Effects of the route of estrogen administration and exercise on hormonal levels in postmenopausal women

Objective: To examine the effects of exercise on serum estrogens, growth hormone, insulin, cortisol, lactate, and glucose levels in postmenopausal women receiving two routes of administration of estrogen replacement therapy (ERT).

Design: Prospective, randomized, crossover study.

Setting: The general clinical research center of an academic medical center.

Patient(s): Eleven active, postmenopausal women.

Intervention(s): The patients were screened with exercise stress testing, then oral micronized estradiol or transdermal estradiol was administered, followed by two 45-minute submaximal exercise tests. Dietary intake before the tests was standardized.

Main Outcome Measure(s): The study measured maximal heart rate and aerobic power ( ₂max), and serum levels of estradiol (E₂), estrone (E₁), cortisol, growth hormone (GH), insulin, glucose, and lactate.

Result(s): Growth hormone, cortisol, and insulin all changed significantly in response to the 45-minute exercise bouts, but no differences were observed between the oral micronized estradiol and transdermal estradiol responses. E₂ levels increased significantly during the transdermal estradiol 45-minute exercise bout; this change did not occur during the oral estradiol exercise bout. In the transdermal estradiol treatment group, the E₂ levels at +30 and +45 minutes of exercise were elevated compared to the post-exercise levels at −15, 0, and 30 minutes. E₁ was not significantly changed during the 45-minute exercise bouts in either group.

Conclusion(s): During exercise, serum E₂ levels rise significantly higher with transdermal but not oral routes of E₂ administration. However, the elevated levels are not prolonged and normalize by 30 minutes after exercise.     

Thyroid disease and female reproduction

Objective: To review the menstrual function and fertility in thyroid disease, mainly in hyperthyroidism and hypothyroidism. Also to register the consequences of ¹³¹I therapy, which is used widely in the treatment of Graves’ disease and thyroid cancer, on subsequent pregnancies and on fertility in these patients.

Design: A MEDLINE computer search was used to identify relevant studies. The type of menstrual disturbances and the status of fertility were recorded from all the studies found. Also, the fertility and genetic hazard of female patients with Graves’ disease and thyroid cancer who were treated with ¹³¹I were registered.

Result(s): Both hyperthyroidism and hypothyroidism may result in menstrual disturbances. Menstrual abnormalities are less common now than in previous series. In a recent study, we found that only 21.5% of 214 thyrotoxic patients had some type of menstrual disturbance, compared to 50 to 60% in some older series. The most common manifestations are hypomenorrhea and oligomenorrhea. According to the results of endometrial biopsies, most thyrotoxic women remain ovulatory. Moreover, the genetic hazard incident to radioiodine therapy in Graves’ disease and thyroid carcinoma is very small; exposure to ¹³¹I does not cause reduced fecundity, and the risk of loss of fertility is not a contraindication for its use in these patients. mIn hypothyroidism, the frequency of menstrual irregularities has very recently been reported to be 23.4% among 171 hypothyroid patients studied. This is much less than that reported in previous studies, which showed that 50 to 70% of hypothyroid female patients had menstrual abnormalities. The most common manifestation is oligomenorrhea. Severe hypothyroidism is commonly associated with failure of ovulation. Ovulation and conception can occur in mild hypothyroidism. These pregnancies are, however, often associated with abortions, stillbirths, or prematurity. The latter may be of greater clinical importance in infertile women with unexplained infertility.

Conclusion(s): These new data, mainly concerning menstrual abnormalities in hyperthyroidism and hypothyroidism, are inconsistent with what is generally believed and written in the classic thyroid textbooks and indicate that such opinions should be revised.     

