Prospective comparative trial comparing O-RADS, IOTA ADNEX model, and RMI score for preoperative evaluation of adnexal masses for prediction of ovarian cancer.

INTRODUCTION: Preoperative assessment of ovarian tumors to distinguish between benign and malignant is important. At this time, many diagnostic models were available and the popularity of the risk of malignancy index (RMI) in Thailand is still high. The IOTA Assessment of Different NEoplasias in adneXa (ADNEX) model and the Ovarian-Adnexal Reporting and Data System (O-RADS) model were both new models with good performance. OBJECTIVES: The purpose of this study was to compare O-RADS, RMI, and ADNEX models. DESIGN: This diagnostic study was performed using data from the prospective study. METHODS: Data from 357 patients from a previous study were included and calculated using the RMI-2 formula then applied to the O-RADS system and the IOTA ADNEX model. The diagnostic significance of the results was evaluated by receiver operating characteristic (ROC) analysis and pairwise comparison between models was made. RESULTS: The area under the receiver operating characteristic curve (AUC) to distinguish an adnexal mass as a benign or malignant tumor was 0.975 (95% CI, 0.953-0.988) for the IOTA ADNEX model; 0.974 (95% CI, 0.960-0.988) for O-RADS; 0.909 for RMI-2 (95% CI, 0.865-0.952). There were no differences in pairwise AUC comparisons between the IOTA ADNEX and O-RADS models, and both were better than those of RMI-2. CONCLUSIONS: The IOTA ADEX and O-RADS models are excellent tools for distinguishing the adnexal mass in the preoperative assessment and were better than RMI-2. The use of one of these models is recommended.

Prevalence of ovarian mass and diagnostic performance of ultrasonography pattern recognition among women at the Gynaecologic Ultrasonography Unit at University Hospital in Thailand.

The aim of this retrospective study was to determine the prevalence of ovarian masses and calculate the diagnostic performance of the pattern recognition approach in ovarian pathology. A total of 1001 patients diagnosed with ovarian mass were included, of which 92.6% were diagnosed with ovarian pathology and the presence of a pathological result, while 7.4% of cases were diagnosed with functional ovarian cyst. The prevalence of ovarian malignancy was 15%. A specific ultrasound diagnosis was suggested in 62.9% of all cases, while sonographers did not explicitly provide a diagnosis in remaining cases. A subjective assessment showed 80.3% sensitivity (95% confidence interval (CI) 68.7-89.1) and 97.6% specificity (95% CI 96-98.6) in differentiating between benign and malignant ovarian masses. The sensitivity and specificity for the diagnosis of endometriotic cyst were 77.03% and 90.63% and 63.19% and 94.3% for mature cystic teratoma, respectively. In conclusion, assessment showed good performance in differentiating between benign and malignant ovarian mass and it was possible to diagnose several specific ovarian tumours. Impact StatementWhat is already known on this subject? Pattern recognition is an acceptable method for classifying ovarian mass, which exhibits specific morphological features on grey-scale ultrasonography, and can be used to predict nature and histological type.What do the results of this study add? Even in the hands of an expert examiner, there were a number of cases in which the diagnoses could not be specifically stated. Pattern recognition correctly classified 90.3% of ovarian masses as either benign or malignant and correctly provided specific histologic diagnoses after exclusion of unspecified diagnosis in 80.6% of all cases. The diagnostic performance of this approach was high in differentiating between benign and malignant ovarian mass and in diagnosing some specific ovarian pathologies.What are the implications of these findings for clinical practice and/or further research? A subjective assessment is simple and easy to use in clinical practice and has shown promising results in classifying benign and malignant ovarian mass. Moreover, it can also be used to make some specific diagnoses. However, specialised and experienced gynaecological ultrasound examiners are required to provide the most accurate diagnosis. Therefore, criteria to describe ultrasound features and convincing operators to make a definite diagnosis as often as possible should be encouraged. A prospective study to verify diagnostic performance of pattern recognition or comparing with other ultrasonographic diagnostic tools should be considered.

Preoperative Evaluation of the ADNEX Model for the Prediction of the Ovarian Cancer Risk of Adnexal Masses at Siriraj Hospital.

INTRODUCTION: Distinguishing benign adnexal masses from malignant tumors plays an important role in preoperative planning and improving patients' survival rates. The International Ovarian Tumor Analysis (IOTA) group developed a model termed the Assessment of Different NEoplasias in the adneXa (ADNEX). OBJECTIVE: Our objective was to evaluate the performance of the ADNEX model in distinguishing between benign and malignant tumors at a cutoff value of 10%. METHODS: This was a prospective diagnostic study. 357 patients with an adnexal mass who were scheduled for surgery at Siriraj Hospital were included from May 1, 2018, to May 30, 2019. All patients were undergoing ultrasonography, and serum CA125 was measured. Data were calculated by the ADNEX model via an IOTA ADNEX calculator. RESULTS: Of the 357 patients, 296 had benign tumors and 61 had malignant tumors. The area under the receiver operating characteristic curve for using the ADNEX model was 0.975 (95% confidence interval, 0.953-0.988). At a 10% cutoff, the sensitivity was 98.4% and specificity was 87.2%. The best cutoff value was at 16.6% in our population. CONCLUSIONS: The performance of the ADNEX model in differentiating benign and malignant tumors was excellent.

Effect of estradiol vaginal gel on vaginal atrophy in postmenopausal women: A randomized double-blind controlled trial.

AIM: To evaluate the efficacy and safety of 25 µg of estradiol gel on postmenopausal vaginal tissue. METHODS: This randomized double-blind controlled trial included postmenopausal women with vaginal atrophy who attended our menopause clinic during July 2017-January 2018. Women were randomly assigned to the estradiol gel group or control group (K-Y® Jelly). Treatment consisted of 2 mL of product applied intravaginally daily for 2 weeks, and two doses per week for the next 6 weeks. The most bothersome symptom (MBS), vaginal health index (VHI), vaginal pH, vaginal maturation index, vaginal maturation value (VMV), female sexual function index (FSFI), serum estradiol level and endometrial thickness were evaluated at baseline, 4 and 8 weeks. RESULTS: Seventy-five of 80 women completed the trial. After 8 weeks of treatment, VMV, VHI, vaginal pH and FSFI improved significantly in the estradiol group, with no observed change in the control group. The MBS was decreased in both groups with no significant difference between groups. Serum estradiol level and endometrial thickness were not significantly different between groups at baseline or at week 8. CONCLUSION: Estradiol vaginal gel demonstrated an ability to reverse vaginal atrophy with a high safety profile and low systemic absorption of estradiol.

Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial.

OBJECTIVE: To determine the effectiveness of desogestrel for relieving endometriosis-related pain. METHODS: A double-blinded randomized placebo-controlled trial was conducted in 40 patients who had endometriosis with moderate-to-severe dysmenorrhea or chronic pelvic pain undergoing laparoscopic conservative surgery. After surgery, patients were randomized to desogestrel or placebo group. Outcomes included changes in visual analog scale (VAS) of dysmenorrhea, pelvic pain and dyspareunia, patient satisfaction, and adverse effects. RESULTS: Forty patients were randomized to desogestrel group (n = 20) and placebo group (n = 20). At month 6, the desogestrel group had significantly lower median VAS of overall pelvic pain, dysmenorrhea and noncyclic pelvic pain. Comparing with the placebo group, the desogestrel group had greater reduction in VAS of overall pain, dysmenorrhea and pelvic pain, but comparable reduction in VAS of dyspareunia. No patient in the desogestrel group but 4 patients in the placebo group still had moderate-to-severe pelvic pain at 6 months postoperatively. The proportion of patients who rated the treatment as very satisfied was higher in the desogestrel group than in the placebo group. There was no serious adverse event during the study period. CONCLUSIONS: Desogestrel is effective and acceptable for postoperative therapy for patients with moderate-to-severe pain related to endometriosis.

Prevalence of endometriosis in women undergoing surgery for benign gynecologic diseases.

OBJECTIVE: To determine the prevalence of endometriosis among other benign gynecologic diseases and to identify the characteristics of patients at increased risk of concomitant diagnosis before surgery MATERIAL AND METHOD: A descriptive cross-sectional study of331 women with benign gynecologic diseases who underwent surgery in the Department of Obstetrics and Gynecology, Faculty ofMedicine Siriraj Hospital, Mahidol University, Bangkok, Thailand were included The subjects were interviewed for demographic data, obstetrics, and medical history. Data from medical records were reviewed and collected Operative notes and pathological reports were reviewedfor the diagnosis of endometriosis. The outcome measurement is the prevalence of endometriosis that was diagnosed by the surgeon from operative finding or pathological report and the characteristics of the patients at increased risk of concomitant diagnosis before surgery. RESULTS: Of the 331 women with benign gynecologic diseases, 101 had coexistent endometriosis. Prevalence ofendometriosis in benign gynecologic diseases was 30.5%. Of the 285 women with benign gynecologic diseases that did not have concomitant diagnosis of endometriosis before surgery, endometriosis was found in 55 patients postoperatively. Prevalence of endometriosis in this group was 19.3%. The three most common diseases in women undergoing surgery were uterine leiomyoma, adenomyosis, and benign ovarian cysts, respectively. The coexistence ofendometriosis with uterine leiomyoma, adenomyosis, and benign ovarian cysts were 28%, 43.5%, and 50%, respectively. Women with preexisting endometriosis were significantly younger than those with postoperative diagnosed endometriosis. CONCLUSION: The prevalence of coexistence of endometriosis and benign gynecologic diseases, especially uterine leiomyoma, adenomyosis, and benign ovarian cyst, was high. The diagnosis of concomitant diseases was made intra-operatively and postoperatively in more than half of the cases. Physicians should be concerned about the coexistence of both conditions and put this finding into the preoperative counseling data and definite surgery should be informed in advanced stage of endometriosis.

Summary of the 2023 Thai Menopause Society Clinical Practice Guideline on Menopausal Hormone Therapy.

The Thai Menopause Society is an academic organization consisting of healthcare professionals engaged in menopause medicine. The position statement was first issued in 1994 and updated in 2003 and 2023. Herein, we reviewed the important updates of the 2023 position statement on menopausal hormone therapy (MHT) as an international reference for healthcare professionals in Thailand. An advisory panel of clinicians and research experts in the field of menopause reviewed the recommendation of published International Consensus Statements and updated the evidence using the MEDLINE database through PubMed. The evidence-based information and relevant publications were assessed, and a consensus on recommendations was subsequently achieved using the level of evidence to determine the recommendation strength and evidence quality. MHT remains the most effective treatment for vasomotor symptoms and genitourinary syndromes of menopause even after 20 years. Additionally, it is effective in preventing bone loss and fractures in postmenopausal women. The cardiovascular risk of MHT increased in women who initiated MHT after 60 years of age. Hormone therapy should be individualized following the hormone type, dose, administration route, use duration, and progestogen inclusion. The necessary pretreatment evaluation and appropriate follow-up recommendations were added for improved MHT standard care. The updated 2023 Clinical Practice Guideline on MHT is useful for gynecologists, general physicians, endocrinologists, and other healthcare professionals in treating menopausal women receiving hormone therapy in Thailand.

Intraperitoneal sub-diaphragmatic instillation of bupivacaine plus morphine for reducing postoperative shoulder pain after gynecologic endoscopy.

BACKGROUND: Gynecologic endoscopic surgery is a minimally invasive surgical technique for treatment of various gynecologic diseases. When compared to conventional laparotomy, this procedure has advantages in many aspects such as reduced postoperative pain, short hospital stay, and decreased morbidity associated with laparotomy. However 15 to 30% of the patients experienced moderate or severe postoperative shoulder pain. Methods to minimize postoperative shoulder pain after gynecologic endoscopy are essential to maximize the quality of life of the patients. OBJECTIVE: To evaluate the benefit of intraperitoneal instillation of bupivacaine plus morphine for reducing postoperative shoulder pain incidence after gynecologic endoscopy. MATERIAL AND METHOD: A randomized clinical trial was conducted in 158 patients undergoing laparoscopic procedures. The patients were randomly assigned to receive either 0.5% bupivacaine hydrochloride 20 mL mixed with morphine 3 mg (study group) or normal saline (control group) instillation to subdiaphragmatic area before finishing the procedure. Shoulder pain was evaluated at immediate post-operative time, and at 12 and 24 hours from the termination of surgery. The data of requested analgesic drugs after surgery was also recorded. RESULTS: Baseline characteristics were comparable between the two groups. Diagnosis, laparoscopic procedures, and duration of operation were also comparable. There were comparable proportions of patients reporting shoulder pain at 12 and 24 hours between the study and control group (30.4% and 30.4% at 12 hours, and 11.3% and 21.5% at 24 hours, respectively). Median pain scores at 12 and 24 hours were comparable between the study and control group (3 and 2 at 12 hours, and 4 and 4 at 24 hours, respectively). Requirement of analgesics was slightly greater among control than study group, but without statistical significance (17.7% and 24.1% respectively). CONCLUSION: Intraperitoneal instillation of bupivacaine plus morphine had no efficiency for reducing postoperative shoulder pain incidence after gynecologic endoscopy.

Hyperprolactinemia: a 12-year retrospective study at gynecologic endocrinology unit, Siriraj Hospital.

BACKGROUND: Hyperprolactinemia is one of the most common endocrine disorders of the hypothalamic-pituitary axis. To date, no available data about hyperprolactinemia in Thai women has been published OBJECTIVE: To determine clinical and laboratory findings of Thai female patients with different etiology of hyperprolactinemia, as well as the response of treatment, recurrence, and pregnancy after treatment. MATERIAL AND METHOD: Medical records of 139 female patients with the diagnosis of hyperprolactinemia in Gynecologic Endocrinology Unit, Siriraj Hospital between January 1, 1999 and December 30, 2011 were retrospectively reviewed after the study protocol was approved by Siriraj Institutional Review Board. The data was analyzed to determine patient demographic data, presenting symptoms, duration of symptoms, initial serum prolactin levels, causes, imaging studies, treatment, treatment outcomes, and adverse events. RESULTS: Ninety-seven female patients with hyperprolactinemia were included in the study. Mean age at diagnosis was 31.8 +/- 7.7 years. Amenorrhea was the most common presenting symptom (49.5%) followed by galactorrhea (44.3%). Median initial serum prolactin level was 117 ng/mL (25.1-1,624 ng/mL). Pituitary adenoma is the most common cause (40.2%) followed by idiopathic hyperprolactinemia (37.1%). Microadenomas were found in 74.3% of pituitary adenoma. The median size of the tumor was 9 mm. Medical treatment was given to 79 (88.8%) patients. Bromocriptine was given to 66 patients. Mean of maximum dose of bromocriptine was 5.8 mg. Median duration of treatment was 35.8 months. Adverse events were reported in 24.2% of patients, dizziness was the most common adverse event. Median time to normalize serum prolactin level was 3.8 months. In 29 patients who desired pregnancy, eight patients got pregnant. Median time to pregnancy was 25.9 months. Patients with macroadenoma had significantly higher prolactin level than those with microadenoma (p = 0.024). Patients with galactorrhea had the shortest duration of symptom (p = 0. 010). There were no statistically significant difference in symptoms, duration of symptoms, and initial prolactin level between patients with and without pituitary adenoma. Patients with pituitary adenoma needed higher doses (p = 0.009) and longer duration of treatment (p = 0.007) than those without a tumor Normalization of prolactin level and recurrence rate was not different between the two groups (p = 0.056 and 0.374). Log rank test showed that the time to normalize and survival time of recurrence were not significantly different between patients with and without a tumor (p = 0.136 and 0.146, respectively). CONCLUSION: Amenorrhea was the most common presenting symptom in Thai hyperprolactinemic females, who attended Siriraj gynecologic endocrinology unit, followed by galactorrhea. Pituitary adenoma is the most common cause followed by idiopathic hyperprolactinemia. Patients with pituitary adenoma needed higher doses and longer duration of treatment than those without a tumor

Causes of primary amenorrhea: a report of 295 cases in Thailand.

AIMS: The aim of this study was to determine the prevalence of etiologic causes of primary amenorrhea in Thailand. METHODS: A retrospective study was performed using 295 complete medical records of women with primary amenorrhea who attended the Gynecologic Endocrinology Clinic, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand from September 1992 to February 2009. RESULTS: The three most common causes of primary amenorrhea were Müllerian agenesis (39.7%), gonadal dysgenesis (35.3%), and hypogonadotropic hypogonadism (9.2%). Amongst 88 cases of gonadal dysgenesis, 59 cases (67.0%) incurred abnormal karyotype including 45X (n=21), mosaic (n=31), and others (n=7). CONCLUSIONS: The present study has currently been the largest case series of primary amenorrhea. Müllerian agenesis is the most prevalent cause in our study, while gonadal dysgenesis is the most common cause in the largest-scale study in the USA. Hence, racial, genetic and environmental factors could play roles in the cause of primary amenorrhea.

Dysmenorrhea in Siriraj medical students; prevalence, quality of life, and knowledge of management.

OBJECTIVE: To determine the prevalence of dysmenorrhea, effect on daily activity, academic activities, quality of life, and knowledge of management in Siriraj medical students. MATERIAL AND METHOD: A cross-sectional descriptive study at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand that included 552 female medical students who were asked to complete two questionnaires. The first questionnaire (32 items) included demographic data, menstrual pattern, severity of dysmenorrhea, pain score, impact of dysmenorrhea on daily and academic activities, the method and knowledge of medications to treat dysmenorrhea. The second questionnaire was Short Form (SF)-36 questionnaires used to evaluate the health-related quality of life. RESULTS: The prevalence of dysmenorrhea was 77.7%. The prevalence of mild, moderate, and severe dysmenorrhea was 35.3%, 39.3%, and 3.1% respectively. Age of menarche, duration of menses, and the family history of dysmenorrhea were significantly different between two groups. Students who had moderate to severe dysmenorrhea reported the negative impact on daily and academic activities. The scores of SF-36 in moderate and severe group was significantly lower than the mild group (p < 0.001). In the moderate to severe dysmenorrhea group, 82.9% and 66.7% of participants used mefenamic acid and paracetamol for pain relief respectively. CONCLUSION: Dysmenorrhea in medical students has high prevalence and it has negative effects on daily activities, academic activities, and quality of life. Most of the subjects know that mefenamic acid and/or paracetamol can relief dysmenorrhea. Dysmenorrhea is a significant public health problem.

Comparison of OSTA index and KKOS scoring system for prediction of osteoporosis in postmenopausal women who attended Siriraj Menopause Clinic.

OBJECTIVE: To compare diagnostic performance of the Osteoporosis Self-Assessment Tool for Asians (OSTA) index and Khon Kaen Osteoporosis Study (KKOS) scoring system with standard measurement of bone mineral density (BMD) by dual energy X-rays absorptiometry (DEXA) for screening osteoporosis and to determine osteoporosis risk factors in postmenopausal women who attended the Siriraj Menopause Clinic, Siriraj Hospital SUBJECTS: Four hundred forty one postmenopausal women who attended the Siriraj menopause clinic, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand and had BMD measurement by DEXA and had a diagnostic test were included in the study MATERIAL AND METHOD: The data were collected from medical records. Subjects who met the inclusion criteria, without exclusion criteria were collected data and calculated for OSTA index and KKOS score. Both indices at < or = -1 were classified as high risk of osteoporosis. Sensitivity, specificity, PPV NPV and AUC of OSTA index, and KKOS score were compared Risk factors for osteoporosis were analyzed. RESULTS: The prevalence of osteoporosis was 19.7%, 18.8% for osteoporosis of lumbar spine, 2.3% for osteoporosis of femoral neck, and 2% for osteoporosis of total hip. The OSTA index in identifying osteoporosis at least one site of femoral neck, total hip or lumbar spine at original cut point of < or = -1 had sensitivity and specificity of 51.7% and 77.4% respectively and KKOS at original cut point of < or = -1 had sensitivity and specificity of 56.3% and 71.8% respectively Sensitivity of OSTA index was 80% at femoral neck, 77.8% at total hip, and 49.4% at lumbar spine. KKOS had sensitivity at femoral neck, total hip and lumbar spine of 80%, 77.9%, and 54.2% respectively. Specificity of KKOS at femoral neck, total hip and lumbar spine were slightly lower than OSTA index. Age > or = 65 years, family history of osteoporosis, and history of fracture at age > 45 years found to be risk factors for osteoporosis with odd ratio of 9.0, 2.7, and 5.3 respectively. CONCLUSION: Both OSTA index and KKOS scoring system had good performance in identifying osteoporosis of femoral neck and total hip but both indices had low sensitivity in identifying osteoporosis of spines. The authors recommend using OSTA index for screening osteoporosis because it is comparable in diagnostic performance and OSTA is more convenient and simpler than KKOS scoring system.

Dysmenorrhea among Siriraj nurses; prevalence, quality of life, and knowledge of management.

OBJECTIVE: To determine the prevalence of dysmenorrhea, impact on daily activity, quality of life, and knowledge of management among Siriraj nurses. SUBJECTS: Four hundred ninety three female nurses in the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand MATERIAL AND METHOD: A cross-sectional descriptive study was done at Siriraj Hospital, Bangkok, Thailand Subjects were asked to complete a questionnaire (32 items) and a Short form-36. The questionnaire included demographic data, menstrual pattern, age at dysmenorrhea, severity of dysmenorrhea, pain score, impact of dysmenorrhea on daily activity, and method and knowledge of medications to treat dysmenorrhea. Evaluation of the quality of life using short form-36 questionnaire was also asked. RESULTS: The prevalence of dysmenorrhea was 70.2%. The prevalence of mild, moderate, and severe dysmenorrhea was 29.6%, 38.9%, and 1.6% respectively. Dysmenorrhea was significantly associated with age of participants, amount of menses, and the family history of dysmenorrhea. Nurses who had moderate to severe dysmenorrhea reported the impact on daily activities as limited sport activity (93%), limited social activity (66%), affected their concentration (81%), and absenteeism from work (16.5%). The mean total score of short form-36 in moderate and severe dysmenorrhea group was 69.9, significantly lower than mild and no dysmenorrhea group (75.2). Eighty-one percent and 68% of nurses with moderate and severe dysmenorrhea used paracetamol and mefenamic acid for pain relief respectively. CONCLUSION: The prevalence of dysmenorrhea among nurses was high and it had a negative impact on daily activities and quality of life. Most of the subjects knew that paracetamol and mefenamic acid can relieve dysmenorrhea. The hospital administrators should be concerned with this problem in nurses working in their hospital.

Quality of life in Thai women with various types of abnormal uterine bleeding.

OBJECTIVE: To determine the quality of life (QoL) in Thai women with various types of abnormal uterine bleeding (AUB). METHODS: A cross-sectional study was conducted on 353 AUB patients between November 2010 and January 2012. They were grouped according to the duration of symptom: <6 months (acute AUB, n = 122), ≥6 months (chronic AUB, n = 138), and postmenopausal bleeding (PMB, n = 93); and the bleeding pattern: hypermenorrhea (n = 24) and irregular bleeding (n = 236). QoL was determined using the 36-Item Short-Form Health Survey (SF-36) Thai version. RESULTS: The acute AUB and chronic AUB groups had a mean age of 43.84 ± 4.87 and 43.81 ± 6.55 years; they were younger than the PMB group (55.62 ± 7.55 years) (P < 0.001). Medical diseases were more prevalent in the PMB than in the acute and chronic groups (66.7% vs. 27.9% and 35.5%, respectively, P < 0.001). Some subscales of the SF-36 were significantly lower in the women with AUB than in those with normative values, in those with chronic AUB or PMB than in those with acute AUB, and in those with hypermenorrhea rather than in those with irregular bleeding. CONCLUSION: Thai women with any AUB types have a poorer QoL than general Thai women. QoL tends to be poorer in women with symptoms longer than 6 months or with hypermenorrhea.

The effectiveness of desogestrel for endometrial protection in women with abnormal uterine bleeding-ovulatory dysfunction: a non-inferiority randomized controlled trial.

Women with chronic abnormal uterine bleeding-ovulatory dysfunction (AUB-O) are at increased risk of endometrial neoplasia. We conducted a non-inferiority randomized controlled trial to determine the effectiveness of two cyclic-progestin regimens orally administered 10 d/month for 6 months on endometrial protection and menstruation normalization in women with AUB-O. There were 104 premenopausal women with AUB-O randomized to desogestrel (DSG 150 µg/d, n = 50) or medroxyprogesterone acetate (MPA 10 mg/d, n = 54) group. Both groups were comparable in age (44.8 ± 5.7 vs. 42.5 ± 7.1 years), body mass index (24.8 ± 4.7 vs. 24.9 ± 4.7 kg/m2), and AUB characteristics (100% irregular periods). The primary outcome was endometrial response rate (the proportion of patients having complete pseudodecidualization in endometrial biopsies during treatment cycle-1). The secondary outcome was clinical response rate (the proportion of progestin withdrawal bleeding episodes with acceptable bleeding characteristics during treatment cycle-2 to cycle-6). DSG was not inferior to MPA regarding the endometrial protection (endometrial response rate of 78.0% vs. 70.4%, 95% CI of difference - 9.1-24.4%, non-inferiority limit of - 10%), but it was less effective regarding the menstruation normalization (acceptable bleeding rate of 90.0% vs 96.6%, P = 0.016).Clinical trial registration: ClinicalTrials.gov (NCT02103764, date of approval 18 Feb 2014).

Prevalence of metabolic syndrome in reproductive-aged polycystic ovary syndrome Thai women.

OBJECTIVE: To determine the prevalence of metabolic syndrome (MS) in reproductive-aged polycystic ovary syndrome (PCOS) Thai women. MATERIAL AND METHOD: A Cross sectional study was done at the Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital of 250 PCOS Thai women who were diagnosed using Revised Rotterdam 2003 criteria, and who did not take medications affecting sex hormones or lipid metabolism, and attended the Gynecologic Endocrinology Unit between May 2007 and January 2009. Patents were interviewed and examined for weight, height, waist circumference, and blood pressure. Venous blood sample of each patient was drawn after 12-hour fasting. Prevalence of MS determined using the definitions of National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and National Heart Lung and Blood Institutes/American Heart Association (NHLBI/AHA). RESULTS: Mean +/- SD of age, body mass index (BMI), and waist circumference (WC) were 25.4 +/- 5.8 years, 26.2 +/- 7.6 kg/M2, and 82.3 +/- 16.3 cm, respectively. Prevalence of MS by the definitions of NCEP ATP III, IDF and NHLBI/AHA was 18.0%, 21.2%, and 21.2%, respectively. Of non-MS women, > 40% already had one to two criteria of IDF definition. Among MS women, 100% had central obesity, 50.9% had high blood pressure, 28.3% had impaired fasting blood glucose, 62.3% had hypertriglyceridemia, and 92.5% had high-density lipoprotein cholesterol < 50 mg/dL. The prevalence of MS increased from 10.3% in women aged < 20 years to 50.0% in those aged > or = 40 years (p of trend = 0.003), and from 0.0% in women with BMI < 23 kg/M2 to 54.5% in those with BMI > or = 30 kg/M2 (p of trend < 0.001). CONCLUSION: The prevalence of MS in reproductive-aged PCOS Thai women was 18.0% by NCEP ATP III and 21.2% by IDF and NHLBI/AHA. The prevalence varies only little with definitions of diagnostic criteria. The prevalence increases with age and body mass index. Slightly more than 40% of the non-MS PCOS Thai women already had one to two criteria of MS.

Vaginal atrophy and sexual dysfunction in current users of systemic postmenopausal hormone therapy.

OBJECTIVE: To determine the prevalence of vaginal atrophy and sexual dysfunction in current users of systemic postmenopausal hormone therapy (pHT). MATERIAL AND METHOD: A cross-sectional study was conducted in 97 current users of pHT at Siriraj Menopause Clinic from 2005 to 2007. Subjective symptoms of vaginal atrophy and sexual dysfunction were assessed by interviewing. Objective signs of vaginal atrophy were assessed using pelvic examination, vaginal pH, and maturation value (MV). RESULTS: The prevalence of vaginal atrophy in current users of systemic pHT determining from patient's symptoms, pelvic examination, vaginal pH, and MV were 44.3%, 15.5%, 21.6% and 8.8%, respectively. The prevalence of sexual dysfunction varied from 48.7% to 71.6% depending on types of dysfunction. There was poor association between the subjective symptoms and signs, and the objective indicators of vaginal atrophy. Among various regimens of pHT, tibolone had the lowest prevalence of subjective atrophic symptoms; estrogen-only pHT had the lowest prevalence of objective atrophic signs; and raloxifene had the highest prevalence of atrophic symptoms and signs, and sexual dysfunction. There was statistically significant association between regimens of pHT and objective indicators for vaginal atrophy (p = 0.004 for pH, and 0.000 for MV). CONCLUSION: Current users of systemic pHT still have vaginal atrophy and sexual dysfunction which relates to regimens of pHT. The prevalence of vaginal atrophy varies depending on the assessment methods. The subjective method gives higher prevalence than the objective one does. Since the subjective symptoms of vaginal atrophy would have more adverse effect on quality of life than the objective signs do, the authors suggest that patients' complaints be used to assess factors affecting vaginal atrophy in further research.

Characteristics of 250 reproductive-aged polycystic ovary syndrome Thai women at Siriraj Hospital.

OBJECTIVE: To determine the clinical characteristics of reproductive-aged polycystic ovary syndrome (PCOS) Thai women. STUDY DESIGN: Cross sectional study SETTINGS: Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. SUBJECTS: 250 PCOS Thai women who registered at the Siriraj PCOSprojectfrom May 2007 to January 2009. PCOS were diagnosed using Revised Rotterdam 2003 criteria. Women who were taking medications affecting sex hormones or lipid metabolism within 3 months before registration were excluded from the present study. MATERIAL AND METHOD: Patients were interviewed and examined for weight, height, waist circumference, blood pressure, presence of acanthosis nigricans, and signs of hyperandrogenism. Ovarian ultrasonography was examined using vaginal probe inserting into the vagina or rectum. Venous blood sample of each patient was drawn during 8.00-10.00 o'clock after 12-hour fasting. MAIN OUTCOME MEASURES: Clinical characteristics and laboratoryprofiles in PCOS Thai women. RESULTS: Of all participants, 62% were 20-29.9 years old, 30% had high blood pressure, 57% were overweight to obese, 49% had central obesity, and 27% had acanthosis nigricans. Clinical hyperandrogenism was found in 15.6% of the patients. Approximately 7% of PCOS women had impaired fasting glucose and one third had dyslipidemia. Prevalence of the PCOS criteria presenting in the population were oligomenorrhea and/or amenorrhea (98.4%), hyperandrogenism (49 2%), and ultrasonographic polycystic ovary (97.2%). Of all participants, 44% had three components of diagnostic criteria. Among those who had two components, presence of abnormal menstrual cycle plus polycystic ovary was the most common finding. CONCLUSION: Menstrual problem was the most common presenting symptom among the presented participants. Hyperandrogenism/ -emia adds only a little value on making PCOS diagnosis. Most of the PCOS Thai women have menstrual problem. In these patients, ovarian ultrasonography has high value to diagnose PCOS; addition of androgen blood test can diagnose only 3% more PCOS cases. Although the presented PCOS Thai women are stillyoung, approximately 50% already have some parameters of health risk. It is suggested to provide preventive measures for these patients to prevent long term medical problems.

Health check-up program for pre/postmenopausal women at Siriraj Menopause Clinic.

OBJECTIVE: To determine the general health status of pre/postmenopausal women attending the menopause clinic. STUDY DESIGN: Retrospective descriptive study. SETTING: Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. STUDY POPULATION: Pre/postmenopausal women (i) presumed to have no medical disease (no disease group) or (ii) with unknown status of medical disease (no record group) and undergoing health check-up program at the time of registration without prior hormone therapy. MATERIAL AND METHOD: Medical records of new patients registering at the menopause clinic from January 1999 to December 2005 were reviewed. RESULTS: Among 1,020 patients undergoing health check-up program, there were 366 patients in the no disease group. They had abnormal health parameters listing by frequency of prevalence including hypercholesterolemia (62.3%), suboptimal blood pressure (49.3%), overweight to obese (30.2%), suboptimal fasting blood sugar (2 7.9%), hypertriglyceridemia (21.3%), abnormal liver function tests (5.4-6.9%), and abnormal kidney function tests (0.5%). The prevalence of dyslipidemia was statistically higher in the no record group compared to the no disease group; such abnormal parameters included hypercholesterolemia (> or =200 ml/dL), high blood level of low density lipoprotein cholesterol (LDL-C > or = 130 mg/dL), and high ratio between LDL-C and high density lipoprotein cholesterol (LDL-C/HDL-C ratio >3). Osteoporosis was found in 6.6% of the patients. Abnormal mammographic findings that needed close follow-up or breast biopsy were found in 13.5%. Twelve patients had breast biopsy and none had breast cancer. CONCLUSION: Abnormal health parameters are common in pre/postmenopausal women presumed to have no medical disease. The similar or even worse findings are also found in those whose status of medical diseases was unknown. Therefore, a routine health screening program, especially for metabolic diseases, should be offered to pre/postmenopausal women regardless of their medical history.

Serum follicle stimulating hormone and estradiol in peri/postmenopausal women attending Siriraj Menopause Clinic: a retrospective study.

OBJECTIVES: To determine serum levels of Follicle Stimulating Hormone (FSH) and Estradiol (E) in peri/postmenopausal women attending the menopause clinic. STUDY DESIGN: Retrospective descriptive study. SETTING: Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. STUDY POPULATION: Peri/postmenopausal women attending Siriraj Menopause Clinic from January 1994 to December 2003. MATERIAL AND METHOD: Medical records of women who had a blood test for FSH and/or E2 prior to hormonal therapy were reviewed. RESULTS: During a 10 year period, there were 116 eligible patients who could be classified into perimenopausal (31 cases), natural postmenopausal (43 cases), and surgical postmenopausal (32 cases) groups. Age at registration of perimenopausal (47.87 +/- 4.38 yr) and surgical postmenopausal (48.06 +/- 6.49 yr) groups were younger than that of the natural postmenopausal group (55.74 +/- 6.80 yr). The perimenopausal group, who still had regular menstruation, was the youngest. The average FSH level of 60.46 +/- 33.15 mIU/mL was not different among groups. The estradiol level of perimenopausal (79.05 +/- 83.62 pg/mL) and surgical postmenopausal (63.05 +/- 136.39 pg/mL) groups were significantly higher than that of natural postmenopausal (25.05 +/- 37.663 pg/mL) group (p = 0.001). Serum level of FSH or E2 was not correlated with age or years since menopause. There was significant but minimal negative correlation between serum levels of FSH and E2. CONCLUSION: Serum FSH and/or E2 levels are not accurate enough by themselves to rule in or rule out perimenopause. The authors suggested that clinicians should diagnose perimenopause based on menstrual history and age, without relying on laboratory testing.