Bone mass in women with premature ovarian insufficiency: a comparative study between hormone therapy and combined oral contraceptives.

OBJECTIVE: The aim of the study was to evaluate whether combined oral contraceptives (COCs) can be used as hormone therapy (HT) to preserve bone mineral density (BMD) in women with premature ovarian insufficiency (POI). METHODS: An observational study of women with POI comparing the use of COC (ethinylestradiol 30 µg + levonorgestrel, continuously) with: low-dose HT (continuous conjugated estrogen 0.625 mg plus medroxyprogesterone or continuous estradiol [E2] 1 mg + norethisterone), high-dose HT (continuous conjugated estrogen 1.25 mg + medroxyprogesterone or continuous E2 2 mg + norethisterone), tibolone 2.5 mg, or no treatment. Bone density scans were performed every 2 ±â€Š1 years. The difference between final and initial (delta) BMD values was calculated for the lumbar spine, total femur, and femoral neck. Generalized estimating equations were used to analyze the effect of treatment over time. Variables without normal distribution were transformed into ranks. RESULTS: Overall, 420 scans (210 deltas) of 119 women were analyzed. The women were 30.3 ±â€Š9.2 years old (mean ±â€ŠSD). BMD deltas at the lumbar spine and total femur were grater in the COC and high-dose HT groups. At the lumbar spine, the differences between two scans were greater in the COC group when compared to low-dose HT group: -0.043 (95% CI -0.062 to -0.024), untreated: -0.056 (-0.080 to -0.032), and tibolone: -0.050 (-0.094 to -0.006) groups. Total femur BMD decreases and the delta were lower in the low-dose HT group -0.038 (-0.052 to -0.024) when compared to COC. CONCLUSION: Continuous COC was associated with increased BMD in women with POI compared to low-dose HT, with similar improvement in the COC and high-dose HT groups. : Video Summary:http://links.lww.com/MENO/A620.

Video Summary:http://links.lww.com/MENO/A620.

Comparison of endometrial assessment by transvaginal ultrasonography and hysteroscopy.

OBJECTIVE: To compare transvaginal ultrasonography and hysteroscopy for the diagnosis of endometrial pathologies. METHODS: In the present retrospective cohort study, data were reviewed from women with ultrasonography findings suggestive of endometrial lesions and/or abnormal uterine bleeding who underwent hysteroscopy at a single center in Campinas, Brazil, between January 2011 and December 2013; data were stratified based on reproductive-aged and postmenopausal groups. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography and hysteroscopy for the diagnosis of endometrial lesions were determined. Histopathology was used as the gold standard. RESULTS: There were 754 patients included (256 reproductive age, 498 postmenopausal). In the reproductive-age group, ultrasonography had a sensitivity of 96.0%, specificity of 58.0%, PPV of 94.4%, NPV of 66.6%, and accuracy of 91.5%, whereas hysteroscopy had a sensitivity of 91.8%, specificity of 76.6%, PPV of 96.0%, NPV of 60.5%, and accuracy of 89.7% for the diagnosis of endometrial disease. In the postmenopausal group, ultrasonography had a sensitivity of 99.0%, specificity of 19.0%, PPV of 96.1%, NPV of 50.0%, and accuracy of 95.3%, whereas hysteroscopy had a sensitivity of 96.7%, specificity of 86.9%, PPV of 99.2%, NPV of 58.8%, and accuracy of 96.2%. CONCLUSION: Ultrasonography was found to be an effective method for the diagnosis of endometrial disease, especially among postmenopausal women.

Efficacy of misoprostol before diagnostic hysteroscopy in postmenopausal women: a randomized clinical trial.

OBJECTIVE: To evaluate pain and determine the efficacy of misoprostol, compared with placebo, for postmenopausal women before diagnostic hysteroscopy. METHODS: This randomized, double-blind, placebo-controlled clinical trial included 158 postmenopausal women who received either 200 µg of misoprostol or placebo through the vaginal route before diagnostic hysteroscopy (79 women/group). The primary outcome was pain assessment (presence and intensity) during the four steps of hysteroscopy: cervical grasping with a Pozzi tenaculum forceps immediately before hysteroscopy, during hysteroscopy, during performance of the endometrial biopsy, and postprocedure. The secondary outcomes were duration of the procedure, need for additional cervical dilatation, complications, and adverse effects. RESULTS: Mean ages of the women were 62 ±â€Š8.2 years and 60 ±â€Š7.3 years in the misoprostol and placebo groups, respectively. Abnormal bleeding (misoprostol group, 45.6%; placebo, 43%) and endometrial thickening (54.4% in the misoprostol group and 57% in the placebo group) were the most common indications for the examination in both groups (P = 0.49). There was no significant difference between groups in the pain intensity of the four steps of the procedure. The duration of hysteroscopy was similar in both groups (misoprostol group, 2.5 ±â€Š2.7 minutes; placebo, 2.1 ±â€Š1.6 minutes; P = 0.43). Additional cervical dilatation was needed in 11 women in the misoprostol group versus 9 in the placebo group (P = 0.63). In both groups, there was no significant difference in terms of complications. Adverse effects were reported by 25.3% of women using misoprostol (vaginal bleeding, 11.3%; cramping, 12.6%; diarrhea, 2.5%; 1 woman reported both vaginal bleeding and cramping). In the placebo group, only 2.5% of women developed adverse effects (P < 0.0001). CONCLUSION: Misoprostol does not reduce pain intensity, the duration of the procedure, or need for additional cervical dilatation, and causes more adverse effects when used in postmenopausal women before diagnostic hysteroscopy.

