Love, factually: Gerontologist finds the formula to a happy marriage

A gerontologist has uncovered common advice for couples walking down the aisle or decades into marriage. To capture the voice of lived experience, the study included a random national survey of nearly 400 Americans age 65 and older, asking how to find a compatible partner and other advice on love and relationships. In subsequent in-person interviews with more than 300 long-wedded individuals -- those in unions of 30, 40, 50, or more years -- the study captured more insights for overcoming common marriage troubles. The team of researchers interviewed divorced individuals, too, asking how others might avoid marital breakups.

With wedding season in full swing, America's newlyweds stand to learn from the experts: older adults whose love has endured job changes, child-rearing, economic certainty, health concerns and other life challenges.

Filling our knowledge gap on finding a mate and remaining married, Cornell gerontologist Karl Pillemer completed the Cornell Marriage Advice Project, the largest in-depth interview study ever done of people in very long unions, surveying more than 700 individuals wedded for a total of 40,000 years. The findings are detailed in Pillemer's book, "30 Lessons for Loving: Advice from the Wisest Americans on Love, Relationships, and Marriage."

To capture the voice of lived experience, Pillemer conducted a random national survey of nearly 400 Americans age 65 and older, asking how to find a compatible partner and other advice on love and relationships. In subsequent in-person interviews with more than 300 long-wedded individuals -- those in unions of 30, 40, 50, or more years -- Pillemer captured more insights for overcoming common marriage troubles. His team interviewed divorced individuals, too, asking how others might avoid marital breakups.

The average age of interviewees was 77 and included 58 percent women and 42 percent men. The average length of marriage in the sample was 44 years; the couple with the longest marriage were ages 98 and 101 and had been married 76 years. Responses were coded into the most commonly occurring recommendations, resulting in a list of the most frequently selected lessons for a successful, long-term relationship.

"Rather than focus on a small number of stories, my goal was to take advantage of the 'wisdom of crowds,' collecting the love and relationship advice of a large and varied cross-section of long-married elders in a scientifically reliable and valid way," said Pillemer.

Pillemer uncovered common advice for couples walking down the aisle or decades into marriage. The top five lessons from the elders, along with Pillemer's analysis:

Learn to communicate: "For a good marriage, the elders overwhelmingly tell us to 'talk, talk, talk.' They believe most marital problems can be solved through open communication, and conversely many whose marriages dissolved blamed lack of communication."

Get to know your partner very well before marrying: "Many of the elders I surveyed married very young; despite that fact, they recommend the opposite. They strongly advise younger people to wait to marry until they have gotten to know their partner well and have a number of shared experiences. An important part of this advice is a lesson that was endorsed in very strong terms: Never get married expecting to be able to change your partner."

Treat marriage as an unbreakable, lifelong commitment: "Rather than seeing marriage as a voluntary partnership that lasts only as long as the passion does, the elders propose a mindset in which it is a profound commitment to be respected, even if things go sour over the short term. Many struggled through dry and unhappy periods and found ways to resolve them -- giving them the reward of a fulfilling, intact marriage in later life."

Learn to work as a team: "The elders urge us to apply what we have learned from our lifelong experiences in teams -- in sports, in work, in the military -- to marriage. Concretely, this viewpoint involves seeing problems as collective to the couple, rather than the domain of one partner. Any difficulty, illness, or setback experienced by one member of the couple is the other partner's responsibility."

Chose a partner who is very similar to you: "Marriage is difficult at times for everyone, the elders assert, but it's much easier with someone who shares your interests, background and orientation. The most critical need for similarity is in core values regarding potentially contentious issues like child-rearing, how money should be spent and religion."

According to Pillemer, "These unique insights show the value of using rigorous survey methods to uncover the practical wisdom of older people. Although a number of general studies of elder wisdom have been conducted, no one had researched the specific advice elders have for a critical life domain like marriage. Therefore, the study points the way toward the need for future research on concrete lessons we learn over the course of our lives."

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The above post is reprinted from materials provided by Cornell University.

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Non-steroidal anti-inflammatory drugs inhibit ovulation after just 10 days

The results of a new study show that diclofenac, naproxen and etoricoxib significantly inhibit ovulation in women with mild musculoskeletal pain. Of the women receiving NSAIDs, only 6.3 percent (diclofenac), 25 percent (naproxen) and 27.3 percent (etoricoxib) ovulated, compared with 100 percent of the control group.

New findings suggest that readily available non-steroidal anti-inflammatory drugs (NSAIDs) could have a harmful effect on fertility.

