Hormone replacement therapy and malignancy.
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Breast Neoplasms↗
Biomedical subjects
M Elstein
Publications and source records attributed to M Elstein.
Comparison of Yuzpe regimen, danazol, and mifepristone (RU486) in oral postcoital contraception.
OBJECTIVE: To compare the effectiveness and acceptability of three regimens of postcoital contraception. DESIGN: Randomised group comparison of ethinyloestradiol 100 micrograms plus levonorgestrel 500 micrograms repeated after 12 hours (Yuzpe method); danazol 600 mg repeated after 12 hours; and mifepristone 600 mg single dose. SETTING: Community family planning clinic. SUBJECTS: 616 consecutive women with regular cycles aged 16 to 45 years. MAIN OUTCOME MEASURES: Number of pregnancies, incidence of side effects, and timing of next period. RESULTS: The raw pregnancy rates (with 95% confidence intervals) for the Yuzpe, danazol, and mifepristone groups were 2.62% (0.86% to 6.00%), 4.66% (2.15% to 8.67%), and 0% (0% to 1.87%) respectively. Overall, these rates differed significantly (chi 2 = 8.988, df = 2; p = 0.011). The differences between the mifepristone and Yuzpe groups and between the mifepristone and danazol groups were also significant. Side effects were more common and more severe in the Yuzpe group (133 women (70%)) than in either the danazol group (58 (30%)) or the mifepristone group (72 (37%)). The Yuzpe regimen tended to induce bleeding early but mifepristone prolonged the cycle. Three women bled more than seven days late in the Yuzpe group compared with 49 in the mifepristone group. CONCLUSIONS: Mifepristone was effective in reducing expected pregnancy rates and the Yuzpe method also had a clinical effect. Danazol had little or no effect. A further multicentre trial is needed.
Adolescent↗
Quantification of the in vitro activity of some compounds with spermicidal activity.
The in vitro spermicidal activity of the commonly used surfactant spermicides and the antiseptic chlorhexidine, were quantified in a statistically reproducible manner, using donor semen and image capture analysis. The spermicidal activity was expressed as the ED50 under defined assay conditions. Using these parameters, the order of spermicidal activity was: Menfegol > nonoxynol-9 approximately benzalkonium chloride > sodium docusate > chlorhexidine. These differences were statistically significant.
Benzalkonium Compounds↗
Pituitary-ovarian function in women with minimal or mild endometriosis and otherwise unexplained infertility.
OBJECTIVE: To determine whether abnormalities of pituitary-ovarian function are associated with minor degrees of endometriosis in women with otherwise unexplained infertility. DESIGN: Comparison of pituitary-ovarian function in a group of 22 patients with that in a control group of 10 healthy fertile women. PATIENTS: Twenty-two women with minimal or mild endometriosis and otherwise unexplained infertility. MEASUREMENTS: Ovarian ultrasound and radioimmunoassay of pituitary and ovarian hormones. RESULTS: Abnormalities, including luteinization of unruptured follicles, broad LH surges and low concentrations of progesterone during the luteal phase, were demonstrated in 82% of study cycles. CONCLUSION: Pituitary-ovarian dysfunction appears to be associated with minimal or mild endometriosis in women with otherwise unexplained infertility but the diversity of endocrine abnormalities demonstrated suggests that endometriosis is unlikely to be an aetiological factor in their development.
Adolescent↗
[Current status of contraceptive vaginal rings].
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Clinical Trials as Topic↗
Undergraduate education and recruitment in obstetrics and gynaecology.
The extent and quality of exposure to obstetrics and gynaecology that is required in the undergraduate curriculum has bearing on the knowledge, clinical skills and behaviour that are expected from the student. How much involvement should clinical obstetricians and gynaecologists have in teaching human reproduction and basic physiology and related science to the undergraduate? Who should teach sexual medicine? What is the extent of practical experience which students should have? Should the student have an opportunity to study a particular area in the discipline at depth in order to encourage interest and involvement and thereby facilitate recruitment? These issues are being addressed in curricular changes in Manchester, and option teaching is considered to have the potential of enhancing interest in obstetrics and gynaecology as a definitive career.
