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Objective: To assess efficacy and tolerability of ulipristal acetate, a selective progesterone receptor modulator, for treatment of symptomatic uterine leiomyomas.Methods: This phase 3, double-blind, placebo-controlled study enrolled premenopausal women (aged 18-50 years) with abnormal uterine bleeding, one or more discrete leiomyomas, and uterine size 20 weeks of gestation or less. Patients were randomized 1:1:1 to 5 mg ulipristal, 10 mg ulipristal, or placebo once daily for 12 weeks followed by 12-week drug-free follow-up. Coprimary endpoints were rate of and time to amenorrhea, defined as no bleeding for the last 35 consecutive days of treatment. Secondary endpoints included rates of amenorrhea from day 11 and change from baseline to endpoint in the Revised Activities subscale of the Uterine Fibroid Symptom and Quality of Life questionnaire, which includes questions pertaining to physical and social activities. Safety assessments included adverse event monitoring and endometrial biopsies. A sample size of 150 was planned to compare separately each dose of ulipristal with placebo.Results: From March 2014 to March 2016, 157 patients were randomized. Demographics were similar across treatment groups. Amenorrhea was achieved by 25 of 53 (47.2% [97.5% CI 31.6-63.2]) and 28 of 48 (58.3% [97.5% CI 41.2-74.1]) patients treated with 5 mg and 10 mg ulipristal, respectively, compared with 1 of 56 (1.8% [97.5% CI 0.0-10.9]) placebo-treated patients (both P<.001). Time to amenorrhea was shorter for both ulipristal doses compared with placebo (P<.001), and both doses of ulipristal resulted in improved quality of life compared with placebo (P<.001). Common adverse events (5% or greater in either ulipristal group during treatment) were hypertension, elevated blood creatinine phosphokinase, and hot flushes. Serious adverse events occurred in four patients, but none was considered related to treatment. Endometrial biopsies were benign.Conclusion: Ulipristal at 5 mg and 10 mg were well tolerated and superior to placebo in rate of and time to amenorrhea in women with symptomatic uterine leiomyomas.Clinical Trial Registration: Clinicaltrials.gov number, NCT02147197. [ABSTRACT FROM AUTHOR]

Objective: To compare the long-term risks associated with salpingo-oophorectomy with ovarian conservation at the time of benign hysterectomy.Data Sources: MEDLINE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials were searched from inception to January 30, 2015. We included prospective and retrospective comparative studies of women with benign hysterectomy who had either bilateral salpingo-oophorectomy (BSO) or conservation of one or both ovaries.Methods Of Study Selection: Reviewers double-screened 5,568 citations and extracted eligible studies into customized forms. Twenty-six comparative studies met inclusion criteria. Studies were assessed for results, quality, and strength of evidence.Tabulation, Integration, and Results: Studies were extracted for participant, intervention, comparator, and outcomes data. When compared with hysterectomy with BSO, prevalence of reoperation and ovarian cancer was higher in women with ovarian conservation (ovarian cancer risk of 0.14-0.7% compared with 0.02-0.04% among those with BSO). Hysterectomy with BSO was associated with a lower incidence of breast and total cancer, but no difference in the incidence of cancer mortality was found when compared with ovarian conservation. All-cause mortality was higher in women younger than age 45 years at the time of BSO who were not treated with estrogen replacement therapy (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.04-1.92). Coronary heart disease (HR 1.26, 95% CI 1.04-1.54) and cardiovascular death were higher among women with BSO (HR 1.84, 95% CI 1.27-2.68), especially women younger than 45 years who were not treated with estrogen. Finally, there was an increase in the prevalence of dementia and Parkinson disease among women with BSO compared with conservation, especially in women younger than age 50 years. Clinical practice guidelines were devised based on these results.Conclusion: Bilateral salpingo-oophorectomy offers the advantage of effectively eliminating the risk of ovarian cancer and reoperation but can be detrimental to other aspects of health, especially among women younger than age 45 years. [ABSTRACT FROM AUTHOR]

The article discusses the diagnosis and management of benign breast disorders. It outlines the common benign breast disease symptoms in women. It notes the appropriate evaluation and management of benign breast disease. It mentions the three categories of benign breast lesions including nonproliferative, proliferative without atypia and atypical hyperplasia.

