Effect of low-dose combined OCs on lactation patterns.

PIP: The effect of low-dose combined oral contraceptives (OCs) on lactation patterns during the 1st 6 months postpartum was investigated in 20 fully lactating, menstruating women. OC use was initiated on the 5th day of the 1st menstrual bleeding, and subjects were advised to take the pill during the longest interval between breastfeedings. There were no significant differences in milk yield between the subjects and nonmedicated lactating controls. However, in the 4th month the milk yield in the medicated group was significantly lower that that in the control group. The total protein content in both groups showed no significant difference. The fact that this investigation started after lactation was established may in part explain why lactation was maintained without inhibition. An estimated 10% of lactating women use OCs. Despite unresolved questions about the adverse effects of OCs on milk yield, family planning clinics continue to provide OCs to lactating women because of concern that these women may either discontinue breastfeeding in order to use OCs or use no contraception. Future studies should investigate the secretion of hormones in breastmilk, the effect of low-dose combined OCs on amenorrheic lactating women, and the duration of lactation.^ieng

Laparoscopy on patients with previous lower abdominal surgery: a new technique.

During the period June 1979--May 1981, 1582 diagnostic and operative laparoscopic procedures were performed at Al-Azhar University Endoscopy Unit and during field visits to several hospitals in Egypt, Sudan and Mauritania. Ninety-nine of these had had previous lower abdominal surgery. Laparoscopy was performed on 93 of these patients using a modified technique of laparoscopy. The modified technique involves direct visualization of the previous peritoneal scar with the scope before its careful puncturing with the trocar and cannula. The paper describes the technique, findings, complications, limitations of the procedure and its application.

Laparoscopic ventrosuspension: a new technique.

During 42 months of study, 150 cases of laparoscopic ventrosuspension were performed at Al-Azhar University hospitals. In 98 patients (65.33%), the primary complaint was infertility. Retroversion of the uterus was the only abnormality detected during laparoscopic examinations. The remaining 52 patients (34.66%) had retroversion of the uterus concomitant with other conditions requiring surgery. Ventrosuspension was performed via the laparoscope by applying Falope rings (KLI, Newtown, Pennsylvania USA) to the round ligaments. These patients were followed up for 6-30 months. Pregnancy occurred in 29 infertile patients and improvement of backache, deep dyspareunia, congestive dysmenorrhea and leukorrhea occurred in 81.25%, 89.25%, 68.18% and 56.66%, respectively. The technique is simple and safe; it reduces the length of hospitalization and can be performed concomitant with other surgical procedures.

Hysterographic study of some side effects of the copper T 200 device.

PIP: A hysterographic study using the diluted dye technique (Urographin diluted to 15%) was carried out on 80 women to study the side effects that might result during the use of the T Cu 200 device in te 1st year of insertion. The hysterographic pictures showed the position and orientation of the device inside the uterine cavity and the side effects were related to the position of the device and size of the uterus in some cases. The women were divided into 4 groups according to their subjective symptoms; a control group with no complaints (37 cases), a group complaining of bleeding (27 cases), a group complaining of pain (11 cases) and a group who expelled the device (5 cases). The group complaining of bleeding were found to have a large sized uterine cavity. This was found to be statistically significant when compared to the control group. The other X-ray findings of orientation, anchorage or displacement of the device inside the uterine cavity were statistically insignificant when compared to the findings of the control group. The hysterographic findings in the group complaining of pain were statistically insignificant when compared to those in the control group. Cases of expulsion of the devices were found to have a large sized uterine cavity, a wide fundus and a diluted uterine isthmus. These findings were statistically significant when compared to thagt in the control group. Tables, charts and photographs illustrate the results of this study.^ieng

Lactation pattern in Egyptian women using the Progestasert system.

