Current Women's Health Reviews - Volume 15, Issue 1, 2019

Background: Adnexal masses are a common presenting concern among women of all age groups. While the majority of adnexal masses are benign, the differentiation of a mass and diagnosis of malignancy can present a dilemma. The use of laboratory studies and tumor markers, which can be obtained through minimally invasive means, can aid in the diagnosis of a mass or the decision to refer a patient to a specialist. Objective: This review provides information on current available tumor markers, their use in the diagnosis of various adnexal masses and tumors, a review on current biomarker panels, and the role these results play in treating pre- and postmenopausal patients with adnexal masses. Results: Many tumor markers exist; however, the majority of markers are not specific to one tumor or cancer. Many benign conditions also cause elevations in tumor markers, which can make distinguishing benign and malignant conditions difficult. In recent years, the development of biomarker panels has served to improve diagnostic accuracy when dealing with an adnexal mass and algorithms have been developed to aid with triaging a patient to continued observation versus referral to a specialist. Conclusion: It is important to merge clinical and laboratory data together when diagnosing and managing any patient with an adnexal mass given the many benign and malignant conditions that can cause elevations in tumor markers.

Background: Imaging plays a major role in the detection, diagnosis, and ultimate treatment strategies of adnexal masses. As high as 10% of women in the United States undergo surgical evaluation for a suspected adnexal neoplasm. Objective: To understand the advantages and disadvantages of each imaging modality used in the evaluation of adnexal masses. Results: Ultrasound is frequently the imaging modality of choice for initial characterization. Computed tomography, magnetic resonance imaging, and positron emission tomography – computed tomography are frequently employed if malignancy is suspected to assess for metastasis. Conclusion: A basic understanding of adnexal imaging modalities will be of benefit to care providers and, in turn, be of benefit to patients.

Surgical exploration of an adnexal mass for the management of pelvic pain or to exclude malignancy is a common gynecologic procedure. While most adnexal masses are benign in nature, all surgeons performing pelvic surgery should understand the surgical recommendations of how to proceed when an ovarian neoplasm is identified. Appropriate pre-operative assessment can help to best identify patients at high-risk of malignancy to ensure appropriate consultation with a gynecologic oncologist. With the evolution of laparoscopy, most adnexal mass surgeries can be performed using minimally invasive surgical techniques. As a guiding principle, all adnexal mass surgery should abide by principles of ovarian cancer staging until malignancy is disproven.

It is important for the obstetrician-gynecologist to be able to decipher the diagnostic clues of an adnexal mass and manage it appropriately. This becomes even more of a challenge when faced with adnexal masses in the pediatric population. Adnexal masses can be of gynecological (cervical, vaginal, primary peritoneal, uterine/endometrial, ovarian) or of non-gynecological origin. In order to approach adnexal masses in any age group, a thorough history and physical examination, along with proper laboratory studies and radiological studies need to be obtained. This pertains as much for adults as it does for assessing adnexal masses in children. This article will review the evaluation to include the initial assessment, usefulness of imaging and markers in the diagnosis, and management of adnexal masses in neonates, young children, and adolescents, and the newest recommendations for each, respectively.

Background: Adnexal masses in premenopausal women are common reason for referral to OB-GYN. The etiologies vary from non-gynecologic to gynecologic. Once the mass is determined to be gynecologic in its origin, the gynecologist needs to predict if the mass is more likely to be benign or malignant which could lead to a diagnostic dilemma. Objective: This article reviews different histologic type of ovarian tumors, its epidemiology, clinical presentation, imaging appearance and ovarian tumor markers. Familiarity with these patterns will help the clinician narrow the differential diagnosis thus facilitating further management. Results: The incidence of malignancy increases with age. Vast majority of adnexal masses that are ovarian in etiology, 90.5% are benign. The first line imaging is usually a pelvic ultrasound. There are imaging characteristics that could assist in categorizing a mass as more likely to be benign or suspicious for malignancy. Furthermore, there are tumor markers that are approved by FDA to be used as tools to evaluate adnexal masses. Conclusion: Adnexal masses in the reproductive age group demonstrate the greatest histologic variance that is mostly benign. Clinical judgement is important to predict if a mass is likely to be benign or malignant based on risk factors, imaging appearances, and tumor markers. If suspicion of malignancy is high, referral to a gynecologic oncologist is warranted as this may improve patient's survival.

In the postmenopausal women, adnexal masses can have numerous etiologies. They can range from benign to neoplastic, with origins from a variety of organ systems. The diagnostic work up includes a thorough history, physical exam, as well as potential imaging and laboratory testing. There should be a low threshold for consultations with oncologists when there are cancer concerns. Specifically for gynecologic neoplasms, a referral to a gynecologic oncologist should be strongly considered. In this paper, there is particular attention to ovarian cancer given the gravity of delayed diagnosis.

