Letrozole and desogestrel-only contraceptive pill for the treatment of stage IV endometriosis

BACKGROUND: It has recently been suggested that aromatase inhibitors may effectively reduce pain symptoms related to the presence of endometriosis both in postmenopausal women and in subjects of reproductive age. AIMS: This study aims to evaluate the effectiveness of a combination of letrozole and desogestrel in the treatment of pain symptoms related to the presence of endometriosis. METHODS: This open-label prospective study included 12 women with endometriosis-related pain symptoms that were refractory to previous medical and surgical treatments. All women had previous laparoscopy documenting stage IV endometriosis. The treatment protocol included the daily oral administration of letrozole 2.5 mg (Femara), desogestrel 75 microg (Cerazette), elemental calcium 1000 mg and vitamin D 880 I.U. The scheduled treatment period was six months. RESULTS: None of the women included in the study completed the six-month treatment because all patients developed ovarian cysts; the median length of treatment was 84 days (range, 56-112). At interruption of treatment, all women reported significant improvements in dysmenorrhoea and dyspareunia. Pain symptoms quickly recurred at three-month follow up. There were no severe adverse effects of treatment; no significant change in the mineral bone density was observed during treatment. CONCLUSIONS: The combination of letrozole and desogestrel induces a relief of pain symptoms in women with endometriosis but it causes the development of ovarian cysts. Pain symptoms quickly recur after the completion of treatment.     

Splenosis: An Unusual Cause of Pelvic Pain

A 37-year-old woman, G4P2A2 presented to her gynaecologist with a six-month history of pelvic pain and deep dyspareunia. Her past medical history was significant for a traumatic splenic rupture at age six which required immediate splenectomy. Pelvic ultrasound and subsequent laparoscopy revealed the presence of a solid pelvic mass. At the time of exploratory laparotomy, a diagnosis of splenosis was made: four splenules were found filling the cul-de-sac, as well as two splenules over the transverse colon. Her symptoms were subsequently much relieved by the removal of the uterus and of the four autotransplanted spleens.     

Diagnosis and Treatment of Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM), formerly referred to as vulvovaginal atrophy or atrophic vaginitis, is a common chronic condition that requires a collaborative treatment plan between a health care provider and a woman to relieve symptoms and improve quality of life. Many women are not aware that symptoms can be controlled with treatment. Current treatment options approved for GSM include vaginal moisturizers, lubricants, and hormones. For women with GSM symptoms that are unresponsive to nonhormonal therapy, low-dose vaginal estrogen therapy is the preferred pharmacologic treatment. Clinicians should be trained to routinely ask appropriate questions during the history to elicit sufficient information to assess for GSM. Physical examination findings may further confirm suspicion of GSM.     

Women's quality of life and sexual function after transvaginal anterior repair with mesh insertion

Objective

Current evidence about the impact of pelvic floor surgery on sexual function is conflicting. Only a few studies have reported with validated questionnaires on sexual function after transvaginal mesh repair, with a discrepancy in reported outcomes. The aim of this study was to prospectively explore the impact of anterior repair (AR) with mesh insertion on sexual function, quality of life and dyspareunia.

Study design

69 women with symptomatic stage II or greater prolapse exclusively of the anterior compartment participated in a prospective study on safety and efficacy of two mesh implantation techniques for anterior vaginal wall prolapse repair between September 2007 and May 2009. They were invited to complete the validated condition-specific short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and quality of life (QoL) questionnaires (Pelvic Organ Prolapse (POP) Distress Inventory (POPDI), Urinary Distress Inventory (UDI), POP Impact Questionnaire (POPIQ), and Urinary Impact Questionnaire (UIQ)) pre-operatively and 6 months post-operatively. All data were processed and analyzed in Statistical Computing Environment R, version 2.9.1.

Results

A significant decrease of Qol scores and a significant increase of PISQ-12 scores occurred after surgery. All sexually active women resumed sexual activity postoperatively. The majority of non-sexually active women remained sexually inactive. Postoperatively the frequency of pain during intercourse increased in 31% of cases and decreased or stayed unchanged in 69% of cases. The incidence of de novo dyspareunia after mesh repair was 4% while the incidence of dyspareunia slightly increased from 25% to 29% postoperatively.

Conclusions

The results of this study suggest no deterioration in sexual function, a significant improvement in quality of life and a low incidence of de novo dyspareunia six months after AR with mesh insertion. Despite these findings, the majority of non-sexually active women remain sexually inactive postoperatively. These conclusions should be confirmed in a longer follow-up.     

Impact of endometriosis on quality of life: A pilot study

Endometriosis affects 6–10% of women in reproductive age, 35–50% of whom experience pain, infertility or both. Mild cases are managed medically but surgery provides relief to women in pain. However, symptoms recur in 75% of cases within 2 years. We investigated the impact of endometriosis on quality of life among 65 women aged 18–60 years working at a city supermarket in Giessen, Germany. Of the 65 women, 12 had undergone surgeries, 22 had dysmenorrhoea, 24 dyspareunia and 3 were infertile. Of the 22 women with dysmenorrhoea, 10 had difficulties performing gardening, housework, sports and leisure activities. Five of these 10 women experienced social isolation, 6 professional setbacks; 6 declined efficiency at work and 3 had taken time off work. Of the 24 women with dyspareunia, 7 experienced minimal, 12 light and 5 moderate to strong pain. Only 16 of these 24 women discussed the problem with their partners. This study demonstrates that pain is a major cause of physical, psycho-social, emotional and professional or work related impairment among women with endometriosis. Because endometriosis is likely to impose emotional and financial burdens, we suggest that future studies should be extended to include interviews with family members.     

Psychosexual disorders

Consultations in the gynaecology clinic should seek to understand the patient's problem and the effect on their quality of life and physical and psychological health. All unexpected symptoms may be expressed in various ways, often not corresponding with the doctor's categorisation. Frequently psychosexual disorders are therefore not addressed. Understanding sexual problems by using psychosexual skills and understanding human sexuality, will help management, using a mind-body approach and combining treatment of the physical complaints and exploring psychological distress.     

Sex therapy for the chinese in hong kong

Despite the availability of the Chinese self-help and traditional treatments for sexual dysfunctions, sex therapy using a modified Masters & Johnson technique is receiving growing acceptance in Hong Kong, In a series of 60 cases referred for treatment, 48 cases were given sex therapy with a success rate of 58.3%. Further development of sex therapy in Hong Kong has to be supported by improvements in sex education for doctors and the general public and a better understanding and utilisation of traditional Chinese sexual beliefs and treatment methods.