Safety of vaginal erbium laser: A review of 113,000 patients treated in the past 8 years.

Background: Energy-based devices are becoming a popular option for minimally invasive vaginal procedures. The aim of this study was to obtain information on the frequency of occurrence of adverse effects (AEs) related to vaginal erbium laser (VEL™) treatment.Materials and methods: The global survey was conducted among practitioners using the non-ablative VEL™ (Fotona, Ljubljana, Slovenia). Users were invited to provide the number of patients treated with VEL™ and the number of observed laser-related AEs.Results: The survey was conducted from August 2018 to April 2019. Responses from 535 practitioners were collected, with a total of 113,174 patients treated in the period from 2012 to 2019. Out of 535 respondents, 160 (30%) shared detailed information about the indications they treated in a population of 62,727 patients, whereas 188 (35%) respondents provided information on the frequency of AEs observed in their treated population of 43,095 patients. All observed AEs were mild to moderate, transient and appeared with low frequencies.Conclusions: Minimally invasive thermal-only laser treatment using the non-ablative VEL™ procedures appears to be safe and the incidence of AEs is low

Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases?

Menopausal disorders may include shorter-term symptoms, such as hot flushes and night sweats (vasomotor symptoms, VMS) and longer-term chronic conditions such as cardiovascular disease (CVD), osteoporosis, and cognitive impairment. Initially, no clear link between the shorter-term symptoms and longer-term chronic conditions was evident and these disorders seemed to occur independently from each other. However, there is a growing body of evidence demonstrating that VMS may be a biomarker for chronic disease. In this review, the association between VMS and a range of chronic postmenopausal conditions including CVD, osteoporosis, and cognitive decline is discussed. Prevention of CVD in women, as for men, should be started early, and effective management of chronic disease in postmenopausal women has to start with the awareness that VMS during menopause are harbingers of things to come and should be treated accordingly

Sexual function after vaginal erbium laser: the results of a large, multicentric, prospective study.

The aim of this multicentric, prospective study was to evaluate the effects of vaginal erbium laser (VEL-SMOOTH®) on sexual function in postmenopausal women suffering from the genitourinary syndrom..

Hormone replacement therapy and cardioprotection. A new dawn? A statement of the \u27Gruppo di studio sulle malattie cardiovascolari nella donna\u27 of the societ? italiana di cardiologia on hormone replacement therapy in postmenopausal women

Cardiovascular disease is the leading cause of death in women in western countries. Despite preventive strategies, in the past decades, the incidence of cardiovascular events has shown a decline in men but a rise in women, matching the growth of the population of postmenopausal women. Several epidemiological findings suggest the causative pathophysiological role of ovarian hormone deficiency in the development of cardiovascular disease in women. Observational and randomized studies have suggested that hormone replacement therapy in early postmenopause could be beneficial from a cardiovascular point of view. Conversely, aging, time since menopause and presence of cardiovascular risk factors or cardiovascular disease may decrease its efficacy and increase the risk of cardiovascular events. It is plausible that the unfavorable effects of the estrogen/progestin combination used in the randomized studies are not related to the hormone preparation per se but rather to the use of hormones in the less receptive group of women, older and with cardiovascular risk factors. Clinical judgment, choice of the right dose and estrogen/ progestin combination are of pivotal importance to maximize the beneficial effect of estrogen replacement therapy/hormone replacement therapy, especially if given within a reasonable time after the menopause to the women who need the therapy for the relief of menopausal symptoms

Reflections and recommendations on the COVID-19 pandemic: Should hormone therapy be discontinued?

