Women and Health

Table of Contents

Cover image

Title page

Front-matter

Copyright

Dedication

Preface to the Second Edition

Preface to the First Edition

List of Contributors

Introduction

20th Century Achievements

21st Century Challenges

In Closing

Part I: Women, Health, and Medicine

Section 1: Introduction to Women’s Health

Chapter 1. Women’s Health in the 21st Century

Why Women’s Health?

The Second Edition

An Overview of the Health of Women

Future Directions in the Study of Women’s Health

References

Chapter 2. The Mutability of Women’s Health with Age: The Sometimes Rapid, and Often Enduring, Health Consequences of Injustice

Sex, Gender and Survival

Age, Health and Weathering

Stress Physiology and Aging

Global Application of Weathering

References

Chapter 3. Current Approaches to Women’s Health Care

Women’s Health through a Health Services Lens

Changes in the Paradigm of Women’s Health

Women’s Interactions with the Health Care System

New Models for Women’s Health Services and Research

Future Considerations and Challenges

Women Become Active Stakeholders in their Care

Acknowledgment

References

Chapter 4. The Impact of Health Coverage on Women’s Access to Care in the US

Introduction

Health Coverage for Women Today

Insurance Regulations Affecting Services of Importance to Women

How Coverage Affects Use of Health Care Services

Costs and Other Barriers to Care

Coverage Concerns for Older Women

Health Reform and Women’s Coverage

Conclusion

References

Chapter 5. Complementary, Alternative, and Integrative Medicine and Women’s Health

Introduction/Background

CAM Modalities in Women

Clinical Conditions Difficult to Manage Solely with Conventional Medicine

Epidemiologic Issues, Including Research Methodology and Public Health Impact

Summary and Conclusions/Future Directions

References

Chapter 6. Research on the Health of Sexual Minority Women

Importance of Studying the Health of Sexual Minority Women

Who are Sexual Minority Women?

History of Research on the Health of Sexual Minority Women

Specific Health Concerns for Sexual Minority Women

Barriers and Facilitators to Health Care Access

Future of Research on Sexual Minority Health

References

Section 2: Research Methods in Women’s Health

Chapter 7. Understanding Research Designs

Introduction

Terminology

The Randomized Trial Design

The Cohort Design

The Case-Control Design

The Cross-Sectional Design

Case Reports and Case Series

The Ecological Design

Sources of Error in Epidemiologic Studies

Conclusion

References

Chapter 8. Progress in Women’s Health Research

Introduction

Gender Disparity in Health Research

Intervention Studies

Observational Studies

Remedying the Disparity: Advocacy, Seminal Studies, NIH Response

Women’s Health Movement

Seminal Studies Restricted to Women

Office of Research on Women’s Health

Inclusion of Women in Clinical Trials

Increase in Number of Women Researchers

Lessons Learned and Future Challenges

Research Agenda

Conclusions

References

Chapter 9. Life Course Approach to Research in Women’s Health

Introduction

Life Course Epidemiology

Life Course Theory and Models

Life Course Influences on Health

Life Course Reproductive Characteristics and Health

Life Course Methodology and Study Design

Prevention and Policy

References

Chapter 10. Principles of Genetics and Genomics

Introduction

Understanding the Human Genome

The Genetic Contribution to Disease

Other ‘Omics’ Initiatives

Clinical and Public Health Implications

Acknowledgments

References

Part II: Sexual and Reproductive Health

Section 3: Introduction: Sexual and Reproductive Health

Section 3. Introduction: Sexual and Reproductive Health

Chapter 11. Puberty and Adolescent Pregnancy

Hormonal Regulation of Growth at Adolescence

Biological Maturation and Maturity Indicators

Adolescent Changes in Linear Growth and Body Composition

Characteristics Influencing Adolescent Growth and Maturation

Factors Influencing Secular Change in Growth and Maturation

Short Term Consequences of Early Maturation

Long Term Consequences of Early Maturation

References

Chapter 12. Menstruation and Menstrual Disorders: The Epidemiology of Menstruation and Menstrual Dysfunction

