RESUMEN
OBJECTIVE: To determine the prevalence of metabolic syndrome among pre- and post-menopausal women attending a tertiary clinic in Turkey. STUDY DESIGN: This is a cross-sectional study consisting of one hundred and eighty healthy postmenopausal women and fifty-three healthy premenopausal women evaluated for presence or absence of metabolic syndrome. The t test and Fischer exact test were used for continuous variables and chi-square test was used for categorical variables. RESULTS: The prevalence of metabolic syndrome among pre-menopausal women was 15.09% according to NCEP criteria. The prevalence of metabolic syndrome among postmenopausal women was 19.44% according to NCEP criteria. There was no significant difference in the prevalence of metabolic syndrome between premenopausal and postmenopausal women in our study population. CONCLUSION: There was no significant difference in the prevalence of metabolic syndrome between premenopausal and postmenopausal women attending a tertiary clinic in Turkey.
Asunto(s)
Síndrome Metabólico/epidemiología , Posmenopausia , Premenopausia , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Hiperglucemia/etiología , Hipertrigliceridemia/etiología , Síndrome Metabólico/complicaciones , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Servicio Ambulatorio en Hospital , Sobrepeso/complicaciones , Guías de Práctica Clínica como Asunto , Prevalencia , Estadística como Asunto , Turquía/epidemiologíaRESUMEN
AIM: To determine the impact on osteopenia/osteoporosis of serum follicle-stimulating hormone (FSH), estradiol levels and time since menopause in a group of Turkish postmenopausal women. METHODS: Four hundred and thirty-three healthy postmenopausal women seen at the Marmara University Menopause Outpatient Clinic were enrolled for this prospective cohort study. The women were allocated to one of three groups according to the bone mineral density (BMD) of the lumbar vertebrae and total hip, as measured by dual energy X-ray absorptiometry (DEXA). Serum FSH, estradiol levels, age and time since menopause were compared between the groups. RESULTS: The mean serum FSH, LH, estradiol and testosterone levels for women with normal, osteopenic and osteoporotic BMD at lumbar vertrebra L1-L4 and total hip were comparable. Time since menopause had a stronger predictive value for low BMD (osteopenia or osteoporosis) in the lumbar and hip areas than did serum FSH or estradiol levels. CONCLUSIONS: Our study showed that neither FSH nor E2 has a strong impact on postmenopausal BMD. However it appears that time since menopause has a weak non-significant association with postmenopausal osteopenia and osteoporosis.
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Estradiol/sangre , Hormona Folículo Estimulante/sangre , Osteoporosis Posmenopáusica/sangre , Posmenopausia/sangre , Anciano , Densidad Ósea , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , TurquíaRESUMEN
AIM: To determine the impact of metabolic syndrome (MS) on dual-energy X-ray absorptiometry (DEXA) derived mean T scores of lumbar vertebra of Turkish women during postmenopausal period. METHODS: One hundred and eighty healthy postmenopausal women seen at the University Gynecology or Menopause Outpatient Clinics were enrolled for this cross sectional study. The women were allocated to one of two groups according to the presence or absence of MS. The groups were then compared for bone mineral density (BMD) of the lumbar vertebrae, as measured by DEXA. The Fischer exact test were used for continuous variables and chi-square test was used for categorical variables. Multivariable logistic regression modeling was used to compute the odds ratios of variables predictive of diminished T scores at lumbar area less than -1. RESULTS: The mean T scores for the lumbar area for women with or without MS were comparable either according to National Cholesterol Education Program criteria. Moderate positive correlation was found between T score less than -1 and high density lipoprotein (HDL) cholesterol. Triglyceride/HDL cholesterol and fasting blood glucose showed weak negative correlation with T score less than -1. CONCLUSIONS: It appears that MS in postmenopausal women does not have an impact on BMD in our population.
