bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteoporosis in Black South African Women: Myth or Reality
Authors: Matsela Lineo , Towobola Olakunle , Mokgokong Ephraim T 
Published: September 2019

ABSTRACT
Aim
The study was conducted to ascertain the severity of the occurrence of osteopenia and osteoporosis among black South African women during their transition from premenopause to postmenopause.

Materials and methods
Sixty-eight black South African women, aged between 32 and 77 years, residents of three districts of Pretoria, South Africa, constituted the participants in the study. Following informed consent, the women were randomly recruited and assessed for age, medical history, and lifestyle data. Each woman was classified as being premenopause, perimenopause, or postmenopause based on her menstrual history within the preceding 12 months to the study. Bone mineral density (BMD) of the L1-L4 vertebrae and the hip vertebrae was measured using dual-energy X-ray absorptiometry (DEXA) method and the results were expressed as T-scores based on World Health Organization (WHO) classifications for osteopenia and osteoporosis.

Results
Osteopenia was found in 2 of the 8 (25%) premenopausal women aged 37 and 38 years. Similarly, 2 perimenopausal women out of the 28 (7.1%), aged 45 and 49 years, also had evidence of osteopenia. Among 32 postmenopausal women, 11 (34.4%) had osteopenia and 8 (25%) were diagnosed with osteoporosis. There was no statistical significant difference (p = 0.0832) for osteopenia between premenopausal and perimenopausal women. However, the incidence of osteopenia became statistically significant between premenopausal and postmenopausal women (p = 0.0137), and between perimenopausal and postmenopausal women (p = 0.0218).

Conclusion
Even from this small cohort study, it is apparent that osteoporosis does afflict postmenopausal black South African women. The need to institute screening strategies and appropriate guidance to prevent osteoporosis in these women is strongly advocated.

Clinical significance
The study draws special attention to the necessity to investigate black South African women for early detection of osteopenia and osteoporosis.

How to cite this article
Matsela L, Towobola O, Mokgokong ET. Osteoporosis in Black South African Women: Myth or Reality. J South Asian Feder Menopause Soc 2017;5(2):111-116.

Source of support
The authors herewith express their gratitude to both MSD (South Africa) and the South African Menopause Society for their financial donations, which enabled the DEXA evaluations of participants in this study.
Knowledge and Attitudes of Black South African Women toward Menopause: Impact of Culture and Traditions
Authors: Matsela Lineo , Towobola Olakunle , Mokgokong Ephraim T 
Published: September 2019

ABSTRACT
Introduction
Vasomotor symptoms of menopause could affect the quality-of-life of most women. The understanding of menopause by African women and the coping mechanisms of these women are essential factors that may be influenced by culture and traditions. This study has evaluated the psychosomatic and sociodemographic profiles of menopausal black South African women in order to ascertain the role played by their culture and traditions during the menopausal years.

Materials and methods
The study was carried out at three periurban districts close to the city of Pretoria, South Africa. A qualitative, prospective, community-based, cohort study was conducted over a 2-year period. The targeted population included women between 40 and 80 years, and each woman was interviewed using a structured questionnaire. Data on sociodemographic, psychosomatic profiles of the women as well as cultural and traditional beliefs relating to menopause were documented. The data from the study were analyzed by descriptive statistics.

Results
Totally, 450 women were interviewed: 250 (perimenopausal) and 200 (postmenopausal). The ages of the women ranged between 42.5 and 50.8 years (perimenopausal) and between 51.5 and 68.4 years for postmenopausal women. Only 20% of the women interviewed for the study had no formal education and 78% of them were financially independent. The percentage of the women who had an understanding of menopause and expressed cultural explanations for it was 96%. The women explained the impact of support systems on which they relied and by which their attitudes toward menopause were greatly influenced. Knowledge of hormone replacement therapy (HRT) and its importance in the alleviation of vasomotor symptomatology ranged between 80 and 84%, yet the women were reluctant to seek medical remedy for their vasomotor symptoms.

Conclusion
The study provides insight into the impact that traditions and culture of black South African women have on their capacity to cope with menopause.

