- Email: [email protected]
Effects of low-dose oral contraceptives on lipid metabolism in women with insulin-dependent diabetes mellitus
90
the proportion of population in each district (213rd are selected from primary health centres and 1/3rd from secondary care institutions). Conclusions: Analysis of the first 1400 smears suggested an incidence of 2.8% of cervical pre-cancer abnormalities. No cancer cases were seen. The final result of this study will be discussed in the meeting.
P1.04.09 DIAGNOSTIC VALUE AND EFFECTIVNESS OF LOOP DIATHERMY IN TREATMENT OF CIN LESIONS Pantovic S, Petkovic S, Kesic V, Argirovic R, Milenkovic V, Mirkovic Lj, Vukajlovic S, Radovic M., Department of Gynecology and Obstetrics, Clinical center of Serbia, Belgrade, Yugoslavia Objectives: Premalignant changes of uterine cervix develop in the reproductive period of women aged 15-50. The incidence of these changes used to be low, but nowadays it reaches 7011000 in sexually active women below the age of 20. Study methods: In order to investigate advantages and disadvantages and to analyze the efficacy of diathermy in treatment of premalignant changes on the uterine cervix, we compared the results obtained in 178 patients treated by LLETZ method and 100 subjected to conventional surgery. Results: Histopathology after biopsy and LOOP diathermy coincided in 69.1%. The findings obtained with biopsy and after LOOP diathermy coincided in 19.0% of cases with benign changes and 68.2% of CIN III changes. The best results were obtained in cases of HPV infection and CIN I 89.7% and 78.8% of our patients. Significant difference was found between distribution of corresponding histopathological results obtained by biopsy on one hand and postoperative results obtained by LOOP diathermy and conisation on the other. Diathermy yielded corresponding results in 69.1% and conisation in 52.8% of our patients. Conclusions: LLETZ (LOOP) is an effective method in treatment of cervical dysplasia. The advantages include simple and short procedure, possible for outpatient’s treatment in local anesthesia, shorter hospitalization, and improved quality of sample obtained for histopathologic examination and substantially lower cost of the procedure.
P1.04.10 DETECTION OF HUMAN PAPILLOMAVIRUSES IN INTRAEPITHELIAL CERVICAL NEOPLASMS B.Stanimirovic’, N. Kuljic-Kapulica’, R. Radosavljevic’, V. Stanimirovi?, N. Antic’, V. Rajkovic’ ’GYN/OB Clinic “Narodni front”, Belgrade; ‘Institute of Virology, Military Medical Academy, Belgrade; 3 Gale&a R&D Institute, Belgrade Objectives: In the 1994-1998 period 1000 patients suffering from cervical squamous intraepithelial lesions (SIL) were checked for the presence of Human Papillomavirus (HPV) infection. Nowadays, it has been fully acknowledged that certain types of these viruses play a key role in the onset and evolution of these diseases. Study Methods: The methods used in the study included cytodiagnostic methods, colposcopy, histopathological examination of cervical specimens and HPV typing of cervical swabs using commercial kits. Results: The investigation showed that SIL of the cervix occurred in very young women. The highest incidence was found in age groups 24 -28 years (21.2%) and 29-33 years (19.1%). Therefore, over 40% of the entire study group was under 34 years of age. Histological analysis of tissue specimens showed that 79.3% of patients had lesions of low histological grade (LSIL), while in 20.7% the disease progressed to a high histological grade (HSIL). Detection of Human Papillomavirus infection rendered negative results in 34.9% of patients, 17.8% were 6111 positive (non-oncogenic type) and in 47.3% oncogenic types were found (16, 18, 31,33). This finding in the LSIL group was of extreme significance since it influenced the treatment approach. Oncogenic types of viruses were detected in 34.3% of LSIL, which indicates a high progression potential of the pathological changes. Conclusions: The study showed a high incidence of HPV infection in cervical SIL as well as its significance in the onset and evolution of these changes. Detection of oncogenic HPV types in LSIL was crucial in deciding on the treatment approach.
