Przeglad Menopauzalny最新文献

Introduction: The study aim was to predict the risk of climacteric syndrome (CS) developing in perimenopausal women with hypothyroidism (HT) according to the developed algorithm and mathematical model for timely preventive measures.

Material and methods: 146 perimenopausal women with autoimmune HT were enrolled in this study. Assessment of the severity of metabolic, neurovegetative and psychoemotional symptoms was graded according to the Blatt-Kupperman menopause index. All women were interviewed according to a specially designed questionnaire for predicting the development of severe CS. Multiple regression analysis was used to build a multifactorial mathematical model. Shapiro-Wilk and Kolmogorov-Smirnov criteria were used to assess the normality of the distribution of traits.

Results: Regression analysis was used to determine the most significant multicollinear risk factors for CS developing: pathology of the thyroid gland, smoking, alcohol consumption, adverse environmental conditions, low physical activity, history of stress and anxiety. The predicted value of the risk factor for severe CS with a high degree of probability was determined in 72 (49.32%) women, medium probability in 58 (39.73%) women, and low probability in 16 (10.95%) women.

Conclusions: The developed algorithm and mathematical model are informative and allow one to prevent CS and its complications. The decay of women's health starts many years before menopause and prevention of its consequences is an important task for the clinicians.

Introduction: Renal cancer is the seventh most common cancer in men and the tenth most common cancer in women. Renal cell carcinoma accounts for 3% of all adult malignancies and 85% of all primary renal tumours. It metastasizes most often to the lungs, liver, bones, and brain and very rarely to the vagina.

Case report: We present a case of a 60-year-old patient, in whom the renal cell carcinoma manifested for the first time as an intense bleeding, soft tumour formation with dimensions 4/6 cm originating in the vagina.

Discussion: Renal cell carcinoma metastasizes in about 30% of cases. Metastasizing can be lymphatic, hematogenous, transcoelomic, or by direct invasion. Most commonly it affects the lungs, bones, adrenal glands, liver, lymph nodes, and brain. Much less often, it metastasizes to the thyroid, orbit, nasal structures, vagina, gallbladder, pancreas, sublingual tissues, and soft tissues of distal extremities. Metastases can be synchronous and metachronous. The described cases in the literature of renal cell carcinoma manifested with vaginal metastases are isolated.

Conclusions: We present an extremely rare case of renal cell carcinoma manifested by profuse genital bleeding from a vaginal metastasis. In such cases, especially if the vaginal lesion does not appear as the primary vaginal carcinoma, we must consider the possibility of metastasis from renal carcinoma.

Introduction: Menopause is a process that affects hormonal levels and metabolic processes in women. The decline in oestrogen levels can predispose to the development of type 2 diabetes mellitus and obesity.

Material and methods: The study group included 614 women with a history of bariatric surgery, who were divided into 2 groups according to their menopausal status. The purpose of the study was to assess the influence of menopausal status on the effects of bariatric surgery in terms of weight loss.

Results: The percentage of estimated weight loss (%EWL), total weight loss (TWL), percentage of total weight loss (%TWL), and change in body mass index (BMI) after bariatric surgery are lower in postmenopausal than in premenopausal women.

Conclusions: Menopause can be considered as a factor influencing the efficacy of bariatric surgery, with lower effects in postmenopausal women.

Free radicals and oxidant molecules are part of our organism in a stable balance. However, when addressing female infertility, questions about their role in oocyte quality arise. This review outlines the major alterations of redox homeostasis in the follicular fluid through pathophysiological conditions in female reproduction and its potential effect on IVF outcome. A review of the literature was accurately performed. Manuscripts investigating follicular fluid biomarkers, especially related to oxidant molecules, were screened and used in this review. Studies assessing the follicular reactive species were found and screened. Moreover, studies assessing the IVF outcomes related to biomarkers were considered. The results are provided in an analytical pathway. The study of biomarkers confirms the shift to enhanced oxidizing modification of macromolecules and antioxidative consumption in the follicular fluid of women undergoing IVF treatment. A lack of congruency in methods appears to be marked in the design of scientific studies. However, it is not clear whether redox disbalance has a disruptive effect on the oocyte competence or whether it plays a role in the oocyte maturation process. Red-ox balance plays a questionable role in IVF outcomes. Possible further insights may consider the antioxidant role of adjuvants during controlled ovarian stimulation cycles.

