Women In Perimenopausal Period Research Articles

COMPARATIVE STUDY OF TRANSVAGINAL SONOGRAPHY AND HYSTEROSCOPY FOR THE DETECTION OF PATHOLOGICAL ENDOMETRIAL LESIONS IN WOMEN WITH PERIMENOPAUSAL BLEEDING

Background: Abnormal uterine bleeding is a common gynecological presentation in outpatient clinic, but is often complex and difficult to diagnose. Abnormal uterine bleeding (AUB) is the main reason in women to refer to gynecologists and accounts for two thirds of all hysterectomies. Objectives: The aim of this study was to compare the diagnostic accuracy of two dimensional transvaginal ultrasound and hysteroscopy referring to histopathology in evaluation of uterine cavity lesions in perimenopausal women with abnormal uterine bleeding. Subjects and methods: This was a prospective cohort study. The study was carriedout at Al Agouza Police Hospital, on fifty women in peri-menopausal period, The study was conducted the period from April 2019 till December 2019. All participants received comprehensive information regarding objective and the expected benefit of the study. All ethical considerations were taken throughout the whole work. Results: The results of the study revealed that sensitivity 2D TVS in detection of endometrial hyperplasia was 100%, specificity was 88.7%, PPV was 73.30%, NPV was 100%, and accuracy was 94% with area under ROC curve 0.99, and sensitivity of hystroscope in detection of endometrial polyp was 36.3%, specificity was 100%, PPV was 100%, NPV was 84.7%, accuracy was 86% with area under ROC curve 0.45. Conclusion: Transvaginal sonography has a moderate diagnostic accuracy in detecting endometrial hyperplasia and other intrauterine pathology. It is safe, acceptable and easily available in most secondary and tertiary care setting and is noninvasive. It should be continued as 1st line diagnostic tool in patients with abnormal uterine bleeding in perimenopausal women.

Peculiarities of the psycho-emotional state of patients with endometrial pathology

The objective: a determination of anxiety and depression levels in patients in perimenopausal period with hyperplastic processes of the endometrium and myometrium.Materials and methods. 150 patients in the perimenopausal period were examined. The main group included 100 persons with hyperplastic process, the control group – 50 healthy women in perimenopausal period. We used the PHQ-2 and PHQ-9 questionnaires to study the level of anxiety and depression. In order to objectively assess the degree of anxiety and depressive symptoms, a questionnaire was conducted according to the Hospital Scale of Anxiety and Depression (HADS).Results. The analysis of data on the frequency of major types of extragenital pathology in the examined patients demonstrated that in the structure of extragenital pathology the following diseases dominated: varicose veins of the lower extremities – 61.0±4.9 %, arterial hypertension of 2–3 stages – 46.0±4.98 %; coronary heart disease, stenocardia – 8.0±2.7 %; obesity – 43.0±4.95 %, liver, gallbladder and pancreas pathologies – 42.0±4.93 %. In 78.0 % of patients, somatic pathology was represented by two or more diagnoses. The results of the survey demonstrated that in the main group 23.0 % of women had mild «subclinical» depression; 19.0 % – moderate, and 12.0 % – moderate depression. The women in the main group had the following psychoemotional disorders: the feeling of fatigue and exhaustion – 64.0±4.8 %, sleep disorders – 64.0±4.8 %, appetite problems – 46.0±4.98 %, depressed mood and low interest in ordinary affairs – 54.0±4.98 %, the difficulty concentrating – 33.0±4.7%, hypodynamia – 26.0±4.4 %. Four percent of patients intended to do something with themselves. Analysis of the results obtained using the HADS scale revealed that both anxiety and depressive symptoms in patients in the main group were more pronounced than in the control women.Conclusion. The identified psycho-emotional disorders are the result of adverse effects of somatic diseases and gynecological pathology. The results of the study indicate the need to correct psycho-emotional disorders and take them into account when choosing a method of treatment for such patients.

