Metformin doses and body mass index: clinical outcomes in insulin resistant polycystic ovary syndrome women.

OBJECTIVE: PCOS is the most common endocrinopathy among reproductive age women. Approximately 60% of PCOS women have insulin resistance. While the efficacy of metformin in reducing insulin resistance and decreasing androgen level has been widely validated, there is no agreement on the dose of metformin to be used. PATIENTS AND METHODS: Prospective non-randomized cohort study of 108 insulin resistant, overweight and obese PCOS women, aged between 22 and 35 years. All patients received 1500 mg of metformin (500 mg x 3 times/day) for the first 6 months. At the end of this period, the patients' HOMA index was evaluated. In subjects, who did not demonstrate normalization of the HOMA index, the dose was increased to 2500 mg/day (500 mg at breakfast and 1000 mg at lunch and dinner) for additional 6 months. The hormonal blood profile, fasting insulin and fasting glucose levels, HOMA index, anthropometric assessment, pelvic ultrasound, FAI index and cholesterol were evaluated. RESULTS: Overall results showed a good response to metformin therapy in insulin-resistant PCOS patients with BMI >25, while in patients with higher BMI (31.15 ± 0.40), no normalization of HOMA was found. At the higher dose of metformin, obese patients achieved a good response to therapy, with improvement in BMI, menstrual pattern, cholesterol levels and hyperandrogenism. CONCLUSIONS: Our results demonstrate a correlation between the required dose of metformin, BMI and hyperandrogenism. The dose of metformin should be adjusted to patients' BMI in order to obtain significant results in terms of clinical, metabolic and hormonal responses.

Hormone replacement therapy in menopause and in premature ovarian insufficiency.

Menopause is defined by world health organization (WHO) as the permanent cessation of menstruating resulting from a loss of ovarian follicular activity, after one year of amenorrhea. It signifies the last menstrual cycle and the end of women's fertile and reproductive life. The average age for a women to undergo menopause is 51 years; unlike menarche, whose average age has decreased over the past decades, the age of menopause has remained unchanged. We can distinguish: 1) premenopause, the time interval leading up to menopause; 2) climacteric, the time interval between the reproductive e non-reproductive life; 3) premature menopause, that occurs in 1% of women. Menopause can also be induced iatrogenically as a result of surgery, medical therapy, chemotherapy and radiotherapy. Beyond the life the number of oocytes falls until there are no more suitable follicles for reproduction and the menopause ensues. At the same time, the ability of the ovary to produce hormones falls, leading to an increasing pulsatile release of FSH in order to stimulate the ovary to produce oestrogens. Menopause is characterized by different symptoms such as hot flushes, night sweats, dispareunia, prolapse, vulval itching due to vaginal atrophy and dryness, urinary incontinence, dysuria, and also the psychological aspects don't should be underestimated because of many women suffer of depression, mood instability, insomnia, fatigue and decreased libido. Long term symptoms include osteoporosis, cardiovascular and neuro-degenerative diseases. The main aim of different treatments was symptoms relief. Pharmacological agents and psychological support represent the goal for menopause treatment.

[Treatment with carnitine, acetyl carnitine, L-arginine and ginseng improves sperm motility and sexual health in men with asthenopermia]. / Il trattamento con carnitina, acetilcarnitina, L-arginina e ginseng migliora la motilità spermatica e la salute sessuale negli uomini con astenozoospermia.

AIM: Among the factors contributing to male infertility, asthenospermia constitutes both a health and a social problem frequently associated with alterations in sexual function. Studies have shown that acetyl carnitine and L-arginine improve sperm motility and that ginseng enhances libido and sexual performance. This study examined the effect of treatment with carnitine, acetyl carnitine, L-arginine and ginseng in men with idiopathic asthenospermia and altered sexual function. METHODS: The study population was 180 patients with asthenospermia randomly assigned to two groups: group A (90 men) received treatment and group B (90 men) did not. The sperm count was 16.6 ± 3.2 x 106/mL and the total sperm motility was 26.5 ± 3.4%. RESULTS AND CONCLUSION: Sexual satisfaction was measured using the sexual satisfaction index (SSI). At the end of therapy, a significant improvement was observed in progressive sperm motility on spermiogram evaluation and in SSI scores in the treatment group.

[Low dose oral contraceptives: 30 microg are still used?]. / Contraccettivi a basso dosaggio: quelli contenenti 30 microg sono ancora da prescrivere?

The choice between oral contraceptives (OC) containing 30 or 20 microg of ethinylestradiol (EE) is founded on clinical sign and medical history of the women. Not always a lower dose of EE cause less side effects than an higher dose. Often 20-microg-EE OC induces menstrual cycle alterations and sexual dysfunctions, inducing the women to stop the treatment. Low estrogens concentration have a negative effect on external genital tract, with a consequent vaginal dryness and dispareunia. It is known that OC with 20-microg of EE determine a lower increase of sex hormone binding globulin compared to 30 mg EE and the consequence can be a reduction in antiandrogen effect of OC. OC containing 30 microg of EE have a positive effect on peak in young women, particularly in lean subjects. Moreover, 30 microg of EE induce a better ovarian suppression associated with a lower steroidal production during the week of interruption. Besides, 30-microg-EE OC works well in blocking ovarian cysts formation in women with endocrine dysfunctions like polycystic ovary syndrome or with previous luteal cysts. In conclusion, an OC with 30 microg of EE and an antiandrogen progestin is better than another with 20 microg of EE with the same progestin, because 30 microg of EE have a more powerful antiandrogenic action and guarantee very good cosmetics and endocrine results.