Misconceptions about Miscarriage
Many women suffer silently, a cycle that leads to further misconceptions and isolation. Below, NPR talks to women about their personal experiences & challenges, along with the medical facts:
Most people think a miscarriage is rare, and many believe that if a woman loses a pregnancy that she brought it upon herself. Neither of those things is true, but the enduring beliefs cause great pain to women and their partners.
In fact, almost half of people who have experienced a miscarriage or whose partner has had one feel guilty, according to a survey to be published Monday in Obstetrics & Gynecology. More than a quarter of them felt shame. Many felt they’d lost a child.
When NPR asked visitors to its Facebook page to tell us what they wished people knew about miscarriage, the response was overwhelming — 200 emails and counting, many heartbreaking. Their sentiments often echoed what the survey found.
“I wish people knew how much it’s possible to miss a person you have never met, and to mark time by their absence,” wrote one woman. “I will always think about how old my baby would be now and what our lives would be like if I hadn’t lost the pregnancy.”
The survey came about after Dr. Zev Williams realized that many of his patients had misconceptions about miscarriage. “I’d tell them how common a miscarriage was, and they seemed shocked,” says Williams, an OB-GYN who directs the Program for Early and Recurrent Pregnancy Loss at Einstein College of Medicine of Yeshiva University and Montefiore Medical Center in New York.
In fact, between 15 percent and 20 percent of clinically recognized pregnancies end in miscarriage, defined as a pregnancy loss earlier than 20 weeks of gestation. (Pregnancy loss after that point is called a stillbirth.) Miscarriage is actually “by far the most common complication of pregnancy,” says Williams. He and his colleagues wanted to find out how widespread some of the mistaken beliefs about miscarriage are.
They asked 1,084 adults about miscarriage and its causes. They also asked the 15 percent of survey respondents who had suffered a miscarriage, or whose partner had, about their experience. The results echoed what he’d seen in his patients: Some 55 percent of all respondents believed that miscarriage occurred in 5 percent or less of all pregnancies.
The cultural silence around miscarriage contributes to those misunderstandings, Williams says. “A lot of other conditions that people used to speak of only in hushed tones, like cancer and AIDS, we speak about a lot more,” he says.
Not so for miscarriage. Because early pregnancy loss is so common, women are often advised not to share their pregnancy news with friends and family until the start of the second trimester. At that point the chance of miscarriage has drastically declined. But that secrecy means women who do miscarry in the first trimester may not get the support they need, Williams says.
“It’s bizarre that the topic is so taboo,” wrote one reader on Facebook. “I really feel an obligation now, having had a miscarriage, to mention my miscarriage when I’m talking about fertility or the process of conceiving or childbirth.” She added a sentiment that many other women expressed: “I felt alone until I realized there is this big, secret miscarriage club — one that nobody wants to be a member of — and when I realized it existed, I felt angry that no one told me they had active membership.”
Chromosomal abnormalities in the fetus cause 60 percent of miscarriages. A handful of other medical conditions are also known to cause miscarriage. Most survey respondents knew that genetic or medical problems were the most common cause of early pregnancy loss. But they also mistakenly believed that other factors could trigger a miscarriage: a stressful event (76 percent); lifting something heavy (64 percent); previous use of contraception like an IUD (28 percent) or birth control pills (22 percent); and even an argument (21 percent). Some 22 percent believed that lifestyle choices, like using drugs, tobacco or alcohol, were the single biggest cause of miscarriages. That’s not true.
Those who shared their experiences with NPR said many of those myths were repeated back to them by friends, family or colleagues after their own miscarriages. One said someone blamed her high heels. That kind of talk can be incredibly painful, even if you know you have the facts on your side.
“I wish people understood that miscarriages are the flip side of the coin,” wrote one woman. “If you’ve had a healthy pregnancy that went full term — you won a lottery. Short of obvious substance abuse and bull riding — your healthy baby is not the result of anything you did or didn’t do. As much as you want to think you are in control — you aren’t. And the same goes when I lost each pregnancy — as much as I wish I could have been — it was not in my control.”
