http://www.jmidlifehealth.org/currentissue.asp J Mid-life Health 2013 - 4(1) Journal of Mid-life Health Medknow Publications0976-7800 Navneet Magon Hema Divakar Alka Kriplani Editorial Journal of Mid-life Health 2013 4(1):1-5doi:10.4103/0976-7800.109622 Journal of Mid-life Health 10.4103/0976-7800.109622 http://www.jmidlifehealth.org/text.asp?2013/4/1/1/109622 http://www.jmidlifehealth.org/text.asp?2013/4/1/1/10962241 1 5 http://www.jmidlifehealth.org/text.asp?2013/4/1/1/109622 Navneet Magon, Hema Divakar, Alka Kriplani

Journal of Mid-life Health 2013 4(1):1-5

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/1/109622 Sonia Malik Editorial Journal of Mid-life Health 2013 4(1):6-7doi:10.4103/0976-7800.109625 Journal of Mid-life Health 10.4103/0976-7800.109625 http://www.jmidlifehealth.org/text.asp?2013/4/1/6/109625 http://www.jmidlifehealth.org/text.asp?2013/4/1/6/10962541 6 7 http://www.jmidlifehealth.org/text.asp?2013/4/1/6/109625 Sonia Malik

Journal of Mid-life Health 2013 4(1):6-7

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/6/109625 Navneet Magon Monica Chauhan Poonam Goel Sonia Malik Krishan Kapur Alka Kriplani Lakhbir Dhaliwal Suchitra N Pandit Review Article Journal of Mid-life Health 2013 4(1):8-15doi:10.4103/0976-7800.109627 Journal of Mid-life Health 10.4103/0976-7800.109627 http://www.jmidlifehealth.org/text.asp?2013/4/1/8/109627 http://www.jmidlifehealth.org/text.asp?2013/4/1/8/10962741 8 15 http://www.jmidlifehealth.org/text.asp?2013/4/1/8/109627 Navneet Magon, Monica Chauhan, Poonam Goel, Sonia Malik, Krishan Kapur, Alka Kriplani, Lakhbir Dhaliwal, Suchitra N Pandit

Journal of Mid-life Health 2013 4(1):8-15

A review of literature was conducted to report on the effectiveness of levonorgestrel intrauterine system (LNG-IUS) in women with heavy menstrual bleeding (HMB). The relevant data were obtained by computerized searches of PubMed up to December 2012 and other references available with the authors. Information was obtained from references listed. Studies and case reports were excluded if they did not specifically provide information about LNG-IUS usage in women with HMB. After perusal, each relevant publication was summarized and appraised in terms of whether it contained information relevant to the stated objective. Available data shows that LNG-IUS therapy is effective and safe, providing significant reduction of menstrual bleeding in patients with HMB. LNG-IUS is a good strategy to reduce the number of hysterectomies in women with HMB.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/8/109627 Parul Kotdawala Sonal Kotdawala Nidhi Nagar Review Article Journal of Mid-life Health 2013 4(1):16-21doi:10.4103/0976-7800.109628 Journal of Mid-life Health 10.4103/0976-7800.109628 http://www.jmidlifehealth.org/text.asp?2013/4/1/16/109628 http://www.jmidlifehealth.org/text.asp?2013/4/1/16/10962841 16 21 http://www.jmidlifehealth.org/text.asp?2013/4/1/16/109628 Parul Kotdawala, Sonal Kotdawala, Nidhi Nagar

Journal of Mid-life Health 2013 4(1):16-21

Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, office vacuum aspiration (Pipelle) and the use of office hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of finding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-ΰ-vis each other. Histological assessment is the final word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Ca. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. A single-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the office hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/16/109628 Shikha Seth Neeru Goel Ekta Singh AS Mathur Garima Gupta Original Article Journal of Mid-life Health 2013 4(1):22-26doi:10.4103/0976-7800.109630 Journal of Mid-life Health 10.4103/0976-7800.109630 http://www.jmidlifehealth.org/text.asp?2013/4/1/22/109630 http://www.jmidlifehealth.org/text.asp?2013/4/1/22/10963041 22 26 http://www.jmidlifehealth.org/text.asp?2013/4/1/22/109630 Shikha Seth, Neeru Goel, Ekta Singh, AS Mathur, Garima Gupta

