| 1. |
- Andersson, K, et al.
(author)
-
Intrauterine or oral administration of levonorgestrel in combination with estradiol to perimenopausal women--effects on lipid metabolism during 12 months of treatment
- 1996
-
In: International Journal of Fertility and Menopausal Studies. - 1069-3130. ; 41:5, s. 476-483
-
Journal article (peer-reviewed)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.
|
|
| 2. |
- Samsioe, Göran, et al.
(author)
-
Ethical issues in obstetrics
- 1996
-
In: International Journal of Fertility and Menopausal Studies. - 1069-3130. ; 41:3, s. 284-287
-
Journal article (peer-reviewed)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?
|
|
