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Background: Whereas symptomatic endometriosis may affect work performance, the impact of endometriosis in the general community is not known. Aims: The associations between endometriosis and each of sick leave and work ability, were investigated in a large sample of non‐healthcare seeking women. Materials and Methods: This community‐based, cross‐sectional study recruited 6986 women, aged 18–39 years, from three eastern states of Australia between 11 November 2016 and 21 July 2017. Women were identified as having endometriosis if they had undergone a pelvic ultrasound and reported a diagnosis of endometriosis. Working women completed the Work Ability Index. Results: Participants were predominantly of European ancestry (73.1%) and 46.8% were overweight or had obesity. The prevalence of endometriosis was 5.4% (95%CI 4.9–6.0%) with the highest prevalence of 7.7% (95%CI 6.5 to 9.1%) for women aged 35–39 years. Among the 4618 working women, those with endometriosis had significantly more sick days from work (33.6% reported ≥10 days vs 13.5%, overall χ2P < 0.001). Endometriosis was associated with a greater likelihood of poor to moderate work ability, after adjusting for age, body mass index, ethnicity, relationship status, student status, insecure housing, being a carer for another person, parity, ever use of assisted reproductive technologies, and depressed mood (odds ratio 1.90, 95%CI 1.40–2.58, P < 0.001). Conclusions: This study provides new evidence that the negative impact of endometriosis on work attendance and work ability is not limited to women with prevalent symptoms and severe disease, but appears to encompass women across a broader spectrum of this condition in the community. [ABSTRACT FROM AUTHOR]

Summary: Background: We investigated whether metformin prevents tamoxifen‐induced endometrial changes and insulin resistance (IR) after a diagnosis of breast cancer. Methods: This was a single‐centre, randomized, double‐blind, placebo‐controlled, parallel group trial. Postmenopausal women with hormone receptor‐positive breast cancer taking tamoxifen were randomly allocated to metformin 850 mg or identical placebo, twice daily, for 52 weeks. Outcome measures included double endometrial thickness (ET) measured by transvaginal ultrasound, fasting insulin, glucose and IR estimated by the homeostasis model of assessment (HOMA‐IR). Results: A total of 112 women were screened and 102 randomized. Results are presented as median (range). The 101 women who took at least one dose of medication were aged 56 (43‐72) years, with 5(0.5‐28) years postmenopause, and had taken tamoxifen for 28.9 (0‐367.4) weeks. The baseline ET was 2.9 mm (1.4‐21.9) for the placebo group (n = 52) and 2.5 mm (1.3‐14.8) for the metformin group (n = 50). At 52 weeks, the median ET was statistically significantly lower for the metformin (n = 36) than for the placebo group (n = 45) (2.3 mm (1.4‐7.8) vs 3.0 (1.2‐11.3); P = 0.05). 13.3% allocated to placebo had an ET greater than 4 mm vs 5.7% for metformin (P = 0.26). There was no endometrial atypia or cancer. Compared with placebo, metformin resulted in significantly greater baseline‐adjusted reductions in weight (P < 0.001), waist circumference (0.03) and HOMA‐IR (P < 0.001). Conclusions: Metformin appears to inhibit tamoxifen‐induced endometrial changes and has favourable metabolic effects. Further research into the adjuvant use of metformin after breast cancer and to prevent EH and cancer is warranted. [ABSTRACT FROM AUTHOR]

