Perimenopausal Period Research Articles

Changes in insul resistance, glucose effectiveness, and first and second phase of insulin secretion in women aged 45-60 years old in Taiwan.

In women after menopause, the incidence of diabetes mellitus increases. Increased insulin resistance (IR), decreased glucose effectiveness (GE), and the first and second phases of insulin secretion (FPIS and SPIS), are the four most important factors that trigger glucose intolerance and diabetes (diabetogenic factor [DF]). In the cross-sectional study, we enrolled non-diabetic women between the ages of 45 and 60 years to observe the changes in DFs during the perimenopausal period and to elucidate the underlying mechanisms of diabetes in menopausal women. We randomly enrolled 4,194 women who underwent health checkups. Using demographic and biochemical data, IR, FPIS, SPIS, and GE were calculated using previously published equations. The relationship between the DFs and age was evaluated using a simple correlation. Body mass index, blood pressure, fasting plasma glucose, low-density lipoprotein-cholesterol, triglyceride, and SPIS were higher, and GE was lower in older women (≥ 52 years old). A significant decrease in GE and increased SPIS were observed with age. However, no changes were observed in IR or FPIS. The IR and FPIS did not change during perimenopause. Increased SPIS may compensate for the decrease in GE, which is probably one of the reasons for the higher incidence of diabetes in menopausal women.

The association between depression during perimenopause and progression of chronic conditions and multimorbidity: results from a Chinese prospective cohort.

The association between perimenopausal depression and many chronic conditions among women has been well-established. However, the role of depression during perimenopause in the progression of multiple chronic conditions (multimorbidity) remains poorly understood. A total of 1,216 community-dwelling women in their perimenopause period between 2010 and 2016 were enrolled in our analysis, and followed up for the progression of multimorbidity. Depression, as well as its severity, was evaluated by the Center for Epidemiologic Studies Depression 10-item scale (CES-D-10). Progression of multimorbidity was defined as the first report of two or more chronic conditions for participants without multimorbidity or the new report of one or more conditions for those with multimorbidity. Univariable and multivariable Cox proportional hazards model and the restricted cubic spline regression model were performed to assess the prospective association between perimenopausal depression and the progression of multimorbidity. A total of 480 (39.5%) women reported depression during perimenopause, and 529 (43.5%) women progressed to multimorbidity. After adjusting for socio-demographic and lifestyle factors, perimenopausal depression was independently associated with the progression of multimorbidity (hazard ratio [HR]: 1.34; 95% confidence interval [CI]: 1.13 to 1.60). Moreover, the severity of depression was positively and linearly associated with the progression of multimorbidity (P < 0.05). Our finding reveals a prospective association between perimenopausal depression and the progression of multimorbidity, indicating interventions targeting perimenopausal depression may reduce the burden of chronic diseases and multimorbidity in women's post-menopausal life.

Invited Perspective: PFAS and Dyslipidemia-The Perimenopausal Period as a Critical Time Window.

Invited Perspective: PFAS and Dyslipidemia-The Perimenopausal Period as a Critical Time Window.

Long-Term Follow Up of Sexual Function and Steroid Levels in Women after Perimenopausal Hysterectomy with or without Concomitant Oophorectomy.

Hysterectomy, most often performed because of bleeding disorders or uterine leiomyoma, is one of the most common major surgical procedures in women and is usually performed during the perimenopausal period on ages 45-55 years. Hysterectomy may be combined with bilateral salpingo-oophorectomy, as a risk-reducing procedure to minimize the risk of ovarian cancer. An open question is whether concomitant oophorectomy, with cessation of ovarian androgen secretion, has any long-term effects on sexual function. In the present prospective cohort study of women undergoing benign hysterectomy, the long-term (10-12 years) effects on sexual function and changes in sex hormone levels were investigated in women having undergone perimenopausal hysterectomy, with or without concomitant bilateral salpingo-oophorectomy. Originally, 491 women (mean age around 50 years) were operated with (patient preference) either only hysterectomy (HYST) or hysterectomy plus bilateral salpingo-oophorectomy (HYST + BSO), and 441 women (90%; HYST; n = 271 and HYST + BSO; n = 170) completed a one-year survey. In the present study, 185 women (42%) of the cohort with one-year follow up participated in the long-term follow up after 10-12 years. Follow-up was with the 10-item McCoy Female Sex Questionnaire and blood analysis of levels of testosterone, estradiol and sexual-hormone-binding globulin. The results showed that specific aspects of sexual function were lower after HYST + BSO compared to HYST 10-12 years after surgery. These lowered items were frequency of sexual fantasies, enjoyment of sexual activity, sexual arousal, and orgasmic frequency. No long-term differences in sex hormone levels were found between the two groups. In conclusion, some items related to sexual function were lower after HYST + BSO in a long-term perspective study, although the levels of testosterone were unaltered. This finding may have implications for clinical recommendations concerning prophylactic salpingo-oophorectomy or for hysterectomy during the perimenopausal age.

