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What is the best PCOS treatment? Learn about your options

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Getting a diagnosis of polycystic ovary syndrome likely came with a mix of emotions. You might have felt confused and frustrated. Perhaps even feelings of thankfulness now that you finally have an answer to the strange symptoms you’re experiencing.

Simply called PCOS by many, this common hormonal disorder affects 6-12% of women of reproductive age. And while there’s no cure for PCOS, a diagnosis can give you many things. It can open the door to a range of helpful treatment options. It can lead to a better quality of life. And as one of the most common causes of female infertility, it can help you and your doctor talk about options that may help you reach your pregnancy goals.

From symptom management to hormone medications to fertility treatments, here’s what you need to know about polycystic ovary syndrome treatment options and how they can help you reach your goals, whether it’s living more comfortably or getting pregnant.

How PCOS is treated depends on a few factors

The best polycystic ovary syndrome treatment plan for you will be unique. That’s because your doctor will work with you to make a plan that considers a range of personal factors. Below, we dive into some of the top considerations.

Your pregnancy goals

Polycystic ovary syndrome is one of the most common causes of infertility in women. During ovulation, the ovary releases an egg, which typically happens once per cycle. For people with PCOS, ovulation doesn’t happen consistently or at all. This is called anovulation — when an egg isn’t released — and it’s the cause of approximately 25% of infertility cases. The prevalence of PCOS in women with anovulatory infertility is around 80%. The hormone imbalance associated with PCOS interferes with ovulation, making it more challenging for women to get pregnant, but not impossible.

When discussing your treatment, your doctor will ask about your pregnancy goals. If you hope to become pregnant, they will focus on a plan that helps your body ovulate regularly to increase your chances of conceiving. This will help rule out other treatment options that include hormonal birth control or medications for symptom management that may cause birth defects.

Your age

Polycystic ovary syndrome directly impacts your menstrual cycle. And although the hormonal imbalance of PCOS doesn’t change with age, many women have noticed that their menstrual cycles become more regular as they get closer to menopause age. This is likely because the decrease in estrogen levels as you get older causes your body to eventually stop ovulating. But some may still experience symptoms during and after menopause.

Polycystic ovary syndrome is also linked to other medical conditions like heart disease, diabetes and stroke. And since the risk of these conditions often increases with age, it’s another factor your doctor will consider to guide your PCOS treatment plan.

The type and severity of your symptoms

There are many symptoms associated with PCOS, including an irregular menstrual cycle and irregular ovulation, acne, weight gain and hirsutism (excessive hair growth). But the type and severity of symptoms you experience will be unique, which means your PCOS treatment plan will also be unique. For example, cysts in a polycystic ovary aren’t usually painful.

PCOS treatment: Symptom management

Since polycystic ovary syndrome is a chronic condition, symptoms persist and may worsen over time. Symptom management is the first treatment step for most people.

Changing your diet and physical activity level

Many women with PCOS are overweight because the condition can cause their body to become resistant to insulin. Insulin controls your blood sugar, and when your body can’t properly respond to insulin, it sends a signal to your pancreas to keep producing more. When this happens, your body isn’t able to process the extra insulin and blood sugar, so it’s stored in the body as fat. To help address this and other related symptoms, your doctor may recommend that you change your diet and increase your physical activity.

The weight loss that would come with changing your diet and physical activity can help manage and relieve some of your symptoms. A weight loss of as little as 5% of your body weight can lead to more normal menstrual cycles and ovulation. Losing weight can also help regulate your body’s insulin levels and possibly decrease androgen production that can lead to excessive hair growth and acne.

Hair removal procedures

Between 70-80% of women with PCOS experience excessive hair growth on their face, back, chest, abdomen or thighs. Doctors may recommend hair removal procedures like waxing, electrolysis or laser hair removal to reduce this growth. Most hair removal procedures are not recommended while pregnant, but there are no studies to indicate that procedures like electrolysis or laser are unsafe up to the point of conception.

