Journal of Women's Health

: Because of the limited efficacy of available agents and to limit toxicity, there is considerable interest in combination pharmacotherapy for osteoporosis.

: A search was performed for randomized controlled trials in MEDLINE (1966-present) using the keywords osteoporosis treatment and combination.

: Twenty-four randomized controlled trials evaluated osteoporosis medications in combination. Study duration ranged from 1 to 4 years. No serious adverse events were definitively attributable to study drugs. Fracture reduction outcome is not shown for any combination regimen. The literature was mixed regarding bone density augmentation. Combinations of nandrolone decanoate plus calcitonin, calcitonin plus growth hormone (GH), or pamidronate plus GH may be contradictory or detrimental to bone mineral density (BMD). For postmenopausal osteoporosis or osteopenia, four combinations appear to increase hip and lumbar BMD: 10 mg alendronate with 0.625 mg conjugated equine estrogens (CEE), cyclic etidronate with 0.625mg CEE, 10 mg alendronate with 2 mg estradiol (E₂), and tibolone with fluoride. For steroid-related osteoporosis, intermittent etidronate with fluoride increases lumbar BMD.

: The few trials including Food and Drug Administration (FDA)-approved medications suggest that 10 mg/day alendronate with estrogen (equivalent of 0.625 mg CEE daily) can increase BMD moreso than each medication given singly in postmenopausal osteoporotic women. Estrogen dose and type must be controlled in future trials. Long-term safety data are lacking. The utility of these combinations rests on whether bone density changes will translate into decreased fracture rates.

: Compared with men, women use more fat and less carbohydrate to fuel exercise at the same relative intensity. Circulating levels of estrogen and progesterone are likely to play an important role in explaining this gender difference in exercise substrate utilization.

: Studies, mainly using animal models, have shown that estrogen increases fatty acid availability (lipolysis) and decreases carbohydrate availability and uptake. Studies conducted in humans corroborate the reduction in carbohydrate turnover and oxidation in the presence of estrogen, but the impact on fatty acid availability and utilization is less clear.

: The effect of circulating estrogen may be mediated, at least in part, by changes in the sensitivity of stored carbohydrate and lipids to mobilization in response to epinephrine. The role of progesterone in metabolic regulation during exercise has not been systematically studied in humans.

: Understanding the role of the ovarian hormones in fat and carbohydrate metabolism during exercise may have practical applications in terms of understanding the metabolic consequences of amenorrhea, menopause, and hormone replacement therapy(HRT).

: Women have lower rates of participation in leisure time physical activity than men and have been studied to a lesser extent than men. Because physical activity plays a vital role in overall health, it is important to identify factors than can help increase physical activity rates for women.

: Defining and understanding correlates of physical activity is critical for at-risk populations and for planning effective interventions. This paper reviews research conducted in the past two decades on correlates of physical activity in women. An ecological model with an added physical environment component was used to organize the correlates. Studies conducted among adult white, black, American Indian, Asian, and Hispanic women are included. A total of 91 studies were reviewed. Many studies included white women, fewer studies included black and Hispanic women, and even fewer included American Indian women, and only 3 studies included Asian women.

: The correlates most studied are sociodemographic variables, with nonwhite race, lower educational levels, and older age most consistently associated with lower levels of physical activity. Few studies focused on environmental and policy correlates. Social support was an overwhelmingly positive determinant of physical activity for all groups of women.

: Based on these findings, we recommend that future research include more diverse groups of women and evaluate modifiable factors, such as psychological, interpersonal, and environmental correlates. Future research also should include more intervention and longitudinal studies.

: This study examined the prevalence of revision surgery in which silicone gel breast implants were either removed (explanted) or replaced in a cohort of women from Birmingham, Alabama. The main reason leading up to the surgery and the prevalence of ruptured implants reported after explantation are described.

: Data were collected from telephone interviews with 907 women previously identified in a larger cohort study of women with breast implants. Women who reported breast surgeries subsequent to their index mammoplasty were asked to consent to retrieval of the surgical records describing the surgery.

: Surgery in which a silicone gel breast implant was removed or replaced was reported by 33% of the 907 women in this cohort. The most common reason for surgery was problems with the implant that affected the breast (103 of 303 surgeries). Of the 303 women reporting surgery, 145 (48%) reported knowing after a surgery that an implant was ruptured when it was removed, and 171 (56%) reported knowing that an implant was ruptured or leaking. Overall, 16% of the 907 women reported knowing that either of their implants was ruptured after any surgery. At least one surgical record was retrieved for 165 (54%) of the 303 women reporting surgery. Among these women, the rupture rate was 69 of 165 (42%) according to the surgical record and 85 of 165 (51.5%) according to self-reports, a statistically significant difference (p = 0.008 from McNemar's test). The mean time from implantation to surgery was 11.5 years among women reporting surgery and estimated at 21.4 years for all women.