Pelvic masses can pose a diagnostic dilemma with a broad differential to include both gynecological and non-gynecologic etiologies. While the initial instinct may be to search for gynecologic causes for the female patient, non-gynecologic etiologies must be considered as well. The presentation can be similar amongst many different causes of pelvic masses and imaging is generally required for further assessment to determine if the mass is intra- or extraperitoneal. The etiology of adnexal masses covers several subspecialties: gynecology, urology, gastroenterology, neurology, and oncology. For this reason, it is important for all to be aware of the differential diagnosis for pelvic masses.

Adnexal masses are commonly found on imaging of patients presenting to the emergency department with pelvic pain. Depending on the clinical context, emergent surgical exploration may be warranted. In this review article, we discuss the most common causes of adnexal masses requiring emergent surgical treatment, to include ectopic pregnancy, ovarian torsion, ruptured hemorrhagic cyst, and tubo-ovarian abscess.

Diagnosis of adnexal masses in pregnancy has been increasing due to the routine use of obstetric ultrasound examinations. The clinical course varies widely based on the symptomatology, gestational age and ultrasound characteristics of the adnexal mass. Most adnexal masses identified in pregnancy are benign and resolve spontaneously. Complications, although relatively rare, can occur and include torsion, rupture and malignancy. This review will discuss the epidemiology, diagnosis, evaluation and management of adnexal masses during pregnancy.

Background: The phenomenon of natural and spontaneous cessation of menstruation in women is termed as menopause. The phase after menopause is called post menopause. Women encounter enormous changes in various physiological factors during and after menopause. Objective: Objectives of this article are to brief the various issues associated with health ailments in postmenopausal Indian women, to address the various factors unique to Indian women involved in the postmenopausal health issues, to discuss the differences in socioeconomic, nutritional and health status between Indian women from rural regions and those from urban regions and to discuss possible precautionary measures against the postmenopausal health issues. Prime methodology followed in composing the present review article is based on understanding the present scenario regarding the health status of postmenopausal Indian women by considering the various literature and statistics available on the topic. Results: The changes those occur in a woman's body following menopause are deteriorative, and lead to several health issues. Though some of the health issues including amenorrhea, night sweats, frequent mood swings, cramp pains etc. which a woman experiences during the onset of menopause gradually decrease as her postmenopausal days progress, yet some new detrimental gradual changes occur in her physiological system during the postmenopausal periods. Conclusion: Proper diet, improved lifestyle, self-care, slightest basic precautions and medical aids can help to minimise the ailments which worsen the life of a postmenopausal woman. Awareness and care for postmenopausal Indian women are extremely necessary for providing better life, improved health status and enhanced longevity to them (the mothers) leading to a healthy and developing society.

Background: Low-income racial/ethnic minority women are disproportionately represented in substance use and intimate partner violence (IPV) among those who are at risk for or live with HIV– collectively called the SAVA syndemic. Little is known about how IPV exposure and substance use impact HIV testing uptake among low-income racial/ethnic minority women. Aim: The objective of the current study is to conduct systematic literature review of SAVA syndemic on HIV testing among women. Design/Methods: A systematic literature review was conducted between February and September 2016 using databases of PubMed, Ovid/Medline, PsychINFO, Embase, and CINHAL/Nursing. Quantitative and qualitative peer-reviewed studies published in English that covered the topics of HIV testing, women, IPV, and substance use were reviewed. Study contents were summarized and reviewed to identify the gap in studying the impact of substance use and IPV on HIV testing in women. Results: Among women at risk for substance use and IPV (N = 6,259), HIV testing was perceived to be a priority especially if they were injecting drugs and engaging in risky sexual practice; however, barriers were also identified including stigma, privacy issue, convenience, and fear of receiving an HIV-positive result. Conclusions: Findings were informative in meeting the needs of HIV testing and counseling for women at risk for substance use and IPV while addressing the potential barriers to increase access to the service.

Background: Infertility has been considered as a serious public health problem. Nevertheless, it is still very difficult to assess the epidemiology of this individual and public health problem. On the other hand, promotion of access to infertility treatments must be treated as a priority to national and regional policies. Objective: The aim was to evaluate the perception of women concerning the barriers and access to infertility consultations. Methods: Socio cultural and economic access to infertility consultations is detached and three municipalities of the northwest of Portugal were chosen as an example of a peripheral country. A quantitative/qualitative study was done with 60 women. Results: Three dimensions were evaluated: geographic and structural and functional access, economic access and sociocultural access. The main barriers were mainly identified in the last two dimensions. The economic access was less well evaluated by women bearing the cost of treatment (medication, and concentration of costs in a short period) which is difficult to bear. Conclusion: This can justify a greater involvement of the Portuguese Government, by developing policies for the reimbursement of part of the costs. Also, some changes in structural and functional access must be done with special regard to the separation of the infertility consultations from the reproductive medicine section. The setting of the teams, with a follow-up by the same team of health professionals is also needed.