Clinicians who provide women’s health care struggle to stay up-to-date with the
many changes and advances in medicine related to their care. The Focus on Women’s Health Conference will provide evidence-based recommendations related to medical conditions that are unique, occur more frequently or present differently in women.

Focus on Women's Health Conference Topics

Endocrine Causes of Menstrual Dysfunction - More Common Than You Think
Veronica Piziak, MD

The hypothalamic pituitary gonadal axis is very sensitive to changes in the function of a number of endocrine organs and this case-based discussion will help identify endocrine problems earlier when management is easier and more effective.

Objective:

  • Discuss the endocrine-related causes of menstrual dysfunction.

Management of Gestational Diabetes, Type 1 Diabetes, and Type 2 Diabetes in Pregnancy
Veronica Piziak, MD

Gestational diabetes is increasing in the US and providers who manage pregnancy will have to know appropriate management of the disease using insulin and oral agents. Patients with Type 1 and Type 2 diabetes can now have successful pregnancies if they are properly treated. The types of insulin and the delivery devices have changed and will be discussed. Strategies for adjusting insulin and oral agents will be illustrated with cases.

Objectives:

  • Describe the management of Gestational Diabetes;
  • Discuss the Management of Type 2 diabetes during pregnancy;
  • Review the management of Type 1 diabetes during pregnancy.

Osteoporosis: What is Happening?
Veronica Piziak, MD

Osteoporosis is largely untreated due to lack of knowledge of the therapeutic agents’ risks and benefits. The discussion will present case-based examples of different approaches to osteoporosis diagnosis and therapy.

Objectives:

  • Describe when to treat the osteopenia patient;
  • Interpret when to stop bisphosphonate therapy;
  • Discuss new agents for the treatment of osteoporosis.

Cases in Diabetes & Thyroid Disease (New Thoughts)
Veronica Piziak, MD

Treating diabetes in elderly patients or patients with complications is more difficult due to limited medication options and higher risk of complications such as CHF or hypoglycemia. This cased based lecture discusses optimal options for different complications and diabetes management in the elderly patient.

The American Thyroid Association has developed guidelines for treating thyroid disease in pregnancy and the new results about the effects of biotin on thyroid hormone assays.

Objectives:

  • Discuss management of thyroid disease in pregnant patients;
  • Review management of diabetes in elderly patients.

Healthy Living: What's New? Guiding Your Patients in 2019
Veronica Piziak, MD

Over the last year there have been new exercise guidelines for the United States and new information suggesting that any degree of movement is better than sitting. This allows providers of care to advise about personalized exercise programs for even compromised patients that will decrease the risk of cardiovascular death. Plant-based food plans have also been shown to decrease mortality and this discussion with suggest ways to help your patients try to reduce the animal fat in their food plans.

Objectives:

  • Discuss the strategies to improve the food plans your patients' use;
  • Develop exercise programs for your patients;
  • Recognize food plans that should not be used by certain groups of patients.

Concussions and Gender Variations
David Joyner, MD

Many changes in the concussion “present view” are occurring, including definitions, treatment basics, recovery expectations, long-term issues, and increased awareness. Research on gender differences is sparse, but does exist. Understanding present general state and gender differences, with future research, hopefully will improve outcomes and prevention in all at risk populations.

Objectives:

Upon understanding current, basic concussion principles and emerging concepts, (including gender differences), the learner will have an increased basis for recognition and treatment options.

Newer Orthopedic Modalities & Therapies
David Joyner, MD

New and intriguing developments that are in trials will potentially improve, in the future, the ability to appropriately use biologics (stem cells) and other treatments. Examples will be given of several studies that are ongoing to scientifically delineate the safety and effectiveness (or not) of these biologics, and techniques.

Future patient outcomes will hopefully be positively influenced as the providers learn what new treatments may be available for various orthopedic conditions.

