Cervical Cancer - Causes and Treatment

Cervical cancer causes are primarily related to a specific virus. Cervical cancer or cervical cancer signs symptoms usually evolve very slowly. Over a period of several years, cells on the surface of the cervix change from normal to abnormal.

As for cervical cancer causes, at least 95% or 9 out of every 10 cases of cervical cancer are linked to the human papilloma virus (HPV), which is a sexually transmitted infection.

Symptoms of HPV very often have no cervical cancer signs symptoms. Warts can appear after weeks or even years after sexual contact with anyone with HPV. These growths very often stay flat and invisible.

The Pap Smear is defined as a test for cancerous or precancerous cells of the cervix. HPV can be detected through an annual pap smear test. While pap smear tests are necessary because they are the best screening technique currently available, they are not always accurate in detecting a cervical signs symptoms. A newer testing method is being developed that uses a small fiber optic probe that may replace pap smears. This new method is still being tested and it should give women more accurate screening, eliminate unnecessary biopsies and find cervical cancer signs symptoms at its early stages. Research is ongoing to possibly find an HPV vaccine for men and women. Ask your doctor if any newer, more accurate tests are now available in his or her practice.

What are the early symptoms of cervical cancer ?

The cervical cancer symptoms are : vaginal bleeding after sexual intercourse, pelvic pain, pain during sexual intercourse, unusual vaginal discharge, abnormal bleeding between menstrual periods, heavy bleeding during your menstrual period, and increased urinary frequency.

When the early symptoms of the cervical cancer are suspected, Pap smear test and other screening techniques are currently available to evaluate the cells status in the cervix.

Treatment of cervical cancer

Staging

If the screening test shows that you have cancer, your doctor will do a thorough pelvic exam and may remove additional tissue to learn the extent (stage) of your disease. The stage tells whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

These are the stages of cervical cancer :

• Stage 0: The cancer is found only in the top layer of cells in the tissue that lines the cervix. Stage 0 is also called carcinoma in situ.
• Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.
• Stage II: The cancer extends beyond the cervix into nearby tissues. It extends to the upper part of the vagina. The cancer does not invade the lower third of the vagina or the pelvic wall (the lining of the part of the body between the hips).
• Stage III: The cancer extends to the lower part of the vagina. It also may have spread to the pelvic wall and nearby lymph nodes.
• Stage IV: The cancer has spread to the bladder, rectum, or other parts of the body.
• Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

To learn the extent of disease and suggest a course of treatment, the doctor may order some of the following tests :

• Chest x-rays: X-rays often can show whether cancer has spread to the lungs.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive contrast material by injection in your arm or hand, by mouth, or by enema. (Some people are allergic to contrast materials that contain iodine. Tell your doctor or nurse if you have allergies.) The contrast material makes abnormal areas easier to see. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan.
• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
• Ultrasound: An ultrasound device is held against the abdomen or inserted into the vagina. The device sends out sound waves that people cannot hear. The waves bounce off the cervix and nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show whether cancer has spread.

Treatment

Many women with cervical cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment.

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor—to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.

Your doctor may refer you to a specialist, or you may ask for a referral. Gynecologists, gynecologic oncologists, medical oncologists, and radiation oncologists are specialists who treat cervical cancer.

Getting a second opinion

Before starting treatment, you might want a second opinion about the diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with cervical cancer need treatment right away.

There are a number of ways to find a doctor for a second opinion :

• Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
• NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can provide online assistance through LiveHelp at http://www.cancer.gov.
• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists in your area.
• The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries. Or you can look up doctors at http://www.abms.org. (Click on "Who's Certified.")

Preparing for treatment

The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. If a woman is of childbearing age, the treatment choice may also depend on whether she wants to become pregnant someday.

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values.

You may want to ask the doctor these questions before treatment begins:

• What is the stage of my disease ? Has the cancer spread ? If so, where ?
• What are my treatment choices ? Which do you recommend for me ? Will I have more than one kind of treatment ?
• What are the expected benefits of each kind of treatment ?
• What are the risks and possible side effects of each treatment ? What can we do to control my side effects ?
• How will treatment affect my normal activities ?
• What can I do to take care of myself during treatment ?
• How long will treatment last ?
• Will I have to stay in the hospital ? What is the treatment likely to cost ? Does my insurance cover this treatment ?
• How often should I have checkups ?
• Would a clinical trial (research study) be appropriate for me ?

Methods of treatment

Women with cervical cancer may be treated with surgery, radiation therapy, chemotherapy, radiation therapy and chemotherapy, or a combination of all three methods.

At any stage of disease, women with cervical cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care. Information about such treatment is available on NCI's Web site and from NCI's Cancer Information Service at 1-800-4-CANCER.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

1. Surgery

Surgery treats the cancer in the cervix and the area close to the tumor.

Most women with early cervical cancer have surgery to remove the cervix and uterus (total hysterectomy). However, for very early (Stage 0) cervical cancer, a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery, or LEEP.

Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix, and part of the vagina.

With either total or radical hysterectomy, the surgeon may remove both fallopian tubes and ovaries. (This procedure is a salpingo-oophorectomy.)

The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

You may want to ask the doctor these questions about surgery :

• What kind of operation will I have ? Will my ovaries be removed ?
• Do I need to have lymph nodes removed ? Will other tissues be removed ? Why ?
• How will I feel after the operation ?
• If I have pain, how will it be controlled ?
• How long will I have to stay in the hospital ?
• Will I have any lasting side effects ? If I don't have a hysterectomy, will I be able to get pregnant and have children ? Is there increased risk of miscarriage ?
• When will I be able to resume normal activities ?
• How will the surgery affect my sex life ?

2. Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Women have radiation therapy alone, with chemotherapy, or with chemotherapy and surgery. The doctor may suggest radiation therapy instead of surgery for the small number of women who cannot have surgery for medical reasons. Most women with cancer that extends beyond the cervix have radiation therapy and chemotherapy. For cancer that has spread to distant organs, radiation therapy alone may be used.

Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

• External radiation: The radiation comes from a large machine outside the body. The woman usually has treatment as an outpatient in a hospital or clinic. She receives external radiation 5 days a week for several weeks.
• Internal radiation (intracavitary radiation): Thin tubes (also called implants) containing a radioactive substance are left in the vagina for a few hours or up to 3 days. The woman may stay in the hospital during that time. To protect others from the radiation, the woman may not be able to have visitors or may have visitors for only a short period of time while the tubes are in place. Once the tubes are removed, no radioactivity is left in her body. Internal radiation may be repeated two or more times over several weeks.