Since the COVID-19 pandemic outbreak, the extent of seriouscomplications and high rate of mortality has concerned all the healthauthorities worldwide. Death by COVID-19 is mainly due to acute re-spiratorydistresssyndrome(ARDS),althoughheartandmultipleorganfailure may contribute [1]. Underlying mechanisms are COVID-19-in-duced endothelial alteration, cytokine storm, inflammation, exudationin the lungs, and vessel occlusion.1. DifferencebetweensexesMortalitybyCOVID-19ishigherinmenthaninwomen.Amongtheadvocated reasons are a different exposure to risk factors such assmoking, reduced care of men about their health or different associa-tion with other morbidities. Nevertheless, a different expression ofACE2 may explain the different mortality between sexes. COVID-19disease progression is reduced by ACE2 enzyme expression in en-dothelial cells mainly at the lung and heart, where it exerts vasodi-lating, anti-inflammatory and anticoagulant effects [2]. ACE2 is codedby the X chromosome, of which men have only one, and ACE2 ex-pression in endothelial cells is stimulated by estrogens [2]. The possi-bility that thismechanisms accountsfor the lowermortalityof womenvs. men (Yi et al.) is sustained by the recent evidence that reducedmortality (−72 %) of fertile women vs. men is lost, at least in part, inthe postmenopausal years (−49.6 %) [3].2. HormonetherapyThese data lead to speculation that hormone therapy or even po-tentiating estrogen stimulus by exogenous estrogens may antagonizethe deadly progression of the disease. On the other hand, exogenousestrogens may increase coagulating factors and the risk of throm-boembolic events with a potential consequent increase in mortality.Hospitalized individuals with very severe COVID-19 disease have anactivated coagulation defined by high levels of D-dimers, products offibrin degradation, and when D-dimer levels are very high, antic-oagulants like heparin may reduce mortality [4]. In order to decreasethe risk of thromboembolic events a recent publication has re-commended that peri- and post-menopausal women immediatelywithdraw from exogenous hormone administration after becoming in-fected by COVID-19 [5]. This position stimulates some considerations.1) Thrombophilic states are not among the comorbidities that ac-celerate COVID-19 disease progression. To date, there is no reportdocumenting that the most thrombophilic state in woman life, i.e.pregnancy,orevenhormonalcontraceptiveuse[6],isassociatedwithaworst prognosis of COVID-19 infection. 2) Locally formed thrombi,consequenttomassiveendothelialdisruptionandlocalactivationoftheextrinsic coagulation cascade, rather than cloth emboli, appear to oc-cludelungvesselsofCOVID-19-infectedindividualsinthelaststageofdisease[4].Indeed,theevidencethatmanywomenwithoccludedlungvessels lack peripheral vein thrombosis challenges the theory of amassively increased thrombophilic condition [4]. Of the Virchowtriadexplainingbloodclotformation,i.e.increasedcoagulation,bloodstasisand altered endothelium, it is the third component that is highly pre-valent in COVID-19 individuals, the contribution of increased coagu-lation being unknown and probably negligible [4]. 3) The dose of he-parinusedinCOVID-19-infectedindividuals(80−100mg)exceedstheprophylacticdoseforthrombophilicstates.4)Aputativeincreasedriskof venous thrombosis due to increased synthesis of coagulation factorsis mainlylimited tothefirsttwo years oforal estrogenadministration,and up to now no study has reported a thrombophilic effect of trans-dermal estrogens [7]. 5) Perimenopausal women requiring hormonalcontraception are usually in their late forties and postmenopausalwomen start their hormone therapy for symptoms before 60 years ofage. In these years, mortality from COVID-19 is below 1 % [3], andthere is no report that it is higher in women on hormones.3. ConclusionsAt first sight, indications for COVID-19-positive individuals towithdraw from hormone therapy or oral contraceptives may seem awise recommendation, but it is not based on real data. It takes intoconsideration only one side of the coin, the procoagulant activity ofexogenousoralestrogens.ThiseffectforCOVID-19patientsislikelytheleast important. In these individuals, increased coagulation is con-sequent to massive endothelial disruption and to the activation of theextrinsic coagulation cascade, with no evidence that an increase incoagulating factors plays any role [4]. By contrast, the advice towithdraw from estrogens misses a consideration of the main effect ofestrogens, i.e. their ability to stimulate ACE2 enzyme expression, acritical factor in reducing mortality from COVID-19 [2].4. RecommendationsOn these bases, we suggest that advice for COVID-19-infectedwomen should be:a Hormone therapy or hormonal contraceptives [6] should be con-tinued, unless the woman is severely ill, a condition in which hor-monalbalanceisprobablynotsocrucial.Intheotherconditions,thepossibility that hormone withdrawal may accelerate COVID-19https://doi.org/10.1016/j.maturitas.2020.05.022Received 16 May 2020DOI of original article:https://doi.org/10.1016/j.maturitas.2020.05.021Maturitas 138 (2020) 76–770378-5122/ © 2020 Elsevier B.V. All rights reserved.

Acute Modulation of Adipose Tissue Lipolysis by Intravenous Estrogens

Objective: The aim of this study was to determine whether intravenous (IV) conjugated estrogens (EST) acutely enhance the suppression of whole-body or regional subcutaneous adipose tissue (SAT) lipolysis by insulin in postmenopausal women. Research Methods and Procedures: We assessed whole-body lipolysis by [2H5]glycerol rate of appearance (GlycRA) and abdominal and femoral SAT lipolysis (interstitial glycerol; GlycIS) by subcutaneous microdialysis. Postmenopausal women (n = 12) were studied on two occasions, with IV EST or saline control (CON), under basal conditions and during a 3-stage (4, 8, and 40 mU/m2/ min) hyperinsulinemic, euglycemic clamp. Ethanol outflow/inflow ratio and recovery of [13C] glycerol during microdialysis were used to assess blood flow changes and interstitial glycerol concentrations, respectively. Results: Compared with CON, EST did not affect systemic basal or insulin-mediated suppression of lipolysis (GlycRA) or SAT nutritive blood flow. Basal GlycIS in SAT was reduced on the EST day. However, insulin-mediated suppression of lipolysis in SAT was not significantly influenced by EST. Discussion: These findings suggest that estrogens acutely reduce basal lipolysis in SAT through an unknown mechanism but do not alter whole-body or SAT suppression of lipolysis by insulin. Originally published Obesity (Silver Spring), Vol. 14, No. 12, Dec 200

Ovarian Damage During Chemotherapy in Autoimmune Diseases: Broad Health Implications beyond Fertility

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94402/1/Marder_2012_Ovarian_damage_chemotherapy_autoimmune.pdf165