AEEM-SEGO position statement on menopausal hormone therapy / Posicionamiento AEEM-SEGO sobre la terapia hormonal de la menopausia

According to the latest data from the medical literature, the Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia [AEEM]) has brought together a group of experts to re-evaluate the use of menopausal hormone therapy so that women can make an informed, evidence-based decision to determine the most appropriate dose, formulation, route of administration, and duration of menopausal hormone therapy. There is some disagreement between scientific evidence on the efficacy and safety of menopausal hormone therapy and how this evidence is perceived by menopausal women and the clinicians who care for them, leading to an unnecessary loss of quality of life in those who reject it or in the unjustified fear of those who choose to use it. A critical review of the most recent available literature was conducted. The review mainly covered randomized clinical trials and epidemiological studies published since January 2015. This paper reviews clinical trials published since then, as well as new information on the potential risks and benefits of HT for the treatment of menopausal symptoms. Decisions about menopausal hormone therapy should be based on a woman’s specific health risks, age, and time since onset of the menopause, as well as on the goals of therapy. The Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia) and the Spanish Society of Gynecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia) updated their position statement on menopausal hormone therapy. This statement updates the clinical practice guidelines on the menopause

Conocidos los últimos datos de la literatura médica, la Asociación Española para el Estudio de la Menopausia ha reunido a un grupobde expertos para reevaluar el uso de la terapia hormonal de la menopausia con el fin de adoptar una decisión informada, basada en la evidencia que determina el tipo más apropiado de dosis, formulación, vía de administración y duración del uso de la terapia hormonal de la menopausia. Existe una discordancia entre las evidencias de carácter científico, sobre la eficacia y la seguridad de la terapia hormonal de la menopausia y la percepción que tienen de ello las mujeres que están en la menopausia y los médicos que las atienden, lo que redunda en una pérdida innecesaria de la calidad de vida en las que lo rechazan o en el temor injustificado de las que optan por su utilización. Se ha realizado una revisión crítica de la literatura disponible más reciente, fundamentalmente de ensayos clínicos aleatorizados y estudios epidemiológicos, publicados desde enero de 2015. El presente documento revisa los nuevos ensayos clínicos publicados desde entonces, así como nueva información sobre los posibles riesgos y beneficios de la terapia hormonal de la menopausia para el tratamiento de los síntomas de la menopausia. Las decisiones sobre la terapia hormonal de la menopausia deben basarse en los riesgos de salud específicos de cada mujer, la edad o el tiempo desde la menopausia y los objetivos de la terapia. La Asociación Española para el Estudio de la Menopausia y la Sociedad Española de Ginecología y Obstetricia actualizaron su posicionamiento con respecto a la terapia hormonal de la menopausia. Dicho posicionamiento de la Asociación Española para el Estudio de la Menopausia/Sociedad Española de Ginecología y Obstetricia actualiza las guías de práctica clínica de menopausia ya publicadas

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

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Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

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Endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer: is screening necessary?

OBJECTIVE: To evaluate the prevalence of endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer and to know if a baseline pretamoxifen endometrial assessment should be taken into consideration in these women at high risk. METHODS: A cross-sectional study was carried out with 201 women with breast cancer. A diagnostic hysteroscopy was performed in all women. All formations suspected as polyps were removed. The prevalence of endometrial polyps was analyzed in all patients (n=182) and in premenopausal (n=49) and postmenopausal (n=118) women with estrogen receptor (ER) positive breast cancer (BC) according to their body mass index (BMI) and other risk factors. RESULTS: Hysteroscopic evaluation was possible in 182 cases (90.5%). Of the total of women, 160 (87.9%) were ER(+)BC patients, 133 (73.1%) postmenopausal women and 41.5% were obese (BMI≥30kg/m(2)). Endometrial polyps were found in 52 cases (28.5%) (3 cases of simple hyperplasia harbored within a polyp). In premenopausal patients with ER(+)BC, there were no statistical differences in endometrial polyps according to their BMI (22.3% in non-obese women vs 31.7% in obese) while in all patients (26.4% in non-obese vs 44.0% in obese) and in postmenopausal women with ER(+)BC (25.9% in non-obese vs 48.6% in obese) there were statistical differences. In all women the relative risk (RR) of endometrial polyps in obese patients was 2.24 (1.01-4.83), in obese postmenopausal women with ER(+)BC was 2.75 (1.01-7.40) and in obese premenopausal patients with ER(+)BC was 1.42 (0.80-3.29). CONCLUSIONS: Asymptomatic women with breast cancer have a high prevalence of baseline subclinical endometrial polyps and it is very high in obese postmenopausal patients with estrogen receptor positive breast cancer. Therefore, there may be a future role for baseline pretamoxifen screening of some sort for the obese asymptomatic postmenopausal patient, especially if they are elderly and ER positive.