You may want to ask the doctor these questions before having radiation therapy :

• What is the goal of this treatment ?
• How will the radiation be given ?
• Will I need to stay in the hospital ? If so, for how long ?
• When will the treatments begin ? When will they end ?
• How will I feel during therapy? Are there side effects ?
• How will we know if the radiation therapy is working ?
• Will I be able to continue my normal activities during treatment ?
• How will radiation therapy affect my sex life ?
• Will I be able to get pregnant and have children after my treatment is over ?

3. Chemotherapy

Chemptherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because the drugs enter the bloodstream and can affect cells all over the body. For treatment of cervical cancer, chemotherapy is generally combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy alone may be used.

Anticancer drugs for cervical cancer are usually given through a vein. Women usually receive treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a woman needs to stay in the hospital during treatment.

You may want to ask the doctor these questions before having chemotherapy:

• Why do I need this treatment ?
• Which drug or drugs will I have ?
• How do the drugs work ?
• What are the expected benefits of the treatment ?
• What are the risks and possible side effects of treatment ? What can we do about them ?
• When will treatment start ? When will it end ?
• How will treatment affect my normal activities ?

Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) involves a multitude of symptoms occurring during the last week of the luteal phase (the weeks before menstruation) in most menstrual cycles. About half of the women who have PMS report only mild symptoms. For the remaining half, the symptoms are more severe. These symptoms usually disappear a few days after menstruation begins. PMS can occur at any time during the woman's reproductive years and seems to remain fairly constant until menopause, although symptoms may vary between cycles. The risk for PMS is usually higher in younger women, and in women who have a mother with PMS. In addition, women who have given birth to several children, those who are sedentary and women under stress have increased risks.

Causes and Symptoms

The exact cause of PMS is still unclear. One theory suggests that some women who experience PMS may be abnormally sensitive to normal amounts of estrogen and progesterone in their bodies - perhaps because of altered hormone receptors in the brain.

The following are some common symptoms :

• Breast tenderness
  
• Fluid retention
• Weight gain
• Acne
• Abdominal bloating
• Irritability
• Depression
• Mood swings
• Increased appetite with specific food cravings, typically sweet and salty foods
• Lethargy and fatigue
• Insomnia

Keep in mind that these symptoms may also be caused by other factors, particularly if they persist or do not follow a pattern consistent with the occurrence of menses.

Suggested Lifestyle Changes

• Keep a sympton diary. This may help you understand the symptoms when they occur, predict them rather than be taken by surprise, and rule out other causes of the symptoms if they are not actually tied to your menstrual cycle.
• Avoid alcohol and caffeine, including chocolate. Both of these can make the symptoms of PMS worse.
• Keep blood sugar levels stable. Eat small, frequent, balanced meals throughout the day.
• Get regular aerobic ecercise.
  
• Practise relaxation. Use breathing exercises daily and make use of a technique like yoga or meditation.

Nutrition and Supplements

The following supplements can be of help in relieving symptoms:

• Calcium. Recent studies have demonstrated that, when used for three months, supplemental calcium can help reduce the severity of PMS symptoms. I recommend supplementing with 500-700 mg daily.
• Magnesium. Magnesium deficiency has been associated with PMS. Supplemental magnesium may help alleviate some of the emotional symptoms, fluid retention and breast tenderness.
• Vitamin B6. Take a good multivitamin or B complex
• Evening primrose oil or black currant oil. These are sources of gamma-linolenic acid (GLA) that can help influence prostaglandin synthesis.
• Dong quai is a readily available Chinese herb used traditionally as a general tonic for women, however this herb should not be taken if a woman is experiencing heavy bleeding. Chaste tree herb (vitex) can also be helpful.
• Raspberry leaf tea is an effective remedy for painful menstrual cramps.

Should I Get Help?
Don’t feel badly if you can’t control PMS on your own. Many women can’t. If you need more help, see your health care provider for further treatment.
Medications sometimes used are : some types of birth control pills, a diuretic to help with bloating, an antidepressant, sometimes taken for only part of the cycle and which can help both the mental and physical symptoms.

Smoking Spreads Cancer

Smoking among women is on the rise. But the alarm bells are soaring against the same when the researchers identify that female smokers with breast cancer face an increased risk of their tumors spreading to the lungs and other organs than do nonsmokers "There is a relationship between smoking and the spread of the disease," says study author Susan Murin, MD, associate professor of medicine at the University of California at Davis. Dr. Murin says the research may help explain why breast cancer is more likely to be fatal among smokers as it is common for breast cancer to metastasize to the lung. Smoking also causes changes in the lungs that increase the risk of tumors spreading from other sites. Inspite of the fact that it is not completely clear whether smoking provides a nidus in the lungs which envisages the spread, there may also be some lifestyle factors to explain the risk. Murin also points out, however, that it's not completely clear whether smoking affects something in the lungs directly to make breast cancer more likely to spread or whether smoking causes a systemic response in the body that encourages cancers to grow and spread to other organs. There may also be other lifestyle factors unique to smokers that may also help explain the link. Smokers can still reduce their risk of dying by quitting - even after the cancer is diagnosed.

Some things to avoid during pregnancy

When you're pregnant, what you don't put into your body (or expose your body to) is almost as important as what you do.

Here are some things to avoid:

Alcohol

Although it may seem harmless to have a glass of wine at dinner or a mug of beer out with friends, no one has determined what's a "safe amount" of alcohol to consume during pregnancy. One of the most common known causes of mental and physical birth defects, alcohol can cause severe abnormalities in a developing fetus.

Alcohol is easily passed along to the baby, who is less equipped to eliminate alcohol than the mother. That means an unborn baby tends to develop a high concentration of alcohol, which stays in the baby's system for longer periods than it would in the mother's. And moderate alcohol intake, as well as periodic binge drinking, can damage a baby's developing nervous system.

If you had a drink or two before you even knew you were pregnant (as many women do), don't worry too much about it. But your best bet is to not drink any alcohol at all for the rest of your pregnancy.

Recreational Drugs

Pregnant women who use drugs may be placing their unborn babies at risk for premature birth, poor growth, birth defects, and behavior and learning problems. And their babies could also be born addicted to those drugs themselves.

If you're pregnant and using drugs, a health clinic such as Planned Parenthood can recommend health care providers, at little or no cost, who can help you quit your habit and have a healthier pregnancy.

