GYNAECOLOGY
DIET AND UTERINE MYOMAS
Myomas are a common, benign, hormone-dependent gynaecological
condition. It has been suggested that unopposed oestrogen
may increase the risk of myomas so, therefore, any factor
that reduces endogenous oestrogen levels and increases progesterone
levels may reduce the risk. Diet has been associated with
oestrogen levels so a study was undertaken to analyse the
relation between selected dietary indicators and the risk
of uterine myomas. The study looked at 843 women with uterine
myomas whose clinical diagnoses dated back no more than
2 years and 1,557 controls.
It was found that women with uterine myomas reported more
frequent consumption of beef, other red meat and ham, and
less frequent consumption of green vegetables, fruit and
fish. The multivariate odds ratios in the upper tertile
were 1.7 for beef and other red meat, 1.3 for ham, 0.5 for
green vegetables, and 0.8 for fruit consumption. Thus myoma
is associated with beef and ham consumption but a high intake
of green vegetables and to a lesser extent fruit, seems
to have a protective effect.
Chiaffarino, F. et al
OBSTET. GYNECOL. 1999, 94 (3) 395-8
OPTIMAL SPACING FOR HEALTHY BABIES
Conceiving a subsequent child 18 to 23 months after a live
birth may provide the ideal conditions for having a healthy,
full term baby, according to a study published in the New
England Journal of Medicine.
The study, conducted by the United States Centers for Disease
Control and Prevention, found that although having babies
too close together may be associated with an adverse effect
on an infant's health, having them too far apart may be
even worse.
Compared with babies conceived 18 to 23 months after a
live birth, babies conceived within 6 months had a 40% greater
chance of being premature or undersized at delivery. Women
who waited 10 years before having another child were twice
as likely to have a small baby and 50% more likely to deliver
prematurely. In this study, researcher evaluated inter-pregnancy
interval in relation to low birth weight, pre-term birth,
and small size for gestational age in 173,205 singleton
infants born alive to multiparous mothers in Utah from 1989
to 1996. They controlled for 16 factors that could affect
outcomes including smoking, drinking, prenatal care, and
mother's age.
BMJ no.7184 p624
CONTRACEPTIVE PILL INCREASES RISK OF MENTAL ILLNESS
Studies have shown that the contraceptive pill can lower
the levels and metabolism of certain vitamins and minerals
in the body, including zinc, copper, folic acid, vitamins
B6 and B12. These nutrients are essential to control emotions
and moods, and deficiencies could account for the depression
and increased risk of suicide amongst women taking the pill.
J. NUTRIT. & ENVIRON. MED. 1998, 121-7
ESSENTIAL FATTY ACIDS AND PRE-ECLAMPSIA
Scientists in the US examined the fatty acid composition
of umbilical arteries, veins and blood platelets in 27 pre-eclamptic
women. Results showed that they had abnormal levels of essential
omega-3 fatty acids, which are essential for maintaining
normal blood pressure.
AM. J. CLIN. NUTRIT 1999, 69, 2, 293-8
ALCOHOL AND FERTILITY
A follow-up study involving 430 couples aged 20-35 years
found that a woman’s alcohol intake is associated
with decreased fertility even among women with a weekly
alcohol intake of five or fewer drinks.
Jenson et al
BMJ no7157 pp505-510
POSTERIOR VAGINAL PROLAPSE AND BOWEL FUNCTION
The aetiology of rectocele is not completely understood
and may encompass different mechanisms in different patients.
A study was therefore carried out to describe symptoms related
to bowel dysfunction in women with uterovaginal prolapse
and to compare these symptoms according to extent of posterior
vaginal prolapse. The mean age of the study group was 59.2
years and 78% of the women were postmenopausal. According
to the furthest extent of posterior vaginal prolapse at
point Bp, 22 (15.5%) were in stage 0, 46 (32.4%) were in
stage 1, 50 (35.2%) were in stage II, 23 (16.2%) were in
stage III, and 1 (0.7%) was in stage IV.
Most (92%) of the women reported having bowel movements
at least every other day. 38 (26.6%) reported that they
never or rarely strained when having a bowel movement, 71
(49.6%) reported sometimes, 20 (14%) reported usually, and
14 (9.8 %) reported always. 23 women (16.1%) had faecal
incontinence. The study concluded that women with uterovaginal
prolapse frequently have symptoms related to bowel dysfunction,
but this is not associated with the severity of posterior
vaginal prolapse.
Weber, A.M. et al
AM. J. OBST.GYN. 1998, 179 (6) 1446-50
DO GASTROINTESTINAL SYMPTOMS VARY WITH THE MENSTRUAL CYCLE?
It is generally believed that some women experience peri-menstrual
alteration in bowel habit. This may be a normal, physiological
phenomenon or it may be associated with pathology such as
endometriosis. A review of the literature was carried out
regarding the effect of the menstrual cycle on bowel symptoms
in women with and without irritable bowel syndrome. The
studies surveyed suggest that gastrointestinal symptoms
do vary with the menstrual cycle. One-third of otherwise
asymptomatic women may experience gastrointestinal symptoms
at the time of menstruation, and almost 50% of women with
functional bowel disorder report an increase in symptoms
during menstruation. In addition, women who suffer from
dysmenorrhoea are more likely to have functional bowel disorder.
The physiological basis of these phenomena is unknown. It
has been suggested that raised serum progesterone levels
in the luteal phase may be one of the mechanisms responsible
but little is known of the physiological effects of sex
hormones on the gut in vitro. It has also been suggested
that prostaglandins released by the uterus at the time of
menstruation might cause diarrhoea. Further research is
needed to explore what common hormonal or neurological pathways
may underlie the covariance in gastrointestinal and menstrual
symptoms.
