparoscopically assisted hysterectomies are comparable. However the reduced recovery time of the latter approach promises considerable benefits to women, their families and employers.

An economic evaluation that compared the costs of abdominal hysterectomy and endometrial resection in England for the four months up to and including surgery, found total costs for the former were nearly twice that of the latter. The authors suggested, however, this was not the end of the story:

Given the fact that a subgroup of women requires re-treatment due to resection failure and that this study considers a relatively short period of follow-up, the long-term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.

The all-up cost of an abdominal hysterectomy in Australia in 1993 was about $5000, and for a vaginal hysterectomy it was considerably less at $3550. The cost of a laparoscopically assisted hysterectomy was about $5700, of which almost $1200 was for disposable instruments. Women who do not have private health insurance and whose hysterectomy is carried out in a public hospital ca*n expect to pay nothing. Women with private health insurance can expect to pay $500 or more, regardless of whether they attend a public or private hospital. Their payment will depend on their level of insurance and the fees charged by their surgeon and anaesthetist. Uninsured patients having a hysterectomy in a private hospital face payments of $2500 to $3000.

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Sperm are manufactured in seminiferous tubules (thread-like structures which fill the two testes). It takes at least three months for sperm cells to mature, ready to be ejaculated. That is why it is vital for a preconception programme to be put into place at least three months (preferably four) before trying to conceive. It is also important that, if there are problems with the sperm (e.g. low motility), then the man should follow a preconception programme for at least three months before re-testing because the benefits may not be apparent before then.

The head of the tadpole-like sperm carries the genetic material which will enter the egg and join the female genetic material. The head of the sperm has to be hard enough and contain certain enzymes in order to penetrate the egg.

I have seen a number of couples where the man’s semen analysis was fine and there were no problems with his partner. They had been referred for IVF treatment and at the vital point when the egg and sperm were put in the same dish, no fertilisation took place. This highlights an important limitation of semen analysis. It cannot identify one important reason for failure to conceive – the fact that a partner’s sperm, however fertile it is, cannot get into the egg.

Sometimes sperm heads are not strong enough to penetrate the egg. Sometimes the egg’s outer layer, the zona pellucida, is too tough to be penetrated.

Or it could be a combination of both that is making fertilisation difficult.

In this situation, even though the man has a good semen count, you would probably be advised to have ICSI treatment which involves inserting the sperm directly into the egg and is usually used to treat men with extremely low sperm counts. However, it’s certainly preferable to try other more natural ways of toughening up the sperm head and increasing the chances of conception before contemplating ICSI.

The middle part of the sperm provides the energy needed by the tail to move forward and also contains the mitochondrial DNA which plays a part in the inheritance of genes.

Also inside the testes are the Leydig cells which produce the hormone testosterone. Like oestrogen in the woman, this hormone is responsible for changes that occur around puberty, resulting in body and facial hair and a deep voice. Testosterone is needed for the sex drive and helping to achieve and maintain an erection.

As in a woman, the pituitary gland plays a large part in fertility because it releases the two vital hormones, follicle stimulating hormone (FSH) and luteinising hormone (LH). It is interesting that we tend to think of ‘male’ and ‘female’ hormones and yet both men and women share the same reproductive hormones. The only difference is the proportions of these hormones. Testosterone is often classed as the ‘male hormone’ and yet women also produce testosterone, which is needed for sex drive just as in the man. However, the ratio of testosterone to oestrogen will be different in the man and the woman, resulting in either female or male characteristics, depending on the dominance of one or other of those hormones.

So we come back again to the idea of balancing our hormones, so that they can function efficiently, in the right amounts, and do the job they are supposed to do. This can be achieved by aiming for optimum health through changes in lifestyle and diet, so that the body has the tools to balance itself- so simple really and yet so effective.

Both women and men produce FSH and LH. In the man FSH is responsible for stimulating the cells in the seminiferous tubules to produce sperm, and LH stimulates the Leydig cells to produce testosterone.

*80/73/5*

Naturopaths believe that natural therapies are able to help many aspects of endometriosis including pain, infertility and irregularity of the menstrual cycle which can accompany the problem. We asked a naturopath the following questions.

What causes endometriosis

Many naturopaths see endometriosis as a complex condition and causes include inherited predispositions, possible congestion of the lymphatic glands, mineral and other biochemical imbalances, subsequent adhesions or scarring and hormonal factors. They stress that each woman needs individual treatment.

Medical science has not yet discovered why the endometrial tissue is found both within and outside the peritoneal cavity in some women, nor why it develops metaplastic changes in both the uterus and other organs of the pelvic cavity.

Naturopaths, especially those trained in homoeopathic theory, understand that the tissue changes involved with endometriosis have a number of predisposing factors and these include inherited predispositions which homoeopaths call miasms.

