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Hormone replacement therapy (HRT) plays a large part in maintaining and improving the quality of life (QOL) of postmenopausal women. Despite this obvious role, the use of HRT has stagnated in Japan as well as the United States, since the interim report of the HRT trial of Women's Health Initiative study was published in 2002. The Japan Society of Obstetrics and Gynecology and Japan Society for Menopause and Women's Health formulated the Guidelines for Hormone Replacement Therapy in 2009, which was subsequently revised in 2012, with the aim of organizing perceptions about HRT and allowing people to provide or receive HRT with a sense of security. Later on, in light of changes in indications for HRT and attitudes toward its impact on cancer risks, amendments were made again in 2017. With the establishment of the 2017 guidelines, practitioners in Japan are able to address various issues related to HRT with more appropriate judgment. Moreover, the practice of reliable, safe and effective HRT is expected to promote further efforts toward improvement or maintenance of QOL in patients.

To improve women's quality of life, the activity of the Women's Health Care Committee over a year up to July 2017 focused upon: (i) breast management; (ii) the influence of gynecological disease therapy on physical condition; (iii) non-surgical management of pelvic organ prolapse; (iv) survey of infectious diseases in obstetrics and gynecology in Japan; (v) health care for female athletes; (vi) a training program for women's health care advisors; (vii) revising the Japanese guidelines on hormone replacement therapy; and (viii) revising the 2016 Japanese guidelines for the proper use of emergency contraceptives. The detailed activity of the eight subcommittees is described herein. This report is based on the Japanese version of our annual report (Acta Obst Gynaec Jpn 2017;69(6):1480-1491), to publicize the activities of our committee.

Hereditary breast and ovarian cancer syndrome (HBOC) is a hereditary tumor that can be definitively diagnosed by detection of germline mutation of the BRCA1 or BRCA2 gene. The HBOC Public Awareness and Management Sub-committee of the Tumor Committee, Japan Society of Obstetrics and Gynecology carried out a fact-finding survey on the status of treatment of HBOC in Japan. The directors of medical specialty teaching facilities were notified of the questionnaire by post, with the request for one respondent per facility. The response period was from 8 July 2014 to 31 March 2015. Of the 678 facilities that were asked to compete the questionnaire, 341 (50.3%) responded. The responses are shown in the respective tables. For questions with free responses, similar answers have been grouped together, and the written answers have been freely translated. Based on these results, the Japan Society of Obstetrics and Gynecology considers that the 14 conditions, including consultations by specialist staff, must be met before risk-reducing salpingo-oophorectomy is carried out.

In order to improve women's quality of life, over the year leading up to June 2016, the Women's Health Care Committee of the Japan Society of Obstetrics and Gynecology focused upon: (i) breast management; (ii) influence of a therapy for gynecologic disease on physical condition; (iii) nonsurgical management of pelvic organ prolapse; (iv) survey of infectious diseases in Obstetrics and Gynecology in Japan; (v) health care for female athletes; (vi) a training program for women's health-care advisers; and (vii) revising the Japanese guideline on hormone-replacement therapy. In order to publicize the activities of our committee widely, the detailed activities of the seven subcommittees are described in this report, which is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2016; 68 (6): 1404-1416).

We hypothesized that feeling mucosal dryness in one body region and the skin may be associated with dryness in other regions and that there are common background factors for dryness. In an earlier web-based survey, we reported prevalence figures of dry eyes, nose, mouth, skin, and vagina. In the present study, additional analyses were made to investigate the factors associated with dryness in each region, and simultaneous dryness in multiple regions.A web-based questionnaire was completed by 310 Japanese women. The questions included dryness of the eyes, nose, mouth, vagina, and skin. Menopausal and other symptoms were also addressed. Multiple logistic regression modeling was performed to identify factors associated with dryness in each region and in multiple dry regions.Dry eyes were associated with dryness in the nose and with headache; dry nose was associated with dryness in the vagina and eyes; dry mouth was associated with sticky mouth symptom and dryness of the nose; dry skin was associated with use of xerogenic medications and vaginal discharge; and dryness of the vagina was associated with vaginal itchiness and dry nose. Vaginal discharge (odds ratio, 9.64; 95% confidence interval, 3.15-29.51) and sticky mouth (odds ratio, 6.35; 95% confidence interval, 1.29-31.29) were further associated with dryness in multiple regions.The present results confirmed our study hypothesis by showing that dryness in one region was clearly associated with that in another or in multiple regions. The result implies the need for holistic diagnosis and counseling for patients with dryness complaints.

The activity of the Women's Health Care Committee over a two year period up to June 2015 focused upon: (i) management of breast diseases in obstetrics and gynecology; (ii) investigation of lifestyle-related disease and bone mineral density after gynecologic cancer therapy; (iii) postoperative women's health care; (iv) current surgical treatment for pelvic organ prolapse among gynecologists in Japan; (v) cesarean indication for pregnant women with active/inactive genital viral lesions; (vi) health care of young female athletes concerned about menstrual cycle abnormalities, stress fractures and premenstrual syndrome/premenstrual dysphoric disorder; (vii) a training program for women's health care advisers; and (viii) a new edition of the oral contraceptive and low-dose estrogen-progestogen guideline. Detailed activities of the eight subcommittees are described in the text.

