Giulia Gava

Long-term influence of combined oral contraceptive use on the clinical course of relapsing–remitting multiple sclerosis

OBJECTIVE To assess the long-term effects of combined oral contraceptives (COCs) on the clinical course of relapsing-remitting multiple sclerosis (RRMS), focusing on disability progression and evolution to secondary-progressive multiple sclerosis (SPMS). DESIGN Retrospective and exploratory study. SETTING Academic medical center. PATIENT(S) A total of 174 women with clinically confirmed MS; of these, 33 had evolved to SPMS at the time of enrollment in the study, whereas 141 still had a relapsing-remitting form of disease. INTERVENTION(S) Women were interviewed to obtain gynecologic and obstetric history. MAIN OUTCOME MEASURE(S) Expanded Disability Status Scale (EDSS); Multiple Sclerosis Severity Score (MSSS); annualized relapse rate; evolution to SPMS. RESULT(S) Mean±SD duration of disease was 14.3±9.8 years. Compared with non-users of COCs, COC users had lower EDSS scores and MSSS only in the subset of the population with prior or current immunomodulatory treatment. Nonuse of COCs was a predictor of disease evolution in SPMS, whether treated or not with immunomodulatory drugs. The annualized relapse rate was not influenced by COC use. No differences in EDSS scores and evolution to SPMS depending on COC formulation were detected. CONCLUSION(S) Our results suggest that COC use is associated with a less severe disease and less severe evolution. Whether different doses or types of progestin may have different effects remains to be defined.

Endocrine care of transpeople part I. A review of cross‐sex hormonal treatments, outcomes and adverse effects in transmen

Gender dysphoria (GD) is characterized by discomfort with the assigned or birth gender and the urge to live as a member of the desired sex. The goal of medical and surgical treatment is to improve the well‐being and quality of life of transpeople. The acquisition of phenotypic features of the desired gender requires the use of cross‐sex hormonal therapy (CHT). Adult transmen are treated with testosterone to induce virilization. In adolescents with severe and persistent GD, consideration can be given to arresting puberty at Tanner Stage II and if dysphoria persists, CHT is generally started after 16 years of age. Currently available short‐ and long‐term safety studies suggest that CHT is reasonably safe in transmen. Monitoring of transmen should be more frequent during the first year of cross‐sex hormone administration reducing to once or twice per year thereafter. Long‐term monitoring after sex reassignment surgery (SRS) includes annual check‐ups as are carried out for natal hypogonadal men. In elderly transmen, special attention should be paid to haematocrit in particular. Screening for breast and cervical cancer should be continued in transmen not undergoing SRS.

Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a comparison of safety and effectiveness.

To retrospectively compare the effectiveness and safety of 1‐year administration of transdermal oestradiol (TE) with cyproterone acetate (CPA) or leuprolide acetate (Leu) in transwomen.

Effects of ospemifene on vaginal epithelium of post-menopausal women

Abstract Ospemifene is a selective estrogen receptor modulator used for the treatment of vulvo-vaginal atrophy (VVA) in post-menopausal women. No direct evidence of its effects on histological features of the human vagina has been reported. To evaluate the effects of ospemifene on histological parameters, glycogen content, proliferation, and estrogen receptor α expression (ERα) of vaginal epithelium in post-menopausal women. Thirty-two post-menopausal women undergoing surgical procedures were enrolled. Sixteen subjects taking ospemifene at the time of inclusion (OSP) were compared to 16 subjects not taking any hormone (CTL). Vaginal biopsies were taken from the proximal and distal vaginal wall during surgery to evaluate histology, Ki-67 and ERα expression. OSP group showed thicker vaginal epithelium (349 ± 64 vs. 245 ± 53 μm, p < .001), higher proliferation index (212 ± 47 vs. 127 ± 28 Ki-67+ cells/mm, p < .001), higher epithelial (27.3 ± 3.1 vs. 20.6 ± 2.9 score, p < .001) and stromal (26.6 ± 4.9 vs. 20.6 ± 2.6 score, p < .001) ERα expression when compared to the CTL group. In postmenopausal women affected by VVA, 1 month intake of ospemifene is associated with an increased maturation, and ERα expression of the vaginal mucosa. These changes may partially explain the improvement of symptoms of vaginal atrophy reported with this drug.

Air Pollution and Gynecological Diseases

Implementation of industry and vehicular traffic led to a great diffusion of air pollution with a major impairment of air quality especially in urban areas over the last decades. Air pollution is an environmental contaminant containing thousands of harmful compounds derived from exhaust emissions containing a mixture of gaseous, liquid, and solid substances. Evidences associating air pollution exposure to respiratory and cardiovascular systems have been growing in the last decades as these are the most frequently affected organs. Anyway, constantly increasing data are available regarding an increased risk of women’s health disorders after exposure to air pollution. In fact, recent studies have underlined that common and widespread air pollutants could affect both reproductive health and pregnancy outcomes. Indoor and outdoor air pollution has been associated to a higher risk of malignant and benign gynecological diseases. Furthermore, exposure to toxic air pollution particles can have a detrimental role on ovarian function starting from the intrauterine time of life both affecting time of puberty and of menopause but also harming the fertility potential of women. It has been demonstrated that air pollutants are able to decrease the success rate of IVF techniques. These results are derived from animal and human epidemiological data, even if some limitations of the available literature should be acknowledged; in fact, evidences of the biological mechanisms are still limited, and the reliability of information on personal exposures is sometimes scarce. Future toxicological and clinical studies are mandatory to confirm previously hypothesized associations and to clarify the involved mechanism. If possible, they should be also useful in identifying which subgroups of subjects are most prone to air pollution exposure in order to implement public health strategies and preventive efforts against the dangerous effects of air pollution.

Air Pollution Effects in Pregnancy

Greater diffusion of industries and vehicular traffic caused a major impairment of air quality especially in urban areas.

Testosterone undecanoate and testosterone enanthate injections are both effective and safe in transmen over 5 years of administration

To retrospectively evaluate and compare safety and efficacy of short and long‐acting testosterone (T) parenteral formulations over 5 years in transmen.

Problematiche endocrine della disforia di genere

SommarioIl ruolo dell’endocrinologo nel percorso di transizione del soggetto con disforia di genere (DG) è fondamentale, in relazione alla necessità emergente di coniugare le indicazioni degli standard d’intervento con l’opportunità di effettuare terapie sempre più individualizzate. Questi nuovi scenari richiedono risposte efficaci sul piano della salute generale e dell’effetto fenotipico richiesto. All’insegna di queste considerazioni è doveroso valutare gli aspetti salienti dei trattamenti ormonali nelle due sottopopolazioni di soggetti con DG che necessitino di tale trattamento.