Urinary incontinence in female university students.

INTRODUCTION AND HYPOTHESIS: We aimed to determine the prevalence of urinary incontinence (UI) in nulliparous female university students and to provide an overview of risk factors associated with urinary continence. METHODS: A total of 1,397 female university students aged 18-28 years were enrolled into this cross-sectional questionnaire study. The self-administered questionnaires, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder V8 (OAB-V8), demographics, and general characteristics were recorded. The frequency, type, and severity of urinary incontinence and related factors were evaluated. RESULTS: The mean age of the students was 20.27 ± 1.69 years. The prevalence of UI in female university students was 18.4% (n = 258). ICIQ-SF total score was 0.85 ± 2.11 (0-14). OAB-V8 total score was 5.97 ± 5.35 (0-40) and 27.0% of participants had scores of ≥8. Elevated BMI, childhood enuresis, constipation, exercising, positive family history for UI, accommodation in a dormitory, and holding urine at school are risk factors associated with UI in female university students. CONCLUSION: We demonstrated that UI is a common condition among female university students. The identification of the associated risk factors will help to further raise the knowledge and awareness of the problem, and preventive strategies may be proposed to young women to improve the quality of life and psychological well-being.

Effects of hormone replacement therapy on plasma and tissue fibrinolytic activity in a rat model of surgically induced menopause.

PURPOSE: The purpose of this study was to analyze the effects of estrogen deficiency and hormone replacement therapy (HRT) on fibrinolytic activity in a rat mode of surgically-induced menopause. METHODS: Twelve-week-old, sexually mature female Sprague-Dawley rats, each weighing 200-250 g, were randomly divided into four groups: (1) sham-operated group, (2) ovariectomy group, (3) ovariectomy group followed by oral administration of daily 17ß-estradiol (0.02 mg/kg/day) (E2) + norethisterone acetate (0.01 mg/kg/day), and (4) ovariectomy group followed by oral administration of daily 17ß-estradiol (0.01 mg/kg/day) + drospirenone (0.02 mg/kg/day). Tissue plasminogen activator (tPA) antigen, plasminogen activator inhibitor-1 (PAI-1) antigen, and PAI-1/tPA levels were measured as markers of fibrinolysis in plasma and liver and brain tissue. RESULTS: Compared with sham-operated rats, ovariectomized rats showed higher levels of fibrinolytic activity; however, the increased fibrinolytic activity in plasma and liver tissue was significantly reduced by HRT regimens. No change was observed in the levels of fibrinolytic activity in brain tissue. CONCLUSIONS: HRT showed beneficial effects by decreasing fibrinolytic activity related to surgically-induced menopause. Short-term HRT treatment was associated with a shift in the procoagulant-anticoagulant balance toward a procoagulant state.

The effects of 17ß-estradiol plus drospirenone on anthropometric and biochemical measures of adiposity in menopausal women.

PURPOSE: To assess whether there are changes on anthropometric and biochemical measures of adiposity in pre- and postmenopausal women and in the latter before and after 6 months treatment with 17ß-estradiol plus drospirenone. METHODS: Twenty postmenopausal and 20 premenopausal women were enrolled in a prospective comparative study. Postmenopausal women received 1 mg 17ß-estradiol plus 2 mg drospirenone daily for 6 months. Measurements of body mass index (BMI), waist/hip ratio and plasmatic levels of insulin, glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride, leptin, adiponectin, orexin-A, glucagon-like peptide-1 (GLP-1) and ghrelin were performed in premenopausal (group 1) and postmenopausal women and in the latter before (group 2a) and after (group 2b) 6 months treatment with 17ß-estradiol plus drospirenone. RESULTS: No significant changes in BMIs, insulin and glucose were observed between group 1 and 2a; and group 2a and 2b. GLP-1 levels were significantly increased in group 1 compared to group 2a (p = 0.035). Leptin levels were significantly increased (p = 0.001) and GLP-1 levels were significantly decreased (p = 0.021) in group 2b compared to group 2a. HDL was significantly decreased while LDL and triglyceride levels were significantly increased in group 2a compared to group 1. (p = 0.030, p = 0.001, p = 0.020; respectively) LDL was significantly decreased (p = 0.010) in group 2b compared to group 2a. GLP-1 had a positive correlation with orexin-A (p < 0.001, r = 0.520) and negative correlation with leptin (p = 0.008, r = -0.345). CONCLUSION: Leptin was significantly higher and GLP-1 was significantly lower in women receiving 17ß-estradiol plus drospirenone treatment. GLP-1 levels were significantly lower after the menopause compared to premenopausal levels. Orexin-A and GLP-1 were positively correlated.

