Gynecological Endocrinology最新文献

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.

Objectives: This study aims to investigate the effects and potential mechanisms of berberine in conjunction with Jianpi Yishen Huazhuo formulation (JPYSHZF) on obese rats that serve as a model for polycystic ovary syndrome (PCOS).

Methods: Letrozole combined with high-fat diet (HFD) was used to establish an overweight PCOS rat model. After successful modeling, each intervention group was monitored for 28 d. An oral glucose tolerance test (OGTT) is performed to assess glucose metabolism. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of sex hormones and serum levels of gastrointestinal hormones in rats. Biochemical analyzers were used to assess blood lipid levels. The protein expression levels of p38, PI3K, GLUT4, and AKT in ovarian tissue were demonstrated using Western Blotting (WB). Real-time fluorescence quantitative PCR (RT-qPCR) was used to measure the mRNA expression levels of p38, PI3K, GLUT4 and AKT in the same tissue. The morphological changes of ovarian tissue were observed using Hematoxylin-eosin (HE).

Results: Treatment with berberine in conjunction with JPYSHZF has been shown to reduce serum testosterone T and luteinizing hormone (LH) levels while increasing serum follicle-stimulating hormone (FSH) and E2 levels. This combination therapy also decreases the LH/FSH ratio and ameliorates polycystic ovary-like pathological changes in the ovaries of rats with PCOS. Additionally, this treatment decreases serum TC, TG, and LDL-c levels while increasing HDL-c levels. It also reduces levels of GLU and Ghrelin while enhancing levels of CCK, PYY, and GLP-1. Furthermore, the relative 6 of PI3K and AKT proteins, as well as the mRNA levels of PI3K, GLUT4, and AKT, were found to be increased.

Conclusions: Berberine combined with JPYSHZF can improve the sex hormone levels, ovarian function, glucose and lipid metabolism levels, and gastrointestinal hormone levels in obese PCOS rats by activating the PI3K/AKT signaling pathway, thereby playing a role in treating obese PCOS.

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.

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.

Inflammation exerts an essential role in gestational diabetes mellitus (GDM), but the relationship between peripheral blood inflammatory markers and GDM remains unclear. The purpose of this study was to explore the relationship between inflammatory markers and GDM in US adults. Data were extracted from the National Health and Nutrition Examination Survey. Five inflammatory markers were derived from complete blood count. Survey-weighted multivariable logistic regression models were used to assess the association between inflammatory markers and GDM. Restricted cubic splines and subgroup analyses were conducted to validate the stability of the results. Finally, a total of 2363 women aged 20-44 were included based on specific criteria, with 229 self-reported GDM cases (9.69%). The increased lymphocyte-monocyte ratio (LMR) was associated with the higher risk of GDM, aOR = 1.82 (CI:1.30-2.56). Compared with the lowest tertile, the highest tertile group of LMR showed a significantly increased risk of GDM, aOR = 2.24 (CI: 1.28-2.85). Conversely, the highest tertile group of systemic inflammation response index (SIRI) was negatively associated with GDM, aOR = 0.61 (95% CI: 0.40-0.94). And high platelet-lymphocyte ratio (PLR) levels are related to a lower risk of GDM. No non-linear relationships were observed. Furthermore, subgroup analysis revealed that the association between LMR, SIRI, and GDM remained consistent with the overall results. Our study indicated that LMR, PLR, and SIRI may be potential predictors of GDM. Further large-scale prospective study is needed to investigate the role of LMR, PLR and SIRI in GDM.

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.