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Background: This study determined the prevalence of bothersome menstrual symptoms and their association with workability in naturally menstruating women not using hormonal contraception. Materials and Methods: A representative sample of community-dwelling Australian women aged 18–39 years selected from two large national electronic databases responded to a survey on general health. This study focuses on self-reported dysmenorrhea and menstrual bleeding and their association with workability and absenteeism in working women, assessed by the Workability Index. Results: Of 3,555 women, 1,573 (44.2% [95% CI: 42.6%–45.9%]) reported moderate to severe dysmenorrhea and 774 (21.8% [95% CI: 20.4%–23.2%]) reported heavy to very heavy bleeding. Women with dysmenorrhea were 50% more likely to report poorer work performance and twice as likely to report more days of sick leave in the past year (absenteeism) than other women. Conclusions: Despite the availability of safe and effective management options, Australian working women aged 18–39 years continue to experience bothersome dysmenorrhea and menstrual bleeding. Dysmenorrhea is associated with increased absenteeism and poorer workability. Therefore, awareness needs to be raised among women and health care providers of ways to manage dysmenorrhea and heavy bleeding and the unmet need for intervention in the community, respectively. [ABSTRACT FROM AUTHOR]

Background: Whereas symptomatic endometriosis may affect work performance, the impact of endometriosis in the general community is not known. Aims: The associations between endometriosis and each of sick leave and work ability, were investigated in a large sample of non‐healthcare seeking women. Materials and Methods: This community‐based, cross‐sectional study recruited 6986 women, aged 18–39 years, from three eastern states of Australia between 11 November 2016 and 21 July 2017. Women were identified as having endometriosis if they had undergone a pelvic ultrasound and reported a diagnosis of endometriosis. Working women completed the Work Ability Index. Results: Participants were predominantly of European ancestry (73.1%) and 46.8% were overweight or had obesity. The prevalence of endometriosis was 5.4% (95%CI 4.9–6.0%) with the highest prevalence of 7.7% (95%CI 6.5 to 9.1%) for women aged 35–39 years. Among the 4618 working women, those with endometriosis had significantly more sick days from work (33.6% reported ≥10 days vs 13.5%, overall χ2P < 0.001). Endometriosis was associated with a greater likelihood of poor to moderate work ability, after adjusting for age, body mass index, ethnicity, relationship status, student status, insecure housing, being a carer for another person, parity, ever use of assisted reproductive technologies, and depressed mood (odds ratio 1.90, 95%CI 1.40–2.58, P < 0.001). Conclusions: This study provides new evidence that the negative impact of endometriosis on work attendance and work ability is not limited to women with prevalent symptoms and severe disease, but appears to encompass women across a broader spectrum of this condition in the community. [ABSTRACT FROM AUTHOR]

Study Question: Can serum anti-Müllerian hormone (AMH) replace polycystic ovary morphology (PCOM) determined by ultrasound as a diagnostic component of polycystic ovary syndrome (PCOS)?Summary Answer: Despite good correlations between serum AMH and PCOM, the use of a high serum AMH as a proxy for PCOM resulted in the reclassification of PCOS in 5% of study participants, with the main effect being more women identified, although some women previously classified as having PCOS were no longer classified as such.What Is Known Already: AMH has been proposed as an alternative to PCOM as a diagnostic component of PCOS. Previous studies are limited by poorly defining PCOS, use of infertile women as comparators, measurement of hormones by immunoassay that lack precision in the female range, low-resolution ovarian ultrasound and inconsistent handling and storage of serum samples.Study Design, Size, Duration: This is an Australian cross-sectional study of 163 non-healthcare-seeking women.Participants/materials, Setting, Methods: Serum AMH was measured by both the Ansh picoAMH assay and the Beckman Coulter Access 2 (BA2) assay, in parallel with androgens measured by liquid chromatography-tandem mass spectrometry, in blood samples of women, not pregnant, breast feeding or using systemic steroids, who also underwent high-resolution ovarian ultrasound. PCOS was determined by the Rotterdam criteria with PCOM defined by the Androgen Excess-PCOS Taskforce recommendation of ≥25 follicles in at least one ovary. Cut-off serum concentrations that best identified women as having PCOM were identified by receiver operator characteristic (ROC) curves.Main Results and the Role Of Chance: A total of 163 women, mean (SD) age 32.5 (5.5) years, who provided a blood sample and had both ovaries visualized on ultrasound were included in the analysis. Women with isolated PCOM had higher median (range) Ansh AMH and BA2 AMH concentrations than those with no PCOS characteristics [56.9 pmol/l (34.6, 104.2) versus 18.7 (3.2, 50.9), P = 0.002 and 38.5 pmol/l (22.2, 100.2) versus 16.7 (3.5, 38.9), P = 0.002, respectively]. An AMH ≥ 44.0 pmol/l, suggested by the ROC curve, identified 80.6% of women with PCOM, falsely identified 15.2% of women without PCOM as having PCOS and had a positive predictive value of 55.6%. The negative predictive value was 94.9%. An AMH BA2 assay cut-off of ≥33.2 pmol/l provided a sensitivity of 80.6%, a specificity of 79.5% and a positive predictive value for PCOM of 48.1%. The negative predictive value was 94.6% for PCOM. When serum AMH was used in the place of PCOM as a diagnostic criterion for PCOS, the Ansh assay resulted in an additional seven women classified as having PCOS and no longer classified one woman as having PCOS. For the BA2 assay, eight additional and two fewer women were classified as having PCOS. Overall, both assays resulted in six more women being classified as having PCOS.Limitations, Reasons For Caution: Women with functional hypogonadotrophic hypogonadism were not excluded and may have been misclassified as having an oligo-amenorrhoea-PCOM phenotype. As study participants were predominantly Caucasian/White, our findings cannot be generalized to women of other ethnicities.Wider Implications Of the Findings: Although serum AMH reflects the number of developing ovarian follicles, the absolute values vary between assays and specific reference ranges for individual assays are required. Irrespective of the assay used, replacing PCOM with serum AMH to diagnose PCOS in a community-based sample altered the number of women classified as having or not having PCOS. Consequently, although overall the risk of women being identified as having PCOS would be increased, some women would no longer be classified as having this condition.Study Funding/competing Interest(s): The study was supported by the Norman Beischer Research Foundation and the Grollo-Ruzzene Foundation. S.R.D. is an NHMRC Senior Principal Research Fellow (Grant No. 1135843). S.R.D. reports unrelated support that includes grants from the NHMRC Australia, personal fees for educational activities from Besins Healthcare, Abbott Chile, BioFemme and Pfizer Australia, personal Advisory Board/consultancy fees from Theramex, Abbott Laboratories, Astellas, Mayne Pharmaceuticals, Roche Diagnostics, Lawley Pharmaceuticals and Que Oncology and has received institutional grant funding from Que Oncology and Ovoca research. The other authors declare no conflicts of interest.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Objective: To document associations between anti‐Müllerian hormone (AMH) and circulating androgens in nonhealthcare‐seeking premenopausal women. Design: Community‐based, cross‐sectional study. Setting: Eastern states of Australia. Participants: Women aged 18–39 years not using systemic hormones, not pregnant or breastfeeding within 3 months, and not postmenopausal. Measurements: AMH, measured by the Beckman Access 2, 2 site immunometric assay from fresh samples, and testosterone, androstenedione, dehydroepiandrosterone (DHEA) and 11‐oxygenated C19 steroids, measured by liquid chromatography–tandem mass spectrometry. Results: Data were available for 794 women, median age of 33 years (range: 18–39). 76.1% were of European ancestry and 48.2% were parous. Serum AMH was positively associated with testosterone (rho =.29, p <.001) androstenedione (rho =.39, p <.001) and DHEA (rho =.10, p =.005) but not 11‐ketoandrostenedione or 11‐ketotestosterone. When adjusted for age, body mass index and smoking, using quantile regression, independent positive associations remained between AMH and testosterone (β coefficient: 20.90, 95% confidence interval [CI]: 13.79–28.03; p <.001) and androstenedione (β coefficient: 5.90, 95% CI: 3.76–8.03; p <.001). The serum concentration of testosterone was greater at the top AMH quintile than other quintiles (0.56 nmol/L [range: 0.21–1.90] vs. 0.36 nmol/L [range: 0.13–0.87]; p =.001) in women with self‐reported polycystic ovary syndrome. Conclusions: The positive associations between serum testosterone and androstenedione and AMH in premenopausal women is consistent with androgens directly or indirectly influencing AMH production during follicular development. As the highest AMH concentrations are most likely to be seen in women with multifollicular ovaries, it would be expected that women with multifollicular ovaries would have higher serum testosterone. Therefore, whether hyperandrogenemia and multifollicular ovaries should be considered independent characteristics of polycystic ovary syndrome warrants review. [ABSTRACT FROM AUTHOR]

