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Archive for May, 2010


Posted by avnerhershlag on May 4, 2010

Is menstruating once a month good for you?

Pincus, who developed the first contraceptive pill, wrote in 1958: ‘a cycle of any desired length could presumably be produced.”

However, the belief that having a period every month is normal.

What’s good about having a period?

  • Hippocrates wrote: “menstruation was designed to cleanse women of bad humors.”
  • Many cultures believe that a woman is impure during the period and even several days afterwords.
  • Orthodox Jewish religion prohibits sex and other physical contact for 7 days post menses,.  Sex can only be resumed after the woman purifies herself in a water bath, the “Mikveh.”
  • Menstruating women in Islam are exempt from prayers, fasting and pilgrimage to Mecca.  They are not allowed to have sex, but may have other contact with their husband.
  • When a woman gets her scheduled period, she knows that she is not pregnant.  A relief for some.  For others, a period signifies fertility, and that soon, in a couple of weeks, she will ovulate and have another chance to get pregnant.
  • So the traditional pill was designed in keeping with the natural schedule; 21 days of active pills and 7 days of placebo will give you, by design, regular ‘period” every 28 days.

In recent years, new contraceptives have become available that reduce the number of bleeding episodes annually.

How do women view these new options?

Benagiano et al (Patient Prefer Adherence.,2009) reviewed so the attitudes towards the new pills:


  • Black women conservative – prefer monthly period.
  • 2/3 of  white women don’t like monthly bleeds and would prefer bleeding-free intervals ranging from 90 days to no periods at all.
  • 40% of these women – ready to consider using a hormonal contraceptive that stops menstruation altogether. (Kaunitz, Contraception. 2000)


  • How many women would like to have no periods?
  • Netherlands: 25%
  • France: 57%
  • Italy: 29%
  • Germany – 37-46%
  • Spain: 5% only, but 50% of women < 25 years old.

Continuous birth control pills are safe.  In a multicenter European study (Teichmann et al, Contraception 2009), continuous pills (90 mcg levonorgerstrel/20 mcg ethinyl estradiol) resulted in 535 amenorrhea after a year and 79% no bleeding (with or without spotting) After 1 year.

Return to fertility following discontinuation of oral contraceptives

A recent survey (Barnhardt & Schreiber, Fert Steril 2009 Mar 91:659-63), reported that the return of fertility in former OC users (both cyclical and extended/continuous regimens) in women who stop to conceive is comparable to that observed with other contraceptive methods.

The reported 12-months conception rates were;

  • Cyclic OC – 72-94%
  • IUD – 70-95%
  • Condoms – 91%
  • Natural family planning – 92%


Over the years, Oral Contraceptives (OCs) has been blamed for practically everything, from heart attack and stroke to cancer.

However, the WHI – the Women’s health Initiative, found that OCs do not increase the risk of breast cancer, thus diffusing a major fear from previous studies.

The WHI also reported a LOWER risk of heart attacks and strokes.

This in addition to well known benefits:

If you take OC’s over 4 years, the risk of Ovarian Cancer drops by 42% and of uterine cancer by 31%.


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Posted by avnerhershlag on May 2, 2010


How many women with breast cancer would like to have a baby?

In 2009, 192,370 women were be diagnosed with breast cancer.

It is estimated that about 15% are in the reproductive age.

I was just diagnosed with breast cancer.  And I’ve never had a child.  Will I be fertile when I’m done with my treatment?

About 15% of women diagnosed with breast cancer (192,370 new cases in the US in 2009) are in the reproductive age.

When the diagnosis is made, women not only have to worry about their cancer.  They also worry about losing their fertility as a result of chemotherapy.

Good News: A recent study from Egypt by Badawy et al (Fert Ster 2009) reported that the GnRHa (a drug to suppress ovarian function) during chemotherapy helps the return of menstruation and ovulation.

89.6% resumed menses and 69.2% resumed spontaneous ovulation within 3-8 months of termination of the GnRHa/chemotherapy co-treatment.

How can I improve my chances of having children in the future?

  • You should see a fertility doctor as soon as possible.
  • When you call the office, ask if the center has a Fertility Preservation Program for Cancer patients.
  • The doctor will evaluate you and discuss your options.

What options do I have, doctor?

  • There is a “window of opportunity” of about 6 weeks between surgery and chemotherapy.
  • During that time you can be given fertility drugs for an average of 10 days.
  • Following this treatment, eggs can be harvested from your ovaries.
  • This is a short procedure, less than half an hour, done under anesthesia.
  • If you have a partner, your eggs will be fertilized with his sperm to create embryos.
  • All embryos will be frozen.
  • If you don’t have a partner yet, your eggs will be frozen.
  • Less frequently, a piece of an ovary may be frozen.

How long will I have to wait to have children?

  • It is currently recommended to wait 2 years.
  • However, the doctors taking care of your breast cancer have to clear you based on your specific situation.

What treatment will I have once I’m allowed to conceive?

  • Your fertility potential will be evaluated (physical exam, ultrasound of your ovaries and blood tests).
  • If the tests show that your ovaries are producing eggs, you may want to try to conceive on your own.
  • If your ovaries are functioning but you’re worried that time is running out, you can get treatment to enhance your chances 9fertility drugs and inseminations or IVF).
  • If your ovaries don’t produce eggs and you have frozen embryos, they can be thawed out and transferred to your uterus.
  • If you have frozen eggs and now have a partner, your eggs can be thawed out, injected with your partner’s sperm and the embryos thus created transferred into your uterus.

What if I have frozen eggs and l haven’t yet met “Mr. Right?”

  • Then you have 2 options:
  • One option is to wait until you have a partner.  Your eggs will continue to be frozen until you have a partner.
  • Or, if you don’t want to wait, you may choose to use donor sperm.  In that case, your eggs will be thawed out, injected with the donor’s sperm and the embryos transferred into your uterus.

What do I do if I never had eggs or embryos frozen before I started chemo?

In that case you can use eggs from a donor of your choice.  We can create embryos for you (with your partner’s sperm or if no partner – with donor sperm).  Pregnancy rates from donor eggs are very high.

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