1.  Title: Gonadotropin-releasing hormone analog combined with a low-dose oral contraceptive to treat heavy menstrual bleeding. Author: Cetin NN; Karabacak O; Korucuoglu U; Karabacak N Source: International Journal of Gynaecology and Obstetrics. 2009 Mar;104(3):236-9. Abstract: OBJECTIVE: To compare the effects of low-dose oral contraceptives used alone and in combination with a gonadotropin-releasing hormone (GnRH) analog to treat heavy menstrual bleeding. METHODS: Fifty-eight patients with heavy menstrual bleeding were prospectively randomized into two treatment groups to receive either a low-dose oral contraceptive alone (group 1), or combined with a GnRH analog (group 2) for 6 months. The patients' hormonal profiles, and hemoglobin and hematocrit levels were measured at the beginning and at the end of the treatment period. RESULTS: Hemoglobin and hematocrit levels significantly improved in both groups after 6 months of treatment (P<0.05 and P<0.01, respectively). Even in the first month of the study, the number of pads used and the duration of menstruation were significantly decreased in both groups and markedly lower in group 2 (P<0.01). CONCLUSION: The addition of a GnRH analog to low-dose oral contraceptive treatment for heavy menstrual bleeding resulted in bettercontrol of vaginal bleeding, even in the first month of therapy. Language: English Keywords: TURKEY | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | MENORRHAGIA | TREATMENT | ORAL CONTRACEPTIVES, LOW-DOSE | GONADOTROPINS | ENDOMETRIAL EFFECTS | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Menstruation Disorders | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Hormones | Endocrine System | Physiology | Biology | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System Document Number: 341388 |
| 2. Peer Reviewed Title: Prevention of tamoxifen induced endometrial polyps using a levonorgestrel releasing intrauterine system long-term follow-up of a randomised control trial. Author: Gardner FJ; Konje JC; Bell SC; Abrams KR; Brown LJ; Taylor DJ; Habiba M Source: Gynecologic Oncology. 2009 Sep;114(3):452-6. Abstract: OBJECTIVES: In a RCT, we have previously shown that the levonorgestrel intrauterine system (LNG-IUS, Mirena) produces a decidual response protecting the endometrium at one year follow-up. We here report on the long-term follow-up of this group of women, to test the hypothesis that a LNG-IUS could prevent the pro-proliferative uterine responses of tamoxifen for up to 4.5 years. METHODS: A randomised-controlled trial of postmenopausal women who had taken at least one year of adjuvant tamoxifen therapy. RESULTS: One hundred twenty-two women were recruited. Nine were found to be ineligible after randomisation. The average duration of follow-up was 26.25 months (IQR 14.5-36 months) in the surveillance group and 24.2 months (IQR 13.75-32.5 months) in the LNG-IUS group. Women with LNG-IUS in situ at the time of final assessment had decidualised endometrium, and no polyps. In the surveillance group new polyps arose in 8 cases. There were 3 new polyps in the group initially randomised to LNG-IUS, one in a patient who did not have the device inserted and 2 occurred in patients following the removal of the LNG-IUS. Univariate Cox proportional hazards regression models identified only endometrial thickness at trial entry as a statistically significant variable (HR 1.12, 95% CI 1.02 to 1.22, p=0.01) for the development of polyps. CONCLUSION: This study confirms that LNG-IUS induces benign endometrial changes and prevents endometrial polyps but only during its use in women taking tamoxifen. Endometrial thickness is a risk factor for the development of polyps. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | BREAST CANCER | TAMOXIFEN | ENDOMETRIAL EFFECTS | IUD, HORMONE RELEASING | LEVONORGESTREL | HYSTEROSCOPY | ULTRASONICS | Developed Countries | Europe, Western | Europe | Research Methodology | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Fertility Agents | Reproductive Control Agents | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | IUD | Contraceptive Methods | Contraception | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342402 |
| 3. Peer Reviewed Title: Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Author: Kaunitz AM; Meredith S; Inki P; Kubba A; Sanchez-Ramos L Source: Obstetrics and Gynecology. 2009 May;113(5):1104-16. Abstract: OBJECTIVE: To compare the effects of the levonorgestrel intrauterine system and endometrial ablation in reducing heavy menstrual bleeding. DATA SOURCES: Medline and EMBASE were searched online using Ovid up to January 2009, as well as the reference lists of published articles, to identify randomized controlled trials comparing the levonorgestrel intrauterine system with endometrial ablation in the treatment of heavy menstrual bleeding. METHODS OF STUDY SELECTION: This systematic review and meta-analysis was restricted to randomized controlled trials in which menstrual blood loss was reported using pictorial blood loss assessment chart scores. TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials that included 390 women (levonorgestrel intrauterine system, n=196; endometrial ablation, n=194) were retrieved. Three studies pertained to first-generation endometrial ablation (manual hysteroscopy) and three to second-generation endometrial ablation (thermal balloon). Study characteristics and quality were recorded for each study. Data on the effect of treatment on pictorial blood loss assessment chart scores were abstracted, integrated with meta-analysis techniques, and presented as weighted mean differences. Both treatment modalities were associated with similar reductions in menstrual blood loss after 6 months (weighted mean difference, -31.96 pictorial blood loss assessment chart score [95% confidence interval (CI), -65.96 to 2.04]), 12 months (weighted mean difference, 7.45 pictorial blood loss assessment chart score [95% CI, -12.37 to 27.26]), and 24 months (weighted mean difference, -26.70 pictorial blood loss assessment chart score [95% CI, -78.54 to 25.15]). In addition, both treatments were generally associated with similar improvements in quality of life in five studies that reported this as an outcome. No major complications occurred with either treatment modality in these small trials. CONCLUSION: Based on the meta-analysis of six randomized clinical trials, the efficacy of the levonorgestrel intrauterine system in the management of heavy menstrual bleeding appears to have similar therapeutic effects to that of endometrial ablation up to 2 years after treatment. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | BLEEDING | LEVONORGESTREL | IUD | ENDOMETRIAL EFFECTS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Clinical Research | Research Methodology | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Contraceptive Usage | Contraceptive Effectiveness Document Number: 341342 |
