Przeglad Menopauzalny最新文献

Introduction: The use of vascular ports in oncology patients for the administration of irritating and chemotherapeutic drugs clearly solves the problem of peripheral vascular damage caused by oncological drugs, and at the same time provides a comfortable way of treating patients in the long term. Although there are risks associated with the long-term maintenance of implanted ports, any risk factors for infection associated with an implantable intravenous port should be minimized.

Material and methods: The main purpose of the study was to investigate the reasons for removal of vascular ports in patients undergoing systemic treatment at the wards of the University Clinical Hospital. Patients who had a vascular port implanted for the duration of their therapy were monitored for complications that had become the reason for removing the implants within 24 months of implantation.

Results: The main reason for removing a vascular port was the conclusion of therapy (82.7%). The second reason for removing the ports was infection (13.5%), which, despite the use of rigorous procedures, could not be avoided due to the significant reduction in immunity in patients treated with oncological drugs.

Conclusions: Despite their limitations in oncological treatment, ports have no alternatives, and thus further technological progress is essential. Education of staff working with patients with implants allows an increase in the benefits of therapy in the long run and significantly improves the quality of life of oncological patients. The education of patients and their families, as well as frequent re-training of staff, provides greater opportunities to minimize the side effects of therapy and reduce the number of adverse reactions related to infections.

Introduction: Urinary incontinence has a negative impact on women's quality of life. One way to treat this may be to perform pelvic floor muscle exercises. This study evaluated the effects of an original exercise programme performed for 6 weeks.

Material and methods: The study involved premenopausal (before-menopause group exercise - BMGE) and postmenopausal (post-menopause group exercise - PMGE) groups of women. Postural pattern, pelvic type were determined prior to exercise. A 1-day subpubic test was used to determine the amount of urine lost before and after exercise. The Kruskal-Wallis test, Dunn test and Wilcoxon test were used.

Results: The results indicate that the original exercise programme had the effect of reducing urine loss in both groups, p < 0.0001. In the study groups, the number of deliveries had no effect on urinary incontinence, p = 0. 7021 (BMGE) and p = 0.4073 (PMGE), nor did route of delivery, p = 0.713 (BMGE) and p = 0.3613 (PMGE), pelvic type, p = 0.5079 (BMGE) and p = 0.4885 (PMGE), or postural pattern, p = 0.7331 (BMGE) and p = 0.7331 (PMGE).

Conclusions: The original exercise programme reduced stress urinary incontinence in both groups women. Postural pattern, pelvic type, number of deliveries and route of delivery had no effect on the incidence of urinary incontinence in both groups of women.

This position paper of the expert panel presents a comprehensive review of the efficacy, safety, and clinical application of bioidentical hormone replacement therapy (HRT), with particular focus on transdermal 17β-oestradiol gel (Oestrogel^®). Bioidentical hormones - chemically identical to endogenous human hormones - are increasingly recognised as the preferred option in modern HRT, consistent with current international guidelines. Based on a review of randomised clinical trials and observational studies (sourced primarily from PubMed and Medline), transdermal oestradiol demonstrates a superior safety profile compared to oral formulations. Benefits include stable serum oestradiol levels without supraphysiological fluctuations; minimal impact on hepatic synthesis of procoagulant factors, triglycerides, hormone-binding proteins (SHBG, TBG, CBG), and inflammatory mediators (e.g. C-reactive protein); no increased risk of venous thromboembolism or ischaemic stroke; and the ability to use lower doses while maintaining efficacy. Additional advantages are a more physiological E2/E1 ratio, reduced inter-individual variability, and the option to monitor serum oestradiol levels. Oestrogel^® supports dose flexibility and personalisation, allowing treatment to be tailored according to patient needs and guideline-based therapeutic schemes. When combined with micronised progesterone - the gold-standard progestogen for endometrial protection and the preferred option due to its favourable overall safety profile - this form of HRT offers a modern, well-tolerated, and individualised approach to the management of menopausal symptoms and osteoporosis prevention.

Introduction: Lifestyle changes are one of the main therapeutic approaches for women with polycystic ovarian syndrome (PCOS), non-alcoholic fatty liver disease (NAFLD), and obstructive sleep apnea (OSA). This 8-week study aimed to assess the effect of lifestyle modifications on liver enzymes, triglycerides (TG), sex hormones, and daytime sleepiness in PCOS women with NAFLD and mild and moderate OSA.

