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PubMed1979

Probability of menopause with increasing duration of amenorrhea in middle-aged women.

The empirical percent probability that natural menopause has occurred after first presentation of amenorrhea of various durations in women greater than or equal to 45 years of age has been calculated using data from a cohort of subjects who prospectively recorded menstrual flow and related gynecologic events. The probability that menopause has occurred increases with the amenorrheal interval (duration), and for a given interval, the probability increases with age. After 180 days of amenorrhea, 45% to 72% of subjects were menopausal; after 360 days, 90%. These data may offer assistance in advising patients on the probability of menopause and the continuance of contraceptive practices, and in considering whether late genital bleeding after amenorrhea represents a physiologic or pathologic process.

Age Factors↗
PubMed1992

Transitions in fertility research.

History reveals that the genesis of progress in fertility research comes chiefly from animal research, and that subsequent applications of this research to humans have touched on many sensitive beliefs, prejudices, religions, and philosophies. Developments in fertility research, when applied to the human, diverge into two sensitive and very complex applied research categories-assisted reproduction and contraception. History also shows that these concurrently progressing research disciplines have undergone vacillating interludes of progress and of being blocked or restricted. Many of the technological improvements considered to be major transitional states in the progress of each of these categories are identified. They include artificial insemination, the invention of the sheath and the intrauterine device, the identification of hormones, and the elucidation of their activities as well as their interdependent relationships, the social acceptance and rejection, early embryo manipulation techniques, enzyme and sperm capacitation, and certain modern techniques involved in assisted fertility. Giant steps occurred in the 1950's with the rapid and seemingly unrestrained upward movement in chemical and clinical research that produced the hormonal contraceptives. This continued into the 1960's with additional advances providing improvements and popular choices such as intrauterine devices. In the following decades, many improvements were realized in both disciplines; however, changes in the legal environment, the litigious attitude of the public, sources of financial support, and basic priorities by industry and governments have caused uncertainty in many areas. The progressive moves seem to have occurred at certain periods when our population was not preoccupied with other matters and tended to pursue intellect and logic. This paper attempts to summarize a portion of the history of discoveries and developments in fertility research within each of the two applied research categories, and thereby to reveal and discuss a few of the underlying factors and the human qualities that impacted on the evolution of fertility research.

Journal Article↗
PubMed1996

Abortion policy and practice in Greece.

Despite its illegality until recently, abortion is estimated to have been responsible for almost half of the sharp postwar decline in the Greek birth rate. This article examines abortion as a part of a Greek contraceptive culture which has taken shape during the postwar period both in response, and in resistance to, a variety of macro- and micropolitical institutions and forces. During much of this period, pronatalist policies and discourses of both state and church combined to foreclose most medical contraceptive alternatives. In contrast, illegal abortion was a relatively safe, medicalized procedure widely practiced by doctors. Even after being legalized in 1980, female medical contraceptive methods continue to be rejected by the great majority of Greek women, and abortion and male methods of birth control remain the principal means of controlling fertility. The article focuses on the specific abortion practices and meanings of three generations of married women living in the city of Rhodes, capital of the Dodecanese Province of Greece's Eastern Aegean, and explores the ways in which they have been shaped by, and reflect, local cultural understandings of the body, health, sexuality, morality, motherhood and childhood, as well as micropolitical relations within the family.

Abortion, Illegal↗
PubMed2006

Cystic myometrial lesion in the uterus of an adolescent girl.

The clinical course and radiographic appearance of a cystic myometrial lesion in a 13-year-old adolescent girl are described. Hormone suppression with continuous oral contraceptive (OC) pills resulted in partial regression of the lesion, as well as control of symptoms.

Adolescent↗
PubMed2002

Tetralogy of Fallot, imperforate anus, and Müllerian, renal, and cervical spine (MURCS) anomalies in a 15-year-old girl.

