Comparison of mass spectrometry and radioimmunoassay to measure medroxyprogesterone acetate in patients with endometrial cancer.

Serum medroxyprogesterone acetate (MPA) was measured by radioimmunoassay (RIA) and gas chromatography-mass spectrometry (GC-MS) in patients with endometrial cancer. Samples were obtained 3, 6 and 24 h after the oral administration of 100 or 200 mg MPA once a day. The levels obtained by GC-MS were lower (median 16-29%) than those obtained by RIA, which is probably attributable to the presence of metabolites interfering with the RIA. Two commercial MPA formulations gave different MPA serum levels by both RIA and GC-MS. The levels obtained by GC-MS were so low that frequently only partial saturation of the endometrial progesterone receptor may be achieved which may explain why high oral doses are needed to produce optimum therapeutic response.

Sarcomas of the uterus: a clinicopathologic study of 119 patients.

This series consists of 119 uterine sarcoma patients treated at the University of Helsinki Central Hospital during the 20-year period of 1958 to 1977. It comprises the three main histologic varieties: leiomyosarcomas, 51 patients; mixed müllerian sarcomas, 45 patients; and endometrial stromal sarcomas, 23 patients. The clinicopathological features that could have had a bearing on prognosis were examined retrospectively. The clinical stage at the time of primary treatment was the main prognostic factor. Other important factors were the degree of histologic differentiation and the mitotic activity. The overall five-year survival rate for patients with leiomyosarcomas was 39%; for mixed müllerian sarcomas, 33%; and for endometrial stromal sarcomas, 61%. The ten-year survival figures were 27, 14, and 37%, respectively. Some features of the diagnosis, the natural history, and the different methods of treatment of these diseases are discussed.

Endocrinologic features of oligomenorrheic adolescent girls.

The plasma concentrations of sex hormones were measured in 45 oligomenorrheic and 28 regularly menstruating adolescent girls. Testosterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone-sulfate, estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, prolactin, and sex hormone-binding globulin levels were determined in blood samples collected during one menstrual cycle. The oligomenorrheic girls had significantly higher concentrations of luteinizing hormone, androstenedione, dehydroepiandrosterone-sulfate, and free testosterone than regularly menstruating girls. Sex hormone-binding globulin concentrations were significantly lower in the oligomenorrheic group. The oligomenorrheic girls were not obese. Signs of acne or hirsutism were absent or mild. Sixty-six percent of the oligomenorrheic cycles were ovulatory. The significance of the hormonal findings is discussed.

Sex hormone profiles in oligomenorrheic adolescent girls and the effect of oral contraceptives.

The hormonal profiles and the effect of oral contraceptives (OCs) on 16 oligomenorrheic and 10 regularly menstruating adolescent girls were studied. Testosterone, androstenedione, dehydroepiandrosterone, estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, prolactin, and sex-hormone-binding globulin were determined on blood samples obtained during a control cycle, during OC treatment, and during the follow-up cycle after discontinuation of OC use. The oligomenorrheic girls had significantly higher concentrations of androstenedione and total and free testosterone than regularly menstruating girls during the control cycle. Sex-hormone-binding globulin concentrations were significantly lower in the oligomenorrheic group. Both in oligomenorrheic and regularly menstruating girls OC treatment caused a decrease in the mean concentrations of all hormones, except prolactin, to similar levels. For 2 to 4 weeks after treatment the oligomenorrheic girls had significantly lower levels of androstenedione, total and free testosterone, and luteinizing hormone than before treatment. In the control group there were no significant differences between pretreatment and posttreatment hormone concentrations. The risks and benefits of prescribing OCs for oligomenorrheic adolescent girls are discussed.

