Quality of life in Thai women with various types of abnormal uterine bleeding

OBJECTIVE

To determine the quality of life (QoL) in Thai women with various types of abnormal uterine bleeding (AUB).

METHODS

A cross-sectional study was conducted on 353 AUB patients between November 2010 and January 2012. They were grouped according to the duration of symptom: <6 months (acute AUB, n = 122), ≥6 months (chronic AUB, n = 138), and postmenopausal bleeding (PMB, n = 93); and the bleeding pattern: hypermenorrhea (n = 24) and irregular bleeding (n = 236). QoL was determined using the 36-Item Short-Form Health Survey (SF-36) Thai version.

RESULTS

The acute AUB and chronic AUB groups had a mean age of 43.84 ± 4.87 and 43.81 ± 6.55 years; they were younger than the PMB group (55.62 ± 7.55 years) (P < 0.001). Medical diseases were more prevalent in the PMB than in the acute and chronic groups (66.7% vs. 27.9% and 35.5%, respectively, P < 0.001). Some subscales of the SF-36 were significantly lower in the women with AUB than in those with normative values, in those with chronic AUB or PMB than in those with acute AUB, and in those with hypermenorrhea rather than in those with irregular bleeding.

CONCLUSION

Thai women with any AUB types have a poorer QoL than general Thai women. QoL tends to be poorer in women with symptoms longer than 6 months or with hypermenorrhea.

Effect of estradiol vaginal gel on vaginal atrophy in postmenopausal women: A randomized double-blind controlled trial

AIM

To evaluate the efficacy and safety of 25 μg of estradiol gel on postmenopausal vaginal tissue.

METHODS

This randomized double-blind controlled trial included postmenopausal women with vaginal atrophy who attended our menopause clinic during July 2017-January 2018. Women were randomly assigned to the estradiol gel group or control group (K-Y® Jelly). Treatment consisted of 2 mL of product applied intravaginally daily for 2 weeks, and two doses per week for the next 6 weeks. The most bothersome symptom (MBS), vaginal health index (VHI), vaginal pH, vaginal maturation index, vaginal maturation value (VMV), female sexual function index (FSFI), serum estradiol level and endometrial thickness were evaluated at baseline, 4 and 8 weeks.

RESULTS

Seventy-five of 80 women completed the trial. After 8 weeks of treatment, VMV, VHI, vaginal pH and FSFI improved significantly in the estradiol group, with no observed change in the control group. The MBS was decreased in both groups with no significant difference between groups. Serum estradiol level and endometrial thickness were not significantly different between groups at baseline or at week 8.

CONCLUSION

Estradiol vaginal gel demonstrated an ability to reverse vaginal atrophy with a high safety profile and low systemic absorption of estradiol.

Effect of metformin on cardiovascular risk factors in middle-aged Thai women with metabolic syndrome: A randomized placebo-controlled trial

AIM

To evaluate the effect of metformin on cardiovascular risk factors in middle-aged Thai women with metabolic syndrome that are in menopausal transition.

METHODS

This study was double-blind randomized placebo-controlled trial. Metabolic syndrome was diagnosed using American Heart Association and National Heart, Lung, and Blood Institute criteria. After taking metformin 1700 mg/day for 6 months, cardiovascular risk factors were evaluated at baseline and month-6; the values of which were used to calculate delta (Δ, month-6 minus baseline values).

RESULTS

Forty menopausal participants were equally, randomized into either the placebo or metformin group. The two groups had comparable metabolic parameters at baseline, except that the mean triglyceride level was higher in the metformin group than in the placebo group. The significant improvements found only in the metformin group were body mass index, fasting blood glucose, high-sensitivity C-reactive protein and 10-year risk of coronary heart disease (Framingham heart study) (P = 0.0004, P = 0.049, P = 0.035 and P = 0.029); whereas that only in the placebo group was high density lipoprotein cholesterol. However, there was no statistically significant difference in the improvement between the two groups.

CONCLUSION

Metformin can improve some parameters of metabolic syndrome in middle-aged Thai women. Metformin is not superior to placebo for the improvement of cardiovascular risk factors.

Prevalence of type 2 diabetes mellitus compared between lean and overweight/obese patients with polycystic ovarian syndrome: a 5-year follow-up study

PURPOSE

To investigate the prevalence of type 2 diabetes mellitus (T2DM) at the 5-year follow-up after polycystic ovarian syndrome (PCOS) diagnosis compared between lean and overweight/obese groups.

