Early menopause treatment pregnancy

Breakthrough stem cell treatment reverses symptoms of early menopause

Pioneering treatment that reverses the symptoms of early menopause has raised hopes that women affected could go on to have children naturally.

As The Daily Mail reports, stem cells from bone marrow were injected into the ovaries of 33 women suffering premature ovarian failure (POF) who began to have periods again after six months.

As well as treating early menopause, which can lead to women becoming infertile in their forties or earlier, it could also offer an alternative to hormone replacement therapy.

The US researchers who conducted the study said their aim was to ‘support improvement in quality of life and reverse infertility’. Professor Prosper Igboeli, of the University of Augusta in Georgia, said: ‘POF is a challenging condition due to loss of ovarian function in women younger than 40 years.

‘It is particularly traumatic when the diagnosis is made in early reproductive life, leaving them with post-menopausal symptoms and infertility.

‘When POF patients desire pregnancy, the only current option is to receive donor eggs. Many women, due to various religious, cultural or ethical considerations, would like to use their own eggs.’

The oestrogen levels of the women in the study rose after they received the stem cell injections, and after six months their periods began again.

In a paper to be presented at the Society for Reproductive Investigation in San Diego, California, next week, the researchers said: ‘The patients demonstrated diminished post-menopausal symptoms from episodes of hot flushes to vaginal dryness and insomnia. In addition, no complications or safety issues have been reported so far in our study. This is an active ongoing study and we plan to present additional patient data in March 2018.’

They added a ‘longer follow-up in a larger cohort will be needed to validate the utility of this novel approach’.

All the women in the study are now trying to get pregnant.

Around one in 100 women suffer POF, also known as premature ovarian insufficiency (POI).

Dr Adam Balen, of the British Fertility Society, said: ‘When a woman goes through an early menopause there are no eggs remaining in the ovaries that are able to be ovulated. However, there is some evidence that a few eggs may remain that don’t have the mechanism to be released and fertilised.

‘This interesting research suggests it may be possible to resurrect activity within a dormant ovary. For how long and with what degree of fertility potential is still very uncertain and there is no doubt that much more research is required before this can be seen as a solution for women who experience POI.’

Dr Kate Maclaran and Dr Marie Gerval, of the Daisy Network charity, said: ‘This study offers hope for women with POI that in the future, they may be able to conceive naturally or have fertility treatment using their own eggs.

‘This technique has the potential to stimulate the resumption of ovarian function, not just allowing ovulation and pregnancy but also a return of normal hormone levels, which may reduce or avoid the need for hormone-replacement therapy. ‘Many questions remain unanswered… and cautious optimism must be the message at present. Although this treatment provides an exciting hope for the future, the efficacy and long-term safety of stem cell transplant for POI needs to be established in larger studies.’

Dr Christos Coutifaris, president of the American Society for Reproductive Medicine, who was not involved in the study, said: ‘These preliminary findings are exciting.

‘The presented information suggests that injection of bone marrow-derived stem cells results in the prolongation of the lifespan of the ovary.

‘If these observations are validated under further experimental protocols, their implications for female fertility and reproductive hormonal function may prove extremely significant.’

Early Pregnancy Loss Treatment & Management

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Medical Care

A complete abortion usually needs no further treatment, medically or surgically. Patients do not need to remain in the hospital when a diagnosis of complete abortion is made; these patients are usually sent home. However, if there are concerns about significant blood loss, then the patient may need to stay for 24-hour observation and receive blood transfusions. If there are concerns regarding significant infection, IV antibiotic therapy may be needed for a short time until fever/symptoms resolve.