If you've used any drugs at any time during your pregnancy, it's important to inform your health care provider. Even if you've quit, your unborn child could still be at risk for health problems.

Nicotine

You wouldn't light a cigarette, put it in your baby's mouth, and encourage your little one to puff away. As ridiculous as this scenario seems, pregnant women who continue to smoke are allowing their fetus to smoke, too. The smoking mother passes nicotine and carbon monoxide to her growing baby.

The risks of smoking to the fetus include:

• stillbirth
• prematurity
• low birth weight
• sudden infant death syndrome (SIDS)
  
• asthma and other respiratory problems

If you smoke, having a baby may be the motivation you need to quit. Talk to your health care provider about options for stopping your smoking habit.

Caffeine

High caffeine consumption has been linked to an increased risk of miscarriage, so it's probably wise to limit or even avoid caffeine altogether if you can.

If you're having a hard time cutting out coffee cold turkey, here's how you can start:

• Cut your consumption down to one or two cups a day.
• Gradually reduce the amount by combining decaffeinated coffee with regular coffee.
• Eventually try to cut out the regular coffee altogether.

And remember that caffeine is not limited to coffee. Many teas, colas, and other soft drinks contain caffeine. Try switching to decaffeinated products (which may still have some caffeine, but in much smaller amounts) or caffeine-free alternatives.

If you're wondering whether chocolate, which also contains caffeine, is a concern, the good news is that you can have it in moderation. Whereas the average chocolate bar has anywhere from 5 to 30 milligrams of caffeine, there's 95 to 135 milligrams in a cup of brewed coffee. So, small amounts of chocolate are fine.

Certain Foods

Although you need to eat plenty of healthy foods during pregnancy, you also need to avoid food-borne illnesses, such as listeriosis and toxoplasmosis, which can be life-threatening to an unborn baby and may cause birth defects or miscarriage.

Foods you'll want to steer clear of include:

• soft, unpasteurized cheeses (often advertised as "fresh") such as feta, goat, Brie, Camembert, and blue cheese
  
• unpasteurized milk, juices, and apple cider
  
• raw eggs or foods containing raw eggs, including mousse, tiramisu, raw cookie dough, homemade ice cream, and Caesar dressing (although some store-bought brands of the dressing may not contain raw eggs)
  
• raw or undercooked meats, fish (sushi), or shellfish
  
• processed meats such as hot dogs and deli meats (unless they are reheated until steaming)

Also, although fish and shellfish can be an extremely healthy part of your pregnancy diet (they contain beneficial omega-3 fatty acids and are high in protein and low in saturated fat), you should avoid eating:

• shark
• swordfish
• king mackerel
• tilefish
• tuna steak
  

These types of fish may contain high levels of mercury, which can cause damage to the developing brain of a fetus. When you choose seafood, limit the total amount to about 12 ounces per week — that's about two meals. Also, if you eat canned tuna, limit consumption to no more than 6 ounces per week. Also, check any local advisories before consuming recreationally caught fish.

Changing the Litter Box

Pregnancy is the prime time to get out of cleaning kitty's litter box. Why? Because toxoplasmosis can be spread through soiled cat litter boxes and can cause serious problems, including prematurity, poor growth, and severe eye and brain damage. A pregnant woman who becomes infected often has no symptoms but can still pass the infection on to her developing baby.

Over-the-Counter and Prescription Medications

Even common over-the-counter medications that are generally safe may be considered off-limits during pregnancy because of their potential effects on the baby. And certain prescription medications may also cause harm to the developing fetus.

To make sure you don't take anything that could be harmful to your baby:

• Ask your health care provider which medicines — both over-the-counter and prescription — are safe to take during pregnancy.
  
• Talk to your health care provider about any prescription drugs you're taking.
  
• Let all of your health care providers know that you're pregnant so that they'll keep that in mind when recommending or prescribing any medications.
  
• Also remember to discuss natural remedies, supplements, and vitamins.

If you were prescribed a medication before you became pregnant for an illness, disease, or condition you still have, consult with your health care provider, who can help you weigh potential benefits and risks of continuing your prescription.

If you become sick (e.g., with a cold) or have symptoms that are causing you discomfort or pain (like a headache or backache), talk to your health care provider about medications you can take and alternative ways to help you feel better without medication.

Healthy pregnancy

Staying healthy during pregnancy depends on the mother. Key to protecting the health of your child is to get regular prenatal care. If you think you're pregnant, call your health care provider to schedule an appointment. You should schedule your first examination as soon as you think that you are pregnant.

At this first visit, your health care provider likely do a pregnancy test, and will figure out how many weeks pregnant you are based on a physical examination and the date of your last period. He or she will also use this information to predict your delivery date (however, an ultrasound performed sometime during your pregnancy will help to verify that date).

If you're healthy and there are no complicating risk factors, most health care providers will want to see you:

• every 4 weeks until the 28th week of pregnancy
• then every 2 weeks until 36 weeks
• then once a week until delivery

Throughout your pregnancy, your health care provider will check your weight and blood pressure while also checking the growth and development of your baby (by doing things like feeling your abdomen, listening for the fetal heartbeat starting during the second trimester, and measuring your belly). During the span of your pregnancy, you'll also have prenatal test, including blood, urine, and cervical tests, and probably at least one ultrasound.

If you still need to choose a health care provider to counsel and treat you during your pregnancy, there are several options:

• obstetricians/gynecologists (also known as OB/GYNs — doctors who specialize in pregnancy and childbirth, as well as women's health care)
  
• family practitioners (doctors who provide a range of services for patients of all ages — in some cases, this includes obstetrical care)
  
• certified nurse-midwives (advanced practice nurses specializing in women's health care needs, including prenatal care, labor and delivery, and postpartum care for uncomplicated pregnancies; there are also other kinds of midwives, but you should look for one with formal training who's been certified in the field)

Any of these is a good choice if you're healthy and there's no reason to anticipate complications with your pregnancy and delivery. However, nurse-midwives do need to have a doctor available for the delivery in case an unexpected problem arises or a cesarean section (C-section) has to be performed.

Nutrition and Supplements
Now that you're eating for two (or more!), this is not the time to cut calories or go on a diet. In fact, it's just the opposite — you need about 300 extra calories a day, especially later in your pregnancy when your baby grows quickly. If you're very thin, very active, or carrying multiples, you'll need even more. But if you're overweight, your health care provider may advise that you consume fewer extra calories.

Healthy eating is always important, but especially when you're pregnant. So, make sure your calories come from nutritious foods that will contribute to your baby's growth and development.

