Prasong Tanmahasamut

Postoperative levonorgestrel-releasing intrauterine system for pelvic endometriosis-related pain: a randomized controlled trial.

OBJECTIVES: To estimate the effectiveness of a postoperative levonorgestrel-releasing intrauterine system for relieving pelvic pain in patients with endometriosis. METHODS: A double-blind randomized controlled trial was conducted in 55 patients with endometriosis and moderate-to-severe dysmenorrhea (visual analog scale, greater than 50 mm) undergoing laparoscopic conservative surgery. After surgery, patients were randomized to a levonorgestrel-releasing intrauterine system (n=28) or expectant management (n=27) group. Primary outcome was the change of dysmenorrhea visual analog scale. Secondary outcomes included changes of pelvic pain and dyspareunia visual analog scale, Short Form-36 score, and adverse effects. RESULTS: The two groups were comparable in age, body mass index, parity, and baseline pain scores. At 12 months, the levonorgestrel-releasing intrauterine system group had a significantly lower median value of dysmenorrhea and noncyclic pelvic pain score. Compared with the control group, the levonorgestrel-releasing intrauterine system group had greater reduction in dysmenorrhea visual analog scale (−81.0 compared with −50.0 mm, P=.006) and pelvic pain visual analog scale (−48.5 compared with −22.0 mm, P=.038) but a comparable reduction in dyspareunia visual analog scale (−15.0 compared with −19.0 mm, P=.831). Two patients in levonorgestrel-releasing intrauterine system group (7.4%) and nine in the expectant management group (39.1%) had recurrent dysmenorrhea within 1 year postoperatively (P=.014). Number-needed-to-treat to prevent one case with recurrent dysmenorrhea within the first year was three cases. The Short Form-36 scores improved in the levonorgestrel-releasing intrauterine system group but did not change in the expectant management group. There was no serious adverse event during the study period. CONCLUSION: The levonorgestrel-releasing intrauterine system is effective and well accepted for long-term therapy after conservative surgery for patients with moderate to severe pain related to endometriosis. It can improve the patients quality of life, including physical and mental health. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00455845. LEVEL OF EVIDENCE: I

Predictors for metabolic syndrome in perimenopausal and postmenopausal Thai women

Objective To determine the prevalence and predictors of metabolic syndrome in perimenopausal and postmenopausal Thai women. Materials and Methods The cross-sectional study was carried out in the Siriraj Menopause Clinic, Faculty of Medicine Siriraj Hospital, Mahidol University, a tertiary-care university hospital, from May 2006 to August 2009. Metabolic syndrome was diagnosed using the International Diabetes Federation (IDF) criteria for an Asian population, the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria with Asian waist circumference, and the NCEP-ATP III with body mass index cut-off value. The outcome measures were the prevalence and predictors of metabolic syndrome in perimenopausal and postmenopausal Thai women. Results There were 971 women classified into perimenopausal (n == 331), naturally postmenopausal (n == 442) and surgically postmenopausal (n == 198) groups. The overall prevalences (95%% confidence interval, CI) of metabolic syndrome were 16.0%% (15.1–24.3%%), 15.9%% (13.6–18.2%%), and 14.9%% (14.0–19.8%%) by IDF criteria, modified NCEP-ATP III criteria with Asian waist circumference, and with body mass index cut-off value, respectively. Focusing on the NCEP-ATP III criteria with Asian waist circumference, the prevalence was the highest in the surgically postmenopausal group (19.7%%, 95%% CI 15.1–24.3%%) followed by the perimenopausal (12.4%%, 95%% CI 9.4–15.4%%) and naturally postmenopausal (16.9%%, 95%% CI 14.0–19.8%%) groups, but without statistical significance. The prevalence increased with age, body mass index and family history of cardiovascular disease. Conclusion The overall prevalence of metabolic syndrome in perimenopausal and postmenopausal Thai women is 14.9–16.0%%, depending on diagnostic criteria, and its significant predictors include age, body mass index, and family history of cardiovascular disease.

