Population-based survey on menopausal symptoms and treatment use.

OBJECTIVE: This article aimed to study the use of menopausal hormone therapy (MHT) among Spanish perimenopausal and postmenopausal women, the presence of menopausal symptoms and the sources of information. METHODS: The epidemiological study using a survey included Spanish perimenopausal or postmenopausal women aged between 40 and 70 years in August 2021. RESULTS: A total of 1254 women were included. In the postmenopausal group, 86% reported one or more menopausal symptoms; the most frequent was vulvovaginal dryness (57%). Among the symptomatic women, 15.2% used some treatment. Vasomotor symptoms (p = 0.001), vulvovaginal atrophy (p < 0.001) and symptoms related to sexuality (p < 0.001) were associated with greater use of treatments; 2.5% of postmenopausal women used MHT. In the perimenopausal group, 75.1% were symptomatic, hot flashes being the most frequent. Only insomnia was related to greater use of some treatment (p = 0.021); 1.6% of perimenopausal women used MHT. The most common reason for women's rejection of MHT was the fear of side effects, especially cancer. The gynecologist was the most frequently used source of information. CONCLUSIONS: Although there is a high prevalence of symptoms, the use of MHT in Spanish perimenopausal and postmenopausal women is very low.

Sexual health in Spanish postmenopausal women presenting at outpatient clinics.

OBJECTIVE: One of the most common complaints among postmenopausal women is a change in sexual drive. The aim of this study was to assess the current state of sexual health in Spanish postmenopausal women who present at outpatient gynecology clinics. METHOD: In this multicenter, observational, cross-sectional, questionnaire-based study, a survey was conducted that included 3026 Spanish postmenopausal women in a routine clinical setting in outpatient gynecology clinics at public and private institutions throughout Spain. We used the Women's Sexual Function questionnaire, which has been validated in Spain. RESULTS: In the multivariate analysis, we found that the best indicators of sexual health in postmenopausal women were a higher education (p < 0.001), working or previously worked (p < 0.001), a stable partner (p < 0.001), living in an urban area (p < 0.01), healthy habits and received information about menopause (p < 0.001). CONCLUSION: These results indicate that it is important to provide health education and information about menopause and the complaints associated with this period in a woman's life.

Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: symptoms, management and treatment perceptions.

OBJECTIVES: To gain a deeper comprehension of current vulvovaginal atrophy (VVA) knowledge among Spanish postmenopausal women. METHODS: An online survey (REVIVE) was conducted in four European countries with an overall sample of 768 participants included in Spain. Perceptions, experiences and needs of Spanish postmenopausal women in terms of sexual and vaginal health were reported. RESULTS: Vaginal dryness was the most common VVA symptom in Spain (81%). The severity of symptoms reported by postmenopausal women tended to be similar or worse than at onset, especially in the most troublesome symptom, dyspareunia (80%). VVA symptoms significantly impact on Spanish participants' ability to achieve sexual enjoyment (75%), relationship with partner (67%) and sexual spontaneity (66%). Although 71% of participants with partners (83%) were sexually active, their sex drive was reduced by one-third as a consequence of VVA. Despite the fact that women expected doctors to start asking them about menopausal symptoms, this rarely occurred. Treatments were administered mainly vaginally without prescription (62% were using over-the-counter products at the time). Postmenopausal women who had discussed their symptoms with physicians were twice as likely to be treated (66% vs. 33%) than those who had not. Low compliance with treatment was justified by Spanish participants with not bothersome enough symptoms (22%), relief (21%), inability to reverse vaginal changes (15%) and treatment price (13%). Almost half of the participants with a current local estrogen prescription showed satisfaction. The acknowledged main limitation for all treatments was the inability to restore the natural conditions of the vagina. The price of over-the-counter products was also reported as an important concern in Spanish postmenopausal women. CONCLUSION: VVA remains underdiagnosed and undertreated in Spain, despite its high frequency and significant impact on quality of life. Since patient satisfaction with available treatments remains compromised, an effective discussion of symptoms and therapies with doctors would improve its management.

Factors determining the use of hormonal therapy and phytotherapy in Spanish postmenopausal women.