In vivo evaluation of the genotoxic effects of gonadotropins on rat reticulocytes.

BACKGROUND: Gonadotropins, as ovulation-inducing drugs, have been used widely to treat infertility. An epidemiologic correlation between infertility therapy and ovarian cancer development has been reported. However, the effect of gonadotropins in the formation of reproductive tract cancers is controversial. OBJECTIVE: The aim of the study was to determine the in vivo genotoxic effects of gonadotropins on rat reticulocytes. METHODS: In this prospective, randomized, controlled study, rats were randomly assigned to 1 of 5 groups. The calculated rat doses of 0.65 human menopausal gonadotropin (hMG), 0.95 hMG, 0.65 follitropin beta (FB), 0.95 FB, or normal saline (control group) were injected, respectively. These calculated rat doses (U/g) are based on average human gonadotropin doses of 150 and 225 IU/d for a 70-kg woman given in 2-mL saline (the control group received 2 mL of saline). Injections were administered once per day for 5 days, followed by 5 days of rest. Each treatment was repeated for 6 estrus cycles in the rats for a total of 12 estrus cycles. Six months after the last day of the 12(th) cycle, the rats were euthanized. Bone marrow tissues were removed, and pluripotent reticulocyte cells with micronuclei, nuclear buds, and binuclear abnormalities were analyzed using an in situ micronuclei assay under light microscopy. The proportion of micronucleated cells, cells with anaphase bridge, nuclear buds, and other nuclear abnormalities were measured. RESULTS: The number of cells with nuclear buds and binuclear abnormalities in the hMG 225 and FB 225 groups was significantly higher (P < 0.05) than that from the hMG 150, FB 150, and control groups in the cytogenetic analysis of bone marrow stem cells. An increased rate of genotoxicity in all gonadotropin groups versus that of placebo was found. CONCLUSION: In rats, the micronucleus genotoxicity assay suggests a dose-dependent gonadotropin effect on genomic instability in bone marrow stem cells in vivo.

Redistribution of corticotropin-releasing hormone receptor R2 using fluorescence immunohistochemistry in fetal membranes of women delivering preterm or at term.

OBJECTIVE: The aim of our study was to determine whether a difference exists in expression of corticotropin-releasing hormone receptor-R1 (CRH-R1) and corticotropin-releasing hormone receptor-R2 (CRH-R2) in fetal membranes of preterm and term women with or without labor. MATERIAL AND METHODS: Small pleces of fetal membranes were obtained from the placenta of each of forty patients undergoing cesarean section. Ten samples each were taken from preterm and term patients, with and without labor. Antibodies against CRH-R1/2 and CRH-R2 were used for localization by conventional fluorescence immunohistochemistry. The evaluation of staining was based on examination of the entire histologic section by three independent observers. RESULTS: In women at term without labor, CRH-R2 receptor was predominantly expressed in the amniotic epithelium and the amniotic mesenchyme. In laboring women at term, the expression of CRH-R2 receptor was shown in the chorionic mesenchyme and the cytotrophoblast cells, but no specific staining could be detected in the amniotic membranes. Changes in CRH-R2 receptor expression could not be demonstrated during preterm labor of early pregnancies. In preterm women, the antibody against CRH-R1/2 receptor detected additional signals in the amniotic mesenchyme and epithelium, suggesting expression of CRH-R1 in these tissues. In women at term, the overlapping pattern of CRH-R1/2 was recognized in both the chorionic and amniotic mesenchyme, in contrast to the specific CRH-R2 staining, suggesting expression of CRH-R1 in the mesodermal cell compartments. CONCLUSION: At term, changes in CRH-R2 expression are directly related to the progression of normal labor; such changes were not observed during preterm labor of early pregnancies. The increased CRH-R2 expression in the chorionic mesenchyme may possibly provoke rupture of the membranes or at least play a role in some key regulatory events in the initiation of normal labor. The fact that this mechanism does not occur in preterm labor strengthens the hypothesis that onset of labor could be controlled by distinct mechanisms in preterm and term pregnancies.

