Clinical Features and Plasma Hormone Levels After Surgical Menopause

This study reports the plasma levels of follicle stimulating hormone, luteinising hormone, oestradiol and testosterone in 43 women who had undergone bilateral o?phorectomy. Age was the only variable of those investigated which appeared to influence a hormone level; testosterone levels were found to decrease with increasing age. Two significant associations were found between clinical features of the menopause and the plasma hormone levels measured. Low levels of oestradiol were associated with pruritus vulvae and high levels of testerone were associated with headaches.     

A Comparative Study of CEE,Tibolone, and DHEA as Hormone Replacement Therapy for Surgical Menopause

Objective(s)

The objective of this study was to compare the efficacy and safety of CEE, tibolone, and DHEA for prevention of menopausal symptoms.

Method(s)

One hundred patients with surgical menopause were included in this study: 25 of whom were not treated with any HRT, 25 were treated with 0.625 mg of CEE, 25 were treated with 2.5 mg of tibolone, and 25 were treated with 25 mg of DHEA for 1 year, and the results were statistically analyzed regarding drug efficacy and side effects at follow-up periods of 1, 6 and 12 months.

Result(s)

Frequency of menopausal symptoms was significantly less in cases received with CEE, tibolone, DHEA with p values 0.001, 0.004 and 0.004, respectively. Percentage gain in BMD was 2.8 % with CEE at lumbar spine, which was greater than that caused by DHEA and tibolone, but this difference was not statistically significant. CEE caused side effects like headache (40 %) and nausea (28 %).

Conclusion(s)

CEE, Tibolone, and DHEA are very effective in alleviating climacteric symptoms. CEE has beneficial effects on lipid and bone and is a low-cost drug but frequently causes side effects. Tibolone offers beneficial androgenic effects on mood and libido with fewer side effects but is a costly drug. DHEA shows positive effects on psychological symptoms. However, its cost and androgenic side effects limit its use as long-term HRT.

     

不同术式切除子宫、卵巢对内分泌及更年期症状的影响

目的了解不同术式切除子宫、卵巢对内分泌改变的影响。方法对125例45岁以下非绝经期妇女因妇科良性疾病而手术治疗的患者,根据手术范围的不同分为五组进行研究。分别在术前,术后3个月测定血FSH、LH、E2、P水平。并在术后3～6个月进行更年期症状的随访。结果全子宫加双附件切除术,FSH、LH升高,E2下降明显,更年期症状严重。保留一侧卵巢组,保留一侧附件组,保留二侧附件而作子宫切除的各组与术前激素水平的变化有显著性差异。各组间激素水平的变化和更半期症状的出现也都有显著性差异。保留子宫仅作一侧附件切除组术后体内激素水平无明显改变,更年期症状几平不出现。结论卵巢的功能与卵巢血液供应直接有关。     

Hormone Replacement Therapy at the Menopause A Double Blind Controlled Study of Women's Preferences

Summary: Forty-nine women who had previously undergone hysterectomy and bilateral oöphorectomy took part in a double blind cross-over trial of hormone replacement therapies. This consisted of 3 months each of ethinyl oestradiol 50 μ g per day, d norgestrel 250 μg per day, a combination of these 2 substances ('Nordiol'), and a placebo. All drugs were administered in a randomized sequence as identical tablets. The 36 women who completed the study concorded in their preference of the drug received. The order of preference was ethinyl oestradiol, the combination of ethinyl oestradiol and d norgestrel, d norgestrel and placebo. From a symptomatic viewpoint, this suggests the use of oestrogen alone as the preferred hormone replacement therapy in menopausal women. The combination of oestrogen and progestogen may provide a satisfactory alternative where the use of unopposed oestrogens is undesirable.     

