[Let us register all cases of IUD perforation!].
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Female↗
Biomedical subjects
I Milsom
Publications and source records attributed to I Milsom.
Beneficial effect of treatment with transdermal estradiol-17-beta on exercise-induced angina and ST segment depression in syndrome X.
We investigated the acute effect of transdermal estradiol-17-beta on exercise-induced ischemia in 15 postmenopausal women (mean age 58 +/- 6 years) with syndrome X (angina pectoris, positive exercise test and normal coronary angiogram) and eight healthy women (mean age 58 +/- 5 years) in a placebo-controlled, double-blind crossover trial. Two exercise tests were performed on separate days, separated by at least 1 week, after application of placebo or 100 micrograms/24 h estradiol-17-beta. In the control group there was no difference between estradiol and placebo. Patients with syndrome X, on the other hand, showed an increased time to angina (323 +/- 99 versus 233 +/- 67 s, P = 0.0044), time to 1 mm ST depression (257 +/- 142 versus 187 +/- 122 s, P = 0.039), total exercise time (363 +/- 104 versus 323 +/- 85 s, P = 0.038), and working capacity (93 +/- 17 versus 89 +/- 15 W, P = 0.0086) during active treatment. In conclusion, estradiol-17-beta has a beneficial effect on myocardial ischemia in postmenopausal women with syndrome X and may be a useful therapeutic agent in this disease.
Administration, Cutaneous↗
[TENS is effective in painful menstruation].
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Adult↗
Oral contraceptives and thrombotic diseases: impact of new epidemiological studies.
Oral contraceptives (OCs) are, or perhaps more correctly, were, until recently, being taken by approximately 65 million women worldwide, which corresponds to approximately 6% of all women of reproductive age. OCs have been available since the early 1960s, and there is substantial evidence to suggest that no single medication has had such a profound impact on our reproductive and social life than the pill. In the Scandinavian countries, 30-50% of young women have been reported to be using OCs. Its widespread use throughout the world for several decades indicates that women and their doctors have considered that the benefits of OCs outweigh potential side effects. On October 18, 1995, the Committee on Safety of Medicines in the United Kingdom sent a warning to all British doctors and pharmacists about OCs containing desogestrel or gestodene. A similar warning was subsequently distributed by the German and Norwegian health authorities. As these OC types dominate the market in Northern Europe, many gynaecologists, general practitioners, women of reproductive age, different national bodies on drug safety, and people in general have been asking: * What was the background for these actions? * How do we interpret the new studies? * What do we do now concerning prescription of OCs? * What is the moral of this story?
Contraceptives, Oral↗
Management of hormone replacement therapy: the Swedish experience.
OBJECTIVE: To describe the experience of Swedish physicians in the management of hormone replacement therapy (HRT). METHODS: A postal questionnaire was sent to a sample of Swedish women aged between 46 and 62 years of age. The sample represented one woman in two from the birth cohorts 1946, 1942, 1938, 1934 and 1930. RESULTS: A total of 5990 women were sent the questionnaire and 4525 (76%) completed and returned it. Of this sample, 21% currently used HRT and a further 20% had used it in the past. A high proportion who continued using HRT derived benefit from it which was reflected in relief from vasomotor symptoms, irritability, insomnia, vaginal dryness and muscle and joint pain. Only 27% of those trying other, non-hormonal therapy considered that they had benefited from it. The major reasons for not taking HRT was fear of side-effects, a belief that the menopause should not be interfered with, and at the recommendation of their physician. The same reasons were given by those women starting HRT but discontinuing it later. CONCLUSIONS: The figure of 21% using HRT compares favourably with other Scandinavian countries. A high proportion of HRT is prescribed by gynaecologists reflecting that many GPs were unfamiliar with its use. When HRT is given by GPs, many favour the transdermal route. Compliance is a major problem and few women continue long enough to benefit fully. One way of minimizing this is to ensure that patients are fully informed and have any fears and misconceptions dealt with. Adverse and misleading information from the media may have to be countered. Individualization of therapy is important and should be tailored to particular age groups. Transdermal HRT may be more acceptable in some cases.
