Duru Shah

Sexuality in midlife: Where the passion goes?

Womens sexuality is highly capricious and multifaceted. Sexual functioning is an imperative component of womens lives and has progressively received public health, medical and even pharmaceutical attention. Sexual functioning, however, declines with age, leading to much debate about the contribution of menopause to sexual activity and functioning among women. The past two decades have witnessed an explosion of research into female sexuality. It is now understood that healthy and satisfying sexual function may extend all through the life cycle, and does not finish with end of child bearing years. Very few womens healthcare physicians are adequately trained to monitor a womans sexual health through her menopausal transition and beyond, much less how to treat the sexual problems that can arise during this special time. The strong association of physical health and psycho-social factors with sexual functioning accentuates the clinical domineering to explore these factors when discussing womens apprehensions regarding sexual dysfunction. It is need of hour to create scientific evidence to help womens health care physicians understand the requirements of women in these special years of her life and help deliver the care they need and so rightly, deserve.

Postmenopausal endometriosis: An enigma revisited

Endometriosis is a common gynecological disorder associated with infertility and chronic pelvic pain and traditionally been considered as a disease of the premenopausal years.[1] For pelvic disease alone, three clinical forms have been described: superficial implants on the pelvic peritoneum and ovaries, ovarian endometriotic cysts and rectovaginal nodules.[2] Besides pelvic disease, extra pelvic disease has also been reported.[3] Many theories have been proposed to explain the cause of endometriosis, but no single theory is capable of explaining the pathophysiology of endometriosis in its various forms. It has been suggested that the three different presentations of pelvic endometriosis may be caused by three different mechanisms. [4] As no single mechanism has been elucidated for premenopausal disease, it is highly unlikely that one single theory could account for postmenopausal disease.

Management of Polycystic Ovary Syndrome in India

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrinopathy affecting women.[1] It has an unknown etiology and is recognized as a heterogeneous disorder that results in overproduction of androgens, primarily from the ovary, and is associated with insulin resistance (IR).[1] The Rotterdam 2003 criteria defines PCOS as incidence of any two of the three key criteria, namely, oligoovulation and/or anovulation, excess androgen activity and polycystic ovaries(PCO).[1,2] However, the terminology used in the context of PCOS needs to be revisited to reflect the actual clinical nature of PCOS.

Menopausal Hormone Therapy, can we safely use it in women with co-morbidities?

The landscape of menopausal hormone therapy (MHT) has been changing very fast through newer developments across the globe. After a decade of fear and uncertainty, the critical reanalysis of the data of the Women’s Health Initiative (WHI) study along with the results of recent studies, have clarified the risks and benefits of systemic MHT. Current data indicates that MHT is beneficial when initiated in younger women closer to the onset of menopause, and in those women who take it for less than 10 years. The recommendations for MHT use have been provided by all the major professional organizations which include the International Menopause Society (IMS), the North American Menopause Society (NAMS), the European Menopause Society (EMAS), the British Menopause Society (BMS), and the Indian Menopause Society (IMS, India). It is important to keep in mind that MHT is a tool that affects the care of menopausal women not only during their transition years, but may extend over a longer period. During this phase, a woman faces many comorbid conditions which require consultation and treatment from multispecialty domains. As gynecologists, we look after the reproductive and sexual health of women during various stages of their lives. But as women develop many other comorbidities or chronic illnesses, we are faced with challenges in their management, especially with the use of MHT.

Journal of Midlife Health: The first bibliometric analysis

Journal of Midlife Health, in existence for 2½ years, has been working to disseminate information and research in the field of midlife health, including menopause management. This bibliometric review aimed to assess the coverage of this journal across article types, country, and specialty of origin. An online analysis of all the published articles from 2011 to July 2012 was carried out by the authors. Datas collected were analyzed by descriptive statistics. The journal has succeeded in ensuring broad-based, comprehensive, multidisciplinary coverage of midlife health-related issues, as shown by the variety of types of articles published, the emphasis on original articles, the international authorship, and the wide spectrum of medical and surgical specialties covered.

Thirteenth World Congress on Menopause, Rome, 8 - 11 June, 2011

Journal of Mid-life Health ¦ Jan-Jun 2011 ¦ Vol 2 ¦ Issue 1 is not an uncommon symptom in premenopausal and menopausal women. This symptom needs to be diagnosed correctly as a sign, so as to institute the right treatment; especially in SUI wherein the treatment is an operation, however simple the operation may be. The above case should be a lesson for how important it is to take thorough history and carry out proper clinical examination, which will help to make a diagnosis in 80% of cases. Only in 20% of cases, one may need to proceed to investigations and only in 10%, sophisticated investigations will be required. An operation carried out when not needed or indicated is likely to do more harm than good. First principle in medicine is “DO NO HARM.” Letters to Editor

Treatment of hirsutism.

Hirsutism is a distressing and relatively common problem for women in the reproductive age group. It is defined as excess terminal hair growth in a female in a typically male distribution. Although it may be a sign of hyperandrogenaemia, it may also be seen in women with normal circulating androgen levels, an entity known as ‘idiopathic hirsutism’ [1]. A variety of medical and cosmetic options are now available for the treatment of hirsutism. This article mainly deals with the use of anti-androgen therapy in hirsute women.