ABSTRACT
OBJECTIVE: To study the effect of 17beta-estradiol+norethisterone acetate and raloxifene on the endometrium and uterine volume in postmenopausal women. METHODS: Patients were randomly assigned to 17beta-estradiol 2 mg+norethisterone acetate 1mg (E2+NETA) daily (n=90) or raloxifene HCl 60 mg (Evista) daily (n=43). Transvaginal sonography was done at baseline and at 6, 12 and 18 months, and at 6 and 12 months in-patients treated with E2+NETA and EVISTA respectively. Patients were asked to record bleeding-spotting episodes. Whenever required patients were referred for hysteroscopy+/-biopsy of the endometrium. RESULTS: Patients under E2+NETA had a higher bleeding-spotting incidence (48.6%) compared with EVISTA (7.7%). Endometrial thickness increased significantly under E2+NETA as compared with baseline; however, at end point thickness reverted to baseline values. Evista had a non-stimulatory effect on the endometrium. Changes in uterine volume were not statistically significant. CONCLUSIONS: Both treatment regimens provided comparable uterine safety. However, raloxifene exhibited a more favorable safety profile on the uterus as expressed in the bleeding-spotting incidence and the effect on endometrial thickness and uterine volume. Transvaginal sonography appears to be a dependable method for monitoring the effect of treatment on the uterus.
Subject(s)
Estradiol/pharmacology , Estrogen Replacement Therapy , Norethindrone/analogs & derivatives , Norethindrone/pharmacology , Raloxifene Hydrochloride/pharmacology , Selective Estrogen Receptor Modulators/pharmacology , Uterus/drug effects , Administration, Oral , Adult , Drug Administration Schedule , Endometrium/diagnostic imaging , Endometrium/drug effects , Estradiol/administration & dosage , Female , Humans , Middle Aged , Norethindrone/administration & dosage , Norethindrone Acetate , Postmenopause , Prospective Studies , Raloxifene Hydrochloride/administration & dosage , Selective Estrogen Receptor Modulators/administration & dosage , Treatment Outcome , Ultrasonography , Uterus/diagnostic imagingABSTRACT
During a 15-year period (Jan. 1981 to Dec. 1995) a total of 14,950 patients were delivered in our hospital. Throughout this period fetal heart rate monitoring during labor was increased from 10% up to 85%. The overall antepartum testing was also increased from 8 to 15%. In patients with significant complications in pregnancy the mean number of non-stress tests (NST's) per patient was 1.8 tests in 1981 to 4.8 tests in 1995. The average perinatal mortality was 15.2/1000, with a gradual decline. In patients who were subjected to antepartum testing the previous rate was only 3.7%/1000. Our conclusion is that the use of antepartum and intrapartum cardiotocography has increased during the last 15 years in our clinic. As a consequence a considerable decrease was noted in the overall perinatal mortality. The non-stress test is still today the first line of antepartum fetal assessment.
