Benign Gynecological Disorders Research Articles

The Role of Nanomedicine in Benign Gynecologic Disorders.

Nanomedicine has revolutionized drug delivery in the last two decades. Nanoparticles appear to be a promising drug delivery platform in the treatment of various gynecological disorders including uterine leiomyoma, endometriosis, polycystic ovarian syndrome (PCOS), and menopause. Nanoparticles are tiny (mean size < 1000 nm), biodegradable, biocompatible, non-toxic, safe, and relatively inexpensive materials commonly used in imaging and the drug delivery of various therapeutics, such as chemotherapeutics, small molecule inhibitors, immune mediators, protein peptides and non-coding RNA. We performed a literature review of published studies to examine the role of nanoparticles in treating uterine leiomyoma, endometriosis, PCOS, and menopause. In uterine leiomyoma, nanoparticles containing 2-methoxyestradiole and simvastatin, promising uterine fibroid treatments, have been effective in significantly inhibiting tumor growth compared to controls in in vivo mouse models with patient-derived leiomyoma xenografts. Nanoparticles have also shown efficacy in delivering magnetic hyperthermia to ablate endometriotic tissue. Moreover, nanoparticles can be used to deliver hormones and have shown efficacy as a mechanism for transdermal hormone replacement therapy in individuals with menopause. In this review, we aim to summarize research findings and report the efficacy of nanoparticles and nanotherapeutics in the treatment of various benign gynecologic conditions.

Impact of Endometriotic Cyst Position on Infertility

Endometriosis is one of the most common benign gynecologic disorders affecting reproductive health. There are many theories regarding how endometriosis affects fertility, but the exact mechanisms are still uncertain. We evaluated 100 patients with unilateral ovarian endometriosis and infertility who underwent ovarian cystectomy. The women had at least one patent tube after surgery and were observed for spontaneous pregnancy for up to one year. Patients were divided into two groups according to the endometrioma position. The first group included 67 women with an endometriotic cyst in the left ovary, and the second group included 33 with an endometrioma in the right ovary. Groups were similar according to age, type of infertility, BMI, and size of the endometrioma. The number of patients was significantly higher in the first group. Spontaneous pregnancy after cystectomy occurred in 28.4% of the patients with an endometrioma in left ovary, and in 9.1% with a right endometriotic cyst. The better results regarding spontaneous conception with a left-sided endometrioma in our study are most likely related to the permeability of the fallopian tubes and adhesions in the Douglas pouch as a result of endometriosis. Further investigations are necessary to assess the influence of the laterality of endometriosis on infertility.

Quality of life in long-term cervical cancer survivors compared with healthy women and women with benign gynecological disorders

ObjectiveThe impact of cervical cancer treatment on the quality of life of long-term survivors compared with the general female population is controversial, and no studies have been conducted comparing patients with benign gynecological diseases. The aim of this study was to compare the quality of life of cervical cancer survivors with that of healthy controls. Study DesignA case-control study was conducted to compare the quality of life of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a healthy woman check-up (n 46) or for a benign gynecological disorder (symptomatic, n 113; asymptomatic, n 26).To measure quality of life, self-administered questionnaires, such as the Functional Assessment Cancer Therapy-cervix and World Health Organization quality of life-brief version, were employed. Baseline scores were collected when patients first reported, and further evaluations were completed at 0–6, 7–12, 13–24, 25–60, and more than 60 months.For the contrastive analysis hypothesis, we employed R statistical software. ResultsExcept for the environment domain at 0–6, 7–12, and 13–24 months (51.52 vs. 60.73, p < 0.0001; 52 vs. 60.73, p < 0.0001; 49.81 vs. 60.73, p < 0.0001, respectively), we found no statistically significant differences in the quality of life between cervical cancer survivors and controls. We did find differences in the physical health domain scores at 0–6 months (60.22 vs. 72.42, p = 0.039) and the social relationships domain scores at 13–24 months (54 vs. 71.42, p = 0.017) between cases and asymptomatic controls. ConclusionExcept for physical well-being, environment and social relationships, which were substantially better for controls, especially in the asymptomatic, long-term cervical cancer survivorśquality of life did not vary from that of controls.