With missed, incomplete, or inevitable abortion present before 13 weeks’ gestation, the standard therapy has been suction D&C. However, at least 2 randomized controlled trials show that misoprostol is an effective alternative medical therapy. In one study of incomplete abortion, the patients were randomized between oral misoprostol (600 mcg) or suction D&C, with success rates at 96.3% and 91.5%, respectively. The complication rate is low (0.9% for misoprostol). [27]

The other study was a randomized controlled trial with a 3:1 randomization to medical therapy versus D&C. It included subjects with the following diagnoses: missed abortion (with or without a fetal pole; no fetal heart motion when the fetal pole was present), incomplete abortion, or inevitable abortion. In this study, the initial dose of misoprostol was 800 mcg (4 tab 200 mcg placed vaginally), and the subject was reevaluated on day 3. If the expulsion had not occurred, then a second dose of 800 mcg of misoprostol was placed vaginally. The study showed that 71% had completed abortion after the first dose by day 3, and 84% had success with misoprostol by day 8 (95% confidence interval, 81-87%). The risks for bleeding and infection were similar to those of surgical management. [28]

Medical therapy using misoprostol is an acceptable alternative to surgical therapy for most women based upon these early data. The patient should be counseled regarding the risks and benefits of both. The advantages of medical therapy is that no surgical procedures are needed if it is successful. Passage of tissue should happen within a few days of receiving medical therapy. If it is not successful, then a surgical approach may follow. The risks for medical therapy include bleeding, infection, possible incomplete abortion, and possible failure of the medication to work. The advantage of a suction D&C is that the procedure is scheduled and occurs at a known time. The risks of a D&C include bleeding, infection, possible perforation of the uterus (as noted in Surgical Care), and possible Asherman syndrome after the procedure.

In patients with recurrent pregnancy loss (≥2 miscarriages) and cellur immunity anomalies (eg, elevated natural killer cell levels or cytotoxicity and increased T-helper cell 1 (Th1) to Th2 ratio), intravenous immunoglobulin (IVIG) may improve pregnancy outcomes. [29]

In a murine model, combined therapy with sildenafil and heparin prevented fetal loss, which may have implications in the management of women with impending pregnancy loss or for prevention in women with a history of recurrent miscarriages. [30]

Large blood loss

In the situation in which a considerable amount of blood loss has occurred, aggressive hydration, iron therapy or transfusions may be indicated.

Misdiagnosis

If the diagnosis in not correct, the patient is likely to continue to bleed and cramp for an incomplete or inevitable abortion. In these situations, a suction D&C is indicated. If the patient has any signs of infection, start antibiotics prior to the D&C, if possible, without significantly delaying the suction D&C.

Ectopic pregnancy

An ectopic pregnancy may be treated medically or surgically, depending on the clinical scenario. Treatment guidelines for ectopic pregnancy are available from the American College of Obstetricians and Gynecologists. [31] (See Ectopic Pregnancy for further information.)

Note the following:

Plateau or rising hCG after methotrexate therapy

After methotrexate therapy for an ectopic pregnancy, any plateau or rising of hCG requires evaluation. In some situations, considering a second dose of methotrexate is possible. However, surgery should be considered as well.

Potential ectopic rupture

Any symptoms suggesting ectopic rupture (eg, acute pain, rebound tenderness) should immediately direct the physician to the operating room. NOoe the following:

Complete abortion

For a complete abortion, the medical care is to treat any remaining anemia and to evaluate the blood type and treat the patient with RhoGAM when indicated.

Prehospital care

Monitor vital signs and provide fluid resuscitation if the patient is hemodynamically stable.

Emergency department care

If patients know what to expect, most with complete abortions are not treated in the emergency department. Only those with significant blood loss go to the emergency department.

Patients with threatened, inevitable, incomplete, and ectopic pregnancies may go to the emergency department. Patients with threatened abortions need an ultrasonographic evaluation to confirm the diagnosis and for reassurance.

