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Biomedical subjects

A L Magos

Publications and source records attributed to A L Magos.

65 records · Page 4Linked to original sources
PubMed1986

Treatment of the premenstrual syndrome by subcutaneous estradiol implants and cyclical oral norethisterone: placebo controlled study.

The hypothesis that the many non-specific changes normally associated with cyclical ovarian activity are the primary aetiological factors in the premenstrual syndrome was tested by suppressing ovulation with subcutaneous oestradiol implants. Sixty eight women with proved premenstrual syndrome were treated under placebo controlled conditions for up to 10 months in a longitudinal study. Active treatment was combined with cyclical oral norethisterone to produce regular withdrawal periods. Symptoms were monitored with daily menstrual distress questionnaires, visual analogue scales, and the 60 item general health questionnaire. Of the 35 women treated with placebo 33 improved, giving an initial placebo response rate of 94%. The placebo effect gradually waned, but the response to the active combination was maintained for the duration of the study. Analysis of the prospective symptom ratings showed a significant superiority of oestradiol implants over placebo after two months for all six symptom clusters in the menstrual distress questionnaire. Changes seen in the retrospective assessments were less significant but the trend was the same. Treatment with oestradiol implants and cyclical progestogen was well tolerated and appears to be both rational and effective for severe cases of the premenstrual syndrome.

Administration, Oral↗
PubMed1986

Assessment of menstrual cycle symptoms by trend analysis.

The physical, psychological, and behavioral changes associated with the menstrual cycle can be assessed statistically by time series analysis. One such method, Trigg's technique for trends, has been adapted for the study of prospective symptom ratings used in evaluation of the premenstrual syndrome. Such analysis provides both qualitative and quantitative information concerning menstrual cycle symptomatology. The pattern of symptoms, as denoted by Trigg's tracking signal, can be identified. The premenstrual syndrome can be defined mathematically in terms of significant symptom trends at specified times in the menstrual cycle. The overall severity of symptoms at any point in the cycle can be gauged by the exponentially smoothed average symptom ratings. A derived statistic, the menstrual cycle ratio, is proposed as a global index of menstrual cycle morbidity which can be easily standardized to allow for comparability of research reports.

Adult↗
PubMed1986

Trend analysis of the symptoms of 150 women with a history of the premenstrual syndrome.

The daily symptom records of 150 untreated women with a convincing history of the premenstrual syndrome were investigated qualitatively and quantitatively by means of time series analysis in the form of Trigg's technique for trends. Symptoms were monitored with use of a modified menstrual distress questionnaire. Analysis showed that, depending on the symptom cluster, 60.7% to 85.3% of the women showed symptom trends consistent with the syndrome, 14.0% to 35.3% had trends not typical of the syndrome, and in 0% to 5.3% of records significant trends were absent. Since over 80% of the women were found to have premenstrual syndrome trends for three or more of the six symptom clusters studied, including 32% who showed this trend pattern for all symptoms, a retrospective history of premenstrual syndrome is likely to be confirmed on prospective assessment for at least some symptoms. Quantitatively women who fulfilled the diagnostic criteria for premenstrual syndrome differed from those who did not by exhibiting significantly greater exacerbation of symptoms premenstrually and lesser morbidity postmenstrually. While water retention, negative affect, and pain were the three symptom clusters associated with the most severe ratings, the majority of women suffered from a mixture of physical, psychological, and behavioral complaints, and it was not possible to subdivide the study group by the type of symptoms.

Adult↗
PubMed1986

The effects of norethisterone in postmenopausal women on oestrogen replacement therapy: a model for the premenstrual syndrome.

The influence of norethisterone on mood and behaviour was investigated in prospective placebo-controlled study in 58 postmenopausal hysterectomized women who were being treated with subcutaneous oestradiol and testosterone implants. Norethisterone, 2.5 or 5 mg daily, was given for 7 days and a placebo for two periods of 7 days. Psychological, behavioural and physical variables were assessed using the Menstrual Distress Questionnaire. There were widespread adverse effects which were dose-related. Significant changes in five of the eight symptom complexes studied (pain, concentration, behavioural change, water retention and negative affect) were found with 5 mg/day of the progestogen. The symptoms were similar to the typical complaints of the premenstrual syndrome, such that a combination of oestradiol and testosterone implants with cyclical oral norethisterone appears to be a model for this condition. The dose of this progestogen should therefore be the minimum to achieve the desired therapeutic effect.

Adult↗
PubMed1985

Endometrial and menstrual response to subcutaneous oestradiol and testosterone implants and continuous oral progestogen therapy in post-menopausal women.