Modern views on the correction of violations of the vaginal biotope in perimenopause

ABSTRACT. Ensuring the quality of life of women in the climacteric period remains today the most urgent problem of modern medicine. The goal is to evaluate the effectiveness of the antiseptic Ginodec in the treatment of mixed vulvovaginal infection in perimenopausal women. Materials and methods. We monitored 52 patients with mixed bacterial and candidal infection aged 44 to 52 years. The diagnosis of non-specific bacterial and candidal infection was verified according to the data of clinical and laboratory research methods. The criteria for the effectiveness of the treatment were complete clinical and bacterial sanitation. Patients with bacterial candidal infection received 5 ml of Ginodek vaginal gel once a night for 7 days. The results. Analysis of clinical effectiveness after treatment showed that in perimenopausal women, complaints of vaginal discomfort and vaginal discharge decreased by 4 times, dyspareunia was noted by only 5.8 % of patients compared to 69.2 % before treatment. Regenerative efficiency of vaginal epithelial cells in patients also improved, their maturity index increased to 75-80. Bacteriological examination carried out 2 weeks after the end of the course of treatment confirmed the effectiveness of the Ginodek drug against bacterial infection in 92.3 % of cases, candidal - in 86.5 %. Conclusions. Bacterial-fungal associations of microorganisms in the vaginal biotope in women in the perimenopausal period lead to the formation of a complex complex of unclear clinical symptoms, which makes it difficult to make a timely diagnosis. The drug Ginodek demonstrates high microbiological effectiveness in mixed bacterial-candidal infection in patients in perimenopause, and also increases the functional activity of the epithelium of the mucous membrane of the vagina, which is especially important in this period of a woman's life.

Relationships of Body Mass Index, Relative Fat Mass Index, and Waist Circumference with Serum Concentrations of Parameters of Chronic Inflammation.

(1) Background: Obesity in the perimenopausal period is associated with hormonal changes, lifestyle, and environment. In obesity, elevated levels of IL-6 and TNF-α and reduced levels of adiponectin are observed, and the associated chronic inflammation favors the development of cardiometabolic diseases. Therefore, the aim of our study was to assess the relationship between selected measures of obesity (BMI, WC, RFM, VAI, WHtR) and parameters of chronic inflammation (CRP, TNF-α, IL-6) in perimenopausal women. (2) Methods: The study involved 172 perimenopausal women. The methods used in this study were diagnostic surveys, anthropometric measurements, blood pressure measurements, and venous blood sampling. (3) Results: Preliminary multivariate linear regression analysis showed that CRP moderately positively correlated with IL-6 (β = 0.25; p = 0.001) and weakly negatively correlated with adiponectin (β = -0.23; p = 0.002). Similar associations were noted in preliminary multivariate linear regression analysis adjusted for age, menopausal status, and smoking status. Preliminary multivariate linear regression analysis also showed that BMI positively correlated with IL-6 (β = 0.16; p = 0.033). VAI weakly positively correlated with CRP (β = 0.25; p = 0.001) and negatively correlated with adiponectin (β = -0.43; p = 0.000). (4) BMI, WC, RFM, VAI, and WHtR are clearly related to selected parameters of chronic inflammation. Our study suggests that each of the anthropometric variables provides distinct information on metabolic processes associated with inflammatory parameters.