PCOS treatment if you hope to become pregnant

Doctors will use your pregnancy goals to recommend treatment options for PCOS-related infertility. Whether you’ve been trying to get pregnant or you’re hoping to conceive in the future, the irregular ovulation that happens when you have PCOS can make it harder to become pregnant naturally. Treatment options can include medications, intrauterine insemination and in vitro fertilization.

Ovulation medications for people with PCOS

To increase your chances of getting pregnant, doctors may prescribe ovulation medications that help your ovaries release eggs more regularly, including:

Clomiphene

Clomiphene is an ovulation stimulant that works similarly to estrogen – a female sex hormone that helps the body develop eggs in the ovaries and release them. Regular ovulation is one key factor in increasing your chances of conception each month. Women who benefit the most from using clomiphene are those diagnosed with polycystic ovary syndrome. However, it’s not recommended if you have ovarian cysts.

Clomiphene treatment usually happens in cycles so your doctors can assess the impact, including whether you get pregnant, if cysts have formed on your ovaries, or if the ovaries are enlarged. Clomiphene is designed to stay at a low dosage and treatment time.

Letrozole

Letrozole is an ovulation medication prescribed to women with irregular ovulation. It improves fertility by stimulating the body’s follicle-stimulating hormone (FSH) production. The ovaries have hundreds of follicles that contain an egg, and FSH helps them grow, mature and prepare for ovulation. Letrozole can increase ovulation rates in women with PCOS, and 60-80% of those who take the drug ovulate normally after using it.

Gonadotropins

Gonadotropins can be used as a second line of treatment for PCOS infertility for women who did not ovulate or were unable to conceive after trying clomiphene treatment. Unlike clomiphene and letrozole, the hormone is administered as an injection. Nearly identical to FSH – the hormone the body produces to start ovulation – gonadotropins stimulate the growth and maturation of ovarian follicles. Rather than with a routine women’s health specialist, management with injectable medications is usually done with a reproductive endocrinology and infertility (REI) trained doctor.

Possible risks of ovulation medications

Like other medications, ovulation medications can come with some possible side effects. Those side effects may include headache, upset stomach, blurred vision, shortness of breath and multiple births.

Your doctor can walk you through all the potential risks of ovulation medications and help you decide if they’re right for you.

Intrauterine insemination (IUI)

IUI is a fertility treatment where millions of sperm are placed – artificially inseminated – in the uterus. During intercourse, millions of sperm cells leave the body, but only a couple hundred sperm reach the egg. And there’s no guarantee that the sperm are healthy enough to fertilize it.

During an IUI procedure, a doctor will collect a sperm sample and process it to isolate the healthy sperm. They’ll insert a thin tube (catheter) directly into the uterus so more healthy sperm can be placed closer to the egg, increasing the likelihood of fertilization.

IUI is a minimally invasive procedure and shouldn’t cause much discomfort. Your doctor may recommend IUI during reproductive counseling if you’ve been trying to conceive for at least one year.

In vitro fertilization (IVF)

IVF may be an option for PCOS-caused infertility if more conservative treatments don’t work. Typically, your primary care doctor or women’s health specialist would refer you to a specialty fertility clinic if you’re considering IVF.

IVF is a multi-step process. But at a high level, the first step is for you and your partner’s overall health and fertility to be evaluated to determine the best next steps. Then, to actually start the conception process, you’ll begin taking fertility medications for a certain period of time to boost egg production.

Sometime around the middle of your menstrual cycle, the eggs are retrieved through a minor surgical procedure. If you’re using your partner’s sperm, they’ll likely provide a semen sample on the day of the egg retrieval, which will be used to fertilize the eggs in a laboratory. Over several days, the fertilized eggs will be monitored, with some progressing into viable embryos. Embryos are frozen until they’re ready to be transferred to your uterus to hopefully develop.

When compared to medication, IVF has higher pregnancy rates. However, IVF isn’t covered by many insurances, so it can be very expensive.

PCOS treatment if you don’t plan to become pregnant ever or in the near future

If getting pregnant isn’t part of your plans ever or in the near future, doctors may prescribe a series of medications to regulate your hormones and manage your PCOS. Some of these treatments can be discontinued if you decide later that you want to try to become pregnant.

