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Placental pathology, antiphospholipid antibodies, and pregnancy outcome in recurrent miscarriage patients.

OBJECTIVE: To examine whether there are characteristic histological features in placentas from ongoing pregnancies of patients with a history of recurrent miscarriage, with and without primary antiphospholipid antibody syndrome, in relation to clinical pregnancy outcome. METHODS: Patients attending a recurrent miscarriage clinic were investigated and treated according to an established protocol. One hundred twenty-one consecutive patients achieving a potentially viable pregnancy (at least 24 completed weeks' gestation), including 60 primary antiphospholipid antibody syndrome-positive cases and 61 primary antiphospholipid antibody syndrome-negative cases were included. After delivery, placental pathologic examination was carried out by a pathologist unaware of the clinical details. Histological sections were examined by two pathologists independently. Pregnancy outcome and placental findings were reviewed in relation to the maternal antiphospholipid antibody status. RESULTS: Pregnancy outcome was similar in primary antiphospholipid antibody syndrome-positive and primary antiphospholipid antibody syndrome-negative groups regarding gestation at delivery and antepartum obstetric complications. Several histological placental abnormalities were identified in both groups, but most pregnancies were clinically uncomplicated, with no significant placental abnormalities. In cases with pregnancy complications, the placental pathology was primarily that of uteroplacental vasculopathy, such as placental infarction and preeclampsia, but there were no specific placental lesions or patterns of abnormalities characteristic of primary antiphospholipid antibody syndrome-positive patients. A small subgroup of primary antiphospholipid antibody syndrome-positive patients may be at increased risk of development of maternal floor infarction or massive perivillus fibrin deposition. CONCLUSION: There are no specific histopathologic placental abnormalities characteristic of treated patients with antiphospholipid antibody syndrome and poor reproductive history, but complications of uteroplacental disease are more common.

Abortion, Habitual↗

Reproductive performance in population exposed to pesticides in cotton fields in India.

Data on reproductive histories were collected from 1016 couples in which the males were directly exposed to pesticides. For comparison data were collected from 1020 couples who were not exposed to pesticides and belong to the same socioeconomic group and age range. Statistical analysis revealed a significant decrease in fertile males and a significant increase in abortions among the wives of these exposed males when compared to the control group. The frequency of live births decreased significantly and still births, neonatal deaths, and congenital defects showed a significant increase in the offspring of exposed males when compared to the offspring of control group. Smokers exposed to pesticides showed a higher effect than nonsmokers exposed to pesticides. Eighty percent males in the exposed group showed ill health effects such as severe giddiness, nervous, skin, and eye disorders.

Abortion, Spontaneous↗

Reproductive prognosis in male patients with azoospermia at the time of cancer diagnosis.

OBJECTIVE: Fertility status evaluation in patients found azoospermic at the time of malignancy diagnosis. DESIGN: Case series follow-up. SETTING: University Hospital Sperm Banking service. PATIENT(S): Male cancer patients found azoospermic between 1986 and June 2000. INTERVENTION(S): Patients were interviewed about their reproductive history and were invited for a free semen analysis. MAIN OUTCOME MEASURE(S): Pregnancy rate (PR) and percentage of patients with viable spermatozoa in the ejaculate. RESULT(S): Sixty-five patients were enrolled; 16 were lost at follow-up, 7 died, and 42 were followed to the end of the study. The median (range) time of follow-up for the 42 remaining patients was 9 years (2-14 years). Seventeen patients had wanted to father a child; 12 had a child (71%, 95% confidence interval [CI] 48%-88%). Semen analysis results were available in 11 patients. Resumption of spermatogenesis was documented in 9 cases (82%, 95% CI 53%-97%). CONCLUSION(S): Spontaneous fertility recovery is frequent in patients who are azoospermic at the time of cancer diagnosis.

Adolescent↗

APIKIDS: a cohort of children born after assisted reproductive technologies.

A cohort of children born after assisted reproductive technologies (ART) was set up in 2003 in Italy. It aims to follow up the children in order to study the short- and long-term effects of ART. Parents who agreed to participate were contacted for a telephone interview; questions included occupational and non-occupational exposure to carcinogens, reproductive history, history of index pregnancy (including drugs used during pregnancy), delivery and the child's health status. By August 2005, 40 out of the 50 centres contacted (80%) had agreed to participate in the study, and 17 had already sent their data. Information on a total of 2451 cycles ending with a pregnancy are currently available, from 2245 couples. We have contacted 351 of these couples (16%), 309 of whom (88% of the contacts) agreed to participate in the study and were interviewed, while 36 (11%) refused to be interviewed. The total number of children currently included in the database is 411. This study is the first attempt to create a database containing information on children born after ART in Italy. It will provide results on both short- and long-term outcomes in these children.

