Monthly Archives: January 2014

What Women Still Don’t Know About Getting Pregnant Read more: Women confused about fertility and reproductive health

What Women Still Don’t Know About Getting Pregnant Read more: Women confused about fertility and reproductive health



As surprising as it seems, about half of women of reproductive age have not talked to their health care provider about their reproductive health, according to a new study.

As a result, the researchers, from the Yale School of Medicine, found that women between ages 18 and 40 weren’t aware of some the important factors that influence fertility and their ability to get pregnant, as well as about basic prenatal practices once they were expecting.

Among the most notable findings, which were published in the journal, Fertility & Sterility :

  • 30% of the women reported that they only visited a reproductive health provider less than once a year or not at all.
  • 50% of the women did not know that taking multivitamins and folic acid are recommended to avoid birth defects.
  • A little over 25% of women did not know that things like STDs, smoking and obesity impact fertility.
  • 20% did not know that aging can impact fertility and increase rates of miscarriage
  • 50% of the women thought that having sex multiple times in a day increased their likelihood of getting pregnant
  • Over 33% of women thought that different sex positions can increase their odds of getting pregnant
  • 10% did not know that they should have sex before ovulation to increase the chances of getting pregnant instead of after ovulation

The significant gaps in the women’s knowledge about their fertility may also explain why 40% reported that they had concerns and questions about their ability to get pregnant. The researchers believe that as women put off starting families — the latest CDC report showed women between 25 to 29 years old have the highest pregnancy rates, compared to women aged 20 to 24 in earlier years — doctors, particularly reproductive health specialists, should have more opportunity for improving women’s education about fertility and pregnancy so they know what to expect when they are finally ready to have a child.

Here’s what to do about your anxiety

Here’s what to do about your anxiety


By Dr. Charles Raison

Dr. Charles Raison, CNN’s mental health expert, addresses two questions from readers reacting to a piece on anxiety from Kat Kinsman, CNN Eatocracy managing editor, on her lifelong struggle with the condition. Look for Raison to address other questions in the future.

Q: Can using marijuana or having a drink or two be helpful for people with anxiety? What should they watch out for?

Dr. Raison: If one goes on any search engine looking for study results related to marijuana or alcohol and depression or anxiety, one will immediately see that most of the evidence tells a cautionary tale.

Many studies suggest that regular use of either marijuana or alcohol is associated with an increased risk for a variety of mental health problems, anxiety and depression among them. Increasing data suggests that regular marijuana use in adolescence may also be a risk factor for developing very serious psychotic disorders, especially schizophrenia.

In addition to promoting other disorders, alcohol is especially liable to abuse and dependence and has ruined innumerable people’s lives for millennia.

Far fewer studies have examined whether using these compounds in moderation might improve depression or anxiety.

But as Socrates noted almost 2,000 years ago, alcohol is both a blessing and a curse to mankind. Indeed, now we know that the regular modest use of alcohol actually promotes a number of health factors.

Similarly, it is increasingly clear that many of the chemicals within marijuana hold great promise for the treatment of physical pain. The endocannabinoid system in the brain — which is a primary target for marijuana — has profound effects on how people think and feel.

For example, increasing evidence suggests that the “runners high” many people get after strenuous exercise is produced primarily by activation of the brain’s’ internal endocannabinoid system. Other chemicals in marijuana impact other brain pathways, like serotonin, that are known to play a role in depression and anxiety.

People have been taking a drink or two in the evening since time immemorial. And many people will attest that this practice helps them shed the cares of the day. Recently, I’ve met with several very experienced psychiatrists who have been recommending small amounts of marijuana use for for very depressed patients who haven’t responded to antidepressants. In some patients, they are reporting remarkable improvements.

But the problem at this point is that while many studies have shown an association between alcohol/marijuana and mental illness, I don’t know of any really rigorous studies looking at the therapeutic potential of either for depression and anxiety.

Answering the question of what people who use these substances should watch out for is easier. They should watch out for the possibility that they become more anxious or depressed after drinking or using marijuana. And they should keep a close eye on their use, especially use of alcohol, which can be highly addictive. Whatever potential benefit alcohol and marijuana may offer is 100% lost once they are abused.

Q: What are the best anxiety treatments who don’t want (or are afraid) to take medicines? Is there anything that might ease their concerns? Is there a point where medication becomes essential?