Metabolic profile of follicular fluid in patients with ovarian endometriosis undergoing IVF: a pilot study

Research QuestionEndometriosis is a common benign gynaecological disorder. A number of studies have confirmed that the occurrence of disease in endometriosis patients is associated with metabolic changes in biological fluids and tissues. We set out to investigate the metabolic characteristics of follicular fluid in patients with ovarian endometriosis undergoing in vitro fertilization (IVF). DesignThe current research project is an exploratory cohort study on endometriosis. A total of 19 infertile patients with ovarian endometriosis diagnosed by laparoscopy were enrolled in this study and 23 age- and BMI-matched controls (women with infertility due to male or tubal factors). All the patients underwent IVF treatment with a gonadotropin-releasing hormone antagonist protocol and completed follicular fluid (FF) collection at oocyte retrieval. The metabolomics of FF samples was analyzed by Ultra high performance liquid chromatography-orbitrap exploris-mass spectrometer (UHPLC-OE-MS). The best combination of biomarkers was then selected by performing stepwise logistic regression analysis with backward elimination. ResultsFifteen metabolites were identified as biomarkers associated with endometriosis. A final model containing 8-hydroxy-2-deoxyguanosine, biotin, n-acetyl-L-methionine and n-methylnicotinamide was constructed. Receiver operating characteristic analysis confirmed the value of these parameters in diagnosing endometriosis, with a sensitivity of 94.7% and a specificity of 95.7%. Analysis of fortification via the Kyoto Encyclopedia of Genes and Genome showed that 15 metabolites were enriched in 8 metabolic pathways. ConclusionMetabolomics based on UHPLC-OE-MS effectively characterized the metabolomics analysis of FF in patients with ovarian endometriosis. These findings may provide a new basis for a better understanding of how diseases progress and for the discovery of new biomarkers.

Utility of laparoscopic hysterectomy compared to vaginal and abdominal hysterectomy for benign gynecological conditions

In spite of availability of procedures which are less invasive for hysterectomy, some prefer abdominal approach for the hysterectomy (TAH). Laparoscopic hysterectomy (TLH) is useful for the patients, as they recover fast and the convalescence period is reduced.To compare and evaluate three different methods of hysterectomy for benign gynecological disorders with regard to time for recovery, outcome after surgery, cost-effectiveness and complications due to surgery.Prospective study conducted on 90 patients who underwent hysterectomy for benign gynecological conditions. Patients were assigned to either TAH (n=30), TLH (n=30) or Vaginal hysterectomy (VH) (n=30), with or without salpingo-oophorectomy. All patients presenting in the gynecology OPD with indications for hysterectomy with or without salpingo-oophorectomy were included. Pre-operative parameters like age, basal metabolic index, intra-operative and post-operative parameters like reduction in hemoglobin etc. were compared in three groups.The mean blood loss, Time from surgery to tolerance of normal diet (days), Time from surgery to unassisted ambulation (days), post-operative pain score on day 3, mean reduction in hemoglobin and duration of hospital stay (days) were significantly (p&amp;#60;0.05) higher in patients who underwent total abdominal hysterectomy compared to total laparoscopic or vaginal hysterectomy. In terms of intra-operative and post-operative complications, operative time, hospital bill and satisfaction score the differences were not significant statistically (p&amp;#62;0.05). Total laparoscopic hysterectomy and vaginal hysterectomy are safe and less invasive alternative, compared to abdominal hysterectomy, and show significantly better post-operative reconstitution

The Role of Herbal Medicine as An Alternative Treatment Option for Endometriosis: A Literature Review

