[Clinical experience with danazol treatment of endometriosis and mastopathy]

26 women presenting with internal and external endometriosis and 27 women with chronic cystic mastopathy and mastodyny received 400 mg danazol-a 17-ethinyltestosterone derivate-daily for 3 to 6 months. Before, during and after completion of treatment clinical and endocrinological investigation as well haematological examinations and determinations of blood and urinary chemistry were carried out. In cases of mastopathy plate thermography and mammography were performed; in endometriosis the diagnosis was verified by laparoscopy or-tomy. An improvement in, or disappearance of dysmenorrhoea and pelvic pain was observed in the endometriosis group. At laparoscopy or -tomy a decrease in, but not a complete disappearance of endometriotic foci was seen. A most favourable effect of danazol was seen in mastodyny. A change in plate thermographic or mammographic findings was observed on only a few patients. A significant fall in 17 beta-oestradiol after one month and a slight decrease in basal LH levels (statistical trend) were observed. FSH and HPRL levels were not significantly affected. Ovulation was mostly suppressed, but serum progesterone values were found several times to be in the range characteristic of severe luteal insufficiency (100 to 1500 pg/ml). Hence, not only amenorrhoea, but also breakthrough bleeding occurred. The observed side affects can be ascribed to anabolic (weight gain), androgenic (acne, hirsutism) and hypoestronic (atrophic vaginitis, hot flushes, restlessness) symptomatology.

[Hypophyseal reaction state during oral contraceptiva (author's transl)]

In 5 normocyclic women, firstly taking a conventional oral contraceptive, Neogynon (50 mcg EE + 250 mcg levo-norgestrel) for 6 months, the levels of LH, 17 beta-E2 and progesterone did not rise after changeover to a dose-reduced pill, Microgynon 30 (30 mcg EE + 150 mcg levo-norgestrel). This fact indicates maintained central suppression. Examination of the hypothalamic-hypophyseal axis by the Gn-RH test (50 mcg) with Microgynon 30 showed negative results during the first treatment cycle in 13 out of 18 women. In the 6th treatment cycle only 7 Gn-RH non-reactive women were observed and after stimulation with 100 mcg Gn-RH only 5 women remained with negative Gn-RH tests. Of the 20 women who took conventional oral contraceptives over a period of 6 months to 6 years (7 took Eugynon: 50 mcg EE + 500 mcg D,L-norgestrel, 5 Lyndiol: 75 mcg mestranol + 2.5 mg lynoestrenol, 8 Neogynon, only one from the Neogynon group showed a positive result. On the other hand there was a positive reaction in 4 out of 7 women using the two step dose-reduced preparation Sequilar (11 tablets of 50 mcg EE + 50 mct levo-norgestrel and 10 tablets of 50 mcg EE + 125 mcg levo-norgestrel).

[The efficacy of gestoden (delta 15-d-norgestrel) as ovulation inhibitor (author's transl)]

Two single-phase combined low-dosage oral contraceptive preparations were tested with respect to their effects on functional parameters of the menstrual cycle. Twenty young women with a normal biphasic menstrual cycle took part in this random study. Evaluation of cervical function, consistency and crystallisation ability of the cervical mucous and of the karyopyknosis index as well as radioimmunoassay of the serum levels of LH, FSH, HPRL, 17-beta-oestradiol and progesterone were carried out consecutively as from the 8th day over the duration of one control cycle and one in which contraceptive as administered. Preparation I (SH D 356 A) contained 75 micrograms delta 15-d-norgestrel (Gestoden) + 30 micrograms ethinyloestradiol. Whilst preparation II (SH D 356 B) contained 75 micrograms d-norgestrel + 30 micrograms ethinyloestradiol. Both substances successfully inhibited ovulation, whereby the former achieved a markedly greater suppression of function with regard to all parameters and, yet good menstrual cycle control was maintained. Hence, gestoden enables the content of active components in oral contraceptives to be reduced even further without detracting from the safety of the technique.

