Faculty Bibliography

Pieter van Keep was a founder and the third president of the International Menopause Society (IMS). He died, sadly, in 1991. Since then, every retiring president of the IMS has delivered the Pieter van Keep Memorial Lecture. This is an edited version of that lecture delivered at the 18th World Congress of the IMS in Lisbon, Portugal in 2022. In the article, President Steven R. Goldstein describes the path he followed that led him to the presidency of the IMS, including his original entry into transvaginal ultrasound, then gynecologic ultrasound and, ultimately, menopausal ultrasound. His was the first description of the benign nature of simple ovarian cysts, the ability of transvaginal ultrasound to exclude significant tissue in patients with postmenopausal bleeding and the significance of endometrial fluid collections in postmenopausal patients, just to name a few. However, it was his description of the unusual ultrasound appearance in the uterus of women receiving tamoxifen therapy that allowed his entry into the world of menopause. This, ultimately, led to leadership positions, and ultimately the presidency of the American Institute of Ultrasound in Medicine, the North American Menopause Society and, finally, the IMS, all chronicled in this article. In addition, the article describes in detail the activities of the IMS during the COVID pandemic.

The skin is an endocrine organ and a major target of hormones such as estrogens, androgens and cortisol. Besides vasomotor symptoms (VMS), skin and hair symptoms often receive less attention than other menopausal symptoms despite having a significant negative effect on quality of life. Skin and mucosal menopausal symptoms include dryness and pruritus, thinning and atrophy, wrinkles and sagging, poor wound healing and reduced vascularity, whereas skin premalignant and malignant lesions and skin aging signs are almost exclusively caused by environmental factors, especially solar radiation. Hair menopausal symptoms include reduced hair growth and density on the scalp (diffuse effluvium due to follicular rarefication and/or androgenetic alopecia of female pattern), altered hair quality and structure, and increased unwanted hair growth on facial areas. Hormone replacement therapy (HRT) is not indicated for skin and hair symptoms alone due to the risk-benefit balance, but wider potential benefits of HRT (beyond estrogen's effect on VMS, bone, breast, heart and blood vessels) to include skin, hair and mucosal benefits should be discussed with women so that they will be able to make the best possible informed decisions on how to prevent or manage their menopausal symptoms.

OBJECTIVES/OBJECTIVE:Women who experience postmenopausal bleeding (PMB) are considered to have endometrial cancer (EC) until proven otherwise. Initially, dilatation and curettage (D&C) was the gold standard of diagnosis. This was largely replaced by blind endometrial (EM) biopsy. However, recently, the relatively high false negative rate of such blind sampling in women with EC has become understood. Concomitantly, numerous studies indicate that an EM echo of ≤ 4 mm on transvaginal ultrasound (TV U/S) is a reliable enough test to exclude EC such that biopsy is not needed in initial cases of PMB. However, not all PM women will have anatomy that lends itself to a meaningful determination of EM thickness. This study was undertaken to evaluate the frequency of, and reasons for, an inability to adequately visualize an EM echo. METHODS:472 consecutive asymptomatic PM women had TV U/S as part of routine gynecologic care. Their charts and TV U/S were reviewed, and, if adequate, EM thickness was recorded. If EM thickness was not adequately visualized the reason, as judged by the examiner, for inadequacy was recorded. Other demographics included years since menopause, body mass index (BMI), and current use of hormone therapy. RESULTS:Of the 472 women, 292 (61.9%) had an EM echo that was well visualized and reliably measured (mean 3.0 mm, range 1.0 -28.0). Thus, in 180 PM women (38.1%), a distinct measurable EM echo was unable to be adequately visualized. The reasons were: fibroids (n=95, or 20.1% of overall cohort), adenomyosis (n=35, or 7.4% of overall cohort), axial uterus (n=50, or 10.6% of cohort). Mean years since menopause was 14.0 in those visualized (range 1-50), and 14.1 in non-visualized (range 1-40) (N.S.). Mean BMI was 23.9 in those visualized (range 16-41) and 25.4 (range 18-40) in those non-visualized (p=.015). CONCLUSIONS:TV U/S has become an accepted first step in the evaluation of PMB. However, in this cohort 39.8% of women had anatomic reasons for non-visualization of a reliable EM measurement including fibroids, adenomyosis, and axial uterus. There was no significant difference between groups based on years since menopause or current use of hormone therapy, but the mean BMI of the non-visualized group was significantly higher than those visualized. Clinicians should be cognizant of these potential limitations of TV U/S in the initial evaluation of women with PMB. This article is protected by copyright. All rights reserved.