The feelings of guilt, shame and enormous loss reported in the survey were a common theme among those who told their stories to NPR. “I felt, and feel, literally broken, and betrayed by my body,” wrote one woman. “It’s irrational, but there is such a deep shame attached to not being able to carry a baby to term…. I don’t want another baby, I want THIS baby, the one I thought I would have, the one I started planning for, hoping for, dreaming about, talking to. All that got taken away from me.”
Not everyone was so deeply affected; some said the miscarriage came as a relief, either because the pregnancy was unwanted, or because they’d known something wasn’t quite right. Or they said it was painful at the time, but that they’d moved on and weren’t particularly haunted by the loss. “You have every right to feel ALL of your emotions you have,” wrote one person. “Whether you feel grief or relief, your emotions are never wrong.”
But because the loss can be so great, people said they wished others would acknowledge a miscarriage without reverting to a laundry list of well-intentioned but hurtful lines: “Well, at least you know you can get pregnant.” (One reader said this was particularly upsetting after her seventh miscarriage.) “You can always try again.” “If you adopt, you’ll get pregnant.” “It happens for a reason.” “It’s God’s plan.” (That, wrote another reader, sounds an awful lot like “God doesn’t want you to be a parent.”)
Far better, people said, is to simply say, “I’m sorry. Is there anything I can do for you?”
Over and over again, we heard a wish that there was more private and public discussion of miscarriage. “Many women in my family had suffered one or more, and I had no idea until I had one myself,” wrote one woman. “I felt that no one I knew had gone through this.”
Several readers said this code of silence was even stronger for the partners of women who miscarry. One reader wrote that her husband “had hopes and dreams and fears and so much joy tied up into 9.5 weeks of cells,” but he didn’t get time off work, flowers or well-wishes from colleagues or visits from friends to “listen to him cry,” as she did. Instead, “He had to suffer alone.”
The new survey found that 46 percent of respondents who’d miscarried said they felt less alone when friends talked about their own miscarriages. Even a celebrity’s disclosure of miscarriage helped.
One person who recently suffered a miscarriage summed it up: “While I’m definitely still healing emotionally, I would be happy to talk more about it. So many people grieve silently, but I’ve found that talking really helps the most.”
That’s the kind of conversation that Williams says he and his co-authors would like to spark with their survey. “Miscarriage is ancient. It’s always been there.” And all too often, he says, “people often blame themselves and don’t discuss it.”
A Conversation with Dr. Mahnaz Ali, M.D.
Can you tell us a bit about your clinical practice?
I work at a federally qualified health center called PCC Wellness Community Center in the Chicagoland area. I did my Family Medicine training from MacNeal Hospital and the University of Arizona with a fellowship in Maternal-Child Health at West Suburban Hospital. I practice full spectrum family medicine including OB.
What are some of the leading health concerns you see in women?
Many of women’s office visits are related to: STDs, depression, diabetes, hypertension, heart disease, abnormal menses, hot flashes and obesity.
What are three important screening tests for women?
Pap smears for cervical cancer screening starting at age 21
STD screen once sexually active
Diabetes screen for any age woman with risk factors
I will also say mammograms for breast cancer screening starting at the age of 40.
How important is heart disease as a concern for women?
Very important. Heart disease is the leading cause of death in women.
My daughter’s periods are very irregular, and I was told the pill can help. But I’ve also heard that the pill may not be safe, or may cause problems with fertility later – is that true?
The pill can help with regulating periods. Like any medications, pros and cons have to be weighed with the treatment benefit and the medication’s side effect profile, but the pill does NOT cause issues with fertility.
If my mother or aunt had breast cancer, does that increase my risk, and should I be screened earlier?
It may increase your risk and screening can start early at age 30-35.
At what point should a couple think about fertility testing if they are struggling to have a child?
I recommend patients to try to conceive naturally for 1 year. For women 35 or older, they can seek earlier intervention after 6 months of trying on their own.
What are some dietary recommendations for nursing and post-partum mothers?
I recommend moms to continue to take prenatal vitamins and eat a well balanced meal with iron and calcium.
How often do you see issues of emotional stress, domestic violence or other abuse in the community? What resources are available for women to start seeking help?