[Intrauterine contraception with copper-T 200 device- a retrospective analysis of 334 cases (author's transl)]

A review is given of the findings obtained in 334 women in whom a Cu-T 200 intrauterine device had been inserted at least two years previously and regular follow-up examinations were subsequently undertaken. The most frequent indications were an expressed preference for IUD on the patient's part (38.3%), poor tolerance to the "pill" (24.8%) and so-called "pill fatigue" (11.1%). Varicose veins led to IUD preference in 8.1% and thromboembolic disease in 6.-%. The failure rate - with 12 pregnancies - was 3.6%, all within 6 months of insertion of the device. Half of the pregnancies went to full term and resulted in the birth of mature, healthy babies. The most frequent complication were menstrual disturbances (20.1%). pain (19.5%), cervicitis (18.3%), and adnexitis (13.8%), necessitating removal of the device in 5.7%, 4.2%, 5.1%, and 0.6% of all cases for the afore-mentioned reasons, respectively. These rates are relatively high. The expulsion rate of 2.7% was relatively low, however. Further analysis of the complications led to the observation that menorrhagia was relatively common in nulliparae and in women with retroversion of the uterus, whereas the pre-insertion finding of a pressure-sensitive uterus with a normal ESR, led in a significantly higher percentage of cases to pain and adnexitis. The diagnosis by vaginal probe of a reduced uterine length led to faulty positioning and an increased tendency to pain in a significantly higher number of cases. The fact that only 56.6% of all women tolerated intrauterine contraception well and remained totally symptom-free supports th view held by us that even today the "pill" remains the contraceptive of choice and should be recommended as such.

[Timing of ovulation in clomiphene-induced cycles (author's transl)]

214 menstrual cycles, induced by clomiphene in 121 women desiring a family but manifesting disturbances of cycle, type WHO II (1976) were investigated with regard to pattern of cervical function. 184 were ovulatory cycles. The time of ovulation was predictable within a range of two days in 58.7% of cases by means of the cervical score, consisting of the dilatation of the cervical os, the degree of transparency, the quantity and the consistency of the cervical mucus. The occurence of the "LH peak" and the rise in basal body temperature (BBT) were set in relation to this. In 41.3% of cycles the cervical score, influenced by the antioestrogenic effect of clomiphene, gave only insufficient evidence. In subsequent treatment cycles the cervical function, in relation to the individual case and the inducible quality of the cycle, showed a similar response rate as in the first treatment cycle. Our results suggest that, after examination of the first clomiphene-induced cycle by the combined means of cervical score and hormoneanalytic methods, patients with a positive cervical response, can be investigated by any interested doctor, even if he doesn't have a laboratory at his disposal, in order to assess the timing of ovulation for therapeutic measures.

[Treatment of infertile couples--an interdisciplinary task (author's transl)]

The results obtained by closest cooperation between gynaecologist and andrologist in the treatment of sterile marriages are reported. 127 couples were treated over a period of 20 months. Almost 100% of the males and 60% of the females were sub- or infertile. Treatment of both partners was meticulously coordinated in order to increase the success ratio. Interdisciplinary cooperation seemed to be advantageous particularly in homologous insemination. 23 pregnancies were achieved, i.e. 18.1%, despite the unpromising nature of this negatively selected material.

[Contraception in preclimacteric women with special regard to oral contraceptives (author's transl)]

During a period of 9 years 143 women at an age over 40 attended for the first time the I. University Clinic of Gynecology and Obstetrics in Vienna for receiving contraceptive treatment. 71 women (49.6%) received oral contraceptives wiD was inplanted because of either internal contraindications of oral contraceptives (mainly high risk for thrombosis) or negation by the patient. 16 patients were sterilised, mostly with the laparascope. The main side effects in the patients receiving oral contraceptives were nervosity, impairment of libido and complaints in the lower extremities. 60.5% of all women over the age of 40 using oral contraception didn't show any complaints. On the basis of the own results and the reports in literature the advantages and disadvantages of oral contraception in comparison with mechanical devices are discussed.

