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Background: Perimenopause is the period during which many physiological changes mark the transition into the final menstrual period of a woman and these changes are associated with climacteric symptoms.Objectives: This study aimed to assess the efficacy and tolerability of an Ashwagandha root extract on the climacteric symptoms, quality of life (QoL), and hormonal parameters in perimenopausal women. Materials and Methods: In this 8-week, randomized, double-blind, placebo-controlled study, 100 women with climacteric symptoms were randomly allocated to take either a placebo or 300 mg of an Ashwagandha root extract twice daily. Outcomes were measured using the menopause rating scale (MRS), menopausespecific QoL (MENQoL), hot flash score, and hormonal changes in estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. Results: Among 100 participants enrolled, 91 participants completed the study. In comparison with the placebo, ashwagandha supplementation was associated with a statistically significant reduction in total MRS score (p < 0.0001), reflected by significant reductions in the psychological (p = 0.0003), somato-vegetative (p = 0.0152), and urogenital (p < 0.0001) domains. Ashwagandha intake demonstrated a statistically significant reduction in total MENQoL scores (p < 0.0001) and was also associated with a statistically significant increase in serum estradiol (p < 0.0001) and a significant reduction in serum FSH (p < 0.0001) and serum LH (p < 0.05) compared with the placebo. There was no significant between the group differences in the serum testosterone level. Conclusion: These findings suggest that ashwagandha root extract can be a safe and effective option to relieve mild to moderate climacteric symptoms during perimenopause in women.

Abstract:Desmoid is a rare tumor caused by abnormal proliferation of fibroblastic cells. The tumor may arise from fascia or/and aponeurosis of muscle. They may reach huge sizes often causing a diagnostic dilemma. Here, we present a rare case of desmoid tumor mimicking broad ligament fibroid, in a 23 year old woman without any known risk factors. Initial investigations attributed to wrong diagnosis of uterine leiomyoma whereas further investigations and surgical exploration revealed it to be a desmoid tumor. The tumor was removed completely with clear margins, and the decision regarding adjuvant chemo/radiotherapy was kept on hold depending upon the recovery and follow up visits. The patient has remained asymptomatic till date. In the case reported here, the patient's only presenting complaint was a painless abdominal mass. This added to the initial difficulty in diagnosis. So, thorough clinical examination keeping in view all the possible presentations of an abdominal mass in women is equally important in all such cases. Residual tumor and recurrence after initial resection may require adjuvant treatment with chemotherapy and/or radiation in addition to repeat surgery. Close follow up of the patient is the key to complete recovery.

Context Intravaginal placement of misoprostol has been used extensively to terminate second trimester pregnancies. Intracervical misoprostol is an alternative method of termination of pregnancy for women in this period of gestation. Objective To assess the efficacy and safety of combined intracervical and intravaginal misoprostol in the management of mid-trimester medical termination of pregnancy and to compare it with intravaginal misoprostol. Materials and MethodsIn this IRB approved prospective study, twenty-two women (mean age 25.4 ± 3.2 years, range 23-32 years; mean BMI 22.3 ± 3.4 kg/m 2 ; mean parity 2.1 ± 1.4, average gestational age 17.9 ± 2.4 weeks) underwent second trimester termination of pregnancy at our institution. Patient cohort was randomized into two treatment protocols depending on the drug used and route of administration. Induction-abortion interval, need for surgical evacuation, completeness of abortion and side effects if any were documented. Results Mean induction-abortion interval for intravaginal group and combination group was comparable (t = 7.9 ± 1.8 and 6.5 ± 3.5 h, respectively). Three patients required surgical evacuation for incomplete abortion (n = 2 after vaginal misoprostol and one after intracervical-intravaginal misoprostol). Number of patients aborting within 6 h was more in the intracervical-intravaginal group (36.3 %). Patients with intracervical misoprostol complained of abdominal pain more often than