Credit: © Werg / Fotolia

The results of a study presented today at the European League Against Rheumatism Annual Congress (EULAR 2015) show that diclofenac, naproxen and etoricoxib significantly inhibit ovulation in women with mild musculoskeletal pain. Of the women receiving NSAIDs, only 6.3 percent (diclofenac), 25 percent (naproxen) and 27.3 percent (etoricoxib) ovulated, compared with 100 percent of the control group.

These findings suggest that readily available non-steroidal anti-inflammatory drugs (NSAIDs) could have a harmful effect on fertility, and should be used with caution in women wishing to start a family.

'After just ten days of treatment we saw a significant decrease in progesterone, a hormone essential for ovulation, across all treatment groups, as well as functional cysts in one third of patients,' said study investigator Professor Sami Salman, Department of Rheumatology, University of Baghdad, Iraq. 'These findings show that even short-term use of these popular, over-the-counter drugs could have a significant impact on a women's ability to have children. This needs to be better communicated to patients with rheumatic diseases, who may take these drugs on a regular basis with little awareness of the impact.'

NSAIDs are among the most commonly used drugs worldwide, and are taken by more than 30 million people every day. Available without prescription, NSAIDS are largely used for the treatment of pain, inflammation and fever -- all common features of rheumatic conditions.

Thirty nine women of childbearing age who suffer from back pain took part in the study, and received diclofenac (100mg once daily), naproxen (500mg twice daily) and etoricoxib (90mg once daily) or placebo. Treatment was given for 10 days from day 10 of the onset of the menstrual cycle; hormonal analysis (progesterone level) and follicle diameter were conducted via blood sample and ultra sonsography respectively. At the end of the NSAID treatment period, the dominant follicle remained unruptured in 75 percent, 25 percent and 33 percent of patients receiving diclofenac, naproxen and etoricoxib respectively. Rupturing of the dominant follicle, and subsequent release of an oocyte (unfertilised egg), is essential for ovulation to occur.

'These findings highlight the harmful effects NSAIDs may have on fertility, and could open the door for research into a new emergency contraception with a more favourable safety profile than those currently in use,' concluded Professor Sami Salman.

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The above post is reprinted from materials provided by European League Against Rheumatism.

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Data scientists find connections between birth month and health

This data visualization maps the statistical relationship between birth month and disease incidence in the electronic records of 1.7 million New York City patients.

Credit: Dr. Nick Tatonetti

Columbia University scientists have developed a computational method to investigate the relationship between birth month and disease risk. The researchers used this algorithm to examine New York City medical databases and found 55 diseases that correlated with the season of birth. Overall, the study indicated people born in May had the lowest disease risk, and those born in October the highest. The study was published in the Journal of American Medical Informatics Association.

"This data could help scientists uncover new disease risk factors," said study senior author Nicholas Tatonetti, PhD, an assistant professor of biomedical informatics at Columbia University Medical Center (CUMC) and Columbia's Data Science Institute. The researchers plan to replicate their study with data from several other locations in the U.S. and abroad to see how results vary with the change of seasons and environmental factors in those places. By identifying what's causing disease disparities by birth month, the researchers hope to figure out how they might close the gap.

Earlier research on individual diseases such as ADHD and asthma suggested a connection between birth season and incidence, but no large-scale studies had been undertaken. This motivated Columbia's scientists to compare 1,688 diseases against the birth dates and medical histories of 1.7 million patients treated at NewYork-Presbyterian Hospital/CUMC between 1985 and 2013.

The study ruled out more than 1,600 associations and confirmed 39 links previously reported in the medical literature. The researchers also uncovered 16 new associations, including nine types of heart disease, the leading cause of death in the United States. The researchers performed statistical tests to check that the 55 diseases for which they found associations did not arise by chance.

"It's important not to get overly nervous about these results because even though we found significant associations the overall disease risk is not that great," notes Dr. Tatonetti. "The risk related to birth month is relatively minor when compared to more influential variables like diet and exercise."

The new data are consistent with previous research on individual diseases. For example, the study authors found that asthma risk is greatest for July and October babies. An earlier Danish study on the disease found that the peak risk was in the months (May and August) when Denmark's sunlight levels are similar to New York's in the July and October period.

For ADHD, the Columbia data suggest that around one in 675 occurrences could relate to being born in New York in November. This result matches a Swedish study showing peak rates of ADHD in November babies.

The researchers also found a relationship between birth month and nine types of heart disease, with people born in March facing the highest risk for atrial fibrillation, congestive heart failure, and mitral valve disorder. One in 40 atrial fibrillation cases may relate to seasonal effects for a March birth. A previous study using Austrian and Danish patient records found that those born in months with higher heart disease rates--March through June--had shorter life spans.

