Is there an appropriate cutoff age for sampling the endometrium in premenopausal bleeding?

AIM: To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). METHODS: Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. RESULTS: Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. CONCLUSION: There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease.

Female sexual function and associated factors during pregnancy.

AIM: The objective of this study was to assess the changes in female sexual function during pregnancy and to identify associated factors among Turkish population using a validated questionnaire. Furthermore, we aimed to examine Turkish pregnant women's beliefs regarding sexual activity and describe their source of information about sexuality during pregnancy. MATERIAL AND METHODS: In this cross-sectional study, healthy heterosexual pregnant women who had been living with their partners within the last four weeks were asked to complete two self-administered questionnaires, one of which was Female Sexual Function Index (FSFI). RESULTS: A significant association was found between the decrease in intercourse frequency and trimesters, as a decline in frequency was reported by 58.3%, 66.1% and 76.5% of women in each trimester, respectively (P = 0.01). Only the trimester of gestation and employment status were independent factors associated with the decline in sexual intercourse frequency during pregnancy. When the overall FSFI score were compared according to each trimester of pregnancy, there were no statistical significant differences between the first and second trimesters (P = 0.71). The overall FSFI score in the third trimester was found to be significantly lower than the overall scores in the first two trimesters (P < 0.001 for both). In linear regression analysis, overall FSFI scores were adversely affected by only being in the last trimester. 38.7% of women and 36.2% of male partners worried that sexual intercourse may harm the pregnancy. Among the total sample, only 23.8% of women discussed sexuality with the medical staff. CONCLUSION: The third trimester is the independent variable for both decreased sexual activity frequency and sexual function scores in pregnancy. Counseling about sexuality during pregnancy is not frequent in the clinical setting, but conversations about this topic should happen on a regular basis during prenatal care visits.

Comparison of preoperative endometrial biopsy grade and final pathologic diagnosis in patients with endometrioid endometrial cancer.

OBJECTIVE: To compare preoperative grading in endometrioid endometrial cancer with the final pathologic assessment of the hysterectomy specimen. The second objective of the study was to determine a high risk group who will be upgraded in the postoperative evaluation. MATERIAL AND METHODS: A total of 335 patients with endometrioid endometrial cancer were retrospectively reviewed between June 2000 and January 2011. All pathology results were pre- and postoperatively reviewed at two institutions, and all patients underwent surgical therapy. Sensitivity, specificity, positive and negative predictive values and accuracy rates were calculated for all grades in the preoperative assessment. RESULTS: The mean age of the patients was 56.2±9.6 and the vast majority of the patients were postmenopausal (n=239, 71.3%). FIGO grade was determined to be greater in 75 patients in the final hysterectomy specimen. Fifty-five (32.9%) of the patients with preoperative grade 1 were found to be grade 2 and 3.6% of them were upgraded to grade 3. Fourteen of the patients with grade 2 (11.4%) were found to be grade 3. The accuracy rates of the preoperative grade assessment with endometrial sampling were 75.5%, 66.2% and 88.3% for grades 1, 2 and 3, respectively. There were no statistically significant differences in the preoperative demographic characteristics between patients with or without upgraded tumors. CONCLUSION: A high percentage of preoperatively diagnosed grade 1 tumors were upgraded in the postoperative evaluation. The patients who would have been upgraded after hysterectomy could not have been predicted preoperatively using the characteristic features.

Atypical squamous cells of undetermined significance in postmenopausal women: a comparative retrospective analysis.

OBJECTIVES: To determine the outcomes of women with a diagnosis of atypical squamous cells of undetermined significance (ASCUS) with respect to menopausal status. STUDY DESIGN: Between October 2006 and March 2010, the data of 214 postmenopausal women with ASCUS results on Pap smear were evaluated. Sociodemographic data and histopathological results were compared with those of 1018 premenopausal women with ASCUS cytology. RESULTS: At the final diagnosis, most histological findings were normal in pre- and postmenopausal women with ASCUS cytology (70% and 70.1%, respectively). In the premenopausal group, 23.1% of the women had cervical intra-epithelial neoplasia (CIN) 1 lesions and 6.7% had CIN 2/3 lesions. Similarly, CIN 1 and CIN 2/3 lesions were detected in 23.4% and 6.1% of postmenopausal women, respectively. No significant difference in the final diagnosis was found between the two groups (p=0.88). Two premenopausal women (0.2%) and one postmenopausal woman (0.5%) had micro-invasive cervical carcinoma. There were no cases of invasive carcinoma in either group. CONCLUSIONS: According to this study, the rates of pre-invasive and micro-invasive cervical carcinoma were similar in pre- and postmenopausal women with ASCUS cytology.

Comparison of metformin and clomiphene citrate therapy for induction of ovulation in the polycystic ovary syndrome.

OBJECTIVE: To compare the efficacy of metformin and clomiphene citrate (CC) therapies for ovulation induction in anovulatory infertile women with polycystic ovary syndrome (PCOS). METHODS: A total of 69 consecutive infertile, anovulatory women with PCOS were enrolled in this prospective, non-randomized trial. The women were prescribed either 1,700 mg/day metformin or CC with a starting dose of 50 mg/day up to 150 mg/day for a period of six consecutive cycles. RESULTS: Metformin and CC groups were followed for a total of 136 and 94 cycles, respectively. Metformin group had lower rates of ovulation when compared with CC group (32.3 vs. 60.6%, respectively; p = 0.004). There was no statistical difference in pregnancy rates per cycle between the treatment groups (8 vs. 11.7%, respectively; p = 0.33) leading to similar cumulative pregnancy rates (36.6 vs. 35.4%, respectively; p = 0.45). No difference was observed among the abortion rates (10 vs. 10%, respectively; p > 0.05) between the groups. DISCUSSION: Although metformin and CC are two effective first-line approaches for improving pregnancy rates in anovulatory PCOS women, CC is associated with higher rates of ovulation.