Ospemifene plus fractional CO2 laser: a powerful strategy to treat postmenopausal vulvar pain

Abstract

This study is a single-center, retrospective analysis of postmenopausal women presenting with dyspareunia and vulvar pain, aiming to evaluate relative effectiveness of vestibular CO₂ laser therapy as a treatment. Three monthly sessions of laser were performed to each patient and thereafter a three-months follow-up was stablished. A total number of 72 patients undergoing vestibular laser treatment were recruited from patient files in the period between 2016 and 2018. Among these, 39 women also received a concomitant treatment with ospemifene (60?mg/day) during the study period. There was a statistically significant reduction of all the symptoms in both groups up to the three month follow-up. Regarding dryness and dyspareunia, the relief tent to be more prominent in the ospemifene?+?laser group at all follow-ups and remained statistically significant at three-month follow-up. Specifically, vestibular dryness was significantly lower in the ospemifene?+?laser group compared with the laser treatment group (?87% vs???34%, respectively), and the vestibular health score started declining faster in the ospemifene?+?laser group. Although, additional research is needed to understand the mechanism of action, our data shows that a combination regimen of laser and ospemifene may improve clinical effectiveness for long-term treatment of symptoms associated with the under-recognized genitourinary syndrome of menopause.     

按压骨穴调节围绝经期妇女心脏植物神经功能的研究

目的观察按压骨穴对围绝经期妇女心脏植物神经功能的影响。方法设按压骨穴组30例、空白对照组30例。用美国BraemarDL700型动态心电检测仪,检测试验前后的心率变异性(HRV):TF代表总频,LF代表交感神经活性,HF代表迷走神经活性,LF/HF代表交感神经与迷走神经均衡性。结果按压骨穴后4项指标均有显著下降(P<0.01,P<0.05)。空白对照组变化不显著(P>0.05)。骨穴组4项指标的变化率与对照组比较均有显著性差异(P<0.01)。结论按压骨穴有抑制心脏交感神经活性的良性调整作用,此效应具有相对的特异性。     

Gingival crevicular fluid IL-8: correlation with local IL-1β levels and patient estrogen status

Gingival crevicular fluid (GCF) IL-8 and IL-1,1β levels were determined by sandwich enzyme-linked immunosorbent assays. Associations between IL-8 and IL-1β GCF levels, and between these cytokines and patient estrogen status were evaluated. IL-8 and IL-1β were detected more frequently and in higher amounts/30 s GCF sample in estrogen-deficient patients than in estrogensufficient patients. IL-8 and IL-1β GCF levels were significantly correlated. These lindings suggest that GCF IL-8 levels are associated with patient estrogen status and local IL-1β concentrations.     

Effect of female sex hormone supplementation and withdrawal on gastrointestinal and colonic transit in postmenopausal women

Females are disproportionately affected by constipation, which is often aggravated during pregnancy. Bowel function also changes during the luteal phase of the menstrual cycle. The aim was to compare the effects of acute administration of female sex steroids on gastric emptying, small bowel transit and colonic transit in healthy postmenopausal subjects. A second aim was to determine whether withdrawal of the hormones was associated with a change in transit. Forty-nine postmenopausal females were randomized to receive for 7 days 400 mg day(-1) micronized progesterone, 0.2 mg day(-1) oestradiol, combination of the two, or placebo. Treatment groups were balanced on age. Participants underwent whole gut transit measurement by scintigraphy using a 99m-labeled technetium-egg meal and 111-labeled indium-charcoal via a delayed-release capsule. Transit measurement was repeated after withdrawal of the study medications. The primary endpoints were ascending colon (AC) emptying half-life time (t1/2) and colonic geometric centre (GC) at 24 h. Secondary analysis variables were GC at 4 and 48 h, gastric emptying t1/2 and colonic filling at 6 h. There was a significant overall effect of progesterone on colonic transit with shorter AC emptying t1/2 and significantly greater colonic GC at 48 h. No transit endpoints were altered by oestradiol or combined hormonal treatment relative to placebo. Oestradiol and progesterone resulted in looser stool consistency. Withdrawal of the hormone supplement was not associated with significant alteration in transit. Micronized progesterone does not retard colonic transit in postmenopausal females.     

Endocrinology: Gonadotrophins and prolactin rise after bilateral oophorectomy for benign conditions

The aim of this study was to analyse the changes in folliclestimulating hormone (FSH), luteinizing hormone (LH) and prolactinconcentrations in the 3 months following oophorectomy in pre-menopausalwomen operated on for benign gynaecological conditions. Includedin this analysis were 21 women (mean age 47 years, range 46–52)who underwent bilateral oophorectomy plus hysterectomy for fibroidsor ovarian cysts. Plasma concentrations of FSH, LH and prolactinwere measured before and on days 2, 4, 6, 14 and 30 after surgery;in 10 cases measurements were made on day 60, and in five caseson day 90 after surgery. Hormone concentrations were measuredin duplicate daily samples, and immunoenzymatic assay kits wereused for all the immunoassays. The FSH and LH concentrationsincreased constantly after surgery. Mean prolactin concentrationsalso increased from 12.1 ng/ml before surgery to 31.5 ng/mlon day 14 after bilateral oophorectomy, but decreased thereafterto 18.2 ng/ml on day 30, 10.9 ng/ml on day 60 and 6 ng/ml onday 90. In conclusion, transient (2–3 weeks) increasedprolactin concentrations are observed after surgical castration.     

