Minireview: A Need for an Adequate Diet Program for Postmenopausal Women with Obesity in the Republic of Korea

Women undergo various physical changes because of hormonal changes occurring after menopause. Some representative changes caused by the reduction in estrogen levels in these women are dyslipidemia, abnormal lipoprotein levels, obesity, weight gain, and changes in body fat distribution. A characteristic of women approaching menopause is the shift of fat from their hips and thighs to their abdomen. Notably, fat accumulation is common in internal organs, resulting in male-pattern obesity among women approaching menopause; therefore, these women require more exercise therapy than premenopausal women to prevent and treat obesity. To the best of our knowledge, no effective exercise therapy guidelines have been established for postmenopausal women; therefore, I aimed to suggest more effective diet and exercise therapies for postmenopausal women with obesity. For this purpose, I organized the diet and exercise protocol by collaborating with an obstetrician and a researcher specializing in sports medicine; further, this protocol was actually applied to all participants. The results indicated that the protocol is effective in reducing weight; however, joint pain was commonly noted in participants who dropped out of the program. Based on the evaluation of joint pain, this study found that it is necessary to perform exercise therapy by avoiding weight-bearing activities and reinforcing personalized joint strengthening exercises because reduced estrogen level is an important factor exacerbating arthritis in postmenopausal women.

Disseminated Peritoneal Leiomyomatosis Following Previous Laparoscopic Myomectomy with Morcellation

Uterine leiomyomas are common benign neoplasms that develop from uterine muscle tissue, with an estimated incidence of 20%–40% in women of reproductive age. Power morcellators are commonly used during myomectomy, but if all fragments are not removed, they may find another blood supply and develop into abdominal masses. We present a case of disseminated peritoneal leiomyomas in a patient with a history of laparoscopic myomectomy using an Endo-bag.

Disseminated Peritoneal Leiomyomatosis Following Previous Laparoscopic Myomectomy with Morcellation

Uterine leiomyomas are common benign neoplasms that develop from uterine muscle tissue, with an estimated incidence of 20%–40% in women of reproductive age. Power morcellators are commonly used during myomectomy, but if all fragments are not removed, they may find another blood supply and develop into abdominal masses. We present a case of disseminated peritoneal leiomyomas in a patient with a history of laparoscopic myomectomy using an Endo-bag.

Postmenopausal Spontaneous Umbilical Endometriosis: A Case Report

Endometriosis is a benign gynecologic disease that highly influences women of childbearing age. It is characterized by ectopic endometrial tissue. Primary umbilical endometriosis is a rare condition. It is a benign disease with endometrial tissue in an abnormal site in the navel. It may be accompanied with pain in the navel and a discolored bump. Among all locations with the potential for endometriosis, the navel has less than 1% incidence of primary umbilical endometriosis. In the present study, we reported a rare case of umbilical endometriosis revealed via a biopsy performed for a 49-year-old menopausal woman with the complaint of pain in the navel who underwent surgical excision and a biopsy after a scan.

Flibanserin for Treating Hypoactive Sexual Desire Disorder

There have been several products developed for male sexual dysfunction. However, developing agents for female sexual dysfunction is lagging behind for various reasons. Sildenafil citrate (Viagra) and Tadalafil (Cialis), which have been prescribed for male sexual function disorders, are known to act on vessels.[1] On the other hand, flibanserin is thought to act on brain. Flibanserin has been approved by U. S. Food and Drug Administration (FDA) for treatment of hypoactive sexual desire disorder (HSDD) of premenopausal women in 2015, and is expected to be released in South Korea soon. Authors wrote this article to acknowledge flibanserin to sexologists for females or physicians for menopausal medicine, so that this agent can be safely used for females who have HSDD.

Peritoneal carcinomatosis mimicking a peritoneal tuberculosis

Symptoms of a peritoneal progression from ovarian cancer are nonspecific such as abdominal pain, abdominal distention and more. Many imaging studies and serum CA-125 help diagnosis. However, it is difficult to exclude the instances of the diffuse peritoneal diseases that mimic carcinomatosis. The elevated CA-125 level usually correlates with the peritoneal carcimatosis, but it is often found in other peritoneal diseases. Therefore, the pathologic confirmation is necessary because of other mimicking diseases. In our case, CA-125 levels were elevated. Abdominal computed tomography finding was suspected a peritoneal tuberculosis but the pathologic result was the peritoneal carcimatosis, eventually.

Misdiagnosed Rhabdomyosarcoma of the Vulva

Vulvar carcinoma is a rare disease that accounts for 5% of gynecologic cancers. Sarcomas of the vulva are extremely rare, and account for only 1% to 3% of all vulvar malignancies. We report of a case of a 26 years woman with a vulva mass. Excision was done and histopathologic result showed rhabdomyosarcoma.

