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Makary MS, Zane K, Hwang GL, Kim CY, Ahmed O, Knavel Koepsel EM, Monroe EJ, Scheidt MJ, Smolock AR, Stewart EA, Wasnik AP, Pinchot JW. ACR Appropriateness Criteria® Management of Uterine Fibroids: 2023 Update. J Am Coll Radiol 2024; 21:S203-S218. [PMID: 38823944 DOI: 10.1016/j.jacr.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Uterine fibroids are the most common benign tumor in women of reproductive age and can present with symptoms including bleeding, bulk related symptoms, and infertility. Several treatment options are available for the management of uterine fibroids, including medical management, minimally invasive therapies such as uterine artery embolization and MR-guided focused ultrasound ablation, and surgical interventions ranging from laparoscopic myomectomy to open hysterectomy. Given this wide range of therapeutic interventions, it is important to understand the data supporting these interventions and to be able to apply it in different clinical settings. This document provides a summary of recent trials supporting various therapies for uterine fibroids, including recent evidence for MR-guided focused ultrasound ablation and a detailed discussion of fertility outcomes in myomectomy and uterine fibroid embolization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Mina S Makary
- Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Kylie Zane
- Research Author, University of Chicago Hospitals, Chicago, Illinois
| | - Gloria L Hwang
- Stanford University School of Medicine, Stanford, California
| | - Charles Y Kim
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elizabeth A Stewart
- Mayo Clinic and Mayo Clinic Alix School of Medicine; American College of Obstetricians and Gynecologists
| | | | - Jason W Pinchot
- Specialty Chair, University of Wisconsin, Madison, Wisconsin
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Chen CC, Peng IT, Wu MP. The Pros and Cons of Hystero-preservation on Pelvic Reconstructive Surgery. Gynecol Minim Invasive Ther 2023; 12:203-210. [PMID: 38034113 PMCID: PMC10683956 DOI: 10.4103/gmit.gmit_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 12/02/2023] Open
Abstract
In the "boat at the dock" theory, pelvic organ prolapse (POP) may happen when the ropes (uterine supportive ligaments) break and/or the water level drops (pelvic floor muscles). Thus, it causes the boat (uterus and other pelvic organs) to slip from normal position and protrude out of the vagina. Surgical intervention with or without hysterectomy (hystero-preservation) is the most effective treatment for POP. Both hysterectomy and hystero-preservation for POP had a high anatomic and clinical cure rate. There is an increasing trend of hystero-preservation for POP during the past decades. The choices of either hysterectomy or hystero-preservation depend on the surgical factors, psychosocial factors, self-esteem and sexuality factors, and surgeon factors. Pelvic reconstructive surgery, either hysterectomy or hystero-preservation, can be performed via different approaches, including abdominal, laparoscopic, and vaginal routes, with native tissue or with mesh. This review will elucidate their related pros and cons, with further discussion and comparison of hystero-preservation via different routes.
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Affiliation(s)
- Chin-Chiu Chen
- Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Ting Peng
- Division of Obstetrics, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Benoit L, Pajot C, Koual M, Nguyen-Xuan HT, Bentivegna E, Bats AS, Azaïs H. Could uterine conservation be an option in presumed early-stage epithelial ovarian cancer? Arch Gynecol Obstet 2023; 308:953-960. [PMID: 37031304 DOI: 10.1007/s00404-023-07016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/18/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE In early-stage epithelial ovarian cancer (EOC), patients usually undergo a hysterectomy. However, in fertility sparing surgery (FSS), carefully selected patients could conserve their uterus. The aim of our study was to evaluate the incidence and epidemiologic characteristics associated with uterine involvement in patients with early-stage EOC, outside of FSS. METHODS We conducted a retrospective, monocentric, study from 2003 to 2019 and included all patients with a presumed early-stage EOC (FIGO I) who underwent a hysterectomy. The incidence of uterine involvement, predictive factors of uterine involvement, and the impact of uterine involvement on survival (recurrence-free survival and overall survival) were analyzed. RESULTS Eighty-five patients had an early-stage EOC. Of these, six had an uterine involvement (7%). The populations of patients with or without uterine involvement did not differ except for CA 125 at diagnosis (136 ± 138 versus 356 ± 723, p = 0.04, respectively). No patient or tumor characteristics were predictive of uterine involvement. Uterine involvement was not associated with recurrence-free survival (HR = 1.26, IC95% 0.36-4.4, p = 0.72) or overall survival (HR = 0.7, IC95% 0.1-6.1, p = 0.77). CONCLUSION Due to the small size of our sample, no conclusion can be drawn, yet it could be hypothesized that, for selected patients, a systematic hysterectomy could be discussed, notably in restaging surgery.
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Affiliation(s)
- Louise Benoit
- Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, APHP, Paris, France.
- Faculté de médecine Paris-Descartes, Université Paris Cité, Paris, France.
- INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saints Pères, Paris, France.