Journal of Mid-life Health 2013 4(1):22-26

Objectives: To evaluate the effect of Mifepristone (25 mg) on symptomatic myoma in perimenopausal women. Study Design: Open label clinical trial. Materials and Methods: Ninety three perimenopausal women of age 35-50 years having symptomatic myoma were selected from Gynecology OPD and given 25 mg Mifepristone once daily continuously for three months. Variables as; baseline uterine size, uterine volume, myoma size, volume, their number, position, characteristics, hemoglobin and blood parameters, were taken and followed monthly for six months. Bleeding and pain scores were checked on monthly visits. Changes in above parameters were tabulated during the first three months treatment phase and then next three post-treatment phase for analysis. Statistical Analysis: Was done by calculating mean, standard deviation, standard error and percentage distribution of variables. Results: Menorrhagia was the most common symptom which led patients to report to hospital. Mean uterine volume reduced to 63.69% of baseline, Mean dominant Myoma volume reduced to 53.62% and hemoglobin level raised to 137% after complete three months of treatment. Changes persisted in next three months post-treatment follow-up, while hysterectomy was required in 10 (12.2%) cases. Conclusion: Three months treatment of 25 mg Mifepristone effectively controls bleeding, reduces the uterine and myoma volume and thus can avoid blood transfusion and hysterectomy in a lot of symptomatic myoma cases.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/22/109630 Ghazala Rizvi Harishankar Pandey Hema Pant Sanjay Singh Chufal Prabhat Pant Original Article Journal of Mid-life Health 2013 4(1):27-30doi:10.4103/0976-7800.109631 Journal of Mid-life Health 10.4103/0976-7800.109631 http://www.jmidlifehealth.org/text.asp?2013/4/1/27/109631 http://www.jmidlifehealth.org/text.asp?2013/4/1/27/10963141 27 30 http://www.jmidlifehealth.org/text.asp?2013/4/1/27/109631 Ghazala Rizvi, Harishankar Pandey, Hema Pant, Sanjay Singh Chufal, Prabhat Pant

Journal of Mid-life Health 2013 4(1):27-30

Objective : To study adenomyosis and leiomyoma as the cause of Abnormal Uterine Bleeding AUB in hysterectomy specimens. Study Method: A descriptive study was carried out on 184 hysterectomy specimens of patients with AUB during the period of Jan 2010 to Dec 2011. Data including age, parity, symptoms and clinical indication for hysterectomy was collected for the study. The specimens were processed routinely and stained with hematoxylin and eosin stain and examined microscopically. Results: Women in the perimenopausal age (40-50 years) accounted for the highest number of cases (44.56%) presenting with symptoms of AUB. In this age group adenomyosis was the found to be the commonest cause of AUB (46.34%). Conclusion: Adenomyosis was found to be the most common cause of abnormal uterine bleeding in women of perimenopausal age group.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/27/109631 Nina Mansukhani Jyothi Unni Meenakshi Dua Reeta Darbari Sonia Malik Sohani Verma Sonal Bathla Original Article Journal of Mid-life Health 2013 4(1):31-35doi:10.4103/0976-7800.109633 Journal of Mid-life Health 10.4103/0976-7800.109633 http://www.jmidlifehealth.org/text.asp?2013/4/1/31/109633 http://www.jmidlifehealth.org/text.asp?2013/4/1/31/10963341 31 35 http://www.jmidlifehealth.org/text.asp?2013/4/1/31/109633 Nina Mansukhani, Jyothi Unni, Meenakshi Dua, Reeta Darbari, Sonia Malik, Sohani Verma, Sonal Bathla

