Current Women's Health Reviews - Volume 1, Issue 3, 2005

Cervical adenocarcinomas are increasing in incidence each year, both in the United States and worldwide. This increase largely reflects the inherent difficulty in detecting glandular precursor lesions. Since adenocarcinoma in situ generally requires at least five years to progress to invasive disease, there should be ample time for screening and potential intervention. Conization preserves fertility in young women diagnosed with adenocarcinoma in situ, but carries an inherent risk of residual disease higher in the canal. Highly motivated patients with microscopic stage IA1 and IA2 cervical adenocarcinoma may also be managed by fertility-sparing surgery. The treatment of choice for stage IB1 disease is radical hysterectomy. Fewer than 20% of patients will need adjuvant therapy. Primary radiation with weekly cisplatin is the best option for women with stage IB2 and IIA cervical adenocarcinoma. Virtually all patients treated initially by radical hysterectomy will have high-risk surgical-pathologic features that indicate the need for adjuvant chemo-radiation. Patients with stage IIB to IVA disease should also receive primary radiation with weekly cisplatin, but their prognosis is more guarded. The treatment of recurrent cervical adenocarcinoma should be individualized, depending on the location of disease and the type of previous therapy. In this review, we discuss the current management of in situ and invasive cervical adenocarcinoma.

Growing toxicological and epidemiological interests in new therapeutic compounds have arisen with the recent increase in frequency of pregnancies in women with renal disease. Angiotensin-converting enzyme inhibitor and angiotensin II receptor antagonist, at least in the late stages of pregnancy, is associated with adverse fetal development and can cause pulmonary hypoplasia and neonatal anuria. In utero exposure to immunosuppressive drugs poses challenges to management of pregnant renal transplant recipients. Mycophenolate mofetil, a new antiproliferative drug to inhibit inosine monophosphate dehydrogenase, has been recently reported to cause major fetal malformations. Whilst such alleged adverse fetal events are potential concerns for obstetricians and physicians, an understanding of different types of risk estimates and strengths of evidence is also needed - we further elaborate and provide perspective on how to interpret the available information in clinical decision-making of drug use in pregnancy.

World population is expected to rise to 9 billion in next 50 years. Between 2000 and 2030 nearly a hundred percent of the annual population growth will occur in the less developed countries of Africa, Asia, and Latin America. Apparently, there will be growing demand for suitable (discreet, simple to use, long lasting, reversible, sociologically accepted and inexpensive) methods of birth control. Immunocontraceptive vaccines seem to be a promising alternative for the population control. Studies on immunocontraceptive targets have been aimed at either gametogenic (sperm, zona pellucida) components or at sex hormones involved in the regulation of fertility. So far, the only contraceptive vaccine that has undergone the Phase II clinical trial in human model was hCG. However, there are still unknown consequences of the prolonged stimulation with this vaccine. There have been also attempts to use other reproductive hormones (GnRH, FSH) as immunocontraceptives. None of them, however, appeared to be adequate to be applied in humans due to either a lack of efficacy, costs or serious side effects. Recently, there were also published data on novel antigens of spermatogenic origin with a potential of stimulation of the production of antisperm antibodies. They provided limited contraceptive efficacy only in animal models. The article compiles the literature concerning the present status and future perspectives of immunocontraceptive strategies as well as describes different vaccine constructs under study.

Vulvodynia represents an important, but poorly understood collection of health issues affecting 1 in 8 women. Pain and discomfort interfere with normal daily activities such as sitting, exercising and sexual intimacy. The intensely personal nature of these disorders results in feelings of isolation and anxiety for many affected women. Since a variety of benign disorders of the vulva and vagina can contribute to the development and/or maintenance of vulvar pain, clinicians caring for women with vulvodynia must understand the impact and inter-relationships of these conditions. This paper reviews the current classifications and primary causes of vulvodynia. The primary anatomic, dermatologic, myofascial, infectious, neuropathic, and psychosexual factors contributing to vulvar pain are presented, along with evidence-based guidelines to the treatment.

The relationship between uterine myomas and infertility is unclear, and numerous studies have attempted to better define this association. This review article explores the available data about the impact of submucosal, intramural and subserosal myomas, and small and large myomas, on reproductive outcomes in natural conception and assisted reproduction. Overall myoma location, followed by size, is the most important factor determining the impact of myomas on fertility. Distortion of the uterine cavity can also be detrimental to fertility. The importance of proper evaluation of a myomatous uterus and its endometrial cavity is discussed. For patients with myomas and infertility, or for those with symptomatic myomas who desire future fertility, current medical and surgical management options are reviewed. However, myomectomy remains the standard of care for patients with problematic myomas and fertility concerns.

