| Current
Women's Health Reviews
ISSN: 1573-4048
Current Women’s Health
Reviews
Volume 1, Number 3, November 2005
Contents
Current Management of In Situ and Invasive
Cervical Adenocarcinoma Pp.185
John O. Schorge, Shawna L. Bull and Jayanthi S. Lea
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Use of New Therapeutic Compounds in Pregnancy with
Renal Disease Pp.197
Chui M. Lam and Kai M. Chow
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Female Immunocontraceptive Vaccine – Present
Status and Future Perspectives Pp.201
Alina Domagala, Renata Wyrzykowska and Maciej Kurpisz
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Issue/Articles]
A Systematic Approach to Vulvodynia Pp.209
Catherine M. Leclair and Jeffrey T. Jensen
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Uterine Myomas and Infertility: Any Relationship?
Pp.217
Beth W. Rackow and Aydin Arici
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The Relevance of Peripheral Immune Tolerance in Normal
Pregnancy and its Potential Failure in Gestation-Associated
Diseases Pp.225
Andrea Steinborn, Edgar Schmitt and Christof Sohn
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Pre-Eclampsia: Immunological Aspects - A Role of Adhesion
Molecules,Cytokines, Dendritic Cells, MHC Antigens and Auto-Antibodies
Pp.237
Dorota Darmochwal-Kolarz
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Lifestyle Behaviours and Bone Mineral Density Changes
Among Healthy Young Women: A Tentative Salutary Model Pp.243
Carina Elgán and Bengt Fridlund
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Breast Cancer Risks in Premenopausal Women: A Review
Pp.261
Harvey L. Bumpers
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Current Management of In Situ and Invasive
Cervical Adenocarcinoma
John O. Schorge, Shawna L. Bull and Jayanthi S. Lea
Cervical adenocarcinomas are increasing in incidence each
year, both in the United States and worldwide. This increase
largely reflects the inherent difficulty in detecting glandular
precursor lesions. Since adenocarcinoma in situ generally
requires at least five years to progress to invasive disease,
there should be ample time for screening and potential intervention.
Conization preserves fertility in young women diagnosed with
adenocarcinoma in situ, but carries an inherent risk
of residual disease higher in the canal. Highly motivated
patients with microscopic stage IA1 and IA2
cervical adenocarcinoma may also be managed by fertility-sparing
surgery. The treatment of choice for stage IB1
disease is radical hysterectomy. Fewer than 20% of patients
will need adjuvant therapy. Primary radiation with weekly
cisplatin is the best option for women with stage IB2
and IIA cervical adenocarcinoma. Virtually all patients treated
initially by radical hysterectomy will have high-risk surgical-pathologic
features that indicate the need for adjuvant chemo-radiation.
Patients with stage IIB to IVA disease should also receive
primary radiation with weekly cisplatin, but their prognosis
is more guarded. The treatment of recurrent cervical adenocarcinoma
should be individualized, depending on the location of disease
and the type of previous therapy. In this review, we discuss
the current management of in situ and invasive cervical
adenocarcinoma.
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Use of New Therapeutic Compounds in Pregnancy with
Renal Disease
Chui M. Lam and Kai M. Chow
Growing toxicological and epidemiological interests in new
therapeutic compounds have arisen with the recent increase
in frequency of pregnancies in women with renal disease. Angiotensin-converting
enzyme inhibitor and angiotensin II receptor antagonist, at
least in the late stages of pregnancy, is associated with
adverse fetal development and can cause pulmonary hypoplasia
and neonatal anuria. In utero exposure to immunosuppressive
drugs poses challenges to management of pregnant renal transplant
recipients. Mycophenolate mofetil, a new antiproliferative
drug to inhibit inosine monophosphate dehydrogenase, has been
recently reported to cause major fetal malformations. Whilst
such alleged adverse fetal events are potential concerns for
obstetricians and physicians, an understanding of different
types of risk estimates and strengths of evidence is also
needed - we further elaborate and provide perspective on how
to interpret the available information in clinical decision-making
of drug use in pregnancy.