Objectives:

Upon understanding the future potentials, the learner will be able to utilize emerging technologies to make better decisions to enhance patient care and outcomes.

Competing Hypertension Guidelines: Where Are We Now?
Donald J. DiPette, MD

Despite safe and effective non-pharmacologic and pharmacologic treatment for hypertension, the cardiovascular disease burden attributed to partially or untreated hypertension continues to be a major public health crisis. To address this disease burden in the United States, and now globally, hypertension guidelines have been periodically developed to aid in the clinical diagnosis, management, and treatment of the individual with hypertension. Recently in 2018, the American College of Cardiology and the American Heart Association (ACC-AHA) released new hypertension guidelines. These guidelines differed greatly from previous guidelines in the United States as well as other countries. Given the magnitude of the changes in these guidelines, there is a need to review these guidelines and the evidence-based medicine that led to the changes proposed and to determine the clinical applicability of the guidelines. Since the ACC-AHA Hypertension Guideline release, competing guidelines have also been published. Of these guidelines, the European Society of Cardiology/European Society of Hypertension 2018 Hypertension Guideline was most recently released. Some of the recommendations in this most recent guideline differ from those previously. Due to the changes given, there is a need to review these guidelines and the evidence-based medicines that lead to the recommendations of each and to determine the clinical applicability of the guidelines.

Objectives:

  • Compare and contrast the recommendations of the ACC-AHA 2018 Hypertension Guidelines to those previously published;
  • Review the important new clinical studies and their results which led to the changes proposed in the ACC-AHA 2018 guidelines;
  • Review the recommendations of the recently published ESC/ESH 2018 Hypertension Guideline;
  • Determine the clinical importance and applicability of the ACC-AHA 2018 Hypertension Guidelines to the practicing clinician in the management and treatment of hypertension.

Hypertension in Pregnancy
Donald DiPette, MD

Hypertension is the most common medical problem encountered during pregnancy. There is little information available to guide primary care providers about the choice of antihypertensive agents in pregnancy on the basis of comparative trials of one antihypertensive agent versus another. Some antihypertensive agents may be best avoided in pregnancy, although not without controversy. The goal of this session is to review the classifications and risks of hypertension in pregnancy, as well as discuss appropriate management strategies, using case presentations, for antihypertensive therapy of hypertensive disorders of pregnancy.

Objectives

  • Identify the classifications and risks of hypertension in pregnancy;
  • Describe the relative benefits and risks of antihypertensive therapy for severe hypertension and non-severe hypertension in pregnancy;
  • Select an appropriate antihypertensive agent for the initial treatment of severe or non-severe hypertension in pregnancy.

Modalities to Achieve Hypertension Control in Clinical Practice: A Call to Action
Donald DiPette, MD

Cardiovascular disease continues to be the leading cause of morbidity and mortality in the United States and now globally. Hypertension also remains one of the major risk factors for cardio disease including heart disease (coronary heart disease, congestive heart failure, left ventricular hypertrophy, and arrhythmia), cerebrovascular disease (stroke), and renal disease (renal insufficiency and failure). Despite safe and effective treatment for hypertension, the awareness, treatment, and control rates for hypertension are disappointing, including in the United States (hypertension control rates of approximately 50%-60%). Given these rather dismal control rates, it is clear that different approaches to the detection, management, and treatment of hypertension is sorely needed. Newer modalities to approach the hypertensive patient could include the use of smaller pharmacologic formularies and fixed-dose combination anti-hypertensive agents, including in the initial treatment of the hypertension.

Objectives:

  • Describe the barriers that contribute to poor hypertension control;
  • Distinguish the advantages of using a smaller pharmacologic drug formulary in the treatment of hypertension;
  • Demonstrate the advantages of using fixed-dose combinations in the treatment of hypertension;
  • Develop a plan to choose appropriate fixed-dose combination medications in the treatment of hypertension.