Objective: To compare the performance of two anti‐Mullerian (AMH) assays over a range of concentrations, in samples collected from young women. Design: A cross‐sectional method‐comparison study of 168 non‐healthcare‐seeking women. Participants: Included women were aged 18–39 years, not recently pregnant, breast feeding or using systemic hormones. Measurements: Serum AMH levels were analysed with the Beckman Coulter Access 2 assay from fresh samples and the Ansh picoAMH assay using samples stored at −80°C, in a parallel setting. Comparisons between the two assays were examined using Bland‐Altman plots. Results: Participants had a mean ± SD age of 32.6 ± 5.4 years and body mass index of 28.1 ± 7.9 kg/m2, and 60.1% were parous. Although the assay results were highly correlated (Spearman correlation.982, P <.001), the relationship between the assays was nonlinear. Serum AMH values below 4 pmol/L were lower with the picoAMH assay compared with the Access AMH assay (mean difference in this range was −0.49 pmol/L), but for samples with a mean value above 10 pmol/L, the picoAMH assay consistently measured higher than the Access AMH assay (mean difference in this range was +8.2 pmol/L). As AMH concentrations increased the absolute discrepancy between the assays also increased. Conclusions: This study demonstrates that despite the high correlation between two commercially available AMH assays, the assays performed in a discordant manner at high and low concentrations. Hence, the results of these assays are not interchangeable, highlighting the need to establish specific reference limits for individual assays to guide clinical decision‐making and the challenge of establishing future universal cut‐offs for the application of AMH levels in clinical practice. [ABSTRACT FROM AUTHOR]

Study Question: Does the application of reference ranges for sex steroids and the modified Ferriman-Gallwey (mFG) scale established in the community from which the study sample was drawn, combined with the most conservative polycystic ovary morphology (PCOM) criteria to the recognised diagnostic criteria for polycystic ovary syndrome (PCOS) improve the certainty of diagnosis of PCOS in non-healthcare-seeking women?Summary Answer: Despite application of the stringent definitions of the elements used to diagnose PCOS in a non-healthcare seeking community-based sample, the risk of diagnostic uncertainty remains.What Is Known Already: There is heterogeneity in prevalence estimates for PCOS due, in part, to lack of standardisation of the elements comprising the recognised National Institutes of Health (NIH), Rotterdam and Androgen Excess Society (AE-PCOS) diagnostic criteria. The AE-PCOS Society proposed refinements to the definitions of biochemical androgen excess and PCOM that can now be incorporated into these sets of diagnostic criteria to estimate PCOS prevalence.Study Design, Size, Duration: An Australian cross-sectional study of 168 non-healthcare-seeking women.Participants/materials, Setting, Methods: The 168 included women were aged 18-39 years, euthyroid and normoprolactinemic, not recently pregnant, breast feeding or using systemic hormones. Each provided menstrual history and assessment of the mFG, had measurement of sex steroids by liquid chromatography, tandem mass spectrometry, and a pelvic ultrasound. The presence of PCOS was determined using modified (m) NIH, Rotterdam, and AE-PCOS criteria according to AE-PCOS Society recommendations.Main Results and the Role Of Chance: Overall, 10.1% of the included participants met the mNIH PCOS criteria, which requires the presence of menstrual dysfunction, while 18.5% met the mRotterdam and 17.5% the AE-PCOS criteria, with the latter requiring hyperandrogenism. Eight of the 27 participants with menstrual dysfunction, 10 of 31 women with PCOM, and 39 of 68 women with hyperandrogenism had no other feature of PCOS. Of the 19 participants with hyperandrogenaemia, 10 met the mNIH criteria (52.5%) and 14 met both the mRotterdam and AE-PCOS criteria (78.9%). Women who had the combination of hyperandrogenism and PCOM explained the greatest discrepancy between the mNIH and the other criteria.Limitations, Reasons For Caution: Clinical androgenisation relied on participant self-assessment, which has been shown to be valid when compared with clinician assessment. The sample size was a function of both the strict inclusion criteria and the requirements of non-healthcare-seeking women having a blood draw and pelvic ultrasound which may have introduced a selection bias.Wider Implications Of the Findings: Despite applying stringent cut-offs for serum androgens, the mFG scale and the ovarian follicle count, these criteria remain arbitrary. Accordingly, healthy women may be captured by these criteria, and misidentified as having PCOS, while women with the condition may be missed. Consequently, PCOS remains a diagnosis to be made with care.Study Funding/competing Interest(s): The study was supported by the Grollo-Ruzzene Foundation. Dr S.R.D. is an NHMRC Senior Principal Research Fellow (Grant no. 1135843). S.R.D. has been paid for developing and delivering educational presentations for Besins Healthcare, BioFemme and Pfizer Australia, has been on Advisory Boards for Theramex, Abbott Laboratories, Mayne Pharmaceuticals and Roche and a consultant to Lawley Pharmaceuticals and Que Oncology and has received has received institutional grant funding for Que Oncology research; there are no other relationships or activities that could appear to have influenced the submitted work.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Objective: Sex steroid levels in women vary with increasing age from the age of 70 years (70+). Whether this reflects change within individuals with age or a survival advantage is not known. This study aimed to determine the stability of circulating sex steroids and SHBG over time in individual women aged 70+. Design: A prospective cohort study. Participants: 400 women, aged 70+ not using any sex steroid, anti‐androgen/oestrogen or glucocorticoid therapy. Main outcome measurements: Sex steroid concentrations, measured by liquid chromatography‐tandem mass spectrometry and sex hormone‐binding globulin (SHBG) by immunoassay, in paired blood samples drawn 3 years apart and analysed together. Results: 400 women, median (IQR) age 78.0 (8.6) years, were included in the analysis. Mean testosterone concentrations were statistically significantly higher in follow‐up samples compared with baseline. The change was modest (mean change 31 pmol/L, 95% confidence interval (CI) 2.4–59.8; p =.034), and an increase was not observed in all women. There was a statistically significant decline in mean body mass index (mean change −0.4 kg/m2, 95% CI 0.6 to −0.3; p <.001) and a significant increase in the mean serum SHBG concentration (mean change 4.0 nmol/L, 95% CI 2.7–5.4; p <.001). The change observed in testosterone was not explained by the observed change in SHBG. There was no significant change in the mean oestrone or dehydroepiandrosterone concentration. Conclusions: Testosterone concentrations in women aged 70+ were more likely to increase than decrease. Whether increasing testosterone concentrations in older women confer a survival advantage needs investigation. [ABSTRACT FROM AUTHOR]

Background: Although serum ferritin is considered a reliable indicator of iron stores, there are few data documenting the prevalence of low ferritin in representative samples of young women. Aims: To estimate the prevalence of low ferritin and to identify factors associated with low ferritin in young Australian women. Methods: Women, aged 18–39 years, living in the eastern states of Australia were recruited by email to a cross‐sectional, online questionnaire‐based study between November 2016 and July 2017. Participants not pregnant, breast feeding, taking hormonal contraception, using assisted reproduction or postmenopausal were invited to provide a blood sample. Results: Of the 3689 invited participants, 761 (23.1%) provided a sample and 736 women, mean (SD) age 31.7 (±5.6) years, were included in the analyses. The overall prevalence of serum ferritin <30 μg/L was 34.8% (95% confidence interval (CI) 31.4–38.3%), with 41.4% (35.1–48.0%) in NSW, 31.5% (26.4–37.1%) in Victoria and 32.6% (26.8–39.0%) in Queensland. Serum ferritin <30 μg/L was positively associated with the reporting of >2 days of heavy menstrual bleeding (adjusted odds ratio (AOR) 1.73, 95% CI 1.15–2.59), living in New South Wales (AOR 1.57, 95% CI 1.07–2.30), not working outside home (AOR 1.58, 95% CI 1.01–2.49), and inversely associated with never experiencing heavy menses (AOR 0.46, 95% CI 0.23–0.93) and obesity (AOR 0.32, 95% CI 0.21–0.50). Conclusions: This study demonstrates that serum ferritin below 30 μg/L is common amongst young Australian women. Healthcare professionals should note the association between low ferritin and heavy bleeding. [ABSTRACT FROM AUTHOR]

• Low levels of testosterone and oestrone are associated with depressive symptoms in older women. • While statistically significant, the contribution of sex hormones to the likelihood of depression was small in the present study. • The use of sex hormones for the treatment of depression in older women is discouraged. We investigated whether low sex hormone concentrations are associated with depression in older women. This was a cross-sectional study of Australian women, aged at least 70 years, not taking medications modulating sex hormone levels. Associations between hormones, measured by liquid chromatography-tandem mass spectrometry, and depression were examined by logistic regression adjusted for potential confounders. The primary outcome was a Center for Epidemiologic Studies Depression score >10, designated as 'depression', with an expanded definition that included anti-depressant use as a secondary outcome. For the 5535 participants in the analysis, median age 74.0 years (interquartile range 71.7–77.7), depression prevalence was 5.8 % (95 % CI 5.2–6.4 %). In the adjusted models, a statistically significantly greater likelihood of depression was seen for women with testosterone and oestrone blood concentrations in quartile 1 compared with quartiles 2–4 (odds ratio 1.33, 95 % CI 1.04 to 1.70, p = 0.022; and 1.37, 95 % CI 1.06 to 1.78, p = 0.017, respectively). For the expanded definition, the odds ratios for the lowest testosterone and oestrone quartile compared with other quartiles were 1.47 (95 % CI 1.24 to 1.75, p < 0.001) and 1.31 (95 % CI 1.09 to 1.58, p < 0.001), respectively. A significant association for low DHEA was seen only for the expanded definition of depression (1.36, 95 % CI 1.13 to 1.64, p = 0.001). Receiver operating characteristic curves showed that the contribution of each sex hormone to the likelihood of depression was small. Amongst older women not taking medications that influence sex hormone concentrations, low testosterone and oestrone levels are associated with a greater likelihood of depression, but the effects are small. International Standard Randomized Controlled Trial Number Register (ISRCTN83772183) and clinicaltrials.gov (NCT01038583). [ABSTRACT FROM AUTHOR]

