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Background and Objective: As a sizeable proportion of persons with mild cognitive impairment will progress to frank dementia, early detection is an important strategy to prevent and decelerate the progression of cognitive decline. In Thailand, the prevalence of mild cognitive impairment in surgical menopause women has not been well established. The objectives of the present study were to determine the percentage and factors associated with mild cognitive impairment in women with surgical menopause., Material and Method: Between October 2013 and July 2014, 200 eligible women at King Chulalongkorn Memorial Hospital were enrolled. The self-reported questionnaires were used to obtain the demographic data and the Thai version of the Montreal Cognitive Assessment (MoCA) was used to detect mild cognitive impairment (MCI). The MCI was diagnosed when the MoCA score was less than 25. The data were statistically analyzed using SPSS version 17 for student t-test, Chi-square test, and multiple regression analysis., Results: The percentage of MCI in the present study was 43.5%. The univariate analysis showed that factors significantly related to MCI were marital status, educational levels, occupation, monthly income, and duration of hormone replacement therapy (HRT). Nevertheless, multiple regression analysis revealed that only older age at enrollment, marital status, low educational level, and low monthly income were significantly related to MCI., Conclusion: Almost half of the surgical menopause women in the present study had MCI. Older age at enrollment, marital status, low educational level, and low monthly income were significantly related to MCI. Age at surgical menopause and HRT were not found to be associated with MCI in this study.

Objective: To determine cycle control, safety, and acceptability of a 24-day oral contraceptive regimen containing 15 micrograms of ethinylestradiol and 60 micrograms of gestodene., Material and Method: This was an open-label, non-comparative study. Healthy women 18 to 35 years old who attended the Family Planning Clinic of King Chulalongkorn Memorial Hospital were assigned to receive six cycles of the study oral contraceptives, administered daily for 24 days and followed by a 4-day hormone-free interval. Data on bleeding patterns, side effects, body weight, blood pressure, and satisfaction were collected. Descriptive statistics and paired t test were used for the analysis., Results: Ninety-four women completed the present study. There was no pregnancy reported during the present study. Percentages of breakthrough bleeding and spotting were higher in the first cycle (2.1% and 6.4%), then decreased and disappeared after the third cycle. There was no significant change in the body weight and the blood pressure. Only minimal side effects were reported and 93.6% of the women were satisfied or very satisfied. Furthermore, 91.5% would continue using this oral contraceptive., Conclusion: This new oral contraceptive, a combination of 15 micrograms of ethinylestradiol and 60 micrograms of gestodene has acceptable cycle control, minimal side effects, and good acceptability.

Objectives: To investigate the efficacy and tolerability of the oral hormone replacement therapy (HRT) containing 1 mg estradiol (E2) plus 2 mg drospirenone (DRSP) in Thai women with postmenopausal symptoms., Material and Method: Fifty-five Thai women with postmenopausal symptoms participated in this multicenter, open-label, non-comparative Phase IV study. The primary endpoint was the reduction of hot flushes after 12 weeks of treatment. Secondary endpoints included changes infrequency and intensity of menopausal symptoms as well as safety assessments after 4, 8, and 12 weeks of treatment., Results: Treatment with 1 mg E2 plus 2 mg DRSP reduced the frequency of hot flushes in 94.6% of women at the end of the 12-week treatment period. In 60% of women, the frequency of hot flushes was reduced to 10% or less, compared to baseline findings and 49.1% of women had no remaining hot flushes. Other postmenopausal symptoms such as vaginal dryness, urinary incontinence, dysuria, and dyspareunia improved The most common adverse events were vaginal bleeding or spotting and breast tenderness., Conclusion: The oral HRT of 1 mg E2 plus 2 mg DRSP was effective and well tolerated by Thai women suffering from postmenopausal symptoms.

Objective: To assess the attitude and acceptance of Thai women attending menopause clinics on hormone replacement therapy (HRT) after the Women's Health Initiative (WHI) publication., Material and Method: A standardized questionnaire was used to assess attitude and acceptance of HRT in 1,206 women who visited menopause clinics in six hospitals between September 2005 and February 2006., Results: Of the total respondents, 92% were in the age of 40-70 years, 75% were in their peri- and post menopause, 25% were current users and the average duration of hormone use was 5.6 +/- 5.3 years. The women's perception of hormone benefits on osteoporosis prevention, skin improvement, and hot flashes treatment were 39.1%, 31.7%, and 28.9%, respectively. The most common concern of hormone use was malignancy. Hormone side effects were found to be the most common reason for switching hormone regimen. Of all the past users, 85% stopped HRT because they changed to another treatment regimen. Only 3.7% had been aware the WHI, of which 43.5% were influenced by its results. The most common source of HRT information was from doctors. For the ever users, 72.3% had some knowledge about HRT., Conclusion: The present survey revealed that very few women had been aware of the WHI study. Nevertheless, the prevalence of HRT current users was lower compared to a prior survey before the WHI publication. Doctors appeared to be the important source of HRT information, which may indirectly have an influence over women's attitude and acceptance on HRT.