| 4. Title: Activation of NF-kappaB and COX-2 expression is associated with breakthrough bleeding in patients using oral contraceptives in extended regimens. Author: Maia H Jr; Casoy J; Correia T; Athayde C; Valente J; Coutinho EM Source: Gynecological Endocrinology. 2009 Sep 11;:1-5. Abstract: The objective of the present study was to determine whether there is an increase in endometrial inflammation associated with the occurrence of breakthrough bleeding in patients using an oral contraceptive in extended regimens. The presence of nuclear factor NF-kappaB and Cox-2 expression was determined by immunohistochemistry in endometrial samples removed by hysteroscopy from patients with breakthrough bleeding during continuous use of an oral contraceptive containing gestodene. All patients had a history of menorrhagia associated or not with the presence of uterine pathology. The percentage of endometria showing a positive staining reaction for NF-kappaB in cell nuclei was significantly higher in patients with breakthrough bleeding than in those with amenorrhea. Cox-2 expression in the endometrium was also significantly more frequent in patients with breakthrough bleeding. The occurrence of breakthrough bleeding in patients with uterine pathology using combined oral contraceptives is associated with the activation of endometrial inflammation through the NF-kappaB pathway. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLIENTS | ORAL CONTRACEPTIVES, COMBINED | ENDOMETRIAL EFFECTS | MENORRHAGIA | ETHINYL ESTRADIOL | GESTODENE | AMENORRHEA | HISTOLOGY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Program Activities | Programs | Organization and Administration | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Menstruation Disorders | Diseases | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin Document Number: 342842 |
| 5. Title: Sonographic appearances of the endometrium after termination of pregnancy in asymptomatic versus symptomatic women. Author: McEwing RL; Anderson NG; Meates JB; Allen RB; Phillipson GT; Wells JE Source: Journal of Ultrasound In Medicine. 2009 May;28(5):579-86. Abstract: OBJECTIVE: The purpose of this study was to describe normal sonographic appearances of the endometrium in asymptomatic women after elective termination of pregnancy (TOP) and to determine whether sonographic findings are discriminatory in symptomatic women after TOP. METHODS: Sonographic parameters were compared in prospectively recruited women after elective TOP. The first 38 were asymptomatic. In a later group, 105 had symptoms suggestive of retained products of conception (RPOC). Endometrial thickness, cavity irregularity, echogenicity of cavity contents, color Doppler flow, and resistive indices (RIs) were assessed. In the symptomatic group, sonographic findings were correlated with symptoms and histologic results. RESULTS: There was a marked overlap in sonographic appearances between the groups. The endometrial cavity is commonly irregular and thickened and may show prominent color Doppler flow in women with an uneventful course as well as in women with histologically proven RPOC. Differences between asymptomatic and symptomatic women were only seen for: endometrial thickness (10.8 mm [range, 1-29 mm] versus 15.3 mm [range, 1.8-34 mm]; P = .0005), and cavity irregularity was greater in symptomatic women (P = .001). Color Doppler flow mean RIs were similar. Symptoms were similar in women proceeding to curettage versus no curettage; no significant relationship was found between individual symptoms and sonographic parameters. Chorionic villi were seen in 47 of 56 women (84%) with positive histologic results. CONCLUSIONS: Sonographic appearances and symptoms correlate poorly with each other and with histologic results. Sonography has limited benefits in triaging women with suspected RPOC after TOP in the first trimester. Our findings support a more conservative approach to suspected RPOC after TOP. Language: English Keywords: NEW ZEALAND | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | PREGNANCY, FIRST TRIMESTER | ABORTION | CURETTAGE | PRODUCTS OF CONCEPTION, RETENTION | SIGNS AND SYMPTOMS | ENDOMETRIAL EFFECTS | ULTRASONICS | HISTOLOGY | Oceania | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy Complications | Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 341998 Notification |
| 6. Title: Why use of dienogest for the first contraceptive pill with estradiol? Author: Mueck AO; Seeger H; Buhling KJ Source: Gynecological Endocrinology. 2009 Aug 11;:1-5. Abstract: Dienogest (DNG) has the essential properties of an effective progestogen for use in a new contraceptive pill using estradiol valerate as estrogenic component - it inhibits ovulation and protects against endometrial proliferation. DNG is a derivative of norethisterone (NET), but has a cyanomethyl- instead of an ethinyl-group in C17 position which may offer a variety of benefits regarding hepatic effects. The similarity to NET is reflected in the high endometriotropy and in similar pharmacokinetics like short plasma half-live and high bioavailability. However, DNG also elicits properties of progesterone derivatives like neutrality in metabolic and cardiovascular system and considerable antiandrogenic activity, the latter increased by lack of binding to SHBG as specific property of DNG. It has no glucocorticoid and antimineralocorticoid activity and has no antiestrogenic activity with the consequence that possible beneficial estradiol effects should not be antagonized. This may be of special importance for the tolerability and safety of the first pill with estradiol valerate instead of ethinylestradiol, although well-designed postmarketing studies are still ongoing to demonstrate what can be expected on the basis of pharmacology. Language: English Keywords: GERMANY | CRITIQUE | ORAL CONTRACEPTIVES, PHASIC | LOW-DOSE PROGESTINS | ESTRADIOL | CONTRACEPTIVE SAFETY | ENDOMETRIAL EFFECTS | HEPATIC EFFECTS | CENTRAL NERVOUS SYSTEM EFFECTS | MENSTRUAL CYCLE | HORMONE REPLACEMENT THERAPY | Europe, Central | Europe | Developed Countries | Oral Contraceptives, Combined | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Safety | Public Health | Health | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Central Nervous System | Menstruation | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342487 |
| 7. Title: Mirena(R) (Levonorgestrel intrauterine system): A successful novel drug delivery option in contraception. Author: Rose S; Chaudhari A; Peterson CM Source: Advanced Drug Delivery Reviews. 2009 May 12; Abstract: This manuscript serves as a review of Mirena(R), the levonorgestrel intrauterine system (LNG IUS) as a very successful drug delivery system. The LNG IUS has a very high contraceptive efficacy rate, and low rates of patient discontinuation. In addition to its contraceptive benefits, most users experience a decrease in menstrual bleeding over the five years of use. LNG IUS has also been used for management of menorrhagia, dysmenorrhea, adenomyosis, and endometrial hyperplasia in some cases. The LNG IUS provides long term efficacy, high rates of compliance, rapid return to fertility, and minimal adverse effects during use. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | IUD | PROGESTERONE | MENORRHAGIA | ENDOMETRIAL EFFECTS | IUD, COPPER RELEASING | CONTRACEPTION | LEVONORGESTREL | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | North America | Americas | Contraceptive Methods | Family Planning | Progestational Hormones | Hormones | Endocrine System | Physiology | Biology | Menstruation Disorders | Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Effectiveness Document Number: 341256 |
