Mother Daughter Relationship Important Key To HPV Vaccination

College women were more likely to be vaccinated against human papillomavirus (HPV) if their mothers communicated with them about sex and if they thought their mothers would approve of their getting vaccinated, according to new Dartmouth research.

Meg Gerrard, PhD, of Dartmouth Medical School and Norris Cotton Cancer Center, Megan Roberts, a PhD student at Dartmouth College, and their colleagues, surveyed 972 female undergraduates at a large Midwestern university between November 2007 and April 2009.

An anonymous questionnaire assessed the undergraduate’s sexual-risk behavior, knowledge of HPV, perceptions of HPV risk, communication from their mothers about sex-related topics (including HPV), and their current vaccination status.

Sixty-five percent of the women reported being sexually active, and 49 percent reported having received at least the first of the three-shot HPV vaccine series.

Those who were unvaccinated were more likely to be interested in future vaccination if they thought their mothers would approve. The young women’s perceptions of their risk of contracting HPV also contributed to their interest in getting vaccinated. Young women whose mothers had discussed values in relation to sex were, as a group, less interested in being vaccinated.

The authors concluded that “mother-daughter communication and approval of vaccination emerged as important predictors of young women’s HPV-vaccination behavior and intentions, even after the women were old enough to not require parental approval.” They also noted that college-age women “are still a very important population to target for vaccination.”

The study was published in the journal Pediatrics. For more information, visit: www.dartmouth.edu/

Awakening Desire: Understanding Female Sexual Dysfunction

Many women experience problems in the bedroom at one time or another. Female sexual dysfunction (FSD) is not uncommon and although some women and healthcare providers have difficulty discussing it, it has been recognized by the medical community for decades. In fact, for the last twenty years, it has been listed in the Diagnostic and Statistical Manual of Mental Disorders, a manual published by the American Psychiatric Association, used to classify and diagnose psychological disorders.

FSD can develop at any age, but many women report sexual problems at times of hormonal fluctuation; for example: post-pregnancy or during menopause. FSD encompasses several conditions that can have an effect on a woman’s health and cause concern and suffering. These symptoms include:

- The desire to have sex is low or absent.
- An inability to maintain arousal during sexual activity, or become aroused despite a desire to have sex.
- An inability to experience an orgasm.
- Pain during sexual contact.

Hypoactive sexual desire disorder (HSDD) affects roughly 1 in 10 women and is the most common sexual dysfunction among women of all ages. It is sometimes difficult to diagnose because a woman’s sex drive varies tremendously from person to person. And the factors causing a lowered sex drive can range from psychological to biological. But some women underestimate what an important role sexual health plays in their overall health and well-being. And if the lack of desire becomes distressing in any way or interferes with her overall quality of life, she may have HSDD.

Many women suffer in silence and some even feel that a decline in sexual desire is a normal part of aging. According to Sheryl A. Kingsberg, PhD, a clinical psychologist and Professor in the Department of Reproductive Biology at Case Western Reserve University School of Medicine in Cleveland, Ohio: “Women should not be expected to accept a distressing loss of sexual desire any more than they should be expected to simply accept arthritis, acid reflux, or any other condition often associated with aging.”

Unfortunately, HSDD in women is not as well recognized as erectile dysfunction (ED) in men. There are many medications available for the treatment of ED, but currently, there are no US FDA approved medications for women with HSDD.

“The problem is further compounded by a lack of attention and interest in women’s sexual satisfaction in many cultures,” said Kingsberg. And as a result, “some women may feel that it is not appropriate to seek help for a sexual problem.”

There are options available. An important step in getting help for FSD is realizing that there is a problem. Too many women ignore their symptoms or are unable to recognize that they have a treatable issue.

Kingsberg suggests that: “Women should speak to their partners about the problem and (they may consider) seeing a professional for guidance; this professional may be a counselor, a sex therapist, a physician or nurse practitioner, or some other trusted person.”

Psychotherapy or sex therapy can be very effective in uncovering the different components that may contribute to the problem. There are a few medical treatments which include hormonal therapies that may help some women. “A number of other very exciting new approaches to the treatment of low sexual desire in women are under development,” said Kingsberg, “and may be available soon.”

