Tamoxifen, a selective estrogen receptor modulator, is the standard adjuvant therapy for hormone receptor-positive breast cancer. Although it acts as an estrogen receptor antagonist in breast tissue, it may exert agonistic effects on the endometrium, increasing the risk of endometrial polyps, hyperplasia, and malignancy. We report a rare case of a 51-year-old woman who developed both an endometrial polyp and a vaginal superficial myofibroblastoma after approximately 4 years of tamoxifen therapy. This case emphasizes the importance of long-term gynecologic surveillance in patients receiving tamoxifen treatment.
Estrogen-progestogen therapy remains the clinical gold standard for managing menopausal symptoms; however, the growing emphasis on precision medicine underscores the need for individualized strategies for females with specific contraindications or distinct clinical profiles. This narrative review examines the physiological mechanisms, clinical efficacy, and safety profiles of progestogen-only and testosterone-only therapies. Evidence suggests that progestogen-only therapy, particularly oral micronized progesterone (oP4), offers a robust alternative for alleviating vasomotor symptoms and sleep disturbances through its action on GABAergic neurosteroid pathways. Notably, observational data from large cohort studies, including the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale study, suggest that oP4 and dydrogesterone are associated with a more favorable risk profile for venous thromboembolism and breast cancer than synthetic progestins used in combined hormone therapy. Testosterone therapy is specifically indicated for hypoactive sexual desire disorder, with transdermal delivery preferred to bypass hepatic first-pass metabolism. In the absence of approved female-specific testosterone products in South Korea, cautious off-label dosing and rigorous monitoring remain essential. Overall, monotherapy with progestogens or testosterone constitutes a vital component of tailored menopause management, if clinicians adhere to evidence-based protocols and remain aware of the current limitations in long-term safety data.
Osteoporosis is a systemic skeletal disorder characterized by compromised bone strength and a higher risk of fractures. Although bone mineral density (BMD) remains the primary diagnostic measure, it has several limitations, including delayed detection of therapeutic response, restricted measurement sites, and limited sensitivity to predict fracture risk accurately. Bone turnover markers (BTMs) are noninvasive indicators of bone remodeling that are increasingly being used as complementary tools in osteoporosis assessment. Among them, serum procollagen type I N-terminal propeptide and C-terminal telopeptide of type I collagen are reference markers of bone formation and resorption. However, BTM levels can be influenced by biological and pathological factors, including circadian rhythms, food intake, and assay variability, thereby limiting their routine use as predictive markers. In individuals at risk of fracture, antiresorptive agents such as bisphosphonates and denosumab cause rapid alterations in BTMs, which correlate with long-term gains in BMD and reduced fracture risk. Monitoring BTMs can help evaluate therapeutic efficacy and adherence and complement BMD measurement in fracture risk prediction. Overall, rather than being used as stand-alone diagnostic markers, BTMs should be used as complementary tools for monitoring therapeutic responses and supporting fracture risk assessment.
OBJECTIVES:This study assessed mandibular cone-beam computed tomography (CBCT) radiomorphometric indices and box-counting fractal dimension (FD) for the detection of osteoporosis in postmenopausal women. It also compared these parameters with those of a healthy control group and evaluated their correlation with bone mineral density measured using dual-energy X-ray absorptiometry (DXA). METHODS:The study included 50 postmenopausal women aged > 45 years, who were categorized into osteoporotic and control groups based on DXA results. Mandibular CBCT radiomorphometric indices and FD analysis were performed. RESULTS:Significant differences were observed in the CT cortical index, with Type 3 changes more frequently in the osteoporotic group (48.0%), whereas Type 1 morphology was predominant in controls (64.0%) (P < 0.001). Mean values were significantly lower in osteoporotic participants (0.24 ± 0.05, 0.29 ± 0.06, and 3.37 ± 0.53, respectively) compared with controls (0.29 ± 0.06, 0.35 ± 0.07, and 4.05 ± 0.46, respectively) (P ≤ 0.002). Fractal dimension value was significantly higher in the osteoporotic group (1.98 ± 0.01 vs. 1.96 ± 0.01, P < 0.001). Receiver operating characteristic analysis showed that an FD cutoff value of > 1.976 yielded 72.0% sensitivity and 100.0% specificity for distinguishing individuals with osteoporosis. CONCLUSIONS:CBCT radiomorphometric indices may serve as a useful adjunct for identifying individuals at risk of osteoporosis and for guiding referral for further evaluation.
