Transdermal estrogen and prevention of osteoporosis.

Transdermal delivery of estrogen is an alternative to the oral route in patients receiving hormone replacement therapy for the prevention of osteoporosis. Both transdermal and oral regimens have been shown to be effective. They can be prescribed as either cyclical or continuous regimens. With the transdermal system, the first-pass hepatic metabolism that occurs with oral agents is avoided. However, the clinical significance of this bypass has not been determined. This delivery system offers a new option in the prevention of osteoporosis, an escalating public health problem.

Treatment of adenomyosis with long-term GnRH analogues: a case report.

Presented here is the first reported case of biopsy-proved adenomyosis treated medically with long-term GnRH analogue. Uterine volume, as calculated by serial ultrasound measurements, was reduced by 65% after 4 months and remained small several months after discontinuation of therapy. Size reduction was accompanied by amenorrhea and relief of severe dysmenorrhea. Though not proposed as a substitute for surgery, GnRH analogue may be useful as a surgical adjuvant or for temporary reduction of symptoms.

Chlamydial antibody, as determined with an enzyme-linked immunosorbent assay, in tubal factor infertility.

Serum chlamydial antibody (CA), as determined with an enzyme-linked immunosorbent assay (ELISA), was evaluated as a predictor for the presence or absence of tubal factor infertility. Two hundred fifty-eight infertile women had CA drawn at the initial visit of an infertility workup. Of them, 46.3% were CA positive (CA+). One hundred forty-five patients underwent laparoscopy (LPY). Tubal factor was diagnosed in 87.2% of CA+ patients and 13.6% of CA negative (CA-) ones (P less than .001), with a rising frequency by CA positivity. CA correctly predicted the presence or absence of tubal factor in 86.9% of patients. The frequency of abnormal hysterosalpingograms (HSG) was higher in CA+ patients. The predictive values for tubal factor with low, mid and high CA+ were 62.5%, 97.5% and 95.8%, respectively, and for no tubal factor with CA- was 72.3%. Combining HSG with CA- increased that value. Agreement between the LPY and HSG findings by the CA result showed a high correlation. A history of pelvic inflammatory disease (PID) or intrauterine device use was more common in CA+ patients, but only 25.3% of patients with tubal factor had a history of PID. The frequency of positive cervical chlamydial cultures was 0.8%. CA determined with ELISA appears to be an accurate screening test for tubal factor infertility and can be used to reliably select the procedure of choice for tubal evaluation.

Coitus during menses. Its effect on endometriosis and pelvic inflammatory disease.

Four hundred ninety-eight consecutive new female patients in a private obstetrics-gynecology practice were asked about their coital habits during menses (SxMs/F = frequent, SxMs/O = occasional, SxMs/N = never) and history of pelvic inflammatory disease (PID). Endometriosis and tubal infertility factor were diagnosed on laparoscopy or laparotomy. The frequency of endometriosis was higher (P less than .05) in patients with coitus during menses (SxMs/F + O) (17.5%) than in the SxMs/N group (10.9%). The frequency of PID was not different between the SxMs/F + O (10.8%) and SxMs/N (9.7%) groups. Thirty-five percent of the infertility patients had a tubal infertility factor. The frequency of tubal infertility factors was higher in the PID group (78.4%) than in the non-PID group (30.4%) (P less than .001). Endometriosis was associated with an increase in tubal infertility factors (47.9% vs. 33.3% in the nonendometriosis group) but to a lesser degree than PID. The frequency of PID in the group with a tubal infertility factor was higher (22.7% vs. no tubal factor, 3.4%) (P less than .001), and the frequency of endometriosis was higher in the group with a tubal infertility factor (19.3% vs. no tubal factor, 11.5%) (P less than .05). Coitus during menses appeared to increase the chances of endometriosis but not of PID. The rate of tubal infertility factors increased in both PID and endometriosis.