Ischemic colitis in postmenopausal women taking hormone replacement therapy.

BACKGROUND AND AIM: Estrogen and progestins have established effects on the gastrointestinal tract and ischemic colitis was related in the past with certain regimens including both hormones. On this basis, we aimed to evaluate a group of postmenopausal women who presented with ischemic colitis after taking hormone replacement therapy (HRT) for the last several months. METHOD: Postmenopausal women taking conjugated estrogens, conjugated estrogens plus medroxyprogesterone acetate, 17beta-estradiol plus norethisterone and estradiol valerate plus norgestrel are included in the present study. All patients, without a medical history of bowel problems, reported an acute crisis of colitis a few months after the beginning of the treatment. RESULTS: Fasting, parenteral nutrition, intravenous antibiotic treatment with metronidazole and discontinuation of HRT proved successful. Antibiotics were continued after the patients' discharge from the hospital. A second-look colonoscopy, 3 to 4 months after the initial episode, was normal in all cases. CONCLUSION: Ischemic colitis is a rare complication of HRT that should not be ignored when HRT is prescribed.

Is dosage of hormone replacement therapy related with endometrial polyp formation?

PURPOSE OF INVESTIGATION: To evaluate the effect of different doses of hormone replacement therapy (HRT) on endometrial polyp formation. METHODS: 398 menopausal women were initially evaluated through transvaginal ultrasound and patients who already had endometrial polyps were excluded from the study. One hundred and six (26.6%) eligible patients were enrolled and randomized into two groups of 53 patients to receive two different doses of HRT. RESULTS: Six patients with endometrial polyps were detected in the first group and one patient in the second one (p = 0.0502 for total chi-square and p = .1172 for chi-square with continuity correction) after a mean duration of treatment of 26 months and 28,5 months, respectively. There was no difference in the mean number or the mean volume of the polyps between the two subgroups with positive results. CONCLUSION: Our study showed that endometrial polyp formation may be related with HRT dosage.

Polycystic ovarian syndrome, insulin resistance and thickness of the endometrium.

INTRODUCTION: Disorders possibly associated with insulin resistance (IR) are hyperandrogenemia, hirsutism, irregular menstrual cycles, central obesity and polycystic ovarian syndrome (PCOS). It is known that PCOS is related to a high risk of endometrial hyperplasia after many years of estrogen stimulation from anovulation. OBJECTIVES: The purpose of the study was to estimate the thickness of the endometrium in women with IR without a diagnosis of PCOS and in women with PCOS without IR. STUDY DESIGN: Three groups of women included in the study: 15 women diagnosed as IR without PCOS, 16 women diagnosed as PCOS without IR and 20 women used as controls matched for age and body mass index (BMI) with the previous patients. Thickness of the endometrium was estimated in all cases with a transvaginal ultrasound in three consecutive measures during a cycle. RESULTS: The mean thickness of the endometrium was statistically higher in the PCOS group (11.1mm), and in the IR group (9.6mm), compared with the control group (6.2mm) (F=13.1, p<0.001). CONCLUSIONS: It is concluded that both in women diagnosed as having insulin resistance without PCOS, and in women with PCOS without insulin resistance, the ultrasonographically estimated thickness of the endometrium is relatively high and a closer follow-up of these women is required in order to detect those in risk to develop hyperplasia and/or atypia.

Effect on endometrium of combined oestrogen-progestogen replacement therapy of 1 mg 17beta-estradiol and 0.5 mg norethisterone acetate.

The purpose of the study was to determine the effects of low-dose hormone replacement therapy (HRT) on ultrasound thickness of the endometrium and on endometrial histology in postmenopausal women. Two hundred and fifty-four postmenopausal women were included in the study; 124 completed three years of treatment with continuous HRT containing 1 mg oestradiol and 0.5 mg norethisterone acetate daily, and 130 women did not take HRT during the same time (control group). Ultrasound scan showed that the mean thickness of the endometrium was similar between the groups under investigation at the end of the study. Ninety-one percent of the women in the HRT group and 78% in the control group had an atrophic or unassessable endometrium and no cases of endometrial hyperplasia or malignancy were detected in either group at endometrial biopsy at the end of the study. It seems that low-dose continuous HRT of moderate duration is not associated with either endometrial hyperplasia or malignancy.

Gynecologic cancer and surgical infectious morbidity.

The purpose of this study was to evaluate retrospectively the surgical infectious morbidity in gynecologic cancer. We examined 1,180 gynecologic oncology patients: 608 women had carcinoma of the endometrium, 510 cancer of the cervix, 48 ovarian cancer and 14 vulvar cancer. Thirty-five (6%), 92 (18%), 7 (15%) and 2 (14%) were complicated by infection in carcinoma of the endometrium, cancer of the cervix, ovarian cancer and vulvar cancer, respectively. Our conclusion is that the highest surgical infectious morbidity occurs in patients with cervical cancer and the lowest in patients with carcinoma of the endometrium.

Postmenopausal uterine bleeding.

The purpose of this study was to evaluate the incidence of the etiologic factors of postmenopausal uterine bleeding and the recurrence rate of uterine bleeding before total hysterectomy. Six hundred and twenty-eight patients (mean age 52.2) with postmenopausal uterine bleeding were studied. Atrophic endometrium was found in 522 cases (83.1%), carcinoma of the endometrium in 70 cases (11.1%), proliferative endometrium in 29 cases (4.6%) and secretory endometrium in 7 cases (1.1%). The recurrence rate of uterine bleeding was very high in carcinoma of the endometrium, moderate in proliferative endometrium and low in secretory and atrophic endometrium.

Tibolone in the treatment of psychosomatic symptoms in menopause.

The purpose of this study was to investigate the value of tibolone in the treatment of psychosomatic symptoms in menopause. Forty-two menopausal women (aged 46-63, mean 53.9) with nightly perspiration, vasomotor flushes, disturbance of libido, dyspnea and other psychosomatic symptoms were assigned to one of two treatment groups for three months: 1st group) 21 users of tibolone; 2nd group) 21 users of placebo. At the end of the trial disturbance of libido was observed in 4 (19.0%) cases tin the 1st group and 11 (52.4%) cases in the 2nd (p < 0.05) and nightly perspiration was observed in 3 cases (14.3%) in the 1st group and 9 cases (42.9%) in the 2nd (p < 0.05). Although vasomotor flushes were observed in only 3 (14.3%) cases in the 1st group and 7 cases (33.3%) in the 2nd group, this difference was not significant (p > 0.05). There was no significant effect of tibolone or placebo in dyspnea, vertigo and headache. From the results it can be concluded that tibolone can have a beneficial effect on some psychosomatic symptoms in postmenopausal women.

Primary fallopian tube adenocarcinoma with metastasis to the uterine cervix. A case report.

Fallopian tube adenocarcinoma (FTA) and uterine cervix adenocarcinoma (UCA) coexistence, in the absence of relevant lesion on the body of the uterus, is a rare condition. The question immediately arises as to whether the coexistence of these two tumors is incidental or metastatic for either. We present the case of an FTA patient whose diagnosis was made during the operation. A UCA was located deeply in the wall of the endocervix, while no disease was present in the endocervical mucosa. Histological examination, based on the morphological, histochemical and immunohistochemical characteristics of both the tumors lead to the conclusion that the UCA was a metastatic lesion. A review of the international literature on the subject is made in the text.