Guideline No. 447: Diagnosis and Management of Endometrial Polyps.

OBJECTIVE: The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the diagnosis and management of endometrial polyps. TARGET POPULATION: All patients with symptomatic or asymptomatic endometrial polyps. OPTIONS: Options for management of endometrial polyps include expectant, medical, and surgical management. These will depend on symptoms, risks for malignancy, and patient choice. OUTCOMES: Outcomes include resolution of symptoms, histopathological diagnosis, and complete removal of the polyp. BENEFITS, HARMS, AND COSTS: The implementation of this guideline aims to benefit patients with symptomatic or asymptomatic endometrial polyps and provide physicians with an evidence-based approach toward diagnosis and management (including expectant, medical, and surgical management) of polyps. EVIDENCE: The following search terms were entered into PubMed/Medline and Cochrane: endometrial polyps, polyps, endometrial thickening, abnormal uterine bleeding, postmenopausal bleeding, endometrial hyperplasia, endometrial cancer, hormonal therapy, female infertility. All articles were included in the literature search up to 2021 and the following study types were included: randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: Gynaecologists, family physicians, registered nurses, nurse practitioners, medical students, and residents and fellows. TWEETABLE ABSTRACT: Uterine polyps are common and can cause abnormal bleeding, infertility, or bleeding after menopause. If patients don't experience symptoms, treatment is often not necessary. Polyps can be treated with medication but often a surgery will be necessary. SUMMARY STATEMENTS: RECOMMENDATIONS.

Oocyte cryopreservation in a transgender man on long-term testosterone therapy: a case report.

OBJECTIVE: To report a case of ovarian stimulation for the purposes of oocyte cryopreservation in a transgender man without cessation of long-term testosterone therapy. DESIGN: Report of a unique case of fertility preservation through ovarian stimulation and oocyte cryopreservation in a transgender man who had been on testosterone therapy for 18 months before treatment. The patient elected to continue testosterone therapy throughout ovarian stimulation and oocyte retrieval. To our knowledge, there have not been any published reports of patients undergoing oocyte cryopreservation while continuing long-term testosterone therapy. SETTING: Private fertility clinic with university affiliation. PATIENTS: A 20-year-old transgender man undergoing oocyte cryopreservation before gonadectomy. INTERVENTIONS: Fertility preservation through oocyte cryopreservation. MAIN OUTCOME MEASURES: This patient had a robust response to ovarian gonadotropin stimulation. Leuprolide acetate was used for final oocyte maturation to minimize ovarian hyperstimulation syndrome risk. RESULTS: Cryopreservation of 22 mature oocytes. CONCLUSIONS: Cryopreservation of mature oocytes is possible for patients on continued long-term testosterone therapy. The impact of long-term testosterone therapy on markers of ovarian reserve, reproductive potential, and long-term reproductive outcomes have yet to be elucidated and further studies are needed in this area.

Confronting the challenges of the menopausal transition.

Canada's Generation X is now entering the menopausal transition and pursuing effective therapy for bothersome vasomotor symptoms. They do so at a time when confusion about the safe and appropriate use of menopausal hormone therapy (MHT) has never been greater. Misplaced fears among women and their health care providers about MHT have, in many circumstances, led them to abandon this most effective therapy. This review discusses the physiology of the menopausal transition, the nature of symptoms related to withdrawal of ovarian estrogen production, and the potential benefits and risks of MHT. It is now clear that for most recently menopausal women the benefits of MHT outweigh the risks. The rationale for choosing different dosages, formulations, and regimens is reviewed.

Histological chorioamnionitis associated with preterm prelabour rupture of membranes at Kingston General Hospital: a practice audit.

OBJECTIVE: To determine the prevalence of histological chorioamnionitis associated with preterm prelabour rupture of membranes (PPROM) in women following spontaneous onset of labour, urgent delivery or planned delivery after 34 weeks' gestation. METHODS: Charts of all women admitted to Kingston General Hospital with PPROM prior to 34 weeks' gestation over five years were collected. Obstetrical outcomes and histopathology reports were reviewed. RESULTS: Two hundred forty-four women with PPROM were identified and reviewed. The majority of women (169; 69%) went into spontaneous labour and, of those, 24 (14%) had clinical chorioamnionitis and 79 (47%) had histological chorioamnionitis. Of the 45 women (18%) who required urgent delivery, 27 (60%) had clinical chorioamnionitis and 31 (69%) had histological chorioamnionitis. Only 26 of the original 244 women with PPROM (11%) were managed expectantly until 34 weeks' gestation and then had a planned delivery. The prevalence of histological chorioamnionitis in this group whose placentas were sent for histopathologic review was 24%. Overall, the clinical suspicion of chorioamnionitis was found to be specific (91%) but not sensitive (37%) for identifying chorioamnionitis on the basis of histopathology. CONCLUSION: Histological chorioamnionitis complicates almost one half of all cases of PPROM that occur prior to 34 weeks' gestation. Most women will progress to spontaneous labour or require urgent delivery for clinical chorioamnionitis or other complications related to ruptured membranes before reaching 34 weeks' gestation. Only a subset of women remain pregnant long enough to have labour induced, but among those the prevalence of histological chorioamnionitis is lower (24%).

