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Interviewer: We all know that a stroke is a serious and potentially life-threatening situation, but it might surprise you that it impacts women more than men. According to the CDC, stroke is the fifth leading cause of death for women in the U.S., and as many as one in five women between the ages of 55 and 75 will have a stroke.

To help us better understand why women face an increased risk of stroke, were joined by Dr. Jana Wold, an associate professor of neurology and a stroke specialist at University of Utah Health.

Dr. Wold, let's start out with why are women at more risk of stroke than men?

Dr. Wold: So the best way to understand it is because women live longer than men and because stroke risk increases with age. So because we have a larger proportion of the population in this older age group, the greater-than-85-years-old age group that are women, and also that's when your stroke risk really ramps up, overall more women have strokes than men.

Interviewer: So I'm hearing that more older women might have strokes than men. What about younger women?

Dr. Wold: Unfortunately, there is a risk of stroke in pregnancy. So, at a younger age, there also is a brief period of time when women are of childbearing age that their stroke risk could be higher than some men.

Interviewer: Yeah. And that is very unique, childbearing, to women obviously. What are some other risk factors that are very unique to women versus men?

Dr. Wold: Yeah. So women take oral contraceptives. Not all women, but some women do. And those medications, unfortunately, do carry a small risk of stroke. So in the wide scheme of things, it's a very small risk.

And women who take oral contraceptives tend to be women younger than the age of 50, so their overall risk of stroke is low, but if you are taking oral contraceptives, that can double your stroke risk. And if you are smoking while you are taking your oral contraceptives, that can dramatically increase your stroke risk.

Also, in speaking of oral contraceptives, oral contraceptives should not be given to women who have migraine with aura because that also increases your stroke risk, because migraine with aura independently increases your stroke risk.

Hormone replacement therapy. So if you are taking hormone replacement therapy for a long period of time, this also can increase your risk of stroke. There was a time many years ago when we thought maybe taking hormone replacement could actually decrease your risk of stroke, and that is not true.

The other important thing that I haven't mentioned yet — atrial fibrillation. So atrial fibrillation carries a high risk of stroke. It is uncommon in the younger population, but as you age, your risk for atrial fibrillation increases. And it's actually riskier for women to have atrial fibrillation than it is for men when you consider their stroke risk. So atrial fibrillation, you can be screened for this in your doctor's office when you are above the age of 75.

Interviewer: So if a woman's listening and she recognized some of these increased risk factors, does that mean that perhaps hormone therapy is not a great idea, birth control is not a great idea? How can a woman weigh the risk versus the benefits of those things?

Dr. Wold: Yes, absolutely. So this is where your primary care doctor comes into play. Everyone should have a primary care doctor whether or not you're a woman or a man, and you need to discuss this with your primary care doctor.

So, for example, if you are a young woman and you're considering going on oral contraceptives, you need to make sure that your physician is aware if you suffer from migraine with aura or if you are a current smoker or if you have high blood pressure. So you need to be in good communication with your primary care physician to make sure that they are also considering your overall risk of stroke.

When it comes to hormone replacement therapy, again, I would have a conversation with your primary care physician or whichever physician would be prescribing this treatment for you. And you would just need to understand the risks and the benefits, because it's going to be different for different women.

Interviewer: And I understand that women sometimes don't experience the standard stroke symptoms. What are those standard symptoms?

Dr. Wold: Yeah. So the standard stroke symptoms, the way we like to remember them is an acronym known as FAST. This stands for face, arm, speech, time.

Face is for that facial asymmetry that you were speaking of before. So if your face is droopy on one side, that can be a symptom of stroke.

Also, if you have one arm that is weak, that can be a symptom of stroke.

And then if you have a change in your speech, that can be a symptom of stroke as well.

The T is for time, because if you notice any of those symptoms, you need to immediately call 911 and go to the emergency room to be evaluated.

Interviewer: And those standard symptoms, those aren't necessarily always the way women experience stroke symptoms. Can you expand on that?

Dr. Wold: Not necessarily. There are some studies showing that women are more likely to have atypical symptoms of stroke, but it's not clearly defined what those would be. So, overall, I would say when you experience any sort of acute change in your vision or your speech or your strength or your walking, that's when you need to consider stroke.

Interviewer: And are there other risk factors that women would want to keep in mind?

Dr. Wold: I would just consider changes in those areas. And a lot of women, also men, like to call their neighbor, call their son, call their daughter. I would encourage you to call 911 when you notice those symptoms.

