Association between Glucose Metabolism and Oral Combined Contraceptive Pills or Cyclic Progestin in Thai Women with Polycystic Ovary Syndrome: A 3-year Observational Study

Objective: To measure the difference in fasting blood glucose (FBG) among Thai women with polycystic ovary syndrome (PCOS), having received either oral combined contraceptive pills (OCP) or cyclic progestin, during 3 years of treatment. Materials and Methods: The data were collected by a retrospective chart review of women with PCOS, who had been treated at Siriraj Hospital before June 2019, backward to the year 2000. The patients were divided into two groups, according to their different treatments, namely: an OCP group and a cyclic progestin group. There were 44 cases in each group, and both groups had received complete hormonal treatment over 3 years. Results: The patients’ baseline characteristics showed a significantly lower body mass index (BMI) and waist circumference (WC) in the OCP group than in the cyclic progestin treatment group. After the 3-year period of treatment, the FBG differences in the OCP group and cyclic progestin treatment group were 3.4±8.4 and 3.6±8.5 mg/dL, respectively; which revealed no statistical significance. Additionally, the difference in the WC and metabolic profile between the studied groups after 3 years of treatment also revealed no significance. However, BMI presented a significant difference between the two hormonal regimens after 3 years of treatment (p-value=0.007), with higher differences in the OCP treatment group. Conclusion: There was no statistically significant difference in FBG between the beginning and at the third year of treatment found in both regimens of hormonal treatment in Thai PCOS women.  

The effectiveness of desogestrel for endometrial protection in women with abnormal uterine bleeding-ovulatory dysfunction: a non-inferiority randomized controlled trial

Women with chronic abnormal uterine bleeding-ovulatory dysfunction (AUB-O) are at increased risk of endometrial neoplasia. We conducted a non-inferiority randomized controlled trial to determine the effectiveness of two cyclic-progestin regimens orally administered 10 d/month for 6 months on endometrial protection and menstruation normalization in women with AUB-O. There were 104 premenopausal women with AUB-O randomized to desogestrel (DSG 150 µg/d, n = 50) or medroxyprogesterone acetate (MPA 10 mg/d, n = 54) group. Both groups were comparable in age (44.8 ± 5.7 vs. 42.5 ± 7.1 years), body mass index (24.8 ± 4.7 vs. 24.9 ± 4.7 kg/m2), and AUB characteristics (100% irregular periods). The primary outcome was endometrial response rate (the proportion of patients having complete pseudodecidualization in endometrial biopsies during treatment cycle-1). The secondary outcome was clinical response rate (the proportion of progestin withdrawal bleeding episodes with acceptable bleeding characteristics during treatment cycle-2 to cycle-6). DSG was not inferior to MPA regarding the endometrial protection (endometrial response rate of 78.0% vs. 70.4%, 95% CI of difference − 9.1–24.4%, non-inferiority limit of − 10%), but it was less effective regarding the menstruation normalization (acceptable bleeding rate of 90.0% vs 96.6%, P = 0.016).

Clinical trial registration: ClinicalTrials.gov (NCT02103764, date of approval 18 Feb 2014).

Polycystic ovarian morphology in Thai women of reproductive age with polycystic ovary syndrome

Background

Advancements in ultrasound technology have facilitated identifying polycystic ovarian morphology (PCOM) in women with and without polycystic ovary syndrome (PCOS), but it still has limitations due to follicle counting methods and variation of phenotypes according to ethnicity. Ethnicity-specific ovarian morphology may help to establish ethnicity-specific follicle count cut points for defining PCOM in women with PCOS.

Objectives

To investigate the prevalence and factors associated with PCOM in Thai women of a reproductive age with PCOS.

Methods

This prospective cross-sectional study was conducted in our gynecology department at a tertiary teaching hospital from February 2016 to May 2017. We included women with PCOS, who were measured for weight, height, waist circumference, and blood pressure. Blood samples were taken to measure fasting blood glucose, lipid profile, testosterone level, and 2 h post-load 75 g oral glucose tolerance test (OGTT). Transvaginal or transrectal sonography was performed to evaluate their ovaries.

