Effect of the subdermal contraceptive etonogestrel implant (Implanon) on biochemical and hormonal parameters (three years follow-up).

OBJECTIVE: To determine whether the use of the subdermal contraceptive implant releasing etonogestrel (Implanon) affects serum hormonal and biochemical indices. METHODS: Seventy women with a mean age of 28.5+/-3.4 years were enrolled into this prospective observational study. After placement of an Implanon rod, they were followed-up for three years. Baseline and end-of-study values of serum low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol, triglycerides, fasting glucose, blood urea nitrogen (BUN), creatinine, SGOT, SGPT, follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, free 3,5,3'-tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and prolactine (PRL) were compared using Student's t-test. RESULTS: There was no failure of contraception during the three year period. No statistically significant differences were observed between the initial and final levels of fasting blood glucose, BUN, SGOT, SGPT, LDL, HDL, E2, FSH, LH, fT3, fT4 and TSH (p>0.05), but the increase in PRL, cholesterol and triglycerides, and the decrease in creatinine levels at the end of three years were statistically significant (p<0.05) although the values were still within normal ranges. CONCLUSION: Our findings confirm data from the literature according to which Implanon does not affect meaningfully reproductive hormonal parameters, thyroid function, hepatic and renal functions, and glucose metabolism. However, further studies are needed to elucidate lipid metabolism changes.

The predictors of retained products of conception following first-trimester pregnancy termination with manual vacuum aspiration.

OBJECTIVE: To identify the risk factors associated with retained products of conception (RPC) following first-trimester pregnancy termination with manual vacuum aspiration (MVA). METHODS: We analyzed 1623 patients who underwent MVA during the first 9 weeks of their pregnancies in SSK Aegean Obstetrics and Gynecology Teaching Hospital Department of Family Planning in between February 2001 and January 2004. RESULTS: A total of 81 patients (5%) had RPC after MVA. We found that RPC after MVA were significantly associated with patient's age (P = 0.026), body mass index (BMI) (P = 0.017), and week of gestation applied MVA (P = 0.012); but not associated with parity (P = 0.063), history of previous MVA (P = 0.845), and history of previous miscarriage (P = 0.918). CONCLUSION: Our study suggests that the frequency of RPC after MVA has been affected by current pregnancy-related factors such as patient age, BMI, and gestational age rather than the prior obstetric history of the patients.

Comparison of the clinical efficacy of flutamide and spironolactone plus Diane 35 in the treatment of idiopathic hirsutism: a randomized controlled study.

OBJECTIVE: To compare the effectiveness of flutamide and spironolactone plus Diane 35 in the treatment of idiopathic hirsutism (IH). DESIGN: Prospective randomized clinical study. SETTING: Social Security Agency, Aegean Obstetrics and Gynecology Teaching Hospital, Department of Reproductive Endocrinology and Infertility, a tertiary referral center. PATIENT(S): Eighty women with IH who had been admitted to our center. INTERVENTION(S): Patients were randomly and equally assigned to receive flutamide (250 mg/d for the first 10 days of the cycle) and spironolactone plus Diane 35 (spironolactone 100 mg/d; Diane 35 is a combination tablet of 2 mg cyproterone acetate and 35 microg ethinylestradiol/d) for 9 months. MAIN OUTCOME MEASURE(S): Modified Ferriman-Gallwey (F-G) score and hormonal profile before treatment and at the end of treatment. RESULT(S): In spite of the fact that there were no statistically significant differences in modified F-G scores in between the two groups, a significant decrease in modified F-G scores was observed in the flutamide (from 19.93 +/- 4.31 to 15.58 +/- 4.28) and spironolactone plus Diane 35 (from 18.77 +/- 3.76 to 14.54 +/- 3.29) groups. There were also no differences between the two groups with respect to hormonal profiles including serum FSH, LH, free T, 17-OH-progesterone, and DHEAS levels. No major side effect, including liver toxicity, was observed in either group. CONCLUSION(S): Our data suggest that both therapies have similar effectiveness in the treatment of IH.

Reproductive and obstetric characteristics of adolescent pregnancies in Turkish women.