Try to maintain a well-balanced diet that incorporates the dietary guidelines including:

• lean meats
• fruits
• vegetables
• whole-grain breads
• low-fat dairy product

By eating a healthy, balanced diet you're more likely to get the nutrients you need. But you will need more of the essential nutrients (especially calcium, iron, and folic acid) than you did before you became pregnant. Your health care provider will prescribe prenatal vitamins to be sure both you and your growing baby are getting enough.

But taking prenatal vitamins doesn't mean you can eat a diet that's lacking in nutrients. It's important to remember that you still need to eat well while pregnant. Prenatal vitamins are meant to supplement your diet not be your only source of much-needed nutrients.

Calcium

Most women 19 and older — including those who are pregnant — don't often get the daily 1,000 mg of calcium that's recommended. Because your growing baby's calcium demands are high, you should increase your calcium consumption to prevent a loss of calcium from your own bones. Your doctor will also likely prescribe prenatal vitamins for you, which may contain some extra calcium.

Good sources of calcium include:

• low-fat dairy products including milk, pasteurized cheese, and yogurt
• calcium-fortified products, including orange juice, soy milk, and cereals
• dark green vegetables including spinach, kale, and broccoli
• tofu
• dried beans
• almonds

Iron

Pregnant women need about 30 mg of iron every day. Why? Because iron is needed to make hemoglobin, the oxygen-carrying component of red blood cells. Red blood cells circulate throughout the body to deliver oxygen to all its cells.

Without enough iron, the body can't make enough red blood cells and the body's tissues and organs won't get the oxygen they need to function well. So it's especially important for pregnant women to get enough iron in their daily diets — for themselves and their growing babies.

Although the nutrient can be found in various kinds of foods, iron from meat sources is more easily absorbed by the body than iron found in plant foods. Iron-rich foods include:

• red meat
• dark poultry
• salmon
• eggs
• tofu
• enriched grains
• dried beans and peas
• dried fruits
• dark leafy green vegetables
• blackstrap molasses
• iron-fortified breakfast cereals

Folate (Folic Acid)

The Centers for Disease Control and Prevention (CDC) recommends that all women of childbearing age — and especially those who are planning a pregnancy — get about 400 micrograms (0.4 milligrams) of folic acid supplements every day. That can be from a multivitamin or folic acid supplement in addition to the folic acid found in food.

So, why is folic acid so important? Studies have shown that taking folic acid supplements 1 month prior to and throughout the first 3 months of pregnancy decrease the risk of neural tube defects by up to 70%.

The neural tube — formed during the several weeks of the pregnancy, possibly before a woman even knows she's pregnant — goes on to become the baby's developing brain and spinal cord. When the neural tube doesn't form properly, the result is a neural tube defect such as spina bifida.

Again, your health care provider can prescribe a prenatal vitamin that contains the right amount of folic acid. Some pregnancy health care providers even recommend taking an additional folic acid supplement, especially if a woman has previously had a child with a neural tube defect.

If you're buying an over-the-counter supplement, keep in mind that most multivitamins contain folic acid, but not all of them have enough folic acid to meet the nutritional needs of a pregnant woman. So, be sure to check labels carefully before choosing one and check with your health care provider.

Fluids

It's also important to drink plenty of fluids, especially water, during pregnancy. A woman's blood volume increases dramatically during pregnancy, and drinking enough water each day can help prevent common problems such as dehydration and constipation.

Exercise

The U.S. Department of Health and Human Services recommends at least 150 minutes (that's 2 hours and 30 minutes) of moderate-intensity aerobic activity each week if you're not already highly active or doing vigorous-intensity activity. If you are very active or did intense aerobic activities before becoming pregnant, you may be able to keep up your workouts, as long as your doctor says it's safe. Before beginning — or continuing — any exercise regimen talk to your doctor first.

Exercising during pregnancy has been shown to be extremely beneficial. Regular exercise can help:

• prevent excess weight gain
• reduce pregnancy related problems, like back pain, swelling, and constipation
• improve sleep
• increase energy
• improve outlook
• prepare for labor
• lessen recovery time

Low-impact, moderate-intensity exercise activities (such as walking and swimming) are great choices. You can also opt for yoga or Pilates classes, DVDs, or videos that are tailored for pregnancy. These are both low-impact and work on strength, flexibility, and relaxation.

But you should limit high-impact aerobics and avoid certain sports and activities that pose a risk of falling or abdominal injury. Typical limitations include contact sports, downhill skiing, and horseback riding.

It's also important to be aware of how your body changes. During pregnancy, your body produces a hormone known as relaxin, which is believed to help prepare the pubic area and the cervix for the birth. The relaxin loosens the ligaments in your body, making you less stable and more prone to injury.

So, it's easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. In addition, your center of gravity shifts as your pregnancy progresses, so you may feel off-balance and at risk of falling. Keep these in mind when you choose an activity and don't overdo it.

Whatever type of exercise you choose, make sure to take frequent breaks and remember to drink plenty of fluids. And use common sense — slow down or stop if you get short of breath or feel uncomfortable. If you have any questions about doing a certain sport or activity during your pregnancy, talk to your health care provider for specific guidelines.

Sleep

It's important to get enough sleep during your pregnancy. Your body is working hard to accommodate a new life, so you'll probably feel more tired than usual. And as your baby gets bigger, it will be harder to find a comfortable position when you're trying to sleep.

Lying on your side with your knees bent is likely to be the most comfortable position as your pregnancy progresses. It also makes your heart's job easier because it keeps the baby's weight from applying pressure to the large blood vessels that carry blood to and from your heart and your feet and legs. Lying on your side can also help prevent or reduce varicose veins, hemorrhoids, and swelling in your legs.

Some doctors specifically recommend that pregnant women sleep on the left side. Because one of those big blood vessels is on the right side of your abdomen, lying on your left side helps keep the uterus off of it. Lying on your left side optimizes blood flow to the placenta and, therefore, your baby.

Ask what your health care provider recommends. In most cases, lying on either side should do the trick and help take some pressure off your back. To create a more comfortable resting position either way, prop pillows between your legs, behind your back, and underneath your belly.

strategies to avoid breast cancer

1. Limit alcohol

A strong link exists between alcohol consumption and breast cancer. The type of alcohol consumed — wine, beer or mixed drinks — seems to make no difference. To help protect against breast cancer, limit alcohol to less than one drink a day or avoid alcohol completely.