Results

All 143 patient participants we included had oligomenorrhea, 77.6% of them had acne, and 64.3% hirsutism. Their average total testosterone level was 0.47 ± 0.10 ng/mL. The prevalence of PCOM was 55.2%. The proportions of PCOM diagnosed by ovarian follicle and ovarian volume criteria were 36.4% and 42.0%, respectively. There were 20.0 ± 9.5 follicles per ovary, 8.3 ± 3.1 follicles per cross section, and the mean ovarian volume was 7.9 ± 3.0 mL.

Conclusion

The overall prevalence of PCOM in Thai women of reproductive age with PCOS was 55.2%. Our univariate analysis found no factors significantly associated with PCOM.

Compliance and health consequences of menopausal hormonal therapy after surgical menopause: A retrospective study in Thailand

AIM

To study compliance with menopausal hormonal therapy (MHT) until age ≥ 50 year and health consequences after surgical menopause.

METHODS

A retrospective cohort study of 1000 consecutive surgically menopausal patients who underwent premenopausal surgery before 50 years of age from benign indications during 1996-2012 was performed. Main outcomes were number in year of MHT compliance and health consequences: hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), ischemic heart disease (IHD)/myocardial infarction (MI), venous thromboembolism (VTE), stoke, osteopenia/osteoporosis, cognitive impairment/dementia/Alzheimer's disease (AD) /Parkinsonism and breast/other cancers. The MHT nonuser subgroup served as the control.

RESULTS

Of the 1000 patients, 855 cases used MHT. The median overall follow-up time from surgery for 145 MHT nonuser patients, 435 MHT users until age <50 year and 420 MHT users until age ≥50 year was 12.0 years. Compliance until age ≥50 year was only 49.1%. For MHT users, the overall median age of stopping MHT was 47.0 year with a median MHT use of 6.0 year. After age adjustment at the time of follow-up of all subgroups by forward stepwise logistic regression analysis, the only significantly different health consequence was osteopenia (32.4%, 10.6% and 21.4% in the MHT nonusers, users until age <50 year and users until age ≥50 year, respectively [P < 0.001]). Prevalence of breast cancer, colon cancer and other cancers were not different among subgroups.

CONCLUSION

The majority of patients used MHT with low compliance until age ≥50 year. In addition, MHT initiation after surgery possibly prevented osteopenia compared with MHT nonusers.

The effectiveness of quick starting oral contraception containing nomegestrol acetate and 17-β estradiol on ovulation inhibition: A randomized controlled trial

To determine the effectiveness of quick starting combined oral contraception (COC) contain 2.5 mg nomegestrol acetate and 1.5 mg estradiol (NOMAC/E2) comparing with 0.075 mg gestodene and 0.02 mg ethinyl estradiol (GS/EE) on ovarian ovulation inhibition rate, we conducted a non-inferiority randomized controlled trial involving 69 healthy female volunteers aged 18–40 years who had normal menstrual history and were randomized at a 2:1 ratio to take one pack of COC containing either NOMAC/E2 (study group) or GS/EE (control group) starting on menstrual cycle Day7–9. The ovarian activity was assessed by using Hoogland and Skouby grading. Forty-six and 23 participants were randomized to NOMAC/E2 and GS/EE groups, respectively. Baseline characteristics were similar between groups. No significant difference was observed between the study and control groups for ovulation inhibition rate (93.4% vs. 95.6%, risk difference: –2.2%, 95% CI: –13.1, 8.8), ovarian quiescence rate (91.2% vs. 91.2%, P = 1.000), persistent cyst rate (2.2% vs. 4.4%, P = 1.000), and ovulation rate (6.6% vs. 4.4%, P = 1.000). Quick starting COC during day7–9 of menstrual cycle can inhibit ovulation for more than 90%. The quick starting NOMAC/E2 is non-inferior to GS/EE for preventing ovulation and suppressing follicular growth.

Comparison of change in body weight between contraception containing 30-μg ethinylestradiol/2-mg chlormadinone acetate or 30-μg ethinylestradiol/3-mg drospirenone: a randomised controlled trial

Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-μg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-μg EE and 3-mg drospirenone (DRSP).Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment.Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs -0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs -0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups.Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.

Prevalence of Documented Excessive Weight Gain Among Adolescent Girls and Young Women Using Depot Medroxyprogesterone Acetate

Background

Depot medroxyprogesterone acetate (DMPA) is an accessible contraception with high efficacy among adolescents. However, concern of weight gain can impede DMPA use. The objective of this study was to determine prevalence of excessive weight gain associated with DMPA injection in young women and its predicting factor.

