Journal of Mid-life Health最新文献

Background: Abnormal uterine bleeding (AUB) is a common gynecological condition where there is an altered expression of estrogen receptors (ERs) and progesterone receptors (PRs) in the endometrium which may have a role in the etiology of abnormal bleeding.

Objectives: The objective of the study was to study the histopathological findings of endometrium and expression of estrogen and PRs in the endometrium in patients with AUB.

Materials and methods: All endometrial tissue from curettage and hysterectomy specimens of patients presenting to our Institution with complaints of AUB were included from November 2019 to November 2020 (prospective) and November 2015 to October 2019 (retrospective). This comprised a study population of 380 patients in the reproductive age group. The samples were evaluated for the spectrum of endometrial histopathological changes. Fifty-eight cases of endometrial hyperplasia and seven cases of endometrial adenocarcinoma were selected for immunohistochemical testing of ER and PR expression status. The IHC-stained slides were assessed for positive staining and intensity. The intensity of nuclear staining of ER and PR was graded in the epithelium and the stroma. H scores were calculated taking both the intensity and percentage of stained cells into account. The results were statistically analyzed by SPSS version 20, P < 0.05 was considered significant.

Results: AUB was more prevalent among age group 41-50 years. The predominant pattern observed was secretory and proliferative endometrium. Of the 58 nonatypical hyperplasia, 51 patients showed positive nuclear staining with moderate-to-high intensity of ER and PR in both epithelium and stroma. Among seven endometrial adenocarcinomas, five cases were Grade I, one case was Grade II, and one case was of a serous papillary adenocarcinoma. Of the five Grade I adenocarcinomas, 3 out of 5 had absent and the rest showed mild-to-moderate ER expression; while 2 out of 5 had absent and the rest showed moderate-to-high PR expression. Grade II adenocarcinoma showed negative ER and PR expression. Serous papillary-type carcinoma also showed negative expression.

Conclusion: Endometrial carcinoma showed reduced hormonal expression compared to endometrial hyperplasia.

Background: Weight management is essential during menopause to manage symptoms, prevent metabolic diseases, and enhance quality of life. Intensive lifestyle interventions can be helpful for comprehensive weight loss. This study assessed the efficacy of such an intervention during menopausal transition.

Methodology: A total of 160 perimenopausal women were randomized to the intervention (n = 80) and the control arm (n = 80). The intervention arm consisted of a combination of hypocaloric, low-fat, high-protein, and high-fiber diet, along with physical activity, psychological support, and behavioral modification techniques, while standard care was provided for the control arm.

Results: After a follow-up of 6 months, 134 participants were retained for the analysis. Participants showed notable reductions in a median change in weight, body mass index, waist circumference (P < 0.01), waist-to-hip ratio (P < 0.05) and fat percentage (P < 0.01), along with improved blood pressure. Favorable changes were also seen in biochemical markers such as median change in glycated hemoglobin, very low-density lipoprotein (VLDL), total cholesterol, and triglycerides (P < 0.01); and VLDL (P < 0.05). Dietary habits shifted toward lower energy and fat intake (P < 0.01), with increased moderate-intensity and leisure activities (P < 0.05) and improved depression and anxiety scores (P < 0.01). Across intervention arm, 42.5% of the participants achieved significant weight loss (>5% of the baseline weight) while only 2.5% in the control arm.

Conclusion: The intensive lifestyle intervention effectively improved weight, metabolic markers, and psychological well-being among perimenopausal women, emphasizing its significance for comprehensive health management in this demographic.

The synergistic role of Vitamin D (VD) and Vitamin K (VK) in maintaining skeletal and cardiovascular health has garnered increasing scientific interest. While VD is well known for its role in calcium metabolism, VK, particularly its K2 isoform, ensures that calcium is deposited in bones and not in soft tissues. Recent evidence suggests that the interplay between these two fat-soluble vitamins may have significant implications for bone health, vascular integrity, and chronic disease prevention. This editorial explores current research on their combined supplementation, potential therapeutic benefits, and the caution warranted in clinical practice.

