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Rios-Espinosa A, Cruz-Luna M, Garmendia-Gallardo C, Hernández-Castañón MY, Hernández-Hernández VY, Sánchez-Tinoco PM, Bajonero-Domínguez A, Vergara Lope-Núñez JA, Álvarez-Pérez MA, González-Quiroz JL, Loranca-Moreno P, Ocampo-Godínez JM. Citalopram improves vasomotor syndrome and urogenital syndrome of menopause in Mexican women: a randomized clinical trial. Arch Gynecol Obstet 2022. [PMID: 35997971 DOI: 10.1007/s00404-022-06732-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aimed to determine the efficacy of non-hormonal therapy with citalopram vs fluoxetine for treating vasomotor syndrome (VMS) and urogenital syndrome of menopause (GSM) in Mexican women. METHODS A parallel prospective randomized clinical trial was conducted in 91 postmenopausal women with a total score on the Menopause Rating Scale (MRS) ≥ 17 and with the clinical diagnosis of VSM and GSM. Patients were randomly assigned to receive citalopram (n = 49) or fluoxetine (n = 42). Follow-up was carried out at 3 and 6 months. RESULTS The citalopram group experienced a significant improvement compared to the fluoxetine group in the MRS total score (p < 0.01), as well as in the psychological (p < 0.001) and somatic (p < 0.0001) domains at 3 and 6 months of follow-up. After 6 months of follow-up, the group that received citalopram decreased the relative risk (RR) to present VMS symptoms (RR = 0.30, CI 0.19-0.5, p = 0.0001), depressed mood (RR = 0.31, CI 0.15-0.6, p = 0.0002), irritability (RR = 0.40, CI 0.22-0.73, p = 0.002), anxiety (RR = 0.30, CI 0.13-0.69, p = 0.003), physical and mental exhaustion (RR = 0.35, CI 0.18-0.67, p = 0.001), sexual problems (RR = 0.18, CI 0.06-0.48, p = 0.0001), vaginal dryness (RR = 0.34, CI 0.14-0.80, p = 0.01), and urinary problems (RR = 0.36, CI 0.14-0.92, p = 0.043). CONCLUSION We conclude that citalopram tends to improve VSM and GSM symptoms in postmenopausal Mexican women. Thus, we recommend the daily use of citalopram 20 mg. However, further studies will be required to support the results of the present work. These should include a larger number of patients and a placebo group. CLINICAL TRIAL REGISTRATION This clinical trial was retrospectively registered by the United States National Library of Medicine in the www. CLINICALTRIALS gov database on 04/20/2022. The given test Registration Number is NCT05346445.
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Eggersmann TK, Wolthuis A, van Amsterdam PH, Griesinger G. Lack of analytical interference of dydrogesterone in progesterone immunoassays. Clin Chem Lab Med 2022; 60:1039-1045. [PMID: 35535412 DOI: 10.1515/cclm-2022-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Progesterone, a sex steroid, is measured in serum by immunoassay in a variety of clinical contexts. One potential limitation of steroid hormone immunoassays is interference caused by compounds with structural similarity to the target steroid of the assay. Dydrogesterone (DYD), an orally active stereoisomer of progesterone, is used for various indications in women's health. Herein, we report a systematic in vitro investigation of potential interference of DYD and its active metabolite 20α-dihydrodydrogesterone (DHD) in seven widely used, commercially available progesterone assays. METHODS Routine human plasma samples were anonymized and pooled to create three graded concentration levels of progesterone (P4 high, P4 medium, P4 low). Each pooled P4 plasma sample (6-7 mL) was spiked at high, medium, and "none" concentration with DYD/DHD and was divided into 0.5 mL aliquots. The blinded aliquots were analyzed by seven different laboratories with their routine progesterone assay (six different immunoassays and one liquid chromatography-tandem mass spectrometry assay, respectively) within the Dutch working group on endocrine laboratory diagnostics of the Dutch Foundation for Quality Assessments in Medical Laboratories. RESULTS The sample recovery rate (P4 result obtained for sample spiked with DYD/DHD, divided by the result obtained for the corresponding sample with no DYD/DHD × 100) was within a ±10% window for the medium and high P4 concentrations, but more variable for the low P4 samples. The latter is, however, attributable to high inter- and intra-method variability at low P4 concentrations. CONCLUSIONS This study does not indicate any relevant interference of DYD/DHD within routinely used progesterone assays.
