Strategy to improve the female fertility in the general gynecologist's office: use of a nutritional supplement based on myo-inositol/D-chiro-inositol and antioxidants.

Subfertility is more than a quality-of-life problem as it has a substantial negative public health impact. Polycystic ovary syndrome (PCOS) is one of the most common causes of subfertility, affecting one out of 10 women in reproductive age. Among PCOS women undergoing assisted reproductive technology, treatment based on myo-inositol and high doses of D-chiro-inositol has been shown to increase pregnancy rate and number of live births, reduce ovarian hyperstimulation syndrome and improve oocyte quality. A preparation based on myo-inositol and high doses of D-chiro-inositol, together with antioxidants, vitamins, and minerals, could have beneficial effects and be an optimal strategy to improve female fertility in the general gynecologist's office. The aim of this review is to highlight the role of inositol and its isomers in improving fertility of women with PCOS.

Managing vulvar and vestibular pain in postmenopausal women: recommendations from the Spanish Menopause Society, Sociedad Española de Ginecología y Obstetricia, Sociedad Española de Medicos de Atención Primaria y Federación Española de Sociedades de Sexología.

Background: Relieving vulvar pain caused by atrophy in postmenopausal women is a challenge in our clinical practice. We know more and more about the vulva, its anatomy and physiology and we are realizing that it is different from the vagina. The importance of the vulvar approach in the management of vulvar or vestibular pain (VP) due to atrophy in postmenopausal women is becoming increasingly important. A panel of experts from several Spanish scientific societies (Spanish Menopause Society, AEEM; Spanish Federation of Sexology Societies, FESS; Spanish Society of Primary Care Physicians, SEMERGEN; and the Spanish Society of Gynecology and Obstetrics) held a meeting to discuss treatment recommendations for women with vulvar and VP based on the best available evidence, creating a report to describe grades of recommendations.

What do Spanish women know about menopause? COMEM study.

The aim of the study was to evaluate the level of knowledge that women have about menopause and to analyse whether sociodemographic aspects can influence it. For this, a multi-centre observational study was conducted in Spain using a survey including 2500 women between 35 and 75 years. Participants were administered a 10-question questionnaire with a maximum score of 45 points. The responses of 2355 women were analysed. The median age was 52 years (IQR 45-59) and the median of knowledge score was 22 points (IQR 16-27). Age (p < .001), menopausal status (p = .030), early menopause (p = .001), educational level (p < .001), type of healthcare (p < .001) and sources of information on menopause (p < .001) were factors related to the score on the questionnaire. We conclude that Spanish women have limited knowledge about menopause and it is urgent to implement training programs that can improve it.IMPACT STATEMENTWhat is already known on this subject? The knowledge and attitudes about menopause among women can vary across countries and also according to sociocultural context. It also seems that negative attitudes towards menopause and poor knowledge of the physiology and the most frequent symptoms have an increasing effect on the severity of the specific symptoms of menopause that cause further discomfort.What do the results of this study add? There are very few available reports or research on the issue of postmenopausal health in Spain. We believe that it is appropriate to explore the level of knowledge of women in our country. We have verified that the level of knowledge of Spanish women is low and that some sociodemographic aspects can influence itWhat are the implications of these findings for clinical practice and/or further research? Taking into account our results, it is a priority to implement health training programs to improve knowledge about menopause in Spanish women and overcome false myths and wrong beliefs.

Observer Influence with Other Variables on the Accuracy of Ultrasound Estimation of Fetal Weight at Term.