PIP: 80 Egyptian women, aged 22-35 and with parity 1-6, were inserted immediately after delivery with Progestasert, an IUD releasing a small amount (65 mcg) of progesterone daily. A group of women not using contraception was used as control. The total expulsion rate was 52.5%, and occurred between the 7th and the 10th day postpartum; the devices were reinserted in all cases. The rate of return of menstruation was significantly higher in Progestasert users than in controls; 25% menstruated after 6 weeks, 71.2% by 6 months, and 82.5% by 12 months. Breakthrough bleeding occurred in 27.2% of cases, scanty menstruation in 27.2%, and menorrhagia in 10.6%. The incidence of return of ovulation was significantly higher in the control group, 42.7% compared to 7.5% in Progestasert users; there were 2 uterine pregnancies, or a failure rate of 2.5%. The amount of milk and total protein and glucose content of milk were significantly higher in Progestasert users. The high rate of expulsion was attributed to the increase in volume of the uterine cavity, and the reduced volume of menstrual bleeding to the progesterone released by the device. The incidence of menorrhagia reported with Progestasert is much lower than that reported with other IUD types.^ieng

Serum-prolactin levels in lactating women using the Progestasert system.

PIP: This study investigates possible changes in serum-prolactin levels in lactating women using the Progestasert system as compared with women fitted with a copper T device and lactating mothers not using any contraceptive method. 46 females (28-35 years of age, parity 1-6) were divided into 2 major groups: 1) 26 menstruating and lactating women (further subdivided into a) control group of 11 normally menstruating women without any contraception; b) 9 Cu T 200 users; and c) 6 Progestasert users); 2) amenorrheic and lactating mothers subdivided into 8 Progestasert users, and 12 Cu T 200 users. No significant differences in the premenstrual and menstrual mean prolactin values were observed in any of the groups. With the onset of menses, a uniform rise in prolactin levels was observed in 3 groups, but was significant only in the Progestasert group. Serum prolactin levels in lactating and amenorrhiec mothers 2 months after delivery showed no significant changes when Cu T 200 and Progestasert IUD users were compared. Further research on this subject should include a matched group of lactating and amenorrheic mothers.^ieng

Corpus luteum function in lactating women using the Progestasert system.

PIP: Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone (P) were determined in lactating and menstruating women, 6-8 months after delivery. The subjects were categorized into 3 groups: non-IUD users, copper T-200 (Cu T 200) users, and Progestasert system users. Both types of IUDs were inserted immediately postpartum. When the values of each hormone determined at days M -4 and M -3 were averaged for each subject, remarkable decreases in the grand mean values of FSH, LH, and P were evident in Progestasert users. However, a significant difference was noted between the non-IUD and Progestasert groups for LH only. Considering serum P level as the index of corpus luteum function, the incidence of ovulation, corpus luteum insufficiency and anovulation was 50%, 17%, and 33%, respectively, in the Cu T 200 group; and 17, 33, and 50%, respectively, in the Progestasert group. Similar hormonal determinations were carried out 2 months postpartum in 2 groups of amenorrheic and lactating females fitted with Cu T 200 or Progestasert IUDs immediately after delivery. Results revealed 100% anovulation in the Progestasert group, whereas in the Cu T 200 amenorrheic group, 19, 9, and 72% were ovulating, poor corpus luteum, and anovulating, respectively. These data provide evidence that the Progestasert IUD exerts systemic depressive effect on the hypothalamic-pituitary-ovarian axis in lactating women.^ieng

Serum cortisol level in lactating women using the Progestasert system.

