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In a recent study presented at the 25th Annual Fall Scientific Meeting of SMSNA, similar diagnosing success was reported between self-diagnosis and diagnosis from a health care provider for vaginismus.

Self-diagnosing vaginismus found accurate vs health care provider diagnosis

Erika Hamilton, MD, discusses concerning increases in breast cancer incidence among younger women and certain ethnic groups, while highlighting new innovations in detection and targeted therapies that offer hope for improved patient outcomes.

Erika Hamilton highlights emerging breast cancer trends and advances in treatment

In a recent study, mothers and fathers with simultaneous parental leave after birth were more likely to utilize mental health care services than those without simultaneous parental leave.

Increased mental health service use reported from simultaneous postpartum leave

Elinzanetant, a non-hormonal drug, shows promising results in reducing hot flashes and night sweats, offering a new option for women seeking effective and safe treatment for vasomotor symptoms.

JoAnn Pinkerton discusses elinzanetant's crucial role in VMS therapy

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Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Authors

Liver Diseases with Pregnancy

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

In a recent interview ObGyn.net conducted for 

 on comprehensive care and cancer screenings at well-woman visits, the topic of stethoscopes came up. Ilene S. Gewirtz, MD, the interviewee, mentioned that she still carries a stethoscope and listens to her patients' heart and lungs at well-woman visits. She also said that she believes she's in the minority regarding this practice. We want to know if she's right.

POLL: Many women consider their OB/GYN their primary care provider. But like your primary care counterpart, do you carry a stethoscope?

Do OB/GYNs Carry Stethoscopes?

The US Food and Drug Administration (FDA) has granted marketing authorization for the first at-home, over-the-counter test to detect 

The blood-based First To Know Syphilis Test, from NOWDiagnostics, was granted authorization from the FDA today with an expressed sentiment that the product will support patient privacy when testing for a potential sexually transmitted infection (STI). Though the product was advised to only indicate the need for a definite diagnostic test by a clinician, it can help to destigmatize STI risk monitoring—a key need at a time when syphilis cases have increased by 80% in the US since 2018.

“Access to home tests may help increase initial screening for syphilis, including in individuals who may be reluctant to see their health care provider about possible sexually transmitted infection exposure,” Michelle Tarver, MD, PhD, acting director of the FDA’s Center for Devices and Radiological Health, said in a statement accompanying the authorization. “This can lead to increased lab testing to confirm diagnosis, which can result in increased treatment and reduction in the spread of infection.”

The FDA further noted that the results of the First To Know test are not sufficient to make a certain syphilis infection diagnosis—successfully treated patients with prior syphilis can still test positive with the product. Patients are advised to seek additional laboratory testing coordinated through a health care provider based on their results.

The at-home test is capable of providing results to consumers within approximately 15 minutes. The FDA believes its authorization will help toward the Department of Health and Human Services’ (HHS) National Syphilis and Congenital Syphilis Syndemic Federal Task Force’s objective to reverse the climb of STI cases in the US.

Indeed, recent data from the World Health Organization (WHO) indicated that the institution’s own effort to reduce global rates of syphilis have been recently challenged; despite their strategy to reduce annual infection diagnoses 10-fold by 2030, annual cases climbed from 7.1 million to 8.0 million in 2022.

US Food & Drug Administration. FDA Marketing Authorization Enables Increased Access to First Step of Syphilis Diagnosis. Press release. Published August 16, 2024. https://www.fda.gov/news-events/press-announcements/fda-marketing-authorization-enables-increased-access-first-step-syphilis-diagnosis?utm_medium=email&utm_source=govdelivery

Abene S. Escalating STI rates undermine global health progress towards 2030 targets. 

 Published May 23, 2024. Accessed August 16, 2024. https://www.contemporaryobgyn.net/view/escalating-sti-rates-undermine-global-health-progress-towards-2030-targets

The over-the-counter, at-home test provides blood results in 15 minutes that could help result in sooner syphilis diagnoses.

Clinical

FDA approves first over-the-counter syphilis test

Very few women have received counseling about the warning signs of endometrial cancer from a health care professional, according to a recent study published in 

Experts have estimated 67,880 new cases of uterine cancer in 2024, as well as 13,250 associated deaths. Nearly all racial and ethnic groups have experienced an annual 2% increase in incidence, caused in part by rising rates of obesity in the United States.

Endometrial cancer is one of the most common female reproductive organ cancers. Associated deaths have also increased over time, with an annual increase of approximately 1.1% reported between 1999 and 2006.

A screening test has not been established for cervical cancer, but detectable symptoms allow diagnosis to occur at an early stage. These symptoms include abnormal and postmenopausal bleeding.

