Gynecological Endocrinology最新文献

This study aimed to investigate the prevalence, severity, and associated factors of menopausal symptoms among middle-aged Chinese women. A multicenter, population-based cross-sectional study was conducted, involving 7,485 women aged 40-69 years from Zhejiang Province, China. Data on demographic characteristics, socioeconomic status, and lifestyle factors were collected using a structured questionnaire. Menopausal symptoms were assessed using the modified Kupperman Menopausal Index (mKMI), and multinomial logistic regression models were employed to identify factors linked to menopausal syndrome. The participants had a mean age of 52.4 (±7.3) years, with 46.1% being nonmenopausal and 53.9% postmenopausal. The most common menopausal symptoms were sexual problems (43.6%), insomnia (33.1%), and fatigue (27.5%). Among nonmenopausal women, insomnia was the most prevalent symptom (26.9%), whereas postmenopausal women most frequently reported sexual problems (61.1%). Both the prevalence and severity of menopausal symptoms significantly increased from nonmenopausal to postmenopausal status (p < 0.001). Significant associations were found between menopausal syndrome and factors such as age, menopausal status, education level, residence, income, passive smoking, physical activity, and occupational toxic exposure (p < 0.05). In conclusion, Sexual problems are the most bothersome menopausal symptom among females in southeast China. Postmenopausal females experience more prevalent and more severe symptoms. Additionally, socioeconomic and lifestyle factors play a significant role in menopausal syndrome.

Objective: To investigate the effects of light fasting diet therapy, including flaxseed powder supplementation, on lipid metabolism and sex hormone levels in patients with polycystic ovary syndrome (PCOS) combined with infertility.

Methods: A total of 104 PCOS patients with combined infertility were divided into the control group (n = 52) and intervention group (n = 52) using a random number table method. Over a two-month study period, the control group received light fasting diet therapy with rice flour as a placebo, while the intervention group received light fasting diet therapy supplemented with flaxseed powder. Differences in general clinical data, anthropometric indicators, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (P), fasting plasma glucose (FPG), fasting insulin (FINS), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)) were compared between the two groups.

Results: After treatment, both groups showed significant reductions in FSH, LH, E2, and P levels compared to baseline (p < .05). In the intervention group, the mean FINS and HOMA-IR levels were significantly lower than those in the control group following 2 months of treatment (p < .05). Furthermore, TC, TG, and LDL-C levels were significantly reduced in the intervention group compared to the control group (p < .05).

Conclusion: Light fasting diet therapy, especially with flaxseed powder, improves obesity, lipid, and glucose metabolism disorders in PCOS patients with infertility. However, longitudinal studies are needed to better understand these associations and assess long-term effects before considering this intervention as a standard clinical recommendation for PCOS.

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorders and characterized by polycystic ovary morphology and oligomenorrhea, affecting fertility and health condition of female around the world. The causative factors of PCOS are complex, and genetic structure remains a long-standing medical challenge in genetics. Previous genome-wide association study (GWAS) showed that Wing-less-related integration site (Wnt) signaling is the most affected pathway among PCOS-related risk genes, and genetic mutations in the Wnt/β-catenin signaling may lead to abnormal development of PCOS.

Objective: To explore the possibility of axis inhibitor-2 (AXIN2) variants in Chinese women with PCOS and assess their pathogenicities.

Methods: A total of 365 Chinese women with PCOS and 905 women without PCOS as control were recruited from Jiangxi Provincial Maternal and Child Health Hospital, All of the 11 exons and flanking regions of the AXIN2 gene were amplified by polymerase chain reaction (PCR), the potential variants were analyzed by Sanger sequencing. The evolutionary conservation analysis of the identified Axin-2 mutant was analyzed among 15 vertebrates from human to zebrafish. The protein structure change was analyzed between the wild-type and mutation-type. The pathogenicity of AXIN2 variant was further analyzed in silico.

Results: We totally identified 7 genetic variants of AXIN2 in this study, including 4 synonymous and 3 missense. Among them, we find a rare deleterious missense variant [p.R714W (c.2140C > T)]. The allele frequencies of this variant were 0.82% and 0.17% in PCOS cases and matched controls, respectively. And it was ranging from 7.89e-5 to 1.47e-4 in public databases. Fisher's exact test indicated that the allele frequencies in PCOS were p < 0.05 compared to both the controls and the databases. Especially, the mutant amino acid site is highly conserved in vertebrates, while the mutation changed the 714th arginine to tryptophan resulting in significant change in the protein structural of Axin-2.