PIP: Premenstrual and menstrual serum-cortisol levels were determined in 3 groups of lactating and menstruating females 6 months after delivery: 1) control not using any contraception (n=11); 2) Progestasert group (n=6); and 3) Copper T 200 group (n=9). All IUDs were inserted immediately postpartum. Another group of women, the amenorrheic and lactating mothers were divided into: 1) Progestasert users (n=8), and Cu T users (n=12). Blood samples were collected from all groups and subjected to cortisol estimation using a competitive protein binding assay according to the method of Baum et al. Comparison of the data obtained revealed decreased levels in both IUD groups as compared to the normal controls at the onset of menstruation. However, the difference was significant only between the non-IUD and Cu T 200 groups. No significant differences between the groups were observed at day M (menstruation)-3. Serum cortisol levels were significantly raised in the control group with the onset of menses, which could be explained on the basis of stress. No significant differences were observed between the two groups of amenorrheic and lactating mothers. It was concluded that the Progestasert IUD system has no effect on cortisol levels in postpartum lactating women.^ieng

Serum cortisol level in lactating women using Progestasert system.

PIP: This study is designed to reveal any possible change in serum cortisol levels of lactating mothers, both menstruating and amenorrheic, fitted with a progestasert intrauterine system immediately postpartum. The subjects of the study were 46 lactating females, in the 28-35 age group and of parity from 1 to 6. The women were classified into 2 groups: 1) menstruating and lactating females (n-26), with restored menstruation for at least 3 successive cycles prior to the study. These women were classified into a control group of 11 normally menstruating mothers not using any type of contraception, 9 mothers fitted with Cu T-200 IUDs, and 6 mothers fitted with a progestasert IUD. Both devices were inserted immediately postpartum. The 2nd group comprised amenorrheic and lactating mothers, delivered 2 months prior to the study, and classified as Progestasert users (n-8) and Cu T-200 users (n=12). Comparison of serum cortisol levels in the various categories revealed decreased levels in both IUD groups as compared to normal controls, at the onset of menstruation. However, a significant difference was only obtained between the non-IUD and Cu T-200 groups. Otherwise, no significant differences between the groups were ovbserved at day M-3. Serum cortisol levels were significantly raised in the control groups with the onset of menses which could be explained on the basis of menstrual stress. Serum cortisol levels were also determined in 2 groups of lactating amenorrheic mothers, 2 months after delivery, fitted with Progestasert and Cu T-200 IUDs. Results indicate non significant difference between the 2 groups. Based on these findings, it is concluded that the progestasert intrauterine system has no effect on cortisol levels of postpartum lactating women.^ieng

Serum prolactin levels in lactating women using progestasert system.

PIP: The aim of the present study is to ddemonstrate any possible change in the serum prolactin level of lactating mothers using the Progestasert system, compared with women fitted with a Copper T device and lactating mothers not using any form of contraception. The study was carried out on a total of 46 females (28 to 35 years of age and 1 to 6 parity), classified into 2 major groups. The 1st included 26 menstruating and lactating women, delivered 6 to 8 months and with restored menstruation for at least 3 successive cycles prior to the study. These women were classified into the following subgroups: control group of 11 normally menstruating mothers not using any type of contraception; Cu T-200 users. The 2nd group included amenorrheic and lactating mothers delivered 2 months prior to the study. These women were classified as follows: Progestasert users and Cu T-200 users. For all users, both devices were inserted immediately postpartum. No significant differences in the premenstrual and menstrual mean + or - SE prolactin values were noted in comparison with a matched group not using any form of contraception. A uniform rise in prolactin levels was observed with the onset of menses in the 3 categories studied, but this was only significant in the Progestasert group. Serum prolactin levels in lactating and amenorrheic mothers, 2 months after delivery, did not reveal significant changes when Cu T-200 and Progestasert IUD users were compared. The amount and biochemical composition of milk were not affected in lactating mothers using inert IUDs, and evidence indicates that progestational contraceptive compounds have no adverse effects on milk yield and composition.^ieng

Fibrinolytic activity of menstrual blood in normal and menorrhagic women and in women wearing the Lippes Loop and the Cu-T (200).

