Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age.

OBJECTIVE: Our purpose was to compare the severity of typical climacteric complaints (vasomotor complaints and vaginal dryness) and 21 other complaints, considered atypical for the climacteric, in women with and without a uterus. STUDY DESIGN: A cross-sectional population questionnaire survey was sent to all women aged 39 through 60 years in Ede, the Netherlands. Subjects were 986 hysterectomized women (one or both ovaries present) and 5636 normal women (uterus and both ovaries present). Statistical analysis was performed by cross tabulations, chi 2 analysis, analysis of variance, meta-analysis of variance, and ratios. RESULTS: Hysterectomized women, especially those aged 39 to 41 years, report significantly more vasomotor complaints, vaginal dryness, and atypical complaints than do normal climacteric women of the same age. The higher prevalence of typical climacteric complaints in hysterectomized women largely explains their higher level of atypical complaints. CONCLUSION: Physicians should be alert to typical climacteric complaints after hysterectomy with ovarian conservation, especially in young women, because the literature indicates that hysterectomized women with ovarian conservation are overrepresented with regard to osteoporosis, cardiovascular disease, osteoarthritis, depression, and sexual problems.

Impact of climacteric on well-being. A survey based on 5213 women 39 to 60 years old.

OBJECTIVE: Our aim was to assess the influence of the severity of vasomotor complaints, menopausal status, and age on the severity of 21 general complaints considered atypical for the climacteric. STUDY DESIGN: A cross-sectional general population survey was conducted through questionnaires of 5213 women aged 39 to 60 years. Statistical analysis was performed by cross tabulation, analysis of variance, and multiple regression analysis. RESULTS: Severity of vasomotor complaints is related to the severity of all 21 general complaints, most pronounced for tenseness and tiredness. Because menstruating women report more severe atypical complaints than nonmenstruating women with similarly severe vasomotor complaints, the change in prevalence of atypical complaints according to menopausal status is rather small. Adjusted for vasomotor complaints, there is virtually no independent effect of age on atypical complaints. CONCLUSIONS: Severity of vasomotor complaints is related to an overall reduced well-being. When climacteric women are seen for atypical complaints it is vital to assess the severity of vasomotor complaints also because others have shown that the severity of vasomotor complaints is indicative of the rate of climacteric bone loss.

Org OD 14 and the endometrium.

Long-term therapy with (7 alpha,17 alpha)-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one (Org OD 14; tibolone, Livial) has no influence on the endometrium in post-menopausal women. This was concluded from endometrial biopsies taken from 39 post-menopausal women treated with 2.5 mg/day for periods of from 3 months to 5 years 11 months at three centres. These results accord with the data published so far on 129 women who have been treated for up to 2 years. A review of the data relating to a total of 168 patients treated with Org OD 14 is presented. The endometrial pattern observed at the start of therapy showed no change during treatment in 90% of patients. In 15 cases slight proliferation was apparent after treatment, this being a similar pattern to that seen in the initial days of a normal cycle. In a considerable number of patients no tissue could be obtained, indicating an atrophic pattern. The picture following Org OD 14 therapy was the same as that observed in untreated normal post-menopausal women.

Long-term effects of Org OD 14 on lipid metabolism in post-menopausal women.

The effects of 2.5 mg/day 7 alpha, 17 alpha-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one (Org OD 14) on lipid metabolism, with particular reference to high-density lipoprotein (HDL)-related variables, were assessed in 14 healthy post-menopausal women after 12 and 36 mth of treatment. There were significant reductions in the following variables after both treatment periods: total phospholipids, total triglycerides, HDL-phospholipids and apolipoprotein A1. No changes were observed in total cholesterol or low-density lipoprotein (LDL) cholesterol over the entire treatment period. A significant but temporary decrease was observed in HDL-cholesterol after 12 mth, with a return to pretreatment values after 36 mth of treatment. The findings of this study clearly show that Org OD 14 has no adverse effects on the atherogenic variables, viz. LDL-cholesterol and triglycerides. Indeed, since the latter were lowered, its action is in fact beneficial. Moreover, its effect on HDL-cholesterol, the anti-atherogenic variable, is only temporary. We concluded from this study that although the composition of HDL changes during Org OD 14 treatment (especially as regards its cholesterol content), there is no evidence that reverse cholesterol transport is impaired.

A preventive approach of the postmenopausal bone loss.

