Summary of the 2023 Thai Menopause Society Clinical Practice Guideline on Menopausal Hormone Therapy.

The Thai Menopause Society is an academic organization consisting of healthcare professionals engaged in menopause medicine. The position statement was first issued in 1994 and updated in 2003 and 2023. Herein, we reviewed the important updates of the 2023 position statement on menopausal hormone therapy (MHT) as an international reference for healthcare professionals in Thailand. An advisory panel of clinicians and research experts in the field of menopause reviewed the recommendation of published International Consensus Statements and updated the evidence using the MEDLINE database through PubMed. The evidence-based information and relevant publications were assessed, and a consensus on recommendations was subsequently achieved using the level of evidence to determine the recommendation strength and evidence quality. MHT remains the most effective treatment for vasomotor symptoms and genitourinary syndromes of menopause even after 20 years. Additionally, it is effective in preventing bone loss and fractures in postmenopausal women. The cardiovascular risk of MHT increased in women who initiated MHT after 60 years of age. Hormone therapy should be individualized following the hormone type, dose, administration route, use duration, and progestogen inclusion. The necessary pretreatment evaluation and appropriate follow-up recommendations were added for improved MHT standard care. The updated 2023 Clinical Practice Guideline on MHT is useful for gynecologists, general physicians, endocrinologists, and other healthcare professionals in treating menopausal women receiving hormone therapy in Thailand.

Summary of the Thai Osteoporosis Foundation (TOPF) Clinical Practice Guideline on the diagnosis and management of osteoporosis 2021.

Objectives: The Thai Osteoporosis Foundation (TOPF) is an academic organization that consists of a multidisciplinary group of healthcare professionals managing osteoporosis. The first clinical practice guideline for diagnosing and managing osteoporosis in Thailand was published by the TOPF in 2010, then updated in 2016 and 2021. This paper presents important updates of the guideline for the diagnosis and management of osteoporosis in Thailand. Methods: A panel of experts in the field of osteoporosis was recruited by the TOPF to review and update the TOPF position statement from 2016. Evidence was searched using the MEDLINE database through PubMed. Primary writers submitted their first drafts, which were reviewed, discussed, and integrated into the final document. Recommendations are based on reviews of the clinical evidence and experts' opinions. The recommendations are classified using the Grading of Recommendations, Assessment, Development, and Evaluation classification system. Results: The updated guideline comprises 90 recommendations divided into 12 main topics. This paper summarizes the recommendations focused on 4 main topics: the diagnosis and evaluation of osteoporosis, fracture risk assessment and indications for bone mineral density measurement, fracture risk categorization, management according to fracture risk, and pharmacological management of osteoporosis. Conclusions: This updated clinical practice guideline is a practical tool to assist healthcare professionals in diagnosing, evaluating, and managing osteoporosis in Thailand.

The effects of exogenous estrogen in women with SAR-CoV-2 infection: a systematic review and meta-analysis.