Carcinogens↗

Laparoscopic application of PGE2 to re-establish oviducal patency and fertility in infertile mares: a preliminary study.

REASONS FOR PERFORMING STUDY: Mares are occasionally encountered that consistently fail to conceive when inseminated, naturally or artificially, with fertile stallion semen in the absence of any identifiable pathology of either the structure or function of their reproductive tract. HYPOTHESIS: Temporary blockage of the oviducts by accumulations of naturally occurring oviducal masses may be preventing oviducal transport of the embryo to the uterus. METHODS: Mares, with known reproductive histories, that had exhibited inexplicable failure of conception were treated by laparoscopically guided administration of PGE2-laced triacetin gel directly onto the surface of their oviducts. RESULTS: Fifteen mares age 10-21 years that had exhibited inexplicable failure of conception during 1-4 years were treated, of which 14 (93%) conceived within the same or subsequent breeding season. CONCLUSIONS: The high success rate of this treatment supports the tentative diagnosis of oviducal obstruction in these mares and indicates that blockage of the mare's oviducts may occur in the form of a moveable accumulation of debris rather than from permanent fibrous adhesions resulting from salpingitis. POTENTIAL RELEVANCE: This laparoscopic application of PGE2 to the oviducts constitutes a sound and practical method of restoring fertility in mares suffering oviducal obstruction and further studies involving the procedure are warranted.

Animals↗

Breast cancer mortality after diagnostic radiography: findings from the U.S. Scoliosis Cohort Study.

STUDY DESIGN: A retrospective cohort study was conducted in 5573 female patients with scoliosis who were referred for treatment at 14 orthopedic medical centers in the United States. Patients were less than 20 years of age at diagnosis which occurred between 1912 and 1965. OBJECTIVES: To evaluate patterns in breast cancer mortality among women with scoliosis, with special emphasis on risk associated with diagnostic radiograph exposures. SUMMARY OF BACKGROUND DATA: A pilot study of 1030 women with scoliosis revealed a nearly twofold statistically significant increased risk for incident breast cancer. Although based on only 11 cases, findings were consistent with radiation as a causative factor. METHODS: Medical records were reviewed for information on personal characteristics and scoliosis history. Diagnostic radiograph exposures were tabulated based on review of radiographs, radiology reports in the medical records, radiograph jackets, and radiology log books. Radiation doses were estimated for individual examinations. The mortality rate of the cohort through January 1, 1997, was determined by using state and national vital statistics records and was compared with that of women in the general U. S. population. RESULTS: Nearly 138,000 radiographic examinations were recorded. The average number of examinations per patient was 24.7 (range, 0-618); mean estimated cumulative radiation dose to the breast was 10.8 cGy (range, 0-170). After excluding patients with missing information, 5466 patients were included in breast cancer mortality analyses. Their mean age at diagnosis was 10.6 years and average length of follow-up was 40.1 years. There were 77 breast cancer deaths observed compared with the 45.6 deaths expected on the basis of U.S. mortality rates (standardized mortality ratio [SMR] = 1.69; 95% confidence interval [CI] = 1.3-2.1). Risk increased significantly with increasing number of radiograph exposures and with cumulative radiation dose. The unadjusted excess relative risk per Gy was 5.4 (95% CI = 1.2-14.1); when analyses were restricted to patients who had undergone at least one radiographic examination, the risk estimate was 2.7 (95% CI = -0. 2-9.3). CONCLUSIONS: These data suggest that exposure to multiple diagnostic radiographic examinations during childhood and adolescence may increase the risk of breast cancer among women with scoliosis; however, potential confounding between radiation dose and severity of disease and thus with reproductive history may explain some of the increased risk observed.

Age Factors↗

Subfecundity: a prenatal risk factor for adults but not for adolescents.

