Women's Health Medicine最新文献

Polycystic ovary syndrome can cause distressing symptoms of hyperandrogenism (such as hirsutism), may impair fertility and is associated with the metabolic syndrome. Management has traditionally been guided by symptoms or by the wish to conceive, but prevention of the possible long-term consequences of the metabolic disturbance characteristic of anovulatory women with PCOS is now an important element of management. By focusing on the treatment of infertility, menstrual regulation, the treatment of symptoms of hyperandrogenism and the prevention of possible consequences of the metabolic disturbance, this article reviews the important elements in the management of PCOS

Assessment of ovulation starts with a detailed menstrual history as menstruation provides the outward sign of the rhythmic changes taking place in the hypothalamus, the pituitary, the ovaries and the endometrium. Regular menstrual cycles in the range 25–35 days are usually indicative of ovulation. Patients with disorders of ovulation often experience absent periods (amenorrhoea) or irregular periods (oligomenorrhoea). Patients experiencing these symptoms require a detailed medical assessment based on a full history and examination followed by appropriate endocrine and imaging investigations. Through its focus on history and examination, laboratory and diagnostic assessment, detection of ovulation and detection of ovarian reserve, this article reviews the effective assessment of disorders of ovulation

Gynaecological causes of abdominal pain may arise from conditions associated with pregnancy and the non-pregnant state, and patients may present as emergencies or to Outpatient Clinics. This contribution focuses on those conditions most likely to present to a surgical trainee. Guidance on management (particularly with respect to investigations and referral for gynaecological assistance) is discussed. By considering gynaecological causes of abdominal pain in a variety of conditions - including, ectopic pregnancy, miscarriages, complicated ovarian cysts, endometriosis, or ovarian tumours - this review article considers a number of conditions for patients in emergency or non-emergency situations, presenting in pregnant or non-pregnant states.

Women and the ovary: self-appraisal

This article offers a broad overview of polycystic ovary syndrome (PCOS), including the prevalence, genetic disorder, pathogenesis and metabolic disorder concerned with PCOS. Until recently, the most widely accepted clinical definition of PCOS was the association of hyperandrogenism with chronic anovulation in women without specific underlying disease of the adrenal or pituitary gland. Early descriptions of the syndrome were based on ovarian morphology, but this was not considered an essential requirement for the diagnosis. However, recent application of modern, high-resolution diagnostic ultrasonography has again tipped the balance towards a more morphologically based diagnosis. The diagnostic criteria for PCOS have now been revised and require at least two of the following features: polycystic ovaries; oligo-ovulation or anovulation; clinical and/or biochemical evidence of androgen excess.

This review article offers a brief overview of skin physiology, including the epidermis, dermis, basement membrane zone and the role of psychological stress. Skin is the largest organ; it is complex and multifunctional, containing many specialized cells that are adapted to different functions. Skin consists of a superficial layer (epidermis) that adheres closely to the deeper layer (dermis) via the basement membrane. Loose connective tissue and fat underlie the dermis. The epidermis is composed of stratified squamous epithelium, comprising layers of closely packed cells produced by cell division of the ‘basal’ cell layer (a single sheet of columnar cells at the lowest level of the epidermis). The dermis lies below the epidermis and supports it structurally and nutritionally. The basement membrane zone forms an adhesion complex between the dermis and epidermis, providing support for the basal cells to allow growth, multiplication and migration, and allowing nutrients and cells to cross from the dermis. Psychological stress may precipitate or aggravate chronic disorders of the skin.

Polycystic ovary syndrome has adverse effects on many organ systems and on women's quality of life, so recognition is important. The diagnosis now requires at least two of the following: (i) polycystic ovarie; (ii) oligo-ovulation or anovulation; (iii) clinical and/or biochemical evidence of androgen excess. The spectrum of presentations of PCOS is wide, ranging from severe hirsutism, obesity and amenorrhoea at one end to mild hirsutism or slight disturbance of menstrual pattern at the other (Figure 2). In the author's clinic, PCOS is the most common cause of anovulatory infertility (73% of cases), amenorrhoea or oligomenorrhoea and hirsutism (> 75% of cases). The diagnosis of PCOS is made primarily on clinical and ultrasonographic criteria (Figure 3). A discussion follows on useful hormonal investigations, careful history and appropriate initial investigations which will usually help distinguish PCOS from other causes of androgen excess and menstrual disturbance.

Sperm cryopreservation as a means of preserving the fertility potential of men has existed for over 50 years, but oocytes (eggs) are such large, delicate structures (imagine a fluid-filled bubble the size of a pin point) that until recently there was little we could offer young women facing a choice between the chemotherapy that could save their lives and the certainty of premature menopause and sterility. The first ‘frozen egg’ baby was born in 1986, but the success rate (100 eggs to produce one baby) was so low that ‘egg freezing’ was neglected for years. Two exciting technological developments (ICSI and dehydro-cryoprotectant) have transformed this picture and now young women who have frozen their eggs can be offered the same chance of a live birth per embryo transfer as women undergoing conventional IVF treatment. Young female oncology patients should now be routinely offered the chance to freeze their eggs before embarking on chemotherapy or radiotherapy. Modern treatment protocols mean that a delay of only 2–3 weeks is required before cancer therapy can be started and even patients with ‘hormone sensitive’ tumours such as breast cancer are not necessarily excluded. Other groups of patients may also want to consider ‘egg freezing’ as a ‘fertility extending’ option such as couples with ethical objections to embryo freezing, women who are not in a position to undertake motherhood yet, women considering becoming egg donors or mothers of baby girls diagnosed with Turner's Syndrome.

Regular exercise brings health benefits, but for some young women it can also bring disordered eating, amenorrhea and osteoporosis. The ‘female athlete triad’ consists of three separate, but interrelated medical entities: (i) disordered eating; (ii) amenorrhea (or absence of menses), and; (iii) premature osteoporosis (altered bone mineral density). Although coaches, athletes, parents, and to some extent team physicians, have been aware of these problems for some time, it is only relatively recently that concerns about short- and long-term health consequences have been voiced in the medical literature. Prevention of the Triad disorders starts with awareness and sensitivity to the pertinent issues. We now know that concerns about weight and dieting emerge in children between the ages of 9 to 11. Athletes and coaches must be thoroughly educated on nutrition and training principles, the development and maintenance of normal menstrual cycles, and the prevention of osteoporosis. By evaluating the female athlete triad, amenorrhea, medical complications, signs and symptoms, key signs at physical examination, and the management and prevention of the triad disorders, this article offers an important review of the female athlete triad.

This review article examines the aetiology, physical assessment, treatment and pharmacological therapies for hirsutism. Hirsutism is defined as the presence in a female of terminal hair in a distribution more typically associated with the adult male. The condition can have a significant negative psychosocial impact on an individual as well as being a sign of underlying endocrine abnormality. Hirsutism develops as the result of the sensitisation of androgen-dependent hair follicles converting vellus hair to darker and thicker terminal hair. Over seventy percent of women with androgen excess demonstrate hirsutism, however, not all women with hirsutism will have detectable androgen excess. In these cases increased end-organ sensitivity to androgen plays an important role. Future developments for assessing and treating hirsutism are discussed.