绝经后妇女子宫颈癌前病变的特点分析

目的探讨绝经后妇女子宫颈癌前病变的特点。方法收集2017年6月至2018年11月在郑州大学第一附属医院行阴道镜下活检诊断为子宫颈高级别鳞状上皮内病变(HSIL)并行子宫颈锥切术的2013例患者的临床病理资料,其中绝经组439例,未绝经组1574例,对两组患者的临床特点、高危型HPV检测、液基薄层细胞学检查(TCT)、阴道镜检查及活检结果、子宫颈锥切术后病理结果等进行对比分析。结果(1)临床特点:绝经组接触性出血的发生率与未绝经组比较无显著差异[分别为4.3%(19/439)、6.4%(101/1574);χ²=2.672,P=0.102]。绝经组有接触性出血症状的患者中锥切术后病理结果为子宫颈癌的比例明显高于未绝经组[分别为10/19、22.8%(23/101);χ²=7.157,P=0.007];绝经组无症状的患者中锥切术后病理结果为子宫颈癌的比例也明显高于未绝经组[分别为9.0%(38/420)、4.3%(63/1473);χ²=14.726,P<0.01]。绝经组子宫颈表面光滑患者的比例明显高于未绝经组[分别为63.6%(279/439)、35.5%(558/1574);χ²=111.601,P<0.01]。(2)高危型HPV检测:绝经组患者高危型HPV阳性率与未绝经组比较无显著差异[分别为92.0%(404/439)、94.4%(1486/1574);χ²=3.394,P=0.065];两组均以HPV 16型阳性率最高[分别为65.8%(289/439)和68.0%(1070/1574)],但两组比较无显著差异(χ²=0.722,P=0.395)。(3)TCT检查:TCT检查结果包括未见上皮内病变或恶性病变(NILM)、未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、不除外高度病变的不典型鳞状上皮细胞(ASC-H)、低级别鳞状上内病变(LSIL)、HSIL,两组TCT检查结果分别比较,差异均无统计学意义(P>0.05)。(4)阴道镜检查:与未绝经组比较,绝经组阴道镜检查不充分的比例[分别为32.5%(511/1574)、87.5%(384/439)]、子宫颈Ⅲ型转化区的比例[分别为21.9%(344/1574)、80.0%(351/439)]、行子宫颈管刮取术(ECC)的比例[分别为20.5%(322/1574)、35.3%(155/439)]、ECC阳性率[分别为53.1%(171/322)、67.7%(105/155)]均显著增高(P<0.01);子宫颈病变累及阴道壁的比例也显著增高[分别为1.0%(16/1574)、5.9%(26/439);χ²=40.443,P<0.01],且绝经组患者累及阴道壁的病变的程度与子宫颈病变的程度呈显著正相关(r=0.660,P<0.01)。(5)锥切术后病理升级情况:与未绝经组比较,绝经组患者锥切术后切缘阳性率[分别为4.8%(75/1574)、14.6%(64/439)]、病理升级的比例[分别为5.5%(86/1574)、10.9%(48/439)]均显著增高(P<0.01)。结论绝经后妇女阴道镜检查常不充分,多为Ⅲ型转化区,病变更易累及子宫颈管及阴道壁,临床上应重视子宫颈管的搔刮及阴道壁的全面检查。绝经后妇女的锥切术后切缘阳性率高,锥切术后病理升级的比例高,常需进一步干预。     

Tamoxifen and proliferation of vaginal and cervical epithelium in postmenopausal women with breast cancer

Objective: The estrogenic effect of tamoxifen on vaginal and cervical epithelium in postmenopausal women with breast cancer is evaluated. Study Design: The tamoxifen group consisted of 92 postmenopausal breast cancer patients, the control group I of 30 postmenopausal women with breast cancer receiving no endocrine therapy and the control group II of 40 postmenopausal women without primary breast cancer taking no hormones. We determined the maturation index and the incidence of endocervical cell hyperplasia and metaplasia in cervical and vaginal smears. Results: The maturation index increased under tamoxifen within the first 24 months from 0.4011 before taking tamoxifen (n = 56) to 0.6039 (n = 138, P<0.0001). The maturation index in the group treated with tamoxifen was statistically significantly higher (P<0.0001) than in the control groups (control group I: 0.3975, P<0.0001; control group II: 0.4102, P<0.0001). Under therapy with tamoxifen endocervical cell hyperplasia (P=0.00156) and metaplasia (P=0.00123) appeared significantly more often. Conclusion: An apparent increase not only of the incidence of endocervical cell hyperplasia and metaplasia but also of the maturation of the vaginal epithelium caused by the estrogenic effect of tamoxifen could be demonstrated.     

