Björn Andersch

An epidemiologic study of young women with dysmenorrhea

The prevalence of dysmenorrhea was studied in a random sample of 19-year-old women from an urban Swedish population. Dysmenorrhea was reported by 72% of the women. Fifteen percent suffered from dysmenorrhea which limited daily activity and was unimproved by analgesics. Dysmenorrhea occurred significantly (p less than 0.01) more often in women not using oral contraceptives. A significant correlation (p less than 0.01) was found between early menarche and an increased severity of dysmenorrhea. There was a significant correlation (p less than 0.01) between the severity of dysmenorrhea and the amount of menstrual flow. Parous women had significantly (p less than 0.01) less dysmenorrhea than women who had never been pregnant or women who had experienced a legal or spontaneous abortion. Smokers as compared to nonsmokers had significantly (p less than 0.01) less dysmenorrhea. The severity of dysmenorrhea was not affected by height, weight, or regularity of the menstrual cycle. Absenteeism as a result of dysmenorrhea was evaluated.

Factors influencing the prevalence and severity of dysmenorrhoea in young women

Summary. Factors influencing the prevalence and severity of dysmenorrhoea were assessed longitudinally in a representative sample of young women born in 1962. The prevalence of dysmenorrhoea was lower (P<0.01) at 24 years of age than at 19 years of age. At 24 years of age, 67% of the women still experienced dysmenorrhoea; 10% reported dysmenorrhoea which limited daily activity. The severity of dysmenorrhoea (linear analogue scale) was lower (P<0·001) at 24 years of age (3·4, SD 2.8) than at 19 years (4.1, SD 3.2). The prevalence and severity of dysmenorrhoea were reduced (P<0.05) in women who were parous in 1986 and nulliparous in 1981; but was unchanged in women who were still nulliparous or women who had had a miscarriage or abortion. Dysmenorrhoea was reduced (P<0.001) in oral contraceptive users. The severity of dysmenorrhoea was significantly associated with the duration of menstrual flow, menarcheal age and cigarette smoking. The severity of dysmenorrhoea was not associated with age as an isolated factor, nor with height, weight, length of menstrual cycle or frequency of physical exercise.

Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes

Background.  Previous studies have shown an association between intra‐amniotic microbial invasion and/or inflammation and spontaneous preterm birth. The aim of this study was to investigate the occurrence of intra‐amniotic microorganisms and cytokines [interleukin (IL)‐6 and IL‐8] in a Swedish population, with low incidence of preterm birth, of women with preterm prelabor rupture of membranes and their correlation to preterm birth.

Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women in preterm labor

Background. Previous studies indicate an association between intra‐amniotic microbial invasion and/or inflammation and spontaneous preterm birth, but there is a limited amount of data available from Europe. The aim of this study was to investigate the occurrence of intra‐amniotic microorganisms and cytokines (interleukin‐6 and interleukin‐8) in a Swedish population of women in preterm labor and their correlation with preterm birth.

A longitudinal study of birth control and pregnancy outcome among women in a Swedish population

The prevalence of contraception and pregnancy outcome in the same women, at 19, 24, and 29 years of age, was assessed in a longitudinal cohort study using a postal questionnaire technique. A one-in-four random sample of all women born in 1962 and resident in the city of Göteborg in 1981, was obtained from the population register (n = 656). Respondents from 1981 were re-assessed in 1986 and 1991. Four hundred thirty women (66%) answered the questionnaire on all three occasions and are included in the analysis. Contraceptive usage was as follows (at 19, 24, and 29 years of age, respectively): oral contraception (OC) 47%/51%/22%; intrauterine device 3%/11%/19%; barrier methods 12%/12%/20%; depot gestagen 0/0.2%/0.4%; no contraception 39%/26%/25%. OCs had been taken at some time by 93%. Reasons give for cessation of OC were: contraception not required 10%/21%/20%; fear of OC 28%/32%/35%; menstrual disorder 17%/13%/14%; weight increase 20%/16%/15%; mental side effects 14%/ 21%/20%; desire to become pregnant 7%/33%/52%. Pregnancy outcome was as follows: Ever pregnant 17%/42%/ 71%; children 5% had 1-2 children/27% had 1-3 children/ 59% had 1-5 children; 12%/25%/30% > or = 1 legal abortion; 3%/8%/15% > or = 1 miscarriage; and > or = 1 ectopic pregnancy 0.2%/1.2%/2.1%. On all three survey occasions, more than 97% of the legal abortions were performed < or = 12 weeks gestation. The complication rate following legal abortion was 7%. The proportion of live births to the total number of pregnancies was 25%, 45%, and 61%. The relationship between method of contraception, history of pregnancy, legal abortion, and smoking habits was analyzed in detail. Despite the availability of effective contraception, the ratio of legal abortions to live births was high. Fear of side effects was the commonest reason for discontinuing OC.

The lower genital tract microbiota in relation to cytokine-, SLPI- and endotoxin levels: application of checkerboard DNA-DNA hybridization (CDH).

