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Objectives@#This study aimed to investigate the correlation of sarcopenic obesity with various cardiometabolic risk factors and fracture risk in middle-aged Korean women. @*Methods@#In this cross-sectional study, the medical records of 1,775 women who had visited Pusan National University Hospital for routine health screenings from 2010 to 2016 were reviewed. The patients were divided into four groups as follows: group 1, nonsarcopenic, nonobese (NS-NO); group 2, nonsarcopenic, obese (NS-O); group 3, sarcopenic, nonobese (S-NO); and group 4, sarcopenic, obese (S-O). Each patient was assessed based on self-reported questionnaires and individual interviews with a healthcare provider. The Fracture Risk Assessment Tool (FRAX) was used to assess bone fracture risk. @*Results@#Postmenopausal women accounted for 68.5% of the total patient population. The proportion of each group was as follows:NS-NO, 71.2%; NS-O, 17.9%; S-NO, 10.2%; and S-O, 0.7%. Statistical analysis of various parameters associated with metabolic and cardiovascular risks revealed that the S-O group had more patients with hypertension, diabetes, osteopenia, and metabolic syndrome.The FRAX scores were significantly higher in the S-O group than in other groups. @*Conclusions@#Middle-aged women with obesity and reduced muscle mass, known as sarcopenic obesity, are at increased risk of hypertension, diabetes, and metabolic syndrome. Furthermore, sarcopenic obesity, individual cardiometabolic risks, and menopause can increase the bone fracture risk.
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Endometriosis is a prevalent benign illness defined by the presence of endometrial glands and stroma outside of the uterine cavity, primarily on the ovary, pelvic peritoneum, and rectovaginal septum, resulting in a variety of symptoms, including dysmenorrhea and infertility. Traditionally, prolonged medical therapy has been needed in most cases since a conservative approach to surgery has usually been taken, especially in young women. In 2022, new European Society of Human Reproduction and Embryology (ESHRE) guidelines were published that present different directions for diagnosis and treatment from the past. Furthermore, the guidelines for the diagnosis and management of endometriosis are more precise and applicable than in previous editions. Thus, referring to the representative changes in the new guidelines and important updates will be beneficial for the diagnosis and management of endometriosis. This paper provides a brief overview of these developments.
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The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive method that has several noncontraceptive benefits. It has been used in various gynecological conditions, such as heavy menstrual bleeding, dysmenorrhea, and endometrial hyperplasia. During the perimenopausal period, hormonal fluctuations occur, and there is a high tendency for the development of several benign gynecologic diseases. Therefore, the use of LNG-IUS in perimenopausal women might be more beneficial than in women belonging to other age groups. Moreover, the insertion of LNG-IUS during the perimenopausal period could confer endometrial protection during estrogen replacement therapy. In this review, we discuss the use of LNG-IUS in perimenopausal women.
ABSTRACT
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive method that has several noncontraceptive benefits. It has been used in various gynecological conditions, such as heavy menstrual bleeding, dysmenorrhea, and endometrial hyperplasia. During the perimenopausal period, hormonal fluctuations occur, and there is a high tendency for the development of several benign gynecologic diseases. Therefore, the use of LNG-IUS in perimenopausal women might be more beneficial than in women belonging to other age groups. Moreover, the insertion of LNG-IUS during the perimenopausal period could confer endometrial protection during estrogen replacement therapy. In this review, we discuss the use of LNG-IUS in perimenopausal women.