[Hormonal and functional parameters in hyperprolactinaemia (author's transl)]

58 women with raised serum prolactin levels and normal hypophyseal-X-ray parameters were subdivided into three groups according to the serum prolactin level (16 to 40, 41 to 80, greater than 80 ng/ml). In addition to the determination of LH, FSH, oestradiol, progesterone and testosterone in the serum and thyroid diagnostic procedures the following hormonal tests were performed: 1. response to gestagen; 2. response to clomiphene; 3. Gn-RH-test for hypophyseal function; 4. ovarian response to administered gonadotropins (only in cases with prolactin levels greater than 80 ng/ml). The grade of menstrual cycle disorders depends on the severity of the observed hyperprolactinaemia. Slight disorders like luteal phase insufficiency, anovulatory cycle and oligomenorrhoea are associated with low- or medium-grade hyperprolactinaemia. Mainly secondary, but also primary amenorrhoea is found in cases with higher serum prolactin levels (greater than 80 ng/ml). In these cases the hypophyseal response to Gn-RH is frequently found (61%) to be negative and, moreover, the ovarian response to administered gonadotropins seems to be diminished. Increasing HPRL levels often appear to be associated with a negative response to the other above-mentioned tests.

[Hormonal and functional parameters in hyperprolactinaemia (author's transl)]

58 women with raised serum prolactin levels and normal hypophyseal X-ray parameters were subdivided into three groups according to the serum prolactin level (16 to 40, 41 to 80, greater than 80 ng/ml). In addition to the determination of LH, FSH, oestradiol, progesterone and testosterone in the serum and thyroid diagnostic procedures the following hormonal tests were performed: 1. response to gestagen; 2. response to clomiphene; 3. Gn-RH-test for hypophyseal function; 4. ovarian response to administered gonadotropins (only in cases with prolactin levels administered gonadotropins (only in cases with prolactin levels greater than 80 ng/ml). The grade of menstrual cycle disorders depends on the severity of the observed hyperprolactinaemia. Slight disorders like luteal phase insufficiency, anovulatory cycle and oligomenorrhoea are associated with low- or medium-grade hyperprolactinaemia. Mainly secondary, but also primary amenorrhoea is found in cases with higher serum prolactin levels (greater than 80 ng/ml). In these cases the hypophyseal response to Gn-RH is frequently found (61%) to be negative and, moreover, the ovarian response to administered gonadotropins seems to be diminished. Increasing HPRL levels often appear to be associated with a negative response to the other above-mentioned tests.

[Results of a long-term clomiphene citrate therapy in women with normogonadotropic menstrual disturbanes (author's transl)]

A total of 72 pregnancies was achieved in 59 women with menstrual cycle disturbances (WHO Type II) by administration of clomiphene. 27 of these pregnancies (34.7%) occurred only after more than three courses of cloimphene. A secondary classification of the patients was based on the symptomatic severity of the menstrual disturbance. Clomiphene (100 mg) was administered on the fifth day after the onset of menstruation for five days, whereby in one or two cases up to 19 courses had to be given. The group consisted of women who had rejected HMG-HCG therapy because of the possibility of multiple pregnancy. 59 pregnancies went to full term; 2 tubal pregnancies and 11 cases of miscarriage were recorded. The commencement of pregnancy was evaluated and the time of ovulation and the length of the luteal phase determined in women requiring up to three courses of clomiphene and those requiring over three courses. The investigation demonstrates that clomiphene therapy can be successful even after more than six courses of the drug. Side effects are minimal.

The influence of burn trauma on the hypothalamus-pituitary axis in normal female subjects

In 5 severely burned women (greater than 25% TBS, II degrees and III degrees burns) the following hormones were investigated by RIA. (1) LH-releasing hormone test in the initial phase of burn shock with 100 gamma 3 LH-RH. (2). Follow-up controls of luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (HPRL), oestradiol (E2), progesterone (P) and testosterone (T) in the catabolic and healing phase of burn disease. All women were before onset of burn trauma regularly ovulating. The following preliminary results can be presented: If the burn trauma occurs in the preovulatory phase of the menstrual cycle, there was no ovulation during the time of observation. As a sign of the normal function of the anterior lobe of the pituitary gland all subjects responded with an increase of plasma LH to the stimulation with LH-releasing hormone. The burn trauma interferes with the female endocrine equilibrium by involving hypothalamic centres. Negative feedback mechanisms by the secretion of adrenal hormones and temporary hyperprolactinemic states as a further result are discussed.