绝经早期低剂量激素治疗对乳腺的影响分析

目的:研究绝经早期低剂量激素治疗(HT)对乳腺的影响.方法:收集绝经早期妇女104例,随机分为激素组和中药组各52例,治疗1年,每3个月随访1次,由专人进行绝经期生存质量量表评分,受试者每日记录乳房胀痛情况.结果:绝经期生存质量量表中,激素组用药前评分为1.90±0.94分,用药后3月,6月,9月,12月评分较前均有显著性下降,分别为1.27±0.67分,1.08±0.62分,0.97±0.64分,0.69±0.50分;中药组用药后3月,6月,9月,12月评分也较用药前有显著性下降.激素组在用药3月,6月,9月,12月的乳房胀痛发生率分别为29.17%.14.63%,22.22%,9.09%,各时间点与中药组相比差异无统计学意义;在用药1～3月,激素组乳房胀痛程度为中度或重度的受试者占35.7%,显著多于中药组0%,其余各时间点两组在乳房胀痛程度上无统计学意义;激素组用药前乳腺小叶增生发生率为60%,用药后为91.4%,用药前后差异有统计学意义.结论:绝经早期低剂量HT和中药治疗1年均能有效提高生存质量,HT使乳腺小叶增生发生率增加,应用HT的过程中应加强乳房监测.     

Hormone Replacement Therapy After Gynaecological Malignancies: a Review Article

Rapid advances in oncology have led to an increased survival rate in cancer patients, who live long enough to reach the natural age of menopause or experience the end of gonadal function as a side effect of oncological treatment. Survivors after gynaecological malignancies are a major challenge as these diseases are hormone-dependent and hormone replacement therapy (HRT) possibly increases the risk of recurrence. This article is based on a selective literature search for relevant studies and guidelines regarding HRT after gynaecological malignancies and provides a broad overview of current research. The data for assessing the oncological safety of HRT after gynaecological malignancy are insufficient overall. According to current knowledge, HRT is fundamentally contraindicated after breast and endometrial cancer. After ovarian cancer, HRT can be used after assessment of the risks and benefits, while there is usually no contraindication to HRT after vulvar, vaginal or cervical cancer.Key words: hormone replacement therapy (HRT), ovarian cancer, BRCA mutation, breast cancer, endometrial cancer, cervical cancer     

Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women

IntroductionMedications used to treat chronic diseases have contributed to increasing longevity and improving quality of life. These medications are considered an indispensable resource in the management of most treatable diseases. However, they can affect sexual function through their effects on the central or the peripheral nervous system or due to hormonal effects.AimTo evaluate the association between the use of medication for chronic diseases and sexual dysfunction in Brazilian women 45–60 years of age.MethodsA secondary analysis of household survey data from a previous cross-sectional, population-based study conducted with a sample of 749 women of a population of 257,434 female urban residents in the age bracket of interest. Sexual function was evaluated using the Short Personal Experiences Questionnaire (SPEQ). Associations between the use of medication and sexual function were evaluated, as were correlations with other variables.Main Outcome MeasureWe found associations of the individual SPEQ domains with the use of some medications.ResultsMean age of participants was 52.5 ± 4.4 years. Mean age at menopause was 46.5 ± 5.8 years. The overall prevalence of medication use was 68.8%, with the drugs predominantly consisting of those used for cardiovascular diseases. In the Poisson regression analysis, sexual dysfunction, as based on the overall SPEQ score, was associated with sexual inactivity (prevalence ratio [PR] = 4.05; 95% CI 3.16–5.20; P < .001), a sedentary lifestyle (PR = 1.49; 95% CI 1.06–2.09; P = .021), and untreated anxiety (PR = 1.44; 95% CI 1.08–1.92; P = .014). Analysis of the individual SPEQ domains revealed that women who scored low in the desire domain were more likely to use antihypertensive agents (P = .019), whereas a lower score for the arousal domain was associated with the use of antidepressants, with treatment for osteoarticular diseases and with polypharmacy (P = .003). Women with lower scores in the satisfaction domain were more likely to use antidepressants, drugs for osteoarticular diseases, diabetes medication, and polypharmacy (P = .019). A lower score in the orgasm domain was associated with the use of antidepressants, the treatment of osteoarticular diseases, and diabetes (P < .001). Hormone therapy proved protective against loss of libido (P = .036).Clinical ImplicationsSome medications can interfere with sexual function negatively and, clinicians have to be aware of it to choose the treatment with fewer collateral effects.Strength & LimitationsThe strength of our study is the large, population-based sample of middle-aged women evaluated for sexual dysfunction with the SPEQ. However, it was a self-reported cross sectional study.ConclusionThis study found no association between the use of medication for chronic diseases and the overall SPEQ score, whereas untreated anxiety was 1 of the main factors associated with female sexual dysfunction. On the other hand, medical treatments were found to contribute to lower scores in the different sexual function domains. Common drug culprits included antihypertensives, antidepressants, treatment for osteoarticular disease, diabetes medications, and polypharmacy. Hormone therapy protected against loss of libido.Gueldini de Moraes AV, Ribeiro Valadares AL, Lui Filho JF, et al. Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women. J Sex Med 2019;16:1371–1380.     