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Objectives@#To evaluate the side effects and causes of discontinuation of either combined oral contraceptives or dienogest (DNG) used to prevent recurrence in patients with surgically confirmed endometriosis. @*Methods@#We retrospectively analyzed the medical records of 213 women with endometriosis who had been treated with combined oral contraceptives (ethinyl estradiol 0.02 mg/drospirenone 3 mg [EE/DRSP]) or DNG 2 mg for 12 months or more. The side effects reported by the patients, laboratory parameters, causes of discontinuation of medication, and recurrence rates were evaluated one, two, three, four, and five years after starting medication (Y1, Y2, Y3, Y4, and Y5). @*Results@#EE/DRSP were administered to 59 patients, while DNG was administered to 154 patients. The mean durations of postoperative use of EE/DRSP and DNG were 44.5 ± 22.6 months and 23.6 ± 13.5 months, respectively. The prevalence of side effects was 27.1%, 19.0%, 10.0%, 10.5%, and 7.4% in the EE/DRSP group and 29.2%, 15.7%, 14.0%, 23.1%, and 0.0% in the DNG group at Y1, Y2, Y3, Y4, and Y5, respectively. The discontinuation rates were 1.7%, 1.7%, 4.0%, 0.0%, and 7.4% at Y1, Y2, Y3, Y4, and Y5, respectively, in the EE/DRSP group and 10.4%, 3.3%, 4.0%, 3.8%, and 0.0% at the same times in the DNG group. The recurrence rates were less than 4% in both the groups. @*Conclusions@#The side effects of commonly prescribed postoperative hormone treatments were relatively mild, and the occurrence of side effects decreased with continuous administration. Further, the long-term use of postoperative hormone treatments is likely to prevent recurrence of endometriosis after surgery.
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Objective@#The aim of this study was to investigate and compare the dietary patterns of Korean women diagnosed with endometrioma or other benign ovarian cysts. @*Methods@#A total of 66 patients, comprising 39 patients who were surgically diagnosed with ovarian endometrioma and 27 control patients with other benign ovarian cysts, were included in this case-control study. Trained interviewers identified and interviewed the case patients and controls on the day before the laparoscopic ovarian surgery, using a semiquantitative food frequency questionnaire developed by the Ministry of Health and Welfare of Korea. Statistical analysis was performed using the Wilcoxon sum-rank test for continuous variables and the χ2 test or Fisher’s exact test for categorical variables. @*Results@#The calcium intake from daily food consumption was significantly lower in patients with endometrioma than in those with other benign ovarian cysts. The dietary intakes of vitamin D, iron, and zinc were also relatively lower in patients with endometrioma than in patients with other benign ovarian cysts, although they did not reach the statistical significance threshold. @*Conclusion@#The risk of endometrioma is significantly associated with a lower dietary intake of calcium. Future studies including a larger number of patients on a nationwide scale are urgently required for further clarification.
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Pelvic organ prolapse (POP) is the herniation or bulging of the pelvic organs to or beyond the vaginal introitus. POP is a common condition affecting more than half of parous women. We recently performed POP surgery and repair in 37 patients using laparoscopic pectopexy, a new technique for apical prolapse surgery, in women with advanced POP. The surgery was performed by a single surgeon at a single institute. The methods of operation were divided into total laparoscopic hysterectomy with pectopexy, supracervical hysterectomy with pectopexy or pectopexy alone, with additional anterior or posterior colporrhaphy selectively performed. All patients were analyzed in terms of age, body mass index, parity, estimated blood loss (EBL), operation time, intraoperative complications, and postoperative complications. The patients were followed up for at least 6 months after surgery, and the short-term clinical outcomes were analyzed.All operations were performed successfully and without severe intraoperative or postoperative complications. The mean EBL was 84 mL, and the mean operation time was 121 minutes. The operation satisfaction rates were high in most patients. All patients had no recurrence of apical prolapse, de novo urgency, frequency, incontinence, de novo constipation, or ileus. In our experience, laparoscopic pectopexy is a feasible method for apical prolapse repair as it does not have severe intraoperative or postoperative complications and de novo gastrointestinal complications. Considerable follow-up period for possible postoperative events is warranted.
