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Long COVID (postacute sequelae of SARSCoV-2 infection, or PASC) is an emerging syndrome that affects 50% to 70% of people who survive COVID-19 for up to 3 months or longer [...]

Although the use is off label, a progestin IUD can provide contraception not only in the reproductive years but also through perimenopause to treat HMB and allow for endometrial protection [...]

The transition to menopause begins with ovarian fluctuation and hormonal changes, often beginning before significant changes in menstruation. Reproductive aging with loss of follicular activity progresses over a wide age [...]

Recent studies show low-dose vaginal estrogen to be a highly effective, and safe, treatment for genitourinary syndrome of menopause, while promising RCT results are emerging for vaginal laser therapy The [...]

Breast cancer survivors entering menopause face the risk of several menopausal symptoms:Hot flashes, the most common symptom, occur in more than 75% of women during menopause and have the potential [...]

Coverage and expert comment on new insights on HT and Alzheimer disease risk, HT route and sexuality outcomes, mortality in WHI participants, and USPSTF recommendations that may adversely impact HT [...]

The North American Menopause Society has updated hormone therapy guidelines; herein, what you need to know. Plus, a continued call for the boxed warning to be removed from low-dose vaginal [...]

Data suggest that several years of systemic hormone therapy are safe in mutation carriers who have intact breasts and no personal history of breast cancer. If such mutation carriers have [...]

CASE: AFTER THREE YEARS, IS IT TIME TO QUIT? My menopausal patient is a 57-year-old woman with a BMI of 21. Her mother, who also was slender, sustained a hip [...]

How do you now manage her menopausal symptoms, including bothersome hot flashes? CASE Atypical ductal hyperplasia Your 56-year-old, married, white patient has been on hormone therapy (H'F) since age 52 [...]

The menstrual cycle and its attendant hormonal changes can exacerbate mental health disorders or trigger new disorders, such as premenstrual dysphoric disorder (PMDD) and perimenopausal depression. The mechanism is unclear, [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.07.061 Byline: JoAnn V. Pinkerton (a), Christine J. Guico-Pabia (b), Hugh S. Taylor (c) Keywords: exacerbation; major depressive disorder; menstrual cycle; premenstrual dysphoric disorder; transition to menopause Abstract: Exacerbation of common medical and mental health disorders at specific phases of the menstrual cycle is a prevalent phenomenon. Although the precise cause is unclear, studies implicate complex interactions between the immune and neuroendocrine systems. The menstrual cycle also is a trigger for the onset of depressive disorders, including premenstrual dysphoric disorder, a disorder specific to the luteal phase of the menstrual cycle, and depression associated with the transition to menopause. This article discusses common mental health problems exacerbated by the menstrual cycle, with a particular focus on premenstrual dysphoric disorder and perimenopausal depression. Throughout the reproductive lifespan, routine screening and assessment for the presence of common psychiatric disorders are critical for accurate diagnosis and provision of effective treatment. Management options include referral or consultation with a primary care provider or psychiatrist; treatment options for premenstrual dysphoric disorder and perimenopausal depression include pharmacotherapy with antidepressant agents and/or psychotherapy. Hormones may be helpful. Author Affiliation: (a) Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA (b) Wyeth Research, Collegeville, PA (c) Yale University, New Haven, CT Article History: Received 20 March 2009; Revised 13 July 2009; Accepted 23 July 2009 Article Note: (footnote) This study was sponsored by Wyeth Research, Collegeville, PA., Dr Pinkerton has received research Grants from Wyeth, Solvay, Lilly and Pfizer. She has served as consultant for Wyeth, Novo Nordisk, Eli Lilly, and Amgen. Dr Guico-Pabia has been an employee for Wyeth Research, Collegeville, PA. Dr Taylor has been on the Speaker's Bureau and received research Grant support from Wyeth. Per the International Committee of Medical Journal Editors (ICMJE) 'Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication', all authors had a significant role in the development of the initial outline, contributed to the writing and preparation of the publication, and approved the final version to be submitted for peer review and, ultimately, published.

No. Vaginal estrogen use (average duration of use, 37.5 months) for genitourinary symptoms of menopause (GSM) was not associated with a higher risk of cardiovascular disease (CVD) or cancer in [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.07.022 Byline: JoAnn V. Pinkerton (a), Alan C. Dalkin (b) Keywords: bisphosphonate; combination therapy; estrogen; hormone therapy; osteoporosis therapy; osteoporosis; selective estrogen receptor modulator Abstract: Combination therapy for osteoporosis has been tested in small trials of short duration with various combinations. Pertinent human and animal randomized clinical trial data were identified through Medline and reviewed with a focus on the risks and benefits of different types of combination therapies. Improvements in bone density were found in some, but not all, combinations. There are no large trials of adequate length or numbers to determine fracture efficacy. Consider combination therapy if monotherapy is unsuccessful, if there is an added nonskeletal benefit to the proposed combination or as sequential treatment with an anabolic agent followed by an antiresorptive agent. Although combination therapy, in general, has limitations based on cost, concern about potential oversuppression of bone, and lack of long-term safety and fracture efficacy, selected patients may benefit. Author Affiliation: (a) Department of Obstetrics and Gynecology, Midlife Health, University of Virginia Health System, Charlottesville, VA (b) Department of Internal Medicine-Endocrinology, University of Virginia Health System, Charlottesville, VA Article History: Received 2 March 2007; Accepted 20 July 2007