Specifics of prescribing menopausal hormonal therapy in patients with the anamnestic endometriosis

Administration of menopausal hormone therapy (MHT) in patients with genital endometriosis (GE) is a controversial issue requiring a patient-personalized approach. Current principles for MHT selection and prescription in patients with anamnestic endometriosis are presented, which are based on the guidelines of the International Menopause Society (IMS), The European Menopause and Andropause Society, local and foreign publications retrieved from electronic data bases PubMed, Cyberleninka. The data of our study on observing 724 patients with GE treated with diverse MHT types were presented and analyzed (428 women in perimenopausal period, 296 in postmenopausal period). Patients with endometriosis in perimenopausal and postmenopausal periods showed more prominent manifestations of climacteric and post-ovariectomy syndromes, as well as high risk of reduced bone mineral density (BMD) due to repeated surgery on the ovaries and preceding long-term “antiestrogen therapy”. Custom-compounded MHT based on components combinations, dosage and administration route provides a significantly improved quality of life for patients with endometriosis, prevents loss of BMD and reduces risk of cardiovascular diseases. Using low and ultra-low dose estrogen bioidentical to natural substances in this patient group minimizes a risk of disease recurrence.

MODERN VIEW ON THE PROBLEM OF DIAGNOSIS AND TREATMENT OF THE GENITOURINARY SYNDROME

The article highlights the current approach on the problem of genitourinary syndrome (GS) diagnosis and treatment in the perimenopausal period patients. Recent studies indicate a significant role of undifferentiated connective tissue dysplasia (UDCTD), which is manifested by a violation of the collagen and the main matrix of connective tissue structure (CT). Nowadays, there is no unified approach on the GS diagnosis and treatment in perimenopausal period women, which determined the purpose and objectives of our research.The purpose of the research: pathogenetically justify CO2 -laser application in the complex treatment of genitourinary syndrome in perimenopausal period patients.Materials and methods of research. We examined 132 women aged 45-55 years with clinical manifestations of GS, who, depending on the proposed therapy, were divided into the main group – 56 women and the comparison group – 76 women. In addition to the General clinical examination patients of the both groups were examined for the contents of CT markers of synthesis (Total P1 NP, P3 NP, Total) and resorption (deoxypiridinolin Pyriliks – D). In order to determine the severity of GS symptoms and to identify sexual dysfunction index we used PFDI-20 and FSFI questionnaires. Women of the main group received therapy that involved the application of 4 sessions of CO2 - laser at an interval of 30-45 days in combination with local application of estradiol-based cream for 7 months. Women of the comparison group received only therapy involving local application of estradiol-based cream for 7 months.The results of the study and their discussion. The average age of patients in the examined groups was 47,3±2,4 years. For women with GS manifestations, the average value of the type I collagen synthesis marker was decreased by 58,5% (the main group) and by 65,2% (the comparison group) from the physiological norm. At the same time, the average value of the marker of III type collagen synthesis in women of the study groups was increased by 52,2% (the main group) and by 36,0% (the comparison group) from the physiological norm. The average value of the connective tissue resorption marker Pyriliks-D in women of the main and the comparison groups, did not differ significantly. According to the PFDI-20 questionnaire, there was a significant decrease in the median score from 55 to 18 in women of the main group during 8 months of treatment. According to FSFI questionnaire, a significant increase in the index of sexual function in women of the main group (the median score before treatment was 25, after treatment – 46; p<0,05) was noticed. Determination of the average Total P1 NP marker concentration in the dynamics of treatment after 4 months demonstrated a significant increase by 72,8% in women who received CO2 -laser therapy in combination with local estradiol treatment. The average Total P3 NP marker concentration in women who received CO2 -laser therapy in combination with local treatment significantly decreased compared to the base value by 62,4%. Against the background of CO2 -laser therapy in combination with local estradiol treatment in women of the main group and the comparison group, there was no significant difference in the indicators of the connective tissue resorption marker Pyriliks-D.Conclusions. The inclusion of CO2 -laser therapy to the complex treatment of genitourinary syndrome can significantly reduce the manifestations of genitourinary disorders, which is confirmed by a significant decrease in the median score from 55 to 18 in women of the main group according to the results of PFDI-20 questionnaire (p<0,05). The positive therapeutic result of the CO2 -laser, from our point of view, occurs due to the effect on the etiopathogenetic mechanisms of the syndrome complex – an age-related imbalance of markers of synthesis and resorption of connective tissue. An increase in the concentration of I type collagen synthesis marker contributed to a synergistic decrease in the concentration of III type Total P3 NP marker in women of the main group and stabilization of its value in the dynamics of treatment. From our point of view, a study of the hormonal status of women with genitourinary syndrome to improve the tactics of etiotropic treatment and prevention of relapse, offers the greatest promise.