Objectif : Déterminer la prévalence de la chorioamnionite histologique associée à la rupture prématurée des membranes préterme (RPMP) chez les femmes à la suite de l'apparition spontanée du travail, d'un accouchement d'urgence ou d'un accouchement planifié après 34 semaines de gestation. Méthodes : Les dossiers de toutes les femmes admises, au cours d'une période de cinq ans, à l'hôpital général de Kingston en raison d'une RPMP avant 34 semaines de gestation ont été rassemblés. Les issues obstétricales et les rapports d'histopathologie ont fait l'objet d'une analyse. Résultats : Deux cent quarante-quatre femmes présentant une RPMP ont été identifiées et leurs dossiers ont fait l'objet d'une analyse. La majorité des femmes (169; 69 %) ont connu un travail spontané et, de celles-ci, 24 (14 %) ont présenté une chorioamnionite clinique et 79 (47 %) ont présenté une chorioamnionite histologique. Chez les 45 femmes (18 %) qui ont nécessité un accouchement d'urgence, 27 (60 %) ont présenté une chorioamnionite clinique et 31 (69 %) ont présenté une chorioamnionite histologique. Seulement 26 des 244 femmes présentant une RPMP qui ont été identifiées à l'origine (11 %) ont fait l'objet d'une prise en charge non interventionniste jusqu'à 34 semaines de gestation, pour ensuite connaître un accouchement planifié. Au sein de ce groupe, la prévalence de la chorioamnionite histologique (dans les cas où le placenta a fait l'objet d'une analyse histopathologique) a été de 24 %. De façon globale, nous avons constaté que les soupçons cliniques à l'égard de la présence d'une chorioamnionite étaient spécifiques (91 %), mais non sensibles (37 %), pour ce qui est de l'identification de la chorioamnionite en fonction de l'histopathologie. Conclusion : La présence d'une chorioamnionite histologique complique près de la moitié de tous les cas de RPMP qui se manifestent avant 34 semaines de gestation. La plupart des femmes en viendront à connaître un travail spontané ou à nécessiter un accouchement d'urgence motivé par la présence d'une chorioamnionite clinique ou d'autres complications liées à la rupture des membranes avant 34 semaines de gestation. Seul un sous-ensemble de femmes demeurent enceintes assez longtemps pour pouvoir faire l'objet d'un déclenchement du travail; toutefois, chez ces femmes, la prévalence de la chorioamnionite histologique est moindre (24 %).

Can online learning adequately prepare medical students to undertake a first female pelvic examination?

OBJECTIVE: To determine whether a novel web-based learning module could adequately prepare first-year undergraduate medical students to skilfully perform their first female pelvic examination. METHODS: First-year Queen's University medical students without prior training or experience in female pelvic examination were recruited for this study. After viewing key segments of the learning module, students were evaluated while performing a pelvic examination on a female volunteer using a standardized assessment checklist (total score = 30 points). Descriptive and comparative statistics were generated. RESULTS: Forty-five students participated with a mean age of 24 years (range 20 to 40). The mean score (±SD) on the assessment checklist was 23.9 ± 3.6 points, (range 17 to 30). All study participants received a passing grade of ≥ 50% (15/30 points), and 53.3% (24/45) received an honours grade of ≥ 80% (24/30 points). Of the participants, 88.9% (40/45) agreed that they were well prepared for their first female pelvic examination after viewing the training video. Mean scores were similar for male students (23.9, n = 22) and female students (23.8, n = 23) (P = 0.90, t test). Mean scores were not higher in those who watched key segments of the learning module more than once. CONCLUSION: This learning module viewed immediately prior to a simulated clinic session afforded first-year medical students the necessary knowledge and skills to perform a first female pelvic examination. This was accomplished with as little as one viewing, and could lead to savings in organizational costs and instruction time for medical school curricula.