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Objectives: To describe and compare acceptability of treatment and quality of life over 12 cycles in 2 groups of women randomised to continuous combined Climodiène (estradiol valerate 2 mg/dienogest 2 mg) or cyclic Climène (estradiol valerate 2 mg, from D1 to D21/cyproterone acetate 1 mg, from D12 to D21, followed by 7 days off), switching from previous sequential estroprogestative HRT because of side effects., Patients and Methods: One hundred forty three postmenopausal women aged 54.39-years were recruited and randomised to Climène (N=68) or Climodiène (N=75). Acceptability was evaluated by the continuation rate in the 2 groups at the end of the 12 cycles study. Assessment of quality of life was obtained from the responses to the women's health questionnaire (WHQ) and to an ad hoc satisfaction questionnaire at baseline, and at the 12th cycle of treatment., Results: No significant difference in baseline characteristics of volunteers were found in the 2 treatment groups except for the socioeconomic status (more town-dwellers in Climène group). Total WHQ score significantly improved after 12 months of treatment with Climène and Climodiène, respectively decreasing from 68.9 to 64.37 (-4.53) and from 69.95 to 62.06 (-7.89), with a trend towards higher improvement with Climodiène, particularly in the hot flushes subscale. In Climodiène group, a significant decrease in sleep problems and cognitive function subscales was found, which is consistent with previous polysomnography and psycho physiological measures data with Climodiène. The evolution of Satisfaction Index is positive and of the same magnitude in the 2 groups, showing an improvement at 12 months: respectively -2.79 (P=0.002) et -2.26 (P=0.02) for Climène and Climodiène., Discussion and Conclusions: Even though the benefit/risk ratio of the hormonal substitutive treatment is recognized effective against climateric symptoms which affect the quality of life, this work is the first randomised prospective study on the effects of Climodiène on quality of life in post-menopausal women assessed by the French validated version of the world-wide used WHQ. Decreases in "sleep problems" and "cognitive function" subscales scores in this study are of a magnitude clinically relevant and consistent with previous data on Climodiène impact on postmenopausal symptoms.

Objective: To compare the effects of a 12-week treatment with 17ss-estradiol given alone and in sequential combination with 3.75 mg of nomegestrol acetate (Naemis), or a placebo on biochemical markers of bone turnover in menopausal women., Patients and Methods: A double-blind, randomized, placebo and estradiol-controlled multicenter study was conducted. A total of 176 patients who had been menopausal for 1-10 years, hysterectomized or not, having no contraindications to hormone replacement therapy, without any risks factors for osteoporosis, received one of these treatments during 12 weeks: placebo, 1.5 mg estradiol (E(2)) or 1.5 mg E(2)/3.75 mg nomegestrol acetate (E(2)/NOMAC). The primary efficacy variables were the change in bone markers (total alkaline phosphatase, bone alkaline phosphatase and osteocalcin; urinary type-I collagen peptides)., Results: The four biochemical markers decreased only in the E(2)/NOMAC group. Bone alkaline phosphatase, osteocalcin and urinary type-I collagen peptides decreased in the E(2) group. For both active treatment groups compared to the placebo group, the changes were statistically significant after a 12-week treatment. There were no statistically significant differences between the E(2) and the E(2)/NOMAC groups except for total serum alkaline phosphatase, whose mean value decreased in the E(2)/NOMAC group but increased slightly in the E(2) group (p < 0.001). Furthermore, after a 6-week treatment, the changes in biochemical markers of bone turnover were similar to those found after 12 weeks. Safety data were satisfactory with regard to estradiol given alone or in combination with nomegestrol acetate., Conclusion: These results demonstrated that 1.5 mg E(2) is effective in reducing bone turnover in postmenopausal women and proved that the combination of 1.5 mg E(2) and 3.75 mg nomegestrol acetate has no deleterious effect on bone remodelling.

Candidiasis, infection due to Trichomonas vaginalis and bacterial vaginosis (Gardnerella vaginalis and/or other species) represent the major three causes of vulvo-vaginitis. Other are rare bacterial infections and non infectious vaginitis such as allergic and post-menopausal vaginitis with epithelial atrophy. Clues for the diagnosis include the clinical features of vaginal discharge, cytological examinations, bacterial and fungal cultures. Only T. vaginalis seems to be responsible of sexually transmitted disease. All appropriate antibacterial or anticandidosic treatment are immediately effective, but the mechanisms of recurrent candidiasis and vaginosis are still unclear.

Every young healthy and truly informed woman may use any contraceptive method. Teenagers have to avoid not only pregnancy but also AIDS and other sexually transmitted diseases. Therefore they may use condoms when aware of postcoital contraception or must use both condoms and oral contraceptives. Non smoker women over 40 may choose between combined oral contraceptives, high doses progestogens or IUDs. Whatever the age, newer preparations with desogestrel, norgestimate or gestodene will be preferentially used due to the absence of clinical and metabolic side-effects. Smokers before 35, nonsmoker women over 35 will be preferentially given pills with only 20 micrograms ethinyloestradiol.

