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Endometriosis among women with uterine myomata: Prevalence and outcome in a series of 256 laparoscopic hysterectomies
[ Tuesday 1 May 18, i999
than on a 35 PcLgEE-containing OC (NGM/EE) following missed pills. Users of 20 pg EE OCs who miss pills may be at more risk for developing larger follicles that lead to ovulation than users of 35 pg EE OCs.
GYNECOLOGY ENDOMETRIOSISAMONG WOMEN THE EFFECTOF EXTENDING THE PILL-FREE INTERVAL ON FOLLICULAR ACTIVITY: TRIPHASIC NORGESTIMATE/% /&-Lg ETHINYL ESTRADIOL VERSUSMONOPHASIC LEVONORGESTREL/20 /kg ETHINYL ESTRADIOL {eel Lippman, MD, Amy Godwin, BS, and William Olson, PhD Ortho-McNeil Pharmaceutical,Raritan, N]
Objective: To determine the effect of extending the pill-free interval on follicular activity in women taking a triphasic oral contraceptive (OC) containing norgestimate (NGM) and 35 pg ethinyl estradiol (EE; Ortho Tri-Cyclen) or a monophasic OC containing levonorgestrel (LNG) and 20 pg EE (Alesse). Methods: This was an open-label, multicenter study in which subjects were randomized to use NGM/EE or LNG/EE for two consecutive cycles. Tablets for pill days 1 and 2 of cycle 2 were deliberately omitted from each pill container, thus extending the cycle 1 pill-free interval from 7 to 9 days. Vaginal sonograms and progesterone measures were performed on pill days 7,10,14,21, and 28 (2 1 day) of cycle 2. The primary analysis was to test the null hypothesis that the means of the maximum follicular diameter were equal for the two treatments in the completer population. Results: Seventy-nine women were randomized, 40 to NGM/EE and 39 to LNG/EE. For completers, the mean maximum follicular diameter was 12.60 mm in the NGM/EE group and 16.38 mm in the LNG/EE group (P = 0.0470). For the intent-to-treat population, the mean maximum follicular diameter was 12.54 mm in the NGM/EE group and 16.14 mm in the LNG/EE group (P = 0.0502). Presumptive ovulation (progesterone at least 3 ng/mL) occurred in 2 (5%) NGM/EE users and in 3 (8%) LNG/EE users (P = 0.67). In the intentto-treat population, 2 (5%) of NGM/EE users and 4 (10%) LNG/EE users ovulated (P = 0.42). Conclusion: The mean maximum follicular diameter was significantly greater on a 20 Fg EE-containing OC (LNG/EE)
8S Tuesday Papers
WITH UTERINE MYOMATA: PREVALENCEAND OUTCOME IN A SERIESOF 256 LAPAROSCOPIC HYSTERECTOMIES CeanaNezhat, MD,* Nicola Berlanda, MD, Farr Nezhat, MD, Erin Johnson, Senol Kalyoncu, MD, and Camram Nezhat, MD *Stanford University Schoolof Medicine, Palo Alto, CA
Objective: To assess the prevalence of endometriosis in women undergoing laparoscopic hysterectomy for uterine myomata and pelvic pain. Methods: Chart review of 256 consecutive patients with a preoperative diagnosis of uterine myomata without prior diagnosis of endometriosis who underwent laparoscopically assisted vaginal hysterectomy between June 1992 and June 1998. Prevalence of surgically confirmed endometriosis and postoperative pain relief was noted for a follow-up period of 2-72 months (mean, 15 months). Results: Seventy-three percent had preoperative pelvic pain. Mean uterine weight was 284 g (range, 80-2,320 g). One hundred forty (55%) patients had endometriosis. The table shows the prevalence of endometriosis associated with the
Pathologic Report Leiomyoma (n = 136) Leiomyoma and adenomyosis (n = 114) Adenomyosis (n = 6) Total (n = 256)
Prevalenceof Endometriosis (%) 74 (54.4%) 63 (55.3%) 3 (50%)
140(54.7%)
different uterine pathologies. Of the cases of endometriosis, 55.5% was stage I, 21.8% was stage II, 10.9% was stage III, and 11.8% was stage IV. Ten patients had recurrent or persistent pain, 8 with endometriosis. Only 2 patients required laparoscopy, and both revealed recurrent endometriosis. Conclusion: Fifty-five percent of patients with myomata had endometriosis as well. Laparoscopically assisted vaginal hysterectomy is advantageous over vaginal hysterectomy for a thorough evaluation of the abdominopelvic cavity, especially in patients with pelvic pain and uterine myomata.
