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Objective To assess the correlation between the intention to undergo immediate versus delayed postpartum contraceptive implant insertion following high-risk pregnancy, and the proportion of utilization and adverse effects.Methods We conducted a retrospective cohort study of women who gave birth after a high-risk pregnancy (according to the criteria defined by the Society for Maternal-Fetal Medicine) and intended to use contraceptive implants. The participants were classified into two groups based on whether they underwent immediate or delayed insertion. The primary outcome was the proportion of utilization of contraceptive implants at 12 months postpartum. We performed multivariate analyses to determine the relationships between the timing of insertion, characteristics, and methods used.Results Of the 482 women classified as having high-risk pregnancies, 103 intended to use contraceptive implants (54 immediate and 49 delayed insertions). Women in the immediate group were more likely to use contraceptive implants than those in the delayed group at 6 (95.2% vs. 26.2%, P

To assess the impact of a high-risk pregnancy on postpartum contraceptive planning and use.We conducted a retrospective cohort study of women who gave birth in a teaching hospital in 2020. We classified women into 2 groups based on their risk status according to the Society for Maternal-Fetal Medicine. The World Health Organization (WHO) tiers of contraceptive efficacy were used to categorize contraceptive planning and administration. The primary outcome was the utilization rate of Tier 1contraceptive methods at their postpartum visit in women with prior high-risk pregnancy. Univariate and multivariate analyses were carried out to determine the relationships between risk status, characteristics, contraceptive preference, and actual utilization.This study included 788 low-risk and 482 high-risk postpartum women. High risk women indicated greater interest in (43.5% low-risk vs 52.2% high-risk, p0.01) and usage rates of (45.7% low-risk vs 54.3% high-risk, p = 0.01) Tier 1 contraception. The most commonly chosen contraceptive methods among low- and high-risk women were progestin-only pills (30.6%) and tubal ligation (36.4%), respectively. Uptake rates of immediate postpartum contraceptive implants did not differ between low (9.3%) and high-risk (11%) women (p = 0.32). Few patients adopted intrauterine devices (1.1%).High-risk status was associated with intention to use and uptake of effective contraceptive methods, which persisted through the postpartum period.To assist women in achieving the recommended interpregnancy intervals, counseling tailored to their individual risks and needs should be provided. Reasons for low intrauterine devices uptake should be explored. Postnatal care should include immediate postpartum long-acting reversible contraception (LARC) services.

ObjectiveTo explore the association between carotid plaque and lumbar spine osteoporosis in post-menopausal women.Study designAge-matched, cross-sectional study.Main outcome measuresCarotid plaque and carotid intima media thickness were measured with B-mode ultrasound. Lumbar spine bone mineral density was measured with dual-energy X-ray absorptiometry. Prevalence odds ratios and the respective 95% confidence intervals (95%CI) were calculated to determine the association.ResultsSeventy-two post-menopausal women with lumbar spine osteoporosis and 72 post-menopausal women with normal lumbar spine bone mineral density were enrolled. The adjusted prevalence odds ratio of carotid plaque presence in post-menopausal women with lumbar spine osteoporosis was 1.73 (95%CI; 0.60 to 4.94) when compared to post-menopausal women with normal lumbar spine bone mineral density. The presence of vulnerable plaque was greater in post-menopausal women with lumbar spine osteoporosis; however, the difference was not statistically significant after adjusting for other risk factors of cardiovascular disease (odds ratio 1.31; 95%CI; 0.39 to 4.43). There was no significant difference in carotid intima media thickness between the two groups. Multiple logistic regression analysis with backward elimination in assessment of potential risk factors for the presence of carotid plaque showed that the year since menopause, family history of cardiovascular disease and systolic blood pressure were nominally significant associated factors with a respective adjusted odds ratio of 1.06 (95%CI; 1.01 to 1.12), 6.23 (95%CI; 1.65 to 23.46) and 1.03 (95%CI; 1.01 to 1.06).ConclusionsThe current study indicates that lumbar spine osteoporosis is not associated with the presence of carotid plaque, whereas year since menopause, family history of cardiovascular disease and systolic blood pressure are associated factors.