Hormonal birth controls

Hormonal birth control can be an effective, short- or long-term treatment for polycystic ovary syndrome in women who don’t want to become pregnant now or in the future. There are several options, including birth control pills, an intrauterine device (IUD) or a birth control patch.

A combination of estrogen and progestin in these medicines can help even out the hormone imbalance caused by PCOS. They work by increasing estrogen and lowering androgens like testosterone, which can help regulate your menstrual cycle, improve acne and reduce hair on your face and body.

It is also not good for your body to not have periods when your estrogen level is normal. Your uterus needs the protection of progesterone, or it can lead to increased risk of a type of uterine cancer called endometrial cancer. If you are not having periods at least every three months, your doctor will talk to you about ways to protect your uterus.

Diabetes medication

Your doctor may prescribe diabetes medication because PCOS can impact the pancreas just like diabetes. These medications make your body more responsive to insulin. This prevents your pancreas from producing excess insulin and can lower insulin and androgen levels. These medicines can also keep glucose levels stable.

Prescription medications aren’t specifically approved for treating PCOS, but they are often used to treat symptoms as they can clear acne, reduce hair growth from hirsutism, regulate periods, improve weight loss and lower cholesterol levels.

Hormone-blocking medications

To treat your PCOS symptoms, your doctor may prescribe hormone blockers like anti-androgen medicines. These medicines are meant to block the effects that come with excess androgen production to prevent acne and excessive hair growth.

Some common hormone blockers used to treat PCOS include finasteride, eflornithine hydrochloride, and oral and topical spironolactone. Anti-androgen medicines are not recommended if you’re pregnant or actively trying to conceive as they can cause birth defects if taken while pregnant.

Take the next step to get treatment for PCOS

There are several options available for treating polycystic ovary syndrome. Although it’s a chronic condition that persists over time, you can manage your PCOS symptoms and significantly improve your quality of life. Talk to your doctor about your goals. Whether you’ve been trying to get pregnant or looking for relief from your symptoms, they can help you create a unique treatment plan that works for your needs.



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Longevity Cheat Sheet: 15 Ways to Live Longer

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First off, this guide is not just about lifespan. These tips can improve your energy, happiness, productivity, and much more than just how long you live.This cheat sheet is designed to be short and jam-packed with science-based tips to improve your longevity. Guava Health will focus exclusively on results of modern science. For each tip in the guide, a reasonable longevity improvement is identified that an average person might be able to attain, ranging from 7% to 66%. The percentage benefit is derived from the hazard ratios in the studies, and the corresponding Scientific Rigor score was subjectively determined by Guava Health’s statistician and medical officer.Disclaimer: The studies below are mostly correlations, not guaranteed causations, and are based on averages of many people. This means that your personal health may react differently than in the studies. Before taking action, you should talk to your doctor about your specific situation.

#1: Do not smoke cigarettes

  • Benefit: +66%
  • Scientific Rigor: 3/3

The most boring and yet most effective recommendation on the list shouldn’t surprise anyone. Don’t light toxic stuff on fire and then inhale it. Never-smokers vs. lifelong smokers have a whopping 66% reduction in mortality by age 79, and quitting after a long time of smoking can also retain much of this benefit.

#2: Take 8,000 to 12,000 steps per day

  • Benefit: +51%
  • Scientific Rigor: 2/3

There’s a reason fitness trackers target 10,000 steps per day: It’s the magic number that gets you most of the possible improvement. Increasing step count from 4,000 to 8,000 per day was associated with a staggering 51% reduction in death from all causes (all-cause mortality). Additionally, the intensity of the steps, like running vs. walking, didn’t matter at all. So 25 minutes on the elliptical might save you time in obtaining your step goal, but each step will benefit your longevity the same as a normal walk.