Background: Perimenopause encompasses significant physiological, psychological, and emotional changes marked by high distress and deteriorating quality of life (QOL). Although studies have shown that cognitive behavioral therapy (CBT) is an effective treatment during period of transition to menopause, limited psychological based-intervention studies have been conducted in India. The aim of this study was to determine the effectiveness of CBT in managing physical and psychological distress in women during the perimenopausal phase.

Materials and methods: A two-group randomized pre- and posttest design was used. Fifty-three women in the perimenopausal age-group presenting to gynecology outpatient clinic with menstrual problems were assessed for associated symptoms such as hot flashes, night sweats, insomnia, anxiety, depression, and other physical complaints. Baseline assessments included the Depression Anxiety Stress Scale, Menopause Rating Scale (MRS), Hot Flush Rating Scale, and insomnia severity index. The participants were randomly assigned to either the CBT or psychoeducation group. The CBT group received four sessions over 6 weeks, whereas the psychoeducation group received a pamphlet on perimenopausal symptoms and their management. Postintervention assessments were conducted after 6 weeks. Data obtained were analyzed using independent and paired samples t-test after check for normality.

Results: Both the CBT and psychoeducation group showed improvements in depression, anxiety, sleep index, and QOL at 6 weeks. However, a significant group difference was found between the two groups on stress, anxiety, MRS's somatic and psychological symptom scales, as well as sleep index, with CBT showing greater reduction in their mean values (P < 0.05). There were no differences between the groups in depression, hot flush frequency and rating, and urogenital symptoms.

Conclusions: Both CBT and psychoeducation was effective in improving the QOL of women in the perimenopausal phase, with results supporting greater effectiveness of CBT as an adjunct treatment for managing menopausal symptoms.

Serous neoplasms are the most frequently encountered tumors of the ovary, typically arising as primary lesions. In contrast, mucinous tumors of the appendix are well-documented for their association with mucinous ovarian tumors and pseudomyxoma peritonei. To date, only one case has been reported in the literature describing the synchronous occurrence of a serous ovarian neoplasm and an appendiceal mucinous tumor. We present the second documented case of a low-grade appendiceal mucinous neoplasm (LAMN) occurring concurrently with a serous carcinoma of the ovary. A 68-year-old postmenopausal female presented with abnormal vaginal bleeding and was found to have a pelvic mass on imaging, raising suspicion for an ovarian malignancy. She underwent radical hysterectomy with a prophylactic appendectomy. Histopathological analysis confirmed a diagnosis of low-grade serous carcinoma in the left ovary, with an incidental finding of LAMN noted in the appendix. This rare coexistence highlights the importance of recognizing such rare association, as the distinction between serous and mucinous ovarian tumors is clinically significant due to their differing biological behaviors and treatment strategies. This case also provides detailed histopathological and immunohistochemical insights supporting the distinct diagnoses of these two neoplasms.

Physical activity (PA) is vital for managing menopausal symptoms and reducing noncommunicable diseases in middle-aged women. Despite the known benefits, many women do not meet the recommended activity levels and view household tasks as sufficient owing to factors such as time constraints, lack of motivation, or physical limitations. This article explores the significance, forms, and health impacts of PA in menopausal women. Regular PA, including aerobic exercise, resistance training, and yoga, offers several health benefits. Exercise enhances adult neurogenesis, brain structure, learning, memory, and cognitive abilities, potentially preventing age-related declines. PA during mid-life, defined as regular engagement in exercise such as walking, cycling, or resistance training, is linked to successful aging. Successful aging refers to the absence of chronic illnesses, disabilities, or mental health issues. Exercise improves sleep quality and reduces stress through endorphin production. Regular PA reduces the risk of chronic diseases including cancer, cardiovascular disease, and diabetes. Recommendations include cardiorespiratory activities, strength training, and balance exercises. Understanding these benefits can promote better health outcomes in this critical life stage.