Methods

This retrospective chart review included young women aged 10 - 24 years who had used DMPA and attended at Family Planning and Reproductive Medicine Unit, Siriraj Hospital for at least 6-month period during January 2010 to June 2016. Baseline clinical data, weight at beginning of contraception, and weight at 6 and 12 months thereafter were reviewed. Excessive weight was defined as weight gain of > 5% of their baseline weight at 6 months. Various baseline variables were compared between groups with and without excessive weight gain.

Results

Among 231 DMPA users in this study, there were 28 women (12.1%, 95% confidence interval (CI): 7.8 - 16.3) who had an excessive weight gain at 6 months. Age, baseline body mass index, or race did not affect the likelihood of excessive weight gain. The excessive weight gain group had significant higher proportion of nulliparity, unmarried status and DMPA-ever used history compared to another one. Six of 13 (46.2%) excessive weight gainers at 6 months who continued DMPA use had gain even more weight (> 10% of their baseline weigh) at 12 months.

Conclusions

The majority of adolescent girls using DMPA had no excessive weight gain in 6 months. However, DMPA users who had excessive weight at 6 months were at high risk of gaining even more weight at 1 year.

Prediction and prevention of pre-eclampsia in Asian subpopulation

The benefit of the early administration of aspirin to reduce preterm pre-eclampsia among screened positive European women from multivariate algorithmic approach (ASPRE trial) has opened an intense debate on the feasibility of universal screening. This review aims to assess the new perspectives in the combined screening of pre-eclampsia in the first trimester of pregnancy and the chances for prevention using low-dose aspirin with special emphasis on the particularities of the Asian population. PubMed, CENTRAL and Embase databases were searched from inception until 15 November 2017 using combinations of the search terms: preeclampsia, Asian, prenatal screening, early prediction, ultrasonography, pregnancy, biomarker, mean arterial pressure, soluble fms-like tyrosine kinase-1, placental growth factor, pregnancy-associated plasma protein-A and pulsatility index. This is not a systematic review or meta-analysis, so the risk of bias of the selected published articles and heterogeneity among the studies need to be considered. The prevalence of pre-eclampsia and serum levels of biochemical markers in Asian are different from Caucasian women; hence, Asian ethnicity needs to be corrected for in the algorithmic assessment of multiple variables to improve the screening performance. Aspirin prophylaxis may still be viable in Asian women, but resource implication needs to be considered. Asian ethnicity should be taken into account before implementing pre-eclampsia screening strategies in the region. The variables included can be mixed and matched to achieve an optimal performance that is appropriate for economical restriction in individual countries.

Postoperative desogestrel for pelvic endometriosis-related pain: a randomized controlled trial

OBJECTIVE

To determine the effectiveness of desogestrel for relieving endometriosis-related pain.

METHODS

A double-blinded randomized placebo-controlled trial was conducted in 40 patients who had endometriosis with moderate-to-severe dysmenorrhea or chronic pelvic pain undergoing laparoscopic conservative surgery. After surgery, patients were randomized to desogestrel or placebo group. Outcomes included changes in visual analog scale (VAS) of dysmenorrhea, pelvic pain and dyspareunia, patient satisfaction, and adverse effects.

RESULTS

Forty patients were randomized to desogestrel group (n = 20) and placebo group (n = 20). At month 6, the desogestrel group had significantly lower median VAS of overall pelvic pain, dysmenorrhea and noncyclic pelvic pain. Comparing with the placebo group, the desogestrel group had greater reduction in VAS of overall pain, dysmenorrhea and pelvic pain, but comparable reduction in VAS of dyspareunia. No patient in the desogestrel group but 4 patients in the placebo group still had moderate-to-severe pelvic pain at 6 months postoperatively. The proportion of patients who rated the treatment as very satisfied was higher in the desogestrel group than in the placebo group. There was no serious adverse event during the study period.

CONCLUSIONS

Desogestrel is effective and acceptable for postoperative therapy for patients with moderate-to-severe pain related to endometriosis.

Validation of osteoporosis risk assessment tools in middle-aged Thai women

OBJECTIVES

To validate osteoporosis risk assessment tools in middle-aged Thai women.

