Przeglad Menopauzalny最新文献

Introduction: Menopause is a natural phase in a woman's life, typically occurring in mid-adulthood, and is characterised by various biological, psychological, and social changes. This study explores the relationship between women's perceptions of menopause, their attitudes toward it, and their overall life satisfaction during this period. Additionally, it examines the impact of hormone replacement therapy (HRT) and the different stages of menopause on these perceptions and attitudes.

Material and methods: A total of 267 women aged 40-65 years were enrolled in the study. An online form was distributed across social platforms. The menopause rating scale, the skala oceny menopauzy (menopause attitude scale), and the satisfaction with life scale were used.

Results: There is a negative correlation between severity of menopausal symptoms and life satisfaction [r = -0.488; p < 0.001; CI95 = (-1; -0.407)]. Menopausal symptoms assessment was found to correlate with the generalised attitude towards menopause [r = -0.657; p < 0.001; CI95 = (-1; -0.596)]. A positive correlation was found between attitudes towards menopause and life satisfaction [r = 0.596; p < 0.001; CI95 = (0.526; 1)]. Generalised attitudes toward menopause partially mediate the relationship between the assessment of menopausal symptoms and perceived life satisfaction.

Conclusions: The menopausal stage affects how symptoms and attitudes toward menopause are evaluated. The use of HRT also differentiates these factors. Results show links between symptom evaluation, life satisfaction, and general attitudes toward menopause. Moreover, general attitudes toward menopause influence the relationship between symptom evaluation and life satisfaction.

Introduction: Premature ovarian insufficiency (POI), a cause of hormonal imbalance and infertility, may be linked to sleep patterns, but the exact relationship is unclear. This study uses Mendelian randomisation (MR) to investigate the causal link between sleep traits and POI, aiming to uncover new treatment methods.

Material and methods: Data from genome-wide association studies were used to examine 11 sleep traits related to POI. The primary method for assessing causality was the inverse variance weighted (IVW) approach, with MR-Egger regression as a secondary analysis. Sensitivity analyses included Cochrane's Q statistic, the MR-Egger intercept test, leave-one-out cross-validation, and funnel plot inspections. A multivariate MR analysis combined significant exposure factors from 2 independent samples to determine their cumulative impact on POI incidence.

Results: The two-sample MR analysis using the IVW method showed a positive causal link between sleep duration and POI (p = 0.037). A negative causal link was found between sleep chronotype and POI (p = 0.032). Cochrane's Q test showed no significant heterogeneity, and MR-Egger intercept analysis indicated no directional pleiotropy. Leave-one-out analysis confirmed the robustness of the findings, and funnel plots showed symmetrical distribution, suggesting no bias. Multivariate MR analysis found no combined causal effect of sleep duration and chronotype on POI risk.

Conclusions: Our study suggests a causal link between sleep traits and POI through Mendelian randomisation. Enhancing sleep habits could reduce POI risk, highlighting sleep hygiene's role in women's reproductive health and opening avenues for new prevention and treatment methods.

The International Federation of Gynecology and Obstetrics (FIGO) 2023 classification for endometrial cancer (EC) introduces significant changes by integrating molecular subtypes (POLEmut, mismatch repair deficient, p53abn, no specific molecular profile) with traditional anatomical and pathological criteria. Key updates include an expanded number of substages, the incorporation of lymphovascular space invasion (LVSI) as a prognostic factor, and a novel division of tumors into aggressive and non-aggressive categories, reflecting advancements in oncology. These updates enhance prognostic precision and inform therapeutic strategies. Non-aggressive tumors, such as low-grade endometrioid carcinomas (G1 and G2), are associated with favorable outcomes and limited invasiveness. For these cases, factors like LVSI and depth of myometrial invasion support individualized approaches, including the potential for therapy de-escalation. Aggressive tumors, including high-grade endometrioid carcinomas (G3), serous and clear cell carcinomas, and p53abn subtypes, exhibit a higher risk of recurrence and metastasis, requiring intensified treatments. However, variability in molecular and histopathological assessments poses challenges to risk stratification within this group. Despite its potential to personalize treatment, the FIGO 2023 system presents implementation challenges. Variability in assessing LVSI, sentinel lymph node ultrastaging, and molecular markers highlights the need for standardized diagnostic criteria. Additionally, tumor heterogeneity complicates classification and therapeutic decisions, necessitating more advanced diagnostic approaches. The future success of the FIGO 2023 classification depends on harmonizing diagnostic standards, improving access to molecular technologies, and validating prognostic implications through prospective studies. While this update represents a significant step forward in tailoring EC management, further refinements are required to address diagnostic and implementation challenges and improve patient outcomes.

