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P752 Myometrial contractility patterns in endometriosis compared to menorrhagia
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
nodule shrunk in response to GnRH analogues, but when it continued to persist, the patient underwent a wide local excision of the nodule with umbilical reconstruction. Histopathology confirmed the diagnosis of endometriosis. The patient was followed up at three months and continues to be asymptomatic. The patient has been warned about the risk of recurrence and scar endometriosis. P752 Myometrial contractility patterns in endometriosis compared to menorrhagia F. Dawood1 , S. Quenby2 , S. Wray3 . 1 Liverpool Womens’ Hospital, United Kingdom, 2 University of Liverpool, United Kingdom, 3 Department of Physiology, University of Liverpool, United Kingdom Endometriosis is a debilitating condition and the exact aetiology is still poorly understood. Previous studies have measured uterine contractility in endometriosis using trans-vaginal probes and intrauterine pressure measurements. Objective: Our aim was to determine myometrial contractility patterns in fresh hysterectomy specimens from women with endometriosis compared to menorraghia. Our hypothesis was that the myometrium of women with endometriosis would contract with greater force and amplitude than in women with menorrhagia. Materials and Methods: We conducted a prospective case control study at the Liverpool Womens’ Hospital, United Kingdom. Full thickness hysterectomy specimens were obtained from 15 women with endometriosis (average age = 45; 35–49) and 40 women with menorrhagia (average age = 44; 32–57) and were subjected to invitro laboratory testing. The force, frequency, duration and amplitude were measured in the laboratory. Contractility force was measured simultaneously with intracellular calcium signalling using fluorescent Indo-1. Results: The frequency of uterine contractility was higher in endometriosis while the amplitude was lower compared to menorrhagia. The amplitude was even lower in women who had several different medical treatments for their endometriosis. Statistical analysis: We used the non-parametric Mann-Whitney Test to compare results and found a statistical difference between amplitude measurements in the endometriosis group compared to the menorrhagia group, p = 0.0081 (P < 0.05). Conclusion: Women with endometriosis seem to contract more frequently but with lower amplitude. The frequency of the contractions may explain the associated dysmenorrhea. P753 Analysis of endometrial carcinoma, diagnosed by an explorative curettage for a period of fourteen years A. Dimitrovska. Health Care Center, Skopje, Macedonia Introduction: Endometrial carcinoma is a serious, malignant disease of the uterus, whose occurring rate has marked a significant growth in the last decades. The disease mostly occurs in a post-menopause period, causing irregular/or excessive bleeding. Therefore, each patient with such symptoms in pre or post menopause must be subjected to probatory abrasion of cavum uteri and histological examination of an endometrium. The purpose of this study is to show how many patients, had heavy bleeding, due to endometrial adenocarcinoma. Materials and Methods: This study is a fourteen year analysis (1995–2008) of histopatological results (HPR) acquired by a fractionalized explorative curettage of endometrium samples. Results: 1995 from 795 HPR, a total of 94 (11.82%) had endometrial carcinoma 1996 from 860 HPR, 79 (9.18%) cases of endometrial carcinoma: – 1997 from 870 HPR, 86 (9.88%) cases of endometrial carcinoma; – 1998 from 774 HPR, 46 (5.94%) cases of endometrial carcinoma; – 1999 from 776 HPR, 75 (9.66%) cases of endometrial carcinoma;
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– 2000 from 810 HPR, 69 (8.51%) cases of endometrial carcinoma; – 2001 from 868 HPR, 85 (9.79%) cases of endometrial carcinoma; – 2002 from 916 HPR, 107 (11.68%) cases of endometrial carcinoma; – 2003 from 1120 HPR, 148 (13.21%) cases of endometrial carcinoma; – 2004 from 1098 HPR, 131 (11.93%) cases of endometrial carcinoma; – 2005 from 1223 HPR, 156 (12.75%) cases of endometrial carcinoma; – 2006 from 1350 HPR, 172 (12.74%) cases of endometrial carcinoma; – 2007 from 1290 HPR, 130 (10.08%) cases of endometrial carcinoma; – 2008 from 1400 HPR, 190 (13.57%) cases of endometrial carcinoma. Conclusion: High percentage of endometrial carcinoma among women with irregular/or excessive bleeding, particularly between their fifties and sixties, imposes a necessity for fractionalized explorative curettage that will provide histopathological verification and diagnose, leading to appropriate treatment. P754 The efficacy of low dose estrogen-only add-back therapy in ovarian endometriosis D.S. Choi1 , U.N. Ryoo2 , S.K. Noh2 , H.J. Park2 , B.K. Yoon1 . 