METHODS

This retrospective cohort study included 400 prediabetes PCOS women who attended our clinic. Participants were divided into either the lean group (body mass index [BMI]: < 23 kg/m²) or the overweight/obese group (BMI: ≥ 23 kg/m²). Patient demographic, clinical characteristics, metabolic profiles, and laboratory values were collected and compared between groups at baseline and during follow-up for 5 years.

RESULTS

At the end of the follow-up, overweight/obese group had a higher risk for developing T2DM than lean group (11.5% vs. 0.5%, p < 0.001). Lean group had a lower incidence of hypertension (3% vs. 38.5%, p < 0.001) and dyslipidemia (35% vs. 53.5%, p < 0.001) than overweight/obese group. The factors found to be independently associated with increased risk for developing T2DM were BMI ≥ 23 kg/m² (odds ratio [OR]: 1.075, p = 0.047), non-use of oral combined contraceptive pills (OR: 0.312, p = 0.028), and impaired fasting glucose at baseline (OR: 38.167, p < 0.001).

CONCLUSIONS

Overweight/obese PCOS patients were found to be at significantly higher risk for developing T2DM than lean PCOS patients. Higher BMI, IFG at baseline, and non-use of oral contraceptive pills found to be independent predictors of T2DM in PCOS.

Serum interleukin 6 and cancer antigen 125 in the non-invasive diagnosis of endometriosis

Background:

The role of interleukin 6 in endometriosis has been extensively studied but results were inconsistent. The purpose of this study was to determine the performance of serum interleukin 6 and serum cancer antigen 125 for non-invasive diagnosis of endometriosis.

Methods:

In this prospective diagnostic study, 100 reproductive women who underwent laparoscopy were studies. Patients were divided into endometriosis group (n = 60) and control group (n = 40). Blood samples were taken preoperatively for analysis of serum interleukin 6 and cancer antigen 125 levels.

Results:

Level of serum interleukin 6 and cancer antigen 125 in endometriosis group were significantly higher than those in control group (1.93 versus <1.50 pg/mL and 41.85 versus 11.86 IU/mL, respectively). A cutoff level of interleukin 6 at 1.52 pg/mL provided sensitivity of 63.3%, specificity of 55%, positive predictive value of 67.9%, and negative predictive value of 50%. The threshold level of cancer antigen 125 at 31 IU/mL had sensitivity of 70%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 69%. The combined test had sensitivity of 86.7%, specificity of 60%, positive predictive value of 76.5%, and negative predictive value of 75%. The area under receiver operating characteristic curve of serum interleukin 6, cancer antigen 125, and combined test were 0.614, 0.945, and 0.945, respectively.

Conclusion:

Serum interleukin 6 is not suitable to be a candidate of serum marker for the diagnosis of endometriosis. Serum cancer antigen 125 is better than interleukin 6 for detection of endometriosis stage III/IV. Both of them had low performance for diagnostic test in minimal to mild endometriosis. The combined test does not add more benefit than using cancer antigen 125 alone.

Endometrial neoplasia in reproductive-aged Thai women with polycystic ovary syndrome

OBJECTIVE

To determine the risk of endometrial neoplasia in relation to endometrial thickness and to evaluate factors influencing endometrial thickness in reproductive-aged Thai women with polycystic ovary syndrome (PCOS).

METHODS

The present cross-sectional study was done at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, between October 1, 2010, and January 31, 2013. We recruited women (aged ≥18 years) with PCOS diagnosed according to the revised 2003 Rotterdam criteria. Data were collected for physical examinations, pelvic ultrasonography, hormonal profiles, and carbohydrate metabolic profiles. Endometrial tissue was obtained using a disposable endometrial-suctioning device.

RESULTS

The final analysis included 122 women. Six (4.9%) patients had endometrial neoplasia. All six women had an endometrial thickness of 7 mm or more, representing a risk of 8.7% (6/69) in this group. The endometrial thickness was significantly but weakly associated with body mass index (r=0.227, P=0.012), 2-hour blood glucose (r=0.323, P=0.001), fasting glucose to insulin ratio (r=0.185, P=0.042), homeostatic model assessment of insulin resistance (r=0.183, P=0.044), and free testosterone (r=0.236, P=0.009). No categorical risk factors for an endometrial thickness of 7 mm or more were identified.

