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I74 Contraception: Evaluation of counselling method for decrease the misuse
S20
Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
not significantly different between Exp and Uexp groups (0.20% and 0.19% respectively – RR (Exp/Uexp) = 1.0247). Conclusion: At the end of the 2nd prospective follow-up of the MISSION cohort: breast cancer cumulative incidence seems to be not different between Exposed and Unexposed groups; no increased risk of CHD was found in the Exposed group compared with the Unexposed group. I74 Contraception: Evaluation of counselling method for decrease the misuse P. De Reilhac1 , B. Letombe2 , D. Serfaty3 , M.-C. Micheletti4 , & F.N.C.G.M.. 1 3 place Ladmirault, 44000 Nantes; 2 CHRU Hˆ opital Jeanne De Flandre, Avenue Eug`ene Avin´ee, 59037 Lille Cedex; 3 9, rue Villersexel, 75007 Paris; 4 Laboratoire Th´eramex, 6 avenue Albert II, BP 59, 98007 Monaco Cedex, France Contraception raises the problem of patient information. This often causes discontinuation or at least misuse and non-compliance. What information is sufficient for the doctor to provide the woman at the first prescription of a combined oral contraceptive (COC) to be assured of proper use? Objectives: Develop and evaluate the best information to provide the woman at the first prescription of a COC to facilitate understanding of key messages and good use. 1st Step of this study is to develop this information by consensus of doctors. Material and Methods: DELPHI method has been used. 100 gynaecologists throughout France are asked to fill in a 1st questionnaire. It included 39 items: how the COC works, how to take it, what to do if you forget it, benefits, risks, side effects, warning signs of adverse events. Information of this 1st questionnaire has been retained if there was a consensus of at least 70% of gynaecologists. Each item fulfilling this selection criterion was in the 2nd questionnaire filled by the same gynaecologists. Item has been then retained if there was a consensus of at least 99% of gynaecologists. The informations fulfilling this criterion would be the “best informations” to deliver to women at the first prescription of a COC. They will be evaluated by women in the 2nd step. Results: Results will be presented at the Congress.
K inhibitors, denosumab, modulators of calcium-sensing receptors and modulators of Wnt signalling. I76 Reconstructive surgery of Mullerian ¨ anomalies in young females E. Deligeoroglou, P. Tsimaris, G. Creatsas. Division of Paediatric, Adolescent Gynecology and Reconstructive Surgery, 2nd Department of Obstetrics, Gynecology, Medical School, University of Athens, Greece Mullerian ¨ anomalies are a morphologically diverse group of congenital disorders of the internal female reproductive tract. Their prevalence in women is considered to be between 0.1 and 3%. It has been estimated that 25% to 67% of female individuals with Mullerian ¨ anomalies have some type of reproductive dysfunction. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is the most common example in this category and the second most common cause of primary amenorrhea in adolescents (first is gonadal dysgenesis). Our treatment of choice for vaginal aplasia, of MRKH, is Creatsas’ Vaginoplasty. Unicornuate uterus has the poorest overall reproductive outcome of all uterine anomalies. Didelphys uterus arises when midline fusion of the Mullerian ¨ ducts is arrested. The bicornuate uterus is formed when the Mullerian ¨ ducts incompletely fuse at the level of the uterine fundus. Compared with other Mullerian ¨ malformations, arcuate uterus is clinically benign and may not affect reproductive outcomes. Patients with imperforate hymen present in the perimenarcheal stage with cyclic abdominal pain and amenorrhea. Hematocolpos is one of the few emergency situations associated with congenital anomalies. Similar clinical presentation occurs in patients with Transverse Vaginal Septum or Cervical Agenesis/Dysgenesis. Patients with complete obstructing Longitudinal Septum present with increasingly severe dysmenorrhea. Establishing an accurate diagnosis is essential for planning management. The surgical approach for correction of Mullerian ¨ Duct Anomalies is specific to the type of malformation and may vary in each group. For most surgical procedures, the critical test of the procedure’s value is the patient’s postoperative ability to have healthy sexual relations and achieve successful reproductive outcomes.
