Safety of vaginal oestrogens for genitourinary symptoms in women with breast cancer.

BACKGROUND: Oestrogen deprivation is the mainstay of treatment for women with hormone receptor-positive breast cancer, but unfortunately it causes multiple side effects that can significantly impair quality of life. Genitourinary symptoms are very common and although these symptoms can be effectively managed with vaginal oestrogens, concerns about their safety in women with breast cancer limits their use. OBJECTIVE: The aim of this review is to provide a summary of the data on the safety of vaginal oestrogens in women with breast cancer to help general practitioners advise their patients in this situation. DISCUSSION: Although there are no large randomised prospective studies to assess safety, the current evidence suggests reassurance can be provided to the majority of women with a history of breast cancer considering vaginal oestrogens. Consultation with the oncology team is advised for women taking aromatase inhibitors, where the safety of vaginal oestrogens is less certain.

Fractional CO2 laser for genitourinary syndrome of menopause: evaluating the evidence.

The fractionated CO2 laser has been marketed to women for a variety of gynecologic symptoms and conditions, including the genitourinary syndrome of menopause (GSM). The evidence has been limited, precluding conclusions regarding the efficacy and safety of the therapy. However, data from randomized, controlled trials evaluating this technology for GSM are now available. This Practice Pearl addresses the latest data concerning the use of the fractionated CO2 laser for the treatment of GSM.

Different effects of CO2 laser and estrogen treatment on vaginal mucosa microbiota and function in genitourinary syndrome of menopause patients.

AIM: To characterize the effects of CO2 laser treatment and estrogen treatment on vaginal microbiota in patients with genitourinary syndrome of menopause (GSM). METHODS: Sixty-four patients with genitourinary syndrome were divided into the estrogen group, the CO2 laser group, and the control group. The control group did not receive any treatment. Vaginal mucosa was collected after 3 and 12 months of treatment. The former was used for 16S rRNA sequencing, and the latter was used for pathological evaluation. Vaginal health and voiding function were assessed using the vaginal health index (VHI) scale and the UDI-6 scale at 3 and 12 months after treatment. RESULTS: The results showed that both treatments reduced alpha diversity in the vaginal flora. Additionally, the abundance of 65 genera differed significantly between the treatment and control groups, with an increase in potentially beneficial bacteria such as Lactobacillus, IheB3_7, Mycoplasma urealyticum, and Streptococcus. In addition, the VHI and UDI-6 scores improved in both treatment groups compared to the control group after 3 months. Whereas VHI and UDI-6 scores were close to baseline in the estrogen group, and remained significantly improved in the CO2 laser group after 12 months. Pathological results showed that both methods improved the vaginal health status of patients with GSM after 12 months of treatment. However, the CO2 group exhibited a more significant increase in type III collagen. CONCLUSIONS: Both CO2 laser and estrogen therapies can regulate the vaginal flora imbalance of GSM and improve the corresponding symptoms. However, the long-term efficacy of CO2 laser therapy is superior compared to estrogen therapy.

Vaginal CO2 laser therapy for genitourinary syndrome in breast cancer survivors-VagLaser study protocol: a randomized blinded, placebo-controlled trial.

