Physiology In Women Research Articles

Testosterone Replacement Therapy in Naturally and Surgically Menopausal Women (CME)

ABSTRACT Introduction Testosterone replacement therapy in naturally and surgically menopausal women is a complex and currently highly debated topic. Opposing guidelines for the use of testosterone exist, which create a therapeutic dilemma for clinicians confronted by severely distressed women who experience a decrease in sexual desire after surgical or natural menopause. Aim In this review, we will address the current knowledge on androgen physiology, conditions associated with a low androgen state, and risks and benefits of androgen therapy. Methods An English-language Medline review was performed. Main Outcome Measure Review of available literature. Results A review of normal androgen physiology in women is summarized and a brief review of prior use of androgens over the last six decades is included. The data on the use of androgen replacement in pre- and postmenopausal women is evaluated, especially its relationship to sexual functioning. Special concerns about the effect of androgens on cardiovascular disease, breast, and endometrial tissue are discussed. The balance of evidence seems to show that androgens have more of a positive effect than a negative effect in women if used properly. Conclusions Testosterone replacement therapy for surgically and naturally menopausal women with low sexual desire can be accomplished physiologically and effectively after ruling out other medical conditions leading to low sexual desire and after proper information of the patient that testosterone therapy is not an FDA-approved medication in the United States. The majority of available data suggests that testosterone replacement in women can be used safely without increased risk of endometrial or breast cancer.

Inclusion and exclusion in women's access to health and medicine

Women's access to health and medicine in developed countries has been characterized by a range of inconsistent inclusions and exclusions. Health policy has been asymmetrically interested in women's reproductive capacities and has sought to regulate, control, and manage aspects of women's reproductive decision making in a manner unwitnessed in relation to men's reproductive health and reproductive decision making. In other areas, research that addresses health concerns that affect both men and women sometimes is designed so as not to yield data relating to the ways in which women's physiology and gendered location may affect their experience of the condition and its response to treatment, despite a literature on the significance of sex and gender differences in health research. This paper draws on the situation in Australia to explore the ethical significance of these inconsistencies as failing the ideals of high-quality medical research and evidenced-based health care.

Clothing Invention

Historians have increasingly used patents to better understand historical antecedents for modern functional attire. This study examined 1,126 patents from the U.S. Patent and Trademark Office “Nether Garments/Skirts” class to investigate skirt function from 1846 to 1920. Thematic content analysis was used to determine a primary purpose for each patent; purposes were then grouped into (a) fashion (primarily shaping devices), (b) wearability, (c) use, and (d) manufacturing. Wearability-related purposes outnumbered those devoted to fashion almost twofold, which emphasizes difficulties women encountered in wearing fashionable skirts. Two major thrusts were determined: (a) between 1846 and 1890, inventors attempted to overcome dysfunctional aspects of wearing fashionable skirt silhouettes, and (b) after 1890 attention turned to skirts designed for sports and professional activities and to meet the special requirements of women's unique physiology (maternity and sanitary protection). Shaping devices followed the generally accepted timeline for fashionable silhouettes, indicating market demand as a patent incentive.

