Damrong Reinprayoon

Effects of clomiphene citrate on the endometrium of regularly cycling women

OBJECTIVE To study the effects of clomiphene citrate (CC) on the endometrium of regularly cycling women. DESIGN Prospective, controlled study. SETTING Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. PATIENT(S) Thirty healthy, regularly cycling, female volunteers. INTERVENTION(S) All volunteers were studied for two consecutive cycles, one control cycle and one CC-treated cycle. Clomiphene citrate (100 mg/d) was given on days 3-7 of the CC-treated cycles. Ultrasonography was performed daily to assess ovulation. Ultrasonography and endometrial biopsy were performed, and blood samples were obtained for determination of E2 and progesterone levels 7 days after ovulation in both the control and CC-treated cycles. MAIN OUTCOME MEASURE(S) Histologic dating, morphometric analysis, and ultrasonographic appearance and thickness of the endometrium. RESULT(S) Histologic dating and ultrasonographic appearance and thickness of the endometrium were similar in the control and CC-treated cycles, but morphometric parameters were different. The number of glands per square millimeter and the mean diameter of the glands were lower in the CC-treated cycles than in the control cycles, but the number of vacuolated cells per 1,000 glandular cells was higher. CONCLUSION(S) Clomiphene citrate has effects on the endometrium of regularly cycling women, as demonstrated by a reduction in glandular density and an increase in the number of vacuolated cells.

Effects of the etonogestrel-releasing contraceptive implant (Implanon on parameters of breastfeeding compared to those of an intrauterine device.

Eighty healthy single births born at a gestational age of 259-294 days were studied in an open, non-randomized, group comparative fashion. The mothers were on average 6 weeks postpartum, healthy, and fully breastfeeding at the start of treatment. Forty-two mothers elected to use the etonogestrel-releasing implant, Implanon, while 38 chose use of a non-hormone medicated intrauterine device (IUD). One month after implant placement, the dose of etonogestrel ingested by the infants via breast milk was 19.86 ng/kg/day, which decreased to 10.45 ng/kg/day at the end of the study period (month 4). The volume of breast milk production was not affected by the use of Implanon. There were no significant differences between groups in milk content of total fat, total protein, and lactose. The timing and quantity of supplementary feedings did not differ between the two groups. Growth of the infants was analyzed by treatment and gender. For the girls, no differences between groups were seen for body weight, body length, and head circumference. The same applied to the boys except for a somewhat larger, although not statistically significant, increase in body weight for boys whose mother used Implanon. There was a low incidence of intercurrent illnesses in the infants of both groups. None of the conditions was of a serious nature. From the present study, we conclude that Implanon did not change the volume and composition of breast milk. The low concentration of etonogestrel ingested by the infant was not associated with adverse effects.

The effect of mefenamic acid on controlling irregular uterine bleeding secondary to Norplant® use

The aim of this double-blind, placebo-controlled study was to evaluate the effect of mefenamic acid and placebo on controlling irregular uterine bleeding secondary to Norplant use. A total of 67 Norplant users attending the Family Planning Clinic of Chulalongkorn Hospital all had irregular bleeding. These women were randomly allocated into two groups. A total 34 users received mefenamic acid, 500 mg twice a day for 5 days, and placebos were given to the other 33 in the same manner. The total days of bleeding and spotting and the percentage of women in whom bleeding was stopped were analyzed in weeks 1 and 4. The percentage of subjects in whom bleeding was stopped during week 1 after initial treatment was significantly higher in the mefenamic acid group than the placebo group (76%, 27%; p < 0.001). In the follow-up period (4 weeks after initial treatment), a bleeding-free interval of > 20 days was found in 68% of the subjects treated with mefenamic acid and 33% treated with the placebo; the mean number of bleeding/spotting days was lower with mefenamic acid treatment (11.6 and 17.2 days; p < 0.05). The difference was statistically significant. It is concluded that mefenamic acid was more effective than placebo in short-term control of irregular bleeding and spotting associated with Norplant use.

Comparative study of weight change between long-term DMPA and IUD acceptors

The study of weight gain in long-term depot-medroxyprogesterone acetate (DMPA) acceptors is reported. The objectives were to study and compare weight gain in long-term DMPA acceptors with intrauterine device (IUD) acceptors. Fifty healthy women who had been using DMPA for 120 months were compared to 50 IUD acceptors who had been using IUD for 120 months as control. Age, parity, income, and weight at the initiation of contraception were matched. The mean ± SD body weight at 120 months in DMPA and IUD groups were 60.9 ± 7.5 kg and 62.1 ± 9.3 kg, respectively. The mean change in body weight in DMPA and IUD groups were 10.9 ± 1.2 and 11.2 ± 1.5 kg. No difference in mean body weight between DMPA and IUD acceptors was demonstrated. It is suggested that weight gain in long-term DMPA use should not be different from nonhormonal contraception. DMPA should not have an unfavorable effect on weight in long-term users.

