Sequelae of postpartum sterilization

This study was designed to investigate the menstrual, psychosexual, psychological and somatic sequelae in a group of women who may be more prone to express regret following postpartum sterilization. The follow-up was conducted by questionnaire at six months and five years following the procedure. Data were available from 242 patient; 76.8% were below the age of 30. Of all patients, 21.9% expressed regrets. About one third had various menstrual disturbances. Patients rated their sex life as generally more enjoyable in many aspects. The most common psychological symptoms were irritability, nervousness and depression; while the common somatic symptoms were pelvic/abdominal pain and backache and tiredness. Received: 9 October 1997 / Accepted: 25 March 1998     

Reasons for tubal sterilisation,regret and depressive symptoms

Objective: To examine the associations between sterilisation reasons, regret and depressive symptoms. Method: Black, Hispanic and non-Hispanic White US women ages 25–45 who participated in the National Survey of Fertility Barriers (NSFB) and reported a tubal sterilisation surgery were included in the sample for this study (n = 837). Logistic regression was used to examine how characteristics of the sterilisation surgery (reasons for sterilisation, time since sterilisation and new relationship since sterilisation) are associated with the odds of sterilisation regret, and linear regression was used to examine associations between sterilisation regret, sociodemographic factors and depressive symptoms. Results: Findings revealed that 28% of US women who have undergone tubal sterilisation report regret. Time since sterilisation and having a reason for sterilisation other than simply not wanting (more) children (e.g. situational factors, health problems, encouragement by others and other reasons) are associated with significantly higher odds of sterilisation regret. Finally, sterilisation regret is significantly associated with depressive symptoms after controlling for sociodemographic characteristics. Conclusion: Sterilisation regret is relatively common among women who have undergone tubal sterilisation, and regret is linked to elevated, but not necessarily clinical, depressive symptoms. The reasons for sterilisation can have important implications for women’s sterilisation regret and associated depressive symptoms.     

The effect of laparoscopic sterilisation by diathermy or silastic bands on post-operative pain, menstrual symptoms and sexuality.

A total of 530 patients was reviewed six months after laparoscopic sterilisation by diathermy (235 patients) or silastic bands (295 patients). In the immediate postoperative period severe lower abdominal pain was more common in the patients who had silastic bands. There was no differences in the nature or incidence of menstrual problems when the two methods were compared. In all, 40 per cent of patients reported an increase in menstrual blood loss ad 26 per cent of patients an increase in menstrual pain, and this could not be attributed entirely to stopping oral contraception; 42 per cent of patients reported improvement in their sex lives after sterilisation, while 6.6 per cent reported deterioration mainly due to lack of libido. There was some regret about the operation in 5.1 per cent of patients.     

Risk factors for strong regret and subsequent IVF request after having tubal ligation

OBJECTIVES: To identify and describe pre-sterilisation characteristics most consistently associated with intensive post-sterilisation regret and subsequent request for IVF. DESIGN: Case control study. SETTING: Fertility clinic in a tertiary referral urban hospital, Sydney, Australia. SAMPLE CASES: Ninety-seven sterilised women who underwent evaluation for IVF during the period 1986-1996; Controls: 101 sterilised women who remained satisfied with their tubal ligation. MAIN OUTCOME MEASURES: Variables known at the time of sterilisation including age, number of living children, history of abortion, underlying medical diseases, marital status, race, education, and timing of sterilisation. RESULTS: In the multivariate analysis of data, age at the time of sterilisation had the most pronounced effect on strong regret. Women younger than 30 years old at the time of sterilisation were more likely to request IVF treatment than women 30 to 34 years old. A concurrent caesarean section was associated with a threefold risk (95% CI, 1.05-10.03) relative to an interval procedure. A strong protective effect (OR = 0.07; 95% CI, 0.01-0.65) was found for women with more than two children compared to childless women. The overwhelming reason stated by women requesting IVF was change in marital status, and the desire to have a child with the new partner. CONCLUSIONS: Women with such characteristics who are considering tubal ligation need further caution and counselling.     