Conclusion: In this study, we identified a rare deleterious missense AXIN2 mutation [p.R714W (c.2140C > T)] in Chinese women with PCOS, and this mutant is probably pathogenic. This study may provide a new perspective on revealing the genetic variation of PCOS.

Background: The effects of granulose cell (GC) senescence on premature ovarian insufficiency/premature ovarian failure have been extensively examined, the association between GC senescence and ovarian aging remains to be clarified.

Methods: Human and mouse GCs from young/control and old/advanced maternal age (AMA) groups were collected, and GC senescence was determined. The role of the DNMT1-p53 axis in GC senescence during ovarian aging was examined and validated in a KGN cell senescence model.

Results: SA-beta-gal-positive GCs were significantly increased in the AMA group, accompanied by activation of the p53-p21 pathway, which was also found in GCs from aged mice and H₂O₂-induced senescent KGN cells. Pyrosequencing methylation analysis revealed that increased expression of p53 was associated with decreased average methylation levels of CpG sites (-1031, -1019, -1012 and -1008) within the P53 promoter CpG island in senescenct GCs and KGN cells. We further found that decreased DNA-methyltransferase 1 (DNMT1) expression was responsible for the reduced methylation levels of the CpG sites.

Conclusion: Decreased DNMT1 with hypomethylation of the CpG sites within the P53 promoter CpG island in GCs is involved in ovarian aging.

Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age and one of the leading causes of hysterectomy in Italy. This survey aimed to report how Italian women perceive and approach UFs, in order to raise healthcare professionals (HCPs)', institutions' and women's awareness of UFs and their treatment options. 1508 Italian women aged 30-50 years completed a web-based survey, answering a structured questionnaire focused on UF prevalence, symptomatology and impact, management and awareness. UF self-reported prevalence was 28.8%. Most UF-diagnosed women had symptom(s) before diagnosis (79.0%), and more than a half of UF-diagnosed participants were symptomatic post-diagnosis (55.8%). The most common symptoms after diagnosis were heavy menstrual bleeding (73.1%), dysmenorrhea (50.4%) and pelvic pain (36.8%). UFs negatively affected the quality of life of most symptomatic women, as well as sexuality and employment. Private gynecologists were the key reference HCPs for consultation and UF diagnosis. The most common UF treatments for symptomatic women were surgery (49.2%), followed by oral contraceptives (39.3%). Surgery was also performed for 22.9% of asymptomatic participants. UF-diagnosed participants were not involved in therapeutic choices in 37.6% of cases. Women's knowledge about UFs was mostly superficial (58.7% of all participants), with gynecologists and family/friends as main information sources. Patient-physician communication was rather unsatisfactory, especially about UF therapeutic options and disease impact on sexuality, fertility and lifestyle. This survey highlights that there is still a need to promote patient's knowledge about UFs and empowerment in treatment decision.

In a society whose needs are constantly changing, family planning plays a central role for women, men, and sustainable development. This comprehensive review and position statement summarises the proceedings of a meeting on contraception held in Rome in March 2024, supported by major scientific societies in the field. The aim is to inform the medical community about current medical and ethical issues of contraception use. First, the review addresses the complex ethical, religious, and social dimensions of contraceptive use and access; second, it provides a comprehensive analysis of traditional and modern contraceptive methods, discussing their safety and effectiveness; third, it examines current knowledge about male hormonal contraception. When prescribing a contraceptive method, medical indications or contraindications must be integrated to women's religious beliefs, the geopolitical context in which they live, the risk of violence, their need for self-determination and their right to make decisions for themselves. If a partner is involved, the couple's dynamics and shared needs must be considered. Healthcare providers are responsible for providing them with all the information they need to make informed choices, while ensuring individual autonomy. This position statement provides recommendations on how to guide contraceptive choice and identifies knowledge gaps about contraception today.

Objective: To evaluate the efficacy and safety of a non-hormonal vaginal moisturizer in alleviating the clinical symptoms of vulvovaginal atrophy (VVA).

Methods: This was an observational, single center, open label study in which the investigational product was applied to postmenopausal women (n = 36) with VVA symptoms three times per week for a period of 12 weeks. Patient's perception of vaginal discomfort, sexual function improvement assessed with the Female Sexual Function Index (FSFI), quality of life evaluated with the Cervantes-SF scale, and subject's satisfaction with the treatment were evaluated after 4 and 12 weeks of product use. In addition, vaginal health was evaluated with the Vaginal Health Index (VHI) score and the vaginal pH.

