Cristina Laguna Benetti-Pinto

Subclinical hypothyroidism in young women with polycystic ovary syndrome: an analysis of clinical, hormonal, and metabolic parameters

OBJECTIVE To analyze the relationship between selected clinical and metabolic parameters in young women with polycystic ovary syndrome (PCOS) and normal thyroid function or subclinical hypothyroidism (SCH). DESIGN A cross-sectional cohort study. SETTING Tertiary care clinic. PATIENT(S) Women diagnosed with PCOS according to the Rotterdam criteria (n = 168). INTERVENTION(S) Clinical, hormonal, and metabolic parameters were evaluated. SCH was defined as TSH levels of 4.5-10 mIU/L. MAIN OUTCOME MEASURE(S) Separately, PCOS and SCH exert adverse effects on metabolic parameters; however, in conjunction their effect is unclear. This study evaluated whether SCH in women with PCOS affects clinical, hormonal, and metabolic parameters. RESULT(S) The mean age of the 168 women was 24 ± 5.8 years. Mean body mass index was 33.4 ± 8.2 kg/m(2). Thyroid function was normal in 149 women, and 19 had SCH. Only serum low-density lipoprotein cholesterol and PRL levels were significantly higher in the women with SCH (122.6 ± 25.6 mg/dL and 17.7 ± 7.7 ng/mL, respectively) compared with those with normal thyroid function (105.6 ± 33 mg/dL and 14 ± 10.3 ng/mL, respectively). CONCLUSION(S) In young women with PCOS, SCH is associated with higher low-density lipoprotein cholesterol levels, albeit with no changes in other lipid profile parameters, insulin resistance, or phenotypic manifestations. This study adds to current evidence supporting an association between PCOS and SCH.

Dienogest and deep infiltrating endometriosis: The remission of symptoms is not related to endometriosis nodule remission

OBJECTIVE To evaluate the effectiveness of dienogest in controlling pain caused by deep infiltrating endometriosis (DIE), its influence on the quality of live (QoL) of women affected by the disease, and the effect of the drug on the volume of endometriotic lesions. STUDY DESIGN A prospective cohort study including 30 women with a sonographic diagnosis of DIE (intestinal and posterior fornix) treated with dienogest 2mg per day for 12 months. We evaluated the pain symptoms and the volume of the intestinal and posterior fornix lesions before and after 12 months of use of dienogest. To perform the statistical analysis, we used the Wilcoxon signed-rank test, and the relationship between the data was tested using the Spearman correlation coefficient. RESULTS Women were on average 36.13±6.24years old. Pain symptoms most commonly reported were dyspareunia (83.3%), dysmenorrhea (73.3%), and pelvic pain (66.7%). After 12 months of treatment with dienogest, there was significant improvement of various symptoms (dyspareunia p=0.0093, dysmenorrhea p<0.0001; pelvic pain p=0.0007; and bowel pain p<0.0001), without a reduction in the volume of endometriotic nodules. There were significant improvements in the parameters that comprise the QoL (physical p<0.0001; p=0.0007 psychological) and the self-assessment of QoL (p=0.0069) and health (p=0.0001). CONCLUSION Dienogest is an effective medication to control symptoms of pain related to DIE, even without reducing the volume of DIE nodules.

The influence of body weight on sexual function and quality of life in women with polycystic ovary syndrome.

PurposeTo assess sexual function (SF) and quality of life (QOL) in women with polycystic ovary syndrome (PCOS).MethodsA cross-sectional study was conducted to assess 56 women with PCOS and 102 control women with regular menstrual cycles. To assess SF and QOL in Brazilian women with PCOS with Female Sexual Function Index (FSFI) and the WHOQOL-bref questionnaires.ResultsWomen with PCOS had a worse evaluation to arousal, lubrication, satisfaction, pain and total FSFI, and there was no difference in sexual desire and orgasm. Besides, they had a worse evaluation concerning health status than controls. The body mass index was inversely correlated to the QOL, especially to the physical, psychological, environment aspects and self-assessment of QOL, but it did not show correlation to the SF.ConclusionWomen with PCOS had a worse sexual function and self-assessment of health condition in comparison to controls. The body weight as isolated symptom was correlated to the worsening in quality of life, but not with the worsening of sexual function.