复方保元煎对绝经后CHD患者脂代谢和血流变影响的研究

目的:研究复方保元煎对绝经后冠心病(CHD)患者脂代谢、血流变的影响。方法:观察180例患者,随机分为治疗组102例,对照组78例。治疗组采用中药复方保元煎治疗,对照组采用维尼安治疗,分别于治疗前后测定脂代谢、血流变指标。结果:治疗后两组脂代谢、血流变指标均有不同程度的改变。治疗组在降低总胆固醇(TC)、甘油三酯(TG),低密度脂蛋白(LDL-C)、载脂蛋白B(apoB)、血流变指标优于对照组(P<0.05或P<0.01)。结论:复方保元煎能改变血脂代谢、调节血黏度,对预防和逆转绝经后的CHD的发生和发展有积极的治疗作用。     

Cyclic hormonal replacement therapy after the menopause: Transdermal versus oral treatment

Summary In an open, randomized, comparative, between-patient trial, 45 postmenopausal women were treated for 4 months with cyclical transdermal oestradiol 0.05 mg per day or oral conjugated equine oestrogens 0.625 mg per day, in both cases, plus, medroxyprogesterone acetate 10 mg per day on the last 8 days of each cycle. Similar relief from postmenopausal symptoms was obtained with both treatments. Post-treatment histological evaluation of the endometrium did not reveal neoplastic or hyperplastic change in any patient.Early follicular-phase plasma oestradiol levels were observed only after transdermal oestradiol. There was a significant reduction in serum total cholesterol and LDL cholesterol in both treatment groups, with no difference between treatments, whereas serum triglyceride levels were decreased only by transdermal oestradiol. Plasma calcium and phosphorus fell significantly and serum intact parathyroid hormone rose significantly, with no difference between the therapies. No significant changes were observed in clotting factors.Transdermal oestradiol appears to be an effective and safe hormonal replacement therapy, and this route of administration may be responsible for the more useful action of the drug on serum lipids and plasma oestradiol levels.     

黄豆苷元胶囊治疗围绝经期综合症疗效观察

目的评价黄豆苷元胶囊治疗围绝经期综合症的有效性。方法60例围绝经期妇女随机分为黄豆苷元组(32例)和对照组(28例),黄豆苷元组口服黄豆苷元胶囊150mg·d-1,对照组口服倍美力片0.625mg·d-1,两组连续治疗3个月。用药前及用药3个月后观察围绝经期征候群,测血清E2,FSH,LH及脂蛋白,并观察药物不良反应。结果两组围绝经期征候群均有显著改善,FSH,LH均显著下降,E2均显著上升,两组比较差异无显著性;两组TC,TG,LDL均有明显下降,HDL略有上升,黄豆苷元组变化略大于对照组,但差异无显著性。胃肠道反应、阴道出血、乳房肿胀发生率黄豆苷元组分别为:12.5%,0,0,对照组分别为:42.9%,75%,21.4%,两组比较有显著差异。结论黄豆苷元胶囊对围绝经期综合征有显著疗效,而且药物副作用小。     

Bone density patterns after normal and premature menopause

Objectives: The investigation of the effect of time and type of menopause on bone mineral density (BMD) at different ages. Methods: Five hundred and fourteen women, who had never received any hormonal substitution were studied in a cross-sectional design: 177 with normal (NMP), 210 with surgical (SUMP) and 127 with premature natural (EMP) menopause. Age at menopause was 49.1±3.9, 38.3±4.7 and 38.1±4.2 years (mean±1 S.D.), respectively. BMD was measured at L2–L4 vertebrae and proximal femur by the DEXA method. Results: EMP women presented significantly lower vertebral BMD than NMP women in the 45–55-years segments (P<0.001), but did not differ from SUMP women. This group exhibited lower vertebral BMD than NMP between 45 and 50 years (P<0.001). Regarding femoral neck, EMP women exhibited lower values than SUMP in the 45–50 and 55–65 age segments (P<0.001) whereas SUMP women presented significantly higher BMD values than NMP women after 55 years of age (P<0.001). The percentages of women with vertebral BMD (T-score values) in the osteoporotic range were significantly greater in EMP compared with either NMP or SUMP groups (both P<0.001) whereas in femoral neck lower in SUMP than the other two categories. Conclusions: Women with either natural or surgical premature menopause exhibit lower BMD of trabecular bone compared with normal menopause women at the age segments 45–55 and 45–50, respectively. However, surgical menopause women exceed normal menopause women in their mixed bone BMD values after 60 years as well as premature natural menopause women at almost all age segments.