Black cohosh efficacy and safety for menopausal symptoms. The Spanish Menopause Society statement.

OBJECTIVE: The increasing interest in Western countries regarding phytotherapy use to treat menopause-related symptoms has led the Spanish Menopause Society (AEEM) to update its position statement performed in 2009 on the role of black cohosh (Cimicifuga racemosa) for the treatment of menopausal symptoms. MATERIAL AND METHODS: A panel of experts from both clinical and research backgrounds were assembled to investigate the best available evidence. Selected studies were obtained by an electronic search, including the Internet search engines MEDLINE-Pubmed (1997-December 2021) and the Cochrane Controlled Trials Register. RESULTS: Most of the well-designed studies published in recent years have been conducted with the isopropanolic extract of black cohosh/C. racemosa. The most common dose is 40 mg/day capable of achieving a significant reduction in hot flushes (particularly in women with intense hot flushes) and an improvement in mood. Used at the recommended doses, C. racemose produces no significant adverse reactions. CONCLUSION: Black cohosh is an effective and safe treatment option for the relieving of vasomotor symptoms. Finally, further clinical trials with sufficient patient enrollment and longer study follow-up are needed.

Position of the Spanish Menopause Society regarding vaginal health care in postmenopausal women.

Vaginal health, defined as the vaginal state in which the physiological condition remains stable, being protected from the onset of symptoms and facilitating a satisfying sex life, is one of the most common and less valued concerns in postmenopausal women. Many of the conditions that affect the vagina are related to its trophism and susceptibility to infection by unusual germs, which are phenomena strongly influenced by estrogen impregnation and the microbiota composition, ultimately affecting sexuality and the quality of life. An expert panel of the Spanish Menopause Society met to establish criteria for diagnosing and treating the processes that affect overall vaginal health and to decide the optimal timing and methods based on the best evidence available.

Position of the Spanish Menopause Society regarding the management of menopausal symptoms in breast cancer patients.

Breast cancer is the most common female cancer in Spain. Its high prevalence, its high survival rate, and its incidence are the reasons treatment is increasingly sought for common problems by young women who have survived it. Besides the contraception and fertility issues, many breast cancer survivors develop sexual disorders and menopausal symptoms, whether as a consequence of treatment-induced menopause or side effects of treatment. For such reasons, a panel of experts from the Spanish Menopause Society has met to develop usage recommendations for the relief of vasomotor symptoms and for sexual and reproductive health in patients with breast cancer based on the best evidence available.

Early embryonic morphology sonographically assessed and its correlation with yolk sac in missed abortion.

PURPOSE: To provide additional information about embryo morphology sonographic assessment and its correlation with yolk sac. METHODS: A systematic study in 200 consecutive cases of missed abortion <10 weeks diagnosed by transvaginal ultrasound. RESULTS: In 104 gestations of embryos with morphological abnormalities, 88 (84.6 %) were at least 1 week smaller than expected for gestational age and 16 (15.4 %) were the expected size. From 32 normal morphologic embryos, 7 (21.9 %) were at least 1 week smaller than expected for gestational age, and 25 (78.1 %) were the expected size (p < 0.005). Normal morphologic embryos are linked more frequently with normal yolk sac (62.5 %). Findings in anembryonic gestations (GD1) included an absent yolk sac (46.9 %) and a cystic yolk sac (25 %). Likewise, findings in GD2-3 embryos included more frequently a cystic yolk sac (42.9 %) and an absent yolk sac (32.5 %). GD4 embryos are associated with an echogenic yolk sac (40 %), a relatively small-hypoplastic- (40 %) and a relatively large-cystic- (20 %). In DI embryos, yolk sac appears cystic (62.5 %) or echogenic (37.5 %). CONCLUSIONS: Our study proves the correlation between morphology of conceptuses and yolk sac appearance in cases of missed abortion.

Preliminary study of a new, fully automated system for liquid-based cytology: the NovaPrep® processor system.

OBJECTIVE: To evaluate a fully automated system for liquid-based cytology (LBC): the NovaPrep® Processor System (NPS), which is based on the new concept of double decantation, versus conventional cytology (CC), the gold standard for cytology. STUDY DESIGN: We performed a preliminary comparative study involving 1,129 female patients who underwent sampling for a Pap test; the sample was first smeared for CC and then, using the remaining specimen on the brush, for LBC with the NPS. The performances of CC and NPS were evaluated for accuracy and compared using the gold standard of a combination of one of the two methods of pathological cytology with screening for positive human papilloma virus, quantification of cells (normal and pathological), and improvement in the quality of samples and reading time. RESULTS: The results showed improvement in sensitivity (3.81% for CC vs. 4.52% for NPS) with a specificity superior to 90% for both, a markedly decreased number of unsatisfactory specimens, notably samples containing too many inflamed cells (7.4% for CC vs. 0.5% for NPS), and a shortening of the reading time, which was three times less using NPS. CONCLUSION: This preliminary study showed a gain in sensitivity, a drop in the number of unsatisfactory specimens and a reduction in reading time with NPS. The results achieved using this fully automated LBC procedure are very promising and will hopefully reduce the overall cost of cervical cancer screening in the future.