METHODS

A total of 1038 women who had bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry were reviewed. Clinical data were used to validate the diagnostic test performance of various osteoporosis risk assessment tools, including ABONE, FRAX^®, ORAI, OSIRIS, SCORE, SOFSURF, and OSTA. The following parameters were evaluated: sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy; those with 95% confidence interval (CI) of the receiver operator characteristics area under the curve (ROC-AUC) > 0.5 were considered statistically significant.

RESULTS

The subjects had a mean age of 53.01 ± 6.20 years and body mass index (BMI) of 23.98 ± 3.38 kg/m². Among the osteoporosis risk assessment tools being evaluated, the tools that had ROC-AUC >0.8 and 95% CI >0.5, and could predict osteoporosis at the femoral neck with high specificity of >75% and NPV of >90%, were FRAX^® without BMD (ROC-AUC 0.83; 95% CI 0.73-0.93; specificity 99.90; NPV 98.89), SCORE (ROC-AUC 0.86; 95% CI 0.78-0.94; specificity 98.79; NPV 98.99), and OSTA (ROC-AUC 0.86; 95% CI 0.79-0.94; specificity 75.03; NPV 99.73).

CONCLUSION

The prevalence of osteoporosis in the middle-aged Thai women attending Siriraj Menopause Clinic is 7.3% at the lumbar spine and/or femoral neck. FRAX^® without BMD, SCORE, and OSTA have appropriate validity as tools for ruling out osteoporosis in these women.

Correlation of clinical and biochemical hyperandrogenism in Thai women with polycystic ovary syndrome

AIM

The aim of this study was to determine the correlation of clinical hyperandrogenism and biochemical hyperandrogenism (hyperandrogenemia) in Thai women with polycystic ovary syndrome (PCOS).

METHODS

This cross-sectional study was conducted at Siriraj Hospital, Thailand. Subjects were 145 women with PCOS who were diagnosed in accordance with the revised Rotterdam 2003 criteria and registered during January to July 2008. Clinical hyperandrogenism was assessed using the modified Ferriman-Gallwey score for hirsutism, the American Academy of Dermatology criteria for severity of acne, and the Ludwig scale for androgenic alopecia and virilization. Biochemical hyperandrogenism was determined from serum concentration of total testosterone (TT), dehydroepiandrosterone sulfate and free testosterone (FT).

RESULTS

The participants had a mean age of 25.5 ± 6.5 years and a body mass index of 26.2 ± 6.9 kg/m(2) . The most common presenting symptom was oligomenorrhea or amenorrhea. The most common expression of clinical hyperandrogenism was acne (56.6%). Most of the participants (84.8%) had high serum-FT. There was a statistically significant correlation between clinical and biochemical hyperandrogenism in the following pairs: hirsutism and FT (r = 0.3, P < 0.001); hirsutism and TT (r = 0.26, P < 0.001); and acne and TT (r = 0.26, P = 0.002). The others had little or no correlations.

CONCLUSION

Clinical hyperandrogenism is not a good predictor for biochemical hyperandrogenism in Thai women with PCOS. A modified Ferriman-Gallwey score cut-off point of 8 has low sensitivity but high specificity for hyperandrogenemia; therefore, it is useful for the diagnosis but not useful for the exclusion of hyperandrogenemia in Thai women with PCOS.

Prevalence and clinical predictors of insulin resistance in reproductive-aged thai women with polycystic ovary syndrome

Objectives. To determine the prevalence of insulin resistance (IR) and its predictors in reproductive-aged Thai women with polycystic ovary syndrome (PCOS). Methods. A cross-sectional study was conducted from May 2007 to January 2009. Participants were 250 Thai women with PCOS. Information regarding medical history and physical examination and results of 75 gram OGTT were recorded. Results. The overall prevalence of IR was 20.0%, comprising the prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetic mellitus of 3.2%, 13.6%, and 5.6%, respectively. Multiple logistic regression analysis showed that the independent predictors for IR were age of ≥30 years old, waist circumference (WC) of ≥80 cm, presence of acanthosis nigricans (AN), and dyslipidemia with odds ratios (95% confidence interval) of 2.14 (1.01-4.52), 3.53 (1.28-9.75), 2.63 (1.17-5.88), and 3.07 (1.16-8.11), respectively. Conclusion. The overall prevalence of IR in reproductive-aged Thai women with PCOS is 20.0%. Age ≥30 years old, WC ≥80 cm, the presence of AN, and dyslipidemia are the significant clinical predictors.

