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Biomedical subjects

R W Stones

Publications and source records attributed to R W Stones.

At least 19 recordsLinked to original sources
PubMed2006

Sources of AIDS awareness among women in India.

Sources of AIDS awareness among rural and urban Indian women were analysed using data from the National Family and Health Survey (1998-2000). Two measures were developed to study the impact each source had on knowledge. 'Effectiveness' was defined as the proportion of women who had heard of AIDS from only one source, from among women who had heard of AIDS from that particular source and other sources. 'Independent effect' was the proportion who had heard of AIDS from only one source in relation to all women who had heard of AIDS. Television was the most effective medium, and also had the highest independent effect. Radio and print had very low effectiveness and independent effect. Although television and print audiences are growing in India, it is likely a sub-group of women will continue to lack media access. There is an urgent need to disseminate AIDS awareness to this 'media underclass'. Since the media will not reach this group, other sources including health workers, community level activities such as adult education programmes, and networks of friends and relatives need to be explored.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Dyspareunia and urinary sensory symptoms in India: population-based study.

INTRODUCTION: Population level estimates of sexual dysfunction in less developed settings where sexuality is not openly discussed or is culturally constrained are lacking. AIM: To determine the prevalence of dyspareunia and identify associated symptoms and sociocultural factors. METHODS: Data from a population-based national level family health sample survey conducted in Indian states from 1998 to 1999 which collected sexual and reproductive health information from 84,644 currently married women. The main outcome measure was dyspareunia. RESULTS: The overall prevalence of dyspareunia was 12.6%, with a higher prevalence in the central region, among newly married and younger women, among Muslims, rural residents, and among nonusers or traditional contraceptive method users. Dyspareunia was significantly more common among respondents who had urinary sensory symptoms when compared with their counterparts (adjusted odds ratio: 6.57, 95% confidence interval: 6.28, 6.87). CONCLUSION: Dyspareunia prevalence and the associated symptoms reported in this analysis could be underestimates because of possible underreporting. There is a substantial hidden burden of sexual health problems especially affecting younger women.

Adolescent↗
PubMed2002

Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea.

BACKGROUND: Dysmenorrhoea is the occurrence of painful menstrual cramps of the uterus. Medical therapy for dysmenorrhoea commonly consists of nonsteroidal anti-inflammatory drugs or the oral contraceptive pill both of which work by reducing myometrial (uterine muscle) activity. However, these treatments are accompanied by a number of side effects, making an effective non-pharmacological method of treating dysmenorrhoea of potential value. Transcutaneous electrical nerve stimulation (TENS) is a treatment that has been shown to be effective for pain relief in a variety of conditions. Electrodes are placed on the skin and electric current applied at different pulse rates (frequencies) and intensities is used to stimulate these areas so as to provide pain relief. In dysmenorrhoea. TENS is thought to work by alteration of the body's ability to receive or perceive pain signals rather than by having a direct effect on the uterine contractions. Acupuncture may also be indicated as a useful, non-pharmacological method for treating dysmenorrhoea. Acupuncture is thought to excite receptors or nerve fibres which, through a complicated interaction with mediators such as serotonin and endorphins, blocks pain impulses. Acupuncture typically involves penetration of the skin by fine, solid metallic needles, which are manipulated manually or by electrical stimulation. OBJECTIVES: To determine the effectiveness of high and low frequency transcutaneous electrical nerve stimulation and acupuncture when compared to each other, placebo, no treatment, or medical treatment for primary dysmenorrhoea. SEARCH STRATEGY: Electronic searches of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials, CCTR (Cochrane Library Issue 3, 2001), MEDLINE, EMBASE, CINAHL, Bio extracts, PsycLIT and SPORTDiscus were performed in August 2001 to identify relevant randomised controlled trials (RCTs). The Cochrane Complementary Medicine Field's Register of controlled trials (CISCOM) was also searched. Attempts were also made to identify trials from the UK National Research Register, the Clinical Trial Register and the citation lists of review articles and included trials. In most cases, the first or corresponding author of each included trial was contacted for additional information. SELECTION CRITERIA: The inclusion criteria were randomised controlled trials of transcutaneous electrical nerve stimulation and acupuncture that compared these treatments to each other, placebo, no treatment, or medical treatment for primary dysmenorrhoea. Exclusion criteria were: mild, infrequent or secondary dysmenorrhoea and dysmenorrhoea associated with an IUD. DATA COLLECTION AND ANALYSIS: Nine RCTs were identified that fulfilled the inclusion criteria for this review, seven involving TENS, one acupuncture, and one both treatments. Quality assessment and data extraction were performed independently by two reviewers. Meta analysis was performed using odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes. Data unsuitable for meta-analysis was reported as descriptive data and was also included for discussion. The outcome measures were pain relief (dichotomous, visual analogue scales, descriptive), adverse effects, use of analgesics additional to treatment and absence from work or school. MAIN RESULTS: Overall high frequency TENS was shown to be more effective for pain relief than placebo TENS. Low frequency TENS was found to be no more effective in reducing pain than placebo TENS. There were conflicting results regarding whether high frequency TENS is more effective than low frequency TENS. One small trial showed acupuncture to be significantly more effective for pain relief than both placebo acupuncture and two no treatment control groups. REVIEWER'S CONCLUSIONS: High frequency TENS was found to be effective for the treatment of dysmenorrhoea by a number of small trials. The minor adverse effects reported in one trial requires further investigation. There is insufficient evidence to determine the effectiveness of low frequency TENS in reducing dysmenorrhoea. There is also insufficient evidence to determine the effectiveness of acupuncture in reducing dysmenorrhoea, however a single small but methodologically sound trial of acupuncture suggests benefit for this modality.

