COVID-19 のパンデミックは，医学のみならず社会経済的に世界的問題となっている．当初，若年者はSARS-CoV-2 に感染しても，無症状あるいは軽症ですむといわれていたが，主な流行株がδ株に置き換わるにつれて，若年者の感染者が増加し，中には重症化するケースも増えてきた．それに伴い，2021 年 7 月以降，妊婦の感染者数も急増している．幸いなことに SARS-CoV-2は風疹やジカ熱のような催奇性の報告は無いが，妊娠中に重症化すると，母体の治療のために予定日よりも前であっても帝王切開で早期に分娩とせざるを得ない場合もある．子宮内での胎児への感染は極めて稀であるが，出生後に水平感染で感染するリスクはある．現在，全世界で新型コロナウイルスワクチンの接種が進められている．妊婦に対するワクチンの有効性や安全性が明らかになったため，妊婦や妊娠を希望する人への接種も推奨されている．しかし，安全性への不安などを理由に接種を希望しない人も多い．COVID-19 に感染した妊婦に対して投与できる薬剤は限られており，ワクチンも含めて厳重かつ積極的な感染予防が重要である．

This Japanese manuscript shows some important hormonal treatments for breast cancer. (1. Oophorectomy)Estrogen regulates breast cancer. This fact was documented 120 years ago. In 1896, Beaton GT showed that breastcancer decreased in size after oophorectomy. (2. Tamoxifen) Then, an estrogen antagonist was invented. Thisagent, called “tamoxifen”, was shown to decrease advanced breast cancer in 1971. Furthermore, 5 years of tamoxifen was demonstrated to improve postoperative survival in early breast cancer patients. (3. Anastrozole inhibitor)After the use of tamoxifen became widespread in daily clinical practice, aromatase inhibitors were introducedfor postmenopausal patients. Aromatase inhibitors prevent the synthesis of estrogen in the tumor and peripheraltissues. A 2005 publication showed that these agents were superior to tamoxifen in terms of survival in postmenopausal early breast cancer patients. (4. LHRH agonist) Recently, existing hormonal agents have been refined. AnLHRH agonist was shown to inhibit the secretion of estrogen in premenopausal women. In the SOFT/TEXT trial,treatment with this agonist and exemestane, an aromatase inhibitor, or tamoxifen provides better survival in earlybreast cancer patients with high recurrence risk than treatment with tamoxifen alone. (5. Fulvestrant) The latestagent that blocks the estrogen pathway is fulvestrant, which is used for postmenopausal women. This medicinereduces the expression of the estrogen receptor. Fulvestrant has a more reliable clinical effect than aromataseinhibitors. (6. CDK4/6 inhibitor) Recent advances in molecular science have demonstrated the mechanisms of cellgrowth, and this advance has provided new agents that enhance the effect of hormonal therapy. CDK4/6, whichis regulated by the intracellular estrogen pathway, controls cell growth. In metastatic breast cancer patients, treatment with CDK4/6 inhibitors and fulvestrant or anastrozole prolong the overall survival time, which is a promising outcome for future treatment.

We live in an era in which half of the population is affected by cancer. Regardless of how much progress hasbeen made in medical science and how high the cure rate is, having cancer significantly impacts patients’ lives aswell as those of their families and friends. Thus, avoiding preventable cancers is an important issue not only for anindividual but also for our society. Cancer prevention consists of two steps. Primary prevention is avoiding factorsthat cause cancer. Secondary preventions include the early detection of cancer or precancer and subsequent earlyand minimally invasive treatment. It is a national policy of Japan to reduce the cancer mortality rate and improvethe quality of life of people through appropriate primary and secondary prevention based on scientific evidence.The Third Basic Plan for the Promotion of Cancer Control, formulated in 2008, declares that more efforts will beput into cancer education and prevention. In this review, I introduce recent findings on endometrial and ovariancancers from the perspective of cancer prevention. Recently, the molecular biological mechanisms of the oncogenesis of these cancers have been elucidated, and progress has been made in cancer treatment and prevention. Ingeneral, cancer is a disease of the relatively older population. However, this review emphasizes the importance ofwomen’s health care from a young age for the prevention of gynecological cancer.

The special focus of this issue is “Women’s Medicine”. I have focused on hereditary breast cancer and ovariancancer (HBOC) syndrome and explained it in an easy-to-understand manner for readers who are not familiar withthis syndrome. Cancer genomic medicine and companion diagnostics have greatly changed the diagnosis andtreatment of HBOC syndrome as well as the cancer treatment system. In particular, the fact that preventive operations are covered by insurance is ground-breaking in Japan. Other hereditary tumors are summarized and outlinedin a table. The present manuscript provides valuable cancer information data not only for females but also formales with hereditary tumors.

Menopausal symptoms are defined as symptoms that are not caused by organic changes among a wide varietyof symptoms that appear during menopause. When these symptoms interfere with daily life, the pathological condition is defined as menopausal disorder. Ovarian dysfunction is a major factor in the pathogenesis of menopause,but sociopsychological stress, which is a family and workplace problem women experience during this period,is also an important factor. Personality factors are also intricately intertwined and show various symptoms. Thediagnosis is that the patient is menopausal and has the peculiar symptoms mentioned. If organic disease is denied,the condition is considered to be menopausal disorder, but there are no international standard diagnostic criteria.Comprehensive evaluation of women with menopausal disorder shows ovarian function decline, age-related physical changes, psychological and psychological factors, and sociocultural environmental factors. Hormone therapy,the use of psychotropic drugs, and other treatments are effective. In Japan, kampo drug treatment for menopausalsymptoms has been adopted for a long time. Furthermore, counseling and psychotherapy are also effective.

Women are more at risk of developing osteoporosis than men because the hormone changes that occur atmenopause directly affect bone density. The female hormone estrogen is essential for healthy bones. After themenopause, estrogen levels fall, which can lead to a rapid decrease in bone density.Postmenopausal osteoporosis, resulting from estrogen deficiency, is the most common type of osteoporosis.Estrogen deficiency results in an increase in bone turnover owing to effects on all types of bone cells. The imbalance in bone formation and resorption affects trabecular bone and cortical bone. Osteoporosis is diagnosed usingbone density measurements of the lumbar spine and proximal femur. Preventive strategies to improve bone healthinclude diet, exercise and abstaining from smoking. Fractures may be prevented by reducing the risk of falls inhigh-risk populations. Several drugs are licensed to reduce fracture risk by slowing bone resorption (such as bisphosphonates and denosumab) or by stimulating bone formation (such as teriparatide).The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures.

Urinary incontinence (UI) has considerable impacts on quality of life (QOL), and the incidence of UI increaseswith age. UI is classified based on pathophysiology into stress urinary incontinence (SUI), urgency urinary incontinence (UUI), overflow incontinence and functional urinary incontinence. SUI alone is the most common amongfemales with UI, followed by mixed urinary incontinence (MUI) of SUI and UUI and UUI alone. In this article,the pathophysiology and treatment of UI are described and discussed.

Eating disorders (EDs) include anorexia nervosa (AN), bulimia nervosa (BN) and their associated disorders. ANis characterized exclusively by restricted eating, and BN is characterized exclusively by a cycle of binge eating.The management of these disorders is often quite difficult. We will introduce some neurobiological experimentson eating disorders and mention important details about psychological therapies.