Obstetrics and Gynecology: 2023 year in review

Obstetrics and Gynecology: 2023 year in review | Image Credit: © Syda Productions - © Syda Productions - stock.adobe.com.

OBSTETRICS

Maternal care deserts have become a hot topic of discussion in 2023. According to the March of Dimes 2022 report,1a maternity care desert is a county with no hospital providing obstetric care.According to the survey, 36% of counties nationwide—largely in the Midwest and South—constitute "maternity care deserts," meaning they have no obstetric hospitals or birth centers and no obstetric providers. For example, it was demonstrated that in California, a woman may travel on average 8.3 miles and approximately 13.7 minutes to their nearest birthing hospital, whereas women living in counties designated as maternal care deserts with the highest travel times (top 20%) could travel up to 106.8 miles and 131.8 minutes, on average, to reach their nearest birthing hospital.

GYNECOLOGY

In 2023, the FDA approved a birth control pill that could be sold without a prescription.² This is a significant and important milestone that could significantly expand access to contraception. Opill (norgestrel;Perrigo Company plc) will ultimately be the most effective birth control method available over-the-counter. In studies, Opill has been shown to be significantly more effective at preventing pregnancy than condoms and spermicides.

With over half of pregnancies in the United States being unintended,² Opill may help reduce potential negative impacts such as reduced odds of early prenatal care and increased cesarean delivery risk. Women’s health care professionals who specialize in family planning and reproductive health advocate for over-the-counter methods of contraception which will be especially useful for teenagers and young women who face challenges with cost, access, and many other obstacles to achieve self-determination over their own reproduction.

MENOPAUSE

A new nonhormonal medication for the treatment of moderate-to-severe hot flashes of menopause was approved earlier this year.³ In May 2023, the FDA approved fezolinetant (Veozah;Astellas Pharma Inc). This drug is first in class and is specifically designed to reduce the frequency and severity of flushing and sweating spells that occur as a woman's estrogen levels fall. Rather than boosting estrogen and progestin levels, fezolinetant manages hot flashes by blocking neurokinin B, a chemical in the brain responsible for regulating body temperature. As hormonal therapy isn’t viable for all patients, fezolinetant provides an additional, nonhormonal option.

SEXUAL HEALTH

2023 was a focus on the vagina biome, vagina pH, and osmolality of vaginally applied moisturizers and lubricants. One of the largest distributors of vaginal lubricants completed exciting research which focused on reformulated vaginal lubricants to meet the World Health Organization criteria for pH and osmolality, and their data demonstrated that even when lowering osmolality and maintaining ph levels as per strict guidelines, the efficacy, safety and sexual satisfaction was not disrupted.⁴ In addition, provocative data suggested that the vaginal biome was also unaffected.

References

1. March of Dimes Report: Maternity Care Deserts Across the USA: https://www.marchofdimes.org/maternity-care-deserts-report
2. FDA approves first nonprescription daily oral contraceptive. US Food and Drug Administration. July 13, 2023. Accessed November 15, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive
3. Snider M. FDA approves new menopause drug for hot flashes, sweating and chills. USA Today. May 13, 2023. Accessed November 15, 2023. https://www.usatoday.com/story/news/health/2023/05/13/menopause-drug-hot-flashes-fda/70215001007/
4. Palacios S., Hood S., Abakah Philips, Savania N, Krychman MK, A randomized trial on the effectiveness and safety of 5 water-based personal lubricant. J Sex Med. 2023;20(4):498-506. doi:10.1093/jsxmed/qdad005