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Background@#This study was conducted to analyze clinical factors that can affect pregnancy rates in normal responders undergoing the freeze-all policy in in vitro fertilization. @*Methods@#We evaluated 153 embryo transfer cycles in 89 infertile women with normal response to controlled ovarian stimulation (COS). After COS, all embryos were cultured to the blastocyst stage, and good quality blastocysts were vitrified for elective frozen-thawed embryo transfer (FET). Clinical variables associated with COS and the results of COS and culture, including the number of retrieved oocytes, fertilized oocytes, and frozen blastocysts were compared between the pregnant group and the non-pregnant group. @*Results@#After a single cycle of COS for each patient, 52 patients became pregnant while 37 did not. Significant differences were observed in the number of matured oocytes, fertilized oocytes, frozen blastocysts, and transferred embryos. The number of frozen blastocysts in the pregnant group was almost twice that in the non-pregnant group (5.6±3.1 vs. 2.8±1.9, p<0.001). The area under the receiver operating characteristic curve for the 4 frozen blastocysts was 0.801 in the pregnant group. @*Conclusion@#In the freeze-all policy, the number of matured oocytes, number of fertilized oocytes, and number of frozen blastocysts might be predictive factors for pregnancy.
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Purpose@#To investigate the efficacy and safety of a newly developed thermo-responsive sol-gel, ABT13107, for reducing the formation of intrauterine adhesions (IUAs) after hysteroscopic surgery. @*Materials and Methods@#In this multicenter, prospective, randomized trial (Canadian Task Force classification I), 192 women scheduled to undergo a hysteroscopic surgery at one of the eight university hospitals in South Korea were randomized into the ABT13107 group or the comparator (Hyalobarrier ® ) group in a 1:1 ratio. During hysteroscopic surgery, ABT13107 or Hyalobarrier® was injected to sufficiently cover the entire intrauterine cavity. @*Results@#The patients returned to their respective sites for safety assessments at postoperative weeks 1 and 4 and for efficacy assessments at postoperative week 4. The post-surgery incidence of IUAs was 23.4% in the ABT13107 group and 25.8% in the comparator group; this difference met the criteria for ABT13107 to be considered as not inferior to the comparator. No differences were found in the extent of adhesions, types of adhesions, or the cumulative American Fertility Society score between the two treatment groups. Most adverse events were mild in severity, and no serious adverse events occurred. @*Conclusion@#ABT13107, a new anti-adhesive barrier containing hyaluronic acid, was not inferior to the highly viscous hyaluronic acid anti-adhesive barrier, Hyalurobarrier® in IUA formation after hysteroscopic surgery (Clinical trial registration No. NCT 04007211).
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BACKGROUND: Tumor markers are useful for detection and preoperative evaluation of ovarian tumors. We evaluated the clinical usefulness of cancer antigen (CA) 125, human epididymis 4 (HE4), and CA72-4 levels and Risk of Ovarian Malignancy Algorithm (ROMA) values for differential diagnosis of malignant and borderline tumors among suspected ovarian tumors, and the effects of endometriosis on these tumor markers. METHODS: In a total of 266 patients (213, 14, and 39 with benign, borderline and malignant tumors, respectively), CA125, HE4, and CA72-4 levels were measured, and ROMA values were calculated. Medians of each marker were compared among the three groups. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to analyze the diagnostic performance of each marker. RESULTS: All markers were significantly higher in the malignant group than in the benign group. HE4 levels and ROMA values were significantly higher in the malignant group than in the borderline group. ROMA value had the highest AUC for distinguishing the malignant and borderline groups from the benign group in premenopausal (0.773) and postmenopausal (0.927) patients. CA125 level was significantly higher in patients with endometriosis than in those without (P<0.001), whereas HE4 and CA72-4 levels were not affected by endometriosis (P=0.128 and 0.271, respectively). CONCLUSIONS: ROMA value is the best marker to distinguish malignant and borderline tumors from benign tumors in pre- and postmenopausal patients. HE4 and CA72-4 levels provide information on possible CA125 elevation due to endometriosis.
