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PURPOSE: Treatment guidelines for gender-affirming hormone therapy with estrogen (GAHT-E) recommend specific dosing regimens based on limited data. Well-controlled efficacy trials are essential to tailoring treatment to patient goals as the guidelines recommend. The goal of this study was to take a foundational step toward designing community-centered effectiveness trials for gender-diverse individuals seeking GAHT-E. METHODS: Our team developed a cross-sectional survey based on broad clinical experience and consultation with our community advisory board. The survey included 60 items covering demographics, transition history, goals and priorities for treatment, indicators of treatment success, sexual function goals, and future research priorities. The survey was distributed during the summer of 2021, primarily through social networks designed for gender-expansive individuals seeking treatment with estrogen. RESULTS: A total of 1270 individuals completed the survey. Overall treatment goals most frequently rated extremely important or very important were the following: (1) improved satisfaction with life (81%), (2) appearing more feminine (80%), (3) appearing less masculine (77%), (4) improved mental health (76%), and (5) being seen as your true gender by others (75%). The three body characteristics most frequently rated highest priority or high priority among changes were the following: (1) facial hair (85%), (2) breast shape or size (84%), and (3) body shape (80%). The highest-rated research priority was comparing feminization with different routes of estrogen administration. CONCLUSION: The goals and experiences of individuals seeking GAHT-E are diverse. Future clinical trials of GAHT-E should be grounded in the needs and priorities of community stakeholders.

• Chlorella proteinosa was cultivated in an MPBR for secondary effluents treatment. • Highest TN removal rate of 23.8 mg/L/day was achieved at a lowest HRT of 8 hr. • Highest microalgae biomass productivity reached 20.2 mg/L/day at the HRT of 8 hr. • Bacterial nitrogen respiration was reduced by 95.5 % from an HRT of 24 hr to 8 hr. Further treatment of secondary effluents before their discharge into the receiving water bodies could alleviate water eutrophication. In this study, the Chlorella proteinosa was cultured in a membrane photobioreactor to further remove nitrogen from the secondary effluents. The effect of hydraulic retention time (HRT) on microalgae biomass yields and nutrient removal was studied. The results showed that soluble algal products concentration reduced in the suspension at low HRT, thereby alleviating microalgal growth inhibition. In addition, the lower HRT reduced the nitrogen limitation for Chlorella proteinosa 's growth through the phase-out of nitrogen-related functional bacteria. As a result, the productivity for Chlorella proteinosa increased from 6.12 mg/L/day at an HRT of 24 hr to 20.18 mg/L/day at an HRT of 8 hr. The highest removal rates of 19.7 mg/L/day, 23.8 mg/L/day, and 105.4 mg/L/day were achieved at an HRT of 8 hr for total nitrogen (TN), ammonia, and chemical oxygen demand (COD), respectively. However, in terms of removal rate, TN and COD were the largest when HRT is 24 hr, which were 74.5% and 82.6% respectively. The maximum removal rate of ammonia nitrogen was 99.2% when HRT was 8 hr. [Display omitted] [ABSTRACT FROM AUTHOR]

The sulfate-reducing anaerobic ammonia oxidation (SRAO) reaction, as a biochemical reaction, is influenced by many factors. Different factors have different removal effects and change the acting bacterial species. In this experiment, we investigated the effects of hydraulic residence time (HRT), organic matter concentration, NO3−, NO2− and N/S on the SRAO reaction. The influent ammonia and sulfate concentrations were maintained at about 120 mg/L and 250 mg/L, respectively, during the experiment. The highest removal rates of 98.5% and 52.4% were achieved at HRT of 48 h. When HRT was 24 h, the removal rates of both decreased, but the highest removal loads of 0.092 kgN/m3·d and 0.168 kgS/m3·d were achieved, respectively. As the concentration of influent organic matter increased, the activity of SRAO strains decreased and the sulfate removal rate increased, suggesting that the functional bacteria strains were gradually transformed into desulfurizing bacteria. Small additions of NO3− (30 mg/L) and NO2− (40 mg/L) during the experimental process could promote the reaction, but too high a concentration would affect the removal of ammonia nitrogen and sulfate. In the SRAO system, controlling the concentration of influent substrate (in the case of low concentration) and N/S in the influent water (N/S = 2) can improve the efficiency of the interconversion of nitrogen and sulfur and reduce the generation of other by-products. [ABSTRACT FROM AUTHOR]

Background: Transgender individuals frequently undergo gender-affirming hormone therapy (GAHT) during their gender transition which plays a vital role in gender identity affirmation. Cholelithiasis, a common condition affecting 10-15% of the US population, has been linked to estrogen therapy in cisgender women. Despite the fact that hormonal profiles achieved after GAHT are not always identical to cisgender individuals, the effects of GAHT on gallbladder disease (GBD) risk have not been evaluated in transgender populations. This research aims to address this gap utilizing a large nationwide database. Methods: The study analyzed medical records data from the TrinetX database from 52,847 trans men and 38,114 trans women. Four cohorts were created: trans women and men either receiving either hormone therapy or no intervention. Descriptive statistics were calculated before matching to estimate disease burden. The groups were then propensity score matched on known risk factors (age, race, BMI, etc.) and rates of GBD were compared. Results: Before matching, trans women on hormone therapy (TWHT) had a significantly higher 10-year GBD probability than those naïve to therapy (TWNI) (4.69% vs 1.88%). For trans men, there was no significant difference in 10-year rates between those on therapy (TMHT) and those not (TMNI) (3.15% vs 3.87%). Cholecystectomy rates were significantly higher for TWHT than TWNI (1.10% vs. 0.57%), but similar between TMHT and TMNI (0.95% vs. 1.10%). After accounting for risk factors, TWHT had increased GBD risk (HR 1.832), while TMHT showed no significant change. Discussion: This study suggests a link between estrogen GAHT and increased GBD risk in transgender women. Notably, testosterone GAHT did not offer protection against GBD in transgender men, contrary to expectations. This study is, to our knowledge, the first to describe the burden of GBD in the transgender population and to investigate the effects of GAHT on GBD risk. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether the type of frozen embryo transfer (FET) regimen — ovulation-induced regimens vs. hormone replacement therapy regimens (HRT) — is associated with live birth rates and the risk of hypertensive diseases of pregnancy (HDP) in women with polycystic ovary syndrome (PCOS). Methods: All studies in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched using a combination of MeSH terms and keywords. Inclusion criteria included studies on women with a diagnosis of PCOS, utilization of FET, and reporting of pregnancy and/or obstetric outcomes. Studies were excluded if they were case series or conference abstracts or used other FET regimens. A random effects meta-analysis was performed. Primary outcomes include relative risk (RR) of live birth and HDP. Results: Eleven studies were included in the meta-analysis for the final review. Ovulation-induced regimens were associated with a higher live birth rate (8 studies, RR 1.14 [95% CI 1.08, 1.21]) compared to HRT regimens. The risk of HDP (3 studies RR 0.78 [95% CI 0.53, 1.15]) was not significantly different. Ovulation-induced regimens were associated with a lower miscarriage rate (9 studies, RR 0.67 [95% CI 0.59–0.76]). Rates of clinical pregnancy (10 studies, RR 1.05 [95% CI 0.99, 1.11]) and ectopic pregnancy (7 studies, RR 1.40 [95% CI 0.84, 2.33]), were not significantly different. Conclusion: This SR/MA demonstrates that for women with PCOS, ovulation-induced FET regimens are associated with higher rates of live birth and lower rates of miscarriage compared to HRT regimens. [ABSTRACT FROM AUTHOR]