Curriculum↗
The efficacy and acceptability of a low-dose levonorgestrel intravaginal ring for contraception in a UK cohort.
The efficacy and acceptability of a levonorgestrel-releasing intravaginal ring (IVR) for contraception was assessed in a British cohort studied as part of a multicentre, multinational clinical trial performed under the auspices of the World Health Organisation. One-hundred-and-fifty women took part in the study in two UK centres and completed 1417.5 months of method use. Fifty-nine women discontinued use of the IVR before the end of one year giving an overall discontinuation rate of 39.9 per 100 woman-years. The discontinuation for pregnancy with the ring in situ, was 3.0 per 100 woman-years (life table analysis). Menstrual disturbance, vaginal problems and involuntary expulsion resulted in discontinuation rates of 8.9, 8.4 and 1.6 per 100 woman-years, respectively. This method is an acceptable and effective method of contraception for women.
Adolescent↗
Extending the duration of the pill-free interval during combined oral contraception.
The effect of increasing the duration of the pill-free interval from 7 to 9 and 11 days during the first 4 months of combined oral contraceptive therapy was studied by hormonal, ovarian follicle and mucus changes. Increasing the pill-free interval allowed more follicular development and more estradiol production. In some cases, pre-ovulatory values were achieved although ovulation did not occur. No differences could be detected between different types of combined oral contraceptive, including monophasic, triphasic, levonorgestrel-containing and gestodene-containing. The variation between individuals in the group of 28 was far greater than any variation in dose.
Adult↗
Present status of contraceptive vaginal rings.
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Contraceptive Agents, Female↗
The effects of nafarelin and danazol on vertebral trabecular bone mass in patients with endometriosis.
Single and dual-energy quantitative computed tomography (QCT) were used to measure spinal trabecular bone mineral content in 24 women treated with either nafarelin (15 patients) or danazol (nine patients) for endometriosis. Significant loss of bone mineral (-9.6 g/l; -5.9% P less than 0.001) was demonstrated after 6 months' treatment with nafarelin. This loss was reversible with no significant difference in the bone mineral measurement made before treatment and that made at 6 months after treatment was stopped (difference -1.95 g/l, NS). A small but statistically significant (+2.2 g/l, P less than 0.05) increase in bone mineral was measured in the group of patients treated with danazol for 6 months. The dual-energy QCT gave similar results, indicating little change in trabecular fat content. A significant correlation was demonstrated between mean serum oestradiol levels during treatment with nafarelin and the change in bone mineral (r = 0.655, P less than 0.005).
Adult↗
Glucagon in women with polycystic ovary syndrome (PCO): relationship to abnormalities of insulin and androgens.
To investigate the glucagon status of women with polycystic ovary syndrome (PCO) and to relate this to serum concentrations of insulin, androgens and SHBG, 44 women with PCO and 23 control subjects underwent a 75-g oral glucose tolerance test. Although obese (body mass index greater than 30 kg/m2) women with PCO had higher concentrations of glucose and insulin than overweight (BMI 25-30 kg/m2) and non-obese (BMI less than 25 kg/m2) women with PCO and control subjects, fasting and summed values of glucagon in response to oral glucose were similar in all groups. The fasting and summed concentrations of glucagon were inversely related to those of testosterone and androstenedione in obese women with PCO, but no other relationships were demonstrated between hormone values and those of glucagon in the other groups. We conclude that glucagon is not implicated in peripheral insulin resistance in women with PCO.
Adult↗
Teaching of medical ethics.
Teaching medical ethics in Manchester within the introductory course of obstetrics and gynaecology is a joint activity with the Centre for Social Ethics and Policy. This interdisciplinary teaching has evolved through lecture sessions with small-group discussions dealing with topics of interest in human reproduction. The small-group discussion have been replaced by an open debate conducted by the students. Their own involvement and participation and an exposure to the disciplines of the humanities has broadened their approach to different ways of problem-solving of these real issues.
Bioethical Issues↗
The effect of prostaglandin synthetase inhibitors on human preovulatory follicular fluid prostaglandin, thromboxane, and leukotriene concentrations.