In the present study the lower genital tract microbiota in asymptomatic fertile women (n=34) was identified and quantified by culturing vaginal secretions. Also, vaginal and cervical samples were analyzed by a semiquantitative checkerboard DNA‐DNA hybridization technique (CDH) based on genomic probes prepared from 13 bacterial species (Bacteroides ureolyticus, Escherichia coli, Fusobacterium nucleatum, Gardnerella vaginalis, Mobiluncus curtisii ss curtisii, Prevotella bivia, Prevotella disiens, Prevotella melaninogenica, Atopobium vaginae, Lactobacillus iners, Staphylococcus aureus ss aureus, Streptococcus anginosus, and Streptococcus agalactiae). The bacterial species found by either culture or CDH were correlated with proinflammatory cytokines (IL‐1α, IL‐1β, IL‐6, IL‐8), secretory leukocyte protease inhibitor (SLPI), and endotoxin in the cervicovaginal samples. Grading the women into healthy, intermediate, or bacterial vaginosis (BV) as based on Gram staining of vaginal smears, the viable counts of lactobacilli (L. gasseri) and of streptococci‐staphylococci combined were highest in the intermediate group. In BV, particularly the high concentrations of Actinomyces urogenitalis, Atopobium vaginae, and Peptoniphilus harei were noted (≥1011 per ml). The total viable counts correlated with both cervical IL‐1α and IL‐1β. A strong negative correlation was observed between L. iners and total viable counts, G. vaginalis, or cervical IL‐1α, while it correlated positively with SLPI. Analysis of vaginal and cervical samples from 26 out of the 34 women by CDH showed that anaerobic bacteria were more frequently detected by CDH compared to culture. By this method, A. vaginae correlated with G. vaginalis, and L. iners with S. aureus. With regard to cytokines, B. ureolyticus correlated with both cervical and vaginal IL‐1α as well as with cervical IL‐8, while F. nucleatum, S. agalactiae, S. anginosus, or S. aureus correlated with vaginal IL‐1α. Furthermore, all Gram‐negative bacteria taken together, as measured by CDH, correlated with vaginal endotoxin and inversely with vaginal SLPI. The significance of the results is discussed. In summary, mapping of the identity and quantity of vaginal bacterial species and their association with locally produced host innate immune factors will help in defining various types of abnormal vaginal microbiota, developing new ways of assessing the risk of ascending subclinical infections, and in treating them. CDH appears to be a suitable tool for future analyses of large numbers of clinical samples with an extended number of bacterial probes.

An Objective Evaluation of Flurbiprofen and Tranexamic Acid in the Treatment of Idiopathic Menorrhagia

The effect of flurbiprofen (100 mg × 2 for 5 days) was compared with tranexamic acid (1.5 g × 3 for 3 days, 1 g × 2 days 4 and 5) in the treatment of 15 women with idiopathic menorrhagia. The mean blood loss during two medication‐free periods was 295 ± 52 ml. A significant (p < 0.01) reduction in menstrual blood loss was recorded during treatment with both flurbiprofen and tranexamic acid. The menstrual blood loss was significantly (p < 0.01) lower during treatment with tranexamic acid (155 ± 33 ml) than with flurbiprofen (223 ± 44 ml). Various side effects were recorded by 7 of 15 women during treatment with tranexamic acid and by 4 women of 15 during treatment with flurbiprofen. Many women with menorrhagia suffer simultaneously from dysmenorrhea. Thus although tranexamic acid was generally more effective in reducing menstrual blood loss, flurbiprofen provides an important therapeutic alternative to antifibrinolytic agents, especially in patients with concomitant dysmenorrhea.

Effect of Various Oral Contraceptive Combinations on Dysmenorrhea

The influence of different oral contraceptives on the prevalence and severity of dysmenorrhea was investigated in a representative sample of 19-year-old women from an urban Swedish population. The prevalence and severity of dysmenorrhea were significantly (p less than 0.01) reduced amongst users of progestogen-dominated oral contraceptives compared to a control group of women who used neither oral contraceptives nor an intrauterine device. However, there was no significant difference in the prevalence and severity of dysmenorrhea between users of oral contraceptives with low progestogen activity and the same control group. Thus, the relative progestogen activity of the oral contraceptive used appears to be of importance for the effective treatment of dysmenorrhea. Possible reasons for the superior therapeutic efficacy of progestogen-dominated oral contraceptives are discussed. Further studies are, however, necessary to evaluate the importance of the progestogen activity of oral contraceptives in the treatment of dysmenorrhea.

Treatment of Bacterial Vaginosis with an Acid Cream: A Comparison between the Effect of Lactate-Gel and Metronidazole

Bacteriological isolation of anaerobes, Gardnerella and lactobacilli was carried out in a group of 62 women with the diagnosis bacterial vaginosis and 42 control women. Lactobacilli were the predominant organisms in the control group whereas anaerobes dominated the flora in bacterial vaginosis patients. Lactate-gel (pH 3.5, 5 ml) inserted into the vagina daily for 7 days is as effective as oral metronidazole, 500 mg twice daily for 7 days. The women in both groups became symptom-free and objectively improved. Anaerobes were significantly reduced (p less than 0.0001) in both groups after 1-week treatment but Gardnerella was not significantly reduced. As bacterial vaginosis is generally looked upon as a mild noninflammatory condition lactate-gel seems to be an ideal treatment for this disease.

Effect of ibuprofen, naproxen sodium and paracetamol on intrauterine pressure and menstrual pain in dysmenorrhoea

Summary. The effects of ibuprofen (400 mg), naproxen sodium (250 mg) and paracetamol (500 mg) on intrauterine pressure and menstrual pain was assessed in 12 women with dysmenorrhoea in a double–blind parallel study. Intrauterine pressure was recorded with a microtransducer catheter for 4 h and resting pressure, active pressure, frequency of pressure cycles and the area under the curve were analysed in 30–min periods. Ibuprofen, in a single oral dose of 400 mg, significantly reduced resting pressure, active pressure, the frequency of pressure cycles and the area under the curve and this was associated with a significant reduction in pain intensity. Neither paracetamol nor naproxen sodium effected significant changes in intrauterine pressure or pain score.