OBJECTIVE -Phytoestrogen consumption has been shown to reduce risk factors for cardiovascular disease. Type 2 diabetes confers an adverse cardiovascular risk profile particularly in women after menopause. The aim of this study was to determine whether a dietary supplement with soy protein and isoflavones affected insulin resistance, glycemic control, and cardiovascular risk markers in postmenopausal women with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 32 postmenopausal women with diet-controlled type 2 diabetes completed a randomized, double blind, cross-over trial of dietary supplementation with phytoestrogens (soy protein 30 g/day, isoflavones 132 mg/day) versus placebo (cellulose 30 g/day) for 12 weeks, separated by a 2-week washout period.RESULTS -Compliance with the dietary supplementation was Ͼ90% for both treatment phases. When compared with the mean percentage change from baseline seen after 12 weeks of placebo, phytoestrogen supplementation demonstrated significantly lower mean values for fasting insulin (mean Ϯ SD 8.09 Ϯ 21.9%, P ϭ 0.006), insulin resistance (6.47 Ϯ 27.7%, P ϭ 0.003), HbA 1c (0.64 Ϯ 3.19%, P ϭ 0.048), total cholesterol (4.07 Ϯ 8.13%, P ϭ 0.004), LDL cholesterol (7.09 Ϯ 12.7%, P ϭ 0.001), cholesterol/HDL cholesterol ratio (3.89 Ϯ 11.7%, P ϭ 0.015), and free thyroxine (2.50 Ϯ 8.47%, P ϭ 0.004). No significant change occurred in HDL cholesterol, triglycerides, weight, blood pressure, creatinine, dehydroepiandrosterone sulfate, androstenedione, and the hypothalamic-pituitary-ovarian axis hormones.CONCLUSIONS -These results show that dietary supplementation with soy phytoestrogens favorably alters insulin resistance, glycemic control, and serum lipoproteins in postmenopausal women with type 2 diabetes, thereby improving their cardiovascular risk profile. Diabetes Care 25:1709 -1714, 2002C ardiovascular diseases (CVDs), especially coronary heart disease and cerebrovascular disease, are the leading causes of death in women (1). Type 2 diabetes increases the risk of death from CVD by two-to fourfold (2), and women with diabetes are four times more likely to die from CVD than men (3). Postmenopausal estrogen depletion (4) and increased insulin resistance (5) may contribute to the high risk of accelerated CVD in women with type 2 diabetes.Epidemiological data suggest that in Japanese-Americans in Seattle, WA, the prevalence of type 2 diabetes is four times that in Japanese in Tokyo (6,7). Despite very similar degrees of hyperglycemia, the Japanese-Americans with type 2 diabetes showed significantly higher levels of plasma insulin after a 75-g oral glucose tolerance test (OGTT) than Japanese with diabetes (6,8), and BMI correlated with insulin levels only for the JapaneseAmerican men (8). This observation suggested a greater degree of insulin resistance among the Japanese-Americans and that factors other than BMI were responsible for the difference in plasma insulin levels between the two groups (9). Soy is a staple in the diet of the Japanese population, and consumption of soy has ...

This paper presents a 5-year follow-up of a randomized, controlled trial, which compared microwave endometrial ablation (MEA) with transcervical resection of the endometrium (TCRE) for women with heavy menstrual bleeding. Two hundred sixty-three women were randomized to receive either MEA (n ϭ 129) or TCRE (n ϭ 134). For the current study, participants who were at least 60 months postprocedure were sent a questionnaire concerning satisfaction with and acceptability of their treatment method, menstrual status, changes in health-related quality of life, and any further surgery received. This was the same questionnaire that had been sent at 1-and 2-years of follow-up.Two hundred thirty-six of the original 263 study participants (90%) returned a completed questionnaire, including 116 MEA patients and 120 TCRE patients. Total or general satisfaction was reported by significantly more of those who underwent MEA compared with those who had TCRE (86% vs. 74%). Similarly, 83% and 75%, respectively, reported a cure or acceptable improvement in their symptoms, 97% and 91% expressed overall treatment acceptance, and 97% and 89% said that they would recommend the procedure to a friend. Both groups had similar, significant improvement in bleeding and pain scores, and 96% overall reported amenorrhea or lighter periods. Significantly more women in the TCRE group experienced dyspareunia compared with the MEA group (11% vs. 6%, respectively). Premenstrual symptoms improved significantly for both groups.Quality-of-life scores were improved for all participants. Disruptions to work or leisure activities were significantly lower in both treatment groups.In all, 24% of the patients who had MEA and 28% of those who had TCRE had undergone further gynecologic surgery in the follow-up period. This includes a 16% hysterectomy rate for the MEA cohort and 25% hysterectomy rate for women who had TCRE. Nearly all of the 20 hysterectomies among women in the MEA arm occurred within 24 months of the initial procedure. Reasons for hysterectomy were bleeding, combined bleeding and dysmenorrhea, cyclic pain, and miscellaneous conditions, including 1 woman in the TCRE arm who was operated on for endometrial carcinoma. GYNECOLOGY Volume 60, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT The authors performed a medical chart review of all women diagnosed with atypical squamous cells of undetermined significance (ASCUS) between July 2002 and February 2004 to determine the presence of oncogenic human papillomavirus (HPV) according to patient age. Other risk factors were also noted. Cervical smears were evaluated using fluid-based thin-layer cytology (PreservCyt; Cytyc Corp., Marlborough, MA). Office Gynecology 435 436 Obstetrical and Gynecological Survey ABSTRACT This paper presents a series of 970 women who reported to the Chronic Pelvic Pain Clinic at the University of North Carolina between July 1993 and December 2000 with pelvic pain of at least 6 months duration. The authors investigated the prevalence of irritable bowel syndrome (IBS) in th...

