Journal of Women's Health

Uterine artery embolization (UAE) as a primary therapy for symptomatic fibroids was first used in France in 1991. Currently, there are at least 250 centers in the United States, as well as centers in Canada and England, with experience in this technique. Initial published results worldwide indicate that after UAE, uterine fibroids shrink at least 50% in volume on average and symptoms of refractory vaginal bleeding and chronic pelvic pain are controlled in approximately 85% of patients. Major complications are rare. Overall, this technique is minimally invasive, preserves the uterus, and requires a shorter hospitalization than hysterectomy or myomectomy.

Screening rates for colorectal cancer are unacceptably low. New guidelines, public education campaigns, and expanded coverage of screening costs by healthcare insurance are expected to increase screening rates, but interventions targeting women may accelerate this change. Most American women already participate in regular cancer screening, in the form of Papanicolaou (Pap) tests and mammography, so they may be receptive to tailored messages about the need to add regular colorectal cancer screening to their preventive health regimen. In addition, their role in promoting the health of family members may position women to influence screening behavior in family and friends. Women may be particularly valuable change agents in populations where screening rates are traditionally low, such as medically underserved populations, the elderly or low socioeconomic status groups with competing health priorities, and populations with cultural values or practices inconsistent with the adoption of a new screening behavior. To serve as agents of change in their family and social networks, women must understand that colorectal cancer is not solely a man’s disease and that the benefits of colorectal screening are similar to those of Pap testing and mammography. Colorectal cancer screening should also be promoted within a framework of a lifelong strategy for health maintenance for both men and women. The message to women should emphasize the value of colorectal cancer screening rather than the disagreement among experts over preferred screening strategies and should emphasize the value of shared decision making between the patient and her healthcare provider.

Most studies of lower extremity arterial disease (LEAD) have not included women. To study the frequency of LEAD and its association with cardiovascular disease risk factors and estrogen use in community-dwelling postmenopausal women, we conducted a cross-sectional study of LEAD in 826 women whose average age was 74 years. Cardiovascular disease risk factors and medical history, body mass index (BMI), blood pressure, glucose tolerance, lipids and lipoproteins, and current and past medication use were determined using a standard protocol. Ankle-brachial artery index (ABI) of systolic blood pressure was measured by a trained technician using Doppler ultrasound. LEAD was defined as ABI <0.8. LEAD prevalence increased with age from nearly 5% in the 60–69-year-old group to >25% in women aged 90 and older. In age-adjusted analyses, women with LEAD had significantly lower levels of highdensity lipoprotein (HDL) cholesterol, were less likely to exercise regularly, and were less likely to have ever used estrogen replacement therapy. They also had significantly higher levels of blood pressure, low-density lipoprotein (LDL) cholesterol, triglycerides, glucose, and insulin. In multivariate analyses, high HDL cholesterol, regular exercise, and estrogen use were each associated with a reduced risk of LEAD, whereas age, high blood pressure, and abnormal glucose tolerance were each associated with increased risk. Few women(6%) were smokers, but they had twice the risk of LEAD compared with nonsmokers. Estrogen was independently associated with LEAD in a model containing all covariates except LDL and HDL, and this association was no longer significant in a second model adjusting for these lipoproteins. LEAD is common in older women and associated with modifiable risk factors. The apparent protection associated with estrogen should be studied in clinical trials.

A cross-sectional survey was conducted to examine quality of life (QOL) related to physiological, somatic, and vasomotor effects of changing progestogen treatment from medroxyprogesterone acetate (MPA) to micronized progesterone in postmenopausal women. Eligible women (n = 176) were currently using hormone replacement therapy (HRT) containing micronized progesterone for 1–6 months and had previously received HRT containing MPA. QOL was assessed via telephone interview using the Greene Climacteric Scale and the Women’s Health Questionnaire. When compared with the MPA-containing regimen, women using micronized progesterone-containing HRT experienced significant improvement in vasomotor symptoms, somatic complaints, and anxiety and depressive symptoms. Women reported improved perceptions of their patterns of vaginal bleeding and control of menopausal symptoms while on the micronized progesterone-containing regimen. Approximately 80% of women reported overall satisfaction with the micronized progesterone-containing regimen. A micronized progesterone-containing HRT regimen offers the potential for improved QOL as measured by improvement of menopause-associated symptoms.

The health maintenance of women with diverse disabilities and chronic disabling conditions has been neglected by medical professionals. Interest in their basic health promotion has been eclipsed by the narrowed focus on their underlying conditions. We surveyed preventive medical practices of 220 women with multiple sclerosis (MS). The objectives of this study were to evaluate the adequacy of preventive healthcare delivery for women with MS and to explore the adequacy of the detection, prevention, and treatment of osteoporosis in this highrisk population. Our survey revealed that 50% of the women do not get regular medical preventive checkups. Twenty-five percent do not have regular pelvic examinations, and 11% have not had a Pap smear within 3–5 years. In women over 40 years old, 52% do not have yearly mammograms. Risk factors for premature osteoporosis in our sample included impaired mobility (53%), corticosteroid use (82%), and vitamin D deficiency as a result of avoidance of sunlight. Despite these risks, 85% have never had bone density testing, 50% are not taking calcium supplements, and 71% are not taking vitamin D. Among the postmenopausal sample, 81% have never had bone density testing, 50% are not taking calcium supplements, and 70% are not receiving hormone replacement therapy (HRT). Only 1% are taking bone resorption inhibitors. The benefits of preventive healthcare and cancer prevention screening should be stressed to women with MS. Referrals should be facilitated by neurologists for dignified, knowledgeable examinations in fully accessible facilities. Osteoporosis prevention, screening, and treatment protocols must be part of the medical plan for all women with MS.