The characteristics of 100 women presenting to a gynecological clinic with premenstrual complaints

100 women consecutively referred to a gynaecological clinic with premenstrual problems were prospectively assessed by daily completion of a set of visual analogue scales (VAS). The relationship of their symptoms to menstrual cycle phase was quantified by calculating the percentage change in symptom intensity between the premenstrual week and the postmenstrual week and also during menstruation itself. The results indicated that the physical symptoms of breast discomfort and swelling were more closely related to menstrual cycle phase than were the psychological symptoms of tension, irritability or lethargy and depression. Only 32 of the women showed reduction of the premenstrual psychological symptoms by 75% or more during the postmenstrual week, while the corresponding degree of physical symptom relief was recorded by 62 women. For almost half the women, adverse mental symptoms reached their peak after the onset of menstrual bleeding. Significantly fewer of the women with almost total (75% or more) relief of their psychological symptoms postmenstrually had a history of psychiatric treatment, marital breakdown, or more than three children, compared with those whose symptoms were less completely relieved. The results suggest that a large proportion of women who experience premenstrual symptoms suffer a premenstrual and/or menstrual exacerbation of problems which are present throughout the cycle and are therefore unlikely to respond to hormonal manipulation.     

Immediate sequelae and rationale of menstrual regulation

Menstrual regulation as a contraceptive method, as well as a form of early pregnancy termination, was studied in 200 patients presenting at the All India Institute of Medical Sciences Hospital for pregnancy termination. Findings supported the contention that menstrual regulation is a simple, safe, and effective procedure. Recommendations were made to incorporate the procedure into family planning services. Women were deemed eligible for the menstrual regulation study if no more than 45 days had elapsed since their last menstrual cycle and if their medical history did not contraindicate the use of the procedure. The women were given a pregnancy test prior to aspiration. The menstrual regulation procedure was performed with an electric vaccum aspirator and the patients received no anesthetic. Following the procedure the aspirate was histologically examined for pregnancy determination. Four weeks later the patients were given a pelvic examination and a urine pregnancy test. Histological examination of the aspirate confirmed pregnancy in 80.5% of the patients. When the findings were compared to the preoperative pregnancy test results, 2.5% of the pregnancy tests were false positives and 4% were false negatives. No severe complications occurred at the time of the procedure an only 2% of the patients required additional curettage. In the 4 week follow-up examination, 10% of the patients reported minor symptoms, 3% reported minor infections, and all pregnancy tests were negative. Following the procedure, 20% of the patients accepted IUDs, 15% accepted horomonal contraceptives, and the remaining 65% opted for conventional methods. Tables show 1) age distribution of patients; 2) distribution of patients by gestation and amount of aspirate; 3) accuracy of pregnancy test compared to histological findings; 4) frequency of histological findings; 5) reported follow-up symptoms for those patients who accepted IUDs and those who did not accept IUDs immediately after menstrual regulation.     

Abdominal Bloating: An Under-recognized Endometriosis Symptom

ObjectiveTo explore the association between the symptom of abdominal bloating and the diagnosis of endometriosis.MethodsTwenty-six patients with endometriosis diagnosed by laparoscopy and 25 women without endometriosis were recruited to a case-control study. Subjects completed detailed questionnaires regarding perception of abdominal bloating, bloating-related symptoms, and effect on lifestyle. Abdominal girth was measured three times daily for one whole menstrual cycle, as were ratings of perceived abdominal bloating severity and discomfort. Experiences of abdominal and gastrointestinal symptoms were compared.ResultsA significantly larger proportion of women with endometriosis than control subjects experienced abdominal bloating (96% vs. 64%). In women with abdominal bloating, the following were more common in those who had endometriosis: associated severe discomfort (30% vs. 0%), wearing loose clothes during bloating (87% vs. 38%), and simultaneous hand swelling (30% vs. 6%). The experiences of cyclically related diarrhea and constipation were more frequent with endometriosis. While there were significant changes in bloating and discomfort ratings across the menstrual cycle, there was a trend towards a difference between the control subjects and unmedicated endometriosis groups only in how the pattern of bloating severity fluctuated across the cycle. Lower abdominal girth measurements changed significantly across menstrual cycle phases. Control and unmedicated endometriosis groups differed significantly in girth changes across the menstrual cycle, controls experiencing much less variation. Compared with the unmedicated endometriosis group, women receiving hormonal treatment had higher bloating severity ratings and discomfort scores, but there was no objective difference in abdominal girth.ConclusionPainful abdominal bloating appears to be common in women with endometriosis and causes considerable symptomatic distress.     