OBJECTIVES:To assess the periodontal status and oral health-related quality of life (OHRQoL) among postmenopausal women attending a tertiary government hospital. METHODS:A cross-sectional study was conducted among 266 postmenopausal women visiting a tertiary government hospital. Demographic data, such as age, education level, marital status, hormonal fluctuations, parity, frequency of tooth brushing, and history of recent dental visits were collected. Participants' OHRQoL was assessed using the oral health impact profile-14 (OHIP-14) questionnaire, and their periodontal status was evaluated using the World Health Organization oral health assessment form for adults. RESULTS:The total mean OHIP-14 score among participants was 26.9 ± 8.48, with the majority (57.1%) reporting poor OHRQoL. Further, they had a significantly higher mean number of teeth with pockets and loss of attachment (P = 0.001). Moreover, the number of teeth with bleeding showed significant negative correlations with the overall OHIP-14 score (r = -0.11, P = 0.05), functional limitation (r = -0.14, P = 0.01), psychological discomfort (r = -0.21, P = 0.004), and psychological disability (r = -0.13, P = 0.02). Overall, OHIP-14 and all its categories demonstrated statistically significant, but, weak positive correlations with the number of teeth with pockets and loss of attachment (P = 0.001). CONCLUSION:The mean numbers of teeth with bleeding, as well as teeth with pockets and loss of attachment are significantly associated with OHRQoL in postmenopausal women.
This systematic review with meta-analysis aimed to investigate the effects of physical exercise and physical activity on sleep quality and urinary incontinence in menopausal women and to assess the strength of evidence from randomized clinical trials. Following the PRISMA checklist, this study was registered in PROSPERO (CDR42024587503), five databases were searched (i.e., Cochrane Library, Embase, Scopus, Web of Science, and PubMed Central®) from October 2017 to November 2017, including randomized clinical trials that assessed certain types of physical exercise and physical activity for urinary incontinence and/or sleep quality in menopausal women, which were written in English and published in the last 10 years. Fourteen articles were selected for this review, which assessed 1,230 women for sleep quality and 482 women for urinary incontinence. A low risk of bias and moderate to high methodological quality were observed in most studies. With regard to sleep quality, the studies showed high heterogeneity (I² = 90%), with a 95% CI of -4.32 to -3.37 (P < 0.01), suggesting favorable results for the groups receiving physical exercise and physical activity interventions. With regard to urinary incontinence, the studies showed high heterogeneity (I² = 97%), with a 95% CI (-0.95 to -0.07, P < 0.01), indicating favorable results for specific pelvic floor strengthening exercises. In summary, physical exercise and physical activity were shown to improve sleep quality and urinary incontinence, but caution is needed when assessing the specific effects of different types of exercise on each outcome.
This review aimed to summarize the biological rationale for the protective effects of estrogen, the robust evidence supporting the benefits of menopausal hormone therapy (MHT), and the evolving regulatory and historical context shaped by the reinterpretation of the Women's Health Initiative data. This study outlines the risk-benefit profile of contemporary MHT regimens and presented a modern clinical framework for the use of MHT as a preventive strategy to support metabolic, cardiovascular, and skeletal health across and beyond the menopausal transition. Moreover, this review emphasized that menopausal symptoms should be recognized as a critical biological inflection point necessitating proactive intervention. Furthermore, the 2025 FDA regulatory shift reinforces the safety and efficacy of individualized MHT when initiated within the "window of opportunity," providing a definitive strategy for long-term prevention of chronic diseases in healthy women.
Sleep disturbances are highly prevalent during menopausal transition and postmenopause; however, the underlying mechanisms remain incompletely understood. Epidemiological cohort studies demonstrate a sharp increase in the occurrence of insomnia symptoms in midlife coincident with declining estradiol levels, vasomotor symptoms (VMS), and increased susceptibility to depression and anxiety. These psychological factors interact bidirectionally with insomnia, amplifying its adverse impacts on health-related quality of life. Additional contributors-including lower urinary tract symptoms, musculoskeletal pain, reduced muscle mass, and sleep-disordered breathing-emphasize the multifactorial nature of menopausal insomnia. Management includes hormonal, pharmacological, and nonpharmacological strategies. Although menopausal hormone therapy remains the most effective treatment for VMS, its benefits for sleep are inconsistent and largely limited to subjective improvement. Randomized trials suggest that non-benzodiazepine hypnotics can enhance sleep initiation and maintenance; moreover, traditional herbal formulas (e.g., Kampo) may benefit selected women, although the evidence is limited. Newer dual orexin receptor antagonists, such as suvorexant, daridorexant, and lemborexant, have shown efficacy with regard to sleep onset and maintenance in adults, including women in their midlife. By integrating epidemiological findings, mechanistic insights, and comparative treatment data, this review emphasizes individualized care tailored to symptom profile, risk factors, and patient preference. Future research should bridge gaps between subjective and objective evaluations and delineate biological pathways (neuroendocrine, circadian, orexin, and inflammatory/myokine) to guide targeted therapies.
