Journal of Mid-life Health Journal of Mid-life Health
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  Citation statistics : Table of Contents
   2013| January-March  | Volume 4 | Issue 1  
    Online since March 28, 2013

 
 
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ORIGINAL ARTICLES
Effect of mifepristone (25 mg) in treatment of uterine myoma in perimenopausal woman
Shikha Seth, Neeru Goel, Ekta Singh, AS Mathur, Garima Gupta
January-March 2013, 4(1):22-26
DOI:10.4103/0976-7800.109630  PMID:23833529
Objectives: To evaluate the effect of Mifepristone (25 mg) on symptomatic myoma in perimenopausal women. Study Design: Open label clinical trial. Materials and Methods: Ninety three perimenopausal women of age 35-50 years having symptomatic myoma were selected from Gynecology OPD and given 25 mg Mifepristone once daily continuously for three months. Variables as; baseline uterine size, uterine volume, myoma size, volume, their number, position, characteristics, hemoglobin and blood parameters, were taken and followed monthly for six months. Bleeding and pain scores were checked on monthly visits. Changes in above parameters were tabulated during the first three months treatment phase and then next three post-treatment phase for analysis. Statistical Analysis: Was done by calculating mean, standard deviation, standard error and percentage distribution of variables. Results: Menorrhagia was the most common symptom which led patients to report to hospital. Mean uterine volume reduced to 63.69% of baseline, Mean dominant Myoma volume reduced to 53.62% and hemoglobin level raised to 137% after complete three months of treatment. Changes persisted in next three months post-treatment follow-up, while hysterectomy was required in 10 (12.2%) cases. Conclusion: Three months treatment of 25 mg Mifepristone effectively controls bleeding, reduces the uterine and myoma volume and thus can avoid blood transfusion and hysterectomy in a lot of symptomatic myoma cases.
  6 5,591 579
REVIEW ARTICLES
Evaluation of endometrium in peri-menopausal abnormal uterine bleeding
Parul Kotdawala, Sonal Kotdawala, Nidhi Nagar
January-March 2013, 4(1):16-21
DOI:10.4103/0976-7800.109628  PMID:23833528
Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, office vacuum aspiration (Pipelle) and the use of office hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of finding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-ΰ-vis each other. Histological assessment is the final word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Ca. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. A single-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the office hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.
  5 15,524 1,236
LETTERS TO EDITOR
Trends of AUB in tertiary centre of Shimla hills
Alok Sharma, Yogita Dogra
January-March 2013, 4(1):67-68
DOI:10.4103/0976-7800.109648  PMID:23833543
  4 2,114 271
ORIGINAL ARTICLES
Histopathological correlation of adenomyosis and leiomyoma in hysterectomy specimens as the cause of abnormal uterine bleeding in women in different age groups in the Kumaon region: A retroprospective study
Ghazala Rizvi, Harishankar Pandey, Hema Pant, Sanjay Singh Chufal, Prabhat Pant
January-March 2013, 4(1):27-30
DOI:10.4103/0976-7800.109631  PMID:23833530
Objective : To study adenomyosis and leiomyoma as the cause of Abnormal Uterine Bleeding AUB in hysterectomy specimens. Study Method: A descriptive study was carried out on 184 hysterectomy specimens of patients with AUB during the period of Jan 2010 to Dec 2011. Data including age, parity, symptoms and clinical indication for hysterectomy was collected for the study. The specimens were processed routinely and stained with hematoxylin and eosin stain and examined microscopically. Results: Women in the perimenopausal age (40-50 years) accounted for the highest number of cases (44.56%) presenting with symptoms of AUB. In this age group adenomyosis was the found to be the commonest cause of AUB (46.34%). Conclusion: Adenomyosis was found to be the most common cause of abnormal uterine bleeding in women of perimenopausal age group.
  3 4,073 575
SURGEONíS CORNER
Laparoendoscopic single-site surgery in gynecology: LESS is actually how much less?
Priya Bhave Chittawar, Navneet Magon, Shilpa Bhandari
January-March 2013, 4(1):46-51
DOI:10.4103/0976-7800.109638  PMID:23833535
Gynecological surgery is evolving continuously. Laparoendoscopic single-site surgery (LESS) is the recent addition in this field that stands to benefit almost 40% of women in midlife who will eventually undergo adnexal surgery or hysterectomy. Carried out through a single umbilical incision, the potential benefit of single site surgery is improvement in operative morbidity and cosmesis. The safety, feasibility and efficacy of laparoendoscopic single site procedures have been established in studies over the last few years. In this article, we will review the nomenclature, instruments, and the evidence around the commonly performed gynecologic surgeries using the LESS procedure.
