Natalie Portman pregnant by choreographer

An Ortho progestin/estrogen pill dial pack

Natalie Portman to wed `Black Swan' choreographer
Associated Press December 27, 2010

“NEW YORK - Natalie Portman is pregnant with her first child and is engaged to Benjamin Millepied, the choreographer of "Black Swan."

A publicist for Portman confirmed Monday that the couple are engaged and expecting, but declined to give any further details. People magazine first reported the news.

The 29-year-old actress and Millepied, a well-regarded ballet dancer and choreographer, met during the making of "Black Swan," Darren Aronofsky's psychological thriller that stars Portman as a ballet dancer. She's been nominated for best actress by the Golden Globes and the Screen Actors Guild.

Millepied played a small on-screen role in the film as a dancer. Portman also stars in Ivan Reitman's upcoming romantic comedy, "No Strings Attached."”

Personal Comment: There goes her figure! Sigh! Because she isn’t a dancer she doesn’t have to stay in that great shape, but still… I wonder if there was a birth control method failure or if she forgot to take her pill or was taking another medicine that reduced the effectiveness of the hormones? Because of the timing that’s what I think happened. But, perhaps not, since she is almost 30 and nearing the age where her fertility will be decreasing. Maybe they just said “let’s go w/o protection and see what happens”… you think? Apparently this time the plumbing was working just fine.

And speaking of the effectiveness of hormonal birth control, below are the results of a large study testing the effectiveness of a 24/4 dosing regimen.


Real life tests of the effectiveness of oral contraceptives

A typical monthly regimen of oral contraceptives includes 21 days of active pills -- usually containing a combination of the hormones estrogen and progesterone -- and a 7-day break of inactive sugar pills.

Oral contraceptives boast annual unintended pregnancy rates well below 1 percent -- if used correctly and consistently, that is.

But in the not-so-perfect real world, longer lasting ingredients and shorter monthly breaks between active pills could prove useful in bolstering this form of birth control, hints a new study from Germany.

A typical monthly regimen of oral contraceptives includes 21 days of active pills -- usually containing a combination of the hormones estrogen and progesterone -- and a 7-day break of inactive sugar pills. The intent is to prevent pregnancy by obstructing ovulation, or the release of an egg during a woman's monthly cycle.

"Forgetting the first active pills of a treatment cycle has the biggest impact on contraceptive failure as this time interval may allow the process that leads to ovulation to start," Dr. Jurgen Dinger of the Berlin Center for Epidemiology and Health Research told Reuters Health in an e-mail.

To test whether decreasing the pill-free interval and using hormones with a longer duration of action may help counteract this common problem, Dinger and his colleagues studied more than 52,000 U.S. women who took part in the "International Active Surveillance of Women Taking Oral Contraceptive" study.

The participants' average age was 26 years, and each had started on a new contraceptive. More than 80 percent of the women had previously taken another version of the Pill.

The researchers did not interfere with the choice of oral contraceptive, but rather categorized the women into three groups based on their new hormone regimens: 21 days of 3 milligrams of drospirenone (progesterone) plus 30 micrograms of ethinyl estradiol (estrogen); 24 days of 3 milligrams of drospirenone plus 20 micrograms of ethinyl estradiol, or another regimen.

The 21-day drospirenone regimen is currently sold under the brand name Yasmin and the 24-day regimen, with longer-lasting progesterone, is sold as Yaz. Generic versions are also available. Bayer Schering Pharma, maker of Yasmin, supported the study.

Over the course of 3 years following the women, more than 1,600 became pregnant unintentionally. About 1,400 of these contraceptive failures were due to an imperfect use of the Pill.

Unintended pregnancy rates for the 21-day and 24-day drospirenone regimens were 2.8 percent and 2.1 percent at the end of the first year, respectively, and 5.7 and 4.7 percent after the third year.