Factors associated with the reduction of bone density in patients with gonadal dysgenesis

OBJECTIVE To correlate bone mineral density (BMD) in women with primary hypoestrogenism caused by 46,XX pure gonadal dysgenesis or Turners syndrome with age, age at estrogen therapy initiation, length of estrogen use, and body mass index (BMI). DESIGN Cross-sectional study. SETTING Academic tertiary-care hospital. PATIENT(S) Thirty-eight women, aged 16 to 35 years (mean, 24.6 years), affected by these genetic disorders. INTERVENTION(S) Measurement of lumbar spine and femoral neck BMD using double x-ray absorptiometry. The results were correlated with the control variables by using Pearsons coefficient of correlation. Variables associated with BMD were evaluated by multiple linear regression analysis. MAIN OUTCOME MEASURE(S) Bone mineral density. RESULT(S) Bone mineral density of the lumbar spine showed that 90% of the women presented osteopenia or osteoporosis. The femoral neck was affected in 55% of these women. The length of estrogen therapy and the BMI showed a positive association with BMD at the lumbar spine and femoral neck, respectively. CONCLUSION(S) Women affected by pure gonadal dysgenesis or Turners syndrome presented a marked decrease in BMD of the lumbar spine and femoral neck. Medical attention for their diagnosis and early hormone replacement therapy are advised.

Dyspareunia and lubrication in premature ovarian failure using hormonal therapy and vaginal health

Abstract Objective To evaluate vaginal microbiological and functional aspects in women with and without premature ovarian failure (POF) and the relationship with sexual function. Methods A cross-sectional study of 36 women with POF under hormonal therapy who were age-matched with 36 women with normal gonadal function. The vaginal tropism was assessed through hormonal vaginal cytology, vaginal pH and vaginal health index (VHI). Vaginal flora were assessed by the amine test, bacterioscopy and culture for fungi. Sexual function was evaluated through the questionnaire Female Sexual Function Index (FSFI). Results Women in both groups were of similar age and showed similar marital status. The two groups presented vaginal tropic scores according to the VHI but the tropism was worse among women in the POF group. No difference was observed with respect to hormonal cytology and pH. Vaginal flora was similar in both groups. Women with POF showed worse sexual performance with more pain and poorer lubrication than women in the control group. The VHI, the only parameter evaluated showing statistical difference between the groups, did not correlate with the domains of pain and lubrication in the FSFI questionnaire. Conclusion These findings suggest that the use of systemic estrogen among women with POF is not enough to improve complaints of lubrication and pain despite conferring similar tropism and vaginal flora. Other therapeutic options need to be evaluated.

Leptin and adiponectin blood levels in women with premature ovarian failure and age- and weight-matched women with normal menstrual cycles

Objective: The aim of this study was to evaluate leptin and adiponectin blood levels in women with premature ovarian failure (POF) and women with a normal menstrual cycle. Methods: This was a cross-sectional study involving 60 women divided into two groups: the study group (G1) comprising 30 women with POF not receiving hormone therapy for at least 3 months and the control group (G2) comprising 30 women with a normal menstrual cycle. Both groups were age and body mass index (BMI) matched. Results: Study participants had a mean (±SD) age of 34.4 (±5.3) and 34.2 (±5.6) years and mean BMI (±SD) of 24.7 (±6.3) and 24.5 (±4.6) kg/m2 in G1 and G2, respectively. Serum leptin levels were significantly lower in G1 compared with G2 (8.8 ± 12.2 and 12.2 ± 9.7 ng/mL; P < 0.05). Serum adiponectin levels were similar in both groups. Leptin levels were positively correlated to weight (r = 0.38; P = 0.03) but were not correlated to BMI and age in women with POF (G1); in G2, they were positively correlated to BMI (r = 0.59; P = 0.0006), weight (r = 0.63; P = 0.0006), and age (r = 0.40; P = 0.02). Adiponectin levels did not correlate to weight, BMI, or age in both groups. Conclusions: These results suggest that gonadal function loss may decrease leptin circulating levels, independently from age and BMI. Adiponectin seems not to correlate to hormonal status.

Breast density in women with premature ovarian failure using hormone therapy.