Ospemifene: A Novel Oral Therapy for Vulvovaginal Atrophy of Menopause

Vulvovaginal atrophy (VVA) resulting from estrogen deprivation at menopause often results in distressing vaginal dryness and dyspareunia. Fewer than 25% of affected women seek help for this condition citing embarrassment, cultural values, an aging or unavailable partner and concerns about use of estrogens following the Women's Health Initiative. Available non-hormonal treatments, such as moisturizers, while affording some relief can be messy to apply and do not prevent disease progression. A new oral selective estrogen receptor modulator, ospemifene, has been found to have strong estrogenic activity in vaginal tissues without adverse estrogenic effects at other sites.     

Postoperative Medical Therapy After Surgical Treatment of Endometriosis: From Adjuvant Therapy to Tertiary Prevention

The high rate of disease recurrence after surgery is critical and frustrating for women with endometriosis. Adjuvant treatments using a 3- to 6-months course of hormone therapy after surgery have been extensively investigated during the last 2 decades; however, results have been unsatisfactory, primarily because the benefits of hormone therapy rapidly vanish once treatment is discontinued. The protective effect is limited to the period of use. Accordingly, it is recognized that suppressive hormone therapy after surgery markedly prevents recurrent episodes only if given over the long term. The emerging view is that estroprogestins do not ameliorate the effects of surgery but demonstrate tertiary prevention of the disease. They prevent ovulation and reduce retrograde menstrual flow, two crucial events in the pathogenesis of endometriosis. The available literature strongly supports the benefits of prolonged administration of estroprogestins after surgery in preventing recurrence of endometriomas and dysmenorrhea. In contrast, data on dyspareunia and nonmenstrual pelvic pain remain scanty and unconvincing, and there is no information about recurrence of other forms of endometriosis such as peritoneal implants and adhesions. Overall, estroprogestin therapy after surgery to treat endometriosis should be recommended in women who do not seek to become pregnant. Further evidence is warranted to better delineate the beneficial effects of this emerging but convincing strategy.     

Surgical Menopause and Bilateral Oophorectomy: Effect of Estrogen-Progesterone and Testosterone Replacement Therapy on Psychological Well-being and Sexual Functioning; A Systematic Literature Review