Constructed wetlands (CWs) have been widely recognised for efficiently removing many pollutants from wastewater, making them vital for environmental bioremediation. The substrates used in constructed wetlands are crucial in determining their overall performance, notably their ability to improve nitrogen and phosphorus removal from wastewater. This study aims to investigate the possibility of removing pollutants from wastewater using a pilot scale vertical flow constructed wetland (VFCW) planted with Phragmites australis applied to various substrates, such as gravel and sand in an arid climate in Southeast Algeria. The study involved using four basins, filled with sand and gravel. Two were planted with Phragmites australis and the others were left as a control without vegetation. The efficiency of the filtration systems was evaluated based on various physicochemical and organic parameters. Results showed that the highest hydraulic retention time is in the 7 days. The removal efficiency values are 84.38% for biological oxygen demand (DBO5), 77.45% for chemical oxygen demand (COD), and 83.30% for total solid matter (TSS) in the planted gravel filter. The planted sand filter had even higher removal efficiency values, with 89.59%, 85.80%, and 86.63% for DBO5, COD, and TSS, respectively. Nitrate concentration increased in all filters due to the complete transformation of ammonium into nitrate. NO2 -, NH4 +, and PO4 3-removal efficiencies were also higher in the planted sand filter 74.45%, 95.43%, and 77.64%, respectively. [ABSTRACT FROM AUTHOR]

A continuous lab-scale integrated bio-system was conducted to treat sewage wastewater from Abu-Rawash wastewater treatment plant (WWTP). The bio-system showed high efficiency in removing chemical oxygen demand (COD), biological oxygen demand (BOD5), and total suspended solids (TSS). The experimental analysis results indicated that the maximum COD removal and methane yields were 97.6 and 13.74 mmol CH4/Kg COD at a hydraulic retention time (HRT) of 6 h, respectively. Zn, Mn, and Fe were removed at a high rate of up to 96.6%. The sponge bio-carriers have improved overall treatment performance and substantially improved mixed liquor volatile suspended solids/mixed liquor suspended solids (MLVSS/MLSS) ratio at an appreciated range, and the total pathogenic organisms were removed up to 99.8% in the second stage. Because the innovative bio-system enables a rapid startup process, is simple to use, and is inexpensive, it can provide an economically feasible alternative for wastewater management and could be extended to full-scale applications for agricultural purposes. [ABSTRACT FROM AUTHOR]

Cisnormative analyses of trans people’s approach to sex hormone therapy (HRT) tend to present trans people in a shallow, banally oppositional way, as passive objects of influence from the transnational capital and knowledge-power flows of the pharmaceutical industry. The article critically examines the above phenomenon by beginning from the author’s private experience as a trans woman in the process of medical transition in order to present an alternative perspective on HRT. Using the theoretical framework introduced in James C. Scott’s anarchist anthropology, the article shows how trans people’s hormonal practices can be understood as the implementation of intermediate areas of agency in search of a bearable life. [ABSTRACT FROM AUTHOR]

Moving bed biofilm reactors (MBBRs) are compact biofilm systems that provide a sustainable solution for biological nitrogen removal. A study was conducted on an innovative post-denitrification method as a polishing step to reduce low nitrate nitrogen concentrations (10 mg/L) to 2.1–4.9 mg/L. The objective was to minimize residual chemical oxygen demand (COD) in the effluent caused by the external carbon source required for this final treatment step. Therefore, four continuous flow reactors with varying synthetic loads and hydraulic retention times (HRTs), as well as two carrier sizes, were operated over 335 days. The results showed that an HRT of 2 h is necessary to successfully reduce the residual COD to 5–6 mg/L. Additionally, it was demonstrated that the protected volume of the biofilm carriers has a significant impact on MBBRs compared to the protected surface, which is commonly discussed in the literature. The available protected volume can limit biofilm growth, as demonstrated by measuring the total biofilm solids (TBS) and biofilm thickness on the carrier at varying COD eliminations. When providing sufficient protected volume for the biofilm through the filling ratio and carrier size, a COD elimination rate of 1.4 to 1.45 kg/(m3d) was achieved with a biofilm thickness of only 500 µm. [ABSTRACT FROM AUTHOR]

The efficiency of anaerobic night soil (human excreta) biodegradation depends on the characteristics of the inoculum used. This anaerobic microbial inoculum (AMI) contains a microbial consortium, including rate-limiting methanogens whose growth depends on various physicochemical and biological parameters necessitating the inoculum characterisation essential for optimum night soil (NS) biodegradation. The inoculum contained 24.567 g/L (±0.07) total solid, 5.022 (±0.57) g/L total dissolved solid, 18.148 (±0.0.058) g/L volatile solid (VS), and 7.0±0.2 pH. The Gas chromatography analysis confirmed the presence of a small amount of volatile fatty acid (VFA), (≤ 4 mM except propionate) showing rapid conversion of VFA to methane, and 55% methane. Further, the presence of methanosaetaceae group of methanogens was detected through Taqman probe-based real-time PCR. The inoculum performance was evaluated for NS biodegradation in semicontinuous mode of feeding in four 2 L anaerobic biodigesters (2D HRT, 4D HRT, 5D HRT, and 10D HRT) with varying hydraulic retention time (HRT) (2, 5, 8, and 10 days, respectively) at mesophilic temperature (35°C). After 5 HRT, VS reduction for 2D HRT and 5D HRT was 45-50% and >45-60%, respectively. The methane content was 45-50% and 50-65% methane, respectively. The % VS reduction and methane content showed the overfeeding of NS in biodigesters 2D HRT and 5D HRT while 8D HRT showed towards optimum and 10D HRT optimum with improved VS reduction and methane content.

The Gidabo River and its tributaries are the main sources of water for more than 1,584,646 inhabitants. It is an important source of water for the surrounding rural communities for various uses such as domestic, irrigation, livestock watering, fishing, and recreation. The river is the main tributary of Lake Abaya. The present study was designed to investigate the water quality status of the Gidabo River and its tributaries for domestic and aquatic life. To assess the water quality status, water samples were collected in monthly intervals for a period of 3 months from September to November (coffee processing time), 2022. Arc GIS 9.3, 3 DEM, and spreadsheet were used to analyze the data collected from SRTM (Shuttle Radar Thematic Mapper, 90 m) and field observation. Of all the water quality parameters analyzed; turbidity, BOD5, DO, COD, pH, Ni, Fe, NO3−, and PO43− were higher than the recommended limits of national and international standards for aquatic life. Based on the Weighted Arithmetic Mean (WAM), Water Quality Index (WQI) calculations of the River, WQI value of the river ranges between 34.83 and 54.31 in different reaches of the watershed which is classified under bad category. The wet coffee processing industry which is the main sources of contamination in the watershed uses 63 L of processing water to produce 1 kg of green coffee beans. Traditional lagoons, with an average hydraulic retention time (HRT) of 1.99 days, are the most common methods of treating wastewater. The river is at higher risk from harmful anthropogenic activities in the watershed and requires urgent monitoring and mitigation to prevent further degradation. [ABSTRACT FROM AUTHOR]