Coffee is believed to prevent postoperative ileus. This systematic review and meta-analysis was undertaken to determine the effectiveness of coffee consumption in stimulating gastrointestinal function after abdominal surgery. A number of databases for randomized controlled trials comparing coffee consumption following abdominal surgery versus water drinking or no intervention were searched. Cochrane’s Risk of Bias tool was used to assess risk of bias in included studies. Six trials involving 601 participants were included. All studies had high risk of performance bias. Three studies had an unclear risk of selection bias. Postoperative coffee consumption reduced time to first defecation (mean difference (MD), −9.98 hours; 95% CI, −16.97 to −2.99), time to first flatus (MD, −7.14 hours; 95% CI, −10.96 to −3.33), time to first bowel sound (MD, −4.17 hours; 95% CI, −7.88 to −0.47), time to tolerance of solid food (MD, −15.55 hours; 95% CI, −22.83 to −8.27), and length of hospital stay (MD, −0.74 days; 95% CI, −1.14 to −0.33). Benefits increased with increasing complexity of the procedure. None of the included studies reported adverse events associated with coffee consumption. Postoperative coffee consumption is effective and safe for enhancing the recovery of gastrointestinal function after abdominal surgery.

Objectives To examine whether carotid intima-media thickness (CIMT), the prevalence of increased CIMT, and the presence of carotid plaque differ according to menopausal status. Methods In this analytical cross-sectional study, we enrolled 61 premenopausal women and 61 postmenopausal women. We matched the two groups for age. Participants were classified as either premenopausal or postmenopausal according to menstrual history and follicular-stimulating hormone level. Two skilled radiologists measured CIMT and carotid plaque in all participants by using B-mode ultrasound. Results The mean age was 49.25 ± 2.0 years. The mean number of years since menopause in the postmenopausal group was 1.9 ± 0.92 years. After adjusted analysis, the mean CIMT of the common carotid artery of postmenopausal women was significantly higher than that of premenopausal women, with a mean difference of 0.068 mm (95% confidence interval 0.023, 0.113). There was no significant association between number of years since menopause and mean CIMT. Although the prevalence of increased CIMT and the presence of carotid plaque were significantly higher in the postmenopausal group than in the premenopausal group according to crude analysis, this difference was not statistically significant after adjusted analysis. Multiple linear regression analysis for assessing potential risk factors for the alteration of mean CIMT showed that only menopausal status and body mass index were independently associated factors. Conclusions Our findings indicate that postmenopausal status is a significant factor of high mean CIMT. These findings add to the growing evidence showing that menopause transition is a critical period for subclinical atherosclerosis development.

Background Despite the abundant sunlight in Thailand, vitamin D deficiency is common in premenopausal and postmenopausal Thai women. Sunlight exposure is a natural way to increase one’s intake of vitamin D. However, limited research has been conducted regarding natural exposure to sunlight as a strategy to improve vitamin D status in postmenopausal women. Objective This study aimed to determine the effects of sunlight exposure compared with oral supplementation with vitamin D2 (weekly 20,000 IU) in combination with sunlight exposure on 25(OH)D levels. Methods A 12-week randomized controlled trial was conducted in 52 postmenopausal women, age 50–70 years. The participants were randomized to either the sunlight exposure group or the sunlight exposure with vitamin D supplementation group. Serum 25(OH)D concentration and parathyroid hormone (PTH) were measured using standard assays at baseline and 12 weeks. Results After 12 weeks, mean serum 25(OH)D had decreased from 32.3 to 29.7 ng/ml in the sunlight exposure group, but significantly increased in the combination group (from 29.9 to 32.4 ng/ml). At the end of the study, 25(OH)D levels were significantly higher in the sunlight exposure with vitamin D supplementation group compared with the sunlight exposure group. However, this difference was not observed in women aged >60 years. Serum PTH had decreased in both groups, but not to a significant extent. Conclusion A combination of weekly vitamin D2 supplementation at a dose of 20,000 IU with sunlight exposure is more effective than sunlight exposure alone in postmenopausal Thai women. Sunlight exposure alone is not sufficient to maintain 25-hydroxyvitamin D levels in this setting.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effectiveness and safety of vitamin and mineral supplementation for alleviating symptoms in women with a diagnosis of premenstrual syndrome or premenstrual dysphoric disorder.