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de la Cimicífuga racemosa en el climaterio / Position statement of the Spanish Menopause Society on the Clinical Use of Cimicifuga racemosa during menopause

Objetivo: Dado el creciente interés en los países occidentales acerca de la utilización de ciertas plantas para el tratamiento de los síntomas relacionados con la menopausia, la AsociaciónEspañola para el Estudio de la Menopausia (AEEM)ha evaluado el papel de la Cimicífuga racemosa en el tratamiento de los síntomas climatéricos sobre la base de las mejores evidencias disponibles. Material y métodos. Se reunió un panel de expertos, clínicos e investigadores, en el campo dela fitoterapia. Los estudios seleccionados se obtuvieron mediante una búsqueda electrónica que incluyó buscadores de Internet, MEDLINE (1985-mayo 2008) y el Registro de Ensayos Clínicos Controlados Cochrane. Resultados: La mayoría de los estudios publicados en los últimos años están realizados con el extractoisopropanólico de Cimicífuga racemosa. La dosis más estudiada ha sido 40 mg/día y ha demostrado obtener una reducción moderada de las sofocaciones, sobre todo en las mujeres con sofocos más intensos, y una mejoría del estado de ánimo. Utilizada a las dosis recomendadas, no hay riesgo relevante desde el punto de vista hepático. Los datos disponibles sobre su efecto en la enfermedad cardiovascular, el hueso, la función cognitiva y la piel son muy escasos o inexistentes. Conclusiones: La Cimic ífuga racemosa es un tratamiento eficaz en el alivio de los síntomas vasomotores, al menos en una población adecuada de mujeres peri y posmenopáusicas, si bien se precisan mejores ensayos clínicos con suficiente número de pacientes incluidas y mayor duración del estudio (AU)

Objective: Due to an increasing interest in the symptoms related to menopause in western countries, the Spanish Menopause Society (SMS)has assessed the role of cimicifuga racemosa in relieving those symptoms based on the mostreliable evidence available. Material and methods: A meeting was held with a panel of experts, health scientists and researchers specialised in the field of phytotherapy. The studies selected were obtained through electronic search which included INTERNET, MEDLINE (1985-May 2008), and the Cochrane Controlled Clinical Trials Register. Results: Most studies published in recent years have been carried out using an isopropanol extract of cimicifuga racemosa. The dose most commonly studied was 40mg/day and was shown to result ina moderate decrease in hot flushes, particularly in those women with the most intense hot flushes, and an improvement in their mood. When recommended doses are used there is no significant risk to the hepatic system. Available data on the effect of cimicifuga racemosa on cardiovascular disease, bones, cognitive function or skin are scarce or non-existent. Conclusions: Cimicifuga racemosa is an effective treatment for relief of vasomotor symptoms, at least within a suitable population of peri- and postmenopausal women. Nevertheless, more accurate clinical trials which include sufficient numbers of patients and a longer follow-up are required (AU)

Transvaginal sonographic evaluation of subendometrial-myometrial contractility in women using a copper-releasing intrauterine device.

BACKGROUND: The aim of this study was to determine the effects of a copper-releasing intrauterine device (IUD) on myometrial contractility midway through the menstrual cycle. STUDY DESIGN: Uterine peristalsis was studied midway through the cycle with transvaginal sonography in two groups of women, a control group and women in whom a copper-releasing IUD had been inserted. RESULTS: The results showed that 12 months after insertion, no uterine motility could be detected with sonography in any of the women with an IUD, but motility did occur in all the controls. CONCLUSIONS: Subendometrial-myometrial contractility midway through the menstrual cycle had been abolished in patients with a copper-releasing IUD. The loss of motility may inhibit sperm transport from the cervix to the oviduct and account for at least part of the contraceptive effect of these devices.

