Change of contraceptive preference after the free-LARC program for Thai teenagers.

BACKGROUND: In 2014, the Thai government launched a free-of-charge long-acting reversible contraception (LARC) program for Thai female adolescents. However, its acceptance had not been reported. Therefore, this study aimed to describe contraceptive use among women of reproductive age before and after the program was implemented. METHODS: This retrospective cross-sectional study was carried out from the medical records of 9000 women of reproductive age, who attended the Family Planning Clinic at Maharaj Nakorn Chiang Mai Hospital between 2009 and 2018. The Chi-square test was used to compare the contraceptive methods administered before and after the program was implemented, and binary logistic regression was used to find the factors associated with implant use after completion of the program. RESULTS: Depot medroxy progesterone acetate (DMPA) injection was the most popular contraceptive method used among 40.9% of the women. The rates of subdermal implant use were increased significantly after the program was implemented (2.3-9.3%, p < 0.001). Implant use for adolescents aged less than 20 years increased from 2.6% to 56.4%, while DMPA was the most popular method used among adult women at 36.4%. Factors associated significantly with implant use after implement of the program included age of less than 20 years (aOR = 4.17 (CI: 1.84-9.44); p = 0.001) and nulliparity (aOR = 8.55 (CI: 3.77-19.39); p < 0.001). CONCLUSION: This study showed a significant increase in contraceptive implant use after the free-LARC program for adolescents had been applied. STATEMENT OF IMPLICATIONS: Contraceptive implant is the most effective hormonal reversible contraception. Its use rate is low among all age groups, but increased clearly after the free-of-charge program was applied for adolescents.

The experience of genitourinary syndrome of menopause (GSM) among Thai postmenopausal women: the non-reporting issue.

Genitourinary syndrome of menopause (GSM) is common among postmenopausal women, but, in general, not all of the patients seek medical advice as this sensitive issue can cause them embarrassment. OBJECTIVES: To explore the prevalence of GSM among Thai postmenopausal women and their disclosure of and attitude towards GSM. METHODS: A questionnaire was used to obtain information on GSM from 499 Thai postmenopausal women who attended the Menopause Clinic at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, from November 2015 to August 2016. RESULTS: The mean age of the 499 participants was 57.8 ± 7.2 years. It was notable that 87.2% of them had had GSM, and the prevalence increased with age. The most common symptoms were nocturia (77.7%) and vaginal dryness (51.7%). Among the symptomatic patients, 63.0% conveyed their problem to other people, i.e., friends and family, while 52.9% of them never reported to health care providers. The most common reason for not talking about their GSM was the acceptance of it being part of the natural aging process. CONCLUSIONS: GSM is common among Thai postmenopausal women. The prevalence of non-reporting is high and underreported.

The Association between Oligomenorrhea, Onset of Menopause and Metabolic Syndrome in Thai Postmenopausal Women.

OBJECTIVES: This study explored the association between a history of oligomenorrhea and onset of menopause and metabolic parameters. METHODS: The study population was 605 postmenopausal women who were patients at the Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between February 2015 and December 2015. A questionnaire was used to ask all women about their history of oligomenorrhea. The study also collected medical data, including weight, height, waist circumference, blood pressure, and blood glucose and lipid profile. RESULTS: Of the 231 postmenopausal women with a complete data record, 31 had a history of oligomenorrhea and 200 did not. The age of onset of menopause was around 48 years in both groups. Prevalence of metabolic syndrome was 12.1%. More women with a waist circumference larger than 80 cm had a history of oligomenorrhea at the interview than women who had not, but a history of oligomenorrhea did not relate to other metabolic parameters. The adjusted odds ratio of a history of oligomenorrhea to waist circumference was 3.69 (95% confidence interval, 1.17-11.64). CONCLUSIONS: A history of oligomenorrhea did not affect the age at menopause, but was associated with waist circumference during menopause.

Bone mineral density and bone turnover among young women in Chiang Mai, Thailand.

The present study was carried out to investigate the influence of lifestyle on bone mineral density (BMD) and bone turnover among young women in Chiang Mai, Thailand. A total of 177 young women affiliated with Chiang Mai University hospital were enrolled. Firstly, questionnaires about their lifestyle and the Osteoporosis Knowledge Test (OKT) were examined. The measurement of BMD was assessed by Quantitative Ultrasound (QUS). Secondly, based on the measurement of BMD, the subjects were divided into 2 groups, a Low BMD group (L group: less than YAM-1.0SD) and a Normal BMD group (N group: more than YAM-1.0SD). L group (n=23) and N group (n=23) were examined using Osteocalcine (OC), type 1 collagen cross-linked N-telopeptide (NTx) and undercarboxylated osteocalcin (ucOC) as bone turnover markers, and serum Ca, 1,25-(OH)2Vitamin D, Vitamin K1 and Vitamin K2 (MK-4) as bone turnover related factors. Based on the results, the percentage of Low BMD group was 23.2%. Concerning lifestyle and BMD, the BMD of the low cheese intake group was 99.7± 17.0 and the BMD of the high cheese intake one was 110.0± 23.3 (p<0.05). The BMD of the fracture experience group was 82.5± 11.6 and the BMD of no-fracture group was 103.3± 19.6 (p<0.05). These were significant differences in ucOC and 1,25-(OH)2Vitamin D between L and N groups (p<0.05). It was suggested that BMI, food and fracture experience might affect BMD level and suppression of bone formation might have contributed to the low BMD group among young women in Chiang Mai, Thailand.