#3: Get sufficient sunlight

  • Benefit: +50%
  • Scientific Rigor: 1/3

This was higher up the list than expected, but it turns out that totally hiding from the sun might really hurt you. A study of 29,518 Swedish women found a 2X decrease in mortality associated with the highest amount of sun exposure. Note that we only gave this study a scientific rigor score of 1/3 because it was only women and took place in a northern climate. The correlation with sunbathing was seen in a country with a very low UV index, which should be interpreted with caution. However, many other studies have found that adequate sunlight is important for longevity, often related to Vitamin D and melatonin.

It’s obvious, but worth stating anyway: Too much sun can kill you. So don’t take this as advice to sit in the sun all day or to get sunburnt.

#4: Consider dry sauna a few times per week

  • Benefit: +40%
  • Scientific Rigor: 1/3

The study showcasing sauna benefits is from Finland, as many sauna aficionados might have guessed. The study only includes men and they’re all from Finland, but it’s the best study Guava Health found and it shows a substantial 40% reduction in all-cause mortality for those who used a sauna 4-7 times per week compared with once per week. Normally the study would include comparisons with zero saunas per week, but apparently that is unheard of in the sauna capital of the world. Keep in mind this is for dry saunas at around 175 degrees F, so does not necessarily apply to cooler saunas, infrared saunas, or steam rooms. However, a study linking infrared sauna with coronary improvements was found.

#5: Brush and floss your teeth nightly

  • Benefit: +37%
  • Scientific Rigor: 2/3

In addition to not aggravating the people within smelling distance, brushing and flossing each independently help you live longer, according to Guava Health’s chosen study on dental behaviors, conducted on adults 52 and older. Brushing and flossing every day compared to not every day was associated with a mighty 37% reduction in death during the study period. Yep, it wasn’t just something your parents bugged you about; it might actually kill you. A curious discovery in the article was that nightly brushing was most important, and was even better than morning and daytime combined. Flossing every day was best, but don’t worry if you’re lazy sometimes, there was still a noticeable benefit in flossing “sometimes,” just not as much.

#6: Minimize your stress levels

  • Benefit: +34%
  • Scientific Rigor: 2/3

Another commonly mentioned factor of faster aging, reduction of perceived stress, landed on the list with thorough scientific evidence. There is an entire industry around stress reduction, but if you’re looking to improve, you should first consider all the other health improvements on this list since many can reduce stress. Then, perhaps consider meditation or massage, which both have scientific evidence of stress reduction.

#7: If you drink alcohol, stay below 7 standard drinks per week

  • Benefit: +31%
  • Scientific Rigor: 3/3

A small amount of alcohol appears to give you slight protection from a few causes of death, notably myocardial infarction, but it’s still detrimental to overall longevity. For amounts below 100 grams (~7 drinks) per week, this study of 599,912 people found negligible effects on mortality. But, as you can see in the chart, those negative effects increased steeply above 7 drinks per week. Cutting down from 3 drinks per day to 1 drink could reduce your risk of death by 31%.

Keep in mind that if you don’t currently drink, it’s not recommended you start, since alcohol is known to be addictive and moderating your consumption might be difficult.

#8: Consider intermittent fasting

  • Benefit: +26%
  • Scientific Rigor: 1/3

Caloric restriction is one of the most effective and persistent methods of extending life across every species of life ever studied. Humans, however, have not been equally proven to live longer simply by reducing calories. There are some studies showing probable positive effects, such as the people who eat less in the Japanese islands of Okinawa, and across studies of fasting, which is a little different from calorie restriction. The best study Guava Health found wasn’t as thorough as hoped because it studied only 2,714 people and they were all recovering from a surgical procedure. But, it did show a very substantial reduction in mortality for those who routinely fasted for 5+ years compared with those who didn’t fast.

#9: Don’t consume too much sugar

  • Benefit: +23%
  • Scientific Rigor: 2/3

This study found that consuming only 10% of your daily calories as sugars compared with 20% or more offered a 23% reduction in mortality. The authors also found that it was more helpful to reduce sugar in beverages than it was in solid foods. Similar to avoiding excess sugar, avoiding high glycemic index foods can also be helpful to your longevity. Basically, eat more of the stuff like nuts and vegetables that don’t give you an instant dump of energy.