Background and Objectives: The accuracy with which the estimation of fetal weight (EFW) at term is determined is useful in order to address obstetric complications, since it is a parameter that represents an important prognostic factor for perinatal and maternal morbidity and mortality. The aim of this study was to determine the role of the experienced observers with other variables that could influence the accuracy of the ultrasound used to calculate EFW at term, carried out within a period of seven days prior to delivery, in order to assess interobserver variability. Materials and Methods: A cross-sectional study was performed including 1144 pregnancies at term. The validity of the ultrasound used to calculate EFW at term was analyzed using simple error, absolute error, percentage error and absolute percentage error, as well as the percentage of predictions with an error less than 10 and 15% in relation to maternal, obstetric and ultrasound variables. Results: Valid predictions with an error less than 10 and 15% were 74.7 and 89.7% respectively, with such precision decreasing according to the observer as well as in extreme fetal weights. The remaining variables were not significant in ultrasound EFW at term. The simple error, absolute error, percentage error and absolute percentage error were greater in cases of extreme fetal weights, with a tendency to overestimate the low weights and underestimate the high weights. Conclusions: The accuracy of EFW with ultrasound carried out within seven days prior to birth is not affected by maternal or obstetric variables, or by the time interval between the ultrasound and delivery. However, accuracy was reduced by the observers and in extreme fetal weights.

Beliefs, knowledge and the impact of COVID19 on menopause therapies in Spanish women: COMEM-treatment study.

OBJECTIVE: To study what women think about menopause treatments and assess their knowledge about them. To analyze adherence to treatment during COVID-19 confinement as a secondary objective. METHODS: A multi-center cross-sectional observational study was conducted using a survey of 2500 women between January and June 2019. This was administered following a non-probability sampling procedure including women between 35 and 75 years. An extension study was conducted during the coronavirus pandemic, between March and June 2020. RESULTS: The responses of 2355 surveyed women were analyzed. Of this sample, 42% knew about menopause hormone therapy (MHT). The most frequently identified indication was the treatment of hot flashes (65.6%). The MHT risks most frequently perceived were weight gain (24.2%) and breast cancer (21.7%); the main reason for rejecting MHT was a lack of information (96.1%). Comparative analyses were conducted according to age, menopausal status, type of menopause, place of residence, type of health care and level of education. During the coronavirus confinement period, 85 women using MHT were located, of which 84.7% continued it. CONCLUSIONS: Women hold certain false beliefs about menopause, and their knowledge of the available treatments is somewhat limited. Adherence to MHT during the COVID-19 confinement in Spain has been high.

High dose of d-chiro-inositol improves oocyte quality in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial.

The aim of this study was to evaluate the effect of two doses of d-chiro-inositol (DCI) in combination with Myo-inositol (MYO) on the oocyte quality (OQ) of women with polycystic ovarian syndrome (PCOS) undergoing intracytoplasmic sperm injection (ICSI). Methods: This was a controlled, randomized, double-blind, parallel group study on 172 oocytes from 11 women. The study compared the effect of two MYO-DCI formulations given over 12 weeks on OQ. Five women received 550 mg of MYO + 300 mg of DCI daily (high DCI content group), while 6 women were given a daily dose of 550 mg of MYO with the only 27.6 mg of DCI (low DCI content group). Results: According to a multivariate analysis using linear mixed effect models, high doses of DCI have a positive influence on the quality of the cytoplasm of the oocyte (ß = 1.631, χ2 = 7.347, d.f. = 1, p = .00672). Zona pellucida, plasma membrane, cytoplasm, and sperm reception have also been improved with any combination of MYO/DCI by decreasing testosterone or improving insulin sensitivity, regardless of age and body mass index. Conclusion: The combination of MYO with high doses of DCI improved oocyte cytoplasm quality in women with PCOS undergoing ICSI.

GnRH agonist treatment of luteal phase deficiency in HCG-triggered IVF cycles: a matched case-control study.