Background Little is known of the impact of aromatase inhibitor (AI) therapy on sexual and pelvic floor function. Aim To document the prevalence of, and factors associated with, low desire, sexually related personal distress, hypoactive sexual desire dysfunction (HSDD), and pelvic floor dysfunction in women 10 years after breast cancer diagnosis. Methods This was a prospective, observational, community-based cohort study of Australian women with invasive breast cancer recruited within 12 months of diagnosis. 1,053 of the 1,305 who completed the initial 5 years of study follow-up agreed to be re-contacted, and 992 of these women alive 10 years after diagnosis were sent the study questionnaire. Outcomes The main outcome measure was HSDD determined by a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI) plus a score of at least 11.0 on the Female Sexual Distress Scale–Revised (FSDS-R). Pelvic floor disorders, including urinary incontinence, fecal incontinence, and pelvic organ prolapse, were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with low desire, personal distress, and HSDD. Results 625 completed questionnaires were returned. The respondents’ median age was 65.1 years (range = 36.4–95.5). Current AI use was reported by 10% and tamoxifen use was reported by 3.4%. 521 of the 608 women (85.7%; 95% CI = 82.9–88.5) who competed the FSFI desire domain had low sexual desire, and 246 of the 563 women (43.7%; 95% CI = 39.6–47.8%) who completed the FSDS-R had sexually related personal distress. 221 of the 559 women (39.5%; 95% CI = 35.5–43.6%) who completed the 2 questionnaires had HSDD. Current AI users were more likely to have HSDD than non-users (55.2% [95% CI = 42.2–68.1] vs 37.8% [95% CI = 33.5–42.0]; P = .01). HSDD was more prevalent in sexually active, current AI users (66.7%; 95% CI = 49.4–83.9) vs current non-users (43.6%; 95% CI = 37.0–50.2; P = .02). In a logistic regression model, HSDD was significantly associated with current AI use and inversely associated with age. Fecal incontinence was more prevalent in AI users than in current non-users (29.8% [95% CI = 17.8–41.8] vs 16.4% [95% CI = 13.2–19.6], respectively; P = .01). Clinical Implications It is important to address women’s sexual health even many years after their breast cancer diagnosis. Strengths and Limitations Strengths include a representative sample, use of validated questionnaires, and few missing data. Limitations include sexual activity being a 4-week recall. Conclusions AI use is associated with HSDD and fecal incontinence in women who are 10 years after breast cancer diagnosis. Robinson PJ, Bell RJ, Christakis MK, et al. Aromatase Inhibitors Are Associated With Low Sexual Desire Causing Distress and Fecal Incontinence in Women: An Observational Study. J Sex Med 2017;14:1566–1574. [ABSTRACT FROM AUTHOR]

Background: This study determined the prevalence of bothersome menstrual symptoms and their association with workability in naturally menstruating women not using hormonal contraception. Materials and Methods: A representative sample of community-dwelling Australian women aged 18–39 years selected from two large national electronic databases responded to a survey on general health. This study focuses on self-reported dysmenorrhea and menstrual bleeding and their association with workability and absenteeism in working women, assessed by the Workability Index. Results: Of 3,555 women, 1,573 (44.2% [95% CI: 42.6%–45.9%]) reported moderate to severe dysmenorrhea and 774 (21.8% [95% CI: 20.4%–23.2%]) reported heavy to very heavy bleeding. Women with dysmenorrhea were 50% more likely to report poorer work performance and twice as likely to report more days of sick leave in the past year (absenteeism) than other women. Conclusions: Despite the availability of safe and effective management options, Australian working women aged 18–39 years continue to experience bothersome dysmenorrhea and menstrual bleeding. Dysmenorrhea is associated with increased absenteeism and poorer workability. Therefore, awareness needs to be raised among women and health care providers of ways to manage dysmenorrhea and heavy bleeding and the unmet need for intervention in the community, respectively. [ABSTRACT FROM AUTHOR]