#10: Minimize processed meat

  • Benefit: +19%
  • Scientific Rigor: 3/3

Of all the meats you can eat, fish is one of the best for longevity, while red meat and processed meat are among the worst. That’s a generalization, of course — some fish are much healthier to eat than others (wild salmon is great), and the quality of red meats can vary significantly. The study Guava Health chose shows the biggest offender to be processed meat by far, but also indicates red meat is slightly harmful on average. So the official recommendation here is to avoid processed meat when you can, and either avoid red meat or be sure it’s high quality.

#11: Avoid bad air quality

  • Benefit: +17%
  • Scientific Rigor: 3/3

Bad air can come from many sources, including polluted cities, factories, forest fires, and high-heat cooking. Basically, it’s not healthy to burn stuff and then breathe it in. A massive study on U.S. cities found that each 10 µg/m3 decrease in PM2.5, a common measure of air pollution, reduces your mortality by 17%. This amount of reduction or more could be achieved by moving from a polluted city or factory to the suburbs. You can easily find your neighborhood’s current PM2.5 measurement online. If you’re in one of the world’s most polluted cities, your potential benefit could be much higher than 17%. And if you don’t plan on moving, you can also use an air purifier in your home and office, and use a car with HEPA filters to help minimize your exposure.

#12: Consider drinking coffee — even decaf

  • Benefit: +15%
  • Scientific Rigor: 3/3

Before modern science began adjusting for confounding factors, researchers used to think that coffee increased death rates. In reality, coffee drinkers were just more likely to also smoke cigarettes. After adjusting for this, recent studies show a non-trivial reduction in mortality for moderate coffee drinking of 2-4 cups per day. Furthermore, the improvement appears to remain even if you’re a slow metabolizer of caffeine, which is something you can test for with popular genetic test kits. Note that it’s coffee studied here, not caffeine. Decaffeinated coffee has shown similar results.

Remember, caffeine is a drug and is often addictive. It can be beneficial, but can also cause serious effects on your body, particularly at high amounts, so consult your doctor if you’re unsure.

#13: Eat 5 servings of fruits and vegetables per day

  • Benefit: +13%
  • Scientific Rigor: 2/3

More servings of fruits and veggies were associated with lower mortality, plateauing around ~5 servings. Notably, this does not include starchy veggies like corn, peas, and potatoes, nor does it include fruit juices. Increasing from 2 to 5 servings per day is what showed the 13% benefit being highlighted.

#14: Sleep 7-9 hours per night

  • Benefit: +11%
  • Scientific Rigor: 3/3

Many studies, including this meta-study, show increased mortality if you sleep too little. One difficulty is they had to combine different definitions of “short sleep” ranging from 4 to 7 hours, but the overall result was that staying above ~7 hours reduced mortality. A curious result of their study was that long sleep was even worse than short sleep. Somewhere in the range of 7-9 hours looked optimal for most studies, and although the studies were based on survey answers and couldn’t measure it, it’s common to recommend 7 hours of time actually asleep and not just laying in bed.

#15: Consider metformin

  • Benefit: +7%
  • Scientific Rigor: 3/3

Normally a drug targeting a specific disease would not be included in a longevity cheat sheet built for everyone, but metformin is a notable exception. In studies meant to understand its effectiveness at improving diabetes, the researchers were surprised to find that metformin reduced death from all causes for diabetics, even beyond non-diabetics, by 7%. This suggests that non-diabetics could benefit by even more than 7% by taking it. However, metformin is a prescription drug in the U.S., so Guava Health only recommends considering it through talking with your doctor, or other legitimate pathways if you live outside the U.S.

Bonus: Drinking more water doesn’t seem to help

  • Benefit: +0%
  • Scientific Rigor: 1/3

Strangely, no correlation was found between the amount of liquids consumed in a day and mortality. We all know that you’ll die within days if you stop drinking water, but perhaps the negative effects only appear with extreme dehydration, whereas all the study participants had full access to water.