BACKGROUND: Vaginal CO2 laser therapy is a new treatment option for genitourinary syndrome of menopause. Its potential is particularly interesting in breast cancer survivors, where existing treatment options often are insufficient as hormonal treatment is problematic in these women. The objective of this study is to investigate the effectiveness of vaginal laser treatment for alleviation of genitourinary syndrome of menopause in breast cancer survivors treated with adjuvant endocrine therapy. The secondary objective is to explore the importance of repeated vaginal laser treatment and the long-term effects in this patient population. METHODS: VagLaser consist of three sub-studies; a dose response study, a randomized, participant blinded, placebo-controlled study and a follow-up study. All studies include breast cancer survivors in adjuvant endocrine therapy, and are conducted at the Department of Obstetrics and Gynecology, Randers Regional Hospital, Denmark. The first participant was recruited on 16th of February 2023. Primary outcome is vaginal dryness. Secondary subjective outcomes are vaginal pain, itching, soreness, urinary symptoms and sexual function. Secondary objective outcomes are change in vaginal histology (punch biopsy), change in vaginal and urine microbiota, and change in vaginal pH. DISCUSSION: More randomized controlled trials, with longer follow-up to explore the optimal treatment regimen and the number of repeat vaginal laser treatments for alleviation the symptoms of genitourinary syndrome of menopause in breast cancer survivors treated with endocrine adjuvant therapy, are needed. This study will be the first to investigate change in vaginal and urine microbiota during vaginal laser therapy in breast cancer survivors. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06007027 (registered 22 August, 2023). PROTOCOL VERSION: Version 1, Date 13.11.2023.

Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer.

OBJECTIVE: To assess the risk of recurrence of breast cancer associated with vaginal estrogen therapy in women diagnosed with genitourinary syndrome of menopause with a history of breast cancer using a large U.S. claims database. METHODS: A U.S. health research network (TriNetX Diamond Network) was queried from January 2009 to June 2022. Our cohort consisted of women diagnosed with breast cancer within 5 years before the initial genitourinary syndrome of menopause diagnosis. Patients with active disease , defined as those undergoing mastectomy, radiation treatment, or chemotherapy within 3 months before diagnosis of genitourinary syndrome of menopause, were excluded. Recurrence was defined as mastectomy, radiation, chemotherapy, or secondary malignancy within 3 months to 5 years after the initiation of vaginal estrogen therapy for genitourinary syndrome of menopause. The study cohort included those with three or more vaginal estrogen prescriptions. The control cohort included women with breast cancer without any vaginal estrogen prescriptions after genitourinary syndrome of menopause diagnosis. Propensity matching was performed. A subanalysis by positive estrogen receptor status, when available, was performed. RESULTS: We identified 42,113 women with a diagnosis of genitourinary syndrome of menopause after breast cancer diagnosis with any estrogen receptor status, 5.0% of whom received vaginal estrogen. Of the initial cohort, 10,584 patients had a history of positive estrogen receptor breast cancer, and 3.9% of this group received vaginal estrogen. Risk of breast cancer recurrence was comparable between those who received vaginal estrogen and those who did not in both the any estrogen receptor (risk ratio 1.03, 95% CI 0.91-1.18) and positive estrogen receptor (risk ratio 0.94, 95% CI 0.77-1.15) status analyses. CONCLUSION: In a large, claims-based analysis, we did not find an increased risk of breast cancer recurrence within 5 years in women with a personal history of breast cancer who were using vaginal estrogen for genitourinary syndrome of menopause.

The effect of CO2 laser therapy on vaginal microcirculatory parameters in an animal model for genitourinary syndrome of menopause.

BACKGROUND: Vaginal laser therapy for the treatment of genitourinary syndrome of menopause (GSM) has been introduced to the market with limited (pre)clinical and experimental evidence supporting its efficacy. It is suggested that vaginal laser therapy increases epithelial thickness and improves vascularization, but the underlying biological working mechanism has not been substantiated yet. OBJECTIVE: To evaluate the effects of CO2 laser therapy on vaginal atrophy using noninvasive incident dark field (IDF) imaging in a large animal model for GSM. DESIGN, SETTING, AND PARTICIPANTS: An animal study was conducted between 2018 and 2019 and included 25 Dohne Merino ewes, of which 20 underwent bilateral ovariectomy (OVX) to induce iatrogenic menopause, and 5 did not. The total study duration was 10 months. INTERVENTIONS: Five months after OVX, ovariectomized ewes received monthly applications of CO2 laser (n = 7), vaginal estrogen (n = 7), or no treatment (n = 6) for 3 months. IDF imaging was performed monthly in all animals. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was the proportion of image sequences containing capillary loops (angioarchitecture). Secondary outcomes included focal depth (epithelial thickness), and quantitative measures of vessel density and perfusion. Treatment effects were evaluated using ANCOVA and binary logistic regression. RESULTS AND LIMITATIONS: Compared to OVX-only, ewes treated with estrogen demonstrated a higher capillary loops proportion (4% vs. 75%, p < 0.01), and higher focal depth (60 (IQR 60-80) vs. 80 (IQR 80-80) p < 0.05). CO2 laser therapy did not change microcirculatory parameters. As the ewes' vaginal epithelium is thinner than that of humans, it may demand different laser settings. CONCLUSIONS: In a large animal model for GSM, CO2 laser therapy does not affect microcirculatory outcomes related to GSM, whereas vaginal estrogen treatment does. Until more homogeneous and objective evidence about its efficacy is available, CO2 laser therapy should not be adopted into widespread practice for treating GSM.