Acupuncture Therapy↗
PubMed2002

GyneFix: a UK experience.

OBJECTIVES: To present the experience of family planning providers and clients in the UK with the GyneFix intrauterine implant device. METHOD: Audit of 138 GyneFix insertions at the Ella Gordon Family Planning Unit in Portsmouth, from 1997 to 1999. RESULTS: Of 138 attempts at GyneFix insertion, 134 were successful. Forty per cent were inserted in nulliparous women. The removal rate was 15%, half of which were due to unacceptable side-effects. The expulsion rate was 8% ranging over a period of a few days to 12 months after insertion. There were no reported perforations or accidental pregnancies with GyneFix in situ in this series. There were no reported pregnancies as a result of unnoticed expulsion. CONCLUSIONS: The results obtained in this study are minimal estimates obtained from a retrospective analysis. The numbers are small but they are comparable to results reported from other family planning centers in the UK. Although GyneFix clearly has a useful role, there is a need for a large-scale prospective randomized study to establish the benefits and potential disadvantages of the GyneFix device.

Adolescent↗
PubMed2001

Randomized placebo controlled trial of lofexidine hydrochloride for chronic pelvic pain in women.

BACKGROUND: We hypothesised that the orally-active alpha(2)-adrenoceptor agonist lofexidine hydrochloride would ameliorate chronic pelvic pain in women. METHODS: A randomized placebo-controlled parallel group trial was undertaken in the University Hospital Gynaecology Clinic. Women with pelvic pain of at least 6 months duration were eligible, and were randomized using a sealed envelope system to receive up to 600 mg lofexidine hydrochloride twice daily over 8 weeks or placebo. Outcome measures were summary and daily diary visual analog scales for pain (VAS) and a 5 point self rating scale. RESULTS: 9/19 women randomized to lofexidine completed the study compared to 14/20 of those randomized to placebo. Intention-to-treat analysis showed that 4/19 in the lofexidine group achieved 50% or greater reduction in VAS compared with 8/20 in the placebo group (OR 2.5, 95% CI 0.6--10.3). Summary and diary VAS were closely correlated. CONCLUSIONS: Within the limits of a small study with power to detect only a substantial effect, we conclude that lofexidine hydrochloride is not effective for the treatment of chronic pelvic pain.

Acetaminophen↗
PubMed2000

Interventions for treating chronic pelvic pain in women.

