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General Gynecology

A pragmatic approach to the management of menopause

25 May, 2023 | 11:30h | UTC

A pragmatic approach to the management of menopause – Canadian Medical Association Journal

News Release: Managing menopause: Hormone therapy is back – Canadian Medical Association Journal


RCT | Spironolactone enhances acne outcomes and offers a viable alternative to oral antibiotics

24 May, 2023 | 13:27h | UTC

Summary: The SAFA (Spironolactone for Adult Female Acne) trial was a multicenter, phase 3, double-blind, randomized controlled trial in England and Wales and evaluated the efficacy of spironolactone for treating adult women with acne vulgaris. A total of 410 women, aged ≥18 years and suffering from facial acne for a minimum of six months, were randomly assigned to receive either 50 mg/day of spironolactone or a placebo, increasing to 100 mg/day until week 24.

The primary outcome was measured by the Acne-Specific Quality of Life (Acne-QoL) symptom subscale score at week 12 and 24. The trial demonstrated that spironolactone improved Acne-QoL scores more effectively than the placebo, particularly at week 24. Additionally, more participants in the spironolactone group reported acne improvement, and treatment success was significantly higher in this group at week 12. Mild side effects, notably headaches, were more common in the spironolactone group.

The findings from the SAFA trial highlight spironolactone’s effectiveness, safety, and tolerability in treating adult women with acne vulgaris, suggesting it is a viable alternative to long-term antibiotic treatments. Future research is proposed on higher initial dosages of spironolactone, and its effects on different subgroups like patients with different ages, body mass index, and ethnicity.

Article: Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial – The BMJ

Editorial: What do we know about prescribing spironolactone for acne? – The BMJ

News Release: Non-antibiotic treatment for women with persistent acne shown to be effective – University of Southhampton


USPSTF Draft Statement recommends biennial screening mammography for women ages 40 to 74 years

22 May, 2023 | 13:56h | UTC

Breast Cancer: Screening – U.S. Preventive Services Task Force

Critical perspectives on the statement:

Earlier screening for breast cancer: Benefits and harms – Lown Institute

Video: Mammography – Does it save lives? | The USPSTF is incorrect | I review ALL the data – By Dr. Vinay Prasad

Why more mammograms aren’t the solution to breast cancer – Vox


RCT | Neck–shoulder region training for chronic headache in women

15 May, 2023 | 12:59h | UTC

Neck–Shoulder Region Training for Chronic Headache in Women: A Randomized Controlled Trial – Clinical Rehabilitation


Commentary on Twitter


RCT | Transvenous occlusion of incompetent pelvic veins to treat chronic pelvic pain in women

15 May, 2023 | 12:54h | UTC

Transvenous occlusion of incompetent pelvic veins to treat chronic pelvic pain in women: A randomised controlled trial – BJOG


Single-arm study | Halting endocrine therapy for pregnancy not linked to increased breast cancer events vs. a control cohort

10 May, 2023 | 16:01h | UTC

Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary: Temporary Interruption of Adjuvant Endocrine Treatment to Attempt Pregnancy Does Not Increase Short-Term Risk for Worsening Breast Cancer Outcomes – ESMO


Commentary on Twitter


Cohort Study | Limited evidence linking COVID-19 vaccines to menstrual disturbance or postmenopausal bleeding

9 May, 2023 | 14:52h | UTC

Association between SARS-CoV-2 vaccination and healthcare contacts for menstrual disturbance and bleeding in women before and after menopause: nationwide, register based cohort study – The BMJ

News Release: New study finds no increased risk of menstrual changes after covid-19 vaccination – BMJ Newsroom

Commentary: Large study shows no changes to menstrual cycles after COVID vaccination – CIDRAP


A prospective study of the association between SARS-CoV-2 infection and COVID-19 vaccination with changes in usual menstrual cycle characteristics.

Editorial: Menstruation and Covid-19 vaccination.