The Society for Women’s Health Research (SWHR), a national non-profit organization based in Washington D.C., is widely recognized as the thought leader in women’s health research, particularly how sex differences impact health. SWHR’s mission is to improve the health of all women through advocacy, education and research. Visit SWHR’s website at swhr.org for more information.

Psychologist Wins Grant To Reduce Risky Sexual Behavior Among African American Girls

Developing and evaluating a faith-based, HIV-prevention program for African-American mothers and their daughters is the focus of Dr. Chisina Kapungu’s $795,000 career development grant from the National Institute of Mental Health.

Kapungu, assistant professor of obstetrics and gynecology at the University of Illinois at Chicago, is a clinical psychologist who has worked on HIV prevention programs, conducted research on the multi-systemic factors of HIV risk in African-American adolescents, and counseled HIV-infected women and kids.

Her proposed research project will work with two Chicago churches to pilot a faith-based HIV prevention program for community-based educators to administer to women and their daughters, ages 13 to 16.

The project, while still in the development stage, is “going to be very collaborative, very much based on principles of community-based participatory research, with shared decision-making throughout the process,” said Kapungu, who developed the project while completing a post-doctoral fellowship at UIC’s Institute for Health Research and Policy.

The intervention is based on two existing HIV prevention programs — one developed by the Religious Coalition for Reproductive Choice in Washington, and the other an evidenced-based program, Sisters Informing, Healing, Living, and Empowering, recommended by the U.S. Centers for Disease Control and Prevention and proven effective among African-American women and girls.

Kapungu plans to integrate the two programs and customize the curriculum based on the needs of the community, to include information about parental monitoring, assertive communication, and negotiating safe sexual practices.

“The goal of the intervention is to decrease sexual possibility situations and delay the onset of sexual debut,” said Kapungu, who describes the intervention as not focused on condom usage.

Research has shown that family factors such as parental monitoring, communication, and parental attachment are associated with delays in sexual intercourse among adolescents, Kapungu said. “There really hasn’t been empirical work in implementing faith- and family-based HIV interventions.”

Although African Americans are 13 percent of the U.S. population, they experience 59 percent of the HIV/AIDS cases in the country, according to the CDC.

“The church has been an untapped resource within the HIV prevention field and can have a potentially important role in educating young people about sexuality and HIV,” Kapungu said. “Worldwide, faith-based organizations have focused on secondary prevention, counseling and support for infected individuals and peer education groups, but less on primary prevention.”

UIC ranks among the nation’s leading research universities and is Chicago’s largest university with 26,000 students, 12,000 faculty and staff, 15 colleges and the state’s major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

For more information, visit www.uic.edu

Convenience Drives U.S. Women To Buy Over-The-Counter Contraception In Mexico

American women who live along the U.S.-Mexico border frequently buy over-the-counter oral contraceptives from Mexican pharmacies because they don’t need a prescription and can send a friend to pick up the pills, according to a study by researchers from two University of Texas campuses and Ibis Reproductive Health.

The research, conducted in the El Paso-Juarez area, suggests there is demand in the United States for over-the-counter birth control pills and that many U.S. women would buy such contraception without a doctor’s prescription if given the option.

“The fact that many women in El Paso make use of the cross-border option suggests a substantial latent demand for an over-the-counter option at pharmacies in the United States,” said lead author Joseph E. Potter, a professor in the Sociology Department and Population Research Center at The University of Texas at Austin.

“Since crossing the border can be time-consuming for many, a domestic over-the-counter option would provide even more convenience than the cross-border option that’s available in El Paso,” he said.

The study’s other authors are Kari White and Kristine Hopkins of The University of Texas at Austin, Jon Amastae of the University of Texas at El Paso, and Daniel Grossman of Ibis Reproductive Health, a non-profit research organization based in Cambridge, Mass., and Oakland, Calif.

Women are now required to get a prescription to obtain oral contraceptives in the U.S. But the high prevalence of unwanted pregnancy and mounting evidence about the safety of such pills have led some to call for an over-the-counter option.

Grossman, who also coordinates a group of researchers, clinicians and advocates exploring the feasibility of an over-the-counter option for pills in the U.S., said, “This study gives us a better idea of who might take advantage of the over-the-counter option if it were available in the U.S., and it suggests that it would appeal to a broad range of women.”

As part of the study, researchers interviewed more than 1,000 El Paso women, about half of whom obtained their birth control pills across the border at Mexican pharmacies and half of whom went to U.S. clinics to get their pills.

