Research Database -
International Updates

Women's Health

Issue 68

CHEN and colleagues, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC, systematically evaluated the effects of weekly support group meetings for women with postnatal distress.
Background: Depression experienced by women postnatally may have profound effects on the lifelong health of the mother and her child.
Methods: 60 postnatally distressed women were randomized to either a ‘support’ (n=30) or control (n=30) group. The ‘support’ group participated in four supportive group sessions comprising discussions about the transition to motherhood, postnatal stress management, communications skills and life planning.
Results: Women in the ‘support’ group had significantly decreased scores on the Beck Depression Inventory (BDI) and the Perceived Stress Scale (PSS) and significantly increased scores on the Interpersonal Support Evaluation List (ISEL) at the end of the fourth weekly supportive group session. No significant changes on these measures occurred in the control group.
Discussion: Participation of postnatally distressed women in support groups appears to result in quantifiable psychosocial benefits. The authors believe this to be the first controlled study to provide such evidence.
Chen CH et al. Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan. Journal of Psychosomatic Research 49 (6): 395-9. Dec 2000.

DELLENBACH and colleagues, Centre de la douleur pelvienne chronique, service de gynecologie, syndicat inter-hospitalier de la Communaute urbaine de Strasbourg, centre medico-chirurgical et obstetrical, 19, rue Louis-Pasteur BP120, 67303 Schiltigheim, France, described their new approach to the treatment of chronic pelvic pain in women.
Background: In up to 40% of cases of chronic pelvic pain, no physical aetiology can be found. Psychological interventions are often used as last-ditch efforts and generally not well accepted by patients. The authors proposed that the pain is in many cases not visceral but parietal and can be approached like classic fibromyalgia.
Methods: Clinical report of a multidisciplinary, simultaneously physical and psychological approach to the treatment of women with chronic pelvic pain.
Results: 70% of women with chronic pelvic pain will be cured using the approach. A slow revelation of the physical, moral or sexual trauma in the history of these patients is observed with the treatment described.
Conclusions: Treatment efficacy is greatly enhanced by considering the physical dimension of body pain as well as the psychological dimensions.
Dellenbach P et al. Chronic pelvic pain. Another diagnostic and therapeutic approach. Gynecologie, obstetrique et fertilite 29 (3): 234-43. Mar 2001.

STAMP and colleagues, Centre for Research into Nursing and Health Care, University of South Australia and North Western Adelaide Health Service, North Terrace, Adelaide, SA 5000, Australia, georgie.stamp@unisa.edu.au, investigated the effects of perineal massage in the second stage of labour on perineal outcomes.
Methods: In a randomized controlled clinical trial, 1340 women at 36 weeks’ gestation, expecting normal birth of a singleton, who during labour progressed to full dilatation of the cervix or 8 cm or more if nulliparous or 5 cm or more if multiparous, were randomized to receive or not to receive massage and stretching of the perineum during the second stage of labour with a water-soluble lubricant. Primary outcome measures were rates of: intact perineum; episiotomies; and first, second, third and fourth degree tears. Secondary outcomes were: pain at 3 and 10 days postpartum; and pain, dyspareunia, resumption of sexual intercourse, and urinary and faecal incontinence and urgency at 3 months postpartum.
Results: Rates of intact perineums, first and second degree tears, and episiotomies were similar in the massage and control groups. The massage group had fewer third degree tears (12 [1.7%] versus 23 [3.6%]; absolute risk, 2.11; relative risk, 0.45; however, the trial was not sufficiently powered to measure this rarer risk. There were no differences in secondary outcomes between the groups.
Discussion: The results do not support an increased likelihood of an intact perineum or reduced risks of pain, dyspareunia or urinary or faecal problems following perineal massage during labour.
Stamp G et al. Perineal massage in labour and prevention of perineal trauma: randomized controlled trial. British Medical Journal 322 (7297): 1277-80. May 2001.