It might be of interest to readers of I Climacteric i that there is currently a consensus recommendation on the Australian guidelines website that clinicians consider ceasing oral menopausal hormone therapy (MHT) in women with severe or critical COVID-19. Clearly groups other than the Australian National COVID-19 Clinical Evidence Task Force have been working on living systematic reviews and guidelines related to the management of COVID-19 including the LIVING project [[17]], COVID-NMA [[18]] and epistemonikos [[19]]. And then along came COVID-19, quickly followed by a tsunami of publications about every aspect of COVID-19 and its management. The development of the COVID-19 core outcomes set for people with COVID-19 disease has been described in detail [[11]]. [Extracted from the article]

Introduction: The aim of this study was to investigate mammographic density in a sample of Victorian women and explore a possible association between mammographic density and ethnicity.Methods: Categories of mammographic density, using Volpara Density Grade, were reported using two editions of Volpara automated software in a data set of women attending two Victorian sites for mammographic screening. The variables available for analysis were age, self-reported exposure to menopausal hormone therapy (MHT) and ethnicity based on country of birth.Results: Data from 16,943 women were available for analysis. Using the VDG 4th edition, 40% of women were classified in the higher two categories (42% for the 5th edition) and 76.9% of women were in the same VDG category using both systems. In the sample, 87.7% of women were in the age range currently invited for screening in Victoria (50-74 years). Of the total group, 82.5% could be classified on the basis of country of birth. In multivariable logistic regression analyses examining factors associated with higher VDG, age (protective), use of MHT (risk factor) and being born in a country with predominantly Asian ancestry (risk factor) were all statistically significant at P < 0.001 for both editions irrespective of whether the reference category was the lowest two or three VDG categories.Conclusions: Mammographic density as assessed by VDG was positively associated with ever exposure to MHT and inversely associated with age. Being born in a country with predominantly Asian ancestry was associated with higher VDG when controlled for age and MHT exposure. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of, and risk factors for, sub-types of urinary incontinence (UI) in a nationally representative sample of midlife Bangladeshi women.Methods: Bangladeshi women, aged 30-59, recruited by multi-stage cluster sampling, completed the Questionnaire for the Diagnosis of Urinary Incontinence. The prevalence and the factors associated with each form of UI were explored using multivariable weighted logistic regression.Results: 59.3% of the women were premenopausal, 8.4% perimenopausal and 32.3% postmenopausal. 83.2% had a BMI < 28 kg/m2 and none were using menopausal hormone therapy. The prevalence of stress UI was 5.4% (95% CI 4.4-6.6%), urgency UI 11.3% (9.8-12.9%), and mixed UI 7.0% (5.8-8.3%). Urgency UI was the most prevalent form of UI at each decade of age. Postmenopausal women were significantly more likely to have urgency UI (AOR 2.41, 95%CI 1.38-4.20; p = 0.002) and mixed UI (AOR 2.35, 95%CI 1.22-4.50; p = 0.010). Having more than 2 children was significantly associated with stress UI (AOR 2.79, 95%CI 1.30-6.00; p = 0.009) and urgency UI (AOR 2.34, 95%CI 1.28-4.30; p = 0.006), pelvic organ prolapse with stress UI (AOR 2.46, 95%CI 1.34-4.52; p = 0.004) and mixed UI (AOR 3.40, 95%CI 2.00-5.80; p < 0.0001), and diabetes with mixed UI (AOR 3.16, 95%CI 1.67-5.97; p < 0.0001). The women in the highest wealth quintile (AOR 0.27, 95%CI 0.10-0.72; p = 0.009) and underweight women had a lower risk of urgency UI (AOR 0.21, 95%CI 0.06-0.77; p = 0.018), while urgency UI was associated with working outside the home (AOR 3.11, 95%CI 1.36-7.15; p = 0.007) and obesity (AOR 3.00, 95%CI 1.57-5.74; p = 0.001).Conclusions: The overall prevalence of UI amongst Bangladeshi midlife women is low, with urgency UI the most common form, in contrast to developed countries, where stress UI predominates. Being postmenopausal, having more than two children, being obese and working outside the home increase the likelihood of urgency UI, whereas higher socio-economic status and lower weight appear to be protective. Menopausal hormone therapy use was not reported by any study participants. [ABSTRACT FROM AUTHOR]

If a screening program was reviewed, this does not mean it would cease - it could be stopped, continue unchanged or be modified in some way, such as a reduced frequency of screening or screening being limited to individuals at higher than average risk. The balance of risks and benefits may be changed when the technical aspects of a form of health screening are changed. Even the best performing screening mammography program (with a low rate of interval cancers coupled with a low recall rate) will miss some cancers which subsequently present as interval cancers prior to the next scheduled screening round. [Extracted from the article]

Background: Little is known of the prevalence and severity of menstrual dysfunction, climacteric symptoms, pelvic floor disorders, sexual problems, and psychological wellbeing after lung transplantation in women. Materials and Methods: Adult female lung transplant recipients, attending the Alfred Hospital Lung Transplant Service in Melbourne, Australia participated in a women's health, cross-sectional questionnaire-based study. Results: The 123 of 149 potential participants were recruited between September 2014 and July 2015. Their median age was 53.5 years, and 44 were premenopausal, 3 perimenopausal, and 76 postmenopausal. Moderate–severe menstrual and premenstrual symptoms were common, and 43% of partnered premenopausal women were not using contraception. Vasomotor symptoms (VMS) were common in postmenopausal women <55 years (80.0%), and the use of menopausal hormone therapy was low (8.9%). The estimated prevalence of low sexual desire associated with distress was 24.4%. Low wellbeing was significantly and independently associated with being aged 50 ≤ 60 years, moderate–severe VMS, impaired forced expiratory volume in 1 second, and psychotropic medication use. Conclusions: Our findings demonstrate that premenopausal lung transplant recipients need to be asked about bothersome menstrual symptoms, and contraceptive compliance needs regular review. Transplant recipients at midlife have substantially lower wellbeing than women of other ages and this needs attention, including assessment and management of menopausal symptoms. [ABSTRACT FROM AUTHOR]

Background Little is known of the impact of aromatase inhibitor (AI) therapy on sexual and pelvic floor function. Aim To document the prevalence of, and factors associated with, low desire, sexually related personal distress, hypoactive sexual desire dysfunction (HSDD), and pelvic floor dysfunction in women 10 years after breast cancer diagnosis. Methods This was a prospective, observational, community-based cohort study of Australian women with invasive breast cancer recruited within 12 months of diagnosis. 1,053 of the 1,305 who completed the initial 5 years of study follow-up agreed to be re-contacted, and 992 of these women alive 10 years after diagnosis were sent the study questionnaire. Outcomes The main outcome measure was HSDD determined by a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI) plus a score of at least 11.0 on the Female Sexual Distress Scale–Revised (FSDS-R). Pelvic floor disorders, including urinary incontinence, fecal incontinence, and pelvic organ prolapse, were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with low desire, personal distress, and HSDD. Results 625 completed questionnaires were returned. The respondents’ median age was 65.1 years (range = 36.4–95.5). Current AI use was reported by 10% and tamoxifen use was reported by 3.4%. 521 of the 608 women (85.7%; 95% CI = 82.9–88.5) who competed the FSFI desire domain had low sexual desire, and 246 of the 563 women (43.7%; 95% CI = 39.6–47.8%) who completed the FSDS-R had sexually related personal distress. 221 of the 559 women (39.5%; 95% CI = 35.5–43.6%) who completed the 2 questionnaires had HSDD. Current AI users were more likely to have HSDD than non-users (55.2% [95% CI = 42.2–68.1] vs 37.8% [95% CI = 33.5–42.0]; P = .01). HSDD was more prevalent in sexually active, current AI users (66.7%; 95% CI = 49.4–83.9) vs current non-users (43.6%; 95% CI = 37.0–50.2; P = .02). In a logistic regression model, HSDD was significantly associated with current AI use and inversely associated with age. Fecal incontinence was more prevalent in AI users than in current non-users (29.8% [95% CI = 17.8–41.8] vs 16.4% [95% CI = 13.2–19.6], respectively; P = .01). Clinical Implications It is important to address women’s sexual health even many years after their breast cancer diagnosis. Strengths and Limitations Strengths include a representative sample, use of validated questionnaires, and few missing data. Limitations include sexual activity being a 4-week recall. Conclusions AI use is associated with HSDD and fecal incontinence in women who are 10 years after breast cancer diagnosis. Robinson PJ, Bell RJ, Christakis MK, et al. Aromatase Inhibitors Are Associated With Low Sexual Desire Causing Distress and Fecal Incontinence in Women: An Observational Study. J Sex Med 2017;14:1566–1574. [ABSTRACT FROM AUTHOR]

