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Biomedical subjects

B M Landgren

Publications and source records attributed to B M Landgren.

At least 37 records · Page 2Linked to original sources
PubMed1997

The effect of progesterone on the haemostatic mechanism.

The hemostatic effect of progesterone administered vaginally at a dose of 100 mg twice a day throughout one menstrual cycle was investigated and compared with the coagulation factors in one untreated normal menstrual cycle in 15 women. The progesterone treatment resulted in a 20-fold progesterone rise in the early follicular phase from 1.2 nmol/l in the pretreatment control cycle to levels between 26 and 29 nmol/l during treatment. Ovulation was completely suppressed in seven women while eight women showed a slight rise in progesterone on treatment days 20 to 25 not compatible with the rise which could have been expected if ovulation had occurred. The effects found on haemostasis during progesterone treatment varied with the menstrual cycle and were so small that they could as well be due to chance and not to treatment.

Administration, Intravaginal↗
PubMed1996

Risk for ovulation in women taking a low-dose oral contraceptive (Microgynon) when receiving antibacterial treatment with a fluoroquinolone (ofloxacin).

The possibility of escape ovulation in women using a fluoroquinolone ofloxacin for antibacterial treatment at a dose of 200 mg twice daily for 7 days when taking a combined oral contraceptive (Microgynon, 150 micrograms levonorgestrel and 30 micrograms ethinyl estradiol) was studied in 20 women. By using a placebo-controlled, randomized, cross-over design 6 contraceptive pill cycles were followed. Follicle-stimulating hormone and estradiol concentrations were measured on tablet days 5-8, 19-21; progesterone was assayed on days 19-21 during treatment with ofloxacin or placebo. Ultrasonographical investigations for measurements of the number and diameter of ovarian follicles were performed on one of days 5-10, 11-17, 18-24, 25-28. No indications of ovulation during ofloxacin medication were detected. It is concluded that alternative contraceptive precautions should not be needed when ofloxacin is prescribed for patients taking oral contraceptives.

Adult↗
PubMed1996

The pharmacodynamic effects of an oral contraceptive containing 3 mg micronized 17 beta-estradiol and 0.150 mg desogestrel for 21 days, followed by 0.030 mg desogestrel only for 7 days.

During oral treatment with 3 mg micronized 17 beta-estradiol and 0.150 mg desogestrel for 21 days followed by 0.030 mg (A) desogestrel (15 women) or placebo (B) (14 women) for 7 days, ovarian function, bleeding pattern and estradiol levels were evaluated. The study was performed in a group-comparative, double-blind fashion. During a pre-treatment control cycle, using ultrasound scan, follicular diameter was measured on cycle days 10-16 and endometrial thickness on one of cycle days 22-26. Estradiol was measured at the time of ultrasound scan and progesterone three times in the luteal phase. During three treatment cycles, follicular diameter and endometrial thickness were monitored three times weekly and at the same time, estradiol and progesterone were measured. Treatment resulted in anovulation in all women. Maximum and mean estradiol levels were approximately 900 pmol/l and 550 pmol/l during treatment, respectively, and approximately 200 pmol/l during the estradiol-free weeks in both groups. Ten women showed ovarian activity (follicle size > or = 15 mm) during treatment, seven in group A and three in group B. Endometrial thickness decreased approximately 3 mm during treatment in both groups. The incidence of breakthrough bleeding and spotting was higher in group A when compared to group B. The study indicates that the combination of 3.0 mg micronized estradiol and 0.150 mg desogestrel is an effective and safe contraceptive, offering an acceptable cycle control. The addition of a low dose of desogestrel during the pill-free period did not further suppress ovarian activity nor improve the bleeding pattern. The results of this study should be interpreted with great care, since the number of women studied is relatively small.

Adult↗
PubMed1996

A new method to study the process of implantation of a human blastocyst in vitro.

OBJECTIVES: To develop a "miniorgan" culture of human endometrium dated according to the LH peak in order to study the process of implantation of a human blastocyst in vitro. DESIGN: Preliminary results of a more extensive study with the same objectives. SETTING: Hospital-based unit of reproductive health and university-related reproductive research laboratories. PATIENTS: Six apparently healthy women with normal regular menstrual cycles providing endometrial material 4, 5 and 6 days after the LH peak. INTERVENTION: One part of the biopsy was used for histologic dating. The other part was incubated in culture medium RPMI-1640 and exposed to the contact with one to three embryos fertilized in vitro. MAIN OUTCOME MEASURE: Biopsy material before and after incubation was studied by morphometric methods in a light microscope. The histologic changes were recorded by photomicrographs. RESULTS: Implantation of an embryo obtained 4 days after IVF penetrated the lining endometrial epithelium of a biopsy obtained 4 days after the LH peak and kept in vitro for 24 hours. The embryo was placed on the lining epithelium of the endometrium within 3 hours after the biopsy was taken. CONCLUSION: A new method to study the process of implantation of a human embryo in vitro has been described, allowing the embryo to penetrate the lining endometrial epithelium in a biopsy obtained at LH +4/+5.

