COURSE CREDITS & HOURS
14 AMA PRA Category 1 Credits™14.0 Contact Hours
14 APA CE Credits
14 ASWB ACE Credits
14 ABIM MOC Points
COURSE FEES
$995.00 for Physicians & Psychiatrists
$795.00 for PAs, NPs, & Psychologists
$595 for Nurses, Students, Social Workers, and Others
$795.00 for PAs, NPs, & Psychologists
$595 for Nurses, Students, Social Workers, and Others
TARGET AUDIENCE
Physicians, Physician Assistants, Psychologists, Social Workers, Nurses
PROGRAM PURPOSE
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Reproductive Hormones 2025 Update (Dr. Cirino)
- An overview of reproductive psychiatry, focusing on how reproductive hormones and neurosteroids impact mood, sexual behavior, and brain function across a woman's lifespan. It explores the biological differences in how psychiatric illnesses are expressed between sexes.
- Explain the hormonal causes of specific mood and anxiety disorders tied to the reproductive cycle, such as Premenstrual Dysphoric Disorder (PMDD), perinatal mood disorders, and perimenopausal mood instability.
- Also aims to help clinicians identify when to use traditional psychotropic medications versus hormone or neurosteroid-based treatments for these conditions.
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Beyond Masters and Johnson: Female Sexual Function (Dr. Adams)
- Contrasts the traditional, linear Masters & Johnson model with more current frameworks for female sexual response, including the Basson Model (circular, intimacy-based), the Biopsychosocial Model, and the Dual Control Model (a balance of excitatory "accelerators" and inhibitory "brakes").
- Details the neurobiology of sexual desire and arousal, identifying the brain regions and neurotransmitter systems that govern the processes of "wanting," "liking," and inhibition.
- Examines the various psychological, interpersonal, and contextual factors that influence sexual desire, such as emotional cues, body image, relationship dynamics, and stress.
- Reviews sexual enhancers and medical treatments, including non-pharmacological options like vibrators and supplements, as well as off-label use of transdermal testosterone and intravaginal prasterone (DHEA) for Hypoactive Sexual Desire Disorder (HSDD).
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Female Sexual Dysfunction â Diagnosis Utilizing DSM-5 Terminology (Dr Cirino)
- Identifies common barriers preventing clinicians from addressing Female Sexual Dysfunction (FSD), including time constraints, embarrassment, and feeling ill-prepared to manage patient concerns.
- Outlines the historical and diagnostic evolution of FSD, highlighting the key changes from the DSM-IV to the DSM-5, such as combining Hypoactive Sexual Desire Disorder (HSDD) and Female Sexual Arousal Disorder into the unified diagnosis of Female Sexual Interest/Arousal Disorder (FSIAD).
- Explores the neurobiology and hormonal influences on female sexual response, contrasting the traditional Masters & Johnson model with the modern Basson Model, which emphasizes responsive desire and emotional intimacy.
- Develops a multidisciplinary treatment plan for FSD by assessing biological, psychological, interpersonal, and sociocultural factors. The presentation details evidence-based behavioral interventions like scheduled sex, mindfulness-based cognitive therapy, and Sensate Focus, alongside medical treatments such as CNS agents (flibanserin, bremelanotide) and hormone therapy.
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When Sex Hurts (Dr Adams)
- Diagnoses three primary causes of sexual pain: vulvodynia (idiopathic vulvar pain lasting over three months), vaginismus (involuntary pelvic floor muscle spasms) , and Genitourinary Syndrome of Menopause (GSM) (vulvar/vaginal dryness and urinary symptoms due to low estrogen).
- Outlines diagnostic procedures for each condition. For vulvodynia, the presentation emphasizes using a swab test to identify localized pain. For vaginismus, it highlights a digital palpation of the levator muscles. For GSM, the diagnosis is primarily visual, noting thin, fragile mucosa.
- Details specific, evidence-based treatment plans. For vulvodynia, it recommends topical therapies like compounded estradiol/testosterone cream. For vaginismus, the primary treatment is Pelvic Floor Physical Therapy (PFPT), often guided by vaginal dilators. For GSM, it recommends a stepwise approach starting with over-the-counter moisturizers and lubricants before progressing to prescription local estradiol treatments.
- Addresses the psychological impact of these pain syndromes, noting they are associated with higher rates of depression, anxiety, relationship issues, and overall sexual dysfunction.
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Navigating the Choppy Seas of Perimenopause (Dr. Adams)
- Explains the physiology of perimenopause, defining it as the symptomatic time leading up to the final menstrual period, characterized by unpredictable hormonal fluctuations as the ovaries respond less consistently to brain signals. It clarifies that perimenopause is a clinical diagnosis based on symptoms, not lab tests.