Estrogen Replacement Therapy↗
Association between urinary incontinence and urinary tract infections, and fractures in postmenopausal women.
OBJECTIVE: The association between urinary disorders, such as ongoing urinary incontinence (UI), history of urinary incontinence (HIST-UI) and urinary tract infections (UTI), and fractures in peri- and postmenopausal women was assessed in an epidemiological study. SUBJECTS AND METHODS: The sample consisted of 10000 women from seven birth cohorts, born between 1900 and 1940, who were investigated regarding urinary disorders, fractures and reproductive history by means of a postal questionnaire. RESULTS: The overall response rate was 74.6%. The respondents (n = 7459) represented 53% of the total population from the respective birth cohorts. There was a significant independent correlation between UI, HIST-UI and UTI, respectively, and fractures after the age of 30. In subjects with HIST-UI, tobacco smokers compared to non-smokers had significant more fractures in both the 1930 and 1940 birth cohorts (P < 0.01). Logistic multiple regression in the 1930 and 1940 cohorts demonstrated that age (P < 0.001), HIST-UI (P < 0.001) and tobacco smoking (P < 0.05), respectively, had an independent explanatory value for fractures. CONCLUSION: The prevalence of fractures increased with increasing age, in smokers compared to non-smokers and in women with a history of UI.
Age Factors↗
A randomized, double-blind, multicentre study comparing the clinical effects of two sequential estradiol-progestin combinations containing either desogestrel or norethisterone acetate in climacteric women with estrogen deficiency symptoms.
OBJECTIVES: The aim of this study was to compare a new estradiol-desogestrel (E2-DG) regimen with an E2-norethisterone acetate (NETA) combination (Trisekvens) regarding the treatment of menopausal complaints, bleeding pattern, histology of the endometrium and the occurrence of adverse experiences. METHODS: A total of 310 peri-/postmenopausal women with climacteric symptoms were randomly allocated to oral sequential treatment with either the E2-DG combination (1.5 mg E2 for 24 days with 0.15 mg DG for the last 12 days followed by 1 placebo tablet for 4 days) or with the E2-NETA combination (Trisekvens, 2 mg E2 for 22 days with 1 mg NETA for the last 10 days followed by 1 mg E2 for 6 days). Treatments were administered double-blind for 12 cycles of 28 days. RESULTS: One hundred and four women, 48 in the E2-DG group and 56 in the E2-NETA group, discontinued the study due to bleeding irregularities and various adverse effects. Both treatments reduced menopausal symptoms and complaints effectively and almost equally. The alleviation of perspirations and the improvement of general fitness were more apparent (P = 0.009) during cycle 1 with the E2-NETA treatment but were greater (P < 0.02) during the last 9/10-12 cycles of E2-DG treatment compared to E2-NETA. Regular withdrawal bleeding appeared in 93% and 90% of the women during treatment with E2-DG and E2-NETA, respectively. Intermenstrual bleeding occurred in 8% of women receiving E2-DG and in 13% of women treated with E2-NETA. The corresponding figures for intermenstrual bleeding-spotting were 21% and 22%. Secretory endometrium was detected in 65% and 54% of the samples taken at the end of treatment with E2-DG and E2-NETA, respectively. No hyperplasia or atypia was found. No serious adverse events related to treatment occurred. CONCLUSIONS: Both regimens alleviated effectively menopausal complaints and did not induce hyperplasia of endometrium. The minor differences recorded between the two regimens were probably due to the differences in their composition concerning the amount of estradiol and its distribution along the cycle, the amount and type of progestin and the length of estradiol/progestin combination phase.
Administration, Oral↗
Urinary incontinence: a minor risk factor for hip fractures in elderly women.