CONCLUSION

Thai women with PCOS and a thick endometrium (≥7 mm) had an 8.7% risk of endometrial neoplasia. Invasive endometrial surveillance for the prevention of endometrial cancer is recommended in these women.

Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS

AIM

To evaluate the relationship between measures of body adiposity and visceral adiposity index (VAI) and risk of metabolic syndrome (MS) and to identify the optimal cut-off points of each measurement in Thai polycystic ovary syndrome (PCOS).

METHODS

A cross-sectional study was completed physical examination, fasting plasma glucose, lipid profiles of 399 PCOS and 42 age-matched normal controls. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and VAI were calculated. Associations between different measures and MS were evaluated and the receiver-operating characteristic (ROC) curve was performed to determine appropriate cut-off points for identifying MS.

RESULTS

Percentage of MS in PCOS was 24.6%, whereas none MS in controls. Previously recommended cut-off values for body adiposity and VAI were significantly associated with MS. ROC curve analysis of the only PCOS showed newly obtained optimal cut-off points for BMI and VAI of ≥28 kg/m(2) (AUC = 0.90) and >5.6 (AUC = 0.94), respectively. Values found to be more accurate than the original ones. VAI was the best predictor, followed by BMI and WHtR.

CONCLUSION

All body adiposity and VAI parameters can predict the risk of MS. Optimal values for Thai PCOS were ≥28 kg/m(2) for BMI, ≥0.85 for WHR, ≥0.5 for WHtR and >5.6 for VAI.

Prevalence of endometriosis in women undergoing surgery for benign gynecologic diseases

OBJECTIVE

To determine the prevalence of endometriosis among other benign gynecologic diseases and to identify the characteristics of patients at increased risk of concomitant diagnosis before surgery

MATERIAL AND METHOD

A descriptive cross-sectional study of331 women with benign gynecologic diseases who underwent surgery in the Department of Obstetrics and Gynecology, Faculty ofMedicine Siriraj Hospital, Mahidol University, Bangkok, Thailand were included The subjects were interviewed for demographic data, obstetrics, and medical history. Data from medical records were reviewed and collected Operative notes and pathological reports were reviewedfor the diagnosis of endometriosis. The outcome measurement is the prevalence of endometriosis that was diagnosed by the surgeon from operative finding or pathological report and the characteristics of the patients at increased risk of concomitant diagnosis before surgery.

RESULTS

Of the 331 women with benign gynecologic diseases, 101 had coexistent endometriosis. Prevalence ofendometriosis in benign gynecologic diseases was 30.5%. Of the 285 women with benign gynecologic diseases that did not have concomitant diagnosis of endometriosis before surgery, endometriosis was found in 55 patients postoperatively. Prevalence of endometriosis in this group was 19.3%. The three most common diseases in women undergoing surgery were uterine leiomyoma, adenomyosis, and benign ovarian cysts, respectively. The coexistence ofendometriosis with uterine leiomyoma, adenomyosis, and benign ovarian cysts were 28%, 43.5%, and 50%, respectively. Women with preexisting endometriosis were significantly younger than those with postoperative diagnosed endometriosis.

CONCLUSION

The prevalence of coexistence of endometriosis and benign gynecologic diseases, especially uterine leiomyoma, adenomyosis, and benign ovarian cyst, was high. The diagnosis of concomitant diseases was made intra-operatively and postoperatively in more than half of the cases. Physicians should be concerned about the coexistence of both conditions and put this finding into the preoperative counseling data and definite surgery should be informed in advanced stage of endometriosis.

Hyperprolactinemia: a 12-year retrospective study at gynecologic endocrinology unit, Siriraj Hospital

BACKGROUND

Hyperprolactinemia is one of the most common endocrine disorders of the hypothalamic-pituitary axis. To date, no available data about hyperprolactinemia in Thai women has been published

OBJECTIVE

To determine clinical and laboratory findings of Thai female patients with different etiology of hyperprolactinemia, as well as the response of treatment, recurrence, and pregnancy after treatment.