The effects of oral micronized progesterone on the endometrium and bleeding pattern have been assessed in a multicenter study of 101 postmenopausal patients. During a minimum of 6 cycles, the participants received either percutaneous 17 beta-estradiol (1.5 mg/day) associated with micronized progesterone (100 mg/day), given at bedtime for 21/28 days or 25 days/calendar month (n = 98) [1], or E2 (3 mg/day) for 25 days associated with progesterone (300 mg/day), from day 16 to day 25 (n = 3) [2], according to their willingness to induce, or not, cyclic withdrawal bleeding. Each endometrial biopsy performed at 6-month minimum was assessed by two independent pathologists: results showed 61% quiescent without mitosis, 23% mildly active with very rare mitoses and 8% partial secretory endometrium. The remaining biopsies showed inadequate tissue (4%) or a sub-atrophy (4%). No hyperplasia was found by any pathologist. In the case of inadequate material, the mean thickness of endometrial mucosa measured by ultrasonography was 3.9 mm. Amenorrhea incidence was 93.3 and 91.6% at the 3rd and 6th month of therapy, respectively. No bleeding occurred in more than 80% of women. The results show that a low dose of oral progesterone (100 mg/day), given during 25 days, efficiently protects the endometrium by fully inhibiting mitoses and induces amenorrhea in the majority of postmenopausal women, allowing better compliance to long-term therapy.

Acne, androgenogenetic alopecia, hyperseborrhea and hirsutism may result from hyperandrogenism in women. This may be peripheral "idiopathic" hyperandrogenism due to cutaneous metabolism of steroids, but in some cases hyperandrogenism is due to abnormal production or input of steroids with androgenic activity (hyperplasia, endocrine tumors, cysts, consumption of progestogens or other hormones with androgenic activity, menopause...). An assessment is useful only in cases of acne or alopecia if they are accompanied by other signs of peripheral hyperandrogenism and/or disturbed menstruation. The treatment is based on the administration of an anti-androgen (in France, usually cyproterone acetate), combined with other local or systemic treatments for the problem, depending on the age, dermatological signs and context.

Sixteen infertile women with the Polycystic ovary syndrome were treated using stimulation of ovulation with purified FSH after Clomid had failed. We compared the results of giving a short course (19 cycles) with giving a long course (54 cycles). With the long course there were fewer cases of hyperstimulation--2 out of 54 cycles (3.70%) as against 1 in 19 cycles with a short course (5.26%). There were fewer changes in the programme needed--6 out of 54 cycles (3.7%) as against 7 cycles out of 19 (31.57%). Ovulatory cycles occurred more frequently in 46 out of 54 cycles (85.18%) as against 12 out of 19 (63.15%). In the long courses 14 pregnancies out of 46 ovulatory cycles occurred (30.43%) as against 3 pregnancies out of 12 cycles (25%). The level of successful pregnancy was much higher in couples who had no other sterility factors--85.10% for the long course as against 63.15% for the short course. In summary purified FSH is an excellent treatment for ovarian dysfunction that is resistant to Clomid. It is necessary to have 3.41 ovulatory cycles to obtain a pregnancy. In this work there were no multiple pregnancies out of the 17 pregnancies and the 3 cases of hyperstimulation that were noted were moderate.

Thermography is a questionable method of diagnosis of breast diseases. In our study, we demonstrate that the low sensitivity and specificity is not related to the experience of the reader. One hundred thermograms were given to five different readers: three of them were thermographists, one was a gynecologist and the last one radiotherapist. Sixteen patients had a breast carcinoma, 18 had benign lesions. Seventy-two patients had no lesion at the time of diagnosis and 4 years after. The false negative and the false positive rates were not different according to the readers. The reproducibility, judged with the Kappa test, was poor. This study, in agreement with most of the previous studies, demonstrates that thermography must not be recommended neither for diagnosis nor for screening of breast diseases.

Current, improved understanding of the physiopathology of polycystic ovary syndrome offers the possibility of more suitable treatment. Formerly, objectives differed for a given patient: re-establish regular cycles using progestogens or estroprogestogens, reduce hirsutism with antiandrogens, trigger ovulation. Clomid is the inducer of choice, but setbacks occur. Injectable gonadotropins were, in principle, a contraindication due to the high incidence of excess stimulation and multiple pregnancy. The introduction of purified FSH offers another method of stimulation. Severe excess stimulation is eliminated with a suitable protocol involving administration of small doses. This offers hope, but as yet no large-scale trial has been published.

The androgen effect of some hormonal compounds are sometimes hidden behind a nomenclature or associations. It is necessary to know how to decipher these messages, confusing at times, in order to have a clear idea of the nature of the compounds which are prescribed.

Treatment remains the same whether there is true idiopathic hyperprolactinemia or microadenomas too small to be detectable by methods of investigation. Bromocriptine has an antitumoral effect and treatment can often be stopped after the disappearance of a microadenoma or even of a larger adenoma. "Cure" of idiopathic hyperprolactinemia is rarer.

After a reminder of the epidemiology: fertilization ability, fertility, hypofertility, the classic work-up of a sterile couple will be presented: temperature, hormonal evaluation, sperm count, cervical secretions, PCT, hysterogram. With each examination, a critical study of the evaluation of the results will be developed and possibly new ideas will be approached. Such a review reveals, most of the time, the etiology of the sterility. If this is not the case, after systematic laparoscopy, the rate of unexplained sterility will be approximately 5 p. cent. This small number of "unexplained sterilities" could then benefit from the most sophisticated new techniques, especially in-vitro fertilization of which the results, in terms of pregnancy, are identical in tubal pregnancies and unexplained pregnancies.

The purpose of this article will be to present informations regarding two new progestational++ medications: nomegestrol acetate (Lutenyl), and promegestone (Surgestone) in order to make use of them in our prescription habits. We will situate them in relation to various groups of progestative medications and present their specific properties and their tolerance. Finally, we will demonstrate their role in contraception and their effectiveness in the main indications of progestative medications.