OBJECTIVE: To identify women's sociodemographic and variables related to health care with the prescription of hormonal therapy (HT) and phytotherapy (PT) in Spanish postmenopausal women. METHOD: The survey consisted of a multicenter, observational, cross-sectional, questionnaire-based investigation and was conducted among 3022 postmenopausal women. RESULTS: Of all the women, 31.8% reported the use of systemic HT or PT sometime in their lives. Hot flushes and information received about menopause were the most important variables that influence HT and PT use, although far more intense symptoms were observed in those who were inclined to use HT. The use of HT or PT was more frequently reported among women with high levels of education, who came from private clinics and lived in urban areas. Women who had primary ovarian insufficiency or surgical menopause were inclined to use HT. CONCLUSION: Hot flushes and information received about menopause are the most important variables that influence HT and PT use.

A prospective study of DT56a (Femarelle®) for the treatment of menopause symptoms.

BACKGROUND: DT56a (Femarelle®) is a natural medication that contains a variety of phytoestrogens derived from tofu. Treatment with DT56a affects bones, vascular tissues and the nervous system in a manner similar to that of estrogen but DT56a acts as an estrogen antagonist in breast and uterine tissues. AIM: The objective of this study was to analyze the efficacy of DT56a in the reduction of menopause symptoms in Spanish women who participated in the Post Marketing Menopausal Symptoms International Survey (POMMSIS). PATIENTS AND METHODS: A total of 631 Spanish menopausal or perimenopausal women with vasomotor symptoms who took DT56a for 4 weeks participated in this study. This study was an observational, questionnaire-based investigation that consisted of a baseline questionnaire, a hot flushes daily diary and a feedback questionnaire. RESULTS: A statistically significant (p < 0.01) reduction in the number and intensity of hot flushes was experienced after 2 and 4 weeks of DT56a treatment. After 4 weeks of treatment with DT56a, 80.7% of the patients reported that their hot flushes were 'better' or 'much better'. The severity of hot flushes was also reduced by 38% in all study participants and by 36% in women who had experienced more than seven hot flushes per day initially, before treatment. CONCLUSION: Treatment with DT56a resulted in a significant reduction in the number and intensity of hot flushes in postmenopausal women, especially in those with frequent symptoms, and these effects were observed within the first month of treatment.

Efficacy and safety of a phyto-SERM as an alternative to hormone therapy.

In this review, we analyze the efficacy and safety of DT56a in the treatment of postmenopausal symptoms. Similar to all selective estrogen receptor modulators (SERMs), DT56a demonstrates dual agonistic and antagonistic effects due to the synergy between its components. DT56a is referred to as a plant-origin SERM (phyto-SERM) and, for this reason, its therapeutic capacity in postmenopausal women differs from other phytoestrogens used independently. Although interesting data on relief of vasomotor symptoms have been reported for DT56a, further clinical studies with a greater number of cases and a longer period of study are required to correctly identify its indications for use as an alternative to hormone therapy, especially in preventing osteoporosis.

Soy isoflavones improve insulin sensitivity without changing serum leptin among postmenopausal women.

OBJECTIVE: To investigate the effect of a soy isoflavone extract over insulin sensitivity and plasma leptin levels. METHODS: Eighty postmenopausal women were randomly assigned to participate for 24 months either to a physical exercise and Mediterranean diet program (Control group: CG) or this intervention plus a daily oral intake of a soy isoflavone extract (Soy isoflavone group: SIG). Anthropometry, body composition analysis, blood biochemistry, menopausal symptoms and health-related quality of life were assessed at baseline and every 6 months. RESULTS: Sixty-five women completed the protocol with no differences found among groups at baseline in age and time since the menopause. At month 24, body mass index (BMI) was lower in the SIG as compared to the CG. Fat mass, glucose, insulin, HOMA-IR, tumor necrosis factor-α (TNF-α), Kupperman Index and Cervantes Scale values significantly decreased in the SIG as compared to baseline and to CG values. Kupperman scores and serum TNF-α levels significantly decreased in both studied groups. No changes in plasma leptin levels were observed after 24 months within and between groups. When analysis was stratified according to BMI values, changes in the aforementioned parameters displayed a similar trend; however, the impact over glucose, insulin and HOMA-IR values was more evident among obese women assigned to the SIG. CONCLUSION: Diet, physical exercise and a daily oral intake of soy isoflavones exerted a beneficial effect on the homeostatic model in postmenopausal women which was not related to significant changes in plasma leptin levels, despite a decrease in TNF-α, fat mass and Kupperman values.

17beta-Estradiol and/or progesterone protect from insulin resistance in STZ-induced diabetic rats.

