Hormone Replacement Therapy Research Articles

Diagnostic options, physiopathology, risk factors and genetic causes of permanent congenital hypothyroidism: A narrative review.

In Permanent congenital hypothyroidism (PCH) is a lifelong condition characterized by a deficiency in thyroid hormone, leading to various neurodevelopmental complications. Early clinical signs are often nonspecific and easily overlooked, but newborn screening programs have improved early detection. This narrative review aims to provide insights comparatively transient and permanent PCH and also the diagnosis, risk factors, underlying pathophysiology, and genetic causes associated with PCH. Relevant studies were identified through a comprehensive search using the term 'Permanent congenital hypothyroidism' (Mesh) across scientific databases of electronic databases such as PubMed, Scopus, and Web of Science. Prompt initiation of thyroid hormone replacement therapy, particularly within the initial two weeks postpartum, crucially enhances neurocognitive development outcomes. Multiple predictive approaches, encompassing screening TSH levels, maternal thyroid history, and levothyroxine dosage per kilogram assessment, aid in identifying PCH. Recent studies have demonstrated a mounting prevalence of PCH, contributing significantly to the overall rise in CH incidence. Genetic factors, primarily DUOX2 and DUOXA2 mutations, alongside environmental influences such as post-term birth, low birth weight, and macrosomia, may induce PCH. Nonetheless, reliable markers for early PCH prediction upon diagnosis remain elusive, leading to delayed recognition post-ceasing levothyroxine treatment around age 3. Recent studies have observed an increased incidence of PCH, contributing substantially to the overall rise in cases of congenital hypothyroidism. Understanding the diagnostic options and genetic etiologies associated with PCH is crucial for the early identification and appropriate management.

Dyslipidemia in Patients with Hypothyroidism at the Abass Ndao Hospital in Dakar

Introduction: Hypothyroidism can lead to lipid abnormalities. Work on this entity remains limited in Africa. The aim was to describe the characteristics of dyslipidemia in hypothyroid patients at the Clinique Médicale II of the Centre Hospitalier Abass Ndao in Dakar. Patients and methods: This was a cross-sectional, descriptive and analytical study conducted from January 01, 2011 to April 30, 2023, a period of 13 years. It focused on patients with hypothyroidism. Epidemiological data and dyslipidemia characteristics were evaluated. Results: We enrolled 52 patients. The incidence of dyslipidemia was 75%, with 38 women (97.43%), giving a sex ratio (m/f) of 0.02. The mean age was 47.46 years, with extremes of 22 and 69 years. The average consultation time was 2.24 years. Dyslipidemia was more marked in the [40-49] age group, with17 cases (73.9%). Clinical signs were dominated by asthenia in 14 patients (35.89%), weight gain in 5 (12.82%) and constipation in 18 (46.15%). Mean systolic blood pressure was 12.79 mmhg, with extremes ranging from 9 to 17 mmhg. The mean LDL cholesterol level was 1.60 g/l with extremes ranging from 0.19 to 4.09g/l. It was higher in dyslipidemics than in non-dyslipidemics (p 0.001). Hypercholesterolemia alone concerned 30 cases (76.9%). Mixed dyslipidemia (hypercholesterolemia +hypertriglyceridemia) concerned 4 cases (10.3%). Atherogenic dyslipidemia (hypertriglyceridemia and low HDL) concerned one case (2.6%). In terms of etiology, Hashimoto's thyroiditis was more prevalent in 26 patients (66.6%), and euthyroidism at 9 months was noted in 65.7% of dyslipidemic patients than in 34.3% of non-dyslipidemic patients (p=0.025). Conclusion: Dyslipidemia remains high in hypothyroidism, especially in women and elderly subjects. Hormone replacement therapy improves dyslipidemia.