Introduction: Endometriosis is a benign gynecological disorder characterized by ectopic growth of endometrial tissue. This condition may deteriorate patient’s quality of life due to pain as its main manifestation and its complications, including impaired fertility and risk of ovarian cancer. Current standard endometriosis treatment still yields numerous side effects and controversy. Thus, herbal medicine is hoped to be the safer alternative treatment with excellent efficacy for endometriosis. Methods: The search of literature published in English or Bahasa Indonesia was performed by incorporating the search queries “endometriosis”, “herbal therapy”, “silymarin”, “curcumin”, “Viburnum opulus”, “Pueraria”, “Allium sativum”, “black garlic”, “naringenin” on databases including PubMed, Cochrane, Springer, Science Direct, Nature, and Google Scholar. The studies included were in vitro studies, in vivo studies, and clinical trials. Results: Various herbal treatments have been widely studied regarding their anti-inflammatory, antioxidant, neuroprotective, hepatoprotective, cardioprotective, antiallergy, and immunomodulatory capacity. A lot of herbal compounds have the potential to suppress and manage endometriosis through various mechanisms, such as inhibiting the migration and adhesion of endometriosis to other tissues, suppressing inflammatory response in endometriosis pathogenesis, generating antioxidant, inhibiting estrogen activity, and inducing apoptosis of endometriosis cell through a number of signaling pathways. Conclusion: Herbal medicine has the potential to manage endometriosis through various mechanisms. Further research is needed regarding the efficacy of herbal therapy in managing endometriosis.

Monomeric myeloperoxidase is a specific biomarker for early-stage ovarian cancer

Background: Ovarian cancer cells are known to express myeloperoxidase (MPO), an oxidant-producing enzyme with a 150 kDa homodimer, consisting of two identical monomers connected by a disulfide bond. Here, we aim to validate monomeric MPO (mMPO) as a biomarker for the early detection of ovarian cancer.Methods: Human ovarian cancer cells, sera from patients at various stages, sera from non-cancer inflammatory gynecological diseases, and healthy volunteers were used. Monomeric and dimeric MPO were measured by ELISA. Receiver operating curves were used to compare the predictive powers of serum dimeric and monomeric MPO to discriminate between samples.Results: The expression of MPO was unique to ovarian cancer cells. Specifically, mMPO was found to be the only form of MPO in all ovarian cancer cell lines. Intriguingly, mMPO was detected in the sera from all patients with ovarian cancer at various stages, but not from healthy individuals. Serum mMPO discriminated between early-stage ovarian cancer, healthy controls, and benign inflammatory gynecologic disorders. In addition, mMPO discriminated between the early and late stages of the disease.Conclusion: This work highlights mMPO as a potential biomarker for early detection of ovarian cancer, which is critically needed.

Evaluation of the Quality and Reliability of YouTube Videos With Turkish Content as an Information Source for Gynecological Cancers During the COVID-19 Pandemic.

Aim During the COVID-19 pandemic, YouTube became a critical information source for people seeking information about several diseases, including benign and malignant gynecological disorders. This study aimed to evaluate the quality and reliability of YouTube videos with Turkish content as an information source for gynecological cancers during the COVID-19 pandemic. Methods The research was performed between December 2nd and 5th, 2020. Two gynecologists searched the terms in Turkish; 'yumurtalık kanseri, COVID-19', 'rahim kanseri, coronavirus', 'rahim ağzı kanseri, COVID-19', 'kadın üreme sistemi kanseri, coronavirus', and 'jinekolojik kanserler, COVID-19'. on YouTube. 'Yumurtalık kanseri', 'rahim kanseri', 'rahim agzı kanseri', 'kadın üreme sistemi kanserleri' and 'jinekolojik kanserler' are the translations for "ovarian cancer, COVID-19", "endometrial cancer, coronavirus", "cervical cancer, COVID-19", "female reproductive system cancers, coronavirus", and "gynecological cancers, COVID-19" in the Turkish language, respectively. Videos were categorized into three groups depending on the upload source: the informative group, the personal experience group, and the news agency group. Moreover, DISCERN, the Medical Information and Content Index (MICI), the Video InformationandQuality Index (VIQI) were evaluated. Results A total of 57 videos were categorized as informative. Additionally, 22 videos and 18 videos were classified as patient experience videos and new agency videos, respectively. Patients who experienced videos had a significantly higher view number (p=0.001). The number of dislikes and DISCERN score were markedly better in favor of informative videos (p=0.009 and p=0.001). The MICI score was calculated as 13.0±1.8 for informative videos. The total VIQI score was 11.9 for informative videos, 8.8 for patient experience videos, and 7.2 for new agency videos (p = 0.001). Conclusions YouTube videos with Turkish content about gynecological cancers are easily accessible resources during the COVID-19 pandemic. Patient-published videos are the most preferred YouTube videos by Turkish citizens, and informative videos have a considerably lower dislike rate. According to the MICI score and significantly better DISCERN and VIQI scores, informative videos have acceptable quality.