Objective: To evaluate the effect of a new oral contraception formulation with drospirenone (Yasmin) on vital signs, complete blood count, glucose, electrolytes, and renal and liver function., Material and Method: An open-label non-comparative clinical trial was conducted. One hundred women who were planning to use oral contraception for at least six months were recruited. The subjects received a blister pack which contained 21 tablets of 3 mg drospirenone /30 tg ethinyl estradiol for the first four cycles (1 cycle = 28 days). Cycle 5 and 6 blister packs were dispensed during the visit in cycle 4. Heart rate and blood pressure of each subject were checked at baseline and each visit. Serum from each subject was collected and sent for complete blood count, glucose, electrolytes, and renal and liver function tests at baseline and at cycle 6. Mean differences in these tests at cycle 6 compared to baseline were assessed., Results: Ninety-two of the 100 subjects (92%) completed the present study. There was no significant change in heart rate, blood pressure, complete blood count, glucose, electrolytes, and renal and liver function tests at cycle 6 when compared to baseline., Conclusion: Oral contraception formulation with drospirenone (Yasmin) is well tolerated and has good contraceptive efficacy. It is safe, as it has no effect on heart rate, blood pressure, complete blood count, glucose, electrolytes, and renal and liver function.

Objective: To determine the efficacy of tranexamic acid in the treatment of idiopathic menorrhgia and to investigate the effect of medical treatment with tranexamic acid on the quality of life of the women with idiopathic menorrhagia., Design: Open, non-comparative study., Setting: Department of Obstetrics and Gynecology King Chulalongkorn Memorial Hospital., Subjects: 40 women with idiopathic menorrhagia was confirmed by menstrual blood loss greater than 80 ml/ cycle (PBAC score > 100) and mid-luteal serum progesterone concentration greater than 5 pg/ml., Intervention: Treatment with tranexamic acid 1 g orally, three times daily, for five days from day 1 of the menstruation for two consecutive menstrual periods., Main Outcome Measures: Menstrual blood loss was measured using the pictorial blood loss assessment chart (PBAC). Hematological assessments were made at the beginning, after the first treatment cycle and at the end of the study. Questionnaires were given to assess subjective endpoint, quality of life. Patients were asked to report any adverse event during the study period., Results: Tranexamic acid reduces the mean PBAC score by 49%, from 350.5 to 178.6. Regarding the change in the quality of life measures, the proportion of women who felt a considerable degree of impairment during the menstruation was reduced from nearly 60% to less than 5% during their third menstruation. No serious adverse events were reported., Conclusion: Tranexamic acid is a safe and effective form of medical therapy in women with menorrhagia; also increases quality of life in these women.

Objective: To conduct a hospital-based survey to assess women's attitude and acceptance towards menopause and hormone replacement therapy (HRT)., Method: The authors conducted a survey in women who visited the menopause clinic in 5 university and public hospitals in Bangkok. A group of 615 women who lived in those catchment areas and voluntarily cooperated in responding to a set of standardized questionnaires was randomly selected., Results: Of the total respondents, 97.0 per cent were in the age range between 40-70 years, 51.7 per cent were in the peri- and postmenopausal period, 65.7 per cent believed that menopause is a natural change but some may need medical treatment, 53.9 per cent were current users of which the average duration of HRT use was 4.70 +/- 3.36 years. The most common reasons for HRT initiation were osteoporosis, hot flashes, and vaginal dryness. The most common side effects found in the current users were breast pain, headache, and vaginal bleeding. Of all the current users, 43.2 per cent wanted to switch from HRT. Most of the respondents (95.4%) based their decision on the choices of treatment on medical advice. Of the total respondents, 62.0-74.7 per cent reported not having enough clear information on menopause and HRT., Conclusion: According to the present study, most of the women regarded menopause as a natural change of life although some need treatment. The most common indications for HRT were osteoporosis, hot flashes and vaginal dryness. Nearly half of the current users wanted to switch from HRT. Most of the respondents based their treatment decision on medical advice.

