Endometrial polyps in postmenopausal women

The malignancy risk of endometrial polyps in postmenopausal women was correlated with the presence or absence of abnormal uterine bleeding. Of 481 postmenopausal women who presented with endometrial polyps at diagnostic hysteroscopy between 2004 and 2007, 48.9% were asymptomatic and 51.1% had postmenopausal uterine bleeding. Transvaginal ultrasound revealed abnormal endometrial thickness in 60.0% vs. 57.7%, polyps in 37.9% vs. 32.9%, endometrial tumors in 1.3% vs. 0.8%, and submucosal myomas in 0.9% vs. 2.0% by the absence or presence of bleeding. Around three-fourth of the polyps were removed. Histopathologic diagnoses showed mucous polyps in 93.7 of asymptomatic women compared to 80.7% of those with bleeding, while endometrial tumors were only seen in those bleeding (7.2%). The malignancy risk within endometrial polyps in postmenopausal women varies with the presence of vaginal bleeding, and is minimal in asymptomatic women

Postmenopausal Bleeding

published_or_final_versio

Clinical and histopathological characteristics in patients with postmenopausal bleeding

Background: Incidence of endometrial carcinoma in Vojvodina is 15-20/100 000. In 75% cases, endometrial carcinoma is diagnosed in postmenopausal period. In 90 % of patients, the first clinical sign is postmenopausal bleeding. The aim of the study was to investigate clinical and histopathological characteristics in patients with postmenopausal bleeding. Methods: The study included 122 patients with postmenopausal bleeding. All of these patients underwent gynecological examination and vaginal ultrasound. We obtained materials for histopathological analysis by fractionate explorative curettage. Once we had definitive histopathological findings, we divided patients in two groups A (endometrial carcinoma) and B (benign changes). Results: We confirmed significant statistical differences between examined group A and B, including age (64.49 compared with 58.81 years), postmenopausal period (13.67 instead 9.11 years), and length of uterine corpus (6.41 instead 5.25 cm). Conclusion: Elderly women with longer postmenopausal interval and postmenopausal bleeding had increased risk for endometrial carcinoma. Measurement of endometrial thickness by transvaginal ultrasound appeared to be insufficient parameter for differentiating the benign from the malignant changes of endometrium. Patients with endometrial carcinoma had significantly longer corpus of uterus comparing to patients with benign changes. Body mass index was not found to be significant risk factor in development of endometrial carcinoma in the examined groups. Obesity was diagnosed in both groups, suggesting that increased body mass index is a risk factor for development of pathological changes in endometrium, which could lead to postmenopausal bleeding

Hormone replacement therapy

Martha Hickey, Jane Elliott, Sonia Louise Daviso

WISDOM: history and early demise - was it inevitable?

In 1989, the UK Medical Research Council (MRC) agreed that, if feasible, a randomized controlled trial to assess the long-term risks and benefits of hormone replacement therapy (HRT) was a priority. Feasibility work began in 1990 and demonstrated that a large-scale multicenter trial was possible. An application for funding for a main trial was submitted to MRC in 1993 and, after extensive review, funding was released in late 1996. Set-up work for the trial - the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) - began in 1997 with recruitment in 1999. In October 2002, following the early discontinuation of one arm of the US Women's Health Initiative HRT trial, the MRC decided to stop the WISDOM trial. This article, by the principal UK investigators of WISDOM, sets out the background and history of the trial

Diagnostic accuracy of sonohysterography vs hysteroscopy in benign uterine endocavitary findings

OBJECTIVE: To compare diagnostic accuracy of sonohysterography vs hysteroscopy in patients with benign uterine endocavitary findings. PATIENTS AND METHODS: This retrospective study evaluated 202 patients submitted to sonohysterography after transvaginal ultrasound examination suspicious for uterine endocavitary findings. Cytological sample was taken and analyzed from the fluid used to distend the uterine cavity. Of 202 patients enrolled for this study, 86 patients underwent gynaecological surgery, of whom 77 were treated with operative hysteroscopy and 9 with other gynaecological surgical techniques. Statistical analysis was performed to evaluate diagnostic agreement between sonohysterography vs hysteroscopy and cytology vs histology. RESULTS: Diagnostic concordance between sonohysterography and hysteroscopy was significant (k value 0.87). The correlation between cytological and histological findings had a moderate level of concordance (k value 0.49).CONCLUSIONS: Sonohysterography provides a diagnostic accuracy as well as hysteroscopy, therefore, it could be considered an alternative procedure in the diagnosis of benign uterine endocavitary findings

Evidence for Action on HIV Treatment and Care Systems in low and middle-income countries: background and introduction.