Exosomes: potential diagnostic markers and drug carriers for adenomyosis.

Adenomyosis is a common benign gynecological disorder and an important factor leading to infertility in fertile women. Adenomyosis can cause deep lesions and is persistent and refractory in nature due to its tumor-like biological characteristics, such as the ability to implant, adhere, and invade. The pathogenesis of adenomyosis is currently unclear. Therefore, new therapeutic approaches are urgently required. Exosomes are nanoscale vesicles secreted by cells that carry proteins, genetic materials and other biologically active components. Exosomes play an important role in maintaining tissue homeostasis and regulating immune responses and metabolism. A growing body of work has shown that exosomes and their contents are key to the development and progression of adenomyosis. This review discusses the current research progress, future prospects and challenges in this emerging therapeutic tool by providing an overview of the changes in the adenomyosis uterine microenvironment and the biogenesis and functions of exosomes, with particular emphasis on the role of exosomes and their contents in the regulation of cell migration, proliferation, fibrosis formation, neovascularization, and inflammatory responses in adenomyosis.

Research advances in drug therapy of endometriosis.

Endometriosis is one of the most common benign gynecological disorders in reproductive-aged women. The major symptoms are chronic pelvic pain and infertility. Despite its profound impact on women's health and quality of life, its pathogenesis has not been fully elucidated, it cannot be cured and the long-term use of drugs yields severe side effects and hinders fertility. This review aims to present the advances in pathogenesis and the newly reported lead compounds and drugs managing endometriosis. This paper investigated Genetic changes, estrogen-dependent inflammation induction, progesterone resistance, imbalance in proliferation and apoptosis, angiogenesis, lymphangiogenesis and neurogenesis, and tissue remodeling in its pathogenesis; and explored the pharmacological mechanisms, constitutive relationships, and application prospects of each compound in the text. To date, Resveratrol, Bay1316957, and bardoxifene were effective against lesions and pain in controlled animal studies. In clinical trials, Quinagolide showed no statistical difference with the placebo group; the results of phase II clinical trial of the IL-33 antibody have not been announced yet; clinical trial stage III of vilaprisan was suspended due to drug toxicity. Elagolix was approved for the treatment of endometriosis-related pain, but clinical studies of Elagolix for the pretreatment of patients with endometriosis to before In vitro fertilization treatment have not been fulfilled. The results of a clinical study of Linzagolix in patients with moderate to severe endometriosis-related pain have not been disclosed yet. Letrozole improved the fertility of patients with mild endometriosis. For endometriosis patients with infertility, oral GnRH antagonists and aromatase inhibitors are promising drugs, especially Elagolix and Letrozole.

The efficacy of GnRH-a followed by SanJieZhenTong capsules in long-term management of endometriosis: Study protocol for a multicenter, double-blinded, double-dummy randomized clinical trial

BackgroundEndometriosis is a common benign gynecological disorder with high risk of recurrence and adverse impact on fertility-sparing. This study aims to evaluate the effectiveness and safety of SanJieZhenTong Capsules, a traditional Chinese medicine, in the long-term management of endometriosis postoperatively. Methodsand analysis: A prospective, double-blinded, double-dummy parallel-group randomized controlled trial will be conducted at three university-based medical centers in China. A total of 600 patients with rAFS III-IV endometriosis diagnosed by laparoscopy will be enrolled. After fundamental treatment (gonadotropin-releasing hormone agonists injection starts on the first day of menstruation postoperatively, and repeats 3 times every 28 days), participants will be randomly allocated to the oral contraceptive group (oral contraceptive + dummy A) or SanJieZhenTong Capsules group (SanJieZhenTong Capsules + dummy B) in a 1:1 ratio. All participants will be treated and followed up for 52 weeks. The primary outcome is a recurrence rate based on endometriosis-related symptoms, physical examination, and/or ultrasound/MRI findings. The secondary outcome includes changes in quality of life and organic function outcome via the 36-item Short-Form scores and gastrointestinal function score. ConclusionThe current trial could provide rigorous evidence on SanJieZhenTong Capsules application in the long-term management of advanced-stage endometriosis.

