Over-the-counter MTP Pills and Its Impact on Women’s Health

Objectives

To study the complications and consequences including maternal morbidity and mortality following indiscriminate self-consumption of abortion pills reporting to a tertiary care center.

Methodology

This is an observational study conducted at Vanivilas hospital between January 2012 to December 2013 for 24 months. After applying inclusion and exclusion criteria, 104 women were studied with respect to period of gestation, parity, clinical features at presentation and management in the institution. An analysis of maternal morbidity and mortality was done with respect to surgical interventions, ICU admissions, need for blood transfusions and maternal deaths.

Observations and results

In this study, there were 75 (72.2 %) cases of incomplete abortion, 10 (9.6 %) cases of missed abortion, 2 (1.9 %) cases of ruptured ectopic and 2 (1.9 %) cases of rupture uterus. Seventy-eight (75 %) cases received blood transfusion, 7 (6.7 %) were admitted to ICU, and 2 (1.9 %) developed acute kidney injury. There were 2 (1.9 %) maternal deaths in the study group.

Conclusion

This study shows urgent need for legislation and restriction of drugs used for medical termination of pregnancy. Drugs should be made available via health care facilities under supervision to reduce maternal mortality and morbidity due to indiscriminate use of these pills.

     

Androgen Replacement Therapy and Women’s Health

Although androgen replacement has been in use for several decades for various gynaecological disorders, it has had few adherents in women’s health because of misconceptions that it is unphysiobgical and a male hormone. The potential role of androgens in the pharmacological management of menopausal hormone deficiency states remains to be firmly defined, but there has recently been renewed interest in the addition of low-dose androgen to the traditional estrogen replacement therapy. This is a welcome development because not all menopausal symptoms are adequately controlled with estrogen or estrogen/progestin therapy. Weight gain, increase in body hair and slight enlargement of the clitoris constitute the most important side effects experienced by androgen users. The purpose of this review is to discuss the role of androgens as an adjuvant to estrogen/progestin replacement therapy with the hope that the clinician will evaluate its incorporation into menopausal women’s health care.     

SOGC and Women’s Health: Toward 2000

The definition of Women’s Health in the context of primary care—i.e. women’s health in its broadest perspective, beyond traditional obstetrics and gynaecology—is outlined. Within this broad perspective, the role of obstetricians and gynaecologists and of the Society of Obstetricians and Gynaecologists of Canada (SOGC) is explored.This introductory article is the first of a series on Women’s Health Issues to be published by the Journal SOGC.     

Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis

BackgroundFemale genital mutilation (FGM) can leave a lasting mark on the lives and minds of those affected.AimTo assess the consequences of FGM on women’s sexual function in women who have undergone FGM compared to women who have not undergone FGM.MethodsA systematic review and meta-analysis were conducted from 3 databases; inclusion and exclusion criterions were determined. Studies included adult women having undergone FGM and presenting sexual disorders assessed by the Female Sexual Function Index (FSFI).ResultsOf 129 studies, 5 that met the criteria were selected. The sexual function of mutilated women, based on the FSFI total score and its different domains, was compared to the sexual function of non-mutilated women. There was a significant decrease in the total FSFI scores of mutilated women compared to non-mutilated women. However, the results obtained for the different domains were not the same for all authors. The meta-analysis highlighted a high heterogeneity with inconsistency and true variance in effect size between-studies.ConclusionAnalysis of studies showed that there is a significant decrease in the total FSFI score, indicating that FGM of any type may cause impaired sexual functioning. But a firm conclusion on this topic is not yet achievable because the results of this analysis do not allow to conclude a cause and effect relationship of FGM on sexual function.Nzinga A-M, De Andrade Castanheira S, Herklmann J, et al. Consequences of Female Genital Mutilation on Women’s Sexual Health – Systematic Review and Meta-Analysis. J Sex Med 2021;18:750–760.     

The Relevance of the Women’s Health Initiative Results on Combined Hormone Replacement Therapy in Clinical Practice

The results of the Women’s Health Initiative’s (WHI) large prospective randomized controlled study on the benefits and risks of combined hormone replacement therapy (HRT) have been reported earlier than expected, due to the findings of a small excess in cases of breast cancer, myocardial infarction, cerebrovascular accident, and venous thrombosis, in conjunction with a slight diminution of the number of cases of bone fracture and colon cancer. These results were obtained in a population of women with a mean age of 63 ± 7 years, many of whom were already presenting relative risks of diseases at randomization. The results provide the best evidence available at present on HRT for prevention of heart disease, and indicate that combined HRT is not indicated for this purpose in the studied population, thus contradicting the reported beneficial effects of HRT on coronary heart disease (CHD) in previous observational studies.Some comments need to be made, particularly with regard to the relevance of the WHI study results to the traditional use of HRT at the beginning of menopause. The results, obtained from a population having a wide age range (50 to 79 years), with only 33% being between the ages of 50 and 59, taking 0.625 mg/day conjugated equine estrogens combined with 2.5 mg/day medroxyprogesterone acetate or placebo, are presented without stratification according to the various decades. Further, 73.9% of the women never took HRT before entering the study; rather, they began HRT several years after menopause. Thus, the age distribution and late start of HRT in the women in the WHI study do not correspond to the traditional use of HRT. The studied population presented numerous risks of diseases related to aging, in particular cardiovascular disease. Except for venous thrombosis, the confidence intervals for outcomes are near the limit of statistical significance, which disappears after adjustment. The accrual of breast cancer cases appearing during the fourth year of observation is similar to that found in previous studies, and remains inferior to the increases related to lifestyle factors reported in other studies. The overall results are being applied to women aged 50 to 60 without specific data for this age group, who are usually considered to be at no or low risk for the traditional use of HRT.There are no data to compare the various formulations actually approved as class labelling (estrogens or estradiol associated or not with a progestin or natural progesterone by the oral or transdermal route) in the various outcomes of the WHI study. Results of the ongoing WHI study on estrogen alone will have to be considered when they become available.The results of the WHI study do not put into question the validity of prescribing combined HRT in early menopause. They are likely to modify somewhat the recommendations of published consensus cautioning the use of HRT. HRT remains an effective and safe intervention when it is prescribed to palliate the signs and symptoms related to estrogen deficiency, mainly in women soon after menopause, but also in women presenting risk factors for osteoporosis but without actual risk factors of cardiovascular disease and without a family history of breast cancer. New mid-term and long-term randomized studies need to be conducted on women starting various formulations of HRT before the age of 60, to evaluate their impact on risk factors and events of cardiovascular disease.