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Women's Issues FAQ

 


Frequently Asked Questions - Women's Issues


  1. Should individuals with PXE avoid birth control pills? 
  2. Are there special management guidelines or risks for pregnancy in PXE? 
  3. Is vaginal delivery safe? 
  4. Should I see a high-risk obstetrician? 
  5. Will the procedure uterine ablation affect my PXE? 
  6. Microcalcifications have been found on my mammograms. Is this typical for PXE? 
  7. Is PXE caused by using hazardous chemicals while pregnant? 
  8. Are Fosamax and Evista safe for women with osteoporosis and PXE? 


For more information, also see the April 2011 webinar, "Women's Health Issues in PXE"


1. Should individuals with PXE avoid birth control pills?


To date, there is no published evidence of difficulties with birth-control pills related to PXE.  [March 2006]

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2. Are there special management guidelines or risks for pregnancy in PXE?


As far as we know from our survey of 795 pregnancies1, there does not appear to be a statistically significant risk of PXE causing an adverse outcome of pregnancy, or of pregnancy adversely affecting the subsequent course or severity of PXE. Because patients with PXE can have pregnancy related complications especially if they have underlying vascular disease or hypertension or are having ongoing eye problems, this can affect the management of the pregnancy. There is a slightly greater risk of GI bleeding, we think, but not as great as was previously thought. Eye monitoring by Amsler grid and periodic retinal examination are especially important during pregnancy, because the presence of neovascularization (growth of small vessels, which could then bleed and cause vision loss) might affect the method of delivery.

A high-risk obstetrician is a good idea, because that individual is more likely to be comfortable monitoring and managing blood pressure and other medical issues that arise during pregnancy and to work closely with your other physicians.

Medical bulletins, including one about pregnancy in PXE, can be found at the Info for Patients page.  [March 2006]

1Bercovitch L, LeRoux T, Terry S, Weinstock MA. Pregnancy and obstetrical outcomes in pseudoxanthoma elasticum. Br J Dermatol. 2004 Nov;151(5):1011-8. Download journal article

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3. Is vaginal delivery safe?


Vaginal delivery is safe for most women with PXE. However, your ophthalmologist should be consulted if you are at risk of retinal bleeding since pressures within the vessels of the eye can rise significantly with pushing during labor.  [January 2007]

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4. Should I see a high-risk obstetrician?


A high-risk obstetrician is a good idea, because that individual is more likely to be comfortable monitoring and managing blood pressure and other medical issues that arise during pregnancy and to work closely with your other physicians.  [Janaury 2007]

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5. Will the procedure uterine ablation affect my PXE?


There is no particular reason that having PXE would lead one to recommend against having a uterine ablation. PXE can also be associated with cardiac or vascular problems, however, so any procedure done under general anesthesia should involve pre-operative evaluation to be certain that there are no underlying cardiac or vascular problems.  [March 2006]

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6. Microcalcifications have been found on my mammograms. Is this typical for PXE?


There have been isolated case reports of arterial and skin calcification in mammograms of patients with PXE, and unpublished anecdotes of many women with PXE undergoing breast biopsy for evaluation of microcalcifications. A 2003 study published in the Journal of the American Academy of Dermatology2 systematically evaluated mammography and breast pathology in PXE. Breast microcalcification and arterial calcification are not rare in the normal population and are often not of diagnostic value. The presence of both of these findings, especially with skin thickening or axillary skin calcification, should suggest a diagnosis of PXE. The majority of breast calcifications in PXE are benign. However, a skilled radiologist should interpret your mammograms in light of these findings and suspicious calcifications or clusters of calcifications should be evaluated further, if necessary by biopsy. 

Read the Patient Summary of this article. [March 2006]

2Bercovitch L, Schepps B, Koelliker S, Magro C, Terry SF, Lebwohl M. Mammographic findings in pseudoxanthoma elasticum. J Am Acad Dermatol. 2003 Mar;48(3):359-66.

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7. Is PXE caused by using hazardous chemicals while pregnant?


PXE is caused by inheriting a mutation in the ABCC6 gene from both your father and mother. It is not caused by chemicals ingested by pregnant women or otherwise encountered during pregnancy.  [March 2006]

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8. Are Fosamax and Evista safe for women with osteoporosis and PXE?


Fosamax is not contraindicated in PXE. The class of drugs it belongs to inhibits bone resorption and does not affect mineralization of elastic tissue. The medication can cause gastric and esophageal irritation because it must be taken on an empty stomach, but PXE International is not aware of any reported problem with this in patients with PXE.

Evista is a selective estrogen receptor modulator. It is an estrogen that does not affect estrogen receptors in the breast, so there is no increased risk of breast cancer. It is associated with a three-fold increase in the risk of venous thromboembolism (clots in veins), but PXE International is not aware of any reports of extra risk in PXE.

The decision can be made based on underlying risk factors and the known need for treatment of fairly significant osteoporosis - which is associated with a high risk of spinal compression, wrist, and hip fracture.  [March 2006]

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Disclaimer


These are replies to general and specific questions which have been submitted to us in the past. Our responses may not apply to any particular individual´s situation and are not a substitute for medical advice given by a physician who is familiar with the individual´s case and who has examined the patient. In addition, the responses are updated on a periodic basis but may not be current.

 

 

Last modified: 03/22/2014