This study was designed to assess the biological variability of total testosterone and SHBG in polycystic ovarian syndrome (PCOS) and to determine the use of SHBG as a surrogate marker of insulin resistance in PCOS. Fasting blood samples were collected at 4-d intervals on 10 consecutive occasions from 12 PCOS patients and 11 age- and weight-matched controls. Duplicate samples were analyzed for SHBG, testosterone, and insulin in a single batch, and insulin resistance was calculated by the homeostasis model assessment method (HOMA-IR). The PCOS group had higher testosterone (mean +/- SD, 3.9 +/- 0.8 vs. 3.2 +/- 1.3 nmol/liter; P = 0.001), lower SHBG (28.6 +/- 17.1 vs. 57.6 +/- 30.2 nmol/liter; P = 0.001), and greater HOMA-IR (5.85 +/- 5.3 vs. 1.67 +/- 0.63 U; P = 0.001) than the controls. In contrast to HOMA-IR (1.09 vs. 0.48 U; P = 0.001), the intraindividual variation in SHBG was lower in the PCOS group (mean, 3.4 vs. 6.3 nmol/liter; P = 0.041). The index of individuality for SHBG and testosterone in PCOS was 0.49 and 0.69, respectively. This study shows that for patients with PCOS, SHBG is an integrated marker of insulin resistance that may be of use to identify insulin-resistant individuals for targeted treatment with insulin-sensitizing agents. However, SHBG and testosterone concentrations measured in isolation are inherently unsuitable for use as tests to detect hyperandrogenemia.

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A diet supplemented with soy protein and isoflavones has been shown to reduce cardiovascular risk factors in postmenopausal women with type 2 diabetes. However, it remains unclear which component is responsible for these effects. Our aim was to determine whether the addition of isoflavones alone modifies cardiovascular disease risk markers in this group of patients. Cardiovascular disease (CVD) is the leading cause of mortality in women in developed countries (1), and women with diabetes are four times more likely to die from CVD than men (2). Among other factors, postmenopausal estrogen depletion, greater insulin resistance, and dyslipidemia (3,4) may contribute to high risk of accelerated CVD.Modification of lifestyle is important to reduce CVD risk factors and delay progression of type 2 diabetes-associated complications. In particular, the addition of oral supplements, such as soy products, as part of a healthy diet has attracted recent interest because of their beneficial effects on lipid profiles (5-10). However, scant information is available on the effects of soy in individuals with type 2 diabetes (11-13), who are at higher risk due to hyperlipidemia, lower HDL levels, and abnormalities in LDL/lipoprotein composition (14). It also remains unclear whether a beneficial effect can be attributed to the soy protein or isoflavones.We have shown that soy protein combined with isoflavones can improve glycemic control, insulin resistance, and lipids in patients with type 2 diabetes (11). Therefore, our aim was to determine if this effect was due to the isoflavone component alone. RESEARCH DESIGN ANDMETHODS -This was a randomized, double-blind, placebo-controlled, crossover study with a 4-week washout period separating the placebo and active phases (12 weeks each). Subjects provided informed consent. Randomization was performed using a random number generator. Thirty-two Caucasian, postmenopausal women with diet-controlled type 2 diabetes (according to World Health Organization criteria) (15) and amenorrhoa (for Ͼ1 year) were recruited. Exclusion criteria were breast/uterine cancer; uncontrolled hypothyroidism; and treatment with oral hypoglycemic agents, insulin, estrogens, or statins initiated Ͻ4 months before the trial.Baseline characteristics are included in Table 1. Six subjects withdrew from the study: one required a cholecystectomy and one a coronary angioplasty, one had an acute attack of polymyalgia rheumatica requiring steroids, and three were unable to comply with study requirements. InterventionThe soy preparation (Essential Nutrition) contained 132 mg isoflavones (53% genistein, 37% daidzein, and 10% glycitein). It was devoid of soluble fiber. The placebo was an identical tablet of microcrystalline cellulose. Compliance was monitored by counting returned medication. Study measurementsVenous blood samples were collected at each visit after a 12-h overnight fast. A1C, glucose, and lipid levels were measured using standard methods. LDL cholesterol was calculated using the Friedewald equation and insulin...