Background: The association between menopausal vasomotor symptoms (VMS) and depressive symptoms remains controversial. We aimed to examine the associations between moderate-severe VMS and moderate-severe depressive symptoms. Methods: Nationally representative cross-sectional survey of 2,020 noninstitutionalized Australian women aged 40-65 randomly recruited between October 2013 and March 2014. Symptoms were assessed by the Menopause-Specific Quality of Life Questionnaire, the Beck Depression Inventory-II, with score ≥20 defined as moderate-severe depressive symptoms. Cigarette, alcohol, and psychotropic medication use was also assessed. Binge drinking was defined as four standard drinks on one occasion. Results: VMS were classified as moderate-severe for 267 of the 2,020 women (13.3%). After adjusting for multiple factors, including age, partnership status, paid employment, housing insecurity, and body mass index, when compared to women with no or mild VMS, women with moderate-severe VMS were more likely to have moderate-severe depressive symptoms (odds ratio [OR] 2.80, confidence interval [95% CI], 2.01-3.88, p < 0.001). Having moderate-severe depressive symptoms was associated with a greater likelihood of use of psychotropic medications (48.9%, 95% CI, 43.1-54.8 vs. 20.1%, 95% CI, 18.2-22.1, p < 0.001), smoking (25.9%, 95% CI, 20.8-30.9 vs. 12.2%, 95% CI, 10.6-13.7, p < 0.001), and binge drinking at least weekly (15.1%, 95% CI, 11.0-19.2 vs. 10.3% 95% CI, 8.8-11.7, p = 0.015). Conclusion: Moderate-severe VMS are independently and significantly associated with moderate-severe depressive symptoms. [ABSTRACT FROM AUTHOR]

Background Low desire is the most common sexual problem in women at midlife. Prevalence data are limited by lack of validated instruments or exclusion of un-partnered or sexually inactive women. Aim To document the prevalence of and factors associated with low desire, sexually related personal distress, and hypoactive sexual desire dysfunction (HSDD) using validated instruments. Methods Cross-sectional, nationally representative, community-based sample of 2,020 Australian women 40 to 65 years old. Outcomes Low desire was defined as a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI); sexually related personal distress was defined as a score of at least 11.0 on the Female Sexual Distress Scale–Revised; and HSDD was defined as a combination of these scores. The Menopause Specific Quality of Life Questionnaire was used to document menopausal vasomotor symptoms. The Beck Depression Inventory–II was used to identify moderate to severe depressive symptoms (score ≥ 20). Results The prevalence of low desire was 69.3% (95% CI = 67.3–71.3), that of sexually related personal distress was 40.5% (95% CI = 38.4–42.6), and that of HSDD was 32.2% (95% CI = 30.1–34.2). Of women who were not partnered or sexually active, 32.4% (95% CI = 24.4–40.2) reported sexually related personal distress. Factors associated with HSDD in an adjusted logistic regression model included being partnered (odds ratio [OR] = 3.30, 95% CI = 2.46–4.41), consuming alcohol (OR = 1.48, 95% CI = 1.16–1.89), vaginal dryness (OR = 2.08, 95% CI = 1.66–2.61), pain during or after intercourse (OR = 1.63, 95% CI = 1.27–2.09), moderate to severe depressive symptoms (OR = 2.69, 95% CI 1.99–3.64), and use of psychotropic medication (OR = 1.42, 95% CI = 1.10–1.83). Vasomotor symptoms were not associated with low desire, sexually related personal distress, or HSDD. Clinical Implications Given the high prevalence, clinicians should screen midlife women for HSDD. Strengths and Limitations Strengths include the large size and representative nature of the sample and the use of validated tools. Limitations include the requirement to complete a written questionnaire in English. Questions within the FSFI limit the applicability of FSFI total scores, but not desire domain scores, in recently sexually inactive women, women without a partner, and women who do not engage in penetrative intercourse. Conclusions Low desire, sexually related personal distress, and HSDD are common in women at midlife, including women who are un-partnered or sexually inactive. Some factors associated with HSDD, such as psychotropic medication use and vaginal dryness, are modifiable or can be treated with safe and effective therapies. Worsley R, Bell RJ, Gartoulla P, Davis SR. Prevalence and Predictors of Low Sexual Desire, Sexually Related Personal Distress, and Hypoactive Sexual Desire Dysfunction in a Community-Based Sample of Midlife Women. J Sex Med 2017;14:675–686. [ABSTRACT FROM AUTHOR]

The editorialists discuss recommendations from the Women's Preventive Services Initiative on screening for urinary incontinence in women and advise caution regarding widespread screening on the basis of limited, indirect evidence. [ABSTRACT FROM AUTHOR]

Objectives: It has been hypothesised that vasomotor symptoms (VMS), the hallmark of menopause, may affect women's workplace performance. The aim of this study was to investigate the association between VMS and self-reported work ability, taking into account socio-demographic characteristics. Study design/Main Outcome measures: A national cross-sectional survey of women, aged 40-65 years, was conducted between October 2013 and March 2014. Participants provided socio-demographic and lifestyle factors and completed the Menopause Specific Quality of Life Questionnaire (MENQOL) and the Work Ability Index (WAI).Results: Of 2020 women who comprised the study sample, 1274 were in paid employment and 1263 completed the WAI. The WAI score was good-excellent for 81.5% of women and poor-moderate for 18.5%. After adjustment for socio-demographic characteristics, having any VMS was associated with greater likelihood of poor-moderate work ability [odds ratio (OR)=2.45, 95% CI 1.69-3.54]. Poorer work ability was significantly and independently associated with being un-partnered, obese or overweight, smoking, being carer and having insecure housing finance, but not with age.Conclusions: Overall, most women functioned well at work. We observed an association suggesting a relationship not only between menopausal VMS and personal wellbeing, but also between VMS and self-assessed work ability. Although 4 in 5 women functioned well at work, recognition of the association with VMS may improve wellbeing and work performance of working women at midlife. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence, and factors associated with, pelvic floor disorders in a representative sample of community-dwelling older Australian women.Methods: 1548 women, aged 65-79 years, were recruited to this cross-sectional study between April and August 2014. Pelvic floor disorders, including urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP), were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with each, and having one or more pelvic floor disorders.Results: Among 1517 women (mean age=71.5 ± 4.1 SD years), 47.2% (95% CI, 44.7-49.7%) of women had one or more pelvic floor disorders, with 36.2% (95% CI, 33.8-38.6%) having UI, 19.8% (95% CI, 17.8-21.9%) having FI, and 6.8% (95% CI, 5.6-8.2%) having POP. Of the women with POP, 53.4% had UI, 33% had FI and 26.2% had both. The proportion of women with one or more pelvic floor disorders increased with parity from 34.6% (95% CI, 7.8-11.7%) for nulliparous women, to 45.3% (95% CI, 40.3-59.1%) for 1-2 births, and 52.1% (95% CI, 48.3-55.8%) for ≥ 3 births. Obese women were more likely to have at least one pelvic floor disorder (OR=1.77; 95% CI, 1.36-2.31, p<0.01).Conclusion: Pelvic floor disorders are common in older women. Physicians caring for older women should be mindful that older women presenting with symptoms of one pelvic floor disorder are likely to have another concurrent pelvic floor problem. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the awareness of breast cancer (BCa) and BCa screening amongst women at midlife in Bangladesh.Methods: A nationally representative cross-sectional survey of women aged 30-59 years was conducted in 7 districts of the 7 divisions in Bangladesh, using a multistage cluster sampling technique. The factors associated with the awareness of BCa and breast assessment of asymptomatic women were investigated separately, using multivariable logistic regression.Results: Of the 1590 participants, mean age 42.3 (±8.0) years, 81.9% had ever heard of BCa and 64.2% of any methods of BCa screening, respectively. Awareness of BCa was associated with being aged 40-49 years (adjusted OR 2.04, 95% CI 1.46-2.84), aged 49-59 years (1.96, 1.32-2.91), being overweight (1.46, 1.07-2.01) and obesity (1.62, 1.01-2.62), while inversely associated with rural dwelling (0.37, 0.22-0.61), primary education (0.44, 0.27-0.70), having no education (0.23, 0.14-0.36) and parity (0.62, 0.44-0.87). Of the 750 women who were aware of clinical breast examination (CBE) or mammography, reasons provided for not undergoing screening included that they had no symptoms (92%) and that they did not know screening was needed (40%). 8% of women reported CBE. Women with no education were less likely to have undergone CBE (0.38, 0.141.04; p=0.059).Conclusion: Lack of understanding of the assessment of asymptomatic women is the key obstacle to BCa screening uptake in Bangladesh. Health education programs, especially BCa awareness programs, have the potential to increase BCa awareness and down-staging of the disease. [ABSTRACT FROM AUTHOR]

