The impact of overactive bladder, stress and mixed urinary incontinence on quality of life in Thai postmenopausal women.

OBJECTIVE: To assess the quality of life (QOL) of Thai postmenopausal women with overactive bladder (OAB), stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). MATERIAL AND METHOD: A total of 420 Thai postmenopausal women (120 had SUI, 60 MUI, 120 OAB and 120 controls) were recruited QOL was assessed by the Thai version short form 36 (SF-36). RESULTS: There was no significant difference in the patients's characteristics. All domains of SF-36 in women with OAB, SUI and MUI were statistically significantly lower than the control group. OAB and MUI had lower SF-36 scores than SUI in all domains except the role of physical health. When compared between OAB and MUI, the women with MUI had lower SF-36 scores than OAB in all domains (except the physical functioning and general health). CONCLUSION: OAB, SUI and MUI had more significant impaired QOL than control. The author found a greater impact on QUL in OAB and MUI in Thai postmenopausal women.

Diagnostic hysteroscopy at King Chulalongkorn Memorial Hospital: 7 years experience.

We reported our experience and results of diagnostic hysteroscopy performed on 294 patients between June 1994 and May 2000 at the Gynecologic Endoscopy Unit, King Chulalongkorn Memorial Hospital. Diagnostic hysteroscopy was performed successfully in 286 patients (97.3%), allowing thorough inspection of the uterine cavity. Cervical dilatation was required in 146 patients (49.6%). The most common indication was endometrial polyps (34.4%) followed by infertility (19.4%) and abnormal uterine bleeding (14.9%), respectively. Each of the hysteroscopic findings accounted for 103 patients (35%) in endometrial polyps and normal endometrium. The procedure failed in 8 patients (2.71%) due to uterine perforation. In conclusion, diagnostic hysteroscopy should be considered as a safe, effective and successful investigation procedure for suspected intrauterine pathology.

Pipelle versus fractional curettage for the endometrial sampling in postmenopausal women.

The experimental and cross over design study was performed to compare the pain, ability to sample the endometrial issue, and pathological results from pipelle and fractional curettage in post menopausal patients. Thirty naturally menopausal patients who visited King Chulalongkorn Memorial Hospital with abnormal bleeding per vagina from June 1 to December 31, 1997, were enrolled in the study. In group A,endometrial tissue sampling was first conducted by Pipelle and followed by fractional curettage. In group B, the fractional curettage was performed before Pipelle. The results showed that the pain derived by the visual analogue scale of Pipelle and fractional curettage were 3.34 +/- 1.44 (mean +/- SD) and 6.58 +/- 1.75 respectively (p<0.01). The sensitivity and specificity of Pipelle in endometrial tissue samplings compared with fractional curettage were 87.5 and 100 per cent, respectively. One from 3 cases of adeneocarcinoma of the endometrium could not be detected by Pipelle. In conclusion, Pipelle significantly produced less pain than fractional curettage. Even though Pipelle is a simple and easy method for endometrium sampling, the use of Pipelle to replace fractional curettage in the management of postmenopausal bleeding should be done with caution. False negative could occur in the focal disease of malignancy of the endometrium.

Accuracy of hysteroscopic diagnosis of endometrial polyps.

OBJECTIVE: To evaluate the diagnostic accuracy of endometrial polyps by hysteroscopy. MATERIAL AND METHOD: One hundred and sixty five women undergoing diagnostic hysteroscopy between January 1996 and December 1998 at the Gynecologic Endoscopy Unit, King Chulalongkorn Memorial Hospital were recruited in this study. The hysteroscopic diagnosis was compared with the histopathology by endometrial curettages performed after hysteroscopy. RESULTS: Endometrial polyps were diagnosed by hysteroscopy in 54 patients (32.73%). When compared to tissue pathology, we found an accuracy of 81.21 per cent, sensitivity of 92.59 per cent, specificity of 78.98 per cent, positive predictive value of 46.29 per cent, negative predictive value of 98.19 per cent, false positive of 17.57 per cent and false negative of 1.21 per cent. CONCLUSION: For endometrial polyps, diagnostic hysteroscopy yields a high accuracy but low positive predictive value. Therefore, endometrial biopsy is necessary to confirm diagnosis of endometrial polyps by hysteroscopy.

The metabolic and bone density effects of continuous combined 17-beta estradiol and noresthisterone acetate treatments in Thai postmenopausal women: a double-blind placebo-controlled trial.