"Faster computers and electronic health records are accelerating the pace of discovery," said the study's lead author, Mary Regina Boland, a graduate student at Columbia. "We are working to help doctors solve important clinical problems using this new wealth of data."

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The above story is based on materials provided by Columbia University Medical Center. Note: Materials may be edited for content and length.

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The infant gut microbiome: New studies on its origins and how it's knocked out of balance

A fecal sample analysis of 98 Swedish infants over the first year of life found a connection between the development of a child's gut microbiome and the way he or she is delivered. Babies born via C-section had gut bacteria that showed significantly less resemblance to their mothers compared to those that were delivered vaginally.

Bäckhed et al. assessed the gut microbiomes of 98 Swedish mothers and their infants during the first year of life. Cessation of breast-feeding was identified as a major factor in determining gut microbiota maturation, with distinct shifts in signature species being hallmarks of its functional maturation.

Credit: Bäckhed et al./Cell Host & Microbe 2015

A fecal sample analysis of 98 Swedish infants over the first year of life found a connection between the development of a child's gut microbiome and the way he or she is delivered. Babies born via C-section had gut bacteria that showed significantly less resemblance to their mothers compared to those that were delivered vaginally.

The study, which appears May 11 in Cell Host & Microbe's special issue on "The Host-Microbiota Balance," also found nutrition to be a main driver of infant gut microbiome development--specifically the decision to breast-feed or bottle-feed.

"Our findings surprisingly demonstrated that cessation of breastfeeding, rather than introduction of solid foods, is the major driver in the development of an adult-like microbiota," says lead study author Fredrik Bäckhed of The University of Gothenburg, Sweden. "However, the effect of an altered microbiome early in life on health and disease in adolescence and adulthood remains to be demonstrated."

Gut bacteria are suspected to be a source of nutrients and vitamins for a growing infant. Our intestinal tenants are able to interact with normal cellular processes to, for example, produce essential amino acids. Understanding the role individual gut microbes play in metabolism, immunity, and even behavior is an active area of investigation.

This new study, led by Bäckhed and Jovanna Dahlgren at the University of Gothenburg, Sweden, and Wang Jun at the Beijing Genomics Institute-Shenzhen, China, supports previous observations that most early bacterial colonizers of the gut are derived from the mother. The investigators noted that while C-section babies receive less of their mother's microbes, they are still able to be passed on through the skin and mouth.

Once bacteria take hold in an infant's gut, their populations shift depending on what a child eats. The researchers believe that the cessation of breast-feeding is such a significant moment in microbiome development because certain types of bacteria thrive on the nutrients breast milk provides. Once these nutrients are no longer available, other bacteria emerge that are more commonly seen in adults.

"Our results underscore the role of breast-feeding in the shaping and succession of gut microbial communities during the first year of life," the authors write. "The gut microbiota of children no longer breast-fed was enriched in species belonging to Clostridia that are prevalent in adults, such as Roseburia, Clostrium, and Anaerostipes. In contrast, Bifidobacterium and Lactobacillus still dominated the gut microbiota of breast-fed infants at 12 months."

The Infant Gut and Antibiotics: Long-Term Effects

Antibiotics account for one quarter of all medications given to children, with a third of prescriptions considered unnecessary. In addition to concerns about antibiotic resistance, these drugs are known to disrupt a child's gut microbiome in ways that a growing amount of evidence suggests may have long-term consequences, including obesity, allergies, and autoimmune diseases.

Based on a review of the literature, biotechnologist Dan Knights, of the University of Minnesota, and colleagues developed a framework for how antibiotics may be acting in the gut to cause these outcomes. In the case of allergies, for example, the use of antibiotics may eradicate key gut bacteria that help immune cells mature. These cells would have been essential for keeping the immune system at bay when confronted with allergens. Even if these bacteria return, the immune system remains impaired.

"The framework presented here links together the existing epidemiological and mechanistic studies on antibiotics and various gut-mediated disease outcomes," the authors write. "Large, integrated studies designed to focus on short- and long-term impact of antibiotics, in terms of both microbiome composition and disease risk, with careful consideration of the factors presented here, will be critical as we move toward an increased understanding of related disease etiologies."

The researchers also developed a diagnostic test that can calculate the developmental age of a baby's gut microbiome relative to healthy babies. A similar test could be used by pediatricians to identify and potentially treat infants more than a month behind normal development.

The Gut Microbiome's Role in Asthma

The search for answers in the medical mystery around the recent increase in asthma prevalence, especially for children up to age four, has led researchers to consider changes in the gut and airway microbiome as a contributing environmental factor in the development of this treatable, but uncomfortable, condition.

