Top 10 Women’s Health Highlights from 2013

Notable advances and healthcare changes

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By: Holly L. Thacker, MD

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Each year, there are changes in healthcare worth noting. As we look back at 2013, here are 10 important health highlights for women that include advancements, greater knowledge and new warnings as well.

1. Hot flash treatment

The first non-hormonal therapy — Brisdelle™ (paroxetine 7.5mg) orally at night — was FDA-approved for the treatment of hot flashes associated with menopause. It became available on November 1, 2013 and is in the class of SSRIs (selective serotonin reuptake inhibitors).

This is a major advance as the lower dose of paroxetine is not associated with sexual dysfunction or weight gain as some higher dosed SSRI antidepressant therapy has been. Previous to this approval, many physicians had to resort to prescribing “off label” psychiatric medications to women who did not have psychiatric conditions, but who did have moderate to severe hot flashes.

2. Medication for vulvovaginal atrophy

Not all women can or want to take menopausal hormone therapy. A very common and under-recognized menopausal-related problem is vaginal thinness and dryness, or what clinicians call vulvovaginal atrophy (VVA). This problem can lead to painful or nonexistent sexual activity. Ospemifene (Osphena®) 60 mg daily with breakfast was the first non-estrogen oral medication approved to treat VVA and became available in June, 2013.

3. Women’s Health Initiative data

The Women’s Health Initiative published ongoing long-term outcomes of women on menopausal Hormone therapy (HT). The most striking datapoint showed reduction in mortality in the hormone therapy users — terrific news for menopausal HT users.

4. Online healthcare

Apps, apps, and more apps with social media, electronic records and text reminders influence healthcare. In 2013, we launched text reminders for appointments and we increased our interactive social media on my Speaking of Women’s Health site.

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Electronics became firmly entrenched in the patient care insurance market with the October 1, 2013 botched roll-out of Obamacare, with the “glitches” on being an unfortunate example of how the internet and electronic access or lack of secure electronic access can directly affect Americans’ healthcare.

5. Treatment for morning sickness

Severe pregnancy-induced nausea like that suffered by Princess Kate is called hyperemesis gravidarum and can result in hospitalization. In April of 2013, the FDA approved Diclegis®, a combination medication used to treat what we commonly call morning sickness — pregnancy-related nausea and vomiting. Diclegis is a combination of doxylamine succinate (which is found in the the over-the-counter sleep aid Unisom®) and the vitamin B6/pyridoxine.

Ah, I only wish I had had that option with all my pregnancies, although I did take B6 twice a day, which allowed me to continue seeing my patients.

6. Fecal transplants

Once considered a radical treatment for life threatening C. difficile colitis, swallowing capsules containing stool bacteria have been shown to stop recurrent C. diff infections by Canadian researchers. Though this might be hard to swallow, there may be other medical conditions positively affected by changing one’s fecal microbiota, so stay tuned!

7. Type 2 diabetes medication

The epidemic of “diabesity” continues. Obesity + type 2 Diabetes = serious health concerns. Good news was recently reported by Cleveland Clinic researchers on the controversial diabetic medication, Avandia® (rosiglitazone) showing reduced risk for cancer in diabetic women (but not men).

8. Genetic testing

There has been an explosion in both awareness and confusion in how our genetic makeup affects disease. Genetics has been used for disease prediction and probable responses to therapy. Awareness of genetics has grown from Angelina Jolie’s announcement of her BRACA1 mutation and her prophylactic bilateral mastectomy, as well as the Supreme Court’s ruling on Myriad Genetic’s patents on human gene genetic tests this past summer.

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When it comes to genetics, consider SNPs (pronounced “snips”), single nucleotide polymorphisms that are the most common genetic variation among people. While most SNPs have no effect on health, some can help predict a person’s response to certain medicines or toxins.

9. Hepatitis C treatment

Speaking of viruses, hepatitis C is a common cause of liver disease in baby boomers, and the year 2013 saw a big push from the Centers for Disease Control (CDC) to screen baby boomers born between 1945-1965 for hepatitis C. There is now a new drug called sofoshuvir (Sovaldi®) — the first oral interferon-free treatment approved by the FDA for chronic hepatitis C infection on December 6, 2013. This drug has a high cure rate for hepatitis C and is considered a nucleotide analog inhibitor, which means that it blocks a protein that the virus needs to multiply.

10. Antibiotic warnings

New warnings were released on commonly used antibiotics like azithromycin (Z-Pak®), which is used for common infections like bronchitis and ear infections. The FDA reported a rare side effect that could prove lethal: irregular heart rhythm that could cause sudden death.

The FDA also noted another class of antibiotics called fluoroquinolones, which are commonly used by women for bladder infections. These may cause neurologic side effects and tendon problems. The bottom line: antibiotics are life saving but they can have rare, potentially deadly side effects. It’s important not to ask for indiscriminate antibiotics but to understand they are for limited, targeted use.

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