BACKGROUND: Adenomyosis symptoms are disabling. Populationbased data on incidence and prevalence of adenomyosis are lacking that could guide future evidence-based treatments and clinical management. OBJECTIVE: To evaluate the incidence, 10-year secular trends, and prevalence of adenomyosis diagnoses and to describe symptoms and treatment patterns in a large U.S. cohort. STUDY DESIGN: We performed a retrospective population-based cohort study of women aged 16e60 years in 2006e2015, enrolled in Kaiser Permanente Washington, a mixed-model health insurance and care delivery system. Adenomyosis diagnoses identified by ICD codes from the International Classification of Diseases 9th and 10th editions and potential covariates were extracted from computerized databases. Women with prior hysterectomy, and for incidence estimates women with prior adenomyosis diagnoses, were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression. Rates and trend tests were examined for all women adjusting for age using direct standardization to the 2015 study population, by age groups, and by race/ethnicity. Chart reviews were performed to validate diagnostic accuracy of ICD codes in identifying adenomyosis incidence. Symptoms and treatment patterns at diagnosis and in the following 5 years were assessed. RESULTS: A total of 333,693 women contributed 1,185,855 woman-years (2006e2015) for incidence calculations. Associated symptom-related codes (menorrhagia or abnormal uterine bleeding, dysmenorrhea or pelvic pain, dyspareunia, and infertility) were observed in 90.8%; 18.0% had co-occurrent endometriosis codes and 47.6% had cooccurrent uterine fibroid codes. The overall adenomyosis incidence was 1.03% or 28.9 per 10,000 woman-years, with a high of 30.6 in 2007 and a low of 24.4 in 2014. Overall age-adjusted estimated incidence rates declined during the 10-year study interval (linear trend P < .05). Incidence was highest for women aged 41e45 years (69.1 per 10,000 womanyears in 2008) and was higher for black (highest 44.6 per 10,000 woman-years in 2011) vs white women (highest 27.9 per 10,000 womanyears in 2010). Overall prevalence in 2015 was 0.8% and was highest among women aged 41e45 years (1.5%). Among the 624 potential adenomyosis cases identified by diagnostic codes in 2012e2015 and with sufficient information in the medical record to determine true case status, 490 were confirmed as incident cases, yielding a 78.5% (95% confidence interval, 75.1%, 81.7%) positive predictive value of adenomyosis ICD-9/ICD-10 codes for identifying an incident adenomyosis case. Health care burden was substantial: 82.0% of women had hysterectomies, nearly 70% had imaging studies suggestive of adenomyosis, and 37.6% used chronic pain medications. CONCLUSION: Adenomyosis burden to the individual and the health care system is high. Incidence rates are disproportionately high among black women. These findings are of concern, as currently available longterm medical therapies remain limited beyond hysterec...

In this population, the risk factors of healthy community-dwelling postmenopausal women reflect the health status of women as they transition toward old age. Sexual activity, history of UTI, treated diabetes, and incontinence were all associated with a higher risk of UTI. The therapeutic role of oral estrogen remains uncertain. Prospective studies in different patient populations are needed to better understand the risk factors of UTI.

The most common side effect of angiotensin converting enzyme inhibitor drugs (ACEi) is a cough. We conducted a genome wide association study (GWAS) of ACEi-induced cough among 7,080 subjects of diverse ancestries in the eMERGE network. Cases were subjects diagnosed with ACEi-induced cough. Controls were subjects with at least 6 months of ACEi use and no cough. A GWAS (1,595 cases and 5,485 controls) identified associations on chromosome 4 in an intron of KCNIP4. The strongest association was at rs145489027 (MAF=0.33, OR=1.3 [95%CI: 1.2–1.4], p=1.0×10−8). Replication for six SNPs in KCNIP4 was tested in a second eMERGE population (n=926) and in the GoDARTS cohort (n=4,309). Replication was observed at rs7675300 (OR=1.32 [1.01–1.70], p=0.04) in eMERGE and rs16870989 and rs1495509 (OR=1.15 [1.01–1.30], p=0.03 for both) in GoDARTS. The combined association at rs1495509 was significant (OR=1.23 [1.15–1.32], p=1.9×10−9). These results indicate that SNPs in KCNIP4 may modulate ACEi-induced cough risk.

Diaphragm/spermicide use increases the risk of urinary tract infection (UTI). To determine whether spermicide-coated condoms are also associated with an increased risk of UTI, the authors conducted a case-control study at a large health maintenance organization in Seattle, Washington. Cases were sexually active young women with acute UTI caused by Escherichia coli, identified from computerized laboratory files during 1990-1993. Age-matched controls were randomly selected from the enrollment files of the plan. Of 1,904 eligible women, 604 cases and 629 controls (65%) were interviewed. During the previous year, 40% of the cases and 31% of the controls had been exposed to any type of condom. The unadjusted odds ratio for UTI increased with frequency of condom exposure from 0.91 (95% confidence interval (CI) 0.65-1.28) for weekly or less during the previous month to 2.11 (95% CI 1.37-3.26) for more than once weekly. Exposure to spermicide-coated condoms conferred a higher risk of UTI, with odds ratios ranging from 1.09 (95% CI 0.58-2.05) for use weekly or less to 3.05 (95% CI 1.47-6.35) for use more than once weekly. In multivariate analyses, intercourse frequency (odds ratio (OR) = 1.14 per weekly episode), history of UTI (OR = 2.64), and frequency of spermicide-coated condom exposure (OR = 3.34 for more than once weekly and 5.65 for use more than twice weekly) were independent predictors of UTI. Spermicide-coated condoms were responsible for 42% of the UTIs among women who were exposed to these products.