Emergency Gynecologic Considerations in the Older Woman.

As women mature through menopause, they will experience normal physiologic changes that can contribute to emergency complaints specific to this patient population. Reviewing the expected physiologic changes of menopause and correlating these normal processes to the development of specific pathologic conditions offers a framework for emergency physicians and practitioners to use when evaluating older women for breast, genitourinary, and gynecologic symptoms.

Management of Menopausal Symptoms: A Review.

Importance: Menopause, due to loss of ovarian follicular activity without another pathological or physiological cause, typically occurs between the ages of 45 years and 56 years. During the menopausal transition, approximately 50% to 75% of women have hot flashes, night sweats, or both (vasomotor symptoms) and more than 50% have genitourinary symptoms (genitourinary syndrome of menopause [GSM]). Observations: Vasomotor symptoms typically last more than 7 years and GSM is often chronic. Efficacious treatments for women with bothersome vasomotor symptoms or GSM symptoms include hormonal and nonhormonal options. Systemic estrogen alone or combined with a progestogen reduces the frequency of vasomotor symptoms by approximately 75%. Oral and transdermal estrogen have similar efficacy. Conjugated equine estrogens (CEE) with or without medroxyprogesterone acetate (MPA) were the only hormonal treatments for which clinical trials were designed to examine cardiovascular events, venous thromboembolism, and breast cancer risk. Compared with placebo, the increased risk of stroke and venous thromboembolism associated with CEE (with or without MPA) and breast cancer (with use of CEE plus MPA) is approximately 1 excess event/1000 person-years. Low-dose CEE plus bazedoxifene is not associated with increased risk of breast cancer (0.25%/year vs 0.23%/year with placebo). Bioidentical estrogens approved by the US Food and Drug Administration (with identical chemical structure to naturally produced estrogens, and often administered transdermally) also are available to treat vasomotor symptoms. For women who are not candidates for hormonal treatments, nonhormonal approaches such as citalopram, desvenlafaxine, escitalopram, gabapentin, paroxetine, and venlafaxine are available and are associated with a reduction in frequency of vasomotor symptoms by approximately 40% to 65%. Low-dose vaginal estrogen is associated with subjective improvement in GSM symptom severity by approximately 60% to 80%, with improvement in severity by 40% to 80% for vaginal prasterone, and with improvement in severity by 30% to 50% for oral ospemifene. Conclusions and Relevance: During the menopausal transition, approximately 50% to 75% of women have vasomotor symptoms and GSM symptoms. Hormonal therapy with estrogen is the first-line therapy for bothersome vasomotor symptoms and GSM symptoms, but nonhormonal medications (such as paroxetine and venlafaxine) also can be effective. Hormone therapy is not indicated for the prevention of cardiovascular disease.

Emerging Use of Vaginal Laser to Treat Genitourinary Syndrome of Menopause for Breast Cancer Survivors: A Review.

