Women's Health

Patients with BRCA mutations should consider prophylactic ovariectomies prior to age 50 based upon this epidemiological simulation. James W. Mold, MD, MPH

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Importance Women with a BRCA1 or BRCA2 variant face a high lifetime risk of ovarian cancer and are often advised to undergo preventive surgery (bilateral salpingo-oophorectomy [BSO]) before cancer develops. The recommended age of BSO is 35 years for BRCA1 carriers and is 45 years for BRCA2 carriers, but some women choose to delay surgery until the age of menopause; there is no standard upper age at which surgery is no longer advised.

Objective To estimate the residual lifetime risk of ovarian cancer among BRCA carriers by current age and projected age at BSO.

Design, Setting, and Participants This was a prospective cohort study in an international cohort of BRCA carriers monitored for incident ovarian cancer. A life table analysis used age-specific ovarian cancer incidence rates and competing mortality rates to estimate lifetime risk of ovarian cancer among women with a BRCA1 or BRCA2 pathogenic variant with both ovaries intact and no prior ovarian cancer at baseline. Patients were recruited between 1995 and 2024 across 24 international centers, and the mean (SD) follow-up was 4.4 (3.9) years.

Exposure Timing of BSO, defined as immediate BSO, delayed BSO, or no BSO.

Main Outcome and Measures Residual lifetime risk of ovarian cancer.

Results The cohort consisted of 4286 BRCA1 and 1427 BRCA2 carriers between the ages of 30 and 74 years at baseline (mean [SD] age, 42.0 [10.8] years). There were 249 incident ovarian cancers in the follow-up period. The lifetime risk of ovarian cancer was 55.0% (95% CI, 48.8-61.9) for a BRCA1 carrier and 24.1% (95% CI, 15.1-36.6) for a BRCA2 carrier. A 30-year-old BRCA1 carrier with BSO delayed to age 50 years had a projected residual ovarian cancer risk of 23.9% (95% CI, 20.7-27.4). At age 75 years, the residual risk of ovarian cancer was estimated to be 8.4% (95% CI, 1.7-22.7) for a BRCA1 carrier and 3.7% (95% CI, 0.1-22.7) for a BRCA2 carrier.

Conclusions and Relevance The residual risk of ovarian cancer for older women in good health is sufficiently high to consider preventive surgery. BRCA1 carriers who defer BSO until age 50 years may face a substantial risk of developing ovarian cancer.

Author/s:

Vasily Giannakeas, PhD, Adriana I. Apostol, MD, Claudia Diella, et al.

Cervical Cancer Screening Updates—Focus on Self-Collected Primary Human Papillomavirus Testing

Mary Cervantes — Fri, 28 Aug 2026 01:36:17 +0000

Date Added:

August 27, 2026

Journal/Publication:

JAMA Internal Medicine: Clinical Insights

Publisher:

JAMA Internal Medicine

Publication Date:

August 24, 2026

URL:

Cervical Cancer Screening Updates—Focus on Self-Collected Primary Human Papillomavirus Testing

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.3980

Keywords

cervical cancer

Cervical Cancer Screening

Papillomavirus Testing

Screening Updates

Women's Health

MeSH

early detection of cancer

Early Detection of Cancer / standards

Early Detection of Cancer* / methods

American Cancer Society

Gynecologists

Papillomavirus Infections

uterine cervical neoplasms

Uterine Cervical Neoplasms* / diagnosis

primary health care

female

An update to the cervical cancer screening guidelines from the USPSTF. James W. Mold, MD, MPH

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The incidence and mortality of cervical cancer have fallen since the adoption of widespread screening, but it still disproportionately affects underserved populations in the US. Expanding access to screening, especially in primary care settings, may reduce these disparities and improve women’s health. This Clinical Insights article summarizes cervical cancer screening recommendations for patients with average and higher than average risk, including recommendations for self-collected human papillomavirus (HPV) testing. It highlights statements by the US National Cancer Institute–sponsored Enduring Guidelines Committee, which was established to continuously evaluate new technologies for cervical cancer screening, management, and surveillance.