| 8. Peer Reviewed Title: A randomized controlled trial of treatment options for troublesome uterine bleeding in Implanon users. Author: Weisberg E; Hickey M; Palmer D; O'Connor V; Salamonsen LA; Findlay JK; Fraser IS Source: Human Reproduction. 2009 Aug;24(8):1852-61. Abstract: BACKGROUND: Pilot data have indicated that both doxycycline alone and mifepristone combined with ethinyl estradiol (EE) are effective in stopping episodes of bleeding in Implanon users with troublesome bleeding. We compared four treatments against a placebo in Implanon users and tested whether repeated treatment improved subsequent bleeding patterns. METHOD: Implanon users aged 18-45 years were randomized to treatment with (i) mifepristone 25 mg given twice on day 1 followed by 4 days of EE 20 microg; (ii) doxycycline 100 mg twice daily for 5 days; (iii) mifepristone 25 mg given twice on day 1 plus doxycycline 100 mg twice daily for 5 days; (iv) doxycycline 100 mg twice daily with EE 20 microg daily; and (v) placebo twice daily for 5 days. The primary end-point was the number of days of bleeding/spotting immediately following initiation of the first 5-day course of each therapy, compared with placebo. RESULTS: There were 204 women assigned to treatment. Mifepristone in combination with either EE or doxycycline was significantly more effective in stopping an episode of bleeding (mean 4.0 days (CI 3.5-4.6) and 4.4 days (CI 3.8-5.2), respectively) than doxycycline alone or in combination with EE, or placebo (6.4 days (CI 4.4-9.2), 6.4 days (CI 4.8-8.6) and 6.4 days (CL 5.1-8.0), respectively). CONCLUSION: Mifepristone combined with either EE or doxycycline was significantly more effective than placebo in terminating an episode of bleeding in Implanon users. However there was no improvement in subsequent bleeding patterns. Trial registration number: ACTR # 012605000206628. Language: English Keywords: AUSTRALIA | RESEARCH REPORT | CONTROL GROUPS | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | MENSTRUATION DISORDERS | TREATMENT | RU-486 | ETHINYL ESTRADIOL | ANTIBIOTICS | ENDOMETRIAL EFFECTS | Oceania | Developed Countries | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Drugs | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System Document Number: 342798 |
9.  Peer Reviewed Title: Adenomyosis uteri in infertile women: Experience in a tropical community teaching hospital. Author: Adesiyun AG; Samaila MO; Kolawole A Source: Pakistan Journal of Medical Sciences. 2008 Jan-Mar;24(1):38-43. Abstract: The objectives were to determine the demographic pattern and clinical presentation of 23 infertile women with intraoperative diagnosis of adenomyosis followed by histopathologic confirmation. The methodology used was a review of 23 consecutive infertile women that underwent surgery due to preoperative misdiagnosis for uterine fibroids over a period of 5 years. The patients mean age was 37.3 years with age range of 26 to 47 years. Only five patients (21.7%) had delivered before. Eighteen patients (78.3%) had had abortion(s) in the past. Secondary infertility accounted for 78.3% and 21.7% had primary infertility. Past gynaecological procedures included dilatation and curettage or manual vacuum aspiration in 17 (73.9%) patients, previous adhesiolysis for uterine synaechiae in 3 (13.1%) patients and past history of myomectomy in 5 (21.7%) patients. Preoperative hysterosalpingogram showed only 2 patients (8.7%) with bilateral tubal patency and 17 patients (73.9%) had bilateral tubal blockage. Unilateral patency of the fallopian tube was observed in 4 (17.4%) patients. Amongst patients with bilateral tubal blockage, cornual blockages were mostly encountered in 15 (88.2%) of the 17 patients. The modes of clinical presentation were abdominopelvic mass 100%, dymenorrhoea 82.6%, menorrhagia 60.9%, dyspareunia 47.8% and metrorrhagia in 34.8% of cases. Intraoperatively adenomyosis encountered were diffuse adenomyosis in 13 (56.5%) patients, multiple focal adenomyosis in 7 (30.4%) patients and unifocal adenomyosis in 3 (13.1%) patients. Co-existing uterine fibroid were found in 17 (73.9%) of the 23 patients. Two patients (8.7%) had coexisting endometriosis. At surgery, significant pelvic adhesion was encountered in 7 (30.4%) patients. In infertile women, adenomyosis is significantly associated with proximal tubal occlusion and tends to co-exist with insignificant uterine fibroids. (author's) Language: English Keywords: NIGERIA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | ENDOMETRIAL EFFECTS | EXAMINATIONS AND DIAGNOSES | ENDOMETRIOSIS | INFERTILITY | FIBROIDS | MYOMETRIUM | SURGERY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Reproduction | Neoplasms, Benign | Neoplasms | Treatment Document Number: 325108 |
| 10. Peer Reviewed Title: Effects of ethinyl estradiol and ibuprofen compared to placebo on endometrial bleeding, cervical mucus and the postcoital test in levonorgestrel subcutaneous implant users. Author: Archer DF; Philput CB; Levine AS; Cullins V; Stovall TG Source: Contraception. 2008 Aug;78(2):106-112. Abstract: The study was conducted to evaluate ethinyl estradiol (EE) or ibuprofen (IBU) compared to placebo (PL) on spotting and bleeding (S/B) and a postcoital test (PCT) in women using the levonorgestrel subcutaneous implant. Women experiencing excessive S/B were enrolled in a multicenter prospective randomized study using EE, IBU or PL. Duration of S/B and a PCT were evaluated. Statistical analysis used a general linear model procedure with Duncan's multiple range tests for individual variables. One hundred seven women were evaluated, and there was no difference in the duration of bleeding among the three therapies, while the mean number of spotting days were 1.8 for EE and 2.8 for PL (p=.04). There was no effect of IBU on S/B. No effect on cervical mucus or sperm was found between treatments. There was a decrease in spotting but no effect on bleeding with EE compared to PL. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | PROSPECTIVE STUDIES | DOUBLE-BLIND STUDIES | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | ETHINYL ESTRADIOL | DRUGS | ENDOMETRIAL EFFECTS | BLEEDING | Developed Countries | North America | Americas | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases Document Number: 327962 |