RESEARCH QUESTION: This study aimed to identify women with IVF failure associated with low serum progesterone levels after embryo transfer in HCG-triggered cycles and to evaluate the effects of gonadotrophin-releasing hormone (GnRH) agonist, administered after embryo transfer, on serum progesterone and pregnancy outcomes in these cases. DESIGN: Fifty women who failed to achieve an ongoing clinical pregnancy and had abnormally low luteal-phase serum progesterone concentrations in their first IVF attempt were assigned to two matched groups in their subsequent attempt. Twenty-five women were treated with the original protocol plus14 daily injections of GnRH agonist, beginning on the day of oocyte recovery, in their second IVF attempt (group 1). These women were matched to 25 women with the same characteristics and outcomes in their first IVF attempt who underwent the second IVF attempt without the use of GnRH agonist after embryo transfer (group 2). In both groups, the two sequential attempts were compared for serum progesterone concentration 14 days after oocyte recovery and pregnancy outcome. RESULTS: The patients in group 1 had significantly higher progesterone levels 14 days after oocyte recovery in the second attempt compared with the first attempt (P < 0.001), and 12 (48%) of them achieved clinical pregnancy and birth. No significant differences in pregnancy outcome or in the serum progesterone concentration were observed between the first and the second attempt in group 2. CONCLUSIONS: In patients with luteal phase deficiency, the administration of GnRH agonist after embryo transfer increases serum progesterone concentration and improves the chance of pregnancy and birth.

Comparison of the effect of two combinations of myo-inositol and D-chiro-inositol in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial.

The purpose of this study was to evaluate the effect of two doses of D-chiro-inositol (DCI) in combination with Myo-inositol (MYO) in women with PCOS undergoing ICSI. This was a multicenter controlled, randomized, double-blind parallel group study with two MYO-DCI formulations for 12 weeks. The study group (SG) was administered 550 mg of MYO + 150 mg of DCI twice daily; the control group (CG) was administered 550 mg of MYO + 13.8 mg of DCI twice daily. The participants comprised 60 women with PCOS undergoing ICSI. At baseline, no differences were found between the two groups regarding age, BMI, HOMA-IR or testosterone levels. The pregnancy and live birth rates were significantly higher in the SG than in the CG (65.5 vs. 25.9 and 55.2 vs. 14.8, respectively) [risk ratio (RR) = 0.4; 95%CI (0.2, 0.79); p = .003 and RR = 0.27; 95%CI (0.10, 0.70); p = .002 respectively]. The risk of ovarian hyperstimulation syndrome (OHSS) was lower in the SG (3.44 vs. 18.5%, p = .07). The combination of MYO-DCI at high doses of DCI improves the pregnancy rates and reduces the risk of OHSS in women with PCOS undergoing ICSI.

What do TSECs provide in the menopausal hormone therapy?

Tissue-selective estrogen complex (TSEC) is projected as a progestogen-free option for the treatment of estrogen deficiency symptoms in postmenopausal, non-hysterectomized women. TSEC combines the benefits of estrogen with a selective estrogen receptor modulator (SERM), in this case bazedoxifene acetate (BZA), which has an antagonistic effect on the endometrium, thus avoiding the use of progestins. The authorized TSEC combination (conjugated estrogens [CE] 0.45 mg/BZA 20 mg) for the alleviation of vasomotor symptoms has been demonstrated in randomized clinical trials compared with placebo or menopausal hormone therapy (MHT). In addition, TSEC has shown improvements in quality of life and vaginal atrophy. In respect to MHT using progestins, the benefits of TSEC are found mainly in the bleeding pattern, amenorrhea rate, and reduction in mammary repercussion (i.e., breast tenderness and radiological density). The objective of this guide will be to analyze the efficacy and safety of TSEC consisting of CE/BZA in postmenopausal women.

Teaching childbirth with high-fidelity simulation. Is it better observing the scenario during the briefing session?