How to cite this article
Matsela L, Towobola O, Mokgokong ET. Knowledge and Attitudes of Black South African Women toward Menopause: Impact of Culture and Traditions. J South Asian Feder Menopause Soc 2017;5(2):117-122.
Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding
Authors: Chandrashekar Nikhitha , GS Jyothi , Shetty Prasanna 
Published: September 2019

ABSTRACT
Aim
The objective of this study was to assess the adequacy of the sample aspirated in order to make a definite diagnosis of endometrial disease in abnormal uterine bleeding (AUB) and to draw comparisons between the histopathological findings of Pipelle endometrial aspiration biopsy and dilatation and curettage (D&C).

Materials and methods
Pipelle endometrial biopsy and D&C samples were collected from 100 patients with AUB in the Department of the Obstetrics and Gynecology and sent to the Department of Pathology of a tertiary care hospital for adequacy of the sample and for histopathological analysis.

Results
The Pipelle sample was adequate in 73% of the cases and inadequate in 27% compared with D&C, which showed 85% and 15%, respectively. About 53% of cases were comparable between D&C and Pipelle and 37% were discordant. For endometrial hyperplasia using Pipelle aspirator, the sensitivity was 58.8%, specificity was 91.6%, positive predictive value (PPV) was 58.8%, negative predictive value (NPV) was 91.6%, and concordance was 86%. For detection of endometrial carcinoma using Pipelle, the sensitivity was 50%, specificity was 99%, PPV was 50%, NPV was 99%, and concordance rate was 98%.

Conclusion
It is more convenient and cost-effective for patients to undergo pipelle biopsy to confirm normalcy and rule out endometrial hyperplasia rather than undergoing D&C initially. Out of the 27% of inadequate samples, 14.8% had fibroids and 11.1% had polyps, thus showing that tumors localized to a polyp or a small area of endometrium went undetected with Pipelle.

Clinical significance
Due to the high specificity and NPV and low sensitivity and PPV in diagnosing endometrial lesions and carcinomas, pipelle is suitable for women with a low risk of cancer. In cases where the diagnosis is hyperplasia on Pipelle, the patients are advised to undergo hysteroscopic-guided D&C following pipelle to confirm the diagnosis. This is also applicable for cases of polyps and fibroids.

How to cite this article
Chandrashekar N, Jyothi GS, Shetty P. Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):123-128.
Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases
Authors: Rajput Disha A , Valecha Shalini M , Sarwade Manisha , Dhumale Shrikant 
Published: September 2019

ABSTRACT
Introduction
Urinary incontinence (UI) is more common than any other chronic disease with the prevalence of approximately 23 and 55%. Among the various forms of UI, stress incontinence (SUI) is the most common (49%), with urgency incontinence (UUI) representing 21% and mixed type (MUI) at 29%. As it affects the quality-of-life of women, the restoration of urinary continence is one of the greatest challenges.

Aim
To review the cases of genuine SUI treated surgically by Burch retropubic urethropexy.

Results
We have managed surgically eight cases of genuine SUI by Burch retropubic urethropexy. On 1-year follow-up, none of the patients had any urinary complaints. All had responded well to surgery and patient's satisfaction index was good.

Conclusion
Since SUI is the commonest among incontinences, it is a challenge to diagnose and treat to improve quality-of-life of patients. Burch retropubic urethropexy is the gold standard treatment for SUI, especially if other indications exist for abdominal surgery. Even in the present era of less invasive vaginal procedures, results are comparable.

How to cite this article
Rajput DA, Valecha SM, Sarwade M, Dhumale S. Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases. J South Asian Feder Menopause Soc 2017;5(2):129-132.
Evaluation of Incompletely Staged Ovarian Malignancy: A Study in Western India
Authors: Kamath Anusha , Dave Pariseema , Mankad Meeta 
Published: September 2019

ABSTRACT
Introduction
Incomplete initial surgery complicates subsequent management of ovarian tumors. This study aimed to study demographic and clinical factors associated with incompletely staged ovarian tumor patients.

Materials and methods
Twenty five patients who had undergone incomplete staging surgery for ovarian tumors outside Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India, were included in this study. Their demographic and clinical features were studied in detail. Patients were either subjected to restaging or were referred for chemotherapy initially.