Hormone Therapy in Postmenopausal Women According to the Correlation of Changes in Bone Mineral Density / 대한폐경학회지

OBJECTIVES: We investigated the relationship between bone mineral density (BMD) and hormone therapy (HT) and its duration in postmenopausal women. METHODS: We performed a retrospective study on 291 postmenopausal women who had their BMD and follow-up BMD measured in a university hospital. We analyzed BMD, HT types and HT duration according to clinical characteristics. RESULTS: The mean age of the study subjects was 53.7 +/- 5.9 years. HT types and HT duration were not statistically related to improvement in BMD (P = 0.956, 0.483). But osteoporosis in patients with hormone therapy improves bone mineral density showed statistical significance (P = 0.001). CONCLUSION: HT types and HT duration did not have any effect on bone mineral density, but further prospective multicenter studies regarding HT should be considered for osteoporosis.

Prevalence of Osteoporosis and Osteopenia in Women in Gumi Gyeongbuk Province / 대한폐경학회지

OBJECTIVES: The aim of the present study was to determine the prevalence of osteopenia and osteoporosis in women aged 20 years and older in Gumi province. METHODS: We recruited a total of 2,347 women aged 20 years and older in Gumi province who visited the health care center in Soonchunhyang University Gumi hospital from January 2010 to December 2011. The bone mineral densities in the calcaneus were measured by an ultrasound bone densitometry. Osteoporosis and osteopenia were defined by World Health Organization criteria. Age-specific prevalence of osteoporosis and osteopenia in Gumi province were determined and compared with the prevalence of osteoporosis and osteopenia from other provinces within Korea. The prevalence of each was described by %. RESULTS: Age-specific prevalence of osteoporosis was less than 2% in women younger than 50 years but it rapidly increased in those older than 55 years and up to about 50% in women older than 70 years. The prevalence of osteoporosis in women in Gumi province was lower than that of Kangwon province. However, its results were higher than Jung-up province. In addition, the prevalence of osteoporosis in women in Gumi province was lower than other provinces including: Gang-hwa, Chun-cheon, Chung-ju, Jungnang and Gangseo in Seoul, Korea Health Statistics 2009. CONCLUSION: The age-specific prevalence of osteoporosis in women in Gumi province increased with ages, especially in those older than 55 years. Also, the prevalence of osteoporosis in women in Gumi province was lower than Kangwon and other provinces within Korea as stated by Korea Health Statistics 2009. However, its results were higher than Jung-up province.

Survey on the Prevalence of Overactive Bladder in Healthy Korean Postmenopausal Women / 대한폐경학회지

OBJECTIVES: Overactive bladder (OAB) is characterized by urinary urgency, usually accompanied with frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection (UTI) or other obvious pathology. This study was performed to investigate the prevalence of OAB and the effect of hormone therapy (HT) on the OAB prevalence in healthy Korean postmenopausal women. METHODS: The frequency, nocturia, urgency, and urgency incontinence were investigated by using questionnaire in 350 healthy postmenopausal women over 45 years old among patients who visited the Department of Obstetrics and Gynecology, Chung-Ang University Hospital, between November 2010 and February 2011. RESULTS: In our study, the prevalence of OAB was 14.3% and OAB with urgency incontinence was present in 8.0% of the investigated participants. There was no difference in OAB related to older age or the presence of HT, but signifi cant difference was found in the duration of menopause (odds ratio [OR] 3.451, 95% confidence interval [CI] 1.422-8.377, P = 0.004). Higher risks for both frequency (OR 2.921, 95% CI 1.587-5.375, P = 0.001) and nocturia (OR 2.469, 95% CI 1.069-5.702, P = 0.037) were observed in OAB subjects compared to postmenopausal women without OAB. CONCLUSION: To the best of our knowledge, this is the fi rst study investigating the prevalence of overactive bladder in Korean postmenopausal women. Older age or HT did not affect the prevalence of OAB, and HT was not effective in treating the symptoms of OAB. However, the prevalence of OAB was increased with the age, duration of menopause.

The National Use of Antiosteoporosis Medication in 2009 / 대한폐경학회지

OBJECTIVES: Osteoporosis is the most common chronic skeletal disease in postmenopausal women. The total sales of anti-osteoporosis medications have rapidly increased in Korea in recent years because of the rapid aging of our society. This study was intended to evaluate the trend in the use of anti-osteoporosis medications in 2009. METHODS: Data from the International Marketing Service (IMS) were used to analyze the sales of medications for osteoporosis. The total sales of anti-osteoporosis medications were considered to correspond to the use of anti-osteoporosis medications. RESULTS: The total market of anti-osteoporosis medications including hormones and calcium was 213.9 billion Korea won (KRW). The proportion of anti-osteoporosis medications accounted for by hormones and calcium was 16% and 84%, respectively. The total consumption of calcium was 26.9 billion KRW and nearly all the sales were over-the-counter products. Total hormone consumption was 35.6 billion KRW, of which tibolone comprised 41%. Bisphosphonate consumption was 129.6 billion KRW; the proportion of bisphosphonates in non-hormonal medications was 85.6%, followed in order by vitamin D (6.9%), raloxifene (5.0%), and calcitonin (2.0%). CONCLUSION: The most commonly used anti-osteoporosis medications based on sales were bisphosphonates comprising 60.6% of the total sales, followed by hormones and vitamin D.

