Women's Health Medical Information

Women's Health

Transexual 2011.pdf

Care of Patients post-Sexual Assault 2011.pdf

Hormone Replacement Therapy 2010.pdf

Menopause 2010 - Position Statement

Menopause 2008 - Position Statement

Management of Menopausal Symptoms 2006 (NEJM)

Management of Menopausal Symptoms 2005 (NIH)

Hot Flahses - Pathophysiology & Treatment (Mayo Clinic Proceedings Nov. 2002)

Female Sexual Dysfunction
Deborah J. Lightner - Mayo Clinic Proceedings July 2002 Volume 77 Number 7

EctopicPregnancy2009.pdf

In Vitro Fertilization 2007 (NEJM) | Contraceptives 2007.pdf

Complementary and Alternative Medicine for Menopausal Symptoms: A Review of Randomized, Controlled Trials
Ann Intern Med. Nov. 11, 2002;137:805-813

WHI Study 2004 (Women's Health Initiative)

Alternatives Rx to Estrogen Therapy Therapy to Menopausal Symptoms:

Medroxyprogesterone acetate 10 mg po qd
Benefits: Relieves hot flushes, prevents osteoporosis
Side effects/risks: Worsening symptoms of urogenital atrophy, depression/sedation, decreased libido, decreased HDL, effect on breast cancer not known

Neurontin (Gabapentin) 300 mg 1-3x/day (Mayo Clinic Proceedings Nov. 2002;77:1159 Charles Loprinzi, etc.)
Benefits:
Side effects/risk: light-headedness & dizziness.

Antidepressant: Venlafaxine 75 mg, or 150 mg daily

SERMS (e.g., raloxifene) 60 mg/day
Benefits: Prevents osteoporosis, may lower cardiac risk factors, may lower risk of breast cancer, may not cause endometrial hyperplasia
Side effects/risks: May worsen hot flushes, more expensive than estrogen, no effect on HDL cholesterol, no cardioprotective effects

Bisphosphonate (as Alendronate/Fosamax) 10 mg/day
Benefits: Prevents osteoporosis
Side effects/risks: Esophageal irritation

Soy protein supplement

Calcium supplementation 1500 mg po qd
Benefits: Minimal effect on osteoporosis prevention
Side effects/risks: Unmask asymptomatic hyperparathyroidism

Clonidine 0.1 mg po qd or bid
Benefits: Moderate relief of hot flushes
Side effects/risks: Dry mouth, sedation

Bellergal 1 tablet bid
Benefits: Relieves hot flushes
Side effects/risks: Drowsiness, paresthesias (rare)

Postmenopausal Hormone Replacement Therapy (Scientific Review)
Heidi D. Nelson; Linda L. Humphrey; Peggy Nygren; Steven M. Teutsch; Janet D. Allan
JAMA. August 21, 2002;288:872-881
Conclusions:
Benefits of HRT include prevention of osteoporotic fractures and colorectal cancer, while prevention of dementia is uncertain.
Harms include CHD, stroke, thromboembolic events, breast cancer with 5 or more years of use, and cholecystitis.

Emergency Contraception 2002
Emergency contraception is used to prevent pregnancy after a coital act not adequately protected by a regular method of contraception. In contrast to early medical abortion, emergency contraception prevents a pregnancy from starting and does not disrupt an established pregnancy.
The most commonly used approaches consist of two oral doses of contraceptive steroids.

The levonorgestrel-only regimen (levonorgestrel, 0.75 mg, repeated in 12 hours) appears to be more effective and better tolerated than
The Yuzpe regimen (ethinyl estradiol, 100 g, and levonorgestrel, 0.5 mg, repeated in 12 hours).

In the largest randomized, controlled trial to date, levonorgestrel prevented about 85% of pregnancies that would have occurred without its use. Hormonal emergency contraception has no known medical contraindications, although it is not indicated for suspected or confirmed pregnancy. However, if hormonal emergency contraception is inadvertently taken in early pregnancy, neither the woman nor the fetus will be harmed. Nausea and vomiting associated with the Yuzpe regimen can be reduced by prophylactic use of meclizine. A strong medical and legal case exists for making hormonal emergency contraception available over the counter, as has happened in countries other than the United States. Easier access to and wider use of emergency contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States. Ann Intern Med. August 8, 2002;137:180-189.

Transdermal Testosterone Treatment in Women with Impaired Sexual Function after Oophorectomy
Jan L. Shifren, M.D
NEJM Volume 343:682-688 September 7, 2000
In women who have undergone oophorectomy and hysterectomy, transdermal testosterone (300 µg of testosterone per day transdermally for 12 weeks each) improves sexual function and psychological well-being.

"Clinical Challenges of Perimenopause: Consensus Opinion of The North American Menopause Society" --
(Menopause 2000;7:5-13).

"A Decision Tree for the Use of Estrogen Replacement Therapy or Hormone Replacement Therapy in Postmenopausal Women: Consensus Opinion of The North American Menopause Society" --
(Menopause 2000;7:76-86).

Hormone Replacement Therapy

Its Breast Cancer Risk
- The relative risk increased by 0.08 with each year of estrogen-progestin use among recent users.
  (JAMA Jan. 26, 2000;283:485 - Catherine Schairer) Editorial

Ischemic Stroke Risk With Oral Contraceptives - A Meta-analysis
JAMA. July 5, 2000;284:72-78 Leslie Allison Gillum, BA; Sai Kumar Mamidipudi, MBBS(India); S. Claiborne Johnston, MD

Context: The relationship between ischemic stroke and oral contraceptive (OC) use has been studied for 40 years, but disagreement about an association persists.
Data Synthesis: The 16 studies were analyzed using random effects modeling. Current OC use was associated with increased risk of ischemic stroke (RR, 2.75; 95% CI, 2.24-3.38). Smaller estrogen dosages were associated with lower risk (P=.01 for trend), but risk was significantly elevated for all dosages. Studies that did not control for smoking (P=.01) and those using hospital-based controls (P<.001) found higher RRs, but no other patient characteristics or elements of study design were important. The summary RR was 1.93 (95% CI, 1.35-2.74) for low-estrogen preparations in population-based studies that controlled for smoking and hypertension. This translates to an additional 4.1 ischemic strokes per 100,000 nonsmoking, normotensive women using low-estrogen OCs, or 1 additional ischemic stroke per year per 24,000 such women.
The RR of stroke due to OC use was not different in women who smoked, had migraines, or had hypertension.
Conclusions: Summary results indicate that risk of ischemic stroke is increased in current OC users, even with newer low-estrogen preparations. However, the absolute increase in stroke risk is expected to be small since incidence is very low in this population.

Chest Pain in Women with Normal Coronary Angiograms NEJM-- March 23, 2000 -- Vol. 342, No. 12

Women's Health on the Web

AHA/ACC Scientific Statement: Consensus Panel Statement 1999
Guide to Preventive Cardiology for Women

Mifeprex / Mifepristone (RU 486 pill) Information site

polycystic_ovary_synd2008.pdf

polycystic_ovary_synd.pdf

2010