Top Cardiovascular Studies in 2018: Practice Implications
Donald Dipette, MD

In general, the management and treatment of disease states has been and continues to expand rapidly. In particular, new scientific knowledge which has been translated to disease management has been robust in cardiovascular diseases. Given this welcomed rapid expansion of disease knowledge and treatment it is critical that the practicing clinician is up to date on newly reported clinical studies which either immediately or in the not too distant future will impact disease treatment.

Objectives:

  • Discuss recent clinical studies which impact patient care and treatment in cardiovascular diseases;
  • Describe new clinical studies which alter the clinical use of aspirin in the primary prevention of cardiovascular events in the general population and in diabetes;
  • Review new clinical studies that explore the use of omega-3 fatty acids in the treatment of cardiovascular disease;
  • Interpret recent clinical studies that suggest a significant role of inflammation in coronary artery disease, thus, targeted therapy to reduce the inflammatory response may be a new target for the treatment individuals with established coronary artery disease.

Preconception Care - The Gateway to a Healthy Pregnancy
Nancy Phillips, MD

Preconception counseling intends to optimize pregnancy outcomes and prevent maternal morbidity and mortality through identifying and modifying biomedical, behavioral, and social risks prior to pregnancy. Currently, 45% of pregnancies in the United States are unintended, 27% of women of childbearing age are obese, and first pregnancies to women over 35 have more than doubled since the 1990s. Maternal comorbidities have also increased. With these statistics, preconception counseling has an increasingly important role and should be part of the discussion in medical care of all women of childbearing age. This lecture will present a historic view of preconception counseling, review the current recommendations and focus on the main comorbidities that can be optimized to make a significant impact on improving outcomes. The increasingly complex world of carrier screening will also be briefly reviewed.

Objectives:

  • Integrate preconception counseling into one's medical practice;
  • Recognize women who should be referred for specialized preconception counseling, including maternal fetal medicine or genetics consultations;
  • Implement changes to medical management of common medical problems to optimize pregnancy outcomes.

Sexual Transmitted Infections: I've Got an APP, What Else Do I Need?
Nancy Phillips, MD

Sexually transmitted infections are possible in anyone in a sexual relationship, and without early diagnosis and intervention may have significant sequelae. General screening and treatment guidelines are easily obtained on readily available apps. The goal of this lecture is to fill the gaps between clinical practice and an app. This will include recognition of STIs and STI imposters, introduction to an alternative diagnostic algorithm of syphilis, reconsideration of the presenting demographics of STIs, an update of HPV vaccination, and a look at some common vaginal infections in the context of sexual transmission.

Objectives:

  • Utilize the CDC STI App to aid in diagnosis and treatment of STIs;
  • Recognize that not all genital lesions are STIs, and proper diagnosis has profound medical and social implications;
  • Interpret the new syphilis diagnostic algorithm;
  • Recommend pre-exposure prophylaxis for HIV.

Contraception Controversies Panel Discussion
Nancy Phillips, MD

Contraception should be individualized for each woman, based on preference, long- and short-term fertility needs, and medical history. All contraception includes risks, and a risk/benefit analysis should be included in the decision. This lecture, through a series of case presentations, will explore contraceptive choices in women with various medical conditions and situations, focusing on the risk/benefit balance.

Objectives:

  • Apply the 2016 US Medical Eligibility Criteria for Contraceptive Use Table and App to use in everyday practice;
  • Utilize long-acting contraception in special populations, including adolescents;
  • Recognize contraceptive counseling as a health intervention in women with chronic disease.

