In this episode we discuss the menstrual cycle and how a few people figured out how to hack it to provide safe, effective contraception. 

Menstrual Cycle Graphic #1

Menstrual Cycle Graphic #2

Effectiveness of Birth Control Methods

History of the Oral Contraceptive #1

History of the Oral Contraceptive #2

Contraception is major element in the life of women throughout the world. In this episode we chart its history from ancient Egypt to modern times and discuss its implications at the personal and societal levels. 

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In this episode, part 3 of 3, we discuss the treatment and prevention of PID along with a detour into antibiotics.

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1. Goupil Bernutz. Clinical Memoirs on the Diseases of Women. 1866
2. Lachlan Aitken. Remarks on Pelvic Peritonitis and Pelvic Cellulitis. Baltimore Medical Journal. 1870. Volume 1
3. David Berry & Alexander Freeland. Manual of Gynecology - Volume 1. 1883
4. Howard Kelly. Operative Gynecology - Volume 2. 1898
5. Sexually Transmitted Diseases Treatment Guidelines. CDC. 2015
6. W. Stamm et al. Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection. N Engl J Med 1996; 334:1362-1366
7. P. Oakeschott et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ 2010; 340

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In the episode, part 2 of 3, we discuss the diagnosis of PID.

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Diagnosis

1. Howard Kelly. The Diagnosis of Pelvic Inflammatory Diseases. 1894.
2. Westrom L. Objectivized diagnosis of acute pelvic inflammatory disease. AJOG 1969
3. Sellors J, Mahony J, Goldsmith C et al. The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol 1991; 164: 113–120. 
4. Paavonen, J et al. Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease. AJOG. 151 (5):645-650. 1985
5. Kiviat, N et al. Endometrial Histopathology in Patients with Culture-proved Upper Genital Tract Infection and Laparoscopically Diagnosed Acute Salpingitis. AJOSP. 1990. 14(2)
6. B. Cacciatore et al. Transvaginal Sonographic Findings in Ambulatory Patients with suspected pelvic inflammatory disease. 1992. 80(6)
7. Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 1999;210:209-16
8. J. Moss et al. Serum CA-125 in the diagnosis of acute pelvic inflammatory disease. Int Journal Gyn & Obstetrics. 1994. 44(1)
9. L Westrom et al. Diagnosis of pelvic inflammatory disease: time for a rethink. Sex Transm Infect 2003:79
10. CDC Statement

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In the episode, part 1 of 2, we delve into the history, prevalence, causes, and consequences of PID.

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History

1. John Hirth. Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins. Journal of Military and Veterans' Health. 20(4). 2012

2. Goupil Bernutz. Clinical Memoirs on the Diseases of Women. 1866

3. Matthew Mann. A System of Gynecology - Vol. 1. 1887

Prevalence

1. L. Westrom. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. 138:880. 1980
2. Pelvic Inflammatory Disease Statistics. CDC. 2015

Definition

1. Howard Kelly. The Diagnosis of Pelvic Inflammatory Diseases. 1894.
2. Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. CDC. 2015
3. R. Brunham, S. Gottlieb. Pelvic Inflammatory Disease. NEJM 372:2309-2048. 2015.

Causes

1. Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. CDC. 2015
2. R. Brunham, S. Gottlieb. Pelvic Inflammatory Disease. NEJM 372:2309-2048. 2015.
3. JA McGregor, et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. AJOG. 170(4):1048-59. 1994
4. DL Draper, et al. Levels of vaginal secretory leukocyte protease inhibitor are decreased in women with lower reproductive tract infections. AJOG. 183(5):1243-8. 2000
5. I Simms, et al. Associations between Mycoplasma genitalium, Chlamydia trachoma's and pelvic inflammatory disease. J Clin Pathology. 56(8):616-618. 2003.
6. CR Cohen, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 81:463-466. 2005

Consequences

1. L Westrom. Effect of acute pelvic inflammatory disease on fertility. AJOG. 121(5):707-713. 1975
2. RB Ness, et al. Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial. Obstet Gynecol. 106(3):573-80. 2005.

Cost

1. Rein DB, et al. Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol. 95(3):397-402. 2000.

Opioid addiction has a profound impact on many aspects of society. In this episode we examine the ways that doctors and other practitioners contribute to the epidemic and how we can be part of the solution.

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Links

1. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies
2. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
3. Abuse-Deterrent Formulations and the Prescription Opioid Abuse Epidemic in the United StatesLessons Learned From OxyContin
4. Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists
5. A Joint Statement From 21 Health Organizations and the Drug Enforcement Administration. Promoting pain relief and preventing abuse of pain medications: A critical balancing act.
6. Primary Care Physicians’ Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion

Opioid Addiction has a profound impact on many aspects of society, including pregnancy. In this episode we delve into the history, pharmacology, effects, and treatment of opioid abuse with special consideration to its effects on pregnancy.

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Links

1. NIH - America’s Addiction to Opioids: Heroin and Prescription Drug Abuse
2. NIH - The Science of Drug Abuse and Addiction: The Basics
3. Economic Botany - Archaeological evidence for the tradition of psychoactive plant use In the old world
4. AAPS - Opioid Tolerance Development: A Pharmacokinetic/Pharmacodynamic Perspective
5. AOGS - Prevalence of substance abuse in pregnancy among Danish women
6. ProPublica - How States Handle Drug Use During Pregnancy
7. CNN - Heroin laced with elephant tranquilizer hits the streets
8. NIH - Methadone Maintenance Treatment: a review of historical and clinical issues
9. Pain Medicine - Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States
10. Obstetrics & Gynecology - Opioid Use Disorder in Pregnancy: Health Policy and Practice in the Midst of an Epidemic