Progresos en Obstetricia y Ginecologia最新文献

Vaginal evisceration is a rare medical emergency that usually occurs in postmenopausal women with a history of pelvic or vaginal surgery, especially hysterectomy, and some pelvic floor dysfunction. Spontaneous vaginal evisceration without previous surgery in these patients is even more uncommon. We discuss a case of spontaneous vaginal evisceration after vaginal trauma in a postmenopausal woman.

Objective

To describe the socio-demographic, diagnostic and treatment characteristics of patients with heavy menstrual bleeding.

Subjects and methods

An observational, cross-sectional, multicenter, national study was conducted in women of reproductive age (18-49 years) with heavy menstrual bleeding with no organic cause attending routine gynecology consultations in Spain.

Results

This study included 1,039 patients, with a mean age of 37.8 ± 8.1 years. Only 52.1% of the women attended their gynecologist due to bleeding abnormalities and 48.0% were diagnosed during the visit.

Patients with longstanding abnormal bleeding reported alterations in quantity, either alone or concomitant to other abnormalities (heavy/prolonged/irregular bleeding). Only 43.7% perceived changes in current bleeding versus usual bleeding, mainly due to an increased quantity.

The main drugs prescribed for the treatment of heavy bleeding were combined oral contraceptives (mainly estradiol valerate 3-2-1 mg + dienogest 3-2 μg) (63.3%), levonorgestrel intrauterine system (14.3%), and combined treatments (11.9%).

Conclusions

Abnormal bleeding is prevalent. Diagnosis through appropriate assessment is a priority

Vaginal atrophy is a chronic disease that is often undiagnosed and has a major impact on sexual health and quality of life. Vaginal atrophy is caused by physiological changes due to a decrease of estrogens. These changes are the basis of a number of symptoms including vaginal dryness, dyspareunia, itching and irritation reported in 40-60% of postmenopausal women in Europe. The percentage of treated women is less than 30%, and compliance is less than 10% per year. Local estrogens are the first-line treatment for moderate-to-severe vaginal atrophy.

A new local estrogen treatment has recently become available in Spain, consisting of a flexible silicone ring with a core containing 2 mg of estradiol hemihydrate. The amount of estradiol released is minimal but in continuous quantities, with a release of 6.5 to 9.5 mcg/day for at least 90 days. The vaginal ring has been proven to be effective in relieving local symptoms (vaginal and urological), improving the vaginal mucosa based on visual examination (pale color, turgor, roughness, and thickness) and on the rate of cytologic maturation (a greater proportion of surface cells and a decrease in basal, parabasal and intermediate cells) and pH.

The ring produces the same side effects as other types of local estrogen and is the most frequently chosen method by patients because of its ease of use and comfort, and the general satisfaction produced.

Objective

Postmenopausal women have an increased risk of cardiovascular disease. Epicardial adipose tissue has been shown to be useful in identifying cardiovascular risk but there is little information in postmenopausal women. The objective of this study was to examine the association between epicardial fat and components of metabolic syndrome in postmenopausal women.

Subjects and methods

A cross sectional study was conducted in 50 postmenopausal women. All participants underwent transthoracic echocardiography and body composition analysis.

Results

A greater amount of epicardial adipose tissue was found in postmenopausal women with metabolic syndrome than in those without this syndrome (515.6 ± 130.9 vs 358.0 ± 138.7, p < 0.001). The amount of epicardial adipose tissue increased with a greater number of metabolic components (p < 0.001).

Conclusions

There is a direct relationship between epicardial fat and cardiometabolic risk after menopause, a period when there is a higher risk of thrombosis.

Introduction

Cutaneous metastases are rare and represent a poor prognostic sign. Clinical forms of presentation differ, requiring differential diagnosis with a variety of dermatoses.

Case report

We report the case of an 86-year-old woman who presented with nodular skin lesions on the lower abdomen and proximal part of both legs as the initial sign of a previously unknown neoplasia. Histological examination revealed metastatic ovarian adenocarcinoma.

Conclusions

Cutaneous metastases from a primary ovarian tumor are rare and have a poor prognosis. They typically develop during the disease, but can be the first clinical sign of a silent neoplasia. Their management remains a clinical challenge; consequently, more studies evaluating the role of specific therapies are needed to standardize treatment.