Effect and safety of 17 beta-estradiol vaginal tablet in postmenopausal women with urogenital symptoms.

OBJECTIVE: To evaluate the effects of a 17 beta-estradiol vaginal tablet on urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level in postmenopausal women with urogenital symptoms. METHOD: Twenty-seven postmenopausal women with urogenital symptoms received 25 microg of a 17 beta-estradiol tablet intravaginally daily for the first 2 weeks, followed by 10 weeks of twice a week dosage. The results of urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level were analysed. RESULTS: The urogenital symptoms improved significantly in all women. The mean vaginal pH was significantly decreased. The vaginal cytology showed estrogenic effect on the karyopyknotic index and the maturation value. There was no significant difference in endometrial thickness and level of plasma estradiol before and after treatment. There was one case of vaginal bleeding from endometrial proliferation. CONCLUSION: Local vaginal treatment of 17 beta-estradiol (25 microg) had a positive effect on the urogenital symptoms, vaginal pH, and vaginal cytology. No elevation of plasma estradiol level was detected after treatment.

Effect of oral estriol on urogenital symptoms, vaginal cytology, and plasma hormone level in postmenopausal women.

OBJECTIVE: To evaluate the effects of oral estriol on urogenital symptoms, vaginal cytology, and plasma follicle stimulating hormone (FSH) and estradiol level in postmenopausal women with urogenital symptoms. METHOD: Twenty-eight postmenopausal women with urogenital symptoms who volunteered to participate in this study received 2 mg of oral estriol daily for 12 weeks. The urogenital symptoms, vaginal cytology, and plasma hormone level before and after treatment were analysed using paired t-test. RESULTS: The genital and urological symptoms improved (P < 0.05) after treatment in all subjects. The vaginal cytology showed estrogenic effect on the karyopyknotic index and maturation value. There was a significantly (P < 0.05) higher level of plasma estradiol after 12 weeks of treatment. However, the difference of plasma FSH level before and after treatment was not statistically significant. CONCLUSION: The daily oral estriol had a positive effect on the urogenital symptoms and vaginal cytology. The plasma estradiol increased after 12 weeks of treatment but the plasma FSH did not change.

Sonographic findings of uterus and ovaries in normal pre- and post-menopausal women.

To investigate the significant findings of ultrasonography before hormonal replacement therapy (HRT) was given in normal pre- and post-menopausal women. Sixty eight Thai pre- and post-menopausal women with no previous HRT were recruited into the study, They were divided into 22 pre-menopausal women (group I), 28 post-menopausal women of < or = 5 years (group II) and 18 post-menopausal women of > 5 years (group III). Their mean age was 48.2, 50.2 and 57.3 years, respectively. Myoma uteri was found in 10 (45.5%), 2 (7.1%) and 1 (5.6%) in group I, II and III. There were 2 (9.1%), 3 (10.7%), 3 (16.7%) cases of ovarian tumor in these three groups respectively. The detection rate of ovaries from ultrasound was 90.7 per cent in group I, 89.1 per cent in group II and III. The corpus to cervix ratio in the three groups was 2.3, 2.4 and 2.3, respectively. Uterine volume in nulliparous and multiparous pre-menopausal women was 56.6 ml and 74.2 ml, but in group II and III were 60.1 ml and 37.1 ml respectively. Endometrial thickness was significantly different in group I, II and III (7.2, 4 and 2.9 mm.) Left and right ovarian volume of group I was significantly larger than that of group II and group III. In conclusion, the ultrasonography is highly recommended to detect uterine and ovarian abnormalities before HRT is given in pre- and post-menopausal women.

Hysteroscopic resection of submucous myoma: a result of 50 procedures at Ramathibodi Hospital.

We reported an initial result of the safety and efficacy of myomectomies performed between September 1994 and June 1997 by the hysteroscopic resectoscope in 50 patients at Ramathibodi Hospital. The indications for hysteroscopy and/or hysteroscopic myomectomy were menorrhagia in 23, metrorrhagia in 3, menometrorrhagia in 2, infertility with abnormal uterine bleeding in 12, abnormal uterine bleeding during hormonal replacement therapy (HRT) in 4, and suspected submucous myomas detected by ultrasonography and/or sonohysterography in 6 patients. The mean age of the 50 patients was 39.5 years with a range of 26 to 66 years. The sizes of the submucous myomas ranged from 1-5 cm. The mean of operation time was 32 minutes (range 15-60 minutes). The mean volume of 1.5 per cent glycine required for irrigation was 800 with a range of 600-2000 ml, and the mean deficit at the end of the operation was 300 with a range of 200-1000 ml. The mean estimation of blood loss during the operation was 80 ml with a range of 50-200 ml. Postoperatively 28 out of 30 patients with menorrhagia had improvement in excessive bleeding (93.33%). One patient underwent subsequent hysterectomy due to persistent heavy uterine bleeding from recurrent submucous myoma. All patients with infertility and patients under HRT had normal menstruation after this procedure. 2 out of 12 (16.67%) patients with infertility became pregnant after submucous resection. No serious complications occurred. One patient had a cervical laceration repaired by simple stitches. One patient had mild endometritis responding to outpatient antibiotics. Forty-eight patients were discharged from hospital the day after the operation, the remaining two staying overnight for observing post-operative bleeding. Our data suggested that resectoscopic myomectomy is a safe and effective surgical procedure. The procedure offers the advantage to the patients of a shorter hospital stay along with a low complication rate. The hysteroscopic approach to the symptomatic submucous myoma has dramatically changed the treatment options for patients who classically would be offered abdominal myomectomy or hysterectomy.

