Changes in ultrasound morphology of the uterus and ovaries during the menopausal transition and early postmenopause: a 4-year longitudinal study

Aging conundrum: A perspective for ovarian aging

Progressive loss of physiological integrity and accumulation of degenerative changes leading to functional impairment and increased susceptibility to diseases are the main features of aging. The ovary, the key organ that maintains female reproductive and endocrine function, enters aging earlier and faster than other organs and has attracted extensive attention from society. Ovarian aging is mainly characterized by the progressive decline in the number and quality of oocytes, the regulatory mechanisms of which have yet to be systematically elucidated. This review discusses the hallmarks of aging to further highlight the main characteristics of ovarian aging and attempt to explore its clinical symptoms and underlying mechanisms. Finally, the intervention strategies related to aging are elaborated, especially the potential role of stem cells and cryopreservation of embryos, oocytes, or ovarian tissue in the delay of ovarian aging.

Endocrine Disorders and Genital Infections Impair Gynecological Health in APECED (APS-1)

Objective

In autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) defects in the autoimmune regulator gene lead to impaired immunotolerance. We explored the effects of immunodeficiency and endocrinopathies on gynecologic health in patients with APECED.

Design

Cross-sectional cohort study combined with longitudinal follow-up data.

Methods

We carried out a gynecologic evaluation, pelvic ultrasound, and laboratory and microbiologic assessment in 19 women with APECED. Retrospective data were collected from previous study visits and hospital records.

Results

The study subjects' median age was 42.6 years (range, 16.7-65.5). Sixteen patients (84%) had premature ovarian insufficiency, diagnosed at the median age of 16.5 years; 75% of them used currently either combined contraception or hormonal replacement therapy. In 76% of women, the morphology and size of the uterus were determined normal for age, menopausal status, and current hormonal therapy. Fifteen patients (79%) had primary adrenal insufficiency; three of them used dehydroepiandrosterone substitution. All androgen concentrations were under the detection limit in 11 patients (58%). Genital infections were detected in nine patients (47%); most of them were asymptomatic. Gynecologic C. albicans infection was detected in four patients (21%); one of the strains was resistant to azoles. Five patients (26%) had human papillomavirus infection, three of which were high-risk subtypes. Cervical cell atypia was detected in one patient. No correlation between genital infections and anti-cytokine autoantibodies was found.

Conclusions

Ovarian and adrenal insufficiencies manifested with very low androgen levels in over half of the patients. Asymptomatic genital infections, but not cervical cell atypia, were common in female patients with APECED.

Intraovarian PRP Injection Improved Hot Flashes in a Woman With Very Low Ovarian Reserve

PRP, rich in growth factors and cytokines, has been gaining considerable attention as an adjunct therapy to fertility treatment for women with very low ovarian reserve and premature ovarian insufficiency. To date, most prior studies have focused on the effect of PRP on ovarian response pertaining to oocyte production and pregnancy outcome following assisted reproductive technology. This report presents a patient with very low ovarian reserve, with medical problems that preclude her from taking hormone replacement therapy, who presented for fertility treatment with PRP and then accidentally reported significant improvement of menopausal symptoms including her hot flashes for 14 weeks following PRP intra-ovarian injection. The purpose of this case report is to increase awareness of clinicians about the use of PRP as a potential alternative therapy for hot flashes in women who have contraindications for hormone replacement therapy.

Changes in ultrasound uterine morphology and endometrial thickness during ovarian aging and possible associated factors: findings from a prospective study

OBJECTIVE

The aim of the study was to provide reference values for sonographic measurements of uterine morphology, quantify changes in uterine morphology across the menopausal transition, and identify possible factors associated with sonographic findings in uterine morphology.

METHODS

This is a longitudinal cohort study conducted in middle-aged Chinese women. Using transvaginal ultrasound, we measured morphologic parameters of the uterus (volume and endometrial thickness) under standardized conditions every year for over a decade.

RESULTS

Uterine volume begins to decrease before the final menstrual period and declines rapidly thereafter. Compared with a baseline measurement taken in the year of the final menstrual period, uterine volume decreased by 20% and 35% at the first year and second year of postmenopause, respectively. The rate of decrease was slower in the third year. Compared with endometrial thickness in the year of the final menstrual period, the figures for 2 and 3 years before the final menstrual period were 5% and 10% higher, while they decreased by 9% and 18% at the first and second year after the final menstrual period. Similarly, the endometrial thickness became relatively stable 3 years after the final menstrual cycle. These observations were fairly consistent across all women without uterine fibroids. Endometrial thickness was significantly positively associated with body mass index (P = 0.049) after adjusting for time and menopausal stage.

CONCLUSIONS

The figures for uterine volume and endometrial thickness decrease around menopause using ultrasound measurments with large reductions in the first and second year after the final menstrual period. A higher body mass index is associated with increased endometrial thickness.

Gynecological pelvic pain as emergency pathology

Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management.

Pain experience during saline-contrast sonohysterography differs between premenopausal and postmenopausal women

PURPOSE

To evaluate whether the pain experienced during and after Saline-contrast sonohysterography (SCSH) differs between premenopausal and postmenopausal women.

METHODS

Sonohysterography was performed on 133 consecutive women because of suspected endometrial pathology. Of these, 34 women were excluded for the following reasons: they had cervical stenosis; they did not complete or return a questionnaire; or tenaculum or cervical dilatators were used during the procedure. All women were asked to fill out a questionnaire to characterize their pain and mark their pain experience on a 100-mm pain visual analog scale.

RESULTS

Data from the 99 patients included were used for statistical analysis. It showed that sonohysterography was well tolerated overall: 41% of the women did not feel any pain. Postmenopausal women experienced pain during SCSH more often than premenopausal women did: 71% (17/24) compared with 32% (24/75) experienced pain; p < 0.002; the median tolerance on the 100-mm visual analog scale was 43. The character of the pain differed between the two groups of women: postmenopausal women more often felt sharp pain (42%; 10/24), whereas premenopausal women more often felt gnawing and/or crampy pain (21%; 16/75) (p < 0.13).

CONCLUSIONS

Postmenopausal women were twice as likely to experience pain during SCSH as premenopausal women were. Therefore, postmenopausal women might benefit from analgesia induced prior to the procedure. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:267-271, 2016.

Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement

The Society of Radiologists in Ultrasound convened a panel of specialists from gynecology, radiology, and pathology to arrive at a consensus regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women. The panel met in Chicago, Ill, on October 27-28, 2009, and drafted this consensus statement. The recommendations in this statement are based on analysis of current literature and common practice strategies, and are thought to represent a reasonable approach to asymptomatic ovarian and other adnexal cysts imaged at ultrasonography.