Clinical Dilemmas: Vulvovaginitis and Vulvodynia
Nancy Phillips, MD

Vulvovaginitis and vulvodynia are conditions which have a negative impact on a woman’s psychosocial and sexual health. Vulvovaginitis presents with nonspecific symptoms of vaginal discharge, itching, irritation, and/or odor. Although most women experience at least a single episode of vulvovaginitis, chronic or recurrent symptoms may occur. Vulvodynia, defined as vulvar pain of at least 3 months duration, without clear identifiable cause, affects up to 16% of women. In 2015, a new definition was introduced which added potential associated factors, which helps in differentiation and treatment of this multifactorial disorder. This lecture will review the most common etiologies of vulvovaginitis, focusing on proper evaluation and therapeutic strategies for chronic and recurrent disease. Additionally, this lecture will review the new definition of vulvodynia and propose a clear diagnostic approach and treatment plan for this chronic pain disorder.

Objectives:

  • Evaluate a woman with vulvovaginal symptoms, considering the basic components of pH, microscopic evaluation, and appropriate laboratory testing;
  • Institute therapeutic and suppressive treatments for chronic or recurrent vulvovaginal symptoms;
  • Recognize the complexity of vulvodynia and initiate a multidisciplinary treatment plan.

PCOS Panel Discussion
Nancy Phillips, MD

Women with polycystic ovary syndrome (PCOS) often present to their gynecologist with absent or irregular menstrual cycles. Most times their cycles are fixed – with medical interventions generally designed to either provide contraception or ovulation induction, depending on their needs However, the diagnosis of PCOS has more serious implications, including metabolic syndrome, type 2 diabetes, cardiovascular disease and endometrial carcinoma. This lecture aims to explore, in a multidisciplinary fashion, a comprehensive approach to the evaluation, treatment and counseling of women with PCOS. After a brief introduction, cases will be presented and an interactive panel discussion will ensue.

Objectives:

  • Recognize PCOS as a disorder which reaches beyond an abnormal menstrual cycle;
  • Develop a treatment strategy for PCOS which incorporated a multi-system or multidisciplinary approach;
  • Counsel women with PCOS to promote healthy habits and lifestyle changes, appropriate screenings and fertility planning.

Diabetes in Pregnancy - Screening and Maternal-Fetal Implications
Nancy Phillips, MD

Gestational diabetes is associated with serious maternal and fetal complications, including pre-eclampsia, macrosomia, shoulder dystocia, increased risk of Cesarean delivery, and stillbirth. Pregestational diabetes is associated additionally with fetal anomalies and accelerated renal, ocular, and vascular disease in the mother. However, the optimal testing to identify women with gestational or undiagnosed pregestational diabetes remains debated. The aim of this lecture is to review the various options of diabetes screening in pregnancy and discuss the risks of this increasingly prevalent disease.

Objectives:

  • Recognize the implications of diabetes (both gestational and pregestational) in pregnancy and beyond;
  • Develop a screening protocol based on their population needs, considering the pros and cons of each suggested method.

Oncofertility: Fertility Preservation and Gynecologic Considerations in Oncology Patients
Julie Sroga-Rios, MD

Greater than 70%-80% of women and children will survive cancer. Infertility is a large concern that survivors report. The American Society for Reproductive Medicine and the American Society for Oncology recommend counseling all patients receiving gonadotoxic therapies regarding the potential impact of cancer/medical treatments on future fertility, as well as offering fertility preservation if applicable. This lecture will review current literature on clinical oncofertility options, as well as gynecology issues and care post-treatment.

Objectives:

  • Assess risk of gonadotoxic therapies;
  • Describe options for both standard of care and experimental fertility preservation options in female patients receiving gonadotoxic therapies;
  • Interpolate special considerations in different populations to address during fertility preservation counseling;
  • Review gynecology considerations in women and girls receiving gonadotoxic therapies both during and following treatment.

Clinician Burnout
Jennifer Wells, MD

There is an epidemic of physician burnout in the United States, and it has a pervasive negative effect on all aspects of medical care, including your career satisfaction. According to one researcher, “Numerous global studies involving nearly every medical and surgical specialty indicate that one in every three physicians is experiencing burnout at any given time.”(Shanafelt 2009) The 2015 Medscape Physician Lifestyle Survey reported an even higher burnout rate – 46 percent of physicians, up from 39.8 percent in the 2013 survey. This burnout leads to an impressive number of undesirable outcomes including but not limited to: alcohol and drug addiction as well as SUICIDE. This lecture will look at the epidemiology of clinician burnout and suicide as well as risk factors. It will also address the relationship between mood disorders and stress in life and finally, look at tools to lower stress and create life balance.

