Gynecological endocrinology patients attending Siriraj Hospital at the beginning of the new millennium.

Objective: The purpose of this study was to analyse the spectrum of new patients with gynecological endocrine abnormalities presenting to a teaching hospital in Bangkok at the beginning of the new millennium. The data obtained may help policy makers, involved health care providers and medical educators plan for the future to best suit the Thai new health care system, medical research or contemporary medical education in a teaching hospital. Methods: Only new patients attending the Gynecologic Endocrinology Clinic at Siriraj Hospital in the year 2000 (excluding natural and surgical menopause patients who separately attended the Menopause Clinic at that time) were included in the analysis. There were 492 new patients attending the clinic including newly referred patients from other departments at Siriraj Hospital or from other hospitals. Of these, 464 (94.3%) had complete records, full follow up and a conclusive final diagnosis. The data was analysed and presented in a descriptive manner. Results: Among 464 patients, the most common presenting symptom was abnormal uterine menstruation (85.5% of cases). The five most common final diagnoses were: endometrial hyperplasia (18.9%), Anovulatory DUB (14.4%), Endometriosis with histodiagnosis (13.7%), Polycystic ovary syndrome (5.1%) and premature ovarian failure (3.0%). Other uncommon diagnoses such as primary amenorrhea, which needs complicated investigations, caused by different etiologies (e.g. Mullerian agenesis, gonadal dysgenesis, androgen insensitivity syndrome), rare cases of secondary amenorrhea (e.g. late onset congenital adrenal hyperplasia, hypogonadotropic hypogonadism, pseudocyesis) were also seen at our clinic in the year 2000. Conclusion: The gynecologic endocrinology clinic of Siriraj Hospital had a great variety of number of cases and diagnoses, both common and uncommon. In most cases, problems could be evaluated and investigated at the outpatient clinic without admission. Treatments were also given and monitored effectively there. Only a few special investigations, such as chromosome analysis, CT or MRI were needed to obtain a final diagnosis. We expect to see a lower number of less complicated cases in the future who may be managed at a primary or a secondary care hospital. Nevertheless, knowledge about gynecological endocrinopathies are still of major importance for both undergraduates and postgraduates.

Health check-up program for pre/postmenopausal women at Siriraj Menopause Clinic.

OBJECTIVE: To determine the general health status of pre/postmenopausal women attending the menopause clinic. STUDY DESIGN: Retrospective descriptive study. SETTING: Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. Study population: Pre/postmenopausal women (i) presumed to have no medical disease (no disease group) or (ii) with unknown status of medical disease (no record group) and undergoing health check-up program at the time of registration without prior hormone therapy. MATERIAL AND METHOD: Medical records of new patients registering at the menopause clinic from January 1999 to December 2005 were reviewed. RESULTS: Among 1,020 patients undergoing health check-up program, there were 366 patients in the no disease group. They had abnormal health parameters listing by frequency of prevalence including hypercholesterolemia (62.3%), suboptimal blood pressure (49.3%), overweight to obese (30.2%), suboptimal fasting blood sugar (2 7.9%), hypertriglyceridemia (21.3%), abnormal liver function tests (5.4-6.9%), and abnormal kidney function tests (0.5%). The prevalence of dyslipidemia was statistically higher in the no record group compared to the no disease group; such abnormal parameters included hypercholesterolemia (> or =200 ml/dL), high blood level of low density lipoprotein cholesterol (LDL-C > or = 130 mg/dL), and high ratio between LDL-C and high density lipoprotein cholesterol (LDL-C/HDL-C ratio >3). Osteoporosis was found in 6.6% of the patients. Abnormal mammographic findings that needed close follow-up or breast biopsy were found in 13.5%. Twelve patients had breast biopsy and none had breast cancer. CONCLUSION: Abnormal health parameters are common in pre/postmenopausal women presumed to have no medical disease. The similar or even worse findings are also found in those whose status of medical diseases was unknown. Therefore, a routine health screening program, especially for metabolic diseases, should be offered to pre/postmenopausal women regardless of their medical history.

Serum follicle stimulating hormone and estradiol in peri/postmenopausal women attending Siriraj Menopause Clinic: a retrospective study.

OBJECTIVES: To determine serum levels of Follicle Stimulating Hormone (FSH) and Estradiol (E) in peri/postmenopausal women attending the menopause clinic. STUDY DESIGN: Retrospective descriptive study. SETTING: Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. Study population: Peri/postmenopausal women attending Siriraj Menopause Clinic from January 1994 to December 2003. MATERIAL AND METHOD: Medical records of women who had a blood test for FSH and/or E2 prior to hormonal therapy were reviewed. RESULTS: During a 10 year period, there were 116 eligible patients who could be classified into perimenopausal (31 cases), natural postmenopausal (43 cases), and surgical postmenopausal (32 cases) groups. Age at registration of perimenopausal (47.87 +/- 4.38 yr) and surgical postmenopausal (48.06 +/- 6.49 yr) groups were younger than that of the natural postmenopausal group (55.74 +/- 6.80 yr). The perimenopausal group, who still had regular menstruation, was the youngest. The average FSH level of 60.46 +/- 33.15 mIU/mL was not different among groups. The estradiol level of perimenopausal (79.05 +/- 83.62 pg/mL) and surgical postmenopausal (63.05 +/- 136.39 pg/mL) groups were significantly higher than that of natural postmenopausal (25.05 +/- 37.663 pg/mL) group (p = 0.001). Serum level of FSH or E2 was not correlated with age or years since menopause. There was significant but minimal negative correlation between serum levels of FSH and E2. CONCLUSION: Serum FSH and/or E2 levels are not accurate enough by themselves to rule in or rule out perimenopause. The authors suggested that clinicians should diagnose perimenopause based on menstrual history and age, without relying on laboratory testing.