Moore, J. et al
BR. J. OBST.GYN. 1998, 105 (12) 1322-5
CALCIUM CARBONATE AND THE PREMENSTRUAL SYNDROME - EFFECTS
ON PREMENSTRUAL AND MENSTRUAL SYMPTOMS
A prospective, randomised, double-blind, placebo-controlled,
parallel-group, multicentre clinical trial was conducted
to evaluate the effect of calcium carbonate on the luteal
and menstrual phases of the menstrual cycle in pre-menstrual
syndrome. Symptoms were documented over 2 menstrual cycles
with a daily rating score that had 17 core symptoms and
4 symptom factors (negative affect, water retention, food
cravings and pain). Participants were randomly assigned
to receive 1200 mg of elemental calcium per day in the form
of calcium carbonate or placebo for 3 menstrual cycles.
There was no difference in age, weight, height, use of oral
contraceptives, or menstrual cycle length between treatment
groups. During the luteal phase of the treatment cycle,
a significantly lower mean complex symptom score was observed
in the calcium-treated group for both the second and third
treatment cycles. By the third treatment cycle calcium effectively
resulted in an overall 48% reduction in total symptom scores
from baseline compared with a 30% reduction in placebo.
In addition, all 4-symptom factors were significantly reduced
by the third treatment cycle.
Thus, calcium supplementation is a simple and effective
treatment in pre-menstrual syndrome, resulting in a major
reduction in overall luteal phase symptoms.
Thys-Jacobs, S. et al
AMER. J .OBSTET. GYNECOL. 1998, 179 (2) 444-52
ORAL CONTRACEPTIVE USE AND SMOKING ARE RISK FACTORS FOR
RELAPSE IN CROHN'S DISEASE
Since lifestyle factors have been shown to influence prognosis
in Crohn's disease, a study was undertaken to prospectively
assess the effects of smoking and oral contraceptive use
on clinical relapse rates. The influence of smoking and
the use of oral contraceptives on relapse risk was measured
using life-table analysis (log rank tests) and Cox proportional
hazards modelling. Out of 152 patients, 61 (40%) had a relapse.
Univariate analysis showed unfavourable outcomes for women,
current smokers, and use of oral contraceptives. The Cox
model retained current smoking vs. never smoking (hazard
ratio, 2.1), oral contraceptive use (hazard ratio, 3.0),
as predictors of relapse. Ex-smokers did not have an increased
risk and sex, age, time in remission, disease location,
and disease duration were not significant predictors.
Timmer, A. et al
GASTROENTEROL. 1998, 114 (6) 1143-50
BREAST DENSITY CHANGES DURING MENSTRUAL CYCLE
US researchers want to encourage premenopausal women to
have mammograms in the follicular phase of their menstrual
cycle rather than the luteal phase, as it may improve the
accuracy of mammographic screening in this group. The researchers
have found that mammographic breast density varies with
the menstrual cycle. In a study of 2,591 premenopausal women
aged 40-49 it was found that fewer women had extremely dense
breasts during week 1 and 2 of their cycle (follicular phase)
than during weeks 3 and 4 (luteal phase). The association
is stronger for women with a lower body-mass index who tend
to have denser breasts.
Bradbury, J.
LANCET 1998, 351 (9120) 1936
EFFECTS OF THE MENSTRUAL CYCLE ON MEDICAL DISORDERS
It is well recognised that certain medical conditions are
exacerbated at specific phases of the menstrual cycle. Abrupt
changes in the concentrations of circulating ovarian steroids
at ovulation and premenstrually may account for menstrual-cycle
related changes in these chronic conditions. Accurate documentation
of symptoms on a menstrual calendar allows identification
of women with cyclic alterations in disease activity.
The evidence supporting a relationship between oestrogen
withdrawal and migraine headache is compelling. The frequency
of migraine headaches in women increases considerably after
menarche and 60% of women with migraine link attacks to
menstruation. Seventy to ninety percent of women with menstrual
migraine experience improvement during pregnancy but may
experience migraine attacks in the postpartum period.
Menstrual exacerbations occur with all types of seizures.
Catamenial epilepsy is believed to result from cyclic alterations
in both ovarian hormone levels and drug metabolism.
In many women with asthma there is an increased frequency
and severity of attacks premenstrually or at menstruation
and may be related to changing levels of progesterone or
prostaglandins.
Symptoms of rheumatoid arthritis often improve in the luteal
phase when gonadal steroid production is maximal. A subjective
increase in morning stiffness and arthritic pain during
menstruation and the early follicular phase has been shown.
In women with irritable bowel syndrome symptoms tend to
recur and become cyclic, with exacerbation during the postovulatory
and premenstrual phases of the menstrual cycle, suggesting
a hormonal influence.
Menstrual cycle-related alterations in glycemic control
during the luteal and premenstrual phases have been reported
in some women with diabetes.
Other disorders exacerbated by the postovulatory and premenstrual
phases of the menstrual cycle include acne, endocrine allergy
and anaphylaxis, erythema multiforme, urticaria, apthous
ulcers, glaucoma and multiple sclerosis.
Case, A.M. and Reid, R.L.
ARCH.INT.MED. 1998, 158 (13) 1405-12
A QUESTION OF TIMING
The success of breast cancer surgery may partly depend
on the phase of the menstrual cycle at which it is performed.
A study reanalysed tissue samples from women who had tumours
removed during the follicular phase of the menstrual cycle
with samples from those operated on in the luteal phase.
The former were found to have a poorer prognosis.
NEW SCIENTIST, 23rd May 1998, p27
