Cleveland Clinic Journal of Medicine (CCJM)Women’s Health Update: A Literature Review Impacting Primary Care

This extensive literature review examines critical developments in women’s health that directly impact primary care practice. The analysis covers cardiovascular disease risk factors, bone health management, genetic testing for breast cancer, cervical cancer prevention strategies, peripartum depression screening, emergency contraception options, and chronic pelvic pain treatment. The findings present evidence-based updates that influence clinical decision-making across multiple aspects of women’s healthcare.

Key Points:

• Cardiovascular risk assessment now incorporates migraine with aura as a significant factor, showing adjusted incidence rates of 3.36 per 1,000 person-years compared to 2.11 for migraine without aura (p<0.001). Severe menopausal vasomotor symptoms, independent of frequency, correlate with increased CVD risk (HR 2.11, 95% CI 1.62-2.76).
• In bisphosphonate therapy, the risk-benefit analysis strongly favors continued treatment: For every 10,000 White women treated for 3 years, 149 hip fractures are prevented while only two atypical femoral fractures occur. The optimal duration remains at 5 years, with individualized assessment for extended treatment.
• Genetic testing for breast cancer has expanded beyond BRCA1/2. New evidence identifies PALB2, CHEK2, and ATM as significant risk genes, with odds ratios ranging from 1.82 to 7.62 for breast cancer development.
• HPV vaccination demonstrates significant efficacy both as primary prevention (88% reduction in cervical cancer when administered before age 17) and as adjuvant therapy following CIN2+ treatment (64% reduction in recurrence, NNTb=28).
• The 52-mg levonorgestrel IUD proves noninferior to copper IUD for emergency contraception, with only one pregnancy occurring among 317 participants in the levonorgestrel group versus zero in 321 copper IUD recipients.

HCN Medical Memo
These findings significantly impact primary care protocols, particularly in cardiovascular risk assessment and cancer prevention strategies. The evidence supports more nuanced approaches to women’s health management, with clear guidelines for implementation in clinical practice.

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