Subject(s)
Female , Humans , Male , Area Under Curve , Biomarkers, Tumor , Diagnosis, Differential , Endometriosis , Epididymis , ROC Curve , Rome , Sensitivity and SpecificityABSTRACT
Pelvic organ prolapse (POP) is the herniation or bulging of the pelvic organs to or beyond the vaginal introitus. POP is a common condition affecting more than half of parous women. We recently performed POP surgery and repair in 37 patients using laparoscopic pectopexy, a new technique for apical prolapse surgery, in women with advanced POP. The surgery was performed by a single surgeon at a single institute. The methods of operation were divided into total laparoscopic hysterectomy with pectopexy, supracervical hysterectomy with pectopexy or pectopexy alone, with additional anterior or posterior colporrhaphy selectively performed. All patients were analyzed in terms of age, body mass index, parity, estimated blood loss (EBL), operation time, intraoperative complications, and postoperative complications. The patients were followed up for at least 6 months after surgery, and the short-term clinical outcomes were analyzed.All operations were performed successfully and without severe intraoperative or postoperative complications. The mean EBL was 84 mL, and the mean operation time was 121 minutes. The operation satisfaction rates were high in most patients. All patients had no recurrence of apical prolapse, de novo urgency, frequency, incontinence, de novo constipation, or ileus. In our experience, laparoscopic pectopexy is a feasible method for apical prolapse repair as it does not have severe intraoperative or postoperative complications and de novo gastrointestinal complications. Considerable follow-up period for possible postoperative events is warranted.
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OBJECTIVE: To evaluate the effect of tamoxifen on female reproductive organs in women with breast cancer. METHODS: We retrospectively reviewed the medical records of 309 women with breast cancer who were currently receiving tamoxifen and undergoing regular gynecological examination. RESULTS: We evaluated 92 pre- and 217 postmenopausal women. The prevalence of endometrial thickening was 12% in the pre- and 10.6% in the postmenopausal group. An endometrial biopsy was performed in 43 women and confirmed endometrial cancer in 1, endometrial polyps in 14, and endometrial hyperplasia in 4 women. Transvaginal ultrasonography showed 25 cases of newly developed ovarian cysts. Most ovarian cysts had disappeared during follow-up. CONCLUSION: Tamoxifen use in women with breast cancer causes few complications and is considered safe for female reproductive organs in case of regular gynecological examination.
Subject(s)
Female , Humans , Biopsy , Breast Neoplasms , Breast , Endometrial Hyperplasia , Endometrial Neoplasms , Endometrium , Follow-Up Studies , Gynecological Examination , Medical Records , Ovarian Cysts , Ovary , Polyps , Prevalence , Retrospective Studies , Tamoxifen , UltrasonographyABSTRACT
OBJECTIVE: This study conducted a preliminary examination of the effects of three-area laser-assisted zona thinning (LAZT) during the cleavage stage of embryo development on the hatching process in human in vitro fertilization-embryo transfer (IVF-ET) with subjects of advanced female age or frozen-thawed (FT) embryos. METHODS: Eight-cell stage embryos were treated with LAZT in three areas of the zona pellucida at 120° intervals. The control group was embryos without LAZT. Of the 72 consecutive fresh cycles and the 28 FT embryo transfer cycles, the patients in 55 fresh cycles and 17 FT cycles declined LAZT, and those cycles were defined as the control group. RESULTS: In the fresh cycles, the pregnancy rates were similar in the LAZT and control groups. However, in the FT cycles, the pregnancy rate was significantly higher in the LAZT group than in the control group (45.5% in the LAZT group vs. 23.5% in the control group, p < 0.05). CONCLUSION: These results show that multi-area LAZT resulted in significantly improved pregnancy outcomes in human 8-cell embryos compared to controls.