Hormonal and age-related physiological changes significantly predispose postmenopausal women to recurrent urinary tract infections (rUTIs). The low estrogen levels characteristic of menopause can lead to genitourinary syndrome, which disrupts vaginal microbiota, weakens urinary defenses, and increases susceptibility to infections. A history of rUTIs, diabetes mellitus, sexual activity, and estrogen therapy is among the key risk factors for rUTIs. These factors may compromise urinary tract defenses, enabling bacterial colonization and infection. Given that frequent antibiotic treatment can lead to antimicrobial resistance, bioactive natural compounds are promising alternatives for UTI management. This review explores the role of bioactive compounds in natural remedies and functional foods as potential non-antibiotic approaches for rUTI management in postmenopausal women. Key bioactive compounds, including benzoic acid, proanthocyanidins, D-mannose, arbutin, phytoestrogens, berberine, vitamin C, and oleuropein, inhibit bacterial adherence and support urinary health. Functional foods enriched with these compounds, along with probiotics and cranberry products, may enhance urinary health and quality of life in postmenopausal women. However, due to the paucity of corroborating evidence, further well-designed clinical research is essential to validate efficacy, determine safety, and establish evidence-based dietary recommendations for UTI prevention.
Osteopenia-defined by a bone mineral density T-score between -1.0 and -2.5-is more common than osteoporosis and accounts for most fragility fractures in postmenopausal women. Approximately 50% of Korean women aged ≥ 50 years have osteopenia. Despite this high prevalence, optimal therapeutic strategies remain unclear. This review summarizes the clinical significance and management of osteopenia. Clinical practice often categorizes osteopenia into mild, moderate, and severe based on specific T-score ranges. Studies indicate that women transitioning from normal or moderate osteopenia to lower bone density experience more fractures. One study reported that approximately 10% of women with normal BMD or osteopenia progressed to osteoporosis, mostly from moderate to severe osteopenia groups. Fracture risks, particularly for hip and vertebral fractures, are elevated mainly in moderate to severe osteopenia. The National Osteoporosis Foundation and the American Association of Clinical Endocrinologists incorporate FRAX® scores alongside T-scores and clinical history to guide pharmacological intervention. Accordingly, South Korean guidelines classify fracture-risk groups as low, moderate, high, or very high, allowing treatment of patients with osteopenia in the high-risk categories. Evidence supporting medications for fracture prevention remains limited. However, growing interest in preventing fractures has directed the ongoing studies to evaluate various drugs. Food and Drug Administration-approved treatments include menopausal hormone therapy, bisphosphonates, and selective estrogen receptor modulators. To reduce fractures in postmenopausal women, treatment should not be restricted to osteoporosis alone. Women with moderate to severe osteopenia may also benefit from medications used for osteoporosis. Clinicians should assess individual fracture risks and select preventive treatments based on risk level, fracture site, menopausal symptoms, patient preference, and cost-effectiveness.
The prevalence of pelvic organ prolapse (POP) is expected to rise as the population ages, leading to an increased demand for surgical interventions. Although surgery is required to treat POP, there is currently no method that can effectively treat the condition with a low risk of recurrence. The purpose of this video is to demonstrate the technique of transvaginal insertion of a band-shaped silicone implant into the vaginal mucosa to repair advanced uterine prolapse and vaginal laxity. A 67-year-old woman presented with complaints of urinary incontinence and uterine prolapse and was classified as POP-Q stage 4. We utilized a live surgical demonstration to illustrate the technique of transvaginal surgery involving the insertion of a medical silicone band, referred to as the Dreamcore, into the vaginal wall. This video demonstrates the procedure of transvaginal insertion of the band-shaped silicone implant (Dreamcore) into the vaginal mucosa to repair uterine prolapse and vaginal laxity. Following surgery, the patient's POP-Q stage improved from 4 to 0. Vaginal volume decreased within 6 weeks post-surgery and remained stable for 1 year after the procedure. This case report suggests that the novel procedure of implanting the Dreamcore into the vaginal wall may be a promising treatment option for advanced stages of POP and vaginal laxity, pending further studies to confirm its safety and effectiveness.
