Risk of venous thromboembolism during the use of oral estrogen-progestogen hormone therapies in light of most recent research findings.

Two important studies evaluating the safety profile of oral estrogen-progestogen hormonal therapies conducted in standard clinical practice with respect to the venous system were recently published. A large prospective controlled cohort study (PRO-E2) based on the non-inferiority design has shown that the relative risk of developing venous thrombosis (VTE) in women using combined oral hormonal contraceptives (COHC) containing 17ß-estradiol (1.5 mg) and nomegestrol acetate (2.5 mg) (E2/NOMAC) was not statistically different from that in users of COHC containing ethinylestradiol and levonorgestrel (EE/LNG). The aim of the recently presented study was to compare the risk of VTE in patients treated with a product for oral continuous combined menopausal hormone therapy containing 1 mg of 17ß-estradiol and 100 mg of micronized progesterone (1 mgE2/100 mgP4) with patients taking conjugated equine estrogens and medroxyprogesterone acetate (CEE/MPA). The study was based on an analysis of records retrieved from a US health insurance database, and was therefore concerned the real-life clinical practice. The hazard ratio of VTE when comparing 1 mgE2/100 mgP4 with CEE/MPA was 0.70 (95% CI: 0.53-0.92). The difference was found to be statistically significant (p < 0.05). The rewieved studies provide further evidence that the use of hormones bioidentical with endogenous steroids in oral contraception and menopausal hormone therapy creates an opportunity to combine high efficacy with a favorable safety profile.

Pulmonary blastoma in a pregnant woman: a case report and brief review of the literature.

BACKGROUND: Pulmonary blastoma (PB) comprises a rare heterogeneous group of lung tumours typically containing immature epithelial and mesenchymal structures that imitate the embryonic lung tissue and extremely rarely occurs during pregnancy. Although cough and haemoptysis are the most common PB symptoms, they usually indicate other serious pregnancy-related complications. CASE PRESENTATION: The article presents the unusual case of a 22-year-old pregnant woman diagnosed with PB during pregnancy. CONCLUSIONS: PB is characterized by poor prognosis and patients' outcome relies on a rapid diagnosis. Surgery remains the most common and effective treatment. Due to the extreme rarity, the literature contains only single mentions of PB in pregnancy, thus its impact on the course of pregnancy and the developing fetus remains unknown.

Position Statement by Experts of the Polish Menopause and Andropause Society on menopausal hormone therapy with an oral combination drug containing oestradiol 1 mg and progesterone 100 mg.

At a meeting held on 20 May 2021, reviewed the available literature on the use of the medicinal product Bijuva® for the relief of menopausal symptoms.

Supplementation of dehydroepiandrosterone (DHEA) in pre- and postmenopausal women - position statement of expert panel of Polish Menopause and Andropause Society.

Dehydroepiandrosterone (DHEA) concentration decreases with age, therefore, DHEA has been considered a hormone that reduces the symptoms associated with aging, so the usefulness of DHEA in premenopausal and postmenopausal women, and the options of hormone therapy have received a large amount of attention. The effectiveness of DHEA in the premenopausal women remains unclear, while in postmenopausal women with coexisting estrogens deficiency is controversial. Despite many years of study, the use of DHEA is still controversial, especially regarding its effectiveness. The aim of present article was to evaluate DHEA specific effects on metabolic parameters, bone mineral density, insulin resistance as well as the therapeutic potential of DHEA in pre- and postmenopausal women using measures of sexual activity, cognition and well-being. The summary of this article is the position statement of expert group of the Polish Menopause and Andropause Society regarding the efficacy and safety of DHEA supplementation in women. We concluded, that currently available clinical trials and meta-analyses indicate that DHEA supplementation is effective in women with adrenal insufficiency and chronically treated with exogenous glucocorticoids, postmenopausal women with low bone mineral density and/or osteoporosis, premenopausal women with sexual disorders and low libido, and in women with vulvovaginal atrophy due to menopause or genitourinary syndrome of menopause. Currently available clinical trials also suggest that DHEA supplementation is probably effective in postmenopausal women with hypoactive sexual disorders, infertile women with diminished ovarian reserve, women suffering from depression and anxiety, and women with obesity and insulin resistance. No serious adverse effects have been reported.

Perinatal Predictors of Postpartum Depression: Results of a Retrospective Comparative Study.

Postpartum mood disorders occur in a considerable number of women with the most common postpartum disorder being baby blues. The study aimed at the identification of the risk factors present before delivery, which may be comprised in prophylactic programs concerning postpartum mood disorders. The research material includes data retrieved from the medical record of patients delivering in Warsaw in the years 2010-2017 who routinely completed Edinburgh Postnatal Depression Scale (EPDS) after delivery. Data of 604 patients were analyzed. The study group included 75 women who obtained at least 12 points in EPDS, which constituted 12.4% of the whole group (mean = 14.92, SD = 3.05). The control group was made up of 75 women who obtained no more than 5 points in EPDS. A significant correlation was reported between the parity and their order vs. the risk of developing postpartum mood disorders. Women with an increased risk delivered at about 37 gestational weeks, while women in whom the risk of such disorders was low delivered at about 39 gestational weeks. No increased risk was noted in women with premature rupture of membranes. Primigravidas and women who delivered prematurely were the most predisposed to developing postpartum depression and should undergo screening tests in the perinatal period.

