We have all heard about Plan B . The  Plan B One-step consists of  one pill containing 1.5 mg (in case you want to know the dose) of a synthetic progestin , levonorgestrel . This is a progestin that is found in lower doses in many birth control pills. Id taken within 72 hours of unprotected intercourse it prevents or deregulates ovulation nd fertilisation and hence prevents pregnancy by up to 89%. If it is taken within 24 hours it is 95% effectiv. We also know about the controversy that has become a political issue reguardng those younger than 17. Currently girls under the age of 17 have to get a doctor’s prescription to obtain emergency contraception. (Many young women cannot get to a physician within the first few days of unprotected intercourse , and are too embarrassed to even attempt to do so….So should they be punished for their youth? The mistake was already made! Moreover multiple studies have shown that access to or knowledge of emergency contraception does not increase sexual activity in teens and young adults. I guess you know how I feel. And I won’t even begin to voice my protests about the issue of payment for contraception…. of course it should be covered by all health plans.)

There is another emergency contraceptive, which has been approved by the FDA as of June 2010. It’s called ellaOne. The generic name is Ulipristal; it is a selective progesterone-receptor modulator. Essentially it sits on the receptors of progesterone and blocks the action of the hormone. It is available as a 30mg pill that is taken once and can decrease pregnancy by two-thrds if taken with 72 hours and 50% for up to 120 hours  (5 days) after unprotected intercourse. It works by delaying the release of an egg thus preventing ovulation. It is currently available by prescription.

The very same medication, but in smaller doses, has now been shown to be effective for treating fibroids, at least prior to surgery.

This was the conclusion of a recent article published in The New England Medical Journal, titled (sorry I know this may not be necessary but it keeps my author credentials valid) “Ulipristal Acetate versus Placebo for Fibroid Treatment before Surgery”. The investigators from several centers in Belgium, Hungary, the Ukraine and the United Kingdom randomly assigned 242 women who had symptomatic fibroids that caused excessive bleeding to either 5 mg of ulipristol, 10 mg of the medication or placebo daily for 13 weeks before they underwent surgery. They found that even the smaller dose of ulipristol controlled bleeding in 91% of the women (whereas only 19% had less bleeding on placebo) and that up to 82% on the higher dose stopped having periods altogether (amenorrhea) compared to 6% on placebo.They also found that the volume of the fibroids decreased up to 21% in the women treated with daily ulipristol, whereas the volume increased during those 13 weeks by at least 3% in the women given placebo.

The authors did point out that the treatment was given for only 13 weeks and before planned surgery. But treatment with ulipristol may become one of the nonsurgical options that are available for women who have symptomatic fibroids. I’ll end this promising statement with the usual “more long-term studies are needed.”

In the past, I wrote that recommendations had been made that boys COULD receive the HPV vaccine. The could has been changed to should… the Committee on Immunization Practices (ACIP) just came out with the recommendation for routine use of the HPV vaccine in young boys aged 11 or 12 years of age. It also recommends vaccination for males aged 13 though 21 years who have not been vaccinated previously or who have not completed the 3 dose series of the Gardesil vaccine. Additionally they went on to state that males aged 22 through 26 years may be vaccinated.

This is not simply a case of “prevent it in men and get protection for women”. HPV- associated cancers in males include many anal, penile, mouth and throat cancers caused primarily by HPV 16 and HPV 18. An estimated 22,000 HPV 16 and 18 associated cancers occur annually in the United States and this includes 7,000 cancers in men. The Gardesil vaccine gives immunity to 4 types of HPV: 6, 11, 16 and 18. In addition to cancer these bad and very infectious HPV’s cause genital warts.

A recent article from the Centers for Disease Control and Prevention in JAMA reports on the efficacy of the Gardesil vaccine in males. In a study of 4,055 males between the ages of 16 and 26, those who were seronegative (which means they were never infected and had no antibodies to the viruses) and who received all three vaccine doses had a 90% protection rate from HPV caused warts. Those who had one just one dose acquired a 68.1% protection rate; those who received no vaccine had no protection.

The vaccine is not a live virus and can be given to everyone, including those who are immunocompromised. (The vaccine is especially important to men who have sex with men or those who are HIV positive since they are most at risk for an HPV infection that is difficult to treat.)

Because Gardesil is prophylactic (prevents infection) and won’t lessen or cure an existing infection, it is best given before any exposure to the HPV virus through sexual contact. Hence the recommendation that it be given at ages 11 and 12. (At which tender age we hope that boys have not yet been sexually active!)

Yes, women are more prone to suffer from HPV associated cancers (approximately 15,000 a year) and “only” 7,000 for men get cancer from these HPV’s. But that number was apparently sufficient to convince the CDC to recommend immunization for all boys (Oh boy!). And since most of the HPV infections that women get are due men, we should welcome this recommendation wholeheartedly.

I think we might consider this a belated valentine day’s gift that makes loving safer.

The FDA and the FTC (The Federal Trade Commission) recently weighed in and proclaimed that, once more, there is no easy “take a pill, a shot or drops under the tongue” way to lose those extra pounds. The two agencies sent out threatening letters warning the makers of so-called homeopathic weight-loss products containing human chorionic gonadotropin (HCG) to cease and desist. They have been told that they are illegally marketing unapproved products and are making unsubstantiated claims by saying these products promote weight loss. If you look at the HCG diet centers’ advertisements, they basically beckon with a “come-on, you can lose that weight, just use our product and go on an extremely low-calorie diet” (usually 500 calories a day). The latter part of this beguiling assertion is often ignored in their marketing scheme as they proclaim the wonders of HCG. According to the Health Agencies Update published in JAMA ,the FDA challenges the claim that HCG has any impact on weight loss. They released a statement that there is little evidence to suggest that HCG, which is made by the placenta and found in the urine of pregnant women, would increase weight loss beyond the weight that would be shed by consuming a very low-calorie diet alone.

Now a word about that very low-calorie diet: Limiting caloric intake to 500 calories starves the body and is basically unsustainable. There is no way that those 500 calories allow for the appropriate balance of carbohydrates, protein and fat. Yes, it will cause fat loss but starvation also causes muscle loss. Muscle is what your body relies on to burn your calories. So once you have lost muscle mass and you return to even a slightly higher caloric intake, you won’t burn those calories… and your weight woes return as they  get stored as fat. Not only will you put on weight when you finally do eat (somewhat normally), you put it on as fat…and the vicious weight cycle continues. This is more than yo-yoing; this is artificial, harmful plumping. (I am trying not to think of those ads about chicken.)

The recommendation for weight loss by nutritionists, physicians and reputable diet centers is to do it slowly with a sustainable diet. That usually means 1200 to1500 calories a day. The majority of studies suggest that it does not make a major difference as to whether the diet is protein, fat or carbohydrate based… what counts are the calories. I’m watching the Super-bowl as I write this…. based on the ads and the promos for half time snacks, the goal of 1500 calories will not be reached by most of us today; but there is always tomorrow.

I will be unable to write my usual article this week due to the death of my Mom who had suffered over the last few years with dementia.

I will be back next week with a new article.

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