Journal of women's health
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Androgens are believed to have an important biologic role in women, particularly in regulation of libido and sexual arousal, although much about their function on other systems in women is unknown. Testosterone, the primary ovarian androgen, has been used to treat carefully selected postmenopausal women with hypoactive sexual desire disorder (HSDD). However, testosterone use in women has not been approved by the United States Food and Drug Administration (FDA) because of uncertainties regarding the effectiveness and long-term safety of this strategy. ⋯ Although this strategy appears to be safe in the short term and no major safety concerns have emerged thus far, long-term effects on cardiovascular risk and breast cancer incidence are not known. A trial of low-dose testosterone therapy may be considered for carefully selected postmenopausal women with HSDD, as long as other contributors to sexual dysfunction have been adequately addressed. However, patients need careful counseling regarding the lack of long-term safety data, and close clinical and laboratory monitoring of these women is recommended to avoid supraphysiologic dosing.
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Journal of women's health · Jan 2020
Mammography Screening Practices in Average-Risk Women Aged 40-49 Years in Primary Care: A Comparison of Physician and Nonphysician Providers in Minnesota.
Background: Breast cancer screening practices and the influence of clinical guidelines or recommendations are well documented for physicians, but little is known about the screening practices of nonphysician providers (physician assistants and advanced practice registered nurses). The seven breast cancer screening guidelines or recommendations on the use of mammography have the most variation for screening average-risk women 40-49 years of age. Therefore, to better understand the practices of nonphysicians, this study will compare the practices of physicians with nonphysician providers for women 40-49 years of age. ⋯ The American Cancer Society guideline was endorsed as influential by the most respondents. Conclusions: Breast cancer screening practices vary between physicians and nonphysician providers for women 40-49 years of age at average risk. Targeted interventions may help reduce practice variation and ensure high-value care.
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Journal of women's health · Jan 2020
Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study.
Background: Lack of quality preventive care has been associated with poorer outcomes for pregnant women with low incomes. Health policy changes implemented with the Affordable Care Act (ACA) were designed to improve access to care. However, insurance coverage remains lower among women in Medicaid nonexpansion states. ⋯ Adjusted logistic regression and zero-inflated negative binomial models examined associations between insurance status at delivery (commercial, Medicaid, or uninsured) and health care utilization (well-woman visits, late prenatal care, adequacy of prenatal care, postpartum follow-up, and emergency department [ED] visits) and outcomes (preterm birth, low birth weight, preeclampsia, and gestational diabetes). Results: Having Medicaid at delivery was associated with lower rates of well-woman visits (rate ratio [RR] 0.25, 95% CI 0.23-0.28), higher rates of ED visits (RR 2.93, 95% CI 2.64-3.25), and higher odds of late prenatal care (odds ratio [OR] 1.18, 95% CI 1.03-1.34) compared to having commercial insurance, with similar results for uninsured women. Differences in adverse pregnancy outcomes were not statistically significant after adjusting for patient characteristics. Conclusions: Findings suggest that large gaps exist in use of preventive care between Medicaid/uninsured and commercially insured women. Policymakers should consider ways to improve potential and realized access to care.
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Journal of women's health · Jan 2020
Assessment of Circulating Anti-Müllerian Hormone in Women Using Hormonal Contraception: A Systematic Review.
Background: The status of ovarian reserve markers during hormonal contraception (HC) remains uncertain with conflicting literature data. The purpose of this study was to assess the impact of HC on circulating anti-Müllerian hormone (AMH) and other ovarian reserve markers. Materials and Methods: A systematic review was conducted, including all cohort, cross-sectional, and randomized controlled studies assessing serum anti Müllerian hormone concentration in women using HC. Data sources included MEDLINE, EMBASE, DynaMed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov, and the Cochrane Library from January 2000 to October 2018. Results: A total of 366 studies were identified, of which 15 were eligible, including 3280 women, mostly using combined HC (CHC). ⋯ Short- and medium-term studies (n = 284) reported no change in circulating AMH in women using cyclical CHC for one to six cycles. Apart from one study, all long- and varied-term studies (six studies, n = 1601) consistently showed a marked decline in AMH, antral follicle count, and ovarian volume. Three long-term studies (n = 1324) provided evidence of AMH recovery after discontinuation of HC. Conclusion: Circulating AMH seems to remain unchanged in women using cyclical CHC for up to 6 months, but appears to markedly decline in long-term users with recovery after discontinuation.
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Journal of women's health · Jan 2020
A Longitudinal Investigation of Military Sexual Trauma and Perinatal Depression.
Introduction: Military sexual trauma (MST), which includes sexual harassment or assault while in the military, is prevalent among women Veterans and associated with depression and suicide. Little is known about women Veterans' perinatal mental health, including the potential role of MST. This is the first study to investigate the impact of MST on risk of depression and suicidal ideation (SI) during and after pregnancy. Methods: Bivariate statistical tests between MST harassment and assault, measured by the two standard Veterans Health Administration screening questions, and pre- and postnatal depression and SI, measured by the Edinburgh Postnatal Depression Scale, were examined using longitudinal data from the ongoing Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study. ⋯ Hayes mediation models were employed to examine whether prenatal depression mediated the association between MST and postnatal depression. Results: MST was associated with higher pre- and postnatal symptoms of depression and SI. Further, prenatal depression mediated the association between MST and postnatal depression (indirect effect [standard error] of harassment on postnatal depression through prenatal depression: 1.11 [0.26], p < 0.001; indirect effect [standard error] of assault on postnatal depression through prenatal depression: 1.50 [0.35] p < 0.001), even after controlling for demographic variables and prenatal stress. Conclusions: Women Veterans who have experienced MST may be at higher risk of perinatal depression and SI. Findings highlight the importance of access to mental health care and trauma-informed obstetrical care for these Veterans.