Detection of corticotropin-releasing hormone receptors R1 and R2 (CRH-R1, CRH-R2) using fluorescence immunohistochemistry in the myometrium of women delivering preterm or at term.

OBJECTIVE: To determine differences in expression of corticotropin-releasing hormone receptors R1 and R2 in the myometrium of women delivering preterm or at term, with or without labor. MATERIAL AND METHODS: Small pieces of myometrial smooth muscle were taken from forty patients undergoing caesarian section. One sample each was taken from all preterm and term patients, with and without labor. Antibodies against CRH-R1/2 and CRH-R2 were used for localization by conventional fluorescence immunohistochemistry. The evaluation of staining was based on examination of the entire histologic section by three independent observers. RESULTS: In women at term, CRH-R2 levels were elevated before labor and decreased with the onset of labor. In eight of 10 term samples from women in labor, no staining was detected. In preterm patients we found no difference in CRH-R2 staining between women with and without labor. The intensity of staining for CRH-R1/2 was generally uniform in all four groups. CONCLUSION: The high level of CRH-R2 expression in term patients without labor, together with the subsequent decrease of CRH-R2 in the myometrium during progression of labor, is consistent with the possibility that CRH may have autocrine/paracrine effects on myometrial contractility in the lower segment of the uterus.

Effects of pinealectomy and melatonin supplementation on endometrial explants in a rat model.

OBJECTIVE: To determine the effects of pinealectomy on endometrial explants in rats and evaluate the activity of superoxide dismutase (SOD) and catalase (CAT) and the levels of malondialdehyde (MDA) in the rat endometriosis model. STUDY DESIGN: Rats with experimentally induced endometriosis were randomly divided into three groups after second-look laparotomies. Group 1 (pinealectomy, n = 8) and Group 2 (pinealectomy+melatonin, n = 8) underwent pinealectomies after the second-look laparotomies. Group 3 was presented as control group (vehicle solution+without pinealectomy (n = 6)). Melatonin was administered intraperitoneally for 4 weeks in Group 2, whereas an equal volume of vehicle solution was given to Groups 1 and 3. Evaluation of the volume of the endometrial explants, histopathological examination and preservation of explant epitheliums according to the scoring system were undertaken. RESULTS: There was a statistically significant increase in spherical explant volumes of Group 1 compared to Groups 2 and 3. In Group 1, the level of MDA was significantly higher and SOD and CAT activity was significantly lower compared to Groups 2 and 3. A statistically significant increase in the epithelial lining scores of explants was noted in Group 1 compared to Groups 2 and 3. CONCLUSION: The effects of pinealectomy on the progression of endometriosis explants were reversed by melatonin.

Intraperitoneal administration of single dose type I collagen or low dose melatonin to prevent intraperitoneal adhesion formation: a comparative study.

OBJECTIVE: To compare the prevention of adhesion formation by type I collagen or melatonin solutions in the rat model. STUDY DESIGN: A total of 40 female Wistar albino rats were randomly assigned to four groups-type I collagen, melatonin, vehicle control and sham groups. Following midline laparotomy, a standard injury was made on the right uterine horn using bipolar cautery. The animals in the sham group underwent midline laparatomy only. One milliliter of type I collagen, melatonin or vehicle control was instilled onto the injured area immediately before abdominal closure. Fourteen days after the surgery, the type and extent of adhesion formation as well as the uterine horn tissue superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels were measured. RESULTS: Both the type and extent of adhesion formation were significantly lower in the type I collagen and melatonin groups compared to the control group. The tissue SOD and CAT activity was significantly higher, and MDA levels were significantly lower in the type I collagen and melatonin groups compared to the control group. CONCLUSION: Intraperitoneal administration of type I collagen or low dose melatonin solution onto the injured areas may be an attractive adjuvant to reduce postoperative adhesion formation.

The effect of hormone replacement therapy on oxidized low density lipoprotein levels and paraoxonase activity in postmenopausal women.