Association Between Self-Reported Food Preferences and Psychological Well-Being During Perimenopausal Period Among Chinese Women.

ObjectiveThe purpose of this study was sought to assess the association between food preferences and Psychological well-being (PWB) in Chinese women undergoing perimenopause and whether the association is different between rural and urban areas.MethodsThis is a longitudinal study of 929 women in perimenopausal period participating in the China Health and Nutrition Survey (CHNS) during 2009 and 2011. Preference for five kinds of food were assessed in face-to-face interviews and the PWB was measured by scoring three self-reported questions with a total score of 15. Multilevel mixed-effects linear regressions were used to estimate the longitudinal association between food preference and PWB scores. In fully adjusted models, dislike for fruits and like for sweetened beverages had regression coefficient (95% CI) for the PWB score of −1.26, (−2.21–0.321) and 0.66 (0.20–1.11), respectively. The above associations were only found among participants in urban areas, with corresponding regression coefficients of −2.61(95% CI = −4.83, −0.39) for dislike fruit and 1.02(95% CI = 0.09, 1.95) for like sweetened beverages.ConclusionIn conclusion, PWB score was negatively associated with the dislike for fruit but positively associated with the preference for sweetened beverages, especially among participants from urban areas. The longitudinal data indicate that the PWB score of perimenopausal women might be improved by increasing the intake of fruit. Given the adverse effects of sweetened beverages, more research was need between PWB and the sweetened beverages.

The effect of medial longitudinal arch height and medial longitudinal arch-support insoles on postural balance in perimenopausal women

Background/aim Changes in balance and postural control have been reported during the perimenopausal period. We investigated the effect of medial longitudinal arch height and medial arch support insoles on postural sway and balance in middle-aged perimenopausal women. Materials and methods 29 women with normal arches and 29 women with low arches were included in the study. The foot arches of the participants were determined using the arch height index. The static balance index (SBI) measured by Kinesthetic Ability Trainer 3000 and functional reach test were used to evaluate postural balance. Measurements were obtained from all participants with and without medial arch support insoles. Results The SBI-total scores without the insoles were found to be significantly higher in the lower arch group than in the normal arch group. SBI-total, SBI-anteroposterior, and SBI-mediolateral scores significantly improved in the low arch group in the presence of insoles, whereas the usage of insoles resulted in no difference in the normal arch group. In the presence of insoles, the reach distances to left and right sides increased in both groups, while the forward functional reach distances decreased. Conclusion Medial longitudinal arch height and medial arch support insoles affect the balance parameters in perimenopausal women.

The quality of sexual life of women with menopause

Abstract Introduction. The approach to women, menopause and its consequences have changed – the perimenopausal period has stopped being treated as the end of femininity, career and sexual activity. However, symptoms coexisting with menopause influence health and female’s life quality. A decrease of sexual activity is observed as one of the most frequent symptoms, and it is induced by physiological and psychological factors. Aim. Assessment of sexual life quality among women with menopause and defining the main factors influencing this area. Material and methods. Thanks to an original questionnaire composed of 28 questions, single and multiple choice, 200 women in the perimenopausal period were examined between July and September 2017. Results. The number of 200 women in perimenopausal period were chosen accidentally. The questionnaire was filled out via the Internet. Statistically significant factors occurred to be: level of education – higher education is connected with more frequent sexual activity, professional activity – 81% of working women remain sexually active while 73% of non-working females deny being sexually active. Hormonal Replacement Therapy does not influence the frequency of sexual contact but it alleviates vagina dryness, and provides a higher level of agitation during cohabitation. Conclusion. Higher educated and professionally active women declare better life satisfaction and see themselves as attractive. However, marital status remains meaningless as well as Hormonal Replacement Therapy. It was observed that men from rural areas and towns initiate sexual contact more often.

Predictors of the quality of life of women in peri-menopausal period.

