Dick H. Bogchelman

Effects of a preovulatory single low dose of mifepristone on ovarian function

Objectives To investigate the effect of a single low dose of mifepristone on ovarian function, when administered in the preovulatory period. Methods Healthy women with regular menstrual cycles were studied during two consecutive menstrual cycles. Either mifepristone or placebo was given in a randomized double-blind order when the leading follicle reached a diameter between 15 and 17 mm. Daily ultrasound and serum hormone measurements were obtained until follicular collapse. Statistical analysis was performed using Wilcoxon signed-rank test. Results Eight women entered the study, although one woman had to be excluded afterwards from analysis because her LH surge had already appeared on the day of treatment. The LH surge was delayed from day 14 to 17 (P = 0.01). Mifepristone caused a 3-day delay in follicular collapse, occurring on day 16 in control cycles and on day 19 in mifepristone treatment cycles (P = 0.02). The median cycle length was 26 days in control cycles and 30 days in mifepristone treatment cycles (P = 0.03). Progesterone measurement 7 days after follicular collapse did not differ significantly between both cycles. Conclusions A single 10-mg dose of mifepristone administered during the preovulatory phase of the cycle delays the LH surge and postpones ovulation.

No increased systemic fibrinolysis in women with heavy menstrual bleeding

Bleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of heavy menstrual bleeding.

Routine evaluation and treatment of unexplained menorrhagia: do we consider haemostatic disorders?

OBJECTIVE Unexplained menorrhagia can be caused by underlying bleeding disorders. The aim of this study was to investigate the current work-up of menorrhagia in routine gynaecological practice, with a special interest in haemostatic evaluation. Secondly, we investigated the outcome of individualized treatment in our centre. STUDY DESIGN Retrospective medical chart review of 112 consecutive patients referred with menorrhagia to a general gynaecology clinic of a university teaching hospital in the Netherlands between January 2006 and January 2007. In April 2008 we performed a structured telephone interview evaluating the effectiveness of their therapy. RESULTS We included 112 patients, whose median age was 42 years. Twenty-nine percent were anaemic (hemoglobin <12.0g/dL). Seventy-one (63%) had unexplained menorrhagia. Only two patients had haemostatic evaluation and neither had von Willebrands disease. Forty percent (29/71) needed two or more different therapies, 17% (12/71) needed three different therapies and two patients needed a total of seven different therapies. Eight patients underwent hysterectomy, six of them after endometrial ablation. Most patients (80%) were successfully treated medically or surgically and were satisfied with their therapy during follow-up. Eleven patients declined therapy and accepted their heavy periods. CONCLUSION Haemostatic evaluation in women with unexplained menorrhagia is uncommon in gynaecological practice in our centre. Although most of the patients were satisfied with their treatment, a significant number required hysterectomy and another important proportion had to accept their menorrhagia. We hypothesize that the identification of haemostatic disorders might improve care for these women.

The relation of fertility and ovarian histology after bilateral ovarian wedge resection

The immediate and long term fertility after bilateral ovarian wedge resection in 53 women with clomiphene citrate-resistant hyperandrogenic chronic anovulation is related to the histology of the ovarian wedges. Patients with polycystic ovaries and hyperplastic stromal abnormalities had most spontaneous conceptions and a normal fertility during follow-up. Apparently, chronic anovulation in these cases had been caused by ovarian disease in the face of normal hypothalamic function. Patients with polycystic ovaries without stromal abnormalities often needed postoperative stimulation of ovulation in order to conceive, which may indicate hypothalamic involvement. Patients with large ovaries, normal stroma, and small follicles, who as a group had the lowest serum levels of luteinizing hormone, and patients whose ovaries contained large follicles and cysts without theca cell activity did not benefit from the bilateral ovarian wedge resection. Generally, their postoperative response to medical induction of ovulation did not improve either. Measures to prevent adhesions were not completely successful. Nevertheless, our results suggest that anovulation rather than formation of adhesions causes persistent infertility after bilateral ovarian wedge resection.