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Female Immunocontraceptive Vaccine – Present
Status and Future Perspectives
Alina Domagala, Renata Wyrzykowska and Maciej Kurpisz
World population is expected to rise to 9 billion in next
50 years. Between 2000 and 2030 nearly a hundred percent of
the annual population growth will occur in the less developed
countries of Africa, Asia, and Latin America. Apparently,
there will be growing demand for suitable (discreet, simple
to use, long lasting, reversible, sociologically accepted
and inexpensive) methods of birth control. Immunocontraceptive
vaccines seem to be a promising alternative for the population
control. Studies on immunocontraceptive targets have been
aimed at either gametogenic (sperm, zona pellucida) components
or at sex hormones involved in the regulation of fertility.
So far, the only contraceptive vaccine that has undergone
the Phase II clinical trial in human model was hCG. However,
there are still unknown consequences of the prolonged stimulation
with this vaccine. There have been also attempts to use other
reproductive hormones (GnRH, FSH) as immunocontraceptives.
None of them, however, appeared to be adequate to be applied
in humans due to either a lack of efficacy, costs or serious
side effects. Recently, there were also published data on
novel antigens of spermatogenic origin with a potential of
stimulation of the production of antisperm antibodies. They
provided limited contraceptive efficacy only in animal models.
The article compiles the literature concerning the present
status and future perspectives of immunocontraceptive strategies
as well as describes different vaccine constructs under study.
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A Systematic Approach to Vulvodynia
Catherine M. Leclair and Jeffrey T. Jensen
Vulvodynia represents an important, but poorly understood
collection of health issues affecting 1 in 8 women. Pain and
discomfort interfere with normal daily activities such as
sitting, exercising and sexual intimacy. The intensely personal
nature of these disorders results in feelings of isolation
and anxiety for many affected women. Since a variety of benign
disorders of the vulva and vagina can contribute to the development
and/or maintenance of vulvar pain, clinicians caring for women
with vulvodynia must understand the impact and inter-relationships
of these conditions. This paper reviews the current classifications
and primary causes of vulvodynia. The primary anatomic, dermatologic,
myofascial, infectious, neuropathic, and psychosexual factors
contributing to vulvar pain are presented, along with evidence-based
guidelines to the treatment.
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Uterine Myomas and Infertility: Any Relationship?
Beth W. Rackow and Aydin Arici
The relationship between uterine myomas and infertility
is unclear, and numerous studies have attempted to better
define this association. This review article explores the
available data about the impact of submucosal, intramural
and subserosal myomas, and small and large myomas, on reproductive
outcomes in natural conception and assisted reproduction.
Overall myoma location, followed by size, is the most important
factor determining the impact of myomas on fertility. Distortion
of the uterine cavity can also be detrimental to fertility.
The importance of proper evaluation of a myomatous uterus
and its endometrial cavity is discussed. For patients with
myomas and infertility, or for those with symptomatic myomas
who desire future fertility, current medical and surgical
management options are reviewed. However, myomectomy remains
the standard of care for patients with problematic myomas
and fertility concerns.
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The Relevance of Peripheral Immune Tolerance in Normal
Pregnancy and its Potential Failure in Gestation-Associated
Diseases
Andrea Steinborn, Edgar Schmitt and Christof Sohn
During pregnancy the maternal immune system is confronted
with paternal allo-antigens. Therefore, feto-maternal rejection
processes may represent a major cause of complications, such
as preeclampsia, Hemolysis, Elevated Liver enzymes, Low Platelet
(HELLP)-Syndrome, placental abruption and Intra-Uterine-Growth
Restriction (IUGR). Several local mechanisms are known, which
protect the fetus from maternal immune attack. In addition,
mechanisms inducing peripheral immune tolerance to the fetus
seem to be of equal if not even of greater importance for
successful course of pregnancy. Such mechanisms may be the
induction of CD25+CD4+ T regulatory cells, a specialized T-cell
population which was shown not only to suppress autoaggressive
immune responses but also to prevent graft rejection due to
induction of transplantation tolerance. Other mediators influencing
peripheral immune tolerance are soluble HLA (sHLA) class I
and II molecules. Fetally derived sHLA molecules are able
to block the allo-reactive cytotoxic T-cell response of the
mother via T-cell-receptor binding. There is further
evidence that sHLA class-I (HLA-A, -B, -C and -G) molecules
inhibit NK-cell and cytotoxic T-cell activity through CD8
ligation. Thus, increased availability of sHLA-class-I molecules
may have strong immune-suppressive effects and affect potentially
maternal immune homeostasis. This review summarizes what is
currently known about the induction of peripheral immune tolerance
in pregnancy and discusses its relevance for the development
of characteristic pregnancy-associated diseases.
