Aim and Objective: To analyze the menopause-related symptoms and its impact on quality of life in post-menopausal women from urban and rural area. Materials and Methods: A cross-sectional 1-year study was carried among women of urban (n = 490) and rural (n = 380) areas, attending the outpatient department in the urban area and a house-to-house survey in rural areas, by interviews with the help of a pretested semi-structured standard questionnaire. For assessment of the menopausal symptoms menopause rating scale (MRS) and for quality of life, World Health Organization Quality of Life Scale (WHO QOL-BREF) questionnaire was used. Results: There was a significant difference between the MRS total scores of the urban (14.67 ± 6.64) and rural (16.08 ± 7.65) group. The somatic, psychological, and urogenital symptoms were high in rural women than in urban women. The results were not significant for urogenital subscale. The mean raw scores of physical health, psychological, social relationships, and environmental domains was more in urban than in rural women. The mean transformed scores (4-20) of physical health, psychological, social relationships, and environmental domains was more in urban than in rural women. The mean transformed scores (0-100) including the physical health, psychological, social relationships, and environmental domains was more in urban than in rural women. The result was not significant for physical health. Conclusion: The high proportions and the scores of MRS were observed in both rural and the urban women. The severity of symptoms was found more distressing for rural women. The quality of life in urban society was average and better than in rural women.

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Uterine smooth muscle tumors and endometrial stromal tumors (ESTs) are the two major types of mesenchymal tumors of the uterus, the latter being fairly uncommon. Among these, endometrial stromal sarcoma (ESS) accounts for 0.2-1.5% of all uterine malignancies. Although routine histopathological examination is sufficient to distinguish between ESS and smooth muscle tumors in most of the cases, the distinction between ESTs and highly cellular leiomyomas (CMs), on several occasions becomes a great diagnostic challenge for the pathologist. The differentiation between EST and CM is necessary on account of the variable clinical course and slight variation in the therapy. However, this is difficult due to the tendency of endometrial stromal cells to differentiate into well-developed smooth muscle cells as well as overlapping immunohistochemical profile in some cases. We hereby report a series of cases which posed a diagnostic challenge to us as to whether they are CMs or ESTs. We therefore discuss the histological features which helped us resolve this dilemma as well as the utility of immunohistochemistry (IHC) as a diagnostic aid in arriving at a final diagnosis in such problematic cases.

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Sertoli-leydig cell tumors are the uncommon sex-cord stromal tumors of the ovary. We report a case of 42-year-old female with retiform variant of sertoli-leydig cell tumour. She presented with the complaint of mass in abdomen for 7 years. Ultrasound revealed bilateral ovarian mass suggestive of malignancy. Bilateral salpingo-oopherectomy with surgical staging was done. The tumor was diagnosed as stage I retiform variant of sertoli-leydig cell tumor on histopathology and immunohistochemistry.

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Peritoneal inclusion cysts are uncommon abdominopelvic cysts seen in perimenopausal women. It is often misdiagnosed clinically as an ovarian tumor due to similar presentation and mimicking findings on radiology. We describe a perimenopausal woman presenting with pelvic mass. Her clinical finding on radiology suggested an ovarian tumor; however, biopsy revealed it as peritoneal inclusion cysts. We discuss the possible ways to avoid such mistakes.

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Objective: To evaluate safety and efficacy of gabapentin in management of psychosexual symptoms in postmenopausal women. Materials and Methods: Fifty symptomatic postmenopausal females were randomly allocated into two groups; Group I received gabapentin 900 mg/day along with calcium 500 mg and Group II was given only calcium for 6 months and followed-up at 1,3, and 6 months. Data was analyzed in terms of percentage reduction of psychosomatic and sexual symptoms. Change in lipid profile and other blood parameters by the end of study were measured. Results: Maximum improvement was seen in insomnia (90-98%) in gabapentin group. Improvement in anxiety was noted by 40.5, 49.5, and 53.8% at 1, 3, and 6 months, respectively, in Group I. While in Group II, maximum improvement noted was 18.6, 19.7, and 20% at 1, 3, and 6 months, respectively. Similarly for depression, improvement was 40.4,47, and 49.5%at 1, 3, and 6 months, respectively, in Group I; while it was 15.4, 16.6, and 17% at 1, 3, and 6 months, respectively, in Group II. No significant improvement in vaginal dryness and dyspareunia noted at all follow-ups in either group. Somatic symptoms reduced by 33, 36.8, and 40% at 1, 3, and 6 months, respectively, in Group I compared to 18% improvement at all follow-up in Group II. Low density lipoprotein (LDL) was raised in Group I significantly more than Group II. Other blood parameters were comparable in both groups. Conclusion: Gabapentin can lead to improvement in postmenopausal psychosomatic symptoms, while sexual symptoms show no improvement. Gabapentin can lead to increase in serum LDL, hence, precaution should be taken in patients with deranged lipid profile before starting therapy and it should be monitored during course of therapy. This drug can cause minor side effects like somnolence and dizziness.