The design of optimal courses for obstetric undergraduate teaching is a relevant question. This study evaluates two different designs of simulator-based learning activity on childbirth with regard to respect to the patient, obstetric manoeuvres, interpretation of cardiotocography tracings (CTG) and infection prevention. This randomised experimental study which differs in the content of their briefing sessions consisted of two groups of undergraduate students, who performed two simulator-based learning activities on childbirth. The first briefing session included the observations of a properly performed scenario according to Spanish clinical practice guidelines on care in normal childbirth by the teachers whereas the second group did not include the observations of a properly performed scenario, and the students observed it only after the simulation process. The group that observed a properly performed scenario after the simulation obtained worse grades during the simulation, but better grades during the debriefing and evaluation. Simulator use in childbirth may be more fruitful when the medical students observe correct performance at the completion of the scenario compared to that at the start of the scenario. Impact statement What is already known on this subject? There is a scarcity of literature about the design of optimal high-fidelity simulation training in childbirth. It is known that preparing simulator-based learning activities is a complex process. Simulator-based learning includes the following steps: briefing, simulation, debriefing and evaluation. The most important part of high-fidelity simulations is the debriefing. A good briefing and simulation are of high relevance in order to have a fruitful debriefing session. What do the results of this study add? Our study describes a full simulator-based learning activity on childbirth that can be reproduced in similar facilities. The findings of this study add that high-fidelity simulation training in childbirth is favoured by a short briefing session and an abrupt start to the scenario, rather than a long briefing session that includes direct instruction in the scenario. What are the implications of these findings for clinical practice and/or further research? The findings of this study reveal what to include in the briefing of simulator-based learning activities on childbirth. These findings have implications in medical teaching and in medical practice.

Inositol supplementation in women with polycystic ovary syndrome undergoing intracytoplasmic sperm injection: a systematic review and meta-analysis of randomized controlled trials.

Polycystic ovary syndrome (PCOS) is a complex and heterogeneous disease that involves menstrual dysfunction and reproductive difficulty, as well as metabolic problems. The aim of this study was to assess the effectiveness of myo-inositol (MYO) and d-chiro-inositol (DCI) on improving oocyte or embryo quality and pregnancy rates for women with PCOS undergoing intracytoplasmic sperm injection (ICSI). We searched the Web of Knowledge, MEDLINE, EMBASE, Pubmed, Scopus and Cochrane databases for all articles published in any language up to March 2017. The selection criteria were as follows: (population) patients with PCOS; (intervention) treatment with inositol (MYO, DCI, or both, with any dose and any duration) in conjunction with an ovulation-inducing agent versus the ovulation-inducing agent alone; (outcome) oocyte and embryo quality; (study design) randomized controlled trials. Of 76 identified studies, eight RCTs were included for analysis comprising 1019 women with PCOS. MYO supplementation was insufficient to improve oocyte quality (OR 2.2051; 95% CI 0.8260 to 5.8868), embryo quality (OR 1.6231, 95% CI 0.3926 to 6.7097), or pregnancy rate (OR 1.2832, 95% CI 0.8692 to 1.8944). Future studies of appropriate dose, size and duration of DCI are vital to clarify its the role in the management of PCOS.

Hormonal contraceptive choice for women with PCOS: a systematic review of randomized trials and observational studies.

INTRODUCTION: This paper provides a critical review of the data concerning the effects of combined hormonal contraceptives (CHC) for polycystic ovary syndrome (PCOS). The aim is to determine the best treatment option for each PCOS phenotype. STUDY DESIGN: A literature search of the PubMed database was conducted for randomized clinical trials (RCTs) and observational studies published in any language prior to October 2013. Hyperandrogenism (HA) is the essential diagnostic criterion for PCOS and is frequently associated with insulin resistance (IR) or obesity. The combinations of these criteria define the different PCOS phenotypes and establish the scale of metabolic and cardiovascular risks. RESULTS AND CONCLUSIONS: 19 RCTs and eight observational studies evaluated issues related to the current objectives. CHC represent an effective and safe treatment in women with any PCOS phenotype. In HA/PCOS patients, any CHC analyzed in this review can be used for symptom relief. For patients with metabolic risk, overweight or moderate IR that does not require metformin, a vaginal contraceptive ring appears to be preferred to oral EE/DRP. In these patients, the combination of CHC and myo-inositol may be more effective in controlling endocrine and metabolic profiles. However, further research is needed to define the optimal duration and to clarify the effects of treatment on long-term metabolic outcomes. Future research should also focus on new CHC.