Journal of Mid-life Health 2013 4(1):31-35

Aim: To determine the efficacy of levonorgestrel intrauterine system (LNG IUS) in treatment of abnormal uterine bleeding (AUB) in women over 35 years and to determine satisfaction of users of LNG IUS in case of AUB. Materials and Methods: This was a multicentric, retrospective, and observational study. Case records of patients with AUB from the hospitals in Pune, Delhi, and Gurgaon for the last 6 years were examined. Records of 80 women who had an LNG IUS inserted were included. The chief complaints and their duration were recorded. Investigation results, histopathology reports, and date of LNG IUS insertion were noted. The incidence of spotting, heavy menstrual bleeding, pain, expulsion, and amenorrhea were recorded at 3, 6, 12, and 18 months following treatment. Following this a telephonic interview was conducted to determine the efficacy of LNG IUS in treating the symptoms. Patients' satisfaction in percentage was also noted and they were asked if they would recommend the LNG IUS to other women. Results: The mean age of women was 42.3 years. 77.5% of the women had menorrhagia as the chief complaint, and the mean duration was 12 months. Fibroids and adenomyosis were the most common pathology, present in 21.3% and 20% of the patients respectively. At 3 months, spotting seemed to be the predominant symptom (59.4%) and only 15% women had heavy bleeding. 49.3% of women were asymptomatic at 6 months. 27.5% had amenorrhea by the end of 18 months. 14 women in whom the device was expelled or removed due to persistent symptoms, underwent hysterectomy at various stages during the study period. Overall patient satisfaction was high at about 80%. Furthermore, 73.8% patients agreed to recommend it to other women. Conclusion: LNG IUS seems to be a viable and effective treatment option for AUB in women after 35 years. There is a high rate of patient satisfaction in appropriately selected patients.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/31/109633 Osama Shawki Amr Wahba Navneet Magon View Point Journal of Mid-life Health 2013 4(1):36-39doi:10.4103/0976-7800.109634 Journal of Mid-life Health 10.4103/0976-7800.109634 http://www.jmidlifehealth.org/text.asp?2013/4/1/36/109634 http://www.jmidlifehealth.org/text.asp?2013/4/1/36/10963441 36 39 http://www.jmidlifehealth.org/text.asp?2013/4/1/36/109634 Osama Shawki, Amr Wahba, Navneet Magon

Journal of Mid-life Health 2013 4(1):36-39

Abnormal uterine bleeding is a common gynecological complaint affecting 10-30% of women in midlife and constitute about one-third of all outpatient gynecological visits. It adversely affects the quality of woman's life and can lead to psychological, social, medical, and sexual problems and thus necessitating appropriate and adequate management. Different treatment modalities for such problems are available, yet the levonorgestrel intrauterine system (LNG-IUS) has recently provided a good treatment option effective in treating such complaints and at the same time, having a reliable contraceptive effect which is desired by such age group. For women in their reproductive years, the LNG-IUS has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists, and decreasing the recourse to operative treatments. It is easy to insert, has a sustained effect, cost-effective, and well tolerated besides providing reliable contraception.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/36/109634 Neela Mukhopadhaya IT Manyonda View Point Journal of Mid-life Health 2013 4(1):40-41doi:10.4103/0976-7800.109635 Journal of Mid-life Health 10.4103/0976-7800.109635 http://www.jmidlifehealth.org/text.asp?2013/4/1/40/109635 http://www.jmidlifehealth.org/text.asp?2013/4/1/40/10963541 40 41 http://www.jmidlifehealth.org/text.asp?2013/4/1/40/109635 Neela Mukhopadhaya, IT Manyonda

Journal of Mid-life Health 2013 4(1):40-41

Gynaecologists in India should be deeply concerned by the message broadcast on the BBC by Jill McGivering (6 th February 2013) in which she suggested that hysterectomy is abused in India, with the overwhelming number of women being subjected to the operation unnecessarily. Their counterparts in the UK should be no more complacent because although the hysterectomy rates have fallen over the years, yet there is widely and wildly varying rates between regions, hospitals and individual gynaecologists. Until research can be undertaken to establish what the true rates of hysterectomy should be, clear simple guidelines could go a long way to ensuring that women are not subjected to an operation they do not need, while those who would benefit are not denied an intervention that can improve their quality of life.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/40/109635 Jai Bhagwan Sharma Manisha Yadav View Point Journal of Mid-life Health 2013 4(1):42-45doi:10.4103/0976-7800.109637 Journal of Mid-life Health 10.4103/0976-7800.109637 http://www.jmidlifehealth.org/text.asp?2013/4/1/42/109637 http://www.jmidlifehealth.org/text.asp?2013/4/1/42/10963741 42 45 http://www.jmidlifehealth.org/text.asp?2013/4/1/42/109637 Jai Bhagwan Sharma, Manisha Yadav