 

This story was produced by Guava Health and reviewed and distributed by Stacker Media.

 





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Amazon's No. 1 Bestselling Pull-Up Bar Just Dipped Below $25, and Shoppers Say It's 'Worth Every Penny'

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Men’s Journal aims to feature only the best products and services.  If you buy something via one of our links, we may earn a commission.

If you’re even remotely interested in setting up a home gym, there’s one item that should be at the top of your shopping list: a pull-up bar. These simple, incredibly useful devices allow you to perform not only pull-ups, but all kinds of other exercises (dips, push-ups, and more), and they’re ideal for building upper body strength. That’s what makes the Ally Peaks Pull-Up Bar such a screaming deal: Now less than $25, you can get a great at-home workout that delivers real results.

The Ally Peaks Pull-Up Bar is now on sale for just $24 after an on-page coupon—a total discount of 25% off the normal $32 price. This well-made, highly versatile home workout tool has stacked up nearly 5,400 glowing five-star ratings from all kinds of fitness enthusiasts, and it’s currently the No. 1 bestselling strength training pull-up bar on Amazon

Ally Peaks Pull-Up Bar in Silver 2, $24 (was $32) at Amazon

Courtesy of Amazon

Get It

There are tons of pull-up bars for doorways on the market, but this is one of the best we’ve seen, especially at this price point. It stands out because of its durable 1.7mm-thick steel frame (including the top crossbar) that’s powder-coated to prevent rust, and it’s rated to hold up to 440 pounds. It’s also easy on your home thanks to durable silicone pads that protect your doorframe, and it even includes a second set of pads that you mount on the doorframe itself for extra protection. Finally (and perhaps most importantly), it’s designed for maximum workout versatility. It features hand grip areas for a variety of exercises, like wide pull-ups (great for working your shoulders), chin-ups, and neutral pull-ups. You can also use it on the floor for incline pushups, dips, and sit-ups, too.

Reviewers love that the Ally Peaks Pull-Up Bar has a solid feel when installed. One shopper called it “really sturdy” and said it “works well” in their home. Another shopper called it “stable and secure” and said they “feel 100% comfortable and confident on it.”

Related: On’s ‘Most Comfortable’ Running Shoes That Shoppers Call Their ‘New Favorites’ Are a Rare 25% Off

Others marvel at the versatility that comes with having this inexpensive piece of equipment. “Sturdy, versatile, and worth every penny,” one shopper said. “It has exceeded all my expectations. As someone who prioritizes fitness but doesn’t have the space for bulky equipment, this pull-up bar is a game changer for my home gym setup.” Another shopper agreed, saying, “So far I’ve been using it for wide pull-ups, close pull-ups, wide and close push-ups, and tricep dips.”

With its compact design and wide variety of uses, the Ally Peaks Pull-Up Bar is a must-have for any home fitness setup. At just $24, it’s a nearly unbeatable bargain, but act fast, because this killer deal won’t last forever.



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Montana Creates Emergency ‘Drive-Thru’ Blood Pickup Service for Rural Ambulances

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By Arielle Zionts

Crystal Hiwalker wonders if her heart and lungs would have kept working if the ambulance crew had been able to give her a transfusion as the blood drained from her body during a stormy, 100-mile ride.

Because of the 2019 snowstorm, it took 2.5 hours to drive from her small town of Lame Deer, Montana, to the advanced trauma center in Billings.

Doctors at the Billings Clinic hospital revived Hiwalker and stopped the bleeding from her ruptured ectopic pregnancy. They were shocked that she not only survived after her heart stopped beating and she lost nearly all her blood, but that she recovered without brain damage.

The Montana State Trauma Care Committee, which works to reduce trauma incidents and to improve care, later realized the ambulance that carried Hiwalker had passed near two hospitals that stocked blood. What if Hiwalker had access to that blood on her way to Billings, committee members asked.

That realization, and question, inspired committee members to create the Montana Interfacility Blood Network, which they say is the first program of its kind in the U.S. The network allows ambulance crews to pick up blood from hospitals and transfuse it to patients on the way to the advanced care they need.

