2 women's health newsletter January 2009
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January 2009
Mirena IUS - a valuable option in the management of menorrhagia (Heavy periods)
The Mirena IUS has proven
to be a most effective method of contraception. A recognized beneificial
side effect of the Mirena-IUS is that periods are reduced and this has been
incorporated as an option in the management of
heavy periods.
Blood loss diminishes quite markedly with a Mirena and this will be a bonus for you if your periods are heavy and painful. You may, however, experience a tendency for spotting through the first two or three months after introduction. A panty liner will usually suffice. The spotting will almost always settle down. Some women stop seeing their periods altogether although the cycle will return once the device is removed. From a medical point of view there is no anxiety if your periods are absent if you have a Mirena. It is a natural phenomenon before puberty, during pregnancy and breast-feeding and after the menopause. Periods are not required by the body to get rid of waste material.
In a recent publication, it has been confirmed that the application of LNG-IUS in reproductive age women seems to decrease fibroid size and increase hemoglobin levels without any significant dysfunction on ovaries.0801
A survey of UK patients' experience Mirena(R) intrauterine system in the treatment of menstrual disorders, acceptability and satisfaction has been conducted in the UK. A retrospective questionnaire was sent to all 1,100 women treated with a Mirena(R) intrauterine system in the Menstrual Disorders Clinic between 1995-2003 at the Queens' Medical Centre, Nottingham. A total of 1,056 (96%) women responded and were included in the study. The majority (73%) of women continued to use the Mirena(R). The women reported a decrease in the heaviness, frequency and pain associated with their period. The commonest side-effect experienced was spotting (19%). Women ranked their satisfaction on a scale of 1-10, with a mean score of 7.07/10. The majority of women are satisfied with the Mirena(R) as a treatment for menstrual disorders. Less than 5% of the women required subsequent operative treatment for menstrual disorders following treatment with the Mirena(R).08022
Pelvic Pain - Irritable Bowel Syndrome - Treatment with fibre, antispasmodics and peppermint oil
Pelvic pain is one of the most common reasons for women attending gynecology
clinics. About one in three adults have some degree of irritable bowel
syndrome (IBS). Not surprisingly, many women have IBS as well as a
gynaecological condition such as
endometriosis,,
fibroids or
pelvic congestion. It is a matter of clinical judgement whether to treat
possible IBS with medication and assess benefit or proceed to other
investigations such as
laparoscopy.
The effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome has been reviewed in a meta-analysis undertaken in Canada.0801 Randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with irritable bowel syndrome were eligible for inclusion. The minimum duration of therapy considered was one week, and studies had to report either a global assessment of cure or improvement in symptoms, or cure of or improvement in abdominal pain, after treatment. Fibre, antispasmodics, and peppermint oil were all more effective than placebo in the treatment of irritable bowel syndrome.
A study in
South Manchester in 1989 found that 52% of women presenting to a
gynaecological clinic with pelvic pain had symptoms suggestive of irritable
bowel syndrome. Only 8% of those with symptoms suggestive of IBS had a proven
gynaecological disorder. One cause of pain associated with intercourse (dyspareunia)
is IBS.
Female Sterilizationn
Seven hundred seventy women with known parity were recruited to participate in a prospective, multicenter study. Bipolar, low-level radiofrequency energy delivery and porous silicon inserts were used. The inserts were placed bilaterally in the fallopian tube lumen. Subsequent bilateral occlusion was assessed with hysterosalpingography. Overall, bilateral placement success was achieved in 611 of 645 women (95%). Bilateral occlusion was confirmed in 570 of 645 (88.4%). The 1-year pregnancy prevention rate as derived with life-table methods was 98.9%.0802
Urinary Stress Incontinence
The effectiveness of tension-free vaginal tape has been compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency in a randomized controlled trial.(Australia Dec 2008).0805 The risk ratio of repeat surgery was 2.6 (95% CI 0.9-9.3) times higher in the transobturator tape group compared to transvaginal tape. It was concluded that retropubic TVT is a more effective operation than the transobturator tape sling in women with urodynamic stress incontinence and intrinsic sphincter deficiency.
Endometrial Cancer Surgery - Robots
Robotic surgery is being developed. The instruments are moved by a robot with the surgeon sitting away from the patient at a console. The advantages are that there is less pain for the patient, the patient can return to normal activity more quickly and the scar is cosmetically better. This has the benefits of reduced post-operative pain, earlier return to normal activities and an improved scar.
In Sandford, USA (December 2008). one hundred and ten patients underwent hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy for endometrial cancer staging.0801 All cases were performed by a single surgeon, at a single institution (40 robotic, 40 laparotomy, and 30 laparoscopic). The complication rate was lowest in the robotic cohort (7.5%) relative to the laparotomy (27.5%) and laparoscopic cohorts (20%). Average return to normal activity for the robotic patients was significantly shorter than those undergoing laparotomy (24.1 days versus 52 days) and those undergoing laparoscopy (31.6 days). Lymph node retrieval did not differ between the 3 groups (robotic 17 nodes, laparotomy 14 nodes, laparoscopic 17 nodes).
Premature labour
Premature delivery is associated with increased mortality and morbidity for the baby. In developed countries, outcomes have improved with better neonatal care. Administration of steroids
It has proven difficult to confirm that tocolytic agents are effective in suppressing premature labour. There is no real evidence that any of these agents are effective in preventing premature labour or preventing it from recommencing. It has recently been shown that when compared with placebo, maintenance nifedipine tocolysis did not confer a large reduction in preterm birth or improvement in neonatal outcomes.0801
December 2008 Newsletter
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