- Gynecologic and Breast Oncologic Surgery Department, European Georges Pompidou Hospital, 20 Rue Leblanc, 75015, Paris, France.
| | - Camille Pajot
- Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Meriem Koual
- Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, APHP, Paris, France
- Faculté de médecine Paris-Descartes, Université Paris Cité, Paris, France
- INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saints Pères, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Enrica Bentivegna
- Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Anne-Sophie Bats
- Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, APHP, Paris, France
- Faculté de médecine Paris-Descartes, Université Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Equipe labellisée Ligue Nationale contre le cancer, Paris, France
| | - Henri Azaïs
- Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, APHP, Paris, France
- Faculté de médecine Paris-Descartes, Université Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, INSERM, CNRS, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Equipe labellisée Ligue Nationale contre le cancer, Paris, France
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Yuan Y, Tan W, Huang Y, Huang H, Li Y, Gou Y, Zeng S, Hu Z. Association between hysterectomy and kidney stone disease: results from the National Health and Nutrition Examination Survey 2007-2018 and Mendelian randomization analysis. World J Urol 2023; 41:2133-2139. [PMID: 37314571 DOI: 10.1007/s00345-023-04465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE Hysterectomy is one of the most common types of gynecological operations and it is associated with numerous postoperative complications. Few studies have reported a definitive association between hysterectomy and kidney stone disease (KSD). This study aimed to explore whether hysterectomy increases the risk of KSD. METHODS This is a cross-sectional study that used six continuous cycles of data obtained from the National Health and Nutrition Examination Survey from 2007 to 2018. The correlations between hysterectomy or age at hysterectomy and the prevalence of KSD were assessed using weighted multivariable-adjusted logistic regression. Further, five methods of two-sample Mendelian randomization (MR) were applied to decrease bias and infer causality in the observational study. RESULTS After adjusting for potential confounders, hysterectomy (OR: 1.37, 95% CI 1.04-1.81) was found to be positively associated with the prevalence of KSD, whereas age at hysterectomy was found to be negatively associated with the prevalence of KSD (OR: 0.96, 95% CI: 0.94-0.98). In the inverse-variance weighted method, MR analyses suggested that genetically predicted hysterectomy is causally associated with a higher risk of KSD (OR: 11.961, 95% CI 1.12-1.28E2). CONCLUSIONS Hysterectomy could increase the risk of KSD. Younger age at hysterectomy is associated with a higher risk of KSD. Further prospective cohort studies with larger sample sizes and longer follow-up times are needed.
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Affiliation(s)
- Ye Yuan
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Wei Tan
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yinchao Huang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Hao Huang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yadong Li
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yuanqing Gou
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Shengjie Zeng
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Zili Hu
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Yang Y, Zhang X, Fan Y, Zhang J, Chen B, Sun X, Zhao X. Correlation analysis of hysterectomy and ovarian preservation with depression. Sci Rep 2023; 13:9744. [PMID: 37328539 PMCID: PMC10275915 DOI: 10.1038/s41598-023-36838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/11/2023] [Indexed: 06/18/2023] Open
Abstract
The relationship between hysterectomy and ovarian preservation and depression is controversial. This study aimed to determine the association of hysterectomy and ovarian preservation with depression using National Health and Nutrition Examination Survey. To assess the association between hysterectomy with or without ovariectomy and depression, we used 3 methods. Method 1: propensity score model (PSM) was established. Method 2 was logistics regression analysis of hysterectomy and depression before and after PSM. Method 3 was a logistics regression analysis of the relationship between hysterectomy and different depressive symptoms. At the same time, in order to evaluate the association between hysterectomy with or without oophorectomy and depression, we explored the effect of four different surgical procedures on depression using logistic regression equations. We enrolled 12,097 women, of whom 2763 underwent hysterectomy, 34.455% were positive for depression. After weighting, 33.825% of the total sample had a PHQ ≥ 5. Finally, a total of 2778 women were successfully matched by propensity score, and 35.537% of them were positive for depression. The OR for PHQ ≥ 5 was 1.236 after crude adjustment of covariates and 1.234 after exact adjustment. This suggests that Hysterectomy is strongly associated with positive depression. Positive depression (PHQ ≥ 5) was associated with little interest, feeling down and trouble concentrating. It was not associated with trouble sleeping, feeling tired, poor appetite, feeling bad, slow moving or speaking, and suicidal thoughts. Oophorectomy-alone is not associated with depression. Hysterectomy-alone is a risk factor for depression, but Hysterectomy combined with Oophorectomy has a stronger correlation with depression than Hysterectomy-alone. Women who have had a Hysterectomy are at higher risk of depression than women who have not had a Hysterectomy, and this risk may be exacerbated if the uterus and ovaries are removed. When clinically appropriate, surgeons should try to preserve the patient's ovaries.
