Treatment of gonococcal infections — Surveillance of N. gonorrhoeae isolates reported to the United States Centers for Disease Control and Prevention (CDC) between 2006 and 2011 demonstrated decreasing susceptibility to the oral cephalosporin cefixime [14,15]. As of 2012, the CDC no longer recommends cefixime as a first-line agent for the treatment of gonococcal infections. Patients who receive cefixime as an alternative agent should return one week following therapy for a test-of-cure. (See "Treatment of urogenital gonococcal infections", section on 'Antibiotic resistance' and "Treatment of urogenital gonococcal infections", section on 'Approach to treatment'.)
Hormonal contraception and arterial thrombosis — The largest cohort study of hormonal contraception and arterial thrombosis risk, which included the entire population of Danish women aged 15 to 49 years, reported a small absolute but statistically significant increase in the risk of thrombotic stroke and myocardial infarction among users of low dose estrogen-progestin oral contraceptives compared to nonusers [16]. The risk of thrombotic stroke was also increased for the contraceptive patch and vaginal ring, but the numbers of myocardial infarctions were too low to estimate risk. No excess risk was seen with any of the progestin-only formulations. (See "Risks and side effects associated with estrogen-progestin contraceptives", section on 'Coronary heart disease' and "Risks and side effects associated with estrogen-progestin contraceptives", section on 'Stroke'.)
Hormonal contraception and HIV acquisition or transmission — Whether use of hormonal contraception, particularly depot medroxyprogesterone acetate (DMPA), increases the risk of acquisition or transmission of HIV is unclear; studies have reported discordant results. The Centers for Disease Control and Prevention (CDC) concluded that women at high risk of or having HIV can continue to use all existing hormonal contraceptive methods without restriction (table 1) [17]. For women who use DMPA and are at high risk of acquiring or transmitting HIV infection, the CDC acknowledged the inconclusive nature of the available evidence and emphasized the importance of condom use and other HIV preventive measures. (See "Depot medroxyprogesterone acetate for contraception", section on 'Effect on HIV acquisition and transmission'.)
Postmenopausal hormone therapy and melanoma risk — Although some epidemiologic studies have suggested that postmenopausal hormone therapy is associated with an increased risk of melanoma, no excess risk of either melanoma or nonmelanoma skin cancer was observed in a post-hoc analysis of the Women’s Health Initiative (for unopposed estrogen or combined estrogen-progestin therapy) [18]. (See "Postmenopausal hormone therapy: Benefits and risks", section on 'Skin'.)
Revised guidelines for cervical cancer screening — New guidelines for screening for cervical cancer have been issued by the U.S. Preventive Services Task Force (USPSTF) [19] and by a combined group representing the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology (ACS/ASCCP/ASCP) [20]. The two sets of guidelines, developed independently, overlap in their major recommendations (table 2). The American College of Obstetricians and Gynecologists (ACOG) is currently reviewing guidelines they last issued in 2009, and ACOG members were involved in the development of the ACS/ASCCP/ASCP guidelines [21]. The two new guidelines advise initiating cervical cancer screening for average-risk women at age 21 and discontinuing screening at age 65 for women who have had adequate negative prior screening. Average-risk women have no history of cervical cancer, DES in utero exposure, or significant immunocompromise (such as HIV infection). Women aged 21 to 29 should be screened every three years with cytology only, and women aged 30 to 65 should be screened by either cytology alone every three years or co-testing (HPV test plus cytology) every five years. The ACS/ASCCP/ASCP prefers the co-testing strategy, while the USPSTF suggests co-testing as an alternative for those women who wish to lengthen their screening interval while accepting an increased risk that colposcopy would be needed. All guidelines advise that cervical cancer screening is not indicated for women who have had a hysterectomy, in the absence of a history of cervical cancer or high-grade cervical cancer precursor. (See "Screening for cervical cancer: Rationale and recommendations", section on 'Recommendations of professional organizations'.)
