Tract In Postmenopausal Women Research Articles

The role of estriol in the treatment of atrophy of the mucous membrane of the lower genitourinary tract in postmenopausal women

Studies of recent decades show a steady increase in the average life expectancy of a person, and women in particular. The World Health Organization predicts a four-fold increase in the number of women over 70 by 2030, and many of them over the age of 45 may face menopausal problems. Menopause is a physiological state in a woman's life, during which, against the background of age-related changes, there is a gradual decrease and shutdown of ovarian function and the cessation of estrogen production. Genitourinary syndrome occurs in every third woman in this period. Estriol is the main estrogen that specifically addresses problems associated with estrogen deficiency: dyspareunia, dryness and itching in the vagina and lower genitourinary tract, urinary incontinence, moderate urinary incontinence, and recurrent vulvovaginitis and cystitis. Vulvovaginal dystrophy in women of the older age group is a multidisciplinary problem at the intersection of gynecology, urology and dermatology, which can and should be solved to prevent more severe gynecological and urological pathologies.

Assessment of the safety of long-term bazedoxifene treatment on the reproductive tract in postmenopausal women with osteoporosis: Results of a 7-year, randomized, placebo-controlled, phase 3 study

ObjectiveTo evaluate the clinical safety of bazedoxifene (BZA) on the reproductive tract in postmenopausal women with osteoporosis over 7 years. Study designThis was a second, blinded, 2-year extension of a 3-year, randomized, double-blind, placebo (PBO)- and active-controlled phase 3 trial. In the core study, subjects were randomized to receive BZA 20 or 40mg, raloxifene 60mg, or PBO. During years 4–5, the raloxifene arm was discontinued and subjects receiving BZA 40mg were transitioned to BZA 20mg. Subjects continued to receive BZA 20mg or PBO during years 6–7. Main outcome measuresThe primary endpoint was the incidence of new vertebral fractures at 7 years (reported separately). Reproductive tract safety findings at 7 years are reported here. Endometrial thickness was assessed by transvaginal ultrasonography for subjects in the endometrial safety substudy. Adverse events (AEs) were recorded throughout the study. ResultsAt 7 years, the adjusted mean (±standard error) change in endometrial thickness was similar with BZA and PBO (−0.11±0.21 and 0.07±0.32mm, respectively). The incidence of endometrial hyperplasia was low (0.1% for both groups). BZA showed significantly lower rates than PBO of endometrial carcinoma (0.1% vs. 0.4%; P=0.020) and vaginitis (6.1% vs. 7.6%; P=0.035). There were more cases of ovarian carcinoma with BZA (n=4 [0.1%]) than PBO (n=0); the difference was not statistically significant. Rates of breast-related and other gynecologic AEs were similar among groups. ConclusionsBZA was associated with a favorable reproductive safety profile in postmenopausal women with osteoporosis over 7 years.

Compartmentalized secretory leukocyte protease inhibitor expression and hormone responses along the reproductive tract of postmenopausal women

Immunity and hormonal responses in the reproductive tissues of postmenopausal women are poorly understood. Secretory leukocyte protease inhibitor (SLPI), a multifunctional antimicrobial protein expressed at mucosal surfaces, is thought to play a key role in infectious and inflammatory contexts. The aim of this study was to measure SLPI production along the female reproductive tract in postmenopausal women with and without hormonal treatment. We additionally quantified estrogen receptor alpha (ERα) and progesterone receptor A (PRA) in these tissues. Expression of SLPI was decreased in the vagina and ectocervix of women under hormonal treatment. Endocervical ERα mRNA expression was increased while this did not reach significance at the protein level. SLPI expression in the endometrium was not influenced by hormonal treatment. We observed attenuated ERα expression in the cervix and endometrium of hormonally treated women, whereas vaginal expression was increased. PRA expression was augmented in the cervix and endometrium and unchanged in the vagina. Taken together, our results indicate that hormonal responses and receptor expression are differentially regulated in vaginal tissue compared with the cervix and endometrium.