The efficiency of anaerobic night soil (human excreta) biodegradation depends on the characteristics of the inoculum used. This anaerobic microbial inoculum (AMI) contains a microbial consortium, including rate-limiting methanogens whose growth depends on various physicochemical and biological parameters necessitating the inoculum characterisation essential for optimum night soil (NS) biodegradation. The inoculum contained 24.567 g/L (±0.07) total solid, 5.022 (±0.57) g/L total dissolved solid, 18.148 (±0.0.058) g/L volatile solid (VS), and 7.0±0.2 pH. The Gas chromatography analysis confirmed the presence of a small amount of volatile fatty acid (VFA), (≤ 4 mM except propionate) showing rapid conversion of VFA to methane, and 55% methane. Further, the presence of methanosaetaceae group of methanogens was detected through Taqman probe-based real-time PCR. The inoculum performance was evaluated for NS biodegradation in semicontinuous mode of feeding in four 2 L anaerobic biodigesters (2D HRT, 4D HRT, 5D HRT, and 10D HRT) with varying hydraulic retention time (HRT) (2, 5, 8, and 10 days, respectively) at mesophilic temperature (35°C). After 5 HRT, VS reduction for 2D HRT and 5D HRT was <40% while for 8D HRT and 10D HRT was >45-50% and >45-60%, respectively. The methane content was <20% in biogas for 2 and 5 days HRT while for 8 and 10 days >45-50% and 50-65% methane, respectively. The % VS reduction and methane content showed the overfeeding of NS in biodigesters 2D HRT and 5D HRT while 8D HRT showed towards optimum and 10D HRT optimum with improved VS reduction and methane content. [ABSTRACT FROM AUTHOR]

Due to increasing life expectancy, women spend a significant part of their lives in menopause. Women with a history of endometriosis are more likely to become menopausal at an early age due to bilateral oophorectomy or repeated ovarian surgery. In addition, some medical therapies used for endometriosis, such as gonadotropin releasing hormone agonists or progestins reduce bone mineral density. Furthermore, women with endometriosis have a higher background risk of cardiovascular disorders and hypercholesterolemia. Hence, it is important to recommend the use of hormone replacement therapy (HRT) to these women when they become menopausal, at least until the age of natural menopause. Although based on limited data, there is a possibility of reactivation of symptoms of endometriosis or its lesions, and a theoretical possibility of malignant transformation, although this remains unproven. Therefore, women should be advised in the light of this information before starting HRT after the age of natural menopause and are asked to seek help if they experience symptoms that may indicate these changes. Estrogen only HRT should be avoided and combined HRT preparations should be recommended, even after a hysterectomy. [ABSTRACT FROM AUTHOR]

Radiotherapy is an effective cancer treatment, particularly for pelvic tumours. The number of patients with pelvic cancer being diagnosed and successfully treated is growing. Radiotherapy to the pelvis causes lasting side-effects collectively referred to as pelvic radiation disease (PRD), including bowel, bladder, sexual dysfunction, vaginal and cervical stenoses, and menopause. There is growing interest in management of menopause in cancer survivors, with the primary focus on the oncologic risk of hormone replacement therapy (HRT). Research examining if the modality with which the cancer was treated causes menopause-specific side effects is rare; however, malabsorption syndromes and anatomical changes in the pelvis post-radiotherapy may complicate effective delivery and monitoring of HRT. Consideration of these changes may significantly benefit patients in this young and growing cohort; thus, there is an urgent need to raise awareness of PRD among all clinicians, including those providing menopause care. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the effects of combining gonadotropin-releasing hormone agonist (GnRHa) downregulation with hormone replacement therapy (HRT, GnRHa-HRT) on the clinical outcomes of patients undergoing frozen–thawed embryo transfer (FET).MethodsIn this retrospective study, we included patients who had FET between January 2018 and December 2022. They were categorized into HRT and GnRHa-HRT groups based on the endometrial preparation protocol. The study compared the clinical outcomes of patients in two groups. Possible factors affecting clinical outcomes were analyzed using univariate analysis. To analyze the impact of two endometrial preparation methods on clinical outcomes, multifactorial logistic regression was performed.ResultsThe rates of clinical pregnancy (47.31% vs. 59.60%), embryo implantation (37.58% vs. 49.65%), biochemical pregnancy (52.36% vs. 64.31%), and early abortion (7.07% vs. 10.77%) were statistically different between the two groups (p

Background: This review aimed to comprehensively investigate the impact of Hormone Replacement Therapy (HRT) on implant osseointegration and bone loss. The study considered factors such as HRT type, osteoporosis, smoking, and diabetes mellitus, and analysed the available literature to provide insights into the association between HRT and implant outcomes. Methods: Multiple databases were utilized, and studies with diverse designs and methodologies were included that examined the relationship between HRT and implant osseointegration. The selected studies were analyzed and relevant data on implant success rates, bone loss, and other correlations was extracted. Results: The review findings indicate that HRT has a detrimental impact on implant osseointegration, as evidenced by lower implant success rates and increased bone loss in HRT-treated individuals. The odds ratio analysis further strengthens this association, with significant values of 0.59 (95% CI: 0.50–0.70) and 0.64 (95% CI: 0.54–0.76), indicating a higher likelihood of implant failure in HRT-treated patients., highlighting the need for caution when considering HRT as a treatment option in patients undergoing implant procedures. Smoking and diabetes mellitus were also found to significantly affect implant outcomes, emphasizing the importance of addressing these factors in patient management. Conclusion: The assessments demonstrate that HRT adversely affects implant osseointegration and increases bone loss. The results suggest the importance of considering the potential negative impact of HRT on implant outcomes and the need for thorough patient evaluation and management. Further research is warranted to explore the underlying mechanisms, assess the impact of specific HRT types and dosages, and evaluate preventive strategies to mitigate the detrimental effects of HRT on implant success.