BackgroundBesides experiencing vasomotor symptoms, after surgical menopause and bilateral salpingo-oophorectomy (BSO), women experience moderate to severe psychological and sexual symptoms.AimsTo systematically review and meta-analyze the effect of systemic hormone replacement therapy (sHRT) on psychological well-being and sexual functioning in women after surgical menopause and BSO.MethodsMedline/Pubmed, EMBASE and PsychInfo were systematically searched until November 2021. Randomized controlled trials investigating the effect of sHRT on psychological well-being and/or sexual functioning in surgically menopausal women and women after BSO were eligible for inclusion. Two independent authors performed study selection, risk of bias assessment and data extraction. Standardized mean differences (SMDs) were calculated.OutcomesPrimary outcomes for psychological well-being were defined as overall psychological well-being, depression, and anxiety. Primary outcomes for sexual functioning were defined as overall sexual functioning, sexual desire, and sexual satisfaction. All outcomes were assessed on short (≤12 weeks) or medium term (13–26 weeks).ResultsTwelve studies were included. Estradiol had a beneficial effect on depressed mood on short term 3–6 years after surgery or 2 years (median) after surgery with high heterogeneity (SMD: ?1.37, 95%CI: ?2.38 to ?0.37, P = .007, I² 79%). Testosterone had a beneficial effect on overall sexual functioning on short to medium term 4.6 years (mean) after surgery (SMD 0.38, 95%CI 0.11–0.65, I² 0%) and on sexual desire on medium term at least 3–12 months after surgery (SMD 0.38, 95%CI 0.19–0.56, I² 54%). For most studies, risk of bias was uncertain.Clinical implicationsEstradiol may beneficially affect psychological symptoms after surgical menopause or BSO and testosterone might improve sexual desire and overall sexual functioning.Strengths and limitationsThis review only included patient-reported outcomes, thereby reflected perceived and not simply objective symptoms in surgically menopausal women and women after BSO. The small number of studies highly varied in nature and bias could not be excluded, therefore our results should be interpreted with great caution.ConclusionIndependent randomized controlled clinical trials investigating the effects of estrogen-progesterone and testosterone on psychological and sexual symptoms after surgical menopause are needed.PROSPERO registration numberCRD42019136698.Stuursma A, Lanjouw L, Idema DL, et al. Surgical Menopause and Bilateral Oophorectomy: Effect of Estrogen-Progesterone and Testosterone Replacement Therapy on Psychological Well-being and Sexual Functioning: A Systematic Literature Review. J Sex Med 2022;19:1778–1789.     

Association Between Marijuana Use and Sexual Frequency in the United States: A Population-Based Study

BackgroundMarijuana use is increasingly prevalent in the United States. Effects of marijuana use on sexual function are unclear, with contradictory reports of enhancement and detriment existing.AimTo elucidate whether a relation between marijuana use and sexual frequency exists using a nationally representative sample of reproductive-age men and women.MethodsWe analyzed data from cycle 6 (2002), cycle 7 (2006–2010), and continuous survey (2011–2015) administrations of the National Survey of Family Growth, a nationally representative cross-sectional survey. We used a multivariable model, controlling for demographic, socioeconomic, and anthropographic characteristics, to evaluate whether a relationship between marijuana use and sexual frequency exists.OutcomesSexual frequency within the 4 weeks preceding survey administration related to marijuana use and frequency in the year preceding survey administration.ResultsThe results of 28,176 women (average age = 29.9 years) and 22,943 men (average age = 29.5) were analyzed. More than 60% of men and women were Caucasian, and 76.1% of men and 80.4% of women reported at least a high school education. After adjustment, female monthly (incidence rate ratio [IRR] = 1.34, 95% CI = 1.07–1.68, P = .012), weekly (IRR = 1.36, 95% CI = 1.15–1.60, P < .001), and daily (IRR = 1.16, 95% CI = 1.01–1.32, P = .035) marijuana users had significantly higher sexual frequency compared with never users. Male weekly (IRR = 1.22, 95% CI = 1.06–1.41, P = .006) and daily (IRR = 1.36, 95% CI = 1.21–1.53, P < .001) users had significantly higher sexual frequency compared with never users. An overall trend for men (IRR = 1.08, 95% CI = 1.05–1.11, P < .001) and women (IRR = 1.07, 95% CI = 1.04–1.10, P < .001) was identified showing that higher marijuana use was associated with increased coital frequency.Clinical ImplicationsMarijuana use is independently associated with increased sexual frequency and does not appear to impair sexual function.Strengths and LimitationsOur study used a large well-controlled cohort and clearly defined end points to describe a novel association between marijuana use and sexual frequency. However, survey responses were self-reported and represent participants only at a specific point in time. Participants who did not answer questions related to marijuana use and sexual frequency were excluded.ConclusionA positive association between marijuana use and sexual frequency is seen in men and women across all demographic groups. Although reassuring, the effects of marijuana use on sexual function warrant further study.Sun AJ, Eisenberg ML. Association Between Marijuana Use and Sexual Frequency in the United States: A Population-Based Study. J Sex Med 2017;14:1342–1347.     

