Caring for the woman with migraine headaches.

About 16% of American women experience migraine headaches. These debilitating headaches cause lost time from family, social activities, and work. Although migraines are thought to be a result of shifting menstrual and perimenopausal hormones, a physiologic connection has not been well established. This article approaches premenstrual and perimenopausal migraine headaches from a chronic disease perspective, focusing on self-care and the use of prescription and nonprescription therapies. Implications for practice and future research also are discussed.

Caring for the woman with migraine headaches.

Approximately 16% of American women experience migraine headaches. These debilitating headaches cause lost time from family, social activities, and work. Although migraines are thought to be a result of shifting menstrual and perimenopausal hormones, a physiologic connection has not been well established. Despite the lack of certainty regarding migraine cause, several theories have been postulated and a significant amount of literature has been published addressing the management of premenstrual migraines. Fewer articles have been published regarding the management of perimenopausal migraines, which are treated somewhat differently. This article approaches both premenstrual and perimenopausal migraine headaches from a chronic disease perspective, focusing on self-care and the use of prescription and nonprescription therapies. Implications for practice and future research are also discussed.

A clinician's guide to Pap smear interpretation.

Cervical cancer is the seventh most common cause of death from cancer in the United States and the most common cause of cancer in women around the world. In the United States, in 1995 alone, there were 15,800 cases of invasive cervical cancer that resulted in 4,800 deaths. The Papanicolaou (Pap) smear screen has helped in the identification of preinvasive disease, and, in fact, the cure rate for cervical disease is greater than 95% with early diagnosis using this test. This article discusses the risk factors for cervical disease, the essentials of diagnosis, the comparison of Pap smear classification systems, treatment guidelines, referral protocols, and future screening techniques for cervical disease.

Hormone replacement therapy.

More than 40 million women in the United States are now going through or are past menopause. Another 3.5 million or more will reach midlife in the next decade. As their life expectancy increases (mean life expectancy of women is now approximately 84 years), so does the need for therapeutic regimens related to reproductive function and aging in woman. Few medical treatments available to menopausal and postmenopausal women have as much potential benefit as well as possible health risks as hormone replacement therapy (HRT). Despite the increasing amount of scientific data available regarding the benefits of HRT, a degree of uncertainty still remains, both in the minds of some women, and with some health professionals, regarding the risks associated with long-term therapy. Even though the literature is voluminous, contradictory, and unclear, health providers must be able to keep abreast of current knowledge about the benefits, risks, and unknowns of these drugs. The purpose of this article is to provide a review and an update on the types of hormones available for HRT, their pharmacology and pharmacokinetics, and their risks, benefits, and contraindications. Newer products, specially compounded formulas, new regimens, and new modes of delivery that offer women alternatives and allow care to be individualized are described. In addition, some of the ongoing management dilemmas that practitioners face with the woman who chooses HRT are presented with practical solutions and suggestions.

Management strategies for hormonal replacement therapy.

Every year for the next 10 years, approximately 4 million women will become perimenopausal. For these women an important decision is whether or not to use hormone replacement therapy (HRT), and if they decide affirmatively, then, for how long to use it. The health provider must be able to help the woman in her decision making process by identifying the risks, benefits, and contraindications to this therapy. This information, based on the latest research, is presented in this article along with the types of hormones available, prescription regimens, side effects, management issues, and possible alternatives to hormone therapy.

Breast disease. The role of the nurse-midwife.

Certified nurse-midwives provide primary care for women. An essential part of a physical examination is a complete assessment of the breasts. Normal breasts and their variations and deviations are discussed, with particular attention paid to breast pain, masses, and nipple discharge, and the clinical implications of each. In addition, the demographics, risk factors, staging criteria, and treatment modalities of breast cancer are presented.

The perimenopausal period. Implications for nurse-midwifery practice.

As more women move into their 40s, it can be anticipated that nurse-midwives will be sought to continue to provide care and anticipatory guidance in the perimenopausal period. This article reviews definitions, demographics, physiology, and clinical manifestations of the perimenopausal period. In addition, management strategies other than hormone replacement therapy for the common discomforts of menopause are identified and discussed.