The Importance of Nutrition in Menopause and Perimenopause-A Review.

Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.

Hemangioma of the uterine cervix: report of four cases and review of the literature. / Haemangioma a méhnyakban: 4 eset ismertetése és irodalmi áttekintés.

Összefoglaló. A haemangioma a noi nemi szervekben viszonylag ritkán, a méhnyakban pedig még ritkábban fordul elo. Kis mérete és szegényes megjelenése miatt elkerülheti a figyelmet, elofordul azonban, hogy mutéti ellátást igénylo vérzést okoz. Az évek során 4 esetben (ebbol 2 esetben terhesség alatt) diagnosztizáltunk méhnyak-haemangiomát (2 esetben cervicalis intraepithelialis carcinomával társulva), melyeknek ismertetjük változatos tüneteit, kolposzkópos megjelenését és a diagnózist biztosító szövettani (immunhisztokémiai) illusztrációit, valamint a képlet terhesség alatti fejlodésének kolposzkópos monitorizálását. 2 esetben capillaris (cavernosus) haemangiomát, 2 esetben arteriovenosus malformatiót igazoltunk. Az általunk hozzáférheto szakirodalomban nem találtunk magyar szerzo(k)tol beszámolót errol a cervicalis lokalizációjú, ritka, jóindulatú, de gyakran veszélyes vascularis daganatról. Orv Hetil. 2022; 163(5): 187-194. Summary. Hemangioma is relatively rare in the female genital organs and even less common in the uterine cervix. Its small size and poor appearance often result in a missed diagnosis, but it may cause bleeding that requires surgery. Over the years, we have confirmed the diagnosis of cervical hemangioma in 4 cases including two in pregnancy. 2 cases were associated with cervical intraepithelial neoplasia. This case report describes the symptoms, colposcopic appearance, and histological characteristics including immunohistochemical findings, and the colposcopic monitoring of development of the condition during pregnancy. In 2 cases, a capillary (cavernous) hemangioma, in 2 cases an arteriovenous malformation was diagnosed. We did not find any report from Hungarian author(s) about this rare, benign, but often dangerous vascular tumor with cervical localization. Orv Hetil. 2022; 163(5): 187-194.

Unusual onset of thyroid associated orbitopathy during pregnancy: case report and review of literature.

BACKGROUND: Thyroid associated orbitopathy (TAO) is the most common extrathyroidal complication of Graves' disease. The disease course ranges from mild, where symptomatic therapy is sufficient, to severe, where high dose steroid administration or orbital decompression surgery is required. Women of their reproductive age are more likely to be affected. Although pregnancy is a state of enhanced immune tolerance, TAO may develop or worsen in 0.2-0.4% of pregnant women. CASE PRESENTATION: We present the case of a 19-year-old woman who has developed hyperthyroidism and progressive TAO during the second trimester of her third pregnancy, which has improved postpartum. The possible mechanisms and the importance of follow up in pregnancy is discussed. CONCLUSIONS: Expectant mothers with Graves' disease require follow up of eye signs throughout pregnancy, preferably in the setting of a thyroid-eye clinic.

Preoperative assessment of endometrial cancer.

Endometrial cancer (EC), the most common among gynaecological malignancies occurs predominantly after the menopause. The diagnosis is most commonly (in about 75-80%) set up at early stage when surgical therapy and if necessary postoperative radiotherapy results in an excellent prognosis, with a 90-95% 5-year overall survival (OS) and a locoregional recurrence rates of 4-8%. Accurate preoperative assessment of the lymph nodes would ideally identify those patients with advanced stage disease, who might benefit from more extensive surgical procedures and adjuvant therapies. magnetic resonance imaging (MRI), hysteroscopic excisional biopsy (HEB) and high resolution 2D or 3D ultrasound performed by expert operator are considered to add valuable information for preoperative staging of EC. The use of biomarkers could be beneficial in decreasing inter-observer variability between the histology of the diagnostic specimen and the final operative sample, as well as to avoid overtreatment in a part of the high-grade tumors with excellent prognosis. The goal of surgical management of EC is to remove the primary tumor and to identify definite prognostic factors to determine whether adjuvant therapy is required. Extended surgery, including para-aortic lymphadenectomy has a significant morbidity, and with the future selection of cases it can be safely avoided, we can decrease complications without compromising oncological safety. In the future, the importance of hysteroscopy guided sampling may increase to gain a representative sample for biomarker detection.

Hormone Replacement Therapy in Cancer Survivors - Review of the Literature.

