Objective To compare the representation of women in Obstetrics and Gynecology department-based leadership to other clinical specialties, while accounting for proportions of women in historical residency cohorts. Methods This was a cross-sectional observational study. The gender of department-based leaders (chair, vice chair, division director) and residency program directors was determined from websites of 950 academic departments of Anesthesiology, Diagnostic Radiology, General Surgery, Internal Medicine, Neurology, Obstetrics and Gynecology, Pathology, Pediatrics, and Psychiatry. Each specialty's representation ratio—proportion of leadership roles held by women in 2013 divided by proportion of residents in 1990 who were women—and 95% confidence interval (CI) were calculated. A ratio of one indicates proportionate representation. Results Women were significantly under-represented among chairs for all specialties (ratios ≤0.60, P≤0.02) and division directors for all specialties except Anesthesiology (ratio: 1.13, 95% CI: 0.87–1.46) and Diagnostic Radiology (ratio: 0.97, 95% CI: 0.81–1.16). The representation ratio for vice chair was below 1.0 for all specialties except Anesthesiology; this finding reached statistical significance only for Pathology, Pediatrics, and Psychiatry. Women were significantly over-represented as residency program directors in General Surgery, Anesthesiology, Obstetrics and Gynecology, and Pediatrics (ratios >1.19, P≤0.046). Obstetrics and Gynecology and Pediatrics had the highest proportions of residents in 1990 and department leaders in 2013 who were women. Conclusion Despite having the largest proportion of leaders who were women, representation ratios demonstrate Obstetrics and Gynecology is behind other specialties in progression of women to departmental leadership. Women's over-representation as residency program directors raises concern because education-based academic tracks may not lead to major leadership roles.

Objective-The aim of this study was to determine the effect of DRIs on hot flash symptoms in menopausal women.Design-This was a randomized, double-blind, placebo-controlled trial of menopausal women, aged 38 to 60 years, who experienced 4 to 14 hot flashes per day. After a 1-week run-in period, a total of 190 menopausal women were randomized to receive a placebo or 40 or 60 mg/day of a DRI for 12 weeks. The primary outcome was the mean changes from baseline to week 12 in the frequency of hot flashes recorded in the participant diary. The secondary outcomes included changes in quality of life and hormonal profiles.Results-A total of 147 women (77%) completed the study. It was found that 40 and 60 mg of DRI improved hot flash frequency and severity equally. At 8 weeks hot flash frequency was reduced by 43% in the 40-mg DRI group and by 41% in the 60-mg DRI group, compared with 32% in the placebo group (P = not significant vs placebo). The corresponding numbers for 12 weeks were 52%, 51%, and 39%, respectively (P = 0.07 and 0.09 vs placebo). When comparing the two treatment groups with the placebo group, there were significant reductions in mean daily hot flash frequency. The supplement (either 40 or 60 mg) reduced hot flash frequency by 43% at 8 weeks (P = 0.1) and 52% at 12 weeks (P = 0.048) but did not cause any significant changes in endogenous sex hormones or thyroid hormones. Menopausal quality of life improved in all three groups, although there were no statistically significant differences between groups.Conclusions-DRI supplementation may be an effective and acceptable alternative to hormone treatment for menopausal hot flashes. Although hormone therapy (HT) is the most effective treatment for the relief of hot flashes to date, evidence suggests that long-term use of HT may increase the risk of developing certain medical disorders. The data from the Women's Health Initiative showed an increased risk of coronary heart disease, stroke, pulmonary embolism, and breast cancer with estrogen + progestogen therapy (conjugated equine estrogens + medroxyprogesterone acetate) after a mean of 5.2 years of follow-up. 3 Estrogen+ progestogen therapy was associated with a 24% increased risk of coronary heart disease. 4 Thus, safe and effective alternatives are needed. KeywordsRecently interest has arisen in isoflavones as a potential therapy for menopausal hot flashes.Isoflavones are one of several classes of phytoestrogens, compounds that exert both estrogenic and antiestrogenic properties. Daidzein and genistein are isoflavones that are found in rich supply in soybeans and soy products. Available data on isoflavones for the treatment of menopausal symptoms have been inconclusive; studies with positive results have reported only a slight improvement. Nonetheless, there are no studies showing harmful effects of isoflavones on menopausal symptoms. This inconsistency may, in part, be due to differences in methods used to isolate isoflavones, concentrations of bioavailable isoflavones, and the composition of isoflav...