Susan Lynch and Kei E. Fujimura of the University of California San Francisco present the latest research in mice exploring this relationship, especially how specific types of bacteria alter the presence of different immune cells. Though still an emerging body of work, they believe it is evidence that manipulation of the airway/gut microbiome at an early age could lead to new strategies to prevent or manage asthma.

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The above story is based on materials provided by Cell Press. Note: Materials may be edited for content and length.

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Do newborns delivered by C-section face higher risk of chronic health problems later in life?

The evidence as to whether newborns delivered by C-section are more likely to develop chronic diseases later in life has been examined by investigators. The authors of a new study find that their evidence warrants concerns that C-section may lead to worse long-term child health.

Cesarean section is sometimes a medical necessity, or even an emergency. But it is increasingly a choice made in cooler moments, and the request is growing globally. At the same time, while repeat cesarean is not necessarily medically indicated for women with otherwise low obstetrical risk, there is a 90% repeat cesarean rate among women giving birth who have had a prior cesarean, in the US.

Credit: © Vivid Pixels / Fotolia

A new paper in the British Medical Journal by Jan Blustein, MD, PhD, of New York University's Wagner School and a professor of Medicine and Population Health at NYU School of Medicine and Jianmeng Liu of Peking University examines the evidence as to whether newborns delivered by C-section are more likely to develop chronic diseases later in life. While the jury is still out and research is ongoing, recent studies underscore the need for health care providers to discuss with expectant parents the risk of babies born through cesarean section developing obesity, asthma, and diabetes, according to the paper by Blustein and Liu.

Cesarean section is sometimes a medical necessity, or even an emergency. But it is increasingly a choice made in cooler moments. C-section on mothers' request is growing globally. At the same time, while repeat cesarean is not necessarily medically indicated for women with otherwise low obstetrical risk, there is a 90% repeat cesarean rate among women giving birth who have had a prior cesarean, in the US.

While cesarean and vaginal deliveries are both associated with well-known acute risks, recent studies link C-section to long-term child chronic disease. The authors review this evidence from a variety of sources. These include observational studies where researchers locate large samples of children, assess the extent of disease, and look back to see how the children were delivered. They also include a clinical trial, in which mothers were prospectively randomized to undergo cesarean or vaginal delivery. The authors find that the evidence warrants concerns that C-section may lead to worse long-term child health.

These risks have yet to be mentioned in clinical guidelines, which are the official documents that are used to educate doctors and midwives. "It's time to update the guidelines to include information about possible risks to long-term child health," comments Dr. Blustein.

She acknowledges that the evidence linking cesarean to worse child health is not unequivocal. "It is clear that cesarean-born children have worse health, but further research is needed to establish whether it is the cesarean that causes disease, or whether other factors are at play," Dr. Blustein says. "Getting definitive answers will take many years of further research. In the interim, we must make decisions based on the evidence that we have. To me, that evidence says that it is reasonable to believe that cesarean has the potential for long-term adverse health consequences for children."

"It takes awhile for research findings to reach clinicians and patients," says Blustein. "This research isn't widely known. It is time for that to change, so that doctors, midwives and patients can weigh the risks and benefits of elective cesarean, and decide accordingly."

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The above story is based on materials provided by NYU Langone Medical Center. Note: Materials may be edited for content and length.

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Oxytocin: What Is It? What Does It Do?

e in the brain, in the hypothalamus, and it is transported to, and secreted by, the pituitary gland, which is located at the base of the brain.¹

Chemically it is known as a nonapeptide (a peptide containing nine amino acids), and biologically, as a neuropeptide. It acts both as a hormone and as a brain neurotransmitter.

The release of oxytocin by the pituitary gland acts to regulate two female reproductive functions:^1,2

• Childbirth
• Breast-feeding.

The release of the hormone during labor makes the muscles of the uterus, womb, contract - in other words, it increases uterine motility. The release of oxytocin is triggered by the widening of the cervix and vagina during labor, and this effect is in turn increased by the subsequent contractions.³

The main role of oxytocin is summed up nicely in a research paper by obstetric and gynecology specialists Navneet Magon and Sanjay Kalra:²

"It is released in large amounts during labor, and after stimulation of the nipples. It is a facilitator for childbirth and breast-feeding."

Stimulation of the nipples results in oxytocin release and milk let-down.

