This CME has expired. The Forum: A Working Group for Women's Healthcare, Volume 5, No. 3 Optimal Management of Premenstrual Disorders: New Options for Effective Intervention Changing the Hormone-Free Interval: Its Day Has Come Examining the Use of Misoprostol in Obstetrics and Gynecology Release Date: November 2007 Expiration Date: November 30, 2009 Faculty: EDITOR-IN-CHIEF Lee P. Shulman, MD Professor & Chief, Division of Reproductive Genetics Department of Obstetrics & Gynecology Northwestern Memorial Hospital Feinberg School of Medicine Chicago, IL EDITORIAL BOARD Raquel D. Arias, MD Associate Dean of Women Associate Professor, Obstetrics and Gynecology Clinical Associate Professor of Gerontology University of Southern California Los Angeles, CA Sarah L. Berga, MD James Robert McCord Professor and Chair Department of Gynecology & Obstetrics Emory University School of Medicine Atlanta, GA Ellen Hirschman Miller, MD Clinical Associate Professor of Medicine Albert Einstein College of Medicine Bronx, NY Anita L. Nelson, MD Professor Department of Obstetrics & Gynecology David Geffen School of Medicine at UCLA Los Angeles, CA Teri Pearlstein, MD Director Women’s Behavioral Health Women and Infants Hospital Providence, RI Owen P. Phillips, MD Professor, Associate Chair Department of Obstetrics & Gynecology University of Tennessee at Memphis Memphis,TN Patricia J. Sulak, MD Director Division of Ambulatory Care & Women's Health Care Research Program Scott & White Hospital Temple,TX Ian Thorneycroft, PhD, MD Professor Department of Obstetrics & Gynecology University of South Alabama Bay Area Physicians for Women Mobile,AL Carolyn L.Westhoff, MD Professor Department of Obstetrics & Gynecology Columbia University School of Public Health New York, NY Susan Wysocki, RNC, NP, FAANP President and CEO National Association of Nurse Practitioners in Women’s Health Washington, DC GUEST AUTHORS David L. Eisenberg, MD Family Planning Fellow Department of Obstetrics and Gynecology Northwestern Memorial Hospital Chicago, IL Melissa A. Simon, MD, MPH Assistant Professor of Obstetrics and Gynecology Feinberg School of Medicine Northwestern University Chicago, IL Sharon Winer, MD Clinical Professor of Obstetrics & Gynecology and Reproductive Bioendocrinology University of Southern California Keck School of Medicine Los Angeles, CA EDITOR/MEDICAL WRITERS Jill Rovitzky Black Dianne Pena Mary Pinkowish, MPH Statement of Need: Clinicians who provide health care for reproductive-aged and menopausal women are faced with continual change that affects the way in which they practice.Among these changes are new and emerging means of family planning, including an increased understanding of noncontraceptive benefits associated with some contraceptives and a growing awareness of the importance of prepregnancy planning. In addition, practitioners are challenged with staying up-todate on the medical literature regarding the comprehensive health needs of women. Demographic trends, such as an aging and increasingly overweight population and advanced maternal age, make it particularly challenging, and crucial, for clinicians to stay abreast of the latest developments in women’s health—with emphasis on preventive strategies, new diagnostic tests and screening recommendations, and treatment not only for conditions directly related to reproduction and menopause but for chronic disorders, such as diabetes, thyroid dysfunction, and cardiovascular disease, that become more prevalent with age. Intended Audience: This program has been developed for obstetrician-gynecologists, family physicians, nurse practitioners, and other health-care providers involved in women’s health. Content: This program provides current information about the role of misoprostol in multiple aspects of women’s health, reviews management approaches for premenstrual dysphoric disorder, and explains the rationale for revising the once-standard 7-day hormone-free interval in oral contraceptive regimens. Learning Objectives: Upon completion of this publication, participants will be able to: List three aspects of women’s health care in which there is evidence-based support for the use of misoprostol Counsel patients about the risks and benefits of nontraditional oral contraceptive regimens that modify or eliminate the hormone-free interval Distinguish between the two types of FDA-approved therapies for the management of symptoms of premenstrual dysphoric disorder Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Dannemiller Memorial Educational Foundation and Haymarket Medical Education LP. The Dannemiller Memorial Educational Foundation is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation Statement: The Dannemiller Memorial Educational Foundation designates this educational activity for a maximum of 1.75 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity. This activity has been evaluated and approved by the Continuing Education Approval Program of the National Association of Nurse Practitioners in Women’s Health for 1.75 contact hours of continuing education credit, including 1.5 contact hours of pharmacology content. Purdue University is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is a continuing education activity of Purdue University, an equal access/equal