OBJECTIVE: To compare the changes of lipid parameters, liver function tests, fasting plasma glucose and bone density in Thai postmenopausal women who received this combined hormonal treatment and placebo. STUDY DESIGN: Double-blinded, randomized controlled trial study. MATERIAL AND METHOD: Sixty postmenopausal women attending the menopause clinic at Chulalongkorn Hospital from July, 1996 to December, 1996, were enrolled in the study. The patients were randomized to receive the placebo or drug (17 beta-estradiol 2 mg and norethisterone acetate 1 mg) continuously. Patient characteristics, physical examination, liver function tests, fasting plasma glucose, lipid parameters (fasting total cholesterol, low density lipoprotein cholesterol (LDL), high density lipoprotein (HDL) and triglyceride level) and bone densitometry were performed before beginning the study. The lipid parameters were repeated at 3, 6 and 12 months. Fasting plasma glucose, liver function tests and bone densitometry were repeated at 12 months. RESULTS: In the drug group, there were significant changes in the cholesterol at 3, 6 and 12 months when compared to the baseline. There were significant differences at 3, 6 and 12 months when compared between groups. The HDL values were not significantly different within groups. The LDL values at 3, 6, 12 months were significantly lower than the baseline in the drug group when compared within groups and at 6, 12 months in the placebo group. The triglyceride values were not significantly different between groups and within groups. There was no significant change between groups and within groups of fasting plasma glucose, total bilirubin, direct bilirubin, AST, ALT, albumin and globulin. The alkaline phosphatase values were significantly decreased at 12 months in the drug group. The bone density of total BMD and T-score at the spine of the drug group increased significantly at 12 months. The per cent change per year was +5.1. In contrast, the values in the placebo group decreased significantly, the per cent change per year was -0.9. The same pattern was also found in the bone density of the total hip. But when focused to the femoral neck, we found no significant change in both groups. CONCLUSION: This continuous combined treatment resulted in beneficial changes of bone density and lipid profiles. The therapy prevented bone loss and the changes in serum lipoprotein were concordant with a lipid profile associated with a decreased risk of coronary heart disease in Thai postmenopausal women.

Bone mineral density of lumbar spine and proximal femur in normal Thai women.

OBJECTIVE: To find the reference data for age-specific normal bone mineral density in a Thai female population. STUDY DESIGN: Cross-sectional, Descriptive study. MATERIAL AND METHOD: 1773 Thai women aged between 11-80 years were recruited, using multistage cluster sampling and stratifying from six represented provinces in the country, each strata was randomly selected. After recruiting, the women were interviewed by well-trained personnel using structured questionnaires. Bone mineral density of the lumbar spine 1-4 and nondominant hip were measured by Dual Energy Photon Absorptiometer. The scientists, X-rays technician were trained and standardized inter and intra observers variation. Quality control of examination was measured periodically. Every BMD outcome was re-examined by a specialist. RESULTS: The peak bone mineral density of both spines and hips was between the age of 30 to 34 years old. Mean Value for spine and femoral neck was 0.957 and 0.814 g/cm2 respectively. The BMD of spine and hip was significantly decreased after the age of 35 and the loss was accelerated at age 50. Osteoporosis for spine and femoral neck is considered when BMD are below 0.682 and 0.569 g/cm2 respectively. CONCLUSION: The results are important data for public health policy, by maximizing bone mass during skeletal growth before menopause and minimizing bone loss throughout life as well as for detection of important risk factors.

Clinical effects of 17 beta-estradiol and norethisterone acetate in postmenopausal Thai women.