I75 Treatment options in osteoporosis
I77 Desire disorders, depression and hormones: The missing link in the lifespan
T.J. de Villiers
L. Dennerstein
The prevention and treatment of osteoporosis related fractures remain a health priority of great importance. Lifestyle changes are important, but a significant reduction in fractures will also require pharmacological intervention. An understanding of treatment options can only be based on a sound knowledge of bone physiology. The concept of bone remodelling is central to this theme. Old bone is removed by the osteoclasts and the resulting resorption pits are filled with new bone by the osteoblasts. This process maintains bone strength and resists fracture. Bone strength is lost if remodelling favours resorbtion. This can be a result of aging or be caused by specific disease processes or drugs. The most common way of modifying this process is to inhibit the osteoclast or to stimulate the osteoblast. Unfortunately, inhibition of the osteoclast will eventually lead to inhibition of the osteoblast and vice versa with a restricted window of treatment, resulting in poor bone quality if used in the long term. Bisphosphonates, estrogen hormone therapy and selective estrogen receptor modulators are the most commonly used drugs in osteoporosis and acts by inhibiting the osteoclasts, while parathyroid hormone stimulate the osteoblast. Recent concerns regarding their long term use will be addressed citing current clinical experience. Strontium ranelate is unique in inhibiting absorption while stimulating formation. Exciting new drugs, based on our better understanding of bone physiology are presently in the pipeline. These include cathepsin
This paper uses data from a large European cross-sectional study (WISHeS) of women aged 20–70 to depict desire disorders and how they change with reproductive aging. Data from the 13 year longitudinal study of women through the menopausal transition (Melbourne Womens Midlife Health Project – MWMHP) is used to further investigate the role of hormones and mood on women’s sexual function. Validated measures were used to assess sexual function domains, sexual distress and mood. (MWMHP-The Short Personal Experiences Questionnaire (SPEQ), Female Sexual Distress Questionnaire, Affectometer 2). WISHeS: Profile of female sexual function, personal distress questionaire. Results: Both WISHeS and MWMHP found profound reduction in all aspects of sexual function with aging and reproductive change (menopause). Distress about sexual function declined with age and postmenopause. Natural and surgical menopause greatly increased the prevalence of low sexual desire. The MWMHP demonstrated a direct relationship between falling estradiol levels, sexual interest and response and vaginal dryness. Mood also directly affected sexual interest and response as did other variables such as feelings for partner and change in partner status. Variables associated with sexual distress and sexual dysfunction included depressed mood scores, low feelings for partner and greater decline in sexual function from baseline. When specific domains
Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
not significantly different between Exp and Uexp groups (0.20% and 0.19% respectively – RR (Exp/Uexp) = 1.0247). Conclusion: At the end of the 2nd prospective follow-up of the MISSION cohort: breast cancer cumulative incidence seems to be not different between Exposed and Unexposed groups; no increased risk of CHD was found in the Exposed group compared with the Unexposed group. I74 Contraception: Evaluation of counselling method for decrease the misuse P. De Reilhac1 , B. Letombe2 , D. Serfaty3 , M.-C. Micheletti4 , & F.N.C.G.M.. 1 3 place Ladmirault, 44000 Nantes; 2 CHRU Hˆ opital Jeanne De Flandre, Avenue Eug`ene Avin´ee, 59037 Lille Cedex; 3 9, rue Villersexel, 75007 Paris; 4 Laboratoire Th´eramex, 6 avenue Albert II, BP 59, 98007 Monaco Cedex, France Contraception raises the problem of patient information. This often causes discontinuation or at least misuse and non-compliance. What information is sufficient for the doctor to provide the woman at the first prescription of a combined oral contraceptive (COC) to be assured of proper use? Objectives: Develop and evaluate the best information to provide the woman at the first prescription of a COC to facilitate understanding of key messages and good use. 1st Step of this study is to develop this information by consensus of doctors. Material and Methods: DELPHI method has been used. 100 gynaecologists throughout France are asked to fill in a 1st questionnaire. It included 39 items: how the COC works, how to take it, what to do if you forget it, benefits, risks, side effects, warning signs of adverse events. Information of this 1st questionnaire has been retained if there was a consensus of at least 70% of gynaecologists. Each item fulfilling this selection criterion was in the 2nd questionnaire filled by the same gynaecologists. Item has been then retained if there was a consensus of at least 99% of gynaecologists. The informations fulfilling this criterion would be the “best informations” to deliver to women at the first prescription of a COC. They will be evaluated by women in the 2nd step. Results: Results will be presented at the Congress.
