[Echography and hysteroscopy. 2 diagnostic technics compared in the identification of endometrial lesions in the postmenopause]. / Ecografia e isteroscopia. Due tecniche diagnostiche a confronto nell'identificazione delle lesioni endometriali in postmenopausa.

METHODS: In this study we compared ultrasonographic scanning of the endometrium and the hysteroscopic view with histology obtained by endometrial biopsy. RESULTS: Forty six postmenopausal women were studied, 25 symptomatic and 21 asymptomatic. In 24 cases endometrial thickness was > 5 mm, it was considered abnormal, and in 12 cases was < 5 mm. Hysteroscopy detects the presence of 7 atrophic endometrium, 19 polyps, 8 myomas, 4 cancer, 5 synechiae. Echography had a sensitivity of 90.9%, specificity of 72% and positive predictive value of 90.9%. Hysteroscopy showed a sensitivity of 96.7%, a specificity of 92.8% and a positive predictive value of 96.8%. CONCLUSIONS: In conclusion we may suggest that TV scanning allows detection of endometrial pathology with a high sensitivity so it may be used as the first diagnostic step in the screening of postmenopausal women, but it should be completed by hysteroscopic evaluation when endometrial thickness is > 5 mm also in asymptomatic women in order to detect cancer in a early stage.

Double-blind, placebo-controlled study of S-adenosyl-L-methionine in depressed postmenopausal women.

S-adenosyl-L-methionine (SAMe) is a naturally occurring substance which is a major source of methyl groups in the brain and has been found in previous studies to be an effective antidepressant. The aim of this study was to assess the efficacy of oral SAMe in the treatment of depressed postmenopausal women in a 30-day double-blind placebo-controlled randomized trial. During the course of the study, 80 women, between the ages of 45 and 59, who were diagnosed as having DSM-III-R major depressive disorder or dysthymia between 6 and 36 months following either natural menopause or hysterectomy, underwent 1 week of single-blind placebo washout, followed by 30 days of double-blind treatment with either SAMe 1,600 mg/day or placebo. There was a significantly greater improvement in depressive symptoms in the group treated with SAMe compared to the placebo group from day 10 of the study. Side effects were mild and transient.

[Contraception in women over forty]. / La contraccezione nella donna oltre i quarant'anni.

PIP: Nonhormonal contraceptives, include the condom that is safe and frequently used lately because of its ability to help in the prevention of sexually transmitted diseases. There is often psychological resistance to the use of diaphragm in the over 40 age group. The rhythm method is not reliable especially in irregular menstrual cycles, and its lack of reliability can cause anxiety. In the US 16% of women over 40 use spermicides. The IUD is recommended to women over 40 because of 1-time insertion, no requirement of care, efficacy, and the risk of pelvic inflammatory disease is modest at this age. IUDs with progesterone are particularly effective and seem to reduce the risk of inflammatory disease by making the cervical mucus more viscous. Surgical sterilization is not recommended at this age. Women over 40 who are not obese, do not smoke, and do not have a family history of cardiovascular disease have no contraindications to using modern oral contraceptives, (OCs). On the other hand, family history of diabetes and hyperlipidemia has to be assessed on an individual basis. Low dose contraceptives can have outright beneficial effects in vascular pathology by improving the hemostatic profile. Recently, animal research has suggested the possibility of a protective effect of OCs on the cardiovascular system. OCs also protect against osteoporosis. Although the debate is still unresolved, at the moment there is no proof whatsoever that OCs increase the risk of breast cancer in women over 40. The evaluation of patients for OC use has to include a diabetic history of mother or father, familial cardiovascular disease, overweight by more than 20%, smoking more than 10 cigarettes a day, and hypertension. If findings are negative, there is no appreciable risk for the patients. Mammography every 2 years for those with familial precedents, laboratory tests (lipid profile, coagulation, and hepatic function) and semiannual checkups are also be recommended.^ieng

[Intrauterine contraception in women over 35-years old: comparison between copper and progesterone IUDs]. / La contraccezione intrauterina dopo i 35 anni: confronto tra dispositivi potenziati al rame e al progesterone.

PIP: Lately physicians have become more cautious about dispensing oral contraceptives to their patients aged 35 and older. Therefore, there has been a increase in IUD prescriptions for this age group. Research has also increased to determine which IUD is most effective and which causes fewer side effects. An Italian survey comparing copper and progesterone IUDs provides some of the necessary facts. The survey was conducted on 100 women ages 35 and over (50 with the progesterone and 50 with the copper). Many had previously used IUDs and most had already had children. The doctors expected to find some alterations in the rhythm of the menstrual cycle but found no significant variations. There was, however, a notable difference in the duration of and in the amount of blood flow during the menstrual cycle. Although apparently augmented in both groups, with copper IUDs the flow seems to be more abundant but the prolongation is less, while with the progesterone the duration seems to be prolonged but blood flow is limited. The few episodes that could be described as hemorrhage were found in progesterone users, who complained with greater frequency of white cell loss. The 1st finding was that 86% of the women studied with the copper IUD were able to complete the designated term, while only 76% were able to with progesterone IUDs. Of the 3 pregnancies which did occur (1 of them was ectopic), all were from progesterone IUD users. Hemorrhaging played a role in early removal in some progesterone users and the reduction in the flow quantity caused a tolerance problem in some cases. The only real drawback to the copper IUD is that it causes more pelvic back pain cases. There are no valid reasons indicated for preferring the progesterone IUD. Overall, 96% of the copper IUD users were satisfied while only 70% of those with the progesterone IUDs were satisfied.^ieng