The effect of ajwa dates (Phoenix dactylifera L) consumption to anti-Mullerian hormone level of perimenopausal woman

Ageing in the female reproductive system is most clearly seen when entering the perimenopausal period, where there is a decrease in the number and function of oocytes and significant endocrine changes. Inflammation and accumulation of reactive oxygen species (ROS) are considered to be the most responsible factors for the reduction in ovarian reserve. Anti-Mullerian Hormone (AMH) is used as a biomarker of ovarian reserve and clinically as a predictive biomarker of menopause. Ajwa dates contain phytochemicals with antioxidant and anti-inflammatory activities. This study aimed to analyse the effect of consuming ajwa dates on AMH levels in perimenopausal women. This research was a quasi-experimental study with a pre-post control design which was conducted at Sitti Khadijah 1 Muhammadiyah Hospital, Makassar, Indonesia, from May until October 2021. It involved 44 perimenopausal subjects aged 42 - 48 years, which were divided into 2 groups randomly (28 subjects consumed ajwa dates as the intervention group, sixteen as the control group). AMH levels were assessed before and after the 8week intervention period and analysed using the ELISA method. The result showed that AMH levels in the intervention and the control groups after 8 weeks of treatment decreased by 0.37±0.36 ng/mL and 0.55±0.19 ng/mL, respectively. The decrease in AMH levels between the two groups was significantly different (p&lt;0.05) where AMH levels in the intervention group declined less than in the control group. In conclusion, AMH levels in perimenopausal women who consumed ajwa dates decreased less than perimenopausal women who did not consume ajwa dates. The reduction of ovarian reserve in perimenopausal women can be inhibited through the intervention of exogenous antioxidants from ajwa dates which AMH levels were the indicator.

Altered gut microbiota profile in patients with perimenopausal panic disorder.

Females in the perimenopausal period are susceptible to mood disorders. Perimenopausal panic disorder (PPD) is characterized by repeated and unpredictable panic attacks during perimenopause, and it impacts the patient's physical and mental health and social function. Pharmacotherapy is limited in the clinic, and its pathological mechanism is unclear. Recent studies have demonstrated that gut microbiota is strongly linked to emotion; however, the relation between PPD and microbiota is limitedly known. This study aimed to discover specific microbiota in PPD patients and the intrinsic connection between them. Gut microbiota was analyzed in PPD patients (n = 40) and healthy controls (n = 40) by 16S rRNA sequencing. The results showed reduced α-diversity (richness) in the gut microbiota of PPD patients. β-diversity indicated that PPD and healthy controls had different intestinal microbiota compositions. At the genus level, 30 species of microbiota abundance had significantly different between the PPD and healthy controls. In addition, HAMA, PDSS, and PASS scales were collected in two groups. It was found that Bacteroides and Alistipes were positively correlated with PASS, PDSS, and HAMA. Bacteroides and Alistipes dysbiosis dominate imbalanced microbiota in PPD patients. This microbial alteration may be a potential pathogenesis and physio-pathological feature of PPD. The distinct gut microbiota can be a potential diagnostic marker and a new therapeutic target for PPD.

Antimüllerian Hormone as a Tool to Predict the Age at Menopause.

This study aimed to assess an eligible cut-off value of anti-Müllerian hormone (AMH) to detect ovarian senescence in a group of premenopausal Greek women to evaluate the possible link between AMH-values and the severity of climacteric symptoms during a follow-up of 24 months. This study included 180 women (group A, 96 women of late reproductive stage/early perimenopause; group B, 84 women in late perimenopause). We measured AMH blood levels and assessed climacteric symptoms using the Greene scale. Log-AMH is inversely associated with postmenopausal status. The AMH cut-off of 0.012 ng/mL predicts the postmenopausal status with a sensitivity of 24.2% and specificity of 30.5%. The postmenopausal stage associated with age (OR = 1.320, 95%CI: 1.084-1.320) and AMH (values ≥ vs. <0.012 ng/mL, OR = 0.225, 95%CI: 0.098-0.529, p-value < 0.001). Moreover, the severity of vasomotor symptoms (VMS) was only associated inversely with AMH (b-coefficient = -0.272, p-value = 0.027). In conclusion, AMH levels measured in the late premenopausal period are inversely associated with the time to ovarian senescence. In contrast, AMH levels measured in the perimenopausal period are inversely associated only with the severity of VMS. Therefore, a cut-off of 0.012 ng/mL predicts menopause with low sensitivity and specificity, making it challenging to use in a clinical setting.