This study evaluates the eicosanoid concentration in luteinized unruptured follicles (LUFs) on the ovaries of patients who had been treated with inhibitors of prostaglandin synthetase. Indomethacin, bromfenac, or azapropazone (or a placebo) was administered orally to 41 women during the periovulatory period. Follicular development was monitored by serial ultrasound examinations, and the onset of ovulation was regulated by an injection of hCG. Follicular fluid was aspirated during sterilization by minilaparotomy, which was performed just before the expected time of ovulation. Prostaglandin E2 and PGF2 alpha levels in the fluid were significantly reduced by indomethacin and bromfenac compared to those after placebo treatment. Bromfenac also reduced the follicular fluid leukotriene B4 level. Therefore, the development of luteinized unruptured follicles after treatment with nonsteroidal antiinflammatory drugs appears to be associated with a significant decrease in the synthesis of ovarian eicosanoids.
Adult↗
Influence of danazol and goserelin on insulin and glucagon in non-obese women with endometriosis.
To investigate the effects of medical treatment of endometriosis on concentrations of insulin and glucagon in comparison with those of androgens, 12 non-obese women with minimal endometriosis were randomly allocated to receive treatment with either danazol or the gonadotropin-releasing hormone analogue, goserelin. In subjects treated with danazol, mean (SD) summed serum insulin (1.08 (0.22) nmol/l pretreatment; 3.00 (1.50) nmol/l after treatment, p less than 0.05) and summed plasma glucagon (94 (21) pmol/l pretreatment; 238 (113) pmol/l after treatment, p less than 0.05) responses to oral glucose administration increased significantly, but remained unchanged in subjects treated with goserelin. In the danazol-treated group, the mean free testosterone index increased from 3.3 (1.6) to 13.3 (4.2) (p less than 0.01), but there was no correlation between either glucagon or insulin and free testosterone index. In the goserelin-treated subjects, however, there was no change in mean free testosterone indices (pretreatment 3.6 (1.0), post-treatment 3.9 (1.8). Thus, the increase in free testosterone index induced by danazol treatment is not responsible for the concomitant development of hyperinsulinaemia and hyperglucagonaemia.
Adult↗
The new progestogens.
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Contraceptives, Oral, Synthetic↗
Pituitary-ovarian activity when switching from various monophasic pills to a triphasic pill.
This study was prompted by the various recommendations given by different oral contraceptive manufacturers to women who wish to switch from a monophasic to a triphasic formulation. Ten women who switched from a variety of monophasic pills to a levonorgestrel triphasic pill formulation after a 7-day pill-free interval were studied. Follicular maturation was monitored by ultrasound scan, and the levels of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P) and estradiol (E2) measured. Pituitary-ovarian activity was suppressed in six of the ten women studied, while in the remaining four women there was some pituitary-ovarian activity during the first 10 days on the triphasic pill. These findings suggest a shorter pill-free interval, as advised in USA data sheets, may be less likely to result in pill failures when women switch from a monophasic to a triphasic preparation.
Adolescent↗
Ovarian follicular fluid eicosanoid concentrations during the pre-ovulatory period in humans.
Prostaglandins are involved in ovulation and in every mammal studied so far, ovulation has been inhibited by prostaglandin inhibition. Information regarding the role of leukotrienes and thromboxanes in ovulation is more limited. In order to study the production of eicosanoids in human pre-ovulatory follicular fluid, follicular aspiration was timed by means of serial ultrasound scans and human chorionic gonadotrophin (hCG) to be immediately pre-ovulatory. 11 women were studied and the eicosanoids measured by radioimmunoassay (RIA). The follicular fluid was found to contain leukotrienes (LT) B4, LTC4 (D4, E4), prostaglandin (PG) E2, PGF2 alpha 6 keto PGF1 alpha k and thromboxane (TX) B2. This is the first published report of leukotrienes in human follicular fluid in spontaneous cycles, and is one of the few reports showing prostaglandins and thromboxanes. The significance of demonstrating leukotrienes in human follicular fluid is discussed as is the correlation between individual eicosanoids in the human ovary.
Dinoprostone↗
Minimal/mild endometriosis and infertility. A review.
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Ascitic Fluid↗