Blastocyst↗
PubMed1996

Luteal phase oestradiol and progesterone levels are stronger predictors than follicular phase follicle stimulating hormone for the outcome of in-vitro fertilization treatment in women with tubal infertility.

Basal follicle stimulating hormone (FSH) in a natural cycle, FSH on cycle days 3 and 10 in a clomiphene citrate-stimulated cycle and oestradiol and progesterone area under the curve (AUC) in the luteal phase of the clomiphene citrate-stimulated cycle were evaluated as hormonal predictors for the outcome of IVF treatment in 53 normally cycling women with tubal infertility. The pregnant women had significantly fewer treatment cycles (P < 0.001) and needed fewer ampoules of gonadotrophins (P < 0.001). They also had more oocyte retrievals (P < 0.001), more oocytes per retrieval (P < 0.01), higher fertilization rate (P < 0.001) and more replaced pre-embryos per replacement (P < 0.01) as compared with non-pregnant women. Significant differences were found in FSH concentrations on cycle days 3 (P < 0.05) and 10 (P < 0.001) after clomiphene citrate stimulation and for oestradiol and progesterone AUC in the luteal phase (P < 0.001) between those women who became pregnant and those who did not become pregnant after IVF treatment. Luteal oestradiol and progesterone had considerably stronger predictive value for the outcome of IVF treatment as compared to basal FSH and clomiphene citrate challenge test.

Adult↗
PubMed1996

High tubal damage grade is associated with low pregnancy rate in women undergoing in-vitro fertilization treatment.

In order to analyse the relationship between grade of tubal damage and pregnancy rate following in-vitro fertilization (IVF) treatment, 50 consecutive couples with isolated tubal infertility who underwent IVF without previous reconstructive surgery were studied. The couples had tried to conceive for 2.5-5.6 years (mean 3.9 years) and had gone through a complete investigation for infertility. All women fulfilled the standard criteria for normal ovulatory cycles. All males had normal spermiograms. Tubal function was in each case evaluated by hysterosalpingography and laparoscopy. Grade of tubal damage was classified on a scale of I-IV. Patients with milder tubal damage (groups I-II) showed considerably higher take-home baby rate per started cycle (48%) than patients with severe tubal damage (group IV; 6%) (P < 0.001) even though patients in group IV underwent more treatment cycles than patients in groups I-II (2.7 versus 1.8; P < 0.01). In the first treatment cycle nine out of 12 patients in groups I-II became pregnant as compared with only one out of 16 in group IV (P < 0.01). As indicators of lower ovarian response, the women in group IV needed a higher number of gonadotrophin ampoules per cycle (P < 0.001) and exhibited lower pre-ovum retrieval oestradiol concentrations (P < 0.001). Oocyte retrievals per started cycle (I-II: 100%; III: 98%; IV: 84%) did not differ significantly between the groups, neither did pre-embryo replacements (I-II: 95%; III: 80%; IV: 73%) nor pre-embryos per replacement (I-II: 3.0; III: 2.9; IV: 2.8). The present results concerning the role of tubal damage grade for the outcome of IVF treatment should be considered in patient counselling. Further studies are needed to elucidate the mechanisms by which the extent of tubal damage may impair ovarian function and reduce IVF outcome.

Adult↗
PubMed1995

Ovarian function in relation to the outcome of in vitro fertilization (IVF) treatment in regularly menstruating women with tubal infertility.

STUDY DESIGN: Ovarian endocrine function was evaluated in 53 regularly menstruating women, 27 to 38 years of age, who failed to conceive at least 2 years following reconstructive surgery for tubal infertility. Thirty apparently healthy women, 24 to 40 years of age with proven fertility, served as controls. Blood samples were obtained daily on cycle days 2-4 and 22-26 to assess FSH, E2, and P4 results. RESULTS: There was a tendency for women with more advanced tubal damage to be subjected to more extensive surgery. Based on extent of reconstructive surgery, the patients were divided into three groups. Group A (n = 29) had less extensive surgery, limited to the fallopian tubes, group B (n = 14) included patients with extended adhesiolysis, and group C (n = 10) comprised patients that had the most extensive reconstructive procedures involving ovarian surgery. Significantly highest FSH levels were found in group C (P < 0.001) compared to groups A and B in the early follicular phase. During the luteal phase, E2 levels were lower in groups B (P < 0.01) and C (P < 0.001) compared to group A. P4 levels were lower in group C compared to groups A and B. CONCLUSION: When the patients underwent IVF treatment higher grades of tubal damage, more extensive surgery and hormonal signs of ovarian insufficiency were highly related to treatment failure.

