Hormone Therapy and Ovarian Cancer

Abstract

The use of synthetic mesh to augment vaginal repair procedures for pelvic organ prolapse has increased in large part because of dissatisfaction with the success rates of traditional colporrhaphy. Its use, however, is controversial. Four randomized controlled studies comparing traditional colporrhaphy with vaginal repair using mesh augmentation had conflicting results. This unblinded, prospective, randomized controlled trial investigated whether mesh augmentation during vaginal repair would reduce the rate of recurrent prolapse at 12 months compared with traditional colporrhaphy. A total of 139 women with stage 2 or more prolapse who required both anterior and posterior compartment repair were randomized to mesh augmentation (mesh group, n ϭ 69) or colporrhaphy (no mesh group, n ϭ 70). Study subjects were enrolled between 2003 and 2005 at a tertiary teaching hospital. Prolapse was staged using the pelvic-organ-prolapse quantification (POP-Q) system. The primary study outcome was objective success of surgery defined as the absence of POP-Q stage 2 or more prolapse at 12 months following surgery. Questionnaires were used to assess secondary outcomes including symptoms, quality of life, and patient satisfaction.Of the 139 women, 63 of 69 (93.1%) in the mesh group and 61 of 70 (87.1%) in the no mesh group attended the 12-month follow-up. There was no significant difference at 12 months in objective success (POP-Q stage 0 or 1) between the mesh and no mesh groups (mesh: 81.0% ͓51/63͔ vs. no mesh: 65.6% ͓40/61͔; P ϭ 0.07). Although patients in both groups expressed a high level of satisfaction with the surgery and improved symptoms and parameters of quality of life compared to baseline, there was no statistically significant difference in these outcomes between the 2 groups (P ϭ ns). Postoperative complications in the mesh group included four cases (5.6%) of vaginal mesh exposure. At 12 months, de novo dyspareunia was reported in 27.8% (5/18) of the sexually active women without preoperative dyspareunia in the mesh group and in 41.7% (5/12) of those in the no mesh group. These differences were not significant (P ϭ 0.46).These findings show that anterior and posterior vaginal repair with mesh augmentation at 12 months after surgery does not result in significantly less recurrent prolapse than traditional colporrhaphy. GYNECOLOGY Volume 64, Number 12 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe presence of myomas can impair fertility. To preserve fertility in women with myomas wanting to become pregnant, myomectomy can be performed with laparotomy, laparoscopy, or hysteroscopy and achieve pregnancy rates of up to 70%. Advantages of laparoscopic techniques compared with laparotomy include shorter hospital stay, more rapid recovery, and less intra-abdominal adhesions. In addition, the overall complication rate is lower. Precise dissection and suturing, however, is especially difficult with traditional laparoscopy for myomas with a deep intramural and/or another unfavorable localization that have a probable impact on fec...

Menopausal hormone therapy and risk of ovarian cancer in the European prospective investigation into cancer and nutrition

“…It is difficult to determine whether this reflects a real similarity in associations by constituent, regimen, and route of administration or a lack of statistical power based on small numbers in these subgroups. However, our findings are consistent with data from other large prospective studies [11,12,14,16].…”

“…These findings are consistent with other prospective studies that have reported increased risks of between 25 and 107% for estrogen-only use and ovarian cancer risk [10][11][12][13][14][15][16]. The evidence for an association with use of estrogen plus progestin therapy is less consistent; most case-control studies have found no association [17- 23], while some [11,14,16], but not all prospective studies have reported small increased risks [10,12,13,15]. The Women's Health Initiative trial found a non-significant 58% higher risk (95% CI, 0.77-3.24) for estrogen plus progestin HT, based on 32 cases of ovarian cancer during an average of 5.6 years of follow-up [24].…”

“…Results from three meta-analyses have shown elevated risks for both estrogenonly and estrogen plus progestin HT, with risk estimates being somewhat higher for estrogen-only preparations, and which is entirely consistent with our findings [1][2][3]. However, a subsequent prospective study from Denmark, and the largest individual study to date, reported a stronger association for estrogen plus progestin therapy (OR, 1.50; 95% CI, 1.34-1.68) than estrogen-only HT (OR, 1.31; 95% CI, 1.11-1.54) compared with never-users [16]. In light of these findings, a revised meta-analysis or pooled analysis is needed to examine whether there are real differences in the associations by type of HT and the magnitude of these differences.…”

“…Although our study is the third largest to date [11,16], we lacked the statistical power to investigate the association of HT use with ovarian cancer risk in several subgroups defined by specific subtypes of hormone use or histological subtypes of ovarian cancer. Another limitation of this study is that HT use was assessed by self-reports only at recruitment.…”

Hormone therapy and ovarian borderline tumors: a national cohort study

“…Recently, it has been suggested that the risk is increased irrespective of the type of HT [3,4]. However, a differential risk between combined HT and estrogen-only therapy has also been suggested.…”