The Usefulness of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) for Detection of Glucose Intolerance in Thai Women of Reproductive Age with Polycystic Ovary Syndrome

Objectives. To study the cut-off point of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) as a screening test for detection of glucose intolerance in Thai women with polycystic ovary syndrome (PCOS). Study Design. Cross-sectional study. Setting. Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. Subject. Two hundred and fifty Thai PCOS women who attended the Gynecologic Endocrinology Unit, during May 2007 to January 2009. Materials and Methods. The paitents were interviewed and examined for weight, height, waist circumference, and blood pressure. Venous blood samples were drawn twice, one at 12-hour fasting and the other at 2 hours after glucose loading. Results. The prevalence of glucose intolerance in Thai PCOS women was 20.0%. The mean of HOMA-IR was 3.53  ±  7.7. Area under an ROC curve for HOMA-IR for detecting glucose intolerance was 0.82. Using the cut-off value of HOMA-IR >2.0, there was sensitivity at 84.0%, specificity at 61.0%, positive predictive value at 35.0%, negative predictive value at 93.8%, and accuracy at 65.6%. Conclusion. HOMA-IR >2.0 was used for screening test for glucose intolerance in Thai PCOS women. If the result was positive, a specific test should be done to prove the diagnosis.

The prevalence of hepatitis B in premarital counseling clinic at Siriraj Hospital

OBJECTIVE

To study the prevalence and associating factors of hepatitis B infection in the Premarital Counseling Clinic at Siriraj Hospital.

MATERIAL AND METHOD

The data (medical history, physical examination, and Hepatitis B profile) was collected from medical records of 740 couples who attended the Premarital Counseling Clinic in Siriraj Hospital between September 2005 and December 2009 for this retrospective study.

RESULTS

The prevalence of positive HBsAg in couples who attended the Premarital Counseling Clinic, Siriraj Hospital was 4.2%, which was 3.0% in male and 1.2% in female. The mean age of male was 32.9 +/- 5.1 years old and 30.7 +/- 3.9 years old in female. History of hepatitis B vaccination was found less in male (male 6.1% vs. female 8.8%). Four point two percent of participants were positive HBsAg but negative of HBsAb. Twenty-four couples were at risk or 3.2%. Male gender and history of no hepatitis B vaccination was significantly associated with positive HBsAg. No significant difference was found between age and occupation.

CONCLUSION

The prevalence of positive HBsAg in the Premarital Counseling Clinic, Siriraj Hospital was 4.2%. Male gender and history of no hepatitis B vaccination had significant association with positive HBsAg.

Clinical responses to the combination of estradiol and drospirenone in symptomatic postmenopausal Thai women

OBJECTIVES

To investigate the efficacy and tolerability of the oral hormone replacement therapy (HRT) containing 1 mg estradiol (E2) plus 2 mg drospirenone (DRSP) in Thai women with postmenopausal symptoms.

MATERIAL AND METHOD

Fifty-five Thai women with postmenopausal symptoms participated in this multicenter, open-label, non-comparative Phase IV study. The primary endpoint was the reduction of hot flushes after 12 weeks of treatment. Secondary endpoints included changes infrequency and intensity of menopausal symptoms as well as safety assessments after 4, 8, and 12 weeks of treatment.

RESULTS

Treatment with 1 mg E2 plus 2 mg DRSP reduced the frequency of hot flushes in 94.6% of women at the end of the 12-week treatment period. In 60% of women, the frequency of hot flushes was reduced to 10% or less, compared to baseline findings and 49.1% of women had no remaining hot flushes. Other postmenopausal symptoms such as vaginal dryness, urinary incontinence, dysuria, and dyspareunia improved The most common adverse events were vaginal bleeding or spotting and breast tenderness.

CONCLUSION

The oral HRT of 1 mg E2 plus 2 mg DRSP was effective and well tolerated by Thai women suffering from postmenopausal symptoms.

Vaginal atrophy and sexual dysfunction in current users of systemic postmenopausal hormone therapy

OBJECTIVE

To determine the prevalence of vaginal atrophy and sexual dysfunction in current users of systemic postmenopausal hormone therapy (pHT).

MATERIAL AND METHOD

A cross-sectional study was conducted in 97 current users of pHT at Siriraj Menopause Clinic from 2005 to 2007. Subjective symptoms of vaginal atrophy and sexual dysfunction were assessed by interviewing. Objective signs of vaginal atrophy were assessed using pelvic examination, vaginal pH, and maturation value (MV).