2. Eat fruit

You can't go wrong with this – almost all dietary advice comes down to the single instruction to eat more fruit and veg. Diet is thought to be a key factor in one in four cancer deaths – and animal fat in the diet is the suspect ingredient in breast cancer. The Japanese, who eat a diet of fish, rice and vegetables that is extremely low in animal fat, also have low rates of breast cancer.

A high-fat diet increases the levels of the female hormone estrogen in the blood, which encourages the growth of cancer cells. In populations with a high-fat diet, women tend to start their periods earlier and reach menopause later so they are exposed to high levels of estrogen for longer, increasing their risk of breast cancer.

Studies into what effect eating fruit and vegetables has on breast cancer have produced mixed results. One study found that, when combined with taking exercise, the results were dramatic. Published in the Journal of Clinical Oncology last June, it showed that women who ate their five portions a day and walked briskly for at least 30 minutes halved their risk of breast cancer.

3. Walk

It is enjoyable, simple and requires no equipment. Walking is good for all aspects of physical and mental health – and cancer is no exception. Brisk walking (or other exercise) for 30 minutes a day, five times a week, is all that's needed. Currently only one in four women manages this. If all women did, Cancer Research UK estimates it would prevent 1,400 cases a year.

Three large studies in Italy and the US showed that inactivity caused 11 per cent of cases of breast cancer. Exercise works best before the menopause, but it is effective afterwards, too. It is thought to alter estrogen metabolism, resulting in a weaker version being made.

4. Avoid HRT

Hormone replacement therapy is seen as the principal avoidable risk for breast cancer. At the height of its popularity, in 2002, an estimated two million women were taking HRT in the UK, and millions more worldwide. Tens of thousands of women will have developed breast cancer, ovarian cancer and endometrial cancer (of the lining of the womb) as a result. Overall, women currently taking HRT are 63 per cent more likely to develop these three cancers than those who are not. Earlier hopes that these risks would be counterbalanced by a reduction in heart disease have not been borne out. Gynecologists recommend that women who wish to use it to ease the symptoms of the menopause do so for as short a time as possible.

5. Get screened

Women diagnosed with breast cancer at the earliest possible stage have a nine in 10 chance of a successful recovery. This is the rationale for screening – to detect a tumour by mammography when it is still too small to feel. Women aged 50 to 70 are invited for screening every three years – shortly to be extended to ages 47 to 73. It is estimated that the scheme saves 1,400 lives a years in England – one life for every 500 women screened.

However, there is a downside in the shape of false alarms. Screening picks up abnormalities in the breast that look like cancer but turn out not to be. Several thousand women each year suffer the anxiety and discomfort of being recalled for further tests and undergoing biopsies of the breast to check for cancer – before being given the all-clear. Screening is now more accurate, since two views of the breast are taken, reducing the chances of cancers being missed.

6. Give birth

Having children, especially before the age of 30, helps protect against breast cancer. It is down to those hormones, again. Over the last century, economic progress has led to delayed childbirth and smaller families as women with their own careers have sought to balance the demands of work and home. But researchers estimate that delaying childbearing increases the risk of breast cancer by 3 per cent for each year of delay.

7. Breast-feed

Breast-feeding protects against breast cancer, as well as being best for the baby. But smaller families and the rise in the number of working mothers has meant the time spent breast-feeding has reduced. Breast-feeding for six months reduces the risk, experts say. Yet many women never get that far. In England, 77 per cent of mothers start breast-feeding but more than a third switch to bottle-feeding in the first six weeks.

8. Lose weight

Obesity increases the risk of breast cancer – but only after the menopause. A large European study called Epic found post menopausal women who were obese had a 31 per cent higher risk of breast cancer than women with a healthy weight. Reducing obesity could save 1,800 cases of breast cancer a year.

Obesity increases the risk of other cancers including those of the bowel, womb, kidney and esophagus. Overall it is estimated that 5 per cent of cancers in women and 3 per cent in men are due to being obese or overweight. In the UK, 12,000 people might avoid getting cancer each year if they maintained a healthy body weight.

9. Sleep Safely

Shut out all light: Sleeping in a dark room aids production of neurotransmitter serotonin, which is crucial in making melatonin.

Get nine hours' sleep: A Finnish study found that women who slept nine hours were one-third as likely to get breast cancer as those who slept seven-eight.

Get a red light bulb: Place a red light bulb in one fixture. If you get up in the night, only use this one.

Get outside in the morning: Just 10-15 minutes of morning light will send a strong time-keeping signal to the brain's clock, leaving it less likely to be confused.

10. Live somewhere clean

It has long been claimed that exposure to pollutants used in the manufacture of products from plastics to cosmetics has an "endocrine disrupting" effect. The chemicals are said to mimic the action of oestrogen and have been blamed for feminised fish and frogs and declining sperm counts in men. A report from the World Wide Fund for Nature last year claimed their role in breast cancer had been neglected. It pointed out that less than half of new breast cancer cases can be explained by genetic and lifestyle factors and chemicals in the environment could be the missing link. Other studies have contradicted this suggestion and experts point out that compared with the natural levels of oestrogen in a woman's blood, the level of the chemicals is too small to have significant impact.

Ways to Help Improve Women's Health

Below are several ways you can help improve women’s health through your clinic, practice, community, or organization. Whether you want to take on one project as an individual or several as a group, there’s something for anyone interested in encouraging women to practice prevention to be healthy and safe.

Breast and Cervical Cancer Screening
CDC provides high-quality screening and diagnostic services to detect breast and cervical cancer at the earliest stages through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The program helps low-income, uninsured, and underinsured women (ages 40-64 years), gain access to breast and cervical cancer screening and diagnostic services.

DES Exposure
Research shows that women exposed to diethylstilbestrol (DES) in utero (DES Daughters) were at increased risk of the development of clear cell adenocarcinoma of the vagina and cervix. CDC's DES Update has been specifically designed to help health care providers learn more about DES exposure and its known health effects to facilitate identifying, managing, and counseling DES-exposed patients.

Gynecologic Cancer Awareness
Help raise awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. When gynecologic cancers are found early, treatment is most effective. Know the central messages of the campaign, and use the fact sheets to increase awareness.