STUDY OBJECTIVE: To examine the etiology of MURCs anomalies and the management of a patient with these anomalies as well as cardiac and anorectal abnormalities causing primary amenorrhea and abdominal pain. DESIGN: Case study. RESULT: Relief of pelvic pain following GnRH agonist therapy and continuous oral contraceptives. CONCLUSION: MURCS (Müllerian, Renal, Cervical Spine) is a well-described grouping of multi-organ, nonlethal abnormalities that are infrequently detected in women with menstrual abnormalities. The association of MURCS with cardiac and anorectal abnormalities may be one of coincidence or may indicate that the abnormalities share common genetic or environmental (cellular or microbiologic) etiologies.

Abnormalities, Multiple↗
PubMed2002

Menstrual pattern in women with sickle cell anaemia and its association with sickling crises.

This was a prospective observational study based on 6-month menstrual diaries in women with sickle cell anaemia (SCA). The aim was to evaluate the natural menstrual pattern and to establish if there was an association between menses and painful crises in these women. The main outcome measures included length of cycle, duration of loss and the occurrence of painful crises in relation to menses. Eighty-two women were recruited initially and 42 returned completed menstrual diaries. A total of 213 continuous natural cycles were evaluated. The mean cycle length was 28.9 (+/- 5.95) days, while the mean duration of menstrual loss was 4.69 (+/- 4.65) days. Thirty-seven per cent of the women had definite cyclical painful crises with each menses and in this group, 61.5% of crises occurred with menstrual flow. An additional 21% had at least three cyclical crises documented in the 6-month period. In 42%, there was no association between menses and crises. In summary, 58% of women had some form of cyclical crises (albeit not severe) in association with menstrual cycles. In severe cases, the use of a continuous combined contraceptive pill regime or Depo-Provera to induce amenorrhoea (as well as to provide contraception) should be considered.

Adult↗
PubMed2004

Emerging drugs for endometriosis.

Medical treatment of endometriosis relies on drugs that suppress ovarian steroids and induce an hypoestrogenic state that causes atrophy of ectopic endometrium. Gonadotrophin-releasing hormone (GnRH) analogues, danazol, progestogens and oestrogen-progestin combinations have all proven effective in relieving pain and reducing the extent of endometriotic implants. However, symptoms often recur after discontinuation of therapy and hypoestrogenism-related side effects limit the long-term use of most medications. Furthermore, these therapies are of limited value in patients with a desire to become pregnant because they inhibit ovulation. An important target for current research is to identify effective therapies that can be safely administered in the long term. GnRH analogues with add-back therapy, progestogens and continuous oral contraceptive are options available for a medium or long-term systemic treatment. Mifepristone, an antiprogestogen, may constitute an alternative if encouraging preliminary data on its effectiveness and tolerability are confirmed. A very appealing area of interest is the possibility of treating endometriosis without suppressing ovarian function. Aromatase inhibitors might have such characteristics as they have been shown to inhibit oestrogen production selectively in endometriotic lesions, without affecting ovarian function; the clinical role of these drugs in the treatment of endometriosis is under evaluation. Levonorgestrel medicated intrauterine device has proven effective in relieving dysmenorrhoea associated with endometriosis, as well as pain associated with rectovaginal endometriosis. Although a systemic absorption is present determining side effects, this approach is promising in the long-term management of this condition. A fundamental objective of research in endometriosis treatment is to develop new therapeutic approaches based on the findings from experimental studies on the aetiopathogenesis of the disease; current research is focusing on anti-inflammatory drugs and modulators of the immune system. TNF-binding protein-1 and IL-12 have proved effective in reducing endometriotic lesions in animal models, while pentoxifylline and INF-alpha 2b have shown encouraging results in clinical studies. This area may be of paramount importance in the near future in order to develop a therapy that could prevent or eradicate endometriosis rather than merely relieving the symptoms.

Adult↗
PubMed2005

Documentation of preoperative counselling for female sterilisation: a complete audit cycle.