Journal of Mid-life Health 2013 4(1):42-45

There is considerable worldwide confusion in the use of terminologies and definitions around the symptom of abnormal uterine bleeding (AUB), and these are increasingly leading to difficulties in setting up multinational clinical trials and in interpreting the results of studies undertaken in single centers. In November 2010, the International Federation of Gynecology and Obstetrics formally accepted a new classification system for causes of AUB in the reproductive years. The system, based on the acronym polyps, adenomyosis, leiomyoma, malignancy and hyperplasia - coagulopathy, ovulatory disorders, endometrial causes, iatrogenic, not classified was developed in response to concerns about the design and interpretation of basic science and clinical investigation that relates to the problem of AUB.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/42/109637 Priya Bhave Chittawar Navneet Magon Shilpa Bhandari Surgeon's Corner Journal of Mid-life Health 2013 4(1):46-51doi:10.4103/0976-7800.109638 Journal of Mid-life Health 10.4103/0976-7800.109638 http://www.jmidlifehealth.org/text.asp?2013/4/1/46/109638 http://www.jmidlifehealth.org/text.asp?2013/4/1/46/10963841 46 51 http://www.jmidlifehealth.org/text.asp?2013/4/1/46/109638 Priya Bhave Chittawar, Navneet Magon, Shilpa Bhandari

Journal of Mid-life Health 2013 4(1):46-51

Gynecological surgery is evolving continuously. Laparoendoscopic single-site surgery (LESS) is the recent addition in this field that stands to benefit almost 40% of women in midlife who will eventually undergo adnexal surgery or hysterectomy. Carried out through a single umbilical incision, the potential benefit of single site surgery is improvement in operative morbidity and cosmesis. The safety, feasibility and efficacy of laparoendoscopic single site procedures have been established in studies over the last few years. In this article, we will review the nomenclature, instruments, and the evidence around the commonly performed gynecologic surgeries using the LESS procedure.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/46/109638 B Ramesh Pooja Sharma Commentary Journal of Mid-life Health 2013 4(1):52-53Journal of Mid-life Health http://www.jmidlifehealth.org/text.asp?2013/4/1/52/109639 http://www.jmidlifehealth.org/text.asp?2013/4/1/52/10963941 52 53 http://www.jmidlifehealth.org/text.asp?2013/4/1/52/109639 B Ramesh, Pooja Sharma

Journal of Mid-life Health 2013 4(1):52-53

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/52/109639 Jyoti Kumari Sonia Malik Meenakshi Dua Case Report Journal of Mid-life Health 2013 4(1):54-56doi:10.4103/0976-7800.109640 Journal of Mid-life Health 10.4103/0976-7800.109640 http://www.jmidlifehealth.org/text.asp?2013/4/1/54/109640 http://www.jmidlifehealth.org/text.asp?2013/4/1/54/10964041 54 56 http://www.jmidlifehealth.org/text.asp?2013/4/1/54/109640 Jyoti Kumari, Sonia Malik, Meenakshi Dua

Journal of Mid-life Health 2013 4(1):54-56

Mirena levonorgestrel intrauterine system (LNG-IUS) is a very reliable method of contraception with the failure rate comparable to sterilization. We present a case of failure of the Mirena intrauterine device in situ in a woman with twin gestational sac with positive Beta Human Chorionic Gonadotropin (β HCG) within 2 years of insertion. Although LNG-IUS is one of the most effective methods of contraception, the risks of failure should always be kept in mind and the women be appropriately counseled before its use.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/54/109640 Priya B Chittawar Kailash Patel Pallavi Agrawal Shilpa Bhandari Case Report Journal of Mid-life Health 2013 4(1):57-59doi:10.4103/0976-7800.109641 Journal of Mid-life Health 10.4103/0976-7800.109641 http://www.jmidlifehealth.org/text.asp?2013/4/1/57/109641 http://www.jmidlifehealth.org/text.asp?2013/4/1/57/10964141 57 59 http://www.jmidlifehealth.org/text.asp?2013/4/1/57/109641 Priya B Chittawar, Kailash Patel, Pallavi Agrawal, Shilpa Bhandari

Journal of Mid-life Health 2013 4(1):57-59

Arteriovenous malformations are a rare but important cause of abnormal uterine bleeding in the midlife. Acquired uterine arteriovenous malformations are being increasingly diagnosed by transvaginal ultrasound, color Doppler and magnetic resonance angiography. We present a case where the suspected diagnosis was placental polyp or retained products of conception and hysteroscopy showed typical findings of uterine arteriovenous malformation, which was later, confirmed by magnetic resonance angiography. The patient underwent arterial embolization and recovered satisfactorily with resolution of hemorrhage and resumption of normal menstrual cycles. Abnormal bleeding due to arteriovenous malformations is worsened by curettage and hence its recognition is important in the management of abnormal uterine bleeding in the midlife.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/57/109641 Navneet Takkar Pragya Goel Irneet Kaur Alka Sehgal Case Report Journal of Mid-life Health 2013 4(1):60-62doi:10.4103/0976-7800.109643 Journal of Mid-life Health 10.4103/0976-7800.109643 http://www.jmidlifehealth.org/text.asp?2013/4/1/60/109643 http://www.jmidlifehealth.org/text.asp?2013/4/1/60/10964341 60 62 http://www.jmidlifehealth.org/text.asp?2013/4/1/60/109643 Navneet Takkar, Pragya Goel, Irneet Kaur, Alka Sehgal

