Women's Health: Birth-Control Pill May Cut ACL Injuries in Female Athletes

Canadian goalkeeper Erin McLeod, shown here in the 2011 World Cup, had to pull out of the 2016 Olympics with an ACL injury. Photo: Thewomensgame

It's long been known that women and girls suffer more injuries to the ACL (anterior cruciate ligament) than males. Estrogen has been thought to be one of the culprits, and a recent study offers more evidence to back up this theory.

Girls aged 15 to 19 who were on the birth-control pill, which reduces estrogen levels, were shown in the study to be less likely to experience severe knee injuries than girls not taking the medication. While the research, conducted at the University of Texas, showed an association between estrogen and ACL injuries rather than a cause-and-effect relationship, the findings are nevertheless intriguing.

Less Estrogen, Fewer Knee Injuries?

"The teens with ACL injuries who were on the birth control pill were less likely to need corrective surgery than girls not taking the pill who had ACL injuries," said an article on the U.S. government website MedlinePlus. "The girls with the highest rates of ACL surgery were 22 percent less likely to be taking birth control pills than those who didn't have an ACL injury."

MedlinePlus also notes "The teens with ACL injuries who were on the birth control pill were less likely to need corrective surgery than girls not taking the pill who had ACL injuries."

The theory of the Texas research is that increased estrogen somehow weakens the ligaments and makes them more susceptible to injury, say the authors of the study. Many athletic girls and women already take birth control pills to have a more regular period and lighter menstrual flow.

Girls and women have many more ACL injuries than male athletes—from twice to eight times as many, depending on what statistics you read. What's more, while the injuries in men occur most likely as the result of contact (as in football or basketball), females often suffer ACL tears in non-contact situations, such as when making a cut in soccer.

Erin McLeod, goalkeeper for the Canadian national team, recently announced she'd have to skip the Rio de Janiero Olympics this summer because of an ACL injury.

Women & ACL Injuries: Possible Culprits

There can be a number of causes to why women are more susceptible to ACL injuries, from the estrogen association the Texas research studied to women's wider hips, a narrower area through which the ACL passes, and greater knee extension. (A WebMD article has a good overview of some of the physical differences between men and women that can possibly explain the increased ACL injuries in women.)

One bit of good news is that doctors have gotten better at treating ACL injuries in women and helping the athletes get back on the field and court. McLeod, the Canadian soccer player, had two previous knee injuries before the current one, and was able to return to professional-level play.

Another hopeful sign is that there's been more focus on helping girls and women prevent ACL injuries, including strength training to build up leg muscles to reduce the strain on knee ligaments. A 2012 study in Sports Health found that two injury-prevention programs "significantly reduced ACL injury rates and improved athletic performance tests."

See the MedlinePlus article on estrogen and ACL injuries in girls, and read an abstract of the Texas study, which was published in the journal Medicine & Science in Sports & Medicine.

Endometriosis: New Hope for a Common (But Not Commonly Discussed) Condition

You won't often hear about endometriosis on the nightly news, or even in the health section of newspapers and websites. But this gynecological condition—in which the type of tissue that lines a woman's uterus (the endometrium) grows in other, nearby parts of the body—is much more common than you'd think. And much more debilitating.

(Read about one woman's experience with the disease in "What I Wish Everyone Knew About Endometriosis.") 

As some recent news reports have pointed out, though, there may be new hope on the horizon for understanding endometriosis.

Illustration of endometriosis. Source: BruceBlaus, Wikimedia Commons.

Endometriosis sufferers can face years or even decades of pelvic pain, inflammation, infertility, and a search for relief. The endometrial tissue can grow in areas like the ovaries, Fallopian tubes, outer surface of the uterus, and pelvic cavity lining. The tissue can form scarring that can cause adhesions between surfaces like the bladder and bowel.

With endometriosis, patients can experience a range of agonizing and potentially embarrassing problems, from pain during sex to extremely painful menstrual cramps, back pain, painful urination or bowel movements, and constipation or diarrhea.
 
To make the situation even more frustrating, researchers don't understand exactly what the causes of endometriosis are. And patients and even doctors may be reluctant to talk about it.

But as a recent New Yorker article notes, in recent years there's been news of an interesting collaboration that may shed important light on the origins of the disease (the article is well worth reading for its explanation of endometriosis and the issues involved in understanding its causes and treating it).