| 11. Title: The role of Essure sterilization performed simultaneously with endometrial ablation. Author: Donnadieu AC; Fernandez H Source: Current Opinion in Obstetrics and Gynecology. 2008 Aug;20(4):359-363. Abstract: Purpose: To review operative procedures, specific risks, complications and evaluation of efficacy of Essure tubal sterilization performed simultaneously with endometrial ablation. Recent findings: Dysfunctional uterine bleeding is a significant health problem in premenopausal women. Endometrial ablation is an effective therapeutic option for the management of menorrhagia and an alternative to hysterectomy. Most women undergoing endometrial ablation are of reproductive age, and, because pregnancy after endometrial ablation could be complicated, many of these women require permanent birth control. Since the introduction of Essure tubal sterilization, this permanent contraception method has been widely used and offers an hysteroscopic approach similar to endometrial ablation techniques. Combining these two procedures offers the advantage of performing the two procedures simultaneously, but inherent rules and technical procedures must be followed to avoid any kind of injury such as heat conduction, material injuries, specific complications and specific follow-up. Summary: The combination of safety and efficacy of endometrial ablation and hysteroscopic sterilization makes a compelling argument for their concomitant use. (author's) Language: English Keywords: GLOBAL | CRITIQUE | TUBAL LIGATION | ENDOMETRIAL EFFECTS | TREATMENT | HYSTEROSCOPY | COMPLICATIONS | SAFETY | Female Sterilization | Sterilization, Sexual | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Diseases | Public Health Document Number: 327708 |
| 12. Peer Reviewed Title: Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding. Author: Fakhar S; Saeed G; Khan AH; Alam AY Source: Annals of Saudi Medicine. 2008 May-Jun;28(3):188-191. Abstract: The authors compared endometrial sampling by pipelle endometrial curette with conventional dilatation and curettage (D&C) in patients with abnormal uterine bleeding. Endometrial sampling with pipelle curette was performed on 100 patients followed by formal D&C. Samples were labeled as A and B, respectively, and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared, taking D&C as the gold standard. An adequate sample was obtained in 98% of cases by pipelle and in 100% of cases by D&C. Pipelle had a sensitivity, specificity, positive predictive value and negative predictive value of 100% for diagnosing endometrial carcinoma, hyperplasia and secretory endometrium. Pipelle also had high diagnostic sensitivity, specificity and negative predictive value (100%, 98% and 100%, respectively) for hyperplasia with atypia, and low sensitivity (57%) and positive predictive value (57%), but high specificity (97%) and negative predictive value (97%) for endometritis. Similarly, for proliferative endometrium, the pipelle technique had values of 94% and 93% for sensitivity and specificity, respectively. Both samples labeled as inadequate for histology by pipelle were polyps on the D&C report. Difficult endotracheal intubation was encountered in two cases of D&C. No other complications of the procedure were observed. The pipelle is a safe device for getting an adequate endometrial sample for histology, with a high sensitivity and specificity for detection of hyperplasia and malignancy. Language: English Keywords: PAKISTAN | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | ENDOMETRIAL EFFECTS | BLEEDING | CURETTAGE | VALIDITY | PHYSICAL EXAMINATIONS AND DIAGNOSES | ENDOMETRIAL CANCER | UTERUS | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Economic Development | Economic Factors | Endometrium | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Examinations and Diagnoses | Cancer | Neoplasms Document Number: 327457 |
| 13. Title: Endometrial structural and inflammatory changes with exogenous progestogens. Author: Hickey M; Salamonsen LA Source: Trends In Endocrinology and Metabolism. 2008 Jul;19(5):167-74. Abstract: Safe and effective contraception is an international public health priority. The long-acting progestogen-only contraceptives are used by over 20 million women worldwide but their main drawback is abnormal uterine bleeding. Such bleeding arises owing to structural and inflammatory changes which compromise endometrial microvascular and epithelial integrity. The molecular and structural changes that lead to the vessel and surface epithelial fragility, and hence the side effect of abnormal uterine bleeding commonly seen with exogenous progestogen use, might be lessened by short-term treatments shown to shorten bleeding episodes. Language: English Keywords: AUSTRALIA | RESEARCH REPORT | WOMEN | BLEEDING | CONTRACEPTIVE AGENTS, PROGESTIN | PROGESTERONE | ENDOMETRIAL EFFECTS | VASCULAR DISEASES | Developed Countries | Oceania | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Progestational Hormones | Hormones | Endocrine System | Physiology | Biology | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System Document Number: 328378 |
| 14. Title: [Dysfunctional uterine bleeding--diagnostics and treatment] Czynnosciowe krwawienia maciczne--diagnostyka i leczenie. Author: Jakimiuk AJ; Grzybowski W; Beta J Source: Ginekologia Polska. 2008 Apr;79(4):254-8. Abstract: Dysfunctional uterine bleeding (DUB) occurs frequently in women at the reproductive age and is unrelated to structural uterine abnormalities. It significantly impairs the quality of life for many otherwise healthy women. Evaluation of patients with abnormal uterine bleeding and identification of those with DUB is based on medical records, physical examination, laboratory tests, uterine imaging and endometrial sampling. Surgical treatment options include hysterectomy and conservative surgery (endometrial resection or ablation). Medical therapy, with the avoidance of possibly unnecessary surgery, is an attractive treatment option. However, there is considerable variation in practice and lack of consensus regarding the most effective therapy. Language: Polish Keywords: BRAZIL | SUMMARY REPORT | WOMEN | BLEEDING | UTERINE EFFECTS | LABORATORY EXAMINATIONS AND DIAGNOSES | REPRODUCTIVE AGE | HYSTERECTOMY | ENDOMETRIAL EFFECTS | SURGERY | TREATMENT | Developing Countries | South America, Eastern | South America | Latin America | Americas | Demographic Factors | Population | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Gynecologic Surgery | Urogenital Surgery | Endometrium Document Number: 328920 |
| 15. Peer Reviewed Title: Effect of oral contraceptives on vascular endothelial growth factor, Cox-2 and aromatase expression in the endometrium of uteri affected by myomas and associated pathologies. Author: Maia H Jr; Casoy J; Pimentel K; Correia T; Athayde C; Cruz T; Coutinho EM Source: Contraception. 2008 Dec;78(6):479-85. Abstract: BACKGROUND: The study was conducted to evaluate vascular endothelial growth factor (VEGF), Cox-2 and aromatase expression in the endometrium of uteri with myomas and other associated pathologies. STUDY DESIGN: Hysteroscopy was performed in 118 women of reproductive age with myomas and menorrhagia, 40 of whom were using a pill containing 75 mcg gestodene+30 mcg ethinylestradiol. Aromatase p450, VEGF and Cox-2 expression was detected using immunohistochemistry. Fisher's Exact Test and the Mann-Whitney test were used in the statistical analysis, with significance established at p<.05. RESULTS: In patients with myomas and menorrhagia, associated pathologies such as adenomyosis, endometrial polyps and endometriosis were found in 32%, 12% and 17% of cases, respectively. Aromatase, Cox-2 and VEGF expression was greater during the proliferative phase compared to the luteal phase of the cycle or following oral contraceptive use. CONCLUSION: Endogenous progesterone or combined oral contraceptives are potentinhibitors of VEGF, aromatase and Cox-2 expression in the endometrium of patients with myomas and menorrhagia. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | GENETIC TECHNIQUES | WOMEN IN DEVELOPMENT | ORAL CONTRACEPTIVES | ENDOMETRIAL EFFECTS | UTERINE CANCER | MENORRHAGIA | ENDOMETRIOSIS | PREVALENCE | SIDE EFFECTS | PROGESTERONE | ORAL CONTRACEPTIVES, COMBINED | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Development | Economic Factors | Contraceptive Methods | Contraception | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cancer | Neoplasms | Diseases | Menstruation Disorders | Measurement | Treatment | Progestational Hormones | Hormones | Endocrine System Document Number: 330522 |
