Current women's health reports最新文献

Osteopenia is a progressive condition that places patients at risk for increased morbidity and mortality if untreated. Patients with bone loss of at least 1.0 standard deviation (SD) from normal are considered osteopenic, whereas those with bone loss of at least 2.5 SDs are considered osteoporotic. Osteoporotic patients are treated to stop bone loss and restore bone mineral density. Patients with bone loss in the osteopenic range, even osteopenic patients with additional risk factors, might not receive treatment. National Osteoporosis Foundation guidelines recommend treatment when bone loss is 2.0 SDs, or less when additional risk factors are present. This is supported by the literature; treatments for bone loss are approved for the prevention of osteoporosis.

Eating disorders are prevalent in the young adult female population. Given the serious medical, nutritional, and psychological risks associated with eating disorders, it is advisable that patients be seen within the framework of a multidisciplinary team. Psychotherapy is the most effective treatment modality for eating disorders and constitutes the core of mental health treatment. Although cognitive behavior therapy trials dominate the research literature on interventions for bulimia nervosa and binge-eating disorder, various modalities of psychotherapy have efficacy. Active weight management is also a key component of treatment for anorexia nervosa. Psychotropic medication therapy is not generally useful for the primary symptoms of anorexia nervosa, whereas it is moderately effective in the treatment of both bulimia nervosa and binge-eating disorder. Given the patient population at Massachusetts General Hospital, to which patients often present with serious and chronic symptoms, comorbid medical and psychiatric illness, and history of poor response to treatment, we have found a flexible and eclectic treatment approach most useful clinically.

The emerging understanding of gender differences among ethnic minorities in the rates, etiology, course, and treatment of substance abuse and common comorbid mental health disorders has significant scientific and practical implications. Growing recognition of these differences and their implications for treatment and policy decisions has highlighted research gaps and the need for more thoughtful application of the knowledge gained from existing research findings. In this brief review, we outline some of the unique aspects of substance abuse and comorbid mental health problems for women, as well as for women of various ethnic/cultural groups, including specific barriers to obtaining and remaining in treatment. Research challenges to improving limited knowledge about the rates, course, and treatment of substance abuse disorders among ethnic minority women are highlighted.

Recently, much has been published about osteoporosis and the suspected vast numbers of patients who are undiagnosed or at risk. Various groups, including the US Preventative Services Task Force and The National Osteoporosis Foundation, have attempted to highlight the recommendations regarding who and when to screen. We know that for a screening test to be effective, not only must it predict morbidity far enough in advance that something can be done but it also must be widely available and cost effective. There are several methods of screening with varying sensitivity and specificity for identifying people at risk for osteoporotic fracture. After an examination of all available approved testing methods, it seems that dual-energy x-ray absorptiometry (DEXA) and calcaneal ultrasound best predict patients at risk for fracture. However, because of the length of time needed to demonstrate bone mineral changes and the small magnitude of these changes, DEXA seems to be the most cost-effective method to follow patients who are receiving treatment.

An extensive review of the literature on sexual orientation and health, lesbian health, and women and smoking revealed no studies that focus on smoking among lesbians or bisexual women. However, several health surveys conducted in the past 15 to 20 years report rates of current smoking. Findings from these studies as a whole suggest that lesbians are more likely than heterosexual women to smoke. Research on women and smoking is reviewed to identify potential risk factors for lesbians' smoking. Implications for future research and for prevention and intervention are discussed.

Recent studies have called into question whether the risks of hormone replacement therapy (HRT) outweigh its long-term benefits. There is a clear causal relationship between estrogen deficiency and osteoporosis. Postmenopausal status or estrogen-deficiency at any age significantly increases a patient's risk for osteoporosis and subsequent fragility fractures. Estrogen, in various formulations, is currently FDA-indicated for the prevention of osteoporosis. However, estrogen is not FDA-approved for the treatment of osteoporosis. Recent randomized clinical trials have demonstrated that estrogen significantly reduces fractures among osteoporotic postmenopausal women. Most postmenopausal women choose to use estrogen for relief of vasomotor symptoms and urogenital atrophy. HRT should be limited to osteoporosis prevention in women with significant ongoing vasomotor symptoms who are not at an increased risk for cardiovascular disease. An annual, individualized, risk/benefit reassessment should be performed on these patients. Further research is needed to assess the potential risks and benefits of various formulations, combinations, doses, and delivery routes of estrogen for postmenopausal women.

Bone loss associated with osteoporosis occurs with high frequency among the elderly and often results in debilitating fractures. A combination of lifestyle behaviors, genetic predisposition, and disease processes contributes to bone metabolism. Therefore, any discussion regarding bone health must address these factors. The impact of menopause on bone turnover has been generally well studied and characterized. Breastfeeding places significant stress on calcium metabolism and, as a consequence, directly influences bone metabolism. The most significant factors affecting bone mineral density (BMD) and bone metabolism are the duration and frequency of lactation, the return of menses, and pre-pregnancy weight. Although transient, lactation is associated with bone loss. As clinical guidelines and public health policies are being formulated, there is a compelling need for further investigation into the relationship of lactation, BMD, and subsequent risk of osteoporosis. Better understanding of this relationship will provide new opportunities for early intervention and ultimately help in the prevention of bone loss in postmenopausal women.

Mood disorders during the postpartum period occur in 10% to 15% of women. The hormonal basis of these disorders, however, has not been investigated systematically and extensively. We review recent studies, primarily from the past 5 years, in which investigators examined the major categories of proposed hormonal etiologies, including gonadal steroids, thyroid hormones, cortisol, prolactin, and melatonin, and then present descriptive statistics of our preliminary findings in these hormonal dimensions from a group of 20 depressed and normal control pregnant and postpartum women.

Increasing numbers of patients are being treated for mood disorders. Most of these patients, particularly those with the diagnosis of major depression, are women of childbearing years. Depression can also occur in the context of bipolar disorder. Concerns regarding fetal exposure to medication, either planned or unplanned, are becoming more pressing in the clinical practices of psychiatrists and primary care physicians. There are relatively few study data available to guide clinicians in the use of psychotropic medications during pregnancy, owing to obvious problems in designing studies of the effects of medications on pregnant women, fetuses, and infants. In this article clinically relevant study and practice information is provided, and suggestions regarding the approach to the treatment of mood disorders during pregnancy based on a risk assessment mode are given.