MONDAY,
SEPTEMBER
P1.05 CONTRACEPTION Pl.OS.01 USE OF HORMONAL CONTRACEPTION BY DIFFUSE BENIGN FIBROCYSTIC DISEASE V.P. S.A Lasachko, G.M. Adamova, State Medical University, Il’yicha, Donetsk, Ukraine. Objective: The aim of the investigation is to study the influence of different kinds of hormonal contraceptives on hormonal background and the course of fibrocystic disease, to determine more acceptable kinds of hormonal contraceptives for these patients. Study Methods: 163 women aged 19 - 38 with fibrocystic disease were examined. Patients were divided into three groups: I group - 60 women with fibrocystic disease, they didn’t use hormonal contraceptives; II group - 52 women using monophase combined contraceptives; III group - 51 women pure gestogene. The content of estradiol, progesterone, prolactin in blood serum before contraception was defined in dynamics. Results: Improvement of the disease took place in 10.0% of the I group, in 26.9% of the II group, in 51.0% in the III group. Stabilization of the process was in 80.0%, 69.3%, 47.0% accordingly, aggravation-in lO.O%, 3.8%, 2.0% accordingly. There were no cases of malignisation. In the second group, galactorrhea symptoms increased in 14.3%. The direct correlating dependence between the degree of disease expression and estradioVprogesterone quotient was revealed, correlation quotient was 0.41%. Before contraception hormone content in the three groups didn’t differ. For two years in the third group decreasing of estradiol and prolactin, increasing of preogesterone levels was marked. In the second group decreasing of estradiol, increasing of progesterone and prolactin levels was marked. In the first group, no change in hormone levels was marked. Conclusion: Hormonal contraceptives show positive influence on mammary glands by fibrocystic disease. Pure gestogene must be chosen, if there are galactorrhea symptoms.
Pl.OS.02 MEASURE AND COMPARE THE USE AND EFFECTIVENESS IRANIAN AND FOREIGN TYPES OF IUDs S. Taavoni Iran University of Medical Sciences, Tehran, Iran ->
OF
This is a field study. The purpose was to measure and compare the use and effectiveness of different types of Iranian IUDs (cooper 7 - Tcu200ML) and foreign types of IUDs (LOOP, B, C, D - cooper 7, T ~~200, T380A - ML375) in 1,620 women who have been using the aforementioned methods for birth control in the family planning clinics of Iran Medical Sciences University in 1994. Poisson statistical selection was used. With attention to the goals of research, the tool used was a checklist composed of three main parts -personal characteristics, type of IUD and IUD complications. To analyze the information, the descriptive statistics and life table were used. The results of this research shows that the use and effectiveness of each Iranian and foreign IUD after a period of 1 - 11.5 years is different and is relatively higher than in the reports declared by other countries. Finally, suggestions on the base of gained data for the use of information and the following research were made.
Pl.OS.03 EFFECTS OF LOW-DOSE ORAL CONTRACEmIVES ON LIPID METABOLISM IN WOMEN WITH INSULIN-DEPENDENT DIABETES MELLITUS S. Nikitine 0. Lantseva, V. Potin -> Department of Endocrinology, Ott Institute of OB/GYN RAMS, St. Petersburg, RUSSIA Objectives: The modern progestins and reduction of steroid dose in combined oral contraceptives (OCs) has led to the minimising of adverse effects on metabolism. The aim of the study was to evaluate the effects of OCs on glycometabolic control and lipid metabolism in women with insulin-dependent diabetes mellitus (IDDM).
