Search

Observations from reproductive biology, epidemiology, and clinical assisted reproduction support the hypothesis that the time interval between the onset of accelerated decline of the ovarian reserve and the menopause is more or less fixed. Thus, it is estimated that women who become menopausal by the age of 45 may have experienced an accelerated decline of their fertility before the age of 32. Up to 10% of women in the general population may fall into this category, which has been described as ‘‘early ovarian ageing’’. Because of the long latent phase and predictable natural history, this condition is suitable for screening. High-risk groups include, women with a family history of early menopause. IVF has provided a model for the development of ovarian reserve tests, some of which appear promising as potential screening tools for the detection of early ovarian ageing in asymptomatic women in the general population. # 2003 Elsevier Ireland Ltd. All rights reserved.

Contains fulltext : 238753.pdf (Publisher’s version ) (Open Access) Premature ovarian insufficiency (POI) is an increasing public health problem with a prevalence now approaching 4%. POI results in adverse effects on the skeleton and central nervous system as well as disturbances of metabolic and cardiological factors that predispose to a major increased risk of cardiovascular disease (CVD). This article reviews the effects of the premature loss of ovarian function on lipids and lipoproteins, glucose and insulin metabolism, body composition, hemostasis and blood pressure, together with effects on the development of metabolic syndrome and diabetes mellitus. The article examines the effects of POI on vascular endothelial function and inflammation that result in arterial disease, and reviews the effects of hormone replacement therapy (HRT) on these various metabolic processes and on cardiovascular outcomes. It is essential that women with POI receive hormonal treatment to help prevent the development of CVD, and that this treatment is continued at least until the normal age of menopause. It appears that HRT has a more favorable effect than the combined oral contraceptive, but larger clinical trials are needed to establish the optimal treatment. Other therapeutic measures may need to be added to correct existing metabolic abnormalities and, in particular, attention to lifestyle factors such as diet and exercise must be encouraged.

Contains fulltext : 233788.pdf (Publisher’s version ) (Open Access) Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman's risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).

This study aimed to evaluate the effect of surgical risk factors, including type of surgery, body mass index, uterine size and presence of adhesions, on perioperative outcomes and complication rates in laparoscopic hysterectomy (LH). This was a retrospective cohort study of 264 LH cases performed between 2005 and 2013 at a London University Hospital. One hundred sixty six (62.9 %) underwent laparoscopic subtotal hysterectomy (LASH) and 98 (37.1 %) total laparoscopic hysterectomy (TLH). Mean operation duration was 77 (±35) min and mean estimated blood loss (EBL) was 196 (±128) ml. Mean specimen weight was 323 g (range 46–1765 g). There were no conversions to laparotomy. Patients undergoing LASH were older than TLH patients (46.7 vs 42.8 years, p

Study Objective To investigate the prevalence of and explore risk factors for the coexistence of uterine myomas and endometriosis and to assess operative outcomes during laparoscopic myomectomy. Design Retrospective cohort study (Canadian Task Force classification II-2). Setting Tertiary referral center in London, England. Patients Two hundred twelve women undergoing laparoscopic myomectomy to treat symptomatic uterine myomas. Intervention Laparoscopic myomectomy. Measurements and Main Results Coexisting myomas and endometriosis were identified in 21.2% of patients. Endometriosis was more common in those with subfertility (44% vs 25.7%; p = .02) and less common in those with bleeding disorders (20% vs 45%; p = .003). Parity, location of myoma, and race/ethnicity affected risk of endometriosis, whereas size and number of myomas did not. Of patients with endometriosis, 42% underwent surgical treatment of endometriosis during myomectomy. Significantly more patients with endometriosis also underwent ovarian cystectomy than did those without endometriosis (15.6% vs 3%; p = .004). Operative time was similar in both groups (109.6 minutes vs 116.4 minutes; p = .83), as was estimated blood loss (271 mL vs 327 mL; p = .16). Conclusions A diagnosis of concomitant endometriosis should be considered, in particular in patients with subfertility and pain. This enables optimal preoperative counseling and consent for potential additional procedures such as treatment of endometriosis or ovarian cystectomy.

Learning Objectives Describe the potential contributors to bone demineralization in patients receiving systematic treatment for gynecological malignancies. Define what is meant by “osteopenia” and “osteoporosis” and describe their relevance to fracture risk. Explain the importance of preventing and managing bone mineral loss and its complications in gynecological cancer survivors. Background. An association between treatment for gynecological cancers and risk of osteoporosis has never been formally evaluated. Women treated for these cancers are now living longer than ever before, and prevention of treatment-induced morbidities is important. We aimed to distinguish, in gynecological cancer survivors, whether cancer therapy has additional detrimental effects on bone health above those attributable to hormone withdrawal. Methods. We performed a retrospective cross-sectional analysis of dual energy x-ray absorptiometry (DEXA) scan results from 105 women; 64 had undergone bilateral salpingo-oophorectomy (BSO) followed by chemotherapy or radiotherapy for gynecological malignancies, and 41 age-matched women had undergone BSO for benign etiologies. All were premenopausal prior to surgery. Results. The median age at DEXA scan for the cancer group was 42 years, and 66% had received hormonal replacement therapy (HRT) following their cancer treatment. For the benign group, the median age was 40 years, and 87% had received HRT. Thirty-nine percent of cancer survivors had abnormal DEXA scan results compared to 15% of the control group, with the majority demonstrating osteopenia. The mean lumbar spine and femoral neck bone mineral densities (BMDs) were significantly lower in cancer patients. A history of gynecological cancer treatment was associated with significantly lower BMD in a multivariate logistic regression. Conclusions. Women treated for gynecological malignancies with surgery and adjuvant chemotherapy have significantly lower BMDs than age-matched women who have undergone oophorectomy for noncancer indications. Prospective evaluation of BMD in gynecological cancer patients is recommended to facilitate interventions that will reduce the risk of subsequent fragility fractures.