Introduction

Normal Variation in Menstrual Cycles Across the Lifespan

Menstrual Disorders

Regional, Ethnic, and Socioeconomic Differences in Menstrual Cycle Characteristics

Risk Factors Related to Menstrual Cycle Characteristics

Epidemiologic Issues in the Study of Menstrual Function

Summary, Conclusions, and Future Directions

References

Chapter 13. Premenstrual Syndrome

Definition and Diagnosis

Incidence, Prevalence, and Burden of PMS

Pathophysiology

Risk Factors

Treatments

Conclusions

References

Chapter 14. Women’s Fecundability and Factors Affecting It

Introduction

Background and Terminology

Estimates of Fecundability

Factors Affecting Fecundability

Methodological Issues

Future Directions

Acknowledgments

References

Chapter 15. Contraception

Contraceptive Use in the United States

Contraceptive Cost

Contraceptive Use: Medical Eligibility Guidelines

Contraceptive Methods

References

Chapter 16. Induced Abortion

Introduction: History, Background, Definitions, Chapter Objectives

Abortion Procedures

Ascertainment of Induced Abortion

Induced Abortion in the US

Complications of Abortion – Mortality and Morbidity

Global Abortion

Public Health Impact of Induced Abortion – US and Worldwide

Summary and Conclusions

References

Chapter 17. Infertility

Definition of Infertility

Historical Evolution and Trends

Prevalence of Infertility

Access to and Use of Medical Services

Clinical Presentation

Risk Factors

Clinical Issues

Epidemiological Methods

Conclusions and Future Directions

References

Chapter 18. Endometriosis

Description of Endometriosis and Its Impact

Disease Ascertainment and Methods Issues

Frequency of Endometriosis Occurrence

Theories of Endometriosis Pathogenesis

Risk Factors for Endometriosis

Genetic Markers of Susceptibility

Endometriosis Treatment

Summary, Conclusions, and Future Directions

References

Chapter 19. Uterine Leiomyomata

Introduction

Anatomic, Histopathological, and Molecular Characteristics

Issues in the Design of Epidemiological Studies

Frequency of Occurrence and Demographic Patterns

Etiological Hypotheses and Risk Factors

Clinical Epidemiology

Summary and Directions for Future Research

Acknowledgment

References

Chapter 20. Assisted Reproductive Technologies

Introduction

The Epidemiology of Infertility

Assisted Reproductive Technologies (ART)

General Steps Involved with Assisted Reproductive Technologies

Indications for Assisted Reproductive Technologies

Patient Selection for ART

Defining Success in ART

Predicting Success with ART: Is it Possible?

Complications of ART

Conclusions and Future Directions

References

Chapter 21. Pregnancy Complications and Future Maternal Health

Introduction

Cardiometabolic Changes in Pregnancy

Gestational Diabetes Mellitus

Pre-eclampsia

Opportunities for Intervention and Prevention

Conclusion

References

Chapter 22. Labor and Delivery

Introduction

Topics in Labor and Delivery

Effecting Change in Clinical Practice and in the Organization of Health Services

Conclusion

References

Chapter 23. Female Sexuality and Sexual Function

Introduction

Sexuality Throughout the Life Course

The Interactive Biopsychosocial Model of Sexuality and Health

Normal Sexual Function and Response

Female Sexual Dysfunction

Cancer and Sexuality

Instruments to Measure Sexual Function

Conclusion

References

Chapter 24. Vulvodynia

Introduction

Definition

Historical Evolution

Distribution in Women

Etiology

Clinical Issues

Public Health Importance and Future Directions

References

Chapter 25. Menopause: Its Epidemiology

Introduction

Definition of the Menopause

Hormonal Events and the Menopausal Transition

Age and Duration of the Menopausal Transition

‘Symptomatology’ of the Menopause

Is the Menopausal Transition a Keystone in Subsequent Chronic Disease?