G
MONDAY,
SEPTEMBER
4
Study Methods: The group A (10 IDDM women with the mean age 27,2*1,3 years and the mean duration of diabetes 11,6*2,1 years) used a combination of 0,02 mg ethinylestradiol (EE) and 0,15 mg desogestrel (DSG) (“Mersilon”, Organon). The group B (10 IDDM women with the mean age 30,2*1,6 years and the mean duration of diabetes 11,3*1,7 years) used a combination of 0,03 mg EE/O,lS mg DSG (“Marvelon”, Organon). All patients were treated with insulin, were normotensive, had good kidney function. Evaluation was performed before and after 3,6 months of hormonal intake. Results: The mean HbAlc values were similar at the beginning, after 3 and 6 months of the study in the two groups. There was no statistically significant change in the insulin requirement of the hormonal intake. In the group A increased levels of apolipoprotein-Al (ape-Al) were noted in the end of the study (from 1,7*0,1 g/l to 2,2*0,1 g/l, p
Pl.OS.04 PRIMARY CARE AUDIT ON INJECTABLE CONTRACEPTIVE, MEDROXYPROGESTERONE ACETATE (DEPO-PROVERA) & ITS LONG TERM EFFECT ON SERUM OESTRADIOL LEVEL & BONE DENSITY S.P. Sinnh, Lordswood Health Center, Chatham, Kent, UK. Objective: This audit was carried out to study the long term effect of injecting Depo-Provera, an extremely effective contraceptive with relatively poor continuation rate due to its side effects in spite of thorough counseling as only 31% have continued for over 3 years. The majority stopped after 9-18 months, which was alarming so we decided to explore the reasons for discontinuation. Study Methods: I have given this injection to 147 patients between January 1994 - December 1999, between the ages of 15-51 years (mean 33). Patients given the injection were searched through computer records, notes, and follow-up card. Data was collected on: duration of treatment, number of injections, side effects, reason for discontinuation, weight gain, serum oestradiol level, bone density result, and PMS symptoms. Patients were called for a repeat injection at 12 weekly intervals, earlier if required, after 6 weeks from last injection. Blood pressure, weight, including side effects were recorded at each visit. Serum oestradiol level is carried out at 2-3 yearly intervals, earlier in symptomatic women. Bone density scan arranged in patients with prolonged amennorhoea (>2 years) and low serum oestradiol. Results: Depo-Provera is an extremely effective contraceptive independent of users’ compliance with no reported failure of pregnancy. Fertility returned on average 12-18 months after the last injection, (earliest pregnancy 3 weeks, latest 22 weeks). 31% of patients continued with this method of contraception, majority of patients stopped after 4-6 injections. Reason for stopping: irregular bleeding 21%, weight gain with bloatedness 44% (average weight gain 6kg, range 2-22kg), loss of libido 5%, vaginal dryness 16%, symptoms similar to menopause 14%, hot flushes, depression, tiredness, etc. 2% patients stopped due to recurrent abdominal pains. No significant blood pressure change noted in long term users. 59% of patients who had continued with injection more than 3 years had low serum oestradiol. 70% of them had level below 52 mmoV1 and most were symptomatic. Bone density scan was arranged on patients with serum oestradiol below 100mmol. Only 18% had low bone density. 65% of symptomatic patients with low serum oestradiol have stopped the injection and opted for alternative contraception, 30% patients continued with addback estrogen, 2% of asymptomatic patients continued with low estrogen, 3% refused all contraception. 70% of patients became amennorhoic after 3 injections. Conclusion: Injection Depo-Provera is an extremely effective contraceptive suitable for non-compliant patients with side effects of weight gain and lowering of serum oestradiol level due to ovulation suppression and prolonged amennorhoea. Fortunately the effect on bone density is minimal and it can be offered as a first line to willing patients after counseling for regular follow-up.
