Comparative evaluation of menstrual patterns and hormonal profiles in normal and abnormal perimenopause

Background: Currently there is only one marker to objectively establish perimenopause ie menstrual irregularities. Due to the wide variation in hormones like LH, FSH, estradiol, they become unreliable in predicting approaching menopause. This study was conducted to study and compare the patterns of LH, FSH and Estradiol in normal and abnormal perimenopause using the Stages of Reproductive Ageing Workshop (STRAW) criteria.Methods: A comparative evaluation was done after enrolling 200 patients out of which 100 women were in normal perimenopause (early-25 and late perimenopause-75, depending upon menstrual characteristics as defined by STRAW criteria) and 100 having AUB. Sociodemographic data, presence of menopausal symptoms were recorded. S. LH, S.FSH and S. estradiol we determined by adapted solid phase direct sandwich ELISA.Results: FSH was in menopausal ranges (>20IU/L) in early and late perimenopause. LH and FSH in women with AUB ranged from pre to post menopausal ranges. There was significant difference in LH and FSH between normal perimenopause and abnormal uterine bleeding. Estradiol levels showed a significant difference between late perimenopause and AUB p=0.015.Conclusions: This study shows that there is a progressive incremental trend in FSH and LH and decremental trend in Estradiol from early to late perimenopause due to decrease in ovarian follicular reserve, although the difference is not significant. Clinical symptoms present in 50% of late perimenopausal women showed that besides menstrual characteristics we can correlate these menopausal symptoms with raised FSH and low Estradiol. These women can be picked up and preventive therapy may be provided.

The Effect of Conventional Hormone Therapy and Tibolone on Tear Composition and Function in Postmenopausal Women.

Objective: To compare the effects of conventional hormonal therapy (HT) and tibolone on tear composition and tear function. Material and methods: Prospective randomized study in 60 postmenopausal women who received conventional HT versus tibolone for postmenopausal symptoms. Response assessed on Kupperman index, eye symptoms and qualitative and quantitative tests for tears at six months follow-up. Quantitative data analyzed using Student’s t-test, ANOVA test, Fisher’s exact test and qualitative data by using McNemar-Bowker test with Bonferroni correlation and Kappa test. Results: There was a significant improvement in the mean Kupperman scores with conventional HT and tibolone (p < 0.01). Tibolone effectively reduced foreign body sensation but there was no appreciable change in other eye symptoms with both therapies. P value did not show any significant change in quantitative tests (Schirmer’s I and II) and qualitative tests (break-up time) for tear secretion. Tear immunoglobulin A level was significantly elevated with both therapies. Conclusion: Conventional HT or tibolone did not have any significant beneficial effect on tear composition and tear function. A larger study can be undertaken using systemic or topical estrogen or androgen containing preparation for further evaluation for dry eye symptoms.

Behcet’s disease in pregnancy – A rare phenomenon.

Behcet’s disease is a multisystem relapsing disorder that affects the mucocutaneous surfaces. Though it is rare in pregnancy, suspicion should be kept in mind when any pregnant woman presents with multiple oral and genital ulcers. We wish to share our experience of managing a woman who was diagnosed as having Behcet’s disease first time during pregnancy.

Comparison of cardiac autonomic functions among postmenopausal women with and without hormone replacement therapy, and premenopausal women.

The aim of present study was comparison of cardiac autonomic status during different phases of reproductive life in women – in premenopausal women between proliferative and secretory phase, in postmenopausal women and in postmenopausal women receiving hormone replacement therapy (HRT). The study included 30 premenopausal women (Group 1) who were assessed in both proliferative (Group 1A) and secretory phase (Group 1B) of menstrual cycle, 30 postmenopausal women (Group 2) and 30 postmenopausal women on HRT (Group 3). Various autonomic function tests were done to assess parasympathetic and sympathetic functions. Results were obtained by ANOVA followed by Tukey test. The postmenopausal women (Group 2) showed increased sympathetic and decreased parasympathetic tone compared to premenopausal women (Groupl). The women on HRT (Group 3) showed parasympathetic dominance and decrease in sympathetic activity compared to postmenopausal women (Group 2). Across the menstrual cycle, increased parasympathetic activity was seen in secretory phase while no change was observed in the sympathetic activity in the two phases.

