International Journal of Fertility and Womens Medicine最新文献

The introduction of the first hormonal contraceptive was one of the most important events of the twentieth century for women. The availability of oral contraceptives (OCs) provided women with greater control over their reproductive lives. As OC usage steadily increased, so did concern over health risks associated with their use. Concluding that adverse events were dose-related, scientists sought to develop lower-dose formulations. In the four decades since the first OC, women seeking contraception have benefited from the development of non-oral hormonal delivery systems, including injectables, intrauterine devices, implants, a vaginal ring, and a contraceptive patch. It is hoped that this expanding menu of choices affords women opportunities to find methods better suited to their individual needs. Clinicians should continually evaluate their patients' hormonal contraceptive needs, and provide adequate counseling so that every woman is afforded the opportunity to achieve contraceptive success.

More postemenopausal women with osteopenia fracture than those who have osteoporosis. Algorithms are being developed to enhance risk stratification to facilitate decisions when to treat in the osteopenic population. Evidence exists that osteoporosis agents can reduce fracture risk in the osteopenic population.

Until recently, calcium supplementation with vitamin D and hormone replacement therapy were the mainstays of treating osteoporosis associated with the menopause. Hormone replacement therapy, indeed, was (and is) effective in preventing fracture, but is no longer to be considered to be a primary indication for this purpose. Thus, while continuing with calcium and vitamin D, drug therapy now consists of the antiresorptive agents: raloxifene, calcitonin, and the bisphosphonates. These drugs reduce bone turnover, and do prevent fractures, but are limited to halting further deterioration of skeletal microarchitecture. The newest agent against osteoporosis is teriparatide, an amino terminal fragment parathyroid hormone containing 34 amino acids. PTH(1-34), or teriparatide, exhibits many of the classical actions of the whole molecule. It is anabolic with respect to bone when used according to well-defined protocols. Bone microarchitecture is restored with increases in cortical thickness and in connectivity. This paper describes the activities as known at present of the bisphosphonates and of teriparatide and reviews studies of their use alone and in combination with each other.

Chronic pelvic pain (CPP) affects more than 9 million women in the United States and results in a considerable medical, social and economic toll on affected women and their families. CPP can have multiple causes, and its diagnosis can be especially problematic for clinicians. Gynecologists who care for such women have historically evaluated and treated this condition with a gynecological perspective, considering nongynecologic causes only in selected and sometimes extreme situations. Indeed, such an approach can lead to extirpative surgery, a situation that frequently fails to reduce or eliminate the pain. More recent work clearly demonstrates the important role of nongynecologic causes of CPP, most notably, pain of bladder origin. This paper reviews the role of the bladder in the diagnosis and treatment of CPP and provides suggestions for integrating the assessment and treatment of CPP of bladder origin into the care provided by gynecologists so as to improve clinical outcomes.

Overactive bladder (OAB) is a common, chronic, and debilitating condition that is most often observed in the elderly population. It has a profound impact on the quality of life of patients, affecting many aspects of daily living, social interaction, and self-perception of health status. Possible neurological, muscular, and metabolic causes have been proposed, but in most cases the exact pathophysiology remains unclear. The management of OAB can be initiated conservatively with behavioral modification and antimuscarinics. For refractory cases, neuromodulation, denervation techniques, and bladder augmentation may be indicated. Not all patients are cured, but most may be improved with appropriate individualized therapy.

The prevalence of urinary incontinence (UI) in women has been the subject of many epidemiologic studies. Since 1968 the field has accumulated sufficient data that we now know how stress UI and urge UI appear in populations categorized by race, age, parity, body mass index and other demographic factors. The first comprehensive study in the U.S., the MESA study, was done in 1983. For community-dwelling women 60 years or older, it came up with the now familiar figure of 38% in this age-group. Very similar figures have been found in other national populations, but there are great differences in sub-populations and also by type--stress, urge, or mixed UI. However, with all differences in prevalence acknowledged, no type of UI is unusual in a population of older women. This article delineates, with detailed discussion of individual studies, prevalence by type, age, race, obstetric and gynecologic-surgery history, and anatomic dysfunction, plus consideration of the effects of obesity and menopause on UI. The conclusion is that a problem so widespread is a candidate for prevention, and that the few trials in this direction should be augmented.

Pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and bowel dysfunction, all of which can cause considerable disability and anxiety. One third of all women will suffer from these disorders at some point in their life. All are often embarrassing and may act as barriers to healthy living as many women suffer in silence. The field of urogynecology has evolved over time to meet the needs of women who struggle with disorders of the pelvic floor. An increase in the awareness and treatment of these disorders has led to improved scientific research in the form of prospective randomized clinical trials to develop a unified understanding of their epidemiology, biology, and treatment. This review explores the literature that has promoted advances in the understanding of pelvic floor disorders and discusses some of the new technology and research that is being done in the field.

Overactive bladder (OAB) affects 16.6% of the U.S. population, or 33 million adults, in some form. Despite the prevalence of OAB, almost 60% of those affected seek no medical assistance for the condition either because of embarrassment or the misconception that it represents an inevitable function of aging. A recent surge of interest on the subject has uncovered the dramatic effect that OAB can have on social interactions, sleep, depression, sexual health, and overall health-related quality of life (HRQoL). The introduction of validated, condition-specific QOL questionnaires has enhanced our ability to measure these subjective dimensions of OAB, and to assess their response to therapeutic interventions.

Although surgery is commonly performed to alleviate or cure stress incontinence, there are non-surgical options that might well be explored and tried before a woman undergoes surgery, for which many are poor candidates. The least drastic treatments are behavioral therapies, chiefly pelvic floor muscle training (Kegel exercises), alone or with biofeedback. This method is effective but has the drawback of poor patient compliance. Another therapy, almost noninvasive, is electrical stimulation via needle or surface electrodes of the pudendal nerve and the pelvic plexus in order to treat detrusor instability. Some studies show good results for many patients; and there is no need for long-term compliance. Medical management has included hormone replacement therapy and alpha-adrenergic agonists, but questionable results and intolerable risks have shifted this mode to serotonin-norepinephrine reuptake inhibitors, which have CNS action. Finally, there are urethral occlusive devices, which have poor acceptance owing to side effects and difficulty of use, and vaginal pessaries, theoretically attractive but inexplicably poor performers in the marketplace.