Paru S. David

Hormonal Contraception Update

Unintended pregnancy continues to be a serious public health issue in the United States. Of the 3 million unplanned pregnancies per year, 60% occur in women using some form of contraception. Educating and helping women choose a contraceptive agent that best suits their needs will improve compliance and contraceptive efficacy. A multitude of new contraceptive agents are now available. We review new hormonal contraceptive options and discuss newer oral agents, extended-cycle contraception, and innovative delivery methods.

Developing a Reproductive Life Plan

The purpose of this article is 2-fold: to emphasize the importance of a reproductive life plan and to define its key elements. We review the 2006 recommendations from the Centers for Disease Control and Prevention (CDC) regarding ways to improve the delivery of preconception health care to women in the United States, with particular focus on encouraging individual reproductive responsibility throughout the life span and on encouraging every woman to develop a reproductive life plan. We propose recommendations for the content of a reproductive life plan and explore ways to incorporate the guidelines from the CDC into clinical practice. By encouraging women to consider their plans for childbearing before they become pregnant, clinicians have the opportunity to influence behavior before pregnancy, which may decrease the incidence of unintended pregnancies and adverse pregnancy outcomes.

Migraine in Pregnancy and Lactation

Migraine headache is a significant health problem affecting women more than men. In women, the hormonal fluctuations seen during pregnancy and lactation can affect migraine frequency and magnitude. Understanding the evaluation of headache in pregnancy is important, especially given the increased risk of secondary headache conditions. Pregnancy and lactation can complicate treatment options for women with migraine because of the risk of certain medications to the fetus. This review includes details of the workup and then provides treatment options for migraine during pregnancy and lactation.

Prevention of Migraine in Women Throughout the Life Span

Migraine is a common disorder in women. The 1-year prevalence of migraine is 18% in women compared with 6% in men. Migraine most commonly occurs during the reproductive years, affecting 27% of women 30 to 49 years of age. The predominance of this disorder and its social, functional, and economic consequences make migraine an important issue in womens health. The hormonal milieu has a substantial effect on migraine in women. An understanding of these hormonal influences in the various stages of life in females is essential to the management and prevention of migraines. This article reviews migraine prevention strategies with an emphasis on specific therapies for each stage of a womans life.

The Patient-Centered Medical Home and Preconception Care: An Opportunity for Internists

The patient-centered medical home is defined by the American College of Physicians as a comprehensive approach for delivering medical care to patients. Internists have the role of caring for patients from adolescence through adulthood and have the opportunity to deliver preconception care. Preconception care is the promotion of the health and well-being of a woman and her partner before pregnancy. The goal is to improve pregnancy-related outcomes through interventions that occur before conception and before the patient would ordinarily seek prenatal care. Using the model of the patient-centered medical home, internists can provide comprehensive preconception care to improve the health of women before pregnancy and thus to decrease the risk of adverse pregnancy outcomes.

The association between recent abuse and menopausal symptom bother: results from the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS).

Objective:The aim of the study was to determine whether there is an association between current menopausal symptom bother and a history of abuse (physical, sexual, or emotional/verbal) in the last year. Methods:A cross-sectional survey was completed using the Data Registry on Experiences of Aging, Menopause, and Sexuality and the Menopause Health Questionnaire. Data from the Menopause Health Questionnaire were collected from 4,956 women seen consecutively for menopause consultation in the Womens Health Clinic at Mayo Clinic (Rochester, MN) from January 1, 2006 through October 7, 2014. Data from 3,740 women were included in the analysis. Menopausal symptom ratings were compared between women reporting a history of abuse (physical, sexual, or emotional/verbal) in the last year and those not using a two-sample t test. Analysis of covariance was used to assess whether abuse was associated with menopausal symptom bother after adjusting for baseline participant characteristics. Results:Of the 3,740 women, 253 (6.8%) reported experiencing one or more forms of abuse in the last year, the majority (96%) of which was verbal/emotional abuse. Those reporting abuse in the last year had higher (P < 0.001) mean total menopausal symptom bother scores. Consistent findings were obtained from multivariable analyses adjusting for all demographic and substance use characteristics. Conclusions:In the present study from the Data Registry on Experiences of Aging, Menopause, and Sexuality, menopausal symptom bother scores were directly associated with recent self-reported abuse.

Measures of satisfaction for providers and patients using same day teledermoscopy consultation

We aimed to determine whether patients and providers were satisfied with teledermoscopy consultation for skin lesions.

Imploding and Exploding Migraine Headaches: Comparison of Methods to Diagnose Pain Directionality

The study aims to compare methods of determining headache directionality (imploding, exploding, and/or ocular headaches) in women with migraine, investigate the concordance between physician assignment and patient self‐assignment of pain directionality, and evaluate whether patients assigned their headaches to the same direction when queried using different methods. Directionality of migraine headache pain (imploding, exploding, or ocular) may reflect differences in the underlying pathogenesis of individual migraine attacks among and within individuals. Emerging evidence suggests that directionality of pain in migraine sufferers may predict response to onabotulinumtoxin A. The best method of determining headache directionality in migraine sufferers has not been systematically explored.

Tools of the trade: individualized breast cancer risk assessment.

A 45-year-old Caucasian woman presents to discuss her concern about her risk for breast cancer as she has breast cancer in her family. She is generally healthy. She is 163 cm tall and weighs 67.9 kg. One month prior, she underwent stereotactic biopsy of the right breast following indeterminate calcifications on screening mammogram. Pathology was sclerosing adenosis. She has no other history of breast procedures, including reduction or augmentation. She underwent total abdominal hysterectomy with bilateral oophorectomy 2 years ago for fibroids and menorrhagia. She has not taken hormone therapy. She is gravida 3 para 4 with age at first live birth of 25. She was 12 years old at menarche. Her family history of breast cancer includes her mother, diagnosed at age 50, who is alive and well and two paternal aunts diagnosed at ages 58 and 64 respectively. She has two healthy sisters. There is no ovarian cancer in the family. She is not of Jewish descent. Neither her mother nor other relatives have had genetic counseling or testing. Which of the following do you recommend:

You Can't Fool Mother Nature: New Directions in Oral Contraception

This article reports on a case of a 36-year-old woman complaining of persistent premenstrual symptoms with no resolution after starting on a combined oral contraceptive (COC). It discusses her situation and provides recommendations on how to proceed regarding contraceptive options.