OBJECTIVE: To compare the climacteric symptoms, the bleeding patterns, side effects, endometrial thickness, serum follicular stimulating hormone (FSH) and estradiol level in postmenopause Thai women who received this drug and placebo. STUDY DESIGN: Double blind, randomized placebo controlled trial. MATERIAL AND METHOD: Sixty postmenopausal women attending the menopause clinic at Chulalongkorn Hospital from July, 1996 to December, 1996, were enrolled in the study. The patients were randomized to receive the placebo or drug (17 beta-estradiol 2 mg and norethisterone acetate 1 mg) continuously. After 12 months, 13 patients in the drug group were switched to have placebo and 13 patients in the placebo were switched to the drug group. Recording of patient characteristics, physical and gynecologic examination, pap smear, breast examination and mammogram, climacteric symptom scores, transvaginal ultrasonography, serum FSH and Estradiol level were performed prior to the study. Physical examinations, breast palpitations, measurement of body weight and blood pressure, climacteric symptom scores and side effects were repeated at 3, 6, 12, 18 months. Gynecologic examination, pap smear, serum FSH and estradiol, transvaginal ultrasonography, were repeated at 12 months. RESULTS: The women in the drug group had fewer climacteric symptoms than baseline after 6 months. The incidence of amenorrhea was 74.0 per cent at 12 months. The incidence of abnormal uterine bleeding (spotting and breakthrough bleeding) was 37.0 per cent at 3 months, 29.6 per cent at 6 months, 25.9 per cent at 12 months and 7.1 per cent at 18 months. The women in the drug group had fewer climacteric symptoms than baseline after 6 months. Breast tenderness was the most common side effect. The endometrial thickness decreased significantly in the drug group. Serum FSH decreased and serum estradiol increased significantly in the drug group. CONCLUSION: This combined regimen was more effective in relieving the climacteric symptoms in women who used the drug than those who used the placebo. There was a high incidence of amennorhoea after 12 months. But there was also a high frequency of abnormal bleeding in the first 3 months of treatment. Counseling on the bleeding pattern and common side effects should be conducted before starting the treatment to increase the compliance. This combined regimen proved to be a useful alternative for postmenopausal Thai women who prefer to avoid cyclic bleeding from sequential therapy.

Premarital counseling clinic at Chulalongkorn Hospital.

BACKGROUND: The premarital counseling clinic at Chulalongkorn Hospital was established in 1978. The characteristics and sexual background were reviewed. AIM: To study characteristics, sexual background and choices of contraceptions of premarital couples attending the premarital counseling clinic at Chulalongkorn Hospital during the past ten years, (1988-1998). DESIGN: Descriptive study. MATERIAL AND METHOD: Two hundred couples (men (M) and women (W)) attending the premarital clinic at Chulalongkorn Hospital from July 1988 to January 1998 were recruited in the study. The counseling program included medical counseling, sex education and family planning counseling. The information of couples was recorded by the Family Planning Unit staff and the residents. RESULTS: The mean age was 31.5 +/- 4.3 yrs. (M), 28.9 +/- 3.8 yrs. (W). Most of the couples had a bachelor's degree education (61.5%--M; 72%--W). Most of them were employees (64.0%--M; 60.0%--W), had an income of 10,000-20,000 baht per month (39.0%--M; 38.0%--W) were Buddhist 97.0 per cent (M), 93.0 per cent (W). There were only 4 couples who had an abnormal physical examination. 85.5 per cent of the men had had sexual experience before while it was only 23.0 per cent in women. Most of the men had frequent masturbation 3-4 times/month (31.5%) and most of the women had no masturbation (86.0%) at all. Most of the couples (71.5%) chose to have contraception (contraceptive pill 57.5% and condom 20.0%). CONCLUSION: Premarital counseling should be adjusted to the background of the couples. Most couples had a high income and education. Sex counseling is important for couples especially women. The propagation of premarital clinic encourages further study and to outreach the general population of Thailand.

Similarity of bone mass measurement among hip, spines and distal forearm.

From January-December 1995, bone mineral density (BMD) of lumbar spine, hip and distal forearm were studied in 325 healthy women visiting the menopause clinic, Chulalongkorn Hospital. This retrospective analysis was conducted to assess the correlation of BMD among various measurement sites. Bone mass measurement at hip and spine were performed utilizing dual energy X-ray absorptiometer (DEXA), Hologic QDR 2000 and at distal forearm by single energy X-ray absorptiometer (SEXA), Hologic DTX 100. By canoconical correlation, the results revealed a significant correlation of BMD of distal and ultra-distal part of forearm with various sites of hip (r = 0.602, p < 0.001). There was also significant correlation of distal and ultra-distal part of forearm with various sites of spines (r = 0.619, p < 0.001). Though there is some heterogeneity of bone mass density among different measurement sites, practically with this fairly good level of correlation, bone mass measurement of distal forearm might be used to predict the BMD of hip and spine in Thai women. The accuracy of predicting the BMD of hip and spine by BMD of distal forearm in the mass screening programme in Thailand is now going on. The results will be followed.