MEYER and colleagues, Urogynecology Unit, Department of Obstetrics and Gynecology, CHUV, Lausanne, Switzerland, sylvain.meyer@chuv.hospvd.ch, assessed the effects of pelvic floor education after vaginal delivery on pelvic floor characteristics in nulliparous women.
Methods: 107 women were examined during pregnancy and at 9 weeks and 10 months after vaginal delivery. Assessment methods included: a questionnaire, clinical examination, perineosonography, urethral pressure profiles, and intravaginal and intra-anal pressure recordings during pelvic floor contraction. After the second examination, women were alternately assigned to either 12 sessions of pelvic floor exercises with biofeedback and electrostimulation (n=51) or no training (n=56). The two groups were compared at the third examination.
Results: Incidence of stress urinary incontinence decreased in significantly more women in the pelvic floor education (19%) than in the control (2%) group. Incidence of faecal incontinence (4% versus 5%) and the percentage of women who recovered predelivery pelvic floor contraction strength (41% versus 33%) were no different between treatment and control groups. There were no differences in bladder neck position and mobility, urethral functional length, maximal urethral closure pressure, pressure transmission ratio, residual area of continence at stress standing, or intravaginal or intra-anal pressures during pelvic floor contraction between groups at the third examination.
Discussion: Pelvic floor education begun 2 months postpartum significantly reduced the incidence of stress urinary incontinence, but did not reduce faecal incontinence or weak pelvic floor or affect other pelvic floor characteristics or related functions measured.
Meyer S et al. Pelvic floor education after vaginal delivery. Obstetrics and Gynecology 97 (5 Pt 1): 673-7. May 2001.

Issue 66

CHAMBERS and colleagues, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, London, UK, J.kooner@ic.ac.uk investigated whether endothelial function is impaired in nonpregnant women with previous preeclampsia and whether endothelial dysfunction is mediated by oxidative stress.
Background: Preeclampsia is thought to result from the release of placental factors that damage the maternal vascular endothelium. Most studies, however, have been conducted during pregnancy, so it has not been possible to separate maternal from placental mechanisms underlying the endothelial dysfunction.
Methods: A case-control study was conducted at 3 hospital maternity units in London, UK between July 1997 and June 2000 and involved 113 women with previous preeclampsia (n=78 with a single episode; n=35 with recurrent episodes) and 48 women with previous uncomplicated pregnancies. All were at least 3 months (median, 3 years) postpartum. The main outcome measures were brachial artery flow-mediated (endothelium-dependent) and glycerol trinitrate-induced (endothelium-independent) dilatation. These measures were compared between previously preeclamptic women and controls, and were repeated in 15 cases and 15 controls after administration of 1 gram ascorbic acid (vitamin C) intravenously.
Results: Mean flow-mediated dilatation was lower in women with previous preeclampsia (recurrent group, 0.9%; single-episode group, 2.7%; controls, 4.7%; p<0.001). Glycerol trinitrate-induced dilatation was similar in the 3 groups (19.5%, 21.0% and 21.0% respectively). Impaired flow-mediated dilatation in previously preeclamptic women was not accounted for by recognized vascular risk factors. Ascorbic acid increased flow-mediated dilatation in previously preeclamptic women (from 2.6% at baseline to 5.6%; p=0.001), but not in controls (baseline, 6.2% versus 6.7% after ascorbic acid).
Conclusions: The results indicate that endothelial function is impaired in nonpregnant women with previous preeclampsia, is not explained by established maternal risk factors, but is reversed by administration of the antioxidant ascorbic acid.
Chambers JC et al. Association of maternal endothelial dysfunction with preeclampsia. Journal of the American Medical Association (JAMA) 285 (12): 1607-12. Mar 2001.
Comment: This is a highly interesting finding. Positive Health will be publishing an article in Issue 69 about Intravenous Vitamin C Therapy by Stephen Levine Ph.D.

