OBGYN NEWS   by Dr. Buruiana


ACOG Updates Guidance on Over-the-Counter Access to Hormonal Contraception

September 24, 2019

Washington, D.C. — The American College of Obstetricians and Gynecologists (ACOG) has expanded its recommendations on over-the-counter access to hormonal contraception. ACOG believes that vaginal rings, the contraceptive patch, and depot medroxyprogesterone acetate (DMPA) injections are safe and should be available over the counter with no age restrictions, according to updated guidance released today. 

This broadens and replaces ACOG’s Committee on Gynecologic Practice’s initial recommendation that oral contraceptives be available over the counter. The updated recommendations acknowledge that regulatory action needs to take place to achieve over-the-counter access. ACOG also recognizes that some states are currently implementing direct access to hormonal contraception at pharmacies or through online ordering, but over-the-counter access should be the ultimate goal.

“A prescription is an unnecessary obstacle for some women to get their preferred contraceptive method. Over-the-counter hormonal birth control would be a step toward greater access to an essential component of women’s health care and give adolescents and women more options to manage their reproductive health,” said Rebecca H. Allen, MD, MPH, an ACOG committee member who helped update the opinion. “Over-the-counter access to hormonal contraception will improve availability, but it should not be at the expense of affordability. Insurance coverage and other financial support for contraception should still apply. Each woman should be able to select the contraception that works best for her, including over-the-counter hormonal contraceptives, a long-acting reversible contraceptive provided by her health care provider, or other methods.”

The Committee Opinion says that any plan to make contraception available over the counter should address the issue of cost, including for women whose insurance currently covers their preferred method. It also says there is no medical or scientific justification to limit access to over-the-counter contraception based on age.

ACOG reiterates that women should still see a gynecologist each year for a well-woman health assessment—which can include discussing reproductive health plans, a pelvic or breast exam, cervical cancer screening, or sexually transmitted infection testing—but obtaining contraception does not require an exam or office visit.

“The need to consistently obtain a prescription, get a refill approval, or schedule an appointment can lead to inconsistent use of a preferred birth control method,” said Michelle Isley, MD, MPH, who coauthored the opinion. “Making more methods available over the counter would lead to reliable, equitable access for more women. A move to over-the-counter status would complement, not replace, policies that ensure availability of the full range of contraceptive options and safeguard access to a robust network of qualified family planning providers.”


HPV Vaccine Expanded for People Ages 27 to 45

By Denise Grady and Jan Hoffman in NY Times October 5th, 2018

HPV vaccine is now approved for men and women age 27-45, according to FDA announcement on Friday, October 5th.

The approval was based on a study in women ages 27 to 45, showing that an earlier version of the vaccine was highly effective in preventing persistent HPV infection, genital warts, vulvar and vaginal precancers, cervical precancers and cervical cancers related to the virus types covered by the vaccine.

The vaccine’s effectiveness in men ages 27 to 45 is inferred from the data in women, from its efficacy in younger men and from evidence that it created immunity in a study of men 27 to 45-years-old.

Read more on NY times article: https://www.nytimes.com/2018/10/05/health/hpv-virus-vaccine-cancer.html


My dear patients, I organized a charity event with my friends at MARA Society on October 11th at 6.00 PM. Join us for an evening of music and entertainment as we raise money and awareness for children in need.


Probiotics May Be Good for Your Bones

By Nicholas Bakalar on July 3, 2018

Older women who took a probiotic supplement had less weakening of bones than women who didn’t take the supplements.

A probiotic supplement could be good for your bones, a new study suggests.

Researchers studied 90 women, 75 to 80 years old, all generally healthy but with low bone mineral density. They measured their bone density at the start of the study, and then randomly assigned them to a placebo or to two daily doses of freeze-dried Lactobacillus reuteri, an intestinal tract microbe that occurs naturally in many, but not all, people.

After one year, they measured the women’s bones again. The reduction in density in the shin bone was nearly half as large in women taking L. reuteri supplements as in those taking the placebo. Side effects, most commonly gastrointestinal symptoms, were similar in the treatment and placebo groups. The study is in the Journal of Internal Medicine.

The lead author, Dr. Anna G. Nilsson, said that why this happens is unclear. “Perhaps estrogens could be affected by probiotics,” she said, “and there is some discussion about calcium absorption, a change in the calcium regulating hormones.”

Dr. Nilsson, an associate professor at the University of Gothenburg in Sweden, said that it is not yet time to advise women to take probiotics. “This is the first study in humans,” she said. “We need confirmatory studies. And we’ve only studied one strain of L. reuteri, the type used in animal studies.”



Evidence grows that an HPV screen beats a Pap test at preventing cancer

Publish date: July 3rd 2018

Aimee Cunningham

Evidence continues to grow that screening for human papillomavirus infection bests a Pap test when it comes to catching early signs of cervical cancer.

In a large clinical trial of Canadian women, pap tests more often missed warning signs of abnormal cell growth in the cervix than did HPV tests, researchers report July 3 in JAMA.  As a result, at the end of a four-year period, researchers found 5.5 new cases of severely abnormal, precancerous cervical cells per 1,000 women who got Pap tests, compared with 2.3 cases per 1,000 women who got HPV tests. Pap tests are the standard way to screen for cervical cancer.

