Gynecological Endocrinology最新文献

Objective: To compare the efficacy of oral and transdermal estrogens in improving the quality of life in perimenopausal and recently postmenopausal women.

Methods: 257 women aged 40-55 years, within three years after their final menstrual period were randomized to receive transdermal oestrogel (t-E2) (n = 128) or oral estradiol valerate (o- E2V) (n = 129; both with micronized progesterone 200 mg for 14 days each month). Menopausal symptoms were recorded at screening and at 4, 12, and 24 weeks post-randomization. Menopausal symptoms were evaluated using the Menopause-Specific Quality of Life (MENQOL) questionnaire.

Results: Significant improvements of MENQOL scores were observed in both groups compared with baseline. The decrease of MENQOL scores after treatment showed almost no difference between the two groups (p > 0.05) except the VMS domain which indicated a better result in oral estrogen group after 24 weeks.

Conclusions: This study showed that both transdermal and oral estrogens were highly effective in relieving the overall menopausal symptoms for recently-menopausal women, with little difference in treatment efficacy between the two routes.

Subclinical hypothyroidism (SCH) during pregnancy is a common endocrine disorder, and miR-142-3p has been widely reported to be involved in thyroid function and pregnancy-related diseases. This study aimed to investigate the expression of miR-142-3p in SCH patients during the second trimester of pregnancy and clarify its clinical significance. A total of 135 healthy individuals and 161 SCH patients were included in the study. The expression level of miR-142-3p was detected by RT-qPCR, and its diagnostic efficacy was evaluated by ROC curve. Pearson correlation analysis was used to explore the correlation, and multivariate logistic regression analysis was performed to determine the potential risk factors for SCH. The results showed that the expression level of miR-142-3p was significantly increased in SCH patients and had a high diagnostic value. This indicator was positively correlated with thyroid peroxidase antibody (TPOAb) and thyroid stimulating hormone (TSH) levels, and was a risk factor for SCH during pregnancy. In addition, both SCH and abnormally elevated miR-142-3p were associated with adverse pregnancy outcomes, especially depression and preterm birth. In conclusion, the increase in miR-142-3p has a high diagnostic value in differentiating SCH patients from healthy individuals, is a risk factor for SCH, and is associated with adverse pregnancy outcomes (such as depression and preterm birth).

Objective: To expand the clinical phenotype associated with MYRF mutations in disorders of sex development (DSDs).

Methods: We present a case of a 17-year-old patient with a female phenotype who presented with primary amenorrhea.

Results: The patient's external genitalia was entirely female in appearance, though there was no opening of vagina below the orifice of urethra. The karyotype was determined to be 46, XX. Hormonal analysis showed ovarian function failure. Pelvic ultrasound and MRI revealed the absence of visible uterus, cervix, vagina, and bilateral ovaries. Although MRKH syndrome combined with 46, XX pure gonadal dysgenesis was initially suspected, subsequent whole exome sequencing identified a novel heterozygous variation c.1468C > G in the MYRF gene. Further investigations revealed only hypoplasia of Mullerian derivatives and ovaries, along with a malformation of left kidney duplication, as evidence of MYRF deficiency as part of the cardiac-urogenital-diaphragm-lung (CUDL) syndrome.

Conclusion: This case report describes a patient with MYRF-associated 46, XX DSDs, exhibiting atypical or subtle phenotypic features without significant cardiac, pulmonary, or diaphragmatic abnormalities, but with urogenital anomalies including absent uterus, vagina, and ovaries, and left kidney duplication malformation. This expands the clinical phenotype associated with MYRF mutations and identifies MYRF as a novel pathogenic gene for 46, XX DSDs.

Polycystic Ovary Syndrome (PCOS) is a common reproductive and metabolic disorder causing infertility in women of childbearing age.Circular RNAs are known to be involved in PCOS development, but their regulatory mechanisms remain unclear. This study explored the role of circ_BMPR2 in PCOS to advance early diagnosis and treatment.It found elevated circ_BMPR2 expression in ovarian granulosa cells of PCOS patients. Knocking down of circ_BMPR2 inhibited proliferation and promoted apoptosis in KGN cell. Mechanistically, we confirmed that circ_BMPR2 acts as a sponge to bind miR-619-5p, which could specifically target Rab43 gene.PCOS tissues showed upregulated Rab43, and silencing circ_BMPR2 reduced Rab43 levels, rescued by a miR-619-5p inhibitor. Further experiments confirmed that overexpression of Rab43 reversed the effects of circ_BMPR2 knockdown on cell proliferation and apoptosis in KGN cells. Thus,our findings implicate circ_BMPR2 acts as a key player in PCOS process, by modulating growth and cell cycle progression of GCs through regulating the miR-619-5p/Rab43 axis. This suggests that circ_BMPR2 could be a prospective biomarker for the early diagnosis of PCOS. By understanding its molecular mechanisms, we can pave the way for more effective interventions to treat this complex disease.

Background: Primary Ovarian Insufficiency (POI) impacts 3.5% of women under 40, with its etiology largely unknown. Piwi-interacting RNAs (piRNAs) have emerged as potential biomarkers for gynecological conditions, including POI. We hypothesized that hsa-piR-775 plays a critical role in POI pathogenesis by regulating FOXG1 expression.

Methods: We performed piRNA sequencing on serum samples from POI patients and controls using the Illumina sequencing platform. Bioinformatics analysis for target prediction was conducted using TargetScan and miRanda to identify potential downstream targets of differentially expressed piRNAs (DEPs). qPCR and luciferase reporter assays for in vitro validation to explore the function and targets of DEPs, with a focus on hsa-piR-775.

