Balancing safety and efficacy focus on endometrial protection.

Estrogen replacement therapy (ERT) has demonstrated significant, long-term benefits by improving cardiovascular risk factors and increasing bone mineral density; however, unopposed ERT is associated with an increased incidence of endometrial hyperplasia and progression to endometrial carcinoma in postmenopausal women who retain their uteri. As a result, the use of combined regimens containing both a progestogen and an estrogen is becoming the standard course of therapy. Further study is required, however, to determine the effects of the various available progestogens and discover optimal dosing regimens. Not all progestogens are alike. Careful progestogen selection is critical to ensure a high degree of patient adherence to therapy. Patients discontinue hormone replacement therapy (HRT) for reasons including irregular or breakthrough bleeding, progestogen intolerance and other unpleasant side effects. Working individually with patients to optimize HRT regimens is critical to helping them continue to use HRT long enough to achieve the long-term benefits.

The acute release of maternal prolactin by instrumental cervical dilatation simulates the second stage of labor.

OBJECTIVE: We hypothesize that artificial stimulation of the cervix causes an acute secretion of maternal prolactin (PRL) that mimics PRL secretion during the second stage of human labor. METHODS: Eighteen women scheduled for first-trimester therapeutic abortion had a blood sample drawn at the following times: before and after laminaria tent (LT) insertion for cervical ripening, 18-24 hours later upon entry in the procedure room, after LT removal, during instrumental cervical dilatation and uterine evacuation by suction curretage, soon after evacuation, and 1/2 hour and 1 hour after evacuation. Local cervical anesthesia, intravenous analgesics, and sedation were administered before the procedure. Blood serum was assayed for PRL, human chorionic gonadotropin (hCG), and estradiol. RESULTS: The initial PRL levels were 34 ng/mL +/- 4.2 standard error of the mean (SEM) and did not change after 18-24 hours of LT placement nor after LT removal. However, PRL increased significantly (t = 5.8; P = .00001) over basal levels by 204% +/- 15 at the time of instrumental dilatation and rose to 378% +/- 33 at 1/2 hour postevacuation. After 1 hour, PRL had declined to 173% +/- 10%. Serum levels of estradiol and hCG changed only after evacuation. CONCLUSION: Artificial stimulation of the cervix causes an immediate surge in PRL levels. We suggest that the acute increase in pituitary PRL secretion that occurs during the second stage of labor results from a neural signal from the cervix and not from endocrine changes associated with labor.

Dietary fat and calcium intakes of menopausal women.

OBJECTIVE: The purpose of this retrospective, descriptive study was to assess the baseline dietary intake of fat and calcium in a group of women attending a multidisciplinary menopause clinic. DESIGN: Dietary fat and calcium intakes of this group were determined with food-frequency questionnaires, food records, and dietary interviews. The dietary fat and calcium intakes of those patients who expressed concern of risk for cardiovascular disease or osteoporosis and those patients using herbal preparations were compared with those who did not. RESULTS: Of 75 women, the majority of patients exceeded the dietary fat recommendations and had insufficient intakes of calcium. Significantly fewer patients with an expressed concern of risk for cardiovascular disease exceeded the recommendation for total fat and saturated fat (p < 0.05). There was no significant difference in calcium intake between those with and those without an expressed concern of risk for osteoporosis or in the diets of patients who did or those who did not take herbal products. CONCLUSIONS: The large proportion of patients not meeting recommendations for fat or calcium intakes confirms that the assessment of baseline dietary habits and nutrition education and intervention should be an essential component of the management of menopausal women.

Maternal serum estrogen and progesterone concentrations preceding normal labor.

Simultaneous measurement of serum concentrations of estrone (E1), estradiol (E2), estriol (E3), and progesterone were carried out in multiple serial blood samples obtained during the last 3-10 weeks of pregnancy, labor, and the immediate postpartum period in 5 normal women. Estrogen and progesterone levels showed a small, but statistically significant diurnal variation during pregnancy. They did not change during labor; however, with the exception of E1 levels, all declined following delivery. Individual patterns preceding labor, derived from calculated moving mean values, showed no consistent decline in progesterone levels nor a surge in E1 and E2 concentrations whereas estriol levels showed a steady rise starting 14-28 days prior to the onset of labor. Whether this E3 elevation reflects fetal maturation and/or plays a role in the triggering mechanism of labor is unknow. Failure to detect changes in E1, E2, and progesterone levels in the maternal peripheral circulation does not preclude the possibility that alterations of metabolism of these hormones in the fetal or uterine compartments might be involved in the initiation of human labor.

Serum human chorionic gonadotropin and progesterone patterns in the last trimester of pregnancy: relationship to fetal sex.

Concentrations of human chorionic gonadotropin (HCG) and progesterone were measured in the peripheral sera of 101 normal pregnant women between 25 and 41 weeks' gestation. HCG levels rose significantly with advancing gestation in the 43 female-bearers (r equals 0.516, p less than 0.001), whereas the 58 male-bearers showed no change (r equals 0.168, p greater than 0.1). Mean HCG levels were significantly higher in female- than in male-bearers (10.7 plus or minus standard error 1.0 versus 8.0 plus or minus 0.9 International Units per milliliter; p less than 0.05). Progesterone levels rose significantly in both female- and male-bearers. The calculated regression lines and mean levels (female-bearers 9.1 plus or minus 0.5; male-bearers 9.8 plus or minus 0.4 mug per deciliter) were not significantly different. There was no correlation between HCG and progesterone levels in either sex or in the entire group independent of gestational age. It is postulated that the lower HCG levels observed at term in male-bearers may result from an inhibitory influence of the higher progesterone and/or androgen concentrations in the male umbilical arterial circulation.