91
P1.05.05 EFFECT OF TWO LOW-DOSE ETHINYLESTRADIOL /LEVONORGESTREL ORAL CONTRACEPTIVES ON HEMOSTATIC BALANCE U.H. Winkler’, G. Peterser?, E. Schulte-Wintropz, A.T. Teichmanr? ‘Dept. OBIGYN, Friedrich-Ebert-Hospital, Neumiinster, Germany ‘Wyeth-Pharma, Schleebriiggenkamp 15, D-48159 Muenster, Germany 3Women’s Hospital, Am Hasenkopf 1, D-63739 Aschaffenburg, Germany Objectives: Levonorgestrel (LNG) ISa well-established progestin frequently used in oral contraceptives (OC). In a controlled clinical trial, the long-term effects of two low-dose OC with different doses of both LNG and ethinylestradiol (EE) on hemostatic balance were studied. Study Methods: In a doubleblind, randomized, parallel-group, study 67 healthy women aged 18 to 35 years received for 12 cycles either Leios@ (0.02 mg EEIO.1 mg LNG, n=34), or Stediril30@ (0.03 mg EE/ 0.15 mg LNG, n=33). Blood samples were taken before treatment and at day 17. 21 of cycle 3, 6, and 12. Relevant parameters of the hemostatic system were analyzed. Results: Changes of the hemostatic parameters were seen after 3 treatment cycles, but not after 6 or 12 cycles. No significant differences between the treatment groups were observed. In both groups the anticoagulatory parameters Antithrombin III and Protein C activity increased whereas free Protein S slightly decreased. The pro-coagulatory parameters Fibrinogen, Factor VII, and Fragment 1+2 showed a moderate increase. No changes of the van Willebrand factor were detected. In addition, the fibrinolytic parameters D-dimer-fibrin degradation product and the Plasmin-antiplasmin complex increased whereas the Plasmin activator-inibitor decreased moderately. Conclusions: Both LNG/ EE formulations Leios@and Stediril30@ have only small and well balanced effects on the hemostatic system.
Pl.OS.06 EFFECT OF TWO LOW-DOSE ETHINYLESTRADIOWLEVONORGESTREL ORAL CONTRACEmIVES ON SERUM LIPIDS W. MBrz’ G. Peterser?, E. Quentir?, A.T. Teichmanr?, H. Wieland’ -> ‘University Hospital, Hugstetter Str. 55,79106 Freiburg, Germany ‘Wyeth-Pharma, Schleebriiggenkamp 15, D-48159 Muenster, Germany 3Women’s Hospital, Am Hasenkopf 1, D-63739 Aschaffenburg, Germany Objectives: The effects of oral contraceptives (OC) on lipid metabolism have been investigated extensively. In a recently performed clinical trial we generated data on the long-term effect of two low-dose OC with different doses of both levonorgestrel (LNG) and ethinylestradiol (EE) on serum lipids and lipoproteins. Study Methods: In a double-blind, randomized, parallel-group, multipledose study 67 healthy women aged 18 to 35 years received either Leios@ (0.02 mg EEIO.1 mg LNG, n=34), or Stediril30@ (0.03 mg EE/ 0.15 mg LNG, n=33) for 12 consecutive cycles. Blood samples were taken twice before treatment and at the end of cycles 3,6, and 12. Results: Serum triglycerides (TG) showed the most significant changes. For total TG as well as TG in the different lipoprotein fractions a marked increase after 3 and 6 treatment cycles was observed. Total cholesterol, LDL- and VLDL-C only slightly increased whereas HDL-C showed only minor alterations. In addition, apolipoprotein E decreased whereas apolipoprotein B slightly increased. Regarding lipoprotein (a) and apolipoprotein AI no changes were detected. There were no significant differences between the treatment groups. Conclusions: The well-known influence of oral contraceptives on serum lipids and lipoproteins have been confirmed. Comparing the two lowdose LNG/EE formulations Leios and Stediril30, no major differences were observed.
Pl.OS.07 UNDERSTANDING FACTORS INFLUENCING REQUEST FOR A REPEAT TERMINATION OF PREGNANCY S.K. 0. Diz-Morales, D. Rennie Urquhart, T.A. Mahmood, Forth Park Hospital, Kirkcaldy, Fife, U.K. Abstract: Despite the opposition of the great religions of the world, termination of pregnancy has been practiced throughout the history of mankind. Over the centuries, the procedure of procuring an abortion has
the proportion of population in each district (213rd are selected from primary health centres and 1/3rd from secondary care institutions). Conclusions: Analysis of the first 1400 smears suggested an incidence of 2.8% of cervical pre-cancer abnormalities. No cancer cases were seen. The final result of this study will be discussed in the meeting.
