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Gynecology

• Editor's Note
• List of Articles

List of Articles

• Uterine Myomas: A Comprehensive Review
  Uterine leiomyomata are among the most frequent entities encountered in the practice of gynecology. It occurs in 20-40% of women during their reproductive years. Approximately 600,000 hysterectomies are performed per year in the United States for uterine myomas. Many surgical procedures other than hysterectomy are also commonly performed to deal with myomas. The purpose of this document is to review the literature and medical and surgical advances in the management of uterine myomas. Authors hope this helps healthcare providers the decision-making process as logical as possible.
  
  
• Menopause: A Close-Up Look
  As the life expectancy has increased markedly, more and more women are living longer after menopause. In western society, women can anticipate living for approximately 80 years, spending more than one third of their lives in the postmenopausal period. Menopause refers to the complete or permanent cessation of menstruation; an interval of 6 to 12 months of amenorrhea is usually necessary to establish the diagnosis of menopause. The biologic event of menopause marks a meaningful life passage for every woman. It is a transition made from the reproductive stage of life to the non-reproductive stage. This transition is the period of declining ovarian function, which usually becomes apparent clinically over the 2 to 5 years around menopause. The population of postmenopausal women continues to rise; currently approximately 470 million women in the world are of age 50 and older- a figure that is projected to increase to 1.2 billion by 2030. It is estimated that 25 million women each year pass into menopause. Several studies have shown that both the number of cigarettes smoked and the duration of smoking affects the onset of menopause and it induces earlier menopause.
  
  
• Sexual Dysfunction in Postmenopausal Women
  Sexual dysfunction is common in postmenopausal women and the rate can be well over 80%. Pain during intercourse, decreased arousal and response, decreased frequency of sex, and loss of sexual desire are the most frequently identified problems in this population. The primary care physicians and obstetricians and gynecologists are frequently the first-line in the management of these difficulties. The purpose of this document is to enhance the understanding of sexual dysfunction in postmenopausal women and the development of a strategy for treatment or referral. Sexual problems in postmenopausal women are often amenable to fairly simple interventions that are (or can and should be) within the competence of primary care professionals. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient's individual need.
  
  
• Alternative and Complementary Medicine for Menopause
  Menopause is a journey, which lasts from 3 to 10 years on average, and each woman will experience it in her own unique way. Some women appear to pass through this time with very few physiological or emotional complaints, while others will experience mild hot flashes and some emotional ups and downs.  This change brings about a myriad of important health risks, many of which can be eliminated or reduced with hormone replacement therapy (HRT). Despite the benefits of HRT some women are not candidates for this treatment and many others choose not to take it. For our purposes today, the context is unconventional therapies that fall under the umbrella of what is being called "Alternative and Complementary Medicine". It comprises a very wide range of therapies, including botanical and behavioral, and other practices such as acupuncture and biofeedback. "Alternative" implies "instead of" conventional treatment, whereas "complementary" refers to something used in addition to conventional treatment. Acupuncture is licensed in about 30 states but not in others, and covered by some insurance companies. Biofeedback falls within conventional therapy for migraine but is still considered unconventional therapy for cancer. The term "integrative medicine" helps to get away from the thinking of "us versus them". The idea is to draw on the best of what exists from around the world. To achieve better medical treatment, we may "integrate" current mainstream medical practices with other approaches. The main thing is to be open to what works best for the patients.
  
  

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