OBJECTIVE: The aim of the study was to study the influence of urinary disorders as urinary incontinence on the prevalence of hip fracture in 85-year-old women. METHODS: A representative community-based population study was performed at the geriatric outpatient department of a university hospital in a sample consisting of 658 85-year-old women, of which 69% were living at home and 31% were living were living in institutions. The prevalence of hip fractures was registered and measurement with dual photon absorptiometry of the right calcaneum was performed. The subjects were questioned covering sociodemographic background, the occurrence, type, frequency and amount of urinary incontinence, medical examinations and investigations of the prevalence of hip fracture. RESULTS: Hip fracture was significantly associated with urinary incontinence (P < 0.001) for women and the odds ratio of hip fracture was twice that found in general population (OR = 2.42). Body mass index and weight were both significant higher (P < 0.01) among women with urinary incontinence and hip fracture. The frequency of urinary incontinence was also significant correlated to hip fracture (P < 0.001). Subjects with diabetes had a tendency to be associated with urinary incontinence (P < 0.06). In a logistic multiple regression analysis, body mass index, urinary incontinence and cancers were the only explanatory factors for hip fractures at 85 years of age. CONCLUSION: The association between postmenopausal urinary incontinence and hip fractures are multifactorial and whether this is a result of decreasing estrogen levels or a result of general aging process is still under debate. Women with urinary incontinence and earlier atrumatic multiple postmenopausal fractures should be considered a special target group for estrogen prophylaxis in order to prevent further severe fractures.
Aged↗
A comparison of contraceptive habits and pregnancy outcome at 19 years of age in two cohorts of Swedish women born 1962 and 1972.
The prevalence of contraception and pregnancy outcome in two representative samples of 19-year-old women resident in the city of Göteborg, born in 1962 (n = 596) and 1972 (n = 641), respectively, was assessed and compared using a postal questionnaire technique. The prevalence of different contraceptive techniques was as follows (62/72): Oral contraception (OC) alone 44%/35%, (p < 0.001); OC + condom 1%/12%, p < 0.001; intrauterine device 4%/1%, p < 0.001; condom only 11%/14%; depot gestagen 0%/0.3%; no contraception 40%/38%. The median duration of OC use was 15 and 14 months, respectively. Fear of OCs was the commonest reason given for cessation of OC in the 62 cohort and that contraception was no longer required in the 72 cohort. The proportion of women who gave the latter explanation for cessation of OC had increased (p < 0.001) from 10% in 1981 to 57% in 1991, indicating that young women in Sweden now tend not to continue with OCs when a relationship ends. Although the prevalence of cigarette smoking was reduced (p < 0.05 in the 72 cohort compared to the 62 cohort), there was still an over-representation of smokers in both cohorts among contraceptive users (p < 0.001) and in women who had been pregnant (p < 0.001) or undergone an abortion (p < 0.001). Pregnancies were reported by 11% of the women from the 62 cohort and by 13% from the 72 cohort. A greater proportion (p < 0.001) of pregnancies terminated in legal abortion in the 72 cohort (61%) compared to the 62 cohort (50%). The medical complication rate following legal abortion was lower (p < 0.05) in the 72 cohort compared to the 62 cohort.
Abortion, Legal↗
Treatment of female stress urinary incontinence with a new anatomically shaped vaginal device (Conveen Continence Guard).