Interviewer: Right. Because the tricky thing about stroke is it can kind of trick you, can't it?

Dr. Wold: It can. And the medications that we can provide in the emergency room, there's one medication and it's time sensitive, so you need to get to the emergency room very quickly.

Interviewer: Dr. Wold, in your experience, what are some of the misconceptions that you find that people have when it comes to women and stroke?

Dr. Wold: I think a misconception can be that there's nothing that you can do about your risk for stroke, and because the risk of stroke increases as you age, that it sort of is just inevitable, and that once you have a stroke, then you need to try to prevent the second one. But we as stroke physicians would certainly like people to be interested in preventing that first stroke, which you certainly can do.

Interviewer: If there's a woman listening and she might be worried now about her risk of stroke, what takeaway message would you give to them?

Dr. Wold: The takeaway message would be to know what your independent risk is for stroke, and so to consider if you have high blood pressure. If you have high blood pressure, you need to be under the care of a physician. You need to have it properly treated. And if you are a smoker, you should consider stopping smoking.

The other thing that you can do as far as lifestyle measures are concerned is to exercise regularly, and we mean cardiovascular exercise, and also keep a healthy diet that is high in fruits and vegetables.

So you just had your Pap smear or your mammogram and it wasn't that bad was it? Or your colonoscopy. Okay, it really was that bad, but you didn't remember it. Are you wondering when you can stop doing these tests?

I asked a woman I know, who is in the health and fitness business, when she thought she could stop doing her cancer screening, you know, Paps, mammos, colonoscopy. She said, "Never," with a smile. She never wanted to stop her cancer screening, "It isn't all that bad, and it makes me feel safe," she said. I replied that cancer screening decisions about when and how often is a cost, risk, benefit analysis, and there are some data to inform that decision. She said, "You go with your brain, I go with my heart."

Well, let's go with the brain for a little while, okay? Let's start with Pap smears. The recommendations about Pap smears have been changing as we know more about what mostly causes cervical cancer -- the HPV virus -- and how fast it grows, usually not too fast. Cervical cancer does not increase with age for a lot of reasons. Sexual activity and the number of partners doesn't increase with age. Well, usually. And the cervix in postmenopausal women may not be as receptive to the virus. So there are good reasons to say that when you get to 65, if you've had normal Pap smears for the past 10 years, that means you actually have been having Pap smears in the past 10 years, and you haven't had an abnormal Pap in 20 years, you can stop testing. There's some pretty solid numbers to back this up, and the U.S. Preventive Services Task Force makes that recommendation.

Okay. How about colonoscopy? Well, colon cancer does not decrease with age. But if you don't have any family history of colon cancer and if your previous colonoscopies, that assumes that you've had some, have not shown any polyps or precancerous lesions, you can stop at 75. That's the recommendation of the U.S. Preventive Services Task Force and the American College of Physicians.

Lastly, mammography. Breast cancer does not decrease with age. It increases with age. The aggressiveness of breast cancer is less in older women than it is in younger women. But women still will get treated, which can be aggressive in and of itself. The U.S. Preventive Services Task Force said there's not enough evidence to recommend for or against mammograms at age 75 and older. But about a quarter of deaths from breast cancer each year are attributed to a diagnosis made in women after the age of 74. Women as they get older are less likely to get mammograms. About three-quarters of women 50 to 74 have had a mammogram in the past two years, but only 40% of women over 85. Of course, many women over 85 are in poor health, and mammography is just not on the list of things to do. And clinicians are less likely to recommend mammography if a woman is in poor health. The American Cancer Society suggests women should continue mammograms as long as their overall health is good and they have a life expectancy of at least 10 more years.

Well, how long am I going to live? I went online and Googled, "How long will I live?" There are lots of calculators because insurance companies and pension plans really want to know. Well, I tried a life expectancy calculator that was developed by the University of Pennsylvania and has been mentioned in the mainstream media. It asks sex not gender, age, height, weight, alcohol, smoking, diabetes, marriage status, whether I exercised, ate my veggies. I didn't fudge my weight or height. This calculator said I was going to live till 93 and I had a 75% chance of living to 85.

Another life expectancy calculator from confused.com asked me just a few questions, not my height or weight,or smoking, or alcohol, or diabetes. It did ask my relationship status, and options included happy relationship and married, but these were mutually exclusive. You could only pick one. Well, this one had my life expectancy of 97. And the calculator from Northwest Mutual, a well-respected life insurance company, cranked me out at 98.