A possible treatment for threatened miscarriage is the use of progestogen. In 4 randomized studies involving 421 women that compared the use of progestogen in the treatment of threatened miscarriage with either placebo or no treatment, limited evidence suggests that the use of progestogen can reduce the rate of spontaneous miscarriage. Treatment with progestogens did not increase the occurrence of congenital abnormalities in the newborns, and the women did not have any significant difference in incidence of pregnancy-induced hypertension nor antepartum hemorrhage. Further larger studies are warranted for stronger conclusions. [32]

Consultations

Consult an obstetrician/gynecologist any time uncertainty about the diagnosis exists and to administer treatment.

Diet and activity

The patient’s diet should be regular if the diagnosis truly is a complete abortion. If any uncertainty about the diagnosis exists, restrict oral intake until certain that surgical treatment is not necessary.

The patient should rest for a few days to 2 weeks for a complete abortion. The rest schedule needs to be adjusted if one of the other diagnoses is correct.

Surgical Care

Note the following:

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[Guideline] ACOG practice bulletin. ACOG practice bulletin. Medical management of tubal pregnancy. Number 3, December 1998. Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1999 Apr. 65(1):97-103. [Medline].

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Creinin MD, Schwartz JL, Guido RS, Pymar HC. Early pregnancy failure–current management concepts. Obstet Gynecol Surv. 2001 Feb. 56(2):105-13. [Medline].

Geyman JP, Oliver LM, Sullivan SD. Expectant, medical, or surgical treatment of spontaneous abortion in first trimester of pregnancy? A pooled quantitative literature evaluation. J Am Board Fam Pract. 1999 Jan-Feb. 12(1):55-64. [Medline].

Hurd WW, Whitfield RR, Randolph JF Jr, Kercher ML. Expectant management versus elective curettage for the treatment of spontaneous abortion. Fertil Steril. 1997 Oct. 68(4):601-6. [Medline].

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Early Menopause – How To Prevent It?

Early or premature menopause is a problem that some women experience. Studies show that one out of every hundred women encounter this unfortunate problem, which cuts short their plans just at the point when they are planning to get married and have their own families. Unlike in normal menopause age of about 50 years, premature menopause sets in early in life, mid 30’s in some women. Caused by various factors including unhealthy lifestyle, heredity, poor diet, medical disorders and medications, early menopause symptoms are the same as those experienced by women who attain menopause age of 50 years. Because the effect of early menopause, it is only good that you take prevention measures. Note that although you are likely to experience some of the symptoms of menopause early in your life, you may not link the same to menopause because of your age.

Some of the preventive measures you need to take include:

  • Smoking – Cigarette smoke contains thousands of chemical, the most dangerous of these being nicotine. Apart from presenting other health risks in your body, nicotine interferes with the production of estrogen in your ovaries, leading to early menopause. While nicotine addiction can be a challenge to deal with, the good thing is that help is always available. What you need to do is have a resolve to stop smoking and develop a strong will power. Stopping to smoke and avoiding excess drinking of alcohol is a sure and effective way to stop menopause, in addition to living a healthy life.
  • Diet – Your health and well-being definitely depends on your kind of diet. A poor diet naturally leads to an unhealthy life because your body fails to receive vital life-sustaining nutrients. The production of various body hormones including estrogen depends on the nutrients your body receives. These include vitamins, minerals and essential fatty acids. A poor diet without or with inadequate supply of these nutrients means that your estrogen levels will decline, leading to early menopause. Consuming an estrogen rich diet thus, a healthy diet that is low in fats is an effective way of not only preventing premature menopause but can also reverse the same. If you suspect that your body is not receiving adequate supply of nutrients, you need to consider using estrogen supplements such as Remifemin.
  • Exercises – Unbelievably, exercises do not only keep you physically fit. By exercising, you help your body get rid of waste products faster, leaving body cells performing their functions as designed. More so, exercises relieve stress that can interfere with normal production of estrogen. This is an effective way to stop menopause early in your life.
  • Medical checkups – Certain medical conditions and disorders interfere with the production of hormones, causing early menopause. It is very important to go for medical checkups so that any present medical condition can be managed properly. By doing this, you will be arresting the impact of any condition that can cause menopause. It is during medical checkups that you can request for tests for menopause in case you have experienced first sign of menopause, which can be irregular or missed menstrual flow or hot flashes. Your doctor or health care provider will most likely recommend for the establishment of your blood follicle-stimulating hormone levels (FSH). In case you are diagnosed with early menopause, various menopause treatment options are available which your doctor may recommend.