We screen all of out patients for domestic violence and most of our patients for anxiety/depression because they are very common. We are lucky to have a behavioral health specialist in each of out clinic sites or access to one in the system. We also have pamphlets and help lines.
Achieving balance always seems a top concern for many women – what advice do you have for women struggling to “balance it all”?
This is a tricky question because I don’t think its possible to “balance it all.” What really helps in trying to “do it all” is a great support system with friends and family. Don’t sweat it if you can’t do things perfectly or exactly the way you want it, things will fall into place.
What are a few positive health habits or routines you would recommend for women?
We all want to have healthy habits, but I think getting a restful sleep and exercising tops the list. Other forms of relaxation that are helping are yoga, meditation and massages.
What is the most rewarding aspect of your job caring for women?
Getting to know women at a more personal level and helping them find a happier place in themselves. I love to see women gain confidence and take charge of their lives.
Breast Cancer – FAQs on Screening
October is Breast Cancer Awareness Month – get answers to some FAQs and latest screening guidelines below:
American Cancer Society
1. What is new with the guideline? How does it differ from previous ACS guidelines?
The biggest change to the guideline is that we now recommend that women at average risk for breast cancer start annual screening with mammograms at age 45, instead of age 40, which was the starting age in our previous guideline. Now, women ages 40 to 44 can choose to begin getting mammograms yearly if they want to.
In addition, the new guideline says that women should transition to screening every two years starting at age 55, but can also choose to continue screening annually.
The ACS is also no longer recommending a clinical breast exam (CBE) as a screening method for women in the U.S. Breast self-exam is also no longer recommended as an option for women of any age.
2. This guideline is for women at average risk for breast cancer, but how do I know if I am at average risk?
The best way to determine if you are at average or high risk for breast cancer is to talk with your health care provider about your family history and your personal medical history. In general, women at high risk for breast cancer include women with a family history of breast cancer in a first degree relative (mother, sister, or daughter), women with an inherited gene mutation, and women with a personal history of breast cancer. Learn more about breast cancer risk factors.
3. Why did ACS change its guideline to say routine screening should start at 45 instead of 40?
The evidence shows that the risk of cancer is lower for women ages 40-44 and the risk of harm from screenings (biopsies for false-positive findings, overdiagnosis) is somewhat higher. Because of this, a direct recommendation to begin screening at age 40 was no longer warranted. However, because the evidence shows some benefit from screening with mammography for women between 40 and 44, the guideline committee concluded that women in this age group should have the opportunity to begin screening based on their preferences and their consideration of the tradeoffs. That balance of benefits to risks becomes more favorable at age 45, so annual screening is recommended starting at this age.
4. If we can save even one life, why would you not recommend screening?
Every life lost to cancer is important. But the fact is, even though mammography reduces deaths from breast cancer, it does not eliminate them, even in the age groups where it is agreed that women should be screened. The challenge of screening is maximizing the lifesaving benefits while minimizing its harms. These evidence-based guidelines represent the best current thinking on that balance.
5. What exactly should a woman do at age 40? Should she get screened or not? How should she decide?
The risk of breast cancer is lower in women between the ages of 40 to 44. Still, some women will choose to accept the greater chance of a false-positive finding and the harms that could come from that (biopsy pain and anxiety, for instance) as a reasonable tradeoff for potentially finding cancer. The decision about whether to begin screening before age 45 is one that a woman should make with her health care provider.
6. Why can women choose to start screening every two years at age 55?
Although breast cancer is more common in older women, after menopause, breast cancer grows more slowly in most women, and is easier to detect early because the breasts are less dense. Since most women are post-menopausal by age 55, and because the evidence did not reveal a statistical advantage to annual screening in post-menopausal women, the guidelines committee concluded that women should move to screening every two years beginning at age 55. Still, the guideline says women may choose to continue screening every year after age 55 based on their preferences.