Hispanic women have higher parity and shorter interbirth intervals than women of other ethnic groups. Thus, they are more likely to become pregnant relatively soon after giving birth, which may place these women at risk of low or deficient levels of specific nutrients. Folic acid is of particular concern because recent studies suggest that maternal use of folic acid supplements may be associated with better reproductive outcomes. The purpose of this study was to assess folic acid levels in postpartum Hispanic women. Using a cross-sectional design, we measured erythrocyte folate values for 188 low-income Hispanic women 1–12 months postpartum who were receiving services at the Women, Infants, and Children (WIC) clinics in El Paso, Texas. An interview was administered to collect information on diet, vitamin use, and method of infant feeding. Mean erythrocyte folate levels decreased from >1300 ng/ml during the first 4 months postpartum to a low of 1017 ng/ml by 12 months postpartum, for an overall decrease of approximately 23% (p = 0.004). Use of postpartum vitamin supplements was significantly associated with higher folate levels. However, only 35% of mothers used vitamins beyond 1 month postpartum. Study results suggest that these mothers may be at risk of developing low or deficient levels of folic acid during the postpartum period. Educational campaigns targeting these women as well as other groups of postpartum women should encourage them to comply with the U.S. Public Health Service recommendation that women of childbearing age consume 0.4 mg of folic acid daily.

Our purpose was to measure the beliefs of physicians about victims of spouse abuse and to examine factors related to holding positive (e.g., supportive) and negative beliefs about providing services to victims of domestic violence. This was a total site sample of 150 physicians (76 responded; RR 51%), surveyed at one time, practicing in a large general hospital and the surrounding urban/periurban area. Four specialities are represented: emergency medicine, family practice, obstetrics-gynecology, and psychiatry. Three aspects of beliefs are measured: beliefs toward physician role in assisting victims of spouse abuse, beliefs about victims of spouse abuse, and beliefs about resources available to physicians to assist victims of spouse abuse. Almost all (97%) physicians believe it is part of their role to assist victims of domestic violence. Almost one third (30%) hold victim-blaming attitudes toward victims of spouse abuse, and the majority (70%) do not believe that they have the resources available to them to assist victims of domestic violence. Being female, younger, practicing obstetrics-gynecology, and having fewer years in practice are all significantly related to holding supportive (positive) beliefs. The majority of negative beliefs held are about resource availability. Hence, training programs may need to be developed locally for physicians and tailored to individual community characteristics. Training programs should also emphasize the importance of understanding the victims of spouse abuse and of not blaming the victims for the violence.

Abdominal obesity affects many aspects of women’s health, and recent studies indicate that hyperandrogenicity (HA) may contribute to the excess of body fat in women. As hormone behavior research attributes male-like play patterns in childhood to the effects of androgens, the aim of the present study was to assess the potential association of such behavior with obesity in adult women. In a randomly selected sample of 40-year-old women (n = 1464), 78% volunteered to respond to a questionnaire collecting information on the effect of other variables on childhood behavior. Self-reported body weight, height, and waist and hip circumferences were used to calculate body mass index (BMI) and waist/hip ratio (WHR). Age at menarche showed an inverse association with overweight (BMI >= 25) (odds ratio [OR] = 0.82). Reports of gender-related behavior as a child showed that playing with girls and girl toys was negatively related to both overweight and abdominal obesity (WHR >= 0.85). Among respondents who were overweight, relationships were found for playing with boys (OR = 0.90) and fighting (OR = 1.70). The OR of playing with boy toys and fighting among respondents with abdominal obesity were increased 1.12 and 1.65, respectively. Interests in athletics as a child seemed to decrease the risk for overweight (OR = 0.89) and abdominal obesity (OR = 0.91). Furthermore, dose-response analysis between the individual exposure levels and the OR for overweight showed a negative trend for playing with girls (p = 0.002) and girl toys (p = 0.017) and a positive trend for playing with boys (p = 0.011) and fighting (p= 0.031). Among respondents with abdominal obesity, positive dose-response effects were found for playing with boys (p = 0.026) and boy toys (p = 0.036) and fighting (p = 0.008). Thus, women with an elevated WHR showed a preference to play with boys and boy toys and also fought frequently as children. This might be a sign of a relative HA in childhood ("tomboyism"). These preliminary observations suggest that HA may originate in childhood.

To determine the efficacy and safety of a single-dose (1200 mg) soft gel insert (vaginal ovule) with miconazole nitrate (2%) topical cream compared with Monistat®7 (miconazole nitrate 2%) Vaginal Cream(Advanced Care Products, North Brunswick NJ) in treating vulvovaginal candidiasis (VVC), two randomized, single-blind, multicenter, controlled, comparative phase III studies were performed. Five hundred fifty-eight patients received either a single-dose miconazole nitrate (1200 mg) ovule or seven consecutive doses of Monistat 7. Ovule arm patients also received miconazole nitrate 2% cream for symptom relief, as needed, up to twice daily. The primary end point was a therapeutic cure. Also evaluated were time to complete symptom relief, safety, and patient preference. The ovule had overall cure rates of 71.7%(71 of 99 patients) and 61.5% (64 of 104 patients). Monistat 7 had overall cure rates of 70.1% (68 of 97 patients) and 61.1% (55 of 90 patients). A significantly greater proportion of patients experienced complete symptom relief by day 3 with the ovule (p = 0.008 and p = 0.025), and time to complete relief was significantly faster (median 4 versus 5 days and 3 versus 4 days). Overall safety results were consistent between groups in both studies. Miconazole nitrate vaginal ovule is as safe and efficacious in curing VVC as Monistat 7 while providing complete symptom relief significantly faster. Patients preferred the ovule to prior therapy.