Breast cancer treatment, such as chemotherapy and endocrine therapy, can cause earlier and more sudden menopausal symptoms. Genitourinary syndrome of menopause (GSM) is one of the most bothersome side effects of breast cancer treatment, resulting in sexual dysfunction and impaired quality of life. GSM includes genital, urinary, and sexual symptoms. However, alleviating symptoms of GSM for breast cancer survivors may be challenging due to ineffectiveness, contraindications, and low adherence to treatment. The most recent data show the feasibility and safety of vaginal laser to treat GSM for breast cancer survivors. This narrative review provides the aspects of GSM in breast cancer patients, putting the focus on the efficacy and safety of vaginal laser therapy.

Systemic sclerosis in a patient with Turner syndrome: A case report and a review of associated autoimmune diseases

Turner's syndrome (TS) is one of the most common sex chromosome disorders caused by numeric or structural abnormalities of the X chromosome. A case of TS and Systemic Sclerosis (SSc) is reported, along with a summary of all associated TS/autoimmune diseases described in English literature from 1948 to 2020, using a search in MEDLINE (Pubmed). A 32-year-old woman affected by TS was seen due to inflammatory arthralgia in small joints and dysphagia, as well as a two-year history of Raynaud's phenomenon and puffy hands. Biohumoural laboratory tests and severity scales revealed changes that allowed us to diagnose SSc. This case report emphasises the role played by sex hormones and chromosomal abnormalities in the pathogenesis of autoimmune disorders, and to our knowledge, this is the only case described in literature of a TS patient who developed SSc.

El síndrome de Turner (TS) es uno de los trastornos cromosómicos sexuales más comunes causados por anomalías numéricas o estructurales del cromosoma X. En este documento informamos de un caso de TS y esclerosis sistémica (SSc) y resumimos toda la asociación de TS/enfermedades autoinmunes descrita en la literatura inglesa de 1948 a 2020, encontrada buscando en MEDLINE (PubMed). Una mujer de 32 arios afectada por TS acudió a nuestra observación debido a la artralgia inflamatoria en pequenas articulaciones y disfagia y 2 anos de historia del fenómeno de Raynaud y las manos hinchadas. El laboratorio biohumoral y las pruebas instrumentales revelaron alteraciones que nos permitieron diagnosticar SSc. Nuestro informe de caso hace hincapié en el papel desempefíado por las hormonas sexuales y las anomalías cromosómicas en la patogénesis del trastorno autoinmune; y hasta nuestro conocimiento, este es el único caso descrito en la literatura de un paciente TS que desarrolló SSc.

Clinical and immunological factors associated with lupus nephritis in an Argentine patient population: A cross-sectional study

Introduction: In recent decades, the prevalence of systemic lupus erythematosus (SLE) has increased thanks to early detection and the impact of new therapies on the survival of those affected. Up to 90% will have histopathological signs of kidney disease in the first 3 years of the disease, but lupus nephritis of clinical relevance will appear in 50% of cases, affecting kidney function and mortality. Despite aggressive therapeutic strategies, the prognosis of patients with LN remains unfavourable, mainly due to the high risk of progression to end-stage renal disease (10%-20%) and mortality from all causes. Objective: To describe the clinical and immunological risk factors of a group of patients with lupus, comparing clinical and serological characteristics in relation to renal involvement to establish possible associations. Materials and methods: Cross-sectional study in which 87 patients with SLE were included. Clinical and immunological variables were analyzed. Bivariate and multivariate analyses were performed using the presence of nephritis as an outcome. Results: The prevalence of lupus nephritis was 59%. The significantly associated variables were arterial hypertension (OR 3.1, 95% CI 1.02-9.40), age of onset of lupus less than 25 years (OR 2.7, 95% CI 1.08-6.73), the presence of reticular livedo (OR 4.1, 95% CI 1.09-15.7), positive anti-DNA (OR 2.9, 95% CI 1.18-7.24) and low levels of complement (OR 4.0, 95% CI 1.64-10.2). Conclusions: Urinary sediment abnormalities were the most common renal manifestation and lupus debut before the age of 25 seems to increase the risk of developing nephritis. Future research is required for a better explanation of the associations found.