| 16. Peer Reviewed Title: Endometriosis and human infertility: A new investigation into the role of eutopic endometrium. Author: Minici F; Tiberi F; Tropea A; Orlando M; Gangale MF Source: Human Reproduction. 2008;23(3):530-537. Abstract: Endometriosis is related to infertility even in the absence of mechanical alterations of the reproductive tract. Even though the pathogenesis of this phenomenon is still unclear, an impaired endometrial receptivity has been recently suggested. The aim of the present study was to investigate if endometriotic peritoneal fluids (EPF) could interfere with endometrial stromal cell (ESC) decidualization and if tumor necrosis factor (TNF)-alpha could be involved in the EPF effect. Eutopic ESC were isolated from patients with or without endometriosis. ESC were treated with 17beta-estradiol 10/-8 M and 6alpha-methyl-17alpha-hydroxyprogesteroneacetate 2 x 10/-7 M for 16 days. In vitro decidualization was morphologically and biochemically assessed. We analysed whether ESC decidualization could be affected by EPF or peritoneal fluids from control patients (CPF), with or without soluble TNF-alpha receptor 1 (sTNFR-1). Compared with ESC from control patients, eutopic ESC from patients with endometriosis showed an impaired decidualization. Decidualization of normal ESC was morphologically normal but biochemically abnormal in the presence of EPF, which was able to decrease the secretion of decidualization markers. sTNFR-1 was able to partially counteract this effect. In endometriosis, the milieu surrounding the uterine cavity may be involved in impaired eutopic ESC decidualization, partially due to increased peritoneal levels of TNF-alpha. (author's) Language: English Keywords: ITALY | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | ENDOMETRIOSIS | INFERTILITY | ENDOMETRIAL EFFECTS | DECIDUAL CELL REACTION | Europe, Southern | Europe | Developed Countries | Research Methodology | Demographic Factors | Population | Diseases | Reproduction | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Cytologic Effects Document Number: 324385 |
| 17. Peer Reviewed Title: Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNG-IUD and oral progestins versus observation only. Author: Orbo A; Arnes M; Hancke C; Vereide AB; Pettersen I Source: Gynecologic Oncology. 2008 Oct;111(1):68-73. Abstract: OBJECTIVES: Three different treatment options for endometrial hyperplasia were evaluated in a prospective long-time follow-up study, comparing effects of intrauterine levonorgestrel impregnated device (LNG-IUD), low oral dose of medroxyprogesterone acetate (MPA) and no treatment (observation only). To select patients with high probability for co-existing or future carcinoma we used the objective morphometric algorithm, D-score, stratifying patients into three different risk groups. As far as we know, this is the first prospective long-time follow-up study in which treatment recommendation and outcome is based on the D-score assessment. METHODS: From a total of 370 patients initially diagnosed with endometrial hyperplasia from eight different hospitals in North Norway, 258 were available for long-time follow-up. After D-score classification, one of three different treatment options was chosen: LNG-IUD, low oral dose of MPA or observation only. Follow-up controls were performed and biopsies taken inthe local hospitals. RESULTS: Among the 370 investigated cases with endometrial hyperplasia, only ten endometrial cancers were detected at the entrance of the study, all belonging to the high risk group (D-score <0). No further cancers were detected during follow-up, irrespective of risk group. After 6 months treatment with LNG-IUD proved significantly superior to oral treatment (p=0.001 for D-score >1 and p=0.003 for D-score 0-1 groups) and observation only (p=0.001 for D-score >1 and p=0.001 for D-score 0-1 groups). After 56 to 108 months the LNG-IUD proved significantly superior to oral treatment and to the observation group. Comparison of oral therapy to observation only showed no significant differences, neither after 6 months nor after long-time observation. CONCLUSIONS: LNG-IUD is the optimal treatment for endometrial hyperplasia. Outcome after oral low-dose MPA regimen is comparable to expectation. Language: English Keywords: NORWAY | RESEARCH REPORT | FOLLOW-UP STUDIES | ENDOMETRIAL EFFECTS | CONTRACEPTIVE AGENTS, PROGESTIN | LEVONORGESTREL | IUD | TREATMENT | Developed Countries | Europe, Northern | Europe | Studies | Research Methodology | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 328810 |
| 18. Peer Reviewed Title: Reverse of progestin-resistant atypical endometrial hyperplasia by metformin and oral contraceptives. Author: Shen ZQ; Zhu HT; Lin JF Source: Obstetrics and Gynecology. 2008 Aug;112(2 Pt 2):465-7. Abstract: BACKGROUND: Atypical endometrial hyperplasia usually is treated with high-dose progestin or hysterectomy, but the latter deprives the patient of future child bearing. CASES: Two women with atypical endometrial hyperplasia complicating polycystic ovary syndrome (PCOS) had failed to respond to high-dose progestin therapy. They were both obese, insulin-resistant, and nulliparous with a desire to preserve fecundity. Metformin and oral contraceptives were administered as alternatives. Endometrial curettage performed 3 months later demonstrated a proliferative endometrium without evidence of residual pathology. CONCLUSION: Insulin resistance might play a role in the occurrence of atypical endometrial hyperplasia complicating PCOS. Metformin and oral contraceptives could be an alternative treatment in the presence of progestin resistance. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | ORAL CONTRACEPTIVES | ENDOMETRIAL EFFECTS | CASE STUDIES | OBESITY | WOMEN | NULLIPARITY | Developed Countries | North America | Americas | Contraceptive Methods | Contraception | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Studies | Research Methodology | Body Weight | Demographic Factors | Population | Parity | Fertility Measurements | Fertility | Population Dynamics Document Number: 328233 |