Mammographic breast density in women with premature ovarian failure: a prospective analysis.

OBJECTIVE: This study aims to compare breast density between two mammograms in women with premature ovarian failure (POF). METHODS: A cohort study evaluated 56 women with POF. Two mammograms performed at least 2 years apart were analyzed. Mammogram films were digitalized, and images were assessed using a computer-assisted method; the percentage of breast image that is radiologically dense is referred to as the percentage of mammographic density (PMD). Age at menarche, age at onset of POF, length of POF, length of estrogen-progestin therapy (EPT), body mass index (BMI), pregnancy, and age at the time of each mammogram were evaluated. RESULTS: The mean (SD) age at POF diagnosis was 32.35 (5.95) years. In the first mammogram, the mean (SD) age, BMI, and length of POF were 37.58 (3.72) years, 26.79 (4.86) kg/m, and 5.25 (4.61) years, respectively. EPT had been used for a mean (SD) of 2.71 (3.12) years. In the second mammogram, the mean (SD) age, BMI, and length of POF were 43.23 (4.98) years, 27.6 (5.39) kg/m, and 10.5 (5.11) years, respectively. EPT had been used for a mean (SD) of 7.25 (4.6) years. The mean (SD) interval between mammograms was 5.25 (3) years, and the mean (SD) PMD decreased from 27.78% (21.04%) to 17.53% (15.71%) (P = 0.007). Comparing PMD between women taking EPT and those not taking EPT, we observed no significant differences. In both instances, multiparous women had lower PMD than nulliparous women (P < 0.05). BMI, length of POF, and pregnancy were negatively correlated with PMD. CONCLUSIONS: Breast density in young women with POF decreases across a period of 5 years, regardless of EPT use. Further studies may elucidate how this result will correlate with decision-making in clinical therapeutics and breast cancer risk in POF.

[Comparative study of transvaginal sonography and outpatient hysteroscopy for the detection of intrauterine diseases]. / Comparação do ultra-som transvaginal e da histeroscopia ambulatorial no diagnóstico das doenças intra-uterinas.

INTRODUCTION: Intrauterine diseases are common morbid disorders. Endometrial and endocervical polyps, myomas, synechiae, uterine malformations, endometrial hyperplasia and endometrial cancer are cited among intrauterine pathology. The investigations using transvaginal sonography and outpatient hysteroscopy had been a gold standard. Transvaginal sonography shows endometrial thickness and heterogeneous variations within the echogenecity of the endometrium uterine pathology. Transvaginal sonography is easy to apply for evaluation of intrauterine pathology and it has high sensitivity to diagnostic for intrauterine disorders. Hysteroscopy was used the gold standard control. It permitted the better identification of intrauterine pathology but the histologic examination has been used for definitive diagnostic. Difficulty apprenticeship this technique had very decrease your access. OBJECTIVES: To evaluate the efficiency of transvaginal ultrasonography and outpatient hysteroscopy in the diagnosis of intrauterine pathology. SUBJECTS AND METHODS: The study conducted was a retrospective diagnostic-type test. They involved a total of 469 women underwent diagnostic hysteroscopy in 2006 in Campinas University. Seventy-nine women were excluded due to lack of ultrasound results in their medical charts. One-hundred and forty-seven premenopausal women and two-hundred and forty-three postmenopausal women. For statistical analysis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy. The gold standard of the ultrasonography was the hysteroscopy and the gold standard of the hysteroscopy was the endometrium biopsy. RESULTS: The mean age of postmenopausal women was 61 ± 9.4 years. We observed 6.6% of endometrial hyperplasia and cancer and 54% of endometrial polyps. Ultrasonography had a sensitivity of 95.6%, a specificity of 7.4% and an accuracy of 53.7%, while hysteroscopy had a sensitivity of 95.7%, a specificity of 83% and an accuracy of 88.7%. The mean age of premenopausal women was 40 ± 8.2 years. Endometrial cancer was not observed and two cases of endometrial hyperplasia were found. We observed 34% of endometrial polyps. Sensibility was 52.9%, specificity was 68.4% and the accuracy was 61.2% for polyps on ultrasonography while in hysteroscopy was 78.8%, 67.6% and 73.1% respectively. For myoma, sensitivity was 70.6% and 64.3%, specificity was 44.3% and 98.1% and accuracy was 63.3% and 91.2% in ultrasonography and hysteroscopy respectively. CONCLUSION: Hysteroscopy had better diagnostic accuracy than ultrasonography for the detection of intrauterine pathology.