Subject(s)
Female , Humans , Pregnancy , Pregnancy , Embryo Transfer , Embryonic Development , Embryonic Structures , Fertilization in Vitro , Herpes Zoster , In Vitro Techniques , Pregnancy Outcome , Pregnancy Rate , Zona PellucidaABSTRACT
Artificial uterus using endometrium implant can be a novel treatment strategy for infertile women with refractory endometrial dysfunction. At early pregnancy, the function of uterine endometrial cells for the communication between the conceptus of pre-implantation period and maternal reproductive system is essential. MicroRNA (miR) expression profile of endometrial cells according to progesterone, a crucial pregnancy-maintaining hormone, provides important data for in vitro endometrial cell culture strategy that is useful for engineering artificial uteri using endometrial implants. The present study aimed to evaluate the miR expression profile of in vitro cultured endometrial cells under hormonal milieu mimicking early pregnancy period in terms of progesterone concentration. We cultured murine uterine endometrial cells, human uterine endometrial carcinoma cells, and immortalized human uterine endometrial cells using different progesterone concentrations, and analyzed the expression of miRs critical for early pregnancy. The expression of miR-20a, -21, -196a, -199a, and -200a was differently regulated according to progesterone concentration in different endometrial cell lines. The analysis of candidate target genes showed that the expression of phosphatase and tensin homolog, mucin 1 (MUC1), progesterone receptor, transforming growth factor β receptor II, matrix metallopeptidase-9 was up-regulated by progesterone treatment in mouse and human endometrial cell lines. These results indicate that physiological concentration range (10⁻⁷ and 10⁻⁹ M) of progesterone affect the survival and target gene expression via modulating miR expression. Taken together, progesterone can be a crucial factor in regulating miR expression on in vitro cultured endometrial cells.
Subject(s)
Animals , Female , Humans , Mice , Pregnancy , Cell Culture Techniques , Cell Line , Endometrial Neoplasms , Endometrium , Gene Expression , In Vitro Techniques , MicroRNAs , Mucin-1 , Progesterone , Receptors, Progesterone , Transforming Growth Factors , UterusABSTRACT
Pregnancy-related osteoporosis is a very rare condition characterized by the occurrence of fracture during pregnancy or the puerperium. Despite its relative rarity, it can be a dangerous condition that causes severe back pain, height loss and disability. Normal physiologic changes during pregnancy, genetic or racial difference, obstetrical history and obstetrical disease, such as preterm labor or pregnancy-induced hypertension, are presumed risk factors of pregnancy-related osteooporosis. However, exact etiology and pathogenesis are uncertain. The management and natural history are still poorly defined. Traditional medications for osteoporosis are calcium/vitamin D and bisphosphonate. Concerns with bisphosphonate include accumulation in bone and fetal exposure in subsequent pregnancies. The newly developed medication, teriparatide, has shown good results. We report six cases of pregnancy-related osteoporosis and spinal fracture with literature review.
Subject(s)
Female , Pregnancy , Back Pain , Hypertension, Pregnancy-Induced , Natural History , Obstetric Labor, Premature , Osteoporosis , Postpartum Period , Risk Factors , Spinal Fractures , TeriparatideABSTRACT
OBJECTIVES: The relationship between renal function and bone mineral density (BMD) is controversial. We evaluated the relationship between markers of renal function and BMD in healthy Korean women. METHODS: A total of 1,093 women who visited the health promotion center at Pusan National University hospital were included in the cross-sectional study. We divided the study population into two groups by BMD: osteopenia-osteoporosis and normal in the lumbar and femur regions, respectively. We compared the relationship between renal function and BMD using a logistic regression model and used SAS 9.3 (SAS Institute, Inc., Cary, NC, USA) for all statistical analysis. RESULTS: Blood urea nitrogen (BUN), creatinine, and cystatin C (Cys-C) were correlated with BMD in both the normal and osteopenia-osteoporosis groups, and in logistic regression analysis, BUN and Cys-C were correlated with lumbar and femur BMD. However, after we adjusted for age, menopause, and body mass index, only creatinine showed a negative correlation with lumbar BMD, and estimated glomerular filtration rate (eGFR) was related positively with femur BMD. CONCLUSIONS: Serum creatinine could be a marker for lumbar BMD and eGFR for femur BMD in Korean women without overt nephropathy.