Bazedoxifene effects on the reproductive tract in postmenopausal women at risk for osteoporosis

The aim of this study was to examine the endometrial, ovarian, and breast safety of bazedoxifene, a novel selective estrogen-receptor modulator, in postmenopausal women at risk for osteoporosis. Healthy postmenopausal women (N = 1,583; mean age, 57.6 y) with lumbar spine or femoral neck bone mineral density T scores between -1 and -2.5 and/or other clinical risk factors for osteoporosis were enrolled in a 24-month, phase 3, randomized, double-blind, placebo- and active-controlled trial. They received daily treatment with bazedoxifene 10, 20, or 40 mg; placebo; or raloxifene 60 mg. Reproductive safety assessments included periodic transvaginal ultrasound measurements of endometrial thickness, ovarian volume, and presence of ovarian cysts; periodic endometrial biopsies; and adverse event reporting. Bazedoxifene was not associated with a significant change from baseline in mean endometrial thickness at month 24. The percentage of participants with a change from baseline in endometrial thickness or endometrial thickness greater than 5 mm at month 24 was similar among groups. There was no consensus diagnosis of endometrial hyperplasia or malignancy in the bazedoxifene or raloxifene groups; the rates of other histologic findings, including endometrial polyps, were low (<5%) and similar among groups. No significant between-group differences were found in the change from baseline in ovarian volume, number or size of ovarian cysts, or incidence of ovarian cancer. Reports of breast pain (<4%) and breast cancer (<1%) were low and evenly distributed among groups. A favorable endometrial, ovarian, and breast safety profile was found after 2 years of treatment with bazedoxifene in healthy, recently postmenopausal women at risk for osteoporosis.

P856 Atrophic processes of lower urogenital tract in postmenopausal women

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S656-S656 Poster presentations P856 Atrophic processes of lower urogenital tract in postmenopausal women V. Prilepskaya, V. PrilepskayaSearch for more papers by this author V. Prilepskaya, V. PrilepskayaSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)62346-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S656-S656 RelatedInformation

Effects of vaginal estrogen use on the lower urinary tract in post-menopausal women

Objective To study the effects of vaginal estrogen application on blood flow of the lower urinary tract in post-menopausal women. Methods Arterial blood flow frequency spectrum, peak systolic blood flow, end-diastolic blood flow velocity and resistance index of the peri-urethra and neck of the urinary bladder, as well as changes in their genitourinary system, were measured with color Doppler ultrasound imaging in post-menopausal women before and three months after their use of premarin ointment containing natural estrogen per vagina. Results Three months after treatment with estrogen-premarin ointment per vagina in post-menopausal women, their peak systolic blood flow velocity of the peri-urethra arteries increased to 13.23 cm/s from 11.94 cm/s before treatment, end-diastolic blood flow velocity increased to 3.92 cm/s from 1.91 cm/s and resistance index decreased to 2. 79 from 3. 84 (P <0. 01 ). And, their peak systolic blood flow velocity of the arteries of the neck of the urinary bladder increased to 17.09 cm/s from 12. 77 cm/s before treatment, end-diastolic blood flow velocity increased to 2. 83 cm/s from 1.31 cm/s and resistant index decreased to 2. 78 from 3.78 (P<0.01). It indicated that local vasodilatation and decrease dresistance of the lower urinary tract made blood flow of the arteries of the peri-urethra and neck of the urinary bladder increase, urinary frequency and nocturia occurrence decrease, and sexual satisfaction improve.Conclusions Blood flow, symptoms of the lower urinary tract and their quality of life can be improved in post-menopausal women after treatment with natural estrogen-premarin ointment per vagina. Key words: Menopause; Estrogens; Admitistration, intravaginal; Regional blood flow; Ultrasonography, Doppler, Color

A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomized postmenopausal women

To compare the effects of oral and vaginal estrogen therapy (ET) on the lower urinary tract in postmenopausal women with prior hysterectomy. Randomized, prospective study. Tertiary teaching hospital. Fifty-seven hysterectomized, postmenopausal women. Patients were randomized to receive either oral (0.625 mg of conjugated equine E per tablet; n = 27) or topical (0.625 mg conjugated equine E per 1 g vaginal cream; n = 30) E, administered once daily. All subjects had E2 measurements, urinalysis, pelvic examination, introital color Doppler ultrasonographies, and personal interviews with the Bristol Female Lower Urinary Tract Symptoms Questionnaires before and 3 months after ET. A higher serum level of E2 was noted in the oral group compared with the topical group after ET. The post-ET pulsatility index of periurethral vessels and bladder neck revealed statistically significant decreases in both groups. The incidences of urinary frequency and nocturia were significantly decreased after 3 months of ET in both groups. Changes in the incidence of other symptoms, including stress incontinence and urge incontinence, were not statistically significant. However, subjective improvement of stress incontinence was found in 72.7% of the oral group and 60% of the topical group. The results suggest that ET alone, by an oral or vaginal route, could increase the blood flow around the bladder neck and mid-urethra and relieve the symptoms of overactive bladder and stress incontinence in postmenopausal women with prior hysterectomy. In addition, vaginal preparations are as effective as systemic therapy at the lower serum level of E2.