Sun Protection
Exposure to the sun's ultraviolet (UV) rays appears to be the most important environmental factor involved in the development of skin cancer. When used consistently, sun-protective practices can prevent skin cancer. People with certain risk factors are more likely than others to develop skin cancer.
Take Continuing Education Courses

Women's Health Continuing Education for Health Professionals
View a listing of selected CDC continuing education programs related to women’s health and other topics.
Start a Needed Program in Your Community

A Family Lifestyle Approach to Diabetes Prevention (Power to Prevent)
This program is designed to encourage African Americans at increased risk for type 2 diabetes to become more physically active and to eat healthier foods to prevent or delay the disease.

Assuring Healthy Caregivers- A Public Health Approach to Translating Research into Practice: The RE-AIM Framework
Those concerned with caregivers and their family and friends can use this framework in their work on caregiving. It suggests additional resources for those interested in pursuing the use of RE-AIM for caregiver support programs and policies.

Preventing Falls: How to Develop Community-Based Fall Prevention Programs for Older Adults
This “how-to” guide is designed for community-based organizations who are interested in developing their own effective fall prevention programs. This guide is designed to be a practical and useful tool, and it provides guidelines on program planning, development, implementation, and evaluation. See also Preventing Falls: What Works- A CDC Compendium of Effective Community-Based Interventions from around the World.

WISEWOMAN
Well–Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) provides low-income, under- or uninsured 40- to 64-year-old women with the knowledge, skills, and opportunities to improve diet, physical activity, and other lifestyle behaviors to prevent, delay, and control cardiovascular and other chronic diseases. The interventions may vary from program to program, but all are designed to promote lasting, healthy lifestyle changes. See also Wise Interventions.
Use Resources

Women's Health Podcasts
Take one to six minutes to listen to a podcast to learn more about issues impacting women's health and safety, including cancer, reproductive health, sexually transmitted infections, and violence. See also CDC Podcasts.

Women's Health Professional Resources
View a variety of resources for health professionals, including campaigns, continuing education, slidesets, videos, and more.

Assisted Reproductive Technology (ART) Success Rates Report
The goal of this report is to help potential ART users make informed decisions about ART by providing some of the information needed to answer the following questions: What are my chances of having a child by using ART? Where can I go to get this treatment?

Bleeding Disorders in Women
The most common bleeding disorder is von Willebrand disease (VWD). VWD results from a deficiency or defect in the body's ability to make von Willebrand factor, a protein that helps blood clot. Although VWD occurs in men and women equally, women are more likely to notice the symptoms because of heavy or abnormal bleeding during their menstrual periods and after childbirth. Certain women should be tested.

Breastfeeding
Newborn infant Crib Cards can be used by hospitals for recording a newborn’s vital information. It can also help parents be better informed about breastfeeding and help make this important infant feeding decision at the pertinent time.

Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings
This publication includes a comprehensive inventory of assessment tools that will help practitioners identify victims of intimate partner violence and sexual violence victimization in clinical/healthcare settings and make appropriate referrals for additional services.

Prenatal Testing for HIV Infection
The One Test. Two Lives. campaign focuses on ensuring that all women are tested for HIV early in their pregnancy. One Test. Two Lives. provides quick access to a variety of resources for providers and patients to help encourage universal voluntary prenatal testing for HIV.

Sexually Transmitted Disease Treatment Guidelines
Keep up with the latest guidelines on the treatment of sexually transmitted diseases. These guidelines were developed by CDC after consultation with a group of professionals knowledgeable in the field of STDs. The guidelines are updated periodically.

Be a Role Model

Be Physically Active
Participating in moderate-intensity or vigorous-intensity physical activity on a regular basis can lower an individual's risk of developing coronary heart disease, stroke, non-insulin-dependent (type 2) diabetes mellitus, high blood pressure, and colon cancer by 30–50%. Also, active people have lower premature death rates than people who are the least active. CDC recommends a minimum of 30 minutes of moderately intense physical activity most days of the week.

Eat Healthy
Health professionals recognize the benefits associated with a healthful eating plan based on the Dietary Guidelines for Americans, including decreased risk of overweight and obesity; decreased risk of micronutrient deficiencies; and decreased risk of chronic diseases, such as type 2 diabetes, hypertension, and certain cancers.

Be Smoke-Free
People who stop smoking greatly reduce their risk for many chronic diseases and for dying prematurely. Make this the year you quit smoking for good.

Asthma risk from too many nuts in pregnancy

Pregnant women who eat nuts or nut products like peanut butter daily raise the risk their children will develop asthma by 50 percent, Dutch researchers said on Tuesday.

The study also showed that moderate amounts did not seem to have an effect, meaning it is too soon to say whether pregnant women should give up nuts because they contain many important nutrients and healthy fats a developing fetus needs, they said.

"We were the first to find these strong effects on asthma symptoms," said Saskia Willers, an epidemiologist at Utrecht University, who led the study linking nuts with asthma.

But until we are certain we don't want to restrict them from the diet. So it is important that other studies replicate the findings," she said.

Asthma is an inflammatory disease causing wheezing, coughing and labored breathing that can be life threatening. In some countries as many as 30 percent of children develop the condition, according to the World Health Organization.

Scientists do not exactly know why some children develop asthma, although some believe that allergies can trigger the disease that causes a narrowing of the bronchial tubes.

Nuts and seafood are known to contain allergens that cause food allergies but the Dutch team only found a link between peanuts and asthma, Willers said.

In their study, more than 4,000 pregnant women completed a dietary questionnaire that asked whether they consumed vegetables, fresh fruit, fish, eggs, milk, milk products, nuts and nut products rarely, regularly or daily.

The researchers, who published their findings in the American Journal of Respiratory and Critical Care Medicine, then assessed the children's diets and looked to see who had developed asthma over an eight-year period.

Children whose mothers ate as little as one peanut butter sandwich a day had a far higher risk of asthma, Willers said in a telephone interview.

"If you eat moderately, it is probably not a problem," she said. "It is only if you eat nuts or nut products on a daily basis."

The study did not find a mechanism but Willers said peanut allergens may be crossing the placenta and sensitizing a fetus, making a child more prone to the disease.

The researchers also found a small benefit from eating fruit daily, and reported that the link between asthma and nuts remained after factoring for the child's diet, Willers added.

Ladies, give your breasts a rest, research says

Like many women, I’ve felt guilty about my slipshod breast exams for years. Sure, I’ll give the girls a good once-over in the shower now and then, but I’ve never diligently gone through all the motions (circular and otherwise), month in and month out.

So it was with a certain amount of relief that I read a new analysis confirming that the breast self-exam (or BSE) truly doesn’t make much of a difference after all.

