Reproductive Health
Family Planning
Women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) should discuss family planning as early as possible after diagnosis. (Andreoli et al., 2015) Most women can have successful pregnancies with proper risk assessment and management. Risk factors include disease activity, autoantibody profile, previous vascular/pregnancy complications, hypertension, and medication use. Hormonal contraception and menopausal hormone therapy can be used in stable/inactive disease with low thrombosis risk. Fertility preservation with gonadotropin-releasing hormone analogues should be considered before immunosuppressant use.
Assisted Reproduction
Assisted reproduction techniques can be safely used in SLE/APS patients with stable/inactive disease. Patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. (Andreoli et al., 2015) Careful monitoring of disease activity, renal function, and serological markers is important during pregnancy.
Pregnancy Management
Pregnancy in SLE/APS patients requires close monitoring and management. Assessment of disease activity, renal function, and serological markers is crucial for detecting flares and obstetrical complications. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. (Andreoli et al., 2015) Measures can be taken to reduce the risks of adverse maternal or fetal outcomes.
Menopausal Health
Menopausal Hormone Therapy (MHT)
MHT, including estrogen-alone therapy (ET) and estrogen plus progestin therapy (EPT), has a complex balance of benefits and harms on various health outcomes in perimenopausal and postmenopausal women. [<<paper|e22481fa-b2bb-44c2-8e5e-df3416eaf782|1|0>>]
Benefits of MHT include relief of vasomotor symptoms, prevention of fractures, and reduced risk of diabetes mellitus, cardiovascular mortality (ET), and colorectal cancer (EPT). [<<paper|3d212028-b727-4f36-816b-16aa4cc61700|4|1>>]
Risks of MHT
MHT is associated with increased risks of stroke, venous thromboembolism, cardiovascular disease incidence and recurrence, cerebrovascular disease, nonfatal stroke, deep vein thrombosis, gallbladder disease requiring surgery, and lung cancer mortality (EPT). [<<paper|3d212028-b727-4f36-816b-16aa4cc61700|4|1>>]
The effects of ET and EPT differ for endometrial cancer, endometrial hyperplasia, and Alzheimer’s disease. [<<paper|e22481fa-b2bb-44c2-8e5e-df3416eaf782|1|0>>]
Considerations for MHT Use
The benefits and risks of MHT vary depending on the type, dose, formulation, duration of use, route of administration, and age of initiation. Careful consideration of these factors is important when prescribing MHT. [<<paper|e22481fa-b2bb-44c2-8e5e-df3416eaf782|1|0>>]
MHT is appropriate for symptom management in some women, but its use for chronic disease prevention is not supported by the evidence from the Women’s Health Initiative randomized trials. [<<paper|3d212028-b727-4f36-816b-16aa4cc61700|4|1>>]
Women’s Health Research and Innovation
Gender Disparities in Invention
Women engage in less commercial patenting and invention compared to men, which may affect the diversity of inventions. [<<paper|ce4278df-21f3-4042-9db6-398e6d5603a3|1|0>>]
Patents by all-female inventor teams are 35% more likely than all-male teams to focus on women’s health. This suggests that the gender gap in invention may be partially responsible for the lack of female-focused inventions. [<<paper|ce4278df-21f3-4042-9db6-398e6d5603a3|1|0>>]
Improving Women’s Health Research
Appropriate and accessible preclinical models are essential for the clinical translation of delivery technologies for women’s health, but the physiological and pathophysiological differences amongst species must be considered. [<<paper|84d68736-b0f4-4916-8a64-4f5dc20f8764|2|3>>]
The engineering of delivery systems for women’s health can build on delivery technologies that have shown clinical success in other disease applications. Safety and toxicity are key design considerations for women’s health applications. [<<paper|84d68736-b0f4-4916-8a64-4f5dc20f8764|2|0>>]
Funding and Representation in Women’s Health
There is a disparity between the preclinical funding and disease burden for women-specific disorders compared to men-specific disorders. For almost 75% of disorders that affect primarily one gender, US federal funding favors men. [<<paper|84d68736-b0f4-4916-8a64-4f5dc20f8764|2|3>>]
Women’s health research must also consider the complex social sensitivities in reproductive health and the mother-fetus as a single entity, which can present additional challenges. [<<paper|84d68736-b0f4-4916-8a64-4f5dc20f8764|2|3>>]
