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Management of Urinary Symptoms Associated with Fibroids
Abstract Uterine fibroids are the most common benign tumours in women of reproductive age. Fibroids are linked with a variety of lower urinary tract symptoms (LUTS). Direct pressure on the bladder, but also vascular, neurogenic and hormonal changes have been proposed as underlying pathophysiological mechanisms. There is conflicting evidence in the literature regarding the association between LUTS and fibroid volume and position. Conservative management with bladder retraining, supervised pelvic floor muscle training with or without drug therapy might be used as first line. In the presence of persistent sy...
Source: Current Obstetrics and Gynecology Reports - March 27, 2016 Category: OBGYN Source Type: research

Update on Medical Abortion: Expanding Safe and Equitable, Patient-Centered Care
Abstract Addressing disparities in abortion access and efforts to end the global problem of unsafe abortion are key public health and human rights priorities. Optimizing the role of various health workers in supporting safe medical abortion practices and working to remove unnecessary barriers to care are key strategies that address inequities in outcomes after abortion worldwide. Medical abortion using evidence-based protocols is effective through 70 days gestation and can safely be provided by non-physician providers in outpatient settings. Removing barriers of in-office administration of mifepristone a...
Source: Current Obstetrics and Gynecology Reports - February 13, 2016 Category: OBGYN Source Type: research

The Pill at 56 and Counting: Still Contracepting After All These Years
Abstract Oral contraceptives are one of the most popular contraceptive methods worldwide. They offer many benefits other than contraceptive efficacy; women also choose the pill for medical or personal reasons. While the pill is extremely safe, there are still concerns about side effects and complications, difficulties with cycle control and compliance. Several approaches have been developed to improve overall experience with oral contraceptives, including lowering doses of estrogen to diminish side effects, though that can create more bleeding irregularities and possibly reduce efficacy. Modifications of ...
Source: Current Obstetrics and Gynecology Reports - February 11, 2016 Category: OBGYN Source Type: research

Emergency Contraception: Review and Update
Abstract Unintended pregnancy continues to be a substantial public health problem. Emergency contraception (EC) provides a last chance at pregnancy prevention. Several safe and effective options for emergency contraception are currently available. The Yuzpe method, a combined hormonal regimen, was essentially replaced by other oral medications including levonorgestrel and the antiprogestin ulipristal. The antiprogestin mifepristone has been studied for use as emergency contraception. The most effective postcoital method of contraception is the copper intrauterine device (IUD). Obesity and the simultaneous...
Source: Current Obstetrics and Gynecology Reports - February 6, 2016 Category: OBGYN Source Type: research

The Combined Contraceptive Vaginal Ring: an Update
Abstract The combined contraceptive vaginal ring releases 120 μg of etonogestrel and 15 μg of ethinylestradiol per day for at least a 3-week period. It is as effective as combined oral contraceptive pills with similar side effects but better cycle control. The ring is not associated with weight gain and may have many non-contraceptive benefits including a positive effect on sexual function, dysmenorrhea, premenstrual syndrome, and heavy menstrual bleeding. Contraindications are the same as for combined oral contraceptives, and serious complications are rare. The risk of venous thromboembolism with the...
Source: Current Obstetrics and Gynecology Reports - February 2, 2016 Category: OBGYN Source Type: research

Patient-Centered Contraceptive Counseling: Evidence to Inform Practice
Abstract Patient centeredness is an increasingly recognized aspect of quality health care. The application of this framework to contraceptive counseling and care has not been well described. We propose a definition of patient-centered contraceptive counseling that focuses on and prioritizes each patient’s individual needs and preferences regarding contraceptive methods and the counseling experience. Guided by this definition, we review recent research that has advanced our understanding of how patient-centered contraceptive counseling can be delivered in practice, focusing on how women decide on a contr...
Source: Current Obstetrics and Gynecology Reports - January 29, 2016 Category: OBGYN Source Type: research

Male Hormonal Contraception: Where Are We Now?
Abstract Hormonal male contraception clinical trials began in the 1970s. The method is based on the use of exogenous testosterone alone or in combination with a progestin to suppress the endogenous production of testosterone and spermatogenesis. Studies using testosterone alone showed that the method was very effective with few adverse effects. Addition of a progestin increases the rate and extent of suppression of spermatogenesis. Common adverse effects include acne, injection site pain, mood change including depression, and changes in libido that are usually mild and rarely lead to discontinuation. Curr...
Source: Current Obstetrics and Gynecology Reports - January 29, 2016 Category: OBGYN Source Type: research

Hormonal Contraceptive Effects on the Vaginal Milieu: Microbiota and Immunity
Abstract Hormonal contraceptives may influence the immunological and microbiological milieu of the vagina and alter the risk of acquisition of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Most studies demonstrate more normal vaginal flora and less bacterial vaginosis in hormonal contraceptive users compared to non-users, suggesting that contraceptive-induced alteration in vaginal microbiota is an unlikely mechanism for increased risk of STI/HIV acquisition. Measured impacts of hormonal contraceptive use on the presence and activity of vaginal immune cells and vaginal cyt...
Source: Current Obstetrics and Gynecology Reports - January 29, 2016 Category: OBGYN Source Type: research

