Management of Menopause Symptoms and Quality of Life during the Menopause Transition.

Some women experience bothersome symptoms around the time of menopause that may have a negative impact on their quality of life and prompt them to seek treatments. Menopausal hormone therapy was historically the treatment of choice. However, medical contraindications and personal preference for nonhormonal therapy have prompted the evaluation of a range of nonhormonal pharmacologic and non-pharmacologic therapies. This review provides an update focusing on the latest evidence-based approach for the management of bothersome symptoms of menopause.

Isolated uterine metastasis from a lung adenocarcinoma.

A 65-year-old woman was referred with an incidental finding of a flurodeoxyglucose-avid uterine lesion, following excision of a local lung adenocarcinoma. MRI had features concerning for an atypical fibroid or smooth muscle tumour of uncertain malignant potential. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology demonstrated a leiomyoma infiltrated with adenocarcinoma consistent with a secondary lesion from the lung cancer. Among the small number of cases of uterine metastases of extra-pelvic primary cancers reported in the literature, those from lung cancers are very rare. Concerning features for an atypical fibroid included the patient's age and postmenopausal status, as well as positron emission tomography and MRI findings. A metastatic secondary cancer was not suspected. Diagnosis was only made after histopathological examination. This case represents a very unusual cause of a uterine mass. It demonstrates the importance of thorough preoperative work-up and accurate histopathological assessment.

A longitudinal study of adolescent dysmenorrhoea into adulthood.

Dysmenorrhoea is the most common gynaecological symptom in adolescents. Secondary dysmenorrhoea is mostly due to endometriosis. There are no known follow-up studies of dysmenorrhoea into adulthood. Cases of endometriosis often have a long history of dysmenorrhea; however, studies to date have been retrospective. This longitudinal cohort study aimed at analysing the long-term outcomes of dysmenorrhoea and associated rate of endometriosis identified in this cohort. Participants of a study of adolescents seen for dysmenorrhoea were followed-up at an average of 10.24 years. Of those contactable (74), 70 (94.6%) were included. As adults, 19 (27.1%) had slight or no pain with menstruation. Increased age of menarche was found to be associated with no menstrual pain in adulthood (OR 2.10, p = 0.034). No adolescent characteristic studied was found to be associated with severe or very severe dysmenorrhoea as an adult. At follow-up, 13 young women (18.6%) had been diagnosed with endometriosis. All cases of endometriosis were mild. The use of the oral contraceptive pill as an adolescent and feeling an improvement in symptoms with treatment as an adolescent were found to be associated with a diagnosis of endometriosis.Conclusion: These findings are important for counselling adolescents regarding this common presentation. What is Known: •Dysmenorrhoea is the most common gynaecological complaint for adolescents What is New: •Dysmenorrhoea from adolescence resolves in 1 in 4 of young women and no adolescent characteristics predict severe or very severe pain with menstruation in adults. •Only 1 in 5 of women were found to have endometriosis (all mild disease), despite a mean of 10 years of preceding dysmenorrhoea.

Game of Hospitals.

BACKGROUND: Systems of health care is a key learning area in medical curricula. An understanding of the health care system with regards to reducing medical errors, improving efficiency in the provision of care and cost containment is recognised as being difficult to teach. CONTEXT: A game-based session was designed and executed as part of a medical student conference. This session incorporated numerous aspects of systems of health care, including teamwork, the efficient and equitable allocation of resources, safety, quality, medical errors, structure of health care systems and political influences in the delivery of health care. INNOVATION: Game of Hospitals employs experiential learning, enhanced by role-play and competition. Students take on roles as hospital administrators and doctors to negotiate complex clinical and administrative problems. The scenarios explore themes, and highlight patient outcomes and the finite nature of resources. Student experiences were observed and questionnaire evaluations attempted to explore student perceptions. An understanding of the health care system … is recognised as being difficult to teach IMPLICATIONS: Game of Hospitals appears to be a popular learning activity. Observations during the game demonstrated the active involvement of participants, and questionnaire evaluation revealed this to be a favourite session at the student conference. This paper presents a detailed explanation of the set-up and rules for the game in the hope that others can adopt and modify the game to suit their local context.

Quality of life and menstruation in adolescents.

PURPOSE OF REVIEW: Menstrual problems are known to be common amongst teenagers, but adequate recognition of the impact this may have on the adolescent and appropriate interventions that are focussed on the needs of the adolescents are limited. RECENT FINDINGS: To date, the impact of menstrually related problems on the quality of life of adolescents has been poorly studied. Although some studies report on the impact of, in particular, dysmenorrhoea on school absenteeism, less is known about the impact on psychosocial functioning. For other menstrual problems, even less is known. It is increasingly recognized that understanding the impact on quality of life is an important measure to better understand the impact of the health problem and also to ensure the optimal delivery of patient-centred healthcare. This review will explore the current tools available for assessment of quality of life in adolescents and then focus on the specific menstrual problems (dysmenorrhoea, heavy menses, oligo/amenorrhoea) and what is known about their impact on the general well being of young women. SUMMARY: Cultural differences in the presentation and impact of menstrual problems appear to be present with a greater impact on psychosocial functioning found with particularly oligo/amenorrhoea. There is clearly room for further study to explore and then optimize care.