Hormone replacement therapy usage: a 10 year experience of a solo practitioner.

The objective of this study was to identify factors affecting hormone replacement therapy (HRT) usage among patients of a single physician. All active patients (n = 330) given a HRT prescription over the past 10 years (1985-1995) by the physician were sent a questionnaire on health knowledge, lifestyle patterns, general medical and reproductive histories, responses to HRT usage and decision-making about HRT use. A total of 214 useful questionnaires were returned giving a response rate of 65%. For this cohort, the length of HRT use for those still taking HRT was 60 months; and for those no longer taking HRT, it was 32 months; and 85% of those ever given an HRT prescription were still using HRT at the time of survey. The educational backgrounds, exercise patterns, health knowledge, medical and reproductive histories of this group were representative of those found among suburban postmenopausal women in central Pennsylvania. Among this cohort, the most important reason for them taking HRT was the physicians' recommendation.

Long-term oral contraceptive use does not affect trabecular bone density.

To determine whether long-term exposure to exogenous estrogen in oral contraceptives influences trabecular bone mass in premenopausal women, we studied 25 closely matched, healthy, premenopausal women, who were recruited from an active obstetrics and gynecology practice. Eleven women had never used oral contraceptives, and 14 women had used oral contraceptives for a minimum of 67 months. All oral contraceptive users had used preparations that provided a minimum of 50 micrograms mestranol per day. Trabecular bone density was determined by quantitative single-energy computerized tomography of the L1-3 lumbar vertebral bodies. Trabecular bone density was similar for both the control group and the oral contraceptive users, 160.6 +/- 6.9 versus 161.2 +/- 7.4 mg/ml, respectively. The power to detect a 15% difference in bone density between these two samples was 0.87. We concluded that long-term, premenopausal oral contraceptive use has no effect on vertebral bone density.

PIP: Although oral contraceptives (OCs) cause a depression of circulating estrogen to near postmenopausal levels, longterm OC use does not appear to lead to a reduction in trabecular bone density. In this study, trabecular bone density was determined by quantitative single-energy computerized tomography of the L1-3 lumbar vertebral bodies and compared in 14 longterm OC users (mean use of 120 months) and 11 never users. The controls and OC users were closely matched to eliminate as many potentially confounding variables as possible. Trabecular bone density was basically similar for both groups--160.6 + 6.9 for controls versus 161.2 + 7.4 mg/ml for cases. The power to detect a 15% difference in bone density between these 2 groups was 0.87. It is concluded that premenopausal OC use has neither a beneficial effect nor an appreciable negative effect on bone density after longterm use. If a threshold estrogen level is required for normal premenopausal bone remodeling, such a threshold is not reached by the depression of plasma estrogen levels during OC use. It should be noted that this study measured only the trabecular portion of vertebral bone, which is known to respond more rapidly than cortical bone to metabolic stimuli.

Menstrual delay and dysfunctional uterine bleeding associated with antiprostaglandin therapy for dysmenorrhea.

Antiprostaglandin drugs have been found to provide significant relief from dysmenorrhea. Twelve patients taking ibuprofen or mefenamic acid experienced menstrual delay of several days to two weeks and dysfunctional uterine bleeding. Menstruation returned to normal with the next cycle after the cessation of drug use.

Noncontraceptive uses of the pill.

PIP: Oral contraceptives (OCs) have noncontraceptive uses as well. As with prescription of OCs for contraception, the risks must be measured against the potential therapeutic use. Most of the beneficial effects of the pill result from the action of combination agents on the endometrium. Secretory exhaustion which thins the endometrium so that less tissue is sloughed cyclically is manifested as shorter and lighter periods. This manifestation is particularly useful in cases of excessive flow or anemia. Temporary OC use is recommended to alleviate some dysmenorrhea or dysfunctional bleeding problems. The risk of surgery to alleviate menstrual disorders must be weighed against the admitted increased risks for women over 35-40. Perhaps, therapeutic use of OCs to control these problems is worth the risks in certain cases. Women's life styles have changed to the point where they would rather take OCs noncontraceptively than suffer menorrhagia periodically. There is a detailed discussion of the therapeutic use of OCs for control of primary and secondary dysmenorrhea. OCs function in lessening dysmenorrhea by controlling the excess production and retention of PGs (prostaglandins) in the endometrial cavity. OCs offer temporary relief for acne also.^ieng

Effect of prolonged exercise on plasma prostaglandin levels.

The effects of a strenuous marathon run of 42.2 kilometers on the presence of prostaglandins in blood was investigated in 24 healthy males and females. Testosterone, FSH, LH, epinephrine, norepinephrine, dopamine, T4 and T3 were also measured. With the exercise of the marathon run, a significant elevation of plasma PGE2, PGF2 alpha and 6 keto PGF1 alpha was observed in the runners following the race. Significant increases were also noted in blood catecholamine, dopamine and testosterone levels while a significant decline in the gonadotropins, FSH and LH was observed. No changes in thyroxine or tri-iodothyronine were noted.

A clinical trial of indomethacin and ibuprofen in dysmenorrhea.

Forty patients with primary dysmenorrhea were treated with antiprostaglandin agents. Seventeen were treated with indomethacin, with 71% obtaining significant relief. Of 23 treated with ibuprofen, 87% obtained significant relief. Nausea occurred in 49%, vomiting in 23% and stool frequency in 35%. All of these gastro-intestinal symptoms were relieved by both drugs. Ibuprofen was free of side effects, but four patients had headaches or peculiar psychic effects on indomethacin.

Medical management of the sexually assaulted woman.

Public concern about the sexual assault victim demands that the medical profession be better prepared to evaluate such patients. Modern guidelines for the medical evaluation and treatment of such victims are provided. A list of supplies for a "rape tray" and guidelines for obtaining laboratory tests are included. A detailed patient consent form and laboratory chain of evidence form will facilitate care. A plea is made for legislative support to pay for lab work and the establishment of state or national laboratories equipped to handle evidentiary material.

Prostaglandin levels in endometrial jet wash specimens in patients with dysmenorrhea before and after indomethacin therapy.

A patient with functional primary dysmenorrhea of over two years duration was subjected to the endometrial jet wash technique during the period of active menstrual flow. Prostaglandin F analysis of the jet washings revealed significantly elevated levels during menstruation over normal control levels. Following indomethacin therapy, jet wash prostaglandin F levels were dramatically reduced and the patient became asymptomatic. A cause and effect relationsship between prostaglandin F and dysmenorrhea is suggested by these studied.

Prostaglandin F levels in endometrial jet wash specimens during the normal human menstrual cycle.

The Gravlee endometrial jet wash technique has been used to collect uterine fluid in normal human volunteers for Prostaglandin F analysis throughout the human menstrual cycle. Uterine washings so obtained demonstrated a cyclicity in prostaglandin F content with low concentrations found during the proliferative phase and a 3-4 fold rise occurring during the secretory phase. Menstrual fluid prostaglandin F content collected with the jet wash technique gave the highest total concentrations.