MATERIAL AND METHOD

Medical records of 139 female patients with the diagnosis of hyperprolactinemia in Gynecologic Endocrinology Unit, Siriraj Hospital between January 1, 1999 and December 30, 2011 were retrospectively reviewed after the study protocol was approved by Siriraj Institutional Review Board. The data was analyzed to determine patient demographic data, presenting symptoms, duration of symptoms, initial serum prolactin levels, causes, imaging studies, treatment, treatment outcomes, and adverse events.

RESULTS

Ninety-seven female patients with hyperprolactinemia were included in the study. Mean age at diagnosis was 31.8 +/- 7.7 years. Amenorrhea was the most common presenting symptom (49.5%) followed by galactorrhea (44.3%). Median initial serum prolactin level was 117 ng/mL (25.1-1,624 ng/mL). Pituitary adenoma is the most common cause (40.2%) followed by idiopathic hyperprolactinemia (37.1%). Microadenomas were found in 74.3% of pituitary adenoma. The median size of the tumor was 9 mm. Medical treatment was given to 79 (88.8%) patients. Bromocriptine was given to 66 patients. Mean of maximum dose of bromocriptine was 5.8 mg. Median duration of treatment was 35.8 months. Adverse events were reported in 24.2% of patients, dizziness was the most common adverse event. Median time to normalize serum prolactin level was 3.8 months. In 29 patients who desired pregnancy, eight patients got pregnant. Median time to pregnancy was 25.9 months. Patients with macroadenoma had significantly higher prolactin level than those with microadenoma (p = 0.024). Patients with galactorrhea had the shortest duration of symptom (p = 0. 010). There were no statistically significant difference in symptoms, duration of symptoms, and initial prolactin level between patients with and without pituitary adenoma. Patients with pituitary adenoma needed higher doses (p = 0.009) and longer duration of treatment (p = 0.007) than those without a tumor Normalization of prolactin level and recurrence rate was not different between the two groups (p = 0.056 and 0.374). Log rank test showed that the time to normalize and survival time of recurrence were not significantly different between patients with and without a tumor (p = 0.136 and 0.146, respectively).

CONCLUSION

Amenorrhea was the most common presenting symptom in Thai hyperprolactinemic females, who attended Siriraj gynecologic endocrinology unit, followed by galactorrhea. Pituitary adenoma is the most common cause followed by idiopathic hyperprolactinemia. Patients with pituitary adenoma needed higher doses and longer duration of treatment than those without a tumor

Ovarian reserve evaluation by anti-mullerian hormone in women undergoing laparoscopic cystectomy of endometrioma

OBJECTIVE

To study the serial changes of serum AMH to determine ovarian reserve recovery after laparoscopic cystectomy of endometrioma.

MATERIAL AND METHOD

Forty-three endometrioma patients who underwent laparoscopic cystectomy of endometrioma were tested for levels of serum AMH at preoperation, 1 week, and 3 months postoperation.

RESULTS

Median serum AMH was 2.11 ng/mL (range = 0.22 to 9.24 ng/mL) before surgery. This level also reduced at first week postoperation (p < 0.01) but did not reach a significant difference between the first week and the third month (1.02 ng/mL and 1.06 ng/mL, respectively). The recovery rate of AMH level in unilateral endometrioma was higher than bilateral endometrioma (32.4% vs. -3.6%, p = 0.02).

CONCLUSION

Ovarian reserve was decreased after laparoscopic cystectomy of endometrioma and did not significantly restore after three months of postoperation. The recovery of ovarian reserve after unilateral endometriotic cystectomy was faster than that after bilateral endometriotic cystectomy.

Prevalence and clinical predictors of insulin resistance in reproductive-aged thai women with polycystic ovary syndrome

Objectives. To determine the prevalence of insulin resistance (IR) and its predictors in reproductive-aged Thai women with polycystic ovary syndrome (PCOS). Methods. A cross-sectional study was conducted from May 2007 to January 2009. Participants were 250 Thai women with PCOS. Information regarding medical history and physical examination and results of 75 gram OGTT were recorded. Results. The overall prevalence of IR was 20.0%, comprising the prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetic mellitus of 3.2%, 13.6%, and 5.6%, respectively. Multiple logistic regression analysis showed that the independent predictors for IR were age of ≥30 years old, waist circumference (WC) of ≥80 cm, presence of acanthosis nigricans (AN), and dyslipidemia with odds ratios (95% confidence interval) of 2.14 (1.01-4.52), 3.53 (1.28-9.75), 2.63 (1.17-5.88), and 3.07 (1.16-8.11), respectively. Conclusion. The overall prevalence of IR in reproductive-aged Thai women with PCOS is 20.0%. Age ≥30 years old, WC ≥80 cm, the presence of AN, and dyslipidemia are the significant clinical predictors.

