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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


New Clinical Developments in Women's Health


GOAL
To aid clinicians in understanding both the relevance of clinical data for new treatments, as well as how to effectively integrate these treatments with existing therapeutic options in order to address the multiplicity of factors in women's health.

TARGET AUDIENCE
This activity is designed for obstetricians and gynecologists.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Define the risk factors for coronary heart disease in women and discuss reduction strategies.
  • Identify new developments in diagnosis and the nonpharmacologic/pharmacologic management of the PMDD patient.
  • Recognize the role of the central nervous system and neurotransmitters in lower urinary tract control and the implications for clinical practice.
  • Discuss new information on risk factors for developing osteoporosis, the impact of vertebral fractures, and how osteoporosis can be treated and prevented.

ACCREDITATION STATEMENT
This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this continuing medical education activity for a maximum of 1 hour in Category 1 credit toward the American Medical Association Physicians' Recognition Award. Each physician should claim only those hours of credit that are actually spent on the educational activity. Credits are available until the expiration date of September 30, 2004.

This continuing education activity was produced under the supervision of Harold Fox, MD, Professor and Director of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, and Nikos Vlahos, MD, Assistant Professor of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

This program is supported by an unrestricted educational grant from Eli Lilly and Company.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

CO-CHAIRS

    Harold Fox, MD
    Professor and Director, Gynecology and Obstetrics
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Fox reports no financial or advisory relationship with any pharmaceutical company.

    Nikos Vlahos, MD
    Assistant Professor, Gynecology and Obstetrics
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Vlahos reports receiving grant/research support from Akzo Nobel.

PARTICIPATING FACULTY

    Steven T. Harris, MD, FACP
    Clinical Professor of Medicine and Radiology
    Chief, Osteoporosis Clinic
    University of California San Francisco Medical Center
    San Francisco, California
    • Dr Harris reports receiving grant/research support from Aventis, Eli Lilly, Novartis, and Proctor and Gamble; serving as a consultant for Aventis, Eli Lilly, Proctor and Gamble, and Wyeth-Ayerst; and receiving honoraria from Aventis, Eli Lilly, Merck, Proctor and Gamble, and Wyeth-Ayerst.

    W. Glenn Hurt, MD
    Professor of Obstetrics and Gynecology
    Medical College of Virgina Hospital
    Virginia Commonwealth University Health System
    Richmond, Virginia
    • Dr Hurt reports serving as a consultant for, and receiving honoraria from Eli Lilly.

    Bruce Kessel, MD
    Associate Professor
    Department of Obstetrics, gynecology, and Women's Health
    John A. Burns School of Medicine
    University of Hawaii
    The Queen's Medical Center
    Honolulu, Hawaii
    • Dr Kessel reports receiving grants/research support from Berlex, Proctor and Gamble, and Wyeth-Ayerst; serving as a consultant for Eli Lilly and Proctor and Gamble; and receiving honoraria from Berlex, Eli Lilly, Merck, Proctor and Gamble, and Wyeth-Ayerst.

    Cynthia A. Stuenkel, MD
    Clinical Professor of Medicine Endocrinology and Metabolism
    University of California, San Diego
    San Diego, California
    • Dr Stuenkel reports receiving grant/research support from Eli Lilly, Organon, Pfizer, Proctor and Gamble, and Wyeth-Ayerst; and holding stock in Abbott, Eli Lilly, and Merck.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Off Label Product Discussion
Faculty have disclosed that their articles have referenced the following unlabeled/unapproved uses of drugs or products:

Product(s)
Amitryptyline
Calcium
Duloxetine
Ephedrine
Estradiol
Imipramine
Midodrine
Pseudoephedrine
Investigational use of SSRIs

New Clinical Developments in Women's Health
Harold Fox, MD,* and Nikos Vlahos, MD

Fueled in large part by the standards of evidence-based medicine, clinical investigations into women's health issues have proliferated at an unprecedented pace in recent years. Several large, long-term trials have been launched to assess outcomes that will influence the practice of medicine for years to come.

In the 21st century, the goals of effective medical practice will confront clinicians with ever-higher demands for current information about clinical and scientific advances. Increasingly, physicians will be challenged to incorporate the latest developments in medicine into clinical practice at a pace unimagined within the context of the conventional benchtop-to-bedside transition of investigational developments into routine use. Advances in the diagnosis, evaluation, and management of medical conditions in particular will constitute a substantial share of the new information, products, and services that clinicians must rapidly integrate into their practices in the coming years.

This issue of Advanced Studies in Medicine provides insights into some of the major health issues affecting women. The faculty has concisely addressed the nature and scope of the problems and the available and emerging tools physicians will have at their disposal to meet the challenges of these health problems.

Long neglected and characterized as a minor health issue among women, cardiovascular disease has emerged from the large shadow of breast cancer and other female gender-associated conditions as the major cause of death in women, as well as men. Regarding prevalence, the various manifestations of diseases affecting the heart and blood vessels affect women in greater numbers than men.

Thanks to advances in management of acute myocardial infarction (MI) over the past 2 decades, survival rates are higher than ever—particularly in women, who constitute more than one half of the nearly 13 million survivors of MI in the United States. The growing population of MI survivors, however, suffer effects that drain functional ability and quality of life and consume vast quantities of healthcare resources.

Clearly, advances are needed to reduce the physical, emotional, and social toll of cardiovascular morbidity. Perhaps even more important are new strategies for dealing with the risks that lead to cardiovascular events, including diabetes, obesity, hyperlipidemia, and hypertension. Women stand to benefit at least as much as men from advances in these areas.

More specific to women, premenstrual dysphoric disorder (PMDD) has begun to emerge from its obscured vantage point behind the better-known condition, premenstrual syndrome (PMS). PMDD affects about 5% of menstruating women, but the symptoms are far more severe than those associated with PMS and have a debilitating impact on affected women. PMDD has wide-ranging symptoms that affect virtually every aspect of a woman's life. This disorder has multiple effects on mood and emotions, including potentially severe depression, a condition that affects women to a disproportionate degree compared with men. A variety of effective pharmacologic and nonpharmacologic therapies exist, and the selective serotonin reuptake inhibitors (SSRIs) have demonstrated beneficial effects on a variety of PMDD symptoms. Emerging data on intermittent dosing of SSRIs may make these drugs even safer and more tolerable for patients.

Long a source of emotional and physical discomfort to women, urinary incontinence has won recognition as a health problem affecting millions of Americans, including as many as 30% of all women. As knowledge about etiology and the different subtypes of incontinence has increased, so have the options for managing the condition. Surgery is an effective therapy, but does not always provide a cure for incontinence, and the benefits likely do not persist throughout a woman's remaining lifetime. Nonsurgi-cal strategies can help many women, and advances in the field of neurourology may lead to effective new drug therapies, especially for stress urinary incontinence, which currently has no proven pharmacologic treatment.

Osteoporosis and low bone mass continue to emerge as a threat to the physical, emotional, and social health of women. Prevalence is expected to increase into the foreseeable future, particularly among women. Identification of the factors associated with osteoporosis and related fractures has led to development of effective treatment and prevention strategies. Physicians and their patients can choose from multiple pharmacologic agents that have proven efficacy for prevention and treatment of low bone mass and osteoporosis. As the knowledge base about the disease process continues to grow, treatment can be better targeted to patients who are most likely to benefit. Additionally, the opportunity exists for tailoring therapy to meet the needs of individual patients. Readers of this issue will find the information current and applicable to virtually any clinical practice setting.

*Professorand Director of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
 Assistant Professor of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.