The Health of Women is on the Nation's Agenda

Under the direction of guest editor Diane Seibert, PhD, women's health NP, we are happy to bring you our first special women's health emphasis issue. Through these articles, we are pleased to monitor the progress being made to detect and improve problems of particular concern to women. Only a few decades ago women were excluded from NIH and drug company clinical trials of pharmacological products or treatments. Results from studies of men were generalized to women without recognition of the disparate ways that women's hormones, genetics, circadian rhythm, and physiology impacted disease and pathogenesis. The greater inclusion of women in research clinical trials has contributed significant information that affects how women are diagnosed and treated today and attempts to pinpoint continuing biases and inequities. Research also documents that substantial health disparities continue to exist for some women, particularly women of color, as they suffer a disproportionate burden of some diseases. Ethnic and racial minorities are projected to make up almost half the US population by 2050, so this diversity will mean a continuing challenge to an already overwhelmed health care system. These minority women face unique obstacles in obtaining appropriate health care as a result of linguistic and logistical barriers, as well as cultural differences, race, and gender-based stereotypes. These disparities are not just related to access. Women of different racial and ethnic groups vary in their health risk factors, screening, incidence, and mortality rates for certain diseases and conditions, as well as issues related to pregnancy and compounded by socioeconomic characteristics. These issues will have to be addressed if health disparities are to be eliminated. The Centers for Disease Control and Prevention and the related Office of Health Disparities have documented that Hispanic and African American women have a growing incidence of HIV/AIDS infection from heterosexual partners and from contaminated needles. Tuberculosis is also a growing problem among these women and among Native Americans and Alaskan Natives. HPV and some sexually transmitted diseases (STDs) are also particularly prevalent among Native American and Alaskan Native women. The poverty of minority women is highly correlated with obesity, diabetes, and heart disease. Women of poverty often lack prenatal care and have the highest rate of low birth weight babies. Despite these disparities, progress is being made. Eliminating health disparities is one of the Healthy People 2010 goals. Multiple programs through the Office of Health Disparities focus on prevention, diagnosis, and treatment of diseases that are particularly high in women. The government is taking the pulse of the health of women and paying attention. So should we as nurse practitioners. We recognize that nurse practitioners champion the health of all patients. We applaud NPs everywhere who continue to advocate for their female patients and to ensure that they obtain the health care services they require. We ask you to join your efforts with ours as we continue our focus this year on reducing health disparities.

The Irregular Aesthetic of The Blazing-World

While Robert Boyle and Thomas Hobbes fretted about the irregularity of nature, Margaret Cavendish celebrated it, leading many scholars to claim that she distanced herself from her male contemporaries by denying the existence of natural hierarchies. This article suggests, however, that her interest in irregularity aligns her with Lucy Hay and other noblewomen who argued that women's physiology made them natural rulers. Like Hay, the empress of The Blazing-World empowers herself by exploiting male anxieties about women's irregular bodies. Cavendish, moreover, asserts her own authority through a prose aesthetic intended to inspire a discomfited awe at her ungoverned fancy.

Seeking Women's Participation in Ethnoecological Fieldwork

Introduction As studies increasingly show differences in human experiences according to sex and gender, researchers are recognizing the importance of equitable gender representation of research participants. In studies of traditional ecological knowledge, while it is accepted that differences exist between men's and women's physiology that may affect their ability to metabolize a medicine (Sica et al. 2005), concepts like community and local often mask the gendered nature of cultural knowledge. This is not to say that men and women cannot possess the same knowledge; however, there are often cultural factors that can lead to gendered knowledge spheres' especially in cultures where gender roles are clearly defined and interaction between genders is limited. While most researchers who seek to understand and document local knowledge aim to include both male and female participants, in societies with unequal and segregated gender dynamics this may be easier said than done. Women are often less educated, more reserved, and under cultural restraints that do not allow them to work alongside male researchers or participants. Here I discuss some of the challenges I faced, how I overcame them, and what benefits I received by trying to include women in my field research. My hope is that readers can use this case to think of how it applies to their own research and how they can increase participation of persons from all genders or underrepresented groups. As ethnoecological research often seeks to assess the positive and negative impacts of human activities on socio-ecological systems, to disregard genderdifferentiated activities could grossly underestimate socio-ecological effects,2 and/or introduce a strong bias to the data. Some researchers choose to limit the scope of their question to only one gender, but in ecological research, many effects are synergistic and limiting the scope of the question may actually limit the explanatory power of the results. Here I discuss the methods employed to engage women during my field research on how local knowledge can inform conservation in Niger's Park-W biosphere reserve. Although the challenges discussed are not unique to that location, I draw on examples from my fieldwork in southwest Niger, so I will first briefly explain key elements of the culture and history of this region. Niger has a long history of gender segregation that at first glance seems to relegate women to a position lacking power and means. The national statistics often quoted to summarize the status of women are dreary: literate women make up only seven percent of the national population. Seventeen, the average age at which women get married, is one of the lowest in the region, and the average number of children (7.9) and maternal mortality rates (1/7) are among the highest (United Nations 2006:156-168). Unreported are some advantages for women such as their right to divorce and their right to separate incomes. In parliament, there are only a token number of women in positions that are culturally suited to and created for them. Yet at the same time, there are several powerful female leaders in both the traditional government and religious arenas. In fact, Niger has a duel governance policy in which there are traditional counterparts to any government officials at the state, regional and local level and policy making is split between these two arenas. The traditional governments have distinct male and female spheres of influence and power that operate simultaneously. While these are important facts for practitioners, development agents, and aid workers, these also have implications for participatory researchers. The research project that provides the context for the analysis is situated in the tri-national biosphere reserve, Park W.3 I work with a team of conservation agents, students and villagers to assess the conservation status of the region and ascertain the positive and negative impact of different human activities on the plant communities in and out of Park W. …