  2 3,374 307
VIEW POINTS
The hysterectomy story in the United Kingdom
Neela Mukhopadhaya, IT Manyonda
January-March 2013, 4(1):40-41
DOI:10.4103/0976-7800.109635  PMID:23833533
Gynaecologists in India should be deeply concerned by the message broadcast on the BBC by Jill McGivering (6 th February 2013) in which she suggested that hysterectomy is abused in India, with the overwhelming number of women being subjected to the operation unnecessarily. Their counterparts in the UK should be no more complacent because although the hysterectomy rates have fallen over the years, yet there is widely and wildly varying rates between regions, hospitals and individual gynaecologists. Until research can be undertaken to establish what the true rates of hysterectomy should be, clear simple guidelines could go a long way to ensuring that women are not subjected to an operation they do not need, while those who would benefit are not denied an intervention that can improve their quality of life.
  2 2,826 331
LETTERS TO EDITOR
Health and Islam
Salman Assad, Asfandyar Khan Niazi, Shuja Assad
January-March 2013, 4(1):65-65
DOI:10.4103/0976-7800.109645  PMID:23833541
  1 3,097 539
CASE REPORTS
True Mirena failure: Twin pregnancy with Mirena in situ
Jyoti Kumari, Sonia Malik, Meenakshi Dua
January-March 2013, 4(1):54-56
DOI:10.4103/0976-7800.109640  PMID:23833537
Mirena levonorgestrel intrauterine system (LNG-IUS) is a very reliable method of contraception with the failure rate comparable to sterilization. We present a case of failure of the Mirena intrauterine device in situ in a woman with twin gestational sac with positive Beta Human Chorionic Gonadotropin (β HCG) within 2 years of insertion. Although LNG-IUS is one of the most effective methods of contraception, the risks of failure should always be kept in mind and the women be appropriately counseled before its use.
  - 4,377 376
Hysteroscopic diagnosis and successful management of an acquired uterine arteriovenous malformation by percutaneous embolotherapy
Priya B Chittawar, Kailash Patel, Pallavi Agrawal, Shilpa Bhandari
January-March 2013, 4(1):57-59
DOI:10.4103/0976-7800.109641  PMID:23833538
Arteriovenous malformations are a rare but important cause of abnormal uterine bleeding in the midlife. Acquired uterine arteriovenous malformations are being increasingly diagnosed by transvaginal ultrasound, color Doppler and magnetic resonance angiography. We present a case where the suspected diagnosis was placental polyp or retained products of conception and hysteroscopy showed typical findings of uterine arteriovenous malformation, which was later, confirmed by magnetic resonance angiography. The patient underwent arterial embolization and recovered satisfactorily with resolution of hemorrhage and resumption of normal menstrual cycles. Abnormal bleeding due to arteriovenous malformations is worsened by curettage and hence its recognition is important in the management of abnormal uterine bleeding in the midlife.
  - 5,938 338
Uterine granuloma involving the myometrium: Two case reports
Navneet Takkar, Pragya Goel, Irneet Kaur, Alka Sehgal
January-March 2013, 4(1):60-62
DOI:10.4103/0976-7800.109643  PMID:23833539
Uterine granulomas confined to the myometrium are uncommon. Granulomas maybe infectious, non-infectious or idiopathic in origin. They may be diffuse or focal in nature. In this report, we describe two cases of granulomas of diffuse variety involving the myometrium. The first case shows non-necrotizing granuloma probably related to previous instrumentation. The second case depicts caseating granulomas along with Leiomyoma of uterus.
  - 3,215 271
COMMENTARY
Laparoendoscopic single-site surgery in gynecology: Dawn of a new era
B Ramesh, Pooja Sharma
January-March 2013, 4(1):52-53
PMID:23833536
  - 2,165 249
EDITORIALS
Levonorgestrel-IUS system and endometrial manipulation
Sonia Malik
January-March 2013, 4(1):6-7
DOI:10.4103/0976-7800.109625  PMID:23833526
  - 3,158 435
LETTERS TO EDITOR
Squamous cell carcinoma of the uterine cervix extending to the corpus in superficial spreading manner and causing hematometra
Harveen Kaur Gulati, Mani Anand, Sanjay D Deshmukh
January-March 2013, 4(1):63-64
DOI:10.4103/0976-7800.109644  PMID:23833540
  - 6,876 384
Molecular blockade of angiogenic factors: A new therapeutic tool for the treatment of abnormal uterine bleeding
Subhasish Ghosh, Subhankar Chatterjee
January-March 2013, 4(1):66-67
DOI:10.4103/0976-7800.109647  PMID:23833542
  - 2,017 219
Social issues in post menopausal women
Sukriti Bhutani, Jaikrit Bhutani, Prerna Bhutani
January-March 2013, 4(1):68-69
DOI:10.4103/0976-7800.109649  PMID:23833544
  - 2,149 256
ORIGINAL ARTICLES
Are women satisfied when using levonorgestrel-releasing intrauterine system for treatment of abnormal uterine bleeding?