Rapid advance in oncology leads to increasing survival of oncologic patients. More and more of them live long enough to reach either the natural age of menopause or, as a side effect of their oncotherapy, experience the cessation of gonadal function, leading to premature ovarian insufficiency, with disturbing vasomotor symtoms and long-term negative cardiovascular and skeletal effects. Thus, an ever increasing number of cancer survivors search endocrinologic help in the form of hormone replacement therapy (HRT). The misinterpretation of the WHI (Women's Health Initiative) Study has lead to an irrational fear of female hormone replacement, both by the general population and medical professionals. It has seemed the logical and safe conclusion to many physicians to avoid HRT, supposing that this attitude definitely causes no harm, whereas the decision of prescribing estrogen alone or with progestins might bear oncologic and thromboembolic risks and may even lead to litigation in case of a potentially related complication. However, it was known even before the WHI results that premature menopause and hypogonadism decreases the life expectancy of women by years through its skeletal and cardiovascular effects, and this negative effect correlates with the length of the hypoestrogenaemic period. Therefore, the denial of HRT also needs to be supported by evidence and should be weighed againts the risks of HRT. Yet, the oncologic risk of HRT is extremely difficult to assess. In this work we review the latest evidence from in vitro experiments to clinical studies, regarding HRT in survivors of gynecologic and non-gynecologic cancers. Based on our literature research, we group tumours regarding the oncologic risk of properly chosen female hormone replacement therapy in cancer survivors as follows: 'HRT is advanageous' (e.g. endometrial cancer type I, cervical adenocarcinoma, haematologic malignancies, local cutaneous malignant melanoma, colorectal cancer, hepatocellular cancer); 'HRT is neutral' (e.g. BRCA 1/2 mutation carriers without cancer, endometrial cancer type II, uterinal carcinosarcoma and adenosarcoma, certain types of ovarian cancer, cervical, vaginal and vulvar squamous cell carcinoma, prolactinoma, kidney cancer, pancreatic cancer, thyroid cancer); 'HRT is relatively contraindicated' for various reasons (e.g. leiomyosarcoma, certain types of ovarian tumours, brain tumours, advanced metastatic malignant melanoma, lung cancer, gastric cancer, bladder cancer); 'HRT is diasadvantageous and thus contraindicated' (e.g. breast cancer, endometrial stroma sarcoma, meningioma, glioma, hormone receptor positive gastric and bladder cancer).

The effect of localization and histological verification of endometrial polyps on infertility.

AIM: Our purpose is to investigate if transcervical resection of endometrial polyps improves the fertility in ovulatory infertile women, and whether polyp histology, intrauterine location, and the technique of polypectomy have any influence on the pregnancy rates. METHODS: In this retrospective study, clinical data of 87 ovulatory infertile women who underwent hysteroscopy and polypectomy, and their 12-month follow-up have been analyzed. Subgroups according to the method of polyp removal (resectoscope or curettage), the polyp localization (utero-tubal, anterior, posterior, lateral, multiple) and the histological result were interpreted. RESULTS: Mean age of patients was 33.99 ± 4.24 years. There were no differences in the BMI and basal FSH levels between the subgroups. Pregnancy was recorded in 30 (34.5%) within the next 12 months without any difference between the subgroups of polypectomy method applied. Posterior wall polyp resection increased the pregnancy chance (OR 5.02), but no other differences were observed in 1-year pregnancy rates to other localizations. Removal of polyps which had normal endometrial histology had lower pregnancy rates as compared to that of polyps with hyperplasia or endometrial polyp histology results (OR 0.25). CONCLUSIONS: Polypectomy improved the conception rate in the subsequent year regardless of the intrauterine localization and the method of its surgical removal. Therefore, we can conclude that polypectomy should be considered in infertile women.

Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy.

OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy. METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ). RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually. CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.

Plasminogen activator activity in tears of pregnant women.

PURPOSE: Plasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy. METHODS: PAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study. RESULTS: Tear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively. CONCLUSIONS: Overall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.

[Comparison of current methods of tubal patency assessment]. / A petevezeték-átjárhatóság vizsgálómódszereinek összehasonlító elemzése.

Most common organic cause of infertility is the blockage of the Fallopian tubes. Several methods were introduced to evaluate tubal patency. Hysterosalpingography is a conventional radiology procedure using contrast medium, which gives an accurate image of the uterine cavity and the Fallopian tubes, but radiation exposure is necessary. Hystero-contrast-sonography similarly examines the uterine cavity and tubal patency by ultrasonography, and it enables to detect pelvic pathology, too. Transvaginal hydrolaparoscopy is a minimal invasive direct method using endoscope introduced into the abdominal cavity through the posterior vaginal fornix, both ovaries and tubal patency can be observed. Laparoscopy is the "gold standard" procedure in the tubal testing, however it is a more invasive procedure. A cost-effective testing method is the selective tubal pertubation performed via office hysteroscopy. Recent outpatient methods to detect tubal patency have high negative predictive values and recommended to be the first choice in infertility work-up. Orv. Hetil., 2017, 158(9), 324-330.

