- The aim of the study was to assess the role of the estradiol and progesterone relationship during the late luteal phase and the occurrence of fibrocystic breast disease (FBD). The concentration of ...estradiol/progesterone was measured in the group of women with FBD as study group (n=50) and control group of women without FBD (n=40). All women had regular ovulation cycles. Blood samples for estradiol (E2), progesterone (P) and prolactin determination were obtained in the morning at 8 am on days 21 and 24 of menstrual cycle. Significant mastalgia and mastodynia history in women with FBD was obtained with yes or no questionnaire. FBD diagnosis was confirmed with ultrasound (size and number of simple cysts). In the control group, a reduced E2/P ratio was noticed from day 21 to day 24 of the cycle (from 14.8±11.5 pg/mL to 9.1±6.1 pg/mL; p<0.05), which was not recorded in the group of women with FBD (study group). Even the slightest disturbance of the E2/P ratio may contribute to the occurrence of FBD with clinical manifestations of mastalgia and mastodynia.
Although the use of commercially manufactured hormone therapy (HT) to treat menopausal symptoms has declined during the past 12 years, the use of custom compounded HT seems to have increased. A ...39-year-old woman with refractory anemia sustained premature ovarian insufficiency following allogeneic stem cell transplantation. After systemic biologic treatment (azacitidine) and corticosteroid therapy, besides extreme climacteric symptoms (Green Climacteric Scale, 59) and impaired quality of life, she also had elevated liver enzymes. Therefore, she was not a candidate for oral HT. Treatment was started with 17-beta estradiol patch 0.5 mg (Climara) together with micronized progesterone intravaginally, 2x100 mg (Utrogestan) for 3 months. She was not satisfied, so the custom compound HT started with 17-beta estradiol 0.5 mg gel 2x/day and micronized progesterone in liposomal gel 100 mg/daily. She was much better but she complained of low libido, decreased sex drive and emotional instability, so 1% testosterone gel was added. Now she was completely satisfied, Green Climacteric Scale was 8 and liver enzymes were normal. In conclusion, custom compound HT has the possibility of tailoring and adjusting therapy to the individual need, which has been the everlasting goal in menopause medicine and should be a good option for special clinical cases.
Primary premature ovarian insufficiency (PPOI) is characterized by hypergonadotropic
amenorrhea and hypoestrogenism in women under 40 years of age. PPOI incidence is 1:10,000
in women aged 18-25, ...1:1000 in women aged 25-30 and 1:100 in women aged 35-40. In 10%-28% of
cases, PPOI causes primary and in 4%-18% secondary amenorrhea. The process is a consequence of
accelerated oocyte atresia, diminished number of germinated cells, and central nervous system aging.
Specific genes are responsible for the control of oocyte number undergoing the ovulation process and
the time to cessation of the reproductive function. A positive family history of PPOI is found in 15%
of women with PPOI, indicating the existing genetic etiology. Primary POI comprises genetic aberrations
linked to chromosome X (monosomy, trisomy, translocation, deletion) or to autosomal chromosome.
Secondary POI implies surgical removal of ovaries, chemotherapy and radiotherapy, and
infections. Diagnostic criteria include follicle stimulating hormone level >40 IU/L and estradiol level
<50 pmol/L.
Vaginal birth trauma is the leading cause of stress urinary incontinence (SUI) in women. Also, the process of ageing and hormonal deprivation in postmenopause alters the metabolism of connective ...tissues and decreases collagen production leading to pelvic floor dysfunction. Noninvasive treatment is recommended as first-line management of urinary incontinence (UI) in women. Surgical procedures are more likely to be implemented to cure UI but are associated with more adverse events. Sex hormone deficiency affects changes also in the lower urinary tract where estrogens are the main regulators of physiological functions of the vagina. In the last decade, laser treatment of SUI and of the genitourinary syndrome of menopause (GSM) has been shown a promising treatment method in peer-reviewed literature. This review’s aim is to present the evidence-based medical data and laser treatment of SUI and GSM in an outpatient setting to be a good treatment option, regarding short-term as well as long-term follow-ups. Long-term follow-up studies are needed to confirm that laser treatment is a good, painless outpatient procedure with no side effects in postmenopausal women.
: Until now, overactive bladder (OAB) with or without urge urinary incontinence (UUI) has been treated mainly in two ways: with behavioral methods and patient education, or using antimuscarinic drugs ...and/or beta-3 adrenergic receptor agonists. Unfortunately, these drugs may cause side effects in some women or are insufficiently effective, so patients abandon them. Therefore, in this pilot study, radiofrequency was evaluated as a new option in the treatment of OAB and UUI.
: Nineteen patients were enrolled in this pilot study using radiofrequency (RF), where the level of OAB and UUI was assessed using the validated ICIQ-OAB questionnaire. RF was applied four times for 20 min, once a week. Two weeks after treatment, the level of OAB and UUI was reassessed and processed statistically and the treatment effect evaluated.