RESULTS

The prevalence of vaginal atrophy in current users of systemic pHT determining from patient's symptoms, pelvic examination, vaginal pH, and MV were 44.3%, 15.5%, 21.6% and 8.8%, respectively. The prevalence of sexual dysfunction varied from 48.7% to 71.6% depending on types of dysfunction. There was poor association between the subjective symptoms and signs, and the objective indicators of vaginal atrophy. Among various regimens of pHT, tibolone had the lowest prevalence of subjective atrophic symptoms; estrogen-only pHT had the lowest prevalence of objective atrophic signs; and raloxifene had the highest prevalence of atrophic symptoms and signs, and sexual dysfunction. There was statistically significant association between regimens of pHT and objective indicators for vaginal atrophy (p = 0.004 for pH, and 0.000 for MV).

CONCLUSION

Current users of systemic pHT still have vaginal atrophy and sexual dysfunction which relates to regimens of pHT. The prevalence of vaginal atrophy varies depending on the assessment methods. The subjective method gives higher prevalence than the objective one does. Since the subjective symptoms of vaginal atrophy would have more adverse effect on quality of life than the objective signs do, the authors suggest that patients' complaints be used to assess factors affecting vaginal atrophy in further research.

Characteristics of 250 reproductive-aged polycystic ovary syndrome Thai women at Siriraj Hospital

OBJECTIVE

To determine the clinical characteristics of reproductive-aged polycystic ovary syndrome (PCOS) Thai women.

STUDY DESIGN

Cross sectional study

SETTINGS

Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital.

SUBJECTS

250 PCOS Thai women who registered at the Siriraj PCOSprojectfrom May 2007 to January 2009. PCOS were diagnosed using Revised Rotterdam 2003 criteria. Women who were taking medications affecting sex hormones or lipid metabolism within 3 months before registration were excluded from the present study.

MATERIAL AND METHOD

Patients were interviewed and examined for weight, height, waist circumference, blood pressure, presence of acanthosis nigricans, and signs of hyperandrogenism. Ovarian ultrasonography was examined using vaginal probe inserting into the vagina or rectum. Venous blood sample of each patient was drawn during 8.00-10.00 o'clock after 12-hour fasting.

MAIN OUTCOME MEASURES

Clinical characteristics and laboratoryprofiles in PCOS Thai women.

RESULTS

Of all participants, 62% were 20-29.9 years old, 30% had high blood pressure, 57% were overweight to obese, 49% had central obesity, and 27% had acanthosis nigricans. Clinical hyperandrogenism was found in 15.6% of the patients. Approximately 7% of PCOS women had impaired fasting glucose and one third had dyslipidemia. Prevalence of the PCOS criteria presenting in the population were oligomenorrhea and/or amenorrhea (98.4%), hyperandrogenism (49 2%), and ultrasonographic polycystic ovary (97.2%). Of all participants, 44% had three components of diagnostic criteria. Among those who had two components, presence of abnormal menstrual cycle plus polycystic ovary was the most common finding.

CONCLUSION

Menstrual problem was the most common presenting symptom among the presented participants. Hyperandrogenism/ -emia adds only a little value on making PCOS diagnosis. Most of the PCOS Thai women have menstrual problem. In these patients, ovarian ultrasonography has high value to diagnose PCOS; addition of androgen blood test can diagnose only 3% more PCOS cases. Although the presented PCOS Thai women are stillyoung, approximately 50% already have some parameters of health risk. It is suggested to provide preventive measures for these patients to prevent long term medical problems.

One-year assessment of women receiving sub-dermal contraceptive implant at Siriraj Family Planning Clinic

BACKGROUND

The single-rod Implantable contraceptive method, called 'Implanon', has been introduced for use in Thailand since the 1990s. The outstanding attribute was that it requires only a few minutes for insertion and removal as it has only one capsule. The single-rod implant was used in women at Siriraj Hospital in 2006. The present study looked at characteristics of women, complications of insertion and removal, menstrual events that occurred to women during one year of use and reason for removal of the method.

MATERIAL AND METHOD

This was a retrospective clinic based study. All women's record files were examined at Siriraj Hospital's Family Planning Clinic. There were 166 women enrolled to undergo this method, and only 89 women (54.6%) came back for the one-year follow-up visit. Women's accounts on irregularity of menses, complaints during method used and reason for discontinuation, pregnancy and body weight change were assessed.