| 19. Peer Reviewed Title: A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women. Author: Chan SS; Tam WH; Yeo W; Yu MM; Ng DP Source: BJOG: An International Journal of Obstetrics and Gynaecology. 2007 Dec;114(12):1510-1515. Abstract: The objective was to study the prophylactic use of levonorgestrel intrauterine system (LNG-IUS) in the prevention of endometrial pathology in women having breast cancer treated with tamoxifen. A randomised controlled trial was used. The setting for the study was a tertiary teaching hospital. One hundred and thirteen women (66 premenopausal/ 47 postmenopausal) who required adjuvant tamoxifen for breast cancer after the completion of postoperative radiotherapy and chemotherapy were examined. Women were randomised to treatment group (prophylactic LNG-IUS insertion before the commencement of tamoxifen) or control group. Uterine cavity was examined by outpatient hysteroscopy and endometrial biopsy before and at 12 months after commencement of tamoxifen. The main outcome measures were de novo endometrial pathology at 1 year of tamoxifen. Women in the treatment group had a much lower incidence of endometrial polyp (1.8 versus 15.5%, P = 0.017) (relative risk: 0.12; 95% CI: 0.02-0.91) at 12 months. There was no significant difference in the incidence of submucosal fibroid between the two groups (1.8 versus 3.4%, P = 1.0). LNG-IUS was retained in 95% women in the treatment group at 1 year. LNG-IUS reduces the occurrence of de novo endometrial polyp in women treated with tamoxifen for breast cancer. (author's) Language: English Keywords: HONG KONG | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | BREAST CANCER | TREATMENT | TAMOXIFEN | IUD, HORMONE RELEASING | LEVONORGESTREL | ENDOMETRIAL EFFECTS | Asia, Eastern | Asia | Developed Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Cancer | Neoplasms | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Agents | Reproductive Control Agents | Family Planning | IUD | Contraceptive Methods | Contraception | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 322224 |
| 20. Peer Reviewed Title: Endometrial expression of epithelial neutrophil-activating peptide-78 during the menstrual cycle or in progestin-only contraceptive users with breakthrough bleeding and the influence of doxycycline therapy. Author: Chegini N; Luo X; Pan Q; Rhoton-Vlasak A; Archer DF Source: Human Reproduction. 2007;22(2):427-433. Abstract: Endometrial breakthrough bleeding is characterized by an inflammatory reaction and increased production of proinflammatory mediators, one of which may be epithelial neutrophil-activating peptide-78 (ENA-78), a chemokine with neutrophil-activating properties. We therefore investigated the endometrial expression of ENA-78 in Norplant users as progestin-only contraceptive with various bleeding patterns (n = 35) as compared with non-users with a normal menstrual cycle (n = 55). The endometrial stromal cells (ESCs) were the major site of ENA-78 expression with the highest levels found during the secretory phase. The expression of ENA-78 was increased in Norplant users with irregular bleeding as compared with those with regular cycles and amenorrhoea. The levels of ENA-78 detected in uterine washes and sera after the use of Norplant for 3-6 months (n = 25) increased compared with baseline (P < 0.05). These levels did not significantly change in Norplant users who received doxycycline (Dox) therapy (25 mg/twice daily for 6 months) when measured midway through or at the conclusion of study when compared with the baseline (n = 25). Treatments with medroxyprogesterone acetate (MPA) and tumour necrosis factor-a (TNF-a) (25 ng/ml), but not 17ß-estradiol (E/2) or E/2 + MPA (10/-8 M), representing endometrium exposed to contraceptive and inflammatory conditions, respectively, increased the levels of ENA-78 production by ESCs, and this was reduced by co-treatments with Dox (25 mg/ml) (P < 0.05). The endometrial production of ENA-78 is altered in progestin-only contraceptive users experiencing breakthrough bleeding and is regulated by MPA and TNF-a in ESCs. Although Dox therapy did not alter uterine ENA-78 secretion, its suppression in ESCs suggests that Dox, acting site-specifically and through an anti-inflammatory mechanism, may influence the outcome of breakthrough bleeding in contraceptive users. (author's) Language: English Keywords: FLORIDA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | ENDOMETRIAL EFFECTS | LOW-DOSE PROGESTINS | METRORRHAGIA | DRUGS | CONTRACEPTIVE IMPLANTS | MENSTRUATION DISORDERS | MEDROXYPROGESTERONE ACETATE | Developed Countries | United States of America | North America | Americas | Research Methodology | Demographic Factors | Population | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Bleeding | Signs and Symptoms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods Document Number: 312199 |
| 21. Peer Reviewed Title: The levonorgestrel-releasing intrauterine system: An updated review of the contraceptive and noncontraceptive uses. Author: Chrisman C; Ribeiro P; Dalton VK Source: Clinical Obstetrics and Gynecology. 2007 Dec;50(4):886-897. Abstract: The levonorgestrel containing intrauterine system is an effective and safe form of long-term yet reversible birth control. Intrauterine contraception use in the United States fell dramatically after early studies reported an association between intrauterine contraception use and later tubal infertility. Subsequent evaluation suggests that these early studies were biased. Users often experience menstrual disturbances. Informing patients of these common side effects is important to improve compliance. In addition to its contraceptive effect, the levonorgestrel intrauterine system offers potential therapeutic benefits in other clinical contexts, including menorrhagia, symptomatic fibroids, endometriosis, and endometrial suppression. (author's) Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN | LEVONORGESTREL | IUD, HORMONE RELEASING | CONTRACEPTIVE SAFETY | CONTRACEPTIVE EFFECTIVENESS | INFERTILITY | TUBAL EFFECTS | MENSTRUATION DISORDERS | IUD COMPLICATIONS | USER COMPLIANCE | ENDOMETRIAL EFFECTS | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | IUD | Contraceptive Methods | Safety | Public Health | Health | Reproduction | Fallopian Tubes | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Diseases | Behavior | Endometrium | Uterus Document Number: 322248 |
| 22. Title: Implications of Essure tubal sterilisation for endometrial ablation and magnetic resonance imaging. Author's reply [letter] Author: Clark TJ Source: BJOG: An International Journal of Obstetrics and Gynaecology. 2007 Nov;114(11):1449-1450. Abstract: The Essure Permanent Birth Control System (Conceptus Inc., San Carlos, CA, USA) involves the hysteroscopic bilateral transtubal placement of microinserts, which elicit local tissue fibrosis, leading to tubal occlusion with the microinserts left firmly anchored within the fallopian tube. Although the tubal microinserts contain metallic and synthetic components, Qureshi is incorrect to assume that endometrial ablation (EA) and magnetic resonance imaging (MRI) are contraindicated following the Essure procedure for the following reasons. Concerns about EA following Essure sterilisation centre primarily on the possibility of heat transmission along the metallic microinserts leading to damage to the tubal serosa and subsequent thermal injury to adjacent abdominal organs. Mean tubal temperatures have been measured during EA using the Thermachoice IIIC balloon catheter (Gynecare; Ethicon Inc., Somerville, NJ, USA) immediately following the Essure procedure. The mean tubal temperatures ranged from 37.1 to 37.5degreeC, well below the critical tubal temperature of 45degreeC