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Affiliation(s)
- Yunhong Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangqi Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yinuo Fan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahao Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingchun Chen
- Taihe Town Health Center, Baiyun District, Guangzhou, China
| | - Xiaofeng Sun
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xiaofeng Zhao
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Cecannecchia C, Cioffi F, Cioffi A. Overtreatment by hysterectomy for cervical intraepithelial neoplasia: Medico-legal aspects. Int J Reprod Biomed 2023; 21:521-522. [PMID: 37560065 PMCID: PMC10407918 DOI: 10.18502/ijrm.v21i6.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 08/11/2023] Open
Abstract
The article abstract is not available
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Affiliation(s)
- Camilla Cecannecchia
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Italy
| | - Fernanda Cioffi
- Fertilitas Day Surgery Reproductive Medicine, Salerno, Italy
| | - Andrea Cioffi
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Italy
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Rajkumari S, Chaudhary V, Kasaudhan S, Saraswathy KN. Incidence and determinants of hysterectomy among North Indian women: An 8-year follow-up study. Front Public Health 2022; 10:1065081. [PMID: 36589953 PMCID: PMC9800844 DOI: 10.3389/fpubh.2022.1065081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Despite indications of a rapid increase in the number of hysterectomies performed in India, very few studies have methodically investigated the rate and determinants of the incidence of hysterectomy. The present study aims to estimate the rate of incidence of hysterectomy and identify predictors/determinants of incident hysterectomy in a cohort of North Indian women. Methods In the present study, a cohort of 1,009 ever-married North Indian women (aged 30-75 years) was followed up after a median of 8.11 years. Those hysterectomized at the baseline (63) were excluded; and of the rest 946 participants, 702 (74.2%) could be successfully followed-up. During the baseline assessment, data about sociodemographic variables, reproductive history, menopausal status, physiological health, and selected blood biochemicals were collected. During the end-line assessment, data about sociodemographic variables, current menopausal status, and incident hysterectomy were recorded. Results The overall rate of incidence of hysterectomy was found to be 11.59 per 1,000 women-years, in the study population. Interestingly, the incidence rates were found to be similar among pre- and post-menopausal women. Further, while late age at menarche was found to be negatively associated with incident hysterectomy, folate repletion and high triglyceride (TG) at the baseline were found to be positively associated. Conclusions High rate of incident hysterectomy in the studied population points toward the huge burden of gynecological morbidity and the unavailability of non-invasive protocols. Such a situation warrants immediate policy intervention. Further, maintaining TG and folate within normal physiological ranges may be beneficial in gynecological ailments necessitating hysterectomy.
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Persistent Pelvic Pain in Patients With Endometriosis. Clin Obstet Gynecol 2022; 65:775-785. [PMID: 35467583 DOI: 10.1097/grf.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
As our understanding of chronic pain conditions, including endometriosis-related pain and chronic pelvic pain evolves, the evaluation and management of patients should reflect our increasing appreciation of the role of central sensitization, comorbid conditions and biopsychosocial factors on the pain experience and treatment outcomes. This review provides a systematic approach to persistent pain in patients with endometriosis. Expanding the evaluation and treatment of endometriosis-related pain by all health care providers could limit unnecessary surgical interventions and best meet our patient's needs.
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Kadour-Peero E, Dahan MH. Hysterectomy, a time to change the terminology. J Psychosom Obstet Gynaecol 2022; 43:601-602. [PMID: 35658805 DOI: 10.1080/0167482x.2022.2084377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Einav Kadour-Peero
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada
| | - Michael H Dahan
- MUHC Reproductive Center, McGill University, Montreal, QC, Canada
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Weng CS, Cope AG, Mara KC, Schoolmeester JK, Khan Z, Burnett TL. Association Between Laparoscopic Appearance of Superficial Endometriosis, Positive Histology, and Systemic Hormone Use. J Minim Invasive Gynecol 2022; 29:1339-1343. [PMID: 36154901 DOI: 10.1016/j.jmig.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To assess the association between laparoscopic appearance of superficial endometriosis lesions, histopathology, and systemic hormone use. DESIGN Retrospective study. SETTING Tertiary care academic medical center. PATIENTS We identified 266 women who underwent laparoscopic surgery at an endometriosis center with excision of lesions consistent with possible superficial endometriosis between September 2015 and November 2018. INTERVENTIONS Appearance of the peritoneal lesions was confirmed with review of surgical videos and correlated with each pathology specimen. Lesions were dichotomized on positive or negative pathology assessment. All pathology-positive lesions were further dichotomized by hormone use within 1 month of surgery. MEASUREMENTS AND MAIN RESULTS A total of 841 lesions were biopsied from included subjects during the study period. Of those, 251 biopsies were negative, and 590 were positive for endometriosis on pathology assessment. Lesions had significantly higher odds of positive histology when they were red (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.17-2.48), white (OR, 1.99; 95% CI, 1.47-2.70), blue/black (OR, 2.98; 95% CI, 2.00-4.44), or puckering (OR, 9.78; 95% CI, 2.46-38.91) in appearance. The following combined characteristics had significantly higher odds of positive histology: white and blue (OR, 5.98; 95% CI, 2.97-12.02), red and white (OR, 2.22; 95% CI, 1.38-3.56), red and blue (OR, 4.11; 95% CI, 1.83-9.24), and clear and white (OR, 8.77; 95% CI, 1.17-66.02). Among positive biopsies, those with hormone exposure were more likely to have clear lesions than those without hormone use (OR, 3.36; 95% CI, 1.54-7.34) and were 2.89 times more likely to have clear and white lesions (95% CI, 1.07-7.85). CONCLUSION Although lesions suspicious for endometriosis may have differing rates of positive pathology based on appearance, no lesion characteristic was able to exclude the possibility of endometriosis. In addition, hormone use may influence lesion appearance at the time of surgery, with clear lesions more prevalent. These data have implications for appropriate identification of endometriosis at the time of laparoscopy to ensure accurate diagnosis and complete treatment of disease.
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Affiliation(s)
- Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan (Dr. Weng)
| | - Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota (Dr. Cope)
| | - Kristin C Mara
- Department of Research Services, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - J Kenneth Schoolmeester
- Department of Laboratory Medicine and Pathology (Dr. Schoolmeester), Mayo Clinic, Rochester, Minnesota
| | - Zaraq Khan
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan (Dr. Weng)
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan (Dr. Weng).