Alcohol and drug abuse and risky sexual behaviours in young adult women.

OBJECTIVE: To assess alcohol abuse as a predictor of risky sexual behavior among adolescents and young adult women, a high-risk population for unintended pregnancies. SUBJECTS: Totally 3163 adolescent and young adult women, 18-29 years, were assessed on sociodemographics, alcohol and drug use and risky sexual behaviors. INTERVENTIONS: Participants answered a structured questionnaire on their leisure habits, drug and alcohol consumption, contraception and sexual behaviors. RESULTS: Most of the young adult women perceive that sexuality is an important part of their life but not a main concern (77.6%) and that alcohol removes the barriers to have sex (62.3%). Additionally, 77.0% claimed that contraception had "a lot" (53.4%) and "quite" (23.6%) influence on the quality of their sexuality. However, up to a 38.4% of the interviewed women had had sex without using any contraception and 29.6% of them acknowledged that had taken alcohol and of these, 40.7% said that alcohol was responsible for not using contraception. Alcohol abuse predicted an increase in risky sexual behaviours (4.45 CI: 2.01-9.75, p < 0.0001). The effect of alcohol was independent of age. CONCLUSIONS: These findings suggest that contraception-related behavioural interventions for young adult women should discuss the link between alcohol and sexual risk behavior.

Extended regimens of combined hormonal contraception to reduce symptoms related to withdrawal bleeding and the hormone-free interval: a systematic review of randomised and observational studies.

OBJECTIVE: To assess whether continuous and extended regimens (CRs/ERs) of combined hormonal contraceptives (CHCs) improve symptoms related to withdrawal bleeding or the hormone-free interval and to compare the efficacy, safety, and cost of CRs/ERs to those of conventional 28-day regimens. STUDY DESIGN: A literature search of the PubMed database was conducted for randomised clinical trials (RCTs) and observational studies published in any language between 2006 and 2013. RESULTS: Sixteen RCTs and 14 observational studies evaluated issues related to our objectives. CRs/ERs, whose efficacy and safety were comparable to those described for conventional regimens, were preferred due to their improvement of symptoms related to withdrawal bleeding or the hormone-free interval and the lower costs resulting from the reduced incidence of these symptoms. CONCLUSION: The contraceptive efficacy and safety of CR/ER use of CHCs is at least equal to that of 28-days conventional regimens, and this use may have some cost savings. CRs/ERs are recommended for women willing to take a CHC for treatment of symptoms related to withdrawal bleeding or the hormone-free interval.

Impact of violence against women on quality of life and menopause-related disorders.

Violence against women is a pressing global issue that poses a number of significant health risks. The influence of violence on women's health during the menopause has been underestimated, especially its impact on the early onset of menopause and on the exacerbation of symptoms that determine quality of life. The objectives of our study were to analyse whether experiencing any type of violence increases the risk of early menopause, worsens menopausal symptoms, and results in a lower quality of life. This cross-sectional observational study recruited 29 postmenopausal women who had experienced violence from a partner in their lifetimes. Additionally, 89 postmenopausal who had not suffered from violence were included as a control group. All the women who had experienced violence from a partner reported psychological and economic violence, 75 % reported physical violence, 57.1 % reported sexual violence, and 39.3 % reported all types of violence. Violence was found to be associated with menopausal symptoms and poorer quality of life. These associations persisted after adjustment for multiple factors, and women who had experienced any form of violence reported a worse quality of life during menopause. Moreover, violence-exposed women reached menopause approximately 20 months earlier (p < 0.05), and 20.7 % of these women developed premature ovarian insufficiency (p < 0.001).

Exercise for peri- and postmenopausal women: Recommendations from synergistic alliances of women's medicine and health psychology for the promotion of an active lifestyle.