STUDY QUESTION: Does exogenous estrogen use affect COVID-19-related mortality in women? SUMMARY ANSWER: Menopausal hormone therapy (MHT) was associated with a lower likelihood of all-cause fatality related to COVID-19 in postmenopausal women (odds ratio (OR) 0.28, 95% CI 0.18, 0.44; 4 studies, 21 517 women) but the combined oral contraceptive pill in premenopausal women did not have a significant effect (OR 1.00, 95% CI 0.42-2.41; 2 studies, 5099 women). WHAT IS KNOWN ALREADY: Men are much more likely to die from COVID-19 than women. STUDY DESIGN, SIZE, DURATION: In this systematic meta-analysis, a literature search was conducted using the following search terms related toCOVID-19 and estrogen, sex hormones, hormonal replacement, menopause, or contraception. The PubMed, Scopus, Cochrane Library, and EMBASE databases were searched to identify relevant studies published between December 2019 and December 2021. We also searched MedRxiv as a preprint database and reviewed the reference lists of all included studies and clinical trial registries for ongoing clinical studies until December 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: All comparative studies that compared the rates mortality and morbidity (hospitalization, intensive care unit (ICU) admission, and ventilation support) due to COVID-19 in women using exogenous estrogen to a control group of women (nonusers) were included. A review of the studies for inclusion, extraction of data, and assessment of the risk of bias was performed independently by two reviewers. The ROBINS-I tool and the RoB 2 tool were used for bias assessment of the included studies. Pooled odds ratios (ORs) with 95% CIs were calculated using Review Manager V5.4.1. The I2 statistic was used to quantify heterogeneity. The quality of the evidence was assessed using GRADE criteria. MAIN RESULTS AND THE ROLE OF CHANCE: After searching the databases, we identified a total of 5310 studies. After removing duplicate records, ineligible studies, and ongoing studies, a total of four cohort studies and one randomized controlled trial comprising 177 809 participants were included in this review. There was a moderate certainty of evidence that MHT was associated with a lower likelihood of all-cause fatality related to COVID-19 (OR 0.28, 95% CI 0.18, 0.44; I2 = 0%; 4 studies, 21 517 women). The review indicated a low certainty of evidence for other outcomes. The mortality rate of premenopausal women in the combined oral contraceptive pill group did not differ significantly from the control group (OR 1.00, 95% CI 0.42-2.41; 2 studies, 5099 women). MHT marginally increased the rate of hospitalization and ICU admission (OR 1.37, 95% CI 1.18-1.61; 3 studies, 151 485 women), but there was no significant difference in the need for respiratory support between MHT users and nonusers (OR 0.91, 95% CI 0.52-1.59; 3 studies, 151 485 women). Overall, the tendency and magnitude of the effects of MHT in postmenopausal women with COVID-19 were consistent across the included studies. LIMITATIONS, REASONS FOR CAUTION: The certainty of the evidence for other outcomes of this review may be limited, as all included studies were cohort studies. In addition, the dosages and durations of exogenous estrogen used by postmenopausal women varied from study to study, and combined progestogen administration may have had some effect on the outcomes. WIDER IMPLICATIONS OF THE FINDINGS: The findings of this study can aid in counseling postmenopausal women taking MHT when they are diagnosed with COVID, as they have a lower chance of death than those not taking MHT. STUDY FUNDING/COMPETING INTEREST(S): Khon Kaen University provided financial support for this review and had no involvement at any stage of the study. The authors have no conflicts of interest to declare. REGISTRATION NUMBER: PROSPERO, CRD42021271882.

Effectiveness of vaginal estriol with lactobacilli on urinary symptoms in postmenopausal women: a randomized-controlled trial.

OBJECTIVE: The aim of this study was to compare the effects of a vaginal tablet containing estriol (0.03 mg) plus lactobacilli (E3/L) with placebo on lower urinary tract symptoms (LUTS) in postmenopausal women (PMW). METHODS: This randomized, double-blinded, placebo-controlled trial was conducted at Srinagarind Hospital in Khon Kaen, Thailand. PMW with at least one LUTS, such as frequency, nocturia, dysuria, urgency, or stress or urgency urinary incontinence, were recruited. Participants were randomly assigned to receive either an E3/L tablet or placebo, administered vaginally daily at bedtime for 2 weeks, then twice a week for another 2 weeks. Symptom severity score was assessed using a visual analog scale (VAS), and quality of life (QOL) was measured using the validated Thai version of the Incontinence Impact Questionnaire-Short Form. The primary outcome was proportion of the PMW with LUTS improvement. Secondary outcomes were symptom severity score, participant satisfaction, QOL, and adverse events. Relative risk and 95% confidence intervals (CIs) were calculated using the chi-square or Fisher's exact test. An independent-sample and paired t test were used to compare means. RESULTS: Thirty-eight participants in each group completed the study. The proportion of PMW whose symptoms improved (both in terms of most bothersome symptom and overall) did not differ significantly between the two groups. Relative risk was 1.00 (95% CI, 0.74-1.36) and 0.90 (95% CI, 0.71-1.15), respectively. There were no differences in symptom severity score, participant satisfaction, or QOL. CONCLUSIONS: A 1-month course of vaginal E3/L does not appear to improve LUTS in PMW.