Well, I really don't want to hang around the planet all that long. But I really hope that my savings will take me up there, and I'm going to have to have mammograms for a while yet.

Thanks for joining us for the "Seven Domains of Women's Health" on The Scope.

In medicine, we were taught that women were protected against heart attacks until they went through menopause, and then our risks caught up with men's risks. But what if we weren't really protected that well?

For many years, our research into the heart attacks has been focused on men. Even on TV and the movies, something awful happens, and a man clutches his chest and keels over. And we find if it's a police or a medical show, that he died of a heart attack. Most of us could have figured that out before the forensic pathologist told us on the TV show because we know what men's heart attacks look like.

In fact, we understood men's heart attacks and the causes, high blood pressure, smoking, eating red meat and fatty foods, and high cholesterol. Doctors really got on men's cases, and since 1960, men have decreased their smoking. And if their cholesterol or blood pressure is high, and their wives drag them into the doctor, the men were on blood pressure medications and cholesterol-lowering drugs. And meat and fatty foods, they're still Super Bowl yummies and fast food, and they're doing better.

Men's rates of heart attacks dropped dramatically. And then we noticed that postmenopausal women caught up with men in the rates of heart attacks at about 60. So we sort of got on it and started a national campaign, like the red dress for heart health, to help women understand their risks and the signs of heart attacks. But we were still thinking about women over 50, at least OB/GYNs were. And now comes a troubling study that shows that the rate of heart attacks in young people, people under 50 are increasing and are increasing more for women. This is worrisome. And it's important to look at the communities where this work was done and see what we can learn.

From 1995 to 2014, the ARIC, A-R-I-C, Community Surveillance Study gathered information on almost 29,000 heart attacks. ARIC stands for Atherosclerosis Risk in Communities. And atherosclerosis is the clogging up of the arteries in the heart that can lead to heart attacks.

The communities that were involved in this study were in four geographic areas in the U.S. -- counties in North Carolina, Maryland, Mississippi, and suburbs of Minneapolis. Some of these counties have Americans at risk for heart attacks based on increased rates of diabetes, smoking, hypertension, obesity, and poverty in African American race. Of those 29,000 heart attacks, over the 20 years, one-third in what they called young people, people 35 to 54. Over those 20 years, the annual rate of young men's heart attacks went down some. But women's rates went up to the point that young women, pre-menopausal women had the same rate of heart attacks as young men. These data are alarming, and they mirror similar data from Canada, suggesting that the incidence of heart attacks in young women is rising.

Well, what are some of the risk factors for these young women? Smoking, high blood pressure, and diabetes very substantially increase the risk in women. And black women had very significantly more heart attacks than white women. Seventy-five percent of the young women with heart attacks had high blood pressure, 36 percent had diabetes. And women who had heart attacks were more likely to have multiple risk factors than men.

Young women who had heart attacks were less likely than young men who had heart attacks to have their cholesterol treated or their blood pressure treated. Young men and young women who had heart attacks had a 10% chance of dying the following year. Young women have some extra risk factors for heart attacks compared to men. They're more likely to have demonstrated risk for diabetes by being diabetic in pregnancy. They're more likely to demonstrate risk of hypertension and vascular disease by having preeclampsia when they were pregnant. And they are more likely to suffer the psychosocial stressors of poverty than men.

This information hurts my heart. These young women were mothers of young children and teens. They were at the most productive times of their lives, and they were also at the most stressful times of their lives. So what do we do with this information as women and as physicians? The risk factors in this study are ones that we all know about, risk for heart health, such as smoking, diabetes, and hypertension. But diabetes and hypertension often don't have physical symptoms.

Unless women are getting regular checkups, getting their blood pressure measured, their cholesterol measured, and their blood sugar checked, they may not know. Women used to go to their OB/GYN or their family doctor, get a Pap smear every year, but now they don't. Many women who used to go regularly for their checkups when they were having babies, don't go anymore. All clinic visits, for one reason or another, will have a blood pressure check, but cholesterol or diabetes checks aren't done so often in young women.

Of course, the big risk of smoking cigarettes in an unbelievable 48 percent of the young women who had heart attacks were cigarette smokers, would be addressed by the clinician, if women admitted to it. See our podcast on lying to your doctor.

So all women and men need access to health care. All the women and men need regular checkups at this very busy time of their lives, 35 to 54. All women and men need to have their blood pressure, high sugar, and high cholesterol managed according to national guidelines. And women need to take their medication.

