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Cureus Dec 2023The prevalence of isthmocele or caesarean scar niche is increasing nowadays. This is largely attributed to the increasing rate of caesarean deliveries globally,...
The prevalence of isthmocele or caesarean scar niche is increasing nowadays. This is largely attributed to the increasing rate of caesarean deliveries globally, although the growing awareness among gynaecologists and assisted reproductive technology specialists may contribute to the more frequent diagnosis of isthmocele. Although the presenting complaints, diagnosis, and management of isthmocele are discussed extensively in the literature, this case of large isthmocele with a large degenerated false broad ligament myoma, which caused diagnostic dilemma both preoperatively and postoperatively, needs a special mention. This is one such case of large isthmocele rarely reported in perimenopausal women obscured by concomitant uterine pathology like degenerating large broad ligament fibroid. This also stresses the need for awareness and application of various techniques, such as the Halloween sign, for the proper diagnosis of the emerging but treatable complication of the most common surgery performed worldwide.
PubMed: 38269228
DOI: 10.7759/cureus.51055 -
Nursing Open Jan 2024The aim of the study was to explore and understand the organizational culture of a workplace in terms of support and well-being for staff experiencing perimenopausal and... (Review)
Review
AIM
The aim of the study was to explore and understand the organizational culture of a workplace in terms of support and well-being for staff experiencing perimenopausal and menopausal symptoms at work.
DESIGN
It is widely acknowledged that perimenopause and menopause symptoms are experienced by a large percentage of the female workforce. There is a lack of research into how nurses are supported through menopause (Cronin et al. Issues in Mental Health Nursing, 42, 2021, 541-548). The perimenopause and menopause transition can be a challenging time where many may require symptom management and support (RCN, The Menopause and Work: Guidance for RCN Representatives, 2020). This paper presents a case study research (CSR) approach to examine one healthcare organization.
METHODS
CSR design was used: A survey distributed to all staff employed, a review of the available documentation on menopause and interviews with managers from different levels of the organization. The COREQ consolidated criteria was used for reporting the qualitative research reported this study.
RESULTS
The case study generated both quantitative and qualitative data using surveys, interviews and documentation. Data from the organization (n = 6905) showed a majority female workforce of 81.9% with 40.6% aged between 41 and 55 years old, meaning a third of the organization working through perimenopause and menopause. Survey responses (n = 167) collected biographical and psychometric data on the prevalence of perimenopausal and menopausal symptoms. Seven managers were interviewed highlighting two themes: Access to support and culture of menopause and 13 documents from the organization on menopause were analysed for content. The study design permitted an iterative approach to data collection and providing an in-depth understanding of the needs and support for those experiencing perimenopause and menopause. The findings help healthcare organizations to understand their workforce and take in to account the larger numbers of female employees particularly nurses with the need to provide person-centred support mechanisms and an organizational approach for all employees.
Topics: Female; Humans; Adult; Middle Aged; Menopause; Perimenopause; Case-Control Studies; Workforce; Research Design
PubMed: 38268277
DOI: 10.1002/nop2.2058 -
Frontiers in Endocrinology 2023Sex steroids are essential for whole body development and functions. Among these steroids, 17β-estradiol (E2) has been known as the principal "female" hormone. However,... (Review)
Review
Sex steroids are essential for whole body development and functions. Among these steroids, 17β-estradiol (E2) has been known as the principal "female" hormone. However, E2's actions are not restricted to reproduction, as it plays a myriad of important roles throughout the body including the brain. In fact, this hormone also has profound effects on the female brain throughout the life span. The brain receives this gonadal hormone from the circulation, and local formation of E2 from testosterone aromatase has been shown. Therefore, the brain appears to be not only a target but also a producer of this steroid. The beneficial broad actions of the hormone in the brain are the end result of well-orchestrated delayed genomic and rapid non-genomic responses. A drastic and steady decline in circulating E2 in a female occurs naturally over an extended period of time starting with the perimenopausal transition, as ovarian functions are gradually declining until the complete cessation of the menstrual cycle. The waning of endogenous E2 in the blood leads to an estrogen-deficient brain. This adversely impacts neural and behavioral functions and may lead to a constellation of maladies such as vasomotor symptoms with varying severity among women and, also, over time within an individual. Vasomotor symptoms triggered apparently by estrogen deficiency are related to abnormal changes in the hypothalamus particularly involving its preoptic and anterior areas. However, conventional hormone therapies to "re-estrogenize" the brain carry risks due to multiple confounding factors including unwanted hormonal exposure of the periphery. In this review, we focus on hot flushes as the archetypic manifestation of estrogen deprivation in the brain. Beyond our current mechanistic understanding of the symptoms, we highlight the arduous process and various obstacles of developing effective and safe therapies for hot flushes using E2. We discuss our preclinical efforts to constrain E2's beneficial actions to the brain by the DHED prodrug our laboratory developed to treat maladies associated with the hypoestrogenic brain.