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Affiliation(s)
- Tanja K Eggersmann
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Albert Wolthuis
- Stichting Certe Medische Diagnostiek en Advies, Groningen, the Netherlands
| | | | - Georg Griesinger
- Department of Reproductive Medicine and Gynecological Endocrinology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Abstract
Menopause is one of the most important events in the female reproductive life cycle, being a transition from the reproductive to the nonreproductive stage. It is a milestone that may have a negative influence on quality of life and one that brings in several physiological changes that affect the life of a woman permanently. According to a Polish epidemiological forecast, in 2050 the average female life expectancy will be 87.5, which is 6.4 years longer than today. Thus, the life expectancy of women who will be 60 or older in 2050 will also extend. Therefore, strategies need to be optimized to maintain postreproductive health, in part because of increased longevity. The general gynecologist can expect to see more elderly female patients as the population continues to age. Office management of the gynecologic problems of geriatric women requires sensitivity to the special needs of this group. Nowadays, most women spend more than one-third of their lives after menopause; therefore there is plenty of opportunity for gynecologists to cater to the needs of postmenopausal women. It is in their scope of practice to help postmenopausal women through "healthy aging". In this review we look into screenings, early identification, lifestyle modifications and appropriate intervention that may prevent many chronic conditions that cause morbidity and mortality during the postmenopausal years.
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Affiliation(s)
| | - Tomasz Pertyński
- Faculty of Health Science, Mazovian Public University in Plock, Poland
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De Franciscis P, Conte A, Schiattarella A, Riemma G, Cobellis L, Colacurci N. Non-hormonal Treatments For Menopausal Symptoms and Sleep Disturbances: A Comparison Between Purified Pollen Extracts and Soy Isoflavones. Curr Pharm Des 2020; 26:4509-4514. [DOI: 10.2174/1381612826666200721002022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022]
Abstract
Background:
Besides hot-flushes, sleep disturbances increase around menopause, impacting on the
quality of life. When hormone replacement therapy is contraindicated, it is necessary to provide alternative treatments.
Objectives:
This study aimed to observe the effects of an herbal remedy from pollen extracts and soy isoflavones
for menopausal complaints, particularly on sleep disorders.
Methods:
A six-month prospective observational study was performed in women in natural menopause suffering
from menopausal symptoms and sleep disturbances. Three groups were compared: 57 women receiving two tablets/
day containing herbal remedy from pollen extracts (group A), 60 women receiving one tablet/day containing
isoflavones 60 mg (group B), 47 women not receiving any treatment (group C). At 3 (T3) and 6 months (T6), the
daily number of hot-flushes, Kupperman index for menopausal symptoms, the Pittsburgh Sleep Quality Index
(PSQI) test were assessed.
Results:
Both groups A and B showed a significant improvement of hot flushes (p<0.001) and Kuppermann Index
(p<0.001) from T0 to T3 and from T0 to T6. No significant differences between treatment groups were found
at T3, while at T6 group A showed greater decrease of daily hot flashes and better improvement of Kupperman
Index as compared to group B (respectively, -48.8% versus -18.4% and -24.4% versus -15.4%; p<0.001). Improvement
of global sleep quality was more evident in the pollen treated group compared to isoflavones group at
both three (-24.7% versus -9.3%, p<0.001) and six (-52.9% vs -4.0%; p<0.001) months, mainly for the scores
related to subjective sleep quality, sleep latency and habitual sleep efficiency.