[Influence of malignant tumors occurring in the reproductive age on spermiogenesis: studies on patients with testicular tumor and lymphoma]. / Reproduktív korban eloforduló daganatok hatása a spermiogenezisre: heredaganatos és lymphomás betegek vizsgálata.

INTRODUCTION: The application of chemo- and radiotherapy results in good survival prognosis for young men with malignant tumors, but long-term gonadoxic effect has to be considered. In addition, malignant disease itself has a negative impact on spermiogenesis. AIM: The aim of the authors was to examine the spermiogenetic effect of the most common tumors occurring in the reproductive age in men: testicular cancer, Hodgkin disease and non-Hodgkin disease. METHOD: Spermiogram of men with testicular cancer (N = 68), Hodgkin disease (N = 37) and non-Hodgkin disease (N = 14) who were referred for sperm cryopreservation were analysed in the Reproductive Andrology Laboratory of the authors. RESULTS: Azoospermia was found in 11.8% of all patients (N = 119), while 58.8% of the patients had oligozoospermia even before the treatment. Sperm concentration of men with testicular cancer was significantly lower than those with lymphomas (32.8 M/mL vs. 24.9 M/mL, p = 0.03). There was no difference in sperm concentration between the Hodgkin and non-Hodgkin lymphoma groups. CONCLUSIONS: Spermiogenetic defect is more pronounced in men with testicular cancer than those with lymphomas. Cryopreservation before treatment for fertility preservation should be offered for all reproductive aged men with malignant disease, especially for those with testicular cancer.

[Body image and quality of life in women with polycystic ovary syndrome]. / A testkép és életminoség vizsgálata polycystás ovarium szindrómában.

INTRODUCTION: Polycystic ovary syndrome is the most common endocrine disease in women. Psychic consequences are significant; patients have difficulties to be pregnant and the disease disturbs the quality of life. Due to complications associated with polycystic ovary syndrome, studies on psychological state and disease perception of patients appear to be important. AIM: The aim of the authors was to assess how the disease influences quality of life and changes in body image. METHOD: The authors used the Illness Intrusiveness Ratings Scale, Health-Related-Quality-of-Life Questionnaire for Women with Polycystic Ovary Syndrome and their own body image questionnaire. 121 women took part in the study. RESULTS: There was a negative correlation between illness intrusiveness and quality of life (r = -0.353) and a positive correlation between body image and quality of life (r = 0.614). A significant difference was observed in body satisfaction between patients who had visible body changes and those who had metabolic disturbances (p<0.05). Overweight patients who lost weight with lifestyle changes had significantly better quality of life (p<0.05). CONCLUSIONS: These results appear to be convincing in that in addition to gynecological care, psychotherapy could be offered to patients with polycystic ovary syndrome.

Detection of feeding artery improves the ultrasound diagnosis of endometrial polyps in asymptomatic patients.

OBJECTIVE: To investigate whether transvaginal power Doppler imaging of the vascularity improves the ultrasound detection rate of endometrial polyps in symptomatic and asymptomatic patients. STUDY DESIGN: Forty-one patients with endometrial polyps confirmed by operative hysteroscopy and histologic examination. They were all examined with grey-scale and subsequent power Doppler enhanced ultrasound preoperatively according to the same protocol. Double layer endometrium and detailed endometrial morphology were described at grey scale scan. With power Doppler imaging pattern of endometrial vascularity. In the presence of a single feeding artery the ultrasound diagnosis of an endometrial polyp was made. RESULTS: With grey-scale imaging 20 polyps (49%) were recognized, while the subsequent application of power Doppler diagnosed the remaining 21 polyps increasing the overall detection rate to 10% (P < 0.01). The grey-scale detection rate for the polyp was 11/30 (0.37) in the asymptomatic patients and 9/11 (82%) in the symptomatic patients. No difference in endometrial thickness was observed. With power Doppler imaging, the detection rate for the feeding arteries was 97% (29/30) in the asymptomatic polyps and a similar 91% (10/11) in the symptomatic polyps. In the 21 polyps, where imaging of the vascularity was the only diagnostic marker, all but two were asymptomatic. CONCLUSION: Power Doppler enhanced ultrasound detection of the feeding vessels can be a simple, non-invasive and highly effective first line test for the diagnosis of endometrial polyps in asymptomatic patients.