“We should be moving away from screening with Pap tests toward screening with HPV tests,” says L. Stewart Massad, a gynecologic oncologist at Washington University School of Medicine in St. Louis, who wrote a commentary accompanying the study.

Previous research has found HPV testing leads to increased detection of abnormal cervical cells before they become cancerous compared with a Pap test. For instance, a 2009 study reported fewer cases of advanced cervical cancers and fewer deaths among women in India tested for HPV (SN: 4/25/09, p. 11). The study supported HPV testing in poorer countries, where cervical cancer screenings aren’t widespread. Worldwide, cervical cancer ranks fourth deadliest for women.

The new study suggests that HPV testing could also boost detection rates in countries that have well-established screening programs, such as the United States. Since the 1950s, the number of new U.S. cervical cancer cases and deaths has plummeted. The American Cancer Society estimates there will be 13,240 new cases, and 4,170 deaths, in 2018. The drop is primarily due to screening with the Pap test, in which cells are scraped from the cervix and examined for abnormal growth. But the test sometimes misses early signs of cancer.

An HPV test checks for the presence of a viral infection in cells swabbed from the cervix, similar to a Pap test. HPV, the most common sexually transmitted disease in the United States (SN Online: 4/28/17), causes nearly all cervical cancers. Following a positive result, doctors then examine the cervix for abnormal cells. 

In the new study, roughly half of 16,000 Canadian women in an established screening program got the HPV test and the remainder a Pap test. After four years, all got both tests to check for missed cases. For the HPV-negative women, three more cases of abnormal cell growth were discovered after a Pap test. For women whose Pap test didn’t report abnormal cells, 25 additional cases were found after HPV testing.

“When [an] HPV [test] is negative, women are significantly less likely in four years to have anything abnormal,” says study coauthor Gina Ogilvie, a public health physician at BC Women’s Hospital and Health Centre in Vancouver.

A switch to a screening system that starts with an HPV test will require education for patients and doctors. “Some women in their 40s and beyond in decades-long stable relationships may be alarmed to be identified with a new sexually transmitted infection,” which may have been contracted years before, Massad says. It will be important to emphasize that “the goal of cervical screening is to identify and remove HPV-infected cervical tissue from women at high risk.”

Read more: https://www.sciencenews.org/article/evidence-grows-hpv-screen-beats-pap-test-preventing-cancer



Start your summer off right! Take care of your health, eat fresh great tasting food AND support a local social justice farm doing great work in the community!

Rock Steady Farm & Flowers is a women and queer-owned cooperative farm, rooted in social justice, growing speciality cut flowers and sustainable vegetables in Millerton, NY.

Rock Steady now delivers weekly veggies and fruit to Elena-Maria Buruiana's OBGYN Office.  As a women owned farm, we are super excited for a partnership with our long time friend and CSA member Elena! Her holistic outlook on health and wellness is aligned with our own mission as a farm. 


Community Supported Agriculture (CSA) is one of the only ways to support local farmers directly. 100% of your dollar goes to our farm, located just two hours north of NYC. Your up-front commitment to buy local sustainably farmed veggies supports our farm and makes sure you get the very best of what we have to offer every week. More info on the CSA model can be found on our website.

Veggie Share - $25/week for 6-8 different crops.
Add-on's -  Flowers, fruit, eggs, meat, cheese and yogurt!
When? - Starts every Wednesday, July 11th, 1-6pm. Ends in November.

All tax-deductible donations, as well as left-over shares incase members can not make it to pick-up, will go towards produce boxes for low-income patients at a nearby diabetes health clinic.  Please consider making a donation when you sign-up. 


2017 Rock Steady CSA Member Quotes:

"We have been members of four different CSAs over the last 25 years. Rock Steady is the best one yet - well organized, friendly, professional, and the tastiest veggies around! Winter is very long without our friends from Rock Steady!" 

"I love the challenge of thinking of new ways to use the vegetables."

"These people believe in what they do, and believe in the community they do it for. The food and the people are both spectacular."

"Rock Steady Farm has the best CSA we've ever participated in. No question."

“I farm because I see it as radical action, a vehicle, to approach many of the injustices humanity and our natural world faces. Farming directly for my community, through a CSA,  provides the opportunity for visibility and nourishment we all deserve.”
D. Rooney Farmer/Owner

We partner with other non-profits both upstate and in NYC to make sure ½ of our produce is going to low-income people. This is made possible through donations to their low income CSA fund, partnerships with pantries, gleaning organizations, EBT/SNAP access and sliding scale CSA.  We also host 10 youth in the summer through a job training program! 

Many thanks for supporting our farm!! 
Farmer Maggie & The Rock Steady Farm Team



High testosterone in postmenopausal women may add CVD risk

Publish date: May 29, 2018

By Andrew D. Bowser, Cardiology News

New perspective on sex steroids and CV risk

In postmenopausal women, a higher level of testosterone in comparison to estrogen may increase the cardiovascular disease risk later in life, results of a recent analysis suggest.