Theories and Conceptual Models of Menopause

Summary

References

Chapter 26. Overview of Pelvic Floor Disorders: Epidemiology, Diagnosis, and Treatment

Introduction

Pelvic Organ Prolapse

Bladder Dysfunction

Bowel Dysfunction

Sexual Dysfunction

Methodology for Study

Summary and Conclusions

References

Chapter 27. Hysterectomy

Introduction

Definition and History

Epidemiology

Factors Associated with Hysterectomy

Indications for Hysterectomy

Types and Surgical Routes of Hysterectomy

Prophylactic Bilateral Oophorectomy

Patient-Centered Outcomes

Length of Stay

Cost of Hysterectomy

Alternatives to Hysterectomy

Implications for Practice

Implications for Research

References

Section 4: Introduction: Sexually Transmitted Infections

Section 4. Introduction: Sexually Transmitted Infections

Gender Differences in Risk for Sexually Transmitted Diseases

Section Overview

New Directions

Chapter 28. Gonococcal Infection in Women

Introduction

Microbiology

Epidemiology of Gonococcal Infections in Women

Clinical Spectrum of Infection in Women

Diagnosis of Gonococcal Infections

Specimen Collection

Treatment of Women with Gonococcal Infections

Patient Follow-Up after Therapy

Public Health Aspects of Gonococcal Infections

References

Chapter 29. Chlamydia trachomatis

Introduction

Epidemiology

Transmission

Natural History of Infection

Screening Strategies

Clinical Syndromes

Complications

Sequelae

Risk of HIV Transmission

Microbiology and Diagnosis

Management

STD Control

Cost Effectiveness

Conclusions

References

Chapter 30. Syphilis in Women

Introduction and History

Epidemiology of Syphilis

Considerations in Transmission of Syphilis

Natural History and Clinical Manifestations of Syphilis

Diagnostic Methods

Treatment

Effects of HIV on Syphilis

Syphilis and Pregnancy

Summary

References

Chapter 31. Vaginal Infections

Introduction

The Normal Vaginal Ecosystem

Diagnostic Work-Up of Vaginitis

Vulvovaginal Candidiasis

Trichomoniasis

Bacterial Vaginosis

Conclusion

References

Chapter 32. Genital Herpes

Introduction

Epidemiology

Clinical Epidemiology

Neonatal Herpes

Diagnosis

Therapy

Prevention

Resources for Persons with Genital Herpes

References

Chapter 33. HIV and AIDS in Women

Introduction

Defining and Detecting HIV/AIDS

HIV Acquisition and Transmission

Distribution of HIV/AIDS in Women

Natural History and Clinical Management

Factors Associated with HIV Transmission

Prevention

Conclusions

References

Chapter 34. Human Papilloma Virus Infection in Women

Introduction

Virology

Pathogenesis and Mechanisms of Oncogenicity

Clinical Classification of Oncogenic Changes in the Cervical Epithelium

Epidemiology of HPV

Transmission of Infection

Risk Factors for HPV Infection and Disease

Clinical Screening and Diagnosis of HPV-Related Disease

Treatment of HPV-Related Disease

Primary Prevention: HPV Vaccines

Conclusions

References

Chapter 35. Pelvic Inflammatory Disease and Chronic Pelvic Pain

Introduction

Background

Definition of Chronic Pelvic Pain

Issues Related to Ascertainment

Historical Evolution/Trends

Distribution in Women, Including Incidence, Prevalence, and Mortality Statistics

Risk Factors

Biological Markers of Susceptibility or Exposure

Genetic Markers

Clinical Issues

Methodological Issues for Epidemiological Studies

Prevention and Self-Care

Global Issues

Summary and Conclusions/Future Directions

References

Chapter 36. Urinary Tract Infection

Overview

Range of Clinical Entities and Associated Morbidity

UTI Distribution among Otherwise Healthy Women

UTI Reservoir

UTI Transmission

Risk Factors

Bacterial Virulence Factors

Clinical Issues: UTI among Otherwise Healthy Women

Epidemiological Issues

Future Directions

References

Part III: Occupational, Environmental, and Social Determinants of Health

Section 5: Occupational and Environmental Determinants of Health

Section 5. Occupational and Environmental Determinants of Health

