Journal of Mid-life Health最新文献

Ovarian leiomyomas are rare benign smooth muscle tumors, accounting for <1% of all ovarian neoplasms. While most commonly found in premenopausal women, their occurrence in postmenopausal women is rare and often raises concerns about malignancy. We report a unique case of ovarian leiomyoma torsion in a 73-year-old postmenopausal woman who presented with postmenopausal bleeding and acute pelvic pain. Imaging studies initially suggested an ovarian mass and surgical exploration revealed a twisted mass, which was histologically confirmed as a leiomyoma. Immunohistochemical analysis of the tumor demonstrated strong positivity for progesterone receptors, suggesting a potential role for progesterone in the tumor's growth, even in a postmenopausal setting. This case highlights the diagnostic challenge of ovarian leiomyomas in older women and underscores the importance of histopathological examination, including immunohistochemistry, to guide management and provide insights into the potential hormonal influence on tumor development.

Postmenopausal women are disproportionately affected by two prevalent chronic conditions: osteoporosis and periodontitis. Bisphosphonates (BPs) are synthetic compounds with a high affinity for bone, widely used for treating postmenopausal osteoporosis due to their ability to inhibit bone resorption, thereby increasing BMD and reducing fracture risk. This systematic review evaluates various bisphosphonate therapies in improving periodontal conditions in postmenopausal women. Fifteen studies involving 776 participants were included. These comprised randomized controlled trials (RCTs), one split-mouth RCT, and one single-group follow-up. BPs studied included zoledronic acid, alendronate, and risedronate, administered via IV, oral, or local delivery. Evaluated parameters included clinical (probing depth [PD], clinical attachment loss [CAL], plaque index [PI], gingival index [GI], bleeding on probing [BOP], sulcus bleeding index [SBI], etc.), radiographic (bone fill, density, height changes), and biochemical/microbiological (N-terminal telopeptide [NTx], bone-specific alkaline phosphatase, and bacterial counts). Most studies reported significant improvements in PD, CAL, and indices like PI, GI, and BOP. Xu et al. And Bhavsar et al. demonstrated major reductions in PD and CAL. High bone fill percentages and improved alveolar crest height was seen in some studies. Alendronate reduced ntx levels and improved BMD when evaluated under biochemical or microbiological findings. Bacterial counts also decreased post-treatment. Alendronate outperformed atorvastatin and placebo in several studies for periodontal outcomes. Bisphosphonate therapy, in various forms, provides significant benefits in managing periodontitis among postmenopausal women, with improvements noted in clinical, radiographic, and biochemical parameters. Further high-quality research is necessary to optimize treatment protocols and ensure long-term safety.

Apical prolapse, characterized by descent of the vaginal vault or uterus, continues to pose significant challenges in pelvic reconstructive surgery. Although laparoscopic sacropexy has long been considered the standard approach, it is often associated with defecatory, urinary, and mesh-related complications. Laparoscopic pectopexy, which anchors the suspension to the iliopectineal ligaments, has emerged as a safer and anatomically favorable alternative. This study evaluated the safety, feasibility, and anatomical and functional outcomes of a modified "G-mesh" laparoscopic pectopexy technique performed at a single tertiary-care center. A retrospective observational analysis was conducted on women who underwent the procedure between 2021 and 2025, assessing demographic characteristics, intraoperative details, and postoperative outcomes. Follow-up included POP-Q assessment, recurrence rates, and complication profile. The mean operative duration was 72 minutes with an average blood loss of 50 mL, and no major complications were recorded. Two minor intraoperative incidents-bladder wall thinning and vesicovaginal bleeding-were successfully managed laparoscopically. At 12-month follow-up, 13.3% of patients demonstrated mild prolapse recurrence, all managed conservatively with pelvic-floor rehabilitation. Overall, the G-mesh laparoscopic pectopexy technique appears safe, feasible, and associated with low morbidity and favorable anatomical outcomes. Further large-scale multicentric studies with extended follow-up are recommended to strengthen the evidence base for this technique.