In countries where osteoporosis in the ageing process tends to be a major problem, this phenomenon is of particular interest. The consequences of the osteoporosis in an ageing population, especially in the coming decades could create serious problems for the health authorities. It would be very interesting to see that in an early stage i.e. at menopause it could be influenced by prophylactic treatments. In a few countries the prophylactic approach of the menopausal osteoporosis has been already introduced. But it will take a long time before prophylaxis of postmenopausal osteoporosis could be considered as a standard and routine procedure.

Long-term placebo-controlled efficacy and safety study of Org OD 14 in climacteric women.

In a randomized, double-blind, placebo-controlled efficacy and safety study of Org OD 14 [(7 alpha,17 alpha)-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one] in 60 post-menopausal women, the effects of treatment on clinical parameters (hot flushes and associated complaints) and laboratory parameters (routine haematology and biochemistry) were evaluated. Assessments were made before treatment and after 1, 3, 6, 9 and 12 mth of therapy (in the case of the laboratory parameters after 6 and 12 mth only). In total, 17 patients dropped out, 6 of whom were on Org OD 14 and 11 on placebo. Clinical parameters were evaluated by means of the Yates test. Org OD 14 had a significantly better effect than placebo on hot flushes and sweating at all stages of assessment. A similar effect, albeit to a lesser extent, was seen on sleeplessness, fatigability, irritability and psychic instability. Serum levels of alkaline phosphatase, triglycerides, high-density lipoprotein cholesterol and phosphate decreased during Org OD 14 treatment. It was concluded that Org OD 14 provides a new, efficient and safe means of treating the post-menopausal syndrome.

The endogenous concentration of estradiol and estrone in normal human postmenopausal endometrium.

The endogenous estrone (E1) and estradiol (E2) levels (pg/g tissue) were measured in 54 postmenopausal, atrophic endometria and compared with the E1 and E2 levels in plasma (pg/ml). The results from the tissue levels of both steroids showed large variations and there was no significant correlation with their plasma levels. The mean E2 concentration in tissue was 420 pg/g, 50 times higher than in plasma and the E1 concentration of 270 pg/g was 9 times higher. The E2/E1 ratio in tissue of 1.6, was higher than the corresponding E2/E1 ratio in plasma, being 0.3. We conclude that normal postmenopausal atrophic endometria contain relatively high concentrations of estradiol and somewhat lower estrone levels. These tissue levels do not lead to histological effects.

Plasma progesterone levels after using high dose suppositories. A preliminary report.

Rectal administration of progesterone in relatively high doses is sometimes advocated for a few gynaecological disorders. Two different kinds of suppositories, containing 200 mg of active substance in a fatty base, were administered to six volunteers. The progesterone plasma concentrations, measured at I, 2 and 6 hours after administration, showed large interindividual differences. However, the average concentrations did not differ significantly between the two kinds of suppositories. The concentrations reached are in the order of magnitude of the normal top levels in the second half of the menstrual cycle.

Comparison of oral prostaglandin E2 and intravenous oxytocin for induction of labor in hypertensive pregnancies.

Labor was induced with oral prostaglandin (PGE2) without amniotomy in 20 patients (10 nulliparae and 10 multiparae) with hypertension, whether or not associated with edema and/or proteinuria. An average dose of 8 mg was required to achieve effective uterine contractility in both nulliparae and multiparae. Multiparae required only a mean dose of 12 mg but nulliparae a dose of 18 mg to achieve delivery. The mean duration of labor was slightly longer in both nulliparae and multiparae than that achieved with fast escalating doses of i.v. oxytocin. The need for analgesia was greater in oxytocin-induced patients than in the prostaglandin-induced patients. Otherwise no differences were found between the two groups.

Premenstrual tension and functional infertility. Aetiology and treatment.

17 women with premenstrual symptoms received bromocriptine (CB 154) and placebo in a double-blind crossover manner. 5 because pregnant and 10 who completed 2 cycles showed significant improvement in breast symptoms, oedema, weight gain, and mood with bromocriptine. Prolactin concentrations were suppressed. In 34 women with premenstrual symptoms, who had been warned of possible increased fertility, bromocriptine 2-5 mg twice daily from the 10th day of the menstrual cycle for 1--11 months gave marked or complete relief. 45 women attending the infertility clinic took 2-5 mg bromocriptine twice daily for 186 cycles; 23 became pregnant, 2 had marked relief and 20 complete relief from premenstrual symptoms. The relief of premenstrual symptoms by bromocriptine may be due to suppression of prolactin concentrations, which may be a major factor in premenstrual syndrome.