Exploring the Use of Exchange Transfusion in the Surgical Management of Priapism in Sickle Cell Disease: A Population-Based Analysis

IntroductionPriapism is a urologic emergency that may require surgical intervention in cases refractory to supportive care. Exchange transfusion (ET) has been previously used to manage sickle cell disease (SCD), including in priapism; however, its utilization in the context of surgical intervention has not been well-established.AimTo explore the utilization of ET, as well as other patient and hospital-level factors, associated with surgical intervention for SCD-induced priapismMethodsUsing the National Inpatient Sample (2010–2015), males diagnosed with SCD and priapism were stratified by need for surgical intervention. Survey-weighted regression models were used to analyze the association of ET to surgical intervention. Furthermore, negative binomial regression and generalized linear models with logarithmic transformation were used to compare ET vs surgery to length of hospital stay (LOS) and total hospital charges, respectively.Main Outcome Measures: Predictors of surgical intervention among patients with SCD-related priapismResultsA weighted total of 8,087 hospitalizations were identified, with 1,782 (22%) receiving surgical intervention for priapism, 484 undergoing ET (6.0%), and 149 (1.8%) receiving combined therapy of both ET and surgery. On multivariable regression, pre-existing Elixhauser comorbidities (e.g. ≥2 Elixhauser: OR: 2.20; P < 0.001), other forms of insurance (OR: 2.12; P < 0.001), and ET (OR: 1.99; P = 0.009) had increased odds of undergoing surgical intervention. In contrast, Black race (OR: 0.45; P < 0.001) and other co-existing SCD complications (e.g. infectious complications OR: 0.52; P < 0.001) reduced such odds. Compared to supportive care alone, patients undergoing ET (adjusted IRR: 1.42; 95% CI: 1.10–1.83; P = 0.007) or combined therapy (adjusted IRR: 1.42; 95% CI: 111–1.82; P < 0.001) had a longer LOS vs. surgery alone (adjusted IRR: 0.85; 95% CI: 0.74–0.97; P = 0.017). Patients receiving ET (adjusted Ratio: 2.39; 95% CI: 1.52–3.76; P < 0.001) or combined therapy (adjusted Ratio: 4.42; 95% CI: 1.67–11.71; P = 0.003) had higher ratio of mean hospital charges compared with surgery alone (adjusted Ratio: 1.09; 95% CI: 0.69–1.72; P = 0.710).ConclusionsNumerous factors were associated with the need for surgical intervention, including the use of ET. Those receiving ET, as well as those with combined therapy, had a longer LOS and increased total hospital charges.Ha AS, Wallace BK, Miles C, et al. Exploring the Use of Exchange Transfusion in the Surgical Management of Priapism in Sickle Cell Disease: A Population-Based Analysis. J Sex Med 2021;18:1788–1796.     

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+ _CNB stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy. Key words: breast cancer, neoadjuvant chemotherapy, sentinel LNE, targeted axillary dissection     

Use of Antenatal Corticosteroid Therapy: A Descriptive Study of Clinical Practice Trends

Objectives

Antenatal corticosteroids (ACS) received within 7 days of delivery reduce perinatal morbidity and mortality associated with preterm birth. We aimed to describe the trends of ACS administration over the last decade.