Effect of Vitamin D analog supplementation on levator ani strength and plasma Vitamin D receptor expression in uterine prolapse patients.

Uterine prolapse is a pathological condition that can negatively impact women's quality of life. It is caused by weakening of the pelvic floor muscles. Function of levator ani muscle and other striated muscles is thought to be influenced by Vitamin D levels. Vitamin D exerts its biological effects by adhering to Vitamin D receptors (VDRs) present in striated muscles. We aim to analyze the effect of Vitamin D analog supplementation on levator ani muscle strength in uterine prolapse patients. This was a quasi-experimental study with a pre-post design on 24 postmenopausal women diagnosed with grade III and IV uterine prolapse. Vitamin D levels, VDR, levator ani muscle, and hand grip muscle strength were measured before and after three months of Vitamin D analog supplementation. We found that Vitamin D level, VDR serum level, levator ani muscle strength, and hand grip muscle strength all significantly increase (p < 0.001) following Vitamin D analog supplementation. The correlation coefficient between levator ani muscle and handgrip muscle strength was 0.616 and with p value of 0.001. To conclude, Vitamin D analog supplementation can significantly increase levator ani muscle strength in uterine prolapse patients. We propose that determining Vitamin D level in postmenopausal women and replenishing its deficiency with Vitamin D analog supplementation might aid in preventing POP progression.

Correlation between the expression of matrix metalloproteinase 9 and the expression of tissue inhibitor of metalloproteinase-1 of uterosacral ligament in uterine prolapse.

OBJECTIVE: This study aimed to analyze the correlation between the immunoexpression of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TiMP1) in the uterosacral ligaments in patients with uterine prolapse. METHODS: This analytic-correlative cross-sectional study included 32 patients who were admitted at the Hasan Sadikin General Hospital from July to December 2013. Sixteen of the patients had uterine prolapse, while the rest did not. The patients underwent total hysterectomy, radical hysterectomy, or staging laparotomy. MMP-9 and TiMP1 expression in the uterosacral ligaments was measured via immunohistochemical staining. The median expression per field of view was calculated using a histoscore. RESULTS: MMP-9 expression in patients with uterine prolapse was found to be higher than that in the control group. Meanwhile, TiMP1 expression showed no significant difference between the groups. Spearman's analysis showed a moderate correlation between the expression of MMP-9 and uterine prolapse incidence (P=0.02), with a correlation coefficient of 0.574. CONCLUSION: There is a moderate correlation between MMP-9 expression and the incidence of uterine prolapse. It can be considered one of the primary etiologies of uterine prolapse.

Randomized trial of one versus two transcervical insertions of quinacrine pellets for sterilization.

OBJECTIVE: To determine the relative effectiveness of single vs. two transcervical monthly insertions of 252 mg of quinacrine for female sterilization. DESIGN: Controlled clinical study. SETTING: Family planning clinics of 6 academic centers. PATIENT(S): Sexually active reproductive-age women requesting sterilization. INTERVENTION(S): At each of six centers 70 and 30 women were randomly assigned to receive either one or two, respectively, monthly transcervical insertions to the fundus of 252 mg of quinacrine and 75 mg of diclofenac as pellets and they were followed for 1 year. MAIN OUTCOME MEASURE(S): Complications, side effects, and pregnancy failures. RESULT(S): There were no serious complications and side effects were transient and easily treated. There were 31 (7.4%) pregnancy failures in the single insertions group and 2 (1.1%) in the two insertions group, but with marked center variation. CONCLUSION(S): Quinacrine sterilization using two monthly insertions of 252 mg of quinacrine appears safe and reasonably effective.