Dr. Raison: By far the best studied non-medicine treatment for depression or anxiety is psychotherapy. Literally hundreds of studies have shown that on average psychotherapy works as well for these conditions as do medications.

Of the various psychotherapies, the best studied is cognitive behavioral therapy, or CBT. But studies are being done all the time, and other forms of therapy are also emerging as highly effective.

Over and above the type of therapy employed, a key factor of therapeutic success is the “fit” between the client/patient and therapist. In practical terms, this means that people should feel comfortable with their therapists. If one feels ignored, looked down upon, dismissed or attacked, it is very unlikely the therapy will be successful. Very often when therapy works people start feeling better within a few weeks, so this is also something to look for.

No other non-medical treatment for depression or anxiety has anywhere near the amount of supporting evidence that psychotherapy does. Having said this, significant evidence now points to the usefulness of exercise for improving mental health.

Especially when it comes to depression, exercise has been repeatedly shown to be of value. Both strength training and aerobic exercise have benefits and combining them is the best of all.

However, to get the full antidepressant effect of exercise requires real commitment. To work optimally, exercise must be engaged in for at least 30 minutes a day five days a week. And the intensity level should be such that one has some difficulty carrying on a conversation while doing it.

However, other health benefits accrue from far less strenuous exercise and in general many people feel better with even moderate exercise.

Several supplements have shown promise in depression. Both SAMe and L-methylfolate have shown promise as additions to people not fully responding to antidepressants. Most of us in the field think they also work by themselves, although more data are needed.

The data for St. John’s Wort is plus/minus. Some evidence suggests that omega-3 fatty acids and N-acetyl-cysteine may also hold promise for the treatment of depression

If someone has a pattern of becoming depressed every winter, bright light therapy with a light box delivering at least 10,000 lux of light has been shown to be very effective. About 10% of the population suffers from some degree of low mood and energy in winter. This phenomenon is more common in cold, dark, gray places than in warm, sunny Southern ones. The power of a light box to lift mood and give energy can really be exceptional. This is an option that is sadly too often overlookied.

Many people swear by a variety of non-traditional approaches. The bottom line is that if someone is helped by these modalities and not harmed, the goal has been achieved.

Dr. Charles Raison is an associate professor of psychiatry at the University of Arizona in Tucson.

Heavy Women May Be More Likely to See Breast Cancer Recur

Heavy Women May Be More Likely to See Breast Cancer Recur

Overweight and obese women may have a tougher battle in store when it comes to breast cancer: a new study published in the journal Cancer finds that carrying extra pounds is linked with a higher risk of cancer recurrence and death.

Previous studies have linked obesity with breast cancer recurrence, but the new study is among the first to find the same trend even among women who are overweight but not obese. The researchers found that having higher body mass index increased women’s risk of breast cancer recurrence and death, even if they had state-of-the-art treatment like chemotherapy and hormonal therapy.


“We found that obesity at diagnosis of breast cancer is associated with about a 30 percent higher risk of recurrence and a nearly 50 percent higher risk of death despite optimal treatment,” said lead study author Dr. Joseph Sparano of the Montefiore Einstein Center for Cancer Care, in New York City, in a statement.

(MORE: Good News for Women With Dense Breasts: No Higher Risk of Breast Cancer Death)

For the study, researchers analyzed data on 6,885 patients with stage 1, 2 or 3 breast cancer who were enrolled in three National Cancer Institute–sponsored treatment trials. The researchers compared outcomes of obese and overweight women with those of normal-weight participants. Aside from their weight differences, all the women in the new study had normal heart, kidney, liver, and bone marrow function and were considered healthy overall.

Over eight years of follow-up, about 1 in 4 women saw their cancer come back and 891 died (including 695 women who died from breast cancer). The researchers found that the association between excess weight and cancer recurrence and death was strongest among women with estrogen receptor positive breast cancer, which is the most common type of breast cancer, affecting about two-thirds of all patients, according to the study authors.

The study wasn’t designed to identify the underlying factors connecting weight and breast cancer recurrence, but the hormone estrogen may play a role, the authors surmise. People with more fat stores produce more estrogen, which may fuel the growth of hormone receptor positive tumors.