OBJECTIVE: To evaluate the clinical efficacy of a new vaginal device for the treatment of female stress urinary incontinence. PATIENTS AND METHODS: This multicentre study comprised 90 women with stress incontinence (mean age 47.5 years, range 31-65). The diagnosis of stress urinary incontinence was based on the result of a quantitative provocation test. The device was used daily for 4 weeks. Urinary leakage with and without the device was assessed using a 24 h pad-test at home. The patient's subjective opinion concerning their urinary leakage and the efficacy and function of the device were assessed using a questionnaire. RESULTS: Eighty-five women completed the study and successfully performed the pad test on both occasions. The mean (SEM) urinary leakage at the end of the study period whilst using the device was 13.9 (3.2) mL, which was less than the 41.6 (7.6) mL mean leakage measured before treatment (P < 0.001). Of the 85 women, 39 (46%) were completely dry during the pad test with the device in situ, 29% had a smaller leakage, 17% had the same leakage and 8% had a greater leakage. Accordingly, the overall objective improvement was 75%; 72% of the women considered the product to function satisfactorily and 60% expressed a wish to continue with the treatment. The vaginal device caused some local discomfort in 62% of the patients, but 72% of these women wished to continue with the device despite the reported discomfort. CONCLUSION: The new vaginal device reduced urinary leakage in stress incontinent women and 46% became continent. Even women with severe leakage had some improvement when using the device.
Adult↗
Transvaginal sonography of the endometrium in a representative sample of postmenopausal women.
The aim of this study was to assess endometrial thickness using transvaginal sonography in a representative sample of postmenopausal women and to evaluate whether the technique can be used for screening of endometrial cancer. A random sample (n = 1000) of the total population of women aged 45-80 years resident in the city of Göteborg in 1993 was invited to attend for transvaginal sonography. The only exclusion criterion was hysterectomy. Transvaginal sonography was performed in 827 women. An endometrium of < or = 4 mm was not investigated further. Women with an endometrium of 5-7 mm and non-measurable cases were re-assessed 1 year later, and women with an endometrial thickness of > or = 8 mm were investigated directly with hysteroscopy and/or dilatation and curettage. A total of 559 women were postmenopausal and 183 were taking some form of hormonal substitution (33%). One case of endometrial cancer (endometrial thickness 19 mm), 23 cases of polyps without atypia (endometrial thickness 8-18 mm) and no cases of endometrial hyperplasia were diagnosed. Endometrial thicknesses were as follows (mean +/- SEM; respectively grouped as < or = 4 mm, 5-7 mm and > or = 8 mm): total population of postmenopausal women (3.4 +/- 0.1 mm, 82%, 13% and 6%); postmenopausal women without estrogens (3.0 +/- 0.1 mm, 90%, 7% and 3%); postmenopausal women on medium-potency estrogens + gestagen (5.1 +/- 0.3 mm, 49%, 40% and 11%) and women with low-potency estrogens only (3.6 +/- 0.3 mm, 85%, 6% and 9%). The prevalence of endometrial cancer was 0.2% and for benign polyps 3.2% in this representative sample of postmenopausal women. Our results do not support generalized endometrial screening with transvaginal sonography.
Aged↗
The relationship between knowledge about sexually transmitted diseases and actual sexual behaviour in a group of teenage girls.
PURPOSE: To assess longitudinally the relationship between knowledge about sexually transmitted diseases (STDs) and sexual behaviour, contraceptive use, STD protection and social class in a group of Swedish teenage girls. METHODS: Girls starting their upper secondary school education were invited to attend a teenage clinic during a period of 2 years (5 visits). Questions were asked about family situation, sexual activity, contraceptives, STD protection and knowledge about STD. Gynaecological examinations were performed on entry and completion, and when necessary during the observation period. RESULTS: Eighty-eight girls completed all visits during the observation period. At 16 years of age there were no significant differences in knowledge about various STD and STD protection between girls from different social classes or with respect to coital experience, age of coitarche and the subsequent number of sexual partners at 18 years of age. At 18 years of age there was a better knowledge about STDs and the need for STD protection (p < 0.01) among girls with coital experience compared with those who had no coital experience. Girls reporting many lifetime partners were best informed, but in spite of solid knowledge they did not protect themselves from infection. Even though 34% of the girls with coital experience were found to harbour a STD during the course of this study, almost all girls denied the possibility of having acquired or transmitted an infection. CONCLUSIONS: Although girls were well-informed about sexually transmitted diseases and knew how to avoid infections this knowledge had little influence on behaviour.