VUTYAVANICH and colleagues, Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand, tvutyava@mail.med.cmu.ac.th investigated the effectiveness of ginger for treating nausea and vomiting of pregnancy.
Methods: 70 women with nausea and vomiting of pregnancy who first attended an antenatal clinic at or before 17 weeks’ gestation were randomized in a double-masked design to receive for 4 days either:
1) oral ginger 1 gram/day or; 2) an identical placebo. Before treatment, and again during the 4 consecutive days while taking treatment, the women graded the severity of their nausea using visual analogue scales (VAS) and recorded the number of vomiting episodes in the previous 24 hours. The severity of their symptoms was assessed at a follow-up visit 7 days later using 5-item Likert scales.
Results: All participants, except 3 in the placebo group, remained in the study. VAS scores of nausea decreased significantly in the ginger group (by 2.1) compared with the placebo group (0.9; p=0.014). The number of vomiting episodes decreased significantly in the ginger group (by 1.4) compared with the placebo group (0.3; p<0.001). Likert scales showed that nausea symptoms improved in 28 of 32 in the ginger group, compared with 10 of 35 in the placebo group (p<0.001). No adverse effect of ginger on pregnancy outcome was detected.
Conclusions: The authors concluded that ginger is effective for relieving the severity of nausea and vomiting of pregnancy.
Vutyavanich T et al. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstetrics and Gynecology 97 (4): 577-82. Apr 2001.
Comment: Many pregnant women already use ginger to help with nausea and vomiting; it is good to see the clinical research supporting the efficacy of ginger in this regard.

Issue 65

SHIIZAKI and colleagues, Kampo and Pharmacognosy Laboratories, Tsumura & Co., 3586 Yoshiwara, Ami-machi, Inashiki-gun, Ibaraki 300-1192, Japan. shiizaki-kazuhiro@mail.tsumura.co.jp have established a highly sensitive bioassay system aimed at measuring oestrogen activity in Chinese herbal medicines.
Background: Plants contain substances with oestrogen activity referred to as phytoestrogens, comparable to those in animals where oestrogens are steroid hormones. Phytoestrogens may be responsible in part for the effects of Chinese herbal prescriptions for postmenopausal disorders. Oestrogen activity in herbal medicine is considered extremely important for patients in whom oestrogen administration is contraindicated.
Methods: The most important action of oestrogen is the transcriptional
regulation of specific genes via oestrogen receptors (ER). The investigators therefore established a highly sensitive bioassay system by placing oestrogen-responsive elements (ERE) upstream to the reporter gene, and used this assay to determine the oestrogen activity in herbal medicines.
Results: Phytoestrogens were found in many Chinese herbal prescriptions for postmenopausal disorder.
Conclusion: Some prescriptions were considered to effectively administer hormone replacement therapy (HRT). However, since oestrogen activities in most Chinese herbal preparations were thought to be weak, it was considered that these prescriptions improved postmenopausal disorder via a mechanism different to that of oestrogen replacement therapy.
Shiizaki K et al. Bioassay of phytoestrogen in herbal medicine used for postmenopausal disorder using transformed MCF-7 cells. Phytotherapy Research 13 (6): 498-503. Sep 1999.

Comment: See also Kate Neil’s article Phytoestrogens Re-examined in this issue, page 28. Chinese herbs have played an important role in the
management of menopausal symptoms. This type of research is valuable in that it dissects out the mechanisms of active of these herbs.

Issue 64

BURNS and colleagues, Oxford Centre for Health Care Research and Development, Oxford Brookes University, UK examined whether
aromatherapy contributed to maternal comfort during labour and improved the quality of midwifery care.
Methods: Between 1990 and 1998, 8,058 mothers were evaluated in the delivery suite of a large British teaching hospital. Women were offered aromatherapy to relieve anxiety, pain, nausea and/or vomiting or to strengthen contractions. 60% of the sample were primagravidae, and 32% had their labour induced. Data from the unit audit were used to provide a comparison group of 15,799 mothers not given aromatherapy. Data were analysed for the following outcome measures: mothers’ ratings of effectiveness, outcomes of labour, use of pharmacological pain relief, uptake of intravenous oxytocin, reported associated symptoms, and annual costs.
Results: Aromatherapy use was increasingly popular with mothers and midwives. More than 50% of mothers found it helpful, versus 14% who found it unhelpful. Aromatherapy during childbirth appeared to reduce the need for additional pain relief medication in a proportion of mothers. More than 8% of primagravidae and 18% of multigravidae used no conventional pain relief during labour after using essential oils. The use of pethidine at the centre declined over the years of the study from 6% to 0.2% of women. There were indications that aromatherapy may be able to augment labour contractions for women in dysfunctional labour. The number of associated adverse symptoms reported was very low (1%).
Conclusion: The study demonstrated the successful integration of a complementary therapy into mainstream midwifery practice and forms a basis for future research.
Burns EE et al. An investigation into the use of aromatherapy in intrapartum midwifery practice. The Journal of Alternative and Complementary Medicine 6 (2): 141-7. Apr 2000.
Comments: The Oxford Centre above is becoming a centre of excellence in incorporating complementary therapies into mainstream midwifery.

