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Cancer Screening for Transgender and Gender Diverse Patients
AbstractPurpose of ReviewThe purpose of this review is to summarize the current knowledge base for sex-trait related cancer risks and screening guidelines as applied in transgender and gender diverse (TGD) populations with an emphasis on the potential impact of gender-affirming hormonal and surgical therapies. Additionally, this review will address access to screening services and patient-friendly adaptations to screening approaches for this population.Recent FindingsWhile breast cancer incidence is higher among transfeminine persons relative to genotypic males, it still remains significantly lower than that of genotypic f...
Source: Current Obstetrics and Gynecology Reports - June 24, 2020 Category: OBGYN Source Type: research

Fertility Preservation for the Transgender Individual
AbstractPurpose of ReviewThis review aims to update readers on recent evidence in order to counsel and guide clinical management of individuals with gender dysphoria seeking fertility preservation (FP).Recent FindingsRelevant topics include a discussion of the consistent desire for children in transgender people despite a low utilization rate of FP services, animal models, and human histology depicting the effect of gender-affirming treatment (GAT) on the gonads, varied time for resumption of menses, and start of ovarian stimulation upon discontinuing testosterone (T) in transmen, feasible clinical and experimental options...
Source: Current Obstetrics and Gynecology Reports - June 24, 2020 Category: OBGYN Source Type: research

Medical Transition for Gender Diverse Patients
AbstractPurpose of ReviewThe purpose of this review is to provide an up-to-date overview of gender-affirming hormone therapy, including the various hormone regimens available, the efficacy and potential risks of these treatments, and considerations for surveillance and long-term care.Recent FindingsRecent studies reaffirm that hormone therapy has positive physical and psychological effects for many transgender individuals. The overall risks of treatment are low. Transgender women may have an increased risk of venous thromboembolism and breast cancer based on recent cohort studies, but these findings have yet to be confirme...
Source: Current Obstetrics and Gynecology Reports - June 24, 2020 Category: OBGYN Source Type: research

Ectopic Pregnancy Risk with Assisted Reproductive Technology
AbstractPurpose of ReviewTo investigate the optimal methods for the reduction of ectopic pregnancy incidence due to assisted reproductive technology (ART).Recent FindingsDay five or six blastocyst transfer may decrease ectopic pregnancy rates when compared with day three transfer, similarly, frozen-thawed embryo transfer may lessen the risk of ectopic pregnancy relative to fresh embryo transfer. Single embryo transfers decrease ectopic pregnancy risk and have similar clinical pregnancy outcomes as double embryo transfers.SummaryEctopic pregnancy remains a major cause of maternal morbidity and mortality in the first trimest...
Source: Current Obstetrics and Gynecology Reports - June 22, 2020 Category: OBGYN Source Type: research

Pelvic Pain in the Transgender Man
AbstractPurpose of ReviewThe purpose of this review is to update readers on the multifactorial nature of pelvic pain with specific considerations for the female to male (FtM) transgender patient.Recent FindingsSecondary effects of testosterone therapy include both genital and musculoskeletal changes that may contribute to the development of pelvic pain. Hysterectomy is therapeutic for gender affirmation and underlying pain conditions. Postsurgical pain from further pelvic reconstruction may be the result of the reconstruction itself, surgical scarring, or prostheses.SummaryPelvic pain is a common condition with many contri...
Source: Current Obstetrics and Gynecology Reports - June 12, 2020 Category: OBGYN Source Type: research

Care of the Post-vaginoplasty Patient: Management of Complications and Common Gynecologic Issues
AbstractPurpose of ReviewThe purpose of this review is to provide an overview of the surgical complications associated with penile-inversion vaginoplasty surgery as well as the management required to address these complications. We also review common gynecologic problems after penile-inversion vaginoplasty.Recent FindingsThe incidence of reoperation is not low after penile-inversion vaginoplasty with the literature revealing incidence rates as high as 50% in certain cohorts. However, the majority of these reoperations are for cosmesis. Despite these reported complications, most patients “[feel] positive about their genit...
Source: Current Obstetrics and Gynecology Reports - May 31, 2020 Category: OBGYN Source Type: research

Interactions Between Hormonal Contraception and Anti-Retroviral Therapy: an Updated Review
This article aims to provide an updated review of the most recent data around hormonal contraceptives and anti-retroviral therapy.Recent FindingsPrior data have suggested possible pharmacologic interactions between certain hormonal contraceptives and anti-retroviral therapy. The most significant interactions implicated include those between progestin-based contraceptive implants and efavirenz as well as between combined hormonal contraceptives and protease inhibitors. Most past studies, however, feature small sample sizes with few clinical outcomes reported.SummaryRecent data since 2017 have largely affirmed prior studies ...
Source: Current Obstetrics and Gynecology Reports - May 30, 2020 Category: OBGYN Source Type: research

