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A recent study highlights potential reductions in macronutrient levels in breast milk because of maternal medications, though breastfeeding remains strongly recommended.

Maternal medications linked to reduced protein and fat in breast milk

Point-of-care ultrasounds significantly enhance early pregnancy care by enabling real-time diagnostics, reducing emergency visits, and ensuring timely management of risks, according to a recent study.

Revolutionizing prenatal care with point-of-care ultrasounds

A recent study highlights multimodal physical therapy as the only conservative treatment with proven efficacy in managing chronic pelvic pain, improving pain intensity, sexual health, and psychological function.

Multimodal physical therapy proves effective for women with chronic pelvic pain

A recent study reported an increase in US young adults seeking permanent contraception methods following the Supreme Court’s Dobbs v Jackson Women's Health Organization decision in 2022, highlighting the need for accessible contraception.

Permanent contraception use increased in US young adults following Dobbs

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

RSV Roundtable

STIs

Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Interventional Ultrasound - An Overview

Ovary (Transvaginal) Ovarian Hyperstimulation

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

These are 3D ultrasound images of a 14-week fetus. What is your diagnosis?

occipital meningocele and umbilical hernia

Clinical

DailyDx: 3D Images of a 14-week fetus

Neurokinin and Estrogen Balance in Menopausal Hot Flashes for Primary Care

How can we simplify the physiology of KNDY neurons and roles of NK receptors for better understanding among primary care physicians?

Note: NK3 antagonism targets VMS (hot flashes); NK1 antagonism impacts sleep and night sweats

Note: Fezolinetant, a selective NK3 antagonist, reduces hot flashes

Note: Elinzanetant, in addition to reducing hot flashes (via NK3 antagonism) is also an NK1 antagonist which improves sleep disturbances and night sweats

Panelists discuss how to simplify the physiology of KNDy neurons and neurokinin (NK) receptors for primary care physicians, explaining how NK3 antagonism reduces hot flashes, while NK1 antagonism helps alleviate sleep disturbances and night sweats, with fezolinetant and elinzanetant serving as key nonhormonal treatment options.

Peers and Perspectives

Fezolinetant Guidelines and Emerging Data on Menopause and Liver Health

Why was a warning about serious liver injury added to the prescribing information for fezolinetant? (ie, postmarketing case of drug-induced liver injury)

Note: Clarify that when fezolinetant first came out, it had guidelines for baseline liver testing. But in the past month, this was updated- discuss update and what this means for patients/ physicians.

What baseline hepatic laboratory tests are recommended before patients start fezolinetant, and how often should they be monitored?

What symptoms or clinical laboratory values indicate that fezolinetant should be discontinued?

What are important discussion points to address patient concerns on liver health?

Panelists discuss why a warning about serious liver injury was added to the prescribing information for fezolinetant following a postmarketing case of drug-induced liver injury, and review updated guidelines for baseline liver testing, recommended monitoring, symptoms indicating the need to discontinue the medication, and key points for addressing patient concerns about liver health.

Molecular Comparison and Safety Profiles of Fezolinetant and Elinzanetant

Why will elinzanetant likely be associated with a lower risk of liver injury?

(ie, molecular structure is very different from fezolinetant; liver toxicity is generally related to certain structural elements and not its receptor binding properties)

How do the adverse event profiles differ among fezolinetant and elinzanetant?

Notes: In phase 3 clinical trials, headache and fatigue were the most common adverse events with elinzanetant. In a phase 3, 52-week safety study, The most common adverse events with fezolinetant were abdominal pain, diarrhea, insomnia, back pain, and hot flashes.

Panelists discuss why elinzanetant is likely to be associated with a lower risk of liver injury due to its distinct molecular structure compared to fezolinetant, and compare the adverse event profiles of the 2 drugs, highlighting that elinzanetant is more commonly associated with headache and fatigue while fezolinetant is linked to abdominal pain, diarrhea, insomnia, and back pain.

Malignancy Risks of Neurokinin Receptor Antagonists

What does data from the clinical trials suggest about the incidence of neoplasms with fezolinetant and elinzanetant?

Notes:Across 3 clinical trials, fezolinetant is associated with a small, but higher incidence of endometrial hyperplasia or endometrial malignancy.

There were no cases of endometrial hyperplasia or endometrial malignancy observed with elinzanetant in a long-term safety study.

Panelists discuss clinical trial data suggesting a small but higher incidence of endometrial hyperplasia or malignancy with fezolinetant, while no cases of endometrial hyperplasia or malignancy were observed with elinzanetant in a long-term safety study.

R. Udayakumar

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