Oxidized low-density lipoproteins (oxLDL) are involved in initiation of atherosclerosis. Paraoxonase 1 (PON1), the isoenzyme of PON, is located on high-density lipoprotein (HDL) and protects against the oxidative modification of both HDL and LDL by hydrolysing lipid peroxides. Postmenopausal women have a higher risk of cardiovascular events compared with premenopausal women. The aim of this clinical study was to evaluate the effects of hormone replacement therapy (HRT) on oxLDL and PON1 activity in menopausal status. The subjects included 45 healthy postmenopausal women, aged 43 to 57 years, and 30 premenopausal women with regular cycles, aged 31 to 40 years. None of the participating women had a history of hypertension, diabetes mellitus or medications known to affect the cardiovascular system. Twenty five of the postmenopausal women received conjugated estrogens at dose of 0.625 mg/day per oral (P.O.) and medroxyprogesterone acetate (MPA) (1 mg/d P.O.) for 10 days. Twenty of the postmenopausal women received 17-beta estradiol (2 mg/day) and norethysterone acetate (NETA) (5 mg/day P.O.) for 10 days. Fasting blood samples were taken from premenopausal women (baseline) and postmenopausal women after HRT of 6 months to determine serum malondialdehyde (MDA), oxLDL, and PON1 activity. After 6-month therapy, MDA and oxLDL levels showed a statistically significant reduction in the treated groups versus baseline (p <0.05), whereas PON1 activities were increased (p <0.05). Increase in oxidative status may be one of the factors leading to reduction in PON1 activity and increased oxLDL in menopause. HRT may be effective on oxidative stress and lipoprotein metabolism in apparently healthy postmenopausal women.

High rate of aneuploidy in luteinized granulosa cells obtained from follicular fluid in women who underwent controlled ovarian hyperstimulation.

We performed a prospective study to detect the cell cycle changes in luteinized granulosa cells in patients undergoing controlled ovarian stimulation with GnRH analog and gonadotropin therapy. Aneuploid DNA content was observed in 37 of 70 women (52.9%), and multiple logistic regression analysis revealed that only the dose of gonadotropins used significantly predicted the ploidy status of granulosa cells, which indicates that ovarian hyperstimulation in IVF treatment might be detrimental for the DNA content of granulosa cells.

Mood scores in relation to hormone replacement therapies during menopause: a prospective randomized trial.

There is lack of studies in literature about the long-term effects of hormone replacement therapies and cholesterol levels on mood scores in menopause. In the present study we have investigated whether serum lipid levels affect mood scores in menopause and evaluated the long-term effects of the combined hormone replacement regimens (HRT) on depressive symptoms in postmenopausal women. In this prospective-randomized, placebo-controlled, double-blind study, 286 women in menopause were divided into four groups according to therapeutic regimens they received; 1) Conjugated equine estrogen (CEE) of 0.625 mg plus medroxyprogesterone acetate (MPA) of 2.5 mg (n = 79), 2) CEE (0.625 mg) plus MPA of 5 mg (n = 77), 3) tibolone of 2.5 mg (a selective tissue estrogenic activity regulator) (n = 76), and 4) Calcium (Ca) of 1,000 mg (n = 54). Beck Depression Inventory (BDI), and serum levels of lipoprotein lipids were assessed before and after 12-months of treatment with oral continuous HRT and Ca supplementation. BDI scores in the study groups were not correlated with lipid profiles. We compared two subgroups of patients with initial BDI scores 0-14 (normal mood scores) in order to asses for the possible relation between the lipid profile and mood. Following treatment, first subgroup had increased scores to 15-30 (mildly depressed women, n = 27) and the second subgroup preserved BDI scores of 0-14 (normal mood scores, n = 23). Serum levels of total cholesterol, high-density lipoprotein, low-density lipoprotein and body mass index were found to be similar between these two groups. BDI scores decreased significantly in all HRT groups after 12 months of treatment, compared to Ca group (p < 0.05). We did not observe any correlation between BDI scores and lipid profiles before and following continuous HRT or Ca supplementation. Continuous combined hormone replacement regimens, CEE + MPA and tibolone, have superior long-term effects on mood scores in menopause and should be considered during the decision process for use of HRT due to menopausal symptoms.