BESINS HEALTHCARE Innovating for Well-being HOME ABOUT US THERAPEUTIC AREAS PRODUCTS INNOVATION PARTNERING MEDICAL EDUCATION CAREERS WOMEN'S HEALTH Fertility Miscarriage Preterm Birth Hormone Replacement Therapy in Menopause Mastodynia VulvoVaginal Atrophy For more than 50 years, Besins Healthcare has discovered, developed and delivered healthcare solutions to help women successfully manage the often unexpected issues related to pregnancy and birth, breast pain and transition through menopause. Our estrogen-based and progesterone-based products are confidently prescribed by physicians in more than 100 countries worldwide. We are a major player In Menopause Hormone Therapy (MHT), being the first in developing a transdermal estradiol gel in the seventies and the first in developing a micronized natural progesterone in an oily formulation bioavailable by oral and vaginal routes of administration. Luteal phase support, threatened and recurrent miscarriage, pre-term birth, vulvovaginal atrophy, irregular bleeding, cycle control, hormone replacement therapy in menopause and mastodynia are core areas of focus for Besins. We remain committed to discovering additional innovations in gynecology, fertility and obstetrics. From Häggström, Mikael (2014). “Medical gallery of Mikael Häggström 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436. FERTILITY Infertility is defined as the inability of a sexually active couple who are not using birth control to become pregnant after one year of trying. An estimated 35 to 40 percent of infertility cases are due to female infertility and an equal number can be due to male infertility. Approximately 20% of infertility cases occur from an unknown cause [1] . Luteal phase deficiency (LPD) has been associated with infertility. It is described as a condition in which endogenous progesterone is not sufficient to maintain functional secretory endometrium and allow normal embryo implantation and growth [2]. Exogenous progesterone (also named Luteal Phase Support) is common element in the treatment regimen in infertility, particularly those related to Assisted Reproductive Technologies (ART). MISCARRIAGE Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 10 to 20 % of known pregnancies end in miscarriage. Most miscarriages occur before the 12th week of pregnancy [1] There are two types of miscarriage: sporadic and recurrent [2]. Recurrent miscarriage affects about 1% to 2% of couples [3]. By contrast, at least 25 % and probably as many as 50 % of all women experience one or more sporadic miscarriages usually due to random fetal chromosomal abnormalities[3-5], the risk of which rises with increasing maternal age [6]. PRETERM BIRTH Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. An estimated 15 million babies are born preterm every year and this number is rising. Over 1 million babies die annually from preterm birth complications and it is the leading cause of newborn deaths (babies in the first four weeks of life) and the second leading cause of death after pneumonia in children under five years [1] . About 30–35 % of pre-term births are indicated, 40–45 % follow spontaneous preterm labor and 25–30 % follow preterm premature rupture of the membranes (PPROM). Births that follow spontaneous labor and PPROM are together designated spontaneous preterm births [2] . The complex etiopathology implicated in preterm birth syndrome include intrauterine infection, uterine ischemia, uterine over distension, abnormal allogenic recognition, allergic-like reaction, cervical disease, and endocrine disorders [3] . MENOPAUSE Menopause is a stage in life when a woman stops having her monthly period and is diagnosed when she has gone without a period for 12 consecutive months in the absence of other pathological or physiological causes. It is a normal part of aging and marks the end of a woman’s reproductive years. Menopause typically occurs in a woman’s late 40s to early 50s. However, women who have their ovaries surgically removed undergo “sudden” menopause. Approximately 75 % of women experience hot flushes and night sweats at some point during perimenopause and approximately 25 % of women suffered from them for more than five years[1] . The impact of hot flushes on quality of life may be considerable and is often underestimated. Hot flushes and night sweats negatively affect quality of life for an estimated 20 – 25 % of women, due to physical discomfort and social embarrassment, with night sweats associated with sleep disruption. The sleep and mood disturbances that result from hot flushes / night sweats can have a significant negative impact on overall quality of life [2]. MASTODYNIA Painful breasts (Mastodynia or Mastalgia) is the most common breast symptom experienced by women [1] and may affect up to 70 % of women in their lifetime [2]. It may be severe enough to interfere with usual daily activities and its effect on quality of life often is underestimated [1]. It is not unusual for women to have 2–3 days of mild breast pain premenstrually, but 8–30 % of women report moderate to severe breast pain with a duration of 5 or more days each month [3]. The etiology of mastodynia is not well understood. The relationship to the menstrual cycle suggests a hormonal cause. It is postulated by many that a hormone imbalance is responsible: either elevated estrogen levels or low progesterone levels, or an abnormal estrogen/progesterone ratio [4]. VULVO VAGINAL ATROPHY VulvoVaginal Atrophy (VVA) is a progressive medical condition caused by decreased estrogen that can evolve into chronicity and may affect many menopausal women. VVA, a component of Genitourinary Syndrome of Menopause (GSM), refers specifically to thinning of vulvar and vaginal tissue, decreasing of vaginal blood flow, as well as narrowing and shortening of the vagina. Lubrification during sexual stimulation can be decreased or delayed leading to possible painful intercourse, the most bothersome symptom of VVA. Atrophic vaginitis is usually a term used when inflammations is also noted [1]. Vulvovaginal atrophy (VVA) can have significant effect on a woman’s sexual health and quality of life. It can be progressive and less likely to resolve without intervention [1]. Symptoms include lack of lubrication and pain with intercourse, which affects 20% to 45% of midlife and older women [2-3] . 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