7. Why is a clinical breast exam (CBE) no longer recommended?
Clinical breast examination (CBE) is a physical exam done by a health professional. During the beginning of the mammography era, the combination of CBE and mammography was associated with a lower risk of dying from breast cancer, and CBE was shown to offer an independent contribution to breast cancer detection. Since then, as mammography has improved and women’s awareness and response to breast symptoms has increased, the few studies that exist suggest that CBE contributes very little to early breast cancer detection in settings where mammography screening is available and awareness is high.
In addition, there was moderate evidence that doing CBE along with mammography increases the rate of false positives. Based on this information, the new guideline does not recommend CBE for U.S. women at any age.
There are settings in the U.S. where access to mammography remains a challenge, and the Society will continue to work to ensure that all women have access to mammography screening. We recognize that some health care professionals will continue to offer their patients CBE, and there may be instances when a patient decides with their health care provider to have the exam- and that is okay. The important message of this guideline is that CBE should not be considered an acceptable alternative to mammography screening, no matter the challenges of access to mammography.
8. Why is a breast-self-exam no longer an option for women in these new guidelines?
Evidence does not show that regular breast self-exams help reduce deaths from breast cancer. However, it is very important for women to be aware of how their breasts normally look and feel and to report any changes to a health care provider right away. This is especially important if a woman notices a breast change at some point in between her regular mammograms.
9. What are the limitations of mammography and why is it important for women know about them?
Mammography is the best test we have at this time to find breast cancer early, but it has known limitations — it will find most, but not all, breast cancers. The Society supports informing women about the limitations of mammography so they will have reasonable expectations about its accuracy and usefulness. Studies show that informing women of the limitations of mammography before they have one decreases anxiety and improves later adherence with screening recommendations.
The accuracy of mammography improves as women age – thus, accuracy is slightly better for women in their 50s than women in their 40s and slightly better for women in their 60s than women in their 50s, and so on. However, a woman undergoing breast cancer screening needs to know that mammography at any age is not 100% accurate. Overall, mammography will detect about 85% of breast cancers.
Women also need to be prepared for the possibility of being called back for additional testing, even though most women who get further testing do not have breast cancer. On average, about 10% of women are recalled for further evaluation, including additional mammography and/or ultrasound, and sometimes a biopsy to determine if cancer is present.
Women also need to know that if their mammogram result is normal, but they detect a symptom months later before their next mammogram, they should see a doctor right away.
10. What about women who are at higher risk?
The Society has separate recommendations for women at increased risk for breast cancer, which are also being updated.
11. Why are there no recommendations for 3D mammography (tomosynthesis)?
Although digital breast tomosynthesis units are steadily being introduced in mammography facilities, at the time the protocol for the evidence review was developed, there was too little data on digital breast tomosynthesis to include comparisons to 2D mammography. The issue will continue to be revisited and will be updated as evidence emerges.
12. Will the new guideline affect my ability to get a mammogram?
Insurance coverage is usually linked to U.S. Preventive Services USPSTF (USPSTF) screening recommendations, not ACS guidelines. It’s too soon to tell what the long-term impact of the Society’s guidelines, or draft recommendations issued in April by the USPSTF, will be. If you have health coverage, the recommendation should not have any impact on your coverage this year. Your insurer may decide to change its coverage of routine mammograms in the future as a result of the new USPSTF guidelines or ACS guidelines. It’s also possible that your insurer will decide to keep its mammography coverage the same. The American Cancer Society strongly believes that women between the ages of 40-44 and women over the age of 55 should have access to annual mammograms without being charged a co-pay. To be sure, you can check with your health insurance company before scheduling the mammogram.
13. What about screening women in their 30s and younger? They get breast cancer, too. Doesn’t ACS care about that?
Cases of breast cancer in women who are in their 30s are rare, but that doesn’t make them any less tragic or important. The reason why none of the major guidelines recommend routine screening in this younger age group is because the evidence so far shows that the risk of harms such as false positive, additional procedures, and potential overdiagnosis outweighs the potential benefits, and routine screening for women in their 30s or younger doesn’t reduce deaths from cancer. The bottom line is that you can and should talk to your doctor about any concerns you have with your breast health at any age.
What is endometriosis?
Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.
How common is endometriosis?
Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and 40s.
Where does endometriosis occur?