BACKGROUND: Chronic pelvic pain is common in women in the reproductive age group and it causes disability and distress and results in significant costs to health services. The pathogenesis of chronic pelvic pain is poorly understood. Often, investigation by laparoscopy reveals no obvious cause for pain. There are several possible explanations for chronic pelvic pain including undetected irritable bowel syndrome, the vascular hypothesis where pain is thought to arise from dilated pelvic veins in which blood flow is markedly reduced and altered spinal cord and brain processing of stimuli in women with chronic pelvic pain. As the pathophysiology of chronic pelvic pain is not well understood, its treatment is often unsatisfactory and limited to symptom relief. Currently, the main approaches to treatment include counselling or psychotherapy, attempting to provide reassurance using laparoscopy to exclude serious pathology, progestogen therapy such as medroxyprogesterone acetate, and surgery to interrupt nerve pathways. OBJECTIVES: We aimed to identify and review treatments for chronic pelvic pain in women in the reproductive years. The review included studies of patients with a diagnosis of pelvic congestion syndrome but excluded those with pain known to be caused by i) endometriosis, ii) primary dysmenorrhoea (period pain), iii) pain due to chronic pelvic inflammatory disease, or iv) irritable bowel syndrome. SEARCH STRATEGY: The search strategy adopted by the Cochrane Menstrual Disorders and Subfertility Group was used. SELECTION CRITERIA: Randomised controlled trials (RCTs) with women who had chronic pelvic pain, excluding endometriosis, primary dysmenorrhoea, pain due to chronic pelvic inflammatory disease, or irritable bowel syndrome. The reviewers were prepared to consider studies of any intervention including lifestyle, physical, medical, surgical and psychological treatments. Outcome measures were pain rating scales, quality of life measures, economic analyses and adverse events. DATA COLLECTION AND ANALYSIS: For each included trial, information was collected regarding the method of randomisation, allocation concealment, blinding, whether an intention to treat analysis could possibly be performed and relevant interventions and outcomes (see previous sections). Data were extracted independently by the two reviewers, using forms designed according to the Cochrane guidelines. MAIN RESULTS: Seven studies were identified of which four were of good methodological quality. One study was reported in a brief abstract only and was excluded. Progestagen (Medroxyprogesterone acetate) was associated with a reduction of pain during treatment. Counselling supported by ultrasound scanning was associated with reduced pain and improvement in mood. A multidisciplinary approach was beneficial for some outcome measures. Adhesiolysis was not associated with an improved outcome apart from where adhesions were severe. REVIEWER'S CONCLUSIONS: Further studies to confirm these observations are needed, together with full reporting of those studies which have been undertaken. Given the prevalence and health care costs associated with chronic pelvic pain in women, randomised controlled trials of other medical, surgical and psychological interventions are urgently required.

Chronic Disease↗
PubMed2000

Psychosocial and economic impact of chronic pelvic pain.

According to a population-based estimate, chronic pelvic pain (CPP) affects approximately 15% of women aged 18-50. The psychosocial impact of CPP is reflected in mood disturbance, disruption of normal activity and relationships as well as pain. Identification of psychosocial factors as cause or effect remains problematic. Results of a study of 105 women with CPP using the British version of the SF-36 Health Survey Questionnaire are presented, together with analyses of face validity and reliability. While generally reflecting health status, specific problems with the questionnaire are identified related to the episodic nature of pelvic pain, and avoidance as a means of preventing pain exacerbations. Health economic analyses relating to CPP are reviewed and the implications for future directions in treatment strategy are discussed in the context of limited options of proven efficacy.

Adolescent↗
PubMed1999

Morphology and functional characteristics of human ovarian microvascular endothelium.

Corpus luteum formation is characterized by a period of extensive vascularization, as capillaries in the thecal layer of the collapsed follicle following ovulation invade the previously avascular granulosa layer. In order to study these processes in vitro we have developed an endothelial cell preparation from the specific microvasculature of the ovarian follicle. Follicular aspirates, obtained at oocyte collection for in-vitro fertilization (IVF), were filtered to obtain fragments of follicle wall. These were set in Matrigel and then cultured allowing the growth of capillary-like structures through the matrix. Upon emergence from the Matrigel the growing cells formed monolayers with the characteristic cobble-stone morphology of endothelial cells. Immunocytochemistry demonstrated the presence of a range of endothelial-specific markers including von Willebrand factor (vWF), Ulex europeus agglutinin (UEA)-1, CD31 and E-selectin, as well as VCAM-1, which is normally associated with stimulated endothelial cells. RT-PCR analysis showed the expression of two receptors for vascular endothelial growth factor (flt-1 and KDR), and the endothelial nitric oxide synthase, adding further evidence of their identity as human ovarian microvascular endothelial cells (HOMEC). Thus, the novel preparative procedure described now allows the generation of HOMEC cultures from readily available material resulting from IVF procedures.

Cells, Cultured↗
PubMed1998

Factors influencing outcome in consultations for chronic pelvic pain.