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Densidad Ósea , Síndrome Metabólico/fisiopatología , Posmenopausia/fisiología , Absorciometría de Fotón , Estudios Transversales , Femenino , Humanos , Vértebras Lumbares , Persona de Mediana EdadRESUMEN
OBJECTIVE: To determine if follicular dominance on the fifth day of controlled ovarian stimulation (COS) predicts implantation rates in down-regulated intracytoplasmic sperm injection (ICSI) cycles. STUDY DESIGN: One hundred and sixty-two consecutive women undergoing ICSI treatment with long down-regulation and recombinant follicle-stimulating hormone injections were included in a prospective cohort analysis. The clinical pregnancy and implantation rates per transfer were compared between two groups, one with and the other without follicular dominance detected by ultrasound on the fifth day of COS. RESULTS: There was no significant difference between the groups regarding the number of good quality embryos transferred, but clinical pregnancy and implantation rate per transfer were higher in group with follicular synchrony. CONCLUSIONS: Follicular dominance on COS day 5 results in reduced implantation rates after ICSI.
Asunto(s)
Implantación del Embrión , Ciclo Menstrual , Inducción de la Ovulación , Inyecciones de Esperma Intracitoplasmáticas , Adulto , Femenino , Humanos , Folículo Ovárico/efectos de los fármacos , Embarazo , Índice de Embarazo , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
AIM: To determine if endometrial trauma during embryo transfer trials (ETTs) improves implantation and clinical pregnancy rates in intracytoplasmic sperm injection treatment cycles. PATIENTS: One-hundred fifty women undergoing their first IVF treatment were included in a prospective randomised study in a University hospital clinic. ETTs were performed either on day 21 of the previous cycle, or on day 6 of the controlled ovarian hyperstimulatin (COH) cycle, or conducted at least two cycles before COH cycle. Clinical pregnancy and implantation rates were compared between the groups. RESULTS: There was no difference between the groups in terms of clinical pregnancy or implantation rates. CONCLUSION: Endometrial trauma by ETTs performed either during the preceding cycle or on day 6 of the COH cycle does not improve pregnancy rates.
Asunto(s)
Implantación del Embrión/fisiología , Transferencia de Embrión/métodos , Inyecciones de Esperma Intracitoplasmáticas/métodos , Adulto , Transferencia de Embrión/estadística & datos numéricos , Estradiol/sangre , Femenino , Humanos , Infertilidad/sangre , Infertilidad/terapia , Masculino , Placebos , Embarazo , Índice de Embarazo , Inyecciones de Esperma Intracitoplasmáticas/estadística & datos numéricos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the prevalence of the different human papillomavirus (HPV) genotypes in women seen at 2 Marmara University Hospital gynecologic outpatient clinics in Istanbul, Turkey. METHODS: From May 1 through August 31, 2008, specimens were obtained from 500 women for cytologic evaluation by the split-sample method. HPV types were identified by PCR and hybridization using a microarray that identifies 35 types. RESULTS: The overall prevalence of HPV was 16.5%, multiple genotypes were found in 35.8% of the infected women, and 75% of the types were high risk; 79% of the infected women had negative cytologic results, 3.7% had ASCUS, 10% had LSIL, and 6% had HSIL; the highest infection rates were 36% for women aged 20 to 30 years and 35% for those aged 31 to 40 years; 65.2% of the infected women were university graduates; and 34% were single. CONCLUSION: HPV infection involved numerous types, most of them high risk, even in women with negative cytology results. Further studies with larger groups will provide more information on HPV distribution in Turkey, which may guide the development of local vaccination programs.
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ADN Viral/análisis , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Adulto , Factores de Edad , Escolaridad , Femenino , Genotipo , Humanos , Análisis por Micromatrices , Persona de Mediana Edad , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Infecciones por Papillomavirus/virología , Reacción en Cadena de la Polimerasa , Prevalencia , Factores de Riesgo , Turquía/epidemiología , Salud Urbana , Frotis Vaginal/métodos , Adulto JovenRESUMEN
OBJECTIVE: To investigate the relationship between vasomotor symptoms (hot flashes) and osteopenia or osteoporosis in perimenopausal women. METHOD: In this cross-sectional study 79 perimenopausal women aged between 45 and 55 years and seen at the Gynecology or Menopause Outpatient Clinic of Marmara University School of Medicine were allotted to one of 2 groups according to the presence or absence of hot flashes. The groups were then compared for bone mineral density (BMD) of the lumbar vertebrae, as measured by dual energy X-ray absorptiometry. RESULTS: The mean BMD measurement for vertebrae L2 to L4 was 0.32+/-0.19 for the group with no hot flashes and -0.53+/-0.21 for the group with hot flashes (P=0.007). In the former, 6.1% of the women and in the latter, 32.6% of the women had a BMD value less than a 1.5 standard deviation from the mean (P=0.005). CONCLUSION: Women with vasomotor symptoms are more prone to have osteopenia or osteoporosis.