PIP: The hormonal profiles and effect of oral contraceptives (OCs) on 16 oligomenorrheic and 10 regularly menstruating adolescent girls were studies. Testosterone, androstenedione, dehydroepiandrosterone, estradiol, progesterone, luteinizing hormone, follicle stimulating hormone, prolactin, and sex hormone binding globulin were determined on blood samples obtained during a control cycle, during OC treatment, and during the follow-up cycle after OC discontinuation. The oligomenorrheic girls had significantly higher concentrations of androstenedione and total and free testosterone than regularly menstruating girls during the control cycle. Sex hormone binding globulin concentrations were significantly lower in the oligomenorrheic group. Both inoligomenorrheic and regularly menstruating girls, OC treatment caused a decrease in the mean concentrations of all hormones, except prolactin, to similar levels. For 2-4 weeks after treatment, the oligomenorrheic girls had significantly lower levels of androstenedion, total and free testosterone, and luteinizing hormone than before treatment. In the control group, there were no significant differences between pretreatment and posttreatment hormone concentrations. The risks and benefits of prescribing OCs for oligomenorrheic adolescent girls are discussed.

Ovarian function during oestrogen-progestin replacement treatment in pre-menopausal women.

Thirty-five pre-menopausal women were treated for 3 mth with sequential combinations containing oestradiol valerate and levonorgestrel in two different doses. Three treatment cycles, and 2 cycles before and 2 after treatment were studied. Subjective symptoms were relieved in 62% of women during treatment. Normal secretory phase was observed in 25-53% before and 33-35% at the end of treatment. Serum FSH and the frequency of serum progesterone increase greater than 5 nmol/1 decreased, particularly during treatment with the higher dosage. Ovulations occurred during both treatments; these combinations cannot therefore be used for contraceptive purposes. In ultrasonic studies, the average volume of ovaries in which no follicles were found, was 7.6 cm3. The volume of ovaries with follicles was 10.5 cm3. The follicular growth was often defective, also in ovulatory cycles, in both treatment and control cycles. In ovulatory cycles, luteinized unruptured follicles occurred in 2% before treatment and in 5% during treatment. In anovulatory cycles, persistent follicles were observed in 13% before treatment and in 19% during treatment. The frequency of luteinized unruptured follicle (LUF) syndrome did not increase significantly in pre-menopausal women during oestrogen-progestin treatment. However, persistent follicles were frequent during anovulatory cycles. Serum oestradiol concentrations correlated significantly with the diameter of the dominant follicle. No significant changes were found in uterine volume. Both of the tested regimens are useful for treatment of pre-menopausal symptoms.

The effect of oral contraceptives on hormone profiles of oligomenorrheic adolescent cycles.

Nineteen adolescent girls with oligomenorrhea were studied to evaluate the effect of oral contraceptives (OCs) on hormone profiles, and 19 adolescent girls with regular menstruations served as control subjects. Serum levels of luteinizing hormone and androgens were higher in the oligomenorrheic girls than in the regularly menstruating girls. During the OC treatment the hormone levels of the oligomenorrheic girls decreased, approaching those of the control subjects. During follow-up cycle immediately after stopping the OCs the hormone levels increased rapidly, but in the oligomenorrheic girls the levels of luteinizing hormone, androstenedione, total and free testosterone were still significantly lower at the end of the post-treatment cycle than during the luteal phase of the pre-treatment cycle. The frequency of ovulation decreased to the same magnitude as reported in adults after discontinuation of OCs. No post-pill amenorrhea existed in either group of adolescents.

Prostaglandin induction of 424 midtrimester abortions.

PIP: 424 pregnant women seeking termination of 2nd trimester pregnancy had either PGF2alpha (290 women) or PGE2 (134 women) administration. Oxytocin was concomitantly administered as an intravenous infusion to 185 women. The patients were divided into 11 groups based on PG (prostaglandin) type and dose, route of PG administration, and oxytocin infusion (Table 1). Vital signs were monitored hourly and blood samples collected from most patients for analysis of erythrocyte sedimentation rate, hemoglobin, blood leukocytes, and glutamic oxaloacetic transaminase before induction, at or immediately after abortion, and 24-48 hours after abortion. Side effects reported included diarrhea, vomiting, headache, and vasovagal symptoms. Complications included bleeding of 500 ml or more; pelvic infection and cervical rupture. Intraamniotic administration of 50 mg PGF2a either alone or with supplemental intravenous oxytocin, and intraamniotic use of 10 mg of PGE2 supplemented with oxytocin provided the best results in terms of success rate (100%) and shortest induction-abortion interval (14.1 to 16.2 hours). Extraamniotic administration had success rates ranging from 83% to 90%, depending on frequency of PG application. Intravenous PG administration was associated with low efficacy and high frequency of side effects.^ieng

