Latest Updates

Permanent Contraception

Siripanth Nippita, MD, MS
    • All methods for permanent contraception are safe and effective.
    • Some surgeons offer salpingectomy as an option for permanent contraception.
    • Hysteroscopic tubal occlusion using micro-inserts is not available in the United States as of December 31, 2018.

Fecal Incontinence: Nonsurgical Management

Madeleine Blank, MD, Lilian Chen, MD
    • Fecal incontinence is a prevalent and often undiagnosed entity.
    • Fecal incontinence is associated with significant stigmata and decreased quality of life.
    • It is a multifactorial disease, and initial evaluation should be initiated with a thorough history and physical examination.
    • Initial management starts with medical management and pelvic floor physical therapy.

Nonsurgical Management of Overactive Bladder

Sharon Jakus-Waldman, MD, MPH
    • β3 adrenergic agonists
    • Dementia associated with anticholinergic use
    • Benefit of combining medication with behavioral or pelvic floor muscle therapy

Gestational Trophoblastic Disease

Elizabeth T Kalife, MD, Dario R Roque, MD, Anze Urh, MD
    • Gestational trophoblastic neoplasia (GTN) is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation.
    • Once a diagnosis of GTN has been made, the WHO prognostic score and FIGO 2000 staging are the best tools for establishing prognosis and treatment.
    • Treatment for low-risk GTN confined to the uterus may include a second suction curettage as 40% of patients treated with second curettage instead of single-agent chemotherapy had a β-hCG normalization within 6 months and avoided chemotherapy.
    • Patients with high-risk metastatic GTN should be treated by individuals who have experience in treating this relatively rare disease.

The Menopause Transition: Physiology, Definition, Symptoms, Diagnosis, and Evaluation

Jessica L Bauer, MD, MS, Nanette F Santoro, MD
    • Abnormal meiotic spindles as well as microtubule and mitochondrial dysfunctions are more common in aging oocytes and contribute to declining oocyte quality with age.
    • The Stages of Reproductive Aging Workshop developed a reliable and useful staging system that addresses the medical and social consequences of reproductive aging.
    • The Study of Women’s Health Across the Nation cohort has been examined multiple times to demonstrate the racial/ethnic, socioeconomic, and age-related disparities in symptomatology of the menopause transition.

Health of Immigrant and Refugee Women

Aniyizhai Annamalai, MD
    • It is increasingly recognized that health of migrants is significantly impacted by many factors before, during, and after migration.
    • Migrants are increasingly presenting with chronic health conditions similar to people in high-income countries.
    • There is a higher prevalence of posttraumatic stress disorder in forced migrants, which affects psychosocial health during resettlement.
    • Specific cultural practices (eg, female genital cutting) may still be seen in migrant women, and require appropriate follow-up and care.

Musculoskeletal Problems In The ­Female Athlete

Irfan M Asif, MD, Kimberly Harmon, MD, Mallory Shasteen, MD
    • Operative treatment is not as successful for atraumatic shoulder instability as it is for traumatic instability. Treatment should start with a supervised exercise regimen.
    • Prevention programs, including neuromuscular and proprioceptive interventions, reduce ACL injuries by 50.7%.
    • There is a lack of evidence to show that knee orthoses reduce knee pain or improve function in individuals undergoing exercise programs for patellofemoral pain.

Stress Fractures And The Reproductive System In The Female Athlete

Irfan M Asif, MD, Kimberly Harmon, MD, Mallory Shasteen, MD
    • Due to the radiation exposure involved with oblique radiography and CT, the recommended imaging modalities when spondylolysis is suspected include initial two-view radiography followed by MRI.
    • Surgery for spondylolysis is recommended only when bilateral spondylolysis is present and has progressed to significant spondylolisthesis.
    • Female athletes should have 1,500 mg/day of calcium and maintenance of vitamin D levels at 32 to 50 ng/mL, which may generally occur with 800 IU of vitamin D/day.
    • Female athletes should have baseline dual-energy x-ray absorptiometry if they have one or more “high-risk” triad risk factors or two or more “moderate-risk” triad risk factors. 
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