Older women and those who were born and educated in Mexico were more likely to buy their pills in Mexican pharmacies. Women who received public assistance from such federal programs as Women, Infant and Children were more likely to go to the U.S. clinics.

Among both groups, most of the women said they believed the facility where they obtained the pills was cheaper and more convenient than the options on the other side of the border.

About 90 percent of the women who obtained oral contraceptives on the U.S. side said they trusted their clinic to give them good information (versus 46 percent of Mexican pharmacy consumers) and that they liked the other health services provided there.

Conversely, about 90 percent of the women who bought pills from the Mexican pharmacies said they wanted to bypass a doctor’s prescription and be able to send family or friends to pick up the pills.

“Making oral contraceptives available over the counter in the U.S. would add another option for women who find the clinic inconvenient or inaccessible. Our research shows that some women highly value the services they receive at clinics, and it’s important that they continue to have access to those services even if the pill goes over the counter,” said Grossman.

The findings are published in the American Journal of Public Health. For more information, visit: www.utexas.edu.

HIV Preventive Gel Begins Testing With $350,000 Grant

 A gel designed to protect heterosexuals from the transmission of HIV will be tested for safety at the Los Angeles Biomedical Research Institute (LA BioMed), at Harbor-UCLA Medical Center, funded by a $350,000 grant.

The grant will be used for 180 volunteers, women age 18-40, to participate in a 12-week evaluation of the gel’s absorption and safety of absorption into women’s tissue. The study will be conducted at LA BioMed and an additional four sites.

The grant is supported by the International Partnership for Microbicides (IPM) a nonprofit global initiative to develop products for the reduction of HIV transmission and the U.S. Agency for International Development (USAID).

“IPM is committed to providing women with an affordable and self-initiating HIV-prevention strategy. The organization’s goal is to reduce the cycle of infection that has led to the deaths of more than 25 million people worldwide and orphaned more than 15 million children since 1981,” Dr. Susan Ballagh said, as she begun her recruitment of volunteers for LA BioMed’s study.

“If this gel is found to be safe, further testing will be undertaken to determine its effectiveness in preventing the transmission of HIV,” she concluded.

For more information on the study or how to become a part of it, visit: www.labiomed.com or call (310) 222-3840.

Encouraging Home Test Kits Could Increase HPV Detection

 

More high risk cases of human papilloma virus (HPV) could be detected by offering home testing kits to women who do not come forward for cervical screening, according to research published online in the British Medical Journal.

While cervical cancer screening programs in Western countries (U.S.) have contributed to a decrease in deaths from cervical cancer, one of the major drawbacks remains the number of women who do not come forward for smears.

Researchers in the Netherlands, led by Professor Chris Meijer from the VU University Medical Centre, investigated whether home testing kits would improve HPV detection rates. It has long been established that some strains of HPV are found in most cases of cervical cancer so early discovery is important.

As part of the Dutch cervical screening program, PROHTECT, the authors identified 28,073 women who had not responded to two invitations for screening.

Meijer and his team invited 27,792 of these women to use the Delphi Screener device to collect a cervical fluid sample at home and return it to the researchers. The remaining 281 women were recalled for a conventional cervical screening test.

The results show that over a quarter (26 percent) of the self-sampling group fulfilled the request, compared with only 1 in 7 (16 percent) of the recall group.

Participants in both groups whose samples were HPV positive were referred for further tests.

The authors conclude that using home testing kits for detecting HPV is an effective way to target women who do not attend for cervical screening and that it would lead to twice as many cases of cervical cancer being diagnosed compared with the regular screening program.

For more information, visit: www.bma.org.

Survey Finds: Most Women Not Worrying About Sexual Effects Of Gynecologic Surgery

 

Most women scheduled for gynecologic surgery to address noncancerous symptoms said in a recently published survey, by the Ohio State University, that they were not worried about the effects of the procedure on their sex lives.

However, a surprising 37 percent of women planning to be sterilized did express concern in this study that they might have less sexual desire after the operation – even though that surgery does not affect hormone levels.

Among those in the study who were having reproductive organs surgically removed, fewer than 15 percent expressed concerns about sex. Women scheduled for ovary removal were more likely to expect to lose sexual desire and enjoy sex less after surgery than were women scheduled for hysterectomies.