Nattapong Buddhabunyakan, Srinaree Kaewrudee, Chompilas Chongsomchai, Sukree Soontrapa, Woraluk Somboonporn, Jen Sothornwit Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Background: Premenstrual syndrome (PMS) is a common health problem among adolescents.Objective: To assess the prevalence of PMS in Thai high school students.Materials and methods: This was a prospective study conducted among menstruating high school students in Khon Kaen, Thailand, from September to December, 2015. Participants were asked to prospectively complete an anonymous questionnaire, which included information about demographic data, menstrual patterns, and symptoms to be recorded on a daily calendar of premenstrual experiences according to the diagnostic criteria proposed by the American College of Obstetricians and Gynecologists. All of the data were prospectively recorded for 90 consecutive days.Results: Of the 399 participants, 289 (72.4%) completed the self-report questionnaire. Eighty-six participants (29.8%; 95% CI, 24.5%–35.4%) reported having PMS. The most common somatic and affective symptoms among participants with PMS were breast tenderness (74.4%) and angry outbursts (97.7%). There were significant differences between the PMS and non-PMS groups, and PMS was associated with various problems related to educational activities, including lack of concentration and motivation, poor individual work performance, poor collaborative work performance, and low scores. However, there were no significant differences regarding interpersonal relationships between the PMS and non-PMS groups.Conclusions: PMS is a common menstrual disorder among Thai high school students. The most common symptoms reported in this study were angry outbursts and breast tenderness. Keywords: premenstrual symptoms, prevalence, association, high school students

Background The spacing of pregnancies has a positive impact on maternal and newborn health. The progestin contraceptive implant, which is a long-acting, reversible method of contraception, has a well-established low failure rate that is compatible with tubal sterilization. The standard provision of contraceptive methods on the first postpartum visit may put some women at risk of unintended pregnancy, either due to loss to follow-up or having sexual intercourse prior to receiving contraception. Therefore, the immediate administration of contraception prior to discharge from the hospital that has high efficacy may improve contraceptive prevalence and prevent unintended pregnancy. Objectives To compare the initiation rate, effectiveness, and side effects of immediate versus delayed postpartum insertion of implant for contraception. Search methods We searched for eligible studies up to 28 October 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE. We examined review articles and contacted investigators. We also checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies. Selection criteria We sought randomised controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant for contraception. Data collection and analysis Two review authors (JS, YW) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL or SK). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables. Main results Three studies that included 410 participants met the inclusion criteria of the review. We did not identify any ongoing trials. Two included studies were at low risk of selection, attrition, and reporting biases, but were at high risk of performance and detection biases due to the inability to blind participants to the intervention. One included study was at high risk of attrition bias. The overall quality of the evidence for each comparison ranged from very low to moderate; the main limitations were risk of bias and imprecision. Initiation rate of contraceptive implants at the first postpartum check-up visit was significantly higher in the immediate insertion group than in the delayed insertion group (RR 1.41, 95% CI 1.28 to 1.55; three studies, 410 participants; moderate quality evidence). There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant used at six months after insertion (RR 1.02, 95% CI 0.93 to 1.11; two studies, 125 participants; low quality evidence) or at 12 months after insertion (RR 1.04; 95% CI 0.81 to 1.34; one study, 64 participants;very low quality evidence) Women who received an immediate postpartum contraceptive implant insertion had a higher mean number of days of abnormal vaginal bleeding within six weeks postpartum (MD 5.80 days, 95% CI 3.79 to 7.81; one study, 215 participants; low quality evidence) and a higher rate of other side effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; one study, 215 participants; low quality evidence) than those who received a delayed postpartum insertion. There appeared to be little or no difference between the groups in heavy, irregular vaginal bleeding or associated severe cramping within 12 months (RR 1.01, 95% CI 0.72 to 1.44, one study, 64 participants;very low quality evidence). It was unclear whether there was any difference between the groups in scores for participant satisfaction on a 0-10 scale (MD -0.40, 95% CI -1.26 to 0.46, low quality evidence), or in rates of unintended pregnancy (RR 1.82, 95% CI 0.38 to 8.71, 1 RCT, 64 women, very low quality evidence) at 12 months, or in rate of breastfeeding rate at six months (RR 2.01, 95% CI 0.72 ro 5.63, 1 RCT, 64 women, very low quality evidence) rate did not differ significantly between the groups. Authors' conclusions Evidence from this review indicates that the rate of initiation of contraceptive implant at the first postpartum check-up visit was higher with immediate postpartum insertion than with delayed insertion. There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant use at 6 months. It was unclear whether there was any difference between the groups in continuation of contraceptive use at 12 months or in the unintended pregnancy rate at 12 months.