Introduction: We examined the association between age at menopause and multimorbidity in postmenopausal women in the United States.

Material and methods: The data were obtained from the National Health and Nutrition Examination Survey (2007-2010, 2013-2014, and 2017-2018), which included 3168 postmenopausal women over 40 years old. The exposure variable was age at menopause, while the outcome variable was multimorbidity, defined as having 2 or more health conditions. Health conditions included hypertension, diabetes, cardiovascular disease (CVD), cancer, arthritis, obesity, osteoporosis, thyroid disease, chronic bronchitis, emphysema, and liver conditions. Logistic regression models were employed to estimate unadjusted and adjusted odds ratios (OR) and 95% confidence intervals. We also used logistic regression models with restricted cubic splines to illustrate the association between continuous menopausal age and multimorbidity.

Results: The adjusted OR for multimorbidity in women with age at menopause of < 40, 40-44, and 55+ years were 4.25 (3.07-5.89), 1.46 (1.08-1.99), and 0.61 (0.43-0.85), respectively, compared to age at menopause of 45-54 years. Premature menopause was associated with every health condition and multimorbidity except for liver conditions. Early menopause was related to hypertension and CVD. Continuous menopausal age, regardless of menopausal type, presented inverse and linear associations with multimorbidity. The study found no significant interaction effects between age at menopause and hormone therapy on the association between age at menopause and multimorbidity.

Conclusions: Premature or early menopause was associated with increased risks of developing multiple health conditions. Implementing early surveillance and intervention strategies is imperative to mitigate the burden of multimorbidity among women undergoing premature or early menopause.

Interstitial pregnancy (IP) is a rare kind of tubal pregnancy, which occurs in 2-4% of all ectopic pregnancies. It occurs as a result of implantation of the gestational sac in the proximal intramural part of the fallopian tube. Risk factors include the following: pregnancy conceived after assisted reproductive technologies, ipsilateral salpingectomy, previous ectopic pregnancy, congenital tubal and uterine malformations, pelvic inflammatory disease, and the presence of an intrauterine device. Given the rare and complex nature of interstitial pregnancies, diagnosis and management are difficult. Transvaginal ultrasound is the most specific instrumental method for early diagnosis that can decrease possible complications, such as rupture, severe haemorrhage, and risk of future infertility in the case of misdiagnosis. There are various surgical and non-surgical methods for the treatment of interstitial pregnancy. The method of choice depends on gestational age, whether the pregnancy is intact or ruptured, and the patient's desire for future fertility. However, surgery is still the main option for the treatment of IP because it offers definitive treatment. Generally, complicated IP is associated with high rate of mortality due to delayed diagnosis and treatment. We present a case report related to a multiparous woman with amenorrhoea and ultrasound findings corresponding to sonographic criteria for interstitial pregnancy. Laparoscopy was performed, which confirmed the diagnosis. Bilateral salpingectomy and right cornual resection were performed because the patient had no intention for future pregnancies.

Hysterectomy is performed by various surgical methods: abdominal, vaginal, laparoscopic, or robotic, and with different extents: supracervical, total, or radical. Scientific reports indicate that hysterectomy is a risk factor for stress urinary incontinence (SUI). The aim of this paper is to review scientific studies on the effect of the type of hysterectomy on the incidence of SUI. Original open-access articles in English language available in the PubMed, Google Scholar, and ScienceDirect databases published in the period 2004-2024 were included. Studies suggest the following: vaginal hysterectomy is associated with a higher risk of SUI than abdominal hysterectomy; abdominal hysterectomy is associated with a higher risk of SUI than laparoscopic hysterectomy; and it is likely that supracervical hysterectomy is associated with a higher risk of SUI than total hysterectomy; however, some scientific reports do not show significant differences in SUI between the above types of hysterectomy, so the first 3 conclusions should be approached with caution; it is uncertain whether the removal of the adnexa during hysterectomy increases the risk of SUI; and there were no differences between traditional laparoscopic hysterectomy and robotic-assisted laparoscopic hysterectomy. More good-quality studies on the effect of the type of hysterectomy on the incidence of SUI are necessary.

Introduction: To analyse the effect of concurrent training after 4 months of intervention compared to the control group on the symptomatology of menopause, symptoms of depression, sexual function, and aging perspective of women during menopause.