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Pre-Eclampsia: Immunological Aspects - A Role of Adhesion
Molecules, Cytokines, Dendritic Cells, MHC Antigens and Auto-Antibodies
Dorota Darmochwal-Kolarz
There are many suggestions that pre-eclampsia has an immunological
basis. According to the immunological theory of the disease,
there is a failure of the immunological recognition of fetal
alloantigens during pregnancy. It seems that abnormal activation
of the immune system may play a role in the etiology of pre-eclampsia.
Many authors have found a number of changes in the adaptive
immune system which may contribute to the development of pre-eclampsia.
Recent data suggest that pre-eclampsia is a T helper 1/T helper
2 immunity disorder with predominant Th1 type immunity. Furthermore,
there is an evidence regarding the activation of the innate
immune system in pre-eclampsia. It has been shown lately that
normal third trimester pregnancy is characterized by the activation
of peripheral blood leukocytes, which is further increased
in pre-eclampsia.
The possible immunological etiology of pre-eclampsia has
been suggested because of some clinical and epidemiological
observations. It has been observed lately that there is a
protective effect of sperm exposure and that the duration
of sexual cohabitation before conception is inversely related
to the risk of pre-eclampsia. There are also epidemiological
data that there is a higher incidence of pre-eclampsia in
women conceiving by intrauterine insemination with donor sperm
compared IUI with partner sperm.
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Lifestyle Behaviours and Bone Mineral Density Changes
Among Healthy Young Women: A Tentative Salutary Model
Carina Elgán and Bengt Fridlund
The aim was to investigate, by means of a salutogenic approach,
bone mineral density (BMD) and changes in BMD over a two-year
period in a group of women in relation to lifestyle behaviours
and to explore their perceptions of these behaviours. The
method used was multiple and sequential triangulation. Over
the two years, 62% had decreased/unchanged BMD, while 38%
had increased their BMD. Self-rated sleep satisfaction explained
3% of the variability in BMD and women who reported greater
satisfaction with their sleep were more likely to have a healthier
lifestyle. Time spent outdoors may moderate the negative influence
of smoking. Women’s views on lifestyle behaviours were
characterised by a number of interrelated dimensions; motivation,
goals, actions and strategies. Women with a relaxed outlook
on life had increased BMD while women with a rigid outlook
on life had decreased their BMD irrespective of smoking and
physical activity. Women with a rigid outlook on life viewed
actions such as lifestyle habits as a means to an end while
respondents with a relaxed outlook on life, the enacted lifestyle
behaviours were a goal in themselves. Motivation and sleep
may be salutary factors associated with improved BMD. A tentative
bio-psychosocial salutary model of the association between
motivation, outlook on life, sleep, lifestyle behaviours and
BMD is presented.
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Breast Cancer Risks in Premenopausal Women: A Review
Harvey L. Bumpers
Breast cancer in young women has always carried an ominous
prognosis. There has been little evidence that these concerns
are unfounded. The risk for developing premenopausal breast
cancer is multifactorial. The younger and less developed breasts
are subject to endogenous factors such as hormones and growth
factors, as well as exogenous agents occurring in environmental
pollutants and other chemicals. Most data indicate that genetic
mutations, reproduction history, and family history of breast
cancer disproportionately affect the risks of breast cancer
in the premenopausal woman. More controversial risk factors
that have recently received much attention include diet, physical
activity, and stress. Many women who are delaying pregnancy
to a much later age will pose an increasing demand for attention
to a whole new set of issues in the young women. More effort
must be devoted to diagnosing and treating young women aggressively,
avoiding toxicity to the fetus, and reducing postpartum risk
of recurrence. Though the etiological pathway for breast cancer
in the young women is quite a winding one, improving prognosis
may be as simple as early detection.
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