We aimed to document the demographic and clinical characteristics of women referred by primary care physicians for investigation of chronic pelvic pain to a university hospital gynecology outpatient clinic and to test the hypothesis that specific patient features and the quality of doctor/patient communication at the initial consultation would influence pain outcomes. A clinical questionnaire, visual analog scales for pain, and instruments for hostility and the experience of the consultation were administered at the initial clinic attendance to 105 consecutive women. Follow-up pain scores were obtained 6 months later from 98 women. The mean hostility score was highly significantly elevated compared with normative data (p < 0.001). In a logistic regression model, a favorable patient rating of the initial consultation was associated with complete recovery at follow-up and interacted significantly with whether or not exercise was impaired (p < 0.005). For those in whom symptoms persisted, significant factors found by multiple regression models to predict continuing pain levels were the initial level of pain, the number of functions of daily life impaired, endometriosis, and the doctor who carried out the initial consultation. Patient hostility scores and the doctor's level of experience or gender were not significantly associated with continuing pain. This study highlights the importance of good communication as a basis for successful treatment of a group of hostile patients and indicates the influence in individual doctors of subtle attitudinal and personality factors that modify patients' experience of the medical consultation.

Adolescent↗
PubMed1996

Release of vasoactive agents from the isolated perfused human ovary.

OBJECTIVE: To investigate local vascular control in the isolated perfused premenopausal human ovary by measuring flow-induced release of vasoactive substances. DESIGN: Release of adenosine 5' triphosphate (ATP), substance P (SP), endothelin (ET), and vasopressin (AVP) from the ovarian vascular endothelium was estimated in perfusate under basal conditions and during two periods of increased flow. MAIN OUTCOME MEASURES: Vascular resistance; ATP, SP, ET and AVP release. RESULTS: The mean ratio (pressure/flow during increased flow):(pressure/flow at basal flow) was 1.27 +/- 0.04 for the first, and 1.15 +/- 0.05 for the second period of increased flow (n = 10), indicating significant vasoconstriction (P < 0.01 and 0.05, respectively), present to a greater extent during the first period of increased flow compared to the second (P < 0.05). ATP release was seen in response to increased flow (n = 8, P < 0.05). From 12 ovarian bed preparations, five released ET and SP and three of these released AVP. Four of the five perfused ovaries that released peptides contained either a developing follicle or a corpus luteum while all those that showed no peptide release were inactive. CONCLUSIONS: ATP release may play a role in the local control of the human premenopausal ovarian vasculature independent of ovulatory status. Peptides may also contribute to local vascular control in the ovary and their release from predominantly active ovaries suggests a relationship between ovulation and vascular endothelial function.

Adenosine Triphosphate↗
PubMed1996

Hostility and doctor-patient interaction in chronic pelvic pain.

BACKGROUND: Interaction in medical consultations is of interest for many reasons and has long been thought an important variable in determining outcomes. Relatively few methods or instruments exist that attempt to access this phenomenon. The design, validation and possible application of a simple instrument to assess doctor-patient interaction are reported. Rapport and hostility may be related and we hypothesised that interaction between doctor and patient would be related in part to hostility. METHODS: A simple instrument to assess doctor-patient interaction was designed based on 4 areas related to interaction and perception of 'the other'. These were the areas of communication, rapport, trust and sense of ease. The instrument was compared with an external previously validated measure of hostility. Data were obtained from 74 women attending initial and follow-up consultations for chronic pelvic pain during the course of a larger study. RESULTS: The instrument had acceptable reliability and a single-factor structure. Patients' assessment of the initial consultation as unsatisfactory correlated with inwardly directed hostility (Spearman correlation coefficient, r = 0.30, p = 0.011). Patients' tendency to rate the consultation worse than the doctor was correlated with inwardly directed hostility (r = 0.42, p < 0.001). Pain outcomes were not directly related to the variables studied. CONCLUSIONS: This instrument offers a simple method of assessing some interactional aspects of a medical consultation.

Chronic Disease↗
PubMed1996

Innervation of vasculature and microvasculature of the human vagina by NOS and neuropeptide-containing nerves.

