| 1. |
- Andersson, K, et al.
(författare)
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Intrauterine or oral administration of levonorgestrel in combination with estradiol to perimenopausal women--effects on lipid metabolism during 12 months of treatment
- 1996
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Ingår i: International Journal of Fertility and Menopausal Studies. - 1069-3130. ; 41:5, s. 476-483
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Limited data concerning serum lipids and lipoproteins are available on the effect of HRT in perimenopausal women, who commonly have marked bleeding disturbances and may have severe climacteric symptoms. Almost all previously published data have utilized a simplified form of lipoprotein analysis, which includes an estimation and not a determination of LDL cholesterol. To delineate the role of locally administered progestogen, perimenopausal women were studied for a year. PATIENTS AND METHODS: 40 perimenopausal women with climacteric complaints. The continuous release of low-dose levonorgestrel from an intrauterine device was used as progestogen co-medication to estradiol in a new type of continuous combined hormone replacement therapy. Women were randomized to either cyclical treatment with 2 mg of oral estradiol valerate in combination with 250 micrograms of levonorgestrel for the last ten days (Cyclo Progynova) or continuously with 2 mg estradiol valerate orally in combination with a 20 micrograms per 24 hour levonorgestrel releasing intrauterine device. RESULTS: Reduced HDL cholesterol was initially recorded in both treatment arms and disappeared after 1 year of treatment. Triglycerides were reduced in the orally treated group, but not in the device group. No changes in LDL cholesterol were noted. CONCLUSIONS: The findings suggest that continuous combined HRT with intrauterine release of 20 micrograms levonorgestrel per 24 hours in perimenopausal women is neutral as far as lipid metabolism is concerned, since no alterations compared with pretreatment values could be noted after 12 months of treatment. Less marked lipid changes were obtained in perimenopausal women as compared with data on postmenopausal women. Differences in methodology may partly account for this.
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| 2. |
- Heimer, G, et al.
(författare)
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Effects of vaginally delivered estrogens
- 1996
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. Supplement. - 0300-8835. ; 163, s. 1-2
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Atrophic condition in the vagina and lower parts of the urethral tract are common in elderly women. From population based surveys it has been estimated that 40% or more of women over 60 complain of insufficient control of micturation. In addition, lower urinary tract infections are common in this age group and recurrent cystitis is a scourge for many women (1, 2). Vaginal problems such as vaginal dryness, dyspareunia as well as infectious and non infectious disorders in the vagina may be even more common in elderly women (3) Vasomotor symptoms such as sweats and hot flushes commonly commence around the time of the menopause. In the majority of cases urogenital dysfunction does not become a problem until a decade later. Endogenous estrogens decline during the climacteric and the fall of estradiol levels from the time of onset of vasomotor symptoms until commencement of urogenital problems cannot be disregarded. In other words, it seems as if urogenital integrity can be maintained at lower estrogen levels than those required to resist vasomotor symptoms and conserve bone mass. Further evidence for this concept is achieved from numerous clinical studies in which various estrogens have been administered both orally and vaginally to elderly women with signs of urogenital atrophy which have resulted in amelioration. Such an alleviation of urogenital symptoms can be achieved without provoking endometrial growth.
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| 3. |
- Samsioe, Göran, et al.
(författare)
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Ethical issues in obstetrics
- 1996
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Ingår i: International Journal of Fertility and Menopausal Studies. - 1069-3130. ; 41:3, s. 284-287
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Tidskriftsartikel (refereegranskat)abstract
- Ethical issues in modern obstetrics commonly relate to a conflict between the rights and possibilities of the fetus versus those of the mother. After delivery, when the fetus by definition is a child, all legal rights are granted to this new individual. Whether any rights should be given or offered to the fetus is dependent on the prevailing situation. General rules are difficult to give due to the rapid evolution of clinical medicine-too firm rules given today could well be an obstacle in the near future. All cultures have well-established opinions regarding issues related to pregnancy and childbirth. Cultural and religious dogmas are often in conflict with modern medical technology and financial issues. In several modern societies, state laws regulate legal abortion and other aspects of termination of pregnancy. Current laws often determine not only decisions but also the minds of doctors, as well as of patients. Advanced medical technology has yielded a possibility of selective feticide. Again our experience with this new technique is limited, and several issues of ethical importance may arise from the use of such techniques. The indications for a selective feticide are dependent upon the benefits and risks of the procedure itself, and also on the selection process of what fetus should be aborted. Clearly, no definitive rules could be given at this stage of development. The advice given to the woman by her doctor is of critical importance for the outcome of the given pregnancy, be it selective feticide or legal abortion. However, the prevailing social welfare system and the support a woman could be given by her society are also factors. Should she give birth to a child with an inborn error of metabolism, or some other chronic illness? Drug abuse, including alcohol and, indeed, also tobacco, constitutes a special problem. In Sweden, drug-addicted pregnant women are hospitalized during their last trimester. This policy results in a drug-free last trimester and a reduction of afflicted newborns. Should a similar approach also be enforced when dealing with abuse of alcohol and tobacco during pregnancy? The improvement of in vitro fertilization techniques has introduced a novel concept, the surrogate mother. In some countries, this is forbidden by law, in others, it is an accepted medical practice, but several medico-legal as well as ethical issues warrant further clarification. What are the legal rights of the surrogate mother? Should there be an age limit for surrogate mothers? Who is responsible for problems in the pregnancy itself? In cases of male infertility, ethical issues may arise. Should the child have a legal right to learn the name of the biological father? Should there be a limit for the use of donor sperm in respect to number of fertility attempts, as well as potential female patients who may use the same sperm donor?