Results: A statistically significant decrease was observed in the severity of the most bothersome symptoms from moderate at baseline (mean 2.47 ± 0.55) to mild after 4 weeks (mean 1.33 ± 0.58) and 12 weeks (mean 1.32 ± 0.74, p < 0.0001). VHI scores significantly improved after 4 and 12 weeks compared to baseline (from 11.70 to 16.36 at 4 weeks and 17.34 at 12 weeks, both p < 0.0001). Vaginal pH decreased significantly from a mean pH of 6.27 ± 0.46 at baseline to 5.77 ± 0.59 at 4 weeks and 5.56 ± 0.60 at 12 weeks of treatment (p < 0.0001). Total FSFI scores significantly increased, indicating improvement of sexual function, after 4 and then after 12 weeks of product use (Baseline score 20.16 compared to 24.27 at 4 and 23.94 at 12 weeks, both p < 0.0001). Quality of life improved (decrease of total Cervantes-SF scores) after 12 weeks of product use as compared to baseline (Baseline 32.09 vs 26.45, p = 0.0004). At 12 weeks, a 97.5% reported overall satisfaction with the product and no adverse events related to the product were reported.

Conclusion: Through limited size study, the proposed non-hormonal vaginal moisturizer demonstrated being effective and safe for the management of VVA symptoms in postmenopausal women, offering significant improvements in symptom severity, vaginal health, sexual function, and quality of life. There is a need for further research with a larger sample and comparison with other similar products.

Letrozole, an aromatase inhibitor, is commonly used for ovulation induction in patients with polycystic ovary syndrome (PCOS). However, the effect of different doses of letrozole on pregnancy outcomes remains controversial. This systematic review and network meta‑analysis aims to compare the effects of different doses of letrozole on pregnancy outcomes in PCOS patients. A systematic search was performed in databases such as PubMed, WOS, and Wanfang for randomized clinical trials (RCTs) assessing different doses of letrozole in PCOS patients. The primary outcome was pregnancy outcome. A network meta‑analysis was conducted using Stata 17's network package and the 'netmeta' and 'gemtc' packages in R software. A total of 30 RCTs involving 3663 patients were included, comparing 11 intervention strategies. Compared with 2.5 mg letrozole, 5 mg letrozole (OR = 1.99, 95% CI: 1.47-2.68; p > 0.05), 7.5 mg letrozole (OR = 1.89, 95% CI: 1.17-3.06; p > 0.05), and 7.5 mg letrozole combined with clomiphene (OR = 7.60, 95% CI: 1.33-43.35; p > 0.05) all significantly improved pregnancy outcomes. Additionally, compared with 2.5 mg letrozole combined with human gonadotropin (HMG), 5 mg (OR = 1.12), 7.5 mg (OR = 1.19), and 20 mg (OR = 1.72) letrozole combined with HMG showed improvements in pregnancy rates, though the differences were not statistically significant (p > 0.05). The lack of unpublished studies and non‑English publications may have introduced publication bias. Letrozole treatment significantly improves pregnancy outcomes in PCOS patients. Moderate‑dose letrozole is recommended as the most effective strategy for improving pregnancy outcomes. Further clinical studies are required to confirm these findings.

This study investigated the association between serum Klotho levels and all-cause mortality in postmenopausal women. Utilizing data from 3,448 postmenopausal women in the US National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016, multivariable-adjusted weighted Cox proportional hazards models were employed. Over a median follow-up of 106 months, 449 deaths occurred. Compared to the second tertile (T 2, 707.3-936.5 pg/mL), the adjusted HRs for all-cause mortality were 1.44 (95% CI: 1.11-1.86, p=0.005) for the first tertile (T 1, <707.3 pg/mL) and 1.31 (95% CI: 0.94-1.83, p=0.112) for the third tertile (T 3, ≥936.5 pg/mL). The restricted cubic spline model revealed an L-shaped association between serum Klotho levels and all-cause mortality, with an inflection point at an ln-transformed Klotho level of 6.638 pg/mL. Our findings suggest an L-shaped relationship between ln-transformed serum Klotho levels and all-cause mortality in postmenopausal women. Further research is needed to validate these results and elucidate the underlying mechanisms. .