Pharmacoeconomic evaluation of Levothyroxine in the treatment of Hypothyroidism in Nepal

INTRODUCTION: Hypothyroidism, is an endocrine disorder, wherein the thyroid gland does not make enough thyroid hormones to meet the body’s needs. Levothyroxine is the mainstay of hormone replacement therapy for hypothyroidism. This study was aimed to evaluate the cost ratio and percentage cost variation, of different brands of levothyroxine, available in the Nepali market. MATERIALS AND METHODS: This observational pharmacoeconomic study was carried out at Department of Pharmacology of Janaki Medical College, Janakpurdham, Nepal from 5 April to 30 May, 2023. Maximum retail price (Cost) in Nepalese currency (NRs), of various brands of levothyroxine available in Nepali market, of same dosage form, strength and number was reviewed for calculating the cost ratio and the percentage cost variation of levothyroxine manufactured by Nepali and Indian Pharmaceutical companies. RESULTS: For 120 tablets of levothyroxine, maximum cost ratio of 1.37 and percentage cost variation of 37.14% was observed with 50 mcg of levothyroxine. For 100 tablets of levothyroxine, maximum cost ratio of 1.65 and percentage cost variation of 65.44% was observed with 50 mcg of levothyroxine. CONCLUSIONS: The findings of this study can be used by a treating physician for prescribing an alternative cheaper brand of levothyroxine for better compliance and for reducing the total health-care cost. Continuous pharmacoeconomic analysis, if carried out at government level, can greatly minimize the cost variation as well as reduce the overall treatment cost for hypothyroid patients in Nepal.

Risk Factors Causing Hypothyroidism in Patients With Head and Neck Cancer After Radiotherapy Using SIB-VMAT.

We evaluated the incidence of radiation-induced hypothyroidism and its risk factors in patients with head and neck cancer who underwent radiotherapy using simultaneous integrated boost-volumetric-modulated arc therapy (SIB-VMAT). This retrospective study included 86 patients who received definitive radiotherapy using SIB-VMAT for head and neck cancer. The incidence of ≥ grade 2 hypothyroidism was evaluated. We also evaluated the relationships between hypothyroidism development and clinical factors and thyroid dose-volume parameters. During a median follow-up period of 17 months (range=3-65 months), 31 patients (36.0%, 31/86) developed grade 2 hypothyroidism requiring hormone replacement therapy. No patients experienced ≥ grade 3 hypothyroidism. The cumulative incidences of hypothyroidism at 1 and 2 years after radiation therapy were 24.5% and 38.7%, respectively, with a median onset time of 10.0 months (range=3.0-35.0 months). Thyroid volume (p=0.003), volume of the thyroid spared at 60 Gy (VS60; cut-off value, 5.16 ml; p=0.009), VS70 (cut-off value, 8.0 ml; p=0.007), VS60 equivalent dose in 2 Gy fraction (EQD2; cut-off value, 7.78 ml; p=0.001), and VS70EQD2 (cut-off value, 10.59 ml; p=0.008) were significantly associated with the development of radiation-induced hypothyroidism. Radiation-induced hypothyroidism is not rare in patients with head and neck cancer undergoing radiotherapy using SIB-VMAT. Radiation dose-volume parameters detected in this study may be useful indicators to prevent this complication.

Could Transplantation into the Thyroid Gland Benefit Pancreatic Islet Grafting in Unstable Type 1 Diabetes (T1DM), Complicated Type 2 Diabetes (T2DM), and Patients with Total Pancreatectomy?

Insular allograft for unstable type 1 diabetes and autograft in pancreatectomy patients are nowadays considered established procedures with precise indications and predictable outcomes. The clinical outcome of islet transplantation is similar to that of pancreas transplantation, avoiding the complications associated with organ transplantation. We hypothesised that transplantation of islets of Langerhans within an endocrine organ could better promote their engraftment and function. This could help to resolve or ameliorate known pathological conditions such as unstable type 1 diabetes and complicated type 2 diabetes. Pancreatic islet transplantation is currently performed almost exclusively in the liver. The liver provides a sufficiently favourable environment, although not entirely. The hepatic parenchyma has a lower oxygen tension than the pancreatic parenchyma and the vascular structure of the liver is not typical of an exclusively endocrine organ. Moreover, islet transplantation into the liver is not without complications, including hematoma or portal vein thrombosis. The thyroid gland is the endocrine gland proposed as a 'container'. In fact, it has all the characteristics of 'physio-compatibility' which can address the objectives assumed. It is indeed an ideal site because it is an easily accessible anatomical site that allows islets to be implanted using ultrasound-guided transcutaneous inoculation technique. Moreover, it has physiological and anatomical endocrine affinities with pancreatic islets and, if necessary, it can be removed, using hormone supplementation or replacement therapy. The thyroid gland may be proposed as an ideal site for islet implantation due to its anatomical and physiocompatibility characteristics.

