Maturitas最新文献

Objective

Female sexual problems are common but are not routinely assessed in obstetrician-gynecologist appointments. Therefore, we evaluated obstetrician-gynecologists' attitudes and practice patterns regarding their patients' sexual problems.

Study design

A web-based questionnaire was used to collect information from each respondent on gender, age, education, occupational status, and the total number of patients treated per day and sexual issues dealt with per day.

Main outcome measures

This study covered three fields of interest: 1) attitudes toward sexual problems, 2) practice patterns in sexual history-taking, and 3) practice patterns in the treatment of sexual problems.

Results

Of the 328 respondents, 299 provided eligible responses (specialists, 83 %, n = 249; residents, 17 %, n = 50). Almost all obstetrician-gynecologists (95 %) considered treating sexual problems as an important health care practice, but only 45 % and 53 % asked about sexual problems and sexual life satisfaction during general medical history-taking, respectively. Most obstetrician-gynecologists (86 %) used open conversation to assess sexual history. Half (52 %) of them reported that diagnosing female sexual problems is difficult, with the female obstetrician-gynecologists (54 %) more likely to report difficulty than the male obstetrician-gynecologists (29 %). Of the obstetrician-gynecologists, 15 % prescribed medications, whereas 58 % prescribed other treatments. A third (34 %) received distinct instructions from their organization for referring patients to continued care.

Conclusions

Although almost all obstetrician-gynecologists reported that treating sexual problems is an important health care issue, fewer than half routinely inquired about sexual problems. The practice patterns regarding sexual problems were disorganized. Our results show a need for additional clinical practice guidelines and education in sexual medicine.

Objectives

To explore the imaging features and the molecular characterization of adenomyosis after menopause.

Study design

An observational cross-sectional study was performed in a group of postmenopausal patients undergoing a transvaginal ultrasound (TVUS) (n = 468). Among those presenting the US criteria for adenomyosis, also confirmed by magnetic resonance imaging (MRI), previous menstrual symptoms, gynecological and obstetric history were reviewed. In a subgroup undergoing hysterectomy, uterine specimens were analyzed by histology and expression of genes implicated in the epithelial-mesenchymal transition, inflammation and fibrosis, including the sphingosine-1-phosphate (S1P) pathway, was evaluated and compared to matched non-menopausal adenomyosis specimens.

Main outcome measures

Direct and indirect US features of adenomyosis according to Morphological Uterus Sonographic Assessment at TVUS. Molecular characterization of postmenopausal versus pre-menopausal adenomyosis samples.

Results

According to TVUS and MRI, adenomyosis was identified in 49 patients (10.4 %). On US, diffuse adenomyosis was the most common phenotype, whereas internal adenomyosis with diffuse pattern and asymmetric type was the most prevalent on MRI. Molecular analysis showed that adenomyosis lesions express markers of epithelial-mesenchymal transition, inflammation and fibrosis also in postmenopausal women. By comparing the results with those from pre-menopausal samples, the expression of α smooth muscle actin (αSMA), a marker of fibrosis, was significantly greater after menopause, and altered S1P catabolism and signaling were observed.

Conclusions

Adenomyosis may be identified in postmenopausal women by imaging, either TVUS or MRI, and fibrosis is one of the key features on molecular analysis.

Benign breast disease encompasses a spectrum of lesions within the breast. While some lesions pose no increase in risk, others may elevate the likelihood of developing breast cancer by four- to five-fold. This necessitates a personalized approach to screening and lifestyle optimization for women. The menopausal transition is a critical time for the development of benign breast lesions. Increased detection can be attributed to the heightened precision and utilization of screening mammography, with or without the use of supplemental imaging.

While it is widely acknowledged that combined hormone therapy involving estrogen and progesterone may elevate the risk of breast cancer, data from the Women's Health Initiative (WHI) indicates that estrogen-alone therapies may actually reduce the overall risk of cancer. Despite this general understanding, there is a notable gap in information regarding the impact of hormone therapy on the risk profile of women with specific benign breast lesions.

This review comprehensively examines various benign breast lesions, delving into their pathophysiology and management. The goal is to enhance our understanding of when and how to judiciously prescribe hormone therapy, particularly in the context of specific benign breast conditions. By bridging this knowledge gap, the review provides valuable insights into optimizing healthcare strategies for women with benign breast disease, and offers a foundation for more informed decision-making regarding hormone therapy.

Introduction

Menopause is a natural part of a woman's life that coincides with a time when many women play significant roles in the workforce. Menopause symptoms, such as hot flashes, fatigue, and difficulty with concentration and memory, can have a negative effect on work productivity and efficiency.