Topics: Female; Humans; Estradiol; Estrogens; Hot Flashes; Brain; Genomics
PubMed: 38260155
DOI: 10.3389/fendo.2023.1310432 -
Journal of Clinical Medicine Jan 2024(1) Background: Women in their middle years undergoing perimenopause encounter a range of physical and psychological alterations attributed to hormonal changes. The... (Review)
Review
(1) Background: Women in their middle years undergoing perimenopause encounter a range of physical and psychological alterations attributed to hormonal changes. The prominent symptoms among menopausal women are depressive symptoms and sleep-related problems. The aim of this study was to conduct a meta-analysis examining the effects of Cognitive Behavioral Therapy (CBT) on women going through menopause, specifically focusing on depressive symptoms and sleep problems. We analyzed studies conducted both within the country and across international settings over the last decade. (2) Methods: A search of the literature was conducted-a targeted search, exclusively considering randomized controlled trials (RCTs) that were published within the timeframe spanning from 15 June 2013 to 15 June 2023. (3) Findings: Upon reviewing nine studies that satisfied our inclusion criteria and involved a total of 923 participants, it was noted that four of these studies incorporated diverse cognitive-behavioral strategies. Among the nine studies, a total of four were included in the meta-analysis: two measured depressive symptoms, and two measured sleep quality. The combined effect size for depressive symptoms was found to be 3.55 (95% confidence interval: -5.48, -1.61; < 0.05), and for sleep quality, it was 0.78 (95% confidence interval: -1.32, -0.25; = 0.004). (4) Conclusions: Our review emphasizes the necessity for conducting larger-scale studies focused on the application of CBT for women experiencing menopausal symptoms. Additionally, it is recommended to approach the interpretation of these results with caution due to discrepancies in methodology and the overall quality of the studies. Further clinical trials are necessary to establish the ideal number of CBT sessions needed for the effective treatment of depression in menopausal women. Future studies should cover a wider range of geographical locations, including more countries, and focus on various outcomes such as depressive symptoms and sleep quality.
PubMed: 38256545
DOI: 10.3390/jcm13020412 -
Biomedicines Jan 2024Perimenopausal depression, occurring shortly before or after menopause, is characterized by symptoms such as emotional depression, anxiety, and stress, often accompanied... (Review)
Review
Perimenopausal depression, occurring shortly before or after menopause, is characterized by symptoms such as emotional depression, anxiety, and stress, often accompanied by endocrine dysfunction, particularly hypogonadism and senescence. Current treatments for perimenopausal depression primarily provide symptomatic relief but often come with undesirable side effects. The development of agents targeting the specific pathologies of perimenopausal depression has been relatively slow. The erratic fluctuations in estrogen and progesterone levels during the perimenopausal stage expose women to the risk of developing perimenopausal-associated depression. These hormonal changes trigger the production of proinflammatory mediators and induce oxidative stress, leading to progressive neuronal damage. This review serves as a comprehensive overview of the underlying mechanisms contributing to perimenopausal depression. It aims to shed light on the complex relationship between perimenopausal hormones, neurotransmitters, brain-derived neurotrophic factors, chronic inflammation, oxidative stress, and perimenopausal depression. By summarizing the intricate interplay between hormonal fluctuations, neurotransmitter activity, brain-derived neurotrophic factors, chronic inflammation, oxidative stress, and perimenopausal depression, this review aims to stimulate further research in this field. The hope is that an increased understanding of these mechanisms will pave the way for the development of more effective therapeutic targets, ultimately reducing the risk of depression during the menopausal stage for the betterment of psychological wellbeing.