: Using the ICIQ-OAB, the severity of OAB and UUI was assessed: 0-3 mild symptoms; 4-7 moderate symptoms; 8-11 severe symptoms; 12-16 very severe symptoms. Before treatment, 10.5% of patients had mild symptoms, 21.1% moderate symptoms, 63.2% severe symptoms and 5.3% very severe symptoms. After treatment, 42.9% had mild symptoms, 50% moderate symptoms and 7% severe OAB and UUI symptoms. All four main symptoms-frequency, nocturia, urgency and incontinence-decreased statistically significantly, with the best results being found in urgency (
= 0.002).
: Based on this pilot study, RF seems a very promising method in the treatment of OAB and UUI. To extend our initial findings, it is necessary to perform a prospective, randomized and placebo-controlled study in order to obtain reliable results and to determine for how long one set of treatment maintains the results obtained immediately after the end of that treatment. In this way, we may determine how often the treatment needs to be repeated, if necessary, and when.
Urinary incontinence (UI) is a condition that affects patients of all ages, starting with childhood. There are two peaks in its incidence, i.e., in childhood and another one in patients over 40 years ...of age, which increases continuously with patient age. It is a condition recognized by the World Health Organization as a set of diseases (International Classification of Diseases, ICD-10), and the International Classification of Functionality recognizes the associated extreme disablement. UI is a major health problem affecting the lives of an estimated 400 million persons worldwide. The global aging of the population will cause rise in the incidence of UI in the future. It is expected that UI itself will become a serious health and social burden for both patients and health service providers. UI can be an isolated problem, or it can be associated and/or aggravated by any associated disorder affecting the nervous system such as myelomeningoceles, Parkinson's disease or stroke. UI often affects the patient daily life, and it can have repercussions on their physical, financial, social, and emotional well-being. At last, it has a negative influence on their sexual health.
Inkontinencija mokraće (IM) je stanje koje pogađa osobe svih dobnih skupina počevši od djetinjstva. Postoje dva vrhunca
incidencije i to u djetinjstvu, a drugi u bolesnika starijih od 40 godina, koji ...se stalno povećava s dobi bolesnika. To je stanje
koje Svjetska zdravstvena organizacija prepoznaje kao skup bolesti (Međunarodna klasifikacija bolesti, MKB-10), a Međunarodna
klasifikacija funkcionalnosti prepoznaje pridruženu ekstremnu onesposobljenost. IM glavni je zdravstveni problem
koji utječe na živote oko 400 milijuna ljudi širom svijeta. Globalno starenje stanovništva uzrokovat će porast učestalosti IM u
budućnosti. Očekuje se da će i sama IM postati ozbiljno zdravstveno i socijalno opterećenje za bolesnike i pružatelje zdravstvenih
usluga. IM može biti izolirani problem ili može biti povezana s i/ili pogoršana bilo kojim povezanim poremećajem koji
pogađa živčani sustav, kao što su mijelomeningocele, Parkinsonova bolest, moždani udar itd. IM često utječe na svakodnevni
život bolesnika i može imati posljedice na njihovo fizičko, financijsko, socijalno i emocionalno stanje. Napokon ima negativan
utjecaj na njihovo seksualno zdravlje.
Osteoporosis is a highly prevalent public health problem with osteoporosis-related fractures that account for high morbidity and mortality. Therefore, prevention strategies and early detection of ...osteoporosis should be carried out in primary gynaecological care units, so as to substantially reduce the risk of fractures and allow the best treatment option for a particular woman.
From 2002 to 2011, we recruited 2956 women. Of the total number of women, we additionally extrapolated 1274 women aged 60-75 years, assumingly, the group of women at higher risk of osteoporosis. Demographic and anthropometrical data as well as the information regarding risk factors for osteoporosis were collected using a questionnaire.
The odds ratio for osteoporosis increased by 8% (p=0.001) with each additional year of life. The OP prevalence increased with age from 24.9% in 60-64 years to 37.4% in 70-75 years. In non-smokers the odds ratio for osteoporosis was 0.424, which was statistically significant (p<0.05). BMI <18.5 increased the odds ratio for osteoporosis by 2 times, which was not statistically significant. In women 60-75 years old (N=1274), the risk of fractures increased with increasing age, considering previous fractures in the last 5 years (p<0.001), hip fracture (p=0.001), wrist fracture (p=0.002) and observed height loss (p<0.001). Hormone therapy (HT) use decreased the prevalence of OP by 25% in comparison with non-users.
Primary care gynaecologist with a DXA centre has every opportunity for a holistic approach to the management of postmenopausal women, including the prevention and treatment of postmenopausal osteoporosis.
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