Beneficial Effects of Probiotics on Benign Gynaecological Disorders: A Review.

Probiotics are live microorganisms that confer beneficial effects on human health when an adequate dose is administered. Recently, the use of probiotics has gained tremendous interest from the public due to its promising effects in the management of various reproductive diseases. However, the review of probiotics' benefits on benign gynaecological disorders, including vaginal infections, polycystic ovary syndrome (PCOS) and endometriosis, remains scarce. Therefore, this review is built on current knowledge on the beneficial effects of probiotics against selected benign gynaecological disorders. Recent findings point out that probiotics' supplementation in different clinical and in vivo models showed promising health effects and results in the amelioration of disease symptoms. Thus, in this review, we showed the findings of both studies performed in clinical settings and animal studies. However, current information, solely based on clinical trials or animal studies, is inadequate in communicating the excellent findings on the beneficial effects of probiotics on human health. Therefore, future clinical intervention studies are required to further elucidate the evidence of the benefits of probiotics benefits regarding these gynaecological disorders.

Black Race and Racism Affect Likelihood of Undergoing Surgery After Referral to a Minimally Invasive Gynecologic Surgeon [ID: 1377814]

INTRODUCTION: Significant racial and ethnic disparities persist in access and outcomes for patients with benign gynecologic disorders. The role of sociodemographic factors in surgical delays after referral to a minimally invasive gynecologic surgery (MIGS) specialist is unknown. METHODS: A retrospective cohort study of patients who completed a MIGS consultation at a single, large academic hospital between March 2015 and July 2016 (n=1,110) was performed. Logistic regression was used to assess effect of age, self-reported race and ethnicity, primary language, and insurance type on likelihood of surgical intervention within 12 months of consultation. RESULTS: Of patients undergoing surgery, the average wait time after consultation was 86 days (SD 69). Black patients had 2.6 times the odds of having surgery within 12 months of consultation (odds ratio [OR] 2.6, 95% CI 1.96–3.47) compared to White patients. Patients with Medicare had lower odds of completing surgery (OR 0.4, 95% CI 0.21–0.72) compared to those with other insurance or no insurance. Age, ethnicity, and primary language were not found to be correlated with surgical intervention. CONCLUSION: Race was found to be independently associated with likelihood of surgical intervention. Black patients in our study had more than twice the odds of having surgery compared to White patients, irrespective of age, ethnicity, primary language, or insurance. This may be due to more advanced disease at time of presentation secondary to care delays as well as surgeon bias in more readily pursuing surgery for Black patients, both of which stem from racism.

Evaluation of protein expression of microchimeric Y-chromosome in ovarian endometriosis