The aims of the present study were to determine whether nerves that contain nitric oxide synthase (NOS), calcitonin gene-related peptide (CGRP) or substance P (SP) are present in the human vagina and, if so, to determine the pattern of innervation relative to that of other neurotransmitters, particularly vasoactive intestinal polypeptide (VIP) and neuropeptide Y (NPY). Surgical specimens of vaginal tissue (n = 10) from pre- and postmenopausal women were fixed and processed for immunohistochemistry of peptides and NOS and for histochemistry of NADPH-diaphorase. SP-immunoreactive nerves were very sparse, being absent from 9 of the 10 tissue samples. For other peptides and NOS, the innervation of the deep arteries and veins was greater than that of blood vessels in the propria. Capillaries in the epithelial papillae also appeared to be innervated by nerves containing NOS, CGRP, NPY and VIP. Beneath the epithelium nerve fibres formed a subepithelial plexus; no nerve cell bodies were seen. The relative density of innervation by immunoreactive fibres was PGP-9.5 > NPY > VIP >> NOS > CGRP > SP. These results imply that nerves that utilise nitric oxide or NPY, VIP or CGRP as a neurotransmitter may play a role in controlling blood flow and capillary permeability in the human vagina. The origin and function of all these nerves is discussed.

Adult↗
PubMed1995

Substance P: endothelial localization and pharmacology in the human ovarian vein.

OBJECTIVE: To investigate the possible role of substance P as an endothelial factor in the local regulation of vascular tone in the human ovarian vein. METHODS: We performed immunolocalization of substance P in human ovarian venous endothelium in situ and in culture, and observed responses to substance P in preconstricted ring preparations of human ovarian vein in the presence of either the prostaglandin synthesis inhibitor indomethacin or the inhibitor of nitric oxide synthesis L-nitro arginine methyl ester (L-NAME), with and without luminal rubbing. RESULTS: Substance P was localized in a subpopulation of ovarian vein endothelial cells. Maximal relaxation induced by substance P was not significantly affected by indomethacin (10 mumol/L), but was reduced from 58.7% (95% confidence interval [CI] 41.3-76.1) in control experiments to 24.7% (95% CI 18.3-31.1) after luminal rubbing and to 32.3% (95% CI 19.8-44.8) after exposure to L-NAME (0.1 mmol/L) (P = .001). CONCLUSION: The localization of substance P in ovarian vein endothelium together with vasodilator effects mediated partially via the endothelium suggests that the peptide has a role in the local control of vascular tone in this vessel.

Adult↗
PubMed1994

Pharmacology of the human ovarian vein: responses to putative neurotransmitters and endothelin-1.

OBJECTIVE: An investigation of excitatory vascular responses in the human ovarian vein, a blood vessel normally exposed to high concentrations of ovarian steroid hormones and capable of adaptation to circulatory changes associated with reproductive life. DESIGN: Pharmacological responses of surgical specimens of human ovarian vein to electrical field stimulation of sympathetic nerves, noradrenaline, alpha,beta-methylene adenosine 5'-triphosphate (alpha,beta-MeATP), endothelin-1 (ET-1), and 5-hydroxytryptamine (5-HT) were studied. Comparisons were made between in vitro pharmacological responses and the diagnostic category, age, smoking status, reproductive history and hormonal status of patients. SETTING: Research laboratory. RESULTS: Maximal contractile responses in longitudinal preparations, expressed as a percentage of the response to potassium chloride 125 mmol l-1, were 28% (SE 7.2) to electrical field stimulation and 107% (SE 15.1) to noradrenaline. In ring preparations, maximal responses to various agents were: noradrenaline 93% (SE 10.2); 5-HT 79% (SE 8.0); alpha,beta-MeATP 48% (SE 8.4); and ET-1 87% (SE 10.1). pD2(-log EC50) values for noradrenaline were 5.82 (SE 0.21) in longitudinal preparations and 5.65 (SE 0.10) in ring preparations; for ET-1 in ring preparations these values were 7.88 (SE 0.74). Responses to sympathetic nerve stimulation were attenuated by the adrenoceptor antagonist phentolamine; any residual responses were blocked by desensitisation of P2-purinoceptors with alpha,beta-MeATP or the addition of suramin, indicating that noradrenaline and adenosine 5'-triphosphate may be co-transmitters in these nerves. pD2 values for 5-HT were 5.97 (SE 0.12) in specimens from unsterilised patients (n = 19) compared with 5.20 (SE 0.24) in specimens from those who had previously undergone sterilisation (n = 6) (P < 0.05). No other relation between clinical characteristics and pharmacological responses were detected and, in particular, there were no apparent changes associated with ageing or hormonal status. CONCLUSIONS: Three main conclusions may be drawn from this study: (1) adenosine 5'-triphosphate is a co-transmitter in sympathetic nerves in the human ovarian vein; (2) tubal sterilisation affects vascular responsiveness to 5-HT; and (3) ovarian steroid hormones are likely to influence sympathetic vascular control via effects on catecholamine and adenosine 5'-triphosphate synthesis, storage, release, degradation or re-uptake, rather than via effects on vascular smooth muscle receptors.