Sarcopenia, an age-related loss of muscle mass and function, represents a significant musculoskeletal condition in menopausal women, affecting up to 80% of those with musculoskeletal complaints, and poses a growing public health concern in India where 71% of the population lives in rural areas with high prevalence of risk factors like poor nutrition and physical inactivity. This systematic review aimed to examine the prevalence, risk factors, hormonal mechanisms, and management strategies for sarcopenia in menopausal women, with emphasis on implications for maternal health and preventive interventions. A literature search from 2015 to 2025 was conducted via PubMed and Google Scholar using terms such as sarcopenia, menopausal complaints, and preventive measures, including only original, peer-reviewed, English-language full-text articles relevant to menopause and sarcopenia. From 92 identified articles, 12 met the criteria, revealing sarcopenia prevalence in India ranging from 10% to 43.6%, higher in rural settings and among diabetics. Hormonal declines in estrogen, testosterone, dehydroepiandrosterone (DHEA), progesterone, and growth hormone (GH)/insulin-like growth factor 1 (IGF-1), coupled with increased cortisol, contribute to muscle loss. Effective interventions include protein intake of 0.8-1.2 g/kg/day, vitamin D supplementation of 800-1000 IU/day, physical activity comprising 150 min/week of aerobic exercise plus resistance training, and hormone therapy. Maternal complications encompass elevated fall risk and physical disability, which indirectly impact fetal health in perimenopausal pregnancies. Overall, sarcopenia in menopausal women demands heightened awareness and targeted interventions, especially in rural India, with future research needed on biomarkers and optimized protocols.

This article present current perspectives on the midlife crisis in women, incorporating the latest research, analyses, and coping strategies within the context of contemporary challenges. Contemporary research highlights various aspects of this phenomenon, including biological, social, professional, and psychological changes that affect the functioning of middle-aged women. Emotional difficulties experienced by women in midlife have often been narrowly attributed to the effects of menopause, which oversimplifies the complexity of this experience. Stereotypes and cultural narratives reinforce negative perceptions of this stage, neglecting its significance as a psychological challenge. Indeed, modern transformations, such as increased professional activity and a growing sense of autonomy, point to the need for a holistic approach to this issue. Awareness of the challenges faced during this life stage underscores the necessity for further research that could form the basis for supportive, preventive, and educational programs. This article reviews literature recently published literature to understand contemporary approaches to this issue, identify knowledge gaps, and propose directions for future research.

Background: Cardiovascular diseases (CVDs) account for 32% of global deaths, with a significant share occurring prematurely in low- and middle-income countries such as India. Adults in mid-to late life face increased vulnerability due to cumulative exposure to behavioral and metabolic risk factors. Early identification of at-risk individuals can enable timely preventive interventions.

Objective: To estimate the 10-year CVD risk and identify associated factors among adults aged 40-74 years attending a tertiary care hospital in Kolkata, West Bengal.

Materials and methods: An institution-based cross-sectional study was conducted from August to December 2024 among 221 adults aged 40-74 years, excluding those with preexisting CVD or severe comorbidities. Data on sociodemographic, clinical, and lifestyle factors were collected through face-to-face interviews using a pretested schedule. The World Health Organization/ISH nonlaboratory-based risk prediction chart was used to estimate 10-year CVD risk. Logistic regression analyses identified predictors of moderate-to-high CVD risk.

Results: The median age was 53 years; 46.1% were aged 40-50 years. Overweight or obesity affected 47.9% of participants, 38.9% had prehypertension, and 19.5% had Stage II hypertension. Moderate (10-<20%) CVD risk was present in 25.7%, while 0.7% had high risk (≥30%). Psychological distress increased the odds of moderate-to-high CVD risk (adjusted odds ratio [AOR] 2.01, 95% confidence interval [CI]: 1.08-3.71), while moderate-to-high intensity physical activity was protective (AOR 0.39, 95% CI: 0.19-0.82).

Conclusion: Among mid-to late-life adults, obesity, elevated blood pressure, and psychological distress were common, with over one-quarter at moderate 10-year CVD risk. Integrating mental health support and promoting physical activity into midlife health programs could reduce future CVD burden.

Introduction: HPV infection is causative agent for cervical cancer, majority of HPV infections are low-grade, self-limited, and revert spontaneously in some HPV infection fails to clear this hints towards presence of certain genetic factors which predispose them to increase risk of pre-cancer and cancer. We aimed to investigate the factors which have bearing on rising cancer cases in India and to elucidate the genetic susceptibility distribution of NAD (P) H: quinone oxidoreductase 1 C609T gene polymorphism.