Journal of Mid-life Health 2013 4(1):60-62

Uterine granulomas confined to the myometrium are uncommon. Granulomas maybe infectious, non-infectious or idiopathic in origin. They may be diffuse or focal in nature. In this report, we describe two cases of granulomas of diffuse variety involving the myometrium. The first case shows non-necrotizing granuloma probably related to previous instrumentation. The second case depicts caseating granulomas along with Leiomyoma of uterus.]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/60/109643 Harveen Kaur Gulati Mani Anand Sanjay D Deshmukh Letter to Editor Journal of Mid-life Health 2013 4(1):63-64doi:10.4103/0976-7800.109644 Journal of Mid-life Health 10.4103/0976-7800.109644 http://www.jmidlifehealth.org/text.asp?2013/4/1/63/109644 http://www.jmidlifehealth.org/text.asp?2013/4/1/63/10964441 63 64 http://www.jmidlifehealth.org/text.asp?2013/4/1/63/109644 Harveen Kaur Gulati, Mani Anand, Sanjay D Deshmukh

Journal of Mid-life Health 2013 4(1):63-64

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/63/109644 Salman Assad Asfandyar Khan Niazi Shuja Assad Letter to Editor Journal of Mid-life Health 2013 4(1):65-65doi:10.4103/0976-7800.109645 Journal of Mid-life Health 10.4103/0976-7800.109645 http://www.jmidlifehealth.org/text.asp?2013/4/1/65/109645 http://www.jmidlifehealth.org/text.asp?2013/4/1/65/10964541 65 65 http://www.jmidlifehealth.org/text.asp?2013/4/1/65/109645 Salman Assad, Asfandyar Khan Niazi, Shuja Assad

Journal of Mid-life Health 2013 4(1):65-65

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/65/109645 Subhasish Ghosh Subhankar Chatterjee Letter to Editor Journal of Mid-life Health 2013 4(1):66-67doi:10.4103/0976-7800.109647 Journal of Mid-life Health 10.4103/0976-7800.109647 http://www.jmidlifehealth.org/text.asp?2013/4/1/66/109647 http://www.jmidlifehealth.org/text.asp?2013/4/1/66/10964741 66 67 http://www.jmidlifehealth.org/text.asp?2013/4/1/66/109647 Subhasish Ghosh, Subhankar Chatterjee

Journal of Mid-life Health 2013 4(1):66-67

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/66/109647 Alok Sharma Yogita Dogra Letter to Editor Journal of Mid-life Health 2013 4(1):67-68doi:10.4103/0976-7800.109648 Journal of Mid-life Health 10.4103/0976-7800.109648 http://www.jmidlifehealth.org/text.asp?2013/4/1/67/109648 http://www.jmidlifehealth.org/text.asp?2013/4/1/67/10964841 67 68 http://www.jmidlifehealth.org/text.asp?2013/4/1/67/109648 Alok Sharma, Yogita Dogra

Journal of Mid-life Health 2013 4(1):67-68

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/67/109648 Sukriti Bhutani Jaikrit Bhutani Prerna Bhutani Letter to Editor Journal of Mid-life Health 2013 4(1):68-69doi:10.4103/0976-7800.109649 Journal of Mid-life Health 10.4103/0976-7800.109649 http://www.jmidlifehealth.org/text.asp?2013/4/1/68/109649 http://www.jmidlifehealth.org/text.asp?2013/4/1/68/10964941 68 69 http://www.jmidlifehealth.org/text.asp?2013/4/1/68/109649 Sukriti Bhutani, Jaikrit Bhutani, Prerna Bhutani

Journal of Mid-life Health 2013 4(1):68-69

]]> Thu,28 Mar 2013http://www.jmidlifehealth.org/text.asp?2013/4/1/68/109649