Objectives:

  • Discuss Background and Context;
  • Define Epidemiology of Suicide;
  • Identify Epidemiology of Suicide specific to physicians;
  • Recognize the underlying neurobiology of mood disorders and neurotransmitter dysfunction;
  • Obtain an understanding of the relationship between mood disorders and stress in life;
  • Review what can be done and what are we doing.

Behavioral Change for the Office-based Clinician
Jennifer Wells, MD

Healthy behaviors may reduce or prevent morbidity and mortality (Lin et al., 2004). A healthy diet, for instance, helps to prevent many diseases such as diabetes, coronary heart disease and cancer (van Kreijl et al., 2004). Physical activity prevents diseases such as cardiovascular disease and diabetes (Koek et al., 2003) and results in improved cardiovascular health, lowered blood pressure, reduced risk of mortality, increased muscle strength, decreased depression and anxiety and improved quality of life (Bouchard et al., 1994). Smoking is the most important single risk factor for mortality and has been related to 12% of the burden of disease in Western Europe (Feenstra et al., 2006). Thus, behaviors are relevant to health yet unhealthy habits are still highly prevalent and many healthcare providers struggle to promote and educate their patients on how to make lasting behavior change. This lecture will provide an overview of strategies for behavior change, their effectiveness and tips for use by the outpatient clinician.

Objectives:

  • Examine how predisposing factors, beliefs, attitudes, and significant others affect a person’s behavior changes;
  • Assess behavior change techniques and learn how to apply them to clinical situations;
  • Recognize the benefits of healthy behaviors;
  • Establish motivation to change health behaviors.

Eating Disorders Panel Discussion
Jennifer Wells, MD

According to eating disorders statistics estimated by the National Eating Disorder Association, up to 30 million people in the United States suffer from an eating disorder such as anorexia nervosa, bulimia nervosa or binge eating disorder. The primary care provider should play an active role in identifying and treating patients with eating disorders. Eating disorders have the highest mortality rate of any mental illness. Enhancing diagnostic skills and increasing the primary care physician’s comfort level in dealing with these disorders is key to reach and treat more patients. This multi-specialty panel will offer a comprehensive insight into these disorders, addressing psychological, endocrine/metabolic, and reproductive health issues which present in this population.

Objectives:

  • Define common eating disorders;
  • Distinguish warning signs and symptoms of eating disorders;
  • Recognize psychological, endocrine/metabolic and reproductive health issues which present in this population.

Difficult Challenges from this Year
All Faculty

As clinicians, we attend conferences each year to learn new things, review old challenges, and sometimes ponder the ethical decisions we face each day. For example, this year, endometriosis now has elagolix; hormone replacement has an FDA-approved bioidentical combination of estrogen and progesterone; the first live birth after a deceased donor transplant was reported in Brazil; a family fought over their deceased son’s sperm; ACOG states they no longer recommend routine pelvic exams. These challenges also include the management of uncontrolled diabetes in patients with multiple complications, and treatment options for patients with severe hypercholesterolemia. The goal of this session is to review new interventions, explore the ethics of medicine, and discuss the interaction of technology and hands-on medical practice through an interactive audience discussion. At the conclusion of this activity, participants should be able to:

Objectives:

  • Utilize new medications into the treatment of common gynecologic disorders;
  • Implement strategies to manage patients with severe hypercholesterolemia, and those with uncontrolled diabetes who have multiple complications;
  • Examine the interaction of medicine, technology and ethics;
  • Incorporate “shared decision making” into their medical practices.