Objective Whether moderate to severe obesity (body mass index (BMI) ≥ 30 to <40 kg/m 2 ) contributes to breast cancer recurrence and mortality remains uncertain. Subjects and methods 1199 women, recruited within 12 months of their diagnosis of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−) invasive breast cancer completed an enrolment questionnaire and an annual follow-up questionnaire every 12 months for another 5 years. The impact of obesity on time to either local or distant recurrence or new breast cancer, or death due to breast cancer was determined by Cox regression. Women in the most extreme categories of BMI (<18.5 and ≥40) were excluded from the analysis. Results Of the 1155 included women, mean age, 58.4 ± 11.6 years, 53.8% had Stage 1 disease and 88.9% received oral adjuvant endocrine therapy (OAET) within 2 years of diagnosis. The likelihood of an event was significantly associated with moderate to severe obesity (HR = 1.71, 95%CI, 1.12–2.62, p = 0.014), disease beyond Stage 1 (HR = 2.87, 95% CI 1.73–4.75, p < 0.001), OAET (HR = 0.26, 95%CI 0.14–0.46, p < 0.001), mastectomy (HR = 3.28, 95%CI 1.98–5.44, p < 0.001) and radiotherapy (HR = 2.12, 95%CI 1.24–3.63, p = 0.006). For Stage 1 disease, only moderate to severe obesity (HR 3.23, 95%CI 1.48–7.03, p = 0.003) and OAET use (HR 0.41, 95%CI 0.17–0.98, p = 0.046) were significantly associated with an event. Conclusion Moderate to severe obesity is associated with a poorer invasive breast cancer prognosis; this is also true for women with Stage 1 disease, and is independent of age and treatment. [ABSTRACT FROM AUTHOR]

Objective Sex hormone-binding globulin (SHBG) is a robust predictor of insulin resistance. Whether this is independent of circulating sex steroid levels remains uncertain. The aim of this study was to investigate the determinants of SHBG in postmenopausal women and whether the relationship between SHBG and insulin resistance is independent of oestrogen and androgen levels. Design A cross-sectional study of naturally and surgically menopausal women. Participants Seven hundred and sixty three postmenopausal women not using any systemic hormone therapy, mean age 54·4 ± 5·8 years, recruited in the US, Canada, Australia, UK and Sweden between July 2004 and February 2005. Measurements Relationships between log-transformed (ln) SHBG and ln homoeostasis model assessment for insulin resistance (HOMA-IR) were explored, taking into account age, body mass index (BMI), blood pressure (BP) and circulating oestradiol, oestrone, testosterone and dihydrotestosterone. Results Taking into account age, race, years since menopause, menopause type, BMI, BP, prior postmenopausal hormone use and the sex steroids measured, 34·4% of the variation in SHBG could be explained by the model that included negative contributions by HOMA-IR, BMI and diastolic BP, and a positive contribution by total testosterone ( P < 0·001). None of the sex steroids made independent contributions to HOMA-IR, which was best explained by the model that included BMI, SHBG, systolic BP and surgical menopause, with each variable being positively related to HOMA-IR ( r2 = 0·3152, P = 0·03). Conclusions The relationship between SHBG and HOMA-IR, as an estimate of insulin resistance, is not explained by endogenous oestrogen and androgen levels and is, at least in part, independent of BMI in postmenopausal women. [ABSTRACT FROM AUTHOR]

This paper discusses findings from research conducted in an inner-city middle school in England where the majority of pupils spoke languages other than English as a first language. The research was motivated both by a belief that the language needs of English as an additional language (EAL) pupils are not properly addressed in the National Curriculum and by a specific concern of the subject teachers that the EAL pupils' small English vocabularies resulted in their lack of oral participation in lessons and contributed to their below average attainment. The paper discusses the effects on the pupils' learning of subject teachers' practices in teaching key vocabulary in science and geography lessons. It argues that a more explicit, systematic and principled approach to vocabulary teaching needs to be integrated into National Curriculum pedagogy. [ABSTRACT FROM AUTHOR]