Efficacy of the swim-up method in eliminating sperm with diminished maturity and aneuploidy.

BACKGROUND: We have previously shown that after 80% Percoll centrifugation there is an overall 2.7-fold reduction of sperm with chromosomal disomies and diploidies (3.2-fold and 2.0-fold respectively), and of sperm with diminished maturity as detected by cytoplasmic retention. The relationship between disomies and immature sperm was r = 0.7, suggesting that disomy primarily originates in immature sperm. In the present work we studied the efficacy of the swim-up method in elimination of sperm with diminished maturity and with chromosomal aberrations in the swim-up sperm fractions of 10 patients (sperm concentration: 20 +/- 3.9 x 10(6)/ml, range 8.9-45.5; sperm motility: 45.2 +/- 2.4, all mean +/- SEM). METHODS: The validity of the study was enhanced by assessing each sperm fraction with three-colour (X, Y and 17; 5000 sperm) and two-colour (10 and 11; 5000 sperm) chromosome probes using fluorescence in-situ hybridization (FISH). Thus, in each sample 10 000 sperm were evaluated. The incidence of diminished maturity sperm was assessed with creatine kinase immunocytochemistry. RESULTS: In the swim-up fractions there was a reduction in the frequencies of disomic sperm, whether considering the sex chromosomes (1.4-fold) or the three autosomal chromosomes (1.5-fold based on the aggregate frequencies of disomy 10, 11 and 17). There was also a 1.5-fold reduction in diminished maturity sperm, indicating a relationship between the proportion of immature sperm and chromosomal aneuploidies (r = 0.46, P < 0.05, n = 20). Diploid sperm were reduced at a 2.7-fold rate, whether assessed with two- or three-colour FISH. There was a slight increase in the X/Y ratios. CONCLUSIONS: Swim-up reduces the proportion of sperm with chromosomal aberrations and of sperm with diminished maturity. When compared with the results of the previous study with gradient centrifugation performed on semen samples with similar quality, the efficacy after swim-up is lower for disomies and higher for diploidies than that of gradient centrifugation.

[Ultrasound diagnosis of focal intrauterine lesions]. / Méhen belüli körülírt elváltozások ultrahang-diagnosztikája.

OBJECTIVE: To compare the efficacy of the conventional grey-scale real time ultrasound, color Doppler ultrasound (color flow mapping) and hysteroscopy in the diagnosis of circumscript intrauterine lesions, such as endometrial polyps and submucosal myomas. METHODS: Preoperative transvaginal ultrasound data of 124 patients with focal intrauterine lesions, as confirmed by operative hysteroscopy, were elaborated. Using grey-scale ultrasound the detailed endometrial morphology, with color Doppler the vascularization pattern of the endometrium was examined. The ultrasound diagnosis, the hysteroscopic diagnosis and the histological diagnosis were matched and the sensitivity of conventional grey-scale ultrasound, color Doppler ultrasound and hysteroscopy were calculated. Age, menstrual and fertility status, medication and symptoms (abnormal bleeding) of patients were also evaluated. RESULTS: Of the 124 removed lesions the histological examination confirmed 114 endometrial polyps and 10 leiomyomas. Conventional grey-scale ultrasound was performed at 79 patients (TVS group), while 45 patient were examined by color Doppler ultrasound (TVCD group). In the TVS group the intrauterine lesion was detected in 59 cases, and the origin was also correctly diagnosed in 48 cases. In the TVCD group 42 lesions were detected, and the ultrasound diagnosis was consistent with the histological diagnosis in 41 cases. At hysteroscopy 118 endometrial polyps and 6 myoma were described. In this material the sensitivity of conventional transvaginal grey-scale ultrasound, the color Doppler ultrasound, and hysteroscopy in the detection of circumscript intrauterine lesions was 0.74, 0.93 and 1, respectively; in the diagnosis of the intrauterine lesion was 0.66, 0.91 and 0.97, respectively. Statistically significant differences were found between the ultrasound detection rates (p < 0.05) and between the diagnosis rates (p < 0.01) of the TVS and the TVCD group. Abnormal menopausal bleeding, recurrent bleeding, infertility, and tamoxifen therapy were present with high frequency in clinical data. CONCLUSION: Visualization of the feeding vessels using color or power Doppler ultrasound imaging improves the detection rate and the ultrasound diagnosis of the circumscript intrauterine lesions, approaching the sensitivity of hysteroscopy. First line application is recommended for patients at risk, such as infertility, recurrent postmenopausal bleeding, or for patients receiving long term tamoxifen.