New York, NY -- In a national survey of their own health habits, women obstetrician-gynecologists indicate they practice what they preach when it comes to good health. At a time when many Americans are exercising less and weighing more, most women ob-gyns report getting regular exercise and maintaining a healthy weight, according to a Gallup Organization survey conducted for The American College of Obstetricians and Gynecologists (ACOG).

Seventy-two percent (72%) of women ob-gyns surveyed report that they regularly exercise, 67% say their weight is about right, and 81% rate their own physical fitness as good or excellent.

"As women in a women's health profession, female ob-gyns may be benefiting from an 'insider's perspective' in how to address the health challenges in their own lives," says ACOG President Elect Vivian M. Dickerson, MD. "This puts them in a unique position to help American women have healthier lifestyles," she adds, speaking at today's ACOG news conference, "Woman to Woman: Female Ob-Gyns Reveal Their Trade Secrets."

In other survey results, women ob-gyns are nearly unanimous (99%) in the view that menstrual suppression -- the daily use of oral contraceptives to stop monthly periods -- is safe for their patients. More than half of women ob-gyns have tried menstrual suppression themselves. On the subject of elective or "patient choice" cesarean delivery, however, women ob-gyns are sharply divided: 36% say they would not perform a cesarean at a woman's request if not medically necessary, 32% say they would, and 28% say it would depend upon the woman's circumstances.

The influence of women physicians in the field of obstetrics and gynecology is growing. Although women represent only 36% of all practicing ob-gyns in the US, they now fill 71% of all US residency positions in ob-gyn. "ACOG was curious to see what its female members believe about key women's health issues and how they maintain their own health," reports Luella Klein, MD, a past president of ACOG and the first woman elected to that position.

The survey also indicates that menopausal symptoms are common, experienced in the last year by three-fourths of the women ob-gyns age 48 and over. Hot flashes were the symptoms cited most often (by 61% of the women ob-gyns), followed by night sweats (52%), sleep disruption (40%), and vaginal dryness (36%).

Hormone therapy (HT) was the most frequently mentioned treatment these doctors used for themselves (mentioned by 50%). Thirteen percent (13%) tried anti-depressants for symptoms, another 13% tried "natural alternative treatments" (such as the botanical black cohosh), and 19% said they did not use any treatment.

The women ob-gyns also estimate that about 62% of their menopausal patients were on HT prior to the 2002 report of the Women's Health Initiative (WHI) and that of these patients about 35% have continued to take HT following the WHI report. Although women ob-gyns who had experienced menopausal symptoms in the last year were also asked whether they had been taking HT before and after the WHI report, the sample size of this group was too small to be statistically valid.

"For any women considering whether to continue or discontinue hormone therapy for menopausal symptoms, ACOG recommends that she talk with her physician about her individual risks and benefits in HT use, to develop an individualized plan that's right for her," notes Dr. Dickerson. "If a woman does use HT, ACOG recommends she do so for the shortest period of time -- evaluating the decision at least annually -- and in the smallest effective dosage for her."

The Gallup Organization in September 2003 conducted telephone interviews of 301 women ob-gyns, a representative sample of female Fellow and Junior Fellow members of ACOG who currently practice ob-gyn in the US. The survey has an estimated error rate due to sampling and other random effects of plus or minus seven percentage points (95% confidence level).

Details of the survey results released today include the following:

* Menstrual Suppression: Not a Controversy for Women Ob-Gyns

Women ob-gyns were asked about the safety of menstrual suppression, which is the practice of taking a birth control pill each day of the month to stop a woman's monthly period. (When used for contraception only, birth control pills are generally taken 21 days a month, followed by 7 days of a placebo pill, which allows menstrual bleeding). Virtually all the women ob-gyns surveyed believe it is safe, including 69% who feel it is safe for long-term suppression and 30% who say it is safe if used occasionally. Only 1% believe it is unsafe.

When asked if they themselves had ever used menstrual suppression, slightly more than half (53%) said they had. Women ob-gyns under age 40 were more likely than those 40 years and older to have tried menstrual suppression (59.2% versus 42.5%, respectively).

"These numbers indicate that women ob-gyns are very comfortable with the practice of menstrual suppression, not only as a matter of convenience for their patients or themselves, but also because suppressed ovulation can have safety benefits, such as reduced risk of ovarian cancer," notes Laura E. Riley, MD, chair of ACOG's Committee on Obstetric Practice.

* The Pill Tops Birth Control Methods,
  But Ob-Gyns More Likely Than Other Women to Use the IUD

When asked which contraceptive method they would choose for themselves if they wanted to postpone pregnancy, respondents were most likely to say oral contraception, mentioned by one in every two (49%) of the women ob-gyns surveyed. The pill is also the most popular reversible method of birth control among the general population of US women, used by 26.9% of childbearing-age females, or 10.4 million women, according to the Alan Guttmacher Institute (AGI).