P1.04.09 DIAGNOSTIC VALUE AND EFFECTIVNESS OF LOOP DIATHERMY IN TREATMENT OF CIN LESIONS Pantovic S, Petkovic S, Kesic V, Argirovic R, Milenkovic V, Mirkovic Lj, Vukajlovic S, Radovic M., Department of Gynecology and Obstetrics, Clinical center of Serbia, Belgrade, Yugoslavia Objectives: Premalignant changes of uterine cervix develop in the reproductive period of women aged 15-50. The incidence of these changes used to be low, but nowadays it reaches 7011000 in sexually active women below the age of 20. Study methods: In order to investigate advantages and disadvantages and to analyze the efficacy of diathermy in treatment of premalignant changes on the uterine cervix, we compared the results obtained in 178 patients treated by LLETZ method and 100 subjected to conventional surgery. Results: Histopathology after biopsy and LOOP diathermy coincided in 69.1%. The findings obtained with biopsy and after LOOP diathermy coincided in 19.0% of cases with benign changes and 68.2% of CIN III changes. The best results were obtained in cases of HPV infection and CIN I 89.7% and 78.8% of our patients. Significant difference was found between distribution of corresponding histopathological results obtained by biopsy on one hand and postoperative results obtained by LOOP diathermy and conisation on the other. Diathermy yielded corresponding results in 69.1% and conisation in 52.8% of our patients. Conclusions: LLETZ (LOOP) is an effective method in treatment of cervical dysplasia. The advantages include simple and short procedure, possible for outpatient’s treatment in local anesthesia, shorter hospitalization, and improved quality of sample obtained for histopathologic examination and substantially lower cost of the procedure.
P1.04.10 DETECTION OF HUMAN PAPILLOMAVIRUSES IN INTRAEPITHELIAL CERVICAL NEOPLASMS B.Stanimirovic’, N. Kuljic-Kapulica’, R. Radosavljevic’, V. Stanimirovi?, N. Antic’, V. Rajkovic’ ’GYN/OB Clinic “Narodni front”, Belgrade; ‘Institute of Virology, Military Medical Academy, Belgrade; 3 Gale&a R&D Institute, Belgrade Objectives: In the 1994-1998 period 1000 patients suffering from cervical squamous intraepithelial lesions (SIL) were checked for the presence of Human Papillomavirus (HPV) infection. Nowadays, it has been fully acknowledged that certain types of these viruses play a key role in the onset and evolution of these diseases. Study Methods: The methods used in the study included cytodiagnostic methods, colposcopy, histopathological examination of cervical specimens and HPV typing of cervical swabs using commercial kits. Results: The investigation showed that SIL of the cervix occurred in very young women. The highest incidence was found in age groups 24 -28 years (21.2%) and 29-33 years (19.1%). Therefore, over 40% of the entire study group was under 34 years of age. Histological analysis of tissue specimens showed that 79.3% of patients had lesions of low histological grade (LSIL), while in 20.7% the disease progressed to a high histological grade (HSIL). Detection of Human Papillomavirus infection rendered negative results in 34.9% of patients, 17.8% were 6111 positive (non-oncogenic type) and in 47.3% oncogenic types were found (16, 18, 31,33). This finding in the LSIL group was of extreme significance since it influenced the treatment approach. Oncogenic types of viruses were detected in 34.3% of LSIL, which indicates a high progression potential of the pathological changes. Conclusions: The study showed a high incidence of HPV infection in cervical SIL as well as its significance in the onset and evolution of these changes. Detection of oncogenic HPV types in LSIL was crucial in deciding on the treatment approach.
