O. Muneyyirci-Delale

Adverse effects of phytoestrogens on reproductive health: a report of three cases.

BACKGROUND Phytoestrogens have been thought to have favorable effects on womens health and perhaps in offsetting cancers. The possible adverse effects of phytoestrogens have not been evaluated. CASES Abnormal uterine bleeding with endometrial pathology in three women was found to be related to a high intake of soy products. The first woman had postmenopausal bleeding with uterine polyp, proliferative endometrium and a growing leiomyoma. The second woman presented with severe dysmenorrhea, abnormal uterine bleeding, endometriosis and uterine leiomyoma not responding to treatment. The third woman with severe dysmenorrhea, abnormal uterine bleeding, endometriosis and uterine leiomyomata presented with secondary infertility. All three women improved after withdrawal of soy from their diet. CONCLUSION Additional information on phytoestrogens is necessary to ascertain their safety before they can be routinely used as supplements.

Role of 11βHSD Type 2 Enzyme Activity in Essential Hypertension and Children with Chronic Kidney Disease (CKD)

BACKGROUND The mineralocorticoid receptor is protected from excess of glucocorticoids by conversion of active cortisol to inactive cortisone by enzyme 11β-hydroxysteroid dehydrogenase type 2 present in the kidney. The metabolites of cortisol and cortisone are excreted in the urine as tetrahydrocortisol (5αTHF+5βTHF) and tetrahydrocortisone (THE), respectively. HYPOTHESIS Patients with chronic kidney disease (CKD) and essential hypertension have a functional defect in their ability to convert cortisol to cortisone, thus leading to the activation of mineralocorticoid receptor. OBJECTIVE The objective of the investigation was to study the ratio of urinary steroids (5αTHF+5βTHF) to THE in patients with CKD, postrenal transplant, and essential hypertension and to compare the ratio with controls. DESIGN/METHODS We enrolled 44 patients (17 with CKD, eight postrenal transplant, 19 with essential hypertension) and 12 controls. We measured spot urinary 5α-THF, 5β-THF, THE, free active cortisol and inactive cortisone by gas chromatography/mass spectrometry. We collected data on age, sex, cause of kidney disease, height, weight, body mass index, blood pressure, serum electrolytes, aldosterone, and plasma renin activity. Blood pressure percentiles and z-scores were calculated. The glomerular filtration rate was calculated using the modified Schwartz formula. RESULTS The ratios of 5αTHF+5βTHF to THE were significantly higher in patients with CKD [mean±sd score (SDS)=1.31±1.07] as compared with essential hypertension (mean±SDS=0.59±0.23; P=0.02) and controls (mean±SDS=0.52±0.25; P=0.01). In the postrenal transplant group, the ratio was not significantly different (mean±SDS=0.71±0.55). The urinary free cortisol to free cortisone ratios were significantly higher in the hypertension and CKD groups as compared with the controls. The 5αTHF+5βTHF to THE ratio negatively correlated with the glomerular filtration rate and positively correlated with systolic and diastolic blood pressure z-scores. The correlation of the blood pressure z-scores with ratios was stronger in the CKD group than the essential hypertension and posttransplant groups. CONCLUSIONS We have elucidated a functional deficiency of 11β-hydroxysteroid dehydrogenase type 2 in children with CKD and a subset of essential hypertension. Urinary 5α-THF, 5β-THF, and THE analysis by gas chromatography/mass spectrometry should be a part of routine work-up of CKD and hypertensive patients.

Norethindrone Acetate in the Medical Management of Adenomyosis

The role of norethindrone acetate (NA) in the management of adenomyosis was evaluated with a retrospective chart review of 28 premenopausal women between 27–49 years of age presenting with moderate to severe pelvic pain and bleeding. Bleeding and dysmenorrhea scores were analyzed using paired T-tests. There was significant improvement of both dysmenorrhea and bleeding after treatment. Age showed no correlation with dysmenorrhea or bleeding. Low dose NA could be considered an effective, well-tolerated and inexpensive medical alternative to surgery for treating symptomatic adenomyosis. Large multicentric studies may help validate our findings.