[Why does a woman decide on a abortion?]. / Mikä saa naisen valitsemaan abortin?

PIP: This study consists of 99 patients, all over age 18, who chose an induced abortion (group 1) and 100 patients who delivered a full-term baby (group 2). The mean age was 26.0 years in the abortion group and 26.4 years in the delivery group. Of those in group 1, 33 were married and of those who delivered their baby, 75 were married and 25 gave birth to a child out-of-wedlock. The difference is social background between the groups is statistically highly significant (p0.001). Only 3% of women in group 1 belonged to the 4 highest strata of society as compared with 26 in group 2. The previous use of contraceptive methods was similar in both groups. However, there was a clear difference between the 2 groups in the pattern of their relationship with the other sex. The patients in the abortion group had their 1st intercourse significantly earlier (p0.01). In the abortion group, 12% had their 1st coitus prior to age 15 and 46% before the age of 18. The corresponding percentages in the delivery group were 2% and 29%. The women in the abortion group had more partners than the women in the delivery group. The most common motivations for abortion were economic difficulties alone or together with poor housing conditions. These were responsible for 36% of the abortions in the case of married women and in 48% when the women were not married. In the group of unmarried women, 12% had not completed their education and therefore wished to have an abortion. Among the married women, 9% stated that the sexual partner in the intercourse leading to the present pregnancy was not their husband, thus the motivation to have the abortion. The number of previous children was not reported to be a reason for abortion. The women who decided to deliver the baby considered their marriages very happy (more than 2/3) or at least fairly happy. The patient's own childhood did not affect the decision in favor of or against abortion in this group of women. The decision was influenced by the actual life situation and thus this finding differs from the previous studies on adolescent abortions. (author's modified)^ieng

Dysmenorrhea during adolescence.

Different aspects of the menstrual pattern including dysmenorrhea, premenstrual tension and working performance during menstruation was studied in three different investigations. The first study includes 5458 adolescent girls aged 10 to 20. The incidence of invariably painful menstruation was 7.2 per cent during the first gynecological year and 26 per cent five years later. A correlation was found between mothers and daughters for dysmenorrhea as well as for premenstrual tension. In a second study including 331 girls aged 13 to 20 years the overall absence from school due to pain was 23.4 per cent. The frequency of dysmenorrhea increased from 36 per cent to 56.5 per cent between 13--14 years and 17--20 years. Socio-medical aspects of menstrual pattern were studied in 865 adult women. Approximately 88 per cent had premenstrual tension and almost 45 per cent had menstrual pain. Thus the treatment of menstrual distress during adolescence is of great importance and the use of modern prostaglandin synthetase inhibitors may be very useful.

[Estrogen treatment only when symptoms are present but complaints should not be neglected]. / Ostrogenterapi endast vid symtom men besvären får inte negligeras

PIP: The use of estrogen during the climacterium is discussed. Estrogen should be used only when objective symptoms of a lack of estrogen can be established. Thrombosis, hypertension, breast cancer, uterine cancer and ruptured blood vessels are contraindications to climacteric estrogen use. Progestagens administered in conjunction with sedatives and diuretics can often relieve climacteric afflictions. Continued administration of estrogen should be avoided; estrogen can be administered with or without gestagens 7-10 days before menstruation or in 21-day periods. General practitioners are qualified to administer estrogen and should give patients regular examinations. There is a risk of developing endometrial cancer under climacteric estrogen treatment. Only women who want and need climacteric estrogen treatment should receive it.^ieng