Menopausal hormone therapy in questions and answers - a manual for physicians of various specialties.

This manual has been prepared by the Expert Team of the Polish Menopause and Andropause Society for physicians representing various medical specialties who see patients with menopausal symptoms in their daily practice. In order to make the manual as practical as possible, the current state of knowledge on menopausal hormone therapy (MHT) is presented in the form of questions and answers. They address issues which are essential for initiating and managing MHT based on the most up-to-date treatment algorithms and, at the same time, in line with the old maxim "primum non nocere".

Moral dilemmas of women undergoing pregnancy termination for medical reasons in Poland.

OBJECTIVES: We explored the religious views and dilemmas of Polish women making the decision to terminate a pregnancy. The article discusses the highly restrictive legislation and significant influence of the Church on the lives of Polish citizens. METHODS: This study was designed to investigate the effect of religious and political beliefs, social and moral conditioning and professional support on the decision to abort a fetus. A 65-item questionnaire was administered to 60 participants at the time of their pregnancy termination. RESULTS: Pregnancy termination was performed outside the resident county in 32% of cases. Approximately 88% of respondents declared themselves Catholic, but only 22% intended to admit to the pregnancy termination during confession. Five percent of respondents feared the reaction of the priest, while the remaining respondents did not perceive termination of pregnancy for medical reasons as a sin. Of the women who had previously opposed pregnancy termination, 27% changed their mind once they were personally involved. CONCLUSIONS: The decision to abort a pregnancy for medical reasons is sensitive to religious and social determinants, especially in the current political situation in which abortion may become prohibited in Poland. The high response rate (100%) was probably the result of the patients' attitudes: they repeatedly emphasised they were thankful for the help and empathy of the medical personnel and for being allowed to undergo the procedure. In Poland, the majority of centres use conscience clauses to justify their refusal to terminate a pregnancy.

Progestogens in menopausal hormone therapy.

Progestogens share one common effect: the ability to convert proliferative endometrium to its secretory form. In contrast, their biological activity is varied, depending on the chemical structure, pharmacokinetics, receptor affinity and different potency of action. Progestogens are widely used in the treatment of menstrual cycle disturbances, various gynaecological conditions, contraception and menopausal hormone therapy. The administration of progestogen in menopausal hormone therapy is essential in women with an intact uterus to protect against endometrial hyperplasia and cancer. Progestogen selection should be based on the characteristics available for each progestogen type, relying on the assessment of relative potency of action in experimental models and animal models, and on the indirect knowledge brought by studies of the clinical use of different progestogen formulations. The choice of progestogen should involve the conscious use of knowledge of its benefits, with a focus on minimizing potential side effects. Unfortunately, there are no direct clinical studies comparing the metabolic effects of different progestogens.

Late preterm infants - impact of perinatal factors on neonatal results. A clinical study.

INTRODUCTION: Infants born between the 34(th) - 36(th) week of pregnancy account for 75% of all preterm infants. Their seemingly slight immaturity is related to serious health problems. OBJECTIVE: The aim of the study was to analyse perinatal factors that influence the occurrence in infants of such problems as respiratory failure, metabolic problems and early onset sepsis (EOS). MATERIALS AND METHOD: The material for the study included all mothers and their late preterm infants: 34+0 - 36+6 born in our hospital (a tertiary referral academic centre) in 2010 and 2011. The course of pregnancy and delivery, the type of delivery, applied preventive measures and treatment, as well as demographic data and the clinical state of infants were all analysed. Data from individual documentation of each mother and infant were collected by 5 designated people and data reliability was independently monitored by a random control of the documentation conducted by the supervising person. RESULTS: A statistically significant relationship between the occurrence of respiratory distress syndrome and infant immaturity, bad state after birth and sepsis in infants were confirmed. Sepsis was more common in the case of vaginal delivery, and coexisted with respiratory distress syndrome. The mother's diseases during pregnancy, a perinatal preventive antibiotic therapy, and possible delivery complications did not influence the infection. Perinatal asphyxia in an infant positively correlated with a Caesarean section and respiratory distress syndrome after birth. CONCLUSIONS: It is necessary to thoroughly establish the type of delivery of a late preterm infant in order to prevent an infection in the newborn child. The improvement of diagnosis of intrauterine hypoxia may reduce the number of Caesarean sections. The decision about late preterm delivery should be based on indices of the mother's state of health. Premature delivery is related to the occurrence of respiratory distress syndrome in a late preterm infant, although the risk is reduced by the application of an antenatal steroid therapy.

Placenta accreta: review and 3 case reports.