Results: Among 43 DEPs, hsa-piR-775 was notably upregulated in POI patients. Target gene prediction and enrichment analysis implicated FOXG1, a gene associated with ovarian function, as a potential target of hsa-piR-775. In vitro validation confirmed hsa-piR-775 can influence FOXG1 mRNA, reducing FOXG1 expression. These findings suggest hsa-piR-775 influences POI progression by modulating FOXG1 levels.

Conclusion: We demonstrate that hsa-piR-775 is upregulated in POI and regulates FOXG1 expression, revealing a novel pathogenic mechanism. This supports piRNAs' potential as biomarkers and therapeutic targets in POI. Future studies should focus on validating these findings in larger cohorts and exploring piRNA-based therapeutic interventions for POI.

Unexplained recurrent pregnant loss (URPL) is associated with immune imbalance at the maternal-fetal interface. Decidual immune cells regulate the response of the maternal immune system to the fetus. However, the effect of decidual stromal cells (DSCs) and trophoblast cells on cytokine secretion by decidual NK cells remains unclear. In this study, we investigated the influence of JEG-3 cells and DSCs on the secretion of cytokines in dNK cells. Furthermore, we investigated whether or not cytokine secretion was regulated by the mitogen-activated protein kinase (MAPK) signaling pathway at the maternal-fetal interface. Our study showed that the secretions of both IFN-γ and TNF-α in dNK cells in URPL were significantly higher than those in normal pregnancy. In the coculture of JEG-3, DSCs, and dNK cells, IL-10 and IL-4 production increased in dNK cells during normal pregnancy; whereas IFN-γ and TNF-α production increased but IL-10 and IL-4 levels decreased during URPL. Furthermore, pretreatment with P38/MAPK inhibition significantly inhibited the secretion of NK1- and NK2-type cytokines in the coculture of the three types of cells. Our study elucidated the influence of trophoblasts and DSCs on the expression of cytokines in dNK cells in patients with URPL and uncovered a complicated crosstalk through the MAPK signal at the maternal-fetal interface.

Purpose: To comprehensively compare and rank hormone therapy for patients with perimenopausal syndrome.

Methods: A comprehensive search was conducted on PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases from inception to August 20, 2024. The quality of the included randomized controlled trials (RCTs) were measured by the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was applied to grade the quality of evidence in this network meta-analysis. Network plots were depicted to show direct and indirect comparisons of hormone therapy for each outcome. The influences of different hormone therapy on the outcomes were illustrated via forest plots and league tables. Rank probabilities showed the ranking of different administration routes.

Results: Seven studies involving 704 perimenopausal syndrome patients were included. The rank probabilities suggested that oral estradiol (E₂₎ combined with medroxyprogesterone and general health guidance had the highest likelihood to be the optimal therapy for the severity of menopausal syndrome. General health guidance combined with oral E₂ was less likely to have a nausea and vomiting, and breast pain.

Conclusion: Oral E₂ and medroxyprogesterone or general health guidance combined with oral E₂ may be the effective and safe option for the management of perimenopausal syndrome.

Objective: To evaluate the effects of a combination of carnitines, L-arginine, L-cysteine and myo-inositol on metabolic and reproductive parameters in PCOS overweight/obese patients.

Methods: This was a retrospective study analyzing information of a group of PCOS (n = 25) overweight/obesity patients, not requiring hormonal treatment, selected from the database of the ambulatory clinic of the Gynecological Endocrinology Center at the University of Modena and Reggio Emilia, Modena, Italy. The hormonal profile, routine exams and insulin and C-peptide response to oral glucose tolerance test (OGTT) were evaluated before and after 12 weeks of a daily oral complementary treatment with L-carnitine (500 mg), acetyl-L-carnitine (250 mg), L-arginine (500 mg), L-cysteine (100 mg) and myo-inositol (1 gr). The hepatic insulin extraction index was also calculated.

Results: The mix of complementary substances significantly improved metabolic parameters, homeostatic model assessment for insulin resistance index values and gonadotropin plasma levels. Glucose, C-peptide and insulin response to OGTT was significantly reduced as well as the hepatic insulin extraction index.

Conclusion: The administration of a combination of carnitines, L-arginine, L-cysteine and myoinositol improved gonadotropin plasma levels and insulin sensitivity in overweight/obese PCOS patients and restored hepatic clearance of insulin as demonstrated by the decreased hepatic insulin extraction index.

Objective: This study aimed to determine the prevalence of vitamin D deficiency and its associated factors among women attending women's health clinics at a university medical center in Lebanon.

Methods: We retrospectively reviewed clinical and obstetric data, including 25-hydroxyvitamin D [25OHD] serum levels and vitamin D3 supplementation, from 873 healthy singleton pregnancies delivered between 2006 and 2017. Women with preexisting comorbidities or prior gestational complications were excluded. VDD was defined as a 25OHD serum level <20 ng/ml.

Results: At baseline, 63% of participants were vitamin D deficient. Poisson regression was used to identify independent predictors of deficiency. In early gestation, 25OHD levels varied significantly by age, pre-pregnancy BMI, parity, smoking status, and season of presentation (all p < 0.05). At late gestation, vitamin D levels were associated with pre-pregnancy BMI, hemoglobin status at delivery, and vitamin D status at early gestation. Women with 25OHD <20 ng/ml at late gestation were more likely to be anemic compared to those with levels ≥20 ng/ml (adjusted odds ratio 1.6; 95% CI: 1.1-2.5).

Conclusion: Vitamin D deficiency is highly prevalent among pregnant Lebanese women. Identified risk factors including higher BMI, younger age, multiparity, and anemia should prompt consideration of more aggressive vitamin D supplementation strategies for women planning pregnancy.

Synopsis: Vitamin D deficiency is quite prevalent among pregnant women in the Middle East. We aim to report the prevalence of Vitamin D deficiency and its associated predictors during pregnancy.