MONDAY,
SEPTEMBER
P1.05 CONTRACEPTION Pl.OS.01 USE OF HORMONAL CONTRACEPTION BY DIFFUSE BENIGN FIBROCYSTIC DISEASE V.P. S.A Lasachko, G.M. Adamova, State Medical University, Il’yicha, Donetsk, Ukraine. Objective: The aim of the investigation is to study the influence of different kinds of hormonal contraceptives on hormonal background and the course of fibrocystic disease, to determine more acceptable kinds of hormonal contraceptives for these patients. Study Methods: 163 women aged 19 - 38 with fibrocystic disease were examined. Patients were divided into three groups: I group - 60 women with fibrocystic disease, they didn’t use hormonal contraceptives; II group - 52 women using monophase combined contraceptives; III group - 51 women pure gestogene. The content of estradiol, progesterone, prolactin in blood serum before contraception was defined in dynamics. Results: Improvement of the disease took place in 10.0% of the I group, in 26.9% of the II group, in 51.0% in the III group. Stabilization of the process was in 80.0%, 69.3%, 47.0% accordingly, aggravation-in lO.O%, 3.8%, 2.0% accordingly. There were no cases of malignisation. In the second group, galactorrhea symptoms increased in 14.3%. The direct correlating dependence between the degree of disease expression and estradioVprogesterone quotient was revealed, correlation quotient was 0.41%. Before contraception hormone content in the three groups didn’t differ. For two years in the third group decreasing of estradiol and prolactin, increasing of preogesterone levels was marked. In the second group decreasing of estradiol, increasing of progesterone and prolactin levels was marked. In the first group, no change in hormone levels was marked. Conclusion: Hormonal contraceptives show positive influence on mammary glands by fibrocystic disease. Pure gestogene must be chosen, if there are galactorrhea symptoms.
Pl.OS.02 MEASURE AND COMPARE THE USE AND EFFECTIVENESS IRANIAN AND FOREIGN TYPES OF IUDs S. Taavoni Iran University of Medical Sciences, Tehran, Iran ->
OF
This is a field study. The purpose was to measure and compare the use and effectiveness of different types of Iranian IUDs (cooper 7 - Tcu200ML) and foreign types of IUDs (LOOP, B, C, D - cooper 7, T ~~200, T380A - ML375) in 1,620 women who have been using the aforementioned methods for birth control in the family planning clinics of Iran Medical Sciences University in 1994. Poisson statistical selection was used. With attention to the goals of research, the tool used was a checklist composed of three main parts -personal characteristics, type of IUD and IUD complications. To analyze the information, the descriptive statistics and life table were used. The results of this research shows that the use and effectiveness of each Iranian and foreign IUD after a period of 1 - 11.5 years is different and is relatively higher than in the reports declared by other countries. Finally, suggestions on the base of gained data for the use of information and the following research were made.
Pl.OS.03 EFFECTS OF LOW-DOSE ORAL CONTRACEmIVES ON LIPID METABOLISM IN WOMEN WITH INSULIN-DEPENDENT DIABETES MELLITUS S. Nikitine 0. Lantseva, V. Potin -> Department of Endocrinology, Ott Institute of OB/GYN RAMS, St. Petersburg, RUSSIA Objectives: The modern progestins and reduction of steroid dose in combined oral contraceptives (OCs) has led to the minimising of adverse effects on metabolism. The aim of the study was to evaluate the effects of OCs on glycometabolic control and lipid metabolism in women with insulin-dependent diabetes mellitus (IDDM).