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Absorciometría de Fotón/métodos , Densidad Ósea , Sofocos/epidemiología , Osteoporosis Posmenopáusica/diagnóstico por imagen , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Enfermedades Óseas Metabólicas/fisiopatología , Estudios Transversales , Femenino , Sofocos/etiología , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Persona de Mediana Edad , Osteoporosis Posmenopáusica/fisiopatologíaRESUMEN
OBJECTIVE: To compare the changes in body composition and in leptin levels in postmenopausal women receiving hormone therapy (HT) or tibolone. DESIGN: Prospective comparative study. SETTING: Menopause Unit in a tertiary Hospital. PATIENT(S): One hundred twenty women were recruited. INTERVENTION(S): Women were assigned into a control group, HT, and tibolone group. MAIN OUTCOME MEASURE(S): Anthropometric indices, leptin levels, tissue fat percentage, total fat, and lean mass measurements were performed at baseline and after 6 months. RESULT(S): The serum leptin levels were in strong correlation with the total fat percentage and total fat mass at baseline. Untreated women had weight gain and a gradual decrease in leptin levels. Women receiving HT had significantly increased leptin levels. Women in the tibolone group, however, had a significant decrease in leptin levels accompanied by decreased total fat mass, fat percentage, and increased total lean mass. The changes in leptin levels were more pronounced in lean women. CONCLUSION(S): Postmenopausal women tend to gain weight accompanied with a reduction in leptin concentrations. Hormone therapy administration increases leptin levels while maintaining body weight and body fat distribution, whereas tibolone use decreases leptin levels, total fat percentage, and total fat mass.
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Adiposidad/efectos de los fármacos , Terapia de Reemplazo de Estrógeno , Estrógenos Conjugados (USP)/uso terapéutico , Leptina/sangre , Acetato de Medroxiprogesterona/uso terapéutico , Norpregnenos/uso terapéutico , Posmenopausia , Aumento de Peso/efectos de los fármacos , Adulto , Índice de Masa Corporal , Femenino , Humanos , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Relación Cintura-CaderaRESUMEN
OBJECTIVE: To report a case of ongoing pregnancy in a woman who underwent hysteroscopy during the implantation phase. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 34-year-old woman with unexplained infertility who was scheduled for IVF. INTERVENTION(S): Office hysteroscopy. MAIN OUTCOME MEASURE(S): Hysteroscopy during early pregnancy. RESULT(S): An ongoing pregnancy after hysteroscopy during the implantation phase. CONCLUSION(S): The risk of a properly performed hysteroscopy in the implantation phase of an unrecognized pregnancy may be less than expected.
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Histeroscopía , Adulto , Implantación del Embrión , Femenino , Humanos , EmbarazoRESUMEN
OBJECTIVE: To analyze the predictive value of cycle day 7 follicle count (CD7-FC) for poor ovarian response during IVF in women down-regulated with a luteal start of GnRH analogue (long protocol). DESIGN: A retrospective analysis. SETTING: University hospital. PATIENT(S): Ninety-one consecutive IVF cycles of 82 subjects. INTERVENTION(S): Basal levels of FSH and E2 were determined in the spontaneous cycle before the IVF cycle. During the IVF cycle, the number of basal and CD7 follicles and CD7 endometrial thickness were determined by ultrasound, and CD7 serum E2 levels were measured. MAIN OUTCOME MEASURE(S): Ovarian response determined according to the number of mature oocytes retrieved. RESULT(S): On receiver operating characteristic analysis, CD7-FC had the highest combination of sensitivity and specificity to detect women with poor ovarian response when compared with the basal ovarian reserve tests. When a combined basal antral FC and CD7-FC evaluation was used with the optimum cutoff values of 6.5 and 7.5, respectively, sensitivity and specificity improved to 85% and 90%, respectively. CONCLUSION(S): Cycle day 7 follicle count during a long IVF protocol is helpful in predicting ovarian response in combination with the antral FC. This combination has high positive and negative predictive values. This may help clinicians and women to cancel cycles earlier and decrease the psychological, financial, and medical burden of a later cancellation.