Women older than age 30 were significantly less likely than younger women to get pregnant unintentionally. Women with a college education and who had never carried a child were also less likely to become pregnant.

Obese women -- who made up nearly a quarter of the U.S. women studied -- had about a 50 percent greater risk of contraception failure after accounting for age, education level and whether or not they had prior children.

According to the researchers, under all the situations studied, the 24-day drospirenone regimen yielded more protection against pregnancy than the 21-day drospirenone regimen, as well as the other oral contraceptives.

However, compared to findings from the same study conducted in Europe, U.S. women showed an overall four-fold higher unintended pregnancy rate.

Dinger suggested that multiple factors could explain this gap in effectiveness, from higher rates of obesity in the U.S. to cultural, behavioural and genetic differences between the regions.

Dinger also noted that most programs that have tried to improve the proper use of the Pill have failed. "Our approach," he emphasized, "did not intend to investigate ways to improve compliance but to look at whether specific oral contraceptive regimens are more 'robust' against incompliance than others."

"This should not mitigate the need for good counseling of female adolescents and women intending to use the Pill," added Dinger. "A highly effective oral contraceptive regimen in conjunction with good counseling is the only way to minimize unintended pregnancies."

SOURCE: Obstetrics and Gynecology, online December 3, 2010. The full text of the article can be found at: http://journals.lww.com/greenjournal/Fulltext/2011/01000/Effectiveness_of_Oral_Contraceptive_Pills_in_a.6.aspx

Personal comment: We have known since the introduction of Yaz in the U.S. that the long half-life of drospirenone reduces the chance of breakthrough ovulation during the hormone free interval. Most students on oral contraceptives at St Lucy’s are on Yaz the 24/4 dosing regimen of 3 milligrams of drospirenone plus 20 micrograms of ethinyl estradiol. There are no obese students and roommates buddy to make sure each girl takes her pill at the same time daily. Even so there are times when a student is on meds that decrease the effectiveness of her pills and will ovulate and a few of these instances will result in the need for emergency contraception to avoid an unintended pregnancy. The availability of ella (the five-day EC pill) has increased the effectiveness of EC for St Lucy’s girls.


FDA Approves Gardasil for Prevention of Anal Cancer in Both Sexes

December 23, 2010 — FDA on Wednesday approved Merck's human papillomavirus vaccine, Gardasil, for the prevention of anal cancer in people ages nine through 26, Reuters reports. The vaccine already was approved to prevent cervical, vulvar and vaginal cancers associated with HPV for the same age group.

On Wednesday, FDA cited data showing that Gardasil was effective in a study of men who have sex with men, a group that has a higher incidence of anal cancer than other populations. The agency said the data support the vaccine's efficacy in women because the disease is the same in both sexes.

Although anal cancer is less common than most other types of cancer, with about 5,300 new U.S. cases diagnosed annually, FDA said incidence of the disease is increasing (Krauskopf, Reuters, 12/22). About 90% of anal cancers are linked with HPV, according to Dow Jones/Wall Street Journal (Solsman, Dow Jones/Wall Street Journal, 12/22).

Karen Midthun, director of FDA's Center for Biologics Evaluation and Research, said, "Treatment for anal cancer is challenging; the use of Gardasil as a method of prevention is important, as it may result in fewer diagnoses and the subsequent surgery, radiation or chemotherapy that individuals need to endure."

As of the end of May, more than 65 million doses of Gardasil had been distributed since its 2006 approval, with sales reaching $1.1 billion as of 2009 (Reuters, 12/22). The vaccine once was expected to be a blockbuster for Merck, but sales have declined as more individuals are immunized and GlaxoSmithKline's HPV vaccine, Cervarix, provides more competition, according to Dow Jones/Wall Street Journal (Dow Jones/Wall Street Journal, 12/22).

Personal comment: Starting last year our clinic began giving Gardasil injections to male dancers and all escort candidates as an off label use to protect men from anal cancer.