“What is an appropriate dosage and interval of vitamin D2 supplementation to achieve a sufficiency level in postmenopausal women of Thailand?” A randomized, double-blind, placebo-controlled trial

AbstractObjectiveThis study primarily evaluated serum 25-hydroxy vitamin D levels in postmenopausal women with vitamin D insufficiency who received different dosages and intervals of vitamin D2 supplementation. We secondarily evaluated the percentages of those who achieved vitamin D sufficiency level (Defined as ≥30 ng/ml).Study designRandomized double-blind, placebo-controlled trial.MethodsPostmenopausal women who met the criteria of vitamin D insufficiency (<30 ng/mL) were randomized into 4 groups (N = 25/group). Participants received a 12 week-treatment of different dosages and intervals of vitamin D2 (placebo, vitamin D2 20,000 IU/2 weeks, vitamin D2 20,000 IU/week, and vitamin D2 40,000 IU/week). Serum total 25-hydroxy vitamin D was determined at baseline, after 4 and 12 weeks of supplementation with electrochemiluminescence immunoassay (Elecys, Roche Diagnostics). Changes of 25-hydroxy vitamin D levels were compared among the groups.ResultsForty seven percent of postmenopausal women (100/212) screened for study enrolment were found to have vitamin D insufficiency. At 12 weeks, serum 25-hydroxy vitamin D increased significantly from baseline in all groups (p < 0.01) (mean serum 25-hydroxy vitamin D level increased from 23.03 ± 4.56 at baseline to 25.60 ± 4.79 ng/ml (placebo), 23.54 ± 5.14 to 27.83 ± 5.27 ng/ml (vitamin D2 20,000 IU/2 weeks), 22.68 ± 5.21 to 30.50 ± 5.14 ng/ml (vitamin D2 20,000 IU/week), and 22.88 ± 4.83 to 37.89 ± 5.47 ng/ml (vitamin D2 40,000 IU/week)). In addition, the 25-hydroxy vitamin D levels were statistically significantly different at 4 and 12 weeks (p < 0.01) among all 4 groups. The percentages of those achieving vitamin D sufficiency level after 12 weeks of supplementation were 16% (placebo), 27.3% (vitamin D2 20,000 IU/2 weeks), 44% (vitamin D2 20,000 IU/week), and 86.4% (vitamin D2 40,000 IU/week); statistically significantly different among the four groups (p < 0.01). There was no participant with 25-hydroxy vitamin D after 12 weeks of >50 ng/mL in this study.ConclusionVitamin D2 40,000 IU/week was found to be the most effective dosage for postmenopausal women in this study to achieve serum vitamin D sufficiency level

Number of vaginal lactobacilli in postmenopausal women with vaginal atrophy before and after treatment with erbium–YAG laser: a randomized sham-controlled trial

Abstract Primary objective To evaluate the effect of erbium–YAG laser on the number of vaginal lactobacilli in postmenopausal women. Secondary objectives To evaluate the effect of erbium–YAG laser on vaginal atrophy symptoms and vaginal pH in postmenopausal women. Materials and methods A total of 44 postmenopausal women who met the inclusion criteria were randomized in the laser group (n = 22) and sham group (n = 22). Vaginal lactobacilli grading, vaginal pH, vaginal atrophy score, and vaginal atrophy symptoms were assessed before and after treatment with erbium–YAG laser for two consecutive times, with a four-week interval; the results were compared with the effects of the sham procedure. Any adverse events after the treatment were recorded. Results A total of 44 women were included, and five were lost to follow-up. Compared with sham procedure, vaginal lactobacilli grading improved in the laser group (5/20 in the laser group and 1/19 in the sham group). However, the improvement did not reach statistical significance (adjusted odds ratio = 5.32, 95% CI = 0.5–56.21). Vaginal atrophy symptoms measured by the visual analog scale (VAS) and vaginal pH were improved in both groups without a statistically significant difference between the two groups. Vaginal “dryness” VAS and vaginal atrophy score after treatment were significantly lowered in the laser group compared with the sham group. Conclusions This study showed an improvement in vaginal lactobacilli grading after vaginal laser treatment. However, the difference in vaginal lactobacilli grading after treatment in both groups was not statistically significant

Thai Interest Group for Endometriosis (TIGE) consensus statement on endometriosis-associated pain

This consensus statement has been developed by the Thai Interest Group for Endometriosis (TIGE) for use by Thai clinicians in the diagnosis and management of endometriosis. TIGE is a group of clinical and academic gynaecologists with a particular interest in endometriosis. Endometriosis is an oestrogen-dependent inflammatory disease which causes chronic symptoms such as dysmenorrhoea, chronic pelvic pain, dyspareunia and subfertility, and it is common in reproductive-age women. There is limited overall data on its prevalence in different clinical settings in Thailand, but it is clear that the disease causes significant problems for patients in terms of their working lives, fertility, and quality of life, as well as placing a great burden on national healthcare resources. Decisions about selecting the appropriate treatment for women with endometriosis depend on many factors including the age of the patient, the extent and severity of disease, concomitant conditions, economic status, patient preference, access to medication, and fertility need. Several hormonal treatments are available but no consensus has been reached about the best option for long-term prevention of recurrence. Bearing in mind differences in environment, genetics, and access to the healthcare system, this treatment guideline has been tailored to the particular circumstances of Thai women