Breast Reconstruction after Mastectomy in Young Women

Young women with breast cancer differ from older women in a number of ways that may affect their experience with breast reconstruction after mastectomy. Parenting, work, or recreational activities may influence a young woman's decisions about whether or not to have reconstruction, timing of reconstruction, and type of reconstruction. Young women with breast cancer are known to experience greater psychological morbidity and poorer quality of life than older women. A young woman's breast anatomy and physiology and overall medical condition generally allow more reconstructive options. Young women can often tolerate autologous reconstruction well, and more young women are expressing interest in perforator-based free tissue transfer to reduce donor site morbidity. Although the reconstructive issues are different for younger women, outcomes of breast reconstruction appear to be the same for women of all ages.

Gender-specific care of the patient with diabetes: Review and recommendations

Men and women differ in their experience of diabetes mellitus (DM). For optimal prevention and treatment of the disease, these differences must be acknowledged. Unfortunately, most studies of diabetes have focused almost exclusively on men. The purpose of this review was to survey the literature about the sex-specific features of DM and to make recommendations for the gender-specific care of patients. An initial literature search was performed with Google Scholar and MEDLINE (1995-2005) using the search terms sex/gender, women, diabetes mellitus, and coronary artery disease, and specific topic headings such as polycystic ovary syndrome. The bibliographies of articles were used extensively to augment the search, and more specific search terms were included. The strength of each recommendation was assessed. : Even when women were included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the reported results. Existing studies, however, reveal several differences between men and women with diabetes. The prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of triglycerides), and these risk factors for CAD have a stronger influence in women. Oxidative stress may confer a greater increase in the risk of CAD for women with diabetes than for men with diabetes. Many other sex differences in DM are due to women's reproductive physiology. Polycystic ovary syndrome is an important correlate of insulin resistance and the metabolic syndrome. Gestational diabetes mellitus (GDM) increases the risk of cardiovascular disease and type 2 DM. Women are less likely than men to receive aggressive treatment for CAD and to achieve treatment goals. Critical recommendations for women include exercise, testing for CAD, daily aspirin to counteract the prothrombotic state, depression screening, careful treatment to avoid weight gain, long-term follow-up of children of women with GDM, control of risk factors for CAD, and aggressive treatment with coronary angioplasty for CAD. Disease management programs for patients with diabetes have been shown to save money and improve outcomes, and should continue to incorporate information about sex-specific differences in DM as it becomes available. Gender-specific care of the patient with diabetes should be informed by evidence-based recommendations.

Pelvic floor physiology in women with faecal incontinence and urinary symptoms.

Anorectal manometry, balloon proctometrography, measurement of anorectal angles and videourodynamics were used to investigate 45 asymptomatic women and 13 with faecal incontinence and urinary symptoms, nine of whom also had stress urinary incontinence. The anorectal angle was measured and videourodynamics performed on 17 constipated women with urinary symptoms. Mean (s.e.m.) values obtained with anorectal manometry were lower in women with faecal incontinence and urinary symptoms than in controls (maximum resting pressure 42.5(8.1) versus 82.5(9.3) cmH2O, P = 0.001; maximum attained pressure 80.5(13.7) versus 216.2(11.2) cmH2O, P = 0.001; maximum squeeze increment 35.3(7.5) versus 141.6(10.0) cmH2O, P = 0.001), indicating a weakened puborectalis and external anal sphincter. Mean(s.e.m.) anorectal angles at rest, squeeze and strain were all significantly greater in the doubly incontinent women than in those with constipation (114(3.8) versus 93(5.9) degrees, P = 0.01; 103(2.5) versus 78(3.5) degrees, P < 0.001; 120(2.9) versus 104(4.2) degrees, P = 0.01). Urinary incontinence was worse in the doubly incontinent than in the constipated women (eight of nine versus one of eight with grade 2a or higher, P = 0.002). These results suggest that doubly incontinent women have a significantly weakened pelvic floor and that this should be taken into account before any planned surgery for urinary incontinence.