Sonographic appearance of Mycobacterium pyometra mimicking carcinoma of uterine corpus

Mycobacterium pyometra is extremely rare, and only 12 cases have so far been reported in the English literature (1–4). We report a case of Mycobacterium pyometra in an 84-year-old woman presenting with bloodstained vaginal discharge. Preoperative transvaginal ultrasound scan showed an intrauterine echogenic shadow, the appearance of which mimics carcinoma of uterine corpus. An 84-year-old woman was admitted because of bloodstained vaginal discharge. She suffered from diabetes, hypertension, dementia and stroke. There was no known history of pulmonary tuberculosis or tuberculosis infection of other organs. Pelvic examination revealed foul-smelling bloodstained discharge in the vagina. The uterus was of normal size and there was no adnexal mass. There was no tenderness. She was afebrile and her white cell count was 8.3 × 109/L. Transvaginal ultrasound scan showed fluid collection inside the uterine cavity and there was a 12.5 × 9.4 mm intrauterine echogenic shadow (Fig. 1). The provisional diagnosis was pyometra with suspected carcinoma of the uterine corpus. Transvaginal ultrasound image showing intrauterine fluid collection and an echogenic shadow. She underwent cervical dilatation under general anesthesia and a moderate amount of pus was drained upon dilatation. Hysteroscopy was performed using normal saline as the distending medium. The endometrium appeared inflamed but was smooth with no evidence of malignancy or other intrauterine growth. The cervical canal was normal. Uterine curettage was performed. She made a good recovery and was discharged two days after the procedure. Histological examination of the uterine curettage revealed endometrium with granulatomatous inflammation. There was no evidence of malignancy. Acid-fast bacilli were identified by Ziehl–Neelsen stain. Fungal stain was negative. A chest X-ray did not reveal any evidence of past tuberculosis infection. She was treated with a course of antituberculosis therapy that included isoniazid, rifampicin, ethambutol and pyrazinamide. Pyometra is an uncommon gynecologic condition that occurs mainly in postmenopausal women. The main risks of pyometra are its association with genital tract malignancy and spontaneous perforation of the uterus (5). The most common bacteria isolated are Escherichia coli and Bacteroides fragilis (6). Mycobacterium infection of the female genital tract mainly occurs in premenopausal women. Mycobacterium infection manifest as pyometra in postmenopausal women is extremely rare, with only 12 cases having been reported in the English literature so far (1–4). In the present case, the diagnosis of pyometra was made base on the clinical symptom of foul-smelling vaginal discharge and sonographic appearance of intrauterine fluid collection. In addition, there was an intrauterine echogenic shadow with features suggestive of endometrial carcinoma (7). The echogenic intrauterine shadow probably represented calcified tissue such as that seen in mycobacterium infection of the lung. The appropriate management of patients with suspected pyometra should comprise cervical dilatation to drain the pus, together with antibiotics. Assessment of the endometrial cavity should be deferred until the acute inflammation has subsided. Performing hysteroscopy in the presence of pyometra is potentially dangerous and should be contraindicated (8). This is because the infected material inside the uterine cavity may disseminate into the peritoneal cavity via the fallopian tube during hysteroscopy (9), resulting in peritonitis and septicemia. In addition, hysteroscopic examination of the endometrial cavity may be difficult in the presence of acute inflammation. The absence of complication in this patient may be related to the possible tubal blockage secondary to the mycobacterium infection, thus preventing the intraperitoneal spread of the infected materials. It is important to make the diagnosis of Mycobacterium pyometra so that antituberculous therapy can be given to cure the infection and to prevent recurrence and spread of disease to other organs. Mycobacterium infection is very prevalent in our community (10). There are also data to suggest that the incidence of mycobacterium infection of the genital tract in postmenopausal women is rising (11). Hence gynecologists may encounter more cases of Mycobacterium pyometra in the future. Although routine culture of uterine curettage with Lowenstein–Jensen medium in patients with pyometra is probably not justified, a careful histologic examination of the uterine curettage would be valuable and the presence of granulatomatous inflammation may suggest Mycobacterium pyometra. Clinicians and pathologists should be aware of this condition in order to avoid delay in diagnosis and appropriate therapy.

Long term effects of tibolone on the genital tract in postmenopausal women.