Exploring the potential for a set of UK hormone replacement therapy eligibility guidelines: A suggested proposal on the topic of venous thromboembolism.

To explore the feasibility for a set of hormone replacement therapy (HRT) eligibility guidelines that follow a similar structure and appearance to the UKMEC guidance for contraception. To enable non-specialists to feel confident in safely prescribing HRT and to aid selection of the most appropriate first line treatment. A literature review was undertaken with evidence summarised on the topic of venous thromboembolism (VTE) which is an area frequently considered a barrier to prescribing. Medical eligibility tables which separated HRT by type were then produced for a set of VTE-related topics. The literature search confirmed the importance of distinguishing between different types and routes of administration when considering the suitability of HRT. Much of the evidence has been based on older synthetic types of HRT and whilst they still have a role in management, these medications carry different risks to the now more accepted use of body identical types. The search also highlighted the nuances involved, increasing the complexity of forming guidelines, with the need for consideration to be given to an individual's own perception of risks and benefits. The demand for HRT has risen in recent years and there is a need for this to be managed effectively, particularly for patients in primary care. The production of this type of guidance will enable the non-specialist to feel confident in safe and evidence-based prescribing. The guidelines are also designed to demonstrate to prescribers which complex patients should be referred onto menopause specialists.

Diagnosing and treating the elderly individual with hypopituitarism.

Hypopituitarism in the elderly is an underestimated condition mainly due to the non-specific presentation that can be attributed to the effects of aging and the presence of comorbidities. Diagnosis and treatment of hypopituitarism often represent a challenging task and this is even more significant in the elderly. Diagnosis can be insidious due to the physiological changes occurring with aging that complicate the interpretation of hormonal investigations, and the need to avoid some provocative tests that carry higher risks of side effects in this population. Treatment of hypopituitarism has generally the goal to replace the hormonal deficiencies to restore a physiological balance as close as possible to that of healthy individuals but in the elderly this must be balanced with the risks of over-replacement and worsening of comorbidities. Moreover, the benefit of some hormonal replacement therapies in the elderly, including sex hormones and growth hormone, remains controversial.

Comprehensive Analysis of Phytoestrogens Intervention in Osteoporosis Management: A Systematic Review of Randomized Controlled Trials

Introduction: Osteoporosis is a medical condition characterized by increased bone turnover and decreased bone mass, which leads to bone fractures. Antiresorptive therapy, hormone replacement therapy (HRT), and bisphosphonates are used as first-line therapy related to numerous side effects. The osteoprotective properties of phytoestrogens are well known. This systematic review aims to explore the potential of phytoestrogen in the management of osteoporosis patients based on serum bone biomarker analysis. Methods: The literature search was conducted in six databases. The outcome of interest measures the mean changes in bone mineral density (BMD) and other serum bone biomarkers. Various forms of phytoestrogen intervention were used, including isoflavone extracts with an administered dose (tablets, capsules), genistein extract (tablets), resveratrol, and isolated soy protein (IBS) in powder form, beverages, food and snacks, and soy products. Quality appraisal was done using the Cochrane Risk of Bias Tool 2. Ten articles were included in the systematic review. Results: Seven studies found the mean changes in BMD values were significantly higher than the control group's after phytoestrogen intervention. Phytoestrogens dramatically boost numerous bone formation markers, including calcium, phosphorus, Ca/P ratio, and vitamin D, followed by a drop in BAP and osteocalcin levels. Phytoestrogens dramatically increased numerous bone formation markers, including calcium, phosphorus, Ca/P ratio, and vitamin D, followed by a decrease in BAP and osteocalcin levels. Furthermore, intervention may reduce bone resorption indicators such as CTX, RANKL, AKP, OPG, DPD, and PTH. Conclusion: Phytoestrogen intervention has demonstrated effectiveness in increasing bone mineral density and serum bone biomarkers.