[Prophylactic medication to prevent miscarriage in pregnant women with a history of sterility (author's transl)]

A report is given of the outcome of 451 pregnancies occurring among women who had previously attended the Infertility Clinic. General gestagen therapy was given prophylactically in 129 cases before the appearance of any signs of threatened abortion. Massive gestagen therapy was initiated in 41 cases in response to signs of threatened abortion. Gestagen was not given either prophylactically or therapeutically in the remaining 281 pregnancies. The incidence of abortion was 10.1% in women given prophylactic gestagen, whilst the overall rate of abortion in the entire series of 451 women was 13.3%. It transpired on closer scrutiny of the 129 cases given prophylactic gestagen therapy that the abortion rate was 12.0% in the 108 pregnancies in which prophylactic gestagen therapy had been initiated at the time of the first missed period or later, whereas not one single abortion was registered amongst the 21 women who had been given gestagen therapy in the immediate post-ovulatory phase. It can be concluded that commencement of prophylactic gestagen therapy at the earliest possible moment provides optimum conditions for successful implantation of the fertilized ovum, especially in cases with masked insufficiency of the corpus luteum.

[The place of laparoscopy in the investigation of infertility (author's transl)]

An assessment of the value of hysterosalpingography (HSG) and laparoscopy was made on the basis of a comparison of the respective findings obtained during routine investigation of 105 women attending the Infertility Clinic. The results of the two procedures concurred in 76% of the women; in the remaining cases, apparently normal findings on HSG had to be rectified on the basis of laparoscopic investigation and vice versa. The divergent results are discussed in detail. In particular, intramural obstruction of the tubes diagnosed on HSG often appears to be merely functional and the presence or absence of adhesions in the region of the tubes must be viewed with reservation. HSG and laparoscopy should be considered complementary, not rival procedures.

[Contraceptive efficiency of triphasic inhibitors (author's transl)]

The effects of two newly developed triphasic preparations with a sequence of 6/5/10 and a reduced content of the total dose of oestrogen per cycle on the parameters of cycle function were studied in 10 young women with normal phasic cycles using a randomized trial design. Cervical function, spinnbarkeit and crystallisation of cervical secretion and the karyopyknotic index were monitored and LH,E2 and progesterone levels in serum radioimmunologically determined in a pretreatment control cycle, the immediately following 1st treatment cycle, the 3rd treatment cycle and a subsequent treatment-free cycle. Both preparations brought about suppression of ovulation already in the 1st treatment cycle with the periphery (cervical barrier) greatly reduced but still reactive. The results of the study show that by adapting the ratio of active substances to the phases of the normal cycle, not only good cycle control and tolerance are achieved but also inhibition of ovulation.

[Anti-androgen treatment of acne (author's transl)]

A group of women suffering from acne vulgaris or post-pubertal acne was selected for a trial of anti-androgen treatment on the basis of suspected concomitant endocrine disorder from the case history. A satisfactory response to anti-androgen treatment was obtained in 80% of these subjects. The serum testosterone levels, which were slightly elevated or within the normal range prior to therapy, decreased significantly in response to anti-androgen treatment with an oral contraceptive of the combined type containing cyproterone acetate and ethinyl oestradiol. The highest rate of response was observed in patients with post-pubertal acne resistant to conventional therapy.

[Central and peripheral actions of an oral contraceptive with reduced oestrogen content (author's transl)]

The action spectrum of an oral contraceptive which contained a reduced amount of the oestrogen component (0.04 mg ethinyl-oestradiol and 2.0 mg lynoestrenol) was investigated in 4 volunteer subjects. Serum levels of LH, 17 beta-oestradiol and progesterone were determined by radioimmunoassay and, in addition, the karyopyknotic index and cervical function were studied daily from the 8th day of the cycle. These parameters were determined in a control cycle, in the cycle during administration of the oral contraceptive and in the subsequent treatment-free cycle. Furthermore, the bleeding patterns were studied in 284 treatment cycles of 26 patients. Results of these studies indicate complete contraceptive protection by inhibition of ovulation and by an efficient cervical barrier action already during the first treatment cycle. Withdrawal bleeding was observed 3 to 4 days after ingestion of the last tablet. Spotting was recorded in 11 subjects during the first treatment cycle but was rarely observed during further treatment. Blood loss and bleeding control is comparable to that of other combined oral contraceptives with reduced oestrogen content.