The Usefulness of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) for Detection of Glucose Intolerance in Thai Women of Reproductive Age with Polycystic Ovary Syndrome

Objectives. To study the cut-off point of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) as a screening test for detection of glucose intolerance in Thai women with polycystic ovary syndrome (PCOS). Study Design. Cross-sectional study. Setting. Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. Subject. Two hundred and fifty Thai PCOS women who attended the Gynecologic Endocrinology Unit, during May 2007 to January 2009. Materials and Methods. The paitents were interviewed and examined for weight, height, waist circumference, and blood pressure. Venous blood samples were drawn twice, one at 12-hour fasting and the other at 2 hours after glucose loading. Results. The prevalence of glucose intolerance in Thai PCOS women was 20.0%. The mean of HOMA-IR was 3.53  ±  7.7. Area under an ROC curve for HOMA-IR for detecting glucose intolerance was 0.82. Using the cut-off value of HOMA-IR >2.0, there was sensitivity at 84.0%, specificity at 61.0%, positive predictive value at 35.0%, negative predictive value at 93.8%, and accuracy at 65.6%. Conclusion. HOMA-IR >2.0 was used for screening test for glucose intolerance in Thai PCOS women. If the result was positive, a specific test should be done to prove the diagnosis.

Causes of primary amenorrhea: a report of 295 cases in Thailand

AIMS

The aim of this study was to determine the prevalence of etiologic causes of primary amenorrhea in Thailand.

METHODS

A retrospective study was performed using 295 complete medical records of women with primary amenorrhea who attended the Gynecologic Endocrinology Clinic, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand from September 1992 to February 2009.

RESULTS

The three most common causes of primary amenorrhea were Müllerian agenesis (39.7%), gonadal dysgenesis (35.3%), and hypogonadotropic hypogonadism (9.2%). Amongst 88 cases of gonadal dysgenesis, 59 cases (67.0%) incurred abnormal karyotype including 45X (n=21), mosaic (n=31), and others (n=7).

CONCLUSIONS

The present study has currently been the largest case series of primary amenorrhea. Müllerian agenesis is the most prevalent cause in our study, while gonadal dysgenesis is the most common cause in the largest-scale study in the USA. Hence, racial, genetic and environmental factors could play roles in the cause of primary amenorrhea.

Nutritional supplements in health-conscious pre-/ post-menopausal Thai women

OBJECTIVE

To survey prevalence, knowledge, attitude, and factors affecting the behavior of nutritional supplement consumption in health-conscious pre-/post-menopausal Thai women.

MATERIAL AND METHOD

A survey was conducted in 327 women, aged 40-67 years, who were new participants in the health promotion education program of Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, between January and July 2008. The participants completed a self-administering questionnaire inquiring their demographic data, attitude, knowledge, and behavior of supplement consumption. The participants were divided into three groups, i.e., current-, past-, and never-users, and then compared.

RESULTS

The majority (54.7%) of the presented participants consumed at least one kind of supplements, 37.3% and 17.4% were current-and past-users, respectively. The current-, past-, and never-users were not different in age, medical diseases, education levels, reading frequency, and economic status. The majority of participants obtained the information ofsupplements from newspaper or magazine. The users primarily purchased the supplements from hospitals or clinics. All participants had knowledge on health promotion and supplement products, however, 7.6% and 11.5% of such knowledge, respectively, was inaccurate. All participants had both positive and negative attitudes on supplement consumption, the negative attitude was found in 33.4% of the items tested. The never-users had trivial but statistically significant (p < 0.001) more accurate knowledge and more negative attitude than other groups had.

CONCLUSION

More than 50% of health-conscious pre-/post-menopausal Thai women are ever-users of nutritional supplements. A lot of misunderstanding and misconception do exist even in the health-conscious women, regardless of their consumption behaviors. More education on this issue should be provided in order to reduce unnecessary expenditure and increase the efficiency of supplement consumption expenditure.