PubMed: 38255289
DOI: 10.3390/biomedicines12010184 -
Cureus Dec 2023A nipple adenoma is an epithelial tumor of the lactiferous ducts, typically affecting women aged 50-60 years old. This case report discusses a 52-year-old woman who...
A nipple adenoma is an epithelial tumor of the lactiferous ducts, typically affecting women aged 50-60 years old. This case report discusses a 52-year-old woman who developed a papillary adenoma of the right nipple after initiating oral estrogen replacement therapy (ERT) for perimenopausal symptoms. A 4 mm punch biopsy and subsequent immunohistochemistry stain revealed the proliferation of ductal structures consistent with a papillary adenoma and tumor cells expressing estrogen receptors (ER) and progesterone receptors (PR). Despite their benign nature, nipple adenomas may exhibit alterations in immunophenotype, including ER and PR expression, which could lead to potential tumor growth in women undergoing these treatments. This case describes the first reported growth of a nipple adenoma in the context of estrogen replacement therapy, highlighting a potential risk of hormone therapy in promoting hyperproliferation of benign tumors such as nipple adenomas. When utilizing ERT, it is important to weigh the potential advantages and risks, as its application in the management of vasomotor symptoms during menopause may increase the risk of both breast cancer and benign proliferative breast diseases. These considerations underscore the need for individualized therapy when approaching perimenopausal and postmenopausal care.
PubMed: 38249210
DOI: 10.7759/cureus.50843 -
Fertility and Sterility Mar 2024Fibroids significantly impact the quality of life (QOL) and mental health of affected women. However, there are limited comparative data on QOL measures after medical,... (Review)
Review
Fibroids significantly impact the quality of life (QOL) and mental health of affected women. However, there are limited comparative data on QOL measures after medical, surgical, and radiologic interventions in women with fibroids. This study aimed to assess the current literature evaluating the impact of fibroids on QOL measures using several validated questionnaires for radiologic, medical, or surgical interventions or a combination of interventions before and after treatment. PubMed, PsycINFO, ClinicalTrials.gov, Embase, and Cochrane Library were searched from January 1990 to October 2023 to evaluate the available evidence, and the risk of bias was assessed using Cochrane RoB 2.0 or the Newcastle-Ottawa Scale. The review criteria included randomized controlled trials (RCTs) and observational cohort studies that included premenopausal women with symptomatic uterine fibroids, confirmed by imaging, who underwent an intervention to target fibroid disease. Only reports using validated questionnaires with a numerical baseline (pretreatment) and posttreatment scores were included. The exclusion criteria included perimenopausal or postmenopausal patients, conditions in addition to uterine fibroids that share similar symptoms, or studies that did not focus on QOL assessment. Abstracts were screened, and full texts were reviewed to determine whether studies met the inclusion criteria. A total of 67 studies were included after final review: 18 RCTs and 49 observational studies. All interventions were associated with a significant improvement in uterine fibroid-specific QOL measures, mental health metrics, and a reduction in symptom severity scores after treatment. These data reveal a substantial impact of uterine fibroids on the QOL and mental health of women with fibroids and indicate the metrics that can be used to compare the effectiveness of fibroid treatment options.
Topics: Female; Humans; Uterine Neoplasms; Mental Health; Leiomyoma; Quality of Life; Cohort Studies
PubMed: 38246400
DOI: 10.1016/j.fertnstert.2024.01.021 -
BMJ Open Jan 2024To evaluate the hospitalised patients with uterine fibroids (UFs) and describe treatment patterns in hospital-treated patients in central China from 2018 to 2021.