Objectives: This study aimed to determine the prevalence of hypothyroidism and its association with menopausal symptoms and evaluated the diagnostic performance of Zulewski’s clinical score for predicting hypothyroidism in peri-/post-menopausal Thai women. Materials and Methods: This hospital-based cross-sectional study was conducted between June 2015 and April 2016 in Srinagarind Hospital, Khon Kaen, Thailand. We enrolled 305 peri-/post- menopausal women 45-65 years of age without previous history of thyroid diseases, radiation exposure at the neck, or concurrent use of lithium. The participants were interviewed by two research assistants’ vis-à-vis symptoms of menopause and hypothyroidism, current medications and menstrual characteristics. Blood samples were taken for TSH and FT4 levels. Main outcomes were prevalence of hypothyroidism, the Menopause-Specific Quality of Life (MENQOL) score, and diagnostic performance of Zulewski’s clinical score . results: Mean age was 56 ± 4.7 years. The prevalence of hypothyroidism was 6.2% (95%CI 3.5% to 8.9%). The sensitivity of Zulewski’s clinical score at the cutoff point ≥ 3 was 70%. Neither the MENQOL domain score nor the composite score was associated with hypothyroidism. Conclusion: The prevalence of hypothyroidism in peri-/post-menopausal Thai women is low. There is no association between MENQOL score and hypothyroidism. Zulewski’s clinical score is not a good screening test for hypothyroidism in this group.

Objective:The objective of this study was to compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) with those of systemic progestogen in perimenopausal and postmenopausal women taking systemic estrogen therapy (ET).Methods:We searched Medline (August 8, 2009), Emb

Objective:To study the prevalence, types, sources of information, and physicians’ awareness regarding the usage of complementary and alternative medicine (CAM) in postmenopausal women at Srinagarind Hospital.Study design: Cross sectional descriptive study.Materials and methods: A survey was conducted between July and October 2013 in 200 postmenopausal women with general gynecologic problems who attended the outpatient department of Obstetrics and Gynecology, Srinagarind Hospital, a tertiary care hospital, in northeastern Thailand. Validated questionnaires for determining the prevalence, types, sources of information, and awareness of the physicians in CAM were used.Results: The mean age of the participants was 56.1 years. The prevalence of current CAM use was 63.0%. Ya satree was the most commonly used (18.6%) followed by fermented herb juice (16.5%) and chlorophyll (13.1%). The most important sources of information of participants in deciding to use CAM was the recommendation of acquaintances or friends (79.4%) followed by advertisements in newspaper or magazine (16.7%) and advertising on television (13.5%). Only 28.0% and 19.5% of the participants were asked by the physician about their history of CAM use and informed by the physician about the potential risk of CAM such as herb-drug interaction and adverse effects, respectively.Conclusions: More than 60% of postmenopausal women interviewed at Srinagarind Hospital used CAM. Most participants (72%) never had asked about their history of CAM use by the physician. More education on this issue should be provided to patients in order to reduce unnecessary CAM used, and CAM used should be a part of routine history taking in all patients.

