eEditor’s Note: The following is a summary of a

national survey conducted at the request of the

American College of Obstetricians and Gyne-

cologists regarding the health habits, attitudes

and behaviors of their female OB/GYN mem-

bers. For more information about the survey,

go to www.acog.org.

In a national survey of their own health habits,

women OB/GYNs indicate they practice what

they preach when it comes to good health.

At a time when many Americans are exer-

cising 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 of women OB/GYNs

surveyed report that they regularly exercise, 67

percent say their weight is about right, and 81

percent 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.”

Health Habits & Behaviors

Female OB/GYNs are nearly unanimous (99

percent) in the view that menstrual suppres-

sion—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.

Regarding elective or “patient choice”

cesarean delivery, however, women OB/GYNs

are sharply divided: 36 percent say they would

Speak Out Female OB/GYNs

About Health

SurveyDemonstrates

Female Practitioners

Have “Insider’sAdvantage”

In a national survey

of their own health

habits, women

obstetrician-

gynecologists indicate

they practice what

they preach when it

comes to good health

14 AWHONN Lifelines Volume 8 Issue 1

Practices

not perform a cesarean at a woman’s request if

not medically necessary, 32 percent say they

would and 28 percent 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 percent of

all practicing OB/GYNs in the U.S., they now

fill 71 percent of all U.S. residency positions in

OB/GYN.

The survey also indicates that menopausal

symptoms are common, experienced in the last

year by three-fourths of female OB/GYNs ages

48 and older. Hot flashes were the symptoms

cited most often (by 61 percent of the women

OB/GYNs), followed by night sweats (52 per-

cent), sleep disruption (40 percent), and vagi-

nal dryness (36 percent).

Hormone therapy (HT) was the most fre-

quently mentioned treatment these doctors

used for themselves (mentioned by 50 per-

cent). Thirteen percent tried antidepressants

for symptoms, another 13 percent tried natural

alternative treatments (such as the botanical

black cohosh), and 19 percent said they did not

use any treatment.

Female OB/GYNs also estimate that about

62 percent 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 percent have continued to

take HT following the WHI report.

Although female OB/GYNs who had experi-

enced menopausal symptoms in the last year

were also asked whether they had been taking

HT before and after the WHI report, the sam-

ple size of this group was too small to be statis-

tically 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 indi-

vidual 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

U.S. The survey has an estimated error rate due

to sampling and other random effects of plus

or minus seven percentage points (95 percent

confidence level).

Menstruation andContraception

Female 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. Vir-

tually all the women OB/GYNs surveyed

believe it’s safe, including 69 percent who feel

it’s safe for long-term suppression and 30 per-

cent who say it’s safe if used occasionally. Only

1 percent believe it’s unsafe.

When asked if they themselves had ever

used menstrual suppression, slightly more than

half (53 percent) said they had. Female

OB/GYNs age 40 or younger were more likely

than those 40 years and older to have tried

menstrual suppression (59.2 percent versus

42.5 percent, respectively).

“These numbers indicate that female

OB/GYNs are very comfortable with the prac-

tice of menstrual suppression, not only as a

matter of convenience for their patients or

themselves, but also because suppressed ovula-

tion can have safety benefits, such as reduced

risk of ovarian cancer,” notes Laura E. Riley,

MD, chair of ACOG’s Committee on Obstetric

Practice.

OB/GYNs More Likely ThanOther 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 percent) of the female

OB/GYNs surveyed. The pill is also the most

popular reversible method of birth control

among the general population of U.S. women,

used by 26.9 percent 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 percent of female

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 U.S.

February | March 2004 AWHONN Lifelines 15

More than one-third

(36 percent) of

female OB/GYNs say

they would not

perform an elective

cesarean if their

patient requested it,

and female OB/GYNs

under age 40 are the

most likely age group

to say they would not

do so (at 41 percent)

OB/GYNs say they would choose the IUD, fol-

lowed by 10 percent selecting the flexible ring

(a vaginal ring containing hormones), 8 per-

cent mentioning the contraceptive patch, and 7

percent saying the diaphragm.

Noting the relatively high personal use of

the contraceptive ring or patch by women

OB/GYNs, Dr. Riley commented, “It makes

sense because women OB/GYNs are more like-

ly 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 American

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 percent), followed

by tubal ligation/surgical sterilization (22 per-

cent), oral contraceptives (20 percent), and

vasectomies for their partner (13 percent). In

contrast, among the general population of

American women, tubal ligation/surgical steril-

ization is popular but the IUD is rarely used.

Female sterilization is the number-one contra-

ceptive overall, used by 27.7 percent of

American women of childbearing age (ages 15

to 44) or over 10.7 million women. The IUD is

used by less than 1 percent of American

women (0.8 percent), numbering only 310,000,

according to 1995 AGI data.

Emergency ContraceptionShould Be OTC

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

female OB/GYNs surveyed (87 percent) said

they had not. Thirteen percent had used EC

themselves: among physicians under age 40,

the figure was 15 percent, compared to 11 per-

cent 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 percent of American

women have ever used EC. Although this figure

represents a growing knowledge of EC—only 1

percent of American 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 U.S. women,” notes Dr.

Riley, “and we support both advance prescrip-

tions and over-the-counter availability of this

option for our patients.”