Even though menopause treatment options are available, note that they have their own side effects. In any case, it is always better to prevent rather than cure. The above help for menopause are not only effective in preventing the onset of early menopause but also help attain overall health. Rather than wait search relief for menopause, take necessary measures to help you avoid premature menopause at all costs.

Early Menopause

The chance to conceive is directly related to the number of follicles follicles and eggs left in ovaries. Women in the relatively early stages in the process toward early menopause (i.e., women with POA POA ) have fewer follicles and eggs than they should at their age, but they usually still have enough for a good chance of pregnancy. In contrast, POF patients (i.e., women who are already in early menopause) are often down to such a small enough pool of follicles and eggs that they no longer have a realistic chance at pregnancy with use of their own eggs.

DHEA Supplementation and IVF

“With ovaries prematurely aging but not yet in early menopause, we can still help most women get pregnant, typically with in vitro fertilization (IVF).”

With POA, women usually still have a reasonable likelihood of achieving pregnancy with their own eggs, as opposed to donor eggs. Supplementation with dehydroepiandrosterone (DHEA) dehydroepiandrosterone (DHEA) , a mild male hormone treatment introduced into fertility care by CHR physicians, has played a crucial role in vastly improving treatment outcomes of younger patients with POA (early pre-menopause) and older DOR DOR patients. DHEA helps to rejuvenate ovarian function, helping women produce more better-quality eggs in preparation for IVF.

As reported in 2007, DHEA supplementation prior to IVF cycles more than doubled pregnancy rates [Barad et al. J Assist Reprod Genet 2007;24(12):629-34]. Our published data since then have shown that DHEA supplementation improves pregnancy rates, improves egg and embryo quality and reduces chromosomal abnormalities. At CHR, careful DHEA supplementation, coupled with aggressive ovarian stimulation protocols, has been an integral part of our treatment approach for women with on the unfortunate path toward early or premature menopause.

DHEA supplementation with POF, or outright early menopause, is still under investigation but appears much less successful. In contrast to women with POA, women in early menopause in most cases still needs egg donation to conceive.

IVF with Egg Donation

In vitro fertilization (IVF) with egg donation is a very effective treatment option for women with early menopause who want to conceive. In egg donation cycles, eggs are retrieved from a young donor with normal ovarian reserve (who are typically anonymous in our program), and fertilized using the patient’s partner’s (or donor’s) sperm. After a few days, embryos are transferred into the patient’s uterus.

Egg donation from young egg donors circumvents the problems of poor egg quality and small number of eggs, typical problems women in early menopause face. Because of the much higher egg quality and simply a larger number of eggs being available, pregnancy chances are much higher with egg donation. Indeed, recipients have the pregnancy chances and miscarriage risks of women at the egg donors’ age and ovarian reserve status. Cumulative pregnancy rates from a single donor IVF cycle at CHR, therefore, have been consistently in the high 80s to low 90s.

Read more about Early Menopause

What Is Early Menopause?

The average age at which women typically experience menopause is around age 51.

По материалам:

http://med.news.am/eng/news/17372/breakthrough-stem-cell-treatment-reverses-symptoms-of-early-menopause.html

http://reference.medscape.com/article/266317-treatment?cc=aHR0cDovL2VtZWRpY2luZS5tZWRzY2FwZS5jb20vYXJ0aWNsZS8yNjYzMTctdHJlYXRtZW50&cookieCheck=1

Early Menopause – How To Prevent It?

http://www.centerforhumanreprod.com/infertilityedu/causes/early-menopause/treatment/

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