Conclusions:
Non-hormonal treatments can effectively be used in symptomatic menopausal women: among these,
after six months of treatment, pollen extracts might achieve a better improvement of hot flushes, sleep disturbances
and menopause-related symptoms than soy isoflavones. Herbal remedy from pollen extracts is mainly
effective when the quality of sleep is the most disturbing complaint.
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Affiliation(s)
- Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anna Conte
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Schiattarella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Cobellis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Nicola Colacurci
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
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De Franciscis P, Schiattarella A, Riemma G, Labriola D, Ambrosio D, Vitale SG, Cianci A, Cucinella G, Calagna G, Colacurci N. Hysteroscopic and ultrasonographic evaluation of ulipristal acetate treatment for symptomatic myomas in premenopausal women: a prospective study. MINIM INVASIV THER 2020; 31:435-440. [PMID: 33043778 DOI: 10.1080/13645706.2020.1829648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to analyze the effects of a six-month therapy with ulipristal acetate (UPA) on myoma size and endometrial thickness in premenopausal women. MATERIAL AND METHODS Seventy-four women undergoing conservative therapy with UPA were enrolled for this study. All women underwent transvaginal ultrasound evaluation to assess the endometrial thickness, and the number and size of myomas at the beginning and after six months. Hysteroscopy and biopsy were performed after six months, if necessary. RESULTS After six months of treatment, sonographic examination showed a statistically significant (p < .05) reduction of the size of the largest myoma (56.3 ± 5.1 vs. 31.7 ± 10.1 mm) and a statistically significant (p < .05) increase in endometrial thickness (5.9 ± 2.1 vs. 9.7 ± 3.4 mm). Twenty-two patients with endometrial thickness >10 mm or nonhomogeneous pattern and ten patients with metrorrhagia underwent hysteroscopy: the most frequent finding was the combination of endometrial hypotrophy, floating surface, and chicken-wire vascular pattern aspect (14 cases, 43.7%). Histologic findings showed no case of complex hyperplasia. CONCLUSION UPA is a safe, effective and assured method to decrease symptoms, reduce the need for surgery in premenopausal women suitable for the treatment.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Domenico Labriola
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Domenico Ambrosio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Cianci
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Gaspare Cucinella
- Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy
| | - Gloria Calagna
- Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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La Rosa VL, De Franciscis P, Barra F, Schiattarella A, Török P, Shah M, Karaman E, Marques Cerentini T, Di Guardo F, Gullo G, Ponta M, Ferrero S. Quality of life in women with endometriosis: a narrative overview. Minerva Med 2019; 111:68-78. [PMID: 31755667 DOI: 10.23736/s0026-4806.19.06298-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endometriosis is a very complex condition and has a significant impact on the quality of life, psychological wellbeing and interpersonal relationships of affected women. Endometriosis symptoms progressively impair the woman's ability to carry out some daily activities and result in a perception of worsening health status and overall well-being. The impact of these symptoms has been only partially investigated, and further studies and clinical insights are needed to fully understand the extent of this condition. It has been shown that endometriosis is associated with considerable direct and indirect costs, comparable to those of major worldwide chronic diseases such as diabetes. In addition, endometriosis-related symptoms substantially interfere with the employment of affected women, resulting in many cases in several working days missed. In this scenario, the aim of this narrative review is to provide a general overview of the psychological and social impact of this disease, as well as the effects of different therapeutic options, on quality of life and general well-being.