Ovaries are the primary sites of cancerous disease that is derived from endometriosis. Uterine cancer originating from endometriosis is very rare. The most frequent histological subtype of cancer derived from endometriosis is endometrioid adenocarcinoma, a subtype of clear cell carcinoma which is exceedingly rare. We report a case of a 40-year-old Japanese woman with a six year history of uterine leiomyoma. The patient was clinically and radiologically suspected to have degenerative uterine myoma with a possible malignant association and underwent a transabdominal total hysterectomy. Histopathological examination of the specimens revealed clear cell adenocarcinoma arising from the adenomyotic cyst. A literature review of clear cell adenocarcinomas arising from uterine adenomyotic cysts (cystic adenomyosis), emphasizes the clinically and radiologically important features of this very rare entity. Clear cell carcinoma association should be suspected in patients who are under follow-up for uterine myomas and present with cystic uterine changes with solid component on magnetic resonance imaging or computed tomography scans.

Aim: Premenstrual syndrome (PMS) affects 40–80% of women. Japanese herbal medicine, known as Kampo, is frequently prescribed for PMS, so we examined the efficacy of Kamishoyosan using two methods: first, the second derivative of the fingertip photoplethysmogram (SDPTG) evaluating vascular age (VA), and second, a self-assessment questionnaire on subjective symptoms. Methods: The SDPTG was recorded in 45 patients with PMS (mean ± SD = 32 ± 6 years of age) before (0 M), on the first (1 M) and third (3 M) month of therapy. Patients answered a questionnaire (44 questions) on their complaints every month. The reproducibility of the SDPTG was confirmed with 15 normal volunteers (33 ± 9 years of age). Results: In patients with older VA than their chronological age (Age) before therapy, we found linear correlations of the VA–Age differences at 1 M versus 0 M (y = 0.45x + 1.59, standard error of estimate [SEE] = 6.13 years), and at 3 M versus 0 M (y = 0.18x + 4.09, SEE = 6.03 years). The VA–Age decreased from 11.3 ± 6.4 (0 M) to 6.6 ± 6.7 (1 M) and 6.1 ± 6.0 years (3 M) (P

Aim: To examine the status and characteristics of climacteric symptoms reported by generally healthy middle-aged to elderly women in Japan, those living in Saitama Prefecture were surveyed . Methods: The subjects comprised 398 women ranging in age from 40 to

Aim: To examine current depressive tendencies among Japanese patients visiting a menopause clinic with complaints of climacteric symptoms. Methods: The subjects were 389 Japanese women (age range: 45–60 years; mean: 51.4 ± 3.8 years) who visited the menopause clinic in Department of Obstetrics and Gynecology, Keio university hospital, reporting climacteric symptoms. Their depressive tendencies were examined with the SDS (Self-rating Depression Scale, filled out by the patient). Results: The SDS was computed to be 42.4 ± 9.9. Ninety-three (23.9%) suffered from an intermediate or higher level depressive tendency; 132 (33.9%) had a mild depression; and 164 (42.2%) were free of any depressive tendency. It was concluded that more than one-half of the subjects suffered from some form of depression. Correlations between age, time after menopause/oophorectomy, and depressive tendency were ambiguous. In comparing the total scores of SDS for pre-, peri-, and postmenopause groups, the incidence of probable depression was higher in the second group, but no significant differences were noted among each group. When the parameters were compared in relation to their hormonal environments, the natural menopause group rated significantly higher in the scores related to sleep disturbance, hopelessness and dissatisfaction than the premenopause group. The number of those who probably exhibited mild or more exaggerated depression was significantly lower in the surgical menopause group in comparison with the natural menopause group. Conclusion: A depressive tendency occurred frequently among Japanese patients with menopausal disorders. It is important to evaluate the mental status of these patients with the aid of an appropriate tool.

Objectives: We objectively assessed the effects of counseling on climacteric symptoms in Japanese postmenopausal women. Methods: Symptoms in 44 women (age, 51.4 + 3.4 years; period after menopause, 3.6 + 3.4 years) treated with counseling were evaluated according to the Keio modified menopause index. The response to counseling was compared with that to hormone replacement therapy (HRT). Results: Forty cases (90.9%) showed an improvement in index score. There were no significant relationships between improvement and age, the period after menopause, or the severity or type of symptoms before counseling. The most improved symptom was headache, followed by palpitation and insomnia. Physical symptoms accounted for most of the common symptoms. The pattern of improvement with counseling was markedly different from that with HRT. Conclusions: We suggest that counseling is effective for treating climacteric symptoms, since it improves not only psychological symptoms, but also physical ones. Counseling may deserve evaluation as a complementary treatment to HRT.