(MORE: Study: For Some Women in their 40s, Routine Mammograms May Be Worth the Risks)

Another theory is that heavier people are more likely to be insulin-resistant and therefore to have more insulin, another hormone that is thought to trigger the growth of breast cancer cells. Having excess body fat may also cause more inflammation in the body, which could drive breast cancer cells to spread or cancer to recur. “There are several possibilities and it could be any one of these factors or a combination of a few,” says Sparano.

The authors say obese women may do better with breast cancer treatment strategies aimed at such hormonal changes and inflammation. Perhaps these women need to be treated longer, or would benefit from lifestyle changes that would encourage weight loss — and improve health overall — after breast cancer diagnosis.

The authors call for more research into whether lifestyle modification could lead to positive long-term outcomes in obese breast cancer patients. “It’s possible that changes in diet could complement chemotherapy successfully,” says Sparano.

Read more:

Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe Read more: Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe

Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe Read more: Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe



The European Medicines Agency (EMA) — the European version of the U.S. Food and Drug Administration (FDA) — launched a broad review of whether body weight influences the ability of emergency contraceptives to prevent unintended pregnancies.

The agency recently required makers of the European version of Plan B, called Norlevo, to add an alert that the product may be less effective for overweight women. The move was spurred by a 2011 study that found that women with a body mass index (BMI) greater than 25 who used levonorgestrel, which prevents pregnancy by blocking the release of the egg from the ovary, inhibiting fertilization or changing the uterine lining to discourage pregnancy, were four times more likely to get pregnant than women with lower BMIs.

Now, based on that study and other data, the EMA is turning its attention to other emergency contraceptive measures that rely on hormones to prevent pregnancy. These include Norlevo, Levonelle/Postinor and Levodonna which all contain the hormone levonorgestrel. All the medications are available over the counter, and the agency is also studying one prescription-based medication called ellaOne that includes ulipristal acetate.

It’s unclear why emergency contraception could be less effective in overweight women, but the U.S. FDA is also reviewing existing data to determine if any changes in labeling or action is necessary. Calls to the FDA were not immediately returned.

Reproductive health experts say women who are concerned about whether their emergency contraceptive will prevent pregnancy should consider other birth control methods known to be more effective, like the IUD.

Why It’s Still a Big Deal If Your Teen Smokes Pot Read more: Pot Legalization: Why It’s Still a Big Deal If Your Teen Smokes POt

Why It’s Still a Big Deal If Your Teen Smokes Pot Read more: Pot Legalization: Why It’s Still a Big Deal If Your Teen Smokes POt



With each passing day, it seems, smoking pot becomes less and less stigmatized in our society.

In a much-buzzed-about piece in The New Yorker this week, President Obama suggested making pot legal in large part to correct the vast inequities that minorities face in terms of cannabis-related arrests and imprisonment. Besides, said the president, who was known to smoke his fair share of weed back in the day, “I don’t think it is more dangerous than alcohol” for the individual user.

Even the straight-laced Bill Gates recently announced his support of legalization. And this year’s Super Bowl has been dubbed the “Super Doobie Bowl,” a reference to the fact that the teams vying for the NFL championship, the Denver Broncos and Seattle Seahawks, hail from the two states that have legalized marijuana for recreational use. Mainstream websites are circulating marijuana-laced game-day snack recipes. It won’t be long before Martha Stewart comes up with her own pot-brownie concoction.

With all of this hanging in the air, it’s obvious we parents should be talking to our kids about smoking dope. But what are we supposed to tell them when it’s clear that “just say no,” isn’t going to cut it?

After consulting with two researchers from Northwestern University’s Feinberg School of Medicine, I now know what I’m going to tell my own 16-year-old: Not so fast, buddy. Your brain simply isn’t ready for you to start using pot.

“Adolescence is a sensitive time for brain development,” says Matthew J. Smith, a research assistant professor of psychiatry and behavioral sciences. “If a teen introduces the abuse of marijuana at that point in their life, it could have consequences for their ability to problem solve, for their memory and for critical thinking in general.”

Unfortunately, this crucial message is getting lost in the pro-legalization fervor. Use of pot among adolescents, which had declined from the late 1990s through the mid-to-late 2000s, is again on the rise, according to the National Institute on Drug Abuse. One likely reason: “The percentage of high-schoolers who see great risk from being regular marijuana users has dropped,” over time the agency points out.