The aim of this double-blind, placebo-controlled study was to evaluate the effect of mefenamic acid and placebo on controlling irregular uterine bleeding secondary to Norplant use. A total of 67 Norplant users attending the Family Planning Clinic of Chulalongkorn Hospital all had irregular bleeding. These women were randomly allocated into two groups. A total 34 users received mefenamic acid, 500 mg twice a day for 5 days, and placebos were given to the other 33 in the same manner. The total days of bleeding and spotting and the percentage of women in whom bleeding was stopped were analyzed in weeks 1 and 4. The percentage of subjects in whom bleeding was stopped during week 1 after initial treatment was significantly higher in the mefenamic acid group than the placebo group (76%, 27%; p0.001). In the follow-up period (4 weeks after initial treatment), a bleeding-free interval of20 days was found in 68% of the subjects treated with mefenamic acid and 33% treated with the placebo; the mean number of bleeding/spotting days was lower with mefenamic acid treatment (11.6 and 17.2 days; p0.05). The difference was statistically significant. It is concluded that mefenamic acid was more effective than placebo in short-term control of irregular bleeding and spotting associated with Norplant use.This double-blind, placebo controlled study evaluates the effect of mefenamic acid and placebo on controlling irregular uterine bleeding secondary to Norplant use. A total of 67 Norplant users attending the Family Planning Clinic of Chulalongkorn Hospital who had irregular bleeding were divided into two groups. About 34 users received mefenamic acid, 500 mg twice a day for 5 days; placebos were given to the other 33 in the same manner. The total days of bleeding and spotting and the percentage of women in whom bleeding was stopped were analyzed in weeks 1 and 4. The percentage of subjects in whom bleeding was stopped during week 1 after initial treatment was significantly higher in the mefenamic acid group than the placebo group (76% vs. 27%; p 0.001). In the follow-up period (4 weeks after initial treatment), a bleeding-free interval of 20 days was found in 68% of the subjects treated with mefenamic acid and 33% treated with the placebo; the mean number of bleeding/spotting days was lower with mefenamic acid treatment (11.6 and 17.2 days; p 0.05). The difference was statistically significant. Therefore, mefenamic acid was more effective than placebo in short-term control of irregular bleeding and spotting associated with Norplant use.

The efficacy of hormone therapy (HT) on dry eye syndrome remains debatable.To study the efficacy of HT on dry eye syndrome.A randomized controlled, double blind, parallel group, community-based study in 42 post-menopausal patients was conducted. The patients had dry eye syndrome and were not taking any medications. They were assigned to one of two groups. Group A comprised 21 patients given transdermal 17 beta-estradiol (50 mg/day) and medroxy progesterone acetate (2.5 mg/day) continuously for three months and group B comprised 21 patients given both transdermal and oral placebo. Participants in the study were included for final analysis. The improvement of dry eye symptoms were measured by visual analog scale, tear secretion, intraocular pressure, corneal thickness, and tear breakup time determined before treatment and at 6 and 12 weeks of treatment.At 12 weeks, the number of patients who reported improvement of dry eye symptoms was greater in the HT group than that in the placebo group. However, the difference was not statistically significant (RR 0.25, 95% CI 0.04-2.80 and 0.60, 95% CI 0.33-2.03 in right and left eye, respectively). For other parameters, there was no significant difference between the two groups.According to the present study, there is no strong evidence to support the use of HT for treating dry eye syndrome. The limited number of participants included in the present study may have contributed to the insignificant effects.