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Aims: To asses self-reported sleep disturbance and its associated factors in 50-60-year-old Menopause women. Settings and Design: This cross sectional study included 700 healthy 50-60-year-old women volunteers who were postmenopausal for at least 1 year. The volunteers were interviewed after providing informed consent. The study questioner included two main aspects: Personal characteristics and the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by using SPSS 14 software. Results: The mean sleep scale score was 7.84 ± 4.4. Significant correlations had seen between sleep disturbance and characteristics of occupational status, educational status, husband's occupational status, and economical status, and (P = 0.002). There were no significant correlation between sleep disturbance and other personal characteristics, such as age; partner's age; number of children; family size; consumption of tea, coffee, or cola. Conclusions: Sleep disturbance is common in menopausal women. Taking into account the sleep-related personal characteristics, suitable interventions should be taken to improve sleep quality, which is a very important for maintaining the quality of life.

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Introduction: To study the efficacy of levonorgestrel intrauterine system (LNG-IUS; Mirena) in conservative management of abnormal uterine bleeding (AUB). Materials and Methods: Seventy women between 30 and 55 years with AUB were included in a study conducted over a period of 3 years. Response was assessed monthly for first 4 months and then yearly for maximum 2 years. Results: Mirena caused a 80% decrease in median menstrual blood loss (MBL) at 4 months, 95% decrease in MBL by 1 year, and 100% decrease (amenorrhea) by 2 years. Mean hemoglobin (Hb) % showed a significant rise of 7.8% from baseline 4 months post Mirena insertion. Mirena acted as an effective contraceptive in women not using any other form of contraception. Hysterectomy could be avoided in most of the women. Conclusion: Mirena provides an incredible nonsurgical alternative in treatment of menorrhagia. Its effects are reversible and it is an excellent fertility-sparing device. It is also an effective contraceptive.

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Introduction: Atherosclerosis leading to ischemic heart disease (IHD) is the most common cause of cardiac deaths worldwide. To evaluate the prevalence of atherosclerosis, an autopsy-based study conducted on subjects who died of noncardiac causes can be a valuable tool. With this hypothesis, we conducted this study on the hearts of subjects who died of noncardiac causes. Materials and Methods: This study was conducted from August 2012 to February 2013 at Department of Pathology, BJ Medical College, Ahmedabad, Gujarat. The deceased patients who died of noncardiac causes and underwent autopsy at our hospital, their hearts were sent to our department for histopathological analysis. The hearts were fixed in 10% formalin, weighed, measured, and the three main coronary arteries were dissected out and carefully examined for any histological evidence of atherosclerotic plaques and associated pathological lesions and graded according to the classification given by American Heart Association. Results: A total of 250 autopsy cases were evaluated. Amongst them 113 were deaths due to noncardiac causes, of which 83 (73.45%) subjects had evidence of atherosclerosis. In the study, 68 (82%) were males and 15 (18%) were females. Left anterior descending artery (LADA; 69%) was the most commonly involved coronary artery. Triple vessel disease was found in 22% of subjects. Conclusion: The study showed alarmingly high prevalence of atherosclerosis. The pathogenesis of coronary atherosclerosis begins at a younger age in Indian population. Though the incidence of atherosclerosis is more common in males compared to females; coronary atherosclerosis is an important risk factor for IHDs in both sexes and screening for the same should begin at an early age.

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