A Proposed Platform for Phenotyping Endometriosis-Associated Pain: Unifying Peripheral and Central Pain Mechanisms
AbstractPurpose of the ReviewEndometriosis is defined by a finding of ectopic endometrial glands/stroma, and is characterized by a wide variability in pain symptoms. The goal of this review is to identify peripheral to central factors that can modulate pain output in a given patient with endometriosis. Based on this constellation of factors, we propose a pain classification for endometriosis.Recent FindingsThe development and persistence of endometriosis-associated pain is influenced by a complex interplay between local factors that then interact with central variables. Starting peripherally, endometriosis anatomic charact...
Source: Current Obstetrics and Gynecology Reports - May 29, 2020 Category: OBGYN Source Type: research

Long-Term Health Consequences of Endometriosis —Pathways and Mediation by Treatment
AbstractPurpose of ReviewThe purpose of this review is to discuss the most up to date research on endometriosis and chronic disease risk, highlighting the role treatments for endometriosis may play in these associations.Recent FindingsPrevious studies have shown a consistent association between endometriosis and risk for epithelial ovarian cancer but the association with other cancers is less clear. Current research indicates that endometriosis may in be associated with risk of systemic lupus erythematosus, and potentially other autoimmune diseases. Limited evidence is also present for the association between endometriosis...
Source: Current Obstetrics and Gynecology Reports - May 28, 2020 Category: OBGYN Source Type: research

Treatment of Midlife Women with Chronic Low Back Pain —Opioids Are a Last-Resort Option
AbstractPurpose of ReviewThe purpose of this narrative review is to inform readers of the particular impact opioids have had on midlife women and to provide perspective on non-opioid treatment options for women with chronic low back pain.Recent FindingsResearch has shown that midlife women experience more chronic low back pain than men and other age groups of women. As a result, opioids have been particularly deleterious in this demographic group. In addition, there are no data to recommend them for long-term use, while there is a breadth of data on the negative consequences of long-term opioid use. Treatment guidelines no...
Source: Current Obstetrics and Gynecology Reports - May 28, 2020 Category: OBGYN Source Type: research

Pharmacokinetics of Hormonal Contraception in Individuals with Obesity: a Review
AbstractPurpose of ReviewObesity continues to affect many women globally. In the USA, almost 40% of all women are obese and many of these women use hormonal contraception for pregnancy prevention. How well hormonal contraceptive works for these individuals has been an area of ongoing research. Pharmacokinetics (PK), the study of drug passage through the body, can shed light on how differences in physiology between obese and non-obese populations can impact drug disposition and subsequent efficacy. This review aims to reflect on these types of studies and empower clinicians with information to help tackle the challenges of ...
Source: Current Obstetrics and Gynecology Reports - May 3, 2020 Category: OBGYN Source Type: research

Single-Port Laparoscopic Surgery for Endometrial Cancer: a Systematic Review
AbstractPurpose of ReviewThis review aimed to provide an overview of single-port laparoscopic surgery and related literature. Based on previous reviews on endometrial cancer, we focused on the benefit of single-port laparoscopic surgery in endometrium cancer.Recent FindingsEndometrial cancer is the most common gynecological cancer and can be treated with laparoscopic surgery without negatively affecting the oncological outcome. Single-port laparoscopic surgery is a recently emerging endoscopic technique, and it was shown that endometrial cancer could be staged using this method.SummaryResearch shows that endometrial stagin...
Source: Current Obstetrics and Gynecology Reports - May 1, 2020 Category: OBGYN Source Type: research

Recent Advances in the Medical Management of Early Pregnancy Loss
AbstractPurpose of ReviewTo provide an update on advances in medical management of early pregnancy loss, including the addition of mifepristone pretreatment to existing regimens.Recent FindingsThe utilization of misoprostol for medical management of early pregnancy loss has been studied extensively and is established as a safe and effective treatment. Two recent randomized controlled trials have demonstrated that the addition of mifepristone pretreatment significantly increases the effectiveness of misoprostol and a large body of data demonstrate the excellent safety profile of mifepristone. However, the Food and Drug Admi...
Source: Current Obstetrics and Gynecology Reports - April 5, 2020 Category: OBGYN Source Type: research

Telemedicine for Medication Abortion: The Time Is Now
AbstractPurpose of ReviewThis review will provide an overview of the current restrictions to medication abortion in the USA, strategies for incorporating telemedicine into medical abortion care, and new evidence on the efficacy and safety of telemedicine as a means to provide medication abortions.Recent FindingsNewly published data from the TelAbortion study, the first direct-to-patient medication abortion service in the USA, shows that it is as safe, successful, and acceptable to patients as previous international data on similar care delivery systems. Other groups have continued to build upon the existing body of literat...
Source: Current Obstetrics and Gynecology Reports - April 5, 2020 Category: OBGYN Source Type: research

Endometrial Stem/Progenitor Cells
AbstractPurpose of ReviewTo summarize endometrial stem/progenitor cell biology and endometrial cancer stem cells.Recent FindingsThe subject is relatively new that only about 15  years ago, colony-forming units, as putative endometrial stem/progenitor cells, have been demonstrated in an endometrial sample. Earlier and some recent studies have justifiably focused on endometriosis as the serious gynecologic problem of women. However, on the side of endometrial stem cells res earch, many current studies are still working on in vitro methods, and the majority of the rest are on animal models. Reported cells as endometrial stem...
Source: Current Obstetrics and Gynecology Reports - February 28, 2020 Category: OBGYN Source Type: research