Young maternal age is associated with an increased incidence of low birth weight and prematurity; controlling for sociodemographic factors reduces the significance of this relationship. We hypothesized that this is partly because in a sociodemographically homogeneous population the adverse effects of maternal subfecundity on fetal growth confound the relationship between maternal age and infant outcome. To test this hypothesis, we studied the reproductive histories of 90 adolescent (less than 20 years old) and 35 adult lower socioeconomic, black prenatal patients. We found a strong, positive relationship between maternal age at conception and duration of unprotected intercourse prior to conception (r = 0.40; p less than 0.0001). Adults reporting 2 or more years of unprotected intercourse prior to conception were at highest risk for low birth weight (p = 0.02). Our findings demonstrate that it is important that adult controls for adolescent pregnancy studies have voluntarily postponed conception.

Adolescent↗

Multiple primary tumors: 17 cases of renal-cell carcinoma associated with primary tumors involving different steroid-hormone target tissues.

The aim of this study was to analyze the characteristics of 17 women with renal-cell carcinoma (RCC) associated with other primary neoplasms occurring in steroid-hormone target tissues. The reproductive history of these patients and the use of exogenous hormones were taken into consideration. In all, 10 RCCs were associated with breast carcinoma; 4, with endometrial carcinoma; and 3, with ovarian carcinoma. The presentation of a second primary tumor was described as synchronous or metachronous by evaluation of the interval between the discovery of the two neoplasms. Hormone and surgical treatment as well as pathologic findings for each primary tumor were also reported. In these 17 RCCs the overall rate of disease-specific survival recorded after a mean follow-up period of 32.7 months (range 9-66 months) was 58.8%; 7 patients died of metastatic disease after surviving for a mean of 14.7 months. In terms of the pathologic stage of RCC, a significant difference in mean survival was found between pN0 (mean survival 22.1 +/- 3.4 months) and pN1 RCCs (mean survival 13.7 +/- 3.5 months). A total of 13 (76.4%) women were postmenopausal at the time of diagnosis of the first primary tumor; the mean age of these women at menopause was 51.7 +/- 1.2 years. No prior use of oral contraceptives was reported by 12 (70.5%) of the 17 patients. Plasma 17-beta-estradiol and estrone levels were determined in only 7 patients at the diagnosis of each of the primary tumors. High plasma estrogen levels were found in 4 women with RCC and breast carcinoma and in 1 patient with RCC and endometrial carcinoma; in the remaining 2 patients low-normal values were found. A relationship appears to exist between certain reproductive and hormone-related factors and the risk of developing these tumor associations. Data emerging from the present study do not provide strong support for the hypothesis of hormone dependency of RCC; however, a role for estrogens in cases in which RCC is associated with other primary tumors involving steroid-hormone target tissues can be hypothesized.

Adult↗

Factors associated with fetal mortality in the triethnic population in texas, 1993 through 1995.

We examined the underlying causes of fetal deaths reported for 1993 through 1995 in relation to the mother's ethnicity, reproductive history, and medical factors listed on birth and fetal death certificates. The overall fetal mortality rate (FMR) was 6.3 per 1000 live births plus fetal deaths, and 5.6, 5.9, and 9.8 per 1000, respectively in pregnancies of white, hispanic, and black women. Preterm birth (low birth weight) was a major predictor (or consequence) of fetal death, and extremes of maternal age, increased parity, and plural pregnancies were also associated with increased FMRs, especially in black women. The underlying causes reported on fetal death certificates were complications of the placenta, cord, and membranes (36%); ill-defined conditions arising in the perinatal period (23%); fetus affected by maternal complications of pregnancy (10%); fetus affected by maternal conditions unrelated to pregnancy (6%); and short gestation and unspecified low birth weight (5%); 14% of fetal deaths were associated with congenital abnormalities. Factors reported most frequently were premature rupture of the membranes, disorders of amniotic fluid volume, pregnancy-associated hypertension, diabetes, anemia, previous preterm or small-for-gestational-age births, incompetent cervix, chronic hypertension, and sexually transmitted diseases. More than 40% of fetal deaths were not associated with any medical risk factor. FMRs associated with maternal anemia, cardiac disease, pregnancy-associated hypertension, eclampsia, and previous birth weighing more than 4 kg were at least 1.5 times higher in pregnancies of black women than in the other 2 ethnic groups. The underlying causes of fetal death provide few targets for their primary prevention; preventive efforts might better be directed to the closer surveillance and care of pregnant women with demographic, reproductive, and medical factors associated with increased risk.