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de las isoflavonas en el climaterio / The use of isoflavones during climaterium: position statement of the Spanish Menopause Society

Objetivo: Existe un interés creciente en los países occidentales acerca de la utilidad de las isoflavonas de la soja para el tratamiento de los síntomas y enfermedades relacionadas con la menopausia y el envejecimiento, que se ha traducido en la aparición de un importante número de publicaciones, muchas de las cuales presentan resultados contradictorios. La Asociación Española para el Estudio de la Menopausia (AEEM) ha evaluado el papel de las isoflavonas en la salud de la mujer menopáusica, basándose en las mejores evidencias disponibles. Material y métodos: Se reunió un panel de expertos, clínicos e investigadores en el campo de las isoflavonas. Los estudios seleccionados se obtuvieron mediante una búsqueda electrónica que incluyó buscadores de internet, Medline (1966-marzo de 2007) y el Registro de Ensayos Clínicos Controlados Cochrane. Resultados: Las diferentes revisiones y metaanálisis sobre los efectos de las isoflavonas en la salud de la mujer son controvertidos. La diversidad de resultados puede deberse, entre otras causas, a la falta de uniformidad de los compuestos estudiados. En relación con la dosis y el contenido en genisteína, se han demostrado efectos beneficiosos en el perfil lipídico, como antioxidantes, así como una reducción moderada de los sofocos. Algunos estudios sugieren un efecto positivo en la masa ósea. Los datos disponibles en otros aspectos, como la mama, cánceres dependientes de los estrógenos, función cognitiva y piel, entre otros, son escasos. Conclusiones: En diversas situaciones, las isoflavonas pueden ser una alternativa terapéutica en el climaterio, si bien antes de poder proceder a la realización de recomendaciones generales acerca del consumo de preparados de isoflavonas, se necesitan ensayos clínicos específicos, de diseño adecuado, con preparados normalizados en cuanto al contenido en isoflavonas y sus tipos, y con suficiente número de pacientes y tiempo de estudio

Introduction: Western countries have shown an increasing interest in the use of soya isoflavones to treat aging and menopause-related diseases and their associated symptoms, stimulating a proliferation of studies, many of which report contradictory results. Consequently, the role of isoflavones was assessed by the Spanish Menopause Society (SMS) using the most reliable scientific evidence. Material and methods: A panel of experts on isoflavones was gathered. The selected studies were obtained by electronic search engines, Medline (1966-March 2007) and the Cochrane Controlled Clinical Trials Registry. Results: The various reviews and meta-analysis on the effects of Isoflavones on women's health are controversial. The contradictory results may be due, among other factors, to the lack of uniformity in the compounds under study. Data on doses and genisteine content have indicated beneficial effects on lipid profile, like antioxidants, as well as a mild decrease in hot flushes. Some studies suggest a positive effect on bone mass. However few data are available on other aspects such as breast, estrogen-dependent cancer, cognitive function, or skin Conclusions: In certain situations, isoflavones can be a therapeutic alternative during the climacteric period. However, before general recommendations on the use of isoflavone supplements can be made, more specific clinical trials should be performed. These studies should be adequately designed, with supplements that are standarized according to isoflavone content and types, a sufficient number of patients and study duration

El fruto de sauzgatillo en el tratamiento del síndrome premenstrual / No disponible

El síndrome premenstrual (SPM) es un trastorno recurrente que aparece en la fase lútea del ciclo, caracterizado por la aparición de síntomas físicos (hinchazón abdominal o de las extremidades, tensión mamaria, cefaleas) y psicológicos (depresión, irritabilidad, ansiedad, fatiga). Afecta a más del 50% de las mujer es en la etapa reproductiva y , en una minoría de casos (3-5%), puede llegar a ser incapacitante. En su etiología intervienen diversos factor es, entre los que destacan los relacionados con distintos sistemas de neurotransmisión (sero-toninérgico, gabaérgico, dopaminérgico y opioide) así como la influencia que sobre los mismos ejercen las hormonas sexuales y sus metabolitos. Una de las posibilidades terapéuticas con las que se cuenta en el tratamiento del SPM son los preparados del fruto de sauzgatillo (Vitex agnus-castus L.), activos sobre los receptores D2 y opioides, y que han sido objeto de varios ensayos clínicos en los que se ha demostrado su efecto beneficioso sobre este síndrome (AU)

The Premenstrual Syndrome (PMS) is a recurrent disorder that occurs in the luteal phase of the menstrual cycle, characterised by symptoms both physical (abdominal bloating, breast swelling, headache) and psychological (depressed mood, irritability , anxiety, fatigue). It affects more than 50% of women in reproductive age, and, in a minority of cases (3-5%) can become disabling. Several factors are involved in its aetiology, the most outstanding among them being those related with several neurotransmitter systems (serotoninergic, gabaergic, dopaminer gic, and opioid), and the influence of sexual hormones and its metabolites on them. One of the therapeutic possibilities to consider in the treatment of PMS are the preparations obtained from the fruit of chaste tree (Vitex agnus-castus L.), which are active on brain D2 and opioid receptors, and have demonstrated efficacy on PMS in several clinical trials (AU)