Introducción: En las últimas décadas, la prevalencia del lupus eritematoso sistémico (LES) se ha incrementado gracias a la detección temprana y al impacto de las nuevas terapias en la sobrevida de los afectados. Hasta el 90% de ellos tendrá signos histopatológicos de afección renal en los primeros 3 arios de la enfermedad, pero la nefritis lúpica (NL) de relevancia clínica aparecerá en el 50% de los casos, afectando la función renal y la mortalidad. A pesar de las estrategias terapéuticas agresivas, el pronóstico de los pacientes con NL sigue siendo desfavorable, principalmente debido al alto riesgo de progresión a enfermedad renal crónica terminal (10-20%) y de mortalidad por todas las causas. Objetivo: Describir los factores de riesgo clínicos e inmunológicos de un grupo de pacientes con lupus, comparando características clínicas y serológicas en relación con el compromiso renal, a fin de establecer posibles asociaciones. Materiales y métodos: Estudio de corte transversal en el que se incluyeron 87 pacientes con LES. Se analizaron variables clínicas e inmunológicas. Los análisis bivariado y multivariados se realizaron utilizando la presencia de nefritis como desenlace. Resultados: La prevalencia de NL fue del 59%. Las variables asociadas significativamente fueron hipertensión arterial (OR: 3,1; IC 95%: 1,02-9,40), edad de aparición del lupus menor de 25 años (OR: 2,7; IC 95%: 1,08-6,73), presencia de livedo reticularis (OR: 4,1; IC 95%: 1,0915,7), anti-DNA positivo (OR: 2,9; IC 95%: 1,18-7,24) y niveles bajos de complemento (OR: 4,0; IC 95%: 1,64-10,2). Conclusiones: Las anormalidades en el sedimento urinario fueron la manifestación renal más común, en tanto que el inicio lúpico antes de los 25 años parece incrementar el riesgo de desarrollar nefritis. Se requieren futuras investigaciones que den una mejor explicación a las asociaciones encontradas.

Hallazgos genitourinarios en mujeres con tumores ováricos / Genito-urinary findings in women with ovarian tumors

Los tumores de ovario son los trastornos ginecológicos más comunes. Los tumores de ovario son el tercer tumor más común en las mujeres. Los tumores de ovario a veces son asintomáticos y tienen síntomas no específicos, lo que hace que la mayoría de los casos sean difíciles de detectar temprano. El objetivo de este estudio fue investigar las características genitourinarias del tumor ovárico en un estudio hospitalario. Se realizó un estudio observacional en Bagdad, Iraq, entre septiembre de 2018 y febrero de 2021. Las mujeres diagnosticadas con tumores ovarios a los 18 años de edad o más. Un total de cincuenta mujeres que se inscribieron en nuestro hospital. Datos clínicos y patológicos recopilados y analizados. Los datos sobre comorbilidades y resultados fueron aprobados y diagnosticados por un equipo completo de médicos ginecológicos y urológicos multidisciplinarios. La incidencia general de tumores ováricos fue 70% maligna y 30% benigna. El estudio mostró que la mayor parte del grupo de edad de tumores ováricos era superior a 55 años (62%). La mitad de los pacientes eran nuliparidades. El nivel educativo era principalmente de bajo nivel en analfabeto (20%), primario (24%), secundario (36%) en comparación con el alto nivel. Las mujeres usaron anticoncepción en 52%. La historia familiar informó en el 18% de las mujeres. El tipo histopatológico más común era el carcinoma seroso ovárico 15 (30%). Las etapas regionales eran comunes en el 50% de los pacientes. Tumores de bajo grado en 32%, intermedio en 36%y alto en 32%. Casi, el 80% de las mujeres se sometieron a TAH. Alrededor del 60% de los pacientes recibieron quimioterapia. Los resultados de salud genitourinaria adversos a largo plazo incluyeron nefritis (6%), insuficiencia renal aguda (16%), enfermedad renal crónica (18%), infección urinaria (38%), cálculo (16%), hidronefrosis (20%), Obstrucción de la vejiga (2%), estenosis ureteral (12%), retención de orina (8%), incontinencia de orina (12%), hematuria (22%), PID (14%), adhesión de órganos (8%), cervicitis (2 %), Endometriosis (2%), quiste (6%), trastornos menstruales (24%), infertilidad (2%) y dolor menopáusica (32%). En conclusión, el cáncer de ovario representa el tercer tipo de cáncer ginecológico más común. Era más común en mujeres mayores de cinco décadas. El tipo histopatológico más común es el carcinoma seroso ovárico. Observamos que los sobrevivientes de cáncer de ovario experimentaron mayores riesgos de varias enfermedades genitourinarias. Comprender los escenarios de la morbilidad múltiple para los tumores ováricos es de vital importancia para mejorar la atención clínica después del diagnóstico.

