Long-Acting Reversible Contraception (LARC)

Adapted from NEJM 2/2/2017 review article, "Long-Acting Reversible Contraception": THE PROBLEM: Unintended pregnancies are common in the US, though decreasing from 2008 to 2011:  45% of US pregnancies are unintended (compared to 35% in W Europe).  54/1000 in 2008 down to 45/1000 in 2011. From 2011-13, only 62% of women 15-44 yo were using contraception;… Continue reading Long-Acting Reversible Contraception (LARC)

Uterine Fibroids – AFP 1/15/17

Epidemiology:  most common benign tumors in reproductive-age women; prevalence age-dependent, up to 80% by 50 yo.  Account for 39% of all US hysterectomies. Etiology and Pathophysiology:  smooth-muscle origin; growth estrogen and progesterone dependent.  Fibroid tissue produces aromatase and endogenous estrogen/progesterone, and stem cells express estrogen- and progesterone receptors. Increase risk:  African descent, age > 40,… Continue reading Uterine Fibroids – AFP 1/15/17

CA-125 Specific for the Diagnosis of Endometriosis

Clinical Question:Is serum cancer antigen 125 an accurate noninvasive test for diagnosing endometriosis in symptomatic women?Bottom Line:For women with symptoms suggestive of endometriosis, serum cancer antigen 125 (CA125) is a relatively specific (93%) and noninvasive test. It can be used to makea presumptive diagnosis in cases for which a medical management approach isbeing considered without… Continue reading CA-125 Specific for the Diagnosis of Endometriosis

Primary Care for the Solid Organ Transplant Recipient

AFP February 1, 2016 - 50% of transplant-related deaths are due to immunosuppressive drugs, mostly infections - Most immunosuppressive drugs are metabolized via cytochrome P450 3A4 - so lots of interactions - Transplant recipients have increased risk of CAD and cardiovascular death HTN - goal (expert recommendation) is less than 130/80 mmHg - CCB reduce… Continue reading Primary Care for the Solid Organ Transplant Recipient

Ovarian Cancer Screening Does Not Improve Outcomes

Ovarian cancer screening does not improve outcomes (UKCTOCS)Clinical Question:Do women who are screened for ovarian cancer have better healthoutcomes than women who are not screened?Bottom Line:In this study (with methods that are biased in favor of the intervention), women who arescreened for ovarian cancer are unlikely to experience any mortality benefit. (LOE = 1b-)Reference:Jacobs IJ, Menon U, Ryan… Continue reading Ovarian Cancer Screening Does Not Improve Outcomes