This inherited predisposition towards overgrowth of tissue is caused by infectious pelvic disease in the family tree which is often unknown by relatives as it may come from several generations back. This particular factor is responsible for the development of cysts in the uterus and other associated pelvic tissues and is always an indication for supplementation with calcium phosphate in an easily assimilated form.

What type of woman do you treat

Most clients come for treatment having already undergone a surgical exploration which has demonstrated the presence of endometriosis in various parts of the pelvic cavity. We treat people at all stages of the disorder and during the first interview I make it plain that the treatment may need to be continued for up to two years.

Can alternative medicine cure pain

Pain is usually the first symptom to disappear. Many practitioners say it is frustrating when a woman discontinues treatment because the pain has stopped. They see that as the beginning of treatment – not the end.

What is your success rate in treating infertility

My success rate is about 80%. Women usually continue their treatment throughout pregnancy as there are no dangers in using natural remedies during pregnancy. The few herbs which should be discontinued during pregnancy are well known to those trained adequately in herbal medicine.

How do you treat hormonal problems

The hormonal factors are treated by particular herbs. Herbs are also used for lymphatic congestion and to tone up the nervous system. Treatment will include vitamins, minerals, herbs, homoeopathic remedies and flower essences for balancing emotions and nerves.

Does diet plays an important role

Environmental factors contributing to the problem will include poor diet which results in mineral deficiencies; if your diet includes too much junk food, this can burden the lymphatic system with waste. Good nutritional advice and help in the selection of correct food is essential.

Is zinc important

One of the main problems associated with endometriosis involves the formation of adhesions of the uterus, ovaries, fallopian tubes and bowel. Zinc in a suitable form is given to resolve or prevent adhesions. It should be stressed that the zinc and calcium used by natural therapists often differs from that prepared by the average pharmaceutical company. Our products are often prepared in a special way so they can be absorbed easily and they are used in a form which prevents side-effects.

What does a consultation cost

The cost of treatment for an average patient attending once a month, including remedies is around $80.1 use iridology to assist with the diagnosis; during the first visit – which lasts about half an hour – I take a comprehensive case history.

*70/41/5*

The problem may lie in one of these areas:

• The woman—70 to 75 per cent of infertile couples have a female factor.

• The man—30 to 35 per cent have a male factor.

• The couple—40 per cent of infertile couples have more than one factor. In some couples no cause will be identified.

However, the most common causes of infertility are:

• Anovulation (not producing an egg)—about 30 to 40 per cent of infertile couples have this problem.

• Having blocked fallopian tubes—about 20 per cent.

• Sperm problems—about 20 to 30 per cent.

Rarer causes include problems with the uterus, cervix, chromosomes and male anatomy.

Anovulation. A hold-up in egg production can arise for a variety of reasons. Making eggs requires a delicate balance of the right hormones in the right place at the right time, and an ovary capable of producing them.

Hormone imbalances can result from problems in the brain, specifically in the hypothalamus and pituitary gland, where the ‘stimulating’ hormones are produced. Too much or not enough hormone may be produced, for a variety of reasons, including (stress, weight, illness, etc.). Often there is no obvious cause.

One specific, though relatively uncommon, hormonal cause of anovulation is having too much prolactin, the milk-stimulating hormone. It is produced in the pituitary gland, and sometimes the gland will overgrow, causing what is known as an adenoma, a benign (non-cancerous) tumour. These prolactinomas account for 3 to 5 per cent of cases of infertility, and can be treated with medication or surgery.

The ovaries may not respond to the signals sent to them by the brain for various reasons. Polycystic ovary syndrome is one condition in which the messages don’t result in an egg being produced. Instead the ovaries produce heaps of little cysts. The hormone imbalance related to this condition can also lead to increased weight and hairiness, and acne. It is usually diagnosed by ultrasound and can be treated with hormones.

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Most of the tests available these days work on the fact that pregnant women will have a particular hormone in their urine and their blood. This hormone, human chorionic gonadatrophin (fortunately, known as HCG), can be identified with special urine and blood tests.

In the past there was a fair degree of difference between the blood and urine tests, with the blood test being considered more accurate, and able to detect HCG earlier in the pregnancy than the urine test. Better urine tests have now been made, and varieties of these are available from pharmacies. Doctors also commonly use urine tests, and the makers claim that they are nearly as accurate as a blood test, becoming positive within a few days of a missed period.

If you are having a urine test to see if you are pregnant, it is best to wait until your period is at least a few days late. It is also recommended that the wee you use for the test be from first thing in the morning, because urine concentrates overnight. If there is HCG in it, it is likely to be easier to find if it is more concentrated.

So you can do a home pregnancy test, or go to your doctor and have a test. Even if you do a home test, you will usually need to see your doctor to make arrangements for your pregnancy. Your doctor is likely to confirm the pregnancy with another urine test. A positive urine test is enough to confirm a pregnancy. It is not generally necessary to follow a positive urine test with a blood test.

