Key snapshots from Gynecology: AUB, Prolapse and Menopause

In this afternoon’s oral presentation session we had a varied range of talks looking at AUB, GSM and alternative treatment for menopausal symptoms.  Here are our key snapshots of the session’s main presentations:

Investigating methods for investing AUB

-  Abnormal Uterine Bleeding (AUB) is a prominent clinical issue accounting for 70% of all gynecological visits from peri/post-menopausal women. A hospital based comparative retrospective study was done on 100 patients of the perimenopausal age group. The study showed that for perimenopausal women with abnormal uterine bleeding the first investigation should be trans-abdominal (TAS) sonogram if trans-vaginal (TVS) is not available. Data showed that both TVS and TAS were highly sensitive for detecting endometrial hyperplasia. TVS is more sensitive and specific in detecting focal masses or polyps within the endometrial cavity, while TAS is more sensitive to detecting fibroids.

Looking at the impact of GSM on sexual activity

-  The genitourinary syndrome of menopause (GSM) has been associated with having a substantially negative impact on interpersonal relationships, quality of life, daily activities and sexual function. Almost 50% of all postmenopausal women experience vulvovaginal symptoms such as dryness, dyspareunia and irritation. A prospective study was carried out to look at the proportion of postmenopausal women who are or aren’t having sexual intercourse and their reasons to identify if GSM had an impact. Study results showed that whilst almost 50% of all women in the study denied having sexual intercourse, only 7% mentioned vulvovaginal pain as the main reason, whilst a third mentioned dyspareunia after menopause, only a 10th of them believed medical intervention would improve their sexual function, showing that this is something that needs to be discussed further with patients during visits.

Alternative therapies from lemon balm to ICR extracts.

- Previous randomised clinical trials have found that the use of 250 mg of lemon balm twice a day can significantly decrease uncomfortable breathing, coughing and snoring during sleep in healthy menopausal women. Significant decreases in sleep disturbance and an increase in menopause sleep quality have also been reported when mixing lemon balm with valerian in daily capsules. A new randomized, triple-blind clinical trial in healthy women aged 40-60, was carried out collecting data using the menopause rating scale (MRS) and interventions record checklist. After one month there was a significant decrease in MRS scores showing an increase in positive effect of menopause symptoms. There is more data to come but initial results suggests lemon balm could be used to reduce menopausal symptoms!

-  When looking at the pathophysiology of Vasomotor Symptoms (VMS) we know that during a hot flash there is a narrowing of the thermoneutral zone which decreases the sweating threshold and is triggered by estrogen withdrawal of fluctuation. This leads to imbalances in neurotransmitter synthesis and CNS receptor expression. Experimental data was shared on the effects of isopropanolic Cimicifuga racemosa extract (iCR) on CNS receptors binding, activity and expression. Experimental data showed that iCR and estrogen had an equivalent therapeutic effect on OVX induced changes in the 5-HY pathway and both also normalised the NE pathway, the therapeutic effect of iCR was selective in the POAH and equivalent to estrogen in the LC. Clinical results also showed that iCR (40mg/day) is a possible alternative to a low-dosed estradiol path in the treatment of climacteric complaints for women who cannot or do not want to be treated with conventional methods. Further studies looking at the safety of iCR demonstrated that it is well tolerated and there was no evidence of hepatotoxicity making it a viable potential treatment method for VMS.