Material and methods: This is a randomized 2-arm clinical trial. A total of 42 menopausal women (53.21 ±3.65 years of age) were included. Questionnaires related to symptoms of menopause (menopause rating scale - MRS), depression (hospital anxiety and depression scale), sexual function (female sexual function index), and aging perspective (Sheppard inventory) were applied. Intention-to-treat and protocol adherence analysis were performed.

Results: In the analysis by protocol, there was an improvement in menopausal symptoms in all domains of the MRS, specifically somatic symptoms (p = 0.001), psychological symptoms (p = 0.001), urogenital symptoms (p = 0.001), and total score (p = 0.001), as well as a reduction in depressive symptoms (p = 0.016). Additionally, improvements were observed in sexual function across 4 domains, including desire (p = 0.007), lubrication (p = 0.024), satisfaction (p = 0.030), and the overall sexual function score (p = 0.022). Furthermore, concerning the aspect of 'finitude', there was a significant improvement between groups in the domain of happiness (p = 0.046).

Conclusions: Concurrent training was shown to be effective for improving the symptomatology of menopause, depression, sexual function and happiness in menopause.

Minimal access nipple-sparing mastectomy (M-NSM), performed with endoscopic systems or with surgical robot assistance, is a novel alternative to the classic approach to nipple-sparing mastectomies. Leading advancements in M-NSM have primarily come from Asia. We gather experts' opinions from six European countries to establish the current status of M-NSM in Europe. An eight-question survey was designed to explore M-NSM's historical background and current standing in various local settings. We collected data from 6 European countries, including Italy, Spain, France, Switzerland, Belgium, and Poland. The number of centers offering M-NSM procedures in each reported country ranges 1-9. The number of procedures performed annually in four centers exceeds 10. In all reported countries, current national breast cancer recommendations do not include M-NSM, and this procedure is not explicitly covered by any of the national health care providers. All experts have indicated the need for training in M-NSM surgery as a primary way to incorporate these techniques as a standard procedure. Minimal access nipple-sparing mastectomy is still a tool used by a narrow group of specialists in Europe. The main obstacle to broader implementation remains the extra cost of M-NSM, which requires reimbursement from the health care providers. Training courses, data collection, and demonstration of its benefits are the key to promoting M-NSM among breast surgeons and patients.

The onset of menopause usually occurs between the ages of 48 and 52, leading to diverse symptoms in various body systems due to a decrease in estrogen level. Visceral obesity and diminished estrogen level during the menopausal phase are associated with unfavorable metabolic changes, resulting in insulin resistance and increased risk of type 2 diabetes mellitus (T2DM). Owing to the increase in the incidence and prevalence of T2DM in recent decades, it is important to identify predisposing factor such as menopausal age to improve T2DM prevention and management. We searched PubMed, Scopus, and Google Scholar databases to find all studies related to menopause and type 2 diabetes up to August 4, 2023. Studies were reviewed for compliance with the inclusion criteria. Sample size and number of post-menopausal T2DM cases were extracted from studies. Effect sizes and related confidence intervals were calculated for them. The combined analysis of 17 studies demonstrated a significant association between menopausal age and risk of T2DM. The calculated odds ratio (OR) demonstrated that women with menopausal age > 45 had significantly decreased risk of developing T2DM with OR of 0.13 (95% CI: 0.04, 0.22). This effect changed to OR = 0.44 (95% CI: -1.12, 2.00) and 0.21 (95% CI: -1.39, 1.82) for menopausal age > 50 and > 55, respectively. In conclusion, this present meta-analysis emphasizes the importance of the complex relationship between earlier menopausal age and risk of T2DM development.

Müllerianosis of the urinary bladder is a rare pathological condition involving ectopic Müllerian-derived tissues within the bladder. Despite its benign nature, due to its ability to mimic malignant conditions such as bladder carcinoma, diagnosis might be challenging. In this review, data from 36 cases across 32 studies were analyzed, focusing on patient demographics, symptomatology, diagnostic imaging, and histopathological features. The average patient age was 42.4 years. Common symptoms included dysuria, hematuria, and pelvic pain. Diagnostic challenges arise from the nonspecific nature of symptoms and imaging findings, making histopathological confirmation necessary. Surgical treatment is mainly involved, with transurethral resection being the most common approach. In some cases, hormonal therapy is also explored. While the prognosis is generally favorable, recurrence is possible, emphasizing the need for long-term follow-up. The review underscores the importance of early diagnosis and individualized management strategies to improve patient outcomes.