OBJECTIVE: To evaluate reproductive and obstetric characteristics of adolescent pregnancies in Turkish population. DESIGN: Retrospective study. SETTING: Social Security Agency (SSK) Aegean Obstetrics and Gynecology Teaching Hospital (tertiary referral center). PATIENTS: One thousand and eight hundred adolescent pregnant women who referred to our center, between January 12, 2002 and March 15, 2003. The adolescent age group was defined as young women between the ages of 13 and 19. INTERVENTIONS: None. OUTCOME MEASURES: Socio-demographic characteristics, contraceptive histories, sexually transmitted infections (STI), and obstetric outcomes of the patients. RESULTS: Mean age was 17.3 (range 13-19) years. Among all adolescent pregnancies 1368 (76%) cases were planned, and 1512 (84%) cases were married. Approximately 70% of the patients with a non-planned pregnancy were not using any contraceptive methods. Although there were no patients with HIV infection, there were a considerable percentage of patients with positive cervical screening tests for Human Papilloma Virus (8.05%). A majority of adolescent mothers (77%) lacked prenatal care; mean gestational week at the first prenatal visit of the patients taking prenatal care was 28.2 (range 6-39) weeks. There were 249 (13.83%) abortions. Mean gestational age at delivery was 36 +/- 2 (range 25-41) weeks. The most common obstetric complication was low birth weight (28.72%). CONCLUSIONS: Adolescent pregnancy rate in Turkey is similar to those in developed countries. However, there are considerable differences which possible reflect ethnic and socio-cultural differences, in between two populations. Our major problems seem to be the low rate of previous effective contraceptive use for unintended adolescent pregnant women and the high rate of inadequate prenatal care for adolescent pregnant women, even if their pregnancies are intended.

Prothrombin G20210A mutation in cases with recurrent miscarriage: a study of the mediterranean population.

BACKGROUND: Thrombophilic predisposition may be one of the underlying causes of recurrent miscariage (RM). The purpose of this study was to evaluate the Prothrombin G20210A mutation in cases with history of RM. MATERIAL AND METHODS: A total of 104 cases, 55 with diagnosis of RM and 49 control cases, were included in this controlled study. In all cases, in addition to full examination tests, Prothrombin 20210A mutation analysis was carried out by means of Polymerase Chain Reaction (PCR). RESULTS: Mean number of the abortion was 3.51 +/- 0.74 in the RM group and 0.08 +/- 0.27 in the control group (p < 0.05). As a consequence of comprehensive examinations, in 24 (43.6%) of 55 RM cases at least one etiologic factor was put forth. Prothrombin G20210A mutation was observed in six (10.9%) cases of the RM group and one (2.04%) in the control group (p < 0.05). Four of the six cases (66.7%) of Prothrombin G20210A mutation had a subsequent pregnancy. Among these four pregnancies, there was one spontaneous loss at 14 weeks of gestation and one severe pre-eclampsia. CONCLUSION: Our data together with literature suggest that Prothrombin G20210A mutation may be associated with RM. We recommend this genetic testing as a screening tool for women with history of RM.

Ovarian cysts in tamoxifen-treated women with breast cancer.

OBJECTIVE: The objective of this study was to detect any ovarian changes in tamoxifen-treated breast cancer patients. METHODS: In all, 51 patients with breast cancer were enrolled in the study, which was conducted in the SSK (Social Security Agency) Aegean Maternity Hospital between January 1999 and December 2002. The patients' demographic and medical data were reviewed. All patients taking part in the study received tamoxifen therapy, but the duration was not uniform. Gynecological examination and transvaginal ultrasonography (TVU) were performed in each case. Any ovarian cysts or masses were identified, and serum Ca-125 levels were recorded. RESULTS: Of the 51 tamoxifen-treated patients enrolled in this study, 24 were still premenopausal and 27 were postmenopausal when they were monitored for breast cysts during the tamoxifen treatment started after the diagnosis of breast cancer. Their average age was 53.7 (range 31-64) years. The mean duration of tamoxifen therapy was 23.5 (range 8-49) months. Ovarian cysts were diagnosed in nine (17.6%) patients and required surgery in two of these; pathological examination revealed serous cysts of the ovary in both. CONCLUSION: : In cases with ovarian cyst formation during tamoxifen treatment of breast cancer, discontinuation of tamoxifen followed by monitoring is quite a reasonable way to proceed in most cases. Surgical intervention should be carried out when cysts are >5 cm in diameter.

Adenosarcoma of the uterus: a case report.

Adenosarcomas of the uterus are very rarely observed and diagnosed. In this report, we present a case of a uterine adenosarcoma that was diagnosed in February 2002.