Background: Little is known of the prevalence and severity of menstrual dysfunction, climacteric symptoms, pelvic floor disorders, sexual problems, and psychological wellbeing after lung transplantation in women. Materials and Methods: Adult female lung transplant recipients, attending the Alfred Hospital Lung Transplant Service in Melbourne, Australia participated in a women's health, cross-sectional questionnaire-based study. Results: The 123 of 149 potential participants were recruited between September 2014 and July 2015. Their median age was 53.5 years, and 44 were premenopausal, 3 perimenopausal, and 76 postmenopausal. Moderate–severe menstrual and premenstrual symptoms were common, and 43% of partnered premenopausal women were not using contraception. Vasomotor symptoms (VMS) were common in postmenopausal women <55 years (80.0%), and the use of menopausal hormone therapy was low (8.9%). The estimated prevalence of low sexual desire associated with distress was 24.4%. Low wellbeing was significantly and independently associated with being aged 50 ≤ 60 years, moderate–severe VMS, impaired forced expiratory volume in 1 second, and psychotropic medication use. Conclusions: Our findings demonstrate that premenopausal lung transplant recipients need to be asked about bothersome menstrual symptoms, and contraceptive compliance needs regular review. Transplant recipients at midlife have substantially lower wellbeing than women of other ages and this needs attention, including assessment and management of menopausal symptoms. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to examine the effects of testosterone on verbal learning and memory in postmenopausal women. Design Randomized, placebo-controlled trial in which participants were randomized (1:1) to transdermal testosterone gel 300 mcg/day, or identical placebo, for 26 weeks. Patients Ninety-two postmenopausal women aged 55-65 years, on no systemic sex hormone therapy. Measurements The primary outcome was the score for the International Shopping List Task ( ISLT) of CogState. Secondary outcomes included other CogState domains, the Psychological General Well-Being Index ( PGWB) and safety variables. Results Eighty-nine women, median age 60 years, were included in the primary analysis. Testosterone treatment resulted in statistically significantly better performance for the ISLT (improved verbal learning and memory) compared with placebo, adjusted for age and baseline score (mean difference 1·57; 95% CI 0·13, 3·01) P = 0·03). There were no significant differences for other CogState domains or the PGWB scores. At 26 weeks, the median total testosterone was 1·7 n m (interquartile range ( IQR) 1·1, 2·4) in the testosterone group and 0·4 n m ( IQR 0·3, 0·5) in the placebo group. Conclusions The small but statistically significant effect of testosterone treatment on verbal learning and memory in postmenopausal women provides the basis for further clinical trials. [ABSTRACT FROM AUTHOR]

Background: Although pregnancy is a risk factor for urinary incontinence (UI), the extent of UI in nulligravid women has not been reported Objective: To investigate the rate of UI in a sample of young nulligravid women and its potential risk factors and effect on quality of life. Design: Cross-sectional, self-administered questionnaire-based study. Setting: University campuses and medical and allied health clinics. Participants: Nulligravid Australian women aged 16 to 30 years. Measurements: The Questionnaire for Urinary Incontinence Diagnosis, the Psychological General Well-Being Index (PGWBI), the King's Health Questionnaire, and the International Physical Activity Questionnaire-Short Form. Demographic variables and potential risk factors were also documented. Results: 1018 of 1620 questionnaires (63%) were returned, and 1002 provided analyzable data. The mean age of participants was 22.5 years (SD, 3.2). The rate of any UI was 12.6% (95% CI, 10.5% to 14.7%). Incontinence was slightly more common in students than in nonstudents (13.2% [CI, 11.0% to 15.8%] vs. 10.6% [CI, 6.7% to 14.6%]). Rates of UI varied according to sexual activity and use of combined oral contraceptives (COCs), with highest rates reported by students who were ever sexually active and not using COCs (21.5% [CI, 16.7% to 27.3%]). Women with UI reported significantly lower overall well-being than women without UI and had worse PGWBI scores related to anxiety, depression, positive well-being, and self-control. Limitation: A convenience sample of healthy, well-educated women was recruited, and response rates and participant characteristics varied by setting. Conclusion: In a sample of young nulligravid women, UI was associated with ever being sexually active and no COC use, as well as lower psychological well-being. Further research is needed to assess the prevalence and risk factors for UI in nulligravid women. Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Objective: Sex steroid levels in women vary with increasing age from the age of 70 years (70+). Whether this reflects change within individuals with age or a survival advantage is not known. This study aimed to determine the stability of circulating sex steroids and SHBG over time in individual women aged 70+. Design: A prospective cohort study. Participants: 400 women, aged 70+ not using any sex steroid, anti‐androgen/oestrogen or glucocorticoid therapy. Main outcome measurements: Sex steroid concentrations, measured by liquid chromatography‐tandem mass spectrometry and sex hormone‐binding globulin (SHBG) by immunoassay, in paired blood samples drawn 3 years apart and analysed together. Results: 400 women, median (IQR) age 78.0 (8.6) years, were included in the analysis. Mean testosterone concentrations were statistically significantly higher in follow‐up samples compared with baseline. The change was modest (mean change 31 pmol/L, 95% confidence interval (CI) 2.4–59.8; p =.034), and an increase was not observed in all women. There was a statistically significant decline in mean body mass index (mean change −0.4 kg/m2, 95% CI 0.6 to −0.3; p <.001) and a significant increase in the mean serum SHBG concentration (mean change 4.0 nmol/L, 95% CI 2.7–5.4; p <.001). The change observed in testosterone was not explained by the observed change in SHBG. There was no significant change in the mean oestrone or dehydroepiandrosterone concentration. Conclusions: Testosterone concentrations in women aged 70+ were more likely to increase than decrease. Whether increasing testosterone concentrations in older women confer a survival advantage needs investigation. [ABSTRACT FROM AUTHOR]