Vaginal Microenvironment Imbalance and Its Influence on HPV, Multiple Infections, and Cervical Lesions in the Elderly

The vaginal microenvironment in elderly women undergoes dysregulation due to changes in the endocrine and immune systems, thereby increasing the risk of persistent HPV infection, multiple infections, cervical lesions, and related issues. These challenges have become a focal point in clinical attention. This study aims to analyze the role of vaginal microenvironment dysregulation in the development of persistent HPV infection, multiple infections, and cervical lesions. Additionally, it seeks to explore interventions targeting the vaginal microenvironment in older women. Using a literature review method and comparative analysis, this study examines the relationship between vaginal microenvironment disorders and persistent HPV infection, multiple infections, and cervical lesions in middle-aged and elderly women. It comprehensively compares the efficacy of various interventions. According to the literature review and comparative analysis, the vaginal microenvironment is closely linked to persistent HPV infection, multiple infections, and cervical lesions in elderly women. Simultaneously, this paper explores interventions for the vaginal microenvironment in the elderly. It reveals that the vaginal microenvironment in older women can be effectively addressed through local hormone replacement therapy, active probiotics, and pH regulation. The study delves into the role of vaginal microenvironment dysregulation in the development of persistent HPV infection, multiple infections, and cervical lesions. It provides a research foundation for targeted interventions for the vaginal microenvironment in the elderly. The hope is that the discussions presented in this study can offer a more comprehensive and effective support framework for the health management of elderly women.

Metabolomic study of the estrogenic and anti-osteoporotic potential of Erythrina bidwillii leaf.

Erythrina bidwillii Lindl., Leguminosae, constitutes a valuable crop for horticulture and medicine; however, it is rarely investigated. Menopause is a crucial transitional period in women's health. Women worldwide consider the use of phytoestrogens as a safe hormone replacement therapy to alleviate detrimental menopausal symptoms. Thus, the discovery of novel phytoestrogens is highly demanded. The present study aimed to investigate, for the first time, the metabolomic profile and the estrogenic potential of E. bidwillii Lindl. leaf. Ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry and gas chromatography-mass spectrometry metabolite profiling revealed the prevalence of alkaloids, flavonoids, isoflavonoids and fatty acids. Additionally, five erythrinan alkaloids, cristanine A (1), 8-oxoerythraline (2), (+)-erythrinine (3), (+)-erythraline (4) and 8-oxoerythrinine (5), along with the isoflavonoid genistin (6), were isolated. Erythrina bidwillii leaf extract exhibited significant in vivo estrogenic, anti-osteoporotic, anti-hyperlipidemic, hepatoprotective, and nephroprotective activities, utilizing ovariectomized rat model. Moreover, ethyl acetate and hexane fractions possessed significant in vitro estrogeic potential on MCF-7 cell lines. An in silico study of the isolated metabolites revealed that (+)-erythrinine (3) and 8-oxoerythrinine (5) exhibited the highest affinity for ERα and ERβ, respectively, modeling them as potential estrogenic lead metabolites. Therefore, E. bidwillii leaf could be employed as promising hormone replacement therapy for postmenopausal women after thorough clinical trials.

