Obesity has in fact become so prevalent that the World Health Organization (WHO) has classified it as a global epidemic. The past two decades in particular have seen an explosion of the rates of obesity, especially in the United States. The economic, social and psychological burden of obesity on the individual and on society will continue to grow until the factors contributing to the increasing rates of obesity over the past two decades are identified and addressed. Though this article has focused on how an individual can approach obesity, society needs to develop a plan of action. Encouraging physical activity programs in schools and communities for children, developing cheap, healthful alternatives to fast food, providing better social and psychological support to those struggling with chaotic lifestyles, and redefining work load and the workplace so they are more compatible with maintaining healthy, balanced personal lives may be some strategies to consider.Read More

Polycystic ovary syndrome (PCOS) is a condition of unexplained chronic anovulation state. The purpose of this document is to enhance understanding of the best available evidence on the diagnosis and clinical management of polycystic ovary syndrome (PCOS). A question which has puzzled gynecologists and endocrinologists for many years is what causes polycystic ovaries. The characteristic polycystic ovary emerges when a state of anovulation persists for any length of time. Whether diagnosis is by ultrasound or by the traditional clinical and biochemical criteria, a cross-section of anovulatory women at any one point of time will reveal that approximately 75% will have polycystic ovaries. Variety of treatments of PCOS is also discussed in this chapter and the healthcare providers must appreciate the clinical impact of anovulation and should undertake appropriate managements.Read More

Approximately 20% of infertile women have ovulatory disorders. When anovulation is the only infertility factor, the prognosis for pregnancy is very good because modern ovulation induction strategies are highly effective. When anovulation can be attributed to a specific treatable cause, ovulation induction can achieve pregnancy rates comparable to those observed in the normal population. The purpose of this document is to understand various modalities of ovulation induction. Anovulation is among the most common causes of infertility, and clinicians caring for infertile couples must have a thorough understanding of the many treatment options, their indications, and their risks. With these goals in mind, this article reviews the principles that guide both the traditional therapies and more recently described treatment strategies.Read More

Over the past two decades, the use of assisted reproductive technology (ART) has increased dramatically worldwide and has made pregnancy possible for many infertile couples. ART encompasses all techniques involving direct manipulation of oocytes outside of the body. The purpose of this document is to provide an understanding, overview and indications for assisted reproductive technologies (ART). The results and complications of ART with an emphasis on newly developing technologies and areas of controversy are also discussed. Pregnancy rates after ART have shown nearly continuous improvement in the years since its conception. A number of factors affect the pregnancy rate, with the most important being a woman's age. Many studies are now finding that there is a slight increase in adverse pregnancy outcomes after ART. Although the vast majority of children born from these procedures are healthy, there is some concern about increased rates of prematurity, small for gestational age infants and a slight increase in the rates of birth defects following ART. Some of these complications can be linked to the problem of multiple gestations which are common following ART.Read More

Contraception is a women's health issue. It is about choices and human rights, not fear, guilt and shame. The negative images and concepts perceived regarding family planning and contraception in some religious and social arenas are the major factors for non-compliance and meager usage of birth control methods in many areas of the world. The purpose of this document is to help healthcare providers and women to identify their individual health care needs, and to make choices that will meet those needs. It also means that the patient has satisfied her personal preferences and arrived at the choice that best fits her life. A fundamental tenet in ethical, female-centered care is that women have a right to participate in their choice of contraceptive method. A woman who has actively chosen a method is more likely to use it consistently and correctly. Health benefits of hormonal contraception are also discussed. All contraception-methods offer health benefits in terms of reduced risk of unintended pregnancy, abortion, ectopic pregnancy, pregnancy complications, and pregnancy-related death. The help comes in focusing attention on the section of society with the most desperate needs.Read More

Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ Tis (DCIS) Ductal carcinoma in situ Tis (LCIS) Lobular carcinoma in situ Tis Paget’s disease Paget’s disease of the nipple with no tumor T1 Tumors 1 cm and not more than 2 cm in greatest dimension T2 Tumor > 2 cm and not more than 5 cm in greatest dimension T3 Tumor > 5 cm in greatest dimension T4 Tumor of any size with direct extension to (a) chest wall or (b) only as described below T4a Extension to chest wall, not including pectoralis muscle T4b Edema (including peau d’orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast T4c Both TT4a and TT4ba T4d Inflammatory carcinoma REGIONAL LYMPH NODES (N) Nx Regional lymph nodes cannot be assessed (e.g., previously removed) N0 No regional lymph node metastasis N1 Metastasis to movable axillary lymph node(s) N2 Metastasis in ipsilateral axillary lymph nodes fixed or matted, or clinically apparent ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastasis N2a Metastasis to ipsilateral axillary lymph nodes fixed to one another (matted) or to other structures N2b Metastasis only in clinically apparent ipsilateral internal mammary nodes and in the absence of clinically evident axillary lymph node metastasis N3 Metastasis in ipsilateral infraclavicular lymph node(s) or clinically apparent ipsilateral internal mammary node(s) and in the presence of clinically evident axillary lymph node metastasis; or metastasis in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement N3a Metastasis in ipsilateral infraclavicular lymph node(s) and axillary lymph node(s) N3b Metastasis in ipsilateral internal mammary node(s) and axillary lymph nodes(s) N3c Metastasis in ipsilateral supraclavicular lymph node(s) PATHOLOGICAL CLASSIFICATION (PN) pNx Regional lymph nodes cannot be assessed (e.g., previously removed or not removed for pathologic studies) pN0 No regional lymph node metastasis histologically, no additional examination for isolated tumor cells (ITC) Note: ITC are defined as single tumor cells or small cell clusters not greater than 0.2mm, usually detected with immunohistochemistry (IHC) or molecular methods but that may be verified with H&E stains. ITCs do not usually show evidence of metastatic activity (e.g., proliferation or stromal reaction). pN0(i-) No regional lymph node metastasis histologically, negative IHC pN0(i+) No regional lymph node metastasis histologically, positive IHC, no IHC cluster > 0.2 mm pN0(mol-) No regional lymph node metastasis histologically, negative molecular findings (RT-PCR) pN0(mol+) No regional lymph node metastasis histologically, positive molecular findings (RT-PCR) pN1mil Micrometastasis (>0.2 mm, none > 2 mm) pN1 Metastasis in 1-3 axillary lymph nodes and/or internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent pN1a Metastasis in 1-3 axillary lymph nodes pN1b Metastasis in internal mammary lymph nodes with microscopic disease detected with sentinel lymph node dissection but not clinically apparent pN1c Metastasis in 1-3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected with sentinel lymph node dissection but not clinically apparent (if associated with >3 positive axillary lymph nodes, the internal mammary nodes are classified as pN3b to reflect increased tumor burden) pN2 Metastasis pN2a Metastasis in 4-9 axillary lymph nodes in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis pN2b Metastasis in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis pN3 Metastasis to > 10 axillary lymph nodes, in infraclavicular lymph nodes, or in clinically apparent ipsilateral internal mammary lymph nodes in the presence of > 1 positive axillary lymph nodes; or in > 3 axillary lymph nodes with clinically negative microscopic metastasis in internal mammary lymph nodes; or in ipsilateral supraclavicular lymph nodes pN3a Metastasis in > 10 axillary lymph odes (at least 1 tumor deposit > 2.0 mm) or metastasis to the infraclavicular lymph nodes pN3b Metastasis in clinically apparent ipsilateral internal mammary lymph nodes in the presence of > 1 positive axillary lymph nodes; or in > 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected with sentinel lymph node dissection but not clinically apparent pN3c Metastasis in ipsilateral supraclavicular lymph nodes DISTANT METASTASIS (M) Mx Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasisRead More