Spanish consensus on vulvar disorders in postmenopausal women.

INTRODUCTION: The consequences of vulvar disorders in terms of health, sexuality, and quality of life are usually undervalued, with disparities in the conceptual, diagnosis and treatment criteria. AIM: The objective of this guide will be to analyse the factors associated with the diagnosis and treatment of vulvar disorders and to provide recommendations for the most appropriate diagnostic and therapeutic measures. METHODOLOGY: A panel of experts from various Spanish scientific societies related to sexual health (Spanish Menopause Society [SMS] and the Asociación Española de Patología Cervical y Colposcopia [AEPCC]) met to reach a consensus on these issues and to decide the optimal timing and methods based on the best evidence available. RESULTS: We recommend a biopsy of all vulvar lesions with an uncertain diagnosis, especially with asymmetry, irregular borders, variegated and irregular colour and diameter >6mm. For vulvodynia, we recommend the use of lubricants or topical treatments with lidocaine or bupivacaine, amitriptyline, baclofen or triamcinolone. For vulvar epithelial disorders, we recommend beginning with topical corticosteroids of moderate to high potency. For sexual dysfunction, a multidisciplinary approach is the best management strategy in these patients.

Position of the Spanish Menopause Society regarding the management of menopausal symptoms in breast cancer patients.

Breast cancer is the most common female cancer in Spain. Its high prevalence, its high survival rate, and its incidence are the reasons treatment is increasingly sought for common problems by young women who have survived it. Besides the contraception and fertility issues, many breast cancer survivors develop sexual disorders and menopausal symptoms, whether as a consequence of treatment-induced menopause or side effects of treatment. For such reasons, a panel of experts from the Spanish Menopause Society has met to develop usage recommendations for the relief of vasomotor symptoms and for sexual and reproductive health in patients with breast cancer based on the best evidence available.

Hysterectomy after endometrial ablation-resection.

STUDY OBJECTIVE: To evaluate the reasons for performing a hysterectomy in patients who had previously undergone endometrial ablation-resection (EA-R), after a follow-up of at least 6 years. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Eighty-nine premenopausal women who underwent EA-R from February 1991 through February 2003. INTERVENTIONS: Endometrial ablation-resection by electrocoagulation using a rollerball of the uterine fundus and tubal ostia zone, and electroresection using a cutting loop of the rest of the uterine cavity. MEASUREMENTS AND MAIN RESULTS: During a minimum follow-up period of 6 years, hysterectomy was performed in 16 of 89 (17.97%) patients. In eight (9%) patients, hysterectomy was performed exclusively because of the failure of EA-R. The only factor that was related significantly to the increased possibility of requiring subsequent hysterectomy was the existence of myomas. CONCLUSION: After long-term follow-up (more than 5 years), approximately one out of every five women who undergo EA-R will require a hysterectomy. The majority of these will be required during the first 2 years following EA-R. The existence of uterine myomas at the time of EA-R can be considered a risk factor for the subsequent need for hysterectomy.

Long-term results of endometrial ablation-resection.

STUDY OBJECTIVE: To estimate long-term (>5 yrs) results of endometrial ablation-resection performed in women with abnormal uterine bleeding (AUB). DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Fifty-five women. INTERVENTION: Endometrial ablation-resection by electrocoagulation with a rollerball of the uterine fundus and zone of tubal ostia, followed by electrodissection with a cutting loop of the rest of the uterine cavity. MEASUREMENTS AND MAIN RESULTS: At 5 years after the procedure the success rate was 81.8%. Of 10 women in whom the procedure failed, hysterectomy had to be performed in 6 (10.9%) for recurrent AUB. Of 55 patients, 47 were followed for 6 years for a success rate of 85.1%, 36 were followed for 7 years with a success rate of 83.3%, and 20 were followed for 8 or more years with a success rate of 80.0%. CONCLUSION: Endometrial ablation-resection achieved a success rate of 81.8% at 5 years, and this percentage remained fairly stable throughout the following 4 years. Taking into account only cases of AUB without other organic pathology, the rate was close to 90%. In women with a relatively large uterus (=10 cm), those with myomas or polyps, and patients with dysmenorrhea, the success rate tends to be lower.