Introduction: the role of hormone replacement therapy in prevention and treatment of cardiovascular disease in postmenopausal women.
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Aged↗
Biomedical subjects
Daniel R Mishell
Publications and source records attributed to Daniel R Mishell.
Vaginal rings delivering progesterone and estradiol may be a new method of hormone replacement therapy.
OBJECTIVE: To determine whether a low dose of P delivered together with E(2) from a vaginal ring on a continuous schedule can prevent endometrial proliferation and yield a bleeding pattern dominated by amenorrhea. DESIGN: Longitudinal clinical study. SETTING: Three university hospitals. PATIENT(S): Fifty-five women 45 to 75 years of age, not hysterectomized, with E(2) levels of <20 pg/mL and hot-flash incidence of two or more per day in the past week. INTERVENTION(S): A vaginal ring delivering approximately 150 microg/d of 17beta-E(2) and approximately 5 mg/d or approximately 9 mg/d of P used continuously for 4 and 6 months. MAIN OUTCOME MEASURE(S): Endometrial thickness, bleeding pattern, and hot flash incidence. RESULT(S): Endometrial proliferation was prevented by both P doses. Bleeding incidence decreased. In months 4, 5, and 6, 8 of 12 women had no bleeding. Incidence of hot flashes and night sweats decreased quickly and significantly. CONCLUSION(S): A vaginal ring delivering E(2) and a low dose of P merits further study as a method for long-term hormone replacement therapy.
Adult↗
A prospective randomized, double-blinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy.
BACKGROUND: Vaginal misoprostol has been shown to be an effective single agent for medical abortion. This randomized, double-blinded, placebo-controlled trial compared a regimen of mifepristone and misoprostol with misoprostol alone for termination of early pregnancy. METHODS: 250 women with gestations < or = 56 days were randomized by a random number table to receive either 200 mg mifepristone orally or placebo followed 48 h later by 800 microg vaginal misoprostol. Administration of misoprostol was repeated every 24 h up to three doses if abortion failed to occur. Abortion success was defined as complete abortion without the use of surgical aspiration. RESULTS: Successful medical abortions occurred in 114 out of 119 subjects (95.7%) after mifepristone followed by vaginal misoprostol. In all, 110 out of 125 subjects (88.0%) successfully aborted after placebo and vaginal misoprostol. The higher success rate of complete abortion with the mifepristone and misoprostol regimen was statistically significant compared with the placebo and misoprostol regimen (P < 0.05). CONCLUSIONS: A regimen of mifepristone and misoprostol was significantly more effective for termination of pregnancies < or = 56 days than misoprostol alone. The 88% efficacy obtained with vaginal misoprostol alone may be clinically acceptable when mifepristone is not available.
Abortifacient Agents, Nonsteroidal↗