Black cohosh efficacy and safety for menopausal symptoms. The Spanish Menopause Society statement.

OBJECTIVE: The increasing interest in Western countries regarding phytotherapy use to treat menopause-related symptoms has led the Spanish Menopause Society (AEEM) to update its position statement performed in 2009 on the role of black cohosh (Cimicifuga racemosa) for the treatment of menopausal symptoms. MATERIAL AND METHODS: A panel of experts from both clinical and research backgrounds were assembled to investigate the best available evidence. Selected studies were obtained by an electronic search, including the Internet search engines MEDLINE-Pubmed (1997-December 2021) and the Cochrane Controlled Trials Register. RESULTS: Most of the well-designed studies published in recent years have been conducted with the isopropanolic extract of black cohosh/C. racemosa. The most common dose is 40 mg/day capable of achieving a significant reduction in hot flushes (particularly in women with intense hot flushes) and an improvement in mood. Used at the recommended doses, C. racemose produces no significant adverse reactions. CONCLUSION: Black cohosh is an effective and safe treatment option for the relieving of vasomotor symptoms. Finally, further clinical trials with sufficient patient enrollment and longer study follow-up are needed.

Early embryonic morphology sonographically assessed and its correlation with yolk sac in missed abortion.

PURPOSE: To provide additional information about embryo morphology sonographic assessment and its correlation with yolk sac. METHODS: A systematic study in 200 consecutive cases of missed abortion <10 weeks diagnosed by transvaginal ultrasound. RESULTS: In 104 gestations of embryos with morphological abnormalities, 88 (84.6 %) were at least 1 week smaller than expected for gestational age and 16 (15.4 %) were the expected size. From 32 normal morphologic embryos, 7 (21.9 %) were at least 1 week smaller than expected for gestational age, and 25 (78.1 %) were the expected size (p < 0.005). Normal morphologic embryos are linked more frequently with normal yolk sac (62.5 %). Findings in anembryonic gestations (GD1) included an absent yolk sac (46.9 %) and a cystic yolk sac (25 %). Likewise, findings in GD2-3 embryos included more frequently a cystic yolk sac (42.9 %) and an absent yolk sac (32.5 %). GD4 embryos are associated with an echogenic yolk sac (40 %), a relatively small-hypoplastic- (40 %) and a relatively large-cystic- (20 %). In DI embryos, yolk sac appears cystic (62.5 %) or echogenic (37.5 %). CONCLUSIONS: Our study proves the correlation between morphology of conceptuses and yolk sac appearance in cases of missed abortion.

Preliminary study of a new, fully automated system for liquid-based cytology: the NovaPrep® processor system.

OBJECTIVE: To evaluate a fully automated system for liquid-based cytology (LBC): the NovaPrep® Processor System (NPS), which is based on the new concept of double decantation, versus conventional cytology (CC), the gold standard for cytology. STUDY DESIGN: We performed a preliminary comparative study involving 1,129 female patients who underwent sampling for a Pap test; the sample was first smeared for CC and then, using the remaining specimen on the brush, for LBC with the NPS. The performances of CC and NPS were evaluated for accuracy and compared using the gold standard of a combination of one of the two methods of pathological cytology with screening for positive human papilloma virus, quantification of cells (normal and pathological), and improvement in the quality of samples and reading time. RESULTS: The results showed improvement in sensitivity (3.81% for CC vs. 4.52% for NPS) with a specificity superior to 90% for both, a markedly decreased number of unsatisfactory specimens, notably samples containing too many inflamed cells (7.4% for CC vs. 0.5% for NPS), and a shortening of the reading time, which was three times less using NPS. CONCLUSION: This preliminary study showed a gain in sensitivity, a drop in the number of unsatisfactory specimens and a reduction in reading time with NPS. The results achieved using this fully automated LBC procedure are very promising and will hopefully reduce the overall cost of cervical cancer screening in the future.

Transvaginal sonographic evaluation of subendometrial-myometrial contractility in women using a copper-releasing intrauterine device.

BACKGROUND: The aim of this study was to determine the effects of a copper-releasing intrauterine device (IUD) on myometrial contractility midway through the menstrual cycle. STUDY DESIGN: Uterine peristalsis was studied midway through the cycle with transvaginal sonography in two groups of women, a control group and women in whom a copper-releasing IUD had been inserted. RESULTS: The results showed that 12 months after insertion, no uterine motility could be detected with sonography in any of the women with an IUD, but motility did occur in all the controls. CONCLUSIONS: Subendometrial-myometrial contractility midway through the menstrual cycle had been abolished in patients with a copper-releasing IUD. The loss of motility may inhibit sperm transport from the cervix to the oviduct and account for at least part of the contraceptive effect of these devices.

Position of the Spanish Menopause Society regarding vaginal health care in postmenopausal women.

Vaginal health, defined as the vaginal state in which the physiological condition remains stable, being protected from the onset of symptoms and facilitating a satisfying sex life, is one of the most common and less valued concerns in postmenopausal women. Many of the conditions that affect the vagina are related to its trophism and susceptibility to infection by unusual germs, which are phenomena strongly influenced by estrogen impregnation and the microbiota composition, ultimately affecting sexuality and the quality of life. An expert panel of the Spanish Menopause Society met to establish criteria for diagnosing and treating the processes that affect overall vaginal health and to decide the optimal timing and methods based on the best evidence available.

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.