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Abstract
Endometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus, which in many patients is associated with debilitating painful symptoms. Patients with endometriosis are also at greater risk of infertility, emergence of fatigue, multisite pain, and other comorbidities. Thus, endometriosis is best understood as a condition with variable presentation and effects at multiple life stages. A long diagnostic delay after symptom onset is common, and persistence and recurrence of symptoms despite treatment is common. This review discusses the potential genetic, hormonal, and immunologic factors that lead to endometriosis, with a focus on current diagnostic and management strategies for gynecologists, general practitioners, and clinicians specializing in conditions for which patients with endometriosis are at higher risk. It examines evidence supporting the different surgical, pharmacologic, and non-pharmacologic approaches to treating patients with endometriosis and presents an easy to adopt step-by-step management strategy. As endometriosis is a multisystem disease, patients with the condition should ideally be offered a personalized, multimodal, interdisciplinary treatment approach. A priority for future discovery is determining clinically informative sub-classifications of endometriosis that predict prognosis and enhance treatment prioritization.
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Affiliation(s)
- Andrew W Horne
- EXPPECT Edinburgh and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Stacey A Missmer
- Michigan State University, Grand Rapids, MI, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Ainsworth AJ, Sadecki E, Zhao Y, Weaver AL, Stewart EA. Women With a History of Primary Infertility and Increased Rates of Bilateral Oophorectomy. Obstet Gynecol 2022; 140:643-653. [PMID: 36075082 PMCID: PMC9669109 DOI: 10.1097/aog.0000000000004916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the association of primary infertility with subsequent bilateral oophorectomy and hysterectomy, using a population-based cohort of women with primary infertility and age-matched women in a referent group. METHODS The Rochester Epidemiology Project record-linkage system was used to assemble a population-based cohort of women with primary infertility diagnosed between 1980 and 1999 (index date). Women were age-matched (±1 year) 1:1 to women without a history of infertility or hysterectomy at the index date (referent group). Cox proportional hazards models were fit to compare long-term risks of bilateral oophorectomy and hysterectomy, respectively, between women with infertility and women in the referent group. RESULTS Among both groups of 1,001 women, the mean age at the index date was 29.2±4.4 years. Median duration of follow-up was 23.7 years for both groups. Women with primary infertility were 1.7 times (adjusted hazard ratio [aHR] 1.69, 95% CI 1.22-2.33) more likely to undergo bilateral oophorectomy compared with women in the referent group. In a sensitivity analysis that excluded women with a diagnosis of infertility related to endometriosis and their matched referent group participants, this association persisted (aHR 1.50, 95% CI 1.06-2.14). Women with primary infertility did not have a significant increased risk of hysterectomy (aHR 0.98, 95% CI 0.79-1.23). However, risk of hysterectomy was increased in those with primary infertility related to endometriosis (aHR 1.94, 95% CI 1.12-3.34). We observed that women with primary infertility were more likely to undergo hysterectomy with bilateral oophorectomy. Women in the referent group were more likely to undergo hysterectomy with ovarian conservation. Few women in either group had isolated bilateral oophorectomy. CONCLUSION Primary infertility, with and without a diagnosis of endometriosis, is associated with an increased risk of bilateral oophorectomy. In women with endometriosis-related infertility, there is an association with future hysterectomy. These findings represent important confounders in the evaluation of long-term health outcomes related to primary infertility.
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Affiliation(s)
- Alessandra J Ainsworth
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, the Alix School of Medicine, and the Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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Li L, Chen Q, Zhang N, Yao X, Wang C. Use of antidepressants following hysterectomy with or without oophorectomy: A national sample in the US. Maturitas 2022; 167:32-38. [DOI: 10.1016/j.maturitas.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/11/2022] [Accepted: 09/25/2022] [Indexed: 10/14/2022]
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14
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Casarin J, Ielmini M, Cromi A, Laganà AS, Poloni N, Callegari C, Ghezzi F. Post-traumatic stress following total hysterectomy for benign disease: an observational prospective study. J Psychosom Obstet Gynaecol 2022; 43:11-17. [PMID: 32319346 DOI: 10.1080/0167482x.2020.1752174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Over the last decade, there has been growing interest in the psychophysical integrity of surgical patients in the context of healthcare events. In the present study, we aimed to evaluate the incidence rate of postoperative distress symptoms, namely post-traumatic stress disorder (PTSD), following total hysterectomy for benign disease. We also investigated possible associations between sociodemographic characteristics, clinical outcomes, anxiety, depression, and PTSD. METHODS We prospectively enrolled 100 consecutive patients who underwent total hysterectomy for benign disease between 01/01/2019 and 15/04/2019. Demographic and surgical-related characteristics have been registered. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered preoperatively (Time1), postoperatively (Time2), and at follow-up clinical evaluation, between two and three months after surgery (Time3). PTSD was defined based on the results of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) at Time3. RESULTS At Time3, the median PCL-5 score was 12,8 (0-70), and 16.4% of patients had PTSD symptoms (PCL-5 > 33). No correlation between sociodemographic or gynecologic characteristics and PTSD was detected. A significant association between depression (HADS > 8) at Time2 (p = 0.002) and Time3 (p < 0.001) and PTSD symptoms was shown. CONCLUSION Hysterectomy for benign disease is associated with a non-negligible risk of PTDS; the use of the HADS questionnaires might be useful to select patients who might benefit from dedicated psychological support.