- Lists the major symptoms of perimenopause, including changes in the menstrual cycle (100%), vasomotor symptoms like hot flashes (80%), mood and sleep disturbances (68% and 60%, respectively), joint pain (50%), and vaginal dryness (50%).
- Details racial and ethnic disparities in the experience of severe vasomotor symptoms, noting that 46% of Black women experience them for an average of 10.1 years, and 35% of Hispanic women for 8.9 years, compared to 31% of Caucasian women for 6.5 years. It also highlights that the standard 4mm ultrasound endometrial stripe measurement is not a reliable indicator for endometrial hyperplasia in Black women with postmenopausal bleeding, who should always be biopsied.
- Individualizes therapy based on patient needs, differentiating between Oral Contraceptive Pills (OCPs) for women who need contraception and cycle control, and Menopause Hormone Therapy (MHT) for symptom management in those who do not. Treatment options discussed include low-dose OCPs, a levonorgestrel IUD combined with an estradiol patch, or standard MHT with close monitoring for bleeding.
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Menopause: Everything to know in 2025 (Dr. Adams)
- Recontextualizes MHT risks and benefits by reviewing the 20-year follow-up data from the Women's Health Initiative (WHI). It emphasizes the "timing hypothesis," showing that MHT initiated in women aged 50-59 is associated with a statistically significant reduction in all-cause mortality. The data also reveals that estrogen-only therapy (for women without a uterus) is associated with a reduced risk of breast cancer compared to placebo.
- Details how to individualize Menopause Hormone Therapy (MHT) based on a patient's age, time since menopause, and risk factors. It identifies absolute contraindications (e.g., CV disease, hormone-dependent cancer) and recommends transdermal estradiol with micronized progesterone as the preferred regimen because oral estrogens are associated with a higher risk of thromboembolic events.
- Addresses the duration of MHT, arguing against an arbitrary stopping age. It cites recent 2024 observational data showing that continuing transdermal estrogen therapy beyond age 65 is associated with a reduced risk of all-cause mortality, breast cancer, and cardiovascular events, making it a safe option for low-risk women.
- Outlines evidence-based non-hormonal options for vasomotor symptoms based on The Menopause Society's 2023 position statement. Recommended treatments include SSRIs/SNRIs, gabapentin, and the neurokinin B (NKB) blocker fezolinetant (Veozah), which has efficacy comparable to estradiol. The statement does not recommend ineffective therapies like herbal supplements and acupuncture.
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51 Is Getting Younger All The Time: Maximizing Long Term Health at Menopause and Beyond (Dr. Adams)
- Provides a clinical framework for prescribing Menopause Hormone Therapy (HT) to women with common chronic medical conditions, emphasizing an individualized risk-benefit assessment that should be reevaluated annually.
- Recommends transdermal estradiol with micronized progesterone over oral formulations for women with comorbidities like hypertension, obesity, and VTE risk factors, as this route has neutral or beneficial effects on blood pressure and lipids and does not increase the risk of blood clots.
- Strongly advises HT for women with premature or early menopause, including BRCA-positive women after risk-reducing surgery, at least until the average age of menopause to mitigate long-term risks to bone, heart, and cognitive health.
- Highlights lifestyle as a strong method for dementia prevention, as HT is not recommended for this purpose. The presentation emphasizes lifestyle changes such as a whole-food, plant-based, or Mediterranean diet to reduce the risk of cognitive decline.
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Mood and Menopause (Dr. Adams)
- Explains that perimenopause is a "window of vulnerability" for mood disorders due to chaotic fluctuations of estrogen and progesterone, which disrupt the brain's mood-regulating neurotransmitter systems. Women with a history of PMS or postpartum depression are at higher risk.
- Identifies psychosocial stressors that contribute to mood changes, including negative body image, societal stigma, and adverse impacts on partner relationships and career confidence. It also differentiates between Perimenopausal Mood Instability (PMI)âcharacterized by intermittent irritability and low moodâand clinical Major Depressive Disorder (MDD), recommending validated screening tools like the PHQ-9 for diagnosis.
- Highlights a key treatment principle: Estrogen therapy is an effective treatment for mood disturbances during perimenopause, working similarly to antidepressants, but it is not effective for mood symptoms that begin in postmenopause.
- Outlines a treatment strategy where hormone therapy (e.g., continuous OCPs or transdermal estrogen) is a first-line option for PMI or mild depression, especially with co-occurring vasomotor symptoms.
- SSRIs/SNRIs are the primary treatment for moderate-to-severe MDD, and behavioral interventions like Cognitive Behavioral Therapy (CBT) are also effective.
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Depression Across the Female Reproductive Cycle (Dr. Cirino)
- Defines Perinatal Mood and Anxiety Disorders (PMADs) as a spectrum of illnesses affecting women during pregnancy and postpartum. It highlights that mental health conditions are the leading cause of pregnancy-related deaths, all of which are considered preventable.