Clinical responses to the combination of estradiol and drospirenone in symptomatic postmenopausal Thai women.

OBJECTIVES: To investigate the efficacy and tolerability of the oral hormone replacement therapy (HRT) containing 1 mg estradiol (E2) plus 2 mg drospirenone (DRSP) in Thai women with postmenopausal symptoms. MATERIAL AND METHOD: Fifty-five Thai women with postmenopausal symptoms participated in this multicenter, open-label, non-comparative Phase IV study. The primary endpoint was the reduction of hot flushes after 12 weeks of treatment. Secondary endpoints included changes infrequency and intensity of menopausal symptoms as well as safety assessments after 4, 8, and 12 weeks of treatment. RESULTS: Treatment with 1 mg E2 plus 2 mg DRSP reduced the frequency of hot flushes in 94.6% of women at the end of the 12-week treatment period. In 60% of women, the frequency of hot flushes was reduced to 10% or less, compared to baseline findings and 49.1% of women had no remaining hot flushes. Other postmenopausal symptoms such as vaginal dryness, urinary incontinence, dysuria, and dyspareunia improved The most common adverse events were vaginal bleeding or spotting and breast tenderness. CONCLUSION: The oral HRT of 1 mg E2 plus 2 mg DRSP was effective and well tolerated by Thai women suffering from postmenopausal symptoms.

Bone mineral density in women using the subdermal contraceptive implant Implanon for at least 2 years.

OBJECTIVE: To compare the effect of the long-term use of a subdermal single-rod contraceptive implant on bone mineral density (BMD) between users and a control group. METHODS: In this cross-sectional study, BMD was measured at the lumbar spine, femur, and distal radius and ulna in 100 Thai women of reproductive age, 50 who had used the Implanon implant for contraception for at least 2 years and 50 controls. RESULTS: Ethnicity, age, age at menarche, parity, menstrual pattern, and body mass index were similar in the 2 groups. The mean duration of Implanon use was 32.8+/-6.3 months. Although the prevalence of osteoporosis was rare at all sites in both groups, the Implanon users had a significantly lower BMD at the distal radius and ulna than the controls. CONCLUSION: The long-term use of Implanon seemed to have a negative impact on the mineral density of the distal radius and ulna.

Bone mineral density in women using depot medroxyprogesterone acetate (DMPA) for at least 2 years compared to a control group: a cross sectional study.

OBJECTIVE: To compare the effect of long-term use of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) in Thai women compared to the control. MATERIAL AND METHOD: A cross sectional study was conducted on Thai women of reproductive age who used DMPA (50 subjects) for contraception for at least 2 years and non-hormonal users (50 subjects). BMD was measured at the lumbar spine, femur and distal radius, and ulna. RESULTS: There was significantly lower BMD at the lumbar spines in the DMPA group but there was no significant difference in BMD between groups at the femur distal radius, and ulna. CONCLUSION: Long-term use of DMPA has a negative impact on lumbar spine BMD.

Comparison of osteoporosis self assessment tool for Asian (OSTA) and standard assessment in Menopause Clinic, Chiang Mai.

OBJECTIVE: To compare osteoporosis self assessment tool for Asian (OSTA) with the standard measurement of bone mineral density (BMD) by dual energy x-rays absorptiometry (DXA) in- identifying the prevalence of osteopenia and osteoporosis in Thai menopausal women who attended the Menopause Clinic, Faculty of Medicine, Chiang Mai University. MATERIAL AND METHOD: The data was retrospectively collected from the medical records of women who had lumbar femoral neck and radius BMD t-score measurement by DXA (Hologic, QDR-4500C) between January 2004 and December 2005. The body weight and age ofpatients were calculated for the OSTA index score. The women with OSTA score < -1 and > or = -1 were classified as "moderate to high risk" and "low risk" for fracture, respectively. The BMD T-scores of < -1 and > or = -1 were classified as "osteopenia to osteoporosis " and "normal" respectively. RESULTS: Three hundred and fifteen menopausal women of the age of 45-87 years were included. The BMD T-scores assessment revealed that more than half of the subjects had osteopenia to osteoporosis (T-score < or = -1), 196 women (62%) at lumbar spine, 133 women (42.2%) at femur and a third, 114 women (36.2%) at radius respectively. The OSTA index at the standard cut-point of < -1 had a sensitivity and specificity of 36.2% and 71.4% respectively for the lumbar spine and 40.6% and 72.0% respectively for the neck of the femur in predicting osteopenia to osteoporosis status. CONCLUSION: The OSTA index score had a low sensitivity (36-48%) but a high specificity (71-75%) for identifying osteopenic to osteoporotic women among population of menopausal period Nevertheless, it is a useful screening tool in old age women (> 65 years).

