Our Bodies, Ourselves (223 page)

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These terms derive from the kinds of care physicians and midwives have historically provided. However, their use is not meant to imply that all midwives follow a midwifery model or that all physicians follow a medical model. Some people believe it is more accurate to refer to the different models of care as a physiologic model (that is, care in accord with the normal functioning of a woman's body) versus an interventionist or pathology-driven model.

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Estimates of higher efficacy are possible when one selects a subset of clinical trials that omits studies showing less efficacy or when an analysis puts a positive spin on negative results. It is also true that many studies show a considerable response rate to a placebo. Moreover, most depression episodes are temporary and resolve on their own, and in many cases it is hard to distinguish between the effects of drugs and those of other forms of social support and care.

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The FDA has classified paroxetine as class “D” in pregnancy. This means that the FDA has determined good evidence of human fetal risk and thus recommends “do not use” during pregnancy. The other SSRIs are classified as “C,” indicating that there is only animal evidence and/or lack of human studies. Therefore, the FDA recommends their use with caution. Drugs classified as “A” or “B” are generally considered appropriate for use in pregnancy; “D” and especially “X” drugs should be avoided if possible.

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Teratology is the study of the causes and biological processes leading to abnormal fetal development and birth impairments.

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Excerpted from Claire Mysko and Magali Amadeï,
Does This Pregnancy Make Me Look Fat? The Essential Guide to Loving Your Body Before and After Baby
(Deerfield Beach, Fla.: Health Communications, Inc., 2009).

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The medical term for miscarriage is spontaneous abortion. If your provider uses this term, he or she does not mean that you chose to terminate the pregnancy.

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The actual number is likely significantly higher because many miscarriages occur very early on, before a woman knows she is pregnant, and may simply seem to be a heavy period on or near schedule.

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The definition of perimenopause has been through many versions. The World Health Organization has defined it as three years before menopause, but this can be determined only in retrospect. In 2001, a committee of experts met to try to define the process more clearly. The committee noted that in a woman's late reproductive years, her menstrual cycle was often reduced by up to two days. Early menopause transition was defined as variation in cycle length of seven days, and late menopause transition was defined as having skipped two periods, or going sixty days without a period. This does not adequately describe all the ongoing changes, but it is one way of defining the process.

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Factors that may be involved in hot flashes include the body's core temperature regulation and brain chemicals. The body's thermostat has an upper set point, at which the blood vessels open up and perspiration occurs in an effort to release heat. There is also a lower threshold, at which shivering begins to generate heat. Between these two extremes is a temperature zone known as the thermo-neutral zone, at which the body normally functions. Researchers now theorize that the zone between the high and low set points in perimenopausal and postmenopausal women who experience hot flashes is narrower than in women who don't experience them. A slight increase in core body temperature (from having a cup of tea or getting upset, for example) could cause a sensitized woman to experience a hot flash as her body tries to reduce its temperature. Another factor that could be affecting the body's core temperature regulation is the brain neurotransmitter norepinephrine, which has been shown to reduce the thermoneutral zone in animals. Levels seem to be higher in some perimenopausal and postmenopausal women who experience hot flashes.

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Officially recommended levels remain lower than this. Despite calls by some experts for people to take in much more vitamin D, a November 2010 report from the Institute of Medicine (IOM) declared that most people are getting enough of the nutrient each day. The IOM did bump up the recommended dietary allowance of vitamin D from the amount cited in its last report, released thirteen years ago: 600 international units (IU) of vitamin D for people age 51 to 70 (up from 400 IU recommended in 1997), and 800 IU daily for those over 70 (up from 600 IU).

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Until recently, taking hormones for perimenopausal and menopausal discomforts was called hormone replacement therapy (HRT). This term made it sound as though menopausal women are missing something—that we are somehow deficient without the hormones we had in youth. Yet most hormone therapy prescribed today does
not
provide the same levels of hormones that our ovaries were making during our menstruating years. The term “hormone therapy” (HT) avoids the implication that all women should be replacing something essential that is now missing.

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Search “Robert Wilson” at ourbodiesourselves.org for more on Wilson's 1966 book,
Feminine Forever
, and the decades-long fascination with using synthetic estrogen for a wide spectrum of age-related conditions.

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HER-2/neu stands for “human epidermal growth factor receptor 2.” It is overexpressed in 20 to 30 percent of breast cancer tumors and is associated with more aggressive disease.

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The word “tumor” used to be a euphemism for cancer, but in fact, tumors are just growths of cells that serve no purpose. Over 90 percent of all tumors are benign (not cancerous) and harmless.

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A panel appointed by the Institute of Medicine is set to recommend whether to include prescription contraceptives as a preventive service, in which case they would be covered without charge beginning in 2012.

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For more information about the Callen-Lorde Community Health Center, see callen-lorde.org.

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The term statutory rape is a legal term that describes sexual activity where one participant is below the age required to legally consent to sex. In most states, the age of consent for sex is between sixteen and eighteen. Even if a child or teen says yes to having sex, the law considers the act to be rape.

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