Effect of oestrogen replacement therapy on bone mass in post-menopausal Bangladeshi women.

The female population comprises 48.66% of our total population, of which 10.30% are above the age of 49, many of whom are post-menopausal. Menopause is associated with bone-loss and its consequences. Hormone replacement therapy (HRT), particularly replacement of estrogen, prevents bone-loss. We undertook this prospective case-controlled study to find out whether or not HRT is beneficial to our women. A total of 106 patients were studied, amongst them 60 were cases and 46 were controls. The women in the first group were given either conjugated equine estrogen alone (surgical menopause group) or conjugated equine estrogen plus cyclical progesterone (natural menopause group). Results showed that there was 4.29% increase in bone mineral density in women who received hormone replacement therapy (HRT). This increase was 5.23% in early and 3.56% in late menopause group. Women with natural menopause gained more bone mass (4.22%) than women with surgical menopause (3.9%). Our results also showed that women who denied HRT (controls) lost bone mass (5.26%), the loss was more in those with surgical menopause (6.24%) than those with natural menopause (4.87%). Therefore it can be concluded that post-menopausal hormone replacement therapy prevents bone-loss. However, to evaluate the beneficial effect of long-term HRT, further studies with larger samples are recommended.

Clinical down staging of cancer cervix with cytology.

A prospective study was carried out on 1500 patients attending the Gynaecology outpatient department of three referral hospitals in Dhaka City. These patients were selected on some selected clinical criteria to correlate several clinical markers (clinical down staging) with that of Pap's smear for early detection and secondary prevention of cancer cervix. Speculum examination and Pap's smear were done in all cases. Among 1500 women, 224 had abnormal Pap's smear. Histologic examination of specimens from these cases showed chronic cervicitis in 45 cases, dysplasia in 84 and squamous cell carcinoma in 95. Carcinoma was found in 130. Thus, there were 297 Pap's smear negative cases were biopsied on clinical ground. 225 cases of invasive carcinoma. From this study, it seems that clinical downstaging with cytology programme has to be started immediately throughout the country for diagnosis of carcinoma of the cervix in its preinvasive and potentially curable stage.