According to a review by the Cochrane Collaboration, an international organization that evaluates medical research, there’s no evidence that self-exams actually reduce breast cancer deaths. In fact, the often-recommended monthly chore may even do more harm than good, according to the group’s analysis of a pair of studies of nearly 400,000 Chinese and Russian women.

Data from two large trials do not suggest a beneficial effect of screening by (BSE) but do suggest harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed,” concluded the authors in Tuesday’s issue of The Cochrane Library. “At present, screening by breast self-examination … cannot be recommended.”

One fewer thing to do?
Chris Herget, a 44-year-old notary public from Bellevue, Wash., says while she’s surprised to hear this news, she, too, feels relieved.

“I’ve never really felt competent doing it myself anyway and I have very fibrous breasts so everything feels like a ‘pea,’” she says. “In fact, the first time I told a doctor that I thought I’d found a lump, he was like, ‘That’s nothing, that’s a fat cell.’”

But the news that the BSE is officially on the way out perplexes others.

“I guess it’s one less thing that I need to be doing, but it is a little confusing,” says Liz Lane, a 29-year-old public relations manager from New York City. “Now I’m not sure what I am supposed to do to check myself.”

The issue is complicated, acknowledges Dr. David B. Thomas, breast cancer epidemiologist at Seattle’s Fred Hutchinson Cancer Research Center and professor of epidemiology at the University of Washington.

“It’s important to separate out the public health implications from the implications for an individual woman,” says Thomas, who is also the author of the 2002 landmark study involving more than 250,000 Chinese women that was analyzed and affirmed by this latest review.

“If a woman is highly motivated — let’s say her mother or sister has been diagnosed with breast cancer — then of course she should practice breast self-exam. But that’s a different situation than trying to reach women on a mass scale. Our study shows that that’s probably a waste of time. You’re not going to get women sufficiently motivated to practice it well enough and frequently enough to make that big of a difference.”

Lumps and bumps can be normal
What’s more, Thomas says BSEs can be problematic because the lumps and bumps women do report often turn out to be benign.

“The price you pay for doing more thorough breast exams is you’re going to find more benign lesions and that will result in unnecessary surgical procedures,” he says.

Rhebe Greenwald, a 65-year-old retired art director and systems analyst from Port Townsend, Wash., has experienced this firsthand.

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Vote: Put your breast health in your own hands?

“I’ve never felt breast self-exams were that useful for me,” she says. “I’m extremely lumpy and I’ve had three benign tumors removed that were all found through self-exams. The last time, they removed about a quarter of the tissue in my breast and found nothing.”

But others, like Dianne Pomon, a 59-year-old registered nurse and breast cancer survivor from Pottstown, Pa., swear by the BSE.

“I’ve been diagnosed with breast cancer three times and found the lumps myself every time,” she says. “I would strongly encourage women to check themselves every month.”

What's a woman to do?
What’s a woman to do? It all depends on your age and family history, says Thomas.

“Women in their 20s and 30s rarely get breast cancer,” he says. “But they do have a lot more benign lumps and bumps. It’s not worth emphasizing breast self-exams for women at this age.”

As we get older, though, the benign lumps tend to go away and the breast cancer risk goes up.

When women are in their 40s, it’s a good time for them to become more aware of their breasts and more aware of changes that might be due to breast cancer,” he says. “It’s kind of controversial as to whether it’s worth the screening — either BSEs or mammograms — but they can do both if they want.”

After age 50, though, an annual mammogram is a proven lifesaver, he says, reducing the risk of breast cancer death by about 30 percent to 40 percent. And women who know they’re at high risk for breast cancer may be able to enhance the benefit of mammograms with diligent BSEs between screenings.

As for me, while I'm relieved to scratch breast self-exams from my to-do list for good, I’ve got no problem putting my girls into the hands of true professionals. I’m heading for the local breast health care center for my annual mammogram. It’s time.

Menopause raises risk of metabolic syndrome

As women begin to enter menopause, their risk of developing a collection of heart disease risk factors appears to climb, a study has found.

Researchers found that among 949 U.S. women followed for nearly a decade, the risk of developing metabolic syndrome increased during perimenopause — the years during which a woman’s body begins to transition into menopause, usually starting somewhere in her 40s.

Metabolic syndrome refers to this cluster of risk factors for heart disease, stroke and diabetes — including high blood pressure, abdominal obesity, high blood sugar, low levels of ”good” HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is usually diagnosed when a person has three or more of these traits.

The new findings, published in the Archives of Internal Medicine, appear to be the first showing that the incidence of metabolic syndrome begins to rise during perimenopause.

More specifically, the study found, the risk is related to increases in testosterone activity.

The “main message” here for women is that maintaining a healthy lifestyle may be especially critical during perimenopause, lead researcher Dr. Imke Janssen, of Rush University Medical Center in Chicago, told Reuters Health.

Healthy habits can help
Not smoking, eating a healthy diet and getting regular exercise can all help reduce a woman’s risk of the various components of metabolic syndrome, Janssen said.

She and her colleagues based their findings on an ethnically diverse sample of U.S. women who were between the ages of 42 and 52 and free of metabolic syndrome at the outset. The women were followed for nine years.

Overall, Janssen’s team found, nearly 14 percent developed metabolic syndrome by the time they had their final menstrual period. The risk of developing the syndrome increased progressively starting six years before the final menstrual period.

But while the odds of developing metabolic syndrome were elevated after menopause, the risk was greater during perimenopause, Janssen noted.

It has long been known that women generally have a lower risk of cardiovascular disease than men do before the age of 45. But after age 55, the trend reverses, with women actually being at greater risk than men their age.

“Obviously, something happens there, between 45 and 55,” Janssen said, noting that it was once assumed that diminishing levels of estrogen told the whole story.

Testoserone may play greater role
But in this study, women’s estrogen levels were unrelated to the odds of developing the metabolic syndrome. Instead, the syndrome correlated with an increase in testosterone activity — suggesting that the direct negative effects of testosterone are more important than the loss of estrogen’s positive effects in women’s cardiovascular risks.

This idea, Janssen and her colleagues note, is consistent with clinical trials that have found no cardiovascular benefits from estrogen replacement therapy.

The bottom line for women, according to Janssen, is that during these years of hormonal change, healthy habits become more important than ever.

Urban teens misunderstand ‘morning-after pill

Urban-living minority girls appear to lack general knowledge about emergency contraceptive pills — more commonly known as the "morning-after" pill, new research hints.