opportunity institution. Universal Program Number (UPN): 018-999-07-200-H01-P, 1.75 contact hours (.175 CEU). Release Date: 11/29/2007 Expiration Date: 11/30/2009. Method of Participation: This activity should take approximately 1.75 hours to complete. The participant should read the objectives, read the newsletter, take the post-test, complete the registration, and complete the evaluation form. The evaluation form provides each participant the opportunity to comment on the extent to which educational objectives were met, the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his or her views on future educational needs. To receive credit for this activity, follow the instructions provided on the post-test. This credit is valid through November 30, 2009. No credit will be given after that date. In the event you are unable to print the certificate, please submit the post-test and then email editor@dannemiller.com and a certificate will be mailed to you within two weeks. If you have questions, you can contact Stephanie Coley at stephaniec@dannemiller.com. Faculty Disclosures: In accordance with the Accreditation Council for Continuing Medical Education (ACCME), the Dannemiller Memorial Educational Foundation requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest. Accordingly: Raquel D. Arias, MD, reports that she is a consultant for Barr Pharmaceuticals, Inc; Bayer HealthCare Pharmaceuticals; Novo Nordisk; Organon USA; Ortho-McNeil, Inc.; Pfizer, Inc; Schering AG; and Wyeth Pharmaceuticals. Sarah L. Berga, MD, reports that she is a consultant for Bayer HealthCare Pharmaceuticals; QuatRx Pharmaceuticals; Med Link; MedPro; Solvay Pharmaceuticals, Inc.; and Wyeth Pharmaceuticals. David L. Eisenberg, MD, reports that he has nothing to disclose. Ellen Hirschman Miller, MD, reports that she is on the speakers’ bureaus for GlaxoSmithKline; Merck & Co.; and Sanofi-Aventis. Anita L. Nelson, MD, reports that she is on the speakers’ bureaus for Bayer HealthCare Pharmaceuticals; Duramed/Barr Laboratories; Esprit Pharma; Merck & Co.;Ther-Rx; and Wyeth Pharmaceuticals. Dr. Nelson is also a consultant for Bayer HealthCare Pharmaceuticals; Duramed Pharmaceuticals; Church & Dwight; and Wyeth Pharmaceuticals and has received grant and research support from Bayer HealthCare Pharmaceuticals; Organon USA;Pfizer, Inc.; and Wyeth Pharmaceuticals. Teri Pearlstein, MD, reports that she is on the speakers’ bureau for Bayer HealthCare Pharmaceuticals, and is a consultant for Wyeth Pharmaceuticals. Dr. Pearlstein and her partner/ spouse are stockholders of Amgen and Teva Pharmaceuticals. Owen P. Phillips, MD, reports that she is a consultant for Bayer HealthCare Pharmaceuticals and Eli Lilly. Her spouse/partner is on the speakers’ bureau for Ortho-McNeil, Inc. Lee P. Shulman, MD, reports that he is on the speakers’ bureaus, serves as a consultant for, and has received grant and research support from Duramed Pharmaceuticals and Wyeth Pharmaceuticals. Dr. Shulman also serves on the speakers’ bureaus and is a consultant for Bayer HealthCare Pharmaceuticals; GlaxoSmithKline; Merck & Co.; and Ortho-McNeil and is on the speakers’ bureau for Warner Chilcott. Melissa A. Simon, MD, MPH, reports that she has nothing to disclose. Patricia J. Sulak, MD, reports that she is on the speakers’ bureaus for Barr Laboratories; Bayer HealthCare Pharmaceuticals; Merck & Co.;Warner Chilcott; and Wyeth Pharmaceuticals and is a consultant for Barr Laboratories. Dr. Sulak has received grant and research support from Barr Laboratories; Bayer HealthCare Pharmaceuticals; Organon USA; and Warner Chilcott. Ian H.Thorneycroft, PhD, MD, reports that he is on the speakers’ bureaus and is a consultant for Bayer HealthCare Pharmaceuticals; Duramed Pharmaceuticals; and Wyeth Pharmaceuticals. He is also on the speakers’ bureau for Merck & Co. Carolyn L.Westhoff, MD, reports that she is a consultant for Barr Laboratories; Bayer HealthCare Pharmaceuticals; and Organon USA. Sharon A.Winer, MD, reports that she is on the speakers’ bureaus and serves as a consultant for Bayer HealthCare Pharmaceuticals and Organon USA. Susan Wysocki, RNC, NP, FAANP, reports that she is on the speakers’ bureaus and serves as a consultant for Bayer HealthCare Pharmaceuticals; Duramed Pharmaceuticals; Organon USA; Ortho Women’s Health; and Wyeth Pharmaceuticals. She is also a consultant for Eli Lilly and Novogen. The Dannemiller and Haymarket Medical Education LP staffs that were involved in the development of this activity have no financial relationships with any commercial interests that are relevant to this activity. To resolve identified conflicts of interest, the educational content was fully peer reviewed by a physician member of the Dannemiller Clinical Content Review Committee, who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced. Off-label Discussion: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA.The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program. Disclaimer: The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of the Dannemiller Memorial Educational Foundation, National Association of Nurse Practitioners in Women’s Health, Bayer HealthCare Pharmaceuticals, or Haymarket Medical Education LP.The material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.