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| 2. |
- Borring, Margareta, et al.
(författare)
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Akut buksmärta under pågående graviditet var spontan ruptur av a uterina. Ovanligt och livshotande tillstånd
- 2010
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Ingår i: Läkartidningen. - 0023-7205. ; 107:41, s. 2484-2486
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Tidskriftsartikel (refereegranskat)abstract
- This case report illustrates a very rare and very serious complication during ongoing pregnancy, namely spontaneous rupture of the uterine artery. Late diagnosis increases the morbidity and mortality for the foetus as well as for the pregnant woman. Angiography gives the diagnosis. In the differential diagnosis of acute abdomen in a pregnant woman spontaneous rupture of the uterine arteries as the cause of intra abdominal bleeding during the second and third trimester should be included, especially with a history of endometriosis.
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| 3. |
- Gemzell-Danielsson, Kristina, et al.
(författare)
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Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods : results of the CHOICE program in Sweden
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 869-877
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the influence of counseling on women's contraceptive decisions. Design. A cross-sectional multicenter study. Setting. Seventy Swedish family planning clinics. Population. Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method. Methods. Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional. Main Outcome Measures. Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice. Results. In all, 173 healthcare professionals and 1 944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% ( n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method. Conclusions. Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.
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| 4. |
- Kopp Kallner, Helena, et al.
(författare)
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Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women : A Nationwide Survey
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe contraceptive use and attitudes towards contraceptive use in Sweden which has the highest abortion rate in Western Europe. Secondary objectives were to investigate knowledge of contraceptive methods and outcomes of unplanned and unwanted pregnancies.Design: Telephone survey.Setting: National survey of women living in Sweden.Population: Women between 16 and 49 years.Methods: The survey contained 22 questions with free text and multi choice answers on demographics, contraceptive use, knowledge of and attitudes towards contraception, the importance of monthly bleeding and experience of unintended pregnancy.Main Outcome Measures: Distribution of use of contraceptive methods and non-use of contraception among Swedish women. Prevalence and outcome of unintended pregnancies.Results: A total of 1001 women participated in the survey. Of all women, 721/1001 (72.1%) currently used contraception whereas 268/1001 (26.8%) women did not. Long acting reversible contraception, (LARC; implant and intra uterine contraception) was used by 24.3% of women. The unmet need of contraception in Sweden was estimated at 8.9% (89/1001 women). A total of 781 (78%) women had never experienced an unintended pregnancy whereas 220 (22%) women had had at least one unintended pregnancy. Users and non-users alike stated that one of the most important characteristics of a contraceptive method is its effectiveness.Conclusions: Sweden has a large unmet need for contraception. Furthermore, a large proportion of women have experienced at least one unintended pregnancy. Increasing contraceptive use and promotion of LARC is a possible way forward in the effort to reduce the rates of unwanted pregnancies.
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| 5. |
- Thunell, Louise, 1961, et al.
(författare)
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Changes in attitudes, knowledge and hormone replacement therapy use: a comparative study in two random samples with 6-year interval
- 2005
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Ingår i: Acta Obstet Gynecol Scand. - : Wiley. - 0001-6349. ; 84:4, s. 395-401
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study changes in: (i) the prevalence of hormone-replacement therapy (HRT) and (ii) women's attitudes and knowledge about the climacteric. Design. Cross-sectional comparison was performed on two populations of women both aged 46-62 years and resident in the same urban Swedish population over a period of 6 years. MATERIAL AND METHODS: In 1992, a random sample of 5990 women, from five birth cohorts, 46, 50, 54, 58, and 62 years in the city of Goteborg, were assessed using a postal questionnaire technique. In 1998, the same technique was used and a similar questionnaire was sent to another cohort of women (n=5411) of the same ages, resident in the city of Goteborg. The overall response rate was 76%. Information was obtained regarding climacteric symptoms, HRT use, and attitudes and knowledge. RESULTS: The prevalence of HRT use with medium-potency estrogens had increased from 13% (1992) to 31% (1998). The highest prevalence was reported in women 54 years of age (46%). The most common reasons why women started HRT were: hot flushes and sweats, depression/irritability, sleeping disturbances, and vaginal dryness. Forty-four percent of the women in this study were prepared to consider extended HRT if the treatment was free from withdrawal bleedings (35%, 1992). Eighty percent believed that the risk of osteoporosis decreased during HRT use (61%, 1992) and 68% thought that the risk of breast cancer increased (58%, 1992). CONCLUSIONS: A marked increase in the use of HRT was reported between 1992 and 1998. Women's attitudes to HRT were more positive in 1998 compared to 1992. Knowledge about HRT among women had increased during the same 6-year period.
