1,721,035 research outputs found
Minimal and mild endometriosis. Is there anything new under the sun?
No full textResearch on endometriosis in patients with minimal or mild lesions is marred by our ignorance of the prevalence of limited stages in the asymptomatic female population of reproductive age. Laparoscopic studies performed on women undergoing tubal sterilization suggest that 2-8% are affected. However, the estimates may be unreliable because the studies were retrospective and misdiagnosis of subtle endometriosis cannot be excluded. In a recent prospective study of 86 asymptomatic women, more than 40% had minimal or mild lesions at laparoscopy. The data available do not support the suggestion that limited forms must always be treated to prevent disease progression, nor do they demonstrate worsening in all cases of minimal and mild endometriosis. Furthermore, there is no definitive evidence that the medical and surgical cytoreductive treatments available are effective in preventing eventual progression of the disease in some of the patients. We still do not know the prevalence of minimal and mild endometriosis in the healthy population, the percentage of progression towards severe stages or the risk factors of evolution of the disease. The hypothesis to test is that minimal endometriosis is partly a paraphysiologic condition that is frequently self-limited or resolves spontaneously
Progestins for symptomatic endometriosis: a critical analysis of the evidence
No full textObjective: To obtain estimates of the effects of progestin treatment for pelvic pain associated with endometriosis. Data Identification: Information from studies published in the English-language literature between 1966 and 1996 was pooled. Articles were identified through hand and computerized searches using MEDLINE. Study Selection: A total of 27 trials that were published in peer-reviewed journals were identified, and 13 of these were excluded from the analysis because of methodologic limitations. Nine of the remaining 14 studies were noncomparative (8 prospective and 1 retrospective), 1 was quasi-randomized, and 4 were true randomized controlled trials. Data Extraction and Synthesis: The sample size was generally limited; the mean number of patients included was 26 in the noncomparative trials and 29 in the randomized controlled trials. The mean duration of treatment was 6 months. A total of 355 women had pain at entry. Considering all noncomparative studies, the pooled frequency of nonresponders at the end of treatment was 9% (18/203; 95% confidence interval [CI], 5.3% to 13.6%). The common odds ratio from the four randomized controlled trials comparing progestins with danazol or a GnRH agonist was 1.1 (95% CI, 0.4 to 3.1), suggesting equivalence in treatment effect. In the only double-blind, placebo-controlled trial, the frequency of nonresponders was not significantly different in the two arms. Only four studies assessed pain after drug withdrawal. The pooled frequency of pelvic pain at the end of follow-up was 50% (35/70; 95% CI, 37.8% to 62.2%). The overall crude conception rate after therapy among women who desired pregnancy was 44% (86/194; 95% CI, 37.2% to 51.6%). Side effects of limited clinical relevance were observed frequently. Conclusion(s): The available data suggest that the efficacy of progestins for temporary relief of endometriosis-associated pelvic pain is good and comparable to that of other, less safe treatments. (C) 1997 by American Society for Reproductive Medicine
Female contraception over 40
No full textBackground: The majority of women 40-49 years of age need an effective method of contraception because the decline in fertility with age is an insufficient protection against unwanted pregnancy. Although pregnancy is less likely after the age of 40 years, the clinical and social consequences of an unexpected pregnancy are potentially detrimental. No contraceptive method is contraindicated by advanced reproductive age alone; thus there is a need to discuss the effectiveness, risks and non-contraceptive benefits of all family planning methods for women in this age group. Methods: MEDLINE searches were done by topic (epidemiology, age and reproduction, sexual function, delayed childbearing and specific contraceptive methods). The topic summaries were presented to the Workshop Group and omissions or disagreements were resolved by discussion. Results: The decline in fecundity in the fifth decade is insufficient for contraceptive purposes. Thus a family planning method is needed. Sterilization is by far the most common method in several countries. Copper intrauterine devices and hormone intrauterine systems have similar effectiveness, with fewer than 1% failures in the first year of typical use. Special considerations in this age group include the frequency of menstrual irregularity, sexual problems and the possibility of menopausal symptoms, all of which may respond to hormonal methods of contraception. Conclusions: Women should be advised to continue with a contraceptive method until they have reached the menopause with its natural state of sterility
Hysterectomy for benign gynecologic disorders - When and why?
No full textCritical examination is needed whenever indications for hysterectomy are difficult to justify. Contrary to what much of current literature seems to suggest, the real problem may not lie in the choice of treatment, but rather in identifying patients for whom conservative treatment is not suitable and who may benefit from surgical intervention. The application of rational diagnostic protocols, use of appropriate medical therapies, and observation of internationally accepted surgical indications could lead to an appreciable reduction in the number of hysterectomies performed worldwide. Nonetheless, this procedure undoubtedly will continue to be a simple and important tool for improving quality of life
Sustained prolactin release associated with precocious ovarian failure
No full textFive women after precocious menopause and 1 patient with primary ovarian failure showed a simultaneous elevation of plasma gonadotropin and prolactin. The hypersecretion of plasma prolactin was still present 6 months after ovarian failure. After 12-18 months of observation while FSH and LH concentration remained elevated, prolactin concentrations normalized in 5 women and decreased in 1
Advances in the management of endometriosis : an update for clinicians
No full textEndometriosis is a chronic and recurrent disease characterized by the presence and proliferation of endometrial tissue outside the uterine cavity, which occurs in approximately 10% of women of reproductive age. In this estrogen-dependent disorder, lesions become inactive and gradually undergo regression during states of ovarian down-regulation, such as amenorrhoea or menopause. The impact of endometriosis includes impaired fertility potential, as well as symptoms of dysmenorrhoea, dyspareunia and chronic non-menstrual pain, all of which adversely affect quality of life. Management of endometriosis focuses on pain relief and includes medical and surgical treatment. Pharmacologic therapies currently in use include combination oral contraceptives (COCs), danazol, GnRH analogues and progestins. Although some agents show efficacy in relieving pain, all differ in their side effects, making it difficult to achieve a balance between efficacy and safety. Efficacy has been demonstrated with danazol or GnRH analogues; however, treatment is limited to 6 months because of significant metabolic side effects. Alternatives for longer-term management of symptoms include add-back therapy with GnRH analogues, COCs or progestins. Newer options for treatment of endometriosis include depot medroxyprogesterone acetate subcutaneous injection, as well as several agents under investigation that may prove to have therapeutic potential
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