The article discusses a study for creating awareness regarding the application of using the iodine supplementation by the women of Australia leading to the growth and development of infant along with the maintenance of the maternal health. Topics include the results of a survey conducted on pregnant women using iodine supplements, understanding of women for taking iodine supplements, and the need for the involvement of the general practitioners (GPs) for creating awareness.

Background: The association between menopausal vasomotor symptoms (VMS) and depressive symptoms remains controversial. We aimed to examine the associations between moderate-severe VMS and moderate-severe depressive symptoms. Methods: Nationally representative cross-sectional survey of 2,020 noninstitutionalized Australian women aged 40-65 randomly recruited between October 2013 and March 2014. Symptoms were assessed by the Menopause-Specific Quality of Life Questionnaire, the Beck Depression Inventory-II, with score ≥20 defined as moderate-severe depressive symptoms. Cigarette, alcohol, and psychotropic medication use was also assessed. Binge drinking was defined as four standard drinks on one occasion. Results: VMS were classified as moderate-severe for 267 of the 2,020 women (13.3%). After adjusting for multiple factors, including age, partnership status, paid employment, housing insecurity, and body mass index, when compared to women with no or mild VMS, women with moderate-severe VMS were more likely to have moderate-severe depressive symptoms (odds ratio [OR] 2.80, confidence interval [95% CI], 2.01-3.88, p < 0.001). Having moderate-severe depressive symptoms was associated with a greater likelihood of use of psychotropic medications (48.9%, 95% CI, 43.1-54.8 vs. 20.1%, 95% CI, 18.2-22.1, p < 0.001), smoking (25.9%, 95% CI, 20.8-30.9 vs. 12.2%, 95% CI, 10.6-13.7, p < 0.001), and binge drinking at least weekly (15.1%, 95% CI, 11.0-19.2 vs. 10.3% 95% CI, 8.8-11.7, p = 0.015). Conclusion: Moderate-severe VMS are independently and significantly associated with moderate-severe depressive symptoms. [ABSTRACT FROM AUTHOR]

We audited the files of 114 postmenopausal women who had been treated with subcutaneous Estrapel (50mg oestradiol implants). Of the 92 women who received more than one implant, the median number of days between implants was 223.5 (range 49-875), with an estimated median time to return to baseline of 311days (range 108-1228). Although oestradiol implants can provide an excellent non-oral treatment option, their prolonged action makes patient selection important, as the implants cannot easily be removed. In women with an intact uterus, the continuation of progestin therapy after cessation of implant therapy is imperative. [ABSTRACT FROM AUTHOR]