How we manage the stressors of poverty, the stresses of being a minority are issues that we all need to address as a community and as a state and as a national level. So, ladies, please take care of your heart. And thanks for joining us on "The Seven Domains of Women's Health" on The Scope.

updated: September 5, 2019

originally published: February 7, 2014

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Four in 10 women are obese, and over 2 in 10 are overweight. That adds up to 6 in 10 women who are overweight or obese. And many of these women would like to lose some weight. And many of those women have medical problems, such as diabetes, or pre-diabetes, or high blood pressure that would be improved or resolved with weight loss.

Okay, diet and exercise can help with weight loss, and exercise alone doesn't really lead to much weight loss. So the focus of interventions for weight loss is diet. There've been medications approved to decrease appetite. These medications change brain chemistry to decrease interest in eating, but these medications have side effects and some of them are very significant, and the FDA has been very careful about approving new weight loss medications.

Many women who take these medications gain their weight back when they stop them. The alternative is weight loss surgeries that decrease the room in your stomach or decrease the absorption of food in your intestines. This approach has been the most successful for sustained weight loss, but it's expensive and with all surgeries it can be risky.

So what if you feel full before you ate, sort of like weight loss surgery without the surgery? The FDA just unanimously approved a new device for weight loss. The device is a pill with a special compound called Gelesis 100 that absorbs water. If you take these pills 20 to 30 minutes before you eat and drink half a liter of water, which is about two eight-ounce glasses, the compound, which is cellulose, swells up and fills up your stomach so that you aren't too hungry and you can't eat so much. The compound is like those over-the-counter bulk laxatives, a cellulose compound.

Now how well did it work? The GLOW study, that's the name of the study with Gelesis as the G, published in the "Journal of Obesity," was conducted in the U.S. and was sponsored by the manufacturer. About 400 men and women took the active pills or placebo with two eight-ounce glasses of water 20 to 30 minutes before lunch or dinner for six months. The average weight loss for those who took the active pills was about 6% of their body weight, and those who took the placebo pills was the average about 4% of their body weight.

So in a 200 pound person . . . Now of this is for people who are math averse, so I'm doing the numbers for you. The average weight loss was 12 pounds over 6 months in the active group and 8 pounds in the placebo. Now looking more carefully at these results, it appears early on that you could predict who is going to lose weight with the pills and who wasn't. Of course, eating patterns are different person to person. If you get lots of your calories in snacking between meals, and that's such an American thing, taking these pills before meals won't make a difference, because you will have already snacked up your calories in there too late. If you're someone who doesn't really pay attention to how full you are before you eat that second serving of pizza or that dessert, that won't make a difference.

But for those who were losing weight on the active pills in the first several weeks, they were very likely to lose over 10% of their body weight in 6 months, about 20 pounds for a 200 pound person, and that's significant.

And among the participants with pre-diabetes or lifestyle treated type two diabetes, people taking the active pills were 6 times more likely to lose 10% of their baseline weight by the end of the study. And people who are pre-diabetic, or had diabetes that was treated with diet, were more likely to have a significant drop in their fasting glucose and insulin. So these pills helped people with diabetes or pre-diabetes get better control over their sugars.

Now unfortunately, the study didn't differentiate between men and women, and that's outrageous. There's the . . . I got the numbers. They should have done that. Women probably eat differently than men, have different eating and fullness cues, and we're going to need to find out more about that.

Now, one quarter of the participants dropped out in both the active pill group and the placebo group. Now that may be related to how hard it is to eat moderately, one, on a schedule, two, exercise 30 minutes a day, and three, drink water and take pills. All were required of the study, and, of course, there were side effects that were bloating, that only women use and I've never heard a man use, was more common in the active pill than in the placebo. Of course, they didn't call it bloating. They called it fullness or distension. It was noted 11% of the time in active pills and 6% in the placebo group. There you go, take nothing and you get bloated. I don't figure that one out.

Now, tummy side effects were common, 43% in the active pill group and 34% in the placebo, but that's how the pills work. The cellulose, which expands to fill up the stomach breaks down as it passes through the intestines and the large bowel, and it's excreted with bowel movements and so you have more bowel movements.

The product which will be called Plentity, that's kind of a cool name, is termed a device because cellulose is a commonly available chemical in food and in laxatives, but the way it's delivered in these pills makes it unique. It will be marketed in the fall of 2019 and available probably in early 2020.

