COMMENTARY

December 2002: The Year in Review. Part 1. Highlights in Obstetrics and Gynecology

Members of the Medscape Ob/Gyn & Women's Health Editorial Board and Ursula Snyder, PhD

Disclosures

December 11, 2002

Introduction

Without doubt, 2002 was as an eventful year in many fields relevant to the health of women. As a number of board members of Medscape Ob/Gyn & Women's Health pointed out, the single most news-breaking event was the early termination of the estrogen and progestin arm of the Women's Health Initiative (WHI) this past summer -- the largest ever randomized clinical trial in women investigating the putative benefits of long-term combination menopausal hormone therapy for primary prevention of cardiovascular disease.[1] The trial was stopped after a mean of 5.2 years of follow-up because of a significant increase in risk of coronary heart disease, stroke, venous thromboembolic events, and breast cancer that outweighed the benefits of reduced risk of hip fracture and colorectal cancer.

Medscape posted a number of commentaries from our board members and distinguished authors[2,3,4,5] and a comprehensive review[6] soon after the public announcement of the termination in July. In October, a Scientific Workshop on Menopausal Hormone Therapy was held at the National Institutes of Health to discuss the implications of the WHI findings. It was apparent by the end of the meeting that there is much to learn about the action of exogenous estrogen on the premenopausal, perimenopausal, and postmenopausal body. Indeed, the number of studies that have been published since July has been substantial. An area of particular focus is the role of estrogen in cognitive function.[7,8,9] The National Institute of Aging is funding studies that will compare how well combination estrogen/progestin therapy or estrogen alone helps prevent loss of memory and cognitive function in women over age 65. In addition, the role of hormone therapy in cardiovascular disease prevention is still being actively investigated.[10,11,12] Data presented at the recent 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America suggest that the beneficial effect of estrogen on bone is related to its protection of bone microarchitecture.

However, it seems that, from now on, in clinical practice menopausal hormone therapy will be used much more judiciously -- and primarily for the treatment of severe vasomotor and vaginal symptoms that some women experience during the menopausal transition. Keep on the lookout for an article in the Medscape Women's Health eJournal on decision aids for hormone therapy that we anticipate will post early in the new year. For primary disease prevention, the focus clearly needs to be on weight, blood pressure, and cholesterol control and lifestyle modification, including exercise and nutrition, smoking cessation, and stress management.

The year was not just about hormone therapy, however, and this year being the first of the renamed Medscape Ob/Gyn & Women's Health, we asked board members to discuss some of the highlights of the year in gynecology and obstetrics.

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