OBJECTIVE
To evaluate the hospitalised patients with uterine fibroids (UFs) and describe treatment patterns in hospital-treated patients in central China from 2018 to 2021.
DESIGN
A retrospective analysis.
SETTING
The gynaecology departments of class A and class B secondary and tertiary hospitals in Hubei Province, China.
PARTICIPANTS
101 008 patients diagnosed with UFs from 1 January 2018 to 31 December 2021.
RESULTS
The hospitalised patients with UFs increased with age, reaching a peak at ages 45-49 years and then gradually decreasing. Among these patients, 19.05% had anaemia symptoms. Women aged 25-29 years were more likely to be treated with laparoscopic myomectomy (62.22%), while women aged 20-24 years tend to choose open myomectomy (34.58%). Women over age 45 years who had entered perimenopause tended to be treated with laparoscopic hysterectomy (64.85% for those aged 65-69 years). Patients with fibroid with moderate-to-severe anaemia mostly chose hysterectomy. As a whole, the proportion of patients who chose laparoscopic hysterectomy was similar to that of patients who chose laparoscopic myomectomy (31.38% vs 31.14%). Only 2.08% of UFs were treated with high-frequency MRI-guided focused ultrasound surgery (MRgFUS). The number of patients who choose laparoscopic surgery or MRgFUS treatment was increasing year by year. After stratifying by hospital grade, we found that women treated at class A tertiary hospitals were more likely to have laparoscopic than open surgery (66.12% vs 31.26%). At class B secondary hospitals, 61.9% of the patients underwent myomectomy. By contrast, hysterectomy was used to treat the majority of patients at class A secondary hospitals and class B tertiary hospitals (57.79% and 57.57%, respectively). Use of MRgFUS was mainly concentrated within class A tertiary hospitals.
CONCLUSION
UFs affect mainly women in childbearing period. Most patients chose to receive treatment at class A tertiary hospitals, among which laparoscopic myomectomy was the mainstream surgical method for patients in Hubei Province.
TRIAL REGISTRATION NUMBER
NCT05840042.
Topics: Humans; Female; Middle Aged; Retrospective Studies; Uterine Neoplasms; Leiomyoma; Hysterectomy; Hospitals; Anemia; Treatment Outcome
PubMed: 38233053
DOI: 10.1136/bmjopen-2023-081736 -
Journal of Menopausal Medicine Dec 2023Cervical adenocarcinomas constitute for approximately 10%-20% of all invasive cervical cancers. Villoglandular adenocarcinomas (VGAs) are a rare subtype of cervical...
Cervical adenocarcinomas constitute for approximately 10%-20% of all invasive cervical cancers. Villoglandular adenocarcinomas (VGAs) are a rare subtype of cervical adenocarcinoma, representing approximately 5% of all cases of cervical adenocarcinomas. Herein, we report the case of a 49-year-old perimenopausal woman successfully treated for VGA. The patient presented to the hospital with a primary complaint of vaginal discharge persisting for 7 months with worsening symptoms. She had no underlying medical conditions or history of oral contraceptive use. A punch biopsy revealed an adenocarcinoma, and a human papillomavirus (HPV) test indicated positive for HPV-16. The patient underwent a radical hysterectomy with bilateral pelvic lymph node dissection, and a pathological diagnosis of VGA was established. After surgery, the patient underwent a 6-week course of concurrent chemoradiotherapy with cisplatin. During the 42 months of follow-up, no signs of disease recurrence or metastasis were observed. Because of the limitations of specimen acquisition, achieving a precise diagnosis through cervicovaginal cytology and punch biopsy is challenging. Instead, conization should be considered to prevent misdiagnosis.
PubMed: 38230601
DOI: 10.6118/jmm.23020 -
Skin Research and Technology : Official... Jan 2024
Topics: Female; Humans; Perimenopause; Rosacea
PubMed: 38221784
DOI: 10.1111/srt.13542