RESULTS

Most women (68%) using the implant contraceptive method were 29 years of age with 74% of vocational or lower education. Their BMI was 22.66 +/- 4.06 Insertion time was about 1 minute with no difficulty or complication. Of those women, 40.4% of them considered having regular menstrual cycle and 30.3% had regular menstrual flow for a few months alternately with no menses for a few months. Prolonged menstrual bleeding was the most complaint in this group of women. Amenorrhoea was also reported. Vertigo had occurred to some women without reported medication. One woman asked for the removal of the method due to pain at the implanted site after 8 months of use. Removal time was around 2-3 minutes. There was no pregnancy that occurred in the course of one year of use.

CONCLUSION

Of 89 women using the implant contraceptive method, menstrual irregularity was the important issue that women complained about. However, the removal of the method in one woman was due to the pain at the implanted site. There was no difficulty or complications in insertion or removal of the implant. Close counseling about side effects of the method is emphasized during use to maintain long-term use or until completion of the duration of the device.

Health check-up program for pre/postmenopausal women at Siriraj Menopause Clinic

OBJECTIVE

To determine the general health status of pre/postmenopausal women attending the menopause clinic.

STUDY DESIGN

Retrospective descriptive study.

SETTING

Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University.

STUDY POPULATION

Pre/postmenopausal women (i) presumed to have no medical disease (no disease group) or (ii) with unknown status of medical disease (no record group) and undergoing health check-up program at the time of registration without prior hormone therapy.

MATERIAL AND METHOD

Medical records of new patients registering at the menopause clinic from January 1999 to December 2005 were reviewed.

RESULTS

Among 1,020 patients undergoing health check-up program, there were 366 patients in the no disease group. They had abnormal health parameters listing by frequency of prevalence including hypercholesterolemia (62.3%), suboptimal blood pressure (49.3%), overweight to obese (30.2%), suboptimal fasting blood sugar (2 7.9%), hypertriglyceridemia (21.3%), abnormal liver function tests (5.4-6.9%), and abnormal kidney function tests (0.5%). The prevalence of dyslipidemia was statistically higher in the no record group compared to the no disease group; such abnormal parameters included hypercholesterolemia (> or =200 ml/dL), high blood level of low density lipoprotein cholesterol (LDL-C > or = 130 mg/dL), and high ratio between LDL-C and high density lipoprotein cholesterol (LDL-C/HDL-C ratio >3). Osteoporosis was found in 6.6% of the patients. Abnormal mammographic findings that needed close follow-up or breast biopsy were found in 13.5%. Twelve patients had breast biopsy and none had breast cancer.

CONCLUSION

Abnormal health parameters are common in pre/postmenopausal women presumed to have no medical disease. The similar or even worse findings are also found in those whose status of medical diseases was unknown. Therefore, a routine health screening program, especially for metabolic diseases, should be offered to pre/postmenopausal women regardless of their medical history.

Serum follicle stimulating hormone and estradiol in peri/postmenopausal women attending Siriraj Menopause Clinic: a retrospective study

OBJECTIVES

To determine serum levels of Follicle Stimulating Hormone (FSH) and Estradiol (E) in peri/postmenopausal women attending the menopause clinic.

STUDY DESIGN

Retrospective descriptive study.

SETTING

Siriraj Menopause Clinic, Gynecologic Endocrinology Unit, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital.

STUDY POPULATION

Peri/postmenopausal women attending Siriraj Menopause Clinic from January 1994 to December 2003.

MATERIAL AND METHOD

Medical records of women who had a blood test for FSH and/or E2 prior to hormonal therapy were reviewed.

RESULTS

During a 10 year period, there were 116 eligible patients who could be classified into perimenopausal (31 cases), natural postmenopausal (43 cases), and surgical postmenopausal (32 cases) groups. Age at registration of perimenopausal (47.87 +/- 4.38 yr) and surgical postmenopausal (48.06 +/- 6.49 yr) groups were younger than that of the natural postmenopausal group (55.74 +/- 6.80 yr). The perimenopausal group, who still had regular menstruation, was the youngest. The average FSH level of 60.46 +/- 33.15 mIU/mL was not different among groups. The estradiol level of perimenopausal (79.05 +/- 83.62 pg/mL) and surgical postmenopausal (63.05 +/- 136.39 pg/mL) groups were significantly higher than that of natural postmenopausal (25.05 +/- 37.663 pg/mL) group (p = 0.001). Serum level of FSH or E2 was not correlated with age or years since menopause. There was significant but minimal negative correlation between serum levels of FSH and E2.

