Suchada Indhavivadhana

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

Effectiveness of intrauterine anesthesia for pain relief during fractional curettage.

Objective: To study the effectiveness of intrauterine anesthesia for pain relief during fractional curettage. Methods: A double-blinded, randomized, placebo-controlled trial was conducted in 66 patients with abnormal uterine bleeding undergoing fractional curettage under paracervical block, using 10-mL 1% lidocaine plus intrauterine 5-mL 2% lidocaine (n = 33) or saline (n = 33). The primary outcome was the maximum pain score measured with a 10-cm visual analog scale. Other outcomes measured included pain profile, number of patients with pain score more than 4, each patients global satisfaction index, adverse events, and serum lidocaine profile. Results: The 2 groups were comparable in age, body mass index, education, socioeconomic status, menopausal status, and parity. Compared with the saline group, the lidocaine group had a significantly lower median value for the maximum pain score (2.3 versus 4.7, P = .022) and fewer patients with a pain score more than 4 (33.3% versus 60.6%, P = .026). The pain scores were lower at the endocervical curettage and the uterine curettage steps. There was no difference between the 2 groups in other outcomes. The number needed to treat to prevent a case with a pain score more than 4 was 3.7 (95% confidence interval 2.4–38.5). Conclusion: The addition of intrauterine anesthesia to paracervical block can further reduce pain during fractional curettage without increasing adverse effects. 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.

Measures of body adiposity and visceral adiposity index as predictors of metabolic syndrome among Thai women with PCOS

Abstract Aim: To evaluate the relationship between measures of body adiposity and visceral adiposity index (VAI) and risk of metabolic syndrome (MS) and to identify the optimal cut-off points of each measurement in Thai polycystic ovary syndrome (PCOS). Methods: A cross-sectional study was completed physical examination, fasting plasma glucose, lipid profiles of 399 PCOS and 42 age-matched normal controls. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and VAI were calculated. Associations between different measures and MS were evaluated and the receiver-operating characteristic (ROC) curve was performed to determine appropriate cut-off points for identifying MS. Results: Percentage of MS in PCOS was 24.6%, whereas none MS in controls. Previously recommended cut-off values for body adiposity and VAI were significantly associated with MS. ROC curve analysis of the only PCOS showed newly obtained optimal cut-off points for BMI and VAI of ≥28 kg/m2 (AUC = 0.90) and >5.6 (AUC = 0.94), respectively. Values found to be more accurate than the original ones. VAI was the best predictor, followed by BMI and WHtR. Conclusion: All body adiposity and VAI parameters can predict the risk of MS. Optimal values for Thai PCOS were ≥28 kg/m2 for BMI, ≥0.85 for WHR, ≥0.5 for WHtR and >5.6 for VAI.

Correlation of clinical and biochemical hyperandrogenism in Thai women with polycystic ovary syndrome

The aim of this study was to determine the correlation of clinical hyperandrogenism and biochemical hyperandrogenism (hyperandrogenemia) in Thai women with polycystic ovary syndrome (PCOS).

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.