Effect of metformin on cardiovascular risk factors in middle-aged Thai women with metabolic syndrome: A randomized placebo-controlled trial.

AIM: To evaluate the effect of metformin on cardiovascular risk factors in middle-aged Thai women with metabolic syndrome that are in menopausal transition. METHODS: This study was double-blind randomized placebo-controlled trial. Metabolic syndrome was diagnosed using American Heart Association and National Heart, Lung, and Blood Institute criteria. After taking metformin 1700 mg/day for 6 months, cardiovascular risk factors were evaluated at baseline and month-6; the values of which were used to calculate delta (Δ, month-6 minus baseline values). RESULTS: Forty menopausal participants were equally, randomized into either the placebo or metformin group. The two groups had comparable metabolic parameters at baseline, except that the mean triglyceride level was higher in the metformin group than in the placebo group. The significant improvements found only in the metformin group were body mass index, fasting blood glucose, high-sensitivity C-reactive protein and 10-year risk of coronary heart disease (Framingham heart study) (P = 0.0004, P = 0.049, P = 0.035 and P = 0.029); whereas that only in the placebo group was high density lipoprotein cholesterol. However, there was no statistically significant difference in the improvement between the two groups. CONCLUSION: Metformin can improve some parameters of metabolic syndrome in middle-aged Thai women. Metformin is not superior to placebo for the improvement of cardiovascular risk factors.

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.

Prevalence of type 2 diabetes mellitus compared between lean and overweight/obese patients with polycystic ovarian syndrome: a 5-year follow-up study.

PURPOSE: To investigate the prevalence of type 2 diabetes mellitus (T2DM) at the 5-year follow-up after polycystic ovarian syndrome (PCOS) diagnosis compared between lean and overweight/obese groups. METHODS: This retrospective cohort study included 400 prediabetes PCOS women who attended our clinic. Participants were divided into either the lean group (body mass index [BMI]: < 23 kg/m2) or the overweight/obese group (BMI: ≥ 23 kg/m2). Patient demographic, clinical characteristics, metabolic profiles, and laboratory values were collected and compared between groups at baseline and during follow-up for 5 years. RESULTS: At the end of the follow-up, overweight/obese group had a higher risk for developing T2DM than lean group (11.5% vs. 0.5%, p < 0.001). Lean group had a lower incidence of hypertension (3% vs. 38.5%, p < 0.001) and dyslipidemia (35% vs. 53.5%, p < 0.001) than overweight/obese group. The factors found to be independently associated with increased risk for developing T2DM were BMI ≥ 23 kg/m2 (odds ratio [OR]: 1.075, p = 0.047), non-use of oral combined contraceptive pills (OR: 0.312, p = 0.028), and impaired fasting glucose at baseline (OR: 38.167, p < 0.001). CONCLUSIONS: Overweight/obese PCOS patients were found to be at significantly higher risk for developing T2DM than lean PCOS patients. Higher BMI, IFG at baseline, and non-use of oral contraceptive pills found to be independent predictors of T2DM in PCOS.

Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS.

AIM: To evaluate the relationship between measures of body adiposity and visceral adiposity index (VAI) and risk of metabolic syndrome (MS) and to identify the optimal cut-off points of each measurement in Thai polycystic ovary syndrome (PCOS). METHODS: A cross-sectional study was completed physical examination, fasting plasma glucose, lipid profiles of 399 PCOS and 42 age-matched normal controls. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and VAI were calculated. Associations between different measures and MS were evaluated and the receiver-operating characteristic (ROC) curve was performed to determine appropriate cut-off points for identifying MS. RESULTS: Percentage of MS in PCOS was 24.6%, whereas none MS in controls. Previously recommended cut-off values for body adiposity and VAI were significantly associated with MS. ROC curve analysis of the only PCOS showed newly obtained optimal cut-off points for BMI and VAI of ≥28 kg/m(2) (AUC = 0.90) and >5.6 (AUC = 0.94), respectively. Values found to be more accurate than the original ones. VAI was the best predictor, followed by BMI and WHtR. CONCLUSION: All body adiposity and VAI parameters can predict the risk of MS. Optimal values for Thai PCOS were ≥28 kg/m(2) for BMI, ≥0.85 for WHR, ≥0.5 for WHtR and >5.6 for VAI.

No association between CYP17 -34T/C polymorphism and insulin resistance in Thai polycystic ovary syndrome.

AIM: To investigate the association of CYP 17 -34T/C polymorphism with insulin resistance (IR) in Thai polycystic ovary syndrome (PCOS). METHODS: A cross-sectional study was performed on 210 Thai women diagnosed with PCOS. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to analyze CYP17 polymorphism at -34T/C. Student's t-test was used to compare the mean of normally distributed variables between A1/A1 and A2/X. Chi-squared or Fisher's exact tests and OR were used to analyze the association at P < 0.05. RESULTS: Out of 210 cases, PCR-RFLP was successful in 199. Mean patient age was 24.4 ± 4.7 years, with body mass index 25.2 ± 6.3 kg/m(2) . There were 65 and 134 women in the A1/A1 genotype group and A2/X genotype group, respectively. The A2/X genotype group was statistically significantly younger and had a strong trend toward overweight/obesity compared with the A1/A1 genotype group. The prevalence of IR according to different methods varied from 15.4% to 70.8% and was not different between the two groups. On subgroup analysis, in the overweight/obese PCOS group, the A2/X genotype was not associated with any indices of IR. CONCLUSION: No significant association between CYP17-34T/C polymorphism and IR was found in Thai PCOS women, although the A2/X genotype group was statistically significantly younger than the A1/A1 genotype group.

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.

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.

Ovarian reserve evaluation by anti-mullerian hormone in women undergoing laparoscopic cystectomy of endometrioma.

OBJECTIVE: To study the serial changes of serum AMH to determine ovarian reserve recovery after laparoscopic cystectomy of endometrioma. MATERIAL AND METHOD: Forty-three endometrioma patients who underwent laparoscopic cystectomy of endometrioma were tested for levels of serum AMH at preoperation, 1 week, and 3 months postoperation. RESULTS: Median serum AMH was 2.11 ng/mL (range = 0.22 to 9.24 ng/mL) before surgery. This level also reduced at first week postoperation (p < 0.01) but did not reach a significant difference between the first week and the third month (1.02 ng/mL and 1.06 ng/mL, respectively). The recovery rate of AMH level in unilateral endometrioma was higher than bilateral endometrioma (32.4% vs. -3.6%, p = 0.02). CONCLUSION: Ovarian reserve was decreased after laparoscopic cystectomy of endometrioma and did not significantly restore after three months of postoperation. The recovery of ovarian reserve after unilateral endometriotic cystectomy was faster than that after bilateral endometriotic cystectomy.

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.