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Affiliation(s)
- Jvan Casarin
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | - Marta Ielmini
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Antonella Cromi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | | | - Nicola Poloni
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Camilla Callegari
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
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Demakakos P, Steptoe A, Mishra GD. Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy: A national retrospective cohort study of women in England. BJOG 2022; 129:1481-1489. [PMID: 34978369 PMCID: PMC9250543 DOI: 10.1111/1471-0528.17088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
Objective To examine the associations between adverse childhood experiences (ACE) and the risk of hysterectomy and bilateral oophorectomy in a national sample of women in England. Design Retrospective cohort study. Setting A stratified random sample of households across England. Population 2648 women aged ≥55 years in 2007 from the English Longitudinal Study of Ageing (ELSA) were included in the bilateral oophorectomy analyses and 2622 in the hysterectomy analyses. Methods Logistic and multinomial logistic regression analyses of the associations between categories of the ACE summary score (0, 1, 2, ≥3 ACE), eight individual ACE, and hysterectomy and bilateral oophorectomy. Results 615 women had undergone hysterectomy and 259 women bilateral oophorectomy. We found graded associations between the summary ACE score and risk of hysterectomy and bilateral oophorectomy. In the fully adjusted model, compared with women with no ACE, those with ≥3 ACE had double the odds of hysterectomy (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.30–3.11) and more than double the odds of bilateral oophorectomy (OR 2.61, 95% CI 1.54–4.42). The exclusion of women with cancer history made the associations stronger, especially in women who underwent hysterectomy at age <40 years or bilateral oophorectomy at age ≤44 years. Several individual ACE were positively associated with both outcomes. Conclusions ACE are associated with increased risk of hysterectomy and bilateral oophorectomy. Individual‐level covariates did not explain these associations. Our findings highlight the importance of a life course approach to understanding surgical menopause and add to our knowledge of the societal and public health impact of ACE. Tweetable abstract Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy in a national sample of women in England. Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy in a national sample of women in England. Linked article: This article is commented on by Walter A. Rocca, pp. 1491–1492 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17105.
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Affiliation(s)
- Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Sciences and Health, University College London, London, UK
| | - Gita D Mishra
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
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16
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Chiuve SE, Huisingh C, Petruski-Ivleva N, Owens C, Kuohung W, Wise LA. Uterine fibroids and incidence of depression, anxiety and self-directed violence: a cohort study. J Epidemiol Community Health 2022; 76:92-99. [PMID: 34301795 PMCID: PMC8666805 DOI: 10.1136/jech-2020-214565] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression and anxiety are prevalent among women with uterine fibroids (UF). The rate of mental health diagnoses in women with UF has not been studied. METHODS Women aged 18-50 years with diagnosed UF were identified in the Optum Clinformatics commercial insurance claims database (OptumInsight, Eden Prairie, Minnesota) from 1 May 2000 to 31 March 2020 (n=313 754) and were matched 1:2 on age and calendar time to women without (n=627 539). Cox proportional hazards models estimated HRs and 95% CIs between UF and diagnosed depression, anxiety and self-directed violence, adjusting for demographics and comorbidities. Among women with diagnosed UF, the association between hysterectomy and mental health outcomes was estimated. RESULTS After adjusting for confounders, women with diagnosed UF had a higher rate of depression (HR: 1.12; 95% CI 1.10 to 1.13), anxiety (HR: 1.12; 95% CI 1.10 to 1.13) and self-directed violence (HR: 1.46; 95% CI 1.29 to 1.64) than women without. Among women with pain symptoms and heavy menstrual bleeding, the HR comparing women with diagnosed UF to women without was 1.21 (95% CI 1.18 to 1.25) for depression, 1.18 (95% CI 1.15 to 1.21) for anxiety and 1.68 (95% CI 1.35 to 2.09) for self-directed violence. Among women with diagnosed UF, the HR comparing women who underwent a hysterectomy to women who did not was 1.22 (95% CI 1.17 to 1.27) for depression, 1.13 (95% CI 1.09 to 1.17) for anxiety and 1.86 (95% CI 1.39 to 2.49) for self-directed violence. CONCLUSIONS Rates of depression, anxiety and self-directed violence were higher among women with diagnosed UF, particularly among those who experienced pain symptoms or who underwent hysterectomy.
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Affiliation(s)
| | | | | | | | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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17
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Maioli S, Leander K, Nilsson P, Nalvarte I. Estrogen receptors and the aging brain. Essays Biochem 2021; 65:913-925. [PMID: 34623401 PMCID: PMC8628183 DOI: 10.1042/ebc20200162] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
The female sex hormone estrogen has been ascribed potent neuroprotective properties. It signals by binding and activating estrogen receptors that, depending on receptor subtype and upstream or downstream effectors, can mediate gene transcription and rapid non-genomic actions. In this way, estrogen receptors in the brain participate in modulating neural differentiation, proliferation, neuroinflammation, cholesterol metabolism, synaptic plasticity, and behavior. Circulating sex hormones decrease in the course of aging, more rapidly at menopause in women, and slower in men. This review will discuss what this drop entails in terms of modulating neuroprotection and resilience in the aging brain downstream of spatiotemporal estrogen receptor alpha (ERα) and beta (ERβ) signaling, as well as in terms of the sex differences observed in Alzheimer's disease (AD) and Parkinson's disease (PD). In addition, controversies related to ER expression in the brain will be discussed. Understanding the spatiotemporal signaling of sex hormones in the brain can lead to more personalized prevention strategies or therapies combating neurodegenerative diseases.