“Most women were not very concerned, and among any women who do have these worries, I think we can reassure them that they don’t necessarily have to fear a detriment to sexual function,” said Jonathan Schaffir, a clinical associate professor of obstetrics and gynecology at Ohio State University and senior author of the study.

“Some women who have their ovaries removed might have a decrease in hormone levels and might have a problem, but that is certainly not the rule,” he said.

Ovary removal leads to menopause in women, which can be characterized by such symptoms as hot flashes, night sweats, sleeping difficulties, irritability and vaginal dryness, as well as the possibility of reduced interest in sex, Schaffir said. He added that doctors can offer remedies, especially a variety of therapies to replace lost estrogen, for most of those symptoms.

Hysterectomy – removal of the uterus – and sterilization through tubal ligation or other, less invasive methods do not affect hormone levels.

Schaffir said the findings also pointed to differences in counseling proficiency between long-term attending physicians and medical residents, suggesting that residents could benefit from additional training in how to address sexual function concerns with patients who are scheduled for these surgeries.

Schaffir and colleagues collected data over six months from women admitted for benign gynecologic surgeries at Ohio State University Medical Center. During that time, 150 women were admitted for eligible surgeries, and 75 women completed the surveys.

Demographically, the women were not all that different, except in age. Patients undergoing sterilization were significantly younger than those having their ovaries or uteruses removed, and women undergoing oophorectomy – ovary removal – were generally older than those having a hysterectomy. Between 68 percent and 74 percent of the women reported that they were sexually active.

Though the patients were not questioned about symptoms or circumstances that led to their surgeries, Schaffir said most benign hysterectomies and oophorectomies are done to treat fibroid tumors, abnormal bleeding or chronic pain.

Sterilization options for the women included either tubal ligation or a nonsurgical procedure that involves permanently blocking the fallopian tubes with an instrument inserted through the vagina.

The questionnaire contained 10 statements about sexual function and asked the women to answer whether they agreed or disagreed with the statements on a scale of 1 through 5, with 1 representing strong agreement and 5 representing strong disagreement.

Women undergoing oophorectomy were the most likely to agree with two statements regarding sexual function: “I may have less sexual desire after surgery” and “This surgery will make me less able to enjoy sex.” Women having hysterectomies were the least likely to agree with those statements.

Overall, 10 percent of women having hysterectomy and 13 percent of women having oophorectomy thought they would have lower sexual desire following surgery, and 13 percent in each group agreed that they would feel less feminine after the procedures.

The 37 percent of women facing sterilization who believed they would have less sexual desire after the procedure took Schaffir by surprise.

“The opposite is often true. And research has also been done that shows that women who have an effective method of contraception feel free to participate more sexually because they no longer have fear of pregnancy,” he said. “These procedures don’t change the hormone levels or the anatomy. So it’s a little unclear where that fear might come from.”

He also noted that reproductive organ removal, and even ovary loss, should also improve sex for some women, depending on their symptoms leading to the surgery.

“Hormones contribute to sexual desire, but there are so many other issues that influence how a woman is able to function sexually and how much she will want to have sex, a large part of it being confounding medical issues,” Schaffir said. “If someone is bleeding all the time, she’s not going to want to have sex, and the same is true if she’s in horrible pain and sex causes discomfort. So surgery can relieve a lot of problems and improve her sex life even if there is some hormonal disruption.”

On average, the women surveyed did not wish for more time to discuss the sexual effects of the surgeries. Most also did not initiate the discussion with their doctors about sexual effects of surgery.

“If it was going to happen, the doctor probably initiated the discussion,” Schaffir said.

The researchers also gauged women’s reactions to certain issues based on whether they were referred for surgery by a private attending physician or a medical resident practicing in the Medical Center clinic.

More than half of patients seeing private doctors agreed that their physicians spoke to them about how the surgery could affect their sex life, compared to just 19.5 percent of patients counseled by residents. Almost 20 percent of the women counseled by residents expressed the wish for more discussion about sexual effects of surgery, vs. just 6.3 percent of patients seen by private doctors expressing the same wish.

One in four women counseled by private physicians also looked elsewhere for information about sexuality and sexual function, compared to 7.3 percent of patients counseled by residents.

Schaffir said most resident training, especially in the first two years of a four-year program, emphasizes treating pregnant women because they constitute the majority of patients seen in the clinic. Performing surgeries and counseling patients facing major surgery typically come later in training, particularly during the fourth year, Schaffir said.

