Its etiopathogenesis involves mechanical and infectious factors. A key role is played by poor attachment of the infant at the breast. The diagnosis is based on history and breast examination; culture of a milk sample is sometimes indicated. An essential part of treatment is to ensure frequent milk removal through the mammary gland.
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Expression of oestrogen receptors is associated with the age and menopausal condition of women. The results showed a significant change in immunoreactivity of both studied receptors after three months of hormone therapy. The highest increase in the overall intensity occurred after three months of topical therapy. The results indicate that hormone therapy administered vaginally is the most effective in the treatment of urogenital ailments during menopause.
In addition, topical therapy eliminates adverse effects of systemic oestrogen. Menopause in women initiates a period characterised by a number of changes caused by a physiological deficiency of oestrogens. Vaginal epithelium undergoes thinning, the cells become flattened, their content of glycogen is reduced, and epithelial-connective papillae disappear.
The pH increase that accompanies these processes leads to recurrent vaginal infections and infections of the lower urinary tract. The vagina becomes susceptible to injuries. Frequent symptoms reported by patients include irritation, vaginal discharge, painful intercourse, and bleeding. The results of experimental, clinical, and epidemiological studies suggest benefits of hormone replacement therapy in menopause [ 1 , 2 ]. The benefits of this therapy and associated complications are analysed in terms of location, expression, and function of oestrogen receptors in various tissues and organs.
For a number of years it had been thought that there was only one form of oestrogen receptor through which oestrogens could affect the cells. In the presence of a new form of oestrogen receptor was demonstrated in rat prostate cells [ 3 ]. During menopause the quantity of oestrogens is reduced, leading to numerous symptoms in oestrogen-dependent tissues, i. The use of menopausal hormone therapy HTM is based on replacing natural ovarian function by administration of oestrogens or progesterone in minimum effective doses.
Oestrogens are usually administered using oral, transdermal, and vaginal routes. The advantages of oral therapy include its ease of use, a possibility to correct the dose, good drug tolerance, and the possibility to quickly stop the therapy. The disadvantages include an increased concentration of the drug immediately after administration, and its worse absorption in the case of small intestine diseases or antibiotic therapy.
Transdermal therapy allows bypassing of the liver in the first step, and also elimination of adverse symptoms of irritation in the gastrointestinal duct.
The idea for the topical therapy is the urogenital effect of hormonal drugs with a minimal systemic effect [ 1 ]. The aim of this study was a qualitative and quantitative assessment of oestrogen receptors in epithelium of the vaginal mucosa in women subjected to different forms of hormonal therapy.
The study was conducted using material collected from 60 patients of the Gynaecology Clinic of the University Clinical Hospital in Bialystok. Smears from the mucous membrane of the vagina side wall were collected from 20 patients mean age Patients were qualified for HTM based on their history and clinical examination. The examined patients did not report any organ ailments and did not take any other medications.
Four smears before the treatment and four smears after three months of menopausal oestrogen therapy were collected from each patient using a brush Cervex- Brush Rovers, Netherlands. The ABC method according to Hsu et al. The slides were rinsed with Tris buffer pH 7.
The reactions were performed in accordance with the procedures indicated by the manufacturer of antibodies. The smears from the vaginal mucous membranes were analysed by means of optical microscopy Olympus BX41 and photographed. In each case, photographs of five areas were analysed for the presence of protein stained dark brown in the nuclei as well as in the cytoplasm of epithelial cells.
The assessment of the histological pattern was conducted in a semi-quantitative way, using an immunoreactivity score. Receptor expression intensity was assessed, by evaluating coloured reaction products, in the nuclei of different cells, in each sample, at different views.
We divided the results into groups with high intensity of receptor expression in the cell nucleus intensity 3 , medium intensity of receptor expression intensity 2 , low intensity of receptor expression intensity 1 , and no receptor expression intensity 0. We quantified the number of cells with different intensity of expression in each view and performed statistical analysis by Kolmogorov-Smirnov test.
Cell labelling was usually observed in the nuclei, and only occasionally in the cytoplasm. In oral therapy, epithelial immunostaining was slight or limited to scattered nuclei Figs. In transdermal therapy the mean intensity value equalled 0. The highest increase in the overall intensity occurred after three months of topical therapy an increase from 0.
In topical hormone therapy epithelial immunostaining was more intense than in transdermal and oral hormone therapies. The average value of overall intensity in oral therapy equalled 0. In transdermal therapy the average value of overall intensity equalled 0.