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Affiliation(s)
- Silvia Maioli
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Per Nilsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Ivan Nalvarte
- Department of Biosciences and Nutrition, Karolinska Institutet, 141 57 Huddinge, Sweden
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18
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What We Know about the Long-Term Risks of Hysterectomy for Benign Indication-A Systematic Review. J Clin Med 2021; 10:jcm10225335. [PMID: 34830617 PMCID: PMC8622061 DOI: 10.3390/jcm10225335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 12/29/2022] Open
Abstract
Hysterectomy is the most common treatment option in women with uterine fibroids, providing definitive relief from the associated burdensome symptoms. As with all surgical interventions, hysterectomy is associated with risk of complications, short-term morbidities, and mortality, all of which have been described previously. However, information on the potential long-term risks of hysterectomy is only recently becoming available. A systematic literature review was performed to identify studies published between 2005 and December 2020 evaluating the long-term impact of hysterectomy on patient outcomes. A total of 29 relevant studies were identified. A review of the articles showed that hysterectomy may increase the risk of cardiovascular events, certain cancers, the need for further surgery, early ovarian failure and menopause, depression, and other outcomes. It is important to acknowledge that the available studies examine possible associations and hypotheses rather than causality, and there is a need to establish higher quality studies to truly evaluate the long-term consequences of hysterectomy. However, it is of value to consider these findings when discussing the benefits and risks of all treatment options with patients with uterine fibroids to allow for preference-based choices to be made in a shared decision-making process. This is key to ensuring that patients receive the treatment that best meets their individual needs.
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19
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Khalife T, Fatchikov T, Anil G. Intraoperative Genitourinary Injuries During a Hysterectomy: Risks, Management, and Mitigation Strategies. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tarek Khalife
- Department of Obstetrics and Gynecology, Mayo Clinic Health System, Mankato, Minnesota, USA
| | - Tzvetan Fatchikov
- Department of Obstetrics and Gynecology, Mayo Clinic Health System, Mankato, Minnesota, USA
| | - Gokhan Anil
- Department of Obstetrics and Gynecology, Mayo Clinic Health System, Mankato, Minnesota, USA
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20
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Goudarzi F, Khadivzadeh T, Ebadi A, Babazadeh R. Iranian Women's Self-concept after Hysterectomy: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:230-237. [PMID: 34277374 PMCID: PMC8262543 DOI: 10.4103/ijnmr.ijnmr_146_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/16/2020] [Accepted: 02/23/2021] [Indexed: 11/14/2022]
Abstract
Background: The loss of female organs leads to profound changes in one's perception of oneself. There is limited information about the impact of hysterectomy on women's self-concept and culture. Therefore, this study was conducted with the aim to deepen our understanding of the self-concept of Iranian women after hysterectomy. Materials and Methods: This qualitative study was conducted using directed content analysis approach. The participants included 30 women with a history of hysterectomy who were selected through purposive sampling method. Data were collected from August 2018 to November 2019 using in-depth and semi-structured interviews based on the self-concept mode of the Roy Adaptation Model (RAM) in Mashhad, Iran. Data analysis was performed using the deductive approach of Elo and Kyngäs in MAXQDA software. Results: As a result of the analysis of the interviews, the main category of “incoherent cognition of self-concept” emerged, which included the two generic categories of “heterogeneous feelings toward and imaginations of the body” and “changed self-perception”, and five subcategories. Conclusions: Women's self-concept changed after hysterectomy in both its physical and psychological aspects. Therefore, counseling before and after hysterectomy is recommended to improve women's self-concept after hysterectomy.
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Affiliation(s)
- Fatemeh Goudarzi
- Ph.D.Candidate in Reproductive Health, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Associate Professor in Reproductive Health,Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- Professor in Nursing Sciences, Baqiyatallah Sciences Research Centre, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Raheleh Babazadeh
- Assistant Professor in Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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21
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Kim H, Kim Y, Fava M, Mischoulon D, Shin MH, Lee DY, Jeon HJ. Increased risk of depression before and after unilateral or bilateral oophorectomy: A self-controlled case series study using a nationwide cohort in South Korea. J Affect Disord 2021; 285:47-54. [PMID: 33631480 DOI: 10.1016/j.jad.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is insufficient evidence of the association between oophorectomy and depression. METHODS A nationwide medical records database of South Korea was used to investigate incidence rate ratios (IRRs) of major depressive disorder before and after oophorectomy (n = 36,284) using a self-controlled case series design. Outcomes before and after hysterectomy (n = 25,415) were identified to compare with those around oophorectomy. RESULTS In all oophorectomy and hysterectomy groups, the risk of depression was increased before and after surgery, peaking immediately before or after the operation, with no significant difference in the pattern of the results according to type of surgery. In the bilateral oophorectomy group, the IRR was increased between 2-3 months before the surgery, peaking immediately before surgery at 1.39 (95% CI: 1.30-1.49, p < .0001), and remained heightened for one-year postexposure. Subgroup analyses performed according to ovarian cancer, age group, and hormone replacement therapy produced results similar to those of the main outcome. LIMITATIONS Because we used claims data, the detailed clinical information related to oophorectomy is lacking. There is possibility that time-varying confounder besides age and season might have affected the results CONCLUSIONS: The risk of depression increased before and after oophorectomy. The increase in risk of depression started before oophorectomy and peaked immediately before or after the operation, but no significant differences between unilateral and bilateral surgery and cancer and noncancer or among age groups were noted.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yuwon Kim
- Department of Data Science, Evidnet, Seongnam, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, South Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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22
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Stewart EA, Missmer SA, Rocca WA. Moving Beyond Reflexive and Prophylactic Gynecologic Surgery. Mayo Clin Proc 2021; 96:291-294. [PMID: 33549251 PMCID: PMC8088594 DOI: 10.1016/j.mayocp.2020.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN; Women's Health Research Center, Mayo Clinic, Rochester, MN.