Despite the unprecedented scale-up of treatment for HIV in low and middle-income countries over the past decade, 49% of adults and 77% of children in need of HIV treatment still do not have access to it. ART programmes that were initially set up as an emergency response now need to be adapted to ensure that they include all the essential components and are well integrated with other health services; meet the needs of special groups, including children, adolescents, pregnant women and older people; address the mental health needs of HIV-positive people; and monitor as well as report their impact in valid and comparable ways.This supplement is an output from the Evidence for Action on HIV Treatment and Care Systems research programme consortium. Evidence for Action was a 5-year, multidisciplinary research programme, which ran from 2006 to 2011, with partners in India, Malawi, Uganda, Zambia and the United Kingdom.The primary aim of this supplement is to stimulate reflection and provide guidance on what should be in the package of HIV treatment and care systems, as national programmes look to maintain the major advances of the past decade and scale-up treatment to the other 50% of people in need of it

Optical properties, physiologic parameters and tissue composition of the human uterine cervix as a function of hormonal status

The influence of sex hormones on the human uterine cervix is likely to be important in the process of cervical ripening. Frequency domain near-infrared spectroscopy (FD-NIRS) was used to investigate non-invasively the changes in the optical properties that reflect physiologic parameters and tissue composition of the uterine cervix in the different phases of the menstrual cycle. Twenty premenopausal and nine postmenopausal women were examined. Optical properties of the uterine cervix were measured, and physiological parameters [concentration of water, oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb), total hemoglobin (tHb), oxygen saturation (StO2), water, and scattering power] were calculated. Analysis of variance (ANOVA) was used to test for statistical significance. The optical properties of the anterior cervical lip did not differ from those of the posterior lip. HHb was significantly lower in cervices during menstrual bleeding than during the follicular, luteal, or postmenopausal phases. The ratio of O2Hb to HHb was highly significantly increased by a factor of 2 when cervices during the menstrual bleeding were compared with those during the follicular, luteal, or postmenopausal phases. The scattering power was significantly lower during menstrual bleeding than during the follicular or postmenopausal phases. We demonstrated that withdrawal of sex hormones during menstrual bleeding is associated with a significant decrease in HHb and scattering power, with stable values of O2Hb, tHb, StO2, and H2O compared with the values during the follicular, luteal or postmenopausal phases of the menstrual cycle. Cervical softening during menstrual bleeding seems to be different from cervical softening for labo

Progestins Related to Progesterone and Testosterone Elicit Divergent Human Endometrial Transcriptomes and Biofunctions.

Progestins are widely used for the treatment of gynecologic disorders and alone, or combined with an estrogen, are used as contraceptives. While their potencies, efficacies and side effects vary due to differences in structures, doses and routes of administration, little is known about their effects on the endometrial transcriptome in the presence or absence of estrogen. Herein, we assessed the transcriptome and pathways induced by progesterone (P4) and the three most commonly used synthetic progestins, medroxyprogesterone acetate (MPA), levonorgestrel (LNG), and norethindrone acetate (NETA), on human endometrial stromal fibroblasts (eSF), key players in endometrial physiology and reproductive success. While there were similar transcriptional responses, each progestin induced unique genes and biofunctions, consistent with their structural similarities to progesterone (P4 and MPA) or testosterone (LNG and NETA), involving cellular proliferation, migration and invasion. Addition of estradiol (E2) to each progestin influenced the number of differentially expressed genes and biofunctions in P4 and MPA, while LNG and NETA signatures were more independent of E2. Together, these data suggest different mechanisms of action for different progestins, with progestin-specific altered signatures when combined with E2. Further investigation is warranted for a personalized approach in different gynecologic disorders, for contraception, and minimizing side effects associated with their use