Adopting healthy behaviors is a multifaceted and complex process that poses significant challenges for individuals. Despite awareness of the detrimental effects of certain behaviors on health, many individuals continue to engage in risky practices. Traditional medical advice and prescriptions, while well intentioned, often fall short in fostering lasting lifestyle changes. Although individuals may also have good intentions, solely relying on doctor's counsel does not ensure successful lifestyle adjustments. One primary reason for this limitation is the lack of specialized expertise in behavioral modification among gynecologists and healthcare providers. Health psychologists are specialized professionals capable of effectively guiding and assisting individuals in modifying health-related behaviors. Their expertise in behavior change strategies and psychological interventions proves invaluable in empowering individuals to embrace healthier lifestyles and contributes to people's well-being. This paper emphasizes the importance of collaborative efforts between medical professionals, such as gynecologists, and health psychologists to promote healthy behaviors among peri- and postmenopausal women and enhance women's health. By forging integrative alliances, they can develop comprehensive and tailored interventions. By bridging the gap between medical advice and behavior modification, this collaborative effort has the potential to ensure a more effective intervention process. This holistic approach not only addresses women's specific health needs but also fosters sustainable behavior change when promoting healthy behaviors among middle-aged women. The ultimate goal of such a synergy is to improve women's health outcomes and contribute to a healthier society overall.

Current practices and perceptions of misoprostol use for cervical preparation prior to outpatient hysteroscopy: a nationwide survey among gynecologists in Spain.

BACKGROUND: Although misoprostol has been used as a potential option for cervical priming prior to hysteroscopy, the available scientific evidence regarding its use is not always conclusive. The purpose of this article is to assess the different practices and criteria applied for the use of misoprostol use for cervical preparation in outpatient hysteroscopy without anesthesia among gynecologists across Spain, exploring the need for the corresponding evidence-based guidelines. METHODS: We carried out a cross-sectional study in which a two-step approach survey was conducted. Firstly, an online pilot survey was conducted with a limited sample of 10 professionals from 10 centers to identify initial patterns and gather feedback. Subsequently, a comprehensive online survey was carried out over a larger sample of respondents. The comprehensive survey covered aspects of misoprostol usage, including dosage, timing, indications, safety concerns, and overall perception. The survey design allowed for a thorough examination of existing practices and provided valuable insights to help address the disparities noted in misoprostol use for cervical preparation in outpatient hysteroscopies. RESULTS: Through the comprehensive online survey, we received response of 102 gynecologists from 54 centers across Spain. The overall results show a considerable variation in misoprostol use prior to hysteroscopy, with 21.57% of respondents not using misoprostol in any case, while a substantial majority (78.43%) use it selectively (68.83%) or consistently (9.8%). When asked about the type of patients, the vast majority (72.55%) use it in postmenopausal nulliparous patients, while its was used considerably less in premenopausal nulliparous patients (35.29%), postmenopausal multiparous patients (22.55%), and premenopausal multiparous patients (3.92%), whereas some choose not to use it in any patients (26.47%). Furthermore, 89.22% of respondents felt that there is a lack of clear criteria on misoprostol use, while 79.41% believed that it is necessary to establish such criteria. CONCLUSIONS: There was a diverse landscape of misoprostol use which underscores the complexity and individual approach to cervical preparation for an outpatient hysteroscopy. Indeed, the findings regarding its application, notably more prevalent among postmenopausal patients, contravene the prevailing body of published evidence. Moreover, a considerable proportion of respondents expressed the need for clear criteria, which emphasizes the importance of evidence-based protocols to guide the optimal use of misoprostol.

Eligibility criteria for using menopausal hormone therapy in breast cancer survivors: a safety report based on a systematic review and meta-analysis.