Author/s:

Hunter K. Holt, MD, MAS, Yasaswi Kislovskiy, MSc, George F Sawaya

Nonhormonal Treatment of Menopausal Vasomotor Symptoms

Erin Blanchette — Wed, 07 May 2025 21:26:26 +0000

Date Added:

May 7, 2025

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

May 5, 2025

URL:

Nonhormonal Treatment of Menopausal Vasomotor Symptoms

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.0990

Keywords

Obstetrics and Gynecology

PMID (1):

40323611

MeSH

A concise evidence-based review of non-hormonal approaches to treatment of menopausal vasomotor symptoms. James W. Mold, MD, MPH

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Vasomotor symptoms are the most widely recognized menopause symptoms in Western nations, with at least 75% of women reporting hot flashes or night sweats during or after the menopause transition. Many women struggle to choose between treatments, given lack of data on direct comparisons of different treatments, concerns about short-term adverse effects and longer-term treatment risks, and confusion about complementary or alternative remedies with unclear evidence of benefit.

Author/s:

Alison J Huang, Stephanie Faubion, Deborah Grady

Sexual Dysfunction in Women

Erin Blanchette — Mon, 26 Aug 2024 15:39:15 +0000

Date Added:

August 26, 2024

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

August 22, 2024

Issue:

Volume:

391

Pages:

736-745

URL:

Sexual Dysfunction in Women

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2313307

Keywords

Sexual Dysfunction

Estrogen Replacement Therapy

PMID (1):

39167808

MeSH

Estrogen Replacement Therapy

Hysterectomy

Libido

menopause

A review of what we think we know about sexual dysfunction in women across the lifespan. James W. Mold, MD, MPH

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The Clinical Problem
Because there is no universal definition of normal sexual function, what constitutes sexual difficulty is determined by a person’s subjective definition of unsatisfactory sexual well-being. The condition is usually described as unsatisfactory interest, arousal, orgasm, or other aspects of sexuality (e.g., sexual self-image), and the symptoms often coexist. The term “sexual dysfunction” is used when at least one of the symptoms is of substantial concern to the affected person. Sexual dysfunction negatively affects mental health, vitality, and social functioning and has an overall effect on quality of life that is of similar magnitude to that associated with chronic back pain or diabetes.

Author/s:

Susan R Davis

The Women’s Health Initiative Randomized Trials and Clinical Practice

Alex Haga — Mon, 13 May 2024 21:25:57 +0000

Date Added:

May 13, 2024

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

May 1, 2024

URL:

The Women’s Health Initiative Randomized Trials and Clinical Practice

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2024.6542

Keywords

PMID (1):

38691368

A summary review of the results of the Womens Health Initiative Study pertaining to HRT, Vit D/calcium supplementation, and low-fat diet in menopausal women. James W. Mold, MD, MPH

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Importance: Approximately 55 million people in the US and approximately 1.1 billion people worldwide are postmenopausal women. To inform clinical practice about the health effects of menopausal hormone therapy, calcium plus vitamin D supplementation, and a low-fat dietary pattern, the Women's Health Initiative (WHI) enrolled 161 808 postmenopausal US women (N = 68 132 in the clinical trials) aged 50 to 79 years at baseline from 1993 to 1998, and followed them up for up to 20 years.

Observations: The WHI clinical trial results do not support hormone therapy with oral conjugated equine estrogens plus medroxyprogesterone acetate for postmenopausal women or conjugated equine estrogens alone for those with prior hysterectomy to prevent cardiovascular disease, dementia, or other chronic diseases. However, hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms. These benefits of hormone therapy in early menopause, combined with lower rates of adverse effects of hormone therapy in early compared with later menopause, support initiation of hormone therapy before age 60 years for women without contraindications to hormone therapy who have bothersome menopausal symptoms. The WHI results do not support routinely recommending calcium plus vitamin D supplementation for fracture prevention in all postmenopausal women. However, calcium and vitamin D are appropriate for women who do not meet national guidelines for recommended intakes of these nutrients through diet. A low-fat dietary pattern with increased fruit, vegetable, and grain consumption did not prevent the primary outcomes of breast or colorectal cancer but was associated with lower rates of the secondary outcome of breast cancer mortality during long-term follow-up.

Conclusions and relevance: For postmenopausal women, the WHI randomized clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases. Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms among women in early menopause, without contraindications, who are interested in taking hormone therapy. The WHI evidence does not support routine supplementation with calcium plus vitamin D for menopausal women to prevent fractures or a low-fat diet with increased fruits, vegetables, and grains to prevent breast or colorectal cancer. A potential role of a low-fat dietary pattern in reducing breast cancer mortality, a secondary outcome, warrants further study.