Results
Mean age of patients was 42 years (23—60 years); 64% of patients had abdominal pain as initial complaint; 64% patients were operated initially using a transverse incision. Only four patients were managed laparoscopically initially, others by laparotomy. Single/part of one ovary was removed in 60% of patients as part of initial surgery. Infundibulopelvic ligament was tied distally in 40% of patients. Omentectomy (Om) and lymphadenectomy were not done in most of the patients. Nineteen patients were found to have malignancy on final histopathological examination; 3 borderline malignancy; 1 granulosa cell tumor; and 2 benign tumors; 52% (n = 13) patients were subjected to chemotherapy; 4% (n = 1) were observed, and rest underwent restaging procedures.

Conclusion
Incompletely staged ovarian tumor patients, especially those with malignant histopathology, should be managed by gynecologic oncologists. The management needs to be individualized and cannot be a blanket therapy.

How to cite this article
Kamath A, Dave P, Mankad M. Evaluation of Incompletely Staged Ovarian Malignancy: A Study in Western India. J South Asian Feder Menopause Soc 2017;5(2):133-137.
Endometrial Metastasis from an Occult Colonic Primary presenting with Massive Ascites
Authors: Mathew John , Komaranchath Ashok S , Gopalakrishnan Sindhu , John Shirly , Mahadevan Pushpa , Kumar Lijesh 
Published: September 2019

ABSTRACT
In most developed nations, endometrial cancer is the most common gynecological malignancy. However, the endometrium is an extremely rare site for metastasis from an extragenital site. Also, the most common presentation of such metastasis is with uterine bleeding, similar to primary endometrial cancers. We present an unusual case of a 38-year-old female who presented with abdominal pain and distension. Evaluation revealed an endometrial mass lesion with bilateral adnexal masses and massive ascites. An endometrial biopsy was done, which revealed a mucinous adenocarcinoma with signet ring cells. Immunohistochemistry showed cells positive for CK20 and CDX2 and negative for CK7, which was in favor of a colonic primary. A colonoscopy was attempted, but failed due to extrinsic compression at the rectosigmoid junction. There was no evidence of supradiaphragmatic disease. She was started on palliative chemotherapy. This case report highlights the indispensability of histological correlation and immunohistochemistry in the diagnosis of pelvic malignancies.
How to cite this article
Komaranchath AS, Gopalakrishnan S, John S, Mahadevan P, Mathew J, Kumar L. Endometrial Metastasis from an Occult Colonic Primary presenting with Massive Ascites. J South Asian Feder Menopause Soc 2017;5(2):138-141.
Papillary Squamotransitional Cell Carcinoma Cervix: A Rare Variant
Authors: Singh Amrita , Anant Monika , Singh Vandita Y 
Published: September 2019

ABSTRACT
Papillary squamotransitional cell carcinoma (PSTCC) is a lesser known histological subtype of the most common type of cervical “squamous cell carcinoma (SCC).” Papillary carcinomas of the uterine cervix with transitional or squamous differentiation often resemble transitional cell carcinomas of the urinary tract. In the literature, PSTCC is underdiagnosed, has late presentation, is more common in postmenopausal age group, and has a late recurrence. Here we report a case of a 52-year-old lady presenting with postmenopausal bleeding, whose cytological evaluation reported atypical squamous cells of undetermined significance (ASCUS) and cervical biopsy as high-grade squamous intraepithelial lesion (HSIL). She underwent laparoscopic hysterectomy to be diagnosed with PSTCC mixed type. With an 18-month follow-up, she has shown no locoregional recurrence. A high index of suspicion on the part of the clinician and an awareness of PSTCC subtype of cancer cervix by the histopathologist are required to make an accurate diagnosis.
How to cite this article
Anant M, Singh A, Singh VY. Papillary Squamotransitional Cell Carcinoma Cervix: A Rare Variant. J South Asian Feder Menopause Soc 2017;5(2):142-144.
Surgical vs Natural Menopause: Cognitive Issues
Authors: Henderson VW , Sherwin BB 
Published: September 2019

Abstract

Objective
Women who undergo both natural and surgical menopause experience the loss of cyclic ovarian production of estrogen, but hormonal and demographic differences distinguish these two groups of women. Our objective was to review published evidence on whether the premature cessation of endogenous estrogen production in women who underwent a surgical menopause has deleterious consequences for cognitive aging and to determine whether consequences differ for women if they undergo natural menopause. Studies of estrogen-containing hormone therapy are relevant to this issue.