“This is just one questionnaire at one hospital, but I would guess it could be generalized to the typical training schedule at other academic centers,” he said. “This survey suggests residents should probably be getting that training earlier on to be sure they raise important points with patients.”

Because the study was small, Schaffir said researchers could get a better idea of women’s perceptions of their sexual function after surgery if they were questioned before the procedure and again a few months later.

“A lot of sexual topics are under-researched. But it is more openly discussed than it was 50 years ago,” he said.

Co-authors of the study were Mary Fleming and Valerie Waddell, both of Ohio State’s Department of Obstetrics and Gynecology.

The survey findings are detailed in a recent issue of the Journal of Sexual Medicine; for more information, visit: www.wiley.com/bw/journal.asp?ref=1743-6095&site=1.

UW Researchers Eliminate Cervical Cancer in Mice with FDA-Approved Drugs

Researchers at the University of Wisconsin (UW) School of Medicine and Public Health have eliminated cervical cancer in mice with two FDA-approved drugs currently used to treat breast cancer and osteoporosis.

The drugs, which keep estrogen from working in cells, also cleared precancerous growths, or lesions, in both the cervix and vagina, and prevented the onset of cancer in mice that had the precancerous lesions.

“We have begun to test whether the drugs are as effective in treating cervical cancer in human cells as they are in our mice,” said senior author Dr. Paul F. Lambert, of the McArdle Laboratory for Cancer Research and the UW-Madison Carbone Cancer Center.

The lab studies, which should take one or two years to complete, could be followed quickly with phase-two or phase-three clinical trials. Early-phase trials would not be necessary since the drugs have already been approved for clinical use, researchers said.

Lambert and his team use special mice they developed more than 20 years ago to study cervical cancer. The mice were genetically engineered to carry human papillomavirus (HPV) 16, known to be strongly associated with cervical cancer.

HPV is also the most common sexually transmitted infection in women in the United States. While new vaccines can prevent some of the many kinds of HPV infections, they do not eliminate already-existing infections or cervical cancers or precancerous lesions arising from pre-existing infections.

“Virtually all cervical cancers in women test positive for HPV 16,” said Lambert, a professor of oncology at the UW School of Medicine and Public Health.

But not everyone who becomes infected with HPV gets cervical cancer, so scientists have suspected that something else was going on.

“Since the cervix and other female reproductive organs are so responsive to estrogen, our lab and others began to focus on that hormone,” Lambert said.

Dr. Sang-Hyuk Chung, a postdoctoral fellow in Lambert’s lab, zeroed in on one of the two receptors that mediate estrogen function in cells-estrogen receptor (ER) alpha. He crossed his HPV mice with mice in which ER alpha had been knocked out, then gave the animals estrogen. When the mice didn’t develop cervical cancer or even precancerous lesions, Chung knew that ER alpha was an essential player in the slow cancerous process.

“We then wanted to learn if drugs that interfere with the receptor and block estrogen’s ability to bind to it could be used to treat or prevent cervical cancer,” he said.

Chung turned to an ER alpha blocker used to treat breast cancer, fulvestrant, and tested it on the HPV-positive mice with cervical cancer. After one month, he found that 11 of 13 mice lost all signs of cancer. But cancer remained in all the control mice that hadn’t gotten the drug.

“It was amazing to see that not only was the cancer gone, but all the precancerous lesions that give rise to cancer were also gone,” said Lambert.

Chung then tested a second drug, raloxifene, which is used to treat breast cancer and osteoporosis, to make sure that the first results weren’t a fluke. He found the same strong, blocking effect.

Finally, the researchers gave the drugs to animals with the precancerous lesions and found that the ER alpha blockers prevented the lesions from progressing to cancer.

Lambert’s team is now testing human cervical cancer cell lines to see if ER alpha blockers stop the growth of the malignant cells. The next step will be to test the drugs on tissue samples removed from women following surgery for the cervical cancer.

“We can’t be sure how the science will translate from animals to humans,” says Lambert, “but we have faith in our mouse model. There are many similarities in how cervical cancer develops and manifests itself in women and in mice.”