Clinical, microbiological, immunological and hormonal profiles of patients with granulomatous mastitis.

Various studies on the etiology and other aspects of granulomatous mastitis (GM) have been performed; however, a lot of controversies have arisen. The present study aimed to present the clinicopathological findings and identify the sensitivity and resistance of isolated bacteria in patients with GM. In this cross-sectional study 63 female patients with a confirmed histopathological diagnosis of GM were included. A core needle biopsy was conducted for the patients to obtain a sample for histopathological examination and bacterial culture. In total, 46 types of antibiotics were used to determine the sensitivity and resistance of each isolated bacterial species. All the medical and clinical records of the patients were acquired through the completion of a questionnaire form in person or, if necessary, through the evaluation of their medical records in the database of the relevant center. The majority of the patients were in the premenopausal or perimenopausal period. GM was unilateral in 58.7% of the patients. The most common symptom was pain, followed by fever and chills. The mean ranges of the erythrocyte sedimentation rate, C-reactive protein, IL-6, IL-17, C5a, white blood count, neutrophil-to-lymphocyte ratio, and prolactin tests were significantly elevated in comparison to the normal ranges. In total, nine different bacterial species were isolated from the bacterial culture of the core biopsy samples, and 50% of the isolated bacterial species were sensitive to trimethoprim-sulfamethoxazole. Since there is no consensus on the etiology of GM, any additional studies related to this aspect expand the current understanding of this puzzling condition.

Characteristics of Frailty in Perimenopausal Women with Long COVID-19.

The aim of this study was to compare the prevalence of risk factors for frailty between perimenopausal women with long COVID-19 syndrome, women having successfully recovered from COVID-19, and controls from the community. Women with a diagnosis of long COVID-19 and at least one symptom related to the perimenopausal period, women who had successfully recovered from COVID-19, and healthy women of comparable age were included in this study. Symptom severity and functional disability were assessed with the COVID-19 Yorkshire Rehabilitation Scale, and the presence of frailty was evaluated considering the Fried criteria. A total of 195 women were included in the study, distributed over the three groups. The long COVID-19 group showed a higher prevalence of perimenopausal symptoms and impact of COVID-19. Statistically significant differences were found between the long COVID-19 group and the other two groups for the frailty variables. When studying the associations between frailty variables and COVID-19 symptom impact, significant positive correlations were found. Perimenopausal women with long COVID-19 syndrome present more frailty-related factors and experience a higher range of debilitating ongoing symptoms. A significant relationship is shown to exist between long COVID-19 syndrome-related disability and symptoms and frailty variables, resulting in an increased chance of presenting disability.

The relationship between polycystic ovary syndrome and coronary heart disease: a bibliometric analysis.

Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrine diseases for women of puberty and reproductive age. PCOS can affect women's health for the rest of their lives since the incidence of coronary heart disease (CHD) may increase in the perimenopausal and senile periods among PCOS women compared with non-PCOS women. A literature retrieval based on the Science Citation Index Expanded (SCI-E) database. All obtained records results were downloaded in plain text format for subsequent analysis. VOSviewer v1.6.10, Citespace and Microsoft Excel 2010 software were utilized for analyzing the following terms: countries, institutions, authors, journals, references and keywords. There were 312 articles retrieved from January 1, 2000 to February 8, 2023, and the frequency of citations was 23,587. The United States, England, and Italy contributed the majority of the records. Harvard University, the University of Athens, and Monash University were the top 3 most productive institutions with publications on the relationship between PCOS and CHD. Journal of clinical endocrinology & metabolism ranked first with the highest publications (24 records), followed by Fertility and sterility (18 records). The keywords were divided into six clusters in the overlay keywords network: (1) the correlation between CHD risk factors and PCOS women; (2) the relationship between cardiovascular disease and female reproductive system hormone secretion; (3) the interaction between CHD and metabolic syndrome; (4) the relationship between c-reactive protein and endothelial function and oxidative stress in PCOS patients; (5) the potential positive effect of metformin on reducing CHD risk factors in PCOS patients; (6) the study of serum cholesterol and body-fat distribution in patients with CHD in PCOS. Oxidative stress, genome-wide association, obesity, primary prevention, and sex difference were main hotspots in this field in recent five years according to the keyword citation burst analysis. The article obtained the hotspots and trends and provided a reference for subsequent research on the association between PCOS and CHD. Moreover, it is hypothesized that oxidative stress and genome-wide association were frontier hotspots in studies that explore the relationship between PCOS and CHD, and prevention research may be valued in the future.