Ethnicity↗

Decisions about prenatal testing for chromosomal disorders: perceptions of a diverse group of pregnant women.

We conducted a study to elucidate factors influencing women's decisions regarding prenatal genetic screening for and diagnosis of chromosomal disorders and to learn about their experiences with these tests and with the medical system. Using focus group interviews and questionnaire assessments, we obtained detailed impressions of a diverse group of 75 pregnant women. Participants varied with respect to race/ethnicity, religious background, and reproductive history, as well as in their decisions about use of prenatal screening and diagnostic testing. Substantial variation surfaced in attitudes toward testing. Factors influencing women's views included available resources, feelings about having a child with Down syndrome, moral beliefs, family and social influences, perceptions of one's own health, the difficulty of becoming pregnant, and willingness to put the fetus at elevated miscarriage risk. Such findings indicate that age-based policies regarding access to prenatal diagnoses that, among other reasons, are based on the balance of risks between bearing a child with a chromosomal abnormality versus procedure-related loss are incompatible with the range of concerns that women bring to this decision and the weight individual women may assign to the outcomes.

Abortion, Eugenic↗

Unintended conception and unwanted fertility in Gondar, Ethiopia.

This is a report on unintended conception and unwanted fertility in Gondar, Northwestern Ethiopia. The purpose of the study was to explore the extent of the problem and to inquire whether there is a need for fertility regulation. To this end, relatively numerous questions on reproductive history of women aged 15-49 have been raised. Results showed that the proportion of abortion to delivery was 0.3984 to 0.6016 and the ratio of unintended conception to intended conception was 0.4043 to 0.5957. The proportion of unwanted fertility to wanted was 0.4099 to 0.5901. Mean desired interpregnancy interval was substantially higher than actual interpregnancy interval. The relatively high rate of abortion, high proportion of unintended conception and unwanted fertility combined with the wide difference between desired interpregnancy interval and current interpregnancy interval all point to the need for a policy that increases the capacity to regulate fertility.

Adolescent↗

Abortion admissions in rural Matebeleland north province.

OBJECTIVES: To describe the characteristics, clinical features and management of women admitted with an abortion in rural Zimbabwe. DESIGN: Cross sectional descriptive study. SETTING: Four government and two mission hospitals in rural Matebeleland North province. SUBJECTS: Hospital records of 355 consecutive women admitted with the diagnosis abortion from May to October 2000, and delivery registers covering the same six month period. MAIN OUTCOME MEASURES: Age, marital status, reproductive history, referral status, distance home to hospital, presenting symptoms, findings on examination, complications, management in hospital, final diagnosis, length of hospital stay. RESULTS: Abortion patients tended to be older and of higher parity than women who delivered in the same period. Fifteen percent were teenagers, 81.2% were married and 2% nullipara. Mean period of gestation was 11.3 weeks. About half of the women had been referred and 74.4% lived within a 50 km radius from the hospital. Forty two percent had never used contraception. Of the users, 38.6% had discontinued in order to conceive and 19.3% had fallen pregnant on the method. Thirty one percent of the women wanted no more children. One third of the abortion patients had a temperature above 37.6 degrees C; 25.9% offensive vaginal discharge and 7% a haemoglobin of less than 6 g/dl. Eighty percent were given antibiotics and 4.2% received a blood transfusion; 73.2% had an evacuation of the uterus for incomplete abortion, with a mean delay between admission and evacuation of 32.5 hours. Only 17.5% of the women had on record that they were given a contraceptive method on discharge. Mean length of hospital stay was 3.1 days. The case fatality rate was more than 1%. An estimated 43.4% of the women had a possibly unsafe induced abortion prior to admission. CONCLUSION: As evidenced by the high morbidity and mortality, abortions are a serious public health problem in rural Matebeleland North. Taking into account that only a minority of the women with both unsafe and spontaneous abortions present to a hospital, it is imperative that the reproductive needs of the women who do come are addressed. No opportunity should be missed to offer contraceptives to a group of women whose use of contraception is lower than average. Clinical management of abortion patients could improve by earlier evacuation of the uterus in cases of incomplete abortion, use of local or no anaesthesia and by increased availability of suction cannulas in district level hospitals, which would also reduce length of hospital stay.

Abortion, Induced↗

Incidence of thyroid cancer in women in relation to reproductive and hormonal factors.