1 Department of Obstetrics & Gynecology, Samsung Medical Center; and Sungkyunkwan University School of Medicine, Seoul, Korea, 2 Department of Obstetrics & Gynecology, Samsung Medical Center Objectives: In order to prevent side effects and improve the compliance of postoperative GnRH agonist (GnRHa) treatment, various add-back therapies have been tried. But most add-back regimens including progestogen showed unexpected bleeding patterns that decrease patients’ compliance. The aim of this study was to evaluate the efficacy of low dose estrogen only regimen as an shortterm add-back therapy for GnRHa treatment of patients with ovarian endometriosis. Materials and Methods: The medical records of 137 endometriosis patients receiving postoperative GnRHa treatment (every 4wks, 6 cycles) were reviewed: Group A (n = 76) used tibolone (2.5 mg) and Group B (n = 61) used estradiol valerate (1 mg), as an add-back therapy for 5 months, starting with the second injection of GnRHa. Results: The incidences of uterine bleeding, hypoestrogenic symptoms and pelvic pain did not differ significantly between the two treatment groups. However, in group B, the incidence of uterine bleeding and hot flash were significantly lower during the last 2 months than in group A (p < 0.05) and the most common pattern of uterine bleeding was irregular vaginal spotting in both groups (74.3% vs. 80.0%). At 2 months after the completion of GnRHa treatment, the endometrial thickness was thicker in group B than in group A, without significance (5.9±0.38 vs. 6.7±0.86, p > 0.05) and the evidence of residual lesion or recurrence (less likely) by ultrasonography was not observed in both groups. The CA-125 level was also not significantly different between the two groups. Conclusions: The regimen of low dose estrogen only (Estradiol valerate, 1 mg) is efficacious as an shortterm add-back therapy during postoperative GnRHa treatment in patients with ovarian endometriosis, And the occurrence of side effects including uterine bleeding is similar or better campared with tibolone. Therefore, the regimen of low dose estrogen only within 5 months as an addback therapy is efficacious and well tolerated compared with tibolone.
nodule shrunk in response to GnRH analogues, but when it continued to persist, the patient underwent a wide local excision of the nodule with umbilical reconstruction. Histopathology confirmed the diagnosis of endometriosis. The patient was followed up at three months and continues to be asymptomatic. The patient has been warned about the risk of recurrence and scar endometriosis. P752 Myometrial contractility patterns in endometriosis compared to menorrhagia F. Dawood1 , S. Quenby2 , S. Wray3 . 1 Liverpool Womens’ Hospital, United Kingdom, 2 University of Liverpool, United Kingdom, 3 Department of Physiology, University of Liverpool, United Kingdom Endometriosis is a debilitating condition and the exact aetiology is still poorly understood. Previous studies have measured uterine contractility in endometriosis using trans-vaginal probes and intrauterine pressure measurements. Objective: Our aim was to determine myometrial contractility patterns in fresh hysterectomy specimens from women with endometriosis compared to menorraghia. Our hypothesis was that the myometrium of women with endometriosis would contract with greater force and amplitude than in women with menorrhagia. Materials and Methods: We conducted a prospective case control study at the Liverpool Womens’ Hospital, United Kingdom. Full thickness hysterectomy specimens were obtained from 15 women with endometriosis (average age = 45; 35–49) and 40 women with menorrhagia (average age = 44; 32–57) and were subjected to invitro laboratory testing. The force, frequency, duration and amplitude were measured in the laboratory. Contractility force was measured simultaneously with intracellular calcium signalling using fluorescent Indo-1. Results: The frequency of uterine contractility was higher in endometriosis while the amplitude was lower compared to menorrhagia. The amplitude was even lower in women who had several different medical treatments for their endometriosis. Statistical analysis: We used the non-parametric Mann-Whitney Test to compare results and found a statistical difference between amplitude measurements in the endometriosis group compared to the menorrhagia group, p = 0.0081 (P < 0.05). Conclusion: