Women's Health Medicine最新文献

A regular ovulatory menstrual cycle requires a functional and integrated feedback system involving the hypothalamus, the anterior pituitary and the ovary (Figure 1). In the normal menstrual cycle, periods occur at regular intervals of 21–35 days and bleeding lasts for up to 7 days. Disorders of ovulation usually cause menstrual disturbance and present with irregular periods (oligomenorrhoea) or absent periods (amenorrhoea). Irregular periods with anovulatory cycles are commonest under age 20 and over age 40. Ovulatory disorders account for one-quarter of couples presenting with infertility. Anovulation may be classified by the anatomical location of the defect in the hypothalamo-pituitary-ovarian axis (Figure 2). By focusing on ovarian, hypothalamic and endocrine defects, this article offers an overview of the disorders of ovulation.

This review article evaluates the management of disorders of ovulation by first examining the specific conditions covering hypothalamic disorders, polycystic ovary syndrome and hyperprolactinaemia. Treatment options for disorders of ovulation depend on the clinical presentation, the underlying cause and the woman's wishes. Those who seek fertility require treatment to induce ovulation, and this treatment should be offered in conjunction with assessment of other factors relevant to fertility, including semen analysis and the exclusion of pelvic pathology. The uses of clomiphene citrate, gonadotrophins, gonadotrophin releasing hormone (GnRH), metformin, laparoscopic surgery and in vitro fertilization (IVF) are discussed. Ovulation should not be induced in women who do not wish to conceive. These women usually seek a diagnosis and cycle control. This is best achieved using cyclical progestogens or an oestrogen-progestogen pill, and treatment choice depends on the woman's oestrogen status and her contraceptive needs. The final section concentrates on adverse outcomes of induction ovulation including multiple pregnancy, ovarian hyperstimulation syndrome (OHSS) and ovarian carcinoma.

Women’s mental health: self-appraisal

The transition to motherhood is an emotional watershed which is punctuated by feelings of loss as well as gain. Not surprisingly, it is a period that is associated with significant social and psychological changes and upheavals that may give rise to feelings of uncertainty and self-doubt. The National Services Framework for Children, Young People and Maternity Services (Department of Health 2004) acknowledges the demands of parenthood and identified clear standards for promoting health and wellbeing of women, children, partners and families as a whole, placing emphasis on supporting and helping parents prepare and adjust to their parenting role. Furthermore, it outlines a number of vulnerability factors that may have adverse consequences for maternal and neonatal outcomes. This, for example, takes account of social deprivation/social exclusion, teenage pregnancy, substance abuse, domestic violence and minority ethnic groups. To comprehend the enormity of childbearing on women’s lives this paper considers the social and psychological context of motherhood as a major life event.

Online resources for women’s mental health

This paper examines the psychological aspects of ageing. In particular, it focuses on two experimental psychology phenomena – the speed of performance and intellectual performance – in order to understand how these two aspects of functioning interrelate and change with normal ageing. This helps to provide useful insights into psychological adaptation across the lifespan, and helps to identify opportunities for constructive intervention. The focus is on: slowing down with age, the trade-offs made in speed and accuracy, ageing and intellectual performance (particularly the use of the Wechsler Adult Intelligence Scale, WAIS), intellectual skills in relation to mortality and ‘terminal decline’ and factors associated with maintaining intellectual functioning in later life. Finally, since the centenarian population has increased at a rate of approximately 7% a year throughout the economically developed world since 1960, it briefly considers the need for a new generation of longitudinal studies in order to throw considerable light on the developments occurring in extreme old age.

Women often have different outcomes and experiences with mental illness compared to men. However, there is still a ‘gender-blind’ approach to the understanding and development of new treatments for mental illness. The emphasis is on: women and schizophrenia, depression in women and existing sex differences in anxiety disorders (including phobias, agoraphobia, panic disorder, generalised anxiety disorder and post-traumatic stress disorder). Utilizing gender differences in the onset, course and outcomes of mental illness may enable a better development of best outcomes for women with mental illness.

This paper assesses the use of psychiatric medications in childbearing women who are displaying acute symptoms of a moderate-to-severe mental illness. Childbearing may affect the course of illness and alterations in treatment are often required. In particular, the paper discusses the use of psychotropic drugs (including lithium, anti-epileptic drugs, antipsychotics, antidepressants, hormone treatment and electroconvulsive therapy) and their subsequent effects on the neonate, breastfeeding, development and teratogenicity. Since approximately 7% of women of childbearing age suffer from the acute symptoms of a moderate-to-severe mental illness, or have recently had an episode requiring drug treatment, a number of important problems need to be considered in the management of those episodes.

This paper examines the social aspects of ageing in contemporary society. It emphasises: the quality of life in older people, ageing and health, two case studies on the experiences of older people, social exclusion, perceptions of risk and insight and overcoming stigma. Despite the democratic revolution in which human lifespans are increasing steadily worldwide – mainly as a result of improvements in living conditions, sanitation and healthcare – it is the case that age stratification and discrimination are widespread and in most Western cultures older people are marginalized and socially excluded on the basis of age. It concludes that this hegemony of institutionalized ageism and the negative cultural representation of older people remain major barriers to greater social inclusion for all older citizens.

This paper specifies the scale and nature of the challenge for women’s forensic services. It reviews recent information on patterns of female offending and mental ill health in relevant populations. It discusses both the origins of current secure services for women and the recent proposals of alterations to them. This is in light both of a better clinical understanding of mentally disordered female offenders and changing perceptions of their security needs. Mentally disordered female offenders are now more widely recognised to have been vulnerable to abuse in childhood. Within the last twenty years, there has been a developing view that women are rarely in need of high secure hospital services, but there continues to be a lack of consensus about how and where their needs would best be met.