Adolescent↗
Comparative assessment of pelvic floor function using vaginal cones, vaginal digital palpation and vaginal pressure measurements.
A group-comparative study to assess pelvic floor muscle function using vaginal cones, vaginal digital palpation, and vaginal pressure measurements in 30 women suffering from genuine stress urinary incontinence and in an age-matched group of continent women was undertaken. Vaginal digital palpation score and vaginal pressure during active contraction were greater (p < 0.001) in continent women (1.9 +/- 0.1 and 8.6 +/- 0.7 cm H2O, respectively) as compared with incontinent women (1.0 +/- 0.1 and 4.1 +/- 0.4 cm H2O, respectively). Continent women were able to retain a vaginal cone of greater weight (6.3 +/- 0.4; n = 9, weight ranging from 10 to 90 g) than women suffering from stress incontinence (4.7 +/- 0.5; p < 0.001). There was a better correlation between all three techniques of assessing pelvic floor function in continent as compared with incontinent women, especially in the comparisons involving vaginal cones. (Vaginal pressure measurement-vaginal digital palpation, r = 0.86/0.75; vaginal pressure measurement-vaginal cones. r = 0.57/0.10; vaginal digital palpation-vaginal cones, r = 0.60/0.18.) In some women, especially those with incontinence, heavy cones were retained in spite of a weak pelvic floor due to the transverse position of the cone in the vagina which was verified radiographically.
Adult↗
Rational prescribing for postmenopausal urogenital complaints.
Urogenital complaints such as vaginal discomfort, dysuria, dyspareunia, recurrent lower urinary tract infections (UTIs) and urinary incontinence have been reported to affect more than 50% of postmenopausal women. These symptoms cause considerable suffering and an obvious reduction in quality of life for the afflicted individual, as well as being costly in economic terms for the health service. Urinary incontinence alone has been estimated to account for approximately 2% of health care costs in both the US and Sweden. Treatment with low potency estrogens given locally or orally has been shown to alleviate urgency, urge incontinence, frequency, nocturia and dysuria, but there is no conclusive evidence that estrogens alone improve or cure stress incontinence. Estrogen therapy has also been shown to cure or alleviate local urogenital atrophy symptoms, and to induce positive changes in the vaginal bacterial flora of postmenopausal women, which in turn reduces the risk of developing a UTI. There is little or no documentation to support the use of antibiotics in the treatment of local urogenital complaints such as pruritus, vaginal discomfort and discharge, or urinary incontinence in postmenopausal women. Antibiotics are, however, indicated for the treatment of UTIs, and in some cases for prophylactic treatment in women with recurrent UTIs. The number of women with urogenital complaints is expected to increase in the future, as the proportion of elderly women will be greater due to a higher life expectancy. Thus, in the future there will be an even greater need for simple, effective forms of treatment for large numbers of elderly women. Low potency estrogens given topically or orally have been shown to be an effective form of treatment for urogenital symptoms in postmenopausal women.
Drug Prescriptions↗
Estrogen and progestagen modify the hemodynamic response to mental stress in young women.
OBJECTIVE: To evaluate separately the effects of estrogen and progestagen on the cardiovascular response to a standardized mental stress test. METHODS: Seven women were studied during the early follicular phase (day 1-4) of three different menstrual cycles after randomized oral administration of either 6 mg estradiol valerate or 15 mg norethisterone acetate or placebo. Heart rate and blood pressure were recorded at rest for 2 hours after administration and throughout the stress test. Forearm plethysmography was recorded at rest and during stress. RESULTS: Estrogen had no effect on heart rate or blood pressure at rest. After estrogen administration the increases in heart rate (delta 14 bpm/10 bpm; p < 0.01) and diastolic blood pressure (delta 14 mmHg/9 mmHg: p = 0.06) from baseline to stress were augmented compared to those observed after placebo administration. Heart rate, systolic and diastolic blood pressures reached higher levels during stress after estrogen administration compared to placebo (delta 5 bpm, and delta 7 mmHg and delta 5 mmHg respectively; p < 0.05). Estrogen administration also caused a prolongation of the diastolic blood pressure response to stress. Progestagen compared to placebo induced an increase in heart rate already at rest (delta 4 bpm; p < 0.01), and heart rate was maintained on a higher level throughout the stress test (p < 0.05). Blood pressure at rest and pressor responses to stress were not significantly changed after progestagen administration. CONCLUSIONS: The results indicate that estrogen is responsible for the enhanced cardiovascular responses to stress, whereas progestagen provokes a parallel upward shift of basal heart rate which is independent of level of activation.