Introduction: Endometriosis is a benign chronic gynaecological disorder with the presence of endometrium-like tissue outside the uterus. It affects 10% of the reproductive age group of women. The symptoms include infertility 30 – 50%, and dysmenorrhea 40 – 60%. Thus, endometriosis is a global burden with a wide range of symptomatology and hence causes difficulty for women who suffer from the disease. But the pathogenesis of the disease is yet to be understood. The presence of fetal Y-chromosome microchimerism in endometriosis is first reported using the FISH (Fluorescence In-Situ Hybridization) technique. Later, with a similar technique, conflicting results have been reported. The detection probes used were Y-specific chromosomes Yp11.1 – q11.1-Alpha Satellite DNA and Yq12 Satellite III DNA. The genomic evidence of Y chromosome microchimerism is evaluated using microarray expression followed by RNA-seq and quantitative RT-PCR experiments of target inserts for selected targets for further validation. This study reported the presence of 21 non-coding, and 33 protein-coding genes present in the Male Specific region of Y-chromosome (MSY) in ovarian endometriosis. Genomic studies have been reported in the literature but protein expression from Y-chromosome genes in ovarian endometriosis has not been reported. So, we aimed to evaluate protein expressions of EIF1aY, NLGN4Y, and ZFY in the eutopic endometrium of ovarian endometriosis. Method: The 2 study groups are allotted; Group A (Control) and Group B (Endometriosis). The tissue samples collected were annotated, processed, and performed western blot for identification of EIF1aY, ZFY, and NLGN4Y gene expression. The blots were scanned and analyzed using Bio-Rad Pharos FX TM Plus Molecular Imager and NIH Image J software ( http://imagej.nih.gov/ij/ ) respectively. Result: There was a significant increase in the gene expression of EIF1aY in the endometriosis group when compared to the control group (p &lt; 0.01). The Spearman correlation scores for NLGN4Y and ZFY are strongly associated (r = 0.617). Conclusion: The ectopic site promotes the niche and eutopic tissue has an error which enhances the histogenesis. It appears from the present study that proteins coded from Y-chromosome genes, namely EIF1aY, NLGN4Y and ZFY are involved in the pathogenesis of ovarian endometriosis, which could be a potential therapeutic target in future. To the best of our knowledge, this is the first report suggesting the involvement of Y-microchimerism at the protein level in endometriosis. Further studies with larger sample sizes and different stages and phenotypes of endometriosis may bring forth more conclusive knowledge in this regard that seems to promote the histogenesis of endometriosis at ectopic sites. Department of Physiology, AIIMS, New Delhi. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Primary Umbilical Endometriosis: A Rare Entity

Primary umbilical endometriosis is a rare benign gynaecological disorder caused by ectopic endometrial tissue in the umbilicus. The disease typically manifests as a painful umbilical nodule associated with cyclic bleeding or discharge during menstruation. Here, a 46-year-old woman with low parity and without previous history of abdominal surgery has been reported who presented with cyclical per-umbilical bleeding and pain in the umbilical region during menstruation without any palpable umbilical nodule. The patient responded well to initial medical management, but symptoms recurred on discontinuation of the medication. Though clinically, there was no palpable nodule, and ultrasonography revealed a hypoechoic lesion in the lower umbilical region suggestive of endometrial deposition. On resuming medical management, her symptoms abated. J Bangladesh Coll Phys Surg 2023; 41: 173-176

Green Tea and Benign Gynecologic Disorders: A New Trick for An Old Beverage?

Green tea is harvested from the tea plant Camellia sinensis and is one of the most widely consumed beverages worldwide. It is richer in antioxidants than other forms of tea and has a uniquely high content of polyphenolic compounds known as catechins. Epigallocatechin-3-gallate (EGCG), the major green tea catechin, has been studied for its potential therapeutic role in many disease contexts, including pathologies of the female reproductive system. As both a prooxidant and antioxidant, EGCG can modulate many cellular pathways important to disease pathogenesis and thus has clinical benefits. This review provides a synopsis of the current knowledge on the beneficial effects of green tea in benign gynecological disorders. Green tea alleviates symptom severity in uterine fibroids and improves endometriosis through anti-fibrotic, anti-angiogenic, and pro-apoptotic mechanisms. Additionally, it can reduce uterine contractility and improve the generalized hyperalgesia associated with dysmenorrhea and adenomyosis. Although its role in infertility is controversial, EGCG can be used as a symptomatic treatment for menopause, where it decreases weight gain and osteoporosis, as well as for polycystic ovary syndrome (PCOS).

Monozygotic twins with endometriosis in matching locations at time of laparoscopy: A case report

Endometriosis is a common benign gynaecological disorder, which has an increased prevalence amongst twins and first degree relatives of affected individuals. Here we describe a case of remarkable resemblance in the distribution of deep infiltrating endometriosis related to the bowel in a monozygotic twin pair. We provide a literature review of studies of endometriosis in twins. We propose that genetic factors influence the nature and distribution of the disease, while environmental factors may affect the severity.

Association Between Types of Chronic Disease and Receiving Workplace Accommodations: A Cross-Sectional Study of Japanese Workers.