Areas of endometrial tissue (often called implants) most often occur in the following places:
Outer surfaces of the uterus, bladder, ureters, intestines, and rectum
Cul-de-sac (the space behind the uterus)
How does endometriosis cause problems?
Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.
What is the link between infertility and endometriosis?
Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.
What are the symptoms of endometriosis?
The most common symptom of endometriosis is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sex. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain may be felt during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.
How is endometriosis diagnosed?
A health care provider first may do a physical exam, including a pelvic exam. However, the only way to tell for sure that you have endometriosis is through a surgical procedure called laparoscopy. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy.
How is endometriosis treated?
Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.
What medications are used to treat endometriosis?
Medications that are used to treat endometriosis include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal medications, including birth control pills, progestin-only medications, and gonadotropin-releasing hormone agonists. Hormonal medications help slow the growth of the endometrial tissue and may keep new adhesions from forming. These drugs typically do not get rid of endometriosis tissue that is already there.
How can surgery treat endometriosis?
Surgery can be done to relieve pain and improve fertility. During surgery, endometriosis implants can be removed.
Does surgery cure endometriosis?
After surgery, most women have relief from pain. However, about 40–80% of women have pain again within 2 years of surgery. The more severe the disease, the more likely it is to return. Taking birth control pills or other medications after having surgery may help extend the pain-free period.
What if I still have severe pain that does not go away even after I have had treatment?
If pain is severe and does not go away after treatment, a hysterectomy may be a “last resort” option. Endometriosis is less likely to come back if your ovaries also are removed. If you keep your ovaries, endometriosis is less likely to come back if endometriosis implants are removed at the same time you have the hysterectomy.There is a small chance that pain will come back even if your uterus and ovaries are removed. This may be due to endometriosis that was not visible or could not be removed at the time of surgery.
The Mental Health Benefits Of Meditation: It’ll Alter Your Brain’s Grey Matter, And Improve Memory, Sense Of Self
By Lecia Bushak
It appears that scientific evidence of meditation’s powers continues to add up. Meditation, in a way, is like exercise for our brains: it’s been shown to assist in mental health maintenance, improve our memory, empathy, and sense of self — similar to how exercise boosts our resilience, muscle strength, cardiovascular health, and blood pressure/cholesterol.
Perhaps one of the most fascinating studies published on meditation is one from several years ago — but one that is good to keep in mind if you’re interested in mental health and brain plasticity. The study, led by Harvard researchers at Massachusetts General Hospital (MGH), found that meditating for only 8 weeks actually significantly changed the brain’s grey matter — a major part of the central nervous system that is associated with processing information, as well as providing nutrients and energy to neurons. This is why, the authors believe, that meditation has shown evidence in improving memory, empathy, sense of self, and stress relief.
“Although the practice of meditation is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that meditation also provides cognitive and psychological benefits that persist throughout the day,” Dr. Sara Lazar, a Harvard Medical School instructor in psychology, said in the news release. “This study demonstrates that changes in brain structure may underlie some of these reported improvements and that people are not just feeling better because they are spending time relaxing.”
The idea that mindfulness and meditation can bring you compassion, focus, and joy is thousands of years old, but it’s only recently that science has begun to back it.
In the study, 16 participants took a Mindfulness-Based Stress Reduction program for 8 weeks. Before and after the program, the researchers took MRIs of their brains. After spending an average of about 27 minutes per day practicing mindfulness exercise, the participants showed an increased amount of grey matter in the hippocampus, which helps with self-awareness, compassion, and introspection. In addition, participants with lower stress levels showed decreased grey matter density in the amygdala, which helps manage anxiety and stress.
“It is fascinating to see the brain’s plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life,” Dr. Britta Holzel, an author of the study, said in the press release.
Another recent study examining the health benefits of positive thinking found that mindfulness exercises like meditation or yoga actually changed the length of telomeres in breast cancer patients — which works to prevent chromosomes from declining. And in the past, researchers have found that people who practiced meditation actually had different brain structures than people who didn’t.
Indeed, the notion that meditation can foster improved sense of self, compassion, happiness, and focus is thousands of years old, but it’s only now that science has begun backing it.