BACKGROUND: Female sterilisation is a commonly performed gynaecological procedure that attracts a disproportionate number of complaints and litigation. Documentation of the key counselling issues provides an important record of the information given to the woman prior to undergoing sterilisation. METHODS: Auditable standards were obtained from published guidelines. After the initial audit of 100 cases a proforma was introduced in an effort to improve documentation. A re-audit of 50 cases was undertaken to ascertain compliance of documentation following the introduction of the proforma. RESULTS: The proforma was used in 62% of cases and in all such cases documentation was 100% compliant with the auditable standards. Overall, documentation of standards pre- and post-proforma, respectively, was as follows (all the figures quoted are percentage values, with the range given in parentheses): 33 (24-43) vs 68 (53-80) for long-term alternatives, 94 (87-98) vs 78 (62-87) for irreversibility, 96 (90-99) vs 78 (64-88) for failure rate, 48 (38-58) vs 66 (51-79) for ectopic pregnancy risk if sterilisation fails, 39 (29-49) vs 66 (51-79) for the intended method, 67 (57-76) vs 66 (51-79) for operative risks and 37 (28-47) vs 64 (49-77) for continuing current contraception until sterilisation performed. CONCLUSIONS: Documentation of preoperative counselling for female sterilisation is often incomplete and does not comply with published recommendations. The introduction of a proforma resulted in a mixture of both improvement and deterioration of documentation. When the proforma was used, compliance with recommendations was 100%.

Counseling↗
PubMed1975

Further study of d-norgestrel for fertility control.

In a continuing oral contraceptive study of d-norgestrel, the 1,0-mg dose--the dose previously found to give the best cycle control--was administered cyclically on a "21-7 day" schedule to 284 women during 2650 cycles. None of the women conceived, and cycle control, though often altered, was generally acceptable. Side effects were minimal, and laboratory determinations performed prior to and during the administration of this agent revealed no clinically significant changes.

Adolescent↗
PubMedDate not supplied

[Pregnancy and inflammatory bowel disease].

Inflammatory bowel disease (IBD)--Crohn's disease, ulcerative colitis--affects frequently the women in their childbearing years with concerns about both on pregnancy and evolution of the IBD. Important issues concerning a pregnant woman with IBD include the effect of pregnancy on the disease, and, conversely, the effect of IBD on pregnancy and inheritance of IBD in the offspring. Adverse fetal outcomes are not increased when IBD is inactive; however, women with active disease incur a greater risk of premature birth. Most of women with active IBD at the time of contraception have continued or worsening disease activity during pregnancy. Most medications for IBD are safe during pregnancy, with notable exceptions. A key principle of management is that active disease, not therapy, poses the greatest risk to pregnancy.

Colitis, Ulcerative↗
PubMed1990

Etiology and histogenesis of endometriosis.

Based on the available scientific evidence, the mechanism of developing endometriosis appears to be transplantation of viable endometrial cell fragments shed during menses and regurgitated through the fallopian tubes under the influence of prostaglandin-mediated uterine contractions. As all women apparently retrograde menstruate to some extent, it is not surprising that circumstances which increase the total number of menstrual days experienced have been clinically associated with endometriosis. Similarly, factors which lead to relative uterine outflow obstruction have been associated with a higher incidence of endometriosis. There is virtually no other scientific evidence supporting alternate mechanisms of development of endometriosis. There are many unanswered questions regarding endometriosis including: 1) Are all women equally susceptible to development of the disease? 2) As the clinical presentation and course is extremely variable, what factors influence these events? 3) Does medical suppression of ovulation with oral contraceptives or continuous progestins provide a protective effect? 4) Are there systemic immunologic changes associated with endometriosis? Hopefully, this manuscript will help stimulate the next generation of clinical investigators to address these questions, as they are of paramount importance with this apparently increasingly devastating and frequent clinical disease.

Endometriosis↗