Characteristics of 250 reproductive-aged polycystic ovary syndrome Thai women at Siriraj Hospital

OBJECTIVE

To determine the clinical characteristics of reproductive-aged polycystic ovary syndrome (PCOS) Thai women.

STUDY DESIGN

Cross sectional study

SETTINGS

Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital.

SUBJECTS

250 PCOS Thai women who registered at the Siriraj PCOSprojectfrom May 2007 to January 2009. PCOS were diagnosed using Revised Rotterdam 2003 criteria. Women who were taking medications affecting sex hormones or lipid metabolism within 3 months before registration were excluded from the present study.

MATERIAL AND METHOD

Patients were interviewed and examined for weight, height, waist circumference, blood pressure, presence of acanthosis nigricans, and signs of hyperandrogenism. Ovarian ultrasonography was examined using vaginal probe inserting into the vagina or rectum. Venous blood sample of each patient was drawn during 8.00-10.00 o'clock after 12-hour fasting.

MAIN OUTCOME MEASURES

Clinical characteristics and laboratoryprofiles in PCOS Thai women.

RESULTS

Of all participants, 62% were 20-29.9 years old, 30% had high blood pressure, 57% were overweight to obese, 49% had central obesity, and 27% had acanthosis nigricans. Clinical hyperandrogenism was found in 15.6% of the patients. Approximately 7% of PCOS women had impaired fasting glucose and one third had dyslipidemia. Prevalence of the PCOS criteria presenting in the population were oligomenorrhea and/or amenorrhea (98.4%), hyperandrogenism (49 2%), and ultrasonographic polycystic ovary (97.2%). Of all participants, 44% had three components of diagnostic criteria. Among those who had two components, presence of abnormal menstrual cycle plus polycystic ovary was the most common finding.

CONCLUSION

Menstrual problem was the most common presenting symptom among the presented participants. Hyperandrogenism/ -emia adds only a little value on making PCOS diagnosis. Most of the PCOS Thai women have menstrual problem. In these patients, ovarian ultrasonography has high value to diagnose PCOS; addition of androgen blood test can diagnose only 3% more PCOS cases. Although the presented PCOS Thai women are stillyoung, approximately 50% already have some parameters of health risk. It is suggested to provide preventive measures for these patients to prevent long term medical problems.

Health check-up program for pre/postmenopausal women at Siriraj Menopause Clinic

OBJECTIVE

To determine the general health status of pre/postmenopausal women attending the menopause clinic.

STUDY DESIGN

Retrospective descriptive study.

SETTING

Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University.

STUDY POPULATION

Pre/postmenopausal women (i) presumed to have no medical disease (no disease group) or (ii) with unknown status of medical disease (no record group) and undergoing health check-up program at the time of registration without prior hormone therapy.

MATERIAL AND METHOD

Medical records of new patients registering at the menopause clinic from January 1999 to December 2005 were reviewed.

RESULTS

Among 1,020 patients undergoing health check-up program, there were 366 patients in the no disease group. They had abnormal health parameters listing by frequency of prevalence including hypercholesterolemia (62.3%), suboptimal blood pressure (49.3%), overweight to obese (30.2%), suboptimal fasting blood sugar (2 7.9%), hypertriglyceridemia (21.3%), abnormal liver function tests (5.4-6.9%), and abnormal kidney function tests (0.5%). The prevalence of dyslipidemia was statistically higher in the no record group compared to the no disease group; such abnormal parameters included hypercholesterolemia (> or =200 ml/dL), high blood level of low density lipoprotein cholesterol (LDL-C > or = 130 mg/dL), and high ratio between LDL-C and high density lipoprotein cholesterol (LDL-C/HDL-C ratio >3). Osteoporosis was found in 6.6% of the patients. Abnormal mammographic findings that needed close follow-up or breast biopsy were found in 13.5%. Twelve patients had breast biopsy and none had breast cancer.

CONCLUSION

Abnormal health parameters are common in pre/postmenopausal women presumed to have no medical disease. The similar or even worse findings are also found in those whose status of medical diseases was unknown. Therefore, a routine health screening program, especially for metabolic diseases, should be offered to pre/postmenopausal women regardless of their medical history.

Serum follicle stimulating hormone and estradiol in peri/postmenopausal women attending Siriraj Menopause Clinic: a retrospective study

OBJECTIVES

To determine serum levels of Follicle Stimulating Hormone (FSH) and Estradiol (E) in peri/postmenopausal women attending the menopause clinic.

