Twenty six out of the 47 articles in Roman et al.’s meta-analysis had sample sizes of 50 or fewer, only three used a random sample, very few used a comparison group (i.e. non-cycling women such as those using the pill or other anovulatory agent), none included in their methodology an a priori quantification of what is a meaningful increase in symptoms of PMS, the list goes on. The authors themselves expressed their regret over how flawed or inadequate the studies were. The most reasonable conclusion for the authors to have drawn is not that the research to date fails to provide evidence of PMS and therefore it must be a cultural construct, but rather that the research to date has been of such poor quality that it is unable to answer the question of whether or not menstrual cycles significantly affect mood and quality of life. The adage “garbage in, garbage out” applies.
That is a good question. It makes intuitive sense that if you prevent the ovaries from ovulating by using the pill/ring/patch/depo/implant (all work by preventing ovulation) you can preserve or extend their reproductive life. Unfortunately, that is not the case. The ovaries and the follicles (eggs) they contain age right along with the rest of the body, regardless of whether or not you use the pill, etc. Just the same way the number of pregnancies you have does not affect when you become infertile (ovaries are quiescent during pregnancy as well). Taking the pill does have other important health advantages though, such as reducing one’s risk of developing ovarian or uterine cancer, and, of course, preventing undesired pregnancy.
Unlike here in the US, where thanks to the pap and early surgical intervention cervical cancer is a relatively minor killer of women– about 4,000 deaths yearly compared to about 40,000 from breast cancer, in the developing world cervical cancer is a major killer of women. These are countries where women do not get pap smears, and even when they do, often there aren’t enough pathologists to read the slides or medically trained staff to perform important interventions. Prevention of HPV infection with HPV vaccines in these settings is our best bet for stopping these horrible deaths of women in their prime of life. Thankfully the HPV vaccines will make their impact where the suffering is greatest.
Are the HPV vaccines a good thing for the health of women in this country? Sure. Are they necessary? No. We have done an excellent job of reducing cervical cancer mortality without the benefit of the vaccines. If we can reduce it further, great. However, HPV infection does not warrant this high level of attention. These vaccines have gotten dragged into the general anxiety about vaccines, with an added kick because they are associated with sexual behavior. This stuff is complicated, but very little of it really matters for us the way it matters for people less fortunate. As a physician I find it so embarrassing when doctors in the media feed off and promote hysteria. Whom are they really trying to benefit? I think we all know the answer to that.