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- Thunell, Louise, et al.
(författare)
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Scientific evidence changes prescribing practice--a comparison of the management of the climacteric and use of hormone replacement therapy among Swedish gynaecologists in 1996 and 2003
- 2006
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Ingår i: Bjog. - : Wiley. ; 113:1, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study changes in attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynaecologists in Sweden. DESIGN: Comparative questionnaire study. SETTING: National survey. POPULATION: Practising gynaecologists. METHODS: In 1996, gynaecologists in Sweden (n= 1323) were invited to return a postal questionnaire concerning their attitudes, knowledge and management strategies concerning HRT. They were also asked about their own use of HRT. In 2003, a similar questionnaire was sent to practising gynaecologists (n= 1320) in Sweden. MAIN OUTCOME MEASURES: Attitudes to and personal use of HRT. RESULTS: The response rate was 76% in 2003 when 11% of the gynaecologists thought that all women without contraindications should be offered HRT compared with 44% in 1996 and 89% found it difficult to evaluate pros and cons with HRT in a clinical situation (74% in 1996). More gynaecologists in 2003 believed that HRT increased the risk for breast cancer (95% vs 71%). Twenty-five percent in 2003 stated that risk factors for osteoporosis were absolute indications for HRT (60% in 1996). Current ischaemic heart disease was considered to be an indication for HRT by 7% in 2003 (60% in 1996). In 2003, current use of HRT was reported by 71% of female menopausal gynaecologists (88% in 1996). CONCLUSIONS: Swedish gynaecologists were more cautious in their management strategies concerning HRT in 2003 compared with 1996, probably influenced by results from the Heart and Estrogen/Progestin Replacement Study (HERS) and Women's Health Initiative (WHI) studies. Current use of HRT was still high among female gynaecologists, although it had decreased since 1996.
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| 7. |
- Thunell, Louise, 1961
(författare)
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The climacteric. Management and attitudes among women and physicians
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: Paper I: To longitudinally assess the prevalence of climacteric symptoms, the use of hormone replacement therapy (HRT) and life-style factors in the same women in 1992 (aged 46-62 years) and in 1998 (aged 52-68 years). Paper II: To study changes in (i) the prevalence of HRT use and (ii) attitudes and knowledge about the climacteric among 46-62 years old women resident in Göteborg 1992 and 1998. Paper III: To study changes in management strategies concerning HRT among gynecologists in Sweden and to assess possible use of HRT among gynecologists. Paper IV: To investigate the effect on glucose homeostasis and plasma lipids of treatment with estradiol and norethisterone acetate (NETA) in postmenopausal women with type 2 diabetes.Patients and methods: Papers I & II: Population-based studies initiated in 1992 in 46-62 years old women, (5 birth cohorts) randomly obtained from the population register. The women received a postal questionnaire regarding life-style, the climacteric and its treatment. Paper I: In a prospective, longitudinal cohort study the same women (n = 3816) were assessed again in 1998 with a similar questionnaire. Paper II: In a new cross-sectional study 1998, with identical design as the study from 1992, a random sample of 5411 women of the same ages as in the study from 1992 was contacted. Paper III: In 1996, gynecologists in Sweden (n = 1323) were invited to return a postal questionnaire about (i) their attitudes, knowledge and management strategies concerning HRT and (ii) their own or their partners possible use of HRT. In 2003, the same technique was used and a similar questionnaire was sent to practicing gynecologists in Sweden (n = 1320). Paper IV: Thirty-one postmenopausal women with type 2 diabetes were included in a randomised, double-blind, placebo-controlled study with cross-over design. Each treatment period was 6 months. All metabolic and anthropometric examinations were performed at baseline and after each treatment period.Results: Paper I: The prevalence of climacteric symptoms increased in the same women between 1992 and 1998: vasomotor symptoms 52%/62%, sleep disturbances 51%/69%, loss of libido 38%/57%, depression/irritability 57%/65%. Current use of HRT increased from 14% in 1992 to 34% in 1998. The number of smokers decreased (32% to 26%) and BMI and exercise increased. Paper II: HRT use increased between 1992 (13%) and 1998 (31%) in the cross-sectional comparison. The highest prevalence was reported in women 54 years of age (46%). Forty-four percent of the women were prepared to consider life-long HRT if the treatment was free from withdrawal bleedings (35%, 1992). Eighty percent believed that the risk of osteoporosis decreased during HRT use (61%, 1992) and 68% thought that the risk of breast cancer increased (58%, 1992). Paper III: In 2003, 11% of the gynecologists thought that all women without contraindications should be offered HRT compared to 44% in 1996. Twenty-five percent in 2003 stated that risk factors for osteoporosis were absolute indications for HRT compared to 60% in 1996. Current ischaemic heart disease was considered to be an indication for HRT by 7% in 2003 (60% in 1996). Seventy-one per cent of female gynecologists and 68% of the male gynecologists´ partners used HRT in 2003 (88 och 86% in 1996). Paper IV: Estradiol/NETA therapy decreased hyperandrogenicity i.e. sex hormone binding globulin (SHBG) increased and free testosterone decreased. Lipoprotein (a) and plasminogen activator inhibitor-1 (PAI-1) decreased. No changes in glucose homeostasis were found. Conclusions: Symptoms associated with the climacteric period increased in the same birth cohorts of women from 46-62 to 52-68 years of age. Use of HRT increased markedly between 1992 and 1998 in women in Göteborg, Sweden. Gynecologists in Sweden were more cautious in their management strategies concerning HRT in 2003 compared to 1996 and their personal use of HRT had also decreased. The impact on cardiovascular risk factors and glucose homeostasis of 2 mg estradiol/1 mg NETA in postmenopausal women with type 2 diabetes is probably neutral.
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| 8. |
- Thunell, Louise, et al.
(författare)
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The effect of continuous combined HRT on glucose homeostasis and plasma lipids. A placebo-controlled study in postmenopausal women with type 2 diabetes
- 2006
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Ingår i: Maturitas. - : Elsevier BV. - 1873-4111 .- 0378-5122. ; 53:4, s. 430-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hyperandrogenicity in women is a risk factor for cardiovascular disease and noninsulin-dependent diabetes mellitus (NIDDM). Estradiol alone decreases hyperandrogenicity and have beneficial effects on glucose metabolism and plasma lipids in postmenopausal women with type 2 diabetes. OBJECTIVES: To analyse effects on glucose homeostasis and plasma lipids by 2 mg estradiol and 1mg norethisterone acetate (NETA) given as a daily tablet during 6 months in postmenopausal women with type 2 diabetes. DESIGN: Randomised, double-blind, placebo-controlled, cross-over design. MATERIAL AND METHODS: Thirty-one postmenopausal women with type 2 diabetes, glycosylated haemoglobin (HbA1c) of 6% or more and sex hormone-binding globulin (SHBG) values of 60 nmol/L or less were included. Anthropometric variables, blood pressure, sex steroid hormones, HbA1c, serum and lipoprotein lipids, plasminogen activator inhibitor 1 (PAI-1) and insulin-like growth factor 1 (IGF-1) were measured. An oral glucose tolerance test (OGTT) was performed and blood glucose, insulin and C-peptide were analysed. All measurements were taken at baseline and after each 6-month period. RESULTS: An increase of SHBG and a decrease in free testosterone and PAI-1 levels was induced by the estradiol/NETA treatment compared with placebo. Lipoprotein(a) decreased but otherwise lipid metabolism was unaffected. No differences were recorded in glucose homeostasis between active treatment and placebo. CONCLUSION: Estradiol/NETA therapy decreased hyperandrogenicity in postmenopausal women with type 2 diabetes. Lipoprotein(a) and PAI-1 which are independent risk factors for coronary heart disease decreased. No changes in glucose homeostasis were found.
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