That perception, however, is all wrong. In a study published last month, Smith and his colleagues found that teens who smoked a lot of pot had abnormal changes in their brain structures related to working memory—a predictor of weak academic performance and impaired everyday functioning—and that they did poorly on memory-related tasks.

While the study focused on heavy marijuana users—specifically, those who indulged daily for about three years—one of its most crucial findings related not to the amount of pot an adolescent smoked, but when he or she started: The earlier the drug was taken up, the worse the effects on the brain.

“Marijuana is the ideal compound to screw up everything for a kid,” says Hans Breiter, a professor of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine, and a senior author of the study. “If you’re an athlete, a chess player, a debater or an artist, you need working memory, and marijuana hurts the brain circuitry.”

Breiter, who himself has four children 11 to 21, adds: “The more I study marijuana, the more I wonder if we should have legislation banning the use of it for everyone under 30.”

The study, which appeared in the journal Schizophrenia Bulletin, sought to distinguish the effects of daily marijuana use on the adolescent brain from the effects of schizophrenia on the deep regions of the brain that are necessary for working memory.

Although the researchers were not equating pot smokers with those suffering from schizophrenia—a chronic, disabling brain disorder—they did find parallels in one respect. “Schizophrenia is a very disruptive illness on working memory, and using marijuana produced many similar effects to schizophrenia,” Breiter says.

The scientists noted that these effects were still apparent two years after their subjects had stopped using marijuana, but more research will be needed to determine whether the neurological abnormalities in heavy teen pot smokers are permanent.

In the end, you can’t blame kids if they’ve come to believe that smoking pot is not that big a deal. The cultural cues are very strong. President Obama said he tries to fight against this by telling his own two teenage daughters: “It’s a bad idea, a waste of time, not very healthy.”

But I think that parents have an opportunity—and an obligation—to be even more pointed with our children by saying to them: “If you’re tempted to smoke pot, please hold off as long as you possibly can. Your beautiful brain is still developing.”


Randye Hoder writes about the intersection of family, politics and culture. Her articles have also appeared in the New York Times, the Los Angeles Times, the Wall Street Journal, and Slate. You can follow her on Twitter @ranhoder.

What Dreams Are Made Of: Understanding Why We Dream (About Sex and Other Things) Read more: Understanding Why We Dream

What Dreams Are Made Of: Understanding Why We Dream (About Sex and Other Things) Read more: Understanding Why We Dream



Do they predict the future or simply rehash the past? By figuring out why we dream, researchers are hoping to nail down what the nightly cavalcade of images and events means.

Ever since Sigmund Freud published his controversial theories about the meaning of dreams in 1900, we have been fascinated with the jumble of experiences we seem to live through while we slumber. Freud was convinced that dreams represent some unfulfilled desires or hoped-for wishes, while later investigators saw a more pragmatic quality to them, as reflection of waking life. None of these theories, however, have had the benefit of much in the way of solid, objective data.

At least, until now. Two new developments in research — brain imaging and big data — may offer some stronger answers. More detailed and timely snapshots of the brain at work, combined with the information researchers amassed about dreams from experiments in sleep labs, is gradually peeling away the mystery of dreams, and revealing their meaning.

From a strictly biological standpoint, scientists have learned much about the physiological process of dreaming, which occurs primarily in REM sleep. “During dreaming,” says Patrick McNamara, a neurologist at Boston University School of Medicine and the graduate school of Northcentral University in Prescott Valley, Ariz., “the limbic part of the brain—the emotional part—gets highly activated while the dorsal lateral prefrontal cortex, the executive part of the brain, is under-activated. So the kind of cognitions we experience during dreams are highly emotional, visually vivid, but often illogical, disconnected and sometimes bizarre.” That suggests that our dreams may have some role in emotional stability.

That does not necessarily mean, most dream researchers believe, that dreams are random expressions of emotion or devoid of some intellectual meaning. While some scientists maintain that dream patterns are strictly the result of how different neurons in the brain are firing, Deirdre Barrett, a psychologist and dream researcher at Harvard Medical School, believes they represent something more.  “I think it’s a fallacy that knowing brain action negates a subjective, psychological meaning any more than it does for waking thought. I think dreams are thinking in a different biochemical state.”