Association Between Obesity and Clinical Outcomes in Gynecologic Cancer
Abstract Obesity is a known risk factor for many cancers, including gynecologic malignancies. While the association between obesity and risk for endometrial cancer is well established, the association with clinical outcomes has been more controversial. Most studies demonstrate an association between obesity and worse all-cause survival in endometrial cancer; however, it is unclear whether this effect is cancer-specific or secondary to comorbid conditions. In ovarian cancer, studies have shown an association between decreased survival and pre-diagnosis obesity, but not obesity at diagnosis. There are also ...
Source: Current Obstetrics and Gynecology Reports - October 17, 2015 Category: OBGYN Source Type: research

Obesity Education Strategies for Cancer Prevention in Women’s Health
Abstract Obesity is the cause of up to one third of all cancers affecting women today, most notably endometrial, colon, and breast cancers. Women’s health providers are poised to advise women on obesity’s link to cancer development, but often lack resources or training to provide appropriate counseling. Here, we review obesity’s role in increasing the risk of several common reproductive system conditions faced by women, including polycystic ovarian syndrome, infertility, gynecologic surgical complications, and pregnancy complications. These events can be used as teachable moments to help frame the d...
Source: Current Obstetrics and Gynecology Reports - October 13, 2015 Category: OBGYN Source Type: research

Nutrition in Gynecologic Cancer
Abstract Nutrition plays a role in every aspect of gynecologic cancer care from diagnosis to death. Unfortunately, the topic is not well researched in gynecology oncology and much that is known about nutrition comes from other disciplines. Nutrition and resultant body mass index (BMI) affects a patient’s risk of diagnosis of a gynecologic malignancy, treatment tolerance, complications, and survival. Sadly, 20 % of patients with cancer die of malnutrition rather than their disease. However, not all malnourished patients are thin, as patients with BMIs in the obese range often do not have adequate nutrit...
Source: Current Obstetrics and Gynecology Reports - October 6, 2015 Category: OBGYN Source Type: research

Epidemiology and Burden of Disease Associated with HPV Infection
Abstract Human papillomavirus (HPV) infection is a carcinogen for the following human sites: cervix, vulva, vagina, penis, anus and oropharynx. Approximately 4.8 % of the global cancer incidence (in 2008) was attributable to HPV infections, although substantial differences were found by geographical region. The large majority (85 %) of the cancers attributed to HPV are cancers of the cervix, which were the fourth most common cancers worldwide among women in 2012. There is a clear correlation between the incidence (and mortality) of cervical cancer and the average level of development. Approximately 84 ...
Source: Current Obstetrics and Gynecology Reports - October 6, 2015 Category: OBGYN Source Type: research

HPV Vaccination: Current Global Status
Abstract Human papillomavirus vaccines have been in use in populations for nearly 10 years. They now have an established record of high efficacy, effectiveness and safety in the prevention of vaccine-type HPV infection and disease, including genital warts and pre-cancers. Their considerable immunogenicity has resulted in trials to study two-dose schedules, which are now approved by WHO and in many countries for use in young adolescents at a spacing of at least 6 months between doses. As of mid 2015, 65 countries have HPV vaccines on their national immunisation schedule, with variable coverage achieved t...
Source: Current Obstetrics and Gynecology Reports - September 26, 2015 Category: OBGYN Source Type: research

Natural History of Human Papilloma Virus Infection of the Cervix
Abstract Persistent HPV infection with an oncogenic strain of high-risk HPV is a necessary risk factor for the development of invasive cervical cancer. The improved understanding of the cytopathic effects of HPV led to the development of novel diagnostic and preventative tools. HPV manages to evade the immune response of the host. Oncogenic HPV infection does not progress to cancer in all infected individuals and certain variables make individuals more susceptible to the development of pre-malignant and malignant disease. The alpha HPV types are divided into high- and low-risk types according to their abi...
Source: Current Obstetrics and Gynecology Reports - September 26, 2015 Category: OBGYN Source Type: research

Concomitant Infection of HIV and HPV: What Are the Consequences?
Abstract Data support the impact of antiretroviral therapy (ART) on the burden of cervical HPV and related lesions. ART is effective at reducing the prevalence and incidence of high-risk (HR)-HPV infection but only over longer duration, and among patients with effective ART (i.e. with high adherence, HIV viral suppression and increasing CD4+ T lymphocyte counts). ART has a protective effect against squamous intraepithelial lesion (SIL) incidence and progression and induces regression with the greatest likelihood among adherent users. ART initiated at high CD4+ is effective at preventing HR-HPV infection a...
Source: Current Obstetrics and Gynecology Reports - September 26, 2015 Category: OBGYN Source Type: research