Effect of an oral contraceptive containing drospirenone and ethinylestradiol on general well-being and fluid-related symptoms.

Oral contraception is the most widely used reversible contraceptive method. Continuous research over the past decades has led to a range of highly reliable, effective and safe oral contraceptives. Newly developed progestogens may also provide additional non-contraceptive health-related benefits that differentiate the products from each other. Women desiring contraception may thus choose from a wide range of oral contraceptives according to their individual needs. A variety of physical and emotional changes have been linked to hormonal fluctuations during the menstrual cycle. To date, only very few studies have been performed on the impact of fluid retention-related symptoms on well-being and few data are hence available on suggested methods of measurement. This open, multicenter, uncontrolled study evaluated the effects of a combined preparation containing 3 mg drospirenone and 30 microg ethinylestradiol (Yasmin, Schering AG, Berlin, Germany) on general well-being and fluid-related symptoms in women experiencing psychological, behavioral and somatic premenstrual symptoms. The study was conducted over six 28-day cycles, with 336 subjects enrolled. A significant beneficial effect on psychological general well-being, as measured by the Psychological General Well-Being Index (PGWBI), was evident by cycle 3 and maintained at cycle 6. There was a significant reduction in both the incidence and severity of somatic symptoms associated with the menstrual cycle (abdominal bloating and breast tension) during treatment. Assessment by the investigator showed that 80% of subjects had improved on study treatment and 75% of subjects considered themselves satisfied with the study treatment. There was good agreement between the clinician and subject in their assessment of the treatment. Cycle control was very good and body weight remained stable or decreased slightly during the study. In conclusion, 3 mg drospirenone in combination with 30 microg ethinylestradiol has been shown to have a beneficial effect on psychological general well-being, as measured by the PGWBI. Reductions in the incidence and severity of somatic symptoms associated with the menstrual cycle were also observed, suggesting a beneficial effect due to the antimineralocorticoid nature of drospirenone. To our knowledge, this is the first study on oral contraceptives which has used the PGWBI in this population. As quality of life is one of the least explored segments in oral contraceptive users, more studies should investigate the impact of oral contraceptives on quality of life and general well-being in this overall healthy population.     

Endocrine and psychological problems in women subjected to tubal sterilization

Italian law permits sterilization only for therapeutic reasons, i.e., in cases where a woman's health would be endangered by continued pregnancies. Recently, however, new legislative debate has opened for consideration provision of sterilization for nontherapeutic reasons. Ethical, social, and religious questions were raised. Additionally, questions regarding sterilization's psychological effect and its effect on ovarian endocrine activity were raised. Consequently, the authors undertook research to study these areas. 25 women who underwent therapeutic sterilization between 1976 and 1982 were examined. Patients ranged in age from 24 to 42 years, with a median age of 32.8 years. 1 patient had 1 child, 11 had 2 children, 11 had 3 children, and 2 had 4 children. 19 had not used any type of contraception, 4 had used oral contraceptives, and 2 had used IUDs. After sterilization, the women were questioned on the psychological repercussions of their surgery. Regarding sexual activity, 40% reported an increase, 4% a decrease, and 56% reported no change. On psychological aspects of intercourse, 88% reported improvement, while 22% a worsening. The psychosexual attitude of the spouse was positively affected in 60%, negatively affected in 8%, and unchanged in 32%. 12% of the women felt regret over no longer being able to bear children, 72% felt no regret, and 16% were indifferent. Overall satisfaction with the surgery was reported by 88%, while 22% were dissatisfied. Regarding the menstrual cycle, 6 patients reported changes in the rhythm of the cycle, 4 being affected by polymenorrhea and 2 affected by oligomenorrhea. 10 patients reported changes in the quantity of menstrual flow, 8 experiencing hypermenorrhea and 2 hypomenorrhea. 2 patients experienced changes in duration of menstruation. FSH, LH, prolactin, E2, and progesterone blood levels are reported both for women who demonstrated a rise in basal body temperature and for those without temperature elevation. Reduced progesterone levels in 48% of the patients was noted. The authors speculate that this may have occurred because of neurovascular lesions caused during ligation. This hypothesis, confirmed by others, might explain not only cycle irregularities in some sterilized women, but also an increased incidence of fibrocystic breast disease. In conclusion, the authors state that because no psychological or organic alterations exist, except for a slight insuffiency during the luteal phase, that legalization of nontherapeutic sterilization should be considered.     