The change of hormone therapy in postmenopausal women in Korea before and after women's health initiative study: 2000~2009 / 대한산부인과학회지

OBJECTIVE: This study aims to survey the change of comsumption of hormone therapy (HT) before and after publication of Women's Health Initiative Study(WHI) result in Korea from 2000 to 2009. METHODS: Data from Intercontinental Marketing Services were used to analyze and ten years of hormone consumption from 2000 to 2009 was expressed in terms of hormone sales amount (Korean won, KRW, 1 dollar=1,100 won). Total hormone consisted of Estrogen (ET), Estrogen/Progestogen (EPT), and Tibolone. To identify changes in total hormone consumption, the cumulative growth rate was based on the sales in 2002. RESULTS: After publication of WHI result in 2002, HT consumption had been continuously decreased by 39% from 51.1 billion (bn) KRW in 2002 to 31.4 bn KRW in 2006. From 2007 to 2009, HT consumption has been slightly increased to 3.56 bn KRW. The decreased consumption of HT is mainly due to decrease of ET/EPT comsumption by 49%. Tibolone consumption was decreased by 25% during next 2years after WHI publication, but thereafter gradually increased over pre-WHI publication level in 2009. The proportion of consumption of low dosage regimen was markedly increased from 3.5% in 2002 to 41.8% in 2009. CONCLUSION: The total hormone consumption was markedly decreased after WHI. Low dosage regimen consumption was increased, comprising 3.5~41.8% of total EPT consumption. Tibolone consumption was transiently decreased during 2 years after WHI publication, but thereafter increased gradually and reached over the level of pre-WHI publication in 2009. We expect that low-dosage regimen of HT and tibolone will be more widely used. An individual-based treatment approach is essential in assessing the appropriateness of initiating hormone replacement therapy.

The changes of body mass index and abdominal fatness in postpartum period / 대한산부인과학회지

OBJECTIVE: To investigate the changes of body mass index (BMI) and abdominal fatness of women in postpartum period, and to evaluate the relationship between two factors. METHODS: Sixty uncomplicated postpartum women were included. BMI and abdominal fatness using bioelectric impedance method were measured three times; at postpartum one day, one week, and six weeks. RESULTS: Mean BMI was 25.9+/-3.9 kg/m2, 24.8+/-3.8 kg/m2, 23.5+/-3.8 kg/m2, and abdominal fatness was 0.843+/-0.058, 0.850+/-0.054, 0.849+/-0.056 at postpartum one day, one week, and six weeks, respectively. The incidence of overweight women (BMI 23-24.9 kg/m2) was 35%, 25%, 20%, and the incidence of obesity women (BMI> or =25 kg/m2) was 45%, 38.3%, 26.7%, and the incidence of android obesity (abdominal fatness>0.85) was 43.3%, 43.3%, 38.3% at each three postpartum period. The cut-off values of BMI to predict android obesity was >24.9 kg/m2, >23.2 kg/m2, and >22.6 kg/m2 at postpartum one day, one week, and six weeks, respectively. CONCLUSION: The changes of postpartum body weight must be explored with abdominal fatness as well as BMI, and standard references for each postpartum periods are needed.

The Clinical Efficiency of Clomiphene Citrate vs Clomiphene Citrate/GnRH Antagonist on Infertile Women with Normal Ovulatory Cycles / 대한불임학회지

OBJECTIVE: This study was to investigate the clinical efficiency of clomiphene citrate/GnRH antagonist protocol comparing with the clomiphene citrate only protocol in infertile women with normal ovulatory cycles. METHOD: Among 116 patients, 43 were received assisted reproductive technologies using natural ovulatory cycle, 38 and 35 were received clomiphene citrate only protocol and clomiphene citrate/GnRH antagonist combined protocol, respectively, and the clinical results were compared and analyzed. RESULTS: In each group, basal levels of LH, FSH, E2 and FSH, E2 on hCG day injected were not different, but LH level and endometrial thickness on hCG injected day were decreased significantly and the pregnancy rate was increased significantly in clomiphene citrate/GnRH antagonist group. CONCLUSION: The pregnancy rate was increased significantly in clomiphene citrate/GnRH antagonist group compared with natural ovulatory cycle and clomiphene citrate only group.

A Case of Simultaneous Occurrence of Granulosa Cell Tumor and Mature Cystic Teratoma in Same Ovary / 대한산부인과학회지

Mature cystic teratoma of the ovary rarely presents together with sex cord-stromal tumors. Only few cases of ovarian cystic teratoma in association with granulosa cell tumor have been reported in the literature. Granulosa cell tumors are classified as malignant tumors, but considered to be of low-grade malignancy because most granulosa cell tumors are slow growing and inactive. Long term survival rates of granulosa cell tumors are high and recurrence rate is low. Most treatment of granulosa cell tumors has been surgery but treatment after surgery is not well established. FIGO stage and mitotic index are considered to be important prognostic factors for granulosa cell tumors. We experienced a case of mature cystic teratoma and granulosa cell tumor in the same ovary of a 21-year-old woman. We present it with a brief review of literature.