Recent clinical and experimental evidences suggest that sex steroids protect from insulin resistance associated with diabetes. Therefore, we have assessed the influence of E2 and/or P4 on insulin sensitivity by euglicaemic-hyperinsulinaemic clamp in ovariectomized streptozotocin-induced diabetic rats, focusing on key proteins of insulin signaling in skeletal muscle. Although low plasma levels of E2 (days 6 and 11) increased Glut-4 plasma membrane content and subsequent improved insulin sensitivity, they could not fully reverse hyperglycaemia negative effects on p85alpha-IRS-1 association and IRS-1 content during 11 days. However, high plasma levels of E2 (day 16) could reverse hyperglycaemia effects not only on Glut-4 plasma membrane content but also on p85alpha-IRS-1 association and IRS-1 protein content level. In contrast, P4 treatment only improved insulin sensitivity when its plasma concentration was low (days 6 and 11) and its effects were not associated with any proteins study in this paper. The combined therapy had a synergic effect on insulin sensitivity when their plasma levels were low (day 6) or high (day 16), that could be associated with Glut-4 plasma membrane content modulation, p85alpha-IRS-1 association and IRS-1 amount. These new findings improve our understanding of biochemical basis of insulin resistance due to hyperglycaemia and could open up new possibilities of treatment in uncontrolled type 1 DM.

Valoración de la producción nocturna del catabolito de melatonina, 6-sulfatoximelatonina, durante el climaterio / Evaluation of nocturnal excretion of 6-sulfatoximelatonin during menopause

Introducción: durante el envejecimiento del eje reproductor femenino, el climaterio, el agotamiento folicular en los ovarios origina cambios hormonales entre los cuales se encuentra la melatonina. Sin embargo, el conocimiento de las interacciones entre dichos parámetros dista mucho de ser profundo. Objetivo: valorar el ritmo nocturno de producción de melatonina por medio de la excreción urinaria de 6-sulfatoximelatonina (6-SMEL). Pacientes y método: se realizó un estudio entre 27 mujeres que acudían a las consultas de Ginecología y Menopausia del Hospital Central de Asturias, con una edad de 43-60 años, sanas y sin ningún tipo de tratamiento excepto la terapia hormonal sustitutiva. Ninguna había tenido menopausia quirúrgica. La noche anterior a la correspondiente visita ginecológica recogieron muestras de orina a las siguientes horas: 22:00, 24:00, 04:00, 08:00 y 10:00.Resultados: el estudio del ritmo nocturno de producción de 6-SMEL mostró en el grupo de mujeres menopáusicas el valor más bajo a las 22:00 h, de 475 pg/ml, y el más elevado a las 08:00 h, de 6.063,33 pg/ml, con diferencias estadísticamente significativas: p < 0,01; p < 0,05 a las 22:00 h frente a las 10:00, 04:00 y 08:00 h. En el grupo de menopáusicas que recibían terapia hormonal sustitutiva, el valor más bajo se obtuvo a las 22:00 h, 385 pg/ml, y el valor pico a las 08:00 h, 8.560 pg/ml, con diferencias estadísticamente significativas: p < 0,01 a las 22:00 frente a las 24:00 h; p < 0,05 a las 08:00 frente a las 22:00, 24:00 y 10:00 h. En el grupo de perimenopausia no se demostró estadísticamente un valor pico a ninguna de las horas estudiadas. Conclusión: la terapia hormonal sustitutiva influyó sobre el ritmo nocturno de secreción de 6-SMEL, pero la cantidad total excretada no resultó afectada durante el climaterio (AU)

Efficacy and safety of a phytoestrogen preparation derived from Glycine max (L.) Merr in climacteric symptomatology: a multicentric, open, prospective and non-randomized trial.

A multicentric, open, prospective, observational and no-randomized clinical trial was carried out in Spain with 190 postmenopausal women receiving a soy preparation rich in isoflavones (PHYTO SOYA, capsules containing 17.5 mg isoflavones). The main object of the present study was to investigate its efficacy in alleviating the symptomatology derived from the lack of estrogen, mainly hot flushes, but also other symptoms such as sleep disorder, anxiety, depression, vaginal dryness, loss of libido and bone pain. Each patient received 35 mg isoflavones per day in two doses. During the four months' treatment, a statistically significant decrease in the number of hot flushes with PHYTO SOYA was experienced by 80.82% women; only 5,48% patients did not improve with the treatment. The average reduction was 47.8%, which is equivalent to 4 hot flushes. All the other studied parameters also showed a statistically significant decrease. No severe side-effects were reported and tolerance was excellent. Treatment with PHYTO SOYA resulted in a significant improvement of the symptomatology that accompanies the lack of estrogen during menopause.