One year study of Implanon on the adverse events and discontinuation.

OBJECTIVE: To determine adverse events and discontinuation of Implanon in healthy Thai women between 16 and 45 years of age. DESIGN: Prospective descriptive study. SETTING: Family Planning Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECTS: Ninety-two female volunteers with eligible criteria, no contraindication for hormonal contraceptive and wished to have long-term contraception were recruited. MAIN OUTCOME MEASURES: Determination of adverse events was done three months after Implanon insertion. Discontinuation of Implanon use was reviewed during the study period of one year RESULTS: Amenorrhea (40.2%) and infrequent bleeding (39.1%) were the most menstrual adverse events. While most non-menstrual adverse events were headache/dizziness (27.2%) and lower abdominal pain (23.9%). Severe non-menstrual side effect was rare (1-2%). Seven subjects (7.6%) discontinued using Implanon during the one year period of study. CONCLUSION: Implanon demonstrated a high continue rate at the first year of insertion. It produced similar adverse events like other progestin-only contraceptives. Counseling before insertion is important for increased client satisfaction and a higher continuation rate.

Immediate complications of laparoscopic tubal sterilization: 11 years of experience.

OBJECTIVE: To evaluate the complications of laparoscopic tubal sterilization. METHOD: A retrospective study of laparoscopic tubal sterilization performed at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai, Thailand was conducted. The details of the operation, including complications and operation time were collected from the operative and family planning registry. RESULTS: Between January 1987 and December 1997, 948 cases of laparoscopic tubal sterilization were performed as an outpatient setting. The combination of intravenous sedation and local anesthesia was employed in all cases. Minor intra-operative complications were found in 4.6% of cases. The most frequent complications were meso-salphingeal and meso-ovarian bleeding. No serious complication was found in this study. The mean operation time was 19.3 minutes (range 5-75 minutes). CONCLUSION: The present study suggested that out-patient laparoscopic tubal sterilization under the combination of intravenous sedation and local anesthesia is a convenient and relatively safe procedure.

Symptoms of estrogen deficiency in nursing personnel in Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To determine the self-reported prevalence and severity of climacteric symptoms of estrogen deficiency in nursing personnel working in Maharaj Nakorn Chiang Mai Hospital during the year 2002. DESIGN: Cross-sectional descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECT: Six-hundred and eight nursing personnel, including professional nurses and practical nurses, aged 40-60 years, working in Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: The same sets of questionnaires were provided and distributed to each subject. Subjects had self assessment under individual decision with written consent and data was prospectively collected. The data were analyzed using software SPSS version 10 and presented in frequencies and percentage. MAIN OUTCOME MEASURE: The prevalence and severity of each climacteric symptoms. RESULTS: Five-hundred and seventy five of 608 subjects (94.6%) responded to the questionnaires, 62.6% of them were in normal reproductive period, while the remainder (37.4%) were in the menopausal period. The latter group was divided into 4 subgroups of pre/peri-menopause, post menopause, surgical menopause and premature ovarian failure. The prevalence of climacteric symptoms was systematically classified as follows, vasomotor instability 40.7% (severe cases, 5.4%), psychosomatic symptoms 50.9% (severe cases, 3.9%), lower urinary tract symptoms 29.1% (severe cases, 2.4%), lower genital tract symptoms 34.0% (severe cases, 2.7%), and other symptoms 50.7% (severe cases, 4.3%). The first five most common symptoms were as follows, forgetful 84.1% (severe cases, 7.9%), myalgia 74.3% (severe cases, 10.6%), anxious 71.0% (severe cases, 5.3%), tired 70.0% (severe cases, 4.1%), headache 68.3% (severe cases, 8.3%). The least common symptom was needle pain, the prevalence was 19.7% (severe cases, 1.3%). The overall prevalence of women using hormone replacement therapy was 13.1%, only 8.9% were current users. CONCLUSION: Focusing on each symptom of climacteric symptoms, the authors found high prevalence in psychosomatic symptoms and other symptoms such as forgetful, myalgia, anxious, tired and headache. While the classic symptom (vasomotor instability) was found to be low in the present study which was different from the previous reports. This may be due to the racial or cultural and educational factors among different populations.