Comparative effectiveness and impact on health-related quality of life of hysterectomy vs. levonorgestrel intra-uterine system for abnormal uterine bleeding

OBJECTIVE

To compare hysterectomy and levonorgestrel intra-uterine system (LNG-IUS) for the treatment of abnormal uterine bleeding (AUB) and iron deficiency anemia.

PATIENTS AND METHODS

Retrospective study evaluating quality of life, sexual function, satisfaction and blood hemoglobin concentration improvement in 60 pre-menopausal women treated with hysterectomy or LNG-IUS. All analysis was performed with statistical software SPSS 21.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

Despite superior control of bleeding and dysmenorrhea observed after hysterectomy, LNG-IUS showed similar impact on blood hemoglobin levels, quality of life, satisfaction and sexual function resulting more cost-effective.

CONCLUSIONS

In the absence of contraindications, LNG-IUS should always be the first therapeutic choice for chronic AUB. Surgical treatment must be considered as an "extrema ratio".

Cervical carcinogenesis, bacterial vaginosis, HPV-mRNA test and relapse of CIN2+ after loop electrosurgical excision procedure (LEEP)

OBJECTIVE

The aim of the study was to evaluate the relationship between bacterial vaginosis (BV) and relapse of cervical intraepithelial neoplasia grade 2 or more (CIN2+) after Loop electrosurgical excision procedure (LEEP).

PATIENTS AND METHODS

One hundred four patients who underwent LEEP for CIN2+ were followed up every six months for three years. Fifty-three were negative for BV and fifty-one were positive. Each clinical control included Pap test, colposcopy, Amsel criteria test, HPV-DNA, and HPV-mRNA test.

RESULTS

Patients' age, presence of BV, positivity to HPV-DNA and HPV-mRNA tests were analyzed. The average age of patients was 42.5 ± 8.92 years (median: 42.5; range from 27 to 58 years). The minimum follow-up was 6 months and maximum 36 months (average: 22.8 ± 4.53; median: 24). The 10% of the patients with HPV-mRNA test negative had relapsed, compared to 45% of patients with HPV-mRNA test positive. Among the 53 patients without BV the 20% had relapsed compared with 23% of 51 patients with diagnosis of BV.

CONCLUSIONS

There is no evidence for higher percentage of relapse in patients with BV, submitted to excisional procedure for CIN2+ associated to HPV-m-RNA test positivity. There is only a correlation among BV and relapse of CIN2+ lesions after LEEP.

Poor responders in IVF: an update in therapy

INTRODUCTION

Assisted reproduction techniques are the frequent treatment of infertility. Despite the advances in science and technology, the management of poor responder patients is still considered as one of the most urgent problems. The lack of unified definition makes the management of the poor responder patients very difficult. The aim of this review is to examine and compare the different studies done about the problem of poor responder patients.

METHODS

On an online research of MEDLINE/PUBMED, we found several studies on pharmacological treatment for poor responders' patients.

RESULTS

Our review shows that in the years numerous therapies for the management of these patients who do not respond to ovarian stimulation have been evaluated and studied, but the main problem is the large and still not well-defined meaning of poor responder women.

CONCLUSION

The management of the poor responder patients is very difficult. Currently, there is no any standard treatment for poor responder patients. Considering the importance of the problem, it is important to identify a diagnostic and therapeutic target. Our review shows that there are many studies with different therapeutic approaches which deserve further in-depth study to standardize diagnostic and therapeutic target.

Premature ovarian failure in a 17-year-old woman

INTRODUCTION

Premature ovarian failure (POF) in a healthy adolescent is a rare event. It is diagnosed by the presence of amenorrhea, hypoestrogenism, and elevated follicle-stimulating hormone (FSH) levels before the age of 40.

CASE

The patient presented with amenorrhoea at 17 years after identifying a change from her regular to irregular and metrorrhagic cycles. No positive medical history was noted regarding smoking, chemotherapy, radiation or autoimmune diseases and the physical examination was normal. Her family history revealed that both her maternal aunt and grandmother were affected by POF, but the karyotype test was normal and the FMR1 screening premutation test was negative. The patient underwent an ovarian biopsy which revealed the absence of functional follicles. She began a replacement therapy with estroprogestogens and she was informed about the most successful means to start a family, including adoption and oocyte donation.

CONCLUSION

POF is a heterogeneous, multifactorial, and poorly understood condition that involves medical concerns, psychological sphere, and sexuality of the affected patients. Management should be directed at symptoms resolution, bone protection, and psychosocial support for women facing this unexpected and devastating diagnosis.