THE STATE OF THE CORONARY BED IN CORONARY HEART DISEASE IN PATIENTS WITH HYPOTHYROIDISM

Hypothyroidism is a significant aggravating factor for coronary heart disease (CHD). However, there are no practical recommendations for the management of this group to date. The main method of assessing the severity of coronary artery disease is a morphological assessment of the condition of the coronary arteries. The aim. To carry out comparative assessment of clinical parameters, including the state of the coronary bed in patients with coronary artery disease with newly diagnosed (without hormone replacement therapy) and primary manifest hypothyroidism compared with patients with coronary artery disease without hypothyroidism. Materials and methods. Two hundred and forty patients with CHD were examined. The study group included 90 patients with coronary heart disease and hypothyroidism, the comparison group consisted of 150 patients with coronary artery disease without thyroid pathology. A comprehensive examination of patients, including coronary angiography, was performed. The frequency of cases and characteristics of lesions of the coronary bed, the volume of interventions were assessed. The analysis of the obtained data was carried out in Statistica 10.0 (StatSoft Inc., USA). Results. In the study group (CHD and hypothyroidism), a statistically significantly increased level of myoglobin, a change in lipid profile parameters in relation to patients with CHD without hypothyroidism was found. In the group of patients with coronary artery disease and hypothyroidism, a predominance of the frequency of multivessel lesions of the coronary bed was revealed. The volume of surgical interventions between the examined patients did not reveal significant differences. Conclusion. Patients with coronary heart disease and hypothyroidism should be considered as a group of additional cardiovascular risk and require a more careful approach. It is possible to prescribe higher dosages of statins.

Effects of Hormone Replacement Therapy on Autoimmune Markers and Clinical Outcomes in Pediatric Patients with Hashimoto's Thyroiditis

Objective: Hashimoto’s Thyroiditis (HT), a chronic autoimmune thyroiditis, is the predominant cause of hypothyroidism in regions without iodine deficiency. HT is characterized by the loss of immunological tolerance of the thyroid gland, leading to autoimmune attacks. This study aimed to compare the autoantibody profiles, along with clinical and laboratory findings, of patients diagnosed with Hashimoto’s disease who were either receiving treatment or followed without treatment. Material and Methods: Clinical manifestations, laboratory data, and thyroid ultrasonography (USG) findings of patients diagnosed with Hashimoto’s thyroiditis receiving hormone therapy and those followed without treatment were compared in our clinic. Results: Among a total of 249 patients, 116 received hormone replacement therapy, while 133 were followed without treatment. The mean age of all patients was 13.91±3.71 years, with a mean age at diagnosis of 11.51±3.79 years. After twelve months of follow-up, the untreated group showed an increase in serum fT4 and antiTPO levels (p=0.012 and p=0.001), with no significant difference found in serum TSH, fT3, and antiTG levels. Those receiving treatment exhibited a significant decrease in serum TSH levels and a significant increase in serum fT4 levels (p=0.002 and p<0.001, respectively). Although there was an increase in serum antiTPO and antiTG levels over time, no change was detected in serum fT3 levels. Clinical improvement was significantly greater in the treatment group (p=0.044). Conclusion: It has been concluded that early initiation of hormone replacement therapy in Hashimoto’s thyroiditis can mitigate negative clinical effects during follow-up, contributing to patient comfort and alleviating clinical complaints.

Hormone Replacement Therapy Is Associated with Disease Activity Improvement among Post-Menopausal Women with Inflammatory Bowel Disease.

(1) Background: There are limited data available to guide clinical decision-making regarding the effects of hormone replacement therapy (HRT) in post-menopausal women with inflammatory bowel disease (IBD). In this study, we sought to characterize a population of post-menopausal women with IBD and to determine the effects of HRT on their disease activity. (2) Methods: A multicenter, retrospective, case-control cohort study of post-menopausal women with IBD was conducted. The physician global assessment (PGA) score was used to quantify disease activity. To control for the effects of menopause, IBD patients who had not undergone HRT were used as controls. (3) Results: There was a significant reduction in the frequency of PGA scores ≥2 post HRT treatment (p < 0.01). HRT treatment was associated with a 5.6× increase in the odds of post-HRT PGA score improvement compared to controls (OR 5.6; 95% CL 1.6, 19.7) in our univariate logistic regression analysis. (4) Conclusion: Post-menopausal IBD women who underwent HRT therapy showed an improvement in their disease symptoms following HRT compared to post-menopausal women without HRT therapy, who showed no change.

Does exogenous hormonal therapy affect the risk of glioma among females: A systematic review and meta-analysis.