Design
We reviewed evidence-based research, including the systematic identification of randomized clinical trials of hormone therapy with cognitive outcomes that included an objective measure of episodic memory.

Results
As inferred from very small, short-term, randomized, controled trials of high-dose estrogen treatment, surgical menopause may be accompanied by cognitive impairment that primarily affects verbal episodic memory. Observational evidence suggests that the natural menopausal transition is not accompanied by substantial changes in cognitive abilities. For initiation of hormone therapy during perimenopause or early postmenopause when the ovaries are intact, limited clinical trial data provide no consistent evidence of short-term benefit or harm. There is stronger clinical trial evidence that initiation of hormone therapy in late postmenopause does not benefit episodic memory or other cognitive skills.

Conclusion
Further research is needed on the long-term cognitive consequences of surgical menopause and long-term cognitive consequences of hormone therapy initiated near the time of surgical or natural menopause. A potential short-term cognitive benefit might be weighed when a premenopausal woman considers initiation of estrogen therapy at the time of, or soon after, hysterectomy and oophorectomy for benign conditions, although data are still quite limited and estrogen is not approved for this indication. Older postmenopausal women should not initiate hormone therapy to improve or maintain cognitive skills.
Subclinical Thyroid Disorders
Authors: LNU Stuenkel , Cynthia A 
Published: September 2019

ABSTRACT
Symptoms of the menopause transition-altered cycle length, change in amount of bleeding, sleep disruption, fatigue, mood swings, forgetfulness, heat intolerance, and palpitations can also reflect thyroid dysfunction, common in midlife women. Although many clinicians are familiar with diagnosis and management of overt thyroid disorders, subclinical thyroid disease adds an entirely new dimension to this arena.
Combined Estrogenic and Antiestrogenic Properties of Estetrol on Breast Cancer may provide a Safe Therapeutic Window for the Treatment of Menopausal Symptoms
Authors: Gérard Céline , Mestdagt Mélanie , Tskitishvili Ekaterine , Communal Laudine , Gompel Anne , Silva Elisabete , Arnal Jean-François , Lenfant Françoise , Noël Agnès , Foidart Jean-Michel , Pequeux Christel 
Published: September 2019

Abstract
Increased risk of breast cancer is a critical side-effect associated with the use of a menopausal hormone therapy (MHT). Estetrol (E4) is a natural estrogen produced by the human fetal liver and is a promising compound for clinical use in MHT. However, its impact on breast cancer is controversial and poorly defined. In this preclinical study, we show that E4 acts as a weak estrogen by stimulating the growth of hormone-dependent breast cancer only at concentrations exceeding menopausal therapeutic needs. Estetrol (E4) presents also an antitumor activity by decreasing the strong proliferative effect of estradiol (E2). While estrogen receptor alpha (ERá) is the predominant receptor mediating its effects, the dual weak-estrogenic/antiestrogenic feature of E4 results from differential signaling pathways activation. Both nuclear and rapid extranuclear signaling pathway are necessary for a complete estrogenic effect of E4. However, the antitumor action of E4 is not due to a capacity to antagonize E2-induced nuclear activity. Altogether, our results highlight that E4 has a limited impact on breast cancer and may offer a safe therapeutic window for the treatment of menopausal symptoms.
Influence of Selected Reproductive Factors and Smoking on Age at Menopause
Authors: Rumianowski B , Rotter I , Brodowska A , Adler G , Kowalski J , Karakiewicz B , Laszczyñska M 
Published: September 2019

ABSTRACT

Introduction
Early menopause may be associated with serious health risks resulting from, e.g. decreased estrogen levels. This may occur despite hormone replacement therapy.