Diagnosis of endometrial cancer at an early stage is associated with a 5-year survival rate of nearly 95%. However, delayed diagnosis has been linked to a significantly reduced 5-year survival rate of 19%, as the disease has time to progress and metastasize.

A survey was conducted to determine the rate of women who recognize postmenopausal bleeding as a symptom of endometrial cancer. There were 650 participants in the final analysis, 145 of whom were postmenopausal. Of these women, 37% did not recognize postmenopausal bleeding as a key symptom of endometrial cancer.

While even a single episode of postmenopausal bleeding is a symptom of endometrial cancer, 41% of participants states they would not report only 1 episode of bleeding to their health care professional. Notably, only 46.5% of women recognized menopause as not having a period for 1 year or more, likely contributing to the low rate.

Adequate education is also lacking among health care professionals, as under 50% of participants reported receiving counseling about postmenopausal bleeding from their health care professional. This indicated a critical need to improve the education of patients and clinicians. Additionally, patient counseling about endometrial cancer and symptoms to be aware of must be improved.

“This survey study highlights opportunities for improved patient counseling about abnormal and postmenopausal uterine bleeding as an early warning sign of uterine cancer,” said Stephanie Faubion, MD, MBA, medical director for The Menopause Society.

“This is especially important given that the incidence and mortality rates of uterine cancer continue to increase and are notably highest in women of color,” Faubion added.

This information may be especially relevant among Black patients, who face racial disparities in endometrial cancer care compared to their White counterparts.

 A study found that race was not associated with willingness to seek care for endometrial cancer, but the odds of receiving guideline-concordant evaluation were greatly reduced among Black patients vs White patients.

Pretreatment was also significantly delayed among Black patients, with an increased wait of 3 to 5 days vs White patients. Additionally, the risk of waiting more than 6 weeks for surgery compared to White patients was increased by 30% to 40% among Black patients, vs 2% to 40% for Hispanic and Asian patients.

This data indicates significant racial disparities in endometrial cancer care. Increasing patient and provider awareness about obvious symptoms may help reduce these disparities.

What you don’t know about endometrial cancer could kill you. The Menopause Society. July 31, 2024. Accessed August 9, 2024. 

https://www.menopause.org/docs/default-source/press-release/postmenopausal-bleeding-and-endometrial-cancer.pdf

Krewson C. Racial disparities reported in endometrial cancer care. Contemporary OB/GYN. September 25, 2023. Accessed August 9, 2024. 

https://www.contemporaryobgyn.net/view/racial-disparities-reported-in-endometrial-cancer-care

A recent study found that 37% of women do not recognize postmenopausal bleeding as an early symptom of endometrial cancer, indicating a lack of knowledge among patients and providers.

Knowledge about early endometrial cancer symptoms lacking

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

At the 2024 Menopause Society meeting, JoAnn Pinkerton, MD, highlighted phase 3 long-term safety data of elinzanetant from the OASIS 3 trial.

Elinzanetant long-term safety data with JoAnn Pinkerton, MD, FACOG, NCMP

At the 2024 Menopause Society meeting being held in Chicago, Illinois through September 14, 2024, JoAnn Pinkerton, MD, FACOG, NCMP, joined us to discuss phase 3 data of elinzanetant from the OASIS 3 trial.

The trial sought to evaluate the safety and efficacy of elinzanetant in postmenopausal women with moderate-to-severe vasomotor symptoms (VMS).

"OASIS 3 is a clinical trial that built on OASIS 1 and 2, which were 26-week trials that were just published in 

," said Pinkerton, who is a professor of Obstetrics and Gynecology at The University of Virginia Health System in Charlottesville, Virginia.

"OASIS 3 was a longer clinical trial, 52 weeks, that took primarily women who are having bothersome menopausal symptoms of moderate to severe, and they observed them over a year for safety and efficacy. The primary endpoint was the reduction in hot flushes from baseline to 12 weeks, but then we really wanted to look at the safety and efficacy across 52 weeks," Pinkerton said. 

"The good news was that Oasis met its primary objective," she added. "Hot flashes were significantly reduced at 12 weeks in this population of women who were not as severe as those in OASIS 1 and 2—more like you would see in your clinical practice—significantly reduced compared to placebo at 12 weeks, and then maintained that efficacy throughout the 52 weeks.

Click here for more coverage from The Menopause Society Meeting.

Panay N, Joffe H, Maki P, et al. Efficacy and Long-term Safety of Elinzanetant for the Treatment of VMS Associated with Menopause: A Phase 3 Randomized Trial (OASIS 3). Abstract. Presented at: The Menopause Society 2024 Annual Meeting. September 10 - September 14, 2024. Chicago, Illinois.

Mahmoud Farouk Midan, MD

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