Introduction

Chapter 37. Working Women in the United States: A Statistical Profile

Introduction

Wages, Hours, and Family Responsibilities

Occupational Injuries and Illnesses

Concluding Remarks

References

Chapter 38. International Perspectives: Women’s Occupational Health

The ‘Developed/Developing’ Split

Traditional Unpaid Employment

The Informal Sector

Implications for Occupational Health and Safety

An Additional Hazard: Violence

Economic and Social Responses to Women in the Workforce

Documenting the Issues

References

Chapter 39. Multiple Roles and Complex Exposures

Exposures to ‘Invisible’ Workplace Health Determinants

Prolonged Standing

Stress

Workplace Contributions to Work–Family Balancing

Equality and Health

Analytical Approaches

Acknowledgments

References

Chapter 40. Reproductive Hazards of Occupational and Environmental Exposures

Introduction

Chemical Agents

Physical Agents

Biological Agents

Physical and Psychosocial Strain

Methodological Issues

Risk Assessment, Risk Communication, and Prevention

Concluding Remarks

References

Chapter 41. Work-Related Musculo-Skeletal Disorders

Definitions

Gender and Musculo-skeletal Disorders

At-Risk Occupations

Interpreting Gender Differences

Conclusion and Research Needs

References

Chapter 42. Occupational Cancer

Introduction

Carcinogens in the Workplace

Selected Cancer Sites

Epidemiologic Issues/Future Directions

Conclusion

References

Chapter 43. Environmental Exposures and Cancer

Introduction

Definition of the Topic: Environmental Exposures and Cancer

Epidemiological Evidence

Historical Evolution/Trends

Distribution of Environmental Cancer in Women, Including Incidence, Prevalence, and Mortality Statistics

Host Determinants

Influence of Women’s Social Roles or Context on Environmental Cancer

Risk Factors

Biological Markers of Susceptibility or Exposure

Clinical Issues

Epidemiological Issues

Is Breast Cancer an Environmental Cancer?

Conclusions

Acknowledgments

References

Section 6: Introduction: An Introduction to the Social Determinants of Women’s Health

Section 6. Introduction: An Introduction to the Social Determinants of Women’s Health

Chapter 44. Socioeconomic Determinants of Women’s Health: The Changing Landscape of Education, Work, and Marriage

Introduction

Education Effects on Health

Effects of Work on Women’s Health

Marriage and Women’s Health

Recent Trends in Women’s Education, Work, and Marital Status

Understanding Recent Trends in Mortality and Morbidity in the Context of Changes in Social Determinants of Health

How Will Recent Trends in Education, Marriage History, and Labor Force Participation Affect the Future of Women’s Health?

Challenges and Future Directions

Conclusion

References

Chapter 45. Women, Stress, and Health

The Social Stress Model

Key Sources of Stress in Women’s Lives

Women and Aging

Positive Features of the Social Environment

Intersections with Race and Sexuality

Mechanisms

Directions for Research

References

Chapter 46. Tobacco Use: Trends, Determinants, and Health Effects

Introduction

Trends in Tobacco Use among Women and Girls

Determinants of Tobacco Use among Women and Girls

Health Effects of Tobacco Use among Women

Health Effects of Second-hand Smoke

Conclusions

References

Chapter 47. Alcohol Is a Women’s Health Issue

Introduction

Methodological Issues in Studying Patterns of Alcohol Consumption

Alcohol-attributable Deaths and Disability-adjusted Life Years among Women Globally

History of Alcohol as a Women’s Health Issue

Conclusions

References

Chapter 48. Intimate Partner Violence

Introduction

Prevalence

Risk Factors

Challenges

Conclusion

Acknowledgment

References

Chapter 49. Do Social Policies Influence the Health of Women and their Children?: Implications for Designing Future Policies Using a ‘Social Determinants of Health’ Lens

Introduction: Social Policies, Social Determinants of Health, Gender, and Health Outcomes