- Explains the etiology of PMADs using a biopsychosocial model. The primary biological trigger is the dramatic postpartum drop in hormones and neurosteroids (like allopregnanolone) , which is compounded by psychological factors (e.g., a history of depression) and social stressors (e.g., lack of support and paid maternity leave).
- Reviews pharmacologic treatments, concluding that SSRIs are well-studied and generally safe, with the risks of untreated maternal depression often outweighing medication risks. It also introduces the rapid-acting, FDA-approved neurosteroid treatments brexanolone (Zulresso) and zuranolone (Zurzuvae) for moderate-to-severe postpartum depression.
- Outlines a comprehensive treatment plan that begins with universal screening for depression and anxiety. The approach combines medication when appropriate with psychotherapy and crucial behavioral and social interventions, such as sleep preservation, psychoeducation, and connecting patients to resources like Postpartum Support International (PSI).
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Perinatal Anxiety Disorders (Dr. Cirino)
- Focuses on Perinatal Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD), emphasizing that untreated maternal anxiety is associated with adverse birth outcomes and negative long-term effects on child development.
- Details the presentation of perinatal OCD, noting that pregnancy is a common trigger. It highlights the prevalence of ego-dystonic (unwanted and distressing) intrusive thoughts of harming the infant, clarifying that these obsessions are a feature of anxiety and are distinct from the ego-syntonic thoughts seen in postpartum psychosis.
- Explains the causes and symptoms of perinatal PTSD, stressing that the mother's subjective experience of traumaâsuch as a perceived lack of control or an intense fear for her own life or her baby's lifeâis a more significant predictor than the objective medical events. It recommends screening for PTSD with the PCL-5 tool and outlines a time-sensitive approach to intervention.
- Outlines treatment strategies, recommending SSRIs (often at higher doses for OCD) and evidence-based psychotherapies like Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT). It also underscores the importance of a trauma-informed care approach by all providers.
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Bipolar Disorder in Women: Meeting the Challenge (Dr. Cirino)
- Highlights the unique challenges of bipolar disorder in women, who report worse overall well-being than men, likely because standard assessments miss key domains affected by the illness such as parenting and reproductive health. Women more commonly have Bipolar II, a later age of onset, and a course of illness dominated by depressive episodes.
- Stresses the challenge of accurate diagnosis, as many women are initially misdiagnosed with depression. It recommends routine screening for bipolar disorder (using tools like the CIDI-3) before prescribing antidepressants to avoid triggering mania.
- Identifies the perinatal period as a time of extreme vulnerability, noting that 85% of women who discontinue mood stabilizers during pregnancy will relapse. The postpartum period carries a 100-fold increased risk of postpartum psychosis for women with bipolar disorder.
- Outlines a risk/benefit approach to perinatal treatment, emphasizing that the dangers of untreated bipolar disorder in pregnancy are substantial. It advises pre-pregnancy consultation, continuation of mood stabilizers (favoring agents like lamotrigine and lithium over the teratogenic valproic acid ), and aggressive postpartum prophylaxis to prevent relapse and psychosis.
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Managing Postpartum Psychosis during Pregnancy and Postpartum (Dr. Cirino)
- Defines Postpartum Psychosis (PPP) as a psychiatric emergency with a rapid onset, characterized by delusions and mood lability. It highlights that the lack of a formal DSM-5 diagnosis is part of a larger systemic failure that includes no consensus treatment guidelines or required residency training. PPP is strongly linked to Bipolar Disorder and is likely triggered by the dramatic postpartum drop in neurosteroids.
- Differentiates PPP from perinatal OCD, noting that psychotic thoughts of harming the infant are ego-syntonic (believed to be real) and carry a ~4% risk of infanticide, whereas obsessive thoughts are ego-dystonic (unwanted and distressing) and do not increase the risk of harm. The motive in PPP-related infanticide is often altruistic and delusional.
- Identifies the primary risk factors as a personal or family history of Bipolar Disorder or a previous PPP episode, while noting that psychosocial stressors are not significant predictors. The presentation stresses that PPP is preventable with prophylactic medication (e.g., lithium) for high-risk women.
- Outlines an urgent treatment plan requiring hospitalization, antipsychotics/mood stabilizers, and aggressive sleep preservation. It also highlights the legal challenges in the U.S., which, unlike many other developed nations, lacks specific infanticide laws, leading to inconsistent and often punitive legal outcomes for mothers who commit infanticide during a psychotic episode.
IMPORTANT INFORMATION
PLEASE NOTE: To attend the conference, participants must book their cruise accommodations through Continuing Education, Inc. This ensures we can provide full conference services and complimentary social amenities to meeting participants and guests. Participants' family and friends are welcome to book within our group allotment to take advantage of our typically excellent rates. Thanks for your cooperation. We look forward to welcoming you aboard!
BIAS FREE CME - No Commercial Support was provided for this CME activity.
