COMMENTARY

20 Years of Advances in Gynecology and Women's Health, but Many Challenges Remaining

Andrew M. Kaunitz, MD

Disclosures

June 20, 2015

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Hello. I'm Andrew Kaunitz, professor and associate chairman of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville. Today I would like to discuss 20 years of advances in gynecology and women's health, with many challenges remaining.

In the past two decades, the practice of gynecology and women's health has been transformed. In the transcript for this video, I have listed my picks for the top 20 advances that have enhanced how we care for our patients. In this video, I will highlight four of these.

The progestin-releasing intrauterine device (IUD) first became available in the United States in 2001, followed by approval of the single-rod progestin-releasing implant in 2006. These safe, convenient, reversible, and highly effective contraceptives allow women to plan with high confidence when and when not to be pregnant.

Although the prevalence of implants, and particularly IUDs, has increased substantially among US women, their use in this country remains lower than in many European countries. Rates of unintended pregnancy among high-income US women have recently been declining, probably reflecting higher use of IUDs and implants among more affluent women. Unfortunately, rates of unintended pregnancy are increasing among lower-income US women. This disparity underscores the importance of making these highly effective but expensive contraceptives available to all women.

When I was a resident back in the early 1980s, we had no practical way to screen for chlamydia infections. Now, highly sensitive and specific nucleic acid amplification tests are available to screen for chlamydia, gonorrhea, and other common sexually transmitted infections. The use of these tests has contributed to declines in pelvic inflammatory disease over the past decade.

Finally, screening for precursors of cervical cancer represents perhaps the most successful cancer prevention program we have witnessed. A vaccine against human papillomavirus (HPV) first became available in the United States in 2006. In late 2014, the US Food and Drug Administration (FDA) approved an updated vaccine that protects females who are 9-26 years old and males who are 9-15 years old against nine strains of HPV.

HPV vaccines represent tools that, along with screening, can further reduce invasive and preinvasive cervical neoplasia. Unfortunately, uptake of HPV vaccine is lower in the United States than in many countries abroad, underscoring that we are far from adequately deploying this important advance.

Thank you. I'm Andrew Kaunitz.

Top 20 Advances in Gynecology and Women's Health in the Past 20 Years

Fertility Regulation

Screening for Sexually Transmitted Infections

  • Use of highly sensitive and specific nucleic acid amplification tests

Cervical Cancer Prevention and Screening

  • HPV vaccines

  • HPV testing

Menopausal Practice

  • The Women's Health Initiative and other studies that have generated evidence allowing risk stratification to help clinicians and women make sound choices regarding treatment of symptoms

  • New treatments for menopausal symptoms utilizing selective estrogen receptor modulators such as conjugated estrogen combined with bazedoxifene, and ospemifene

  • Low-dose paroxetine mesylate, the first approved nonhormonal treatment for hot flashes

Surgical Techniques for Benign Disease

  • Minimally invasive hysterectomy

Gynecologic Oncology

  • Advances in the treatment of ovarian cancer

    • Platinum/taxane combination chemotherapy

    • Very aggressive surgical cytoreduction

    • Selective use of intraperitoneal chemotherapy

  • Better understanding of the molecular basis of pelvic cancers, allowing "personalized" treatment of selected gynecologic cancers

  • Minimally invasive/robotic surgery for pelvic cancers

Hereditary Breast and Ovarian Cancer

  • Screening for BRCA mutations, and interventions for women who are identified as carriers

Reproductive Endocrinology and Infertility

  • Intracytoplasmic sperm injection for male infertility

  • Blastocyst culture with transfer of a single embryo for patients with good prognosis

  • Fertility preservation for cancer patients

  • Uterine transplantation

Acknowledgment: I gratefully acknowledge the thoughtful suggestions provided by Dr Robert Rebar, reproductive endocrinologist and former executive director of the American Society for Reproductive Medicine and Dr Guy Benrubi, gynecologic oncologist and chairman of my department.

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