Objectives The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40–65 years, taking into account socio-demographic and lifestyle factors. Study design/Main outcome measures This was a cross-sectional survey of 2020 Australian women, aged 40–65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Results Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient ( β ) = −8.17, 95% confidence interval (CI) −10.90 to −5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered ( β = −2.80, 95% CI −4.74 to −0.86), obese ( β = −5.46, 95% CI −7.24 to −3.68) and a smoker ( β = −3.47, 95% CI −6.10 to −0.84). Older age ( β = 0.29, 95% CI 0.06–0.42) and participation in paid and/or volunteer work ( β = 2.72, 95% CI 0.61–4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Conclusions Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase. [ABSTRACT FROM AUTHOR]

Objectives To understand the challenges and experiences encountered during data collection for Bangladesh Midlife Women's Health Study (BMWHS) that investigated the low uptake of cervical cancer (CCa) screening barriers, understanding of breast cancer (BCa) knowledge and practices, the prevalence of urinary and fecal incontinence and menopausal symptoms. Methods A multistage cluster sampling technique was used to recruit women from the 32 districts of Bangladesh that had offered CCa screening. Female interviewers were trained to undertake structured face-to-face interviews that incorporated both non-validated and several validated questionnaires, such as Question for Urinary Incontinence Diagnosis, Pelvic Organ Prolapse Distress Inventory, Colorectal-Anal Distress Inventory and Menopause-Specific Quality of Life. Results We completed surveys of 1590 women, estimated age 30–59 years, between September 2013 and March 2014. We implemented several strategies to deal with low literacy and used the temporal relationship between marriage and childbirth, and the average age of onset of menarche, to estimate age. Cultural and religious sensitivities and personal security were managed by engaging community leaders, limiting activities to daylight hours, adopting local codes of dress, such as the wearing of head scarves. Our major challenges and experiences included difficulties in age determination, selection of and access to households, interview privacy, lack of basic and health literacy, transportation, political unrest and security of the interviewers. Conclusion By anticipating challenges, we have been able to comprehensively survey a representative sample of Bangladeshi women. Disseminating information about the field challenges and experiences from the BMWHS should assist other researchers planning to conduct surveys about women's health issues in similar context. [ABSTRACT FROM AUTHOR]

Objective Whether moderate to severe obesity (body mass index (BMI) ≥ 30 to <40 kg/m 2 ) contributes to breast cancer recurrence and mortality remains uncertain. Subjects and methods 1199 women, recruited within 12 months of their diagnosis of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−) invasive breast cancer completed an enrolment questionnaire and an annual follow-up questionnaire every 12 months for another 5 years. The impact of obesity on time to either local or distant recurrence or new breast cancer, or death due to breast cancer was determined by Cox regression. Women in the most extreme categories of BMI (<18.5 and ≥40) were excluded from the analysis. Results Of the 1155 included women, mean age, 58.4 ± 11.6 years, 53.8% had Stage 1 disease and 88.9% received oral adjuvant endocrine therapy (OAET) within 2 years of diagnosis. The likelihood of an event was significantly associated with moderate to severe obesity (HR = 1.71, 95%CI, 1.12–2.62, p = 0.014), disease beyond Stage 1 (HR = 2.87, 95% CI 1.73–4.75, p < 0.001), OAET (HR = 0.26, 95%CI 0.14–0.46, p < 0.001), mastectomy (HR = 3.28, 95%CI 1.98–5.44, p < 0.001) and radiotherapy (HR = 2.12, 95%CI 1.24–3.63, p = 0.006). For Stage 1 disease, only moderate to severe obesity (HR 3.23, 95%CI 1.48–7.03, p = 0.003) and OAET use (HR 0.41, 95%CI 0.17–0.98, p = 0.046) were significantly associated with an event. Conclusion Moderate to severe obesity is associated with a poorer invasive breast cancer prognosis; this is also true for women with Stage 1 disease, and is independent of age and treatment. [ABSTRACT FROM AUTHOR]

Objective: To explore the associations between endogenous testosterone blood concentrations and muscle mass, strength and performance in community dwelling women. Design, Patients and Measurements: Online databases, including Ovid MEDLINE, EMBASE and Web of Science, were searched for observational studies, with at least 100 female participants, reporting associations between endogenous testosterone blood concentrations and muscle mass, strength and performance. The findings were synthesized in a narrative review. Heterogeneity in study design and analysis precluded a meta‐analysis. Results: Of the 36 articles retrieved for full‐text review, 10 met the inclusion criteria. Eight studies were cross‐sectional, 1 longitudinal and 1 provided both cross‐sectional and longitudinal data. Testosterone was measured by liquid chromatography‐tandem mass spectrometry in two studies and by immunoassay in 8. An association between total testosterone and muscle mass, strength or performance in women was not found. The studies of calculated free or bioavailable testosterone and lean muscle mass reported a positive association, but no association was reported for muscle strength or performance. Each included study was limited by a high risk of bias in at least one assessed domain. Conclusions: This review does not support an association between testosterone and muscle mass, strength or performance in women. This, together with the reported associations between free or bioavailable testosterone and muscle mass should be interpreted cautiously due to the predominant use of immunoassay and the inaccuracy of calculated variables. Additionally, biological significance of nonprotein bound testosterone has not been established. Further studies examining the relationship between precisely measured testosterone and muscle mass and function in women are required. [ABSTRACT FROM AUTHOR]

• Interpretation of data from studies that have explored a possible association between depression and testosterone is limited by methodological heterogeneity. • Studies that have measured testosterone by liquid/gas chromatography with tandem mass spectrometry are lacking. • The available data does not support an association between testosterone and depression in postmenopausal women. The contribution of testosterone to depression in older women is uncertain. This review was conducted to investigate the association between endogenous testosterone blood concentrations and depression in postmenopausal women. We searched Ovid MEDLINE, EMBASE, PsycINFO, and Web of Science databases for observational studies with at least 100 community-dwelling participants. The results were categorised by study design, and the reporting of total, bioavailable and free testosterone findings is narrative. The search strategy retrieved 28 articles for full-text review, of which eight met the criteria for inclusion; these described 6 cross-sectional and 2 longitudinal studies. Testosterone was measured by immunoassay in all of the included studies. No association was seen between total testosterone or free testosterone and depression in either the cross-sectional or the longitudinal studies. A significant association between bioavailable testosterone and incident depressive symptoms was limited to women at least 21 years postmenopause in one study. Most of the cross-sectional studies were not representative of national populations and lacked random selection. This systematic review does not support an association between testosterone and depression in postmenopausal women. However, as the included studies had substantial methodological limitations, studies of community-based samples, employing validated instruments for depression and precise measurement of blood testosterone, are needed to address this knowledge gap. [ABSTRACT FROM AUTHOR]

We audited the files of 114 postmenopausal women who had been treated with subcutaneous Estrapel (50mg oestradiol implants). Of the 92 women who received more than one implant, the median number of days between implants was 223.5 (range 49-875), with an estimated median time to return to baseline of 311days (range 108-1228). Although oestradiol implants can provide an excellent non-oral treatment option, their prolonged action makes patient selection important, as the implants cannot easily be removed. In women with an intact uterus, the continuation of progestin therapy after cessation of implant therapy is imperative. [ABSTRACT FROM AUTHOR]

Introduction Female sexual dysfunction is a side effect of selective serotonin reuptake inhibitor ( SSRI)/serotonin noradrenalin reuptake inhibitor ( SNRI) therapy. Aims The aim of this study is to investigate the efficacy of transdermal testosterone ( TT) as a treatment for SSRI/SNRI-emergent loss of libido. Methods This was a double-blind, randomized, placebo-controlled study. Forty-four women, aged 35-55 years, on a stable dose of SSRI or SNRI with treatment-emergent loss of libido were randomly allocated to treatment with a TT patch delivering 300 mcg of testosterone/day or an identical placebo patch ( Pl) for 12 weeks. Main Outcome Measures The primary outcome measure was the change in the Sabbatsberg Sexual Self-rating Scale ( SSS) total score over 12 weeks. The 4-week frequency of Satisfactory Sexual Events ( SSEs) and the Female Sexual Distress Scale- Revised ( FSDS-R) were also measured. Results At baseline, there were no differences between the treatment groups. At week 12, the change in the SSS score did not differ between the two groups. The increase in the 4-week frequency of SSEs was significantly greater for the TT group than for the Pl group (an increase of 2.3 events vs. 0.1, P = 0.02). The between-group difference in the change in the FSDS-R score approached statistical significance ( P = 0.06). The mean total serum testosterone level at 12 weeks in the TT group was 2.1 nmol/L. No women withdrew because of androgenic adverse events. Conclusions TT therapy resulted in a significant increase in the number of SSEs compared with Pl therapy in women with SSRI/SNRI-emergent loss of libido. The lack of improvement in the SSS total score may reflect lack of sensitivity of this instrument for the measurement of change in sexual function. This provides the first evidence that TT therapy may be a treatment option for women with SSRI/SNRI-emergent loss of libido who need to remain on their antidepressant therapy. Fooladi E, Bell RJ, Jane F, Robinson PJ, Kulkarni J, and Davis SR. Testosterone improves antidepressant-emergent loss of libido in women: Findings from a randomized, double-blind, placebo-controlled trial. J Sex Med 2014;11:831-839. [ABSTRACT FROM AUTHOR]

