Topical vaginal estrogen therapy in managing postmenopausal urinary symptoms: a reality or a gimmick?

Postmenopausal estrogen deprivation has been suggested as a risk factor for lower urinary tract dysfunction including stress incontinence, overactive bladder and recurrent urinary tract infection. These symptoms could have enormous effects on individuals and health-care providers in terms of impact on quality of life and cost. Recent randomized, controlled trials suggested that systemic hormone replacement therapy does have a negative effect on female lower urinary tract function, probably because of the progestogen component. Further, it may be unacceptable for many women because of concerns about breast cancer or the return of withdrawal bleeding. Topical vaginal estrogen preparations reverse urogenital atrophic changes and may relieve associated urinary symptoms while avoiding systemic and progestogenic effects. This article provides an up-to-date overview of the role, effectiveness and safety of topical vaginal estrogen therapy for the treatment of lower urinary tract symptoms in postmenopausal women.

Managing women with post-coital bleeding: a prospective observational non-comparative study.

The management of post-coital bleeding (PCB) is inconsistent in the UK and there are no guidelines to ensure good practice. This prospective study was conducted to review the management and identify the diagnostic outcome of 137 women treated according to a locally devised protocol based on the best available evidence. Women underwent smear testing, taking triple swabs and colposcopy. The endometrium was investigated in postmenopausal women and in those aged >35 years with associated intermenstrual bleeding. Of those who had PCB for >4 weeks, only 8/124 (6.5%) were referred urgently. Twenty eight (20.4%) women were found to have significant pathology; 14 (50%) were <35 years of age, 26 (92.8%) had PCB for >4 weeks, whereas seven (25 %) suffered severe episodes, suggesting that the duration, but not age or severity, is relevant. A large multi-centre study is needed to provide more information in order to optimise the management.

Wegener's granulomatosis occurring de novo during pregnancy.

Wegener's granulomatosis (WG) is rarely diagnosed during the reproductive years and uncommonly manifests for the first time during pregnancy. We report a case of de novo WG presenting at 30 weeks gestation with classical symptoms of WG (ENT, pulmonary). The diagnosis was confirmed by radiological, laboratory, and histological investigations. With a multidisciplinary approach, she had a successful vaginal delivery of a healthy baby. She was treated successfully by a combination of steroids, azathioprine and intravenous immunoglobulin in the active phase of disease for induction of remission and by azathioprine and steroids for maintenance of remission. The significant improvement in her symptoms allowed us to continue her pregnancy to 37 weeks when delivery was electively induced. Transplacental transmission of PR3-ANCA occurred but the neonate remained well. This case of de novo WG during pregnancy highlights the seriousness of this disease and the challenge in management of such patients.

Acupuncture in managing menopausal symptoms: hope or mirage?

There is an increased interest amongst women in seeking alternatives for hormone replacement therapy because of their fear of side-effects. It is claimed that acupuncture is effective for curing menopausal symptoms, and to be a safe treatment in the hands of well-trained and qualified practitioners. About one million acupuncture treatments are given in the National Health Service and two million privately each year in England for various indications. However, because its mechanism of action is not fully understood in physiological terms, acupuncture is considered by many clinicians to be of no value. This article reviews the currently available evidence as regards the effectiveness and safety of acupuncture in treating menopausal symptoms.