CONCLUSION

Serum FSH and/or E2 levels are not accurate enough by themselves to rule in or rule out perimenopause. The authors suggested that clinicians should diagnose perimenopause based on menstrual history and age, without relying on laboratory testing.

Clinical and pathological responses of progestin therapy for non-atypical endometrial hyperplasia: A prospective study

AIMS

To evaluate the clinical and pathological responses and factors predicting non-responders to various progestins currently prescribed for the treatment of non-atypical endometrial hyperplasia.

METHODS

A prospective observational study was conducted in the Gynecologic Endocrinology Unit, Faculty of Medicine, Siriraj Hospital, Thailand, from 1998 to 2003. A 6-month course of progestin therapy was offered to all patients. The clinical response was evaluated from the vaginal bleeding pattern during the first 4 months of treatment. The pathological response was evaluated from the histopathology of the endometrium after completion of the 6-month therapy.

RESULTS

Of 250 registered patients, the number of cases qualified for the evaluation of the clinical and pathological response were 198 and 134 cases, respectively, revealing the overall clinical and pathological response rates of 93.4% and 92.5%, respectively. Among 13 clinical non-responders, 84.6% might have associated pelvic pathology. Among 10 pathological non-responders, three had surgical treatment, and progressive disease was found in one case. Significant factors predicting clinical non-responders included a history of prior bleeding (odds ratio [OR] = 8.79, 95% confidence interval [CI] = 1.63, 47.53), the presence of associated pelvic pathology (OR = 25.52, 95% CI = 3.21, 203.01), and treatment using progestins other than medroxyprogesterone acetate. Factors predicting pathological non-responders were not statistically significant.

CONCLUSIONS

The current regimens of progestin therapy for non-atypical endometrial hyperplasia have high response rates. Patients who fail to have a clinical response should be evaluated for associated pelvic pathology. Follow-up endometrial biopsy should be offered to the patients, because 7.5% have persistent or progressive lesions, necessitating aggressive treatment.

Short and medium term outcomes after rollerball endometrial ablation for menorrhagia

OBJECTIVE

To review prospectively the intraoperative, short and medium term outcomes of patients treated by rollerball endometrial ablation during the learning curve for this relatively new procedure.

PATIENTS AND TECHNIQUES

Seventy-seven women with menorrhagia (71 with dysfunctional bleeding; six with additional small intramural myomas) underwent hysteroscopic rollerball endometrial ablation by coagulation diathermy during 1.5% glycine irrigation, after a two-month period of hormonal suppression. OPERATIVE AND SHORT-TERM EFFECTS: These were recorded at operation and six-week follow-up. No serious short-term complications were recorded. Objective measurement of intraoperative blood loss was always less than 20 mL. One woman experienced uterine perforation with a narrow cervical dilator which did not interfere with the ablation, and two patients had mild postoperative uterine infections. One patient experienced persistent postoperative pain. MEDIUM-TERM OUTCOME: This was recorded at each visit, or by telephone, and confirmed by questionnaire at one year. Twenty-five per cent achieved complete amenorrhoea, 29% staining only, 30% light periods, 10% "normal" or erratic periods and 6% were unchanged. Five patients underwent a second ablation, and three of these later underwent hysterectomy. Measured menstrual blood loss fell from 104 +/- 19 mL (mean +/- standard error of mean) to 1.7 +/- 1.1 mL at six months in 18 women. Other menstrual symptoms were also often dramatically reduced. Of those women with dysmenorrhoea, 33% were cured and 43% markedly improved; of those with midcycle pain, 28% were cured and 53% markedly improved; of those with significant premenstrual symptoms, 13% were cured, 47% markedly improved, 11% unchanged, and 6% were worse.

CONCLUSIONS

This new procedure is a safe and effective treatment for menorrhagia caused by dysfunctional uterine bleeding, with impressive ancillary benefits for dysmenorrhoea, midcycle pain and premenstrual tension. It is often called minimally invasive surgery, but it must be recognised that it is not minor surgery.