Nina Mansukhani, Jyothi Unni, Meenakshi Dua, Reeta Darbari, Sonia Malik, Sohani Verma, Sonal Bathla
January-March 2013, 4(1):31-35
DOI:10.4103/0976-7800.109633  PMID:23833531
Aim: To determine the efficacy of levonorgestrel intrauterine system (LNG IUS) in treatment of abnormal uterine bleeding (AUB) in women over 35 years and to determine satisfaction of users of LNG IUS in case of AUB. Materials and Methods: This was a multicentric, retrospective, and observational study. Case records of patients with AUB from the hospitals in Pune, Delhi, and Gurgaon for the last 6 years were examined. Records of 80 women who had an LNG IUS inserted were included. The chief complaints and their duration were recorded. Investigation results, histopathology reports, and date of LNG IUS insertion were noted. The incidence of spotting, heavy menstrual bleeding, pain, expulsion, and amenorrhea were recorded at 3, 6, 12, and 18 months following treatment. Following this a telephonic interview was conducted to determine the efficacy of LNG IUS in treating the symptoms. Patients' satisfaction in percentage was also noted and they were asked if they would recommend the LNG IUS to other women. Results: The mean age of women was 42.3 years. 77.5% of the women had menorrhagia as the chief complaint, and the mean duration was 12 months. Fibroids and adenomyosis were the most common pathology, present in 21.3% and 20% of the patients respectively. At 3 months, spotting seemed to be the predominant symptom (59.4%) and only 15% women had heavy bleeding. 49.3% of women were asymptomatic at 6 months. 27.5% had amenorrhea by the end of 18 months. 14 women in whom the device was expelled or removed due to persistent symptoms, underwent hysterectomy at various stages during the study period. Overall patient satisfaction was high at about 80%. Furthermore, 73.8% patients agreed to recommend it to other women. Conclusion: LNG IUS seems to be a viable and effective treatment option for AUB in women after 35 years. There is a high rate of patient satisfaction in appropriately selected patients.
  - 2,942 535
REVIEW ARTICLES
Levonorgestrel intrauterine system: Current role in management of heavy menstrual bleeding
Navneet Magon, Monica Chauhan, Poonam Goel, Sonia Malik, Krishan Kapur, Alka Kriplani, Lakhbir Dhaliwal, Suchitra N Pandit
January-March 2013, 4(1):8-15
DOI:10.4103/0976-7800.109627  PMID:23833527
A review of literature was conducted to report on the effectiveness of levonorgestrel intrauterine system (LNG-IUS) in women with heavy menstrual bleeding (HMB). The relevant data were obtained by computerized searches of PubMed up to December 2012 and other references available with the authors. Information was obtained from references listed. Studies and case reports were excluded if they did not specifically provide information about LNG-IUS usage in women with HMB. After perusal, each relevant publication was summarized and appraised in terms of whether it contained information relevant to the stated objective. Available data shows that LNG-IUS therapy is effective and safe, providing significant reduction of menstrual bleeding in patients with HMB. LNG-IUS is a good strategy to reduce the number of hysterectomies in women with HMB.
  - 4,912 758
VIEW POINTS
Abnormal uterine bleeding in midlife: The role of levonorgestrel intrauterine system
Osama Shawki, Amr Wahba, Navneet Magon
January-March 2013, 4(1):36-39
DOI:10.4103/0976-7800.109634  PMID:23833532
Abnormal uterine bleeding is a common gynecological complaint affecting 10-30% of women in midlife and constitute about one-third of all outpatient gynecological visits. It adversely affects the quality of woman's life and can lead to psychological, social, medical, and sexual problems and thus necessitating appropriate and adequate management. Different treatment modalities for such problems are available, yet the levonorgestrel intrauterine system (LNG-IUS) has recently provided a good treatment option effective in treating such complaints and at the same time, having a reliable contraceptive effect which is desired by such age group. For women in their reproductive years, the LNG-IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists, and decreasing the recourse to operative treatments. It is easy to insert, has a sustained effect, cost-effective, and well tolerated besides providing reliable contraception.
  - 3,714 459
New ground breaking International Federation of Gynecology and Obstetrics's classification of abnormal uterine bleeding: Optimizing management of patients
Jai Bhagwan Sharma, Manisha Yadav
January-March 2013, 4(1):42-45
DOI:10.4103/0976-7800.109637  PMID:23833534
There is considerable worldwide confusion in the use of terminologies and definitions around the symptom of abnormal uterine bleeding (AUB), and these are increasingly leading to difficulties in setting up multinational clinical trials and in interpreting the results of studies undertaken in single centers. In November 2010, the International Federation of Gynecology and Obstetrics formally accepted a new classification system for causes of AUB in the reproductive years. The system, based on the acronym polyps, adenomyosis, leiomyoma, malignancy and hyperplasia - coagulopathy, ovulatory disorders, endometrial causes, iatrogenic, not classified was developed in response to concerns about the design and interpretation of basic science and clinical investigation that relates to the problem of AUB.
  - 3,912 564
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