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| 4. |
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| 5. |
- Samsioe, Göran
(författare)
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Hormone replacement therapy: aspects of bleeding problems and compliance
- 1996
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Ingår i: International Journal of Fertility and Menopausal Studies. - 1069-3130. ; 41:1, s. 11-15
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Tidskriftsartikel (refereegranskat)abstract
- Mitigation of vasomotor symptoms and urogenital problems, along with reductions in osteoporosis and cardiovascular disease, provides the rationale for using hormone replacement therapy (HRT), and the duration of use. However, user surveys have indicated poor compliance with HRT, and that means user time may be less than 12 months, a period unlikely to influence metabolic disorders. The main reasons for discontinuing HRT are unacceptable bleeding pattern and fear of cancer. There is solid evidence that HRT does not increase gynecological, gastrointestinal, or other adenocarcinomas. In fact, the only remaining controversy relates to breast cancer. Since the media often underscore and strengthen "old wives' tales" about the menopause and HRT, access to correct, unbiased information is the key to combating the misconceptions about HRT. Information also helps women understand the nature of menstrual-like bleeding, and thus contributes to compliance. Unfortunately, existing formulations do not control the bleeding pattern in every women. Our understanding of spotting and breakthrough bleeding is still poor. Older data, which suggested routine endometrial histology to find the cause and select treatment of vaginal bleeds, have been contradicted, rendering endometrial biopsy less useful in decision making; endometrial ultrasonography seems to be of more value for endometrial surveillance in HRT. Recent advances in understanding the nature and function of growth factors in uterine tissues help to unravel an array of events of importance for explaining the bleeding sometimes encountered during continuous combined therapy. The pharmaceutical industry should be challenged to work closely with scientists and regulating agencies. Doing so will help to advance our knowledge and therapeutic modalities, which will help us to combat the chief cause of poor compliance to, and discontinuation of, a very important potential contributor to maintaining quality of life of elderly women.
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| 6. |
- Samsioe, Göran
(författare)
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Medical and surgical strategies for treating urogynecological disorders
- 1996
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Ingår i: International Journal of Fertility and Menopausal Studies. - 1069-3130. ; 41:2, s. 136-141
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Tidskriftsartikel (refereegranskat)abstract
- Symptoms and signs of the urogenital estrogen deficiency syndrome occur relatively late in a women's life when endogenous estrogen levels are well below those required to stimulate endometrial growth. At age 60 and above symptoms are common and progress with advancing age. The first and most common complaint is vaginal dryness, but symptoms of lost control of micturition as well as urge incontinence are also frequent. Recurrent infections of the lower urinary tract are common, as well as dyspareunia and a sensation of burning and itching. One third of women above age 60 suffer from urogenital estrogen deficiency syndromes, a figure that rises to two thirds at the age of 75. With a rapid growth of the elderly female population, these symptoms are an increasing burden to the individual as well as to any given health care system. Several clinical trials have repeatedly demonstrated the efficacy in alleviating these symptoms of low daily estrogen doses as exemplified by 8 micrograms/day of vaginally administered estradiol. For reasons not completely understood, the urogenital tissues respond to this low estrogen level but the endometrium does not. Hence, estrogen therapy aiming at mitigating urogenital deficiency symptoms could be given without a progestogen. No side effects have been described for vaginal preparations, and neither absolute nor relative contraindications exist. No protection is offered against cardiovascular disease or osteoporosis, though. In 1991, vaginal low-dose estrogens were declared OTC preparations in Sweden. The costs for the society for this program can be limited to the costs of medication only, for medical monitoring is not compulsory. The clinical efficiency is remarkable, and urogenital symptoms are almost abolished in elderly women receiving this type of treatment, which is practically devoid of side effects.
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