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Walter A Rocca
- Women's Health Research Center, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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23
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Panay N, Anderson RA, Nappi RE, Vincent AJ, Vujovic S, Webber L, Wolfman W. Premature ovarian insufficiency: an International Menopause Society White Paper. Climacteric 2020; 23:426-446. [PMID: 32896176 DOI: 10.1080/13697137.2020.1804547] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this International Menopause Society White Paper on premature ovarian insufficiency (POI) is to provide the latest information regarding this distressing condition. The impact of POI has far-reaching consequences due to its impact on general, psychological, and sexual quality of life, fertility prospects, and long-term bone, cardiovascular, and cognitive health. Progress in fully understanding the etiology, diagnosis, and optimal management options has been slow thus far due to the complexity of the condition and fragmented research. Recent advances in epidemiological and genetic research have improved our understanding of this condition and randomized prospective trials are being planned to determine the intervention strategies, which will optimize quality of life and long-term well-being. The International Menopause Society has commissioned a number of experts at the forefront of their specialty to define the state of the art in the understanding of this condition, to advise on practical management strategies, and to propose future research strategies. It is hoped that a global task force will subsequently be convened in order to formulate a consensus statement across key societies, to accelerate date collection and analysis of a global POI registry, and to facilitate progress in the key defined areas of research.
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Affiliation(s)
- N Panay
- Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, Imperial College, London, UK
| | - R A Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - A J Vincent
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
| | - S Vujovic
- Faculty of Medicine, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - L Webber
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - W Wolfman
- Department of Obstetrics and Gynaecology, Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
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24
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Cope AG, Young RJ, Stewart EA. Non-extirpative Treatments for Uterine Myomas: Measuring Success. J Minim Invasive Gynecol 2020; 28:442-452.e4. [PMID: 32841756 DOI: 10.1016/j.jmig.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To analyze outcomes of nonextirpative treatments for uterine myomas compared with myomectomy. DATA SOURCES A systematic search of the following databases from inception to January 2020 was performed: Ovid Medline, Embase, PubMed, and Cochrane Controlled Register of Trials. METHODS OF STUDY SELECTION Two authors reviewed titles and abstracts for relevance, and full articles were obtained and evaluated for inclusion. Studies were included if they compared nonextirpative interventions for uterine myomas to myomectomy and reported at least one outcome of interest. TABULATION, INTEGRATION, AND RESULTS Of the 2010 articles identified and reviewed, 125 full text articles were reviewed, and 22 were ultimately included in the analysis. Nonextirpative treatments reviewed included uterine artery embolization (UAE; 16 studies, n = 9555 subjects), focused ultrasound (FUS; 4 studies, n = 1516), laparoscopic radiofrequency ablation (RFA; 3 studies, n = 49). UAE, FUS, and laparoscopic RFA groups were compared with patients undergoing myomectomy (n = 34 872, n = 20 677, n = 47 respectively). In comparison with myomectomy, UAE had similar quality of life scores, symptom severity scores, sexual function scores, ovarian function, and miscarriage rates following intervention. There was lower likelihood of conceiving after UAE and a higher rate of reintervention after UAE compared with myomectomy. FUS had similar postprocedure sexual function scores and reintervention rates compared with myomectomy. Laparoscopic RFA had similar quality of life scores, symptom severity scores, sexual function scores, reintervention rates, and pregnancy rates after the procedure compared with myomectomy. CONCLUSION Nonextirpative treatments for uterine myomas have similar outcomes to myomectomy in multiple domains, with most available evidence comparing UAE with myomectomy.
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Affiliation(s)
- Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota (all authors)
| | - Riley J Young
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota (all authors)
| | - Elizabeth A Stewart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota (all authors).