Most Female OB/GYNs HaveBeen Pregnant

A large majority (78 percent) of female

OB/GYNs reported having had at least one

pregnancy, as compared to 67 percent of

women in the general American population,

according to the National Center for Health

Statistics (NCHS).

A sizeable minority (14 percent) of the doc-

tors interviewed had undergone some form of

fertility procedure. This is comparable to the

estimated 15 percent of reproductive-age

women who have used some form of service

for infertility, according to the CDC’s

National Survey of Family Growth. I

nfertility affects about 15 percent of couples

in the U.S.

“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 childbear-

ing experiences may affect the specialty itself as

women rise within the ranks of organized

medicine,” she observes.

Cesarean Delivery: ExperienceParallels That of the GeneralPopulation

Female OB/GYNs appear to be as likely as oth-

er women in the general U.S. population to

have a cesarean delivery when they give birth.

Slightly less than three in ten (27 percent) of

the doctors interviewed who have had a preg-

nancy report having at least one cesarean deliv-

ery. Among American women overall, NCHS

preliminary data indicate that cesarean deliver-

ies accounted for 26 percent of all births in

2002.

16 AWHONN Lifelines Volume 8 Issue 1

Among the group of female

OB/GYNs who reported having a

cesarean delivery, most (78 percent)

said it was not elective, meaning it was

performed for medical reasons.

Twenty-two percent 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 sup-

port 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 condi-

tions such as pelvic prolapse or

urinary incontinence.)

More than one-third (36 percent)

of female OB/GYNs say they would

not perform an elective cesarean if

their patient requested it, and female

OB/GYNs under age 40 are the most

likely age group to say they would not

do so (at 41 percent). Nevertheless, 32

percent of all the doctors surveyed said

they would perform one if asked, and

another 28 percent said it would

depend on the circumstances and the

patient.

Most Are Fit and Exercise Regularly

More than one-third (36 percent) of

female OB/GYNs rate their physical

fitness as excellent, and another 45

percent describe it as good. One in

seven say they are only in fair shape,

but only 4 percent feel they are in poor

physical shape. Seven in ten (72 per-

cent) report they exercise on a regular

basis: 95 percent 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 percent. One in

every two (51 percent) cites strength

training, and 41 percent say they run

or jog regularly. Also mentioned were

bicycling (30 percent), swimming (21

percent) and aerobics classes (20 per-

cent), followed by yoga (14 percent)

and Pilates (13 percent).

Most female OB/GYNs report eat-

ing a healthy diet, with 40 percent say-

ing their diet is very healthy and 52

percent saying it’s somewhat healthy.

Two-thirds (68 percent) say their

weight is about right. Only 26 percent

say they are slightly overweight, and 3

percent describe themselves as very

overweight. In contrast, about 55 per-

cent of Americans say they are either

overweight (generally, up to 30 pounds

over a healthy weight) or obese (over-

weight by 30 or more pounds), accord-

ing 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 percent.)

More than half (55 percent) of the

female OB/GYNs take a daily multivit-

amin. Forty-four percent take a calci-

um supplement daily, which can pre-

vent or reduce the risk of osteoporosis

in postmenopausal women. Among

women physicians age 48 and over,

68 percent are taking calcium

supplements.

Screening Scorecard

As might be expected, female

OB/GYNs were more likely than

women in the general American popu-

lation to have been screened recently

for cervical or breast cancer.

Nearly eight out of ten female

OB/GYNs (78 percent) have had a Pap

test within the last 18 months, and 90

percent had one within the past two

years. Among American women of

reproductive age, 89 percent have had

a Pap test within the previous three

years.

Among female OB/GYNs age 48

and over, 73 percent had had a mam-

mogram in the past year and 86 per-

cent had one within the past two years.

In comparison, among women age 40

and older in the general U.S. popula-

tion in 2002, 70 percent had had a

mammogram within the previous two

years.

Fewer female OB/GYNs had ever

had certain colorectal cancer tests,

however. Only 6 percent overall had

ever had a sigmoidoscopy. Thirteen

percent overall had had a colonoscopy,

although this increased to 39 percent

among women age 48 and over.

Colorectal cancer screening is low

in the general population. About 60

percent of the eligible U.S. population

are never screened for colorectal can-

cer, and of the 40 percent 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 col-

orectal 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

five years; or yearly fecal occult blood

testing plus flexible sigmoidoscopy

every five years; or double contrast

barium enema every five years; or

colonoscopy every ten years.

Menopausal Symptomsand Treatment

All female OB/GYNs ages 48 and older

were asked whether they had experi-

enced certain menopausal symptoms

within the preceding 12 months.

About three-quarters (76 percent) of

the women physicians interviewed said

they experienced at least some type of

symptom, with hot flashes mentioned

February | March 2004 AWHONN Lifelines 17

by 61 percent and night sweats men-

tioned by 52 percent. Other symptoms

included sleep disruption (40 percent),

vaginal dryness (36 percent), irritabili-

ty (32 percent), anxiety (30 percent)

and mood swings (27 percent).

More than half (52 percent) of the

women surveyed said they had experi-

enced 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 percent

who had experienced menopausal

symptoms. Other types of treatments

were less frequently mentioned. Thir-

teen percent said they treated their

symptoms with antidepressants, and

13 percent mentioned alternative natu-

ral therapies. One in five (19 percent)

experiencing symptoms said they did

not use any treatment.

“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 dis-

count 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 treat-

ment 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.

18 AWHONN Lifelines Volume 8 Issue 1