A higher ratio of testosterone to estradiol was associated with the development of cardiovascular disease, coronary heart disease, and heart failure in postmenopausal women, according to results from an analysis based on 2,834 postmenopausal women in MESA (Multi-Ethnic Study of Atherosclerosis).

In addition, total testosterone levels were associated with increased cardiovascular disease and coronary heart disease, while estradiol is associated with a reduced risk of coronary heart disease and heart failure with reduced ejection fraction, investigators reported in the Journal of the American College of Cardiology.

Without any interventional studies as guidance, it’s not clear what the “best strategy” would be to modify sex hormone levels and reduce cardiovascular disease risk, wrote investigator Di Zhao, PhD, of the department of epidemiology at Johns Hopkins University Bloomberg School of Public Health, Baltimore, and her study coauthors.

“Nonetheless, a more androgenic sex hormone profile may identify a woman at higher risk for cardiovascular disease who may benefit from other risk-reducing strategies,” Dr. Zhao and her colleagues wrote in their report.

The postmenopausal women included in this analysis all had baseline measurements of testosterone, estradiol, dehydroepiandrosterone, and sex hormone–binding globulin levels between 2000 and 2002, according to the report.

After more than 12 years of follow-up, investigators found that a higher total testosterone to estradiol ratio was independently associated with an increased risk of incident cardiovascular disease (hazard ratio, 1.19; 95% confidence interval, 1.02-1.40), coronary heart disease (HR, 1.45; 95% CI, 1.19-1.78), and heart failure (HR, 1.31; 95% CI, 1.01-1.70).



It's time to get healthy! It's time for your Prolon

Posted by Dr.Buruiana on JANUARY 19, 2018

ProLon® is a 5-day dietary program that nourishes your body while promoting regenerative and rejuvenating changes, including effects on a wide range of markers that contribute to aging, such as cholesterol, inflammation, and fasting glucose.

ProLon® mitigates the burden and danger of water-only fasting, while responding to the unmet need of having a tasty and convenient, proven and safe dietary program that does not require ongoing lifestyle changes, such as long-term dieting.

Is intended for use by healthy individuals who want to optimize their health and wellbeing, by overweight or obese individuals who want to manage their weight in an easy and healthy way, and by people who have well-known markers for chronic and unhealthy conditions. ProLon has been clinically proven to reduce multiple biomarkers for aging and negative conditions such as abdominal fat, waist circumference, glucose, IGF-1, and CRP.

The ProLon dietary program requires guidance from a healthcare provider, such as a dietitian or nurse practitioner, for healthy individuals or a physician for individuals at risk for side effects or presenting certain diseases.

Read more at: https://prolonfmd.com/

Newer hormonal contraception formulations linked to breast cancer risk

By Ian Lacy                          

Publish date: DECEMBER 6, 2017    Ob.Gyn.News



A recent study published in the NEJM shows that women who use hormonal contraceptives including some types of IUD’s for more than a year have a 20%higher risk of breast cancer.
The absolute risk is still very low. It translates in one extra case of Brest cancer for every 7690 women using hormonal contraceptives for one year.
The risk is still less than a tenth of one percent, for a 40 year old it means a change from 1 in 69 to 1 in 57.
ACOG reports that the increase risk was equal to the increase from drinking alcohol.
This is an observational study and this new evidence does not change what we previously know about hormonal contraceptives and breast cancer risk.
The small risk has to be set against the benefits which includes prevention of unwanted pregnancies and “substantial reduction in the risk of ovarian , endometrial and colorectal cancer in life”.

Read more at: https://www.mdedge.com/obgynnews/article/153690/breast-cancer/newer-hormonal-contraception-formulations-linked-breast


Even Light Activity May Increase Your Chances of Living Longer


 NOV. 16, 2017    NY Times

Using accelerometers to precisely measure physical activity, researchers have found that even very light exercise, well below the generally recommended levels, reduces mortality in older women.

The scientists had 6,382 women ages 63 to 99 wear an accelerometer for seven consecutive days, waking and sleeping, except when bathing or swimming. Using this data, they were able to precisely quantify levels of activity without having to rely on self-reports, which can be unreliable.

The study, in the Journal of the American Geriatrics Society, followed the women’s health for an average of 3.1 years, during which time there were 450 deaths.

They found that for each 30 minute a day increase in moderate-to-vigorous physical activity, there was a 39 percent decrease in all-cause mortality. But they also found that 30 minutes of even very light activity — doing light household chores, walking slowly over short distances — was tied to a 12 percent reduction in mortality.

“The results apply to all women, all races, regardless of weight and even for women over 80,” said the senior author, Andrea Z. LaCroix, a professor of epidemiology at the University of California, San Diego. “You do not have to be a marathon runner to benefit from physical activity. We hope that physical activity guidelines will recognize light activity as an evidence-based way to lower the risk for death.”

Read more: https://www.nytimes.com/2017/11/16/well/move/even-light-activity-may-increase-your-chances-of-living-longer.html