Climacteric : the journal of the International Menopause Society
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Multicenter Study Clinical Trial
Effectiveness of hyaluronate-based pessaries in the treatment of vulvovaginal atrophy in postmenopausal women.
Objectives: This study aimed to assess the efficacy and safety of hyaluronic acid-based vaginal pessaries (Hydeal-D) in the treatment of vulvovaginal atrophy (VVA). Study design: The study was a prospective, multicenter clinical investigation of VVA topical treatment in 40 postmenopausal women. Patients applied one Hydeal-D pessary every 3 days for 3 months. ⋯ Patients' overall satisfaction was very high after 1 month of treatment and increased further after 3 months. No severe adverse events were reported. Conclusions: Significant amelioration of VVA-related signs indicates that Hydeal-D vaginal pessaries are an effective, safe, and well-tolerated non-hormonal therapeutic option for VVA in postmenopausal women.
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Background: Women at high risk to develop ovarian cancer opt for risk-reducing salpingo-oophorectomy (RRSO) to reduce the risk by 80-96%. RRSO leads to a direct onset of menopause in premenopausal women. Hormone replacement therapy (HRT) can be used to mitigate menopausal symptoms after RRSO. ⋯ Conclusion: Short-term use of HRT after RRSO seems to be safe. The literature is more favorable toward estrogen alone. The ideal dosage and duration of use are unknown and remain to be investigated in future studies.
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Endometriosis is a common disease but, due to the wide spectrum of symptoms, diagnosis can be delayed 8-12 years. Laparoscopy is nowadays the gold standard for diagnosis. A less invasive method could shorten the time to diagnosis. ⋯ For example, transvaginal ultrasound has a sensitivity of 93% and a specificity of 96% in the diagnosis of endometrioma, while superficial/peritoneal endometriosis cannot be detected with imaging processes. Although several non-invasive tests including imaging, genetic tests, biomarkers, or miRNAs show promising diagnostic potential, further research is required before they can be recommended in routine clinical care. The combination of low invasive tests may be the solution to a reliable low invasive diagnosis of endometriosis.
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In this opinion piece, we discuss the issue of lack of reproducibility in medical research and the different approaches that are being taken to address this problem. One general approach involves much greater transparency including the pre-publication of a study protocol, analysis plan and analysis code as well as the ultimate sharing of data, doing away with the concept of the 'single wrap-up publication'. The other change required is to support the training and mentorship of young researchers and ensure that they are not working in isolation.
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The evidence is reviewed on the efficacy and effectiveness of mammography screening derived from randomized screening trials and from the surveillance of populations where mammography screening for breast cancer has been introduced. Nearly all the trials were performed in the era before modern adjuvant therapy for breast cancer was introduced, apart from the Canadian National Breast Screening Study and the UK Age trial. ⋯ The evidence from population-based surveillance is mixed, most such studies having failed to consider the benefit gained from improved therapy. It is concluded that we have reached the point of negligible benefit from mammography screening for breast cancer in women at average risk, and that we should concentrate on early diagnosis of breast cancer and the application of modern therapy according to clearly defined sub-types of breast cancer.