Patterns of contraceptive use among Thai women aged ≥40 and at risk of pregnancy.

OBJECTIVES: The aims of the study were to identify the patterns of contraceptive use among Thai women aged ≥40 years and the reasons for not using contraception. METHODS: This cross-sectional study included sexually active women aged 40-49 years in Khon Kaen, Thailand. Information on contraceptive practice and reasons for not using contraception was collected through a self-reported questionnaire. The unmet need for a modern method of contraception and the unmet need for any method of contraception were calculated based on the percentage of participants who were not using contraception but who wanted to postpone or prevent pregnancy. RESULTS: Of 400 women, 75.5% were currently using some form of contraception, with female sterilisation being the most used (35%). The main reasons for not using contraception included perceived low risk of pregnancy, health concerns, infrequent sexual intercourse and wish to become pregnant. The unmet need for a modern method of contraception was 23.3% (95% confidence interval [CI] 0.20%, 0.29%). Having children was a significant protective factor (adjusted odds ratio [OR] 0.18; 95% CI 0.08, 0.37; p = 0.000). The unmet need for any method of contraception was 12% (95% CI 0.09%, 0.16%). Previous abortion was a significant risk factor for not using any contraception (adjusted OR 2.23; 95% CI 1.12, 4.44; p = 0.022). CONCLUSION: Although the use of contraception was common, some participants displayed a lack of knowledge and/or did not practise family planning. Our findings address the importance of improving knowledge about the risks of pregnancy and the need for effective contraception in this population.

Combined vaginal administration of nystatin, diiodohydroxyquin, and benzalkonium chloride versus oral metronidazole for the treatment of bacterial vaginosis.

OBJECTIVE: To compare combined vaginal administration of nystatin, diiodohydroxyquin, and benzalkonium chloride versus oral metronidazole for the treatment of bacterial vaginosis (BV). METHODS: A randomized controlled trial was conducted among women diagnosed with BV using the Amsel criteria (n=90) at a university hospital in Khon Kaen, Thailand, between June 27, 2017, and April 30, 2018. The oral metronidazole group (n=44) received 400 mg of metronidazole, administered three times per day. The combined vaginal tablet group (n=46) received a vaginal suppository once daily, which comprised nystatin (100 000 U), diiodohydroxyquin (100 mg), and benzalkonium chloride (7 mg). Treatment was administered for 7 days in both groups. Follow-up visits at 14 and 42 days assessed treatment outcomes and adverse effects. RESULTS: Remission of BV occurred among 41 (93%) women in the oral metronidazole group and 39 (85%) women in the combined vaginal tablet group. The adjusted relative risk was 0.92 (95% confidence interval 0.80-1.06). The rate of nausea and/or vomiting was significantly higher in the oral metronidazole group than that in the combined vaginal tablet group. CONCLUSION: Treatment efficacy of the combined vaginal tablet versus oral metronidazole was equivalent. CLINICAL TRIAL REGISTRATION: TCTR20170627001 (www.clinicaltrials.in.th).

Difference in carotid intima-media thickness between pre and postmenopausal women.

OBJECTIVES: To examine whether carotid intima-media thickness (CIMT), the prevalence of increased CIMT, and the presence of carotid plaque differ according to menopausal status. METHODS: In this analytical cross-sectional study, we enrolled 61 premenopausal women and 61 postmenopausal women. We matched the two groups for age. Participants were classified as either premenopausal or postmenopausal according to menstrual history and follicular-stimulating hormone level. Two skilled radiologists measured CIMT and carotid plaque in all participants by using B-mode ultrasound. RESULTS: The mean age was 49.25 ±â€Š2.0 years. The mean number of years since menopause in the postmenopausal group was 1.9 ±â€Š0.92 years. After adjusted analysis, the mean CIMT of the common carotid artery of postmenopausal women was significantly higher than that of premenopausal women, with a mean difference of 0.068 mm (95% confidence interval 0.023, 0.113). There was no significant association between number of years since menopause and mean CIMT. Although the prevalence of increased CIMT and the presence of carotid plaque were significantly higher in the postmenopausal group than in the premenopausal group according to crude analysis, this difference was not statistically significant after adjusted analysis. Multiple linear regression analysis for assessing potential risk factors for the alteration of mean CIMT showed that only menopausal status and body mass index were independently associated factors. CONCLUSIONS: Our findings indicate that postmenopausal status is a significant factor of high mean CIMT. These findings add to the growing evidence showing that menopause transition is a critical period for subclinical atherosclerosis development.