This review aimed to comprehensively investigate the impact of Hormone Replacement Therapy (HRT) on implant osseointegration and bone loss. The study considered factors such as HRT type, osteoporosis, smoking, and diabetes mellitus, and analysed the available literature to provide insights into the association between HRT and implant outcomes. Multiple databases were utilized, and studies with diverse designs and methodologies were included that examined the relationship between HRT and implant osseointegration. The selected studies were analyzed and relevant data on implant success rates, bone loss, and other correlations was extracted. The review findings indicate that HRT has a detrimental impact on implant osseointegration, as evidenced by lower implant success rates and increased bone loss in HRT-treated individuals. The odds ratio analysis further strengthens this association, with significant values of 0.59 (95% CI: 0.50–0.70) and 0.64 (95% CI: 0.54–0.76), indicating a higher likelihood of implant failure in HRT-treated patients., highlighting the need for caution when considering HRT as a treatment option in patients undergoing implant procedures. Smoking and diabetes mellitus were also found to significantly affect implant outcomes, emphasizing the importance of addressing these factors in patient management. The assessments demonstrate that HRT adversely affects implant osseointegration and increases bone loss. The results suggest the importance of considering the potential negative impact of HRT on implant outcomes and the need for thorough patient evaluation and management. Further research is warranted to explore the underlying mechanisms, assess the impact of specific HRT types and dosages, and evaluate preventive strategies to mitigate the detrimental effects of HRT on implant success. [ABSTRACT FROM AUTHOR]

Aim: Both morbidity and mortality rates of cervical cancer are increasing, especially in reproductive‐aged women. Radical trachelectomy (RT) is an effective fertility‐preserving surgery for early‐stage cervical cancer. This study aimed to determine the influence of RT on endometrial thickness during in vitro fertilization‐embryo transfer (IVF‐ET). Methods: Forty‐four patients had undergone RT, and 23 women undergoing IVF‐ET treatment (105 ET cycles) were included. Endometrial thickness during hormone replacement therapy (HRT) was retrospectively evaluated and compared between patients with and without RT. Results: Eleven patients (50 ET cycles) in the RT group and 12 (52 ET cycles) in the control group were investigated. Compared with the control group, higher ET cancellation rates were observed in patients in the RT group (1 of 52 cycles [control group] vs. 8 of 50 cycles [RT group], p < 0.01). Endometrial thinning was not affected by patient age at first IVF‐ET treatment, history of artificial abortion, preservation of uterine arteries during RT, or postoperative chemotherapy (p = 0.27, 1, 1, and 1, respectively). Conclusions: Our data revealed that RT influenced endometrial thickness in IVF‐ET. This was not affected by the background of the patients or perioperative management in this study. We could not reveal the underlying mechanism, but it is postulated that the transient postoperative uterine blood flow status and postoperative infections may have some effect on the endometrium. To resolve these issues, accumulation of evidences are required. We recommend informing patients about the impact of RT on IVF‐ET before starting assisted reproductive technology (ART). [ABSTRACT FROM AUTHOR]

In this study, we aimed to develop education to assist BRCA mutation carriers in making informed decisions about HRT in the context of risk-reducing surgery, while simultaneously clarifying their treatment-specific values and reducing decisional conflict. We enrolled premenopausal BRCA mutation carriers ages 19–49 without prior cancer or risk-reducing salpingo-oophorectomy to structured interviews in which they reviewed education about the risks and benefits of HRT. Materials included literature-derived data demonstrating associations between HRT and commonly considered health outcomes (breast cancer, vasomotor symptoms, sexual functioning, cardiovascular disease, osteoporosis, and blood clots). Participants completed the 16-item Decisional Conflict Scale (DCS) before and after education, communicated their preferences by rating and ranking the six outcomes, and provided feedback to inform iterative revisions of the educational content. 25 participants completed interviews. DCS scores decreased significantly from 54.6 to 22.8 following education (p < 0.001); sub-scores for uncertainty (71.7 to 37.3), informed (71.7 to 15.3), values clarity (53.7 to 17.0), effective decision (44.2 to 25.5), and support (35.0 to 17.7) also decreased significantly. Participants ranked cardiovascular disease as the most important outcome to consider, followed by breast cancer, osteoporosis, blood clots, decline in sexual function, and hot flashes. Participants with prior mastectomy (N = 10) ranked breast cancer as the most important outcome 25% of the time, compared to 80% in participants without mastectomy (N = 15). Following education, BRCA mutation carriers had significantly less decisional conflict regarding the choice to use HRT. This pilot study was successful in generating a prototype educational aid for further testing. [Display omitted] • After education, BRCA mutation carriers had significantly less decisional conflict about hormone replacement therapy (HRT). • BRCA mutation carriers ranked cardiovascular disease as the most important outcome to consider regarding HRT use. • This pilot study was successful in generating a prototype of an educational aid for further testing. [ABSTRACT FROM AUTHOR]

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), was looked upon as a fountain of youth that kept women young and reduced cardiovascular disease. This led to a large-scale study called the Women's Health Initiative (WHI) that was conducted to show the cardiovascular benefits of HRT. This study was suspended early because of adverse side effects. The USFDA responded by slapping a “black box” warning on all HRT products. USFDA-approved bioidentical HRT formulations are safe and effective. We propose that these formulations have the “black box” warning removed so that doctors feel more confident in prescribing these products for symptoms of menopause and chronic conditions such as cardiovascular health. We propose eliminating the sale of products containing medroxyprogesterone acetate (MPA) because of the increased risk of heart attacks and breast cancers associated with this medication.

Aim & Objectives: To study the mean age of menopause; To study the Prevalence of menopausal symptoms; To study the treatment seeking behavior of postmenopausal women. Materials and method: Descriptive study at Govt Maternity Hospital, Tirupati, AP. 200 postmenopausal women aged between 40 -60 years with natural onset menopause attending Outpatient department of Obstetrics and gynecology were included in the study. A semi structured interview followed by examination and relevant investigations were done for all of the 200 women. Data was analyzed by mean, standard deviation, frequency, percentage and Pearson correlation test. The study was started after ethical committee approval (Lr no. 06/2022). Results: The mean age of menopause was 47.8 years.80 % women had menopausal symptoms. The most frequently reported symptoms were hot flush by 28.7% of women, Backache in 20 % and Joint pain 17.75% women. 78 women (48.75%) were on post-menopausal therapy. Out of which 50 on HRT and 28 on non-HRT management. Conclusion: The present study concluded that mean age at menopause was 47.8 years. This reproductive landmark, the age of onset of menopause has increased in past 15 years. [ABSTRACT FROM AUTHOR]

The modality of endometrial preparation for the transfer of frozen-thawed embryos may influence maternal and fetal adaptation to pregnancy and could thus impact the results of the first trimester combined screening test. We conducted a retrospective cross-sectional study on singleton pregnancies achieved by embryo transfer of a single frozen-thawed blastocyst, comparing two different endometrial preparation protocols: natural cycle (n = 174) and hormone replacement therapy (HRT) (n = 122). The primary outcome was the risk of preeclampsia at the first trimester combined screening test. Secondary endpoints included variable reflecting fetal cardiac function (nuchal translucency and fetal heart rate), maternal adaptation (median arterial blood pressure—MAP and uterine arteries pulsatility index—UtA-PI), and placentation (pregnancy associated plasma protein A and placental growth factor). The risk of early preeclampsia was comparable in the two groups (38% vs. a 28%, p = 0.12). However, women in the natural cycle group showed lower fetal heart rate (159 [155–164] vs. 164 [158–168], p = 0.002) and higher UtA-PI (0.96 [0.74–1.18] vs. 0.72 [0.58–0.90], p < 0.001). The frequency of a screening test at high risk for aneuploidies was similar. The modality of transfer of frozen-thawed embryos is associated with changes in the variables reflecting maternal and fetal cardiovascular function. [ABSTRACT FROM AUTHOR]