Placenta accreta is characterized by excessive penetration of the villi into the myometrium, which obstructs its correct separation during stage III of labor. That in turn leads to a potentially life-threatening maternal hemorrhage. Until recently this pathology has been a rare occurrence but currently it is fifty times more prevalent. Placenta accreta is associated with high morbidity and the risk of maternal death, even despite advances in ultrasonographic diagnostics, well-established surgical treatment, and multi-disciplinary medical care. A dramatic rise in the rates of Cesarean section and intrauterine surgical procedure is considered to be the main factor responsible for the growing incidence of placenta accreta. It is especially frequent in women after a Cesarean section and with placenta previa covering the lower segment. A Cesarean section, combined with hysterectomy and application of various techniques to limit massive bleeding, is usually performed between 34-36 weeks of pregnancy before the onset of labor. Three cases of placenta accreta are presented.

[Metformin in pregnancy]. / Metformina w ciazy.

Metformin is an oral insulin-sensitizing anti-diabetic drug. Polycystic ovary syndrome (PCOS) and gestational diabetes (GDM) are both associated with insulin resistance and hyperinsulinemia. Metformin can bring potential benefits in pregnant women due to its favorable metabolic effect. Nevertheless, there is a possibility of adverse effects on the fetus as metformin crosses the placenta. In this review we discuss safety and indications for metformin administration in pregnancy.

Menopausal hormone therapy and venous thromboembolism.

Menopausal hormone therapy (MHT) is the most effective method of treating vasomotor symptoms and other climacteric symptoms related to estrogen deficiency in peri- and postmenopausal period. In addition to estrogen replacement, women with preserved uterus require the addition of progestagen in order to ensure endometrial safety. One of rare but severe complications of MHT is venous thromboembolism (VTE). The incidence of VTE rises in parallel to women's age and body weight. The condition is also linked to hereditary and acquired risk factors. Oral estrogens increase the risk of venous thromboembolic complications to varying extents, probably depending on their type and dose used. Observational studies have not found an association between an increased risk of VTE and transdermal estrogen treatment regardless of women's age and body mass index (BMI). Micronized progesterone and pregnanes, including dydrogesterone, have no effect on the risk of VTE, whereas norpregnane progestagens cause an additional increase in risk. Among hormonal preparations which are commercially available in Poland, the combination of transdermal estradiol with oral dydrogesterone appears to be the optimum choice, as it does not elevate the risk of VTE (compared to patients not using MHT), and dydrogesterone seems to be the progestagen of choice.

Effects of oral contraceptives on the treatment for internal derangements in temporomandibular joints in women.

OBJECTIVE: The prevalence of signs and symptoms of temporomandibular disorders (TMD) is the highest among women of reproductive age. Estrogens are the major contributor to the regulation of bone growth and development. They also influence peripheral and central mechanism of pain. The aim of this study was to evaluate the efficacy of conservative treatment of temporomandibular joint (TMJ) internal derangements in regular cycling women with and without use of oral contraceptives (OCs). MATERIAL & METHODS: The study included 229 women with TMJ disk displacement with and without reduction (DDwR and DDw/oR). The study group consisted of 191 normally cycling women and 38 women using combined OCs (COCs). The conservative TMD treatment was applied and its efficacy was rated during check-up visits. RESULTS: The decreased odds of obtaining any or sufficient improvement during control visits were observed in women treated for DDwR and taking COCs for less than 3 years (p=0.01). There was a 2.7-fold higher risk for the failure of treatment in women taking COCs for less than 3 years during control visits in both diagnoses, DDwR or DDw/oR (p=0.082). There was investigated an increase in the risk for the lack of sufficient post-treatment improvement in diagnosed DDwR or DDw/oR in women with co-occurrence general osteoarticular lesions (p=0.07, p=0.04). CONCLUSIONS: A worse TMJ internal derangements treatment efficacy was observed in women taking COCs for rather short time (less than 3 years) and in women with disorders in the osteoarticular system, what indicates modification of therapeutic procedures in that groups of patients.

Embolization of renal angiomyolipoma in pregnancy: case report.

BACKGROUND: Renal angiomyolipoma is a rare benign tumour composed of adipose tissue, blood vessels and smooth muscles. However it can locally grow to a great size and its numerous blood vessels may cause major bleeding requiring immediate intervention. CASE: At 20th week of pregnancy a previously healthy 26-year old pregnant woman with an episode of sudden and severe pain in the left flank followed by fainting was diagnosed with a bleeding tumour of the left kidney. The diagnosis was based on ultrasonography and magnetic resonance imaging (MRI). Diagnostic angiography was followed by selective embolization of the tumour blood vessels. At 38th week of pregnancy elective caesarean section was performed and after the puerperium the tumour was resected. CONCLUSION: Embolization of renal angiomyolipoma bleeding vessels during pregnancy can be an effective therapeutic approach protecting against further bleeding and haemorrhagic shock thereby obviating the need to perform urgent surgery and allowing the woman to carry her pregnancy to term safely in outpatient setting.

[Large uterine leiomyoma in pregnancy--case report]. / Olbrzymi miesniak macicy u ciezarnej --opis przypadku.

This is a case report of a successful pregnancy outcome in a 36-year-old primigravida with an enormous leiomyoma. Potential pregnancy complications and pain treatment during pregnancy are discussed in the following work.