Gynecological Endocrinology最新文献

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. .

To analyze and evaluate the correlation between different lipid metabolism levels and endometriosis. The literatures on lipid metabolism and endometriosis published in databases were searched and collected. The search was conducted up to December 2023. The meta-analysis was conducted using Review Manager 5.4.1 software, with odds ratios (ORs) or standardized mean difference (SMD), confidence intervals (CIs), and heterogeneity (I²) being calculated. The literature bias was evaluated by drawing funnel plot. Five hundred and eighty-four literatures were retrieved, and finally, 7 literatures were included in this study. Meta-analysis showed that the level of total cholesterol (TC) in endometriosis groups was higher than control group [SMD = 1.70, 95%CI (0.60-2.80), p = 0.003], while triglyceride (TG) [SMD=-0.24, 95%CI (-0.68-0.21), p = 0.300], low-density lipoprotein (LDL) [SMD = 0.22, 95%CI (-0.34 - 0.78), p = 0.440] and high-density lipoprotein (HDL) [SMD = 0.06, 95%CI (-0.14 - 0.25), p = 0.550] was not statistically significant. Sensitivity analysis indicated that the combined effect size results were stable and reliable [SMD = 1.70, 95%CI (0.60-2.80), p = 0.030]. Funnel plot results showed publication bias. Patients with endometriosis have abnormal blood lipid level, and higher TC level may be a risk factor for endometriosis. The impact of blood lipid metabolism on endometriosis may provide new insights into the pathogenesis and treatment prognosis of endometriosis.

This study amed to investigate the combined use of probiotics and metformin on metabolic parameters in patients with polycystic ovary syndrome (PCOS). 138 patients with PCOS were retrospectively included from January to December 2023 and divided into metformin (n = 70) and probiotics-metformin combination (n = 68) groups based on their clinical treatment regimens. After the three-month intervention, the combination group showed significantly greater improvements compared to the metformin group in high-density lipoprotein cholesterol levels (p < 0.001), insulin levels (p < 0.001), and adiponectin levels (p = 0.033). The combination group also exhibited more significant reductions in weight (p = 0.006), waist circumference (p = 0.037), hip circumference (p = 0.044), and waist-hip ratio (p = 0.031). No significant differences were observed between the groups in changes to other metabolic parameters, hormonal profiles, inflammatory markers, or quality of life assessments (p > 0.05). This retrospective pilot study suggests that the addition of probiotics to metformin therapy may improve HDL levels, insulin sensitivity, anthropometric measurements, and adiponectin levels compared to metformin alone in patients with PCOS.

Background: Abnormal uterine bleeding (AUB) impacts the quality of life of women globally. While international classifications and frameworks exist, there are still critical unmet needs in awareness, diagnosis, treatment, and patient support. To better understand these, the lived experiences of patients with AUB shared on social media can offer valuable insights.

Objective: To identify and analyze unmet needs in the management of AUB as expressed during social media discussions.

Methods: Using the social media listening tool Sprinklr Social (Sprinklr Inc.), public posts from X (X Corp.) related to AUB from seven countries (Brazil, China, India, Mexico, Pakistan, Saudi Arabia, Ukraine) over a 10-year period (2014-2024) were analyzed. Posts were categorized by topic, sentiment, and emotion; further analyses assessed patients' unmet needs and feelings.

Results: A total of 926 posts were included. Analysis revealed five critical unmet needs: lack of awareness and understanding (41.8%), impact on wellbeing (27.6%), diagnosis issues (10.9%), dissatisfaction with treatment options (9.7%), and undervalued impact and advocacy (8.6%). Posts about diagnosis and symptoms carried the most negative sentiments; many patients expressed frustration over delayed diagnoses and dissatisfaction with treatment options. Additionally, the emotional and psychological burden of AUB was a recurring theme, suggesting the need for more holistic care approaches.

Conclusions: Gaps in AUB management were identified, with strong emphasis on the need for better patient education, more effective diagnostic processes, and personalized treatment strategies. Incorporating patient voices during the development of treatment guidelines and healthcare policies is crucial for addressing these unmet needs and improving patient outcomes.