Cervical Dysplasia: Not Always a Cause for Concern

A diagnosis of cervical dysplasia may be disturbing to women, but it's not necessarily an indication of cancer. Dysplasia simply means abnormal growth in an organ or in cells, but a woman who is diagnosed with cervical dysplasia will want to keep an eye on it because this condition can later turn into cancer.

Cervical dysplasia, also called cervical intraepithelial neoplasia (CIN), is considered a pre-cancerous condition. The Medline Plus Medical Encyclopedia looks at the causes, symptoms, and risk factors for cervical dysplasia.

The Women's Health Channel takes a deeper look at symptoms, diagnosis, and staging of cervical dysplasia and cervical cancer.

The Mayo Clinic also has an overview of the subject.

Questions and Answers on Christina Applegate's Breast Cancer

Getting a diagnosis of breast cancer can be a shock at any age, but it's even more surprising when it happens to someone young, as it did to 36-year-old actress Christina Applegate. It's unusual to hear of someone getting the disease at that young an age, but it does happen. A good friend of mine from college was diagnosed with breast cancer in her early 30s, but unfortunately by the time it was caught it was too far advanced. She died at age 35.

The good news is that Christina Applegate's breast cancer was caught early and she has a very good prognosis. WebMD has put together an FAQ (frequently asked questions) on Applegate's breast cancer, so women can learn from her experience.

Obstetric Fibula Gets Attention in "A Walk to Beautiful"

Obstetric fibula is a tragic disease that claims the lives of many women, but what makes it worse is that it is totally preventable. An award-winning film called "A Walk to Beautiful" sheds light on the obstetric fibula, following the lives of five women in Ethiopia. While the film may not have gotten a large viewing as a full-length documentary, it is now getting new exposure in a shortened version being shown as part of the PBS network's "Nova" series.

Obstetric fistula occurs when a hole in the birth canal is caused by prolonged labor (which can sometimes last several days). The World Health Organization has called fistula "the single most dramatic aftermath of neglected childbirth," and says that there are more than 2 million women living with fistula worldwide. Many of these cases are due to inadequate obstetric care, the film's Web site says.

You can find out more about obstetric fistula in a United Nations document and at the Web sites of the Fistula Foundation and End Fistula.

Persistent Sexual Arousal Syndrome (PSAS)

It sounds like something made up in one of those medical disease-of-the-week TV shows, but Persistent Sexual Arousal Syndrome in women is a real disorder. (As far as TV goes, it was actually part of the plot of a recent episode of the show "Grey's Anatomy." And by no small coincidence ABC, which broadcasts "Grey's Anatomy," featured a special on Persistent Sexual Arousal Syndrome on an episode of its newsmagazine "20/20.")

If you haven't heard of Persistent Sexual Arousal Syndrome, it's probably because it was only recently recognized as a syndrome, and because a relatively small percentage of women suffer from it. Of course, that doesn't make the women who have it feel any better.

For more information the Web site FemalePatient.com has an article on Persistent Sexual Arousal Syndrome (PSAS) that discusses the distinguishing features of the syndrome and gives several case histories.

Polycystic Ovary Syndrome: What It Is and What You Can Do About It

Polycystic ovary syndrome (PCOS) affects about one in 10 women of childbearing age, but for those who have it, it can feel like a curse. It's an disorder of the endocrine system and can affect everything from the menstrual cycle to the cardiovascular system and one's ability to have children.

Women suffering from polycystic ovary syndrome may have high levels of androgen hormones, may miss periods or have them irregularly, become overweight, develop acne, and may have numerous fluid-filled cysts in their ovaries (which is where PCOS gets its name). One common problem women with PCOS may have is unfortunately a very noticeable one: growth of hair on the face.

In fact, this topic came up on the Feb. 19th "Oprah" TV show when an audience member asked Dr. Mehmet Oz, Oprah's regular medical consultant, what she could do to eliminate the hair that kept growing on her chin. (Dr. Oz suggested to the woman that she might want to check into taking pills to regulate her hormone levels, but he noted that she didn't have all the typical PCOS symptoms.)

A good resource for learning about polycystic ovary syndrome is a list of frequently asked questions (FAQ) from the U.S. Department of Health and Human Services.

You can find more reputable information about polycystic ovary syndrome here from:

WebMD.com

The Mayo Clinic

Medicine.net