Endometrioid carcinoma (EC) of the ovary represents a distinct subtype of epithelial ovarian cancers, comprising approximately 10%-20% of all ovarian malignancies. It is histologically similar to endometrial carcinoma of the uterus and is often associated with endometriosis. This article presents a comprehensive case report of a 64-year-old postmenopausal woman diagnosed with stage pT1aNxM0 EC of the ovary. We detail her clinical presentation, radiological and histopathological findings, surgical management, and molecular implications. Through an extensive literature review and analysis, this paper aims to emphasize the significance of early detection, the histological diversity of EC, its differential diagnosis, and current perspectives on its molecular pathogenesis and targeted therapies.

Xanthogranulomatous salpingitis is an extremely rare entity, and very few of them have been reported in the literature. The clinical features usually mimic adnexal diseases, both benign as well as malignant. Because it is rare, the entity is often not considered in the differential diagnosis of adnexal masses. Here, we are presenting a case of pelvic mass which was operated on with suspicion of a malignant ovarian tumor. Histopathology revealed it to be a case of xanthogranulomatous salpingitis.

Background: Enabling factors help women to overcome financial and structural barriers to health care, thereby enhancing their ability to access services and adopt healthy behaviors. Unfortunately, there is a lack of data regarding these enabling factors. This study aimed to examine the validity and reliability of the Women's Health-Enabling Factors Questionnaire (WHEFQ) in Iranian menopausal women as well as determine its interrelationship.

Materials and methods: A cross-sectional study was conducted on 571 menopausal women to assess the psychometric properties, including construct validity. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for this purpose. Reliability was assessed using Cronbach's α and McDonald's Omega. The study also investigated the predictive value of the model and the relationships between various constructs. Data analysis was performed using SPSS v. 27 (IBM Corp., Armonk, NY, USA) and AMOS v. 24 (IBM Corp., Armonk, NY, USA) software.

Results: The construct validity was assessed using EFA, which resulted in the identification of 14 items distributed across four subscales. These subscales explained for 55.17% of the total variance. The CFA displayed a strong model fit, with indices such as root mean square error of approximation = 0.02, goodness of fit index (GFI) =0.97, adjusted GFI = 0.95, comparative fit index = 0.98, normed fit index = 0.93, Tucker-Lewis Index = 0.98, incremental fit index = 0.98, and RMR = 0.03 (χ ²/df = 1.23, P = 0.17). The reliability of the 10-item WHEFQ was also confirmed with Cronbach's α and McDonald's Omega coefficients of 0.74 and 0.75, respectively.

Conclusions: The WHEFQ, which consists of 10 items, has been validated and proven reliable for assessing health-enabling factors in Iranian menopausal women. The findings indicate that personal resources are significantly associated with social facilities and skills.

This article emphasizes the transformative power of statistical glossaries and biostatistical methods in obstetrics and gynecology. These glossaries illuminate essential statistical terms and concepts, enriching our understanding of biostatistical techniques critical for analyzing maternal and reproductive health data. Such methodologies are not merely tools; they are keys that unlock insights into fertility, pregnancy complications, treatment effectiveness, and the broader spectrum of women's health. The review illuminates prevalent biostatistical approaches, including linear and logistic regression analyses, showcasing their profound impact on converting health data into meaningful, actionable insights. By establishing a robust framework for interpreting research findings, these techniques empower healthcare professionals and researchers to elevate patient care and shape public health strategies. Ultimately, applying biostatistics in obstetrics and gynecology advances individual patient outcomes while inspiring evidence-based practices and policymaking in maternal health. Statistical indices and models play a vital role in obstetrics and gynecology, serving as essential instruments for healthcare providers and researchers. They enhance our understanding of complex health issues and enable predictions leading to improved health outcomes for women and newborns. By integrating these statistical methodologies into clinical practice and research, we can make informed decisions that positively influence patient care. The ripple effect of these applications extends from individual patient interactions to large-scale public health initiatives, fostering a culture of evidence-based practice and informed policymaking. As we continue to advance our knowledge and use of biostatistical methods, we are ultimately dedicated to uplifting the standard of care for women, ensuring healthier futures for generations to come.