when serosal tissue destruction has been shown to occur. This series of 40 women also demonstrated the feasibility of Thermachoice IIIC EA following Essure sterilisation with no disturbance to the microinserts, no damage to the balloon catheter and no interference with its ability to ablate the endometrium recorded. Others have demonstrated the use of Thermachoice IIIC EA immediately before and after Essure sterilization. The same authors report the successful use of Essure sterilisation immediately after hysteroscopic endometrial resection, NovaSure (Cytyc, Marlborough, MA, USA) EA and Hydrothermablator (Boston Scientific, Natick, MA, USA) EA. However, there were no data pertaining to the use of these more aggressive EA techniques (including microwave endometrial ablation) after the Essure procedure, and so such procedures were contraindicated in this context without further evaluation in research studies. Concerns about MRI following Essure sterilisation relate to potential injury from the movement or excessive heating of the metallic implant. Secondary concerns include impairment of diagnosis due to the creation of substantial artefacts. Thorough, ex vivo testing has been conducted for the Essure device using standardised techniques (a 1.5 and 3.0 Tesla magnet, spatial gradient magnetic field of 720-Gauss/cm or less and maximum MR system-reported whole-body-averaged absorption rate of 3 W/kg for 15 minutes of scanning) to determine whether magnetic field interactions, heating and artefacts occur. These studies showed that there were no magnetic field interactions, the highest temperature changes were <+0.7degreeC, and the induced electrical currents were minimal. Artefacts were not considered a substantial problem for diagnostic MRI unless the area of interest was in the exact same position as where the implant was located. Thus, the findings of these investigations indicate that it is safe for women who have had the Essure sterilisation procedure to undergoMR procedures using MR systems operating with static magnetic fields of 3.0 Tesla or less. (full text) Language: English Keywords: UNITED KINGDOM | CRITIQUE | WOMEN | TUBAL LIGATION | FEMALE STERILIZATION | ENDOMETRIAL EFFECTS | EXAMINATIONS AND DIAGNOSES | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | Sterilization, Sexual | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 321400 |
| 23. Peer Reviewed Title: The introduction of reversible sterilization. Author: Cook R; Dickens B Source: International Journal of Gynecology and Obstetrics. 2007 Oct;99(1):1-3. Abstract: Professor Ingelman-Sundberg's paper on the effect of urine on the endometrium, which exposes a reversible method of inducing sterilization in humans, directs attention to the still unresolved ethical concern of nonconsensual sterilization. The experience he recalls of legal sterilization without their consent of "social undesirables" in Sweden between 1933 and 1975 is consistent with the same practice in several other western countries over the same period. The 1927 decision of the US Supreme Court upholding Virginia's eugenically driven law on nonconsensual sterilization of mentally deficient persons remains unreversed, and was applied, for instance, in North Carolina in 1976 to find comparable legislation a reasonable exercise of the state's police power. In Canada, Alberta's 1928 Sexual Sterilization Act and British Columbia's 1933 Act of the same name were repealed in 1972 and 1973 respectively, and in 1986 the Supreme Court ruled such nonconsensual procedures never to be in the best interestsof those liable to be subjected to them. The highest court in the UK, however, disagreed with this ruling in 1988, preferring each proposal for sterilization without the subject's consent to be addressed on its individual merits. (excerpt) Language: English Keywords: CANADA | CRITIQUE | WOMEN | REVERSIBLE STERILIZATION | ENDOMETRIAL EFFECTS | REPRODUCTIVE HEALTH | HUMAN RIGHTS | SAFETY | CONTRACEPTIVE USE-EFFECTIVENESS | North America, Northern | Americas | Developed Countries | Demographic Factors | Population | Sterilization, Sexual | Family Planning | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Health | Political Factors | Sociocultural Factors | Public Health | Contraceptive Effectiveness | Contraception Document Number: 320175 |
| 24. Peer Reviewed Title: Arias-Stella reaction in upper genital tract in pregnant and non-pregnant women: A study of 120 randomly selected cases. Author: Dhingra N; Punia RS; Radotra A; Mohan H Source: Archives of Gynecology and Obstetrics. 2007 Jul;276(1):47-52. Abstract: The aims were to: 1. To study the diagnostic importance of the Arias-Stella reaction. 2. To study tubal epithelial changes in ectopic pregnancy. 3. To study the occurrence of Arias-Stella reaction in non-pregnant women receiving hormonal treatment. A prospective study was conducted on 120 patients who underwent endometrial curettage and/or salpingectomy. The patients were divided into four groups, each comprising of 30 patients. Groups 1 and 4 included non-pregnant patients who were being evaluated for infertility and dysfunctional uterine bleeding respectively, while pregnant patients were included in Group 2 (intra-uterine abortions) and Group 3 (ectopic tubal gestation). The endometrial curettings and fallopian tube lining epithelial cells were examined for the changes described by Arias-Stella. Cases which showed the presence of the Arias-Stella reaction were further classified. The changes of the Arias-Stella reaction in endometrial glands were observed in 80% cases of intra-uterine abortions. Secretory/hypersecretory pattern was the most commonly observed type (36.67%). The reaction was seen in 3.33% each of patients evaluated for infertility and patients on hormonal therapy with oral progestational agents for the management of dysfunctional uterine bleeding. Although uncommon, the Arias-Stella reaction was noted in the epithelium of fallopian tubes (16.67%) from patients with ectopic tubal gestation. The findings of the present study emphasize the diagnostic importance of the Arias-Stella reaction. The changes of the reaction are a histological clue to the presumptive diagnosis of the presence of chorial tissue in cases in which the chorionic material is not found in the endometrial biopsy. The morphological features can be mistaken for malignancy if the pathologist is not aware of the patient's pregnancy or history of hormonal intake. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | WOMEN | INFERTILITY | ENDOMETRIAL EFFECTS | BLEEDING | ABORTION | PREGNANCY, ECTOPIC | EXAMINATIONS AND DIAGNOSES | HORMONES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Reproduction | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endocrine System Document Number: 317649 Notification |