OBJECTIVE: To assess the association between the use of gelatin-thrombin matrix and the development of pelvic abscess during hysterectomy as well as factors associated with surgeons' use of this product. METHODS: Data for patients undergoing hysterectomy for obstetric-gynecologic pathology were abstracted from databases at a tertiary hospital between 2009 and 2012. Open and minimally invasive hysterectomies were included and vaginal hysterectomies were excluded. Blood loss, surgery type, comorbidities, abscess formation, and use of gelatin-thrombin matrix were examined. Abscess was defined as a walled-off fluid collection (documented with computed tomography scan) with fever (greater than 38°C) or leukocytosis (greater than 11,000/microliter). Standard statistical models were used. RESULTS: Of the 413 patients identified, 213 (51%) underwent surgery for malignancy. Gelatin-thrombin matrix was used in 166 patients (40%). The overall rate of abscess was low (3%). In bivariate analyses, blood loss greater than 500 mL (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.1-12.9, P=.021], ascites (OR 6.5, 95% CI 1.6-26.1, P=.023), drain placement (OR 4.5, 95% CI 1.3-15.1, P=.009), and gelatin-thrombin matrix use (OR 7.0, 95% CI 1.5-32.9, P=.009) were significantly associated with abscess formation. Multivariate logistic regression revealed that only gelatin-thrombin matrix use predicted the development of pelvic abscess (OR 7.0, 95% CI 1.5-32.9, P=.013). CONCLUSION: We found that gelatin-thrombin matrix use was associated with an increased risk of pelvic abscess. Although these products are important in the setting of bleeding, these data suggest that the liberal use of sealants is not without risk. [ABSTRACT FROM AUTHOR]

The article discusses a prospective cohort study which investigated complementary alternative therapies for women suffering from chronic vaginitis. The study found that alternative therapies such as yogurt and acidophilus pills are commonly used in women with chronic vaginitis, particularly young women. Users of complementary were also found to have greater perceived stress.

The article focuses on a study which compared the efficacy and safety of trocar-guided tension-free vaginal mesh insertion with conventional vaginal prolapse repair in women with recurrent pelvic organ prolapse. The study included patients diagnosed with recurrent pelvic organ prolapse stage II or higher, who were randomly assigned to either conventional vaginal prolapse surgery or polypropylene mesh insertion. Study authors found lesser anatomic failures following tension-free vaginal mesh insertion compared to conventional vaginal prolapse repair.

The article presents information about a study on clearance of human papillomavirus (HPV) in women who were treated for cervical dysplasia. The study involved women who were newly diagnosed with high-grade dysplasia and those with persistent low-grade dysplasia treated with either excision or laser ablation. It found that clearance of HPV and HPV 18 infectors were shorter compared with other HPV types.

The article explores the benefits and risks of endometriosis management that involves medical and surgical therapy for adult women who are symptomatic with pelvic pain or infertility or both. It presents a background of the incidence, clinical manifestations, and etiology of endometriosis. Clinical considerations and recommendations are cited, including the limited value of excision of deeply infiltrating endometriosis.

The article presents a study which compares the efficacy of daily gentamicin to eight-hour gentacimin in treating intrapartum chorioamnionitis. Women with chorioamnionitis were divided into two groups and were treated either with daily or eight-hour gentacimin. Ampicillin was also administered to both groups and those who underwent ceasarian delivery also received clidamycin. The study reveals that the two gentacimin treatments are equally effective in curing intrapartum chorioamnionitis.

Breast-related symptoms are among the most common reasons women present to obstetrician-gynecologists. Obstetrician-gynecologists are in a favorable position to diagnose benign breast disease in their patients. The purpose of a thorough understanding of benign breast disease is threefold: 1) to alleviate, when possible, symptoms attributable to benign breast disease, 2) to distinguish benign from malignant breast disease, and 3) to identify patients with an increased risk of breast cancer so that increased surveillance or preventive therapy can be initiated. Obstetrician-gynecologists may perform diagnostic procedures when indicated or may make referrals to physicians who specialize in the diagnosis and treatment of breast disease. The purpose of this Practice Bulletin is to outline common benign breast disease symptoms in women who are not pregnant or lactating and discuss appropriate evaluation and management. The obstetrician-gynecologist's role in the screening and management of breast cancer is beyond the scope of this document and is addressed in other publications of the American College of Obstetricians and Gynecologists (1-3). [ABSTRACT FROM AUTHOR]

The article presents a study which investigates the efficacy of botulinum neurotoxin type A injections in the treatment of vaginismus and vulvar vestibular syndrome. Outpatients with stable levator ani muscle hyperactivity showed in electromyogram (EMG) were recruited and had undergone repeated cycles of botulinum neurotoxin type A injections. Results showed that butolinum improved sexual activity and is effective in the treatment of vaginismus secondary to vulvar vestibular syndrome.

The article discusses the discontinuation rates of anticholinergic medications used for the treatment of lower urinary tract symptoms in women aged 18 years and older. The researchers found 49,419 episodes of anticholinergic therapy available for analysis from 29,369 women and the median time for overall anticholinergic drug discontinuation was 4.76 months.