Eurogin 2013 (Florencia, 3-6 noviembre 2013) / Eurogin 2013 (Florence, November 6-3 2013)

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La vulvovaginitis candidiásica recurrente / Recurrent vulvovaginal candidiasis

La vulvovaginitis candidiásica recurrente (VVCR) es una entidad presente en la práctica diaria en las consultas y en urgencias. Sus síntomas causan molestias crónicas que repercuten seriamente en la calidad de vida de la mujer, empujándola a buscar constantemente una solución que no siempre llega. El diagnóstico debe confirmarse siempre mediante cultivo y el tratamiento debe basarse en el uso de antifúngicos imidazoles, tópicos u orales, con un tratamiento inicial con triple terapia para eliminar los síntomas e intentar eliminar los reservorios; seguida de un tratamiento de mantenimiento durante 6 a 12 meses. Las opciones para la prevención de la VVCR son muy limitadas y, exceptuando la eliminación del agente causal, ninguna otra medida preventiva ha resultado eficaz. Presentamos esta actualización de la VVCR en un intento de ayudar al profesional y colaborar en mejorar la atención de la mujer afecta de VVCR(AU)

Recurrent vulvovaginal candidiasis (RVVC) is a common infection in daily clinical and emergency practice. The symptoms of this infection cause distressing chronic conditions that seriously affect women's quality of life, prompting them to seek solutions that are sometimes hard to find. Diagnosis should always be confirmed by culture and treatment should be based on the use of topical or oral antifungal imidazoles. Triple therapy focused on symptom and reservoir elimination should initially be used, followed by maintenance therapy for 6 to 12 months. The options to prevent RVVC are highly limited and, except for elimination of the causative agent, no other preventive measures have been effective. We provide an updated review of RVVC in an attempt to aid health professionals and improve the care of women with this infection(AU)

Metabolic syndrome in normal and complicated pregnancies.

OBJECTIVE: To evaluate the prevalence of metabolic syndrome and its components in normal and complicated pregnancies. SETTING: university hospital, tertiary referral centre. SUBJECTS: 90 pregnant women in four groups: 20 women with preeclampsia, 20 women with gestational hypertension, 30 women with late-onset gestational diabetes and 20 healthy pregnant women as a control group. INTERVENTION: peripheral insulin resistance was measured by using the insulin tolerance test. Glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and body mass index were analysed. Comparisons were done by Chi-squared test, one-way analysis of variance and the Bonferroni's test. Prevalence of the metabolic syndrome was calculated by adapting both the WHO and the NCEP definitions of the metabolic syndrome to pregnancy. RESULTS: There were no cases of metabolic syndrome in the control group according to any of the adapted definitions. The prevalence of this syndrome was 3.3% and 10% in the late-onset gestational diabetes group, 35% and 20% in the gestational hypertension group and 30% and 30% in the preeclampsia group for the WHO and the NCEP definitions, respectively. CONCLUSIONS: Metabolic syndrome is present in about one-third of women with pregnancy-induced hypertension but only in 10% of women with late-onset gestational diabetes.

Human chorionic gonadotropin and vascular endothelial growth factor in normal and complicated pregnancies.

OBJECTIVE: To study the relationships between maternal serum concentrations of beta-human chorionic gonadotropin (hCG) and vascular endothelial growth factor (VEGF) in both normal pregnant women during late pregnancy and women with pregnancy complications. METHODS: Sixty-six women in three groups were prospectively studied: 1) women diagnosed with fetal growth restriction (n = 22), 2) women with preeclampsia (n = 22), and 3) healthy pregnant women (controls) frequency matched for age, parity, and gestational age (n = 22). Primary outcomes were maternal serum concentrations of both beta-hCG and VEGF. Placental insufficiency was defined by a pulsatility index in umbilical artery greater than the 99th percentile for gestation. RESULTS: Maternal serum concentrations of beta-hCG and VEGF were greater in women with preeclampsia than in controls (P = .001 and P = .002, respectively) and women with fetal growth restriction (P = .002 and P = .002, respectively). Concentrations did not differ between women with fetal growth restricted fetuses and controls. Correlation between beta-hCG and VEGF was not significant in any of the studied groups. Serum VEGF concentrations were significantly increased in a subgroup of 12 women with placental insufficiency (P = .04) and correlated with beta-hCG concentrations (r = .63, P = .02). CONCLUSION: Both VEGF and beta-hCG maternal serum concentrations were increased in women with preeclampsia but normal in women with fetal growth restriction, although VEGF concentrations were increased in those cases with placental insufficiency. Maternal serum beta-hCG and VEGF concentrations did not correlate except in women with placental insufficiency.