So how does this help the overweight or obese woman who wants to lose weight? Well, firstly, you have to know your pattern of eating and whether you can change it to eating most of your foods at lunch and dinner and not snacking or drinking those mocha frappuccinos. Keep a log of what you eat and when you eat it so you can figure this out. If you don't want to wait until this new weight loss device is available, you can drink two large glasses of water before lunch or dinner.

In the GLOW study, those drinking water and the placebo also lost weight and water's free. Or you can do what some dietitians have suggested, and that is to eat a large bowl of low-calorie vegetable soup before your regular lunch or dinner. This soup thing is common all over the world and particularly in Asian cultures. This has also been shown to facilitate weight loss in American women.

Or you can buy a bulk laxative like psyllium. Take two doses with two large glasses of water before lunch and dinner. This is much like the strategy of this new weight loss device. It's also been shown to facilitate weight loss. Taking this much new soluble fiber in your diet all at once may have the same side effects as this new device, fullness, and that's the goal, nausea, bloating, more frequent bowel movements, that's also the goal of bulk laxatives, and possibly diarrhea.

We'll be watching to see how this new weight loss product works in American eaters and adolescents as it's introduced into the U.S. In the meantime, eat more fiber, drink your water, and thanks for joining us on The Scope.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Jones: I'm celebrating five years of "The Seven Domains of Women's Health" on The Scope. This is Dr Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and these are my five favorite episodes on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: After 5 years and 260 short pieces, it's time for a little retrospective. "The Seven Domains of Women's Health" covers all parts of women's lives -- physical, emotional, social, intellectual, environmental, financial, and spiritual. And of course, men's health affects women's health, so we've covered many topics that fall in these domains and some more than once.

Some podcasts have been in response to some medical science that was just released. Some have been interviews with experts and specialists. Some have been just a minute long, and some have been just for fun. So here are my top five. Of course, I have 260 favorites, so picking 5 was a little hard. So I picked my favorites in the different categories of presentations.

Number one. What Does it Mean to be a Healthy Woman? This is my favorite because it welcomes the listener to think about what it means to be healthy and what are the domains of health. And it directs the listener to the wonderful website for the Center of Excellence in Women's Health. So every woman who listens and guys could do it too, I guess, could take a questionnaire about each of the seven domains of health and see where they might improve. It also leads the listener to a larger view of health and resilience as part of living a full and healthy life.

Number two. What is the Normal Birth? This was my favorite interview. This interview was with Celeste Thomas, a midwife at the University of Utah and the Clinical Director of BirthCare HealthCare at the University of Utah. This is a favorite because it had the tension of an OB GYN, me, talking to a midwife, but there was no real tension because Celeste gave a great overview of the science and hormones involved in physiologic birth, and she had the warmest, calm voice. I just felt my tension around the issue of normal birth go away. You should all listen to it again. I did.

Number three. No, Sleeping on Your Back Does Not Necessarily Cause Stillbirth. The Scope has tried to give timely information that you can use in response to what might be the next scariest thing or the next cool thing that you see on the news media. This was a Scope Radio interview in response to a very recent publication which suggested that how women sleep when they're pregnant may increase the risk of stillbirth. This is a very scary publication, and the Department of Obstetrics and Gynecology jumped right in to help women understand this issue a little better by sending us three experts, three perinatologists to interview on this topic.

Number four. How Men's Sperm Affects Pregnancy. Well, this is a topic that allowed us to talk about how men's health can affect women's health and, in this case, pregnancy. We've often picked topics about men's health, how they snore, and other important topics for women. This one also introduced the topic of epigenetics or how behaviors or exposures change how genes work. Epigenetics is a very new look at genetics and inheritance, so it's time to talk about it, and as a reproductive endocrinologist, it's fun to talk about sperm and our listeners thought so too, as this was the seventh most clicked in the seven domains with 70,224 visits as of a week ago.

Number five. Don't Sabotage Your Valentine's Day. This one fell in the category of just for fun, but in fact it includes sociologic research about inflated expectations around romance, and it had some practical suggestions for not getting disappointed.

Whatever my favorites were, they all depended on you, dear listener, to be there. We hope that among the 260 topics in the past 5 years that there were some that were informative, reassuring, timely, and just fun for you too and thanks for joining us on The Scope.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at the scoperadio.com.

Dr. Jones: New news and old news about the risk of breast cancer and hormonal birth control. Get ready for some really very big and very small numbers. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Health and this is The Scope.