To assess the effects of six years tibolone therapy on the genital tract in postmenopausal women against matched voluntary controls. Prospective, non-randomised, open label study of the efficacy of tibolone. Symptoms were assessed by questionnaires every six months. Assessment of genital tract cellular activity comprised annual vaginal smear and endometrial biopsy/smear in the tibolone group (n = 58) and vaginal smear alone in the control group (n = 55). As a recent protocol addition, transvaginal ultrasound assessment of endometrial thickness was performed in all women who gave consent. Endometrial biopsy was performed in control women if the endometrial thickness was > 5 mm. Karyopyknotic index and maturation index were calculated from the vaginal smears. The rate of amenorrhoea between six months and six years treatment was 90% in the tibolone group compared with 91% in the controls (P was not significant). There was improvement in reported vaginal symptomatology in the treatment group but not in the controls. Median endometrial thickness increased slightly in the tibolone treated group (3.2 mm tibolone vs 2.5 mm control; P < 0.05). There were no cases of cytologically proven endometrial stimulation in asymptomatic women in either group. Both vaginal karyopyknotic index and maturation index increased significantly in the tibolone treated group over six years, but not in the control group. Tibolone is effective at maintaining an inactive endometrium while providing oestrogenisation of the lower genital tract over a six year period.

92167189 Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women

92167189 Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women

The menopause, urinary incontinence and other symptoms of the genito-urinary tract

In a study on incontinence and other symptoms of the genito-urinary tract in postmenopausal women covering their prevalence, consequences and predisposing factors, the prevalence of incontinence was found to be 26.4%. Daily incontinence was present in postmenopausal women more than twice as often as before the menopause ( P < 0.05). The frequency of medical consultation for such incontinence was low; only 26.1% of the postmenopausal women had ever seen their doctor about it. Urgency, nocturia and dyspareunia were more prevalent in postmenopausal women, while vaginal itching and discharge were more frequent in premenopausal women ( P < 0.05). The prevalence of incontinence and the other genito-urinary symptoms was higher after surgical than after natural menopause. Multivariate analysis showed the menopause to be the only factor that contributed significantly to the onset of incontinence ( P < 0.001).

Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women.

We investigated 80 postmenopausal women, 48 of whom (60%) agreed to undergo long-term treatment with estriol suppositories. All had symptoms of vaginal atrophy and urinary incontinence. Endometrial samples were taken after 8-10 years of therapy. Estriol had induced slight proliferative changes in the endometrium in 7 of 48 patients studied by endometrial sampling. 75% of the women reported significant subjective improvement of stress incontinence. Estriol supplementation did not produce any significant change in urethral pressure, functional length, or cystometric parameters. However, a significant increase in pressure transmission ratio to the proximal urethra was noted after vaginal medication with estriol. Replacement therapy in post-menopausal women must take into account the patients perception of risks and benefits. The risk of estriol treatment is insignificant.

Histomorphometric study of the lower urogenital tract in pre- and post-menopausal women : Cytometry 1990 11/6 (700–707)

In this study 22 histomorphometric parameters were used to quantify the histologic changes in the vagina, trigone of the bladder, and the proximal and distal urethra of 37 women aged between 18 and 82 years. The results of this quantitative study revealed a hormonally induced, age-independent atrophy of smooth muscle in the lamina propria of the mucosa and the longitudinal part of the muscular layer in the aforementioned anatomical sites in post-menopausal women. In the lamina propria of the mucosa of the lower urogenital tract in post-menopausal women hormonally induced quantitative changes of blood vessels were not observed. Senile atrophy of smooth muscles was only observed in the deeper part of the muscular layer of the vagina and the trigone of the urinary bladder and was less prominent than the hormonally induced smooth muscle atrophy.

Histomorphometric study of the lower urogenital tract in pre‐ and post‐menopausal women

In this study 22 histomorphometric parameters were used to quantify the histologic changes in the vagina, trigone of the bladder, and the proximal and distal urethra of 37 women aged between 18 and 82 years. The results of this quantitative study revealed a hormonally induced, age-independent atrophy of smooth muscle in the lamina propria of the mucosa and the longitudinal part of the muscular layer in the aforementioned anatomical sites in post-menopausal women. In the lamina propria of the mucosa of the lower urogenital tract in post-menopausal women hormonally induced quantitative changes of blood vessels were not observed. Senile atrophy of smooth muscles was only observed in the deeper part of the muscular layer of the vagina and the trigone of the urinary bladder and was less prominent than the hormonally induced smooth muscle atrophy.