Material and methods: This study included 40 women. The included obese PCOS women with OSA and NAFLD were assigned randomly to the study group and control group (n = 20 for each PCOS group). Besides the low-calorie diet (LCD), both PCOS groups received 500 mg of metformin tablets consumed three times daily. The study group additionally received free 30-minute walking exercise daily. Besides aspartate transaminase, alanine transaminase, and TG, the following outcomes were assessed in all PCOS women with OSA and NAFLD: waist circumference, neck circumference, body mass index, waist-hip ratio, serum testosterone, ratio of luteinizing hormone and follicle-stimulating hormone, apnea-hypopnea index, dehydroepiandrosterone, and Epworth sleepiness scale (to assess excessive daytime sleepiness).

Results: A significant improvement in the value of all outcomes was achieved in both PCOS groups, but the improvements were high in the study group. Also, the designed between-group comparison of post values of PCOS women's outcomes showed a significant improvement in the study group.

Conclusions: Adding eight weeks of free-walking exercise to LCD and administration of metformin resulted in significantly greater improvements in PCOS than LCD and administration of metformin alone in women with NAFLD and OSA.

Introduction: Cervical cerclage is a method used to prevent preterm delivery in pregnant women diagnosed with cervical insufficiency or a short cervix. This study aimed to compare pregnancy outcomes between cervical cerclage procedures performed due to history- and ultrasound-based indications.

Material and methods: This retrospective cohort study was conducted at the Department of Obstetrics and Perinatology of the University Hospital in Cracow, Poland, a tertiary healthcare center. The study included women with singleton pregnancies who underwent cervical cerclage placement and subsequently gave birth in our department between 2013-2023.

Results: Among 136 participants, 89 (65.4%) received history-indicated cerclage, and 47 (34.6%) underwent an ultrasound-indicated procedure. No statistically significant differences were found regarding miscarriage rates (3.4% vs. 2.1%) or preterm birth rates before 32 (9.0% vs. 14.9%), 34 (11.2% vs. 14.9%), and 37 (22.5% vs. 38.3%) gestational weeks between the history- and ultrasound-indicated groups (p ≥ 0.05). The median gestational age at delivery was 38.4 weeks for history-indicated cerclage and 38.3 weeks for ultrasound-indicated cerclage (p ≥ 0.05).

Conclusions: Pregnancy outcomes following history-indicated cervical cerclage are comparable to those of ultrasound-indicated procedures. Consequently, emphasis should shift from predominantly performing prophylactic procedures to systematic cervical length screening and selective cerclage placement in cases of cervical shortening. Cervical cerclage remains an effective intervention for prolonging pregnancy in women with cervical insufficiency and a short cervix.

Uterine fibroids and endometriosis are among the most common conditions encountered in gynaecological practice. Fibroids affect 30-70% of women, with up to half experiencing symptoms that significantly impair quality of life (QoL), including anaemia, pain, and pressure-related symptoms. Additionally, fibroids are the sole cause of infertility in 1-3% of women. Endometriosis is the most common gynaecological cause of chronic pelvic pain syndrome and one of the leading causes of infertility. This condition affects between 2% and 10% of women, leading to symptoms that often have a detrimental impact on QoL. For decades, efforts have been underway to develop pharmacological treatments for oestrogen-dependent conditions that would offer both high efficacy and good tolerability. A significant advancement in the treatment of oestrogen-dependent diseases was the introduction into clinical practice of gonadotropin-releasing hormone (GnRH) antagonists. In recent years, publications have demonstrated the promising therapeutic potential of linzagolix in the management of uterine fibroids and endometriosis. It is an oral, small-molecule, non-peptide GnRH antagonist that induces dose-dependent suppression of ovarian function. The aim of this literature review was to evaluate current evidence on the potential applications of linzagolix for the treatment of uterine fibroids and endometriosis. Linzagolix, with or without add-back therapy, significantly alleviates the symptoms of both uterine fibroids and endometriosis in a dose-dependent manner - the therapeutic effect is rapid and sustained. This drug constitutes a valuable addition to existing methods for treating oestrogen-dependent diseases because it enables treatment personalisation allowing for dose adjustment and the optional use of add-back therapy.

Delayed fracture union is a common complication in orthopedic practice, particularly in patients with osteoporosis. Advances in regenerative medicine, including mesenchymal stem cells (MSCs) within the stromal-vascular fraction, have introduced novel therapeutic approaches to address this challenge. This case describes a patient with postmenopausal osteoporosis and a congenital anomaly of the left lower limb who sustained a proximal tibial fracture with fragment displacement. Osteoporosis therapy was initiated, and the fracture was managed using external fixation and compression. Despite an improvement in bone mineral density over an eight-month period, radiographic assessment revealed no evidence of fracture union. Consequently, local administration of MSCs combined with needling at the fracture site was performed, followed by a series of autologous concentrated plasma (ACP) injections. Within three months, radiographic signs of bone callus formation were observed, ultimately leading to complete fracture union six months after the initiation of regenerative therapy. Although the limited number of cases in our clinic prevents definitive conclusions regarding the primary contributing factor in fracture healing, existing literature suggests that the mobilization of endogenous resources at the fracture site in high concentrations promotes tissue regeneration. This process is further facilitated by physical activity and adjunctive pharmacological treatment. Regenerative therapy integrating MSCs and ACP-derived growth factors represents a promising adjunctive approach for managing fracture complications in patients with systemic osteoporosis. This strategy has the potential to enhance bone healing while potentially delaying or even avoiding the need for more invasive surgical interventions.