Influence of menstrual cycle on NK activity

Natural killer (NK) cells are CD3⁻ CD56⁺ and/or CD16⁺ cytotoxic lymphocytes that mediate first-line defense against various types of target cells without prior immunization. To assess the effect of the menstrual cycle and gender on NK activity we evaluated 30 healthy women (mean age 28.1 years, range 21–39) in follicular and luteal phases, 29 postmenopausal women (mean age 58.8 years, range 42–72) and 48 healthy men (mean age 31.6 years, range 21–40). In a flow cytometric test of NK activity, peripheral blood mononuclear effector cells were mixed with K562 targets cells labeled with DiO (3,3′-dioctadecyloxacarbocyanine perchlorate) at effector:target cell ratios of 40, 20, 10 and 5:1. Dead cells were stained with propidium iodide and results were expressed as lytic units per 10⁷ cells. In addition, progesterone levels were determined in the luteal phase of the menstrual cycle of healthy women by a chemiluminescence assay. Our results showed that (1) NK cytotoxicity was higher in the follicular than in the luteal phase of the menstrual cycle (P<0.0001); (2) postmenopausal women and men showed NK activity similar to women in the folicular phase but higher than women in the luteal phase of the menstrual cycle (P<0.05); and (3) there was no correlation between NK activity and levels of progesterone. The data suggest that progesterone does not influence NK activity directly and that other factors may explain the reduction of NK activity in the luteal phase of the menstrual cycle.     

Using a computerized method to measure 99mTc pertechnetate uptake for the assessment of thyroid function: a clinical validation

This retrospective study evaluated thyroid function by the 99mTc pertechnetate uptake ratio, using computer software designed in our laboratory. We expected that this measurement could be a precise and accurate index. The following studies were performed on 187 patients: (1) 24-hour radioimmunoassay of serum thyroid hormones, including serum thyroxine, free T4, triiodothyronine, thyrotropin concentrations, and T3 resin uptake; (2) 99mTc pertechnetate thyroid imaging and uptake measurement; and (3) 24-hour 131I thyroid uptake. Based on the clinical findings and the results from the predescribed laboratory tests, we found that: (1) the mean value of the 99mTc pertechnetate thyroid uptake ratio in the euthyroid groups was 2.77 +/- 1.77% (mean +/- SD); (2) the correlation coefficient between the 99mTc pertechnetate thyroid uptakes and the 24-hour 131I uptakes of the euthyroid patients was 0.71; and (3) hyperthyroidism could be distinguished from euthyroid condition easily. By setting the upper limit of euthyroid 99mTc pertechnetate thyroid uptake at 6.31%, the diagnostic sensitivity was 92.9%, specificity 96.1%, and accuracy 95.6% in separating hyperthyroid from euthyroid patients. These values were similar to those determined by the 24-hour 131I uptake measurements. Thus, thyroid function can be evaluated simultaneously with a routine 99mTc pertechnetate thyroid scan. Both the patient time and cost can be saved with this method, since the measurement takes only 25 minutes. Decreased radiation exposure is another advantage of this method over the traditional 131I uptake measurement.     

Effect of long-term hormone substitution therapy on serum TSH level in postmenopausal women

OBJECTIVE: Dysfunction's of the thyroid gland are one of the most important endocrinological diseases. We report serum TSH levels in postmenopausal women before and during long-term hormone replacement therapy. MATERIAL AND METHODS: 107 postmenopausal patients participated in this study. Criteria for inclusion were: no known thyroid dysfunction and request for hormone replacement. Before starting therapy TSH serum levels were measured in each patient. If basal levels were within normal range TSH serum levels were reported over 4 years of hormone replacement therapy. RESULTS: More than 10% of the postmenopausal women showed pathological TSH-levels without clinical symptoms requiring further diagnostic. During subsequent treatment cycles (4 years) serum TSH in euthyroid patients did not show significant changes. Women using hormone replacement therapy developed no new manifestation of thyroid disease. CONCLUSION: In euthyroid women using long-term hormone replacement therapy are no changes in thyroid function caused by hormone replacement therapy to expect.     