Introduction: Heavy menstrual bleeding leads to depletion of iron stores, with subsequent iron deficiency (ID) and iron deficiency anemia (IDA). To evaluate the efficacy and safety of ferric carboxymaltose (FCM) in treatment of ID/IDA caused by abnormal uterine bleeding (AUB).

Material and methods: One hundred and twenty women ≥ 40 years old with chronic AUB and ID/IDA were included in this study for correction of ID/IDA. Participants received FCM infusion for correction of ID/IDA. The pre-treatment ferritin, hemoglobin (Hb), red blood cell (RBC) mean corpuscular volume (MCV), and RBC mean corpuscular hemoglobin (MCH) values were compared with the 6- and 12-week post-treatment values.

Results: The pre-treatment ferritin and Hb levels significantly increased from 13.2 ±7.4 µg/l and 8.8 ±0.8 g/dl, respectively, to 111.5 ±5.6 µg/l and 13.9 ±0.6 g/dl, respectively, 6 weeks after FCM (p = 0.001 and 0.0009; respectively), and to 98.7 ±6.1 µg/l and 12.9 ±0.65 g/dl, respectively, 12 weeks after FCM (p = 0.01 and 0.01; respectively). In addition, the pre-treatment RBC MCV and RBC MCH values significantly increased from 74.3 ±2.3 fl and 26.6 ±5.3 pg, respectively, to 88.7 ±1.9 fl and 29.6 ±4.5 pg, respectively, 6 weeks after FCM (p = 0.01 and 0.03, respectively), and to 93.3 ±1.75 fl and 30.3 ±3.8 pg, respectively, 12 weeks after FCM (p = 0.001 and 0.0001, respectively).

Conclusions: FCM was safe and effective for correction of ID/IDA caused by chronic AUB within 6 weeks. The serum ferritin, Hb, and RBC indices remained significantly high compared to the pre-treatment values 12 weeks after FCM infusion.

Introduction: The present study aimed to examine the impact of age at menopause on the type 2 diabetes mellitus (T2DM) risk in postmenopausal women.

Material and methods: We included 4,968 postmenopausal women from the National Health and Nutrition Examination Survey 2011-2018. Age at menopause was measured by single year and categorically (< 40 years, 40-44 years, 45-54 years, 55 years and above). The outcome variable T2DM was measured with self-report and fasting blood glucose level. We performed logistic regression to estimate the odds ratio (OR) (95% confidence interval [CI]). Linear regression was used to examine the correlation between age at menopause and age at T2DM.

Results: Of the 4,968 postmenopausal women, 796 (16.0%) had T2DM after menopause. The mean age at menopause was 44.2 years. The mean age at T2DM was 57.2 years. Adjusting for potential confounders, the ORs for the association between age at menopause of < 40 years, 40-44 years and ≥ 55 years and T2DM were 1.97 (95% CI: 1.47-2.63), 1.27 (95% CI: 0.90-1.79) and 0.98 (95% CI: 0.66-1.45), respectively, compared to women having menopause at age 45 to 54 years. Each increase by 1 year in age at menopause was associated with a 3% reduction in the prevalence of T2DM (95% CI: 2-5). Age at menopause was significantly correlated with age at T2DM. Each 1-year increase in age at menopause might lead to a decrease of 0.39 years in age at T2DM.

Conclusions: Premature menopause was associated with increased T2DM risk in women. The earlier menopause occurs, the younger is the age at which T2DM may occur.

Ovarian cancer represents the fifth cause of cancer death among women, carrying one of the worst prognoses among gynaecological malignancies. The need to achieve no residual disease after surgery in order to optimize prognosis of advanced-stage ovarian cancer introduced the idea of neoadjuvant chemotherapy. The present review aims to summarize current state-of-the-art evidence regarding the efficacy and safety of neoadjuvant chemotherapy as well as novel insights regarding the usage of modern therapeutic regimens in the context of neoadjuvant chemotherapy. The last decade has been characterized by the breakthrough scientific evidence that neoadjuvant chemotherapy followed by interval debulking surgery for advanced-stage ovarian cancer may be comparable to primary debulking surgery. Neoadjuvant chemotherapy followed by interval debulking surgery is an acceptable - if not preferable - therapeutic approach in advanced-staged ovarian cancer patients because it is associated with higher optimal debulking surgery, fewer complications, and non-inferior survival outcomes. The addition of bevacizumab to chemotherapy contributes significantly to survival outcomes without causing side effects that outbalance the benefits. Patients with recurrent high-grade serous ovarian cancer and a germline or breast cancer mutation should be offered maintenance olaparib after a response to platinum-based chemotherapy. Finally, the role of hyperthermic intraperitoneal chemotherapy in the context of neoadjuvant chemotherapy remains unjustified.