Introduction: Treatment protocols for Achilles tendinopathy, such as the Alfredson and Silbernagel, have shown beneficial effects on the clinical condition of patients. However, they have never been directly compared in competitive athletes. Objectives: To compare the effectiveness of both the Alfredson and Silbernagel protocols in competitive athletes. A secondary objective was to explore biomechanical or structural changes in the Achilles tendon (AT) and impact on strength endurance of the plantar flexors. Study design: Randomized controlled trial. Methods: A total of 20 competitive athletes with Achilles tendinopathy diagnosed through a combination of ques- tionnaire, ultrasound and clinical assessment were randomly assigned to the Alfredson isolated eccentric loading (AG) or Silbernagel concentric-eccentric loading (SG) group using permuted block randomization stratified by age. Both groups followed the respective protocol for six weeks. The primary outcome was the difference in the clinical condition assessed by the Victorian Institute of Sports Assessment-Achilles (VISA-A) instrument after 6 weeks. Secondary outcomes were plantar flexors strength endurance assessed by heel-rise test (HRT), stiffness of AT assessed by MyotonPRO device (STIF) and cross-section area of AT assessed by ultrasound (CSA). Between-group comparison was performed using an unpaired t-test, and the impact of training was evaluated using a paired t-test. Results: No significant between-group differences were found for the primary and secondary outcomes. When analyzing both groups combined, there was a significant improvement in: VISA-A score (from 60.3±17.5 to 77±13.2, p<0.001), HRT (from 26±3.72 to 31.8±4.65 reps, p<0.001), STIF (from 869 ± 149 to 942±155 N/m, p=0.006), of the tendinopathy leg and there was no significant improvement in CSA of the tendinopathy leg. Conclusions: No differences were found between AG and SG. Both protocols significantly improved clinical condi- tion (VISA-A), plantar flexor strength endurance (HRT), and stiffness (STIF) of the AT with diagnosed tendinopathy. Registration: NCT05659134 (ClinicalTrials.gov) [ABSTRACT FROM AUTHOR]

Introduction: Turner Syndrome (TS) is the commonest chromosomal abnormality in females. Establishing andmaintaining long-term follow-up after transition to adult endocrine services, to allow for essential lifelong surveillance of hypertension and cardiovascular disease, and optimal hormone replacement, remains a challenge. A TS transition clinic was established with the aim of supporting successful transfer and establishing long-term follow-up in adult endocrine services. Our objectives are to evaluate the success of our TS transition service primarily in achieving and maintaining follow-up after transfer to adult services and to assess the adequacy of health surveillance post-transitionwith a specific focus on cardiacmonitoring and hormone replacement. Methods: A departmental database was used to identify young people whose care had transferred to adult endocrine services. An electronic case record was utilised to obtain clinic attendance and relevant clinical information on cardiovascular monitoring and hormone replacement therapy (HRT). Results: Forty-six (n=46) young people transferred to adult endocrine services during the observed 20-year period, 1998-2017. Thirty-six (n=36) had transferred prior to 2015, of whom sixteen (n=16, 44%) are lost to long-term follow-up at 5 years. Overall, 41 (89%) patients have had cardiac imaging surveillance since transferring, However, only 30 (73%) of these were carried out at the recommended frequencies. All 20 women in established follow-up have had cardiac imaging. Five out of the 46 (11%) patients do not have any documented cardiovascular monitoring. Forty (86.9%) women have had a documented BP measurement. Nineteen of the 20 women who are in 5-year established follow-up have a documented blood pressure. Five (11%) women are not on HRT, while two (4%) remain on oestrogen-only HRT. Thirty-seven (80.4%) women are on combined HRT, only eight (21.6%) are on the recommended form of oestradiol. Two (4%) are not on HRT due to normal ovarian function. Conclusion: A significant proportion of girls with TS are currently lost to adult endocrine services. Strategies to improve long-term endocrine follow-up are needed to ensure lifelong health needs and adequate hormone replacement are met. Whilst similar parameters are monitored in adult endocrine services a group of patients may be at risk of receiving inadequate HRT and developing cardiovascular complications. [ABSTRACT FROM AUTHOR]

Premature Ovarian Insufficiency (POI) is a multi-factorial disorder that affects women of reproductive age. The condition is characterized by the loss of ovarian function before the age of 40 years and several factors have been identified to be implicated in its pathogenesis. Remarkably though, at least 50% of women have remaining follicles in their ovaries after the development of ovarian insufficiency. Population data show that approximately up to 3.7% of women worldwide suffer from POI and subsequent infertility. Currently, the treatment of POI-related infertility involves oocyte donation. However, many women with POI desire to conceive with their own ova. Therefore, experimental biological therapies, such as Platelet-Rich Plasma (PRP), Exosomes (exos) therapy, In vitro Activation (IVA), Stem Cell therapy, MicroRNAs and Mitochondrial Targeting Therapies are experimental treatment strategies that focus on activating oogenesis and folliculogenesis, by upregulating natural biochemical pathways (neofolliculogenesis) and improving ovarian microenvironment. This mini-review aims at identifying the main advantages of these approaches and exploring whether they can underpin existing assisted reproductive technologies. [ABSTRACT FROM AUTHOR]

Simple Summary: Ductal carcinoma in situ (DCIS) is recognised as a precursor to invasive breast cancer (IBC), while lobular carcinoma in situ (LCIS) is considered a risk factor for subsequent IBC. To investigate whether the factors that increase the risks of DCIS and LCIS also predispose to IBC, we analysed risk factors for 3075 DCIS cases, 338 LCIS cases, and 1584 controls aged 35–60. Results showed that breastfeeding after childbirth decreased risks of DCIS and LCIS, similar to the association with IBC. Post-menopausal hormone replacement therapy (HRT) increased the risks of DCIS and LCIS, especially in long-term use (10+ years), with a stronger association with LCIS. However, neither parity nor an increasing number of births decreased the risks of DCIS or LCIS, as they do IBC. The study shows both similarities and differences in the risk factors affecting in situ breast cancer and IBC, and results suggest that regular surveillance is warranted in post-menopausal women taking long-term HRT. Ductal carcinoma in situ (DCIS) is widely accepted as a precursor of invasive ductal carcinoma (IDC). Lobular carcinoma in situ (LCIS) is considered a risk factor for invasive lobular carcinoma (ILC), and it is unclear whether LCIS is also a precursor. Therefore, it would be expected that similar risk factors predispose to both DCIS and IDC, but not necessarily LCIS and ILC. This study examined associations with risk factors using data from 3075 DCIS cases, 338 LCIS cases, and 1584 controls aged 35–60, recruited from the UK-based GLACIER and ICICLE case-control studies between 2007 and 2012. Analysis showed that breastfeeding in parous women was protective against DCIS and LCIS, which is consistent with research on invasive breast cancer (IBC). Additionally, long-term use of HRT in post-menopausal women increased the risk of DCIS and LCIS, with a stronger association in LCIS, similar to the association with ILC. Contrary to findings with IBC, parity and the number of births were not protective against DCIS or LCIS, while oral contraceptives showed an unexpected protective effect. These findings suggest both similarities and differences in risk factors for DCIS and LCIS compared to IBC and that there may be justification for increased breast surveillance in post-menopausal women taking long-term HRT. [ABSTRACT FROM AUTHOR]