Commentary on Twitter


Enhanced recovery after surgery (ERAS) society guidelines for gynecologic oncology: addressing implementation challenges

5 May, 2023 | 14:53h | UTC

Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges – 2023 update – Gynecologic Oncology


RCT | Levonorgestrel IUS vs. hysteroscopic niche resection for postmenstrual spotting in cesarean scar

3 May, 2023 | 15:15h | UTC

Comparing levonorgestrel intrauterine system with hysteroscopic niche resection in women with postmenstrual spotting related to a niche in the uterine cesarean scar: a randomized, open-label, controlled trial – American Journal of Obstetrics & Gynecology


Cohort Study | Long-term health consequences after ovarian removal at benign hysterectomy

3 May, 2023 | 14:58h | UTC

Long-Term Health Consequences After Ovarian Removal at Benign Hysterectomy: A Nationwide Cohort Study – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Risks of removing ovaries at benign hysterectomy may outweigh the benefits for women at low risk for ovarian cancer – American College of Physicians


AUA/SUFU Guideline | Updates to surgical treatment of female stress urinary incontinence

2 May, 2023 | 13:43h | UTC

Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023) – The Journal of Urology


SR | Cranberries can prevent recurrent urinary tract infections in selected patients

25 Apr, 2023 | 14:41h | UTC

Cranberries for preventing urinary tract infections – Cochrane Library

Summary: Cranberries for preventing urinary tract infections – Cochrane Library


Cranberry juice can prevent recurrent UTIs, but only for some people – The Conversation

Review confirms that cranberry products help prevent urinary tract infections – News Medical


Study suggests that routine axillary scanning in diagnostic breast ultrasound has limited impact on cancer detection

19 Apr, 2023 | 13:06h | UTC

To scan or not to scan: effect of scanning the axilla of all patients undergoing diagnostic breast ultrasound – Clinical Imaging (link to abstract – $ for full-text)

Commentary: Is scanning the axilla during diagnostic breast ultrasound necessary? – Health Imaging


M-A | Self-sampling strategies in populations at risk of Chlamydia trachomatis and Neisseria gonorrhoeae

18 Apr, 2023 | 13:09h | UTC

Self-sampling strategies (with/without digital innovations) in populations at risk of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analyses – Sexually Transmitted Infections


Commentary on Twitter


RCT | Safety of Fezolinetant for vasomotor symptoms associated with menopause

17 Apr, 2023 | 12:54h | UTC

Safety of Fezolinetant for Vasomotor Symptoms Associated With Menopause: A Randomized Controlled Trial – Obstetrics and Gynecology


RCT | Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause

RCT | Efficacy of Fezolinetant in moderate-to-severe vasomotor symptoms associated with menopause


M-A | The risk of long-term cardiometabolic disease in women with premature or early menopause

11 Apr, 2023 | 13:59h | UTC

The risk of long-term cardiometabolic disease in women with premature or early menopause: A systematic review and meta-analysis – Frontiers in Cardiovascular Medicine


Review | Urinary incontinence and pelvic organ prolapse in women

10 Apr, 2023 | 13:27h | UTC

Urinary Incontinence and Pelvic Organ Prolapse in Women: Prevention and Treatment – Deutsches Ärzteblatt International


Review | Comprehensive care of women with genetic predisposition to breast and ovarian cancer

5 Apr, 2023 | 13:32h | UTC

Comprehensive Care of Women With Genetic Predisposition to Breast and Ovarian Cancer – Mayo Clinic Proceedings


M-A | Vaginal swab outperforms urine for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis

5 Apr, 2023 | 13:23h | UTC

Vaginal Swab vs Urine for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis: A Meta-Analysis – Annals of Family Medicine


Consensus Paper | Definition and criteria for diagnosing cesarean scar disorder

5 Apr, 2023 | 12:51h | UTC

Definition and Criteria for Diagnosing Cesarean Scar Disorder – JAMA Network Open


SR | Adding ultrasound to mammography increases breast cancer detection, but increases false-positives and biopsies

3 Apr, 2023 | 13:55h | UTC

Summary: The systematic review examined the effectiveness and safety of combining mammography with breast ultrasonography versus mammography alone for breast cancer screening in women at average risk. The research included one randomized controlled trial, two prospective cohort studies, and five retrospective cohort studies, involving a total of 209,207 women.