The perimenopausal period and the benefits of progestin IUDs

The perimenopausal period and the benefits of progestin IUDs

356 Upregulated Genes in Age-Related Lobular Involution Stagnation Represent Potential Biomarkers That Link To Increased Breast Cancer Risk

OBJECTIVES/GOALS: Age-related lobular involution (LI) is a physiological process of breast epithelial regression that occurs primarily during perimenopause (ages 45-55); women in this age range for which the process of LI is delayed, defined as LI stagnation, show significantly increased risk of breast cancer as compared to LI progression patients. METHODS/STUDY POPULATION: The Mayo Clinic Benign Breast Disease (BBD) cohort includes ~1000 women who had multiple sequential benign biopsies. 103 patients were found to have sequential biopsies during the perimenopausal period, of which 10 eventually progressed to breast cancer. These patients were assessed for LI stagnation vs LI progression by quantifying 10 lobules per slide and comparing median acini number and median lobule size between initial and subsequent biopsies from the same patients. RNA was derived from whole tissue sections from the initial biopsies, and profiled using NanoString IO360 and BC360, which were normalized using RUVg methods. Differentially expressed genes associated with LI stagnation were defined as having two-tailed, unpaired p-values less than 0.05. RESULTS/ANTICIPATED RESULTS: Analysis showed subsetting patient sets by time between biopsies improves classification of stagnant vs. progression. Differential gene analysis identified 37 genes associated with LI stagnation and LI progression, and 20 of these genes were found to overlap a set of 128 gnese that were differentially expressed between women who subsequently developed breast cancer vs remained cancer-free. These genes represent potential biomarkers of processes that link LI stagnation and increased breast cancer risk. DISCUSSION/SIGNIFICANCE: In future studies, we intend to study these genes that were shown to be upregulated in LI stagnation for their association with subsequent development of breast cancer in independent cohorts of women with BBD. We will use this knowledge to improve individualized risk assessment, which will help focus surveillance and prevention strategies.

Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care “Menopausal disorders and other disorders in the perimenopausal period”

This protocol was developed on the basis of the clinical guideline “Menopausal disorders and other disorders in the perimenopausal period”, which is based on the principles of evidence-based medicine and takes into account the clinical guideline Recommendations on Women’s Midlife Health and Menopause Hormone Therapy, developed in 2016 by specialists of the International Menopause Society (IMS), and corresponds to the specifics of providing medical care in our country.Also, other international guidelines on menopause issues were used in the development of this protocol, such as: “Menopause: diagnosis and management” National Institute for Health and Care Excellence (NICE) guideline, 2019; сlinical guidance “Managing menopausal symptoms” Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), 2020; “The genitourinary syndrome of menopause” North American Menopause Society, (NAMS), 2020; British Menopause Society (BMS) &amp; Women’s Health Concern (WHC) recommendations on hormone replacement therapy in menopausal women, 2020.The goal of the protocol: to ensure the organization of medical care, to establish uniform requirements for the diagnosis and treatment of patients with menopausal symptoms, to recommend the use of STRAW+10 (2011) criteria for menopause to all health care professionals.The protocol describes the organization of medical care for patients with menopausal disorders at all levels – from primary to tertiary care. Detailed information on diagnosis and treatment of this category of patients is presented. Special attention is paid to menopausal hormone therapy, taking into account its possible risks.The protocol is intended for general practitioners – family doctors, obstetrician-gynecologists, gynecological oncologists, oncologists, oncological surgeons, cardiologists, endocrinologists, orthopedic traumatologists and other medical professionals who provide medical assistance to women with menopausal disorders.