An anaerobic baffled reactor (ABR) is one of the useful wastewater treatment technologies, but the knowledge about its treatment performance for actual wastewater with load fluctuation is limited. The organic removal performance of an ABR for treating supermarket wastewater was evaluated. The ABR, which consisted of eight columns, was examined under four hydraulic retention time (HRT) conditions of 19.4, 12.9, 8.0, and 4.4 h. As a result, the unfiltered chemical oxygen demand (COD) removal efficiency was 80 (±8) % at an HRT of 19.4 h. When the HRT was shortened to 12.9 h, the average unfiltered COD removal efficiency decreased to 58 (±15) %. However, it showed buffering effect against high load inflow in the first column, indicating that it is useful as a pretreatment system under this condition. At an HRT of 4.4 h, the unfiltered COD removal efficiency decreased to 9%, indicating the system failed. The results of the microbial community structure analysis showed that the detection frequency of acidogenic bacteria decreased in proportion to the extension of residence time in the reactor. These results indicate that the ABR is useful for the treatment of supermarket wastewater with load fluctuations as a main treatment system at a HRT of 19.4 h and as a pretreatment system at a HRT of 12.9 h. [ABSTRACT FROM AUTHOR]

This review explores the challenges in the diagnosis of hypogonadotropic hypogonadism, the transition of care from paediatric to adult care and the considerable health implications of this condition. The role gynaecologists and general practitioners have in managing hormone replacement therapy and reproductive potential is also highlighted. The fertility treatment options, which include ovulation induction with gonadotrophins and in-vitro fertilisation, are discussed in detail along with highlighting the fact that anovulation and markers of low ovarian reserve prior to priming treatment may not be reflective of poor reproductive potential. The holistic management of women with hypogonadotropic hypogonadism is still not standardised and evidence for subfertility management is scarce. This review aims to highlight this concern and provide guidance by evaluating current evidence. [ABSTRACT FROM AUTHOR]

The anaerobic digestion of sewage sludge in South Korean wastewater treatment plants is affected by seasonal factors and other influences, resulting in lower digestion efficiency and gas production, which cannot reach optimal yields. The aim of this study was to improve the digestion efficiency and gas production of sludge anaerobic digestion in a wastewater treatment plant (WWTP) by using data mining techniques to adjust operational parameters. Through experimental data obtained from the WWTP in Daegu City, South Korea, an artificial neural network (ANN) technology was used to adjust the range of the organic loading rate (OLR) and hydraulic retention rate (HRT) to improve the efficiency and methane gas production from anaerobic sludge digestion. Data sources were normalized, and data analysis including Pearson correlation analysis, multiple regression analysis and an artificial neural network for optimal results. The results of the study showed a predicted 0.5% increase in digestion efficiency and a 1.3% increase in gas production at organic loads of 1.26–1.46 kg/m3 day and an HRT of 26–30 days. This shows that the ANN model that we established is feasible and can be used to improve the efficiency and gas production of sludge anaerobic digestion. [ABSTRACT FROM AUTHOR]

The liver performs a multitude of bodily functions, whilst retaining the ability to regenerate damaged tissue. In this review, we discuss sex steroid biology, regulation of mammalian liver physiology and the development of new model systems to improve our understanding of liver biology in health and disease. A major risk factor for the development of liver disease is hepatic fibrosis. Key drivers of this process are metabolic dysfunction and pathologic activation of the immune system. Although non-alcoholic fatty liver disease (NAFLD) is largely regarded as benign, it does progress to non-alcoholic steatohepatitis in a subset of patients, increasing their risk of developing cirrhosis and hepatocellular carcinoma. NAFLD susceptibility varies across the population, with obesity and insulin resistance playing a strong role in the disease development. Additionally, sex and age have been identified as important risk factors. In addition to the regulation of liver biochemistry, sex hormones also regulate the immune system, with sexual dimorphism described for both innate and adaptive immune responses. Therefore, sex differences in liver metabolism, immunity and their interplay are important factors to consider when designing, studying and developing therapeutic strategies to treat human liver disease. The purpose of this review is to provide the reader with a general overview of sex steroid biology and their regulation of mammalian liver physiology. [ABSTRACT FROM AUTHOR]

A laboratory-scale granular activated carbon-sequencing batch reactor (GAC-SBR) was used to co-treat stabilized landfill leachate with municipal wastewater. GAC-SBR was studied for the different mixing ratios of leachate and municipal wastewater at different hydraulic retention time (HRT). GAC dose (5, 10, 15 and 20 g/L) was optimized for COD reduction with a contact time of 22 h. GAC-SBR treatment efficiency was assessed on mixed liquor suspended solids (MLSS), mixed liquor volatile suspended solids (MLVSS), turbidity, chemical oxygen demand (COD), ammonia, nitrate, and phosphate removal. Univariate ANOVA was applied to test the statistical significance of treatment at different leachate:wastewater ratios. Results showed that the increase in GAC concentration led to an increase in the removal of COD and ammonia from stabilized landfill leachate. Adsorption efficiency decreased or remained constant after 15 g/L GAC. GAC-SBR was efficient in removing COD (83%) and nutrients (80–90%) from stabilized landfill leachate at 10 d HRT. Univariate analysis of variance (ANOVA) highlighted that there was a statistically significant difference in the treatments for the mixing ratio tested. GAC-SBR results showed that treatment efficiency was dependent on landfill leachate concentration and hydraulic retention time (HRT). Coupled treatment tested exhibited a high potential for co-treatment of leachate and municipal wastewater. However, the effluent after treatment could not achieve a complete or very high level of COD, nutrients and turbidity removal which necessitates the incorporation of physico-chemical processes such as coagulation, electrocoagulation, membrane filtration etc. as post-treatment options. Further studies in this direction along with exploring the longevity of GAC in SBR would provide useful information for effective landfill leachate treatment. [ABSTRACT FROM AUTHOR]

European clinical guidelines recommend the use of Exposure and Response Prevention (ERP) and Comprehensive Behavioral Intervention for Tics (CBIT) as first-line treatments for tic disorders. Although ongoing efforts in research are being made to understand the mechanisms underlying these behavioral approaches, as of yet, the neurophysiological mechanisms behind behavioral interventions are poorly understood. However, this is essential to tailor interventions to individual patients in order to increase compliance and efficacy. The Theory of Event Coding (TEC) and its derivative BRAC (Binding and Retrieval in Action Control) provide a theoretical framework to investigate cognitive and neural processes in the context of tic disorders. In this context, tics are conceptualized as a phenomenon of enhanced perception–action binding, with premonitory urges constituting the perceptual and the motor or vocal expression constituting the action part of an event file. Based on this, CBIT is assumed to strongly affect stimulus–response binding in the context of response selection, whereas the effects of ERP presumably unfold during stimulus–response binding in the response inhibition context. Further studies are needed to clarify the neurophysiological processes underlying behavioral interventions to enable the individualization and further development of therapeutic approaches for tic disorders. [ABSTRACT FROM AUTHOR]

