Menopause-related symptoms frequently lead women to seek health care. Recommendations for prescribing hormone therapy have changed significantly since the publication of initial results from the Women's Health Initiative (WHI) study in 2002. The North American Menopause Society and the American College of Obstetricians and Gynecologists have newer guidelines based on long-term analyses of the WHI participants as well as emerging data from other clinical trials. Women with an intact uterus who are using systemic estrogen must also use a progestogen; however, there are 2 new selective estrogen receptor modulators on the market for use without a progestogen. This review discusses current recommendations and new medications as well as the risks and benefits related to hormone therapy. Evidence-based alternatives to hormone therapy to treat symptoms of menopause are also presented.

Approximately 30% of women will experience abnormal uterine bleeding (AUB) during their life time. Previous terms defining AUB have been confusing and imprecisely applied. As a consequence, both clinical management and research on this common problem have been negatively impacted. In 2011, the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Group (FMDG) published PALM-COEIN, a new classification system for abnormal bleeding in the reproductive years. Terms such as menorrhagia, menometrorrhagia, metrorrhagia, dysfunctional uterine bleeding, polymenorrhea, oligomenorrhea, and uterine hemorrhage are no longer recommended. The PALM-COEIN system was developed to standardize nomenclature to describe the etiology and severity of AUB. A brief description of the PALM-COEIN nomenclature is presented as well as treatment options for each etiology. Clinicians will frequently encounter women with AUB and should report findings utilizing the PALM-COEIN system.

Prenatal genetic testing is rapidly evolving and requires that prenatal care providers stay up-to-date with accurate, evidence-based knowledge. Noninvasive prenatal testing (NIPT), first trimester maternal serum markers, and fetal nuchal translucency are the most recently developed screening tests added to the testing repertoire for detection of chromosomal disorders such as trisomy 21 (Down syndrome). NIPT is a new, highly accurate technique that uses maternal serum and is rapidly being introduced as a first trimester screening tool and increasingly being requested by pregnant women. The American College of Obstetricians and Gynecologists recommends that all pregnant women be offered first and second trimester screening options, regardless of risk status, but does not yet recommend NIPT. It is important for prenatal care providers to be aware of and understand these testing options in order to assist women and their families in making well-informed decisions during pregnancy. The purpose of this article is to update midwives and other prenatal care providers on the current prenatal genetic testing options available and how to appropriately offer and discuss them with their clients. We discuss how these tests work; what to do with the results; and most importantly, how to support and communicate accurate information to women and families as they navigate through an increasingly complicated array of testing choices.

This small sample of women demonstrates a significant degree of insufficiency and deficiency in this desert community where sunshine is plentiful. A larger study should be completed to determine ideal supplementation during pregnancy.

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