Adult↗
The pill. The controversy continues.
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Contraceptives, Oral↗
Age of sexual debut related to life-style and reproductive health factors in a group of Swedish teenage girls.
AIM: To compare life-style and reproductive health care factors in girls with a coitus debut < 15 years of age and girls with a later debut. METHODS: Girls resident in the municipality of Karlstad, Sweden, starting their upper secondary school education were invited to attend the teenage clinic during two years (five visits). Gynecological examinations were performed and questions were asked about possible symptoms, sexual activity, contraception and sexually transmitted diseases. RESULTS: Ninety-eight girls accepted the invitation to participate and 88 girls completed all visits (mean age on admission 16 years). Median age for coitarche was 16 years. A sexual debut < 15 years was reported by 17 girls (19.3%), 54 (61.4%) had their debut > or = 15 years and 17 girls (19.3%) had not had their sexual debut on completion of this study. Girls with an early sexual debut had a greater number of sexually transmitted diseases (p < 0.05) and more cervical atypias (p < 0.05), and more often had a menarcheal age < 13 years (p < 0.05), > two brothers and/or sisters (p < 0.01), were more often not living with their parents (p < 0.01) and reported a greater number of life-time partners (p < 0.06) than the remainder, Girls with a sexual debut < 15 years started drinking alcohol earlier than others (p < 0.01). There was a greater proportion of smokers among girls with an early sex debut compared to the remainder (p < 0.05). CONCLUSIONS: Early sexual debut is associated with an earlier menarche and a more premature adult life-style and is an important indicator for continued risk behavior regarding reproductive health.
Abortion, Legal↗
Fetal fibronectin and microorganisms in vaginal fluid of healthy pregnant women.
OBJECTIVE: To determine fetal fibronectin in vaginal fluid from healthy women during uncomplicated pregnancy and to investigate possible relationships to gestational age and the vaginal microflora. MATERIALS AND METHODS: Samples of vaginal fluid were collected for fetal fibronectin determination and for quantitative aerobic and anaerobic microbiological culture from 22 women followed longitudinally at 12, 28 and 37 weeks gestation cross-sectionally in women at 12 weeks (n = 10), 28 weeks (n = 10), 37 weeks (n = 10), and 39 weeks (n = 30) gestation, respectively. Fetal fibronectin was determined by a quantitative enzyme immunoassay (Adeza Biomedical). RESULTS: There were no significant differences between the concentrations of fetal fibronectin in vaginal secretions at any of the four measurement points (12, 28, 37 and 39 weeks gestation). Women with elevated fetal fibronectin concentration (> or = 0.05 mg/L) had less often hydrogen peroxide-producing facultative lactobacilli (p < 0.0001), and more often bacterial vaginosis (p < 0.02) and Peptostreptococcus species (p < 0.002). Bacterial vaginosis (p < 0.01) and Candida albicans (p < 0.01) were more frequently found in women lacking hydrogen peroxide-producing lactobacilli. CONCLUSION: Fetal fibronectin in vaginal fluid was more associated with the vaginal microflora than with the gestational age of the pregnancy. Presence of hydrogen peroxide-producing lactobacilli seems to be the most important factor for a stable vaginal microflora.
Cross-Sectional Studies↗