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Update in Women's Health
- Karen M. Freund, MD, MPH;
- Nancy C. Dolan, MD; and
- Heidi D. Nelson, MD, MPH
- From Boston University Medical Center, Boston, Massachusetts; Feinberg School of Medicine, Northwestern University Medical School, Chicago, Illinois; and Oregon Health & Science University, Portland, Oregon.
2002-2003 Series: Update Sessions from ACP–ASIM's 2002 Annual Session
David A. Cramer, MD, and Paul T. Kefalides, MD, Co-Editors
In 2001, the significant themes in women's health focused again on the controversies in the care of women during the menopausal transition, including hormone therapy, the role of cancer screening tests, and the management of osteoporosis. In addition to these topics, important new information emerged on a breadth of health issues seen daily by general internists, such as physical activity counseling, partner violence, urinary tract infections, and contraception. This Update discusses reports published in 2001 selected through a systematic review of the major general medical journals, subspecialty journals in gynecology and women's health, and review publications such as ACP Journal Club. Each report addresses issues that are important in the care of women, are likely to change clinical practice, and fulfill criteria for sound research methods.
Postmenopausal Hormone Therapy
In 2001, several studies examined postmenopausal hormone therapy (HT) in secondary and primary prevention of cardiovascular and cerebrovascular disease. Previous observational studies suggested a cardiovascular mortality benefit from postmenopausal estrogens. However, the Heart and Estrogen/progestin Replacement Study (HERS) (1), which randomly assigned postmenopausal women with established heart disease to receive conjugated estrogen plus progestin or placebo, found no difference in cardiac events after 5 years and found an increased risk for events in the first year of study. The short-term clinical trials published in 2001, followed by the 2002 release of the Women's Health Initiative (WHI) data, confirm that estrogen alone or in combination with progestin has no role in the secondary prevention of cardiovascular disease and that combination HT has no role in the primary prevention of cardiovascular disease.
Estrogen Is Not Effective for Secondary Prevention of Cerebrovascular Disease or Myocardial Infarction
To evaluate the potential role of estrogen in secondary prevention after cerebrovascular disease, Viscoli and colleagues randomly assigned postmenopausal women with a history …