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Affiliation(s)
- Valentina L La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy -
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, San Martino University Hospital IRCCS, Genoa, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Erbil Karaman
- Department of Obstetrics and Gynecology, Yuzuncu Yıl University, Van, Turkey
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giuseppe Gullo
- AOOR Villa Sofia Cervello, IVF Public Center, Palermo, Italy
| | - Marco Ponta
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, San Martino University Hospital IRCCS, Genoa, Italy
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De Franciscis P, Riemma G, Schiattarella A, Cobellis L, Guadagno M, Vitale SG, Mosca L, Cianci A, Colacurci N. Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination. Diagnostics (Basel) 2019; 9:diagnostics9040142. [PMID: 31591361 PMCID: PMC6963519 DOI: 10.3390/diagnostics9040142] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 12/19/2022] Open
Abstract
The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Luigi Cobellis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Maria Guadagno
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Salvatore Giovanni Vitale
- Unit of Obstetrics & Gynecology, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy.
| | - Lavinia Mosca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Antonio Cianci
- Unit of Obstetrics & Gynecology, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy.
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
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Riemma G, Schiattarella A, La Verde M, Zarobbi G, Garzon S, Cucinella G, Calagna G, Labriola D, De Franciscis P. Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials. ACTA ACUST UNITED AC 2019; 55:E554. [PMID: 31480427 DOI: 10.3390/medicina55090554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.
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De Franciscis P, Colacurci N, Riemma G, Conte A, Pittana E, Guida M, Schiattarella A. A Nutraceutical Approach to Menopausal Complaints. ACTA ACUST UNITED AC 2019; 55:medicina55090544. [PMID: 31466381 PMCID: PMC6780855 DOI: 10.3390/medicina55090544] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 12/21/2022]
Abstract
The menopausal transition, or perimenopause, is characterized by menstrual irregularities, vasomotor symptoms, sleep disturbances, mood symptoms, and urogenital tract atrophy. These changes can also affect the quality of life and one’s self-esteem. Hormone replacement therapy (HRT) is considered the best option to achieve therapeutic relief of different menopausal symptoms but is usually restricted to moderate or severe symptoms. Moreover, many women refuse HRT for a variety of reasons concerning the fear of cancer and other adverse effects. According to these considerations, new topics are emerging: Dissatisfaction with drug costs and conventional healthcare, desire for personalized medicines, and the public perception that “natural is good”. In this context, nonhormonal therapies are mostly evolving, and it is not unusual that women often request a “natural” approach for their symptoms. The aim of this study is to investigate nonhormonal therapies that have been identified to reduce the menopausal symptoms.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Nicola Colacurci
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Gaetano Riemma
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Anna Conte
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Erika Pittana
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", 80138 Naples, Italy
| | - Antonio Schiattarella
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
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Schettino MT, De Franciscis P, Schiattarella A, La Manna V, Della Gala A, Caprio F, Tammaro C, Ammaturo FP, Guler T, Yenigün EH. Prevalence of HPV Genotypes in South Europe: Comparisons between an Italian and a Turkish Unvaccinated Population. J Environ Public Health 2019; 2019:8769735. [PMID: 31236119 DOI: 10.1155/2019/8769735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/28/2019] [Indexed: 01/21/2023]
Abstract
The human papilloma virus (HPV) is a DNA virus associated with benign and malignant lesions of skin and mucous membranes and is the most common sexually transmitted viral infection worldwide. We investigated the prevalence of HPV infection and associated risk factors in Italian and Turkish women population attending the gynecology outpatients clinic in Naples (Italy) and Pamukkale (Turkey). Women were enrolled from the Department of Obstetrics and Gynecology of the University of Campania “Luigi Vanvitelli” in Naples (Italy) and of “Pamukkale University” in Denizli (Turkey) between January 2014 and June 2015. A questionnaire that included sociodemographic and sexual behavior characteristics, questions about HPV awareness, vaccine status, and reasons for not wanting to get vaccinated, and HPV-related knowledge was completed for each participant, and cervical cytology samples were collected. The prevalence of HPV infection was higher in the Italian group (52.6% vs 32.6%, p < 0.001), while the distribution of genotypes is similar (p=0.325). Moreover, the differences in cytological alterations in these patients are significant (p < 0.001). The analysis showed a higher prevalence of sexual behavioral characteristics (p < 0.001) and better attention to the execution of the screening test in the Italian population (p < 0.001). Italian women showed more knowledge and propensity to vaccination compared to Turkish women (p < 0.001). Our data highlighted three relevant aspects: the different prevalence of cytological abnormalities, the different distribution of risk factors and, above all, the different attitude of women towards the primary prevention of cervical cancer between an Italian and a Turkish population group.