Massive Retroperitoneal Tumour Complicating Advanced Pregnancy: A Surgical Challenge.

Leiomyomas or fibroids are most common uterine tumours and are often associated with pregnancy. There is a common belief that uterine growths increase in size during pregnancy.Giant uterine leiomyoma going retroperitoneally concomitant with pregnancy, is a rare clinical entity, a diagnostic dilemma and a great surgical challenge.We hereby, describe a case of giant retroperitonial tumour complicating the pregnancy. A massive tumor of approximately 40cm x 35 cm, unencapsulated, fleshy and 'sarcomatoid' in consistency with increased vascularity occupying entire retroperitoneum was seen.Retroperitoneally tumour was dissected from bilateral ureters, inferior vena cava, aorta and bilateral iliac vessels. Uterus, both ovaries and cervix along with tumour mass was removed.The tumour mass weighed 8 kg and on histopathology a degenerated leiomyoma was diagnosed. I

Differential effects of exogenous estrogen versus a estrogen-progesterone combination on auditory evoked potentials in menopausal women.

The study was undertaken to determine the differential effects of estrogen and progestin on auditory evoked responses in postmenopausal women receiving hormone replacement therapy (HRT). Forty-seven women between 45 and 70 years of age attending menopause and HRT clinic were divided into two groups. Group I included 32 women who attained natural menopause and receiving combined estrogen progestin therapy. While group II included 15 surgically menopausal women receiving only estrogen. Evoked potentials were recorded in form of auditory brainstem response (ABR), middle latency response (MLR) & slow vertex response (SVR). There was improvement of conduction in auditory pathways at the level of brainstem and thalamocortical projections as indicated by the decrease in latencies of most of the waves of ABR and/MLR after 6 months of HRT in both the groups. The conduction in association areas, as indicated by SVR, did not show a significant change. The intergroup comparison after therapy revealed a decrease in latency of wave V and I-V interpeak latency in group II indicating that only estrogen users are benefited more. Thus HRT facilitates the process of sensory conduction, which may form one of the mechanisms of improved neuropsychological functions in menopausal women on HRT. The addition of progestin to estrogen does not have a negative or potentiating effect on it.

Auditory evoked responses in postmenopausal women on hormone replacement therapy.

The effect of hormone replacement therapy (HRT) was studied in 32 postmenopausal women on their auditory Evoked Potentials i.e. auditory brainstem response (ABR), Middle latency response (MLR) & slow vertex response (SVR). Recordings were done on computerized evoked potential recorder using 10/20 system of electrode placement and standard click stimuli. A significant improvement in neural transmission was observed as was evidenced by decrease in the ABR wave latencies I, III, IV & V and interpeak latency III-V and I-V after 6 months of HRT. A similar significant decrease was observed in MLR wave latencies of Po, Na & Pa. The SVR wave latencies although found to be decreased after HRT, could not reach the level of statistical significance. There was a significant inverse correlation obtained between latencies of wave I in ABR, Po in MLR and serum estradiol. The results indicate the effect of sex hormone in improving transmission in auditory pathway from periphery through brainstem, thalamus upto cortex. However slow vertex responses indicate that auditory association areas are not much affected. This might have bearing on improvement of neuropsychological functions in postmenopausal women on HRT.

Severe folate deficiency mimicking HELLP syndrome--report of two cases.

Severe folate deficiency in pregnancy may mimick HELLP syndrome as there are similar features in both. Proper diagnosis is important as far as the prognosis and management are concerned. Two cases of severe folate deficiency occuring in multigravid women mimicking HELLP syndrome are reported below with review of literature.