Introduction: Polycystic ovarian syndrome (PCOS) is a leading cause of infertility linked to insulin resistance and obesity. Zinc-α2-glycoprotein (ZAG) is an adipokine involved in lipid metabolism and insulin sensitivity. We hypothesized that reduced ZAG serum levels among PCOS cases could predict fertility odds. The aim is to examine ZAG's relationship with fertility parameters and to test its role as a predictor for fertility potential.

Material and methods: A comparative cross-sectional study recruited PCOS cases into two groups: the infertile and fertile group; n = 60 for each. Women's anthropometric (age, body mass index - BMI, waist circumference) hormonal (follicle-stimulating hormone, luteinizing hormone, anti-Müllerian hormone (AMH), total testosterone, and prolactin) metabolic parameters and ZAG serum levels, estimated via ELIZA/ELISA were recorded.

Results: Body mass index was significantly high in infertile cases; ZAG levels were significantly lower among the infertile group (37.08 ±3.885 vs. 54.25 ±14.71 µg/ml; p < 0.0001). Zinc-α2-glycoprotein was inversely and significantly correlated to BMI, waist circumference (r = -0.81, -0.78; p < 0.0001), and all hormonal and metabolic parameters. Zinc-α2-glycoprotein cut-off value of > 42 µg/ml predicted fertility potential in PCOS, with 67% sensitivity, 97.50% specificity, and p < 0.0001, but it did not surpass AMH.

Conclusions: Zinc-α2-glycoprotein is a potential biomarker for fertility that links metabolic and reproduction dysfunction in PCOS women. It mediates 13.5% of obesity's inverse effect on fertility. Restoring normal ZAG levels may improve fertility odds and can have prognostic value in following the therapy in those populations. Further longitudinal, larger-sized studies are recommended to explore newer diagnostic and prognostic avenues to improve reproduction potential among PCOS cases.

Uterine artery embolization (UAE) is a minimally invasive method that has been proven to be an effective alternative to hysterectomy and myomectomy for the treatment of symptomatic fibroids, though its impact on fertility and obstetric outcomes remains controversial. This case report presents a 31-year-old nulliparous woman with a history of fibroid-enlarged uterus (about the size of a 16-20-week pregnancy), who underwent UAE treatment, became pregnant, and delivered a healthy child by cesarean section. At the age of 35, a second UAE was performed due to recurrence of symptoms, followed by a successful conception and delivery of a second child. This report explores the clinical course, management strategies and the role of a multidisciplinary approach in achieving successful outcomes. Although substantial evidence has accumulated in the literature about the safety and effectiveness of UAE as a non-surgical option for uterine fibroids treatment, this procedure still raises questions about its impact on future fertility and obstetric outcomes, including the risk of miscarriage, placenta previa, and preterm delivery. Uterine artery embolization is a promising minimally invasive alternative to myomectomy for women with fibroids who want to preserve their fertility. The present case demonstrates that successful conception and childbirth are possible when patients undergo close follow-up and individualized management.

According to the World Health Organization, menopause occurs between 45-55 years old and is correlated with woman's family constitution, genetic and environmental factors, place of residence and ethnicity. Menopause is defined as no menstrual bleeding for 12 consecutive months without any pathological or pathophysiological or iatrogenic causes. Hormonal changes may lead to various sleep and mental disorders. Poor sleep quality, difficulty falling asleep or waking up during sleep are among the most important sleep disorders associated with insomnia. Without treatment, insomnia results in chronic daily fatigue, impaired concentration and depressive symptoms. The aim of this review was to conduct an analysis of available studies on the influence of menopausal status on the sleep quality. Cochrane and PubMed databases were searched for original articles, published in 2010-2023, which analyzed the correlation between menopausal status in women of different ethnic groups and their sleep quality. The analysis shows a correlation between the menopausal status and sleep quality, with different intensity in different populations. Most studies show that postmenopausal status is associated with insomnia and poor sleep quality. It is suggested that development of individualized healthcare strategies adjusted for cultural, social and psychological factors would be more effective for women from different populations.