During pregnancy the maternal immune system is confronted with paternal allo-antigens. Therefore, fetomaternal rejection processes may represent a major cause of complications, such as preeclampsia, Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP)-Syndrome, placental abruption and Intra-Uterine-Growth Restriction (IUGR). Several local mechanisms are known, which protect the fetus from maternal immune attack. In addition, mechanisms inducing peripheral immune tolerance to the fetus seem to be of equal if not even of greater importance for successful course of pregnancy. Such mechanisms may be the induction of CD25+CD4+ T regulatory cells, a specialized T-cell population which was shown not only to suppress autoaggressive immune responses but also to prevent graft rejection due to induction of transplantation tolerance. Other mediators influencing peripheral immune tolerance are soluble HLA (sHLA) class I and II molecules. Fetally derived sHLA molecules are able to block the allo-reactive cytotoxic T-cell response of the mother via T-cell-receptor binding. There is further evidence that sHLA class-I (HLA-A, -B, -C and -G) molecules inhibit NK-cell and cytotoxic T-cell activity through CD8 ligation. Thus, increased availability of sHLA-class-I molecules may have strong immune-suppressive effects and affect potentially maternal immune homeostasis. This review summarizes what is currently known about the induction of peripheral immune tolerance in pregnancy and discusses its relevance for the development of characteristic pregnancy-associated diseases.

There are many suggestions that pre-eclampsia has an immunological basis. According to the immunological theory of the disease, there is a failure of the immunological recognition of fetal alloantigens during pregnancy. It seems that abnormal activation of the immune system may play a role in the etiology of pre-eclampsia. Many authors have found a number of changes in the adaptive immune system which may contribute to the development of pre-eclampsia. Recent data suggest that pre-eclampsia is a T helper 1/T helper 2 immunity disorder with predominant Th1 type immunity. Furthermore, there is an evidence regarding the activation of the innate immune system in pre-eclampsia. It has been shown lately that normal third trimester pregnancy is characterized by the activation of peripheral blood leukocytes, which is further increased in pre-eclampsia. The possible immunological etiology of pre-eclampsia has been suggested because of some clinical and epidemiological observations. It has been observed lately that there is a protective effect of sperm exposure and that the duration of sexual cohabitation before conception is inversely related to the risk of pre-eclampsia. There are also epidemiological data that there is a higher incidence of pre-eclampsia in women conceiving by intrauterine insemination with donor sperm compared IUI with partner sperm.

The aim was to investigate, by means of a salutogenic approach, bone mineral density (BMD) and changes in BMD over a two-year period in a group of women in relation to lifestyle behaviours and to explore their perceptions of these behaviours. The method used was multiple and sequential triangulation. Over the two years, 62% had decreased/unchanged BMD, while 38% had increased their BMD. Self-rated sleep satisfaction explained 3% of the variability in BMD and women who reported greater satisfaction with their sleep were more likely to have a healthier lifestyle. Time spent outdoors may moderate the negative influence of smoking. Women's views on lifestyle behaviours were characterised by a number of interrelated dimensions; motivation, goals, actions and strategies. Women with a relaxed outlook on life had increased BMD while women with a rigid outlook on life had decreased their BMD irrespective of smoking and physical activity. Women with a rigid outlook on life viewed actions such as lifestyle habits as a means to an end while respondents with a relaxed outlook on life, the enacted lifestyle behaviours were a goal in themselves. Motivation and sleep may be salutary factors associated with improved BMD. A tentative bio-psychosocial salutary model of the association between motivation, outlook on life, sleep, lifestyle behaviours and BMD is presented.

Breast cancer in young women has always carried an ominous prognosis. There has been little evidence that these concerns are unfounded. The risk for developing premenopausal breast cancer is multifactorial. The younger and less developed breasts are subject to endogenous factors such as hormones and growth factors, as well as exogenous agents occurring in environmental pollutants and other chemicals. Most data indicate that genetic mutations, reproduction history, and family history of breast cancer disproportionately affect the risks of breast cancer in the premenopausal woman. More controversial risk factors that have recently received much attention include diet, physical activity, and stress. Many women who are delaying pregnancy to a much later age will pose an increasing demand for attention to a whole new set of issues in the young women. More effort must be devoted to diagnosing and treating young women aggressively, avoiding toxicity to the fetus, and reducing postpartum risk of recurrence. Though the etiological pathway for breast cancer in the young women is quite a winding one, improving prognosis may be as simple as early detection.