Subject(s)
Female , Humans , Blood Urea Nitrogen , Body Mass Index , Bone Density , Bone Marrow , Creatinine , Cross-Sectional Studies , Cystatin C , Femur , Glomerular Filtration Rate , Health Promotion , Logistic Models , Menopause , OsteoporosisABSTRACT
OBJECTIVE: This study aimed to investigate the effect of a new clomiphene citrate (CC) regimen on preventing thin endometrial lining in polycystic ovary syndrome (PCOS) patients receiving CC plus gonadotropin treatment with a timed intercourse cycle. METHODS: A total of 114 women with PCOS were included in this trial. Patients were divided into two groups and treated in accordance with the controlled ovarian stimulation (COS) protocol. In group A, 104 COS cycles in 67 patients were included, and in each cycle 150 mg CC was given for three days, starting from day 3. In group B, 69 COS cycles in 47 patients were included, in which 100 mg CC was given for five days, starting from day 3. The thickness of the endometrium was measured on the day of human chorionic gonadotropin (hCG) injection. Timed intercourse was recommended at 24 and 48 hours after the hCG injection. RESULTS: Additional doses of human menopausal gonadotropin and the number of days of hCG administration were not significantly different between the two groups. Endometrial thickness on the day of hCG administration was significantly larger in group A than group B (9.4+/-2.1 mm vs. 8.5+/-1.7 mm, p=0.004). The pregnancy rate was significantly higher in group A than in group B (38.4% vs. 21.7%, p=0.030). CONCLUSION: Three-day CC treatment resulted in a significantly higher pregnancy rate than the standard five-day CC treatment in a timed intercourse cycle in PCOS patients. Facilitating adequate endometrial growth via the early discontinuation of CC might be a crucial factor in achieving a higher pregnancy rate.
Subject(s)
Female , Humans , Pregnancy , Chorionic Gonadotropin , Clomiphene , Endometrium , Gonadotropins , Ovulation Induction , Polycystic Ovary Syndrome , Pregnancy RateABSTRACT
OBJECTIVE: The aim of this study is to investigate the association between oxidative stress and bone mineral density (BMD) according to menopausal status of Korean women. METHODS: A total of 2,232 women who visited to the health promotion center at Pusan National University Hospital between 2010 and 2014 were included in this cross-sectional study. Laboratory tests, such as uric acid, albumin, total bilirubin, which were evaluated as a natural antioxidants. Homocysteine also was evaluated as a factor associated with oxidative stress. Correlation analyses and partial correlation coefficient between BMD scores and laboratory parameters associated with oxidative stress according to menopausal status were performed with Pearson test. RESULTS: By correlation analysis, uric acid had only positive correlation with femur and lumbar BMD in premenopausal and postmenopausal group. But albumin and bilirubin, which were the other natural antioxidants, had no correlation with BMD except total bilirubin with femur BMD in postmenopausal group. Homocysteine had negative correlation with femur BMD in postmenopausal group. But there were different results in partial correlation coefficient adjusted by age and BMI. In premenopausal group, uric acid was still positive correlation with femur and lumbar BMD, whereas in postmenopausal group homocysteine had no correlation with femur BMD, total bilirubin and uric acid had no correlation with lumbar BMD. At the multiple logistic regressions, only age and menopause status, uric acid had correlation with BMD. CONCLUSION: In this study, homocysteine had no correlation with BMD. But in natural antioxidant, uric acid had only positive correlation with BMD.
Subject(s)
Female , Humans , Antioxidants , Bilirubin , Bone Density , Cross-Sectional Studies , Femur , Health Promotion , Homocysteine , Logistic Models , Menopause , Oxidative Stress , Uric AcidABSTRACT
No abstract available.
Subject(s)
Humans , Male , Clomiphene , Infertility , Sinus Thrombosis, IntracranialABSTRACT
Ovarian hemangiomas are usually of the cavernous type, and are rarely encountered. A 73-year-old woman presented with lower abdominal discomfort. Subsequent physical examination depicted a palpable mass in the lower abdomen. Abdominopelvic computed tomography (CT) revealed a well-circumscribed mass with thin septa measuring 12.1 x 9.0 cm in the right ovary. Levels of the tumor markers cancer antigen (CA)-125 and CA 19-9 were within the normal range. At laparoscopy, the tumor was found to be confined to the right ovary and to have a smooth surface. The final histopathological result was ovarian cavernous hemangioma. Microscopically, the mass consisted of multiple, dilated, blood-filled vascular channels separated by loose connective tissue, and all were lined by a single layer of flattened endothelium. The authors present a case of ovarian cavernous hemangioma presenting as a large growing mass in a postmenopausal woman and review previously published literature.