Morning-after pills, which are taken after intercourse, consist of hormones that prevent a pregnancy from occurring. Since they can be taken immediately after intercourse (instead of waiting until the "morning after"), some doctors prefer the term "emergency contraception."

The emergency contraceptive pill is a safe and effective means of preventing pregnancy for up to 5 days after unprotected intercourse or when other forms of contraception, such as birth control pills or condoms, have not been effective, Dr. Cynthia J. Mollen of Children's Hospital of Philadelphia in Pennsylvania told Reuters Health.

Yet, "multiple misconceptions" about emergency contraceptive pills exist, Mollen said.

Mollen and colleagues assessed the knowledge of, and attitudes toward, emergency contraceptive pills among 30 English-speaking black girls between 15 and 19 years old who sought emergency department care.

Sixteen of the girls said they were sexually active — 5 with a history of pregnancy — and 14 said they were not sexually active, the investigators report in the medical journal Pediatrics.

In hour-long interviews with each girl, the researchers learned that 94 percent of the sexually active girls had at least heard of the morning-after pill, Mollen said. However, 40 percent of these young women were unable to answer follow-up questions on how the pills work.

Among girls who were not sexually active, 50 percent had never heard of the morning-after pill, and just 4 girls who had heard of this form of contraception knew when to use it or how to obtain it.

Mollen's group found only 7 girls (5 sexually active and 2 not sexually active) who knew of the Food and Drug Administration approval of non-prescription Plan B — a brand name emergency contraception pill for women age 18 and older.

Many of the adolescents said emergency contraceptive pill users should feel embarrassed and thought healthcare providers would likely call users' parents or caregivers. The girls' also expressed concerns about side effects, including those not known to occur with the morning-after pill, Mollen said.By identifying specific barriers to the use of emergency contraception in this population, Mollen notes, "we provide a framework for future interventions aimed at increasing emergency contraception pill use.

More women are having fewer children, if at all

More women in their early 40s are childless, and those who are having children are having fewer than ever before, according to the U.S. Census Bureau.

In the last 30 years, the number of women age 40 to 44 with no children has doubled, from 10 percent to 20 percent. And those who are mothers have an average of 1.9 children each, more than one child fewer than women of the same age in 1976.
The report, Fertility of American Women: 2006, is the first from the Census Bureau to use data from an annual survey of 76 million women, ages 15 to 50, allowing a state-by-state comparison of fertility patterns. About 4.2 million women participating in the survey, which was conducted from January through December 2006, had had a child in the previous year. The statistics could be used by state agencies to provide maternal care services, the report said
The survey found that in 2006 women with graduate or professional degrees recorded the most births of all educational levels. About 36 percent of women who gave birth in the previous 12 months were separated, divorced, widowed or unmarried.

Unemployed women had about twice as many babies as working women, although women in the labor force accounted for the majority — 57 percent — of recent births. Only a quarter of all women who had a child over the past year were living below the poverty level.

Coupled with fertility data collected biannually, the report also revealed longer term trends, including how second-generation Hispanic women are having fewer babies than their foreign-born grandmothers and first-generation American mothers.

Differences among states also emerged. California, Nevada, Texas, Arizona, Florida, Illinois, New York and New Jersey had a greater percentage of foreign-born women who became mothers in 2006. A bigger share of women in the Southeast and Southwest who gave birth in the year prior to the survey did so in poverty.

Surrogate mom, 61, gives birth to own grandkid

A 61-year-old Japanese woman gave birth to her own grandchild, using an egg donated by her daughter, a clinic said Thursday.

Surrogate births are extremely rare in Japan and banned by industry groups, but they are not illegal. The Suwa Maternity Clinic in Nagano, northwest of Tokyo, refused to provide information such as the date of the birth or gender of the baby. News reports said the baby was born last year.

The clinic said it performed the procedure because the woman's daughter has no uterus, but didn't give details on why she had that condition. The surrogate mother used a fertilized egg donated by her daughter.

Both surrogate mother and baby were fine," said Chihiro Netsu, a spokeswoman for the clinic.

Dr. Yahiro Netsu, who runs the clinic, has long defied national opposition to such procedures, arguing that they should be an option for women who are infertile.

Japan's oldest new mother?
In 2001, he performed what is thought to be the country's first successful surrogate birth. In 1998, Netsu was expelled from Japan's gynecology association for performing in-vitro fertilizations with eggs and sperm of donors who were not married to each other, though he was later reinstated.

Mainichi newspaper reported that the previous oldest mothers in Japan were two 60-year-old women implanted with their own fertilized eggs in the United States.

Japan Society of Obstetrics and Gynecology, a powerful body with over 15,000 members, has banned such procedures, but they are not illegal and individual clinics are free to perform them — though few actually do.

At Suwa Maternity Clinic, eight surrogate mothers have given birth. Of them, four women have delivered babies using fertilized eggs from their daughters.

The clinic will report the latest case at a conference of the Japan Society of Fertilization and Implantation later this month. It was the first time the fertilization conference had taken up the subject of surrogate births, Netsu said.

Yoga soothes worst symptoms of menopause

Yoga can reduce hot flashes and night sweats among women going through menopause, and also appears to sharpen their mental function, researchers from India report.

To investigate whether yoga would help women with physical and cognitive symptoms of menopause, they randomly assigned 120 menopausal women, 40 to 55 years old, to yoga practice or simple stretching and strengthening exercises five days a week for eight weeks.

The postures, breathing and meditation included in the yoga intervention were "aimed at one common effect, i.e. 'to develop mastery over modifications of the mind' ... through 'slowing down the rate of flow of thoughts in the mind,"' the researchers explain.

Women in the yoga group also listened to lectures on using yoga to manage stress and other yoga-related topics, while those in the control group heard lectures on diet, exercise, the physiology of menopause, and stress.

Fewer hot flashes, better concentration
After eight weeks, women in the yoga group showed a significant reduction in hot flashes, night sweats, and sleep disturbances, while the women in the control group did not, Dr. R. Chattha, of the Swami Vivekananda Yoga Anusandhana Samsthana in Bangalore, India, and colleagues found.

Both groups showed improvements in a test of attention and concentration, although improvement in the yoga group was significantly greater. In a test of memory and intelligence with 10 components, the yoga group improved on eight, while the control group improved on six. Improvements were significantly greater in the yoga group than in the control group on seven of the subtests.

"The present study shows the superiority of yoga over physical activity in improving the cognitive functions that could be attributed to emphasis on correctness in breathing, synchronizing breathing with body movements, relaxation and mindful rest," the researchers suggest.