Ovarian tumors are the most common gynecological disorders. Ovarian tumors are the third most common tumor in women. Ovarian tumors are sometimes asymptomatic and have non-specific symptoms, making most cases difficult to detect early. The aim of this study was to investigate genitourinary features of ovarian tumor in a hospital-based study. An observational study was conducted in Baghdad, Iraq, between September 2018 and February 2021. Women diagnosed with ovarian tumors at 18 years of age or older. A total of Fifty women who enrolled in our hospital. Clinical and pathological data collected and analyzed. Data about comorbidities and outcomes were approved and diagnosed by full team of multidisciplinary gynecological and urological doctors were recorded. Overall incidence of ovarian tumors was 70% malignant and 30% benign. The study showed that the most age group of ovarian tumors was above 55 years (62%). Half of patients were nulliparities. Educational level was mostly of low level in illiterate (20%), primary (24%), secondary (36%) compared to high level. Women used contraception in 52%. The family history reported in 18% of women. The most common histopathological type was ovarian serous carcinoma 15(30%). Regional stages were common in 50% of patients. Low grade tumors in 32%, intermediate in 36% and high in 32%. Almost, 80% of women underwent TAH. About 60% of patients received chemotherapy. The long-term adverse genitourinary health outcomes correlated included Nephritis (6%), Acute renal failure (16%), Chronic kidney disease (18%), UTI (38%), Calculus (16%), Hydronephrosis (20%), Bladder obstruction (2%), Ureteric stenosis (12%), Urine retention (8%), Urine incontinence (12%), Hematuria (22%), PID (14%), Organ adhesion (8%), Cervicitis (2%), Endometriosis (2%), Cyst (6%), Menstrual disorders (24%), Infertility (2%), and Menopausal pain (32%). In conclusion, ovarian cancer represents the third most common gynecologic cancer type. It was more common in women aged above five decades. The most common histopathological type is ovarian serous carcinoma. We observed that ovarian cancer survivors experienced increased risks of various genitourinary diseases. Understanding the multi-morbidity scenarios for ovarian tumors is of vital importance to improve clinical care after diagnosis.

An Insight on the Role of Altered Function and Expression of Exosomes and MicroRNAs in Female Reproductive Diseases.