Effect of an oral contraceptive containing drospirenone and ethinylestradiol on general well-being and fluid-related symptoms

Oral contraception is the most widely used reversible contraceptive method. Continuous research over the past decades has led to a range of highly reliable, effective and safe oral contraceptives. Newly developed progestogens may also provide additional non-contraceptive health-related benefits that differentiate the products from each other. Women desiring contraception may thus choose from a wide range of oral contraceptives according to their individual needs. A variety of physical and emotional changes have been linked to hormonal fluctuations during the menstrual cycle. To date, only very few studies have been performed on the impact of fluid retention-related symptoms on well-being and few data are hence available on suggested methods of measurement. This open, multicenter, uncontrolled study evaluated the effects of a combined preparation containing 3 mg drospirenone and 30 μg ethinylestradiol (Yasmin^®, Schering AG, Berlin, Germany) on general well-being and fluid-related symptoms in women experiencing psychological, behavioral and somatic premenstrual symptoms. The study was conducted over six 28-day cycles, with 336 subjects enrolled. A significant beneficial effect on psychological general well-being, as measured by the Psychological General Well-Being Index (PGWBI), was evident by cycle 3 and maintained at cycle 6. There was a significant reduction in both the incidence and severity of somatic symptoms associated with the menstrual cycle (abdominal bloating and breast tension) during treatment. Assessment by the investigator showed that 80% of subjects had improved on study treatment and 75% of subjects considered themselves satisfied with the study treatment. There was good agreement between the clinician and subject in their assessment of the treatment. Cycle control was very good and body weight remained stable or decreased slightly during the study. In conclusion, 3 mg drospirenone in combination with 30 μg ethinylestradiol has been shown to have a beneficial effect on psychological general well-being, as measured by the PGWBI. Reductions in the incidence and severity of somatic symptoms associated with the menstrual cycle were also observed, suggesting a beneficial effect due to the antimineralocorticoid nature of drospirenone. To our knowledge, this is the first study on oral contraceptives which has used the PGWBI in this population. As quality of life is one of the least explored segments in oral contraceptive users, more studies should investigate the impact of oral contraceptives on quality of life and general well-being in this overall healthy population.     

Hormonal management of premenstrual syndrome

Premenstrual syndrome (PMS) is a psychological and somatic disorder of unknown aetiology. The symptoms of PMS regularly occur during the luteal phase of the menstrual cycle and resolve by the end of menstruation. The severe and predominantly psychological form of PMS is called 'premenstrual dysphoric disorder'. PMS results from ovulation and appears to be caused by the progesterone produced following ovulation in women who have enhanced progesterone sensitivity. This enhanced sensitivity may be due to neurotransmitter dysfunction. Treatment is aimed at suppressing ovulation or reducing progesterone sensitivity. This chapter will describe the role of hormones and hormonal treatments in PMS.     

Changes in autonomic nerve function during the normal menstrual cycle measured by the coefficient of variation of R-R intervals

The purpose of this study was to determine if there is a change in autonomic nerve function during the menstrual cycle. The subjects were 20 females (average age 26.1 years +/- 4.6) with a normal menstrual cycle. The coefficient of variation of R-R intervals (CV R.R) was measured to investigate autonomic function in the menstrual, follicular, ovulatory, luteal, and premenstrual phases. Average CV R-R for all phases was 5.2 +/- 1.9%. And the CV R-R tended to be lower in those in their 30s than in those in their 20s. And no noticeable difference was seen in the CV R-R among the 5 phases of the menstrual cycle. On the other hand, the CV R-R of 11 females with premenstrual syndrome was low in the ovulatory, luteal and premenstrual phases. These results, which provide basic data for clinical use, suggest the following. (1) The age of subjects should be taken into consideration. (2) Changes in the CV R-R during the menstrual cycle are negligible. (3) However, in those showing symptoms associated with the menstrual cycle such as premenstrual syndrome, changes during the menstrual cycle should be taken into account. At the same time psychological changes in the subjects were evaluated by the following tests: Cornell Medical Index, Taylor's manifest anxiety scale, and Zung's self-rating depression scale. The results of these tests did not vary significantly during the menstrual cycle.     