This study aimed to evaluate the association between the type of chronic disease and receiving workplace accommodations. This online cross-sectional study analyzed a self-reported questionnaire administered in Japan. A total of 6775 full-time workers who reported needing work accommodations were included. Workplace accommodations were more likely to be provided for workers with cancer, mental illness, and benign gynecological disorders than for workers with no disease under treatment. In contrast, workplace accommodations were less likely for workers with low back pain and skin diseases. Receiving workplace accommodations depends on the type of chronic disease. Chronic diseases for which workers frequently receive workplace accommodations may be those for which support is encouraged by law. It is necessary to support workers with chronic diseases that do not receive adequate workplace accommodations.

Effect of goserelin on the quality of life of women with benign gynecological disorders: a systematic review

Objective: Goserelin reduces the estrogen levels and is approved for several hormonally sensitive benign disorders. There are few data about the quality of life of women using goserelin for benign disorders. The purpose of this article is to objectively assess the quality of life of these women. Methods: We searched from electronic databases as PubMed, Scielo, LILACS, among others. The inclusion criteria were RCTs which evaluated using validated questionnaires the quality of life of women with benign gynecological disorders treated with goserelin. Results: The five RCTs demonstrated improvement in quality of life after goserelin compared to the baseline. It was evidenced a temporary effect of the goserelin. Goserelin by itself or associated with another therapy improves the quality of life when compared to the baseline. Hot flushes are not an expressive cause of patient noncompliance. The temporary effect of goserelin is in accordance with literature. Final considerations: This systematic review suggests that goserelin is an effective treatment for benign gynecological disorders, but more studies are necessary to embark therapy choice.

A Comparative Study of Nondescent Vaginal Hysterectomy versus Total Abdominal Hysterectomy

Background: Hysterectomy is the most common operation performed for benign uterine conditions. It can be done through abdominal, vaginal and laparoscopic routes 1,2.The American college of Obstetricians and Gynaecologists recommends the vaginal approach as the route of choice of hysterectomy for benign disease whenever feasible 9 .Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom vaginal hysterectomy is not indicated or feasible. Objective(S): To compare the surgical outcome of total abdominal hysterectomy (TAH) and non-descend vaginal hysterectomy (NDVH). Methods: This is a cross sectional and comparative study that was conducted from January 2014 to December 2015 in Obstetrics and Gynaecology Department of Sylhet Shaheed Shamsuddin Ahmed Hospital, Sylhet. A Total of 120 patients with benign gynaecological disorder who underwent hysterectomy were included. Among them 60 cases underwent NDVH and 60 cases underwent TAH for similar indication. Main Outcome measures are: i) Duration of operation (min) ii) intra and post-operative complications iii) blood loss (ml) during operation iv) Analgesic requirements v) post-operative hospital stay. Results: Most of the patients in both NDVH and TAH belonged to age group of 41-50 years. Majority of them were multiparousin both the groups. Medical co morbidities were Diabetes mellitus, Hypertension, Hypothyroidism and most common surgical co morbidities were history of lower segment cesarean section (LSCS), bilateral tubal ligation, laparotomy for benign ovarian pathology. Common indication for hysterectomy in NDVH was abnormal uterine bleeding (AUB) (37%) and in TAH was (18%), fibroid uterus 35% cases in NDVH and 37% in TAH. Mean operative time of NDVH group was 51.08±12.59 minutes while that of women in TAH group was 69.25±11.12 minutes. This difference was found to be statistically significant (p&lt;0.05 when df 118). The mean blood loss in NDVH group was 61.08±18.82 ml while in TAH group was 105.50±38.42 ml, this is also statistically significant (p&lt;0.05). Analgesic required in NDVH group 5.91±0.97 doses and in TAH was11.58±2.67 doses which is statistically significant(p&lt;0.05).11(18%) patients developed wound infection in TAH group, but none of the patients of NDVH group developed wound infection which is significant. Post-operative hospital stay in NDVH group was 3.02±1.43 days and those in TAH group was 7.7±3.40 days this is also statistically significant. Conclusions: NDVH is safe, feasible and effective procedure and associated with less blood loss during surgery, decrease operative time, less intra-operative and post-operative complications with shorter hospital stay as compared total abdominal hysterectomy. Hence NDVH is a better option for females requiring hysterectomy for benign conditions.