双极汽化电切技术在绝经后妇女宫腔内病变的应用

目的　探讨双极汽化电切技术在绝经后妇女的良性宫腔病变的应用。方法　患者为 2 0 0 1年 1 0月～ 2 0 0 3年 4月于我院妇科病房收治的接受宫腔镜手术治疗的绝经后妇女。术后病理诊断为子宫内膜息肉或粘膜下子宫肌瘤的患者共 1 0 4例。患者分为A、B两组。A组 5 4例 ,给予双极系统电切除手术 (TCRP或TCRM) ;B组 5 0例 ,给予单极系统切除手术。手术在连续硬膜外麻醉下进行 ,应用Versapoint系统 (Gynecare)和单极电切(Olympus)系统。所得组织均送病理检查 ,证实诊断。结果　患者平均年龄 6 3 0± 6 2岁 (4 8～ 74岁 ) ,平均绝经时间 1 2 4± 7 4年 ,阴道分娩次数 2 0± 1 2次 (0～ 4次 ) ,1 5 38% (1 6 / 1 0 4例 )无阴道分娩史 ,4 0 38% (4 2 / 1 0 4例 )单独合并高血压等心血管疾病 ,5 77% (6 / 1 0 4例 )单独合并糖尿病 ,另 5 77% (6 / 1 0 4例 )同时合并高血压和糖尿病。A、B两组患者在平均年龄、绝经时间和阴道分娩次数相匹配。比较两组的手术结果 :术后均未见复发 ;B组 1例患者手术中发现子宫穿孔。A组平均手术时间较B组缩短 (P <0 0 5 ) ,差异有显著性。结论　在绝经后妇女的宫腔镜手术中 ,双极系统可以节省手术时间而且是比较安全 ,有效的。因此它在此类手术中有一定的发展前景     

Laryngeal cytological aspects in women with surgically induced menopause who were treated with transdermal estrogen replacement therapy

Objective: To investigate the effects of estrogen replacement therapy (ERT) on laryngeal cytology in postmenopausal women.

Design: Prospective open clinical trial.

Setting: Outpatient menopausal clinic in the Department of Gynecology, University of Catania, Catania, Italy.

Patient(s): Eighty-four healthy, surgically postmenopausal women, of whom 48 were treated with ERT and 36 were considered as a control group.

Intervention(s): Transdermal E₂ treatment by patches or gel, evaluation of laryngeal cytology with cytobrush by indirect laryngoscopy, and questionnaire for the voice history.

Main Outcome Measure(s): Changes in cytologic aspects of laryngeal cells with respect to vaginal cytology by hematoxylin and eosin staining; subjective voice changes.

Result(s): Sixty-seven women completed the study. Ten women from the ERT group and five from the control group dropped out because of the invasive laryngoscope method; two subjects in the control group were excluded because of pathologies of the vocal cord. Hematoxylin and eosin staining confirmed similar superficial-intermediate aspects of the cells between the laryngeal and the vaginal smears in ERT-treated women. In the control group, both smears showed aspects of atrophy-dystrophy. The ERT group had a subjectively better quality of voice than the control group.

Conclusion(s): Our study confirms that the larynx is an estrogen target, as are vaginal cells. ERT may provide prevention and treatment of dystrophic pathologies of the vocal cords in postmenopausal women.     

Lack of effect of isoflavonic phytoestrogen intake on leptin concentrations in premenopausal and postmenopausal women

Objective: To assess the effect of soy isoflavone ingestion on plasma leptin concentrations in premenopausal and postmenopausal women.

Design: Randomized, crossover studies, with blinding of participants and laboratory personnel.

Setting: Procedures involving free-living individuals were carried out at the University of Minnesota General Clinical Research Center.

Patient(s): Fourteen regularly cycling premenopausal women, and 18 postmenopausal women.

Intervention(s): Each premenopausal participant consumed, on a daily basis, each of three soy protein powders containing different levels of isoflavones for three menstrual cycles plus 9 days, with plasma samples collected every other day the last 6 weeks of each diet period. Similarly, each postmenopausal participant consumed each of the three powders for 93 days, with plasma samples collected daily on days 64 to 66 and 92 to 94 of each diet period. The powders, dosed on a per-kilogram body weight basis, provided mean isoflavone intakes of 8, 65, and 130 mg/day, for the control, low-isoflavone, and high-isoflavone diet periods, respectively.

Main Outcome Measure(s): Plasma leptin concentrations.

Result(s): Isoflavone intake had essentially no effect on leptin concentrations in either premenopausal or postmenopausal participants. Concentrations in the premenopausal women were higher during the periovulatory and midluteal phases as compared to the early follicular and midfollicular phases.

Conclusion(s): Despite the well-documented effect of estrogens to enhance leptin production, even high levels of isoflavone consumption do not alter leptin concentrations in women. Further studies are needed to more precisely delineate the nature of estrogenic and/or antiestrogenic effects of isoflavones in humans.     

Simplified therapy for Asherman''s syndrome

Objective: To evaluate a technique that converts a blind hysteroscopic procedure to a “septum” division.