The article presents clinical research on the effectiveness of postpartum magnesium sulfate therapy for women experiencing mild preeclampsia. The participants in this randomized controlled clinical trial were grouped into the 12-hour and 24-hour therapy regimens. Outcomes that were compared include the frequency of progression to severe preeclampsia.

OBJECTIVE: To estimate the effect of 2 years of treatment with ultralow-dose transdermal estradiol (1,2) on incontinence in postmenopausal women. METHODS: Ultra Low Dose Transdermal estrogen Assessment (ULTRA) was a multicenter, randomized, double-blinded, placebo-controlled trial of unopposed ultralow-dose (0.014 mg/d) transdermal 1–2 for prevention of osteoporosis in 417 postmenopausal women aged 60 to 80 years. Frequency of incontinence episodes was assessed at baseline and after 4 months and 2 years of treatment using a self-reported questionnaire. We used an intention-to-treat analysis to compare change in incontinence frequency, improved (decreased 2 or more episodes per week), unchanged (increased or decreased no more than 1 episode per week), or worsened (increased 2 or more episodes per week) between the 1,2 and placebo groups among women with and without at (east week(y incontinence at baseline. RESULTS: At baseline, the prevalence of at least weekly incontinence was similar between 1,2 and placebo groups (43%). After 2 years, there was no difference between groups in the proportions of women with incontinence at baseline whose incontinence improved, worsened, or was unchanged. The odds ratio for worsening incontinence in the E2 compared with placebo group was 1.35 (95% confidence interval 0.75–2.42. In women without incontinence at baseline, the odds of developing at least weekly incontinence after 2 years in the 1.2 compared with placebo group was not significant (odds ratio 1.2, 95% confidence interval 0.7–2.2). CONCLUSION: Two years of treatment with unopposed ultralow-dose transdermal E2 did not substantially change the frequency of incontinence symptoms or alter the risk of developing at least weekly incontinence. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the impact of surgical staging of patients presenting with grade 1 endometrial cancer. METHODS: The charts of all patients who presented for surgery for endometrial cancer between March 1997 and July 2003 were analyzed for demographic data, final tumor histology, grade, stage, and complications. RESULTS: A total of 349 patients underwent surgical management for endometrial cancer. Preoperatively, 181 (52%) were identified with grade I disease, with a mean age of 61 years (range 27–89). Surgical staging (pelvic ± para-aortic lymphadenectomy) was performed in 82% of cases and was omitted only in cases when disease was apparently confined to the endometrium and surgical risk was high. In staged patients, 3.2% had severe surgical complications. There were 2 perioperative mortalities (1 pulmonary emboli and 1 myocardial infarct). In comparison of pre- and postoperative histology, 19% of patients were upgraded, with 15% grade 2, 0.5% grade 3, 2.5% serous or clear cell, and 1% mixed mesodermal tumor. Lymph node metastases were found in 3.90/o of patients presenting with grade 1 endometrial cancer, and 10.5% had extrauterine spread (> IIb). High-risk uterine features, including myometrial invasion more than ½, grade 3 lesions, high-risk histologic variants, and/or cervical involvement, were found in 26% of the patients. No patients with stage Ia-IIb endometrioid cancer received adjuvant teletherapy or chemotherapy. Four patients with low-risk uterine features were found to have extrauterine disease. Twelve percent of patients received adjuvant therapy, and 170/0 avoided teletherapy and/or chemotherapy based on surgical staging. CONCLUSION: Surgical staging in patients presenting with grade 1 endometrial cancer significantly impacted postoperative treatment decisions in 29% of patients. Omitting lymphadenectomy in patients presenting with grade 1 endometrial cancer may lead to inappropriate postoperative management. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the efficacy of botulinum toxin injection to treat women with moderate and severe vaginismus. METHODS: Twenty-four women referred to our clinic from February 2002 to February 2004 (mean age 25 years; range 19-34 years) with third- to fourth-degree vaginismus were recruited for this study. These women had previous unsuccessful treatments. Botulinum toxin (150-400 mIU) was injected into the puborectalis muscles in 3 sites on each side of the vagina. RESULTS: Twenty-three patients (95.8%) had vaginal examinations 1 week postoperatively that showed little or no vaginismus, 18 (75%) achieved satisfactory intercourse after the first injection, 4 (16.7%) had mild pain, 1 was cured after a second injection, 1 patient refused vaginal examination and did not attempt to have coitus, and another had no coitus as a result of her husband's secondary impotence. The women were followed up for a mean of 12.3 months (range 2-24 months), and there were no cases of recurrence. CONCLUSION: In refractory cases of vaginismus when conventional therapies have failed, local injection of botulinum toxin can be considered. [ABSTRACT FROM AUTHOR]

