[show abstract][hide abstract] ABSTRACT: A prospective study was performed to evaluate the effects of genital prolapse surgery on sexuality. Additionally we investigated which variables are risk factors for persistence or development of sexual problems after surgery.
All 82 patients participating in a randomized trial comparing vaginal and abdominal surgical correction of descensus uteri, were asked to complete the Questionnaire for screening Sexual Dysfunctions (QSD) before and at six months and one year after surgery.
Sixty-two patients completed the questionnaire. General satisfaction about sexuality was significantly improved after surgery. Of 41 patients who were sexually active both before surgery and at one year after surgery, 28 (68.3%) patients reported sexual problems before surgery. In 13 (46.4%) of these patients, all sexual problems disappeared. Of the 13 patients without sexual problems before surgery, two patients reported de novo sexual problems. The relative risk on disappearance of sexual problems in patients with large cystocele was 1.5 (95% confidence interval 1.1-2.1) times higher than the risk in patients without large cystocele.
Satisfaction about sexuality increases and the prevalence of sexual problems decreases in patients undergoing surgical correction of descensus uteri.
[show abstract][hide abstract] ABSTRACT: To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function.
Three teaching hospitals in The Netherlands.
Eighty-two patients undergoing surgical correction of uterine prolapse stages II-IV.
Participating patients completed the urogenital distress inventory (UDI), before and at six weeks, six months and one year after surgery, to measure discomfort of prolapse and micturition symptoms. Domain scores of the UDI (ranging from 0 to 100, higher scores indicating more discomfort) were compared between groups at all time points. Findings at pelvic examination, number of doctor visits within the first year after surgery because of pelvic floor symptoms and performed or planned surgery of recurrent genital prolapse were also compared.
Domain scores of the UDI at one year after surgery.
At one year after surgery, scores on the discomfort/pain domain (mean difference 7.1, 95% confidence interval [CI] 1.1-13.2), overactive bladder domain (mean difference 8.7, 95% CI 0.5-16.9) and obstructive micturition domain (mean difference 10.3, 95% CI 0.6-20.1) of the UDI were significantly higher in the abdominal group than in the vaginal group. Findings at pelvic examination were similar in both groups. Doctor visits because of pelvic floor symptoms were more frequent in the abdominal group than in the vaginal group. Re-operation was performed or planned in 9 of the 41 patients who underwent abdominal surgery and in 1 of the 41 patients who underwent vaginal surgery (odds ratio [OR] = 11.2, 95% CI 1.4-90.0).
Our findings suggest that vaginal hysterectomy with anterior and/or posterior colporraphy is preferable to abdominal sacro-colpopexy with preservation of the uterus as surgical correction in patients with uterine prolapse stages II-IV.
BJOG An International Journal of Obstetrics & Gynaecology 02/2004; 111(1):50-6. · 3.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: Two hormone replacement therapy (HRT) regimens of combined oral estradiol with either continuous intrauterine or cyclic oral progestin were compared for 2 years.
200 perimenopausal women randomly received an intrauterine system with continuous levonorgestrel release (20 microg/24 h) combined with oral estradiol (2 mg daily), or a cyclic oral regimen of norethisterone acetate (1 mg on day 13-22) and estradiol (days 1-21; 2 mg, days 22-28; 1 mg). Efficacy on endometrial protection, vaginal bleeding patterns, blood loss and practical use were compared during 26 cycles.
Endometrial protection was adequate in both regimens. The cyclic regimen induced a more regular bleeding pattern. The continuous local administration induced a reduction in bleeding (P=0.001) with an initial period of prolonged and frequent bleeding. 38% became amenorrhoeic. Women found both regimens acceptable.
Continuous intrauterine Levonorgestrel administration by using an intrauterine system can well be recommended for use in combination with oestrogen replacement therapy in perimenopausal women.
[show abstract][hide abstract] ABSTRACT: We sought to establish the lowest dose of 3-keto-desogestrel, when added to a copper-releasing intrauterine contraceptive device, that is needed to reduce menstrual blood loss to a very low level and to treat (essential) menorrhagia successfully.
A double-blind group comparative study was designed in which 203 healthy women with or without menorrhagia were enrolled and randomized to four different Multiload Cu250 intrauterine contraceptive devices, releasing 0 (control), 1.5, 3, or 6 microg of 3-keto-desogestrel daily. Menstrual blood loss, hemoglobin, and serum ferritin levels were determined before and during treatment.
All 3-keto-desogestrel-copper intrauterine contraceptive devices reduced menstrual blood loss significantly, causing a reduction of up to 30 to 40 mL after 12 months of use. All women with essential menorrhagia were considered to have been successfully treated after 6 months of use. Serum ferritin levels rose with all three 3-keto-desogestrel-loaded devices.
A Multiload Cu250 intrauterine contraceptive device releasing 1.5 microg of 3-keto-desogestrel daily is able to reduce menstrual blood loss to a very low level and to replete body iron stores in women with or without menorrhagia. Higher doses have no superior effect.
American Journal of Obstetrics and Gynecology 04/2000; 182(3):575-81. · 3.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: Evaluation of endometrial histology patterns in perimenopausal women.
Endometrial biopsies (202) taken from perimenopausal women by suction curette were assessed by light microscopy.
Out of 142 adequate specimens a total of 82 (57.7%) specimens could not be classified in the well-defined categories of the fertile period because of mixed histological patterns. Of the 142 specimens, 59 (41.5%) showed abnormal secretory endometrium, three (2%) disordered proliferative endometrium and 20 (14.1%) a mixture of non-secretory and secretory endometrium.
