Erling Østergaard

The effects of small doses of megestrol acetate on the cervical mucus.

This paper deals with those factors of the cervical secretion which could be evaluated quantitatively. 17 parous women were examined daily from Days 8 or 10 of the cycle until 1 or 2 days after the rise in basal body temperature. Examinations were done first in a control cycle then in a treated cycle; doses were 1 tablet of .05 mg or megestrol acetate per day. Mucus was aspirated from the cervix into a small capillary tube. PH was determined in the cervical canal by a glass electrode. Viscosity was measured by a specially designed vacuum device. Values varied markedly during the cycles. Sperm penetration into the mucus was measured by a modified Kremen technique. Dry matter and sodium and potassium content were determined. To determine ovulation pregnanediol excretion and typical changes in karyopyknotic index (KI) were determined. Treatment with megestrol acetate caused the secretion of cervical mucus to diminish but the cell count tended to increase. PH continued at about 7. Elasticity of mucus became higher during treatment particularly with the higher dose. This decreased sperm penetration. The content of dry matter was higher than in the control cycle. Sodium content of dry matter remained constant. Potassium content increased slightly with treatment possibly due to increase in cell content. The KI was below normal in treated cycles. These methods are considered needed in establishing the optimum dose of megestrol acetate.

Malignant and Pseudomalignant Hyperplasia Adenomatosa of the Endometrium in Postmenopausal Women Treated with Oestrogen

Abstract. Malignant and Pseudomalignant Hyperplasia of the Endometrium in Postmenopausal Women treated with Oestrogens.

Oral Anticonception: Side Effects and Risks

This is a survey of known side effects of commercial oral contraceptives. It is now generally accepted that 10-40% of women who begin oral anticonception develop moderate inconveniences and symptons in the 1st months including nausea general malaise tiredness breast tension and mental depression. These symptons normally disappear within the 1st couple of months with only 5-10% of the cases so severe that the question arises of ceasing administration or changing the treatment. In addition to these more common and transient side effects there are other side effects which require more detailed explanation. A classification of these symptons and side effects is made according to their probable geneses: estrogenic gestagenic androgenic and anabolic effects. This survey includes both minor problems such as irritability and such serious possibilities as endocrine system changes. Following each brief description changes which can be made to relieve the problem are suggested.Oral anticonception based upon the daily peroral administration of a combined oestrogen-gestagen tablet from the 5th to the 25th day of the cycle was introduced, as is known, by Pinkus and his co-workers some 13 years ago and has since enjoyed widespread use in the majority of countries throughout the world. In this country the method was approved by the National Health Service in 1966 after first having been the object of clinical trials in various hospitals. There are between 150.000-200.000 users of this method in Denmark to-day according to the statistics.

LAPAROTOMY OBSERVATIONS DURING ORAL CONTRACEPTION

Since 1962 106 patients (aged 22-43 years) using an oral contraceptive have undergone surgical sterilization. Observed temperature curves were biphasic before oral contraception was begun. Delpregnin (megestrol acetate 5 mg and mestranol .1 mg) was used. Therapy began on Days 5-12 of their cycles. Operations were done on Day 24. Tubal sterilization inspection and biopsy of ovaries and uterine curettage were performed. Urinary gonadotropins or pregnanediol were determined on the day prior to operation. None of the 35 who had started Delpregnin earlier than Day 8 of their cycles ovulated. Of 8 patients who started Delpregnin on Day 8 2 had ovulated. 7 of 9 who started on Day 9 and all who started oral contraception later had ovulated by Day 24. Some patients ovulated after having received only 1 of the 2 components of Delpregnin from Day 5 of their cycles or the 2 components sequentially. Urinary hormone assays from the day preceding the operation showed normal gonadotropins. Pregnanediol secretion was below 1 mg in 24 hours. In 22 patients taking Delpregnin exogenous administration of pregnant mares serum gonadotropin (PMSG) alone did not induce ovulation or corpus luteum formation. Exogenous administration of human chorionic gonadotropin (HCG) alone induced corpus luteum formation during the 1st and 2nd but not the 3rd cycle. PMSG and HCG combined could induce a normal gonadotropin response as late as the 20th cycle. It is concluded that the Delpregnin contraceptive effect of preventing ovulation was due to suppression of pituitary gonadotropins.

Therapeutical Aspects in Early Cases of Cervical Carcinoma

Based on a vaginal cytological screening by post in the population of Frederiksberg, Copenhagen, 267 women with abnormal smears were called in for gynzcological examination including punch biopsies. (G. Stakemann and F. Koch). As a result of the examination, invasive cervical carcinoma, in situ or questionably invasive carcinoma was found in 91 of these 267 women and they were taken into the department for further investigation and treatment. Thirty-two cases of stage I a and I b carcinoma were treated with radical hysterectomy and lymphadenectomy, and the diagnoses were confirmed in the operative specimens. In oiie case of stage I b carcinoma surgical treatment was not advisable, and this patient was treated at the Radium Center. In cases of in sitzi or questionably invasive carcinoma as a rule a cone biopsy was done, and further treatment was founded on histological evaluation of the cone. Consequently 58 cases were classified as stadium o carcinoma and 51 of these were treated with extended hysterectomy. In 5 of these cases small areas of stromal invasion were found in the extirpated uteri. In 7 cases conization or cervical amputation was definitive treatment. In 44 patients treated with hysterectomy a preliminary cone biopsy had been done; in 15 cases a rest tumour was found in

Employment of Androgens in Gynecology

i\ priori one would not I = inclined to assign any particular therapeutic serviceability to androgens in gynecology, as at a first glance the androgens might I)e taken as foreign or even harmful to the female organism. This is not the case, however. Vor. as is well known, hoth men and women possess a sexual bilmtentiality, which, among other things, manifests itself in tlie fact that either sex produces and excretes androgenic as well as estrogenic hormones, though in mutually different proportions in the two sexes. It is this individually relatively fixed proportion letween androgen and estrogen which, on the 1)ackgrountl of individual congenital factors and hormonal sensitivity, is decisive of tlie sexual characteristics of the individual in other words. of the more or less virile or feminine features of a man or woman.

URINE INCONTINENCE IN WOMEN

Urinary continence at rest in women results from the fucction of an automatic closure system. Under stress an additional closure system dependent upon conscious control is required. The automatic closure system is based upon: 1. Muscle tone in the spiral smooth muscle surrounding the urethra. 2. Depth of the urethral epithelium 3. Longitudinal epithelial folds 4. Suburethral spongiosa The conscious closure system is a result of proper use of the muscles of the pelvic floor as well as proper condition of these muscles. About 30% of all stress incontinence occurs without prolapse. Conservative treatment is recommended. Treatment of the automatic closure system: I . Estrogens a) substitition b) local therapy 2. Anticholinesterases a) Distigmine b) Neostigmine 3. Cholinergic drugs a) Carbacoline b) Bethanechole chloride Treatment of the conscious closure system: 1. Conditioning of the pelvic floor musculature a) home care b) treatment given by physical therapists c) electric shock therapy 2. Conditioning of other muscles of the pelvis and thighs 3. Psychotherapy .4. Weight reduction in obese patients. Conservative treatment of mild stress incontinence with careful follow-up is an effective therapeutic method leading to satisfactory results in about 70% of such cases.