: ObjectiveTo examine the effect of centralized surgery on overall survival in patients with ovarian cancer and, in particular, patients with advanced disease (stage III/IV).: MethodsIn a historical prospective study design, patients referred from community hospitals to a teaching hospital for primary surgery during the 2-year period, 1995–1997, were included as cases. For each referred case, two controls, matched for International Federation of Gynecology and Obstetrics (FIGO) stage and age, were selected among patients who had had primary surgery at the referral hospitals (nonteaching) in the years, 1992–1995. Kaplan–Meier survival curves were computed and tested statistically by the log rank test. Cox proportional hazard model was applied for estimation of prognostic factors of survival.: ResultsThere was no difference in postoperative mortality for stage I/II patients by level of care (community hospitals versus teaching hospital). However, for advanced stage disease (III + IV), the controls had significantly shorter crude survival than patients who had been operated on at the teaching hospital (5-year survival: 4% versus 26%; median survival: 12 months versus 21 months) (P = .01). Multivariable analyses showed that completed chemotherapy and size of residual tumor after primary surgery were independent prognostic factors of survival. Patients optimally operated on at the teaching hospital had significantly lower risk of death compared with all other groups, independently of chemotherapy. This indicates that the extent of cytoreductive surgery and the overall management undertaken in the teaching hospital are significant predictors of improved survival.: ConclusionCentralization of primary ovarian cancer surgery in one health region in Norway has improved survival for patients with advanced disease. Patients with apparent advanced ovarian cancer should be referred to a subspecialty unit for primary surgery, and every effort should be made to attain as complete cytoreduction as possible. [Copyright &y& Elsevier]

The article discusses the treatment and management of vulvar intraepithelial neoplasia (VIN). It states that VIN is becoming more prevalent, especially among women in their 40s. It describes the pathology and causes of VIN, and the different types, such as usual-type Vin and differentiated VIN. It describes the treatment methodology, and states that patients should have follow ups 6 months and 12 months later, followed by annual check ups.

In this article the author describes her personal experiences with treating a patient with choriocarcinoma for the first time, and what she learned from it. She explains the woman's diagnosis, the treatments she was subjected to, and expresses wonder at the patient's unflagging positive mental attitude, as well as the unfailing support her sister gave her. She claims that the women taught her to be grateful for what she has, and serves as a reminder of why she became a doctor.

The author comments on the use of oral contraceptive pills (OCP) to treat heavy menstrual bleeding. Studies in the 1970s have found that the incidence of menstrual disorders decreased in women using OCP. However, a Cochrane review of OCP in 2009 revealed no difference between OCP and other treatment options for dysfunctional uterine bleeding. On the other hand, a study by J. T. Jensen and colleagues revealed that in comparison with placebo, OCP is highly effective in treating prolonged menstrual bleeding and heavy menstrual bleeding.

Background: Dysmenorrhoea is characterized by cramping lower abdominal pain that may radiate to the lower back and upper thighs and is commonly associated with nausea, headache, fatigue and diarrhea. Physical exercise has been suggested as a non-medical approach to the management of these symptoms.Objectives: To assess the evidence for the effectiveness of exercise in the treatment of dysmenorrhoea.Search Strategy: A search was conducted using the methodology of the Menstrual Disorders and Subfertility Group (August 2009). CENTRAL (The Cochrane Library), MEDLINE, EMBASE, AMED and PsycINFO electronic databases were searched. Handsearching of relevant bibliographies and reference lists was also conducted.Selection Criteria: Randomized controlled trials comparing exercise with a control or no intervention in women with dysmenorrhoea.Data Collection and Analysis: Trials were independently selected and data extracted by two review authors.Main Results: Four potential trials were identified of which one was included in the review. The available data could only be included as a narrative description. There appeared to be some evidence from the trial that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (P < .05) and resulted in a sustained decrease in symptoms over the three observed cycles (P < .05).Authors' Conclusion: The results of this review are limited to a single randomized trial of limited quality and with a small sample size. The data should be interpreted with caution and further research is required to investigate the hypothesis that exercise reduces the symptoms associated with dysmenorrhoea. Brown J, Brown S. Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD004142. DOI: 10.1002/14651858.CD004142.pub2. [ABSTRACT FROM AUTHOR]

The article reports that the U.S. Food and Drug Administration (FDA) has approved Zoledronic acid, a biophosphonate, for once-yearly intravenous treatment of osteoporosis in postmenopausal women. It was also approved for treatment of Paget's disease, hypercalcemia of malignancy, multiple myeloma and bone metastases from solid tumors. The article describes the adverse effects of Zoledronic acid.