| 25. Peer Reviewed Title: Sonohysterogram, hysterosalpingography, and pelvic ultrasound for diagnosing endometrial tuberculosis. Author: Duenas-Garcia OF; Rico-Olvera H; Garcia-Tinajero A Source: International Journal of Gynecology and Obstetrics. 2007 Dec;99(3):242-256. Abstract: Pelvic tuberculosis is an important cause of infertility in developing countries. There are reports that the most common site of infection is the fallopian tubes, which are affected in almost 100% of cases, followed by the endometrium, which is affected in 50%; few reports document that the endometrium is the most common site. Hysterosalpingography and pelvic ultrasound remain the initial diagnostic procedures for assessing tubal and peritoneal factors leading to infertility. Saline infusion sonohysterogram has been used to improve the accuracy of ultrasound findings when suboptimal ultrasound visualization occurs. However, there have been no previous reports of its use in endometrial tuberculosis. The purpose of this study was to compare these imaging procedures to ascertain the best method for diagnosis of endometrial tuberculosis. (excerpt) Language: English Keywords: MEXICO | RESEARCH REPORT | WOMEN | ULTRASONICS | EXAMINATIONS AND DIAGNOSES | PELVIC INFECTIONS | ENDOMETRIAL EFFECTS | TUBERCULOSIS | North America | Americas | Developing Countries | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 322134 |
| 26. Peer Reviewed Title: The promise and reality of the intrauterine route for hormone delivery for prevention and therapy of gynecological disease. Author: Fraser IS Source: Contraception. 2007 Jun;75(6 Suppl 1):S112-S117. Abstract: Progestins delivered by a variety of routes have been demonstrated, in addition to their high contraceptive effect, to have substantial benefits in the treatment of various gynecological disorders, and the intrauterine route has particular efficacy in treating endometrial and myometrial disorders. It should be possible to extend this to prevention of disease. Those conditions for which there is most evidence of therapeutic benefit from intrauterine release of progestins include heavy menstrual bleeding (due to most causes), endometrial hyperplasia, endometriosis and adenomyosis. Reasonable evidence exists to support the findings that intrauterine levonorgestrel helps to prevent the development of uterine fibroids, endometriosis, endometrial hyperplasia, acute episodes of pelvic infection and a wide range of menstrual symptoms. There is also promise of prevention of endometrial carcinoma, endometrial polyps, infertility and perhaps adenomyosis. There is a need for specific studies to further explore the prevention of these gynecological conditions which can cause major health disturbances and community distress. (author's) Language: English Keywords: AUSTRALIA | LITERATURE REVIEW | WOMEN | IUD | PROGESTERONE | LEVONORGESTREL | GYNECOLOGIC DISEASES | PREVENTION AND CONTROL | BLEEDING | ENDOMETRIAL EFFECTS | MYOMETRIAL EFFECTS | Oceania | Developed Countries | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Progestational Hormones | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Genital Effects, Female | Genitalia, Female | Genitalia | Urogenital System | Diseases | Signs and Symptoms | Endometrium | Uterus | Myometrium Document Number: 316971 |
| 27. Title: Response to Mahajan et al.: Endometrial thickness screening in premenopausal women with abnormal uterine bleeding [letter] Author: Getpook C Source: Journal of Obstetrics and Gynaecology Research. 2007 Dec;33(6):887. Abstract: We would like to response Dr Mahajan et al. with the following: We agree that endometrial biopsy is as effective as dilatation and curettage (D&C) for evaluating the endometrium for bleeding problems. In our institute, both methods are preferred. We selected D&C as the standard tool in the methodology to ensure that endometrial sampling in all cases was performed successfully and adequately to represent the whole endometrium as much as possible. We do not have data on the incidence of abnormal endometrium sonographic texture in our study. Usually, the irregular midline endometrial echo or the heteroechogenic pattern of the endometrium is considered to be abnormal. However, conventional or plain transvaginal sonography (TVS) alone might not be adequate for uterine bleeding triage. Saline hysterosonography is superior to TVS in this case. All of the patients in our study had irregular uterine bleeding patterns. We could not identify their exact menstrual phases. We performed curettage shortly after a diagnosis was made of abnormal uterine bleeding. None of the women in our study had received any previous hormonal treatment. Thank you very much for your interest in our study. (full text) Language: English Keywords: THAILAND | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | ENDOMETRIAL EFFECTS | MENOPAUSE | BLEEDING | MENORRHAGIA | SCREENING | ULTRASONICS | PHYSICAL EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Economic Development | Economic Factors | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Reproduction | Diseases | Menstruation Disorders | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 322696 |
| 28. Title: [Prevalence of endometrial injury in asymptomatic obese women] Prevalencia de lesoes endometriais em mulheres obesas assintomaticas. Author: Gouveia DA; Bahamondes L; Aldrighi JM; Tamanaha S; Ribeiro AL Source: Revista da Associacao Medica Brasileira. 2007 Jul-Aug;53(4):344-348. Abstract: OBJECTIVE. Obesity represents the most important risk factor for endometrial pathology. This study aimed to evaluate the prevalence of endometrial injuries, such as polyps, hyperplasia and endometrial cancer in asymptomatic obese women, as well as to recognize the associated risk factors . METHODS. A cross-sectional study was conducted between December 2004 and February 2006. Ninety-four obese (body mass index >or= 30 kg/mē) women were evaluated, divided in two groups of 47 participants each: pre-menopausal and postmenopausal women. Clinical characteristics, physical exams (anthropometric and gynecological), blood count and endometrial assessment by vaginal ultrasonography, biopsy, and hysteroscopy (only for confirmed endometrial pathology), were the variables appraised. RESULTS. In pre-menopausal women, 12.8% of cases had endometrial pathology statistically associated to age, hypertension, hypercholesterolemia and LDL-c increase. In the post-menopausal women, 40.4% of cases had a pathology identified as statistically associated with hypertension, LDL-c and estrone increase. Two cases of endometrial cancer were identified, one in each group. CONCLUSIONS. The increased incidence of obesity over recent years has increased risk factors of endometrial cancer. In premenopausal women only a small number of cases with endometrial alterations was observed. Therefore, it is suggested that greater attention be given to those over 40 years of age, associated with hypertension and/or higher LDL-c . The menopausal status increases risk of endometrial injury, and when associated with hypertension, LDL-c and/or estrone increase, women become candidates to biopsy aiming for an early diagnosis of cancer, a decisive factor for a favorable prognosis. Language: Portuguese Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | OBESITY | RISK FACTORS | ENDOMETRIAL EFFECTS | ENDOMETRIAL CANCER | HYPERTENSION | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Body Weight | Physiology | Biology | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Cancer | Neoplasms | Diseases | Vascular Diseases Document Number: 324932 |
| 29. Peer Reviewed< |