Adult↗
PubMed1995

The effect of small doses of progesterone released from two types of vaginal rings on ovarian activity and bleeding patterns during the first postpartum year.

A total of 20 breastfeeding women used progesterone-releasing vaginal rings for up to 12 months. The women were divided into two groups, one (n = 9) using rings with an initial release rate of 5 mg/24 h, the other (n = 11) with a release rate of 20 mg/24 h. Individual women started to give breast milk supplements and ceased to breastfeed after various periods of time. Urinary estrone and pregnanediol glucuronide levels were measured by radioimmunoassay three times weekly during the entire trial. Individual diary cards were used to register bleeding and spotting. A significantly higher concentration of pregnanediol glucuronide was seen when the 20 mg/24 h ring was used in the lactation period, in comparison with the 5 mg/24 h ring. In the post-lactation period, pregnanediol glucuronide levels dropped when the 20 mg/24 h ring was used. Estrone glucuronide levels increased after the termination of breastfeeding, indicating an enhanced suppression of ovarian activity in the lactation period with both rings. Although the degree of suppression was dose-related, both rings were likely to offer a sufficient contraceptive effect in the lactation period. No significant changes were observed when milk supplements were added to breastfeeding. The use of the 20 mg/24 h ring resulted in a much better bleeding pattern (significantly less bleeding days) than the 5 mg/24 h ring during the lactation period. In the post-lactation period, the 20 mg/24 h ring the bleeding because much worse than in the lactation period.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravaginal↗
PubMed1995

Trends in the use of climacteric and postclimacteric hormones in Nordic countries.

The extent of menopausal and postmenopausal hormone use in Denmark, Finland, Norway, and Sweden during 1981-1992 was studied by means of drug sales figures and associations between hormone use, education, employment and occupational status, by questionnaire surveys in each of the respective countries in the 1980s-90s. According to sales figures, hormone use has been different in each of the countries studied. In 1981 use was three times more common in Denmark than in Norway. In 1992 use had increased in all the other countries except Denmark, and was highest in Finland and Sweden. Based on 1981 data for Norway, on 1987 data for Denmark and on 1989 data for Finland, use of hormone therapy was related to education, employment or occupational status in Finland but not in Denmark or Norway. Differences in the phases of innovation diffusion between these countries may offer a partial explanation for these results.

Climacteric↗
PubMed1994

Studies on a vaginal ring releasing levonorgestrel at an initial rate of 27 micrograms/24 h when used alone or in combination with transdermal systems releasing estradiol.

Vaginal rings releasing levonorgestrel (L-NOG) at an initial rate of 27 micrograms/24h were studied in a group of 24 normally menstruating women during three months (i.e., during three four-week segments). Each segment consisted of three weeks with the vaginal rings in situ followed by a treatment-free period of one week. The women were divided into three groups (8 subjects each). The first group received vaginal rings only, the second and third groups were treated, in addition, with transdermal systems (patches) releasing estradiol at a rate of 50 and 100 micrograms/24h, respectively. Peripheral blood samples were withdrawn three times weekly (Monday, Wednesday and Friday) during a pretreatment cycle and during the following three months of treatment. The levels of L-NOG, estradiol and progesterone were analyzed by radioimmunoassay techniques. In all subjects, endometrial biopsies were taken in a control cycle and during the last days with vaginal rings in situ in segments II and III. The treatment with estradiol did not significantly influence L-NOG levels. Considerable differences in the L-NOG levels between the subjects of the same group were observed. Fluctuation in ovarian reaction within groups was also large. Nevertheless, estradiol noticeably increased the proportion of anovulatory cycles; the total number of anovulatory segments was 5, 9 and 19 (out of 24) in the groups "No estradiol", "50 micrograms/24h estradiol" and "100 micrograms/24h estradiol", respectively. A morphometric study of the endometrium indicated a significant decrease in the diameter of glands. This change was due to L-NOG alone, but it seemed to be accentuated by the exogenous estradiol. The occurrence of glandular mitoses increased in both groups receiving estradiol in a dose-dependent manner, indicating an increased endometrial proliferation. The treatment with estradiol did not significantly alter the bleeding pattern.

Administration, Cutaneous↗
PubMed1994

Pharmacokinetic and pharmacodynamic effects of vaginal rings releasing levonorgestrel at a rate of 27 micrograms/24 hours: a pilot study.