Obstetrics b Gynecology
than on a 35 PcLgEE-containing OC (NGM/EE) following missed pills. Users of 20 pg EE OCs who miss pills may be at more risk for developing larger follicles that lead to ovulation than users of 35 pg EE OCs.
GYNECOLOGY ENDOMETRIOSISAMONG WOMEN THE EFFECTOF EXTENDING THE PILL-FREE INTERVAL ON FOLLICULAR ACTIVITY: TRIPHASIC NORGESTIMATE/% /&-Lg ETHINYL ESTRADIOL VERSUSMONOPHASIC LEVONORGESTREL/20 /kg ETHINYL ESTRADIOL {eel Lippman, MD, Amy Godwin, BS, and William Olson, PhD Ortho-McNeil Pharmaceutical,Raritan, N]
Objective: To determine the effect of extending the pill-free interval on follicular activity in women taking a triphasic oral contraceptive (OC) containing norgestimate (NGM) and 35 pg ethinyl estradiol (EE; Ortho Tri-Cyclen) or a monophasic OC containing levonorgestrel (LNG) and 20 pg EE (Alesse). Methods: This was an open-label, multicenter study in which subjects were randomized to use NGM/EE or LNG/EE for two consecutive cycles. Tablets for pill days 1 and 2 of cycle 2 were deliberately omitted from each pill container, thus extending the cycle 1 pill-free interval from 7 to 9 days. Vaginal sonograms and progesterone measures were performed on pill days 7,10,14,21, and 28 (2 1 day) of cycle 2. The primary analysis was to test the null hypothesis that the means of the maximum follicular diameter were equal for the two treatments in the completer population. Results: Seventy-nine women were randomized, 40 to NGM/EE and 39 to LNG/EE. For completers, the mean maximum follicular diameter was 12.60 mm in the NGM/EE group and 16.38 mm in the LNG/EE group (P = 0.0470). For the intent-to-treat population, the mean maximum follicular diameter was 12.54 mm in the NGM/EE group and 16.14 mm in the LNG/EE group (P = 0.0502). Presumptive ovulation (progesterone at least 3 ng/mL) occurred in 2 (5%) NGM/EE users and in 3 (8%) LNG/EE users (P = 0.67). In the intentto-treat population, 2 (5%) of NGM/EE users and 4 (10%) LNG/EE users ovulated (P = 0.42). Conclusion: The mean maximum follicular diameter was significantly greater on a 20 Fg EE-containing OC (LNG/EE)
8S Tuesday Papers
WITH UTERINE MYOMATA: PREVALENCEAND OUTCOME IN A SERIESOF 256 LAPAROSCOPIC HYSTERECTOMIES CeanaNezhat, MD,* Nicola Berlanda, MD, Farr Nezhat, MD, Erin Johnson, Senol Kalyoncu, MD, and Camram Nezhat, MD *Stanford University Schoolof Medicine, Palo Alto, CA
Objective: To assess the prevalence of endometriosis in women undergoing laparoscopic hysterectomy for uterine myomata and pelvic pain. Methods: Chart review of 256 consecutive patients with a preoperative diagnosis of uterine myomata without prior diagnosis of endometriosis who underwent laparoscopically assisted vaginal hysterectomy between June 1992 and June 1998. Prevalence of surgically confirmed endometriosis and postoperative pain relief was noted for a follow-up period of 2-72 months (mean, 15 months). Results: Seventy-three percent had preoperative pelvic pain. Mean uterine weight was 284 g (range, 80-2,320 g). One hundred forty (55%) patients had endometriosis. The table shows the prevalence of endometriosis associated with the
Pathologic Report Leiomyoma (n = 136) Leiomyoma and adenomyosis (n = 114) Adenomyosis (n = 6) Total (n = 256)
Prevalenceof Endometriosis (%) 74 (54.4%) 63 (55.3%) 3 (50%)
140(54.7%)
different uterine pathologies. Of the cases of endometriosis, 55.5% was stage I, 21.8% was stage II, 10.9% was stage III, and 11.8% was stage IV. Ten patients had recurrent or persistent pain, 8 with endometriosis. Only 2 patients required laparoscopy, and both revealed recurrent endometriosis. Conclusion: Fifty-five percent of patients with myomata had endometriosis as well. Laparoscopically assisted vaginal hysterectomy is advantageous over vaginal hysterectomy for a thorough evaluation of the abdominopelvic cavity, especially in patients with pelvic pain and uterine myomata.
Obstetrics b Gynecology