Seminars in reproductive medicine
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Semin. Reprod. Med. · Sep 2010
ReviewEvaluation and management of sleep disturbance during the menopause transition.
Sleep disturbances in midlife women are common and have been associated with the menopause transition itself, symptoms of hot flashes, anxiety and depressive disorders, aging, primary sleep disorders (i.e., obstructive sleep apnea, periodic limb movement disorder), comorbid medical conditions and medications, as well as with psychosocial and behavioral factors. Because there are several common sources of sleep problems in midlife women, the cause of an individual woman's sleep disturbance may be multifactorial. ⋯ The review aims to equip clinicians evaluating menopause-age women with the knowledge and evaluation tools to diagnose, engage sleep experts where appropriate, and treat sleep disturbance in this population. Sleep disorders in midlife women should be treated because substantial improvements in quality of life and health outcomes are achievable.
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Biologic sex and sex steroids are important factors in clinical and experimental stroke and traumatic brain injury (TBI). Laboratory data strongly show that progesterone treatment after TBI reduces edema, improves outcomes, and restores blood-brain barrier function. Clinical studies to date agree with these data, and there are ongoing human trials for progesterone treatment after TBI. ⋯ The role of androgens in male stroke or TBI is understudied and important to pursue given the epidemiology of stroke and trauma in men. To date, male sex steroids remain largely evaluated at the bench rather than the bedside. This review evaluates key evidence and highlights the importance of the platform on which brain injury occurs (i.e., genetic sex and hormonal modulators).
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Semin. Reprod. Med. · Sep 2008
ReviewUltrasound criteria for diagnosis of early pregnancy failure and ectopic pregnancy.
Early pregnancy failure and ectopic pregnancy are common clinical diagnoses for which ultrasound can provide useful information. This review explores the use of ultrasound to diagnose early pregnancy failure and ectopic pregnancy. ⋯ In most settings, documentation of a normal intrauterine pregnancy effectively eliminates the possibility of ectopic pregnancy. The presence of an adnexal mass in the absence of an intrauterine gestational sac may indicate an ectopic pregnancy.
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Semin. Reprod. Med. · May 2008
ReviewPolycystic ovary syndrome: the controversy of diagnosis by ultrasound.
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder. The criteria used to establish the diagnosis remain controversial. The 1990 National Institutes of Health conference guidelines required a combination of both chronic anovulation and clinical/or biochemical signs of hyperandrogenism. ⋯ The inclusion of PCOM sparked a controversy as it broadens the population of women who meet the criteria for PCOS and allows for the creation of two phenotypically different patient populations who previously would have been excluded. The ultrasound findings, which are consistent with PCOM, include an assessment of follicle number and/or ovarian volume. As technology advances with two-dimensional and three-dimensional ultrasound, our ability to discretely evaluate independent portions of the ovary may help to redefine the criteria of PCOM and thus standardize for clinical and research interests a more specific descriptor for PCOM.