Design: Open noncomparative clinical study.

Setting: Tertiary care center.

Patient(s): Six women with Asherman's syndrome; five with complete and one with incomplete obliteration of the uterine cavity.

Intervention(s): The patients underwent recreation of the uterine cavity by the hysteroscopic-laparoscopic technique described to establish the correct dissection plane.

Main Outcome Measure(s): The ability to reestablish the uterine cavity; postoperative resumption of menses and fertility.

Result(s): In all patients, the cavity of the uterus was restored; menses resumed in all women who were previously amenorrheic; and 5 women conceived, of whom four had live births and one a missed abortion. At hysteroscopy, two women incurred perforations and in another hemorrhage occurred.

Conclusion(s): This technique appears to be effective and safe for the reconstruction of a functional endometrial cavity in women with Asherman's syndrome.     

Acceptance of outpatient flexible hysteroscopy by premenopausal and postmenopausal women

OBJECTIVE: To compare tolerance for and feasibility of outpatient flexible hysteroscopy in premenopausal and postmenopausal women. STUDY DESIGN: A comparative, prospective study including 475 premenopausal and 216 postmenopausal women who underwent outpatient hysteroscopy without analgesia. RESULTS: Mean pain score was higher in postmenopausal patients (1.55 +/- 0.56 vs. 1.27 +/- 0.38 [P < .0001]). Outpatient flexible hysteroscopy was feasible without analgesia in 471/475 premenopausal (99.2%) and 210/216 postmenopausal women (97.2%) (P = .07). CONCLUSION: Outpatient flexible hysteroscopy was feasible and well tolerated; local anesthesia should be reserved for postmenopausal women.     

Effects of vaginal progesterone administration on uterine contractility at the time of embryo transfer

Objective: To investigate whether uterine contractility at the time of embryo transer (ET) can be reduced by early onset of luteal support with progesterone administered vaginally.

Design: Prospective analysis.

Setting: Assisted reproduction unit.

Patient(s): Eighty-four women undergoing 84 GnRH-a and FSH/hCG cycles for IVF-ET were studied.

Intervention(s): Vaginal progesterone was randomly started on the day of oocyte retrieval (group A, n = 43) or on the evening of ET (group B, n = 41). On the day of hCG administration and just before ET, 2-minute sagittal uterine scans were obtained by ultrasound and digitized with an image analysis system for assessing uterine contraction frequency.

Main Outcome Measure(s): Uterine contraction frequency.

Result(s): Whereas uterine contraction frequency was similar in both groups on the day of hCG (4.6 ± 0.3 and 4.5 ± 0.3 contractions per minute, respectively), only women in group A showed decreased uterine contraction frequency on the day of ET (2.8 ± 0.2 vs. 4.2 ± 0.3 contractions per minute).

Conclusion(s): Vaginal progesterone administration starting on the day of oocyte retrieval induced a decrease in uterine contraction frequency on the day of ET as compared with preovulatory values. Uterine relaxation before ET is likely to improve IVF-ET outcome by avoiding the displacement of embryos from the uterine cavity.     

Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial

Objective: To evaluate possible estrogenic effects of dong quai on vaginal cells and on endometrial thickness in postmenopausal women.

Design: Double-blind, randomized, placebo-controlled clinical trial.

Setting: Department of Obstetrics and Gynecology in a large health maintenance organization (HMO).

Patient(s): Seventy-one postmenopausal women (mean age [±SD], 52.4 ± 6 years) who had follicle-stimulating hormone levels (third-generation assay) of >30 mIU/mL with hot flashes.

Intervention(s): Subjects were randomized to treatment with either dong quai or placebo for 24 weeks.

Main Outcome Measure(s): Endometrial thickness was measured by transvaginal ultrasonography; vaginal cells were evaluated for cellular maturation; menopausal symptoms were evaluated by reviewing the Kupperman index and the diary of vasomotor flushes.

Result(s): We observed no statistically significant differences between groups in endometrial thickness, in vaginal maturation index, in number of vasomotor flushes, or in the Kupperman index.

Conclusion(s): Used alone, dong quai does not produce estrogen-like responses in endometrial thickness or in vaginal maturation and was no more helpful than placebo in relieving menopausal symptoms.     