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Infertilidad Femenina/diagnóstico por imagen , Infertilidad Femenina/fisiopatología , Ciclo Menstrual , Folículo Ovárico/diagnóstico por imagen , Ovario/fisiopatología , Inducción de la Ovulación , Adulto , Área Bajo la Curva , Femenino , Fertilización In Vitro , Hormona Folículo Estimulante/uso terapéutico , Humanos , Infertilidad Femenina/tratamiento farmacológico , Ovario/efectos de los fármacos , Valor Predictivo de las Pruebas , Curva ROC , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Factores de Tiempo , UltrasonografíaRESUMEN
OBJECTIVE(S): To investigate whether the mode of delivery effects the birthweight. STUDY DESIGN: In this retrospective study, 3092 singleton live births following uncomplicated pregnancies were analyzed. Birthweights were expressed as multiples of the median (MoM) for the relevant gestational week. The birthweight of children born vaginally was compared with those born by cesarean section. RESULTS: The birthweight of children born vaginally was lower than that of those born by cesarean section. However, this difference was not observed at all gestational ages. Increasing cesarean rates and birthweights throughout years were observed, and the women, who delivered by cesarean section, were older than those, who delivered vaginally. CONCLUSION(S): It appears that mode of delivery has negligible effect on birthweight.
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Peso al Nacer , Parto Obstétrico/estadística & datos numéricos , Adulto , Cesárea/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Masculino , Paridad , Embarazo , Estudios Retrospectivos , TurquíaRESUMEN
OBJECTIVE: To assess the effect of tibolone treatment on the intima-media thickness (IMT) of the common carotid artery (CCA) and the resistive indices (RIs) of the CCA and internal (ICA) and external (ECA) carotid and the vertebral arteries (VAs) in postmenopausal women as sonographic markers of atherosclerosis. DESIGN: A prospective study. SETTING: University hospital. PATIENT(S): Twenty postmenopausal women who had no cardiovascular disease. INTERVENTION(S): Noninvasive measurements of the IMT of the CCA and the RI of the CCA, ICA, ECA, and VA were made with ultrasound at baseline and after 12 weeks of tibolone treatment. MAIN OUTCOME MEASURE(S): IMT of the CCA and RI of the CCA, ICA, ECA, and VA. RESULT(S): Three months of tibolone treatment decreased the IMT of the CCA (mean +/- SD) from 0.70 +/- 0.22 mm (95% confidence interval [CI], 0.60-0.80) to 0.47 +/- 0.17 mm (95% CI, 0.39-0.55) by 28%. Resistive indices of the CCA, ICA, and VA also decreased significantly. CONCLUSION(S): The present study showed that tibolone treatment decreases both the IMT of the CCA and RI of the CCA, ICA, and VA, which appears to be related to its anti-atherosclerotic effect. Nevertheless, the clinical implications of these findings are yet to be investigated.