STUDY DESIGN

Retrospective descriptive study.

SETTING

Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital.

STUDY POPULATION

Peri/postmenopausal women attending Siriraj Menopause Clinic from January 1994 to December 2003.

MATERIAL AND METHOD

Medical records of women who had a blood test for FSH and/or E2 prior to hormonal therapy were reviewed.

RESULTS

During a 10 year period, there were 116 eligible patients who could be classified into perimenopausal (31 cases), natural postmenopausal (43 cases), and surgical postmenopausal (32 cases) groups. Age at registration of perimenopausal (47.87 +/- 4.38 yr) and surgical postmenopausal (48.06 +/- 6.49 yr) groups were younger than that of the natural postmenopausal group (55.74 +/- 6.80 yr). The perimenopausal group, who still had regular menstruation, was the youngest. The average FSH level of 60.46 +/- 33.15 mIU/mL was not different among groups. The estradiol level of perimenopausal (79.05 +/- 83.62 pg/mL) and surgical postmenopausal (63.05 +/- 136.39 pg/mL) groups were significantly higher than that of natural postmenopausal (25.05 +/- 37.663 pg/mL) group (p = 0.001). Serum level of FSH or E2 was not correlated with age or years since menopause. There was significant but minimal negative correlation between serum levels of FSH and E2.

CONCLUSION

Serum FSH and/or E2 levels are not accurate enough by themselves to rule in or rule out perimenopause. The authors suggested that clinicians should diagnose perimenopause based on menstrual history and age, without relying on laboratory testing.

Distal radius bone mineral density and grip strength in peri/postmenopausal Thai women

To determine the relationship between distal radius bone mineral density (BMD) and grip strength (GS) in peri/post menopausal Thai women. 177 healthy volunteers, > or = 40 years old, were included. Distal radius BMD of the non-dominant side was measured using dual energy X-ray absorptiometry. GS of both dominant and non-dominant sides was measured using a Jamar dynamometer. The association between BMD and GS was determined by correlation analysis. Other factors possibly affecting the BMD or GS including age, years since menopause (YSM), body weight (BW), height (Ht) and body mass index (BMI) were analyzed by the multiple regression method. It was found that BMD had statistically significant but weak, positive correlation to GS (r = 0.262, p < 0.001 for the dominant side, r = 0.193, p < 0.001 for non-dominant side). Age and YSM had a negative correlation, whereas, BW and Ht had a positive correlation to either BMD or GS. After multiple regression analysis, the significant predictors of BMD were age and BW, of dominant GS were age and Ht, and of non-dominant GS was YSM. In conclusion, decrements in distal radius BMD and in GS were found in peri/postmenopausal women. Aging seems to be the most important factor for these features. Although the GS has statistically significant correlation to the corresponding BMD, the clinical significance might not be obvious. Furthermore, the stronger correlation of BMD to the contralateral dominant GS than to the ipsilateral non-dominant GS implies that the influence of muscular strength on BMD, if present, is not due to a direct effect in this age group.

p53 tumor suppressor gene mutation in ovarian cancer in Thai patients

OBJECTIVES

To characterize molecular mutations of p53 gene in Thai ovarian cancer and compare the mutations with their pathological and clinical findings.

MATERIAL AND METHOD

Direct DNA sequencing of hot spot region of p53 gene (exons 5 to 8) from 28 primary ovarian cancer tissues, 2 metastatic tumors and their paired blood samples was performed. The detected mutations were compared to the pathological and clinical findings and responsiveness to treatments after 36 months of follow-up.

RESULTS

One insertion and 4 point mutations in exon 5 of p53 gene were found in 5 out of 28 (18%) ovarian cancer patients. There was no mutation in the paired blood samples. The histological types of the detected tumors were 3 endometrioids and 2 serous cystadenocarcinomas. All 5 patients were in stage I to IV disease and showed overall 4 out of 5 (80%) complete response until 36 months after surgery followed by chemotherapy, compared to 14 out of 28 (50%) of complete response in all cases of ovarian cancer.

CONCLUSION

The authors found 5 cases of ovarian cancer patients with p53 gene mutations giving the same response to complete standard treatment as all cases. Significant factors affecting responsiveness of these patients depended more on stages, grades and histological cell types of the cancer.