Randomized, double-blind, placebo-controlled study of the effects of raloxifene and conjugated equine estrogen on plasma homocysteine levels in healthy postmenopausal women

Objective: To investigate the long-term effects of raloxifene on fasting plasma homocysteine levels in postmenopausal women compared with conjugated equine estrogen (CEE).

Design: Randomized, double-blind, placebo-controlled study.

Setting: Outpatient department of a university hospital.

Patient(s): Fifty-two hysterectomized, healthy postmenopausal women.

Intervention(s): Oral raloxifene in two dosages (60 mg/d [n = 13] and 150 mg/d [n = 13]), oral CEE (0.625 mg/d [n = 13], and placebo (n = 13) were given for 24 months.

Main Outcome Measure(s): Fasting plasma homocysteine concentrations.

Result(s): Plasma homocysteine levels were not altered in the placebo group. After 12 months, a significant reduction versus baseline in the mean plasma homocysteine level (−16%) was found only in the raloxifene 150-mg group. The mean change in plasma homocysteine levels within this group also was significantly different from the changes versus baseline found in the placebo group (+2%) and the raloxifene 60-mg group (−2%), but not different from those found in the CEE group (−8%). After 24 months, plasma homocysteine levels were decreased significantly in the raloxifene 150-mg and CEE groups compared with both baseline (−13% and −10%, respectively) and placebo values (−15% and −11%, respectively). No significant change in plasma homocysteine levels was observed in the raloxifene 60-mg group.

Conclusion(s): Raloxifene has a favorable, dose-related effect on plasma homocysteine levels in postmenopausal women.     

Altered binding of serum thyroid hormone to thyroxine-binding globulin in women with functional hypothalamic amenorrhea

Objective: To further characterize hypothyroidemia with decreased serum concentrations of total triiodothyronine and total T₄ in women with functional hypothalamic amenorrhea.

Design: Cohort study.

Setting: University of California San Diego Clinical Research Center.

Patient(s): 8 women with functional hypothalamic amenorrhea (hypogonadotropic or normogonadotropic amenorrhea of at least 6 months duration) and 9 normal cycling women in the early follicular phase of their cycles.

Intervention(s): 24-hour frequent blood sampling.

Main Outcome Measure(s): Comparison of levels of thyroid hormones and binding proteins between functional hypothalamic amenorrhea and normal cycling women. Measurements of serum free T₄, free triiodothyronine, total T₄, total triiodothyronine, reverse triiodothyronine, thyroid-binding globulin, albumin, and prealbumin levels and determination of T₄ binding and binding affinity to each of the three binding proteins.

Result(s): The results confirmed reduced levels of total triiodothyronine and total T₄, but revealed no significant difference in free triiodothyronine and free T₄, as well as reverse triiodothyronine, levels between functional hypothalamic amenorrhea and normal cycling women. Although serum levels of thyroid hormone-binding proteins were similar between normal cycling women and functional hypothalamic amenorrhea, a significant decrease in T₄ bound to thyroid binding globulin along with a decrease in apparent affinity of thyroid-binding globulin for T₄ was present in functional hypothalamic amenorrhea. No differences in prealbumin-or albumin-T₄ interactions were found.

Conclusion(s): In functional hypothalamic amenorrhea, a reduced thyroid-binding globulin binding affinity appears to explain the disparity between normal levels of free triiodothyronine, free T₄, and binding proteins in the face of reduced levels of total triiodothyronine and total T₄.     

A randomized comparison of continuous combined transdermal delivery of estradiol-norethindrone acetate and estradiol alone for menopause. CombiPatch Study Group.

OBJECTIVE: To determine whether a continuous estradiol-norethindrone acetate transdermal delivery system reduces incidence of endometrial hyperplasia in postmenopausal women more than transdermal estradiol (E2) alone. METHODS: Six hundred twenty-five postmenopausal women were assigned randomly to one of four treatments, transdermal E2 50 microg/day, or transdermal E2-norethindrone acetate with 50 microg E2 and 140, 250, or 400 microg/day of norethindrone acetate. Follow-up visits to collect information on safety and efficacy were scheduled at 3, 6, 9, and 12 months after initiation of treatment. Endometrial biopsy for histologic evaluation was done at baseline and upon exit from the study (completion or withdrawal). Endometrial histology was evaluated by two independent gynecologic pathologists. In the event of a disparate reading, a third gynecologic pathologist evaluated the tissue using predetermined criteria. RESULTS: Endometrial hyperplasia was found in 37.9% (39 of 103) in the E2 alone group versus 0.8% (one of 123), 1% (one of 98), and 1.1% (one of 89) in the E2-norethindrone acetate 50-140, 50-250, and 50-400 groups, respectively (P < .001). Uterine bleeding was less frequent in the E2-norethindrone acetate 50-140 group than other treatments. The mean number of hot flushes per day decreased to less than one in each treatment group at endpoint. The E2-norethindrone acetate combination patch showed skin tolerance comparable to that of E2 alone. CONCLUSION: Continuous transdermal delivery of E2 combined with norethindrone acetate effectively prevented endometrial hyperplasia in healthy postmenopausal women. Continuous combined transdermal delivery systems provide increased dosing flexibility and might improve convenience and compliance with hormone replacement therapy.     