The effect of exogenous hormone replacement therapy (HRT) and oral contraceptive pills (OCPs) on glioma risk in females is unclear despite numerous studies; hence, we conducted a meta-analysis to evaluate this relationship. Studies investigating the impact of exogenous female hormones on glioma risk were retrieved by searching 4 databases from inception until September 2022. Articles of any design, such as case-control and cohort studies, proving the relative risk (RR), odds ratio (OR), or hazard ratio were included. Summary OR values were calculated using a random effects model. Both HRT and OCP use of any duration decreased the risk of developing glioma [HRT OR = 0.78, 95% CI 0.66-0.91, P = .00; OCP: OR = 0.80, 95% CI 0.67-0.96, P = .02]. When stratified by duration of use, HRT use >1 year significantly reduced glioma risk (<1 year: OR = 0.82, 95% CI 0.63-1.07, P = 0.15; 1-5 years: OR = 0.79, 95% CI 0.67-0.92, P = .00; 5-10 years: OR = 0.80, 95% CI 0.66-0.97, P = .02; >10 years: OR = 0.69, 95% CI 0.54-0.88, P = .00). In contrast, only OCP use for >10 years significantly reduced glioma risk (<1 year: OR = 0.72, 95% CI 0.49-1.05, P = .09; 1-5 years: OR = 0.88, 95% CI 0.72-1.02, P = .09; 5-10 years: OR = 0.85, 95% CI 0.65-1.1, P = 0.21; >10 years: OR = 0.58, 95% CI 0.45-0.74, P = .00). Our pooled results strongly suggest that sustained HRT and OCP use is associated with reduced risk of glioma development.

Hypothalamic pituitary dysfunction after nasopharyngeal carcinoma irradiation

PurposeRadiotherapy (RT) is the corner stone of nasopharyngeal carcinoma (NPC) treatment but it exposes to late effects especially hypothalamic pituitary deficiency (HPD). In this article,we aimed to assess the impact of RT on pituitary function in NPC survivors. MethodsWe included 55 patients treated in the radiation oncology department, of Farhat Hached Hospital in Sousse, Tunisia. ResultsAll patients received facio-cervical RT with a mean dose of 73.3 Gy to the nasopharynx. After a mean follow up of 9.56 years, 34 patients (61.8%) presented HPD. Associated peripheral involvement was seen in 18.2%. The most prevalent deficiency was of the GH axis in 50.9% followed by secondary adrenal insufficiency in 20%. Panhypopituitarism was noted in 8.8%. The development of HPD wasn’t related to RT dose (OR: 0.41(0.05–2.92), p = 0.36) but was significantly associated with male gender (OR: 1.67 (1.21–2.37), p = 0.01). ConclusionHPD post RT is a common phenomenon. Therefore, we recommend regular assessment of pituitary function amongst patients treated with RT for NPC because identification of deficits is crucial to allow early and appropriate hormone replacement therapy in order to improve patients quality of life.