Effects of DMPA on weight and blood pressure in long term acceptors

The study of effects on weight and blood pressure in long term DMPA acceptors is reported. The objectives were to study body weight and blood pressure changes in long term DMPA users compared with intrauterine device (IUD) acceptors. A total of 50 healthy women who had been using DMPA for 120 months were compared with 50 IUD acceptors who had been using an IUD for 120 months. Age, parity, income, body weight, and blood pressure at the initiation of contraception were matched. The mean +/- SD body weight at 120 months in the DMPA and IUD groups were 60.9 +/- 7.5 kg and 62.1 +/- 9.3 kg. No difference in mean body weight was demonstrated. The blood pressure change between DMPA and IUD acceptors also was not different. It is suggested that long term DMPA use does not have unfavorable effects on weight or blood pressure.

Twelve-month comparative multicenter study of the TCu 380A and ML 250 intrauterine devices in Bangkok, Thailand

The long-term effectiveness of the copper-bearing intrauterine device (IUD) has been documented. This paper reports 12-month results from a multiyear comparative study of the Copper T (TCu) 380A and Multiload (ML) 250 IUD in Bangkok, Thailand, among 1396 women. Continuation of the assigned IUD was relatively high after 12 months of use, with continuation rates of 90.17 and 87.54 per 100 women, respectively. Whereas the accidental pregnancy rate was higher for the ML 250 IUD than for the TCu 380A IUD (1.0 and 0.2 per 100 women, respectively), this difference was not considered statistically significant (p < 0.69). The rate of IUD expulsion was significantly higher among women using the ML 250 IUD than for women using the TCu 380A IUD (4.61 and 2.40 per 100 women, respectively, p = 0.05).

Prevention of mother-to-child transmission of HIV in Thailand : Physicians' attitudes on zidovudine use, pregnancy termination, and willingness to provide care

We administered a survey to Thai physicians, using regular mail, on their attitudes and practices regarding zidovudine (ZDV) use and pregnancy termination in HIV-infected pregnant women. We surveyed their willingness to care for these patients as well. In 1997, 79.5% of 480 respondents reported that they did not routinely use perinatal ZDV prophylaxis. Predictors of failure to use ZDV found to be significant in our logistic regression model included practice outside of Bangkok (odds ratio [OR] = 2.0), belief that ZDV is not cost effective (OR = 2.5), unfamiliarity with AIDS Clinical Trials Group (ACTG) 076 results (OR = 2.5), and failure to screen for HIV routinely (OR = 4.9). Elective abortion for HIV-infected women was advocated by 45.3% of respondents. Factors associated in multivariable analysis with this preference included specialty training in obstetrics/gynecology (OR = 1.8), practice inside Bangkok (OR = 2.0), male gender (OR = 1.9), and treatment of < or =2 HIV-infected patients yearly (OR = 1.8). A significant proportion of respondents described themselves as unwilling to perform pelvic examinations (19.2%), vaginal deliveries (30.7%), or cesarean deliveries (39.5%) on women who were known to be infected with HIV. We conclude that many Thai obstetric providers are reluctant to care for HIV-infected women, do not routinely use perinatal ZDV prophylaxis, and prefer to terminate pregnancies among HIV-infected patients. Physician education concerning the value of HIV screening and antiretroviral therapy in HIV-infected pregnant women is needed urgently in Thailand.

DMPA use above the age of 35 in Thai women.

A prospective study of depot-medroxyprogesterone acetate (DMPA) use in women aged above 35 years was conducted in Bangkok, Thailand. The objectives of the study were to evaluate efficacy, continuation rate, and side effects of DMPA use in these women. A total of 60 women were enrolled in a one-year clinical trial. Their mean age was 38 years. Most of them had completed primary school. No accidental pregnancies occurred throughout the 1-year use in this study. The continuation rate was 20%. Irregular bleeding was the major cause of termination. The major side effect was also irregular bleeding. Nevertheless, DMPA in older women is a safe and effective contraceptive. DMPA is a contraceptive akterbatuve fir women aged above 35 with contraindications to combination oral contraceptives.

A comparative study of Lippes loop and Delta loop intrauterine devices in early postpartum

Two IUDs (Delta loop, Lippes loop D) were randomly inserted in 260 postpartum women within 2-36 hours after delivery by uterine-packing forceps. The Delta loop was designed with the intention of lowering the expulsion rate compared with the standard Lippes loop. The analysis of the data indicated that the expulsion rate of the Delta loop was as high as the Lippes loop D at the one-month follow-up (Delta loop 24.1%, Lippes loop 23.9%). The comparison of other pertinent event rates also showed no significant differences.

Menstrual problems and side effects associated with long-term TCu 380A IUD use in perimenopausal women.

The study assessing menstrual problems and side effects associated with long-term TCu 380A intrauterine device (IUD) use in perimenopausal women is reported. Fifty perimenopausal TCu 380A IUD acceptors who had IUD inserted after age 40 and used IUD at least 36 months were recruited. The mean age of acceptors at time of insertion was 44.2 years with an average parity of two live births. The mean body weight at insertion was 62.13 kg. Most of the bleeding patterns were regular cycles. Intermenstrual bleeding and pelvic pain were side effects most often reported. No pregnancies, pelvic inflammatory disease, or IUD expulsions occurred during the follow-up period. This study suggests that the use of TCu 380A IUD in perimenopausal women is safe and effective.