Low sexual desire is a prevalent symptom, but not one frequently volunteered by women. When accompanied by distress, loss of libido is known as hypoactive sexual desire disorder, which can have a significant impact on a woman's wellbeing. The etiology of hypoactive sexual desire disorder is multifactorial and its management requires a combination of psychosocial and pharmacological interventions. This article outlines the assessment of patients presenting with the symptom of low sexual desire and discusses the evidence for pharmacological management.

Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Unfortunately, there are many deficiencies in our understanding of the condition as the underlying etiology and optimum management strategies are poorly understood. Improved awareness of POI and its long-term implications has led to increased research interest in recent years. Current research has allowed a greater understanding of the changing epidemiology in POI, genetic factors in its etiology and randomized controlled trials of hormone therapy are underway to provide evidence for treatment. This article reviews the latest literature on POI to summarize current understanding and future directions.

Fibroids are the most common tumor in women and many medical and surgical options exist for their management. The incidence of uterine sarcoma in women undergoing treatment for fibroids has previously been thought to be extremely rare, however there has been recent controversy as to whether this risk has been underestimated. This article reviews the literature investigating the incidence of leiomyosarcoma and explores how different treatment modalities may affect risk from occult malignancy. We aim to provide a tool for counseling women who are considering options for the management of their fibroids.

BACKGROUND: Enteroviruses are non-enveloped, frequently pathogenic RNA viruses infecting humans. Infection is potentially transmissible through blood or blood component transfusion from donor in the viremic phase before seroconversion for antibody. To investigate the threat to blood safety from enteroviruses, a large-scale survey of frequency and levels of viremia in blood donors was conducted. STUDY DESIGNS AND METHODS: Blood donations from Scotland over a period of 22 calendar months were screened for enterovirus RNA sequences by PCR. Positive samples were quantified, and serotypes were identified by nucleotide sequencing of VP1. RESULTS: From a total of 3658 pools of 95 donations tested, 73 samples that were enterovirus-positive were identified (corrected annual frequency 0.024% or 1 in 4000). The highest rates of viremia were in late summer months (e.g., 0.055%, 1 in 1800 in July) and lowest from January to May (0.009 and 0.012%). Viral loads ranged from 500 (the lower cutoff of the assay) to greater than 100,000 amplifiable enterovirus template copies per mL. Coxsackievirus A16, echoviruses 11 and 30, and enterovirus 71 were most often identified. CONCLUSIONS: The detection of enterovirus-positive blood units indicates the potential for enteroviral transmission by blood components. Although the infrastructure established for PCR-based screening for HCV RNA would allow parallel screening for enteroviruses, any decision concerning donor testing would require further information on the outcome of transfusion-acquired enterovirus infections.

A 39- year-old woman, who conceived following in vitro fertilisation (IVF) treatment, presented at 12 weeks gestation with symptoms of ovarian hyperstimulation syndrome (OHSS), abdominal pain, vomiting and diarrhoea. Subsequent investigations found small bowel obstruction secondary to ovarian torsion. Surgical management to remove a necrotic ovary and fallopian tube led to a good recovery from the acute illness. A postoperative ultrasound scan confirmed a viable pregnancy and the patient was discharged. Her case demonstrates a rare complication of OHSS and ovarian torsion leading to small bowel obstruction.

Menopause results in numerous physical, metabolic and psychological consequences. Obesity is associated with increased reporting of vasomotor symptoms and can have a profound effect on how we manage the menopause. Although oestrogen may have a benefit on many of the metabolic consequences of menopause, the shared risks of hormone replacement therapy (HRT) and obesity have led to concerns about the use of HRT in this population. In obese women, HRT has been associated with improvements in cardiovascular risk factors and incidence of type-2 diabetes mellitus. The risk of endometrial and breast cancer is increased by obesity, but HRT does not appear to increase this risk further. HRT is associated with increased risk of venous thromboembolism and stroke, and in obese women using HRT, certain strategies such as low-dose transdermal therapy should be adopted to minimise these risks.

Testosterone is increasingly used as part of postmenopausal HRT regimens. Unfortunately, few androgenic preparations designed specifically for use in women have been approved by regulatory authorities. Ongoing concerns exist surrounding the potential long-term effects of testosterone therapy, Here, we review the most recent data on postmenopausal testosterone therapy, focusing particularly on the effects of testosterone on breast, endometrium and cardiovascular health.

Prevention of cardiovascular disease has increasingly important health implications as our population ages. Menopause is associated with the development of cardiovascular risk factors and there are many plausible biological mechanisms through which estrogen may confer cardiovascular protection. Despite a wealth of observational data to support the use of estrogen, large randomized controlled trials failed to demonstrate a benefit. It is now becoming clearer that the beneficial cardiovascular effects of estrogen are greatest in younger women and those closest to menopause. This has led to the development of the timing hypothesis. Use of age-appropriate estrogen doses is crucial to maximize cardiovascular benefits while minimizing risk of adverse effects such as venous thromboembolism and stroke.

Premature ovarian failure (POF) is the occurrence of amenorrhoea, elevated gonadotrophins and hypoestrogenism in women under 40 years of age. It has important physical and psychological consequences and is increasingly common due to improved survival following treatment for malignancy. Despite this, it remains a poorly understood condition. Here we review the presentation and investigation of POF, discuss recent advances in the management of affected women, and suggest how our knowledge of the condition could be improved.