Heart disease, dementia, depression, cancer. Today few women make it through their lifetimes without suffering from at least one of these diseases. But medical experts agree that the next 10 years will bring greater understanding of these disorders and improve the options for treatment.
"As we better understand the molecular and genetic bases of disease, we will be able to design drugs specifically to correct the defects," says Nancy Milliken, MD, director of the Women's Health Center at the University of California, San Francisco (UCSF).
Researchers are on the verge of learning much more about the role estrogen plays -- not just in a woman's reproductive system, but in heart disease, Alzheimer's disease, depression, osteoporosis, and autoimmune disorders.
What's to Come in Medicine
Medical predictions for the first decade of the new millennium include:
- A better understanding of estrogen's role in heart disease
The 15-year Women's Health Initiative -- a study of more than 160,000 women between the ages of 50 and 79, undertaken by the National Institutes of Health -- will begin to yield results in 2005. This long-term study will yield information on how effective hormone replacement therapy is in preventing heart disease and osteoporosis, and whether or not it leads to an increased risk for breast cancer, according to Rita Redberg, MD, a cardiologist at UCSF. The study is also looking at just how much a diet low in fat and high in fruits, vegetables and grains reduces the risk of breast cancer, colorectal cancer, and heart disease.
- "Designer" estrogen replacement, tailored to individual needs
New estrogens will be designed to act only on specific parts of the body. "We may want estrogen for maintaining bone health, but don't want the estrogen effect on the uterus," says Janet Pregler, MD, director of the Iris Cantor Women's Health Center at the University of California, Los Angeles (UCLA).
- vaccine for the human papilloma virus
One study has found that the sexually transmitted virus infects up to 80% of college coeds and can lead to cervical cancer, says Linda Duska, MD, a gynecologist-oncologist at Massachusetts General Hospital in Boston.
- Prevention of pre-term delivery
About 10% of deliveries are pre-term. Current medications can stop pre-term contractions for only 48 to 72 hours, says Laura Riley, MD, director of obstetrics and gynecology and infectious disease at Massachusetts General Hospital. Research into the biological mechanisms that trigger pre-term birth will lead to medications or other ways to control it. "The pre-term birth rate in this country hasn't changed in years, and in terms of health care dollars and anguish for parents, it's not an insignificant problem," says Riley.
- Techniques to freeze and store human eggs
While men have long been able to freeze and preserve sperm, women have not been so lucky with their eggs. This will change soon, says Thomas Toth, MD, director of the Vincent Center In Vitro Fertilization Program at Massachusetts General Hospital. The technology will be especially important to girls and young women whose ovaries no longer function after cancer therapy.
- Better technologies in assisted reproduction
With current methods of implanting embryos, physicians often must transfer several embryos into the womb in the hope that at least one will actually develop into a fetus. According to Toth, more efficient methods will mean that physicians will be able to transfer just one embryo. This, he says, would more closely duplicate Mother Nature, and is much safer.
- Diagnosis before implanting
In the future, scientists will use gene therapy to diagnose and correct defects in embryos at the one-, two-, or four-cell stage, before they are implanted into the womb, according to Alan DeCherney, MD, professor and chairman of obstetrics and gynecology at the UCLA School of Medicine.
- Keeping ovaries functioning into old age
Understanding how cells in the ovary die may make gene therapy possible, says researcher Jonathan Tilly, PhD, director of the Vincent Center for Reproductive Biology at Massachusetts General Hospital. Besides estrogen and progesterone, he says, "we believe the ovaries are producing many other things that are beneficial to the body and have anti-aging effects." Tilly and fellow researchers have successfully turned off a gene in mice that is responsible for shutting down the ovaries, producing female mice "the equivalent of 100 years old, whose ovaries are functioning like those of a young adult."