Background. Women with premature ovarian failure (POF) are treated with estrogen–progestin therapy; however, doubts remain regarding the effect of this therapy on the breasts of women with POF. Objective. To evaluate the breast density of women with POF using estrogen–progestin therapy compared with normally menstruating women. Methods. A cross-sectional study was performed in 31 women with POF using conjugated equine estrogens and medroxyprogesterone acetate and a control group of 31 normally menstruating women, paired by age. All underwent mammography, analyzed by digitization and Wolfes classification, the latter defined as non-dense (N1 and P1) or dense (P2 and Dy). Parity, breastfeeding and body mass index were evaluated, as well as duration of hormone use and ovarian failure in the POF group. Results. Digitization revealed no difference in mean breast density between the groups: 24.1±14.6% and 21.8±11.3% for POF and control groups, respectively. The Wolfe classification also failed to detect any significant difference between the groups, dense breasts being detected in 51.6% and 35.5% of cases in the POF and control groups, respectively. Conclusion. Periods of hypoestrogenism followed by hormone therapy resulted in no changes in breast density in women with POF, compared with normally menstruating women of the same age.

17-Hydroxyprogesterone deficiency as a cause of sexual infantilism and arterial hypertension: Laboratory and molecular diagnosis – a case report

The differential diagnosis of hypertension associated with hypokalemia in infancy and adolescence should necessarily include deficiency of the 17α-hydroxylase enzyme, a rare form of congenital adrenal hyperplasia (CAH). In addition to hypertension, the classic syndrome caused by this deficiency is characterized by suppressed production of sex hormones and consequently sexual infantilism. Although rare (1% of all forms of CAH), there appears to be a higher incidence of this syndrome in some population groups. This is a case report on two sisters followed up at the Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), who were both found to have the 46,XY genotype with homozygosis for W406R, exon 7 of the CYP17 gene (OMIM 202110). The condition was diagnosed only at puberty when hypergonadotropic hypogonadism resulted in sexual infantilism; however, arterial hypertension had been present since infancy and late diagnosis and lack of timely adequate treatment resulted in complications.

A pituitary adenoma secreting follicle-stimulating hormone with ovarian hyperstimulation: treatment using a gonadotropin-releasing hormone antagonist

OBJECTIVE To describe the management of a patient with a pituitary adenoma secreting follicle-stimulating hormone (FSH) associated with ovarian hyperstimulation who was treated with a gonadotropin-releasing hormone (GnRH) antagonist. DESIGN Case report. SETTING University teaching hospital. PATIENT(S) A woman of reproductive age with secondary amenorrhea and ovarian hyperstimulation due to a pituitary adenoma secreting FSH, which persisted after transsphenoidal surgery. INTERVENTION(S) Clinical treatment with a GnRH antagonist. MAIN OUTCOME MEASURE(S) A decrease in serum estradiol levels. RESULT(S) During the treatment period, ovarian hyperstimulation decreased as shown by a reduction in estradiol levels and an improvement in the patients clinical condition and in the ultrasonography parameters. CONCLUSION(S) The GnRH antagonist was found to be effective for the short-term treatment of ovarian hyperstimulation secondary to a pituitary adenoma secreting FSH, thus representing a therapeutic option that should be taken into consideration in such cases.

Breast density in women with premature ovarian failure or postmenopausal women using hormone therapy: analytical cross-sectional study

CONTEXT AND OBJECTIVE Studies on postmenopausal women have reported increased risk of breast cancer relating to the type and duration of hormone therapy (HT) used. Women with premature ovarian failure (POF) represent a challenge, since they require prolonged HT. Little is known about the impact of prolonged HT use on these womens breasts. This study aimed to evaluate the effects of one type of HT on the breast density of women with POF, compared with postmenopausal women. DESIGN AND SETTING Cross-sectional study at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS 31 women with POF and 31 postmenopausal women, all using HT consisting of conjugated equine estrogen combined with medroxyprogesterone acetate, and matched according to HT duration, were studied. Mammography was performed on all subjects and was analyzed by means of digitization or Wolfes classification, stratified into two categories: non-dense (N1 and P1 patterns) and dense (P2 and Dy). RESULTS No significant difference in breast density was found between the two groups through digitization or Wolfes classification. From digitization, the mean breast density was 24.1% ± 14.6 and 18.1% ± 17.2 in the POF and postmenopausal groups, respectively (P = 0.15). Wolfes classification identified dense breasts in 51.6% and 29.0%, respectively (P = 0.171). CONCLUSION There was no difference in breast density between the women with POF and postmenopausal women, who had used HT for the same length of time. These results may help towards compliance with HT use among women with POF.