Background There is no evidence of benefit in terms of survival or quality of life for intensive surveillance of women with early breast cancer ( BC) and current guidelines reflect this. We have examined whether Victorian women, nearly 4 years from a diagnosis of localized BC, were being managed according to these guidelines. Methods Participants are women in the BUPA Health Foundation Health and Wellbeing after Breast Cancer prospective cohort study. All participants completed an enrolment questionnaire within 12 months of diagnosis and then completed follow-up questionnaires every 12 months thereafter. In the third follow-up questionnaire, completed nearly 4 years from the time of diagnosis, women were asked about imaging tests they had in the previous 12 months. Results The analysis was completed on 673 women who were stage 1 at the time of diagnosis and had not reported evidence of recurrence or a new BC since diagnosis. Of the 673, 603 (89.5%) reported having had a mammogram in the previous 12 months and 319 (52.9% of those having a mammogram) reported a breast ultrasound. Seventy-one per cent of women reported no other imaging investigations in the previous 12 months. Conclusions Our study shows that, nearly 4 years from diagnosis, Australian practitioners are generally adhering to guidelines about imaging surveillance of BC survivors. Practitioners could use the guidelines for the education of BC survivors about appropriate health surveillance. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. Colorectal cancer (CRC) is the second most common cancer. One-third of these cancers occur in the rectum. Treatment of rectal cancer involves surgery with/without radiotherapy and chemotherapy. Surgery is undertaken to prevent damage to the nerves controlling bladder, bowel, and sexual organs, whether this translates into preservation of urinary and fecal continence and sexual function and, ultimately, quality of life (QoL) is not known. Aim. The aim of this review was to summarize the literature regarding the impact of treatment for rectal cancer on bladder and bowel continence, sexual function and QoL in women. Main Outcome Measures. A comprehensive review of the current literature on sexual function, incontinence and wellbeing in women after treatment for rectal cancer highlighting prevalence rates, trial design, and patient population. Methods. We conducted a systematic search of the literature using A systematic search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2011) for English-language studies that included the following search terms: 'colorectal cancer,' or 'rectal cancer,' or 'rectal neoplasm,' and 'sexual function,' or 'sexual dysfunction,' or 'wellbeing,' or 'QoL,' or 'urinary or fecal incontinence.' Results. Although around 1/3 of women aged 50 to 70 years report lack of sexual desire, sexual function problems after treatment for rectal cancer are in the order of 60% among women. QoL improves with length of survival. Urinary and fecal incontinence are ongoing concerns for many women after treatment with rates up to 60%. Conclusion. There is a gap in our knowledge of the effects of rectal cancer and its treatment on urinary and fecal continence, sexual function and QoL in women. There is a need for studies of sufficient size and duration to gain a better understanding of the disease and its management and the long-term effects on these parameters. This information is needed to develop preventative health care plans for women treated for rectal cancer that target those most at risk for these adverse outcomes. Panjari M, Bell RJ, Burney S, Bell S, McMurrick PJ, and Davis SR. Sexual function, incontinence, and wellbeing in women after rectal cancer-A review of the evidence. J Sex Med 2012;9:2749-2758. [ABSTRACT FROM AUTHOR]

Background: Although pregnancy is a risk factor for urinary incontinence (UI), the extent of UI in nulligravid women has not been reported Objective: To investigate the rate of UI in a sample of young nulligravid women and its potential risk factors and effect on quality of life. Design: Cross-sectional, self-administered questionnaire-based study. Setting: University campuses and medical and allied health clinics. Participants: Nulligravid Australian women aged 16 to 30 years. Measurements: The Questionnaire for Urinary Incontinence Diagnosis, the Psychological General Well-Being Index (PGWBI), the King's Health Questionnaire, and the International Physical Activity Questionnaire-Short Form. Demographic variables and potential risk factors were also documented. Results: 1018 of 1620 questionnaires (63%) were returned, and 1002 provided analyzable data. The mean age of participants was 22.5 years (SD, 3.2). The rate of any UI was 12.6% (95% CI, 10.5% to 14.7%). Incontinence was slightly more common in students than in nonstudents (13.2% [CI, 11.0% to 15.8%] vs. 10.6% [CI, 6.7% to 14.6%]). Rates of UI varied according to sexual activity and use of combined oral contraceptives (COCs), with highest rates reported by students who were ever sexually active and not using COCs (21.5% [CI, 16.7% to 27.3%]). Women with UI reported significantly lower overall well-being than women without UI and had worse PGWBI scores related to anxiety, depression, positive well-being, and self-control. Limitation: A convenience sample of healthy, well-educated women was recruited, and response rates and participant characteristics varied by setting. Conclusion: In a sample of young nulligravid women, UI was associated with ever being sexually active and no COC use, as well as lower psychological well-being. Further research is needed to assess the prevalence and risk factors for UI in nulligravid women. Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the effects of testosterone on cognitive performance in healthy postmenopausal women. Study design: Open-label pilot study. Nine postmenopausal women on non-oral hormone replacement therapy, aged 47–60 years received transdermal testosterone spray for 26 weeks. A control group of 30 women provided normative data for comparison. Main outcome measures: Scores from a computerized cognitive test battery performed pre- and post treatment, at 0 and 26 weeks. Results: There were no differences between treatment/normative groups in any parameter at baseline. At week 26 scores for the International Shopping list task including delayed recall (verbal learning and memory) and the continuous paired associate learning task (visual learning and memory) were significantly higher in the treatment group as compared to the normative group (p <0.05). Significant improvements from baseline were observed for the International Shopping list delayed recall (verbal learning and memory) and Groton Maze recall tasks (visual learning and memory) for the treatment group (both p <0.05), after 26 weeks. There were no significant differences between baseline and week 26 in the normative group. In the regression analysis which modeled the score at week 26, and which included a bootstrapping approach, the beta coefficient for the treatment group was statistically significant when age and baseline score were taken into account for the International Shopping list task including delayed recall (both p <0.02). Conclusion: Testosterone improved cognitive performance in the domain of verbal learning and memory in a pilot study of healthy postmenopausal women and is worthy of further exploration in a randomized placebo controlled study. [Copyright &y& Elsevier]

Breast cancer (BC) remains the most common non-skin cancer in women and an increasing number are living as BC survivors. The aim of this article is to evaluate the impact of the first diagnosis of invasive BC and its treatment, menopausal symptoms, and body image on sexual function. The BUPA Foundation Health and Wellbeing after Breast Cancer Study is a prospective cohort study of 1,684 women recruited within 12 months of their first diagnosis with invasive BC. Each participant completed an enrollment questionnaire (EQ) and first follow-up questionnaire (FQ1) 12 months post-EQ. Sexual function was evaluated by the Menopause-Specific Quality of Life Questionnaire embedded within the FQ1. Of the 1,011 women in the analyses, 70% experienced sexual function problems and 77% reported vasomotor symptoms. Women experiencing sexual function problems were postmenopausal ( P = 0.02), experienced vasomotor symptoms ( P < 0.01), and used aromatase inhibitors ( P = 0.03). Women with vasomotor symptoms were twice as likely to experience sexual function problems (odds ratio [OR] 1.93, 95% confidence interval [CI] 141, 2.63; P < 0.001). This association was more extreme for women on aromatase inhibitors (OR 3.49, 95% CI 1.72, 7.09; P = 0.001) but did not persist in women not using endocrine therapies (OR 1.41, 95% CI 0.84, 2.36; P = 0.19). Women on aromatase inhibitors were more likely to report sexual function problems (OR 1.50, 95% CI 1.0, 2.2, P = 0.04) and women with body image issues were 2.5 times more likely to report sexual function problems (OR 2.5 95% CI 1.6, 3.7, P < 0.001). Women using tamoxifen were not more likely to experience sexual function problems (OR 1.1, 95% CI 0.8, 1.5, P = 0.6); however, women with body image issues were twice as likely to experience sexual function problems (OR 2.1, 95% CI 1.5, 3.0, P < 0.001). Seventy percent of partnered BC survivors less than 70 experienced sexual function problems. Sexual problems are related to the use of aromatase inhibitors which can exacerbate menopausal symptoms. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the level of understanding in women with newly diagnosed invasive breast cancer of the key clinical features of their disease that are important determinants in treatment decision making. Methods: The 1684 women aged between 26 and 88 years at diagnosis enrolled in a 5-year cohort study were asked by questionnaire about their estrogen receptor (ER) and progesterone receptor (PR) status and about their past or current treatment with adjuvant endocrine therapy. Information was linked with their ER and PR status determined from the histopathology report. Logistic regression analysis was used to explore the relationship between age and education status and the likelihood of being able to correctly report hormone receptor status, as well as the relationship between the likelihood of receiving adjuvant endocrine therapy and knowledge of hormone receptor status in women who were ER or PR positive. Results: Not being able to correctly report hormone receptor status was associated with being older and having a lower level of education. Of women who were ER positive or PR positive or both and were at least 40 weeks from diagnosis, having received some form of endocrine therapy was significantly associated with self-identification as being ER or PR positive (OR = 1.82, 95% CI 1.24-2.68, p = 0.002), even when age was taken into account. Conclusions: That self-knowledge of hormone receptor status was independently associated with likelihood of receiving endocrine therapy suggests that the methods of helping women understand the nature of their breast cancer are worthy of review. [ABSTRACT FROM AUTHOR]