G
MONDAY,
SEPTEMBER
4
Study Methods: The group A (10 IDDM women with the mean age 27,2*1,3 years and the mean duration of diabetes 11,6*2,1 years) used a combination of 0,02 mg ethinylestradiol (EE) and 0,15 mg desogestrel (DSG) (“Mersilon”, Organon). The group B (10 IDDM women with the mean age 30,2*1,6 years and the mean duration of diabetes 11,3*1,7 years) used a combination of 0,03 mg EE/O,lS mg DSG (“Marvelon”, Organon). All patients were treated with insulin, were normotensive, had good kidney function. Evaluation was performed before and after 3,6 months of hormonal intake. Results: The mean HbAlc values were similar at the beginning, after 3 and 6 months of the study in the two groups. There was no statistically significant change in the insulin requirement of the hormonal intake. In the group A increased levels of apolipoprotein-Al (ape-Al) were noted in the end of the study (from 1,7*0,1 g/l to 2,2*0,1 g/l, p
Pl.OS.04 PRIMARY CARE AUDIT ON INJECTABLE CONTRACEPTIVE, MEDROXYPROGESTERONE ACETATE (DEPO-PROVERA) & ITS LONG TERM EFFECT ON SERUM OESTRADIOL LEVEL & BONE DENSITY S.P. Sinnh, Lordswood Health Center, Chatham, Kent, UK. Objective: This audit was carried out to study the long term effect of injecting Depo-Provera, an extremely effective contraceptive with relatively poor continuation rate due to its side effects in spite of thorough counseling as only 31% have continued for over 3 years. The majority stopped after 9-18 months, which was alarming so we decided to explore the reasons for discontinuation. Study Methods: I have given this injection to 147 patients between January 1994 - December 1999, between the ages of 15-51 years (mean 33). Patients given the injection were searched through computer records, notes, and follow-up card. Data was collected on: duration of treatment, number of injections, side effects, reason for discontinuation, weight gain, serum oestradiol level, bone density result, and PMS symptoms. Patients were called for a repeat injection at 12 weekly intervals, earlier if required, after 6 weeks from last injection. Blood pressure, weight, including side effects were recorded at each visit. Serum oestradiol level is carried out at 2-3 yearly intervals, earlier in symptomatic women. Bone density scan arranged in patients with prolonged amennorhoea (>2 years) and low serum oestradiol. Results: Depo-Provera is an extremely effective contraceptive independent of users’ compliance with no reported failure of pregnancy. Fertility returned on average 12-18 months after the last injection, (earliest pregnancy 3 weeks, latest 22 weeks). 31% of patients continued with this method of contraception, majority of patients stopped after 4-6 injections. Reason for stopping: irregular bleeding 21%, weight gain with bloatedness 44% (average weight gain 6kg, range 2-22kg), loss of libido 5%, vaginal dryness 16%, symptoms similar to menopause 14%, hot flushes, depression, tiredness, etc. 2% patients stopped due to recurrent abdominal pains. No significant blood pressure change noted in long term users. 59% of patients who had continued with injection more than 3 years had low serum oestradiol. 70% of them had level below 52 mmoV1 and most were symptomatic. Bone density scan was arranged on patients with serum oestradiol below 100mmol. Only 18% had low bone density. 65% of symptomatic patients with low serum oestradiol have stopped the injection and opted for alternative contraception, 30% patients continued with addback estrogen, 2% of asymptomatic patients continued with low estrogen, 3% refused all contraception. 70% of patients became amennorhoic after 3 injections. Conclusion: Injection Depo-Provera is an extremely effective contraceptive suitable for non-compliant patients with side effects of weight gain and lowering of serum oestradiol level due to ovulation suppression and prolonged amennorhoea. Fortunately the effect on bone density is minimal and it can be offered as a first line to willing patients after counseling for regular follow-up.