Enfermedad de Crohn vulvar / Vulvar Crohn's disease

No disponible

Thyroid carcinoma originating in a teratoma of the ovary.

The malignant degeneration of a cystic teratoma of the ovary is a rare complication which different authors place at between 0.8 to 4%. Adenocarcinomas represent a relatively rare complication, 8% of secondary cancers, those of thyroid origin being reported in only 5 cases. The aim of this paper is to present the sixth such case of thyroid carcinoma developed in a mature teratoma in the ovary.

[The glucose perfusion test: value in detecting fetal distress]. / L'épreuve de perfusion de glucose: valeur dans le dépistage de la souffrance foetale.

The authors use an intravenous dose of 0.5 g glucose/kg. body weight as a fetal stimulation test in one hundred pregnant patients after the 34th week. Glucose produced a remarkable increase of fetal heart rate variability, as well as an increase in the number of fetal movements and accelerations. Those fetuses lacking reactivity before and after the glucose test presented, in 55.5% of the cases, neonatal depression. This suggests that glucose perinatal surveillance is of utmost importance in these cases. The glucose overload test presents a clear advantage with respect to the oxytocin test, which is the total absence of labor stimulation and this may not be desirable in cases of prematurity or previous uterine scars.

Preoperative colonoscopic diagnosis of villous adenoma of the appendix. Report of a case and review of the literature.

This case of villous adenoma of the appendix reported is unique by virtue of its having been diagnosed preoperatively using colonoscopy. Only 45 such lesions have been described previously, and a review of those cases reveals that 93 percent were discovered at appendectomy performed either incidentally or for acute appendicitis. The malignant potential of this entity is unknown and its treatment is controversial. Because of a report association between adenomas of the appendix and other gastrointestinal neoplasms, long-term surveillance is recommended.

Percutaneous endoscopic gastrostomy: clinical experience and follow-up.

To assess our clinical experience with this method of enteral feeding, we conducted a retrospective study and follow-up of 73 patients having percutaneous endoscopic gastrostomy (PEG). In addition, we conducted a telephone survey of 42 persons who cared for the PEG tube. The most common indication was neurologic impairment of deglutition. Early and late complications occurred in 12% and 33% of cases, respectively, and were usually minor. Our 30-day survival was 74%. Most patients (77%) maintained their weight with standard tube feedings. Satisfaction with and acceptance of the PEG was almost universal. Patients should be carefully selected, with attention to long-range benefit.

Esophageal-atrial fistula.

We report an unusual case of an esophageal-atrial fistula in a patient with CREST (calcinosis, Raynaud's phenomenon, esophagitis, sclerodactyly, telangiectasia) variant of scleroderma. An ulcer in Barrett's esophagus perforated into the left atrium and led to systemic embolization and cerebral abscess. A review of similar reports of esophageal-atrial fistula reveals a symptom complex that includes chronic esophageal pathology, gastrointestinal bleeding, and neurological signs. An antemortem diagnosis has never been made.

Gastric volvulus. More common than previously thought?

Gastric volvulus is torsion of the stomach, which can compromise the gastric orifices and result in either acute or chronic and intermittent symptoms. We believe that gastric volvulus, especially when partial or intermittent, may be more common than has been previously thought. The condition should be suspected in any patient who has a history of retching or vomiting and has a paraesophageal hiatus hernia or eventration of the diaphragm. The classic triad of retching, severe and constant epigastric pain, and difficulty in passing a nasogastric tube should suggest the presence of acute gastric volvulus. The diagnosis is confirmed by specific findings on the upper gastrointestinal series. Acute gastric volvulus is a surgical emergency. Definitive treatment of recurrent chronic gastric volvulus is usually surgical, although conservative measures may have limited success.

Extrahepatic biliary obstruction complicating a diaphragmatic hiatal hernia with intrathoracic gastric volvulus.

Gastric volvulus is an uncommon condition in which an acquired torsion of the stomach results in acute or chronic gastrointestinal symptoms. We report a case of an intrathoracic organoaxial gastric volvulus presenting as a cholestatic syndrome, secondary to partial obstruction of the common bile duct by the diaphragm at the level of the hiatus. This entity has not been reported.