In a randomized trial, the impact of starting day (the first and the seventh day of the period) on ovarian follicular activity was assessed during administration of a very low dose of oral contraceptive pills (20 microgram (mcg) ethinyl estradiol (EE) and 75 mcg gestodene (GS) [Meliane, Schering, Germany]). One hundred and sixty healthy women aged: 23-44 years, who had a regular cycle, and who were not using any type of oral contraceptive (OCs) steroid were studied at the Family Planning Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. In the trial, each subject received a package of Meliane. They were blockwise randomized, 1:1 ratio; in the first group, subjects began their pills on the first day of their period (n = 80) and the other group, the seventh day of their period (n = 80). During the treatment cycle, ovarian activity was evaluated by transvaginal sonography (TVS) to determine the follicular-like structure (FLS). Ovulation was defined as the dominant FLS detected by TVS and followed-up every other day until its collapse. It occurred in 0 of 77 cases who started on the first day of their period and occurred in 8 of 78 cases of the group which started on the seventh day of their period. The difference was of statistical significance (p = 0.006). The result of this clinical trial is beneficial information for users of OCs containing 20 mcg EE who delay start of the OCs package.

Objectives: To investigate the effects of a monophasic oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel (Mercilon) on lipid metabolism in Thai women., Method: The study was carried out at the Family Planning Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Twenty women of fertile age were enrolled and treated with the study oral contraceptives for 12 cycles. Lipid parameters were assessed before treatment and periodically during treatment., Results: There was a significant increase in triglyceride, high desity lipoprotein-cholesterol, apolipoproteins AI and AII. No significant changes were found in total cholesterol, low density lipoprotein-cholesterol and apolipoprotein B., Conclusion: The effects of the oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel on lipid parameters in Thai women appear to be favorably beneficial.

Climacteric is the period of life starting from the decline in ovarian activity until after the end of ovarian function. According to the definition, the period includes peri-menopause, menopause and post-menopause. Climacteric is considered to be a natural change of life which may be accompanied by various health consequences i.e., menopausal symptoms, osteoporosis, coronary heart disease, or Alzheimer's disease. The key concept is that women enter menopause with different menopausal status for instances, natural menopause, surgical menopause, early menopause or even premature ovarian failure. Women may experience various health consequences due to the difference in genetic and environmental interaction. The prevalence and incidence of menopausal problems vary according to ethnic groups. For instance, Asian women seem to have less problems after menopause than their occidental counterparts. Nevertheless, the problems do exist and seem to be increasing due to the longer life expectancy and lifestyle changes of people in the region. Clinical decision in menopausal therapy can be determined according to health risk stratification. Appropriated menopausal therapeutic strategies include medical and non-medical modalities. The non-medical modalities are mainly focussed on lifestyle modification, while the medical modalities are classified as hormone replacement therapy (HRT) and non-HRT. Those in the high risk group will probably benefit most from medication besides lifestyle modification. There are various types, doses, routes and regimens of medication which need to be appropriately matched with the proper women's characteristics. Those who have contraindications to HRT or can not tolerate its side effects may choose other alternatives eg, selective estrogen receptor modulators, bisphosphonates, calcitonin or calcium and vitamin D. The success of menopausal therapy is to give an appropriate therapeutic option to the right woman. The future direction of research will remain focussing on the development in diagnosis and menopausal therapy particularly the main three areas of health promotion, disease prevention and treatment. The trend of research and development will probably be concentrated on new pharmaceutical agents with more specific action and high selectivity in an attempt to maximize its efficacy and safety. Attention may be paid more on the convenience of drug administration to increase its compliance. Alternative medicine and appropriated technologies are also the fields of special interest of which research is underway.

This prospective analysis was conducted to compare the effects of hormone treatments on bone mineral density (BMD) of the lumbar spine, hip, and distal forearm in postmenopausal women with normal BMD and those with low bone mass. Eighty healthy women were randomly assigned to receive a cyclic regimen of standard hormone replacement therapy (HRT) or currently used low-dose oral contraceptive (OC). Women were categorized as normal BMD and low bone mass according to the Thai reference database. The results revealed that women with low bone mass gained more BMD than those with normal BMD. The difference in mean per cent bone acquisition was obvious at the spine. In addition, further subset analysis into OC and HRT groups revealed higher effects of OC on BMD when compared to HRT.