Risk factors in stage III epithelial ovarian cancer: previous sterilisation is an adverse independent prognostic indicator

OBJECTIVES: To determine whether past history of pelvic surgery is of prognostic significance in stage III epithelial ovarian cancer. METHODS: A retrospective review of 140 women with stage III epithelial ovarian cancer. RESULTS: Sixteen women had previously undergone pelvic surgery including eight sterilisations (6%), seven hysterectomies (5%) and one ovarian cystectomy (0.7%). Women with a past history of sterilisation were significantly younger (median age, 46 years) than women without a past history of sterilisation (median age, 63 years), and also significantly younger than women with a past history of hysterectomy (median age, 58 years). In addition, the sterilisation procedure was performed at a significantly younger age than the hysterectomy procedure (p=0.008). On multivariate analysis comparing previous pelvic surgery, previous malignancy, place of surgery, interval/secondary debulking, presence of concomitant tumour, performance of bowel surgery, histological grade, histological type, size of residual disease and age, all of the following were seen to be independent variables associated with outcome survival; previous sterilisation (p=0.0012), age (p=0.0074), histological type (p=0.025), histological grade (p=0.0017) and size of residual disease (p=0.0043). CONCLUSION: Past history of sterilisation appears to be an adverse independent prognostic indicator in women presenting with stage III epithelial ovarian cancer. To have developed ovarian cancer despite the protective effects of a sterilisation procedure against environmental factors might possibly suggest a predisposition to ovarian cancer in these women. Further studies are indicated to confirm the present results.     

An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease

In acute appendicitis, the most difficult group of patients to evaluate is that of women of childbearing age. The results of a recent report showed that women of this age group with acute appendicitis tend to have the onset of symptoms in the luteal phase of the menstrual cycle. In view of this, and since some forms of pelvic inflammatory disease tend to have the onset of symptoms in the menstrual phase of the cycle, a study was undertaken to determine if menstrual history might be of value in differentiating acute appendicitis and PID. In comparing the onset of symptoms of five groups--1, perforated or gangrenous appendicitis; 2, acute suppurative appendicitis; 3, normal appendix; 4, normal appendix with PID (a subgroup of group 3), and 5, PID only--no difference was found in the percentage of patients presenting in each phase of the menstrual cycle among the groups. The incidence of disease (per day) appeared to remain the same between phases of the cycle in each group, suggesting that patients in all groups present in a random manner in relation to the menstrual cycle. We conclude that the menstrual history does not appear helpful in differentiating acute appendicitis and pelvic inflammatory disease in women of childbearing age.     

Psycho-sexual repercussions of female sterilization

239 women, who constituted 61% of the 389 undergoing sterilization operations in a Geneva maternity hospital in 1977, were interviewed by telephone 18 months-2 years later to assess the occurrence of psychosexual side effects. 20% reported gaining more than 3 kg; 10% experienced psychological trouble manifested in irritability, depression, or sleep disorders; 15% reported a persistent desire for a child or pregnancy; 1/3 reported an improved sexual adjustment; 10% reported a deterioration; and 7% reported experiencing pain during intercourse. 20% were under 30 years old at the time of the operation but they did not experience a higher rate of side effects than the older women. Women without any children, women from lower socioeconomic levels, and immigrant women expressed higher degrees of regret. Women exposed to religious opposition to sterilization, all of whom were practicing Catholics, were more likely to experience psychosexual side effects. Negative repercussions were also more common when the decision was made on medical grounds rather than as a personal choice by the woman, and when the procedure immediately followed abortion or childbirth. 16% felt that they had received insufficient medical information prior to the procedure. The experience of regret at not having another child and desire for another pregnancy were less when women who had themselves undergone the operation were involved in counseling.     