“We kind of came up with the idea of having a blood handoff — like driving through a fast-food restaurant drive-thru — and picking up blood on the way,” said Gordon Riha, a trauma surgeon at the Billings Clinic trauma center, where Hiwalker was treated. Riha said timely blood transfusions can prevent death or permanent brain injury.

The network is aimed at rural patients, who face elevated rates of traumatic injuries and death, said Alyssa Johnson, trauma system manager for the state of Montana.

“We have to get more creative. We don’t have a blood bank on every corner, and we don’t have a Level 1 trauma center on every corner,” Johnson said.

Network leaders say the program has helped at least three patients since it launched in 2022. They hope it will be used more in the future.

Hiwalker is excited about the program.

“I’m so glad that something like this got started, because it would save a lot of lives from where I live,” she said.

Hiwalker said she has heard about people bleeding to death after car crashes, gunshot wounds, and stabbings in her rural community. Johnson said work injuries, cancer, gastrointestinal problems, and childbirth can also cause serious bleeding.

The Montana trauma committee began discussing the blood network a few months after Hiwalker’s brush with death. First, it created a map of 48 facilities with blood banks. Then, it created guidelines for how hospitals, blood banks, ambulances, and labs must communicate about, package, transport, document, and bill for the blood.

The network is used only during emergencies, which means there’s no time to test patients’ blood types. So it uses only type O red blood cells, which can be transfused safely into most patients.

The receiving hospital — not the one that provided the blood — is responsible for billing patients’ insurance for the blood. The cost depends on how much blood patients need but typically ranges from several hundred dollars to more than a thousand, said Sadie Arnold, who manages the blood bank at Billings Clinic.

Arnold said blood must be stored in a lab and managed by professionals with specific degrees, clinical experience, and board certifications.

Some rural hospitals lack space for a lab or money to recruit these specialists, Arnold said. Or they may not need blood often enough to justify storing a product that can expire and — especially during the current national blood shortage — is needed elsewhere. The network uses blood that has a maximum shelf life of 42 days.

Rural hospitals that do store blood may have only small amounts on hand. A rural Montanan with severe bleeding experienced that firsthand when he went to the nearest hospital, which had only one unit of type O blood, according to a report on the blood network. But thanks to the new program, ambulance medics picked up more blood from a hospital halfway through an 80-mile drive to the trauma hospital.

Ideally, rural patients with serious bleeding would be transported by medical helicopters or airplanes outfitted for transfusions. But, as in Hiwalker’s case, flying can be impossible during bad weather. That can mean hours-long ambulance rides. Some towns in northeastern Montana, for example, are more than 250 miles away from the nearest advanced trauma center.

“This was truly designed for kind of that last-ditch effort,” Johnson said. When “we’re out of options, we’ve got to get the patient moving towards a larger center, and we can’t fly.”

The blood handoff may involve the ambulance stopping at the second hospital, Johnson said. But during one incident, a police officer picked up the blood and delivered it to the ambulance at a highway exit, she said.

Ambulances may also pick up a paramedic or nurse to provide the transfusion along the way, since many rural ambulance crews are staffed by emergency medical technicians, who in Montana aren’t authorized to do so.

Medics in other cities and states, including ones with rural areas, have started performing blood transfusions in ambulances and helicopters, said Claudia Cohn, chief medical officer of the national Association for the Advancement of Blood & Biotherapies.

She said researchers are also interested in the potential of using frozen and freeze-dried blood products, which could be helpful in rural areas since they’re easier to store and have longer shelf lives.

Johnson said the Montana Interfacility Blood Network is the only program she knows of specifically aimed at rural patients and involving ambulances picking up blood from hospitals along their routes. She said the network is gaining interest from other states with large rural regions, including Oregon.

Hiwalker said receiving a blood transfusion in the ambulance could have prevented her near-death experience and the trauma her husband faced from seeing her suffer as he rode in the ambulance with her. She’s glad her ordeal led to an innovation that is helping others.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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