M S-medecine Sciences最新文献

Perinatal depression is a common condition that concerns 10 to 20 % of women after childbirth. Often underdiagnosed, it has significant consequences for the mother's mental health, the child's development, and family dynamics. This review explores its epidemiology, risk factors, and distinct clinical manifestations. It highlights the need for systematic screening, expert assessment, and a stepped approach to care that integrates pharmacological and non-pharmacological interventions within a coordinated multidisciplinary framework.

Myocardial infarction is a major public health concern for women. Hospitalization rates are increasing, particularly among young women. This trend is probably linked to the growing prevalence of cardiovascular risk factors and specific conditions that can increase the risk of myocardial infraction, such as early menopause, estrogen-progestogen contraception, endometriosis and chest radiation therapy for breast cancer. From a patho-physiological perspective, women have distinct characteristics. They have a higher proportion of myocardial infraction without significant coronary obstruction, including spontaneous coronary dissection, which can occur during pregnancy. Women also have smaller coronary and radial arteries with more frequent tortuosity, which can complicate interventional procedures. Additionally, disparities in the management of myocardial infraction in women have been observed. They tend to seek medical attention later and are less likely to benefit from invasive strategies, such as revascularization or coronary artery bypass grafting. In conclusion, myocardial infraction in women have many clinical and pathophysiological specificities. Additional efforts are needed to improve care and ensure equality in treatment by taking into account the specific characteristics of women.

Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Although recognized since ancient time, the term "menopause" did not appear until the early 19th century. Throughout history, the perception of menopause has always had a cultural and sociological dimension, varying according to cultures and ethnic groups. From the second half of the 20th century, the demonstration of links between estrogen deficiency and a decline in quality of life, as well as an increased risk of certain diseases (such as osteoporosis and cardiovascular diseases), paved the way for the medicalization of this stage in women's lives, a topic that remains the subject of intense debate today. Vasomotor symptoms, commonly referred to as hot flashes, represent one of the main functional manifestations associated with estrogen deficiency induced by the cessation of ovarian activity. Their pathophysiology remains poorly understood, although recent advances have highlighted the role of specific neuromediators in thermoregulation, notably involving a narrowing of the thermoneutral zone under the influence of estradiol decline.

Breast cancer is the most common cancer in women. Women are exposed to various hormonal factors throughout their lives, which can impact their risk of breast cancer. Early menarche and late menopause are associated with an increased risk of breast cancer, particularly hormone-dependent cancers. Parity and breastfeeding, on the other hand, have a protective effect. Hormonal contraception, particularly combined contraception, slightly increases this risk during use. Hormone replacement therapy combining estrogen and progestin is associated with an increased risk, and to a lesser extent when treatment is combined with natural progesterone, or when it consists of estrogen therapy alone. Assisted reproductive technology is not associated with a significant increase in risk. These factors have a different influence depending on the tumour subtype.

In 2022, there were an estimated 9 175 141 new cases of cancer in women worldwide, including 187 526 in France. Breast cancer was the most common cancer in women, accounting for 23.8 % of cases worldwide and 31 % in France. Gynaecological cancers (ovarian, endometrial, and cervical) accounted for approximately 15.25 % of all new cases of cancer in women worldwide and 9 % in France. Beyond breast cancer, the incidence of many non-gynaecological cancers, such as colorectal, lung, pancreatic, liver, oral and pharyngeal cancers, as well as melanoma, is increasing among women, partly due to smoking, but not entirely explained by established risk factors. Overall, 37 % of cancers in women are linked to preventable factors, including tobacco, alcohol, obesity, diet, and infections (particularly HPV). In France, participation in screening programs remains well below European recommendations, with rates of 59 %, 44 %, and 29 % for cervical, breast, and colorectal cancer screening, respectively.

Integrative biomedical research that takes sex and/or gender into account, as well as clinical trials focused on women's diseases, offers opportunities for the discovery and development of innovations, and for a deeper understanding of the differences between women and men. The value of sex- and gender-specific research has already been demonstrated in many areas of health, which is why the participation of women in biomedical research is essential. However, gender distribution in (pre)clinical studies remains inconsistent and often lacks scientific justification, while analyses of results by sex are still rare. Consequently, it cannot yet be stated with certainty that treatments are available with the same level of confidence for women as for men, or that women's health issues are sufficiently addressed. Although there are several real but debatable barriers to the inclusion of women in clinical trials, many of these barriers could be overcome.

Cardiovascular disease is currently the second leading cause of death among women in France. The menopause period is probably the ideal time to screen for all cardiovascular risk factors. This step is essential before offering menopausal hormone therapy to women suffering from disabling climacteric syndrome. If such treatment is authorized, transdermal estradiol combined with natural progesterone is the safest treatment for women with no history of hysterectomy. The tolerability of this treatment, as well as all cardiovascular risk factors, must be assessed annually in order to optimize the benefit/risk balance.