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Today we're going to talk about hormonal birth control and the risk of breast cancer. Primarily, we'll talk about birth control pills, but we'll also talk about hormonal patches, shots, implants, and IUDs. There are now 50 years of data on the topic of hormonal birth control pills and the risk of breast cancer. Largely, the studies have suggested that there's no significant increased risk of breast cancer in birth control pill users except maybe in women who used pills starting early in their teens, used them for a long time, and use them into their 40s. Recently, a study from Denmark looked at 1.8 million women between the ages of 15 to 49 who had used hormonal contraception between 1995 and 2012. They were using contraceptive methods that are commonly prescribed today. Because Denmark has a health system that can follow everyone and link diagnosis with prescriptions and health outcomes, they can really do big studies.

So what did they find? First, the extra risk of breast cancer in women of this age group who took hormonal birth control of any type during this time period was 13 extra breast cancers per 100,000 women per year. That's a very small number, 13, out of a pretty big number, 100,000. That is, for every 100,000 women using hormonal birth control, there are 68 cases of breast cancer annually compared to 55 cases a year among non-users. Another way to crunch these numbers is to say there was one extra breast cancer for every 7,690 women using hormonal contraception.

Of course, the details are a little more interesting. For the users of hormonal patches, the extra breast cancers were 5 per 100,000, but it ranged from 1 fewer and 11 more, and essentially it wasn't different from women not using hormonal birth control. Maybe there are just weren't as many women taking it. It's not clear, because the hormonal patch is kind of like the hormonal pill.

For women using vaginal rings, there were two fewer breast cancers. But the statistical range was 32 fewer to 28 more. So there wasn't any increased risk in this group.

The same kinds of numbers were seen for women using contraceptive implants or injections. There were about 5 to 10 fewer breast cancers, but the ranges were so large that there really wasn't an increase or a decrease.

Hormonal IUD users had about the same increase as pill users with about 16 extra breast cancers per 100,000 women. Importantly, and listen to this, the risk for women under 35 years of age was 2 extra breast cancers per 100,000 women per year, a really small number. Young women had a lower risk of breast cancer on hormonal contraception than older women. And women who had used hormonal contraception for a long time, meaning 10 years or more, had a slightly larger absolute risk than women who only used it a short time.

So what do we do with these numbers? First, don't panic. Every time there's bad news about contraception, even if it's barely bad, women stop their contraception and the unplanned pregnancy rate and abortion rate goes up. Now there, you're really taking some risks. It is really hard to know how to counsel women about a risk that is one extra per 7,960 women. Those are numbers that people don't really understand very well. Also, people really don't like numbers like 7,960. They like 10 or 1,000.

So I consider a significant risk is 1 extra in 10. A low risk is 1 extra in 100. A very low risk is 1 extra in 1,000, and an extremely low risk is 1 extra per 10,000, and that's really what we're talking about. The authors of this study admit that they didn't control for age of first period in these ladies, alcohol consumption, breastfeeding, and physical activity. All of these activities increase or decrease the risk of breast cancer by a little. Breastfeeding decreases the risk of breast cancer, and certainly women who breastfeed are less likely to use hormonal birth control. So that could be part of why there was a slight increase in hormonal birth control users.

Now, there's something called biological plausibility. In population studies, they'd find a correlation of one thing with another. Let's pick alcohol. People who drink alcohol moderately live longer. People who drink alcohol a lot don't live so long. Now, is it the alcohol that makes you live longer? Or is it the people who drink alcohol have more fun, have more friends, and having friends makes you live longer? So this is a biological plausibility issue.

Is there a biological reason that hormonal contraception might very slightly increase the risk of breast cancer? Over the past 20 years, researchers have been more interested in the progestin component of the hormonal contraception and menopausal hormone replacement therapy. We always thought that the risk for breast cancer was all about estrogen, but progestin, that other hormone in hormone replacement or in hormonal birth control, seems to add a little risk as well. So there's a possible biological reason for this very small increase in breast cancer in hormonal contraception users.

The authors of this study also suggest that women don't panic, but they didn't exactly say that. They mentioned that hormonal birth control pills have substantial health benefits. Birth control pills substantially decrease the risk of uterine and ovarian cancer and possibly colon cancer. In fact, women who have the BRCA gene for breast and ovarian cancer have been suggested to take birth control pills because even if the risk of breast cancer is slightly greater, the risk of ovarian cancer, a cancer that's hard to detect and hard to treat, is so much less on birth control pills.