Defining that state, not to mention understanding the rules under which that universe operates, however, is a challenge. It may represent a complex interplay between emotional and cognitive information, says McNamara, so that dreams serve to help our brains process emotional memories and integrate them into our long-term memories. And because traumatic events are associated with higher levels of the stress hormone cortisol, they can cause nightmares. Researchers believe that excessive amounts of cortisol can impair the interaction between the hippocampus and the amygdala, the two main brain systems that integrate memory. “The memories don’t get integrated,” he says, “but just sit around. In post traumatic stress disorder, they get re-experienced over and over.”

In fact, from sleep studies in which people were exposed to images, learning tasks or other experiences immediately before they dozed off and then examined when they awakened, many scientists believe that dreams can help us rehearse for challenges or threats we anticipate—emotionally, cognitively and even physiologically. In our dreams we may try out different scenarios to deal with what’s coming up. Although much of the evidence for this is anecdotal, McNamara says, someone practicing piano or playing video games in waking life may start to do the same while dreaming. People solving a puzzle or studying a foreign language, he adds, can have breakthroughs with dreams that go beyond the perceptions that simply taking a break from the problem can produce. 

And now, Barrett says, brain imaging holds the promise of being able to help scientists “see” what until now could only be reported by subjective, possibly inaccurately recalled, dream accounts. For example, in research with rats trained to run through mazes to get rewards, investigators were able to record neuron activity in sleeping rats and determined that the rats were running the same mazes in their dreams.

In other experiments with humans, scientists monitored volunteers who slept inside an fMRI scanner while hooked up to EEG electrodes that measured brain wave activity. When the EEG indicated they were dreaming, the participants were awakened and asked what images they had seen in their dreams. The investigators were later able to match certain patterns of brain activity to certain images for each person.  “There’s a crude correspondence between the brain scan and the image. “From the scan, you can guess it’s an animal with four legs,” says Barrett. Despite the primitive state of this dream decoding, the ability to actually glean content from a dream is getting closer.

Mining big data bases of reported dreams holds another kind of promise. Until now, researchers have been working on relatively small samples of dream accounts, usually fewer than 200 per study. But new dream websites and smartphone apps like DreamBoard and Dreamscloud are encouraging thousands of people to report their dreams into larger repositories so researchers can finally answer their most urgent questions.  McNamara, for example, is excited to study dreams from different countries to see whether there are cultural differences in what people’s brains do when they aren’t awake.

The data bases also provide an opportunity to investigate the intriguing but under-studied realm of sex dreams. Until recently, says McNamara, they represented only 10% of reported dreams, likely because people are not eager to share this type of content with researchers in white lab coats. But self-reporting via the apps and websites, despite its potential biases, may provide more information on these types of dreams. “This is a wide open area crying for investigation,” he says.

McNamara is also eager to study individuals’ dreams over time to observe differences and changes in emotional tone, colors, words and other significant patterns and connect these to events in their lives. That would bring him closer to answering whether dreams are, in fact, prophetic — it might be possible, for example, that certain kinds of dreams precede getting the flu, or that other other dreams are more associated with happier events.

Such investigations could also reveal more about less welcome dreams, such as nightmares, and potentially lead to ways to control or avoid them. Barrett plans to mine the new database to study how often nightmares occur, and how they relate to an individual’s trauma or a family history of anxiety disorder. One of her first projects will involve the dream data from, which has accumulated 165,000 dreams over the last two years. Because Dreamboard has coded the dreams by the gender, colors, emotions (joy, anxiety, anger) and the number and categories of people in a dream, Barrett says she can identify basic patterns.

We already know, she says, that women dream equally about men and women while men’s dreams are two-thirds populated by men. Research so far also shows that men’s dreams may show slightly more anger and physical aggression while women’s display a bit more sadness and verbal hostility. Interpreting what these differences mean, however, will require deeper studies.

What’s been discovered so far, however, suggests that such studies could reveal an enormous amount about what role dreams play in our lives, and how important they are for biological, psychological or social reasons. With this research, McNamara believes, scientists can find out if what shrinks have been saying for years is true — that reflecting on our dreams is useful and can give us insight into ourselves. Psychologists say so, and many people think so. But this research, he says, gives us the potential to know.
Read more: Understanding Why We Dream |