To determine the prevalence and risk factors of urinary incontinence in menopausal women.Prospective Descriptive study.Menopausal clinic and gynecological outpatient unit, Department of Obstetrics and Gynecology, Srinagarind Hospital, Faculty of Medicine Khon Kaen University.Menopausal women attending the menopausal clinic and gynecological outpatient unit.Between April 23 and July 15, 2004, 229 menopausal women were interviewed by pre-validated questionnaire and in-depth interview to determine the prevalence and risk factors of urinary incontinence.The average age of the study group was 55.8 years. The prevalence of urinary incontinence was 38.86%, the most common type was mixed urinary incontinence (82.02%) followed by stress urinary incontinence (12.36%), and urge urinary incontinence (5.62%). The risk factors of urinary incontinence were vaginal delivery, menopause before 50 years old, and postmenopausal women who had never used hormone therapy.The prevalence of urinary incontinence in menopausal women was 38.86%. Mixed urinary incontinence was the most common type. Associated risk factors were vaginal delivery, menopause before 50 years old, and postmenopausal women who had never used hormone therapy.

To study lipid profile of menopausal women with hormone therapy.Two hundred and sixty eight menopausal women in good health conditions, separated into natural and surgical menopause group, received service at Menopausal clinic in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University since 1996-2004. They regularly took a single type of hormone therapy for about 12 months and obtained blood cholesterol levels for pre- and post-hormone therapy of about 12 months period. The data were analyzed with SPSS v. 10.0.5.The average age of the sample groups were 50.91 +/- 5.93 years and 52.83 +/- 5.28 respectively. Both sample groups have similar mean level of cholesterol levels during pretreatment period. Surgical menopausal group has greater HDL level than the naturally menopausal group with the average level of 64.24 +/- 15.32 mg/ dl. and 58.80 +/- 17.20 mg/dl. respectively. However after taking hormone therapy, blood cholesterol level was significantly changed in both groups. The mean level of LDL decreased (8.59% and 11.49% respectively) and mean level of HDL increased (15.43% and 6.89% respectively).Hormone therapy in menopausal women can improve cholesterol levels by decreasing LDL and increasing HDL with statistical significance (p0.05).

To assess the different effects between non-treatment, estrogen and estrogen-progestin regimens on changes in mammographic density in postmenopausal women.A historical cohort of 105 postmenopausal women who attended the Menopause Clinic, Srinagarind Hospital, Khon Kaen, Thailand, and received 1 of 3 regimens: nontreatment, estrogen or estrogen-progestin (35 in each group). Mammographic examinations were done before and after a 12-24-month period of hormone therapy. Breast density (mammographic density, recorded in the medical records) between the 2 examinations in each group were compared.An increase in mammographic density occurred among women receiving hormone therapy: 40% (14 of 35) in the estrogen-progestin group and 20% (7 of 35) in the estrogen-only group, but no variation in density was observed in the nontreatment group. The increase in mammographic density occurring in women on hormone therapy, as compared to the nontreatment group, was statistically significant (estrogen-progestin, 95% CI 20.91-59.09; estrogen, 95% CI 3.89-36.11). When the different treatment types were compared, the estrogen-progestin group tended to have a higher prevalence of mammographic density change than the estrogen-only group, but the difference was not statistically significant (95% CI -3.81-43.81).Hormone therapy was associated with increased mammographic density. Apparently the estrogen-progestin regimen affects breast density more than estrogen-only does.

Objectives. To determine the prevalence of urogenital symptoms (vaginal dryness, dyspareunia, urinary incontinence) and assess patient’s consultation rate and desire for treatment. Design and Methods. This study was prospective descriptive study, performed with the participation of 125 women who presented in menopausal clinic, Srinagarind Hospital. Women completed the questionnaire including questions about their demographic properties and were interviewed by pre-validated questionnaire and in-depth interview to determine the prevalence of urogenital symptoms, consultation rate and patient’s desire for treatment. Results. The mean age of the participants was 57.1 years. Vaginal dryness was found to be the most common postmenopausal urogenital symptoms (71.2%), followed by urinary incontinence (62.4%) and dyspareunia (52.0%). The consultation rates were 62.2% in vaginal dryness, 46.2% in dyspareunia and 38.5% in urinary incontinence. Patient’s desire for treatment was 66.7% in vaginal dryness, 62.1% in dyspareunia and 53.8% in urinary incontinence. Conclusions. Urogenital symptoms are highly prevalent. Physicians need to improve patient-physician communication and increase their attention to these symptoms and their patient’s attitudes to improve patient’s quality of life.