Sep. 17, 2002
Q. My doctor thinks that I may have the autoimmune disease lupus. I have done some research, and it seems that women are more likely than men to have autoimmune disorders. What are autoimmune disorders, and why are they mainly found in women?
A. Autoimmune disorders occur when the body loses its ability to distinguish between its own cells and foreign cells, and as a result begins attacking its own healthy tissue. The term autoimmune disease is an umbrella term for more than 80 serious and chronic illnesses. The more common disorders are systemic lupus erythematosus (lupus), multiple sclerosis, rheumatoid arthritis, scleroderma, fibromyalgia, type I diabetes and Sjogren's disease. Autoimmune disorders do disproportionately affect women. Eighty percent of the
8.5 million people in the United States with autoimmune disorders are women. Lupus is 10 to 15 times more likely to occur in women then men. Also, women of African, Latino, American Indian and Asian origin develop the disease more frequently than Caucasian women.
It is not fully understood why women are primarily affected. A few theories are under investigation. One major theory centers on the idea that fetal cells are capable of remaining in the mother's body indefinitely. During the course of pregnancy, cells are transferred between the fetus and mother. These fetal cells may cause an autoimmune response. Hormonal and environmental triggers also may play a role. More research is needed to understand gender imbalances in autoimmunity.
Autoimmune diseases are not contagious or rare. They do, however, appear to have a familial tie in that they tend to congregate in families but manifest as different diseases. Only 10 percent of people with lupus have a close relative who has or may develop lupus, and only 5 percent of children born to individuals with lupus will develop the illness. It can take many visits before a specific autoimmune diagnosis can be determined. Despite their increasing prevalence, autoimmune disorders still do not get the attention they require.
Q. My husband and I have been trying to get pregnant for two years. Recently, we've started seeing a fertility specialist. The doctor suggested that I start taking the ovulation drug clomiphene citrate. But I've heard that there may be a link between ovulation drugs and ovarian cancer. Can you explain how this drug works and if it is connected to ovarian cancer?
A. Ovulation drugs are used to control the time of ovulation, to regulate erratic ovulation or to encourage more than one egg to mature at a time. By controlling ovulation, you can pinpoint when it is occurring and, ideally, conceive more easily. Ovulation drugs can be used by themselves or in combination with assisted reproductive technologies such as in vitro fertilization.
Clomiphene citrate is one of the most commonly used ovulation drugs. Marketed by the names Clomid and Serophene, clomiphene citrate works by blocking estrogen receptors in the hypothalamus in the brain. This causes the body to act as though it has an estrogen deficiency and to release follicle-- stimulating (FSH) and luteinizing (LH) hormone, which then trigger ovulation.
A few studies have looked for the possible link between ovulation drugs
and ovarian cancer. The results of these studies conflict, and more research
is needed. Two theories surround the research. The first is that a high
number of ovulations may increase the risk of ovarian cancer, this is why
pregnancy and oral contraceptive use are associated with decreased risk
of ovarian cancer. The other theory is that hormonal surges associated
with ovulation increase the risk of ovarian cancer. Clomiphene citrate,
along with other ovulation drugs, increases hormone levels and causes more
eggs to mature. Some researchers speculate that the longer you use ovulation
drugs, the greater your risk of ovarian cancer. It is not clear whether
certain types of ovulation drugs are riskier than others. As with any treatment,
talk to your health care provider about risks associated with the drug
and how long you will be taking it.
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