Other researchers sum up the reproductive importance of oxytocin by saying it "serves the continued propagation of a species," adding that through evolution its "repertoire has expanded to maintain a central role in more complicated aspects of reproductive behavior. For these reasons, we call oxytocin the great facilitator of life."¹

Oxytocin, used as a prescription drug, is also known by the brand name Pitocin (and Syntocinon, although this is no longer on the market).⁴

Doctors prescribe oxytocin to start birth contractions or strengthen them during labor. It is also used to reduce bleeding after child delivery.^4,5 The drug also has a role in the medical termination of pregnancy or during miscarriage.⁵

Oxytocin's effects on emotion

Oxytocin is released into the bloodstream to produce its classic effects on the uterus and breast milk, but it is also released into defined regions of the brain that are involved in emotional, cognitive, and social behaviors.⁶

One review of the evidence says oxytocin "has attracted intense attention" after the discovery of its "amazing variety of behavioral functions."⁶

The review, by Inga Neumann, says oxytocin has an impact on "pro-social behaviors" and emotional responses that contribute to:⁶

• Relaxation
• Trust
• Psychological stability.

However, another review notes that the hormone does not act alone in the chemistry of love, but is "just one important component of a complex neurochemical system that allows the body to adapt to highly emotive situations."⁷

Oxytocin has been the focus of research into the biology of love.

Another review has also sounded caution, calling for research to look more to the general effects than to the specific effects of oxytocin that are being interpreted.

"After all, it is rather unlikely that any widely acting hormone or neurotransmitter will be narrowly funneled to modulate complex, high-order mental processes that are specific to social cognition," say the authors of a 2013 paper.⁸

Scientific research has nonetheless uncovered brain oxytocin's specific ability to modulate social behavior, including effects on motherly care and aggression, bonding between couples, sexual behavior, social memory, and trust.⁶

Brain oxytocin also reduces stress responses, including anxiety - and these anxiolytic effects have been demonstrated in a number of species.^6,8

One of the so-called 'love hormone' studies was published in 2012, and it examined oxytocin levels in new lovers versus those in single people. It found that there were high levels of the hormone in the first stages of romantic attachment, and these were sustained for six months.⁹

Oxytocin released during sex

In both men and women, sexual intercourse stimulates the release of oxytocin, which has a role in erection and orgasm. The reason for this is not fully understood, although in women, it has been proposed that the increased uterine motility may help sperm to reach their destination.³

Some researchers believe oxytocin may play a part in the experience of sexual orgasm, proposing a correlation between the concentration of oxytocin and the intensity of orgasm.¹⁰

Behavioral effects of oxytocin

As shown in the recent developments listed here, scientists are still busy testing the behavioral effects of oxytocin and its role in human emotions.

Recent developments about oxytocin's effects on emotion

Oxytocin: the monogamy hormone? This study, published in the journal PNAS in November 2013, examined brain scans of men who had received oxytocin or placebo via a nasal spray. The oxytocin was associated with activation of the men's reward centres in their brains, and with greater feelings of attraction to their partners versus other women in photographs. This followed a very similar study in The Journal of Neuroscience in November 2012: A hormone can help keep men faithful.

High oxytocin levels "trigger oversensitivity to emotions of others." Released in January 2014, this study in Emotionfound that people receiving oxytocin nasal spray saw facial expression of emotions in others more intensely.

Oxytocin makes you feel more extroverted. This 2011 research paper in Psychopharmacology gave results from intranasal oxytocin improving self-perception in social situations, amplifying personality traits such as warmth, trust, altruism and openness.

The hormone that allows us to love may also encourage us to lie. This 2014 study found participants given oxytocin were more likely to lie for the benefit of the group.

Oxytocin as potential psychiatric therapy

The research to uncover oxytocin's "anxiolytic and pro-social influences, beneficial to relief, reproduction, and love" is what has led scientists to describe it as a one of the "most promising neuromodulator/neurotransmitter systems of the brain for psychotherapeutic intervention and treatment of numerous psychiatric illnesses, for example social phobia, autism, andpostpartum depression."⁶

In another research paper, from 2011, the conclusion reads:¹¹

"Oxytocin is of potential use in enhancing interpersonal and individual wellbeing, and might have more applications in neuropsychiatric disorders, especially those characterized by persistent fear, repetitive behavior, reduced trust and avoidance of social interactions."

Recent development on oxytocin as potential therapy

Oxytocin activates "social" brain regions in children with autism. A research study involving 17 children with autism spectrum disorders, published in December 2013, used functional magnetic resonance imaging (fMRI) to see differences created by oxytocin in brain responses to social and non-social pictures. Albeit in a small study, the researchers found "oxytocin temporarily normalized brain regions responsible for the social deficits seen in children with autism."

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10 Most Common Birth Control Pill Side Effects

The oral contraceptive pill, commonly referred to as "the pill," is a form of hormonal contraception taken by approximately 12 million women in the United States each year to prevent pregnancy.¹

The pill is a highly effective method of birth control when taken correctly.¹

Each year, 8% of women experience an unintended pregnancy while taking the pill - most commonly because they forgot to take it.