If you have missed a period, and your pregnancy test is not positive, there may be other reasons for this. Women can miss periods for lots of reasons. Stress, illness, hormonal variation, sometimes no reason at all. It may be that you are pregnant, but simply that the test is not yet positive, and a doctor might suggest you repeat the test in a few days. Sometimes a blood pregnancy test will be recommended if there is a doubtful urine test result.

Most pregnant women will have positive pregnancy tests within a week of a missed period. Some women will take longer to have positive tests, and still be pregnant. Only very few women will have a positive pregnancy test and not be pregnant.

Sometimes a woman will have a test which is positive, and within a week or so have a negative pregnancy test, and a period-type bleed will follow. This can result from very early pregnancy failure; a pregnancy which may have just started, and was never going to continue, and fizzled. The resulting period is often a little heavier than usual. If the woman had not actually done the pregnancy test, and not known she was pregnant, this may have seemed like simply a slightly heavier period, a bit late. In fact that is how it probably should be considered, rather than a failed pregnancy, or miscarriage (more on miscarriage later).

Pregnancy tests eventually become negative in an ongoing pregnancy, but that does not tend to happen until the pregnancy has progressed a few months. The level of HCG starts falling after about ten weeks, even if the pregnancy is continuing.

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Infection with hepatitis B may not be noticeable (‘asymptomatic’, or ‘subclinical’, doctors call it), or it may make you ill, even so ill you need to be in hospital. The virus affects the liver, so the liver may malfunction for a few weeks, making you sick with vomiting, weakness, headaches, and maybe dark wee and pale poo, and yellow skin. This phase usually hits between six weeks and six months after the bug has entered the blood stream. After the initial infection, one of two things will happen. Your body may have fought the bug, and it goes away, and you are no longer ‘infectious’ (able to pass the bug on to anyone else). Or sometimes, and we don’t know exactly why, the bug hangs around in the blood stream. You don’t usually feel sick, or even know it is there, but it is, and you are therefore infectious. This may be lifelong.

Having the bug in the blood stream (being a ‘carrier’), may do you no harm. (It may not be too good for other people if you give it to them; see ‘prevention’.) Unfortunately, a proportion of carriers do get problems, in the form of ‘chronic hepatitis’. This means that the bug gradually destroys the liver, or increases the risk of cancer of the liver. This is definitely not a good thing. We need livers to live.

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It is difficult to understand how such an innocent looking little tablet could be the centre of so much controversy. In the twenty or more years since being introduced ‘the pill’ has been seen as a major determining factor in social change, as the liberator of women, the instrument of the Devil, the supposed cause of every discomfort, disease and cancer experienced by women, and more.

There is a lot of misunderstanding about the pill, perhaps partly due to inadequate explanation by the medical profession. It is not our job to tell women whether or not they should take the pill; that is a decision an individual woman should make, guided by reliable information, and in consultation with her doctor. Unfortunately, many decisions are based on misinformation. A woman may make an inappropriate contraceptive choice guided by hearsay, and consequently runs the risk of unwanted pregnancy.

How it works. The combined oral contraceptive pill gives a daily dose of synthetic hormones. The hormones are an oestrogen (usually ethinyl oestradiol), and a progesterone type (usually either levonorgestrol or norethisterone). These synthetic hormones act like the natural hormones in the body. When there is a certain level of these hormones acting on the brain, the ovary does not get stimulated to produce an egg. This is the mechanism by which the pill provides effective contraception (no egg, no pregnancy).

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Like other mammals, we have mammary glands, which we call breasts. Breast tissue produces milk, deigned to have all the correct nutrients for babies. Not only that, but it is cheap, warm, and portable. Clever.

Each breast has glands, and ducts, which drain out of a central nipple. The nipple is surrounded by an area of darker, thicker skin called the areola. The skin of the areola and the nipple also contains many nerve fibres, and is quite sensitive. The nipples tend to become more erect when the surface is stimulated during sexual arousal, or by cold temperatures, or other stimulation. Some people have what are known as accessory breasts or nipples, which arc little extra bits of breast and/or nipple tissue, usually below the normal breast. They are probably remnants from when we, like other mammals, had two lines of breasts down our fronts.

Breast tissue responds to hormonal stimulation. It grows and develops during puberty, under the influence of a variety of hormones, to become mature and functional. It responds to increased levels of the hormone prolactin (secreted from the pituitary gland) by producing milk.

Breast tissue can undergo change, which can result in lumps forming. Many of these are benign (non-cancerous), but some are malignant (cancerous).

We think of breasts as typically female appendages, but men do have a small amount of breast tissue beneath their nipples. Without the stimulus of female sex hormones it docs not develop further.

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