Female residents of western Washington state aged 18-80 years in whom thyroid cancer was diagnosed between January 1974 and December 1979 were interviewed concerning their reproductive histories and their prior use of exogenous estrogens. Their responses were compared with those of a sample of women from the same population, individually matched to cases on telephone prefix. Use of each of several estrogen-containing preparations was associated with a small increased risk of thyroid cancer; parous women who had ever used a lactation suppressant had 1.7 times the risk of parous nonusers (95% confidence interval, 1.1-2.8); ever users of oral contraceptives had 1.6 times the risk of never users (95% confidence interval, 0.98-2.5); and ever users of postmenopausal estrogens had 1.4 times the risk of never users (95% confidence interval, 0.89-2.3). Among the low risk group of women, i.e., those who had never undergone radiation therapy and who had never had a goiter, a history of one or more pregnancies was also associated with a small increase in the risk of thyroid cancer (relative risk = 1.8, 95% confidence interval, 1.1-3.1). However, no increase in risk with increasing duration of use of oral contraceptives or menopausal estrogens or with increasing number of pregnancies was noted. While pregnancy and use of exogenous estrogens have an impact on the production of thyroid-stimulating hormone, their effect on the incidence of thyroid carcinoma, if present at all, appears to be small.

Adolescent↗

Primary infertility and oral contraceptive steroid use.

OBJECTIVE: To determine the association between combined monophasic oral contraceptive (OC) use and primary infertility. DESIGN: Case-control. SETTING: Women serving as controls of the Cancer and Steroid Hormone Study. PARTICIPANTS: Women were 19 to 40 years of age at first conception or infertility diagnosis. Based on 24 consecutive months of unprotected intercourse without a recognized conception, 419 nulligravid women had primary infertility; controls were 2,120 fertile women. A calendar of each women's reproductive history was used to determine fertility status and contraceptive use before infertility diagnosis or first conception. MAIN OUTCOME MEASURE: Primary infertility. RESULTS: Combined monophasic OC use was associated with a lower frequency of primary infertility, particularly among younger (age 20 years) compared with older women (age 30 years) after adjusting for barrier method use and education. A similar association was found for duration of OC use. When adjusted for age at first conception or infertility and barrier method, both higher (> 50 micrograms) and lower (< or = 50 micrograms) estrogen dose use were associated with decreased risk of primary infertility. CONCLUSION: Combined monophasic OC use was associated with a lower frequency of primary infertility.

Adult↗

Dietary soy protein and estrogen replacement therapy improve cardiovascular risk factors and decrease aortic cholesteryl ester content in ovariectomized cynomolgus monkeys.

Estrogen replacement therapy (ERT) decreases the progression of coronary artery atherosclerosis in monkeys. Dietary soy protein also retards the progression of atherosclerosis relative to animal proteins such as casein. Soy protein contains weakly estrogenic compounds called isoflavones or phytoestrogens that may be responsible for the cardioprotective effects. This study was designed as a 2 x 2 factorial to determine the magnitude of soy protein's effects on cardiovascular risk factors relative to casein and lactalbumin, with or without estradiol treatment. Ovariectomized female monkeys were randomized to four treatment groups based on past dietary cholesterol consumption, their origin, and past reproductive history, and studied for 7 months. The animals were divided into (1) a group fed casein and lactalbumin as the protein source (n = 14), (2) a group fed casein and lactalbumin as the protein source plus 17 beta-estradiol (E2) (n = 13), (3) a group fed soybean protein isolate as the protein source (n = 11), and (4) a group fed soybean protein isolate as the protein source plus E2 (n = 10). Soy protein compared with casein consumption resulted in a significant improvement in plasma lipid and lipoprotein concentrations, a significant improvement in insulin sensitivity and glucose effectiveness as determined by minimal-model analyses, and a decrease in arterial lipid peroxidation. E2-treated monkeys had a significant reduction in fasting insulin levels and insulin to glucose ratios, total body weight, and amounts of abdominal fat, and had smaller low-density lipoprotein (LDL) particles. In addition, E2 treatment resulted in a significant reduction (P = .001) in aortic cholesteryl ester content. A similar trend (P = .14) was found for soy protein compared with casein. There also was a significant interaction (P = .02) with soy and E2, such that animals consuming soy protein +E2 had the least arterial cholesteryl ester content. These results suggest that both ERT and dietary soybean protein have beneficial effects on cardiovascular risk factors. Interestingly, the two treatments affected different risk factors and together resulted in the greatest reduction in arterial cholesterol content. Further studies are needed to determine the active component of the soy protein and to assess its long-term effects on the cardiovascular system and other organ systems (such as the bones and reproductive system).

