Period & health research updates: May 2021

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“Pending analysis shows that cervical cancer rates have gone down over the past two decades—in line with HPV vaccine uptake and an increase in Pap smear screenings for prevention.”

Briefing you on the latest in reproductive health research

This month was chock-full of developments in reproductive health, from new and exciting research to market updates to even national celebrations for Women’s Health Week. Among those, we’ve chosen a couple to share with our community:

  • First, a new medical treatment for leiomyomas makes its debut, providing a potential option for those who don’t want to undergo surgical treatment for fibroids
  • Then, we discuss the findings of a landmark trial that examined the effects of secondhand smoke during and after pregnancy on the developing child. 
  • Finally, a brief update on cervical cancer rates (sneak preview, it’s some good news!) and a reminder about STI awareness more generally. 

Phase 3 treatment emerges for uterine fibroids

Uterine fibroids are one of the more common reasons for heavy menstrual bleeding—a.k.a. a heavy period. Fibroids are benign, or non-cancerous, growths of cells that arise from multiple layers of the uterus. Depending on their location, they can cause pelvic pain, abdominal pain or distention (e.g. bloating), and one of the hallmark symptoms, heavy bleeding. 

That last symptom on the list is usually what calls attention to fibroids and leads to their diagnosis. Sudden or unusually heavy flow is something you should never ignore: Always make sure to bring it up with a healthcare provider. 

With uterine fibroids, the heavy bleeding comes from the extra pressure that the fibroids put on the uterine lining. When that lining is shed during your period, the fibroids amp up your usual bleeding—so you might notice that you’re changing period products a lot more often or bleeding through pads in only a couple of hours. Fibroids can also be the cause of intermenstrual bleeding, a.k.a. spotting, between periods.

The single best treatment for fibroids is usually surgical: In other words, actually removing the fibroid itself, preventing it from continuing to grow. In some cases, a healthcare provider might prescribe medication instead of (or in addition to) surgery. Oral contraceptives, for example, may reduce the amount of bleeding caused by fibroids—although they don’t necessarily reduce the size of the fibroid or stop it from growing. 

There is currently a lot of research being done around non-surgical, medication-based treatment options for fibroids, especially those that don’t come with disruptive side effects. One newer agent is possibly entering the ranks, having recently announced results from its Phase 3 trial.((ObsEva SA. (2021, May 20). ObsEva Announces Final Results from the Phase 3 PRIMROSE Program of Yselty® (linzagolix) for the Treatment of Uterine Fibroids. GlobeNewswire News Room. https://www.globenewswire.com/news-release/2021/05/20/2232978/0/en/ObsEva-Announces-Final-Results-from-the-Phase-3-PRIMROSE-Program-of-Yselty-linzagolix-for-the-Treatment-of-Uterine-Fibroids.html )) FYI, Phase 3 trials are usually the last step before drug review by the FDA (any further studies are called “post-market studies”). 

This new med is called Yselty® (linzagolix), and it is a GnRH antagonist. This means it blocks GnRH, short for Gonadotropin-releasing hormone, upstream. This then prevents the release of FSH and LH. Without FSH and LH, ovulation isn’t likely to occur—and this means, in most cases, no period. 

In the trial, researchers looked at a few different factors in study participants: Mainly, heavy menstrual bleeding, quality of life, and bone mineral density recovery. They found that Yselty® was able to be taken in a variety of ways (for example, in different doses and on its own or along with a contraceptive) and, taken any of these ways, resulted in an overall positive outcome. Participants reported lower pain scores across all arms after taking the medication.

The drug is not yet on the market but we hope to see more information coming soon. Check back in the next couple of months to learn more!

Link between secondhand smoke and birth outcomes

It is widely accepted that smoking during pregnancy is a no-no. Developing infants that are exposed to smoke in-utero can be at increased risk of birth defects, lower birth weight, and respiratory problems later on in life. 

However, less research has been done on the effects of secondhand smoke—probably because it tends to be more difficult to assess. Secondhand smoke can come from a variety of sources, from the home, to the workplace, to even public areas depending on the laws of the local area. Although some may think that exposure to secondhand smoke doesn’t hold a candle to actual smoking in terms of damage, it turns out, it can be just as dangerous. 