The current global COVID-19 mortality rate is estimated to be around 3.4%; however, it is dependent on age, sex, and comorbidities. Epidemiological evidence shows gender disparities in COVID-19 severity and fatality, with non-menopausal females having milder severity and better outcomes than age-matched males. However, the difference vanishes when comparing postmenopausal women with age-matched men. It has been suggested that, to some extent, this is due to the protective role of female hormones, such as anti-Müllerian hormone and oestradiol (E2), in non-menopausal women. Oestrogens have been hypothesized to be crucial in modulating viral infection and the progression of the disease via an action on immune/inflammatory responses and angiotensin-converting enzyme type 2 expression. Hence, the most likely explanation is that, because the levels of oestrogen in females after menopause decrease, oestrogen no longer offers a beneficial effect as seen in younger females. The COVID-19 pandemic has highlighted the serious negative effects arising from the state of E2 deficiency. Therefore, hormone replacement therapy gains further support as the damaging effect of the decline in ovarian function affects many biological systems, and recently with the COVID-19 pandemic, oestrogen's vital role within the immune system has become quite clear. However, additional clinical investigations regarding hormone replacement therapy are urgently needed to further verify the protective and therapeutic effects of E2 on menopausal women with COVID-19.

Introduction: Menopause is the last physiological menstrual period and is a complex process involving the following: endocrine, genitourinary, cardiovascular, and locomotor system, and it leads to vasomotor symptoms and psychological complaints. This study aims to investigate the influence of smoking and body mass index (BMI) as risk factors on the age of onset of menopause in women in Bosnia and Herzegovina.

Material and methods: This study included 460 women in natural menopause. The study was conducted in 2 phases: interview and measurement of BMI. Each patient underwent an interview based on the questionnaire, following the verbal consent of the patient, who had previously been explained the nature of the research.

Results: The age at which menopause occurs increases with the BMI increase, and it can be described by the regression equation: age = 0.096 × BMI + 45.7, which has statistical significance. The mean age of menopause occurrence in current smokers was lower (47.5 ±0.4 years) than in non-smokers (48.8 ±0.2 years) (p = 0.010).

Conclusions: Our study confirmed the statistically significant correlation between smoking, BMI, and age of onset of menopause.

Introduction: To detect the morphological parameters of ovarian masses and the accuracy of the risk of mali-gnancy index (RMI) in diagnosing ovarian malignancy.

Material and methods: 264 women in 3 groups (reproductive, premenopausal, and postmenopausal) presented with ovarian masses and scheduled for surgery were included in this study. The participants' preoperative RMI was compared to the postoperative histology (gold standard) to detect the accuracy of RMI in diagnosing ovarian malignancy.

Results: The incidence of malignant and benign ovarian tumours in the reproductive group was 9.1% and 90.9%, respectively, while it was 35.2% and 64.8%, respectively, in the premenopausal group, and 35.2%, and 64.8%, respectively, in the postmenopausal group. The incidence of malignant ovarian tumours was significantly higher in the premenopausal (35.2%) and postmenopausal (35.2%) groups compared to the reproductive group (9.1%), (p = 0.0008, and p = 0.0008, respectively).The receiver operating characteristic curve showed that RMI at cut-off value > 247.5 had 82.9% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 98.1% negative predictive value (NPV) in diagnosing ovarian malignancy in the 3 studied groups (AUC 0.955, p < 0.001). There was significant positive correlation between the participants' age, and RMI (p = 0.001), and between participants' cancer antigen-125 (CA-125) and RMI (p < 0.0001) in the ovarian malignancy group.

Conclusions: The multimodal RMI is an effective tool for primary evaluation of suspected ovarian masses. Risk malignancy index at cut-off value > 247.5 had the best performance (82.9% sensitivity, 100% specificity, 100% PPV, and 98.1% NPV) in diagnosing ovarian malignancy in the 3 studied groups. There was significant positive correlation between participants' age, and RMI, and between participants' CA-125 and RMI, in the studied malignant ovarian tumours.