Leisure time physical activity and bone mineral density preservation during the menopause transition and postmenopause: a longitudinal cohort analysis from the Study of Women's Health Across the Nation (SWAN)

Whether greater leisure time physical activity (LTPA) is associated with less bone mineral density (BMD) loss during the menopause transition (MT) remains an open question. We hypothesized that: 1) larger increases in LTPA from pre-/early perimenopause (period 1) to late perimenopause/postmenopause (period 2) would be associated with a slower period 2 BMD loss rate; and 2) greater entire-study LTPA levels would be associated with better final absolute BMD (g/cm2). Data were from of the Study of Women's Health Across the Nation (1996-2017). Exclusions were: bone beneficial medications, inability to identify start of the MT, and extreme BMD change rates. LTPA measures were a validated ordinal scale and number of metabolic equivalents per hour per week (MET hr wk-1) from sport/exercise. Multiply adjusted, linear regression models estimated: 1) BMD decline rate (annualized %) as a function of LTPA change; and 2) final BMD as a function of entire-study LTPA. Median [p25, p75] MET hr wk-1 were 4.2 [0.9, 10.1] and 4.9 [1.4, 11.2] in periods 1 and 2, respectively; walking was the commonest activity. In adjusted models (N=875), greater increases in LTPA ordinal score and MET hr wk-1 were statistically significantly associated with a slower decline in femoral neck (FN) BMD. Larger entire-study averages of each LTPA measure were statistically significantly related to better final FN and lumbar spine BMD levels. Findings suggest that LTPA, at modest levels, mitigate MT-related BMD decline and even small increases in intensity, duration or frequency of common activities may lessen bone loss at the population level. US-NIH.

TREATMENT TACTICS FOR GENITAL PROLAPSES IN WOMEN WITH ABNORMAL UTERINE BLEEDING AND THYROID GLAND PATHOLOGY

Introduction. Patients with genital prolapse have various extragenital pathologies, in particular thyroid pathology, which affects the regulation of the menstrual cycle both in the reproductive and perimenopausal periods of a woman's life. Abnormal uterine bleeding caused by hormonal disorders, functional and organic changes in the thyroid gland is reported as a common problem of perimenopausal age. The aim of this study is to optimize the treatment of genital prolapse in women with abnormal uterine bleeding and thyroid pathology. Materials and methods. 49 perimenopausal women with genital prolapse who had thyroid pathology were examined and treated. They were divided into the main group (29 women with abnormal uterine bleeding) and the comparison group of 20 patients with genital prolapse without abnormal uterine bleeding. 20 women without signs of gynaecological and extragenital pathology made up the control group. Results. The presence of significant deviations in the serum content of steroid hormones in women with thyroid dysfunction allows us to confirm the relationship between proliferative processes in the endometrium and the functioning of the thyroid system. The examination revealed a significant relationship between thyroid dysfunction and the cause of abnormal uterine bleeding. Depending on the treatment method, the women of the main group were divided into 2 subgroups: the first subgroup included 19 patients who underwent vaginal extirpation of the uterus and simultaneous correction of genital prolapse with additional sacrospinal fixation of the vaginal stump using a mesh implant fragment. 10 patients were included in the second subgroup, which underwent hysteroresectoscopy due to abnormal uterine bleeding, and surgical treatment of genital prolapse was performed after a certain period of time (after 0.5-3 years, on average after 21-24 months). In the comparison group, planned vaginal extirpation of the uterus was performed. Conclusion. The improvement of the treatment of genital prolapse in women with abnormal uterine bleeding and thyroid pathology consists in combining vaginal removal of the uterus followed by strengthening of the vaginal dome through the use of sacrospinal fixation and/or a mesh implant in order to prevent recurrences and improve the economic indicators of the medical institution and the quality of life of patients.

Determining the level of stromal and epithelial cells activity in normal and hyperplastic endometrium of late reproductive and perimenopausal women.

Hyperplastic processes of the endometrium (HPE) are a group of benign endometrial and stromal cells that have undergone altered growth. This study aimed to investigate the potential role of hypoxia (as indicated by Hif-1α) and apoptosis markers (p53 and BCL-2) in the development of hyperplastic processes of the endometrium (HPE). Results showed that endometrial cells with atypical hyperplasia had increased levels of Hif-1ɑ, which indicates the presence of endometrial hypoxia and may trigger pathological manifestations. Though this result was not statistically significant, it could be the cause of atypia hyperplasia in the late reproductive period (Hif-1ɑ=1.89±0.09 units) and the perimenopausal period (Hif-1ɑ=2.09±0.07 units). Additionally, the study found that p53 markers were elevated in epithelial cells in the late reproductive period, and similar patterns were observed in the perimenopausal period, with the biggest expression in atypical hyperplasia. The study also found that the high expression of BCL-2 indicator (+++) was less common in late reproductive period women with atypia than those without it (χ2=7.2 p=0.01). A similar situation was observed in women in the perimenopausal period (χ2=4.2 p=0.04). These findings suggest that hypoxia may play a role in the development of HPE, as well as changes in apoptotic markers present in the endometrial tissue.