The pharmacokinetic and pharmacodynamic effects of vaginal rings releasing levonorgestrel (L-NOG) at an initial rate of 27 micrograms/24 h were studied in a group of 12 normally menstruating women during 90 days of continuous use (i.e., during three 30-day treatment segments). Blood samples were drawn immediately before insertion, 15 and 30 min, as well as 1, 2, 4, 8, 12 and 24 h after insertion of the rings, and thereafter three times weekly throughout the study for the analysis of L-NOG, estradiol, progesterone and sex hormone-binding globulin (SHBG). Endometrial biopsies were obtained for a morphometric analysis in a pre-treatment (control) cycle and in the 6th and 10th weeks of treatment. The peak of average L-NOG levels was reached within two hours after the insertion of rings. Until 24 h after insertion, the levels did not change significantly. Thereafter, a decrease at a rate of 0.2% per day was initiated. The L-NOG and SHBG levels were highly correlated. This was seen for both the pre-treatment SHBG vs L-NOG (r = 0.96) and the treatment SHBG vs L-NOG levels (r = 0.92). There was a significant (p < 0.001) decrease of SHBG levels due to treatment. During the total of 36 treatment segments, a normal ovarian function was seen in 47% of the segments. The women were anovulatory and had an inadequate lutal function in 28% and 25% of segments, respectively. No correlation between the L-NOG levels and ovarian reaction to treatment was found. The use of L-NOG induced significant changes in the endometrium; the number of glands/mm2 decreased after 6 (p < 0.02) and 10 weeks of use (p < 0.01). Also, the diameter of glands and the occurrence of vacuolated cells decreased significantly (p < 0.02 and p < 0.005, respectively). None of the endometrial parameters or dating was correlated with the ovarian reaction to treatment, indicating independent endometrial effects of L-NOG.

Absorption↗
PubMed1994

Reproductive health, use of estrogen and experience of symptoms in perimenopausal women: a population-based study.

OBJECTIVE: The aim of the study was to examine reproductive health, use of estrogen, lifestyle, experience of menopausal symptoms and work-role related issues in a population-based sample of perimenopausal women. METHODS: All women aged 48 years and residing in the catchment area of the Karolinska Hospital were recruited through the Swedish population register. They received a questionnaire covering sociodemographic background, reproductive health and gynaecological characteristics, social and work role related issues as well as a symptom rating scale. RESULTS: Seventy percent of the women returned the questionnaire. Of these, 73% were premenopausal, 21% were postmenopausal and 6% were perimenopausal. Hormone replacement therapy was used by 7.5% of the respondents and the rate of hysterectomy was 8.6%. Regular exercise was reported by 44.4%. Factor analysis of the symptom ratings yielded four independent dimensions: Negative Moods, Vasomotor symptoms, Decreased Sexual Desire and Well-being. Multiple regression analyses showed that only vasomotor symptoms were significantly related to menopausal status. Negative Mood and Reduced Sexual Interest were better explained by the presence of vasomotor symptoms and by reproductive health and lifestyle variables such as current or previous PMS, dysmenorrhea, smoking and lack of exercise. CONCLUSIONS: Only vasomotor symptoms were significantly related to menopausal status. Psychosocial and lifestyle variables as well as past or current reproductive health are more important determinants of women's psychological well-being during transition to menopause than menopausal status.

Attitude to Health↗
PubMed1993

Hormonal and biochemical profiles of premenstrual syndrome. Treatment with essential fatty acids.

Women diagnosed as suffering from premenstrual syndrome and symptom free controls were compared on hormonal parameters, glucose tolerance, mineralocorticoids, cholesterols, triglycerides, apolipoprotein (a), magnesium and calcium in the follicular and luteal phases of the menstrual cycle. The effect of treatment with essential fatty acids on the biochemical variables was also evaluated in a randomized, double-blind crossover design. The results showed that the hormonal and biochemical profiles of women with PMS and symptom free controls were markedly similar, except for aldosterone which was lower in the follicular and luteal phases and cholesterol which was higher in the follicular phase in women with PMS. No effects of treatment with essential fatty acids were found for any of the biochemical variables studied.

Adult↗
PubMed1993

Essential fatty acids in the treatment of premenstrual syndrome.

OBJECTIVE: To determine whether essential fatty acids are effective in the treatment of premenstrual syndrome (PMS). METHODS: In a randomized, double-blind, crossover trial, we studied 27 women diagnosed with PMS over ten menstrual cycles and 22 symptom-free controls over one cycle. The first cycle was used for diagnostic assessment. For the women with PMS, placebos were administered during the second cycle. This was followed by randomization to four cycles of active treatment with essential fatty acids and four cycles of placebo, with a crossover after completion of the fourth cycle. Assessment of symptoms and diagnosis of PMS were based on daily self-ratings made by the women throughout the study. RESULTS: Treatment with essential fatty acids did not reduce premenstrual symptoms or symptom cyclicity. However, time had a significant effect on a number of symptoms, indicating either a placebo effect or an effect from participation in the study. Women with PMS had a significantly higher frequency of dysmenorrhea and familial PMS than did the symptom-free controls. CONCLUSION: Treatment with essential fatty acids is ineffective therapy for PMS. The improvement we observed over time can be ascribed to either a placebo effect or participation in the study.

Adult↗