Women with endometriosis seem to contract more frequently but with lower amplitude. The frequency of the contractions may explain the associated dysmenorrhea. P753 Analysis of endometrial carcinoma, diagnosed by an explorative curettage for a period of fourteen years A. Dimitrovska. Health Care Center, Skopje, Macedonia Introduction: Endometrial carcinoma is a serious, malignant disease of the uterus, whose occurring rate has marked a significant growth in the last decades. The disease mostly occurs in a post-menopause period, causing irregular/or excessive bleeding. Therefore, each patient with such symptoms in pre or post menopause must be subjected to probatory abrasion of cavum uteri and histological examination of an endometrium. The purpose of this study is to show how many patients, had heavy bleeding, due to endometrial adenocarcinoma. Materials and Methods: This study is a fourteen year analysis (1995–2008) of histopatological results (HPR) acquired by a fractionalized explorative curettage of endometrium samples. Results: 1995 from 795 HPR, a total of 94 (11.82%) had endometrial carcinoma 1996 from 860 HPR, 79 (9.18%) cases of endometrial carcinoma: – 1997 from 870 HPR, 86 (9.88%) cases of endometrial carcinoma; – 1998 from 774 HPR, 46 (5.94%) cases of endometrial carcinoma; – 1999 from 776 HPR, 75 (9.66%) cases of endometrial carcinoma;
S627
– 2000 from 810 HPR, 69 (8.51%) cases of endometrial carcinoma; – 2001 from 868 HPR, 85 (9.79%) cases of endometrial carcinoma; – 2002 from 916 HPR, 107 (11.68%) cases of endometrial carcinoma; – 2003 from 1120 HPR, 148 (13.21%) cases of endometrial carcinoma; – 2004 from 1098 HPR, 131 (11.93%) cases of endometrial carcinoma; – 2005 from 1223 HPR, 156 (12.75%) cases of endometrial carcinoma; – 2006 from 1350 HPR, 172 (12.74%) cases of endometrial carcinoma; – 2007 from 1290 HPR, 130 (10.08%) cases of endometrial carcinoma; – 2008 from 1400 HPR, 190 (13.57%) cases of endometrial carcinoma. Conclusion: High percentage of endometrial carcinoma among women with irregular/or excessive bleeding, particularly between their fifties and sixties, imposes a necessity for fractionalized explorative curettage that will provide histopathological verification and diagnose, leading to appropriate treatment. P754 The efficacy of low dose estrogen-only add-back therapy in ovarian endometriosis D.S. Choi1 , U.N. Ryoo2 , S.K. Noh2 , H.J. Park2 , B.K. Yoon1 . 1 Department of Obstetrics & Gynecology, Samsung Medical Center; and Sungkyunkwan University School of Medicine, Seoul, Korea, 2 Department of Obstetrics & Gynecology, Samsung Medical Center Objectives: In order to prevent side effects and improve the compliance of postoperative GnRH agonist (GnRHa) treatment, various add-back therapies have been tried. But most add-back regimens including progestogen showed unexpected bleeding patterns that decrease patients’ compliance. The aim of this study was to evaluate the efficacy of low dose estrogen only regimen as an shortterm add-back therapy for GnRHa treatment of patients with ovarian endometriosis. Materials and Methods: The medical records of 137 endometriosis patients receiving postoperative GnRHa treatment (every 4wks, 6 cycles) were reviewed: Group A (n = 76) used tibolone (2.5 mg) and Group B (n = 61) used estradiol valerate (1 mg), as an add-back therapy for 5 months, starting with the second injection of GnRHa. Results: The incidences of uterine bleeding, hypoestrogenic symptoms and pelvic pain did not differ significantly between the two treatment groups. However, in group B, the incidence of uterine bleeding and hot flash were significantly lower during the last 2 months than in group A (p < 0.05) and the most common pattern of uterine bleeding was irregular vaginal spotting in both groups (74.3% vs. 80.0%). At 2 months after the completion of GnRHa treatment, the endometrial thickness was thicker in group B than in group A, without significance (5.9±0.38 vs. 6.7±0.86, p > 0.05) and the evidence of residual lesion or recurrence (less likely) by ultrasonography was not observed in both groups. The CA-125 level was also not significantly different between the two groups. Conclusions: The regimen of low dose estrogen only (Estradiol valerate, 1 mg) is efficacious as an shortterm add-back therapy during postoperative GnRHa treatment in patients with ovarian endometriosis, And the occurrence of side effects including uterine bleeding is similar or better campared with tibolone. Therefore, the regimen of low dose estrogen only within 5 months as an addback therapy is efficacious and well tolerated compared with tibolone.