A Double-Blind Placebo-Controlled Randomized Trial Evaluating the Effect of Polyphenol-Rich Herbal Congee on Bone Turnover Markers of the Perimenopausal and Menopausal Women.

Based on the benefit of polyphenolic compounds on osteoporosis, we hypothesized that the polyphenol-rich herbal congee containing the combined extract of Morus alba and Polygonum odoratum leaves should improve bone turnover markers in menopausal women. To test this hypothesis, a randomized double-blind placebo-controlled study was performed. A total of 45 menopausal participants were recruited in this study. They were randomly divided into placebo, D1, and D2 groups, respectively. The subjects in D1 and D2 groups must consume the congee containing the combined extract of M. alba and P. odoratum leaves at doses of 50 and 1500 mg/day, respectively. At the end of an 8-week consumption period, all subjects were determined serum bone markers including calcium, alkaline phosphatase, osteocalcin, and beta CTX. In addition, the hematological and blood clinical chemistry changes, and total phenolic content in the serum were also determined. The results showed that the menopausal women in D2 group increased serum alkaline phosphatase, osteocalcin, and total phenolic compounds content but decreased CTX level. Clinical safety assessment failed to show toxicity and adverse effects. Therefore, herbal congee containing the combined extract of M. alba and P. odoratum leaves is the potential functional food that can decrease the risk of osteoporosis.

Effects of sunlight exposure and vitamin D supplementation on vitamin D levels in postmenopausal women in rural Thailand: A randomized controlled trial.

BACKGROUND: Despite the abundant sunlight in Thailand, vitamin D deficiency is common in premenopausal and postmenopausal Thai women. Sunlight exposure is a natural way to increase one's intake of vitamin D. However, limited research has been conducted regarding natural exposure to sunlight as a strategy to improve vitamin D status in postmenopausal women. OBJECTIVE: This study aimed to determine the effects of sunlight exposure compared with oral supplementation with vitamin D2 (weekly 20,000 IU) in combination with sunlight exposure on 25(OH)D levels. METHODS: A 12-week randomized controlled trial was conducted in 52 postmenopausal women, age 50-70 years. The participants were randomized to either the sunlight exposure group or the sunlight exposure with vitamin D supplementation group. Serum 25(OH)D concentration and parathyroid hormone (PTH) were measured using standard assays at baseline and 12 weeks. RESULTS: After 12 weeks, mean serum 25(OH)D had decreased from 32.3 to 29.7 ng/ml in the sunlight exposure group, but significantly increased in the combination group (from 29.9 to 32.4 ng/ml). At the end of the study, 25(OH)D levels were significantly higher in the sunlight exposure with vitamin D supplementation group compared with the sunlight exposure group. However, this difference was not observed in women aged >60 years. Serum PTH had decreased in both groups, but not to a significant extent. CONCLUSION: A combination of weekly vitamin D2 supplementation at a dose of 20,000 IU with sunlight exposure is more effective than sunlight exposure alone in postmenopausal Thai women. Sunlight exposure alone is not sufficient to maintain 25-hydroxyvitamin D levels in this setting.

Premenstrual syndrome (PMS) among high school students.