Changes in premenstrual symptoms in women starting or discontinuing use of oral contraceptives

Abstract

It is not clear whether oral contraceptive (OC) treatment affects premenstrual symptoms in women. The aim of the present study was to evaluate changes in premenstrual symptoms (PMS) in women starting to use or discontinuing the use of OCs. Twenty-four healthy women with no previous diagnosis of premenstrual dysphoric disorder were included in this study with a prospective crossover design. Nineteen women completed daily ratings of somatic and mood symptoms during two hormonally different cycles, during a normal menstrual cycle and while using OCs. The menstrual cycle phases were hormonally verified and the low-dose, monophasic OCs were used in a 21/7 regimen. The onset of OC use significantly decreased premenstrual somatic symptoms, but it did not affect mood symptoms. In the women who discontinued OC use, no significant changes in neither somatic nor mood symptoms appeared in the premenstrual phase.     

Emotional changes within the menstrual cycle: anxiety,anger and depression

The premenstrual syndrome (PMS) includes a regularly occurring increase in psychological and/or somatic symptoms in the days preceding the menstrual flow. Eight hundred and forty-four women responded to a number of questionnaires on days 12, 18, 22 and 26 of their menstrual cycle. Change scores of the four menstrual distress scales pain, water retention, impaired concentration and negative affect served to form subgroups of cases with very clear and moderately clear PMS. Scores for anxiety, anger and depression show a dramatic increase in PMS women over time. The group with a very clear PMS symptomatology consistently experiences a highly significant increase in anxiety, anger and depression. Besides, the relationships between PMS, neuroticism, anxiety, anger and depression are studied. It seems that neuroticism is less powerful in explaining the variation of anxiety, anger and depression than the subgroups derived from PMS change scores. The results suggest, especially for those who view PMS from a ‘biopsychosocial’ perspective, that it might be possible to improve the diagnosis and assessment of PMS by administering anxiety, anger and depression scales at two or more points in time.     

Female sterilisation: a cohort controlled comparative study of ESSURE versus laparoscopic sterilisation

OBJECTIVE: To compare patient satisfaction, discomfort, procedure time, success rate and adverse events of hysteroscopic (ESSURE, Conceptus Inc, San Carlos, USA) versus laparoscopic sterilisation. DESIGN: Cohort controlled comparative study. SETTING: The day surgery and outpatient unit of three large UK hospitals. POPULATION: Eighty-nine women requesting sterilisation were enrolled into the study. METHODS: A 2:1 ratio of ESSURE placement to laparoscopic sterilisation was undertaken. Laparoscopic sterilisation was carried out under general anaesthesia in the day surgery unit whereas all ESSURE procedures were carried out in a dedicated outpatient facility. All patients completed a self-assessment diary on days 7 and 90 post-operatively. Patient satisfaction, tolerance and discomfort were measured using an ordinal Likert style scale. Data were analysed using the chi(2) test for statistical significance. MAIN OUTCOME MEASURES: The primary outcome measure is patient satisfaction with ESSURE versus laparoscopic sterilisation. This included satisfaction with the decision to proceed with the relevant sterilisation method, recovery from the procedure and overall satisfaction following either ESSURE or laparoscopic sterilisation. Secondary outcome measures include successful completion of procedure, procedure time, tolerance, patient discomfort and post-operative adverse events. RESULTS: All women who underwent laparoscopic sterilisation had the procedure successfully completed whereas the overall bilateral device placement rate for ESSURE was 81%. Patient satisfaction with their decision to undergo either ESSURE or laparoscopic sterilisation was high with 94% of the ESSURE group being 'very' or 'somewhat' satisfied at 90 days post-procedure versus 80% in the laparoscopic sterilisation group. At 90 days post-procedure 100% of women in the ESSURE group were 'very satisfied' with their speed of recovery versus 80% in the laparoscopic sterilisation group. The procedure time (defined from the time of insertion of the hysteroscope or laparoscope to its removal) took significantly longer for ESSURE than laparoscopic sterilisation (mean = 13.2 vs 9.7 minutes, P= 0.045). However, the time required for insertion of a Verres needle and insufflation of the abdominal cavity is a necessary part of the laparoscopic sterilisation and had it been included would bring the procedures times more in line with each other. The mean time spent in hospital was significantly shorter for the ESSURE group than the laparoscopic group (188.7 vs 396.1 minutes, P < 0.005). Eighty-two percent of women in the ESSURE group described their tolerance of the procedure between 'good and excellent' compared with only 41% of the laparoscopic sterilisation group (P= 0.0002). Only 31% of the ESSURE group reported moderate or severe pain following the procedure compared with 63% of the laparoscopic sterilisation group (P= 0.08). Only 11% of patients had problems immediately post-operatively in the ESSURE group compared with 27% in the laparoscopy group. Finally, in the more medium term (three months post-operatively), patients still had an advantage in terms of post-procedure adverse events in the ESSURE group (21%vs 50%). CONCLUSIONS: This study provides evidence that ESSURE can be performed in the majority of women and, when successful, is associated with a greater overall patient satisfaction rate than laparoscopic sterilisation. Women also spend less time in hospital, have better tolerance of the procedure and describe less severe post-operative pain. However, the devices cannot be bilaterally placed in all cases and some women do not tolerate the procedure awake.     