: A third of the women in this cohort underwent additional surgery after the initial mammoplasty, and nearly half who underwent surgery reported that their implants were found to be ruptured when removed. Women considering silicone gel breast implants should be informed of the risk of additional surgeries and of the potential risk of breast implant rupture.

: To explore the acceptability of the self-collection of samples for human papillomavirus (HPV) testing in comparison with that of the Pap test.

: The study population consisted of 1069 women 20 years and older who were eligible for coverage through the Mexican Institute of Social Security (IMSS). These women were randomly selected among participants in a larger study to evaluate the use of HPV testing as an alternative in cervical cancer screening. All participants provided a self-collected vaginal sample for HPV testing according to explicit instructions and underwent a Pap test. Afterwards, each woman was interviewed about her experience and opinion regarding the two procedures. Acceptability was measured by a calculated score based on discomfort, pain, embarrassment, privacy, perception of personal treatment during the Pap test, and understanding of how to perform the self-sampling method.

: Ninety-three percent of women experienced sufficient privacy with the Pap test, whereas 98% of women reported that privacy with the self-sampling procedure was acceptable. The Pap test consistently provoked more discomfort, pain, and embarrassment than self-sampling. Sixty-eight percent of the women who indicated a test preference chose self-sampling. Preference for this method was positively associated with monthly household income. Women reported a preference for self-sampling because it is more comfortable (71.2%) and causes less embarrassment (55.8%).

: Self-sampling is more acceptable than the Pap test and could improve coverage rates of early detection programs. The incorporation of self-collected samples to detect HPV could encourage participation in screening programs among those women who reject the Pap test because of the necessary pelvic examination.

: To better evaluate efficacy in clinical trials of drugs as potential treatments for female sexual dysfunctions (FSD), a brief, multidimensional measure of female sexual function was developed.

: Data from semistructured interviews with 82 women with or without FSD, aged 19-65 years, generated a pool of 61 items that addressed aspects of female sexual function. On review by a panel, individual items were selected for face validity and clinical relevance. Thirty-one items were used as a sexual function questionnaire (SFQ-V1) in two multicenter, phase II clinical trials totaling 781 women with FSD. Normative data were generated from a sample of 201 women without FSD.

: Factor analysis produced seven domains of female sexual function: desire, physical arousal-sensation, physical arousal-lubrication, enjoyment, orgasm, pain, and partner relationship. The internal consistency of the domains ranged from 0.65 to 0.91, and test-retest reliability ranged from 0.21 to 0.71 for Cohen's weighted kappa and 0.42 to 0.78 for Pearson's correlation coefficient. There was a significant difference between the baseline mean SFQ domain scores of patients with FSD compared with those of women without FSD (p < 0.0001). End-of-study SFQ scores were significantly different for women who reported improvement vs. women who reported no improvement (p < 0.001).

: The SFQ produced seven domains of female sexual function with excellent internal consistency, moderate to good reliability, excellent discriminant validity, and sensitivity. The results suggest that the SFQ may be a valuable new tool for evaluating and diagnosing subsets of FSD and, ultimately, for evaluating treatments of these disorders.

: Selective estrogen receptor modulators (SERMs) are being used increasingly for the prevention and treatment of breast cancer. The currently available SERMs, tamoxifen and raloxifene, are both associated with antiestrogenic side effects that can be bothersome. However, no data exist on how they compare in this regard. We conducted a retrospective, questionnaire-based study to answer this question.

: Women with early breast cancer in one physician's practice who had received either or both of these drugs were surveyed using a self-administered questionnaire. Respondents graded the frequency and severity of side effects related to estrogen deprivation, such as vaginal dryness, mood changes, hot flashes, weight gain, and changes in libido, as well as other side effects, such as vaginal discharge. They were separated into three groups for analysis (group 1, tamoxifen only; group 2, raloxifene only; group 3, both drugs). Side effects graded 4 or 5 (or weight gain >10 pounds) were considered severe.

: Two hundred sixty-four questionnaires were available for analysis. Women on raloxifene had a shorter average duration of therapy. In comparing the tamoxifen and raloxifene groups, vaginal discharge, severe hot flashes, and weight gain of >10 pounds were significantly more frequent with tamoxifen. However, weight gain was also related to the duration of therapy with either drug.

: In this observational study, antiestrogenic side effects were common with either tamoxifen or raloxifene. Raloxifene is associated with significantly less vaginal discharge and severe hot flashes than tamoxifen in women with early breast cancer. Although weight gain of >10 pounds may also occur less frequently on this drug, this may be confounded by the shorter average duration of raloxifene therapy.