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25
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Zuloaga DG, Heck AL, De Guzman RM, Handa RJ. Roles for androgens in mediating the sex differences of neuroendocrine and behavioral stress responses. Biol Sex Differ 2020; 11:44. [PMID: 32727567 PMCID: PMC7388454 DOI: 10.1186/s13293-020-00319-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/09/2020] [Indexed: 12/17/2022] Open
Abstract
Estradiol and testosterone are powerful steroid hormones that impact brain function in numerous ways. During development, these hormones can act to program the adult brain in a male or female direction. During adulthood, gonadal steroid hormones can activate or inhibit brain regions to modulate adult functions. Sex differences in behavioral and neuroendocrine (i.e., hypothalamic pituitary adrenal (HPA) axis) responses to stress arise as a result of these organizational and activational actions. The sex differences that are present in the HPA and behavioral responses to stress are particularly important considering their role in maintaining homeostasis. Furthermore, dysregulation of these systems can underlie the sex biases in risk for complex, stress-related diseases that are found in humans. Although many studies have explored the role of estrogen and estrogen receptors in mediating sex differences in stress-related behaviors and HPA function, much less consideration has been given to the role of androgens. While circulating androgens can act by binding and activating androgen receptors, they can also act by metabolism to estrogenic molecules to impact estrogen signaling in the brain and periphery. This review focuses on androgens as an important hormone for modulating the HPA axis and behaviors throughout life and for setting up sex differences in key stress regulatory systems that could impact risk for disease in adulthood. In particular, impacts of androgens on neuropeptide systems known to play key roles in HPA and behavioral responses to stress (corticotropin-releasing factor, vasopressin, and oxytocin) are discussed. A greater knowledge of androgen action in the brain is key to understanding the neurobiology of stress in both sexes.
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Affiliation(s)
| | - Ashley L Heck
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Robert J Handa
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA.
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26
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NAMS 2019 Pre-Meeting Symposium, September 2019, Chicago Illinois: The Perimenopause. ACTA ACUST UNITED AC 2020; 27:735-745. [PMID: 32433263 DOI: 10.1097/gme.0000000000001571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The North American Menopause Society held the 2019 Pre-Meeting Symposium on September 25, 2019, in Chicago, Illinois, to review the current state of the science related to the physiology of the perimenopause and to address management of the most prevalent and pressing clinical issues. The perimenopause, as defined by the Stages of Reproductive Aging Workshop + 10, encompasses the menopause transition as well as the first year following menopause, the final menstrual period. This phase in the continuum of women's reproductive lives had been one of the least well understood. Fortunately, contributions from a number of prospective, longitudinal, decades-long studies have provided a better understanding of the perimenopause, whereas posing important new questions related to symptom interaction and linkages between symptoms and long-term health. There is now added clarity to distinguish the effects of reproductive hormonal changes from aging. The variation in symptoms, including vasomotor symptoms, among women over time including differences in experiences by ethnicity and race, provides paradigm shifts in clinical perspective. Refinements in understanding the character, timing, and potential predictive markers for menstrual cycles during the transition have emerged. From the perspective of myriad clinical management challenges, significant progress in recommendations for evaluation and therapeutic approaches has been achieved. Finally, recognizing the menopause transition as an opportunity to initiate positive lifestyle changes to enhance future health was emphasized.
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27
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Miller CK, Krentzel AA, Patisaul HB, Meitzen J. Metabotropic glutamate receptor subtype 5 (mGlu 5) is necessary for estradiol mitigation of light-induced anxiety behavior in female rats. Physiol Behav 2019; 214:112770. [PMID: 31830486 DOI: 10.1016/j.physbeh.2019.112770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/20/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
Anxiety-related behaviors are influenced by steroid hormones such as 17β-estradiol and environmental stimuli such as acute stressors. For example, rats exhibit increased anxiety-related behaviors in the presence, but not the absence, of light. In females, estradiol potentially mitigates these effects. Experiments across behavioral paradigms and brain regions indicate that estradiol action can be mediated via activation of metabotropic glutamate receptors, including Group I subtype five (mGlu5). mGlu5 has been implicated in mediating estradiol's effects upon psychostimulant-induced behaviors, dopamine release and neuron phenotype in striatal regions. Whether estradiol activation of mGlu5 modulates anxiety or locomotor behavior in the absence of psychostimulants is unknown. Here we test if mGlu5 is necessary for estradiol mitigation of light-induced acute anxiety and locomotor behaviors. Ovariectomized adult female rats were pre-treated with either the mGlu5 antagonist MPEP or saline before estradiol or oil treatment. Anxiety and locomotor behaviors were assessed in the presence or absence of white light to induce high and low acute anxiety behavior phenotypes, respectively. In the presence of white light, estradiol treatment mitigated light-induced anxiety-related behaviors but not overall locomotor activity. MPEP treatment blocked estradiol effects upon light-induced anxiety-related behaviors but did not affect overall locomotor activity. In the absence of white light, estradiol or MPEP treatment did not influence anxiety-related behaviors or locomotor activity, consistent with a low anxiety phenotype. These novel findings indicate that mGlu5 activation is necessary for estradiol mitigation of anxiety-related behaviors induced by an acute stressor.
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Affiliation(s)
- Christiana K Miller
- Graduate Program in Biology, North Carolina State University, Raleigh, NC, USA; W.M. Keck Center for Behavioral Biology, North Carolina State University, Raleigh, NC, USA.
| | - Amanda A Krentzel
- W.M. Keck Center for Behavioral Biology, North Carolina State University, Raleigh, NC, USA; Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Heather B Patisaul
- W.M. Keck Center for Behavioral Biology, North Carolina State University, Raleigh, NC, USA; Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA; Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
| | - John Meitzen
- W.M. Keck Center for Behavioral Biology, North Carolina State University, Raleigh, NC, USA; Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA; Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
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