Objective The increased prevalence of osteoarthritis (OA) in postmenopausal women suggests that changes in either circulating sex steroid concentrations or the tissue response to sex steroids may have a role in the pathogenesis of OA. The aim of this study was to examine whether circulating sex steroid concentrations are associated with the incidence of total knee and total hip replacement for OA. Methods Study subjects (n = 2,621; all women) were recruited in 1990-1994 from the Melbourne Collaborative Cohort Study (MCCS). Circulating sex steroid concentrations were measured in blood samples obtained from the women at the time of recruitment. The incidence of total knee and total hip replacement for OA during 2001-2011 was determined by linking the MCCS records to the Australian Orthopaedic Association National Joint Replacement Registry. Results During the followup period, 115 women had undergone total knee replacement and 99 had undergone total hip replacement for OA. Greater log-transformed concentrations of estradiol were associated with a lower incidence of knee replacement (hazard ratio [HR] 0.70, 95% confidence interval [95% CI] 0.50-0.96), and greater log-transformed concentrations of androstenedione were associated with a lower incidence of hip replacement (HR 0.70, 95% CI 0.52-0.93). In contrast, greater log-transformed concentrations of sex hormone binding globulin (SHBG) were associated with a higher incidence of hip replacement (HR 1.70, 95% CI 1.05-2.77). Conclusion A lower estradiol concentration is a risk factor for knee OA, while a lower androstenedione concentration and higher SHBG concentration are risk factors for hip OA in women. These findings suggest that circulating sex steroids have a role in the pathogenesis of OA, and that modifying these steroid concentrations may provide a potential strategy for the prevention and treatment of knee and hip OA. [ABSTRACT FROM AUTHOR]

Introduction Female sexual dysfunction is a side effect of selective serotonin reuptake inhibitor ( SSRI)/serotonin noradrenalin reuptake inhibitor ( SNRI) therapy. Aims The aim of this study is to investigate the efficacy of transdermal testosterone ( TT) as a treatment for SSRI/SNRI-emergent loss of libido. Methods This was a double-blind, randomized, placebo-controlled study. Forty-four women, aged 35-55 years, on a stable dose of SSRI or SNRI with treatment-emergent loss of libido were randomly allocated to treatment with a TT patch delivering 300 mcg of testosterone/day or an identical placebo patch ( Pl) for 12 weeks. Main Outcome Measures The primary outcome measure was the change in the Sabbatsberg Sexual Self-rating Scale ( SSS) total score over 12 weeks. The 4-week frequency of Satisfactory Sexual Events ( SSEs) and the Female Sexual Distress Scale- Revised ( FSDS-R) were also measured. Results At baseline, there were no differences between the treatment groups. At week 12, the change in the SSS score did not differ between the two groups. The increase in the 4-week frequency of SSEs was significantly greater for the TT group than for the Pl group (an increase of 2.3 events vs. 0.1, P = 0.02). The between-group difference in the change in the FSDS-R score approached statistical significance ( P = 0.06). The mean total serum testosterone level at 12 weeks in the TT group was 2.1 nmol/L. No women withdrew because of androgenic adverse events. Conclusions TT therapy resulted in a significant increase in the number of SSEs compared with Pl therapy in women with SSRI/SNRI-emergent loss of libido. The lack of improvement in the SSS total score may reflect lack of sensitivity of this instrument for the measurement of change in sexual function. This provides the first evidence that TT therapy may be a treatment option for women with SSRI/SNRI-emergent loss of libido who need to remain on their antidepressant therapy. Fooladi E, Bell RJ, Jane F, Robinson PJ, Kulkarni J, and Davis SR. Testosterone improves antidepressant-emergent loss of libido in women: Findings from a randomized, double-blind, placebo-controlled trial. J Sex Med 2014;11:831-839. [ABSTRACT FROM AUTHOR]

A response from authors of the article "Incidence of total knee and hip replacement for osteoarthritis in relation to circulating sex steroid hormone concentrations in women" is presented.

Several letters to the editor are presented including two in response to the article "Urinary incontinence in young nulligravid women: a cross-sectional analysis," by Penelope J. Robinson and colleagues in the 2012 issue, and also includes a response from the authors to the above mentioned issue.