K inhibitors, denosumab, modulators of calcium-sensing receptors and modulators of Wnt signalling. I76 Reconstructive surgery of Mullerian ¨ anomalies in young females E. Deligeoroglou, P. Tsimaris, G. Creatsas. Division of Paediatric, Adolescent Gynecology and Reconstructive Surgery, 2nd Department of Obstetrics, Gynecology, Medical School, University of Athens, Greece Mullerian ¨ anomalies are a morphologically diverse group of congenital disorders of the internal female reproductive tract. Their prevalence in women is considered to be between 0.1 and 3%. It has been estimated that 25% to 67% of female individuals with Mullerian ¨ anomalies have some type of reproductive dysfunction. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is the most common example in this category and the second most common cause of primary amenorrhea in adolescents (first is gonadal dysgenesis). Our treatment of choice for vaginal aplasia, of MRKH, is Creatsas’ Vaginoplasty. Unicornuate uterus has the poorest overall reproductive outcome of all uterine anomalies. Didelphys uterus arises when midline fusion of the Mullerian ¨ ducts is arrested. The bicornuate uterus is formed when the Mullerian ¨ ducts incompletely fuse at the level of the uterine fundus. Compared with other Mullerian ¨ malformations, arcuate uterus is clinically benign and may not affect reproductive outcomes. Patients with imperforate hymen present in the perimenarcheal stage with cyclic abdominal pain and amenorrhea. Hematocolpos is one of the few emergency situations associated with congenital anomalies. Similar clinical presentation occurs in patients with Transverse Vaginal Septum or Cervical Agenesis/Dysgenesis. Patients with complete obstructing Longitudinal Septum present with increasingly severe dysmenorrhea. Establishing an accurate diagnosis is essential for planning management. The surgical approach for correction of Mullerian ¨ Duct Anomalies is specific to the type of malformation and may vary in each group. For most surgical procedures, the critical test of the procedure’s value is the patient’s postoperative ability to have healthy sexual relations and achieve successful reproductive outcomes.
I75 Treatment options in osteoporosis
I77 Desire disorders, depression and hormones: The missing link in the lifespan
T.J. de Villiers
L. Dennerstein
The prevention and treatment of osteoporosis related fractures remain a health priority of great importance. Lifestyle changes are important, but a significant reduction in fractures will also require pharmacological intervention. An understanding of treatment options can only be based on a sound knowledge of bone physiology. The concept of bone remodelling is central to this theme. Old bone is removed by the osteoclasts and the resulting resorption pits are filled with new bone by the osteoblasts. This process maintains bone strength and resists fracture. Bone strength is lost if remodelling favours resorbtion. This can be a result of aging or be caused by specific disease processes or drugs. The most common way of modifying this process is to inhibit the osteoclast or to stimulate the osteoblast. Unfortunately, inhibition of the osteoclast will eventually lead to inhibition of the osteoblast and vice versa with a restricted window of treatment, resulting in poor bone quality if used in the long term. Bisphosphonates, estrogen hormone therapy and selective estrogen receptor modulators are the most commonly used drugs in osteoporosis and acts by inhibiting the osteoclasts, while parathyroid hormone stimulate the osteoblast. Recent concerns regarding their long term use will be addressed citing current clinical experience. Strontium ranelate is unique in inhibiting absorption while stimulating formation. Exciting new drugs, based on our better understanding of bone physiology are presently in the pipeline. These include cathepsin
This paper uses data from a large European cross-sectional study (WISHeS) of women aged 20–70 to depict desire disorders and how they change with reproductive aging. Data from the 13 year longitudinal study of women through the menopausal transition (Melbourne Womens Midlife Health Project – MWMHP) is used to further investigate the role of hormones and mood on women’s sexual function. Validated measures were used to assess sexual function domains, sexual distress and mood. (MWMHP-The Short Personal Experiences Questionnaire (SPEQ), Female Sexual Distress Questionnaire, Affectometer 2). WISHeS: Profile of female sexual function, personal distress questionaire. Results: Both WISHeS and MWMHP found profound reduction in all aspects of sexual function with aging and reproductive change (menopause). Distress about sexual function declined with age and postmenopause. Natural and surgical menopause greatly increased the prevalence of low sexual desire. The MWMHP demonstrated a direct relationship between falling estradiol levels, sexual interest and response and vaginal dryness. Mood also directly affected sexual interest and response as did other variables such as feelings for partner and change in partner status. Variables associated with sexual distress and sexual dysfunction included depressed mood scores, low feelings for partner and greater decline in sexual function from baseline. When specific domains