91
P1.05.05 EFFECT OF TWO LOW-DOSE ETHINYLESTRADIOL /LEVONORGESTREL ORAL CONTRACEPTIVES ON HEMOSTATIC BALANCE U.H. Winkler’, G. Peterser?, E. Schulte-Wintropz, A.T. Teichmanr? ‘Dept. OBIGYN, Friedrich-Ebert-Hospital, Neumiinster, Germany ‘Wyeth-Pharma, Schleebriiggenkamp 15, D-48159 Muenster, Germany 3Women’s Hospital, Am Hasenkopf 1, D-63739 Aschaffenburg, Germany Objectives: Levonorgestrel (LNG) ISa well-established progestin frequently used in oral contraceptives (OC). In a controlled clinical trial, the long-term effects of two low-dose OC with different doses of both LNG and ethinylestradiol (EE) on hemostatic balance were studied. Study Methods: In a doubleblind, randomized, parallel-group, study 67 healthy women aged 18 to 35 years received for 12 cycles either Leios@ (0.02 mg EEIO.1 mg LNG, n=34), or Stediril30@ (0.03 mg EE/ 0.15 mg LNG, n=33). Blood samples were taken before treatment and at day 17. 21 of cycle 3, 6, and 12. Relevant parameters of the hemostatic system were analyzed. Results: Changes of the hemostatic parameters were seen after 3 treatment cycles, but not after 6 or 12 cycles. No significant differences between the treatment groups were observed. In both groups the anticoagulatory parameters Antithrombin III and Protein C activity increased whereas free Protein S slightly decreased. The pro-coagulatory parameters Fibrinogen, Factor VII, and Fragment 1+2 showed a moderate increase. No changes of the van Willebrand factor were detected. In addition, the fibrinolytic parameters D-dimer-fibrin degradation product and the Plasmin-antiplasmin complex increased whereas the Plasmin activator-inibitor decreased moderately. Conclusions: Both LNG/ EE formulations Leios@and Stediril30@ have only small and well balanced effects on the hemostatic system.
Pl.OS.06 EFFECT OF TWO LOW-DOSE ETHINYLESTRADIOWLEVONORGESTREL ORAL CONTRACEmIVES ON SERUM LIPIDS W. MBrz’ G. Peterser?, E. Quentir?, A.T. Teichmanr?, H. Wieland’ -> ‘University Hospital, Hugstetter Str. 55,79106 Freiburg, Germany ‘Wyeth-Pharma, Schleebriiggenkamp 15, D-48159 Muenster, Germany 3Women’s Hospital, Am Hasenkopf 1, D-63739 Aschaffenburg, Germany Objectives: The effects of oral contraceptives (OC) on lipid metabolism have been investigated extensively. In a recently performed clinical trial we generated data on the long-term effect of two low-dose OC with different doses of both levonorgestrel (LNG) and ethinylestradiol (EE) on serum lipids and lipoproteins. Study Methods: In a double-blind, randomized, parallel-group, multipledose study 67 healthy women aged 18 to 35 years received either Leios@ (0.02 mg EEIO.1 mg LNG, n=34), or Stediril30@ (0.03 mg EE/ 0.15 mg LNG, n=33) for 12 consecutive cycles. Blood samples were taken twice before treatment and at the end of cycles 3,6, and 12. Results: Serum triglycerides (TG) showed the most significant changes. For total TG as well as TG in the different lipoprotein fractions a marked increase after 3 and 6 treatment cycles was observed. Total cholesterol, LDL- and VLDL-C only slightly increased whereas HDL-C showed only minor alterations. In addition, apolipoprotein E decreased whereas apolipoprotein B slightly increased. Regarding lipoprotein (a) and apolipoprotein AI no changes were detected. There were no significant differences between the treatment groups. Conclusions: The well-known influence of oral contraceptives on serum lipids and lipoproteins have been confirmed. Comparing the two lowdose LNG/EE formulations Leios and Stediril30, no major differences were observed.
Pl.OS.07 UNDERSTANDING FACTORS INFLUENCING REQUEST FOR A REPEAT TERMINATION OF PREGNANCY S.K. 0. Diz-Morales, D. Rennie Urquhart, T.A. Mahmood, Forth Park Hospital, Kirkcaldy, Fife, U.K. Abstract: Despite the opposition of the great religions of the world, termination of pregnancy has been practiced throughout the history of mankind. Over the centuries, the procedure of procuring an abortion has