[Changes in glucose tolerance, serum insulin and blood lipids during contraceptive medication (oestrogen-gestagen) in metabolically-healthy women (author's transl)]

A low-dosage combination type of contraceptive (oestrogen-gestagen) was given to 19 metabolically- healthy women of normal weight over a period of 6 months. Glucose tolerance, serum insulin and serum lipids were measured 1 month before, during and 2 months after medication. There was a slight decrease in the basal insulin values and an opposite trend in the basal blood glucose values, not exceeding 10 mg% in comparison to pretreatment values. The oral glucose tolerance test with a load of 100 g oligosaccharides did not show any statiscally significant changes during the 9 month observation period. The serum insulin curve, however, showed a delayed increase with a tendency to return to original values after medication had stopped. A slight degree of insulin resistance without change in glucose tolerance can, therefore, be assumed. There was a tendency for triglyceride values to increase over the observation period. A trend towards decreased cholesterol, on the other hand, was statistically insignificant. The observed changes were all within the normal range in all cases.

Experimental and clinical data on Cyclabil

The effects of a 2-phase preparation on the parameters of cycle function were studied in 14 normally menstruating women. The preparation, Cyclabil, is administered in a series of 11 tablets with 2.0 mg oestradiol valerate and 10 tablets with 2.0 mg oestradiol valerate in combination with 0.5 mg D,L-norgestrel. The cervical function, the spinnbarkeit of the cervical mucus and its crystallisability and, by means of RIA, FSH, LH, 17beta-oestradiol and the progesterone serum levels were determined continuously in a control cycle before the treatment, in the first and third treatment cycles and in a subsequent control cycle. The results show that no impairment of the normal cycle function were found during cyclical administration of the 2-phase preparation in 13 women. Two pregnancies occurred during the therapy. The process of ovulation was inhibited in one subject during the medication. 20 other women with pronounced premenopausal deficiency symptoms and cycle irregularities were treated with the 2-phase preparation for 6 months. Apart from the good cycle regulation, the deficiency symptoms were eliminated completely in 19 women and almost completely in 1 woman. Checks of the FSH, LH, 17beta-oestradiol and oestrone serum levels conducted at random during a medication cycle showed only a slight influence on the gonadotropin level. During the medication, E2 can be demonstrated in comparison to E1 at a ratio of 1:10.

Bioavailability of natural estrogens in young females with secondary amenorrhea

The bioavailability of 17 beta-estradiol valerate, free 17 beta-estradiol and Premarin was studied in 24 subjects suffering from secondary amenorrhea. 17 beta-estradiol and estrone were determined by specific radioimmunoassay systems. All estrogens were administered as single oral doses. The amounts applied were 2 and 10 mg of 17 beta-estradiol valerate or equivalent amounts of the free estradiol and Premarin, respectively. No elevations of 17 beta-estradiol serum levels were recorded at the lower dosages, whereas the increases of estrone serum levels were approximately tenfold over basal levels. Similar data were recorded in a group of 3 women with normal cycles after the ingestion of 2 mg of 17 beta-estradiol valerate. All subjects responded to the higher doses of estrogens with a moderate increase of 17 beta-estradiol serum levels, but with much higher elevation of estrone levels. These data suggest a rapid conversion of 17 beta-estradiol into estrone. The biological activity of 2 mg 17 beta-estradiol valerate is discussed on grounds of a possible metabolism of estrone sulfate at the target tissues.

[Blood coagulation and fibrinolysis in women receiving estrogen, gestagen and estrogen-gestagen-contraceptives (author's transl)]

Eight femal subjects received a contraceptive with a low estrogen content (Neogynon), the estrogen component (50 mug ethinylestradiol) and consecutively the gestagen component (250 mug D-Norgestrel) of the contraceptive. Each treatment cycle was followed by a control cycle. At various times of the control and therapy cycles several coagulation and fibrinolytic parameters were investigated. Statistical analyses were performed by multivariate two-factorial analysis of variance. Plasminogen exhibities a statistically significant increase during the treatment with ethinylestradiol and the combination of this steroid with D-norgestrel. No significant changes were found for all other parameters, including partial thromboplastin time, fibriogen, factors X, IX, VIII, factor VIII-related antigen, antithrombin III and fibrin(ogen)degradation products.