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Abstract
BACKGROUND Vasomotor symptoms are the most common complaints for which menopausal women seek medical care. Eighty per cent of all menopausal women will have hot flushes and night sweats, and of these 9% will have severe symptoms impacting their quality of life. Ideally, treatment should target the group most severely afflicted, and options for treatment should be tailored to each woman, since, for most women, vasomotor symptoms spontaneously resolve in 3 - 5 years. Recommendation at this time is for the shortest duration of therapy, which means that episodic review of therapy is indicated. OBJECTIVE To review the latest literature investigating therapies for vasomotor symptoms and to discuss their effectiveness with emphasis on placebo-controlled, randomized clinical trials. METHODS A literature search in PubMed for 'vasomotor symptoms', 'menopause symptoms', 'hot flushes', 'hot flashes' and 'night sweats' from 2003 to the present was performed. CONCLUSIONS Estrogen remains the gold standard for treating vasomotor symptoms. As investigations into the physiology of hot flushes continue, centrally active drugs (selective serotonin or norepinephrine-serotonin reuptake inhibitors and gabapentin) have increased in use. The benefit from dietary herbal supplements is still inconclusive; however, recent studies have shown some mild response to soy and black cohosh.
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Affiliation(s)
- Wen Shen
- Johns Hopkins University School of Medicine, Division of Gynecology, 600 North Wolfe Street, Phipps 249, Baltimore, MD 21287, USA .
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12
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Kharode Y, Bodine PVN, Miller CP, Lyttle CR, Komm BS. The pairing of a selective estrogen receptor modulator, bazedoxifene, with conjugated estrogens as a new paradigm for the treatment of menopausal symptoms and osteoporosis prevention. Endocrinology 2008; 149:6084-91. [PMID: 18703623 DOI: 10.1210/en.2008-0817] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The menopausal transition is associated with decreased ovarian function and concomitant decline in estrogen production, which may result in physiological effects such as hot flashes, reduced bone mass, and altered lipid profile. It is well established that these unfavorable changes are effectively offset with estrogen therapy (ET) or, in women with a uterus, estrogens in combination with a progestin (hormone therapy). Selective estrogen receptor (ER) modulators (SERMs), which exhibit both ER agonist and antagonist activities depending on the target tissue, have been regarded as offering the potential to provide the benefits of ET and hormone therapy with an improved safety and tolerability profile. To date, no SERM alone has demonstrated an ideal benefit-risk profile for menopausal therapy. The tissue-selective estrogen complex, or the pairing of a SERM with estrogens, may provide an optimal blend of ER agonist and antagonist activities. We evaluated the physiological profile of this novel therapeutic paradigm by using various in vivo models to assess uterine, vasomotor, lipid, and skeletal responses to a tissue-selective estrogen complex partnering bazedoxifene with conjugated estrogens (CE). Bazedoxifene at 3.0 mg/kg effectively antagonized CE-induced uterine stimulation without reversing the positive effects of CE on vasomotor instability. When paired with CE, bazedoxifene at 3.0 mg/kg reduced total cholesterol levels by up to 20% compared with CE alone and significantly increased total bone density relative to control. These preclinical findings showed that the appropriate dose combination of bazedoxifene/CE exhibits positive vasomotor, lipid, and skeletal responses with minimal uterine stimulation.
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Affiliation(s)
- Yogendra Kharode
- Wyeth Research, Women's Health and Musculoskeletal Biology, Collegeville, Pennsylvania 19426, USA
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