In recent years, women who complain of climacteric symptoms increase, particularly psychological in nature. We suppose that such symptoms influence the everyday life of climacteric women. In this study, we compared health-related quality of life (HRQOL) in climacteric patients and healthy women using Short Form-36 Health Survey (SF-36) and assessed the effects of hormone replacement therapy (HRT) on HRQOL in patients with climacteric disturbance. The subjects included in this study were: 22 patients with climacteric disturbance, aged 47-63 years with a mean age of 54.5 years, who visited the outpatient clinic of the Department of Gynecology of Kobe University Hospital and 22 healthy women, aged 45∼62 years with a mean age of 54.3 years, who had regular uterine cancer screening. We classified the climacteric patients into three groups according to main symptoms: physical (somatic) symptoms group (N=10), psychological symptoms group (N=5) and mixed physical and psychological symptoms group(N=7). Assessment of HRQOL in all patients, before HRT use, using the SF-36 health survey was done and scores in each group were compared. Then, we evaluated the scale scores of the SF-36 questionnaire before and after HRT in climacteric patients. Furthermore, we compared the outcome of HRQOL according to the SF-36 and symptoms level based on Kupperman index (vasomotor, paresthesia, psychological, arthralgia, symptoms index and total index). For all scales except physical functioning, climacteric patients had significantly lower SF-36 scores. This tendency was evident especially in the mixed physical and psychological symptoms group. No significant difference was apparent in scale score of the SF-36 after HRT in the physical symptoms group, but scales of mental QOL in the psychological symptoms group and scales of both physical and mental QOL improved significantly. In addition, patients had significantly improved vasomotor symptoms and total index of Kupperman index after HRT, except for the psychological symptoms group and the mixed physical and psychological symptoms group. In summary, the results of this study imply that climacteric patient's QOL were noticeably impaired, when compared with healthy women and that psychological symptoms affect patient's QOL strongly. Further, it suggested that both physical and mental QOL improved after HRT, and the SF-36 health survey was one of the useful scales for objectively evaluating the severity and treatment outcome in patients with climacteric disturbance. [Adv Obstet Gynecol, 55(1) : 1-10, 2003 (H.15.2)]

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Singleton breech presentations are identified in 30% of second trimester pregnancies, but the incidence of breech presentations decreases to 3∼4% in the last trimester due to the spontaneous cephalic version. We assumed that if spontaneous cephalic version is inhibited, breech presentation will persist until the last trimester. In this study, the contributory factors affecting spontaneous cephalic version were assessed. We investigated 73 singleton breech presentations identified at 25th to 33rd gestational weeks. The relationship between spontaneous cephalic version and the following factors was analyzed ; maternal factors (maternal physique, size of pelvic cavity, angle of pelvic inclination and parity), fetal factors (presentation and fetal size) and fetal environmental factors (AFI, placental site, length and coils of the umbilical cord). Before delivery, 68 fetuses (93%) were converted to cephalic presentation until the 34th gestational weeks and 5 (7%) remained in breech presentation. Regarding the maternal factors, mean age, height, parity and size of pelvic cavity in both groups were similar, but body weight, body mass index (BMI) and the angle of pelvic inclination were larger in non - cephalic version group than those in cephalic version group. Fetal factors studied revealed that the percentage of frank breech presentation was higher in non - cephalic version group than that in cephalic version group. EFBW and BPD in non - cephalic version group were significantly larger than those in cephalic version group. Fetal environmental factors such as AFI, coils of the umbilical cord and thickness of placenta were similar in both groups, but the umbilical cord length in non - cephalic version group was shorter by 4cm on the average than that in cephalic version group. The incidence of placental site involving the uterine horn was obviously higher in non - cephalic version group than that in cephalic version group. The mean age at delivery in non - cephalic version group was significantly earlier than that in cephalic version group, although the mean birth weight was similar in both groups. The percentage of cesarean section in the former group was significantly higher than that in the latter group.
In conclusion, spontaneous cephalic version was less likely to be seen in pregnancies with maternal obesity, large angle of pelvic inclination, frank breech presentation, big fetus, short umbilical cord and implantation site involving the uterine horn. [Adv Obstet Gynecol,55(1):11-17,2003(H.15.2)]

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The National Institutes of Health of US announced discontinuation of the large scale prospective clinical study of hormone replacement therapy (HRT) in postmenopausal women in Women's Health Initiative (WHI) Hormone Program after interim data collection in July 2002. Since this announcement was also informed to Japan, it seemed necessary to survey the recognition of and attitude toward this hormone replacement therapy among physicians who can actually perform the therapy and middle or advanced age women who can be the subject, and to obtain information for considering the direction of the menopausal medical treatment in the future.
We examined the influence of this announcement and the way of grasping or recognition of the hormone replacement therapy by questionnairing to gynecologists and middle or older women living in the Kinki district. The subjects were 1,800 gynecologists who were engaged in medical services in Kinki district, and 6,500 women of middle or older age including patients receiving treatment at the concerned medical institutions. The results of questionnairing to women were analyzed. The recovery rate was 19.8% (1,284 answers: HRT current users, 46.0%; past users, 7.8%; non-users, 46.3%). Of HRT current users, 48.6% had an opinion to recommend HRT, but this rate decreased to 38.8% after the WHI announcement (P=0.033). However, only 4.6% answered that they will quit HRT by themselves. In HRT non-users, 20.5% recommended HRT, and 18.0% after the announcement, showing little change in the rate. Among HRT non-users, 37.7% wanted to have HRT before the announcement. It was shown that HRT was understood as a treatment of menopausal disorders at the highest rate (31.8%) among HRT non-users, but was also understood as a treatment of osteoporosis (17.5%) and a treatment for prevention of dementia (16.8%). The rate of persons who desire to have hormone replacement therapy with a regimen other than that used in this discontinued WHI clinical study as a substitution of current HRT in current users (32.2%) was significantly higher than that in past users (10.0%, P=0.00033) and non-users (14.1%, P<0.0001). The opinion that some expectant treatment is sufficient in current users (11.9%) was significantly lower than that in past users (23.0%, P=0.0057) and non-users (16.2%, P<0.030).
In conclusion, middle-aged or older Japanese women have a correct understanding about the hormone replacement therapy, and the latent demand for HRT is relatively high. Calm reception of the WHI announcement without getting panicked and the will to continue HRT even by changing the regimen in consultation with doctors were found in many HRT current users. These results require re-consideration and newly assessment of the hormone replacement therapy, and we should take prudent and active attitude toward treatment of estrogen deficiency in the menopausal medicine in the future. [Adv Obstet Gynecol, 55(1) : 18-30, 2003(H.15.2)]

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