However, when taken daily at the same time, only one in 100 women will experience an unintended pregnancy within the first year of pill use.¹

There are two types of contraceptive pills, both of which contain synthetic hormones estrogen and progesterone.² Combination pills contain both hormones estrogen and progesterone whereas the "mini pill" known as the progestin-only pill contains only the hormone progestin.¹

The pill can also be taken for non-contraceptive protection to treat medical conditions such as:^2,3

"The pill" is a type of hormonal contraception that is taken by around 12 million women per year in the US to prevent pregnancy.

• Regulation of menstrual periods
• Irregular periods
• Menorrhagia (heavy periods)
• Dysmenorrhea (painful periods)
• Endometriosis
• Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD)
• Acne, hirsutism (excess hair growth) and alopecia (hair loss)
• Decreasing the risk of breast cysts, ovarian cysts, pelvic inflammatory disease (PID) and pregnancies in the fallopian tubes.

Oral contraceptives are also used as a method to prevent ovarian and endometrial cancers. Birth control pills do not prevent sexually transmitted diseases.^1-3

Common birth control side effects

The 10 most common side effects of oral contraceptives are:

1. Intermenstrual spotting: vaginal bleeding between your expected periods is experienced by approximately 50% of women using the pill, most commonly within the first 3 months of initiating the pill. Generally, this resolves in over 90% of women by their third pill pack. During this time of spotting, the pill is still effective as long as the pill has been taken correctly and none were missed. It is recommended that you contact your medical provider if you experience 5 or more days of bleeding while on your active pills or heavy bleeding for 3 or more days.³
2. Nausea: mild nausea when initially starting the pill can occur. However, nausea symptoms usually resolve over a short period of time. One solution is to try taking your pill with food or at bedtime. Seek medical help if the nausea is severe or persistent.³
3. Breast tenderness: birth control pills may cause your breasts to enlarge or become tender, which tends to improve after the first few weeks of starting the pill. However, if there is a presence of a lump or the pain is not going away, seek medical help. Reducing caffeine and salt intake can decrease breast tenderness, as can wearing a supportive bra.³
4. Headaches: the onset of new headaches should be brought to the attention of your medical provider.³
5. Weight gain: despite the failure of clinical studies to reveal that birth control pills cause weight fluctuations, some women do experience some fluid retention, especially in the breast and hip areas.³
6. Mood changes: if you are someone who has a history of depression, it is important that this is discussed with your medical provider - some women do experience depression or other emotional changes while taking the pill. It is important to contact your medical provider if you are experiencing mood changes during pill use.³
7. Missed periods: there are times when despite proper pill use, a period may be skipped or missed. Several factors can influence this such as outside stress, illness, travel or at times hormonal and or thyroid abnormalities. If a period is missed or is very light while on the pill, take a pregnancy test prior to taking your next pack of pills and call your medical provider if this continues.³
8. Decreased libido: the pill can affect your sex drive because of the hormones found in them. However, other outside factors may also cause a decrease in your libido. If this is persistent or bothersome, inform your medical provider.³
9. Vaginal discharge: some women may notice changes in vaginal discharge ranging from an overall increase to a decrease in vaginal lubrication with intercourse. Speak with your medical provider if you are concerned that there is the presence of an infection.
10. Visual changes with contact lenses: you should see your ophthalmologist if you are a contact lens wearer and notice some changes in vision or with lens tolerance during pill use.³

Some women experience side effects with "the pill" such as irregular periods, nausea, headaches, or weight change.

If you experience the side effects with the acronym "ACHES" (see below), contact your medical provider or visit an emergency room immediately as they may signify a serious condition.^3,4

• A: Abdominal/stomach pain
• C: Chest pain (as well as shortness of breath)
• H: Headaches, which are severe
• E: Eye problems such as blurred vision/loss of vision
• S: Swelling/aching in the legs and thighs (also redness, swelling or pain in the calf or thighs).

Birth control pills have also been associated with an increase in blood pressure, benign liver tumors, and a slight increase in the risk of developing cervical cancer.³

Precautions and risks while taking the pill

Combination pills do come with a particular risk for cardiovascular side effects such as heart attack, stroke and blood clots - which at times can be fatal. While blood clots are rare, they can occur. For women with a history of blood clots, heart attacks or stroke, it is advised that they do not take the combination birth control pill and speak with their medical provider about using an alternative method.¹

The US Food and Drug Administration (FDA) advises against the use of combination pills in women aged 35 years or older that smoke. Additional factors that increase your risk of blood clots include obesity or a family history of heart disease.¹

It is not recommended to take hormonal contraceptives if you have a personal history of liver or heart disease, uterine or breast cancer, uncontrolled blood pressure or migraines with an aura.⁴

It is important to note that combination pills with the form of synthetic progesterone called drospirenonone may have a higher risk of blood clots including deep vein thrombosis and pulmonary embolism.^1,4

You should speak with your medical provider to see what type of birth control option is best for you.