Objectives

This paper summarizes the impact of menopause in the workplace, with an emphasis on the impact of symptoms on employed women and how the workplace influences their experiences. It highlights economic implications, promotes awareness, and suggests potential next steps.

Methods

A search for papers was conducted between August and November 2023 in the PubMed and Medline databases. Papers were selected based on personal experience and interpretation of the findings. Recommendations for managing menopause symptoms in the workplace and guidance on an optimal workplace intervention strategy were provided.

Results

Women experiencing severe menopause symptoms are more likely to report adverse work outcomes, including absenteeism and job-related decisions such as quitting, retiring early, or declining promotions than women experiencing few symptoms. Factors such as a lack of awareness about menopause, inflexible work conditions, and high-stress jobs can exacerbate the severity of these symptoms. Additionally, unaddressed menopause symptoms contribute to both direct and indirect economic costs, including medical resource utilization and lost work productivity, resulting in a substantial economic burden.

Conclusion

Menopause symptoms impair women's work experiences and productivity. In addition to dismantling the stigma associated with menopause, it is critical to create and implement menopause workplace policies and interventions aimed at supporting women in this universal life stage.

Objective

The potential effects of polycystic ovary syndrome (PCOS) on the musculoskeletal system are not well established. We examined the musculoskeletal system in women with PCOS in their late reproductive years.

Study-design

This cross-sectional study included 34 women with PCOS and 32 control women matched for age and body mass index (BMI).

Main outcome measures

Dual-energy x-ray absorptiometry (DXA) was used for body composition analysis and cross-sectional areas and fat fraction of muscles were assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF) of the abdomen and thigh. Muscle strength was measured using an isokinetic dynamometer.

Results

The mean age of the PCOS group was 43 ± 3.7 years and of the control group 42.2 ± 3.5 years. Testosterone, free androgen index, and fasting insulin were higher in PCOS patients than controls (p < 0.001, p = 0.001 and p = 0.032, respectively). Patients and controls had similar values for total abdominal muscle area (TAMA), paraspinal muscle area, thigh muscle area, vertebral MRI-PDFF, thigh and paraspinal muscle MRI-PDFF. There was no difference in DXA-derived muscle and bone composition between the two groups. Body composition parameters measured by MRI and DXA were correlated with BMI and fasting insulin levels, but not with androgen levels in both groups. Subgroup analyses showed that PCOS women with obesity had higher TAMA than controls with obesity (p = 0.012). Apart than higher 60°/sec knee extensor average power in nonobese PCOS (p = 0.049), no difference in muscle mechanical function was detected between PCOS patients and controls.

Conclusion

Musculoskeletal composition and function are similar in PCOS patients and healthy women in late reproductive years. Body composition is linked with obesity and insulin resistance rather than hyperandrogenemia.

Water pollution exerts a negative impact on the health of both women and men, inducing hormonal changes, accelerating aging, and consequently leading to the premature onset of age-related health problems. Water pollutants can in general be classified as chemical (both organic and inorganic), physical, and biological agents. Certain chemical pollutants have been found to disrupt hormonal balance by blocking, mimicking, or disrupting functions within the intricate homeostasis of the human body.

Moreover, certain water pollutants, including specific pesticides and industrial chemicals, have been associated with neurological and psychiatric disorders, such as mood swings, depression, cognitive decline, and anxiety, impacting both women and men. Water pollution is also associated with physical ailments, such as diarrhea, skin diseases, malnutrition, and cancer. Exposure to specific pollutants may promote premature menopause and vasomotor symptoms, elevate the risk of cardiovascular disease, and reduce bone density. In men, exposure to water pollution has been shown to reduce LH, FSH, and testosterone serum levels. The oxidative stress induced by pollutants prompts apoptosis of Sertoli and germ cells, inhibiting spermatogenesis and altering the normal morphology and concentration of sperm. Environmental estrogens further contribute to reduced sperm counts, reproductive system disruptions, and the feminization of male traits.

Studies affirm that men generally exhibit a lower susceptibility than women to hormonal changes and health issues attributed to water pollutants. This discrepancy may be attributed to the varied water-related activities which have traditionally been undertaken by women, as well as differences in immune responses between genders. The implementation of effective measures to control water pollution and interventions aimed at safeguarding and enhancing the well-being of the aging population is imperative.

The improvement of drinking water quality has emerged as a potential public health effort with the capacity to curtail the onset of cognitive impairment and dementia in an aging population.

