Current Women's Health Reviews - Volume 3, Issue 2, 2007

The environmental conditions experienced by the developing human during the peri-conceptual, embryonic, fetal, neonatal and adolescent periods, have a profound effect on the future health of that individual. Adverse early-life environmental conditions such as under or over nutrition, stress, vitamin deficiencies, drugs and alcohol exposure can permanently alter the long-term functioning of many organs. These changes significantly increase the risk of developing diseases in adult life such as cardiovascular disease, diabetes and metabolic syndrome, as well as mental health conditions such as attention deficit disorder, autism, and schizophrenia. The now widely studied, yet still mechanistically ill-defined “developmental origins of adult disease” hypothesis, was first proposed by Barker in 1986 [1]. Barker and his colleagues described an association between low birth weight and increased risk of developing ischaemic heart disease in later life. Since then, human epidemiological studies have continued to show a strong association between low birth weight and adult coronary heart disease and hypertension. This hypothesis has since been expanded to show that ‘programming’ can occur independently of low birth weight or growth retardation. Animal models are currently being used to investigate the mechanisms of the developmental origins of adult disease including maternal undernutrition, both global and nutrient specific such as low protein, uterine artery ligation to induce fetal growth restriction and maternal glucocorticoid exposure. Results vary significantly between these models depending on the type, severity and the timing of the insult. What has emerged from many of these studies is that there are key windows of development that are more susceptible to particular insults

The differential diagnosis of adnexal masses still constitutes a major clinical challenge. B-mode ultrasonography is the most used imaging technique and it is the base for this differential diagnosis with acceptable results in terms of sensitivity but a relatively high false positive rate for predicting ovarian cancer. The role of pulsed Doppler remains controversial and seems to be not reproducible in clinical practice. In the last years, new approaches and technologies such as 2D Power-Doppler ultrasound for tumor vessel mapping, contrast-enhanced ultrasound and 3D ultrasound have been proposed for improving our ability to discriminate between benign and malignant adnexal masses. In this review I aim to evaluate critically recent literature of these new technologies in order to show how they work, what they offer and what can be expected in a very next future.

Surgery for stress urinary incontinence has undergone a significant technical evolution in recent years. For many years the open colposuspension has been ‘gold standard’ which, more recently, is replaced by employment of suburethral tapes. There is now a huge range of retropubic, transobturator and minimal invasive tapes available, using a variety of different graft materials. While some of these have been well evaluated, many have become part of routine clinical practice with little or no data available. Careful consideration of the surgical options available is essential to ensure best surgical outcome for women undergoing incontinence surgery. This article reviews the characteristics, efficacy, morbidity and long term success rates of the various surgical treatments available.

Inflammatory bowel diseases (IBD) are disorders of unknown aetiology that give rise from non-serious pathologies to serious chronic diseases and may be associated to other pathologies of immunological origin. Among IBD, Crohn's disease and ulcerative colitis seem to reduce human fertility and some related reproductive processes. In this study we summarize the extensive literature dealing with i) the impact of these two peculiar IBD pathologies on human infertility, conception, pregnancy and delivery; ii) the risks associated with IBD therapies and miscarriages, pre-term delivery and congenital foetal malformations. The data reported show that the major risks in patients affected by IBD are associated with pre-term births and related complications. On the contrary, with some exceptions, the majority of studies do not support high toxicity risk associated with current medications and therapies.

Endometriosis, a disease affecting 3-10% of women of reproductive age, is characterized by the ectopic growth of endometrial tissue. Increasingly, endometriosis is also becoming recognized as a condition in which ectopic endometrial cells exhibit abnormal proliferative and apoptotic regulation in response to appropriate stimuli. Apoptosis plays a critical role in maintaining tissue homeostasis and represents a normal function to eliminate excess or dysfunctional cells. Accumulated evidence suggests that, in healthy women, endometrial cells expelled during menstruation do not survive in ectopic locations because of programmed cell death, while decreased apoptosis may lead to the ectopic survival and implantation of these cells, resulting in the development of endometriosis. Both the inability of endometrial cells to transmit a ‘death’ signal and the ability of endometrial cells to avoid cell death have been associated with increased expression of anti-apoptotic factors and decreased expression of pre-apoptotic factors. This paper is a review of the recent literature focused on the differential expression of apoptosis-associated molecules in the normal endometria of women without endometriosis, and in the eutopic and ectopic endometria of women with endometriosis. The role of apoptosis in the pathogenesis of endometriosis and the basic and clinical research on the treatment of endometriosis with apoptosis-inducing agents will be discussed.

Studies show the enormous influence of psychological stress on lactation. The incidence of pathologic milk stasis during the first week's post partum as well as the incidence of puerperal mastitis seems to be increased by stress. This review quotes possible pathophysiological mechanisms that show a relationship between stress and the genesis of milk stasis and puerperal mastitis. A systematic search on studies on human as well as studies on animal was performed: First of all there was a stress induced change of the release of the hypothalamic-pituitary hormones oxytocin and prolactin with local changes in the lactating glandular tissue. Besides this, an increase in catecholamine and corticoid secretion indicates systemic and local immunosuppressive effects with the defence against pathogenetic agents for mastitis.

There is no standard surgical treatment for patients with stage IB cervical cancer. The current primary operative approaches include class III radical hysterectomy (RH), class II RH, nerve-sparing RH, and individualization of surgical management such as Trachelectomy and Laparoscopic RH. The ideal surgical management of cervical cancer patients should be tailored on the basis of prognostic factors, age and quality of life. Within the discussion concerning the optimal level of radicality of hysterectomy, which is still controversial, the new concept of nerve-sparing RH has to be considered in order to reduce morbidity without compromising the oncological disease control, as well as laparoscopic approach to RH. The trend towards more conservative surgery is most relevant for younger women diagnosed with cervical cancer, for whom pregnancy may be an important issue. Radical Trachelectomy is a method of treating early invasive cervical cancers while retaining the body of the uterus. The radical trachelectomy can offer the chance of fertility preservation with good survival in well selected patients. The main issue is to define the inclusion criteria in a more extensive study. This paper reviews the evolution of concepts concerning the extent of radical hysterectomy for FIGO stage I cervical cancer.

The objective of this review was to make a critical appraisal of the current evidence about the safety of oral contraceptive use in patients with two autoimmune diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis. A Medline search for articles published until September 2006 regarding the relationship between oral contraceptives and these two diseases was performed. The incidence of both illnesses is far greater in women than in men and both appear most frequently during the reproductive stage of life. Pregnancy is not recommended when either of the diseases is active due to the fact that the outcome for both the fetus and the mother can be unfavorable. It has been suggested that conception should take place during a period of disease quiescence. Therefore, effective contraceptive methods are recommended in order to achieve pregnancy ideal conditions for both mother and fetus. Oral contraceptives, when taken under prescription, are among the most effective non-surgical method for contraception. Nevertheless retrospective and prospective studies have shown a deleterious effect on Systemic Lupus Erythematosus activity an increased risk of venous thrombosis associated with the use of exogenous estrogens. In the case of Rheumatoid Arthritis there is a lack of consensus in the literature regarding the association between oral contraceptives and the subsequent development of the disease or in the improvement of its symptoms. These discrepancies are due, at least in part, to significant methodological differences.