PAK and colleagues, Department of Acupuncture and Anatomy, Dongshin University, Naju, South Korea investigated whether acupuncture in
pregnant rats could suppress oxytocin-induced uterine contractions, and compared the results with those of an oxytocin antagonist.
Background: Preterm labour (PTL) is one of the main causes of foetal mortality and morbidity. Current methods of preventing PTL are not very effective and often have significant side effects.
Methods: Uterine contractions were induced in pregnant rats by continuous infusion of oxytocin. The first foetus in one uterine horn near the ovarian end was removed, and a distilled-water-filled catheter was inserted into the vacated amniotic sac to measure uterine contractions (as changes in intrauterine pressure). Two acupoints, Ho-Ku (LI-4) and San-Yin-Chiao (Sp-6), were selected for acupuncture; Kuan-Yuan (Co-4) was used for moxibustion.
Results: Acupuncture on LI-4, but not on Sp-6, significantly suppressed the oxytocin-induced uterine contractions (p<0.05). Stimulation of Co-4 by moxibustion had no significant tocolytic effect (p>0.05). Administration of an oxytocin antagonist eliminated all the oxytocin-induced uterine contractions. Acupuncture to restimulate the uterine activity suppressed by the oxytocin antagonist had no effect; prostaglandins did restimulate the uterine contractions.
Conclusion: Acupuncture on LI-4 suppressed oxytocin-induced uterine contractions in pregnant rats. If it is similarly effective in women, it may offer an alternative medical treatment for women in PTL.
Pak SC et al. The effect of acupuncture on uterine contraction induced by oxytocin. The American Journal of Chinese Medicine 28 (1): 35-40. 2000.

Issue 62

Hernandez-Reif and colleagues, Touch Research Institute, University of Miami School of Medicine, FL 33101, USA. investigated massage therapy for relief of pre-menstrual tension.
Methods: Twenty-four women meeting Diagnostic and Statistical Manual of Mental Disorders criteria for premenstrual dysphoric disorder were randomly assigned to a massage therapy or a relaxation therapy group.
Results: The massage group showed decreases in anxiety, depressed mood and pain immediately after the first and last massage sessions. The longer term (5 week) effects of massage therapy included a reduction in pain and water retention and overall menstrual distress. However, no long-term changes were observed in the massaged group’s activity level or mood. Future studies might examine the effects of a longer massage therapy program on these symptoms.
Conclusion: the authors suggest that massage therapy may be an effective adjunct therapy for treating severe premenstrual symptoms.
Hernandez-Reif M. et al. Premenstrual symptoms are relieved by massage therapy. Journal of Psychosomatic Obstetrics and Gynaecology 21(1): 9-15. Mar 2000.

PANDEY and colleagues, Department of Biochemistry, King George’s Medical College, Lucknow, India. investigated the effect of vitamin ‘A’ on free radical cascade in pregnancy induced hypertension.
Discussion: The role of vitamin A therapy in pregnancy induced hypertension (PIH) on free radical cascade was studied in PIH patients of third trimester. It was found that vitamin A therapy causes a statistically significant decrease in lipid peroxidation. However it has no effect on superoxide dismutase and catalase. This indicates that vitamin A acts as chain breaking antioxidant. The present study opens a future prospective of giving vitamin A for the prophylaxis of PIH.
Pandey S. et al. Effect of vitamin ‘A’ on free radical cascade in pregnancy induced hypertension. Bollettino Chimico Farmaceutico 139(2): 98-102. Mar-Apr 2000.

