2 women's Health Newsletter - November 13th 2008

Crestor may significantly reduce coronary heart disease episodes and strokes even in some men and women with normal cholesterol levels

12th November 2008

The statin - Crestor, Prediction of coronary heart disease using risk factor categories.(1998-01)Rosuvastatin, - could reduce by 44 percent the risk of heart problems among patients who have normal cholesterol but with with elevated High-sensitivity C-Reactive Protein - hsCRP. CRP is a protein produced by the liver that plays an important role in inflammatory processes and serves as a biological marker to measure the risk of artery blockage.

The study of 17,802 men and women aged 50 or more demonstrated that 20 milligrams of Crestor taken daily significantly reduced the combined risk of myocardial infarction, stroke, hospitalization for unstable angina, or death from cardiovascular causes by 44 percent compared to placebo among men and women with elevated hsCRP but low to normal cholesterol levels. The combined risk of heart attack, stroke or death from heart disease was reduced by 47 percent, the risk of heart attack was cut by more than half, the risk of stroke by nearly half and total mortality was reduced by 20 percent.⁰⁸⁰²

PCOS with specific relation to population groupings

1st November 2008

• Polycystic ovary syndrome is one of the most common endocrine (hormone) disorders - 15-20%.
• Affected women may have irregular/infrequent menstrual cycles, anovulatory infertility and excessive body hair.
• Discussion has been assisted by a consensus for diagnosis.⁰⁴⁰¹
• There is evidence that demonstrates differences in the reproductive features of PCOS in index-matched populations from different areas.⁰⁶⁰¹
• Although most of what pertains for all women with PCOS there have been reports of slight variations between racial groupings.^{PCOS-Populations}

Laparoscopy to diagnose endometriosis

31st October 2008

The question of when to investigate pelvic pain with laparoscopy to diagnose endometriosis is a subject of continued debate.

Some take the view that laparoscopy is overused to the extent that clinicians need a tool to determine whether women wish to seek a pathology-based explanation for chronic pelvic pain or whether they just want symptom relief. Such an approach might reduce the number of unnecessary laparoscopies without adversely affecting outcomes.⁰⁶⁰²

Others believe that laparoscopy is often unduly delayed.⁰⁶⁰¹

Surgical Treatment of Stress Urinary Incontinence

30th October 2008

Urinary incontinence is a common problem, particularly after the menopause and it is socially embarrassing leading to loss of self-esteem.

Stress incontinence can respond to medication but there are also several surgical procedures that may help. Increasingly, gynecologists are employing minimally invasive techniques to reduce hospitalization and speed recovery. Success rates in the order of 85% have been quoted for TVT (Transvaginal Tapes) and TOT (Transobturator Tapes).⁰⁷⁰¹

Clinicians should receive specialized training for the transvaginal placement of mesh products and be vigilant for adverse events, the US Food and Drug Administration (FDA) warned on 20th October 2008 in a news release.

Though rare, complications associated with surgical mesh treatment of pelvic organ prolapse and stress urinary incontinence can have serious consequences. During the last 3 years, 9 surgical mesh manufacturers have submitted more than 1000 reports of complications that have included erosion through vaginal epithelium, infection, pain, urinary problems, and recurrence of prolapse and/or incontinence. ⁰⁸⁰¹

Are IUCDs appropriate for adolescents and women who have never been pregnant?

26th October 2008

There are only a few studies on the use of IUDs in adolescents. IUDs are a safe and effective long-term contraceptive method. IUDs are underutilized in the United States, especially by adolescents. Because adolescents contribute disproportionately to the epidemic of unintended pregnancy, IUDs should be considered as a first-line contraceptive choice regardless of parity.⁰⁸⁰¹

The levonorgestrel-releasing intrauterine system (Mirena -LNG IUS) is a particularly good choice for adolescents because of associated non-contraceptive benefits such as decreased menstrual bleeding, dysmenorrhea and pain associated with 0801 the efficacy of oral naproxen with intrauterine instillation of 1% lignocaine was compared for pain relief. Intrauterine lignocaine was no more effective than a single oral dose of 375 mg of naproxen 1 hour prior to HSG. It seems appropriate to administer an oral analgesic about an hour before outpatient procedures, such as hysterosalpingograms to reduce pain.

Vaccination To Prevent Cancer of the Cervix

19th October 2008

Cancer of the cervix has been a potential danger for many sexually active women. Cervical screening and treatment of pre-malignant conditions of the cervix have resulted in less cervical cancer and less cervical cancer deaths. The cause has been shown to be certain strains of the HPV virus and we now have effective vaccinations for those who have never been exposed to the virus - particularly adolescents.  The recent literature on adolescent knowledge about HPV and attitudes about HPV vaccines supports the importance of designing developmentally appropriate educational materials for adolescents about HPV and HPV vaccines, and provides guidance for the development of key educational messages.⁰⁸⁰¹

Management of unexplained infertility.

10th October 2008

A randomised controlled trial has disappointingly found that empirical clomiphene and unstimulated intrauterine insemination are unlikely to offer superior live birth rates compared with expectant management.⁰⁸⁰³

A Genetic Predisposition to Obesity

28th September 2008

The FTO gene has consistently been associated with obesity across multiple populations. However, to date it was not known whether the association between genetic variation in FTO and obesity is mediated through effects on energy intake or energy expenditure. Wardle's group have recently demonstrated (July 2008) that the commonest known FTO obesity-risk gene is likely to exert at least some of its effects by influencing appetite. Those with this obesity-risk gene do not have their appetite satiated easily so that they have a genetic tendency which tends to make them eat more. ⁰⁸⁰²

Medical Treatment of Stress Urinary Incontinence

22nd August 2008

The efficacy of venlafaxine started early and the clinical efficacy associated with the use of the drug continued in the following months. Venlafaxine should be considered a clinically efficient alternative drug in the treatment of stress urinary incontinence.⁰⁸⁰¹

Preventing Spina Bifida

18th September 2008

A study from China suggests that multivitamin supplement containing folic acid taken from a time point of 2 months before conception and continuing until completion of the second month after conception and taken more than five times per week can significantly reduce the risks of NTDs.⁰⁸⁰¹

Improving sexual satisfaction.

15th September 2008

Sildenafil may improve clitoral blood flow and increase sexual satisfaction in postmenopausal women with orgasmic dysfunction.⁰⁸⁰²

Letrozole and Anovulatory Infertility

12th September 2008

The aromatase inhibitor letrozole appears to constitute a good alternative to CC-gonadotropin in patients with unexplained infertility undergoing COH cycles combined with IUI therapy.⁰⁸⁰²

Mullerian inhibiting substance has been studied extensively in the context of in-vitro fertilization and has been correlated with several outcome parameters.^{0801 -} Infertility

Tobacco compounds exert a deleterious effect on the process of ovarian follicle maturation. This effect is expressed by worse in-vitro fertilization parameters in cycles performed on women with smoking habits. Also, uterine receptiveness is significantly altered by the smoking habit. In men, cigarette smoking reduces sperm production. Spermatozoa from smokers have reduced fertilizing capacity, and embryos display lower implantation rates. Even in-utero exposition to tobacco constituents leads to reduced sperm count in adult life. Couples in reproductive age should be strongly discouraged to smoke. - Infertility

Do you have an unanswered women's health question?

Please let us have your general question on our NEW FORUM / MESSAGE BOARDS facility and we will try to answer it for you. I am sure that you will appreciate that we cannot offer advice on the management of an individual's specific problem.