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Access to contraception is a basic human right, and one that empowers women to support pregnancy planning. When assessing a woman over the age of 40 for contraception, concerns such as co-morbidity, changes to menstrual pattern, irregular bleeding and the management of additional perimenopausal and menopausal symptoms are essential considerations. While many methods of contraception can be used in menopause, some may need to be changed to safer, alternative methods. Most women will require some form of contraception (often taken alongside hormone replacement therapy) until the age of 55. This article will focus on contraception consultation and assessment, prescribing considerations in relation to age and menopause, contraceptive formulations (hormonal methods and the copper IUD and the potential health implications of using specific forms of contraception. [ABSTRACT FROM AUTHOR]

Premature Ovarian Insufficiency (POI) is a multi-factorial disorder that affects women of reproductive age. The condition is characterized by the loss of ovarian function before the age of 40 years and several factors have been identified to be implicated in its pathogenesis. Remarkably though, at least 50% of women have remaining follicles in their ovaries after the development of ovarian insufficiency. Population data show that approximately up to 3.7% of women worldwide suffer from POI and subsequent infertility. Currently, the treatment of POI-related infertility involves oocyte donation. However, many women with POI desire to conceive with their own ova. Therefore, experimental biological therapies, such as Platelet-Rich Plasma (PRP), Exosomes (exos) therapy, In vitro Activation (IVA), Stem Cell therapy, MicroRNAs and Mitochondrial Targeting Therapies are experimental treatment strategies that focus on activating oogenesis and folliculogenesis, by upregulating natural biochemical pathways (neo-folliculogenesis) and improving ovarian microenvironment. This mini-review aims at identifying the main advantages of these approaches and exploring whether they can underpin existing assisted reproductive technologies.

IntroductionTurner Syndrome (TS) is the commonest chromosomal abnormality in females. Establishing and maintaining long-term follow-up after transition to adult endocrine services, to allow for essential lifelong surveillance of hypertension and cardiovascular disease, and optimal hormone replacement, remains a challenge. A TS transition clinic was established with the aim of supporting successful transfer and establishing long-term follow-up in adult endocrine services. Our objectives are to evaluate the success of our TS transition service primarily in achieving and maintaining follow-up after transfer to adult services and to assess the adequacy of health surveillance post-transition with a specific focus on cardiac monitoring and hormone replacement.MethodsA departmental database was used to identify young people whose care had transferred to adult endocrine services. An electronic case record was utilised to obtain clinic attendance and relevant clinical information on cardiovascular monitoring and hormone replacement therapy (HRT). ResultsForty-six (n=46) young people transferred to adult endocrine services during the observed 20-year period, 1998-2017. Thirty-six (n=36) had transferred prior to 2015, of whom sixteen (n=16, 44%) are lost to long-term follow-up at 5 years. Overall, 41 (89%) patients have had cardiac imaging surveillance since transferring, However, only 30 (73%) of these were carried out at the recommended frequencies. All 20 women in established follow-up have had cardiac imaging. Five out of the 46 (11%) patients do not have any documented cardiovascular monitoring. Forty (86.9%) women have had a documented BP measurement. Nineteen of the 20 women who are in 5- year established follow-up have a documented blood pressure. Five (11%) women are not on HRT, while two (4%) remain on oestrogen-only HRT. Thirty-seven (80.4%) women are on combined HRT, only eight (21.6%) are on the recommended form of oestradiol. Two (4%) are not on HRT due to normal ovarian function. ConclusionA significant proportion of girls with TS are currently lost to adult endocrine services. Strategies to improve long-term endocrine follow-up are needed to ensure lifelong health needs and adequate hormone replacement are met. Whilst similar parameters are monitored in adult endocrine services a group of patients may be at risk of receiving inadequate HRT and developing cardiovascular complications.

The British Menopause Society, Royal College of Obstetricians and Gynaecologists, and Society for Endocrinology have released a joint position statement on best practices for menopause care. The statement aims to provide evidence-based guidance to healthcare practitioners working with women experiencing menopause, particularly in response to shortages of hormone replacement therapy (HRT) treatment. Menopause can have a significant impact on women's quality of life, personal relationships, and work, with symptoms such as hot flushes, night sweats, vaginal dryness, mood changes, and memory problems. The statement emphasizes the importance of an individualized approach to managing menopause, including considering lifestyle modifications, alternative therapies, and the benefits and risks of HRT. It also addresses misinformation and provides guidance for women with a history of breast cancer. Overall, the statement highlights the need for accurate information and support for women during this life stage. [Extracted from the article]

This cohort study investigated whether letrozole versus hormone replacement therapy (HRT) results in higher live birth rate among anovulatory and oligoovulatory women in frozen-thawed embryo transfer (FET) cycles. It was conducted from 1st February 2018 to 31st January 2019 and included 261 anovulatory and oligoovulatory women. Since letrozole has become an effective alternative to HRT cycles, 121 patients received letrozole in 121 cycles from 1st February 2018 to 31st January 2019 and were compared to 140 HRT FET cycles among 140 women from 1st February 2017 to 31st January 2018. The primary outcome was live birth rate. Secondary outcomes were clinical pregnancy, multiple pregnancy and miscarriage rates. Clinical pregnancy and live birth rates of transferred cleavage embryos were higher in the letrozole compared to the HRT group (36/65 (55.3%) vs. 20/110 (18.1%), p < 0.001) and (25/65 (38.4%) vs. 17/110 (15.4%), p < 0.001) respectively, whilst these rates were similar for transferred blastocyst embryos. Miscarriage and multiple pregnancy rates were similar between groups. The letrozole group was older than the HRT group (31.8 ± 5.1 vs. 29.9 ± 5.1 years, p = 0.002) and more smoked cigarettes (p = 0.035). Groups were similar regarding BMI, male versus non-male indication for fertility treatment, peak oestradiol levels, and numbers of oocytes retrieved, blastocysts, frozen and transferred embryos. Letrozole compared to HRT might improve live birth and clinical pregnancy rates among anovulatory and oligoovulatory women undergoing FET cycles. [ABSTRACT FROM AUTHOR]

The optimal hormone replacement therapy (HRT) in women who have undergone pelvic clearance for endometriosis remains uncertain with insufficient evidence. The purpose of this case report and the national survey was to highlight the potential HRT-related risks and to establish current HRT practice in this group of women. The case was a 45-year-old woman presenting with recurrence of severe chronic pelvic pain while on oestrogen-only HRT (EO-HRT) for five years after subtotal hysterectomy and bilateral oophorectomy for severe endometriosis. MRI revealed multiple peri-cervical endometriomas and severe right hydroureter/hydronephrosis with complete right renal parenchymal loss. The survey was a 21-item questionnaire administered electronically using SurveyMonkey. It was reviewed and approved by British Menopause Society and British Society of Gynaecological endoscopy and was sent to their members as well as NHS Gynaecologists. A total of 216 physicians responded including 120 (55.6%) Gynaecology Consultants and 96 (44.4%) GPs/Nurses in Menopause clinics. Overall, 68.6% of responders prescribe combined HRT (C-HRT), 11.1% tibolone, 13.0% EO-HRT and 7.8% varied HRT. Fifty-one percent prescribe the progestogen component of C-HRT indefinitely, 22% for 3–6 months and 27% for varied durations. In conclusion, this study highlights the real risk of endometriosis recurrence in EO-HRT users after pelvic clearance for endometriosis. The survey revealed that only two thirds of Gynecologists/Menopause practitioners prescribe combined HRT in this group of women. [ABSTRACT FROM AUTHOR]