Issue 57

PASQUALI, School of Nursing, Adelphi University, Garden City, New York, USA described the impact of premature menopause on women's experience of self.
Discussion: Surgically or chemically induced premature menopause may have an impact on women's physical, psychological, social, and spiritual sense of self. This ethnographic research study explores the major factors that assaulted prematurely menopausal women's concept of self and the ways in which they attempted to readjust that concept. A unifying domain, evolution of self, and three constitutive themes emerged: change/loss, connectedness/disconnectedness, and transcendence/transformation. A holistic nurse-client relationship that transcends the hospital experience and extends into the community may help prematurely menopausal women to move toward a more synthesized sense of self and a greater degree of self-actualization.
Pasquali EA. The impact of premature menopause on women's experience of self. Journal of Holistic Nursing 17(4): 346-64. Dec 1999.

TANAKA, UMESAKI and OGITA, Department of Obstetrics and Gynecology, Osaka City University Medical School, Japan reported two cases of thawing of frozen shoulder in menopausal women treated with a Japanese herbal medicine.
Results: The authors describe two patients with frozen shoulder syndrome and severe menopausal symptoms. Short-term administration of Kanzo-to extract thawed the shoulders completely enough for the patients to move their cervical and shoulder joints without any restriction or pain. Their menopausal symptoms were cured simultaneously. Kanzo and Shakuyaku were found to have different effects on shoulder stiffness and disability in shoulder joints.
Tanaka T et al. Thawing of frozen shoulder in menopausal women treated with a Japanese herbal medicine, Kanzo-to extract. Clinical and Experimental Obstetrics and Gynecology 27(1): 14-6. 2000.

Issue 56

FRYE and SILVERMAN, Lancaster General Hospital Family Practice Residency Program, Pennsylvania, USA. gfye@bowdoinmed.com reviewed (22 references) focused diagnosis and therapies for the multiple symptoms of premenstrual syndrome.
Results: Premenstrual syndrome (PMS) is sometimes facetiously blamed when a woman behaves erratically. In fact, the cyclic symptoms of true PMS do cause significant difficulties in everyday life and relationships. This article is concerned with the criteria for diagnosing PMS and premenstrual dysphoric disorder and the authors describe medications, nutritional supplements and behaviour modifications that have proved effective for the relief of PMS symptoms.
Frye GM, and Silverman SD. Is it premenstrual syndrome? Keys to focused diagnosis, therapies for multiple symptoms. Postgraduate Medicine 107(5): 151-4, 157-9. May 2000.

TALWAR and colleagues, International Center for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India outlined the use of polyherbal formulations for reproductive tract infections and sexually transmitted diseases.
Background: Recent reports indicate high incidence of genital infections, most of which are sexually transmitted. Although specific drugs and antibiotics are available for some, a safe spermicidal formulation with wide spectrum antimicrobial action would be a desirable addition to the presently available spermicides.
Methods: Formulations at different dilutions were tested in culture systems on standard strains and clinical isolates including some isolates resistant to drugs. The effect on (HSV)-2 and Chlamydia trachomatis was determined in vivo in progestin sensitized mice. The effect on HIV-1 was investigated in two standardized systems.
Results: Polyherbal cream inhibited the growth in culture of clinical isolates of Candida albicans, Candida krusei and Candida tropicalis. Both the polyherbal cream and the Praneem polyherbal pessary inhibited urinary tract Escherichia coli (including multidrug resistant strains), and Neisseria gonorrhoeae (including 2 strains resistant to penicillin). Both formulations manifested virucidal activity against HIV-1 at >2 and 50% dilutions (in two different test systems) on contact for 1-2 min. Intravaginal inoculation of the cream and the pessary suspensions before inoculation of the pathogen prevented lesions and vaginal transmission of HSV-2 and C. trachomatis in progestin sensitized mice.
Conclusions: Polyherbal formulations have wide spectrum antibacterial, antifungal and antiviral effect against the tested sexually transmitted pathogens.
Talwar GP et al. Polyherbal formulations with wide spectrum antimicrobial activity against reproductive tract infections and sexually transmitted pathogens. American Journal of Reproductive Immunology 43(3): 144-51. Mar 2000.