Aim
The aim of this study was the determination of the effect of selected reproductive factors and smoking on age at the onset of menopause in women from Szczecin and surrounding areas.

Materials and methods
Three hundred and five women after natural menopause were asked to complete a questionnaire, and blood samples were collected from them to test for the levels of follicle stimulating hormone (FSH) andoestradiol (E2).

Results
Smoking women experienced menopause on average more than a year earlier than non-smokers, but this difference was not statistically significant. There was no statistically significant effect of age at menarche or first birth on age at the last menstrual period.

Conclusion
Age at menarche and first birth were not related to age at menopause. In smoking women, menopause occurred earlier but the difference was not statistically significant.
The Association between Menopause Symptoms and Risk of Postmenopausal Breast Cancer among nonusers of Hormone Therapy
Authors: Tricia Li , Han Jiali , Chunyan He 
Published: September 2019

ABSTRACT

Background
Hot flashes are a common symptom among women during their menopause transition, likely due to the changes of endogenous hormone levels. Previous research suggested that hot flashes symptoms were associated with a reduced risk of cardiovascular diseases. Few studies have investigated the association of hot flashes symptoms with the risk of breast cancer. Furthermore, the confounding effect by hormone use has not been sufficiently addressed in previous studies.

Methods
We investigated the association between hot flashes symptoms and risk of postmenopausal breast cancer in the Nurses’ Health Study (NHS). In order to eliminate the confounding by hormone use, we investigated the association only among women who never used hormone therapy. We calculated relative risk of breast cancer using a multivariate Cox model, adjusting for potential confounders, including age, race, family history of breast cancer, age at menarche, age at menopause, parity, age at first birth, body mass index, smoking, alcohol use, and education. We further investigated the severity of hot flashes symptoms in association with risk of postmenopausal breast cancer.

Results
We documented 1079 incidence of breast cancer during 396,166 person-years of follow-up. Hot flashes symptoms were not associated with risk of postmenopausal breast cancer after adjustment for potential confounders (RR = 1.02, 95% CI, 0.90- 1.15) among non-users of hormone therapy. Relative risk of breast cancer across symptom severity categories (mild, moderate, severe) were 1.01 (95% CI, 0.87-1.17), 1.04 (95% CI, 0.88-1.22), and 1.05 (95% CI, 0.75-1.46), respectively.

Conclusion
These data suggested that menopausal symptoms were not associated with risk of postmenopausal breast cancer.
Sleep-disordered Breathing and the Menopausal Transition Among Participants in the Sleep in Midlife Women Study
Authors: Mirer Anna G , Young Terry , Palta Mari , Benca Ruth M , Rasmuson Amanda , Peppard Paul E 
Published: September 2019

ABSTRACT

Objective
Menopause is widely believed to be an established cause of sleep disorders, but evidence for this theory is inconclusive. Attributing any sleep problem to normal processes of menopause may lead to underdiagnosis of treatable sleep disorders in midlife women. This study uses detailed longitudinal data on sleep and menopausal health from participants in the Sleep in Midlife Women Study to investigate whether risk and severity of sleep-disordered breathing increase with progression through menopause, accounting for changes in age and body habitus.

Methods
A total of 219 women aged 38 to 62 years were recruited from participants in the Wisconsin Sleep Cohort Study. Menopause status was determined from daily diaries in which participants reported menstrual flow, hot flashes, and use of hormonal medications. Each participant underwent in-home polysomnography studies every 6 months, to measure the apneahypopnea index (AHI) (N = 1,667 studies). Linear models with empirical standard errors were fit for logarithm of AHI on menopause status and years in menopause, adjusting for age, body mass index, waist girth, and neck girth.

Results
Compared with women in premenopause, AHI was 21% higher among participants in perimenopause (95% CI, −4 to 54), 31% higher among participants in postmenopause (95% CI, 2-68), and 41% higher among participants whose menopausal stage could not be distinguished between peri- and postmenopause (95% CI, 8-82). Among women who had begun perimenopause, each additional year in menopause was associated with 4% greater AHI (95% CI, 2-6).

Conclusions
Progression through menopause is associated with greater sleep-disordered breathing severity. This association is independent of aging and changes in body habitus.