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With the increase in life expectancy, women now live up to one-third of their life in menopause. Postmenopausal bleeding (PMB) is a common gynecologic complaint encountered by the clinician. Endometrial cancer is present in about 10% of patients with PMB. Nevertheless, many other conditions such as endometrial or cervical polyps, genital atrophy, or non-gynecologic conditions may also be present. Hysteroscopy has replaced blind diagnostic procedures and is now considered the gold-standard technique for the diagnosis and management of intrauterine pathology. Gynecologists in clinical practice should be familiar with the use of hysteroscopy in the diagnosis and treatment of the menopausal patient presenting with gynecologic complaints. The aim of this article is to report the current evidence on the role of hysteroscopy in the evaluation and management of the postmenopausal patient with intrauterine pathology.

The climacteric is a stage when different changes in the female genitourinary system (such as a lack of lubrication or vaginal dryness, or genital atrophy) appear. These changes may cause inconvenience and difficulties in sexual relationships of women, and as a result, deteriorate their sexual life and the quality of life as a couple. The present work shows the results of a group cognitive behavioural intervention program for the improvement of sexual response and quality of life in the couple in a sample of climacteric women. Women in the experimental group improved their sexual response after the intervention (increased arousal, lubrication and overall sexual response) as in follow-up (increase of desire, arousal, lubrication, satisfaction and overall sexual response and decrease of pain). They also improved their quality of life in the couple and their quality of life in general. These changes are compared to a baseline period and to the control group.

Effect of Black Cohosh on Genital Atrophy and Its Adverse Effect in Postmenopausal Women Sung Nam Hong, M.D., Jin Ha Kim, M.D., Heung Yeol Kim, M.D., Ari Kim, M.D. Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyungkwan University School of Medicine, Changwon, College of Medicine, Kosin University, Busan, College of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea

PreviewAlthough not appropriate for all postmenopausal women, combined estrogen-progestogen replacement therapy apparently decreases the risk of endometrial and breast cancer and protects against osteoporosis, atherosclerosis, and genital atrophy in later life. Dr Gambrell examines the effects of therapy on the debilitating conditions associated with the menopause, reports on specific studies, and concludes that the benefits of combined treatment clearly outweigh the risks.

Since pituitary ablation has been shown to influence the rate of growth of transplanted (1–4) and autogenous (5) rat tumors, several investigators (6, 7, 8) have made an effort to define the factors by which this effect is produced. The numerous physiologic and anatomic changes which follow hypophysectomy contribute to make the problem complex. The present study is concerned with an appraisal of nutritional factors. McEuen and Thomson have previously observed the influence of degrees of starvation on the rate of growth of Walker tumor 256 and compared their results with the same tumor in hypophysectomized animals. They concluded that starvation may retard tumor growth as much as hypophysectomy. From the data presented, however, there was some question as to the validity of this conclusion (7, 5). We have attempted to restudy the question, using a technic of feeding which we believe increases the accuracy of the experiment. Methods Male rats about four months of age (150–180 grams) were inoculated with Walker tumor 256. The donor tumors were second, third, and fourth generation transplants in our hands from a tumor-bearing female of generation 154–B obtained through the courtesy of Dr. F. C. Wood of the Institute of Cancer Research of Columbia University. Solid tissue grafts were implanted by the trocar method into the left axillary region, through a skin incision in the groin. Ten days to two weeks later the animals were paired prior to removal of the pituitary in one mate. The operations were performed through a neck incision, pains being taken to avoid the nasopharynx. Completeness of removal was judged by the development of genital atrophy, and at death by direct inspection of the pituitary fossa from above.

THERE is much evidence indicating that the central nervous system is of importance in the regulation of the hypophysial secretion of gonadotrophic hormones. (Anderson and Haymaker, 1948; Stieve, 1952). Present evidence favors the hypothesis that such control is mediated by neurohumors passing through the hypophysial portal system. (Harris, 1948, Markee, et al., 1952), but the precise nature of such control has not as yet been clearly defined. Although hypothalamic lesions have been employed for many years, systematic studies of pituitaiy function utilizing this technique have been infrequent. With the popularization of the Horsley-Clarke stereotaxic instrument by Ranson and his coworkers it has been possible to produce accurately localized lesions of varying size and thus to permit a more careful study of the problem. Early workers frequently noted the occurrence of genital atrophy and, adiposity following hypothalamic damage (Erdheim, 1904; Bailey and Bremer, 1921) but considerable dispute existed whethe...

A 53-year-old woman with steroid-treated clinical sarcoidosis was subjected to hysterectomy and bilateral adnexectomy for irregular vaginal bleeding related to postmenopausal genital atrophy. Histological examination revealed many sarcoid granulomas located subserosally in the uterus, parametrium, perisalpinx and ovaries. The differential diagnosis is discussed.

The answer to the question whether the genital atrophy, skeletal undergrowth, and excessive adiposity of the adiposogenital syndrome are due to a pituitary deficiency or to an injury of the hypothalamus without pituitary involvement has rested heretofore upon observation made in two closely allied ways, (1) the extent of the injury inflicted as determined at the time of operation, (2) the extent of the injury as determined by autopsy and a study of sections. Both of these methods are open to the objection that the most careful study may fail to reveal the extent of damage done.Another method is available for determining the significance of the pituitary and brain injury in the genesis of this syndrome, namely, that of a replacement therapy. If we have any confidence in the functional specificity of the endocrine glands, it follows that we must admit the significance of a pituitary impairment as the causative factor if the adiposogenital syndrome or any of its components can be corrected by pituitary admin...

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(Preliminary abstract publication) In order to throw further light on the pathogeny of certain symptoms commonly ascribed to deficiency of the hypophysis considered as an endocrine gland a series of experiments were performed on adult dogs. The chief purpose of the experiments was to differentiate between the effects of lesions in the juxtahypophyseal region of the brain and of the hypophysis itself. Systematic punctures were therefore made in the hypothalarcras. The lateral route of Paulesco and dishing was employed; this gives a perfect exposure of the region and permits avoidance of the hypophysis with practical certainty, which is not true of the transphenoidal procedure hitherto employed for the purpose. The results of the experiments may be summarized as follows: The consequences of the puncture depend strictly on the localization of the lesion and when the localization is correct, upon the extent. A lesion, even an extremely minute one

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As observed by the clinician, there are two clinical entities, both disturbances of growth, ascribed to disturbed functioning of the hypophysis. One is acromegaly, characterized by enlargement of certain bones; the other, delayed development with adiposity and genital atrophy. When the former occurs in early life, gigantism results; when it first appears after maturity, enlargement of only certain portions of the bony skeleton is observed. In the other type, when the disturbance appears in early life, there is delayed skeletal development, with adiposity and failure of sexual evolution; when it appears after maturity, adiposity and sexual atrophy. Pierre Marie, in 1886, first called attention to the relation between acromegaly and the hypophysis, although Carl von Langer in 1872, in an anatomical study of giants, referred to a certain type with enlarged sella turcica. The observations of Marie have been confirmed, until at present it is generally conceded that acromegaly