So what should you do? We all know that hormonal contraception comes with risks and benefits. For the vast majority of us, the ability to control when and how often we have children is a fundamental factor in our ability to manage our lives. Many women use hormonal birth control, such as hormonal IUDs, to manage flooding periods and pain that debilitates them every month.

If these recent findings are a major concern for you, talk to your clinician about the risks and benefits for you personally. Not you in 100,000 women. Put things in your own personal perspective. There are options for us, probably more than you know, and thank you for joining us on The Scope.

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Dr. Jones: "It brought a lump to my throat." This is a phrase that usually implies an emotional response to something. But what if there's really a lump in your throat? Or really a lump in your neck? This is Dr. Kirtley Jones from Obstetrics and Gynecology at the University of Utah Health, and we're talking about thyroid cancer and women today on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Most of the time one of our most important hormone glands in our body just does its thing without us feeling it. For women, men are another story, the thyroid is the only gland that we can touch with our fingers. It's sort of a flat butterfly-shaped gland about two inches across in the front of our neck in front of our throat. It regulates the metabolism at every cell in the body.

Millions of women have thyroid problems, the most common being under or overactive thyroid. The majority of people in the United States with thyroid problems are women. We're not sure why that's the case except that most thyroid problems are due to autoimmune disease, antibodies that we make against part of the thyroid gland. All autoimmune diseases are more common in women.

Over and underactive thyroid symptoms are vague. The symptoms are feeling cold or slightly depressed. For underactive thyroid, feeling hot, your heart pounding and anxious, maybe weight loss are common for overactive thyroid. Sometimes the thyroid is slightly enlarged with over or underactive thyroid problems, but thyroid cancer presents as a lump. Sometimes the lump is noticed by the patient, but sometimes it presents with hoarseness of voice or difficulty swallowing, and sometimes the lump is detected by a clinician during a physical exam.

It's important to know that lumps in the thyroid are very common, and only 5% to 10 % of lumps in the thyroid in women are cancer. Now, thyroid cancer is the most cancer in women 15 to 30 years of age and is the second most common cancer after breast cancer in women under 50. Seventy-five percent of all thyroid cancers occur in women. And thyroid cancers generally happen younger in women than men.

There are a number of risk factors for thyroid cancer, the majority of which you can't change. I already mentioned that being a woman is one of them and you mostly can't change that. There are families that have genetic mutations that make cancers more common, and thyroid cancers are part of that family risk.

Another risk for thyroid cancer is exposure to radiation, especially as a child. The most common reason for a young person to have radiation exposure these days is because of radiation treatment for another cancer when the person was a child. Also, for those of us who grew up in the Intermountain West, the increased exposure to radiation from nuclear testing in the 50s is associated with a slightly increased risk of thyroid cancer. And of course exposure to an accident at a nuclear power plant that releases radiation can increase the risk, but this is uncommon.

Finally, children with a low diet in iodine are at an increased risk, but that's uncommon in the U.S. because table salt and sea salt have iodine and iodine is found in fish and is added when salt is added to some foods. Now, if you have a lump in your thyroid or an enlargement in the front of your neck where your thyroid is, you should see your doctor. The doctor will feel your thyroid, do a blood test to check out the thyroid hormones, and sometimes check a blood test to see if you have antibodies to your thyroid.

If there's any question of a lump in the thyroid, an ultrasound of your thyroid is the next step. If the ultrasound shows a lump, the next step could be to collect cells from the lump with a small needle. Now there's some controversy about when to do this test. So many thyroid lumps or nodules are totally benign. If the lump is less than a half inch or about one centimeter, most experts would just recommend watching it over time, unless of course you have a family history of thyroid cancer. In that case, you really need to watch things more carefully and the biopsy would be right.

If it's over an inch, most experts will recommend a biopsy. Now, if the biopsy shows cancerous cells, the next step is surgery usually to remove the thyroid and make sure the cancer hasn't spread to the lymph nodes. If it's spread, the next step can be radiation. It's most important to know that thyroid hormone can be easily and inexpensively replaced with a pill if you've had your thyroid removed. The other important fact, and listen up, is that thyroid cancer in young women is very curable with over 90%, survival for 20 years. So thyroid cancer is one of the most curable kinds of cancers.