BACKGROUND: Premenstrual syndrome (PMS) is a common health problem among adolescents. OBJECTIVE: To assess the prevalence of PMS in Thai high school students. MATERIALS AND METHODS: This was a prospective study conducted among menstruating high school students in Khon Kaen, Thailand, from September to December, 2015. Participants were asked to prospectively complete an anonymous questionnaire, which included information about demographic data, menstrual patterns, and symptoms to be recorded on a daily calendar of premenstrual experiences according to the diagnostic criteria proposed by the American College of Obstetricians and Gynecologists. All of the data were prospectively recorded for 90 consecutive days. RESULTS: Of the 399 participants, 289 (72.4%) completed the self-report questionnaire. Eighty-six participants (29.8%; 95% CI, 24.5%-35.4%) reported having PMS. The most common somatic and affective symptoms among participants with PMS were breast tenderness (74.4%) and angry outbursts (97.7%). There were significant differences between the PMS and non-PMS groups, and PMS was associated with various problems related to educational activities, including lack of concentration and motivation, poor individual work performance, poor collaborative work performance, and low scores. However, there were no significant differences regarding interpersonal relationships between the PMS and non-PMS groups. CONCLUSIONS: PMS is a common menstrual disorder among Thai high school students. The most common symptoms reported in this study were angry outbursts and breast tenderness.

Relaxation for perimenopausal and postmenopausal symptoms.

BACKGROUND: Since the time of publication of the Women's Health Initiative (WHI) study, menopausal symptom management has become more complex because of increased awareness of the risks associated with hormone replacement therapy (HRT). Currently, a wide range of management options is available. Some women take prescription drugs, and others use self care strategies, including lifestyle modifications, over-the-counter preparations and complementary and alternative therapies, such as herbal preparations, exercise programmes and relaxation techniques. Relaxation techniques consist of a group of behavioural interventions. They are considered relatively harmless, but their effectiveness in treating vasomotor symptoms and sleep disturbances remains debatable.  OBJECTIVES: To determine the effectiveness of relaxation techniques as treatment for vasomotor symptoms and associated sleep disturbances in perimenopausal and postmenopausal women. SEARCH METHODS: Searches of the following electronic bibliographic databases were performed in February 2014 to identify randomised controlled trials (RCTs): the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO, Social Science Citation Index and CINAHL. Handsearches of trial registers, relevant journals and published conference abstracts were also performed. SELECTION CRITERIA: RCTs were included if they compared any type of relaxation intervention with no treatment or other treatments (except hormones) for vasomotor symptoms in symptomatic perimenopausal/postmenopausal women. DATA COLLECTION AND ANALYSIS: Two review authors selected studies, assessed quality and extracted data. Included studies were combined, if appropriate, by using a random-effects model to calculate pooled mean differences and 95% confidence intervals. MAIN RESULTS: Four studies were eligible for inclusion (281 participants): Two studies compared relaxation with electroacupuncture or superficial needling, one study compared relaxation with paced respiration or placebo control (α-wave electroencephalographic biofeedback) and one study compared relaxation with no treatment.No evidence was found of a difference between relaxation and acupuncture or superficial needle insertion in the number of hot flushes per 24 hours (mean difference (MD) 0.05, 95% confidence interval (CI) -1.33 to 1.43, two studies, 72 participants, I(2) = 0%; very low-quality evidence). Nor did any evidence suggest a difference between the two interventions in hot flush severity, measured using the Kupperman Index (MD -1.32, 95% CI -5.06 to 2.43, two studies, 72 participants, I(2) = 0%; very low-quality evidence).The other two studies found no clear evidence of a difference in hot flush frequency between relaxation and paced respiration, placebo or no treatment. The data for these comparisons were unsuitable for analysis.None of these studies reported night sweats, sleep disturbances associated with night sweats or adverse effects as an outcome.The main limitations of identified evidence were lack of data, imprecision and failure to report study methods in adequate detail. AUTHORS' CONCLUSIONS: Evidence is insufficient to show the effectiveness of relaxation techniques as treatment for menopausal vasomotor symptoms, or to determine whether this treatment is more effective than no treatment, placebo, acupuncture, superficial needle insertion or paced respiration.

Effectiveness of a modified version of the applied relaxation technique in treatment of perimenopausal and postmenopausal symptoms.