The often used histological classification for endometrium, with well-defined regular patterns based on normal cyclic changes, often does not apply to endometrial tissue obtained from perimenopausal women due to a mixed pattern within one biopsy.
[show abstract][hide abstract] ABSTRACT: To determine whether the 30-year-old definition of menorrhagia (menstrual blood loss of 80 ml or more) is still valid in gynecological practice today.
Of 313 Dutch women, recruited from gynecological practice, the menstrual blood loss of one bleeding episode was objectively measured and related to the women's hemoglobin concentrations as well as their serum ferritin levels. Also, the 95th percentile of menstrual blood loss was calculated of women with normal hematological parameters, representing an upper normal limit.
The percentage of women suffering from anemia exceeded the overall mean above 120 ml of menstrual blood loss. The 95th percentile of menstrual blood loss of women with normal hemoglobin concentrations (12 g/dl or above) and with normal serum ferritin levels (16 microg/l or above) was 115 ml.
The risk of developing anemia from heavy menstrual bleeding is substantially increased at a menstrual blood loss level of 120 ml, and not, like the current definition of menorrhagia suggests, at 80 ml.
European Journal of Obstetrics & Gynecology and Reproductive Biology 06/1998; 78(1):69-72. · 1.84 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective: To determine whether the 30-year-old definition of menorrhagia (menstrual blood loss of 80 ml or more) is still valid in gynecological practice today. Study design: Of 313 Dutch women, recruited from gynecological practice, the menstrual blood loss of one bleeding episode was objectively measured and related to the women's hemoglobin concentrations as well as their serum ferritin levels. Also, the 95th percentile of menstrual blood loss was calculated of women with normal hematological parameters, representing an upper normal limit. Results: The percentage of women suffering from anemia exceeded the overall mean above 120 ml of menstrual blood loss. The 95th percentile of menstrual blood loss of women with normal hemoglobin concentrations (12 g/dl or above) and with normal serum ferritin levels (16 μg/l or above) was 115 ml. Conclusion: The risk of developing anemia from heavy menstrual bleeding is substantially increased at a menstrual blood loss level of 120 ml, and not, like the current definition of menorrhagia suggests, at 80 ml.
European Journal of Obstetrics & Gynecology and Reproductive Biology - EUR J OBSTET GYN REPROD BIOL. 01/1998; 78(1):69-72.
[show abstract][hide abstract] ABSTRACT: To isolate epidemiological risk factors for menorrhagia.
Menstrual blood loss (MBL) of one bleeding episode of 182 healthy women was measured with the alkaline hematin method and the results were related to age, parity, body mass index and smoking habits. Multiple and logistic regression analysis was performed to isolate the variables that most influence MBL. Two consecutive menstrual episodes were measured in 117 women, to determine individual constancy.
MBL increased significantly with age (Kruskal-Wallis, P < 0.03) and the percentage of women with menorrhagia was significantly higher above 40 years of age (Mann-Whitney's ranks sum test, P < 0.05). The odds ratio of parous:nulliparous women for menorrhagia was 2.27:1, but after adjustment for age this influence disappeared. Body mass index and smoking habits were not significantly related to menorrhagia. The mean difference between the MBL of two consecutive menstruations is 2.1 ml (S.E.: 1.7, 95% CI: -1.3 to 5.5 ml).
Only age could be indicated as a risk marker for menorrhagia. Parity, body mass index and smoking habits appear to have no significant effect on MBL, when adjusted for age. The individual constancy in MBL between two consecutive cycles is very high and therefore one single measurement suffices in studies of MBL.
[show abstract][hide abstract] ABSTRACT: To validate a simple, highly predictive test to discriminate between menorrhagia and normal menstrual blood loss.
The sanitary wear of 489 menstrual bleeding episodes was collected by 288 women for objective measurement of menstrual blood loss (alkaline hematin method); the women made a subjective assessment of the volume and, based on a pictorial chart, recorded the amount of and the degree to which their sanitary wear was soiled. Based on that degree, a score was calculated for each episode and a suitable cutoff point was chosen, above which the presence of menorrhagia was likely and below which it was unlikely.
Using a score of 185 as the cutoff point, the predictive values of positive and negative tests were almost equally high, 85.9 and 84.8%, respectively. Whether or not the presence of clots was recorded, these values did not change. The predictive value of a woman's complaint of heavy bleeding for the presence of menorrhagia was 55.9% and that of anemia (hemoglobin less than 12.0 g/dL) was 74.4%.
We validated and refined a new, simple, visual assessment technique and demonstrated that it is superior to a woman's subjective assessment of menstrual blood loss and the occurrence of anemia for predicting menorrhagia, even if it is performed only once. We also demonstrated that the volume that clots contribute to menstruation is not as large as many clinicians believe. With this technique, the quality of therapy can be enhanced by making it more adequate and rational.
Obstetrics and Gynecology 07/1995; 85(6):977-82. · 4.80 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abdominal-retroperitoneal sacral genito-colpopexy using the expanded polytetrafluoroethylene (ePTFE) soft tissue patch has been found to be highly effective for repair of genito-vaginal prolapse. We treated 61 patients in this way, including patients who had failed multiple previous attempts at repair. At a mean of 32 months of follow-up, more than 95% of patients were still classified as successfully treated. To preserve the uterus in cases of complete genito-vaginal prolapse, we have developed a new surgical technique, which we describe in this paper.
European Journal of Obstetrics & Gynecology and Reproductive Biology 08/1993; 50(2):133-9. · 1.84 Impact Factor