HISTOPATHOLOGICAL SPECTRUM OF ENDOMETRIAL LESIONS IN TERTIARY CARE CENTRE- A PROSPECTIVE STUDY

Introduction: Endometrial sampling is most often performed for abnormal uterine bleeding. Irregular cycles, abnormal and dysfunctional uterine bleeding is considered to be one of the most common presenting symptom in gynaecological practice amongst all age group of patients. Early detection of precursor lesions and exclusions of malignancy is a diagnostic challenge for pathologist. This study aims at evaluation of the histopathological spectrum of endometrial lesions common for particular age group, presenting complaints and underlying cause for the same. Materials and methods: A prospective study for a period of 2 years from January 2021 to December 2022 in the Department of Pathology. Total of 870cases , between 18-80years were included. Histopathological study was done and each sample was categorized on the basis of age, bleeding pattern and histomorphological patterns. The mean age was found out to be 42.5±2 years. M Results: ost common age group was 3rd and 4th decade with 231 patients (26.55%) of 31-40 years and 226 patients (25.97%) of 41-50 years with lower abdominal pain and menorrhagia [210 cases (24.13%) &amp; 191cases(21.83%) respectively], proliferative phase endometrium was noted in 35.74% cases, disordered proliferative endometrium and endometrial polyps in 10.34% cases , non atypical hyperplasia was seen in 8.39% cases, pill endometrium in 3.33% and endometrial carcinoma contributed to 0.46%. Perimenopausal period is a vulnerable age group to a numbe Conclusion: r of endometrial lesions. Lower abdominal pain and menorrhagia were most common clinical presentation and confronted wide spectrum of histomorphological changes in endometrial samples presenting with various patterns of bleeding ranging from normal cyclical changes to malignancy. It is observed that patients with obesity, diabetes mellitus, sedentary lifestyle and low socioeconomic status are more proned to these conditions. Histopathological examination plays a vital role in diagnostic evaluation as a rst modality and therapeutic management

Histopathological discrepancies between colposcopy-directed biopsy and LEEP-conization observed during SARS-CoV-2 pandemic.

Long-term exposure to the human papillomavirus (HPV) is a known cause of squamous intraepithelial lesions that lead to cervical cancer. The loop electrosurgical excision procedure (LEEP) conization is an established treatment method. According to the latest recommendations, we present a paper to evaluate the effectiveness of various diagnostic methods of squamous intraepithelial lesions. We analyzed 229 patients who reported to District Public Hospital in Poznan to undergo LEEP conization in 2019-2021 during the SARS-CoV-2 Pandemic. The analysis included Pap smear/liquid-based cytology, HPV genotyping, colposcopy with targeted biopsy and LEEP-conization. We offered post-treatment HPV vaccination and, as a follow-up, performed HPV re-genotyping after six months. In total, 89.1% of patients were HPV-positive. The coloscopy-directed biopsy (CDB) results show that almost 70% of the patients had high-grade intraepithelial lesions (HSIL). The diagnosis obtained by LEEP-conization showed that half of the women were diagnosed with HSIL and one-third with the low-grade squamous intraepithelial lesion (LSIL). The sensitivity of Pap smear/LBC accounted for 93.7% and was lower than for CDB, which reached 95.1%. Both diagnostic methods tend to underestimate the final diagnosis. The inclusion of a colposcopic examination in an in-depth diagnostic process in women with abnormal Pap smear results facilitates the identification of patients requiring therapeutic intervention. LEEP-conization may be used without the primary biopsy. It applies to multiparous women in the perimenopausal period, extensive abnormalities, discrepancies in test results, extensive visible abnormalities, and suspicion of invasive cervical cancer in the colposcopic examination.