OBJECTIVES:This study was conducted to compare the clinical and hormonal characteristics among women with polycystic ovary syndrome (PCOS) phenotype D, functional hypothalamic amenorrhea (FHA) with polycystic ovarian morphology (PCOM), and FHA without PCOM and investigate potential markers for their distinction. METHODS:This retrospective pilot study included women who were examined for menstrual irregularities at a Korean tertiary hospital during 2018-2025 with following conditions: PCOS-D (n = 66), FHA with PCOM (n = 10), and FHA without PCOM (n = 29). Clinical features and hormonal profiles were analyzed using nonparametric tests, effect size estimation, and logistic regression. RESULTS:BMI, along with LH, FSH, and AMH levels differed significantly across groups. AMH levels exhibited the following gradient: highest in PCOS, intermediate in FHA-PCOM, and lowest in FHA without PCOM. Subgroup analysis indicated that LH and FSH levels alongside LH/FSH ratio distinguished PCOS-D from FHA-PCOM (all P < 0.001, large effect sizes). Logistic regression revealed LH/FSH ratio as the only independent predictor (OR 58.88, 95% CI 3.29-1054.27). FHA without PCOM exhibited more persistent amenorrhea, whereas FHA-PCOM appeared milder and possibly reversible. CONCLUSION:LH/FSH ratio, supported by BMI and clinical history, may help distinguish PCOS-D from FHA-PCOM. FHA-PCOM represents a distinct but understudied subgroup. These results are preliminary and require validation through larger prospective studies.
OBJECTIVES:To evaluate physicians' knowledge and attitudes in Singapore regarding menopause hormonal therapy (MHT). METHODS:We conducted a cross-sectional survey of 186 physicians practicing in Singapore, including 113 in Family Medicine and 73 in Obstetrics and Gynaecology (O&G). Knowledge was assessed using 21 questions: five questions each on indications, contraindications and risks, and six clinical scenario questions. Attitudes were assessed using five questions: confidence in prescribing, beliefs about the necessity of MHT, whether they would recommend it for patients or family, and concerns about its safety profile. Data were analyzed using descriptive statistics. Comparisons of knowledge and attitudes across demographic variables and specialties were performed using t tests for continuous variables and chi-squared tests for categorical variables. RESULTS:Forty point three percent of physicians were unaware that MHT is used to prevent postmenopausal osteoporosis. Sixty-six point one percent and 30.6% of physicians, respectively, were unaware that patients on MHT are at a higher risk of gallbladder disease and stroke. Fifty-two point two percent would have chosen non-hormonal treatments for patients with premature ovarian insufficiency. Most physicians expressed a lack of confidence in prescribing MHT (74.2%), with a significant difference (P < 0.001) between the specialties (58.9% of O&G physicians vs. 84.1% of Family Medicine physicians). More than half (61.3%) of physicians expressed safety concerns about MHT. CONCLUSIONS:Information about MHT continues to evolve, emphasizing the importance of keeping physicians updated. Knowledge gaps vary among specialties. Improving physicians' knowledge by targeted educational interventions should help bolster confidence.
Diminished ovarian reserve (DOR) occurs unintentionally during treatment or spontaneously. Despite its significant clinical manifestations, such as infertility and early menopause, and its high prevalence, most studies on DOR have focused on premature ovarian insufficiency, and reviews specifically addressing DOR remain scarce. This narrative review aims to provide insight into the diverse etiologies of DOR while discussing promising therapeutic approaches. Iatrogenic DOR can occur during chemotherapy, pelvic radiation, and ovarian surgery. Spontaneous DOR may result from ovarian tumors as well as idiopathic or genetic causes. DOR also inevitably occurs during ovarian fragment transplantation. Stem cell transplantation, in vitro activation, and platelet-rich plasma injection have shown some positive results as therapeutic approaches to DOR; however, more high-quality studies are needed to establish their broader applications in clinical practice.
OBJECTIVES:This study aimed to evaluate the relationship between menopausal hormone therapy (MHT) and the development of major ocular diseases, including cataract, glaucoma, and retinal disorders. METHODS:This retrospective cohort study used data from the Korean National Health Insurance Service database (2005-2015) comprising 23,333 women diagnosed with menopause, International Classification of Diseases, 10th Revision code N95. Participants were categorized into MHT and non-MHT groups. Incidence rate ratios (IRRs) of ophthalmologic diseases were analyzed, with subgroup analyses by age at menopause, time to MHT initiation, and duration of therapy. RESULTS:A total of 18,228 women were included. The MHT group had a significantly lower incidence of glaucoma than the non-MHT group (IRR 0.921, 95% confidence interval [CI] [0.869, 0.975]). The protective effect was most evident in women who experienced menopause at 40-49 years (IRR 0.851, 95% CI [0.762, 0.951]). Initiating MHT within 1 year of menopause was linked to a reduced glaucoma risk (IRR 0.896, 95% CI [0.844, 0.951]), while delayed initiation increased the risk (IRR 1.161, 95% CI [1.024, 1.316]). MHT use for ≥ 365 days was associated with lower risks of glaucoma (IRR 0.888, 95% CI [0.816, 0.967]) and retinal disorders (IRR 0.886, 95% CI [0.789, 0.995]) compared to shorter use. CONCLUSIONS:MHT use is associated with reduced glaucoma risk in postmenopausal women, especially those aged 40-49 years. These findings highlight the potential ocular benefits of MHT and the importance of early initiation in younger menopausal women.