Estradiol implants,hormone levels and reported symptoms

Subcutaneous estradiol implants are used to give hormone replacement therapy following hysterectomy and oophorectomy. They may be renewed when symptoms return or when estradiol levels fall. Eighteen women who had requested renewal of implants were assessed on a number of endocrine and psychological measures. All except one reported psychological or vasomotor symptoms but only two had estradiol levels below the normal menstrual range of 200-800 pmol/1. Twelve reported vasomotor symptoms and had lower levels of estradiol but were no different on psychological measures. Symptom rating scores, personality scores and anxiety scores were not related to estradiol levels. Two case histories describe symptoms in women with supraphysiological levels of estradiol. Women who had levels of estradiol within normal range yet reported hot flushes were no more 'anxious' or 'neurotic' than those not reporting hot flushes. Six women requested renewal of the estradiol implant who did not have vasomotor symptoms or vaginal dryness which are regarded as estrogen dependent symptoms. There is no clear relationship between absolute levels of estradiol and reported symptoms. A possible explanation is that symptoms are triggered by a fall in estrogen levels. An alternative explanation is that psychological factors such as locus of control may be important.     

Increased salivary chromogranin A in women with severe negative mood states in the premenstrual phase

The present study investigated whether salivary chromogranin A (CgA), a psychological stress marker associated with sympathetic nervous system activity, changes during the menstrual cycle in women with different degrees of premenstrual psychoemotional symptoms. Forty-five women (28.6?±?1.3 years) with regular menstrual cycles participated in this study. Salivary CgA and cortisol were measured during the follicular and late-luteal phases. The authors used the Profile of Mood State (POMS) to assess current mood states of subjects in each menstrual phase and divided the subjects into three groups depending on increase of total mood disturbance (TMD), a global measure of affective states of POMS from the follicular to the late-luteal phase: Low (4.1?±?0.7%), Middle (18.7?±?1.2%) and High (51.7?±?7.4%). Results showed no intramenstrual cycle differences in salivary CgA in the Low and Middle groups. Women in the High group, in contrast, had a significantly higher level of salivary CgA in the late-luteal phase compared to that of the follicular phase. Additionally, salivary CgA level significantly and positively correlated with TMD and four emotional subscales: tension-anxiety, depression-dejection, anger-hostility and confusion in the late-luteal phase. No intergroup or menstrual-cycle difference occurred in the salivary cortisol. This study indicates a significant late-luteal increase in salivary CgA, reflecting an increase of sympathetic nerve activity in women who experience a substantial increase (>30%) in a cluster of negative psychoemotional symptoms premenstrually. Furthermore, salivary CgA, as opposed to salivary cortisol, could serve as a reliable noninvasive biomarker to more sensitively evaluate neuropsychophysiological fluctuations during the menstrual cycle.