Objectives

Hysterectomy is commonly performed for benign uterine pathologies but there is some controversy over whether it is associated with an increased risk of thyroid cancer. This study examines the associations of hysterectomy with ovarian conservation or with bilateral salpingo-oophorectomy and thyroid cancer incidence in Taiwan.

Methods

We analyzed data from a nationwide health insurance claims database and identified 29,577 women aged ≥30 years who underwent hysterectomy with ovarian conservation or hysterectomy with bilateral salpingo-oophorectomy between 2000 and 2016. Propensity score-matching analyses were performed at ratios of 1:1 for the hysterectomy and no-hysterectomy groups, to reduce selection bias. We monitored thyroid cancer occurrence in both groups until 2017. Cox regression was used to calculate hazard ratios with 95 % confidence intervals and determine thyroid cancer risk in women who underwent hysterectomy.

Results

The study comprised 29,577 patients who underwent any hysterectomy and 29,577 participants who did not. The mean follow-up period was 10.03 ± 4.92 years. Patients who underwent hysterectomy had higher thyroid cancer incidence (4.72 per 10,000 person-years) than those who did not (3.06 per 10,000 person-years) and a greater risk of any thyroid cancer (adjusted hazard ratio = 1.40; 95 % confidence interval = 1.08–1.82). However, there was no association between hysterectomy with bilateral salpingo-oophorectomy and thyroid cancer incidence (p > 0.05).

Conclusions

Our findings suggest that women who undergo hysterectomy are at a higher risk of developing thyroid cancer than those who do not.

Lifestyle/behavioural interventions may improve breast cancer outcomes and quality of life (QoL); however, uncertainty remains about the most effective interventions due to limited evidence. This study aimed to assess and compare the effects of lifestyle/behavioural interventions on cancer recurrence, survival and QoL in breast cancer survivors. Electronic databases including Medline, EMBASE, PsycINFO, CINAHL and EBM Reviews were searched for relevant literature. Randomized controlled trials (RCTs) and quasi-RCTs comparing a lifestyle/behavioural intervention with a control condition in breast cancer survivors were included. Outcomes included cancer recurrence, overall survival and QoL. A network meta-analysis synthesized intervention effect. Studies not included in the analysis were reported narratively. Of 6251 identified articles, 38 studies met the selection criteria. Limited evidence exists on the impacts of lifestyle/behavioural interventions on breast cancer recurrence/survival. Exercise was identified as the most effective intervention in improving overall survival (HR 0.50, 95 % CI 0.36, 0.68). Lifestyle/behavioural interventions may improve QoL; psychosocial interventions (SMD 1.28, 95 % CI 0.80, 1.77) and aerobic-resistance exercise (SMD 0.33, 95 % CI -0.03, 0.69) were the most effective interventions to enhance QoL. This review highlights potential post-breast cancer benefits from lifestyle/behavioural interventions, notably exercise and psychosocial support for QoL and exercise for overall survival. Thus, encouraging active lifestyle, stress management and coping skills programs during and after cancer treatment may enhance physical wellbeing and QoL. However, the findings should be interpreted with caution due to the small number and sample sizes of studies. Future longer-term RCTs are required for conclusive recommendations.

Objectives

The efficacy and tolerability of a non-hormonal pessary (that forms an oil-in-water emollient with the vaginal fluid) were assessed for the treatment of symptoms of vaginal dryness associated with menopause.

Study design

Seventy-nine postmenopausal women (mean age 60.8 $\pm$ 6.5 years) with mild to moderate symptoms of vaginal dryness (including dyspareunia) were enrolled in this open-label, prospective, post-market clinical follow-up trial, conducted in 2022 by one research center in Germany. The investigational pessary was applied for the first 7 days once daily and the subsequent 31 days twice a week, at bedtime. A treatment-free period of 6 days completed the trial.

Main outcome measures

During the trial, participants filled out questionnaires that enabled the calculation of a total severity score for subjective symptoms of atrophy-related vaginal dryness and impairment of daily as well as sexual life. Furthermore, vaginal health index and safety were studied.

Results

A rapid and significant reduction in the severity scores for symptoms was observed over the 38-day course of treatment and beyond. Quality of life assessed by DIVA (day-to-day impact of vaginal aging) questionnaire, dyspareunia and vaginal health index also clearly improved. The tolerability was mainly rated as “good to very good” by the investigator and 94.9 % of participants. The vast majority were very satisfied with the simple and pleasant handling. No serious adverse events occurred.

Conclusion

Overall, the presented data suggest that the investigated non-hormonal pessary is an effective and well tolerated treatment option for vaginal symptoms associated with dryness, thus improving quality of life for women, even those who are sexually active.

ClinicalTrials.gov identifier NCT05211505.