A regimen of subcutaneous implants of oestradiol and testosterone in combination with continuous oral norethisterone (0.35mg to 5mg daily) was used to treat 71 non-hysterectomised post-menopausal women for up to 30 mth in an attempt to avoid the withdrawal periods associated with conventional cyclical therapy, while at the same time protecting the endometrium from oestrogenic overstimulation. Amenorrhoea, defined as no vaginal bleeding for at least 3 mth, occurred immediately in 5.4-55.6% of women, the percentage depending on the daily dose of the progestogen. In those women who bled, the dose of norethisterone was adjusted at 3-mth intervals. Despite this protocol, only 51.0% of the patients were amenorrhoeic after 6 mth, and 63.2% after 1 yr. Although eight women did develop amenorrhoea for 12-27 mth, there was a high drop-out rate by the others, mainly because of unacceptable irregular bleeding. Irrespective of the bleeding pattern, endometrial biopsies 6 mth after treatment revealed endometrial atrophy. It is concluded that this form of therapy is inferior to oral continuous combined hormone replacement where amenorrhoea can almost invariably be achieved.

Administration, Oral↗
PubMed1985

Amenorrhea and endometrial atrophy with continuous oral estrogen and progestogen therapy in postmenopausal women.

An oral regimen of continuous conjugated equine estrogens (Premarin 0.625 or 1.25 mg daily) and low-dose progestogen (Norethisterone 0.35 to 2.1 mg daily) have been used to treat 95 nonhysterectomized postmenopausal women for up to 2.5 years. This method of hormone replacements was undertaken in an attempt to avoid the withdrawal bleeding and progestogenic side effects associated with conventional cyclical therapy with estrogen and progestogen, while simultaneously protecting the endometrium from estrogenic over-stimulation. With the lower dose of estrogen, amenorrhea was achieved immediately in 30 of 46 patients (65%), and after adjustments to the dose of the progestogen in all ten patients observed for at least one year (maximum 2.5 years). With the higher dose of estrogen, irregular spotting during the first three months resulted in the cessation of treatment by six of the 49 patients (12%), but 23 (47%) women had no bleeding during that time; by 15 months, all 13 patients who had remained in treatment had become amenorrheic (maximum 2.25 years). Endometrial biopsy specimens after six months of combined treatment in 56% of patients revealed atrophic histology regardless of the dose of the estrogen.

Administration, Oral↗
PubMed1983

Controlled study comparing vaginal prostaglandin E2 pessaries with intravenous oxytocin for the stimulation of labour after spontaneous rupture of the membranes.

In a prospective randomized study, 36 patients with spontaneous rupture of the membranes of greater than or equal to 4 h duration were stimulated with 3 mg vaginal prostaglandin E2 pessaries or intravenous oxytocin. Oxytocin stimulation was associated with shorter labours and a lower incidence of abnormal cervimetric progress. Of the patients given prostaglandin pessaries, 40% required a second dose after 4 h for slow progress; 45% of the primigravidae subsequently developed abnormal labour which was corrected by augmentation with oxytocin in all cases. One caesarean section was carried out for disproportion, and the remaining 35 patients were delivered vaginally. Prostaglandin pessaries were not associated with an increased incidence of hyperstimulation or sepsis. In conclusion, although PGE2 pessaries are safe in spontaneous rupture of the membranes, intravenous oxytocin is more efficient in stimulating labour.

Adolescent↗
PubMed1983

Treatment of menstrual migraine by oestradiol implants.

The suppression of cyclical ovarian activity and the creation of constant oestradiol levels in blood by subcutaneous oestradiol implants has been used to treat 24 patients with menstrual migraine for up to five years. Twenty-three patients improved with treatment, 20 (83%) became completely or almost completely headache-free. Regular monthly periods were induced with cyclical oral progestogens. The treatment was not associated with any problems. The results support the concept that oestrogen withdrawal in the late luteal and menstrual phases of the ovarian cycle is the important precipitating factor in menstrual migraine, and such attacks can be prevented by suppressing the hormonal fluctuations associated with the ovarian cycle.

Adult↗
PubMed1982

Outcome of spontaneous labour in multigravidae.

From a study of 2000 consecutive labours, the outcome of 847 multigravid patients admitted in spontaneous labour was examined. Labour was classified according to the cervimetric pattern, and response to oxytocin given according to a strict protocol with the use of a nomogram and partogram. The mean 'observed first stage' was 3.4 h, and the caesarean section rate 1.4%. Normal labour occurred in 88.5%, with a vaginal delivery rate of 99.5% in this group. Stimulation was indicated in 98 patients (11.6%), augmentation improving the rate of progress in 86 (87.8%) of these, with vaginal delivery occurring in all but one. Successful accelerated labour was not associated with any increase in neonatal morbidity as judged by Apgar scores, intubation or transfer to the special care baby unit. Twelve patients did not have improvement following augmentation and seven were delivered by caesarean section, including one following a potentially preventable uterine rupture. The greatest neonatal morbidity was in the group with primary dysfunctional labour that did not improve with augmentation. It may be that this was related to the mode of delivery rather than augmentation, as there was no significant difference in neonatal condition between normal and abnormal labour if vaginal delivery occurred.

Apgar Score↗