The peri-menopausal period is the time of many biological, psychological and social changes. The quality of life of women in this period may be conditioned by many factors, and analysis of these factors may indicate the optimum directions of prophylactic and educational actions. Analysis of selected predictive factors of the quality of life of women in the peri-menopausal period. The study covered 268 peri-menopausal women. The qualification criteria were: age 45-55, lack of mental disorders and diseases requiring hospitalization during the period of study. The study was conducted using standardized instruments: Women's Health Questionnaire - WHQ, Beck Depression Inventory (BDI) and an author-constructed questionnaire. The presented study of the quality of life showed that the women examined felt physically unattractive, lacking the full joy of life, and frequently experienced somatic complaints. Nevertheless, the respondents enjoyed life, had no constant feeling of anxiety and concern. Multi-factor analysis showed that the quality of life in the group of women in the study was affected by the following factors: level of depression, self-reported state of health, occurrence of menopausal symptoms, education level, and marital status. The quality of life of the peri-menopausal women examined was the highest with respect to depressive mood (DEP) and anxiety/depressed mood (ANX), while it was the lowest with respect to the sense of attractiveness (ATT), and somatic symptoms (SOM). In addition, in the group of women in peri-menopausal period the quality of life was conditioned: level of depression, self-reported state of health, occurrence of menopausal symptoms, education level, and marital status.

Оптимизация лечебной тактики и профилактика рецидивов бактериального вагиноза и урогенитальных расстройств у женщин в перименопаузальный период

Оптимизация лечебной тактики и профилактика рецидивов бактериального вагиноза и урогенитальных расстройств у женщин в перименопаузальный период

Modern approaches to contraception for women in perimenopausal period (literature review)

Modern approaches to contraception for women in perimenopausal period (literature review)

Цереброваскулярные расстройства у женщин в перименопаузальный период

Цереброваскулярные расстройства у женщин в перименопаузальный период

Depantol drug in the treatment of atrophic colpitis in women in perimenopausal period

In the treatment of aging atrophic vaginitis is widely used hormone replacement therapy. However, from 30% to 67% of women in the menopausal and perimenopausal period not using hormone replacement therapy.The action of non-hormonal drugs used in the treatment of atrophic vaginitis, should be aimed at maintaining the level of lactobacillus and improve the regenerative capacity of the vaginal epithelium. Such properties have a drug depantol. This drug has not only the antibacterial activity but also stimulates the regeneration of the mucous membranes, normalizes cell metabolism, accelerates mitosis, increases the strength of collagen fibers.A study to assess the efficacy of the depantol in atrophic colpitis in perimenopausal women was performed.There were observed 52 patients with a diagnosis atrophic colpitis. All women were perimenopausal age surveyed ranged from 44 to 52 years old. Depantol prescribed 1 suppository 2 times a day for 20 days. The treatment was repeated after 2 weeks: twice in the same regime for 10 days. The efficacy of the therapy was evaluated according colpocytologic, microbiological research and determines the pH level.Dryness of the vagina after treatment was observed in 19.2% of women, whereas before the treatment – in 84.6%. Dyspareunia after treatment observed rarely (5.2%), and its frequency prior to depantol use was 69.2%. Contact spotting after treatment were also absent. Majority of patients had reducing the amount of vaginal discharge. The index of maturity vaginal epithelium after therapy rose to 75–80 points in comparison with the 65–70 points before treatment.Thus, the study showed that the drug depantol in perimenopausal women with atrophic colpitis provides a positive effect and significant antiseptic regenerative activity on vaginal epithelium, which allows recommending its wider use in clinical practice.

The Role of Cosmetic Gynecology Treatments in Women in Perimenopausal Period

The conditions in which we live nowadays contribute to exposure of our bodies to harmful factors such as UV radiation, pollution, smoking, poor eating habits, low physical activity, stress, which thereafter lead to the acceleration of skin aging process. In women, the process is additionally dependent on the menopause, as a result of the disappearance of hormones, the process is faster. Physiological changes that occur in women’s body during perimenopausal and menopausal period affect their sexual function: pain during an intercourse, decreased libido, lack of agitation. Deficiency of hormones, besides skin changes, leads to vaginal dryness, accompanied by inflammation, often correlated with discharge and burning. As a result of the loss of hyaluronic acid labia become slack and less moisturized. In addition, there has been observed: a gradual loss of pigment and hair, involution of the clitoris, and involution and sticking of labia minora, lipoatrophy of labia majora with subsequent reduction in their volume and thinning the lining around the vaginal opening. This article presents processes of skin aging. It describes mechanisms of intrinsic and extrinsic aging. It also presents the mechanisms of accelerated aging in women in perimenopausal period—accelerated skin aging dependent on hormonal factors associated with the loss of ovarian function. The research presents how the hormonal loss influences woman’s body, her genitals—its functionality and aesthetic look. It also shows how using filler treatments in gynecology can restore the aesthetic appearance of female genital and improve their functionality.