Aging↗

Prolonged lactation contributes to depletion of maternal energy reserves in Filipino women.

This paper identifies determinants of women's postpartum weight and weight change in a large group of Filipino women followed for 24 mo. Longitudinal, multivariate models focused on the effects of lactation, while controlling for energy intake, energy expenditure, reproductive history and seasonality. Lactation was found to have a significant negative effect on weight of urban women. The negative effects of lactation increased with the intensity and duration of breast-feeding. Among rural women negative effects of lactation on weight were observed only after 10-14 mo. Models of net postpartum weight change (from 2 to 24 mo) among nonpregnant women confirmed an important role for lactation. The likelihood of weight loss was significantly increased by lactation of more than 12-mo duration, by greater maternal age and by low dietary energy intake. The effects of lactation on maternal energy reserves can be mitigated substantially be increasing maternal dietary energy intakes.

Energy Intake↗

Comparative epidemiology of cancer between the United States and Italy.

Available statistics on smoking, alcohol, food supply, reproductive history, and other lifestyle habits from the U.S. and Italy were compared and related to mortality rates of common neoplasms over the period 1955 to 1980. Per capita cigarette consumption has declined in the U.S. since the early 1960s but continues to rise in Italy, chiefly due to the recent increase in cigarette smoking among Italian women. Alcohol consumption has increased in both countries, being persistently about 40% higher in Italy. Changes were relatively limited in the American diet, but substantial for the Italian one which had particularly marked increases in meat, milk, and fat consumption. Fertility rates have declined in both countries but more sharply in the U.S. These lifestyle changes were reflected by distinctly divergent trends in cancer mortality rates between the two countries. In Italian males, mortality rates of urinary bladder cancer and alcohol-related neoplasms of the aerodigestive tract (oral cavity, larynx, and esophagus) increased in a similar manner and were persistently elevated relative to American males. Similarly, Italian lung cancer rates, while starting from lower values, rose steadily to overtake American rates in the younger and middle age groups of both sexes, and neoplasms of the intestines, breast, and ovary, starting from considerably lower values, tended to approach the American rates over the 25-year period considered. Within Italy, mortality rates of most common neoplasms were substantially elevated in the North of the country relative to the South, thereby paralleling the distinct North to South gradient in socioeconomics, diet, and affluent lifestyle which exists in the country. In our opinion, most of these trends are real, and their explanation should be sought, partly or largely, in the changes in tobacco and alcohol use, and the reproductive and dietary patterns described. The evidence presented underlies the importance of this kind of exercise to formulate and test etiological hypotheses of human diseases, which may be overlooked in studies based on populations with more homogeneous lifestyle habits or environmental exposures.

Alcohol Drinking↗

Gynaecological health care utilization and use of sex hormones--the study of Health in Pomerania.

BACKGROUND: In Germany, there is a lack of population-based data related to the use of gynaecological health care services. The objectives of our analyses utilizing a population-based cross-sectional survey conducted in one geographically defined area [Study of Health in Pomerania (SHIP)] are to assess the prevalences of: (i) attendance of gynaecological outpatient facilities and of (cervical) cancer screening; (ii) gynaecological and breast surgery; (iii) use of oral contraceptives (OC) and menopausal hormone therapy (MHT). METHODS: We analysed socio-demographic factors, reproductive history, gynaecological service utilization, and use of sex hormones in 2186 women aged 20-79 years. We used standard statistics and sex- and age group-specific weighting factors to reflect characteristics of the population of Western Pomerania. RESULTS: Approximately 43% of women reported surgical procedures. Participation in cancer screening at least once was reported by 78% of women (lifetime prevalence). Two-thirds of women stated ever use of OC, 28% (aged >40 years) ever use of MHT. CONCLUSIONS: Women in Western Pomerania reported a high life-time use of both OC and MHT. The use of cervical cancer screening exceeded the national average. Women had an almost 50% risk of undergoing gynaecological, breast or obstetric surgery. The high use of MHT and surgical procedures calls for efforts regarding continuing medical education and health care policy actions.

Adult↗