IMPORTANCE: Menopause hormone therapy (MHT) effectively alleviates menopausal symptoms. However, it is generally not recommended for breast cancer survivors, although the scientific evidence is scarce. OBJECTIVE: This study aimed to establish eligibility criteria for use of the MHT in breast cancer survivors based on a systematic review and meta-analysis of the literature. EVIDENCE REVIEW: We conducted exhaustive literature searches until June 2022 in MEDLINE, The Cochrane Library, and EMBASE, using a tailored strategy with a combination of controlled vocabulary and search terms related to breast cancer survivors and MHT. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and assessed the risk of bias using the Cochrane and Risk of Bias in Non-randomized Studies - of Interventions tools. The quality of the evidence was graded according to grading quality of evidence and strength of recommendations criteria (A, high; B, moderate; C, low; and D, very low). We categorized MHT use into four levels: category 1 (no restrictions on use), category 2 (the benefits outweigh the risks), category 3 (the risks generally outweigh the benefits), and category 4 (MHT should not be used). FINDINGS: A total of 12 studies met the eligibility criteria. Analysis of the three randomized clinical trials using combined MHT or tibolone revealed no significant differences concerning tumor recurrence (relative risk [RR], 1.46; 95% CI, 0.99-2.24). A combined analysis of randomized clinical trials, prospective, and retrospective trials found no elevated risk of recurrence (RR, 0.85; 95% CI, 0.54-1.33) or death (RR, 0.91; 95% CI, 0.38-2.19). The eligibility criteria for patients with hormone receptor (HR)-positive tumors fell into categories 3B and 3C for combined MHT or estrogen alone and 4A for tibolone. For HR-negative tumors, the category was 2B and 2C. CONCLUSIONS AND RELEVANCE: Our findings suggest that MHT could be a viable treatment alternative for breast cancer survivors experiencing menopausal symptoms, especially those with HR-negative tumors. Personalized management is recommended for each peri/postmenopausal woman facing a diminished quality of life because of menopause symptoms. Further randomized trials are needed before considering changes to current standards of care.

EMAS position statement: Thyroid disease and menopause.

INTRODUCTION: Thyroid diseases are common in women in their late reproductive years; therefore, thyroid disease and menopause may co-exist. Both conditions may present with a wide range of symptoms, leading to diagnostic challenges and delayed diagnosis. Aim To construct the first European Menopause and Andropause Society (EMAS) statement on thyroid diseases and menopause. MATERIALS AND METHODS: Literature review and consensus of expert opinion (EMAS executive board members/experts on menopause and thyroid disease). SUMMARY RECOMMENDATIONS: This position paper highlights the diagnostic and therapeutic dilemmas in managing women with thyroid disease during the menopausal transition, aiming to increase healthcare professionals' awareness of thyroid disorders and menopause-related symptoms. Clinical decisions regarding the treatment of both conditions should be made with caution and attention to the specific characteristics of this age group while adopting a personalized patient approach. The latter must include the family history, involvement of the woman in the decision-making, and respect for her preferences, to achieve overall well-being.

Androgen insensitivity syndrome.

Androgen insensitivity syndrome (AIS) is a disorder caused by a mutation of the gene encoding the androgen receptor (AR; Xq11-q12). The prevalence of AIS has been estimated to be one case in every 20,000 to 64,000 newborn males for the complete syndrome (CAIS), and the prevalence is unknown for the partial syndrome (PAIS). The symptoms range from phenotypically normal males with impaired spermatogenesis to phenotypically normal women with primary amenorrhea. Various forms of ambiguous genitalia have been observed at birth. The diagnosis is confirmed by determining the exact mutation in the AR gene. PAIS individuals require precise diagnosis as early as possible so that the sex can be assigned, treatment can be recommended, and they can receive proper genetic counseling. After birth, differential diagnosis should be performed using other forms of abnormal sexual differentiation of primary amenorrhea. The treatment of AIS is based on reinforcement sexual identity, gonadectomy planning, and hormone replacement therapy. The prognosis for CAIS is good if the testicular tissue is removed at the appropriate time. For PAIS, the prognosis depends on the ambiguity of the genitalia and physical and psychosocial adjustment to the assigned sex.