Assessment was made of the fibrinolytic activity in menstrual and peripheral blood of 30 normally menstruating and 30 menorrhagic patients and of 30 women wearing Lippes Loops and 15 wearing CU-T (200)s. Assessment was performed by measuring the area of lysis on heated and unheated fibrin plates. Also, histochemical identification of fibrin fibrils in the menstrual endometrium was performed by Mallory's phosphotungstic acid hematoxylin method. Results in the normally menstruating group were compared to those of the menorrhagic women, and together these were compared with results in the groups of women wearing intrauterine devices. The fibrinolytic activity in menstrual blood was significantly increased in menorrhagic patients compared to that in normally menstruating patients, but no significant difference was detected in the plasma of either group. The histochemical study of the normally menstruating endometrium revealed dense intravascular and extravascular deposits of fibrin. Less dense intravascular fibrin deposits, but no extravascular ones, were present in the menorrhagic patients. The increase in the fibrinolytic activity of menstrual blood and the decrease in the density of fibrin deposits in the menstrual endometrium of the menorrhagic women were thus associated and were probably involved in the excessive menstrual loss. The fibrinolytic activity of menstrual blood in women wearing Lippes Loops was higher than that in women with Cu-T (200)s and was associated with decreased density of fibrin fibrils in the menstruating endometrium. This may explain the increased blood loss associated with the use of the Lippes Loop.

Influence of the copper IUD and the Lippes loop on sperm migration in the human cervical mucus.

PIP: 30 women (24-34 years; parity 3-6) randomly selected from the family planning clinic at Al-Azhar University Hospital, Cairo, were divided into 3 groups: 1) 10 normal fertile; 2) 10 women fitted with T-Cu-200 for 2-20 months; and 3) 10 women fitted with Lippes loop for 2-8 years. On the 13th-15th day of the cycle cervical mucus was sample and tested for sperm penetration, motility, turbidity, Spinnbarkeit, and ferning. Sperm penetration tests used the sperm migration meter of Kremer and turbidity and clarity were assessed by the naked eye. Sperm penetration and motility were greatly impaired with Cu-device users, while with Lippes loop the findings approached that of the normal control women. Turbidity results were significant (p less than .01) for Cu-device users. Diminished Spinnbarkeit and positive ferning were also observed in the presence of the Cu device. The impaired sperm penetration and immobilization with the use of the Cu-devices as opposed to Lippes loop suggests a local lethal effect of the increased copper on cervical mucus rather than a local foreign body reaction.^ieng

Copper levels in women using intrauterine devices or oral contraceptives.

PIP: A study was undertaken to explore the role of the copper IUD (Cu-200) in contraception and to lower its side effects. Endometrial and plasma concentrations of copper were determined spectrographically in the late proliferative and late secretory phases in 15 women wearing the copper IUD, in 6 short-term Lippes loop users, in 23 long-term Lippes loop users, in 17 patients on oral contraception, and in 32 women who were not using contraception,y The last group of women served as controls. The findings showed a decrease in the endometrial copper level in the secretory phase but no change in the plasma concentration of copper in the control group. Both Cu-200 and Lippes loops produced a rise in endometrial copper which was significant during the secretory phase. The possibility of a local foreign body reaction is noted. Combined steroid pills caused variable degrees of increase of endometrial and plasma copper in both phases. Endometrial copper levels were elevated in both phases of the cycle, while plasma copper showed a probably significant rise in the proliferative phase only. The change in plasma copper may be explained by changes occurring in hormonal pattern during pill therapy.^ieng

Serum progesterone in nonpregnant women. I. Comparative study of serum progesterone concentration and urinary pregnanediol excretion.

PIP: The normal range of serum progesterone (measured by radioimmunoassay) and urinary pregnanediol during the menstrual cycle was determined in 86 patients (33 control and 53 with menstrual disorders or sterility) and the values were found to show a logarithmic distribution. The overall correlation between serum progesterone and urinary pregnanediol concentration was .82. Clinical diagnostic applications of these measurements include: 1) anovulatory demonstration, 2) determination of secondary amenorrhea, 3) investigation of prolonged cycles, 4) investigation of probable luteal insufficiency, and 5) response to clomiphene citrate.^ieng