Exosomes are small bilayer-lipid membrane vesicles secreted by living cells that are able to transfer regulatory molecules and genetic information from one cell to another. These vesicles are enriched with several nucleic acids including mRNAs, microRNAs (miRNAs), other non-coding RNAs, as well as proteins and lipids. Alterations in the exosomal content and functions are observed in numerous reproductive diseases in both animals and human cases. MicroRNAs, a class of small endogenous RNA molecules, can negatively regulate gene expression at the post-transcription level. Aberrant microRNA expression has been reported in multiple human reproductive diseases such as polycystic ovary syndrome, preeclampsia, uterine leiomyomata, ovarian cancer, endometriosis, and Asherman's syndrome. This study focuses to review recent research on alterations of microRNA expression and the role of exosomes in female reproductive diseases. It has been demonstrated that exosomes may be a potential therapeutic approach in various female reproductive diseases. In addition, changes in expression of microRNAs act as molecular biomarkers for diagnosis of several reproductive diseases in women, and regulation of their expression can potentially reduce infertility.

Understanding tubulointerstitial injury and repair mechanisms paves the way for renal outcome improvement in lupus nephritis / Entender la lesión tubulointersticial y los mecanismos de reparación será la vía para mejorar los desenlaces renales en nefritis lúpica

ABSTRACT Despite improvements in patient survival and quality of life, long-term renal survival has not changed significantly in the recent decades and nephritis relapses affect over 50% of patients with lupus nephritis. Renal fibrosis affecting the tubulointerstitial compartment is a central determinant of the prognosis of any kidney disease. Notwithstanding this evidence, the current 2003 ISN/RPS classification still focuses on glomerular pathology and does not include a mandatory score with clear subcategories of the tubulointerstitial injury in the biopsy. The pathogenesis, and the morphological and molecular characteristics of this process in patients with lupus nephritis will be considered, together with a discussion about the concepts the clinician needs to efficiently address in this injury during daily practice and in future clinical trials. Both tubulointerstitial inflammation and fibrosis are strongly correlated with poor renal outcomes in lupus nephritis, regardless of the extent of glomerular damage. Therefore, it is essential to develop reliable and noninvasive approaches to predict which patients are most likely to develop CKD so that appropriate interventions can be adopted before ESRD is established. Currently, no ideal method for monitoring kidney fibrosis exists, since repeated renal biopsies are invasive. Promising methods for assessing and monitoring fibrosis non-invasively include imaging techniques, such as magnetic resonance imaging or ex vivo confocal microscopy, integrated in computational and digital pathology techniques. Finally, beyond specific immunosuppressive treatment in Lupus Nephritis, identifying and treating cardiovascular risk factors should be a cornerstone of treatment in these patients.

RESUMEN A pesar de las mejoras en la sobrevida de los pacientes y su calidad de vida, la sobrevida renal en el largo plazo no ha cambiado significativamente durante las últimas décadas, y las recidivas nefríticas afectan a más del 50% de los pacientes con nefritis lúpica. La fibrosis renal, que afecta el compartimiento tubulointersticial, es un factor determinante central en el pronóstico de todas las patologías renales. A pesar de la evidencia, la actual clasificación ISN/RPS del 2003 todavía se concentra en la patología glomerular y no incluye un score obligatorio con claras subcategorías de la lesión tubulointersticial en la biopsia. Se hablará de la patogenia y las características morfológicas y moleculares de este proceso en pacientes con nefritis lúpica, así como de los conceptos que el clínico necesita para abordar esta lesión de manera eficiente en su práctica cotidiana y en los estudios clínicos a futuro. Tanto la inflamación tubulointersticial como la fibrosis se relacionan fuertemente con desenlaces renales pobres en la nefritis lúpica, con independencia de la extensión del dañío glomerular. Resulta por lo tanto esencial desarrollar sistemas confiables y no invasivos para predecir cuáles pacientes tendrán mayor probabilidad de desarrollar enfermedad renal crónica, a fin de realizar las intervenciones apropiadas antes de que se establezca la enfermedad renal terminal (ERT). En la actualidad, no existe un método ideal para monitorear la fibrosis renal, dado que las biopsias repetidas son procedimientos invasivos. Algunos de los métodos promisorios para evaluar y monitorear la fibrosis de manera no invasiva son las técnicas de imágenes, tales como la resonancia magnética o la microscopía confocal ex vivo, integradas en técnicas de patología computarizadas y digitales. Finalmente, más allá del tratamiento inmunosupresor específico para la nefritis lúpica, identificar y tratar los factores de riesgo cardiovascular deberá ser uno de los pilares de tratamiento en estos pacientes.

Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer: Clinical Consensus.

SUMMARY: With an estimated 3.8 million breast cancer survivors in the United States, obstetrician-gynecologists often are on the front lines of addressing survivorship issues, including the hypoestrogenic-related adverse effects of cancer therapies or early menopause in survivors (1). Although systemic and vaginal estrogen are used widely for symptomatic relief of genitourinary syndrome of menopause in the general population, among individuals with a history of hormone-sensitive cancer, there is uncertainty about the safety of hormone-based therapy, leading many individuals with bothersome symptoms to remain untreated, with potential negative consequences on quality of life (2). An effective management strategy requires familiarity with a range of both hormonal and nonhormonal treatment options, knowledge about the pharmaceutical mechanisms of action, and the ability to tailor treatment based on individual risk factors. This clinical consensus document was developed using an a priori protocol in conjunction with two authors specializing in urogynecology and gynecologic oncology. This document has been updated to review the safety and efficacy of newer hormonal treatment options as well as nonhormonal modalities.

The role of hormone therapy in urogenital health after menopause.

Menopause represents an endocrine challenge to urogenital health, as oestrogens deprivation and androgens decline significantly contributes to age-related involution of vulvovaginal tissues and lower urinary tract. Genitourinary syndrome of menopause (GSM) is a clinical entity including the chronic and progressive condition of vulvovaginal atrophy (VVA) and encompassing both anatomical and functional consequences of menopause. The term GSM describes genital, sexual and urinary symptoms with a detrimental impact on quality of life (QOL). Several treatment options are available, but many barriers are still present to adequately diagnose and treat GSM. This review aims to present current evidences about epidemiology, aetiology, diagnosis and treatment of GSM, with a focus on prescription medications [low-dose local oestrogen therapy (LET), prasterone (DHEA) and the SERM ospemifene] for urogenital symptoms in healthy postmenopausal women and in special populations, including women with premature ovarian insufficiency (POI) and breast cancer survivors (BCS).

A Review on Therapeutic Effects of Labisia pumila on Female Reproductive Diseases.

The Labisia pumila (LP) is a traditional plant that is locally known as Kacip Fatimah, Selusuh Fatimah, or Pokok Ringgang by the Malaysian indigenous people. It is believed to facilitate their childbirth, treating their postchild birth and menstrual irregularities. The water extract of LP has shown to contain bioactive compounds such as flavonoids, ascorbic acid, ß-carotene, anthocyanin, and phenolic acid, which contribute extensive antioxidant, anti-inflammatory, antimicrobial, and antifungal. The LP ethanolic extract exhibits significant estrogenic effects on human endomentrial adenocarcinoma cell in estrogen-free basal medium and promoting an increase in secretion of alkaline phosphate. Water based has been used for many generations, and studies had reported that it could displace in binding the antibodies and increase the estradiol production making it similar to esterone and estradiol hormone. LP extract poses a potential and beneficial aspect in medical and cosmeceutical applications. This is mainly due to its phytoestrogen properties of the LP. However, there is a specific functionality in the application of LP extract, due to specific functional group in phytoconstituent of LP. Apart from that, the extraction solvent is important in preparing the LP extract as it poses some significant and mild side effects towards consuming the LP extracts. The current situation of women reproductive disease such as postmenopausal syndrome and polycystic ovary syndrome is increasing. Thus, it is important to find ways in alternative treatment for women reproductive disease that is less costly and low side effects. In conclusion, these studies proven that LP has the potential to be an alternative way in treating female reproductive related diseases such as in postmenopausal and polysystic ovarian syndrome women.