Serum free fatty acid levels in PCOS patients treated with glucophage, magnesium oxide and spironolactone

Abstract To assess the effect of glucophage, magnesium oxide and spironolactone in altering free fatty acids (FFAs), 36 PCOS women were randomly divided into three groups. Group 1 (n = 14) was treated with 500 mg glucophage po bid, group 2 (n = 10) was treated with 400 mg magnesium oxide po bid and group 3 (n = 12) was treated with 50 mg spironolactone po bid for 12 weeks. A glucose tolerance test with 75 g glucose load was performed before and after treatment, collecting blood at 0, 1 and 2 h for insulin, glucose, FFA and aldosterone. Amount of FFA before and after treatment were compared by repeated measure ANOVA and represented as area under the curve. FFA levels before treatment were 0.83 ± 0.23, 0.77 ± 0.15 and 0.85 ± 0.28 and after treatment were 0.77 ± 0.48, 0.71 ± 0.18 and 0.66 ± 0.25 for glucophage, magnesium oxide and spironolactone-treated patients, respectively. The FFA levels were unchanged in the groups treated with glucophage and magnesium oxide but were significantly (p < 0.03) decreased in the group treated with spironolactone. Since FFAs are known to be involved in the development of insulin resistance, these results suggest that spironolactone may be useful for lowering insulin resistance in PCOS patients.

Vaginismus and failed in vitro fertilization

Abstract The new reproductive technologies have allowed many couples battling infertility to achieve a viable pregnancy. There are couples, however, with serious treatable sexual difficulties, such as vaginismus, who may use these expensive technologies to bypass normal intercourse and conceive without ever consummating the sexual relationship. A couple with 11 years of unconsummated marriage came to our clinic after two unsuccessful inseminations and two failed In Vitro Fertilization (IVF) cycles performed at another center. After reviewing the history and careful physical examination, the patient was diagnosed with vaginismus. She was referred to sex therapy, where after eight sessions she was able to achieve penetration and enjoy a satisfactory sexual life with her husband. After resolution of vaginismus she became pregnant without further painful and costly interventions. The purpose of this case review is to suggest greater collaboration between sex therapists, gynecologists and primary care practitioners to increase the chance of procreation without invasive infertility treatment, and to insure a better sexual life and easier pregnancy.

The association between primary dysmenorrhea and hyperemesis gravidarum

Primary dysmenorrhea (PD) and hyperemesis gravidarum (HG) are two diseases that the overall etiologies are both unknown. There are several contributing factors that lead to both PD and HG. We chose to focus on an increase in prostaglandin and hormone levels due to an observation of several patients with HG that reported PD after menarche. After review of several studies, we hypothesize that there is a positive correlation between PD and HG. Further, larger studies will be needed to make a more accurate assessment in the connection of patients with PD being more prone to HG in their first pregnancy as well as subsequent pregnancies.

Vascular compliance in women with polycystic ovary syndrome treated with spironolactone

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age in the United States and has been associated with several diseases including cardiovascular disease, obesity, and glucose intolerance. In this study, systolic blood pressure, diastolic blood pressure, pulse pressure (vascular compliance), large artery elasticity, systemic vascular resistance (SVR), total vascular impedance (TVI), and body mass index (BMI) were measured before and after treatment with spironolactone in 10 women with PCOS. Systolic BP, diastolic BP, and BMI were similar prior to treatment and after treatment. Pulse pressure decreased slightly post‐treatment compared to pretreatment but not to significance (P = 0.07). The results show that after treatment with spironolactone, there was a statistically significant increase in large artery elasticity (P = 0.047), while there was a statistically significant decrease in SVR and TVI (P = 0.0005 and P = 0.03). This study indicates that treatment with spironolactone improves large artery elasticity and reduces systemic vascular resistance without any change in small artery elasticity.

Long-term hormonal treatment for recurrent catamenial pneumothorax

Catamenial pneumothorax is a rare complication of endometriosis. Although fatal, no long-term therapies have been revealed to be efficacious in preventing this disorder. This report discusses two cases of catamenial pneumothorax managed with norethindrone acetate over an extended period of time. The patients responded well without recurrence of pneumothorax during treatment. While current therapies are generally used for a six month to one year period, we present a long-term, highly efficacious, and inexpensive treatment for catamenial pneumothorax in patients with endometriosis.