Association of vitiligo and metabolic syndrome: a case control study

Background: Vitiligo is an acquired disorder of depigmentation which involves skin and mucous membranes characterized by development of well-defined white macules on skin, mucosa and overlying hair of the skin can be involved. Systemic nature of the vitiligo might lead to insulin resistance metabolic profile abnormalities. Objective was to study the association between vitiligo and metabolic syndrome. Methods: The study was done in department of dermatology, venereology and leprosy of Dr. R. P. Government Medical College Kangra (Tanda), Himachal Pradesh. The study included 150 cases and 150 controls. Cases: age above 18 years with a diagnosis of vitiligo were included in the study. Pregnant and lactating women were excluded. Patients who had used medications that could affect the metabolic status (like systemic steroid therapy or cyclosporine or on hormonal replacement therapy). Patients already on lipid lowering agents and antidiabetic drugs. The case group was further subdivided into three subgroups according to VIDA score (group A: 1-0, group B: 1-2 and group C: 3-4). Controls: those visiting outdoor patient department and admitted for minor day care procedures Clinical details of patients were recorded regarding age, sex, smoking/alcohol consumption. General physical examination includes height, weight, body mass index, waist circumference, blood pressure. All the patients and controls were subjected to following tests: fasting blood sugar (FBS), cholesterol (CHOL), triglyceride (TAG), low density lipoprotein (LDL), high density lipoprotein (HDL), very low-density lipoprotein (VLDL), fasting serum insulin level (FSIL). Venous samples were taken after 12 hours of fasting. The participants were screened for metabolic syndrome as per national cholesterol education program adult treatment panel III (NCEP ATP III). Metabolic syndrome rates were compared between case and control groups. Results: The mean age was 35.82±12.9 years among cases and 36.97±11.76 years among controls. The M/F ratio of cases being (1:1.6) and controls (1:1). The mean duration of vitiligo was 117.8±105.5 months. Metabolic syndrome was significantly prevalent amid vitiligo cases 74 (49.3%) as compared to controls 23 (15.3%) with OR (95% CI) =5.37 (3.1-9.3). Metabolic syndrome was more frequent in VIDA subgroup 3{71 (47.3%)} and was statistically significant (p≤0.001). Conclusions: The study found association of metabolic syndrome among vitiligo patients. In addition, the study also found that in non-segmental vitiligo, frequency of metabolic syndrome was higher as compared to another pattern. Furthermore, frequency of metabolic syndrome increased as activity of vitiligo increased in the study.

Transgender and gender diverse youths' experiences of healthcare: A systematic review of qualitative studies.

Transgender and gender-diverse (TGD) populations are identified as high-risk for negative healthcare outcomes. Limited data exists on experiences of TGD youths in healthcare. The review aim is to systematically review literature on healthcare experiences of TGD youths. Seven electronic databases were systematically searched for relevant studies. Pre-determined eligibility criteria were used for inclusion with a double-screening approach. Sixteen studies were included. Studies included were quality appraised, data were extracted, and findings were synthesized narratively. Four narratives were identified including experiences of: accessing care, healthcare settings and services, healthcare providers, and healthcare interventions. Long waiting times, lack of competent providers, and fear were reported as challenges to accessing gender-affirming care. Negative experiences occurred in mental health services and primary care, while school counseling and gender clinics were affirming. Puberty blockers and hormone-replacement therapy were identified as protective factors. TGD youths are at risk of negative health outcomes due to an under resourced healthcare system. Further research is needed to assess interventions implemented to improve TGD youth's experiences.

Advances in diagnosis and treatment of perimenopausal syndrome.

With the development and progress of society, people's average life expectancy has increased, and relevant literature reports that the number of postmenopausal women in China continues to increase. With lifespans extended, the transition period and post-menopause period have become the longest essential period in every woman's life. The life quality of women troubled by perimenopausal syndrome has been significantly reduced, which also places a burden on families and society. It is well known that hormone replacement therapy plays a vital role in improving women's menopause-related symptoms and is the most effective medical measure. With research ongoing into the treatment of menopausal symptoms in different patients, dose size, treatment duration, and medication regimens for hormones are still hot topics of discussion. This article reviews the definition, clinical diagnosis, staging, clinical manifestations, and treatment of menopause and explores the current diagnosis and treatment scenarios of perimenopausal syndrome.

Menopause and premature ovarian insufficiency in rheumatic diseases: A review

Premature ovarian insufficiency (POI) is a clinical syndrome defined as loss of ovarian function before the age of 40 years. Among the causes of POI are genetic, metabolic disorders, as well as infectious or iatrogenic factors, but in some cases the exact cause cannot be established. Given the possible association of ovarian failure with autoimmune disorders, as well as the detection of antibodies to normal ovarian tissue in the serum of patients with POI, it is assumed that an autoimmune mechanism is a significant cause of the syndrome. Taking into account the relationship between POI and autoimmune diseases, it seems relevant to address the issues of mutual influence of the ovarian function of women with POI and rheumatic diseases (in particular, systemic lupus erythematosus, rheumatoid arthritis and systemic scleroderma), which is presented in this review. Hormone replacement therapy may be recommended for women with POI to improve their quality of life.&#x0D; Keywords: premature ovarian insufficiency, menopause, anti-ovarian antibodies, systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma, rheumatic diseases, hormone replacement therapy.