Materials and methods: Study recruited 142 women with biopsy-proven cervical cancer (the case group) and 142 women with normal cytology (the control group). DNA extracted from blood via QIAamp DNA mini kit. The DNA of each participant was amplified and the genotype and allelic frequency were compared.

Results: In our study, maximum women in the case group had stage II (69.7%) squamous cell carcinoma (97.2%). 75.4% of the cases had moderately differentiated carcinoma and had no treatment before (43.7%). Among cases, the prevalence of genotype CC, CT and TT was 42.3%, 19.7% and 38.0%, respectively compared to 54.9%, 13.4% and 31.7%, in controls. The odds of having CC (odds ratio [OR] =0.64; 95% confidence interval [CI] =0.38-1.08), CC or CT in contrast to TT (OR = 0.756; 95% CI = 0.46-1.23), CC in contrast to TT/CT (OR = 0.694; 95% CI = 0.44-1.10) was lesser in cases compared to the controls, while Odds of allele T as compared to C were significantly elevated in cases as compared to that in the controls (OR = 1.48; 95% CI = 1.06-2.06). The proportion of TT genotype was elevated in advanced stages as compared to early stages.

Conclusion: We found the odds of allele T as compared to C were markedly elevated in cases as compared to controls.

Objectives: Patients with pelvic organ prolapse (POP) tend to have urinary storage symptoms. The prolapse quality of life questionnaire (P-QOL) is used to assess POP-related symptoms. However, whether the P-QOL can evaluate storage conditions before and after POP surgery remains unclear. This study aimed to evaluate whether the P-QOL could be used to assess storage dysfunction in patients with POP undergoing laparoscopic sacrocolpopexy (LSC).

Materials and methods: Ninety-seven patients who underwent LSC at our institution were enrolled in this study. The correlation between the selected P-QOL component question scores and the overactive bladder symptom score (OABSS) was evaluated. Differences in the selected P-QOL component question scores between the OABSS ≥3 and ≤2 groups were compared before and after surgery. The changes in the postvoid residual urine volume (PVR), selected P-QOL component question scores, and OABSS were also examined.

Results: Spearman's correlation coefficient by rank test between the total selected P-QOL component question scores and OABSS revealed significant correlations before and after surgery. The box plots also showed a significant difference in the total selected P-QOL component question scores between the OABSS ≥3 and ≤2 groups before and after surgery. The PVR, selected P-QOL component question scores, and OABSS were significantly decreased after surgery compared with those before surgery.

Conclusion: The specific P-QOL component question scores could function as a substitute for the OABSS in patients with POP undergoing LSC. These scores may provide relatively accurate insights into the storage conditions before and after LSC.

Gestational trophoblastic disease (GTD) typically occurs in women of reproductive age and is exceedingly rare in postmenopausal women. Hydatidiform mole is the most common form of GTD. The recommended management is total hysterectomy, as women over the age of 50 years have a higher risk of malignant transformation. Here, we report the case of massive molar pregnancy in a 52-year-old postmenopausal woman, complicated by hyperthyroidism and other comorbidities, with cultural and belief-related barriers influencing treatment decisions.

Large cell neuroendocrine carcinoma (LCNEC) of the endometrium is a rare and aggressive high-grade malignancy, constituting fewer than 1% of endometrial malignancies, with only 33 cases reported in the literature to date. We present the case of a 66-year-old multiparous postmenopausal woman with a previous history of invasive breast carcinoma, managed with mastectomy, chemotherapy, and hormone treatment. The patient presented with vaginal bleeding and leukorrhea. Magnetic resonance imaging revealed endometrial thickening with myometrial and parametrial invasion, and positron emission tomography/computed tomography revealed no evidence of nodal or distant metastases. The pipelle biopsy revealed poorly differentiated cancer. She underwent a robotic hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node biopsy, omental biopsy, and peritoneal cytology procedures. The histopathological analysis verified a pure LCNEC and was staged as pT2N0M0. Immunohistochemistry showed positivity for synaptophysin, CD56, chromogranin, and p53 (mutant), weak positivity for EMA, and a Ki-67 index of 80%. The tumor exhibited microsatellite stability, and next-generation sequencing revealed no relevant mutations. She received adjuvant therapy with pelvic radiation with concurrent cisplatin, followed by vaginal brachytherapy, and four cycles of chemotherapy with carboplatin and etoposide. This case demonstrates favorable outcomes with multimodal therapy, emphasizing the importance of timely management of this rare entity.