The study was published in the Proceedings of the National Academy of Sciences. For more information, visit: http://www.pnas.org/

Psychiatric Disorders Associated With Lower Urinary Tract Symptoms

Depression, anxiety disorders and sexual trauma have all been implicated as risk factors in lower urinary tract symptoms (LUTS) such as incontinence and overactive bladder. The exact nature of these associations is unknown.

In a study published online in The Journal of Urology, researchers from the Division of Urology, Virginia Commonwealth University School of Medicine and the Hunter Holmes McGuire Veterans Affairs Hospital, Richmond, Virginia, explored the possible association of LUTS with those factors.

Two questionnaires, the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7, were administered to 121 women referred to a specialized urology clinic for evaluation of lower urinary tract symptoms. The data was then analyzed according to psychiatric comorbidities, history of sexual trauma, age, race and obstetric history.

Baseline incidence of psychiatric comorbidity and sexual trauma was also compared to a control population of 1,298 women from the Veterans Affairs primary care clinic.

Women referred for evaluation of lower urinary tract symptoms had higher rates of psychiatric comorbidities, 64.5 percent vs. 25.9 percent, and sexual trauma, 49.6 percent vs. 20.1 percent compared to those in the primary care clinic.

Separate analysis showed that women younger than 50 years and with a history of miscarriage had higher Urogenital Distress Inventory-6 scores, while higher Incontinence Impact Questionnaire-7 scores were associated only with psychiatric comorbidities and history of miscarriage, researchers found.

Adam P. Klausner, MD, and colleagues stated in the study’s article, “This is the first study to our knowledge to characterize the association of psychiatric comorbidities and sexual trauma with the type, severity and quality of life impact of LUTS in women using validated surveys. The prevalence of psychiatric comorbidities and sexual trauma is high in women veterans presenting for evaluation of LUTS.”

Dr. Klausner is an associate professor and the Director of Neurourology, Female Urology, and Voiding Dysfunction at Virginia Commonwealth University Medical Center.

For more information, visit: www.jurology.com.

Study: Birth Control Doubles Chance OF Stroke

A 30-year old woman began to experience the classic symptoms of a stroke. What triggered her stroke, at such a young age, may have been the birth control pills she was taking. Oral contraceptives nearly double the risk of stroke, according to a review article in MedLink Neurology by three Loyola University Health System neurologists.

Nearly 100 million women worldwide use birth control pills. Pills now in use contain much lower concentrations of estrogens than older preparations. The relationship between oral contraceptives and stroke has been studied and debated for decades, and studies have yielded conflicting results.

There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. Birth control pills increase the risk 1.9 times, to 8.5 strokes per 100,000 women, according to a well-performed “meta-analysis” cited in the article. (A meta-analysis combines the results of multiple studies.) This is still a small risk; there’s one additional stroke for every 25,000 women who take birth control pills, according to the article.

But for women who take birth control pills and also smoke, have high blood pressure or have a history of migraine headaches, the stroke risk is significantly higher, researchers said.

“When prescribing oral contraceptives, doctors should balance the risks and benefits for each individual patient,” said senior author Dr. Jose Biller. “For a healthy young woman without any other stroke risk factors, the benefits of birth control pills probably outweigh the risks. But if a woman has other stroke risk factors, she should be discouraged from using oral contraceptives.”

The 30-year-old woman was one of two patients described in the article. She had suffered migraine headaches since she was 15 years old, which further increased her stroke risk. Doctors took her off birth control pills and gave her medication for her migraines.

Authors also described a 27-year-old woman who suffered severe right-sided headaches, nausea, vomiting and unsteadiness while on oral contraceptives. She stopped taking birth control pills and was treated with a blood thinner for six months. On a follow up visit, she was doing well except for occasional headaches.

“These observations obviously need to be considered in the proper context of a careful understanding of possible risks and benefits associated with the use of oral contraceptives, as well as those associated with other forms of contraception,” Biller said.

How oral contraceptives might cause strokes is not completely understood, the researchers noted.

But two possible mechanisms are the increased risks of blood clots and high blood pressure associated with oral contraceptives, authors wrote.

Biller is chairman of the Department of Neurology at Loyola University Chicago Stritch School of Medicine. His co-authors are Dr. Michael J. Schneck, a professor in the Departments of Neurology and Neurological Surgery and lead author Dr. Sarkis Morales-Vidal, a stroke fellow in the Department of Neurology.

For more information, visit: http://loyolamedicine.org/ or www.medlink.com.