Objectives: To evaluate the contraceptive reliability and clinical effects of a monophasic oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel (Mercilon) in Thai women., Method: The study was carried out at the Family Planning Clinic of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. One hundred and forty six healthy women of fertile age were enrolled and treated with the study oral contraceptives for 12 cycles. Clinical data of vaginal bleeding, side effects, blood pressure and body weight were assessed periodically., Results: One thousand four hundred and twenty five cycles were evaluated. No conception occurred. The cycles were almost regular. The incidence of irregular bleeding was highest in the first cycle, after the third cycle, the value was below 4 per cent. Side effects were very few. There was no change in blood pressure. A slight decrease in mean body weight was observed., Conclusion: The oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel has high contraceptive efficacy, good cycle control and minimal side effects.

Objective: To find the reference data for age-specific normal bone mineral density in a Thai female population., Study Design: Cross-sectional, Descriptive study., Material and Method: 1773 Thai women aged between 11-80 years were recruited, using multistage cluster sampling and stratifying from six represented provinces in the country, each strata was randomly selected. After recruiting, the women were interviewed by well-trained personnel using structured questionnaires. Bone mineral density of the lumbar spine 1-4 and nondominant hip were measured by Dual Energy Photon Absorptiometer. The scientists, X-rays technician were trained and standardized inter and intra observers variation. Quality control of examination was measured periodically. Every BMD outcome was re-examined by a specialist., Results: The peak bone mineral density of both spines and hips was between the age of 30 to 34 years old. Mean Value for spine and femoral neck was 0.957 and 0.814 g/cm2 respectively. The BMD of spine and hip was significantly decreased after the age of 35 and the loss was accelerated at age 50. Osteoporosis for spine and femoral neck is considered when BMD are below 0.682 and 0.569 g/cm2 respectively., Conclusion: The results are important data for public health policy, by maximizing bone mass during skeletal growth before menopause and minimizing bone loss throughout life as well as for detection of important risk factors.

This prospective analysis was done in 95 postmenopausal women to observe bone loss rate between 59 natural and 36 surgical menopausal women with or without hormonal replacement therapy (HRT). Bone mass measurement was performed at lumbar spines (L1-L4) and hip by dual energy X-ray absorptiometer at 0, 6 and 12 months. The results revealed that in the non-HRT group there was significant faster bone loss rate of lumbar spines (LS) and hip (H) of the surgical group at 12 months (Natural group: LS = -1.11%, H = +2.38%; Surgical group: LS = -4.51%, H = -0.66%, P < 0.05). However, there was no significant difference in bone changes of lumbar spines and hip between natural and surgical group with HRT at 12 months (Natural: LS = +2.0%, H = +4.06%; Surgical: LS = +0.62%, H = +2.28%, P > 0.05). This observation showed that without HRT oophorectomized women had greater magnitude of bone loss than women who entered menopause naturally.

To assess the effect of hormonal replacement therapy on lipid changes, measurement of serum total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), apolipoprotein A-1 (Apo-A) and apolipoprotein B (Apo-B) was performed on 93 postmenopausal women. Women in the study group (HRT) (51/93) received estrogen with or without progestin. The control group (Non-HRT) (42/93) did not receive any hormone regimen. The measurement was done at 0, 6 and 12 months. The results revealed that triglyceride increased significantly more in the non-HRT than the HRT group at 6 and 12 months. (Non-HRT: +21.7%, +21.7%; HRT: -2.8%, +2.4%, respectively P < 0.05). However, there was no significant difference in changes of other lipid profiles between the two groups at 6 and 12 months (Non-HRT: TC -2.7%, +0.7%, HDL +2.9%, +5.1%, LDL -5.2%, -4.1%, Apo-A +0.5%, +0.9%, Apo-B +3.8%, +1.3%: HRT: TC -1.4%, -2.8%, HDL +4.7%, +6.2%, LDL -1.5%, -4.9%, Apo-A -0.9%, +1.6%, Apo-B -2.6%, -1.6%, respectively P > 0.05). The paradoxical changes of triglyceride and HDL might partly be explained by the effect of progestins used in this study.

Unlabelled: Bone mass measurement was performed in 95 healthy postmenopausal women to assess the effect of hormonal replacement therapy (HRT) on bone changes. Women in the study group (51/95) received estrogen with or without progestin. The control group (44/95) did not receive any hormone regimen. The measurement was done at lumbar spines (L1-L4) and hip by dual energy X-ray absorptiometer at 0, 6 and 12 months. The results revealed significantly higher per cent changes of bone density of lumbar spines and hip, at 12 months, in the study group than in the control. (, Study: Lumbar Spine +1.76%, Hip +3.57%;, Control: Lumbar spines -2.32%, Hip +1.32%, P < 0.05). In conclusion, this study showed the value of hormonal replacement therapy for prevention of postmenopausal bone loss in Thai women.