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Hair loss: how does it affect women?

 On seeing a bald man walk past, most of us wouldn't take a second glance. But would this be the case if a bald woman walked past? It is doubtful. Hair loss - although distressing - is generally more accepted in men, despite women accounting for 40% of all hair loss sufferers in the US. In this Spotlight, we look at the main causes of hair loss in women, the emotional toll it can take and why research is lagging behind in treatment for female hair loss.

Women account for 40% of all hair loss sufferers in the US.

The most common cause of hair loss in both men and women is androgenetic alopecia, also referred to as male or female pattern baldness.

A hereditary condition, androgenetic alopecia is believed to be caused by dihydrotestosterone (DHT), which derives from the male hormone testosterone.

An enzyme called Type 2 5-alpha reductase - present in the oil glands of hair follicles, the skin organs that produce hair - helps convert testosterone to DHT. This derivative then binds to and shrinks hair follicles, killing healthy hair.

Because men have higher testosterone levels than women, they are likely to produce higher DHT levels, leading to increased hair loss. As such, men with androgenetic alopecia often experience a receding hairline which can progress to partial or complete baldness, while women tend to experience hair thinning on the top and sides of the scalp.

"Hair thinning in female pattern baldness is different from that of male pattern baldness in that the frontal hairline remains unaffected except for normal recession, which happens to everyone as time passes, and hair loss rarely progresses to total or near total baldness, as it may in men," Dr. Marc Glashofer, a dermatologist and fellow of the American Academy of Dermatology, explained to Medical News Today.

But androgenetic alopecia is not the only cause of hair loss in women.

What are the other common causes of hair loss in women?

Telogen effluvium is a form of hair loss that can develop when the body is put through extreme stress, such as child birth, malnutrition or major surgery.

The condition involves a sudden shift from hair growth or resting phases to the hair shedding phase, known as telogen. This can occur within 6 weeks to 3 months after a stressful experience.

According to Dr. Shani Francis, also a fellow of the American Academy of Dermatology and director of the Hair Disorders Center of Excellence at Northshore University HealthSystem in Illinois, telogen effluvium is much more common in women than men. "It is the typical 'shedding' that happens after childbirth in some women," she told us.

Telogen effluvium is a common form of hair loss in women, which can develop when the body is put through extreme stress.

She added that some triggers of the condition - such as iron deficiency and changes in medication - are more likely to occur in women. "These triggers typically affect women more than men due to menstruation, the most common cause of iron deficiency in women, and the high prevalence of birth control use - some women change birth control quite frequently," she explained.

Traction alopecia is another form of hair loss that is more likely to occur in women. It is triggered by trauma to the hair follicles, most commonly through hair styling that continuously pulls at them - such as braiding, tight ponytails and hair extensions. "This type of hair loss is primarily seen in African-American patients," said Dr. Glashofer.

Another common cause of hair loss in both men and women is alopecia areata - an autoimmune disease that affects around 2% of the US population. The condition can be inherited; around 1 in 5 people who suffer from alopecia areata have a family member with the disorder.

It occurs when the immune system mistakenly attacks the cells in hair follicles, leading to hair loss on the scalp and other areas of the body. In alopecia areata, hair most commonly falls out in small patches. In some cases, however, the condition can lead to complete baldness.

Specific medical conditions - such as anemia and thyroid disorders - and the use of certain medications can also lead to hair loss.

The severe emotional impact of hair loss for women

It goes without saying that hair loss - regardless of gender - can be devastating. It can dent a person's self-esteem and negatively affect their overall quality of life.

"Studies on the psychosocial impact of hair loss have found patients' self-esteem, body image and self-confidence to be negatively impacted," Dr. Francis told  "Known psychosocial complications include depression, low self-esteem, altered self-image and less frequent and enjoyable social engagement."

It seems experts are in agreement, however, that women are significantly more likely to suffer emotionally as a result of hair loss.

"Hair loss in a woman is so emotionally devastating that it can trigger a wide range of social and emotional issues that can negatively impact healthy daily living and overall quality of life. I have heard of women that retreat from social situations, have diminished work performance, and even alter their healthy living - avoiding exercise, overeating, not treating other medical illnesses - due to their hair loss," said Dr. Francis.

But why do women see a greater emotional impact from hair loss than men? According to Dr. Glashofer, it is down to society's perception of beauty. "Society unjustly puts an inordinate amount of pressure on beauty and a great deal of this comes from perceptions of hair," he told us.