BACKGROUND: Awareness of the risks associated with hormone therapy for menopausal symptoms has sparked a global decline in this treatment. Alternative treatments to relieve menopausal symptoms are therefore required. The applied relaxation (AR) technique has proven to be successful for symptom amelioration, but requires participation in 12 weekly classes. The purpose of this study was to determine the effectiveness of a modified relaxation version (MR) of AR for treatment of hot flashes, night sweats, and sleep disturbances. METHODS: We conducted a12-week, randomized, parallel, open-label, controlled trial in perimenopausal and postmenopausal women visiting the menopausal clinic. Participants were randomly assigned to an MR or AR group. The MR group (n=36) received a single session of (MR) training and the AR group (n=35) received conventional 12-week training. Participants were instructed to practice the techniques daily at home for 12 weeks. The main outcome was the measure on the severity scale and frequency of hot flashes, night sweats, and sleep disturbances. RESULTS: All participants completed the study. Total severity scores in both groups decreased after 12 weeks, but there was no difference between the groups (P=0.93). The severity score for hot flashes in the MR group decreased more than in the AR group (P=0.02). The severity scores for night sweats and sleep disturbances decreased in both groups. The frequency of hot flashes, night sweats, and sleep disturbances were also decreased in both groups. CONCLUSION: A shorter, modified version of the AR was equally effective or slightly better than the conventional AR for the relief of hot flashes, night sweats, and sleep disturbances in perimenopausal and postmenopausal women. Recommendations for future research include confirmatory studies and trials with larger samples.

Modified relaxation technique for treating hypertension in Thai postmenopausal women.

AIM: To examine the effectiveness of a modified relaxation (MR) technique in reducing blood pressure levels in Thai postmenopausal women with mild hypertension, compared with a control group who received health education. METHODS: This is a 16-week, randomized, parallel, open-label, controlled trial in a menopausal clinic in a tertiary health care center in Northeastern Thailand. The intervention group received a 60-minute session of MR training and were encouraged to practice 15-20 minutes a day, at least 5 days a week. The control group received lifestyle education, including diet and exercise. The primary and secondary outcomes were systolic and diastolic blood pressure (SBP and DBP). RESULTS: Of 432 participants, 215 and 217 were randomly allocated to the MR and control groups, respectively. Of those, 167 participants in the MR group and 175 participants in the control group completed the study. The SBP was significantly more reduced in the MR group, with a mean of 2.1 mmHg (P < 0.001). There was no significant difference between groups on the changed DBP. CONCLUSION: The MR technique may be effective in lowering SBP in Thai postmenopausal women visiting a menopause clinic. Its efficacy may be observed as soon as 4 weeks after start of treatment. Long-term and combined relaxation therapy and antihypertensive agents are warranted in a large cohort of this population. This trial is registered in clinicaltrials.gov (number NCT01429662).

Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women: systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) with those of systemic progestogen in perimenopausal and postmenopausal women taking systemic estrogen therapy (ET). METHODS: We searched Medline (August 8, 2009), Embase (August 8, 2009), the Cochrane Central Register of Controlled Trials on the Cochrane Library Issue 3 (2009), the MetaRegister of Controlled Trials, and the reference lists of articles for relevant trials. Randomized controlled studies of LNG-IUS versus systemic progestogen in perimenopausal and postmenopausal women taking ET were included in the review. Two reviewers abstracted the trials independently. Any disagreement was resolved through discussion with the third reviewer. For dichotomous outcomes, a Peto odds ratio was calculated. For continuous outcomes, nonskewed data from valid scales were synthesized using a weighted mean difference or a standardized mean difference. RESULTS: Six trials with a total of 518 participants were included. The methodological limitation was an attrition bias. In perimenopausal and postmenopausal women taking ET, the incidence of a proliferative endometrium was comparable between the use of systemic progestogen and LNG-IUS, except for sequential medroxyprogesterone acetate, which had a higher incidence of proliferative endometrium. Descriptive data synthesis showed that ET combined with either LNG-IUS or systemic progestogen effectively relieved climacteric symptoms. Vaginal bleeding and spotting were common in the LNG-IUS group for the first 3 to 6 months of use. The discontinuation rate was not different. There was insufficient evidence to draw any conclusions about the other outcomes. CONCLUSIONS: The LNG-IUS was more effective than sequential medroxyprogesterone acetate but was comparable with other systemic progestogen regimens for endometrial protection in perimenopausal and postmenopausal women taking ET.