Long-term estrogen replacement is associated with improved nonverbal memory and attentional measures in postmenopausal women

Objective: To determine the cognitive domains improved or preserved by long-term hormone replacement therapy (HRT).

Design: A comprehensive neuropsychological test battery was administered to healthy postmenopausal women who had been treated or not treated with long-term HRT without interruption since menopause.

Setting: Women were recruited by advertisement from a university town and surrounding areas.

Patient(s): Women 60 years or older were studied who were treated (n = 16) or not treated (n = 13) with HRT.

Intervention(s): Neuropsychological testing included tests of memory, verbal fluency, executive functions, attention and concentration, and psychomotor function. Tests of intellectual function, depressive symptoms, and emotional functioning assessed general functions and comparability of the groups.

Main Outcome Measure(s): Neuropsychological testing scores were compared between groups.

Result(s): No statistically significant differences between the groups were found for general demographic, intellectual, and psychological measures. Scores from both the Weschler Memory Scale Visual Reproduction (delayed recall) and the Digit Vigilance Test (attention) showed statistically significant better performance and fewer errors in the group of women on HRT.

Conclusion(s): Long-term postmenopausal HRT is associated with higher scores in tests of nonverbal memory and attention.     

妊娠早期甲状腺激素水平与妊娠期糖尿病的相关性研究

目的探讨甲状腺激素水平与妊娠期糖尿病(gestational diabetes mellitus, GDM)的相关性。 方法选择2013年1月至2014年12月在广州医科大学附属第六医院门诊进行规律产前检查的1 329例孕妇为研究对象进行回顾性研究,所有孕妇均在11～13^＋6周行甲状腺功能检测并于24～28周行口服葡萄糖耐量试验,315例GDM患者为研究组,1 014例糖耐量正常患者为对照组,分析两组患者的年龄、甲状腺激素水平与GDM的相关性。 结果(1)年龄：研究组年龄为(28.7±5.2)岁,对照组为(27.5±4.5)岁,研究组较对照组高(t＝3.815,P<0.001);(2)游离型四碘甲状腺原氨酸(FT₄)：研究组为(9.59±2.18)pmol/L,较对照组(10.04±2.97)pmol/L降低,两组比较(t＝－2.479,P<0.05);(3)Logistic回归分析提示：FT₄为GDM保护因素(OR＝0.912,95%CI为0.851～0.977),年龄为危险因素(OR＝ 1.049,95%CI为1.022～1.078)。 结论妊娠早期FT₄水平和高龄与妊娠期糖尿病发生相关。     

Percutaneous vasal sperm aspiration and intrauterine insemination in the treatment of obstructive azoospermia

Objective: To treat obstructive azoospermia by using sperm recovered from percutaneous vasal sperm aspiration in IUI.

Design: Clinical study.

Setting: Institutional clinic in Jinan.

Patient(s): Six men with obstructive azoospermia, three of whom were treated with percutaneous vasal sperm aspiration and IUI; sperm recovered from this procedure were used for IUIs.

Intervention(s): Spermatozoa used for intrauterine injection were retrieved by percutaneous vasal sperm aspiration and incubated at 37°C for 40 to 60 minutes.

Main Outcome Measure(s): Normal pregnancy.

Result(s): Intrauterine insemination was performed in three patients for one or two cycles, with motile spermatozoa. There was one successful term delivery.

Conclusion(s): Percutaneous vasal sperm aspiration can be used successfully to recover sperm in men with obstructive azoospermia for use in IUI. The technique is simple and less traumatic than an open surgical procedure.