A recently published study decided to look at this very thing: Researchers studied the children of pregnant people who were exposed to secondhand smoke.((Lin L, Xu S, Wu Q, et al. Association of Prenatal, Early Postnatal, or Current Exposure to Secondhand Smoke With Attention-Deficit/Hyperactivity Disorder Symptoms in Children. JAMA Netw Open. 2021;4(5):e2110931. doi:10.1001/jamanetworkopen.2021.10931)) They aimed to follow these children as they developed, focusing on neurocognitive effects such as ADHD (attention deficit hyperactivity disorder) and its subtypes. 

The thought here is that the metabolites of nicotine can affect central nervous system maturation for the developing fetus, which, in turn, leads to a host of cognitive issues later on in life. ADHD was chosen as merely one of many possible outcomes of interest.

In this study, they found a strong association between secondhand smoke exposure and development of ADHD in school aged children of the districts that they sampled. Interestingly enough, the association was stronger in the prenatal and immediately postnatal time period. Prenatal makes sense based on what we’ve known, but…why postnatal? 

It turns out that, although the foundation of neural development happens in-utero, the baby’s brain continues to rapidly develop in those first few years of life. It continues to rapidly strengthen neuronal connections and build learning skills like how to speak and make expressions. 

The authors of the study found that secondhand smoke exposure during this time was just as predictive for increasing risk of ADHD later on in life. Importantly, it also doesn’t necessarily need to be the pregnant parent who smokes for the risk to be there: This study found that children of families in which the male parent or father smoked had higher odds of developing ADHD than their counterparts.

Moral of the story: ADHD is likely a multifactorial disease, meaning that there are many factors, both genetic and environmental, that contribute to its formation. This study shows that just one possible driver of ADHD development is secondhand smoke, and that this effect can last for years. Before, during, and right after pregnancy (and, experts would argue, even after that), minimizing or removing any smoking in the household is the safest bet for healthy development.

Cervical cancer rates go down, thanks to screening…but work remains to be done

In a very hot off the presses update, pending analysis shows that cervical cancer rates have gone down over the past two decades—in line with HPV vaccine uptake and an increase in Pap smear screenings for prevention.((Johnson, C. K. (2021, May 19). US cervical cancers fall but other sex-related cancers rise. AP News. https://apnews.com/article/us-news-cervical-cancer-coronavirus-pandemic-science-cancer-2a3539f8ed7bff5a326d12ce0d9f4f88)) 

Overall, this is exciting news. Cervical cancer has been steadily going down over the years in terms of case count, but it remains a tragic cancer that does take the lives of approximately 4000 people AFAB per year. Furthermore, not all have access to the multi-dose HPV vaccine, often known by its brand name of Gardasil—and many folks don’t realize that you can safely take it up until your mid-40s. (Pro tip: if you haven’t yet, ask your doctor about the HPV vaccine!)

Despite this good news, it looks like this decrease in cervical cancer rates is being offset to a degree by an increase in other STI-driven cancers, including anal cancer and rectal cancer in people AFAB as well as mouth/throat cancer in people AMAB. These cancers can develop from STIs spread through oral and anal sex. And let us segue here into a quick reminder that barrier method protection (hello, condoms!) isn’t just for vaginal sex.

Furthermore, the generational divide between when the HPV vaccine came out and when it became widely available is a relatively recent development, meaning that there are plenty of people who are sexually active but who were not routinely offered this vaccine during adolescence. 

Hopefully, you’re already making open and honest conversations about sexual health a habit with all partners—but in case you do need just one more reason to have that awkward but important chat, data like this goes to show that knowledge really is power. And preventing anal cancer…well, that should speak for itself. 

This data was released in tandem with one of the major medical oncologic societies during their annual meeting and will be elucidated in-depth in an upcoming journal article. In other words, more to come soon.

That’s all for May’s edition of our 2021 Period & Health Research Updates. Take a look at our other recent editions here: 

This article is informational only and is not offered as medical advice, nor does it substitute for a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician. 

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