Simple Summary: Advances in molecular genetics have radically changed all aspects of cancer prevention, screening and treatment and, today, women who are suspected of being at risk of hereditary cancer should always undergo genetic counselling. Furthermore, today there is growing attention on the tumor suppressor genes BRCA 1 and BRCA2. In addition, there is growing attention on women who carry mutations of the tumor suppressor genes BRCA 1 and BRCA2 and undergo a prophylactic risk-reducing salpingo-oophorectomy. This paper explores the pathobiology of BRCA1\2 cancer genes in a translational perspective, focusing on molecular aspects of hormonal therapy in early menopausal women as well as on the latest evidence-based guidelines for clinicians. Physicians should counsel motivated patients who ask for relief from early menopausal symptoms about the risks and benefits of hormonal therapy, as well as tailoring and appropriate treatment for selected patients. All cancers develop as a result of mutations in genes. DNA damage induces genomic instability and subsequently increases susceptibility to tumorigenesis. Women who carry mutations of BRCA 1 and BRCA2 genes have an augmented risk of breast and ovarian cancer and a markedly augmented probability of dying because of cancer compared to the general population. As a result, international guidelines recommend that all BRCA1\2 mutation carriers be offered risk-reducing bilateral salpingo-oophorectomy at an early age to reduce the risk of cancer and decrease the mortality rate of this high-risk population. NCCN guidelines recommend risk-reducing bilateral salpingo-oophorectomy in pre-menopausal women, between 35–40 years in BRCA1 mutation carriers and between 40–45 years in BRCA2 mutation carriers. Unfortunately, the well-documented reduction of cancer risk is counterbalanced by early sterility and premature ovarian failure with an early onset of secondary menopausal syndromes such as neuromotor, cardiovascular, cognitive and urogenital deficiency. Hormonal replacement therapy significantly compensates for hormonal deprivation and counteracts menopausal syndrome morbidity and mortality; however, some data suggest a possible correlation between hormonal medications and cancer risk, especially in BRCA1\2 carriers who undergo long-term regimens. Conversely, short-term treatment before the age of natural menopause does not appear to increase the cancer risk in BRCA1 mutation carriers without a personal history of breast cancer after prophylactic surgery. Few data are available on BRCA2 mutation carriers and more well-designed studies are needed. In conclusion, clinicians should propose short-term hormone replacement therapy to BRCA 1 carriers to counteract hormonal deprivation; personalized counselling should be offered to BRCA2 mutation carriers for a balance between the risks and benefits of the treatment. [ABSTRACT FROM AUTHOR]

Abstract Purpose This systematic review and meta-analysis aimed to compare the short-term reproductive and long-term obstetric outcomes after endometrial preparations by ovarian stimulation protocols and hormone replacement therapy (HRT) in women with polycystic ovary syndrome (PCOS) prior to frozen embryo transfer (FET). Method PubMed, EMBASE, Web of Science and the Cochrane Library were searched to identify relevant studies. Primary outcome was live birth rate, secondary outcomes included the rates of clinical pregnancy, miscarriage, implantation and hCG-postive, cycle cancellation, ectopic pregnancy, preterm birth, preeclampsia, gestational hypertension, gestational diabetes mellitus and abnormal placentation. Results Nine studies, including 8327 patients with PCOS, were identified. Live birth rate was significantly higher (RR = 1.11, 95% CI = 1.03–1.19) and miscarriage rate (RR = 0.60, 95% CI = 0.46–0.78) was significantly lower in stimulated protocol compared to the rates in HRT. While the rates of ongoing pregnancy, clinical pregnancy, implantation, hCG-positive, cycle cancellation and ectopic pregnancy showed no significant difference between the two protocols. Compared HRT with different stimulation protocols, significantly higher clinical pregnancy rate (RR = 1.54, 95% CI = 1.20–1.98) were found in letrozole group, but not in the other subgroups. For the obstetric outcomes, the preterm birth and preeclampsia rates were significantly lower in the stimulated group compared to that in the HRT group (RR = 0.85, 95% CI = 0.74–0.98; RR = 0.57, 95% CI = 0.40–0.82, respectively), while gestational hypertension, gestational diabetes mellitus and abnormal placentation rates showed no significant difference. Conclusions The present data suggest that ovarian stimulation protocol as an endometrial preparation regimen prior to FET might be superior to HRT protocol with a significantly higher rate of live birth, lower risk of miscarriage, preterm birth and preeclampsia. Our study showed stimulated protocol is better than HRT regimen as an endometrial preparation for women with PCOS. However, quality of the evidence is low, more well-designed RCT studies are still needed to confirm the results before clinical recommendation, particularly direct comparisons between letrozole and other stimulated regimens.

Objective: 47,XXX is a form of sex chromosome anomaly with an extra copy of X chromosome. It can have a varying presentation ranging from a few physical characteristics to intellectual and learning disabilities to primary ovarian insufficiency (POI). Although for most triple X syndrome patients, sexual development and fertility are normal, a few may present with amenorrhea and POI. We are presenting a case of triple X patient who presented with POI at 23 years of age. The relatively rare occurrence of this entity prompted us to report this case. Case Presentation: Index case was presented to us at 23 years of age with secondary amenorrhea and desire for conception. Secondary sex characteristics were normal except for axillary hair that was scanty. Workup revealed a 47, XXX karyotype and a diagnosis of POI was made. We are presenting this case to highlight this important entity as a differential in cases of amenorrhea and to discuss the fertility options available in such cases. Conclusion: Women with triple X syndrome have varying phenotypic presentations. Those presenting with POI will need hormone replacement therapy, psychological support and counselling for fertility options.

Background: Menopause is an important hormonal transition of women's lifespan which can strike as early as 30–35 years of age. Menopause-specific quality of life (MENQoL) mainly depends upon awareness, frequency, and intensity of menopausal symptoms; sociocultural, lifestyle, and dietary factors; and availability of health services specifically focusing on these issues. As life expectancy increases, women have to spend more years after menopause. So menopause specific quality of life will be a major issue of concern in the near future. The aim of this study was to assess the post-menopausal symptoms and quality of life (QoL) amongst post-menopausal women and their association with various sociodemographic factors. Materials and Methods: A community-based, descriptive, cross-sectional study was undertaken at Sakuri village among 100 postmenopausal women. Information was collected using MENQoL questionnaire. Unpaired t-test and Chi-squared test were used. Results: The mean age of participants and menopause was 51.8 ± 4.54 years and 46.42 ± 4.13 years, respectively. The major symptoms reported were hot flushes (70%), under accomplishment (100%), bloating (100%), decrease in physical strength (95%), and change in sexual desire (78%). Statistically significant association was found between age and psychosocial domain. QoL was associated with age and educational level. Conclusion: More than half of the participants had poor QoL for all four domains. Awareness about post-menopausal changes and available treatment modalities can improve QoL. Accessible and affordable gynaecological and psychiatric health services through channel of primary health care are necessary to alleviate these complaints.