WEDENBURG, MOEN and NORLING, Department of Obstetrics and Gynecology, Vrinnevi Hospital, Norrkoping, Sweden conducted a clinical trial comparing the use of acupuncture with physiotherapy for low-back and pelvic pain in pregnancy.
Background: The aim of this study was to describe the effects of acupuncture in the treatment of low-back and pelvic pain during pregnancy and compare it with physiotherapy.
Methods: Sixty pregnant women were treated with either acupuncture or physiotherapy. The women estimated the severity of their pain using a visual analogue scale (VAS) from 0 to 10 and disability in performing 12 common daily activities using a disability-rating index (DRI) from 0 to 10.
Results: In the acupuncture group, all 30 women completed the study (two exclusions), in the physiotherapy group only 18. Before treatment, the two treatment groups were comparable with respect to pain and disability. After treatment the mean morning VAS had declined from 3.4 to 0.9 (p<0.01) in the acupuncture group and from 3.7 to 2.3 (NS) in the physiotherapy group. The corresponding evening values had declined from 7.4 to 1.7 (p<0.01) and 6.6 to 4.5 (p<0.01), respectively. The mean VAS values were lower after acupuncture than after physiotherapy both in the morning (p=0.02) and in the evening (p<0.01). After treatment the mean DRI values had decreased significantly in the acupuncture group for 11 of 12 activities and the values were significantly lower for all activities than in the physiotherapy group where no significant changes had taken place. Overall satisfaction was good in both groups. There were no serious adverse events in any of the patients.
Conclusions: Acupuncture relieved pain and diminished disability in low-back pain during pregnancy better than physiotherapy.
Wedenberg K et al. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstetricia et Gynecologica Scandinavica 79(5): 331-5. May 2000.

Comment: This study suggests that acupuncture is a valid alternative, if not better than physiotherapy for pregnancy-related back problems.

Issue 53

VALSECCHI and colleagues, VI Department of Obstetrics and Gynecology, University of Milan, H San Raffaele Scientific Institute, Italy set out to assess alpha-tocopherol (vitamin E) serum levels in a population of pregnant women affected by different hypertensive disorders.
Methods: 177 third-trimester pregnant women participated in this study: 63 women were affected by hypertension; 69 had preeclampsia, 26 were affected by chronic hypertension and 19 women were normotensive controls. In 39 out of the 158 hypertensive patients, pregnancy was complicated by intrauterine growth retardation (IUGR). Serum levels of vitamin E were determined by high-pressure liquid chromatography (hplc).
Results: Alpha-tocopherol serum levels were not significantly different among gestational hypertensive, preeclamptic, chronic hypertensive patients and the controls. There was a significant reduction in alpha-tocopherol levels when women with IUGR and those with a normally grown foetus were compared. This significant reduction was maintained when the different classes of hypertension were analysed.
Conclusions: Reduction of antioxidant nutrients, particularly alpha-tocopherol, is not a feature of preeclampsia and appears to be better correlated with the presence of placental insufficiency, rather than maternal disease.
Valsecchi L et al. Serum levels of alpha-tocopherol in hypertensive pregnancies. Hypertension in Pregnancy 18(3): 189-95. 1999.

KASS-ANNESE, Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, Torrance, CA USA reviews (112 references) alternative approaches to hormone replacement therapy (hrt).
Background: The author writes that if a woman does not wish to or cannot use hrt, she must consider other ways to reduce the risk of developing cardiovascular disease (cvd) and osteoporosis. She states that risk reduction of an array of health problems may be achieved through diet, exercise, and stress management.
Results: The nutraceuticals of specific vitamins, minerals, phytoestrogens and essential fatty acids form a vital component of the risk reduction health programme. Osteoporosis risk may be diminished by the use of ipriflavone and a comprehensive ‘bone building’ vitamin and mineral regimen. B vitamin supplementation can control homocysteine levels, prevent cvd and other health problems, including menopausal-related symptoms, particularly when the B vitamins, magnesium, isoflavones and essential fatty acids are used. If lifestyle and nutraceutical interventions do not adequately address menopausal symptomatology, women can choose from numerous excellent multiherbal and homoeopathic therapies, be evaluated by an alternative practitioner and have a programme designed specifically for her health needs.
Conclusions: Despite the limited clinical research regarding herbal and homoeopathic alternative menopausal therapies, these remedies, when taken according to directions and following any contraindications, have the potential for being extremely effective and safe options to HRT.
Kass-Annese B. Alternative therapies for menopause. Clinical Obstetrics and Gynecology 43(1): 162-83. Mar 2000.

More Women's Health research updates