Mars and Venus

Much of current medical practice uses research on men to guide treatment for women. But many illnesses don't hit both sexes equally hard. For example, at any particular age, the incidence of heart disease for men exceeds that for women. Moreover, heart attack symptoms aren't the same for both sexes. Researchers are uncovering unique aspects of women's physiology that might underlie their particular disease profiles and potentially lead to sex-tailored therapies.

Modulatory Effect of the Ovary on LH Secretion

Ovarian steroids are important regulators of gonadotropin secretion during the normal menstrual cycle. Estradiol is the predominant factor in the follicular phase, while progesterone plays an important role in the luteal phase. Gonadotropin surge attenuating factor (GnSAF) is a nonsteroidal ovarian substance that attenuates the endogenous LH surge in superovulated women. Attempts to purify GnSAF from various sources have provided several sequences. In human follicular fluid, GnSAF is shown to be the carboxyl terminal fragment of human serum albumin (HSA) and a molecular mass of 12.5 kDa. Preliminary data have shown the expression of the carboxyl terminal fragment of HSA in human granulosa cells. In vivo studies have provided evidence that GnSAF may participate in the control of LH response to GnRH in the context of a mechanism that facilitates the full expression of the midcycle LH surge. Further research is expected to clarify the role of GnSAF in women's physiology.

Lupus Pregnancy

Pregnancy markedly alters a normal woman's physiology and immune response mechanisms. The effect of pregnancy changes on the course of systemic lupus erythematosus (SLE) remains, however, speculative. Pregnant lupus patients are susceptible to pre-eclampsia, especially if they suffer lupus nephritis, and to steroid-induced hypertension and hyperglycemia. Fetuses are susceptible to placental insufficiency if antiphospholipid antibody or other procoagulant states are present, and to neonatal lupus if anti-Ro/La antibodies are present. Artificial reproductive technologies (" in vitro fertilization") can be safely used in SLE patients. Study of the physiology of pregnancy, for instance complement kinetics, may inform our understanding of SLE, and vice versa.

Shameless: The visionary life of Mary Gove Nichols

Shameless: The Visionary Life of Mary Gove Nichols. By Jean L. Silver-- Isenstadt. (Baltimore: Johns Hopkins University Press, 2002. Pp. xii, 342. Illustrations. Cloth, $24.95.) Shameless is the first book-length biography to chronicle the amazing life of Mary Gove Nichols, health and sex reformer who was in the public eye, on the public stage, and in the public prints for two decades, starting in 1838. This forceful advocate for women's freedom has long deserved far more prominent place in our histories of antebellum reform and women's rights, and Jean Silver-Isenstadt restores her to that prominence in an artfully written book that is pleasure to read. This is the biography that Mary Gove Nichols and her husband Dr. Thomas L. Nichols expected, anticipated, indeed probably ached to have. They had formidably sure sense of their own fame, and why it eluded them for so long is an interesting question. The two show up in cameo roles in number of excellent books on nineteenth-century social movements. But no one, until now, has advanced our biographical knowledge of Mary Gove Nichols beyond the basic outlines. Silver-Isenstadt, who holds an M.D. as well as Ph.D., brings to the project firm foundation in medicine, which is helpful for understanding woman who from her adolescent years studied medical books with obsessive intensity. With sure hand, Silver-Isenstadt appraises the health scene of the 1840s and makes sense of this determined woman's professional rise as medical specialist. When Mary Gove made her 1838 lecturing debut in towns across the Northeast on the subject of women's anatomy and physiology, only handful of women were public lecturers. Her immodest topics-tight lacing, reproduction, and marital sex-drew ridicule from the press and disownment from her Quaker meeting. In 1840 she edited health journal based on the teachings of the diet and sex reformer Sylvester Graham; in many ways, Gove appears to have been female Graham, espousing his anti-sex and anti-meat regimens. Her first pamphlet publication, in 1839, addressed the solitary vice (i.e., masturbation) in females. By 1845 she was committed to the water cure and secured her first posts as paid medical practitioner, seeing women patients, teaching classes, and writing for the Water-Cure Journal. In 1847, Mary Gove- disaffected and separated wife of the churlish Hiram Gove-met Thomas Low Nichols. Mary Gove, Nichols was journalist and editor with strong medical interests. During an early stint at Dartmouth Medical School, he heard Sylvester Graham lecture and adopted his dietary program. Like trains on parallel tracks, Thomas and Mary would spend the next fourteen years [1834-48] living two versions of the same experience (111). And when their trains hooked up, in their 1848 marriage, the two became unstoppable. Over the next ten years, this ambitious couple established several health schools, issued regular periodical, and published half dozen books. Their critique of the sexual system moved in new directions, too, as they relocated to Modem Times on Long Island, joined forces with Stephen Pearl Andrews, and wrote three remarkable books that attacked indissoluble marriage and were widely regarded as promoting Free Love. In this same time period, Mary's talents as medium blossomed, and Spiritualism became central to the Nicholses' lives. And then, quite suddenly, the two converted to Catholicism in 1857, dropped from the reform scene, and in 1861 moved to England, citing moral objections to the Civil War. Silver-Isenstadt notes compelling reasons why these two once-notorious reformers have not gotten their due: they disappeared to England, they passed through many movements instead of sticking with consistent set of allies, their free love program was a liability that made other reformers shun them, and their turnabout conversion has disappointed scholars (8). She offers an intriguing psychological explanation for Mary Gove Nichols's embrace of Catholicism: that baptism and devotion to the Virgin Mary cleansed this woman of an early dread of sex, product of her hateful marriage to Hiram Gove. …