Abstract: Background: The study was conducted to perform a direct comparison of the satisfaction of intrauterine device (IUD) users and Implanon users after 6 months. Study design: Women were recruited to this study in the contraception clinics of Southern Health and Family Planning Victoria. Each woman completed a questionnaire at the time of starting her contraception with either an IUD or Implanon. Women were sent a follow-up questionnaire after 6 months to assess their satisfaction with their chosen method of contraception. Results: A total of 439 participants were recruited for this non randomized cohort study; 211 choosing an IUD and 228 choosing to use Implanon. The main reason patients in both groups chose their contraceptive method was recommendation by the doctor. Follow-up was achieved in over 84% in both groups. More than 50% of women in both groups reported at least one side effect. The most commonly reported side effect in both groups was abnormal bleeding and this was also the most common reason for having the contraceptive device removed. The IUD users reported a higher rate of satisfaction with their chosen method of contraception, although there was no difference between groups in the removal rate or whether the women would recommend the contraception to others. Conclusions: IUD users reported a higher level of satisfaction than did Implanon users at 6 months. Side effects in women using IUDs and Implanon are common. The range of likely side effects should be included in counseling women about long-term reversible contraception. [Copyright &y& Elsevier]

Introduction. Dehydroepiandrosterone (DHEA) and its sulfate DHEAS, which are the most abundant steroids in women, decline with age. We have shown association between low sexual function and low circulating DHEAS levels in women. Aim. The aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young individuals improves sexual function. Methods. Ninety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week randomized, double-blind, placebo controlled trial and received either DHEA 50 mg or placebo (PL) daily. Main Outcome Measures. Efficacy was assessed through 26 weeks. The main outcome measures were the change in total satisfying sexual events (SSE) and the change in the Sabbatsberg Sexual Self-Rating Scale (SSS) total score. Secondary measures were the Psychological General Well-Being Questionnaire (PGWB), and the Menopause—Specific Quality of Life Questionnaire (MENQOL). Hormonal levels, adverse events (AEs), serious adverse events (SAEs) and clinical labs were evaluated over 52 weeks. Results. Eighty-five participants (91%) were included in the 26-week efficacy analysis. There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS, PGWB, and MENQOL change scores. Overall AE reports and number of withdrawals as a result of AEs were similar in both groups; however more women in the DHEA group experienced androgenic effects of acne and increased hair growth. Conclusions. In this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA resulted in no significant improvements in sexual function over PL therapy over 26 weeks. Panjari M, Bell RJ, Jane F, Wolfe R, Adams J, Morrow C, and Davis SR. A randomized trial of oral DHEA treatment for sexual function, well-being and menopausal symptoms in postmenopausal women with low libido. J Sex Med 2009;6:2579–2590. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to evaluate the safety of 52 weeks of DHEA 50mg daily oral dose given to postmenopausal women with low libido to improve sexual function. Method: 93 postmenopausal women were enrolled in a 52-week randomised, double-blind, placebo-controlled trial and received either DHEA 50mg or placebo (PL) daily. The effects of DHEA versus placebo on lipid profile, insulin–glucose homeostasis and the endomentrium were assessed over 52 weeks. Results: Oral DHEA, 50mg/day, was not associated with any effects on blood lipids or insulin resistance. The pattern of breakthrough bleeding did not substantially differ between the DHEA and PL groups and no significant adverse endometrial effects were apparent. Conclusions: The use of 50mg oral DHEA did not significantly alter lipid profile, insulin sensitivity or adversely affect the endometrium in postmenopausal women. [Copyright &y& Elsevier]

Introduction. A validated questionnaire to assess the nature and quality of the recent female sexual experience and that can be employed to evaluate acute therapeutic effects does not exist. Aim. To validate an instrument with which researchers can evaluate the nature and quality of the female sexual experience within 24 hours of a sexual event. Methods. A cross-sectional questionnaire study in 349 sexually active community-based women, aged 20–65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. Main Outcome Measures. Scores from the Monash Women's Health Program Female Sexual Satisfaction Questionnaire (MFSSQ), completed within 24 hours of sexual activity, on two occasions. Results. Participants were 349 women who were sexually active at least once per fortnight, but not necessarily partnered. Almost equal groups of self-identified satisfied, dissatisfied, premenopausal, and postmenopausal women participated. Three hundred forty-five women (99%) completed one MFSSQ, and 326 women (94%) completed two separate questionnaires, each within 24 hours of a sexual event. Missing responses were few, good inter-item correlation was seen, and excellent reliability was demonstrated for most items, based on test–retest data. The questionnaire was able to discriminate well between sexually satisfied and dissatisfied women. Conclusions. The MFSSQ is a 12-item questionnaire specifically designed to assess the quality and nature of a recent sexual experience. It is easy and quick to administer, is reliable and valid, and has the potential to be used to assess the efficacy of acute interventions in the area of female sexual dysfunction. Davison SL, Bell RJ, La China M, Holden SL, and Davis SR. Assessing sexual function in well women: Validity and reliability of the Monash Women's Health Program Female Sexual Satisfaction Questionnaire. J Sex Med 2008;5:2575–2586. [ABSTRACT FROM AUTHOR]

Introduction. Satisfaction with sexual function in community-based women has not been well-described, and little is known of differences in sexual function between pre-(PreM) and postmenopausal (PM) women. Aim. The aim of this article was to describe sexual function in PreM and PM women who self-identify as being satisfied or dissatisfied with their sexual life. Methods. A cross-sectional questionnaire study was conducted among 349 sexually active community-based women, aged 20–65 years, who self-identified as being either satisfied or dissatisfied with their sexual life. Main Outcome Measures. Scores from a daily diary of sexual function for 4 weeks, examining the frequency of sexual thoughts, interest, and activity. Results. One hundred and eighty-four women (53%) were PreM, and 165 (47%) were dissatisfied with their sexual life. The median number of days with sexual activity or events per month for all women was 8 (ranges 2–28 days; 2–57 events). Ninety-two percent of reported events involved a partner, 86% involved intercourse, and in 40% the woman initiated the activity. Women satisfied with their sexual life had higher frequencies of sexual thoughts, interest, events, and initiation of activity than dissatisfied women ( P < 0.0001). PreM satisfied women had higher frequencies of sexual thoughts, numbers of days with sexual activity, and events per month than PM satisfied women ( P < 0.05). PreM oral contraceptive pill (OCP) users had significantly lower average frequencies of sexual thoughts, interest, and days of sexual activity per month ( P < 0.05), whereas PM women hormone therapy (HT) users had higher frequencies of sexual thoughts and sexual interest ( P = 0.04 and P = 0.05, respectively) compared to nonusers. There were no differences in sexual function between PreM and PM women who were sexually dissatisfied. Conclusions. Sexual activity mostly involved a partner, partner initiation, and intercourse. Sexually satisfied women reported more sexual thoughts, interest, events, and initiation of sexual activity than dissatisfied women. PreM sexually satisfied women reported more sexual thoughts, days with sexual activity, and sexual events per month compared to PM satisfied women. OCP and HT use appeared to have contrasting effects on sexual function. Davison SL, Bell RJ, LaChina M, Holden SL, and Davis SR. Sexual function in well women: Stratification by sexual satisfaction, hormone use, and menopause status. J Sex Med 2008;5:1214–1222. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to evaluate whether subclinical thyroid disease is associated with impaired health-related quality of life and a more adverse cardiovascular disease risk profile. Design A community-based cross-sectional study. Setting and participants A total of 1423 non-healthcare-seeking women, aged 18–75 years were randomly recruited from the community via the electoral roll from April 2002 to August 2003. Main outcome measures These were the scores for the Short-Form 36 (SF-36), the Psychological General Well-being Index (PGWI), thyroid hormone levels, serum lipids and high sensitivity C-reactive protein (hsCRP). Subclinical hypothyroidism (SCH) and subclinical hyperthyroidism (SCHyper) were defined as serum TSH > 4·0 mIU/l and < 0·5 mIU/l, respectively, with a normal free thyroxine (free T4) level. Results Evaluable data were available for all participants. 10·7% of all women had an abnormal TSH value. The prevalence of a low TSH level by age group ranged from 1·2% to 6·4%, whereas the prevalence of an elevated TSH level ranged from 2·8% to 9·2% and increased with age ( P = 0·002). There were no significant differences between women with SCH or SCHyper and age-matched controls for the total PGWI score or the Mental and Physical Component Scores of the SF-36. Women with SCH were no different from controls for serum lipids or hsCRP. Using linear regression, SCH vs. euthyroidism did not make an independent contribution to variation in either total cholesterol or triglycerides, with or without adjustment for age ± age2 ± BMI. Conclusions Our data indicate that subclinical thyroid disease in women in the community is not associated with lower well-being or impaired health-related quality of life and SCH is not associated with increased serum markers of CVD risk. [ABSTRACT FROM AUTHOR]