Inflammatory cytokines in intrauterine growth retardation.

BACKGROUND: To evaluate maternal serum levels of two inflammatory cytokines in women with intrauterine growth retardation (IUGR), while studying separately women with or without placental insufficiency. METHODS: The study comprised 14 women with IUGR and Doppler-defined placental insufficiency, 14 women with IUGR without placental insufficiency, and 28 healthy pregnant women as a control group. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured using a commercially available kit. The Kruskal-Wallis test and the corrected Mann-Whitney U-test were used. RESULTS: There was a statistically significant difference in TNF-alpha levels among the three studied groups (p = 0.03). Women with IUGR and placental insufficiency showed statistically significant higher serum levels of TNF-alpha[2.2 pg/mL (1.3-4.1)] and a higher rate of detectable TNF-alpha[85.7% (12/14)] than those in the control group [0 pg/mL (0-2.7) and 32.1% (9/28)] (p = 0.01 and p = 0.001, respectively). On the contrary, there was no difference in either the TNF-alpha level [1.4 pg/mL (0-4.9)] or the rate of detectable TNF-alpha[57.1% (8/14)] between women with IUGR without placental insufficiency and women in the control group. The levels of IL-6 were similar in the three studied groups. CONCLUSION: TNF-alpha is increased in women with IUGR and placental insufficiency but normal in those with IUGR and normal placental perfusion. We suggest that elevations of TNF-alpha could be a specific phenomenon of certain subsets of IUGR, identifying cases with placental dysfunction.

Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications.

OBJECTIVE: [corrected] To test the hypothesis that an early diagnosis of gestational diabetes mellitus (GDM) could avoid some diabetes-related complications. STUDY DESIGN: We compared the rates of pregnancy complications commonly related to diabetes between 189 (later screening group) and 235 (earlier screening group) women with GDM diagnosed before and after adding an universal glucose tolerance screening performed in the first antenatal visit to the traditional screening performed at 24-28 weeks of gestation. RESULTS: Women in the later screening group were likely to have hydramnios (12.7 versus 2.1%, P<0.0001) and preterm deliveries (11.8 versus 5.5%; P=0.03). All cases of preterm premature rupture of membranes and fetal anomalies took place in the later screening group (P=0.03, P=0.007, respectively). Statistical analysis was performed using the Student's t-test, Mann-Whitney's U-test, Fisher's exact test and chi2-test. Statistical significance was set at 95% level (P<0.05). CONCLUSIONS: Early glucose tolerance screening could avoid some diabetes-related complications in women with gestational diabetes. However, further studies are needed to know if it should be done in all pregnant women or only in those with a high risk of developing diabetes.

Insulin, insulin-like growth factor-1, and insulin resistance in women with pregnancy-induced hypertension.

OBJECTIVE: The purpose of this study was to assess insulin, insulin sensitivity, and insulin-like growth factor-I in women with preeclampsia and gestational hypertension. STUDY DESIGN: Insulin resistance was measured with the short insulin-tolerance test in 20 women with preeclampsia, in 18 women with gestational hypertension, and in 20 normotensive control subjects. Sex hormone binding globulin, insulin-like growth factor-I, glucose, fructosamine, glycosylated hemoglobin, insulin, C-peptide, and lipids were measured in the fasting state. RESULTS: Women with gestational hypertension had a significant lower insulin sensitivity index (0.13 +/- 0.1) and a higher level of insulin-like growth factor-I (333.71 +/- 107.6 ng/mL) than women in the control group (0.21 +/- 0.1 [P <.05]; 218.11 +/- 82.3 ng/mL [P <.01]) and women with preeclampsia (0.21 +/- 0.12 [P <.05]; 234.78 +/- 92.76 ng/mL [P <.01]). There were no significant correlations between insulin sensitivity index and insulin-like growth factor-I. CONCLUSION: Insulin resistance is present in women with gestational hypertension but not in women with preeclampsia and did not correlate with insulin-like growth factor-I.