Author/s:

Manson, J.E., Crandall, C.J., Rossouw, J.E.

Postpartum Depression-New Screening Recommendations and Treatments

Erin Blanchette — Tue, 05 Dec 2023 20:35:41 +0000

Date Added:

December 5, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 27, 2023

URL:

Postpartum Depression-New Screening Recommendations and Treatments

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.21311

Keywords

Depressive Disorders

Pregnancy

Obstetrics and Gynecology

Women's Health

Postpartum Depression

PMID (1):

38010647

MeSH

A summary of current recommendations regarding detection and treatment of postpartum depression. James W. Mold, MD, MPH

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Perinatal mental health conditions are those that occur during pregnancy and the year following childbirth, whether onset of the condition(s) predates pregnancy or occurs in the perinatal period. Perinatal mental health conditions are the leading cause of overall and preventable maternal mortality and include a wide array of mental health conditions including anxiety, depression, and substance use disorders. Perinatal depression specifically affects 1 in 7 perinatal individuals. While commonly referred to as postpartum depression, it is more accurately called perinatal depression because its onset corresponds with prepregnancy (27%), pregnancy (33%), and postpartum (40%) time frames.

Author/s:

Tiffany A Moore Simas, Anna Whelan, Nancy Byatt

Women’s health update: A literature review impacting primary care

Aubrey Delammermore — Thu, 21 Jul 2022 05:00:00 +0000

Date Added:

July 21, 2022

Journal/Publication:

Cleveland Clinic Journal of Medicine

Publisher:

The Cleveland Clinic Foundation

Publication Date:

July 1, 2022

Issue:

Volume:

Pages:

373-381

URL:

Women’s health update: A literature review impacting primary care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3949/ccjm.89a.21123

Keywords

Women's Health

primary care

Literature Review

Internal Medicine Practice

Disease Risks

PMID (1):

35777837

MeSH

A case-based review of a variety of common women’s health issues. James W. Mold, MD, MPH

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The authors review studies on key issues in women’s health with potential impact on internal medicine practice. The reviewed articles discuss cardiovascular disease risks, bone health, breast cancer genetics, cervical cancer prevention, depression in the peripartum period, pelvic pain, and emergency contraception.

Author/s:

Dolan, B. M., Merriam, S., Prifti, C. A., Walsh, J. M.

The Women's Preventive Services Initiative Well-Woman Chart: A Helpful Tool for the Practice of Internal Medicine

Devin Evans — Tue, 29 Sep 2020 05:00:00 +0000

Date Added:

September 29, 2020

Journal/Publication:

The American Journal of Medicine

Publication Date:

October 1, 2020

Issue:

Volume:

133

Pages:

1122-1125

URL:

The Women's Preventive Services Initiative Well-Woman Chart: A Helpful Tool for the Practice of Internal Medicine

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amjmed.2020.05.011

Keywords

PMID (1):

32565259

MeSH

pregnancy

Perinatal Care

Preventive Health Services

Women's Health Services

A potentially useful chart of preventive services applicable to women endorsed by a number of professional associations.

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The Women's Preventive Services Initiative (WPSI) is a national coalition of 21 professional organizations and patient representatives that develops, reviews, updates, and disseminates evidence-based clinical recommendations for women's preventive health care services, from adolescence into the postreproductive years. The aim of the WPSI is to provide a clinically useful tool for practicing clinicians to help them identify and implement recommended preventive care services. The Well-Woman Chart (WWC) was created to serve as a central reference of the evidence-based reviews and recommendations. The chart provides a quick summary of screening, risk assessment, and counseling recommendations, along with links to obtain further clarification. The topics included are updates to the 2011 Institute of Medicine recommendations, as well as any other topics that were deemed relevant to the well-being of women. A brief summary of preventive services recommended during the pregnancy and postpartum periods are also included, though the WWC is not meant to be a comprehensive guide for perinatal care. We encourage clinicians to familiarize themselves with the contents of the WWC and use this tool to educate others to ensure women receive optimized preventive services.

Author/s:

Batur, Pelin, Phipps, Maureen, Qaseem, Amir