Biologic and molecular mechanisms for sex differences in pharmacokinetics, pharmacodynamics, and pharmacogenetics: Part II.

There are specific pharmacology issues related to women's unique physiology, including the hormonal changes that occur throughout their life span. Studies have shown alterations in drug metabolism in relation to phase of menstrual cycle, during pregnancy, or after menopause. In the brain, hormones can alter the response to drugs through various mechanisms. Estrogen and other compounds can bind to the estrogen receptor and modulate a wide range of activities within the cell. In addition, animal studies have demonstrated sexual dimorphism in the brain in terms of both the type of response to estrogen and the response as related to timing of administration. Many normal physiological changes that occur during pregnancy can affect pharmacokinetics and pharmacodynamics. These changes during pregnancy are dramatic rises in levels of estrogen and progesterone, increases in maternal blood volume, altered protein binding resulting from a drop in albumin levels, and a rise in levels of other plasma proteins. The field of chronobiology offers a way to study these changes in biological functions. Chronopharmacology is the study of how biological rhythms, particularly 24-hour, menstrual cycle, and annual rhythms, impact the pharmacokinetics and pharmacodynamics of drugs as a function of their timing. Chronopharmacokinetics is the study of the absorption, distribution, metabolism, and elimination of medicines according to the time of day, menstrual cycle, or year. In addition to applying chronobiology to the study of drugs used in women, new technologies were addressed from computer modeling, pharmacogenetics (genetics of the response to drugs), and in vivo drug metabolism studies.

In living memory: Abortion as cultural amnesia

This essay argues that abortion is more than the termination of a pregnancy: it is a metaphor for cultural amnesia. Early medical anti‐abortion rhetoric in the United States established women's bodies as rhetorical sites of cultural memory. Physicians formed a system of mnemonics: cultural truth about humanity was located in women's reproductive physiology, protocols for accessing that truth were formed via diagnostic practices, and a network of bodies (discursive and corporeal) was established through which truth could circulate. In the face of increasing numbers of abortions, physicians made the act of listening to the female body a culturally genealogical act.

Estrogens and human cardiovascular physiology.

The importance of estrogens for cardiovascular physiology in women is accepted, even if the clinical place for hormonal supplementation after menopause remains uncertain. However, although men produce significant quantities of estrogen, relatively little is known about the role of estrogens in the male cardiovascular system. Recent evidence about the epidemiology of cardiovascular disease, the mechanisms of action of estrogens, the biological actions of endogenously produced estrogens in men, and the acute and chronic effects of estrogens on the vasculature in both men and women, suggests that these hormones may well play an important role in normal male cardiovascular physiology. In addition, they may provide useful adjuncts to therapy in selected groups of men.