High certainty evidence from one trial indicated that combining mammography with ultrasonography led to the detection of more breast cancer cases than mammography alone (5 vs. 3 per 1000 women). However, this combination also led to a higher number of false-positive results and biopsies. For every 1000 women screened with the combined approach, 37 more received a false-positive result, and 27 more women underwent a biopsy.

Secondary analysis of the trial data revealed that in women with dense breasts, the combined screening detected more cancer cases than mammography alone, while cohort studies for women with non-dense breasts showed no statistically significant difference between the two screening methods.

The included studies did not analyze whether the higher number of detected cancers with the combined screening method resulted in lower mortality rates compared to mammography alone. Further research, including randomized controlled trials or prospective cohort studies with longer observation periods, is needed to assess the impact of the two screening interventions on morbidity and mortality.

Article: Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk – Cochrane Database of Systematic Reviews

Summary: Mammography followed by ultrasonography compared to mammography alone for breast cancer screening in women at average risk of breast cancer – Cochrane Database of Systematic Reviews


RCT | Early postpartum IUD placement noninferior vs. placement at 6-8 weeks for complete expulsion, but not for partial expulsion

31 Mar, 2023 | 13:48h | UTC

Early vs Interval Postpartum Intrauterine Device Placement: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

News Release: Study: Risk of IUD Expulsion in Early Postpartum Placement – UC San Diego Health

Commentary: IUD Placement at Two to Four Weeks Postpartum Noninferior – HealthDay


SR | Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Placement of an intrauterine device within 48 hours after early medical abortion – a randomized controlled trial – American Journal of Obstetrics & Gynecology


Commentary on Twitter


Study shows a slight breast cancer risk increase with progestogen-only birth control, comparable to combined oral methods

29 Mar, 2023 | 13:35h | UTC

Summary: A UK study and meta-analysis examined breast cancer risk linked to hormonal contraceptives, emphasizing progestagen-only contraceptives in premenopausal women. Utilizing a nested case-control design with the Clinical Practice Research Datalink (CPRD), a primary care database, the study included 9,498 women under 50 diagnosed with invasive breast cancer between 1996 and 2017, and 18,171 closely matched controls. The meta-analysis merged CPRD findings with 12 observational studies on progestagen-only preparations.

The results revealed that current or recent use of combined oral contraceptives, oral progestagen-only contraceptives, injectable progestagen, and progestagen intrauterine devices all led to a similar increase in breast cancer risk. The 15-year absolute excess risk associated with five years of oral combined or progestagen-only contraceptive use ranged from 8 per 100,000 users aged 16-20 to 265 per 100,000 users aged 35-39. The study concluded that both contraceptive types were linked to a slight breast cancer risk increase, and these risks must be weighed against the benefits of contraceptive use during childbearing years.

Article: Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case–control study and meta-analysis – PLOS Medicine

News Release: Study finds similar association of progestogen-only and combined hormonal contraceptives with breast cancer risk – PLOS

Commentary: Expert reaction to study looking at the association between hormonal contraceptive use and breast cancer incidence – Science Media Centre


Consensus Statement | Management of vaginal intraepithelial neoplasia

28 Mar, 2023 | 14:37h | UTC

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus Statement on the Management of Vaginal Intraepithelial Neoplasia – Journal of Lower Genital Tract Disease


RCT | Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause

23 Mar, 2023 | 13:01h | UTC

Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study – The Lancet (link to abstract – $ for full-text)

Related: Efficacy and Safety of Fezolinetant in Moderate-to-Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT – The Journal of Clinical Endocrinology & Metabolism


Commentary on Twitter (thread – click for more)


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