Endothelins↗
PubMed1994

The fine structure of the human ovarian vein.

The human ovarian vein is of particular interest as an adult vessel which changes with the different phases of reproductive life. At the ultrastructural level we have characterised the endothelium, vascular smooth muscle and autonomic innervation of the human ovarian vein. Transmission electron micrographs were prepared from surgical specimens of the human ovarian vein (n = 11) to demonstrate the features of the vessel wall. The pattern of innervation was investigated using an image analysis system which was also used with high-magnification micrographs to count and measure axonal vesicle types. Possible relationships between ultrastructural features and age and reproductive history were investigated. Endothelial cells contained Weibel-Palade bodies and numerous microfilaments. There were 3 muscle coats: no elastic lamina separated the endothelium from an inner layer of smooth muscle; a middle smooth muscle layer consisted of cells orientated in a circular fashion; an outer smooth muscle layer was made up of longitudinally arranged smooth muscle bundles with collagen and nerves penetrating throughout. The percentage of the vessel thickness occupied by the middle circular smooth muscle layer ranged from 0 to 33% and fell with increasing age (r = -0.67, P < 0.05). Penetration of nerves into the circular layer was observed only in 2 of 9 specimens. The observed ultrastructural features are consistent with the ability of the ovarian vein to distend substantially in response to changing circulatory demands. The vascular endothelium may have a role in the local control of haemostasis via the synthesis and storage of von Willebrand factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Risk factors for major obstetric haemorrhage.

The factors associated with major obstetric haemorrhage were analyzed using data relating to 37,497 women delivered in 1988 in National Health Service maternity units in the North West Thames Region, UK. Four hundred ninety-eight cases (1.33%) were complicated by haemorrhage of 1000 ml or more. Intrinsic factors associated with significant risk ratios (99% confidence intervals) included placental abruption 12.6 (7.61-20.9), placenta praevia 13.1 (7.47-23.0), multiple pregnancy 4.46 (3.01-6.61) and obesity 1.64 (1.24-2.17), but not high parity. Significant risk factors related to obstetric management and delivery included retained placenta 5.15 (3.36-7.87), induced labour 2.22 (1.67-2.96), episiotomy 2.06 (1.36-3.11) and birthweight 4 kg or more 1.90 (1.38 to 2.60). Among the 59 women who lost 1000 ml or more in association with a spontaneous vaginal delivery with an intact perineum, significant risk ratios (99% confidence intervals) were retained placenta 13.7 (5.92-31.8) and induced labour 2.35 (1.11-4.98). These data provide a more comprehensive assessment of risk factors for potentially life threatening haemorrhage in British obstetric practice than is possible using maternal mortality statistics. The hazards of well known factors such as multiple pregnancy, abruption, placenta praevia and caesarean delivery were confirmed but attention is drawn to the potential risk of haemorrhage associated with obesity or a large baby and to that associated with retained placenta in women classified as 'low risk'.

Adult↗
PubMed1993

An alternative to hysterectomy? GnRH analogue combined with hormone replacement therapy.

OBJECTIVE: To assess whether GnRH analogues are effective in relieving pelvic pain and congestion and whether menopausal symptoms caused by GnRH analogues can be minimised by supplementation with low dose continuous combined hormone replacement therapy (HRT). DESIGN: Open prospective study. SETTING: Tertiary referral clinic at a teaching hospital. PATIENTS: Twenty-one women with chronic pelvic pain. INTERVENTION: Four months' therapy with goserelin 3.6 mg/month combined with continuous oestradiol valerate 1 mg daily and medroxyprogesterone acetate 5 mg daily. MAIN OUTCOME MEASURES: Visual analogue scale for pain, menopausal symptoms, bleeding patterns, uterine area, endometrial status, oestradiol concentrations and venogram scores. RESULTS: Amenorrhoea was maintained in all but two women. Endometrial atrophy was maintained despite HRT supplementation. Two women had moderate menopausal symptoms but none had severe symptoms. Significant reduction of uterine cross sectional area was maintained throughout the study. There was no significant relief of pain. CONCLUSIONS: HRT supplementation of GnRH analogues abolishes menopausal symptoms and thus may improve patient acceptability. Potentially beneficial effects such as endometrial atrophy, reduction of uterine volume and amenorrhoea were not negated by HRT. This combination is not effective in the treatment of chronic pelvic pain and congestion.

Adult↗