F. Pansini

The effect of dietary soy supplementation on hot flushes.

Objective To study infectious pathology at index ectopic pregnancy and to determine what other factors predispose a woman to repeat ectopic pregnancy. Methods All women (n = 697) with their first (index) ectopic pregnancy histologically verified between January 1, 1978, and December 31, 1993, at the only two hospitals in one Norwegian county were eligible. Included were permanent residents of the county who were 37 years of age or younger and who had not had tubal surgery before the index pregnancy. When the study closed on November 1, 1994, the participants had been observed prospectively for fertility events from approximately 1 to 17 years. Included in the final analyses were 353 women who had from one to five natural conceptions, for a total of 555 pregnancies. Chisquare test was used in univariate analysis, and the generalized estimating equations approach was used to analyze correlated responses and covariates that changed over time. Results Pregnancy order is the stronger correlate of subsequent ectopic pregnancy. The frequency of repeat ectopic pregnancy decreased by one-third for each pregnancy from the first to the third pregnancy. The odds of having another ectopic pregnancy were nearly three times higher for women with a diagnosis of infectious pathology than for women who had no infectious pathology. Other correlates of repeat ectopic pregnancy include age 24 years or younger at first ectopic pregnancy, history of repeat ectopic pregnancy, initiation of infertility work-up, and conception with an intra-uterine device at index pregnancy. Method of surgery was not associated with repeat ectopic pregnancy. Conclusion The most crucial reproductive event after first ectopic pregnancy is the first event to occur. Women who have experienced two ectopic pregnancies should be considered candidates for assisted reproduction.

Sociodemographic and clinical factors associated with HRT use in women attending menopause clinics in Italy

Objective The aim of this analysis is to find any association between the use of hormone replacement therapy (HRT) and sociodemographic and clinical factors among women attending 54 menopause clinics in Italy. Methods The analysis includes data relating to 17 851 women who attended one of 54 menopause clinics in Italy for general gynecological evaluations and counselling between 1995 and 1997. The characteristics of women reporting ever HRT use were compared with those of never users. The odds ratios (ORs) of HRT use were computed in relation to selected reference categories, together with their 95% confidence intervals (CIs). Results Of the 17 851 women interviewed, 8539 reported ever HRT use. The mean age of the never and ever HRT users was 52.8 years and 53.7 years, respectively. Higher education was associated with an increased frequency of HRT use: in comparison with women reporting no or primary-/middle-school education, the OR of HRT use of women reporting a high-school diploma or university degree was 1.3 (95% CI 1.1–1.6). HRT use tended to be less frequently reported with increasing body mass index (BMI): in comparison with women whose BMI was < 23.4 kg/m2, the OR of HRT use in those with a BMI of 23.4–26.1 kg/m2 and ⩾/⩾ 26.2 kg/m2 was 0.8 (95% CI 0.8–0.9) and 0.6 (95% CI 0.5–0.7), respectively. Among the postmenopausal women, those who had undergone surgical menopause had an OR of HRT use of 1.3 (95% CI 1.2–1.4). A history of breast cancer was associated with a lower frequency of HRT use (OR 0.3, 95% CI 0.2–0.4). Likewise, a history of thromboembolic disease (OR 0.5, 95% CI 0.4–0.7) or myocardial infarction (OR 0.7, 95% CI 0.6–0.9) was associated with a lower frequency of HRT use. Conclusions In our study population, the variable most closely related to HRT use was education/social class, thus underlining the impact of information campaigns on HRT and womens health. Among the medical determinants, our analysis indicates that a history of myocardial infarction, thromboembolic disease or breast cancer is associated with less frequent use of HRT.

Neutral effect of prolonged transdermal hormone therapy on liver function of postmenopausal women with chronic active hepatitis.

Objective: To test whether transdermal hormone therapy can be safely administered to postmenopausal women with chronic viral hepatitis B and/or C. Design: Eighty-one postmenopausal women with chronic viral hepatitis B and/or C and with severe vasomotor symptoms were treated for 5 years with transdermal estradiol (50 μg/day) continuously and with transdermal norethisterone (250 μg/day) for 14 days of every 28-day cycle. Another 95 women with viral chronic hepatitis but without climacteric symptoms were used as controls. Liver enzymes (glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase, γ-glutamine-transferase, and alkaline phosphatase) were measured every year. Results: At baseline, liver enzymes were similar in the two groups, with the exception of γ-GT, which was slightly higher in untreated women (P < 0.01). Liver enzymes did not significantly vary with time in hormone-treated and untreated women. No significant difference was observed between the two groups. Conclusions: Transdermal estradiol and norethisterone can be safely administered for a prolonged period to postmenopausal women with chronic viral B and/or C hepatitis.

The ICARUS study group: The effect of HRT on blood lipid and lipoprotein levels in postmenopausal women at risk of cardiovascular disease (CVD)

unfavorable. BMI was significantly correlated to only triglyceride (PC 0.05). Waist circumference and waist to height ratio were significantly positively correlated to total cholesterol, LDL, triglyceride including LDL/HDL and total cholesterol/HDL (PC 0.05) in premenopausal and postmenopausal women. Waist to hip ratio was significantly negatively correlated to HDL in premenopausal and postmenopausal women. Waist to height ratio was superior over the other anthropometric measures in predicting cardiovascular risk factors in women of all age groups. Conclusions: Abdominal obesity is associated with an unfavorable lipid profiles in women. Waist circumference and waist to height ratio were the most consistent and waist to hip ratio the least when comparing across the aged group. However, the waist circumference may not be applicable to young women. The waist measurement appears to be a convenient and informative anthropometric indicator of cardiovascular disease in all women independent of BMI. Therefore, identification of healthy women with large waist circumferences is important for prevention and intervention of cardiovascular disease.

The icarus study group: prevalence of climacteric symptoms in a large Italian population of HRT-free menopausal women

FC2.10.02 CANADIAN MENOPAUSE STUDY: THE HORMONE REPLACEMENT THERAPY DECISION-MAKING PROCESS W.A. Fisher(l), M. Sand (2), W. Lewis (3), R. Boroditsky (4) (1) Dept. OB/GYN, University of Western Ontario, London, Ontario, Canada (2) Fournier Pharama, Montreal, Quebec, Canada (3) Dept. Of Psychology, University of Western Ontario, London, Ontario, Canada (4) Dept. OB/GYN, University of Manitoba, Winnipeg, Manitoba, Canada