Among other birth control methods for postponing pregnancy, 18% of female ob-gyns say they would choose the IUD, followed by 10% selecting the flexible ring (a vaginal ring containing hormones), 8% mentioning the contraceptive patch, and 7% saying the diaphragm.

Noting the relatively high personal use of the contraceptive ring or patch by women ob-gyns, Dr. Riley comments, "It makes sense because women ob-gyns are more likely than women in the general population to know about and use the latest contraceptive options. However, as these same female ob-gyns pass along their insider knowledge about these new contraceptive methods, we may see preferences change among US women in the coming years."

When asked which method they would select if they didn't want any (or any more) children, women ob-gyns mentioned the IUD most often (cited by 28%), followed by tubal ligation/surgical sterilization (22%), oral contraceptives (20%), and vasectomies for their partner (13%). In contrast, among the general population of US women, tubal ligation/surgical sterilization is popular but the IUD is rarely used. Female sterilization is the number-one contraceptive overall, used by 27.7% of US women of childbearing age (ages 15-44) or over 10.7 million women. The IUD is used by less than one percent of US women (0.8%), numbering only 310,000, according to 1995 AGI data.

* Emergency Contraception: "Should Be Over-the-Counter"

When asked if they themselves had ever used emergency oral contraception (or EC, a specific combination of oral contraceptive pills taken within 72 hours after unprotected intercourse to prevent pregnancy), a large majority of women ob-gyns surveyed (87%) said they had not. Thirteen percent had used EC themselves: among physicians under age 40, the figure was 15%, compared to 11% for those ages 40 and over.

"While the percentage of women ob-gyns who have used emergency contraception is not large, women physicians still have far more awareness of and access to this emergency option than do other women," says Dr. Riley. According to a 2003 survey of the Kaiser Family Foundation, 6% of US women have ever used EC. Although this figure represents a growing knowledge of EC -- only 1% of US females in 1997 had ever used EC -- too many women are still unaware of it.

"ACOG wants to make EC far more known and readily available to US women," notes Dr. Riley, "and we support both advance prescriptions and over-the-counter availability of this option for our patients."

* Pregnancy Rate: Most Female Ob-Gyns Have Been Pregnant

A large majority (78%) of the women ob-gyns reported having had at least one pregnancy, as compared to 67% of women in the general US population, according to the National Center for Health Statistics (NCHS).

A sizeable minority (14%) of the doctors interviewed had undergone some form of fertility procedure. This is comparable to the estimated 15% of reproductive-age women who have used some form of service for infertility, according to the CDC's National Survey of Family Growth. Infertility affects about 15% of couples in the US.

"Despite the rigors and long hours of our profession, women ob-gyns are still having families of their own at a rate comparable to or greater than women in the general population," notes Dr. Riley. "This is a unique group of women whose own pregnancy and childbearing experiences may affect the specialty itself as women rise within the ranks of organized medicine," she observes.

* Cesarean Delivery: Experience Parallels That of the General Population

Women ob-gyns appear to be as likely as other women in the general US population to have a cesarean delivery when they give birth. Slightly less than three in ten (27%) of the doctors interviewed who have had a pregnancy report having at least one cesarean delivery. Among US women overall, NCHS preliminary data indicate that cesarean deliveries accounted for 26% of all births in 2002.

* The Elective Cesarean Controversy: Far From Resolved

Among the group of women ob-gyns who reported having a cesarean delivery, most (78%) said it was not elective, meaning it was performed for medical reasons. Twenty-two percent (22%) said their cesarean was elective.

On the general topic of elective cesarean delivery -- also known as "patient choice cesarean" -- the diverse opinions of women ob-gyns reflect the current controversy over this issue. Although some women patients may request elective cesarean instead of a vaginal delivery in the belief that the surgery will prevent future pelvic support or sexual dysfunction problems, or for other reasons, many physicians still believe that such surgery should not be selected over a natural process without immediate and compelling need. (ACOG has also noted that there are still insufficient data on such questions as whether vaginal deliveries are more likely than cesarean deliveries to increase the risk of conditions such as pelvic prolapse or urinary incontinence.)

Over one third (36%) of women ob-gyns say they would not perform an elective cesarean if their patient requested it, and women ob-gyns under age 40 are the most likely age group to say they would not do so (at 41%). Nevertheless, 32% of all the doctors surveyed say they would perform one if asked, and another 28% said it would depend on the circumstances and the patient.

* Large Numbers Are Fit and Exercise Regularly

More than one-third (36%) of the women ob-gyns rate their physical fitness as excellent, and another 45% describe it as good. One in seven say they are only in fair shape, but only 4% feel they are in poor physical shape. Seven in ten (72%) report they exercise on a regular basis: 95% of those who describe their health as excellent report regular exercise.

Walking is the exercise women physicians most frequently mention as something they routinely do to keep fit, mentioned by 71%. One in every two (51%) cites strength training and 41% say they run or jog regularly. Also mentioned were bicycling (30%), swimming (21%) and aerobics classes (20%), followed by yoga (14%) and Pilates (13%).