Bone density in women receiving Norplant implants for contraception.

The aim of this study was to determine whether long-term Norplant uses is associated with changes in bone density. The study group consisted of forty one healthy women aged 19-42 years who had used Norplant for 31.1 +/- 11.2 months with a minimum period of 12 months. Fifty current IUD users constituted the control group. The bone density was measured by dual energy X-ray absorptiometry (DEXA) at the non dominant distal and ultradistal forearm. Serum estradiol was measured by microparticle enzyme immunoassay technique. Age, parity, income, weight, height and body mass index (BMI) of both groups were no differences. Our analysis did not find any differences in bone mineral density of distal forearm and ultradistal forearm between Norplant and IUD users (95% CI -0.01, -0.03 and -0.02, 0.02 respectively). Serum estradiol was not different in the two groups (95% CI -24.9, 110). This study revealed that the Norplant implants do not have any adverse effect on bone mineral density.

Pattern of bone loss in surgical menopause: a preliminary report.

The objective of our study was to assess bone mineral density between surgical menopausal women without hormonal replacement and perimenopausal women. This randomized study group included fifty surgical menopausal women and fifty perimenopausal women. Both groups were assessed in body height, body weight and body mass index. The bone mineral density of the distal radius, midradius, femoral neck, lumbar spine and total body in both groups was determined by dual energy X-ray absorptiometry (DEXA). Data analysis was used ANOVA test and rate of bone loss equation. Both groups were similar with respect to body height, body weight and body mass index. As compared with the values in perimenopausal group, bone mineral density of the surgical menopausal group was significantly lower at distal radius, midradius, femoral neck, lumbar spine, and total body (0.267 vs 0.312 g/cm2, 0.609 vs 0.692 g/cm2, 0.762 vs 0.930 g/cm2, 0.980 vs 1.153 g/cm2, and 1.029 vs 1.141 g/cm2). In the postmenopausal period less than 9 years, the estimated rate of bone loss at the lumbar spine and the distal radius were higher than the other sites (3.05, 2.70 per cent/year). While the postmenopausal period more than 9 years, the estimated rate of bone loss at the femoral neck was higher than the other sites (2.70 per cent/year). Pattern of bone loss in the surgical menopause is responsible for type I osteoporosis in the first 9 years postmenopause and type II osteoporosis in the after 9 years postmenopause. Prevention of bone loss in the surgical menopausal women should be instituted immediately after surgery.

Diagnostic hysteroscopy: a result of 125 patients at Ramathibodi Hospital.

This report summarizes the diagnostic hysteroscopic experience with 125 selected patients. The procedures were all performed under propofol anesthesia. The main indications for diagnostic hysteroscopy were infertility with suspected intrauterine lesions and abnormal uterine bleeding in premenopausal women. The procedures were successful in 123 (98.4%) patients. Cervical dilatation was required in 35 (28%) patients. Of the 125 diagnostic examinations, 91 (72.80%) had intrauterine abnormalities. This result showed that an important factor that appears to influence the prevalence of pathology are the gynecological problems and/or symptoms of the patients. The commonest finding in patients with infertility was intrauterine adhesions, whereas, endometrial polyps was the most common finding found in premenopausal women with abnormal uterine bleeding. There was no complication attributable to this procedure. Our experience suggests that the efficacy and safety of this procedure depend on proper selection of patients, type of anesthesia, the medium for uterine distention, and most importantly the experience of the operator.

Prophylactic oophorectomy of benign uterine disease in premenopausal women: 11 years review.

Between 1982 and 1992, 695 consecutive abdominal hysterectomies and prophylactic oophorectomies in premenopausal women for benign uterine diseases were performed in our department. The trend of prophylactic oophorectomy has declined since 1988 to a minimum in 1990. 60 per cent were 41-45 years of age, 28 per cent were more than 46 years, 12 per cent were 36-40 years. Uterine fibroid was the most frequent indication (77.7%), followed by adenomyosis (21.0%). Ovarian histologies revealed abnormalities only in 1.3 per cent of the removed ovaries, the remainder appeared to be normal.

Urological injury during gynecologic surgical procedures.

Urological injury during gynecologic surgical procedures is an infrequent but serious complication. The incidence from this study is less than other studies. There are 25 cases of urological injuries consisting to twenty-one bladder injuries and four ureteral injuries. The associated factors of the urological injury are previous pelvic operation, distorted anatomy in the pelvis from various diseases and full bladder. Prompt intraoperative recognition of the injury is the best way to prevent serious postoperative complication. Four had vesicovaginal fistulae that were recognized postoperatively. Three had spontaneous closure of fistulae with conservative management and one required surgical management. Patients who had urological injury during the gynecologic surgical procedures had a longer hospital stay. The most important factor in prevention of this injury is a clear exposure of structures at risk.