Tuberculosis at vulva and vagina.

A 60- year-old woman, gravid 4, para 4-0-0-4 was admitted to the Department of Obstetrics and Gynecology, Khon Kaen University due to chronic extensive painful genital ulcer. She was treated by antiviral and antifungal regimens but the ulcer persisted. After acid fast bacilli was found on tissue biopsy, a standard 6- month course of antituberculosis was started. One month after treatment, the ulcer was completely cured.

Preoperative and postoperative agreement of histopathological findings in cases of endometrial hyperplasia.

OBJECTIVE: To determine agreement of preoperative and postoperative histopathology of endometrial hyperplasia (EH). MATERIALS AND METHODS: Histopathology of specimens obtained by curettage and hysterectomy within 1 year was retrospectively compared by a skilled gynecological pathologist. Patients who received hormone therapy were excluded. RESULTS: Of 79 women with a preoperative diagnosis of EH, only 32 were diagnosed as EH from hysterectomy specimens. There was no endometrial cancer. The agreement between preoperative and postoperative histology did not achieve statistical significance (Kappa 0.011). Postoperative histopathology was more severe than preoperative diagnosis in 5 (6.3%) patients, including 3 preoperative diagnoses of simple hyperplasia without atypia, 1 simple hyperplasia with atypia, and 1 complex hyperplasia without atypia. CONCLUSIONS: For EH diagnosed by curettage, we can be sure of the diagnosis. However, 6.3% had more severe histology from hysterectomy specimens. Thus, repeated curettage or other investigations should be reconsidered in women with recurrent bleeding.

Androgen and menopause.

PURPOSE OF REVIEW: Androgen therapy is being increasingly used in the management of postmenopausal women. The most common indication is to improve sexual function. The aim of this review is to evaluate current knowledge pertaining to testosterone and sexual function in postmenopausal women. RECENT FINDINGS: The change of testosterone levels during the menopause transition remains controversial. A correlation of endogenous testosterone levels and sexual function is still inconclusive. A Cochrane Review and recent randomized control trials have, however, consistently demonstrated that short-term testosterone therapy in combination with traditional hormone therapy regimens improves sexual function in postmenopausal women, particularly surgically menopausal women with hypoactive sexual desire disorder. An adverse effect on the lipid profile has been identified which appears to be mostly associated with oral methyltestosterone. Data for other effects of testosterone and long-terms risks are lacking. Testosterone may act in a variety of ways in different tissues. This is, however, an area that requires further investigation. SUMMARY: Testosterone therapy is a promising option for treating women with hypoactive sexual desire disorder after surgical menopause. Two remaining questions need to be answer: who is most likely to benefit from testosterone therapy and what are the long-term health risks?

Testosterone therapy for postmenopausal women: efficacy and safety.

The treatment of postmenopausal women with a variety of androgen formulations is increasing, despite the lack of clear guidelines regarding the diagnosis of androgen insufficiency. This review summarizes evidence on the efficacy and safety of adding testosterone to hormone therapy in postmenopausal women. Fair to good evidence exists that the use of testosterone in combination with hormone therapy has both benefits and risks. The benefits are an improvement in sexual function with various regimens of testosterone use (good evidence), an improved sense of well-being with transdermal testosterone (fair evidence), and a reduction in triglyceride levels with methyl testosterone (fair evidence). The most consistent risk is a reduction in high-density lipoprotein (HDL) cholesterol, particularly with methyl testosterone (good evidence). There has been insufficient reporting of other side effects; hence, testosterone therapy should be used with caution. The use of testosterone may be justified in specific clinical circumstances and should be limited to short-term use; long-term studies are not available. Close surveillance for HDL cholesterol and other side effects is necessary.