So if you have a lump in your throat, first check out and make sure it isn't really your adorable child or the movie you're watching, but if it really is a lump in your neck, and bring it to your attention to your doctor. The chances are highly likely that it isn't cancer, but it should be evaluated. And if it's found to be thyroid cancer, it's often easily cured in women, and that's the best news. And thanks for joining us on The Scope.

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Interviewer: You might be having an allergic reaction to your birth control, but maybe you're not. Let's find out next on The Scope.

Announcer: Questions every woman wonders about her health, body and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking to Dr. Kirtly Parker Jones. She's our expert on all things women. So, Dr. Jones, we've been getting a lot of emails about women who are having "allergies" with their birth control, they're just having some sort of reaction to it and they're thinking its allergies. Is it even possible to have allergies with your birth control?

Dr. Jones: Okay, well, let's talk about what an allergy is. An allergy, or an allergic reaction, is where your body recognizes a substance as foreign, makes an antibody to it, and that causes a process, an allergic reaction, that can cause itching, hives, can cause swelling of your throat, difficulty breathing, low blood pressure and passing out. Not necessarily all of those, but it could be. In reality with respect to birth control it is rare for someone to be truly allergic to birth control. The reason is, with respect to birth control hormones, is the hormones are very much like your own hormones and it's unlikely that you're going to be allergic to it.

Now, sometimes birth control pills have dye, have colors in it, so you know when you open your pack there some blue ones or pink ones, so some people are allergic to the dye, probably not so much the hormones. In birth control shots like Depo-Provera, that's a brand, the carrier or the liquid that's in there you may be allergic to that. There are women who actually have allergy to nickel, that's pretty common, but in fact there aren't any birth control methods with nickel and the copper IUD is copper and it is rare to have someone truly allergic to copper because we all need copper in our body, so we're not allergic to it.

There are people who are truly allergic to latex, as in condoms. So yes, that can cause shortness of breath and hives and itching and all those things, so some people are allergic to latex condoms and some people are allergic to that foreign substances, of which there are quite a few, in spermicides. So when you're using a foam or a gel or something which is a spermicide in conjunction with your condom some people are allergic to those. But in terms of birth control pills or birth control shots or birth control implants or IUD's, true allergies are very rare, meaning less than maybe 1 in a 1,000.

Interviewer: So then is it normal?

Dr. Jones: To be allergic? It is not normal. To have side effects? Yes. Let's go back to that normal thing. So something is not normal if it happens to less than 5% of women and side effects happen to more than 5% of women. Now, side effects happen to women because the hormones in either the pill or the hormonal IUD changes some parts of their bodies. So remember estrogens and progestins, the other hormone that is often in birth control methods, they change your body. That happens to you in your natural hormonal cycle and it may change your body when you use them in birth control. So when people say, "I have breast tenderness," or, "I have nausea," or, "I got some acne from that pill."

Interviewer: That's a side effect.

Dr. Jones: That's a side effect, and a side effect isn't an allergy. The other thing is that life happens and some people have things happen concurrently when they're starting a new birth control method. When people say, "Oh, I must be having a side effect from my IUD because I'm crying all the time." "Well, how long have you had that IUD?" "Over four years." Well, in fact, that's not your IUD. What else is happening in your life?

So when you do studies of birth control methods, you often do a placebo-controlled trial. So when you're looking at things like headache and nausea and breast tenderness, you often find that those happen in people who were given a placebo. It's clear that the real attributable number of people who have a side effect would be the number of people who had it with the real drug minus the number of people who had it with the placebo. So headaches, nausea, not feeling well, mood, those can change just because and you just happen to be on birth control at the same time.

So side effects from birth control pills are common and I consider them normal. In fact, some side effects of something like the levonorgestrel IUD, the hormonal IUD of irregular bleeding or very light periods or no periods, that's actually not a side effect. That's a direct cause and some people are annoyed by the irregular bleeding but some people really like the little light periods.

Interviewer: You're still okay.

Dr. Jones: You're still okay. Now if it turns out . . . so when you first start something like birth control pills, headache, nausea, and breast tenderness may be very common side effects, they tend to go away though. So if it's persisted over three cycles, if you can hang out with it, it actually tends to get better.

Interviewer: If you can hang out with it?

Dr. Jones: Yeah, if you can hang out with it. But remember when you say allergy you're really talking about a very specific set of symptoms which are quite rare with birth control methods except latex condoms and some spermicidal gels, but talk to your doctor about it, talk to your doctor. Hopefully they're experienced enough about it or they can call an expert.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: October 4, 2018
originally published: April 22, 2016