Literature Review Methods

Results: Policy Overviews and Health Impacts

Conclusions and Implications: Lessons to Apply to Future Design of Social Policies to Improve the Health of Women

Conclusion

References

Chapter 50. The Impact of the Built Environment on Health

Introduction

Definition of the Topic: the Neighborhood Built Environment and Health

Methods in Built Environment Research

The Modern Built Environment: Sprawl and Transportation

Air Pollution

Overweight/Obesity, Physical Activity, and Diet

Motor Vehicle Crashes and Motor Vehicle-Pedestrian Collisions

Mental Health and Social Capital

Disparities

Research Needs to Understand the Impact of the Built Environment on Health

Conclusion

References

Part IV: Chronic Disease

Section 7: Introduction: Autoimmune Diseases

Section 7. Introduction: Autoimmune Diseases

How Does Autoimmunity Occur?

Why Do Autoimmune Diseases Occur?

Why Do Autoimmune Diseases Preferentially Develop in Women?

What is the Relationship Between Sex Hormones and Autoimmune Diseases?

Summary

Chapter 51. Rheumatoid Arthritis

Introduction

Etiology and Pathogenesis

Epidemiology

Classification Criteria

Evaluation and Management of RA

Prognosis and Outcomes in RA

Future Directions in Rheumatoid Arthritis

References

Chapter 52. Multiple Sclerosis

Overview of Multiple Sclerosis

Pathophysiology

Diagnostic Evaluation

Clinical Parameters

Reproductive Life: MS, Fertility, and Pregnancy

Disease Monitoring

Treatment Strategies

Summary

References

Chapter 53. Systemic Lupus Erythematosus

Introduction

SLE Epidemiology

Clinical Presentation and Management

Management of SLE

Summary

References

Chapter 54. Sjögren’s Syndrome

Introduction and Background

Primary and Secondary Sjögren’s Syndrome

Evolution Since 1930

Definition of Sjögren’s Syndrome

Epidemiology

Host and Environmental Factors

Clinical Manifestations

Laboratory Abnormalities

Management of Sjögren’s Syndrome

Summary

Note in Proof

References

Chapter 55. Asthma

Introduction

Asthma Diagnosis and Management

Increasing Prevalence of Asthma

Gender Differences

Risk Factors

Discussion

Acknowledgments

References

Section 8: Endocrinology and Women’s Health

Section 8. Endocrinology and Women’s Health

Introduction

Chapter 56. The Obesity Epidemic and Women’s Health

Introduction

Definitions and Classifications

Historical Perspective (Evolution/Trends)

The Current Obesity Epidemic

Why do Men and Women in the United States Gain Weight?

Why Do Women Regain Weight?

Host Susceptibility–Genetics. Is Obesity Inherited?

Obesity-Associated Morbidity and Mortality

Heterogeneity in Obesity-Related Risk of Disease: Why Do Some Obese Women Have More Disease Than Other Women?

Epidemiological Issues–Older Women

Clinical Issues: Diagnosis and Treatment

Summary

References

Chapter 57. Diabetes in Women

Introduction

Definition

Prevalence, Public Health Burden, and Distribution of Diabetes

Risk Factors for Diabetes

Health Consequences of Diabetes

Unique Issues to Women

Treatment and Prevention of Diabetes

Conclusions

References

Chapter 58. Thyroid Disease and Women

Introduction

Thyroid Physiology

Biochemical Thyroid Tests

Overview of Thyroid Disease

Summary and Perspective

References

Chapter 59. Management of Menopausal Symptoms in the Post-Women’s Health Initiative Era

Introduction/Historical Perspective

Definition of the Menopause

Symptoms of the Menopause Transition and Postmenopausal Phases

Summary

References

Chapter 60. Vitamin D and Disease Prevention in Women

Introduction

National Guidelines for Vitamin D Intake

Low Vitamin D: Prevalence and Risk Factors

Methodological Considerations

Outcomes

Clinical Recommendations

Conclusion and Future Research Directions

References

Chapter 61. Osteoporosis

Introduction

Definition and Pathophysiology

Public Health Impact