The Usefulness of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) for Detection of Glucose Intolerance in Thai Women of Reproductive Age with Polycystic Ovary Syndrome

Objectives. To study the cut-off point of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) as a screening test for detection of glucose intolerance in Thai women with polycystic ovary syndrome (PCOS). Study Design. Cross-sectional study. Setting. Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. Subject. Two hundred and fifty Thai PCOS women who attended the Gynecologic Endocrinology Unit, during May 2007 to January 2009. Materials and Methods. The paitents were interviewed and examined for weight, height, waist circumference, and blood pressure. Venous blood samples were drawn twice, one at 12-hour fasting and the other at 2 hours after glucose loading. Results. The prevalence of glucose intolerance in Thai PCOS women was 20.0%. The mean of HOMA-IR was 3.53  ±  7.7. Area under an ROC curve for HOMA-IR for detecting glucose intolerance was 0.82. Using the cut-off value of HOMA-IR >2.0, there was sensitivity at 84.0%, specificity at 61.0%, positive predictive value at 35.0%, negative predictive value at 93.8%, and accuracy at 65.6%. Conclusion. HOMA-IR >2.0 was used for screening test for glucose intolerance in Thai PCOS women. If the result was positive, a specific test should be done to prove the diagnosis.

Clinical and pathological responses of progestin therapy for non‐atypical endometrial hyperplasia: A prospective study

Aims: To evaluate the clinical and pathological responses and factors predicting non‐responders to various progestins currently prescribed for the treatment of non‐atypical endometrial hyperplasia.

Causes of primary amenorrhea: A report of 295 cases in Thailand

Aims:  The aim of this study was to determine the prevalence of etiologic causes of primary amenorrhea in Thailand.

Prevalence and clinical predictors of insulin resistance in reproductive-aged thai women with polycystic ovary syndrome.

Objectives. To determine the prevalence of insulin resistance (IR) and its predictors in reproductive-aged Thai women with polycystic ovary syndrome (PCOS). Methods. A cross-sectional study was conducted from May 2007 to January 2009. Participants were 250 Thai women with PCOS. Information regarding medical history and physical examination and results of 75 gram OGTT were recorded. Results. The overall prevalence of IR was 20.0%, comprising the prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetic mellitus of 3.2%, 13.6%, and 5.6%, respectively. Multiple logistic regression analysis showed that the independent predictors for IR were age of ≥30 years old, waist circumference (WC) of ≥80 cm, presence of acanthosis nigricans (AN), and dyslipidemia with odds ratios (95% confidence interval) of 2.14 (1.01–4.52), 3.53 (1.28–9.75), 2.63 (1.17–5.88), and 3.07 (1.16–8.11), respectively. Conclusion. The overall prevalence of IR in reproductive-aged Thai women with PCOS is 20.0%. Age ≥30 years old, WC ≥80 cm, the presence of AN, and dyslipidemia are the significant clinical predictors.

Cimicifuga racemosa extract for relieving menopausal symptoms: a randomized controlled trial

Abstract Objectives To evaluate the effectiveness of black cohosh extract 40 mg/day for relieving moderate to severe menopausal symptoms and improving quality of life in Thai women. Methods A randomized, double-blind, placebo-controlled clinical trial was conducted in a menopause clinic of a tertiary-care university hospital during 2011–2013. Participants were peri- or postmenopausal Thai women aged at least 40 years, who have moderate to severe menopausal symptoms evaluated using the Kupperman index (KI). Outcome measures included KI, frequency of hot flushes, Menopause-Specific Quality of Life (MENQOL) score, participants’ global satisfaction and safety outcomes. Results There were 54 participants assigned to treatment (black cohosh extract 40 mg/day, n = 27) or placebo group (n = 27). Both the treatment and placebo groups had comparable baseline KI scores (33.9 ± 7.9 vs. 31.3 ± 6.8), frequency of hot flushes (3.1 ± 2.0 vs. 2.8 ± 2.1), and MENQOL scores, all of which improved with time. Neither the improvements nor the global satisfaction were significantly different between the two groups; but the proportion of participants with moderate to severe symptoms seemed to be lower in the treatment group than in the placebo group (40% vs. 60%, p = 0.174). There was no serious adverse event or significant change in liver function tests. Conclusions A black cohosh extract of 40 mg/day is not superior to a placebo for relieving moderate to severe menopausal symptoms or improving quality-of-life scores in Thai women.