Progestin therapy for complex endometrial hyperplasia — Complex atypical endometrial hyperplasia is generally treated with hysterectomy, with the exception of women who desire future pregnancy and thus are treated medically with progestins. The effectiveness of progestin therapy (in a variety of formulations, eg, oral, depot injection, intrauterine device) was illustrated by a meta-analysis of observational studies that found a 66 percent complete response rate, with persistent disease in 14 percent and recurrent disease in 23 percent [22]. (See "Management of endometrial hyperplasia", section on 'Progestin therapy'.)
Ulipristal acetate for uterine fibroids — Ulipristal acetate, a selective progesterone receptor modulator, was evaluated for treatment of symptomatic uterine fibroids in two randomized trials. One trial found that ulipristal acetate was significantly more effective than placebo for treatment of menorrhagia [23]. In the other trial, ulipristal acetate resulted in a comparable rate of resolution of menorrhagia compared with leuprolide acetate, and patients in the ulipristal acetate group had a significantly lower rate of hot flashes [24]. However, the reduction in uterine size was significantly lower for the ulipristal than leuprolide. (See "Overview of treatment of uterine leiomyomas (fibroids)", section on 'Ulipristal acetate'.)
Progestins in combination hormonal contraceptives associated with an increased risk of thrombosis — In a study that assessed the risk of cardiovascular events in 835,826 combined hormonal contraceptives users, use of combined contraceptives containing drospirenone, norelgestromin, oretonogestrel was associated with a significantly increased risk of venous thrombosis compared with use of standard low-estrogen combined hormonal contraceptives [25]. However, when the analysis was restricted to new users, only drospirenone was associated with a significantly increased risk of thrombosis. (See "Risks and side effects associated with estrogen-progestin contraceptives", section on 'Venous thromboembolic disease'.)
Gynecologic and obstetric care of women with hereditary angioedema — An international expert panel produced guidelines on the gynecologic and obstetric care of women with hereditary angioedema [26]. The guideline reviews the impact of menstruation, pregnancy, lactation, and menopause on disease activity. Options for contraception are summarized and information regarding treatment of infertility and hormonal treatments for breast and cervical cancers are reviewed. (See "Prevention of attacks in hereditary angioedema", section on 'Gynecologic and obstetric care'.)
14.Centers for Disease Control and Prevention (CDC). Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections. MMWR Morb Mortal Wkly Rep 2012; 61:590.
15.Centers for Disease Control and Prevention (CDC). Cephalosporin susceptibility among Neisseria gonorrhoeae isolates--United States, 2000-2010. MMWR Morb Mortal Wkly Rep 2011; 60:873.
16.Lidegaard Ø, Løkkegaard E, Jensen A, et al. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med 2012; 366:2257.
17.Centers for Disease Control and Prevention (CDC). Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of hormonal contraception among women at high risk for HIV infection or infected with HIV. MMWR Morb Mortal Wkly Rep 2012; 61:449.
18.Tang JY, Spaunhurst KM, Chlebowski RT, et al. Menopausal hormone therapy and risks of melanoma and nonmelanoma skin cancers: women's health initiative randomized trials. J Natl Cancer Inst 2011; 103:1469.
19.Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2012.
20..Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012; 62:147.
21.http://www.acog.org/About_ACOG/Announcements/New_Cervical_Cancer_Screening_Recommendations (Accessed on April 06, 2012).
22.Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol 2012; 125:477.
23.Donnez J, Tatarchuk TF, Bouchard P, et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med 2012; 366:409.
24.Donnez J, Tomaszewski J, Vázquez F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 2012; 366:421.
25.FDA Office of Surveillance and Epidemiology. Combined Hormonal Contraceptives (CHCs) and the Risk of Cardiovascular Disease Endpoints. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM277384.pdf (Accessed on February 03, 2012).
26.Caballero T, Farkas H, Bouillet L, et al. International consensus and practical guidelines on the gynecologic and obstetric management of female patients with hereditary angioedema caused by C1 inhibitor deficiency. J Allergy Clin Immunol 2012; 129:308.