After using a topical hormone therapy, the presence of the receptor was observed in the majority of the nuclei of epithelial cells Figs. The average value of overall intensity equalled 0. Menopause initiates a period of numerous changes caused by physiological oestrogen deficiency.
A normal level of hormones determines the induction of epithelial cell proliferation, which prevents urogenital atrophy [ 8 ].
Previously published research results concerning the occurrence and distribution of oestrogen receptors are not consistent. However, in other studies of Taylor et al. The highest expression of this receptor was observed in nuclei, while within the cytoplasm it was much lower. However, no significant difference in expression of this receptor before and after menopause was observed. Immunodetection revealed the presence of receptor proteins predominantly in the nucleus, and only occasionally in the cytoplasm of tested cells.
Literature reports regarding the changes in the level of oestrogen receptors present in the vagina as a result of hormone therapy are scarce, and the presented results are controversial. Discrepancies between the results may be caused by different test methods, the health condition, or age of the investigated women.
In comparative studies conducted by Gebhart et al. The patients who used HTM had lower expression levels of both receptors, as compared to women who were not subjected to hormone therapy. In the present study, in contrast to the results presented in the above study, the change of the immunoreactivity of both oestrogen receptor types dependent on the form of treatment was observed.
The results obtained in the conducted studies indicate the highest effectiveness of topical therapy in stimulating oestrogen receptors present in the epithelium of vaginal mucous membrane. The effect of topical treatment on pH change in the vagina was also confirmed by Maloney et al.
As early as after six weeks the vaginal pH decreased from 7. The obtained results led to a conclusion that topical oestrogen therapy may be effective in the treatment of urogenital ailments.
The effectiveness of vaginal oestrogen therapy in alleviating urogenital ailments was also confirmed by the studies of Cardozo et al. The presence of oestrogen receptors in genitourinary organs indicates the obvious connection of sex hormones and atrophic changes both within the reproductive organs, and in the lower urinary tract. The results may confirm beneficial effects, especially of topical oestrogenotherapy on menopausal changes in the urinary system.
National Center for Biotechnology Information , U. Journal List Prz Menopauzalny v. Prz Menopauzalny. Published online Apr Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Oct 23; Accepted Jan This article has been cited by other articles in PMC. Introduction Menopause in women initiates a period characterised by a number of changes caused by a physiological deficiency of oestrogens.
Material and methods The study was conducted using material collected from 60 patients of the Gynaecology Clinic of the University Clinical Hospital in Bialystok. Light microscopy Four smears before the treatment and four smears after three months of menopausal oestrogen therapy were collected from each patient using a brush Cervex- Brush Rovers, Netherlands. Open in a separate window. Discussion Menopause initiates a period of numerous changes caused by physiological oestrogen deficiency.
Disclosure Authors report no conflict of interest. References 1. Jakowicki J. Lublin: Biofolium; Poradnik terapeutyczny. Warszawa: PZWL; Toft D, Gorski J. A receptor molecule for estrogen: Isolation from rat uterus and preliminary characterization. The localization of estrogen receptor alpha and its function in ovaries of postmenopausal women.
Folia Histochem Cytobiol. Immunolocalisation of oestrogen receptor beta in human tissues. J Mol Endocrinol. Pelletier G, El-Alfy M. Immunocytochemical localization of estrogen receptors alpha and beta in the human reproductive organs. J Clin Endocrinol Metab. Expression of estrogen receptor isoforms alpha and beta messenger RNA in vaginal tissue of premenopausal and postmenopausal women.
Am J Obstet Gynecol. Ginekologia praktyczna. Piekarski J. The association of 6,7-H2 oestradiol with nuclear chromatin.
Biochem J. Estrogen receptor and Er-related receptor expression in normal and atrophic human vagina.
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The minilaparotomy is considered to be a safe and effective alternative to laparoscopy and abdominal laparotomy in myomectomy cases. To perform a retrospective analysis of pre-surgical assessment, surgical course and post-operational parameters in women wishing to preserve their uterus and fertility who underwent myomectomy by minilaparotomy in the Department of Gynecology and Gynecological Oncology at the Polish Mother's Memorial Hospital — Research Institute in Lodz in the years — A total of 76 patients were qualified for minilaparotomy due to a benign gynecological pathology. Only 21 patients with uterine fibroids who wanted to preserve their uterus and fertility were appropriate for this study. All studied patients were asked in about conception and pregnancy after minilaparotomy. The median age was The average decrease of hemoglobin was 1.