Clinical study of benign endometrial hyperplasia and response of Unani drugs with estimation of serum oestrogen levels

Endometrial Hyperplasia represents a spectrum of irregular morphological alterations, made by abnormal proliferation of the endometrial glands results in an increase in gland to stroma ratio. When compared to endometrium from proliferation phase of the cycle. The proliferation glands in endometrial hyperplasia can vary greatly in size and shape, and cytological atypia may be present. According to Hakeem Ajmal Khan in his book HAZIQ, Hakeem Anwer Ali Khan in his book Taleem-ul Qabela and Hakeem Shafaqat Azmi in his book Amraaz –e- Niswaan said that the Endometrial hyperplasia is caused due to alteration of humors and the temperament of uterus and the increase in retaining power (quwat-e- masika) of uterus is the cause of thickening of inner layer of uterus which leads to warm-e- daroon-e- raham. Objective: To prove the efficacy of Unani medicine in Benign Endometrial Hyperplasia Methodology: The study was carried out in the P.G Department of Qabalath – O – Amraaz – E – Niswaan at Government Nizamia Tibbi College and Hospital, Charminar, Hyderabad. Randomized single blind study with Pre and Post-test evaluation was conducted. Total 40 cases of Endometrial Hyperplasia were selected which is divided into two Groups. Group A – 20 Cases and Group B – 20 Cases. Inclusion Criteria: Age 25Yrs. to 55 Yrs., Only married women, Simple Hyperplasia with cystic without atypia, Complex hyperplasia with adenomatous without atypia, History of irregular menstrual cycles, PCOD’s, Hormone replacement therapy (HRT). Exclusion Criteria: Simple Hyperplasia with cystic Atypia, Complex Hyperplasia with Adenomatous Atypia/Carcinoma in Situ, Uterine Fibroids, Uterine Polyps, PID (Pelvic Inflammatory Disease), Systemic Disorders like tuberculosis, heart Diseases, Renal Disorders &amp; Neurological Disorder, Unmarried Women. Drugs which were selected for trial were finalized on the basis of these following properties like Mohalil – e- Aoram, Qhabiz, Musaffi – E – Khoon &amp; Dafae Tafoon were selected for the study. In group A &amp; B drugs given in the form of Joshanda, Sufoof, Humool and Zimaad. Group A- JOSHANDA: Gul – e – Banafsha, Babuna, Tukhm – e – Kataan, Sumbul e Tib, Gul – e – Tisu, Makoh – e – Khuskh, Arjun Chall, Gul – e – Surkh. HUMOOL: Mazo, Gul – e – Surkh, Shib – e – Yamani, Chub Zard, Zulal – e- Tukhme Bartang. SUFOOF: Musli Safaid, Mushtagi, Mochras, Gul – e – Surkh, Maye Kalan. ZIMAAD: Gul- e – Banafsha, Makoh – e – khuskh, Magaz – e – Fuloos – e- Qayashambar, Kashneez – e- Sabz, Tukhme Alsi. Group B – JOSHANDA: Gul – e – Banafsha, Babuna, Tukhm – e – Kataan, Sumbul e Tib, Gul – e – Tisu, Makoh – e – Khuskh, Arjun Chall, Gul – e – Surkh. HUMOOL: Luab – e – Tukhme Alsi, Luab –e- Tukhme Khatmi, Aab – e – Kashneez Sabz, Gul – e- Surkh, Makoh – e – Khushk. SUFOOF: Gul – e – Dhava, Gul- e- Gaozaban, Gul – e- Surkh, Gul – e – Banafsha. ZIMAAD: Gul – e – Tisu, Gul – e – Banafsha, Raswat, Tukhme Alsi, Magz – e – Gheegawar. Results: Group A 8 patients (40%) cured; 7 patients (35%) Partially relieved. Whereas in Group B 11 patients (55%) cured and 7 patients (35%) Partially relieved. Conclusion: The study proved efficacy of Unani formulation with good results in Benign Endometrial Hyperplasia with no major side effects.