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Arterias Carótidas/fisiología , Moduladores de los Receptores de Estrógeno/farmacología , Norpregnenos/farmacología , Túnica Íntima/anatomía & histología , Túnica Media/anatomía & histología , Resistencia Vascular/fisiología , Adulto , Arteriosclerosis , Biomarcadores , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/efectos de los fármacos , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia , Estudios Prospectivos , Túnica Íntima/diagnóstico por imagen , Túnica Íntima/efectos de los fármacos , Túnica Media/diagnóstico por imagen , Túnica Media/efectos de los fármacos , Ultrasonografía , Resistencia Vascular/efectos de los fármacosRESUMEN
OBJECTIVE: To compare continuous combined hormone replacement therapy (ccHRT) and raloxifene with respect to compliance and quality of life, which were predefined secondary endpoints of a large, prospective study designed to investigate the uterine effects of both treatments. DESIGN: Double-blind, randomised controlled trial of six-month duration. SETTING: One hundred and twenty-nine gynaecology hospital departments, clinics or practices specialised in women's healthcare, located in Europe, South Africa and Israel. POPULATION: Healthy postmenopausal women (n = 1008). MAIN OUTCOME MEASURES: Changes in quality of life using the Women's Health Questionnaire (WHQ) and compliance using a compliance questionnaire and pill count. Adverse event and early discontinuation rates and satisfaction with treatment using a visual analogue scale (VAS). RESULTS: Women taking raloxifene reported greater satisfaction with their treatment as assessed on the VAS (P = 0.004), and a lower proportion, as compared with ccHRT, reported being worried by the treatment (9.6% vs 20.2%, P < 0.01). Women taking ccHRT reported greater deterioration in scores from the WHQ for depressed mood and menstrual symptoms than those taking raloxifene (P < 0.01). For memory, vasomotor symptoms and sexual behaviour, the ccHRT group reported significantly greater mean improvements (P < 0.05). Over half (58.8%) of those taking raloxifene noticed no effect, 37.7% felt better and 3.4% felt worse as measured using the compliance questionnaire. Fifty percent of the women taking ccHRT felt better, 37.8% noticed no effect but over 10% felt worse. More women on raloxifene (94.6%) than on ccHRT (85.9%) reported that they were taking their double-blinded medication regularly (P < 0.01). CONCLUSIONS: A lower rate of adverse event-related discontinuations, the lack of negative effects on quality of life and a smaller proportion of women being worried by the drug treatment were associated with higher treatment satisfaction and better compliance in postmenopausal women taking ccHRT or raloxifene.
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Terapia de Reemplazo de Hormonas/métodos , Clorhidrato de Raloxifeno/uso terapéutico , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Anciano , Enfermedades de la Mama/inducido químicamente , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Dolor/inducido químicamente , Cooperación del Paciente , Satisfacción del Paciente , Posmenopausia , Calidad de Vida , Encuestas y Cuestionarios , Negativa del Paciente al Tratamiento , Vasodilatación/efectos de los fármacosRESUMEN
OBJECTIVE: To investigate an optimal screening protocol for impaired glucose tolerance (IGT) and type II or non-insulin-dependent diabetes mellitus (DM) by using fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) in postmenopausal women. DESIGN: One hundred consecutive postmenopausal women were screened with FPG determination, and then all underwent an OGTT. Basal serum lipid and insulin levels of these women were also determined. Insulin sensitivity was determined by using the homeostasis model assessment. Receiver operating characteristic analysis was performed to determine the efficacy of these variables in detecting women with IGT and DM, and optimal cutoff values were determined. RESULTS: FPG with a cutoff value of 98 mg/dL had the best combination of sensitivity (71%) and specificity (76%) for the detection of IGT and DM. Combined FPG and body mass index screening (with the optimal cutoff value of 26.5 kg/m2) improved the sensitivity to 96% but decreased the specificity to 47%. This combined screening protocol detected 94% of the women with IGT and all diabetic women. CONCLUSIONS: Given that IGT and DM are common among postmenopausal women and DM can be prevented by nonpharmacologic interventions in women with IGT, OGTT may be used more frequently among these women. Our data indicate that for optimal screening of non-insulin-dependent DM and IGT, OGTT should be considered in postmenopausal women, especially when risk factors in addition to age are present. This model may detect most of the women with IGT and almost all diabetic women.
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Diabetes Mellitus Tipo 2/epidemiología , Prueba de Tolerancia a la Glucosa/estadística & datos numéricos , Posmenopausia/fisiología , Anciano , Glucemia/análisis , Índice de Masa Corporal , Estudios de Cohortes , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Posmenopausia/sangre , Probabilidad , Estudios Prospectivos , Curva ROC , Medición de Riesgo , Sensibilidad y EspecificidadRESUMEN
A 26-year-old woman had classic symptoms of primary ovarian pregnancy. Ultrasound examination disclosed a cystic mass surrounded by a complex mass that was compatible with hematoma in the pouch of Douglas, as well as an intrauterine device (IUD) displaced near the isthmic portion of the uterine cavity. Laparoscopy revealed a ruptured gestational sac in the cul-de-sac that was encapsulated by a hematoma originating from the right ovary. All deep-seated products of conception were excised from the ovary, and the IUD was removed. Treatment was successful and avoided more invasive intervention.