"In looking at these numbers, we see that women ob-gyns may be able to help their patients with advice on how to get exercise despite the time restraints and stresses of daily living," notes Dr. Dickerson. "Walking is an exercise that many of us can fit in. If women physicians can begin a campaign to get more women patients walking we will make an enormous contribution to public health."

* Diet and Supplements Play a Role

Most female ob-gyns report eating a healthy diet, with 40% saying their diet is very healthy and 52% saying it is somewhat healthy. Two-thirds (68%) say their weight is about right. Only 26% say they are slightly overweight, and 3% describe themselves as very overweight. In contrast, about 55% of Americans say they are either overweight (generally, up to 30 pounds over a healthy weight) or obese (overweight by 30 or more pounds), according to a 2003 report of the market-research firm NPD Group, Inc. (The CDC, meanwhile, has estimated the actual percentage of overweight or obese Americans to be approximately 65%.)

More than half (55%) of the female ob-gyns take a daily multi-vitamin. Forty-four percent (44%) take a calcium supplement daily, which can prevent or reduce the risk of osteoporosis in post-menopausal women. Among women physicians age 48 and over, 68% are taking calcium supplements. "We still have a way to go in modeling and encouraging life-long, adequate calcium intake for the prevention of osteoporosis," says Dr. Dickerson.

* Score Card on Screening

As might be expected, women ob-gyns were more likely than women in the general US population to have been screened recently for cervical or breast cancer.

Nearly 8 out of 10 women ob-gyns (78%) have had a Pap test within the last 18 months, and 90% had one within the past two years. Among US women of reproductive age, 89% have had a Pap test within the previous 3 years.

Among female ob-gyns age 48 and over, 73% had had a mammogram in the past year and 86% had one within the past 2 years. In comparison, among women age 40 and older in the general US population in 2002, 70% had had a mammogram within the previous 2 years.

Fewer women ob-gyns had ever had certain colorectal cancer tests, however. Only 6% overall had ever had a sigmoidoscopy. Thirteen percent (13%) overall had had a colonoscopy, although this increased to 39% among women age 48 and over. Colorectal cancer screening is low in the general population. About 60% of the eligible US population are never screened for colorectal cancer, and of the 40% who are screened at least once, only a fraction of these continue to participate in a regular screening program, according to a 1999 report of the Centers for Disease Control and Prevention.

ACOG recommendations on colorectal screening have changed in recent years. For most women age 50 and over, ACOG now recommends the following: yearly fecal occult blood testing; or flexible sigmoidoscopy every 5 years; or yearly fecal occult blood testing plus flexible sigmoidoscopy every 5 years; or double contrast barium enema every 5 years; or colonoscopy every 10 years.

"Even doctors prefer to postpone their colorectal cancer screening," says Dr. Dickerson. "We all need to do a better job of protecting ourselves by screening for this cancer, which is the third leading cause of cancer deaths in US women."

* Three Out of Four Have Experienced Symptoms

All female ob-gyns age 48 and over were asked whether they had experienced certain menopausal symptoms within the preceding 12 months. About three-quarters (76%) of the women physicians interviewed said they experienced at least some type of symptom, with hot flashes mentioned by 61% and night sweats mentioned by 52%. Other symptoms included sleep disruption (40%), vaginal dryness (36%), irritability (32%), anxiety (30%), and mood swings (27%).

More than half (52%) of the women surveyed said they had experienced three or more of these menopausal symptoms within the past year.

* HT: Yes or No?

Hormone therapy (HT) was the most frequently mentioned treatment these doctors reported using to treat their symptoms, mentioned by 50% who had experienced menopausal symptoms. Other types of treatments were less frequently mentioned. Thirteen percent (13%) said they treated their symptoms with anti-depressants, and 13% mentioned alternative natural therapies. One in five (19%) experiencing symptoms said they did not use any treatment.

* Analyzing Results Post-WHI

"Several things stand out in these responses during this post-WHI era of treating menopausal symptoms," notes Dr. Dickerson.

"First, after early reports of WHI data appeared to discount the very prevalence or severity of patient symptoms, women ob-gyns are saying 'I can tell you the symptoms of menopause are real,' " says Dr. Dickerson.

"Second, although HT remains the most common treatment for symptoms, a noticeable minority of women ob-gyns are using their insider knowledge to try antidepressants for relief of symptoms like hot flashes," she adds. "Anti-depressants (such as SSRIs, or selective serotonin reuptake inhibitors) are not FDA-approved for this purpose, but early research suggests they may be helpful in symptom relief," says Dr. Dickerson.

In a separate release issued today on additional survey results, obesity was cited by women ob-gyns as the number-one health issue for women -- with heart disease being the top issue for women over age 50.

"As physicians, we may have our work cut out for us in transferring our insider knowledge to our patients," says Dr. Dickerson. "The good news," she adds, "is that women ob-gyns appear to practice healthy lifestyles while still maintaining a family and a career. The bad news is that as obesity increases across the US, there is much work to be done by all physicians to help patients develop strong coping strategies against this rising health threat."

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