Sexuality of women with diabetes

OBJECTIVES: To gain a more detailed understanding, from a biopsychosocial perspective, of the sexuality of women living with diabetes. DESIGN: Anonymous questionnaire study. METHOD: Thirty-six women with type 1 diabetes, 27 women with type 2 diabetes and 67 women without diabetes completed anonymous, detailed surveys about their sexual desire, sexual satisfaction, sexual self-view and sexual function. Various features of diabetes that have potential sexual relevance were also addressed. RESULTS: Women with diabetes recognized that the following factors are associated with their disease and affect their sexuality: diabetes-associated fatigue, fear of becoming dependent on a sexual partner and an impairment of body image that is associated with diabetes. Other potential diabetes-associated concerns, including issues of fertility, birth control, difficulty finding an accepting partner and the perception of being an eilli woman, were not found to be relevant to sexual desire or sexual function. Women with diabetes were found to be similar to women without diabetes in terms of sexual desire, sexual responses and sexual function. Dyspareunia, which was disconcertingly common in all groups, is discussed. CONCLUSIONS: Despite the likelihood of diabetesassociated impairment of genital sexual physiology in women, any effect on womenis sexual function appears to be limited. Sexual satisfaction, however, may be affected by factors to do with living with diabetes.

Intensification and the discourse of decline: a rhetoric of medical anthropology.

Our use of academic rhetorics does not just deliver old arguments more eloquently, but rather serves an epistemological purpose that enables us to ask new questions. The rhetorical strategy of intensification contests and dislodges unnoticed and untheorized presuppositions in academic arguments by redefining taken-for-granted uses of language, by reemphasizing the often overlooked social imbrication of metaphors presented as neutral scientific descriptions, and by reopening the textual and conceptual "black boxes" that allow authors to evade responsibility for their rhetorical choices. As deployed by Emily Martin (1987) in The Woman in the Body, intensification reveals how rhetorical gestures rooted in negative sociocultural attitudes toward women's bodies sometimes masquerade as "scientific" or "medical" knowledge. Martin reveals a pattern of medical metaphors that incorrectly associate menstruation and menopause with processes of decline and decay. Intensification enables Martin to contest the discourse of decline in accounts of menstruation by underscoring how it is shaped by cultural metaphors of production and information processing, by fore-grounding its anachronistic voices and their outmoded language and attitudes about women's reproductive systems, by calling attention to the persistently negative terminology that permeates discussions of women's reproductive processes, by emphasizing the different languages used for women's reproductive physiology and for similar but ungendered physiological processes, and by accentuating the celebratory language used for men's reproductive physiology. Intensification serves to demonstrate that these metaphors misrepresent or suppress fundamental aspects of physiology, inappropriately impose gendered attitudes on processes more accurately represented by nongendered terms, and negatively influence representations of women, their physiological processes, and their medical needs.

Perimenopause: the complex endocrinology of the menopausal transition.

I. Introduction II. Defining the Perimenopause III. Classic Studies of the Perimenopause A. Historical studies B. Early reports of women’s experiences in the perimenopause C. Early prospective menstrual cycle interval and basal temperature documentation IV. Prospective Epidemiological Studies of the Perimenopause A. Manitoba Project on Women and Their Health in the Middle Years B. Massachusetts Women’s Health Study C. Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study V. Systematic Studies of the Endocrinology of the Perimenopause A. Cross-sectional (single-cycle) hormonal studies in the perimenopause B. Prospective ovarian hormonal levels in the perimenopause VI. Histological Studies of Ovarian Changes Across the Lifespan VII. Physiological Studies of Changing Ovarian Hormones in Women in Their Forties and Fifties A. Folliculogenesis and ovarian hyperstimulation for in vitro fertilization (IVF) B. Inhibin physiology in women over forty VIII. Hypotheses to Explain Perimenopausal Endocrinology A...

WOMEN'S MENTAL HEALTH IN PRIMARY CARE: Depression, Anxiety, Somatization, Eating Disorders, and Substance Abuse

Primary care physicians can improve the care of women patients by applying new concepts of women's physiology and psychosocial development. New developmental models that emphasize the importance of relationships in women's self-concept and well-being have led to effective psychotherapies for depression, eating disorders, anxiety and substance abuse. Many of these therapies can be offered in brief formats suitable to primary care settings. New biological treatments including the use of estrogen, thyroid hormone and bright light for depression and refeeding to increase metabolic rate in eating disorders also promise to expand the range of mental health problems that generalist physicians can treat successfully.