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.10.218 Byline: Lisa M. Pastore (a), Logan B. Karns (a), JoAnn V. Pinkerton (a), Lawrence M. Silverman (b), Christopher D. Williams (a)(c), Teresa R. Camp (a) Abstract: The purpose of this study was to assess patient perception of fragile X premutation genetic testing (FRAX). Author Affiliation: (a) Departments of Obstetrics and Gynecology (b) Pathology, School of Medicine, University of Virginia (c) Virginia Center for Reproductive Medicine and Surgery, Charlottesville, VA Article History: Received 6 June 2005; Revised 26 August 2005; Accepted 9 October 2005 Article Note: (footnote) Supported by the Obstetrics and Gynecology and Pathology Departments of the University of Virginia. Teresa R. Camp, BA, is a medical student at the University of Virginia School of Medicine.

A study was conducted to assess patient perception of fragile X premutation genetic testing (FRAX). The result showed that women with ovarian dysfunction were interested in FRAX testing but the cost, confidentiality and the implications for relatives were their key concerns.

The authors discuss the treatment of the couples who have immunodeficiency virus and who want to have genetically related offspring. They report that the treatment depends on the unique circumstances of each couple, and that in general these couples should be treated aggressively with antiretrovirals and then serum.

In this special installment of Cases in Menopause, I interview series contributor and menopause expert JoAnn V. Pinkerton, MD. We discuss a fairly new therapy: the combination conjugated estrogen and [...]

Obstetricians and gynecologists are being encouraged to provide primary care services to women and to be the woman's primary care physician. For this reason, they must learn to provide end-of-life care to women, whether they are pregnant or not.

Two ethical scenarios are presented to illustrate the use of five ethical theories in clinical practice: deontology, consequentialism, casuistry, ethics of caring, and principilism. The ethical scenarios are an HIV-infected pregnant woman who refuses drug treatment, and a woman pregnant with quintuplets who must decided whether to abort one or more fetuses.

Pregnant women with a cerebral arteriovenous malformation can give birth successfully but they may want to make a living will just in case. A cerebral arteriovenous malformation is a tangle of abnormal veins and arteries in the brain.

Parents and all health care team members should maintain open communication lines regarding decisions about life support measures for near-viable infants. Newborn specialists consider infants born 22 to 24 weeks after conception to be near-viable and are obligated to advocate for medical treatment that is in the best interests of the child. Most specialists will use all means to maintain that life. Court orders can legally limit the scope of parental wishes when newborn specialists believe parents are not making decisions in the child's best interest. The legal and ethical conflicts surrounding two near-viable births are described.

Byline: JoAnn V. Pinkerton, James J. Finnerty Keywords: Fetal-maternal conflicts; maternal refusal of intervention; maternal autonomy; fetal beneficence; court-ordered intervention Abstract: A serious ethical dilemma occurs when a pregnant woman refuses a medically indicated intervention. Should respect for her autonomy preclude any approach other than to accept her decision? Should the caregivers have recourse to 'gentle persuasion'? Is there ever a justification for invoking the power of court-ordered intervention? The societal views on this subject are first developed from an ethical perspective. The pertinent court cases that reflect on this topic are reviewed. The process of developing guidelines within our institution is related. Finally, the guidelines that were eventually developed are offered. (Am J Obstet Gynecol 1996;175:289-95.) Author Affiliation: Charlottesville, Virginia Article Note: (footnote) [star] From the Department of Obstetrics and Gynecology, University of Virginia School of Medicine., [star][star] Reprint requests: James J. Finnerty, MD, University of Virginia Health Sciences Center, Box 372, Charlottesville, VA 22908., a 0002-9378/96 $5.00 + 0 6/6/74745

A synthetic analog of prostaglandin F2-alpha used in combination with urea and cervical laminaria appears to be a safe and effective technique for inducing second-trimester abortions. Sixty-two women having abortions because of fetal genetic abnormalities were treated with 2.0 milligrams of intra-amniotic 15(s)-15-methyl prostaglandin F2-alpha after injection of 80 grams of urea. Laminaria was used to aid cervical dilation. Gestational age at the time of abortion was 16 to 27 weeks. The majority of patients delivered within six to 12 hours of beginning the abortion procedure. Vomiting and diarrhea were the most common side effects. There were five cases of delayed complications including bleeding from a cervical laceration and continued bleeding necessitating curettage. Three additional patients developed infections that were treated with antibiotics. Complications were similar to those experienced by women who had abortions induced with urea and laminaria followed by vaginal prostaglandin suppositories.

YES, A Cochrane Review found clonidine, selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), gabapentin, and relaxation therapy mildly or moderately effective at reducing hot flushes in this [...]