Toxic shock syndrome (TSS) was first described in children in 1978 but was quickly identified as an illness occurring primarily in menstruating women 12-24 years of age. During the 1979-1981 epidemic, tampon users were demonstrated to be 18 times more likely to develop menstrual TSS than non-users. Recent focus has shifted in conjunction with wound infections, postpartum endometritis and vaginitis; the predominance of cases continues to be related to menstruation. The purpose of this document is to understand the pathogenesis of toxic shock syndrome (TSS), clinical picture, early diagnosis and the latest advances in treatment. Of the approximately 30 million menstruating women in USA, it is estimated that 70% use tampons and over 50% of those use super-absorbent types. Almost 1,000,000 women are at theoretic risk. The incidence in menstruating women is now 6-7: 100,000 annually. The incidence on non-menstrual disease has shown only a slight increase in the past 10 years.Read More

Endometriosis is the presence of tissue that resembles normal endometrium at site outside of the uterus. The anatomical areas most commonly affected by endometriosis are the ovaries, the pelvic peritoneum, the uterosacral ligaments, the fallopian tubes, the appendix and the bowel serosa. Endometriomas, or "chocolate cysts" are cysts of endometriosis within the ovary. The "gold standard" for diagnosing endometriosis is laparoscopy, with visual recognition of endometriosis lesions. The severity of endometriosis is defined by the American Society for Reproductive Medicine using a surgical staging system based on the size and location of endometriosis implants and the severity of pelvic scarring. The stages are: Stage I-minimal, Stage II-mild, Stage III-moderate and Stage IV-severe.Read More

Uterine leiomyomata are among the most frequent entities encountered in the practice of gynecology. It occurs in 20-40% of women during their reproductive years. Approximately 600,000 hysterectomies are performed per year in the United States for uterine myomas. Many surgical procedures other than hysterectomy are also commonly performed to deal with myomas. The purpose of this document is to review the literature and medical and surgical advances in the management of uterine myomas. Authors hope this helps healthcare providers the decision-making process as logical as possible.Read More

As the life expectancy has increased markedly, more and more women are living longer after menopause. In western society, women can anticipate living for approximately 80 years, spending more than one third of their lives in the postmenopausal period. Menopause refers to the complete or permanent cessation of menstruation; an interval of 6 to 12 months of amenorrhea is usually necessary to establish the diagnosis of menopause. The biologic event of menopause marks a meaningful life passage for every woman. It is a transition made from the reproductive stage of life to the non-reproductive stage. This transition is the period of declining ovarian function, which usually becomes apparent clinically over the 2 to 5 years around menopause. The population of postmenopausal women continues to rise; currently approximately 470 million women in the world are of age 50 and older- a figure that is projected to increase to 1.2 billion by 2030. It is estimated that 25 million women each year pass into menopause. Several studies have shown that both the number of cigarettes smoked and the duration of smoking affects the onset of menopause and it induces earlier menopause.Read More

Sexual dysfunction is common in postmenopausal women and the rate can be well over 80%. Pain during intercourse, decreased arousal and response, decreased frequency of sex, and loss of sexual desire are the most frequently identified problems in this population. The primary care physicians and obstetricians and gynecologists are frequently the first-line in the management of these difficulties. The purpose of this document is to enhance the understanding of sexual dysfunction in postmenopausal women and the development of a strategy for treatment or referral. Sexual problems in postmenopausal women are often amenable to fairly simple interventions that are (or can and should be) within the competence of primary care professionals. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient's individual need.Read More

Menopause is a journey, which lasts from 3 to 10 years on average, and each woman will experience it in her own unique way. Some women appear to pass through this time with very few physiological or emotional complaints, while others will experience mild hot flashes and some emotional ups and downs.  This change brings about a myriad of important health risks, many of which can be eliminated or reduced with hormone replacement therapy (HRT). Despite the benefits of HRT some women are not candidates for this treatment and many others choose not to take it. For our purposes today, the context is unconventional therapies that fall under the umbrella of what is being called "Alternative and Complementary Medicine". It comprises a very wide range of therapies, including botanical and behavioral, and other practices such as acupuncture and biofeedback. "Alternative" implies "instead of" conventional treatment, whereas "complementary" refers to something used in addition to conventional treatment. Acupuncture is licensed in about 30 states but not in others, and covered by some insurance companies. Biofeedback falls within conventional therapy for migraine but is still considered unconventional therapy for cancer. The term "integrative medicine" helps to get away from the thinking of "us versus them". The idea is to draw on the best of what exists from around the world. To achieve better medical treatment, we may "integrate" current mainstream medical practices with other approaches. The main thing is to be open to what works best for the patients.Read More

The new millennium has brought optimism to the field of family planning. Recent research and modification to existing contraceptive products have generated confidence, among both healthcare professionals and the public, in the safety, efficacy, and importance of contraceptives. According to World Health Organization’s (WHO's) statistics there are an estimated 200 million pregnancies around the world each year, and one third of these, or 75 million, are unwanted. These pregnancies contribute to women's health problems in two ways. First, unwanted pregnancy can threaten women's health or well being because she may have existing health problems or lack of support and resources, which she needs to have a healthy pregnancy and raise a healthy child.Read More

Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the uterine endometrium that is unrelated to an anatomic lesion of the uterus. The purpose of this document is to provide management guidelines for the treatment of patients with menstrual irregularities associated with anovulation based on the best available evidence. Dysfunctional uterine bleeding anovulatory type is the most common form of non-cyclic uterine bleeding and it is a condition for which women frequently seek gynecologic care and accounts for considerable patient anxiety and inconvenience. The choice of treatment for anovulatory bleeding depends on several factors, including the woman's age, the severity of her bleeding, and her desire for fertility. Over the last decade, significant advances have been made in the evaluation and management of women with anovulatory bleeding.Read More

Premenstrual physical and mood symptoms are common among reproductive-age women, but diagnostic criteria and treatment strategies to recognize premenstrual disorders are not always clearly understood. The purpose of this document to examine the evidence for commonly used approaches in the treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Until recently, the difficulty in managing PMS / PMDD was largely attributed to imprecise diagnostic criteria, poorly designed clinical trials, and promotion of treatment options for which there was no scientific support. In the mid-1980s, however, rigorous criteria for the diagnosis of PMS / PMDD were defined. Since then, most studies of pathophysiology and treatment have met recognized standards of scientific design. Selective serotonin reuptake inhibitors (SSRIs) are found to be effective in treating PMS / PMDD symptoms and many other treatment options are discussed.Read More

Vulvovaginal disorders are increasingly recognized as a source of significant pain and discomfort and lead to a substantial decrease in quality of life for many women. The purpose of this document is to discuss signs, symptoms and management of vulvodynia. Provoked vestibulodynia, formerly referred to as vulvar vestibulitis syndrome, is suspected to be the most frequent type of vulvodynia in premenopausal women. In addition to disrupting sexual functioning, there is preliminary evidence to suggest that this pain problem can adversely affect general psychological well-being and overall quality of life. Despite its high prevalence and associated negative sequelae, there is a dearth of controlled treatment outcome studies focusing on vulvodynia. Although there are now several published studies evaluating different treatment approaches for vestibulodynia, there are only a handful of randomized trials, resulting in a hodgepodge of interventions for which there is little empirical support. Thus, current guidelines and recommendations are largely based on clinical observations and uncontrolled data rather than being anchored in findings from rigorous studies.Read More