Challenging Regimen for Long-Term Conservative Treatment of Endometrial Adenocarcinoma in Young Women: A Case Report and Review of the Literature

A 20-year-old obese Thai woman with polycystic ovary syndrome and clinical stage I well-differentiated endometrial carcinoma denied surgical staging. Chest X-ray and magnetic resonance imaging of the whole abdomen suggested neither distance metastasis nor local invasion of the cancer. After 3 months of systemic progestin therapy with megestrol acetate (MA) 480 mg/day, the endometrial carcinoma persisted. The treatment was changed to a combination of levonorgestrel intrauterine system (LNG-IUS) and MA with a stepping-up from 160 to 480 mg/day. Complete remission was achieved at treatment month 9. Prevention of recurrence was provided using LNG-IUS plus MA 160 mg/day. Endometrial surveillance using trimonthly transvaginal ultrasonography and endometrial biopsy suggested no recurrence for at least 24 months after remission.

Validation of osteoporosis risk assessment tools in middle-aged Thai women.

Abstract Objectives: To validate osteoporosis risk assessment tools in middle-aged Thai women. Methods: A total of 1038 women who had bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry were reviewed. Clinical data were used to validate the diagnostic test performance of various osteoporosis risk assessment tools, including ABONE, FRAX®, ORAI, OSIRIS, SCORE, SOFSURF, and OSTA. The following parameters were evaluated: sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy; those with 95% confidence interval (CI) of the receiver operator characteristics area under the curve (ROC-AUC) > 0.5 were considered statistically significant. Results: The subjects had a mean age of 53.01 ± 6.20 years and body mass index (BMI) of 23.98 ± 3.38 kg/m2. Among the osteoporosis risk assessment tools being evaluated, the tools that had ROC-AUC >0.8 and 95% CI >0.5, and could predict osteoporosis at the femoral neck with high specificity of >75% and NPV of >90%, were FRAX® without BMD (ROC-AUC 0.83; 95% CI 0.73–0.93; specificity 99.90; NPV 98.89), SCORE (ROC-AUC 0.86; 95% CI 0.78–0.94; specificity 98.79; NPV 98.99), and OSTA (ROC-AUC 0.86; 95% CI 0.79–0.94; specificity 75.03; NPV 99.73). Conclusion: The prevalence of osteoporosis in the middle-aged Thai women attending Siriraj Menopause Clinic is 7.3% at the lumbar spine and/or femoral neck. FRAX® without BMD, SCORE, and OSTA have appropriate validity as tools for ruling out osteoporosis in these women.

Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial

Abstract Objective: To determine the effectiveness of desogestrel for relieving endometriosis-related pain. Methods: A double-blinded randomized placebo-controlled trial was conducted in 40 patients who had endometriosis with moderate-to-severe dysmenorrhea or chronic pelvic pain undergoing laparoscopic conservative surgery. After surgery, patients were randomized to desogestrel or placebo group. Outcomes included changes in visual analog scale (VAS) of dysmenorrhea, pelvic pain and dyspareunia, patient satisfaction, and adverse effects. Results: Forty patients were randomized to desogestrel group (n = 20) and placebo group (n = 20). At month 6, the desogestrel group had significantly lower median VAS of overall pelvic pain, dysmenorrhea and noncyclic pelvic pain. Comparing with the placebo group, the desogestrel group had greater reduction in VAS of overall pain, dysmenorrhea and pelvic pain, but comparable reduction in VAS of dyspareunia. No patient in the desogestrel group but 4 patients in the placebo group still had moderate-to-severe pelvic pain at 6 months postoperatively. The proportion of patients who rated the treatment as very satisfied was higher in the desogestrel group than in the placebo group. There was no serious adverse event during the study period. Conclusions: Desogestrel is effective and acceptable for postoperative therapy for patients with moderate-to-severe pain related to endometriosis.