Dr. Francis agrees.

"For a women, the hair is the crown, a symbol of beauty/pride. It is typically what a woman identifies with as being feminine or attractive to a mate. If this starts to diminish, it can be devastating to a woman's identity and self-esteem, especially when affected at an early age. For older women, hair loss is perceived as accelerated aging and women have to deal with a sense of loss of virility and sexual attraction to their mate as well.

"Due to societal perception differences, it is much more emotional for women, as there is limited cosmetic acceptance of a bald woman and increased societal pressure on a woman to be attractive. The negative quality of life is likely worse in women."

Drug companies 'aren't falling over themselves' to test new hair loss drugs in women

It is not only support from society that is lacking for women with hair loss; it seems the medical world has been ignoring these women's needs.

There is only one medication approved by the Food and Drug Administration (FDA) for women with androgenetic alopecia - a topical treatment called minoxidil that works by stimulating the hair follicles.

As well as minoxidil, men with androgenetic alopecia can be treated with another medication called finasteride. This drug works by dramatically lowering DHT levels, halting the progression of hair loss.

Due to conflicting clinical trials, finasteride has not yet been approved for the treatment of androgenetic alopecia in women. Some studies have found that finasteride can cause fetal mutations in women of childbearing age.

Such findings, Dr. Francis believes, have deterred researchers from testing hormonally-active medications in women with hair loss. Even the American Hair Loss Association admit that women are in a "catch-22" situation when it comes to hair loss treatment.

"While many drugs may work to some degree for some women, doctors are reluctant to prescribe them, and drug companies aren't exactly falling over themselves to test existing or new drugs specifically for their ability to prevent and treat female pattern baldness," they state.

Dr. Francis also notes that researchers tend to sway more toward testing hair loss medications in men because it is easier to measure their response to treatment; their hair is generally shorter so their scalp is easier to see. "Also, women have very diverse styling and grooming practices - that many are unwilling to change - which makes research harder to standardize," she added.

Recent progress in hair loss treatment for both men and women shows promise

But while it is clear that progress in hair loss treatment for women has been slow, recent research has shown some promise - making hair loss breakthroughs that could be applied to both sexes.

In August 2014, for example, a study published in the journal Nature Medicine revealed how a drug already approved by the FDA for a rare bone marrow disease restored hair growth in patients with alopecia areata.

The researchers found that ruxolitinib fully restored patients' hair within 4-5 months by preventing immune system cells from attacking the hair follicles.

"Women are not able to have the same societal support [as men] for a smooth bald head," said Dr. Francis.

"There are few tools in the arsenal for the treatment of alopecia areata that have any demonstrated efficacy. This is a major step forward in improving the standard of care for patients suffering from this devastating disease," commented Dr. David Bickers, of the Department of Dermatology at Columbia University Medical Center.

More recently, in January 2015, researchers from Sanford-Burnham Medical Research Institute in La Jolla, CA, claimed they have found a way togenerate hair growth using human pluripotent stem cells.

Dr. Glashofer believes such research moves us a step closer to finding effective hair loss treatments for both men and women.

"Most recent groundbreaking hair research is attempting to define the biologic and genetic basis for certain types of hair loss. This obviously has value to both sexes," he told MNT. "Research attempting to utilize stem cells has broad implications for both hair loss treatments for men and woman and may have a role in treatment within the next decade."

While it is good news that progress is being made in terms of treatment for female hair loss, it is clear that greater awareness is needed of how the condition can affect women - particularly how it can affect them emotionally.

Dr. Francis points out that most people may not realize the extent to which these women are suffering, pointing out that many of them cover up their hair loss with wigs, scalp concealer and other cosmetic devices.

Again, this comes down to the fact that hair loss is generally more accepted in men. "Men are much more willing to shave the rest of the heads if hair loss starts to take over and this is cosmetically acceptable and in some cases quite attractive. Women are not able to have the same societal support for a smooth bald head," Dr. Francis told MNT.

It should not be the case that female hair loss is deemed unacceptable. Scottish model and TV presenter Gail Porter - who was diagnosed with alopecia in 2005, which led to complete baldness - is testament to the fact women are beautiful with or without hair. In an interview with the Scottish Express last year, Porter spoke of her challenges with hair loss while being in the public eye.

"As much as they say that people don't judge you on the way you look on TV, they do," She told the newspaper. "They [television bosses] say things like 'Would you consider wearing a wig?' "When I refuse, they say 'Oh, okay, we'll get back to you.' In other words, 'We're not having you because you have no hair.' I'm in a good place and I'm not going to wear a wig for anybody."

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