In developed countries, an increasing incidence of, and decreasing mortality from, cancer is leading to burgeoning numbers of people living with a personal history of cancer[1]. The prevalence of a specific type of cancer in the population is a function of the cancer incidence (including detection through screening) as well as the cancer-specific mortality once it is identified and treated[4]. Originally started in the USA, the ringing of a bell at the completion of cancer therapy has now spread to other countries[5] and involves both children and adults completing their cancer treatment[6]. Over and above the costs of initial cancer treatment, long-term cancer survivors use health services much more than people without a history of cancer[16]. [Extracted from the article]

To identify factors during the neonatal period that are associated with the subsequent development of cerebral palsy (CP). Case–control study. Ten hospitals in Victoria, Australia. Cases were babies with moderate or severe CP identified from the Victorian Cerebral Palsy Register. Controls were matched with cases for year of birth, plurality, sex, birthweight, gestation and hospital of birth. A range of neonatal variables was compared between cases and controls, initially in a univariate analysis and subsequently in a logistic regression. The analysis was matched where possible. Where missing data prevented a matched analysis, an adjusted unmatched analysis was performed. Those neonatal factors making an independent contribution to the risk of CP in both term and preterm infants. Among babies born at term, 73% of cases and 2% of controls were identified by at least one of the following factors: seizures, congenital abnormalities of the brain and elsewhere, ‘other lesions’, abnormal muscle tone and meconium aspiration. Among babies born preterm, 68% of cases and 26% of controls were identified by the following factors: seizures, intraventricular haemorrhage, periventricular leukomalacia, ‘other lesions’ and abnormal muscle tone. The neonatal factors which best identify neonates who will subsequently develop CP are different for term and preterm babies. Babies born at term are identified more efficiently than those born preterm. Among term babies especially, some of these factors are clearly of a long-standing nature and are not associated with delivery. [ABSTRACT FROM AUTHOR]

More than half of Victorian pregnant women are undergoing prenatal testing for birth defects, although little is known about the factors that are influencing their decisions. To examine whom women perceived as influencing their decision about prenatal testing for birth defects, with whom they would have liked to talk more, and what sources of information they preferred. A total of 737 pregnant women aged 37 years and over, who either had or had not undergone prenatal testing (screening and/or diagnosis) completed a questionnaire in 18 hospitals throughout Victoria. Over 90% reported that they themselves had a strong influence on their decision, and 70% reported their partner as strongly influencing their decision. Approximately 30% of women who had both screening and diagnosis and more than 20% of women who had no prenatal testing, would like to have discussed prenatal testing with women who had previously had testing. Face-to-face counselling with a doctor or counsellor was the preferred source of information, followed by a pamphlet as the second choice. Given that both tested and untested women felt so strongly that they were responsible for their own decisions about prenatal testing, it is unlikely that universal acceptance and uptake will occur, even in this group of women of advanced maternal age. A support network of women who have already had testing could supplement existing sources of support. However, there continues to be a need for face-to-face sessions with a doctor or counsellor in combination with printed material. [ABSTRACT FROM AUTHOR]

Objectives: To assess the performance of an artificial intelligence (AI) algorithm in the Australian mammography screening program which routinely uses two independent readers with arbitration of discordant results. Methods: A total of 7533 prevalent round mammograms from 2017 were available for analysis. The AI program classified mammograms into deciles on the basis of breast cancer (BC) risk. BC diagnoses, including invasive BC (IBC) and ductal carcinoma in situ (DCIS), included those from the prevalent round, interval cancers, and cancers identified in the subsequent screening round two years later. Performance was assessed by sensitivity, specificity, positive and negative predictive values, and the proportion of women recalled by the radiologists and identified as higher risk by AI. Results: Radiologists identified 54 women with IBC and 13 with DCIS with a recall rate of 9.7%. In contrast, 51 of 54 of the IBCs and 12/13 cases of DCIS were within the higher AI score group (score 10), a recall equivalent of 10.6% (a difference of 0.9% (CI −0.03 to 1.89%, p = 0.06). When IBCs were identified in the 2017 round, interval cancers classified as false negatives or with minimal signs in 2017, and cancers from the 2019 round were combined, the radiologists identified 54/67 and 59/67 were in the highest risk AI category (sensitivity 80.6% and 88.06 % respectively, a difference that was not different statistically). Conclusions: As the performance of AI was comparable to that of expert radiologists, future AI roles in screening could include replacing one reader and supporting arbitration, reducing workload and false positive results. Clinical relevance statement: AI analysis of consecutive prevalent screening mammograms from the Australian BreastScreen program demonstrated the algorithm's ability to match the cancer detection of experienced radiologists, additionally identifying five interval cancers (false negatives), and the majority of the false positive recalls. Key Points: • The AI program was almost as sensitive as the radiologists in terms of identifying prevalent lesions (51/54 for invasive breast cancer, 63/67 when including ductal carcinoma in situ). • If selected interval cancers and cancers identified in the subsequent screening round were included, the AI program identified more cancers than the radiologists (59/67 compared with 54/67, sensitivity 88.06 % and 80.6% respectively p = 0.24). • The high negative predictive value of a score of 1–9 would indicate a role for AI as a triage tool to reduce the recall rate (specifically false positives). [ABSTRACT FROM AUTHOR]

Summary Background Objective Study design Methods Results Main limitations Conclusions Recent studies have described techniques to acquire ultrasound measurements of the cross‐sectional area of the multifidus muscle to investigate back pain in horses and monitor the response to rehabilitation. These techniques have been extrapolated from human research but have not been clinically validated in the horse.The objective of the study was to investigate whether measuring the cross‐sectional area of the multifidus muscle in horses using ultrasound is a repeatable technique.Cross‐sectional.Ultrasound images of the articular process view and interspinous view of the multifidus muscle were acquired at T15, T18, L2 and L5 on the left and right sides. Three images were acquired at each location and each image was measured three times to give an average cross‐sectional area. Study 1 investigated the repeatability of acquiring images in a single session, and then on two separate days. Study 2 compared measurements of images acquired with a console (Philips EpiQ) and a portable (MyLab™Alpha) ultrasound machine. Study 3 investigated the repeatability of measuring the cross‐sectional area using external software, OsiriX. Intraclass correlation coefficients (ICC) were calculated for each study.Repeatability varied from good to excellent for images taken in a single session. The repeatability for measuring the images using external software was good to excellent. There was poor‐to‐moderate repeatability for images taken on two different days and poor‐to‐good repeatability when using the two different machines.Population size, study population limited to a single breed, only one operator.The measurement of the multifidus muscle in horses has poor repeatability and may have limited application. [ABSTRACT FROM AUTHOR]

Background: Despite the high prevalence of depression among adult women, the proportion of reproductive-aged women with moderate or severe depressive symptoms is uncertain, as is the proportion taking antidepressant medication. We report the prevalence of depressive symptoms in young Australian women, risk factors for depressive symptoms, and psychoactive drug use. Methods: An online survey was completed by population-based sample of 6,986 Australian women, aged 18–39 years, recruited from November 2016 to July 2017. Depressive symptoms were assessed by the Beck Depression Inventory-II, and psychotropic medication use was self-reported. Results: The prevalences of moderate and severe depressive symptoms were 15.0% (95% confidence interval [CI] 14.1%–15.8%) and 14.8% (95% CI 14.0%–15.7%), respectively. Housing insecurity was associated with over a twofold likelihood of moderate to severe depressive symptoms, whereas being parous or at least 25 years of age was protective. Use of any psychotropic medication was reported by 16.3% (95% CI 15.4%–17.2%). A previous cancer diagnosis was the strongest risk factor for current antidepressant use, whereas compared with being of European ancestry, being Asian or of another ancestry was associated with a lower likelihood of antidepressant use. Conclusion: The prevalence of moderate to severe depressive symptoms among young Australian women is alarming. Prevention strategies targeting the sociodemographic circumstances underpinning the identified risk factors are urgently needed. [ABSTRACT FROM AUTHOR]

The author comments on the over-use and under-use of modern medical care. He refers to a recent set of papers published in journal "The Lancet," where the authors provide evidence for both over-use and under-use in high-income countries and low- and middle-income countries. Over-diagnosis is said to be one of the main reasons to give rise to over-use.