Current women's health reports最新文献

A case review of postmenopausal osteoporosis is presented in the context of recent literature in the field. Given the case patient's high risk for future fracture, a thorough workup and pharmacologic intervention are reasonable. Etiology of the patient's disease is explored, particularly vitamin D insufficiency, low body weight, smoking history, celiac sprue, use of glucocorticoids, and estrogen status. Means of reducing fracture risk include lifestyle changes, calcium and vitamin D repletion, antiresorptive therapy, and patient education. Development of new therapies to further reduce fracture risk in such individuals, and efficient strategies to target interventions toward those at highest risk, are needed.

Cognitive impairment and Alzheimer's disease are growing problems as our population ages. Although estrogen appears to beneficially effect neurons, evidence that hormone therapy improves cognition or prevents dementia is limited. All studies are hampered by difficulties in strict dementia ascertainment and confounding due to cognitive testing while observational studies are biased by the healthy hormone therapy user effect. Does estrogen preserve cognition? Some studies demonstrated a small improvement in generally healthy women, but some found no effect. Does estrogen prevent Alzheimer's disease? Many case-control and two cohort studies reported a sizeable benefit of hormone therapy, but many did not adequately adjust for confounders and there are no randomized controlled trial data yet. Does estrogen improve function in women with Alzheimer's disease? A large randomized controlled trial demonstrated no beneficial effect of conjugated estrogen on clinical outcomes in women who already had mild to moderate Alzheimer's disease.

From a public health perspective, the need for contraception has never been greater. Although the existing male-specific methods (withdrawal, condoms, and vasectomy) are safe and effective, increasing male options for fertility control could improve family planning. For new male contraceptive methods to have an impact, they must be acceptable to both men and women, as well as effective. A male hormonal method will likely come to market within the next 5 years. Other strategies such as contraceptive vaccines, and inhibitors of spermatogenesis and sperm motility, provide a potential for nonhormonal male contraceptives.

The debate surrounding postmenopausal hormone replacement therapy (HRT) has become more contentious in the past decade. The relationship between HRT and venous thrombotic events has been confirmed, although the absolute risk is small. Evidence of a relationship between breast cancer and HRT is stronger. Randomized controlled trials reveal an association with cardiovascular events in women with known heart disease, a possibly diminished overall quality of life due to HRT, and worsening of urinary incontinence. There is also some evidence associating HRT with ovarian cancer. However, longitudinal studies continue to demonstrate over the long term that HRT use is associated with fewer cardiovascular events and a reduced risk of developing dementia. Future studies may show that a lower daily dose of HRT can reduce the risks while still providing benefit.

Coronary heart disease (CHD) is the leading cause of death in women aged 60 years and older, yet 40% of this group believe they are unlikely to have a heart attack. Recent data show that the lack of a low-risk lifestyle may account for approximately 82% of coronary events in women. Underappreciation of CHD risk may prevent aging women from making significant changes in dietary habits, activity levels, and tobacco use to decrease their risk. In addition, many physicians may not treat cardiovascular risk factors aggressively in middle-aged and older women, despite data from primary and secondary prevention trials supporting the efficacy of interventions. This article addresses age-related changes in cardiovascular risk factors in women, with a focus on lifestyle interventions.

Diethylstilbestrol (DES), the first orally active artificial estrogen ever developed, was prescribed to several million pregnant women during the 1940s through the 1960s in the mistaken belief that it reduced the risk of miscarriage. In 1971, the US Food and Drug Administration contraindicated its use in pregnancy when DES was associated with the development of vaginal clear cell adenocarcinoma (CCA) in daughters exposed in utero. In daughters whose mothers took DES during pregnancy, the drug has been associated with congenital malformations of the reproductive tract, fertility problems, a possible increased risk of cervical carcinoma in situ, and a presumed lifetime risk of vaginal and cervical CCA. DES mothers have an increased risk of breast cancer (RR = 1.3). DES sons have an increased prevalence of urogenital anomalies, and a possible increased risk of testicular cancer.

The 8th International Conference on Alzheimer's Disease and Related Disorders, held in Stockholm, Sweden from July 20 to 25, 2002, provided an exciting forum for nearly 3700 researchers from 78 countries to present and discuss advances in dementia research on a worldwide stage. Hosted by the Alzheimer's Association (Chicago, IL), this largest dementia research conference ever held united experienced researchers and relative newcomers to the field to learn from one another, challenge one another's thinking, and explore new possibilities for collaboration. The 12-fold growth in attendance, up from 300 scientists at the 1st International Research Conference in 1988, signals the increasing global importance of Alzheimer's disease in the research community as well as among policy makers and the general public. In fact, a recent survey of older Americans by the National Council on the Aging revealed that future memory loss was the number one health worry of the American elderly population.