Search

There are more than 50 studies and at least 6 metaanalyses with varying results concerning breast cancer risk related to hormone replacement therapy. According to the literature the breast cancer risk in hormone replacement therapy may be slightly increased, especially after long-term treatment. After discontinuing hormone therapy the risk decreases and reaches baseline 5 years later. Since prospective randomised studies are lacking, it is still unclear whether hormone replacement therapy really promotes breast cancer or if the increase is due to methodological biases such as more frequent breast examination or mammography. According to the literature there is no evidence that under hormone replacement therapy the risk of relapse is elevated or the prognosis less favourable in women treated for breast cancer. Since prospective randomised studies with long-term follow-up are lacking, we recommend the use of the guidelines of the "Deutsche Gesellschaft für Senologie", based on oestrogen receptor levels and lymph node involvement. Risks and benefits of hormone replacement therapy should be discussed with the well-informed patient and alternative therapy modalities evaluated.

Menopausal loss of ovarian estradiol production has numerous unfavourable effects on woman's health. Frequency and intensity of hot flushes mostly decline after some years. However, urogenital atrophy, incontinence, bone loss and rising risk for cardiovascular disease and probably for M. Alzheimer are of greatest importance as their incidence increases after menopause and because they play a major role in causing morbidity and mortality in elderly women. We discuss the pathophysiology of hot flushes, estradiol's effects on bone turnover, on the arterial vessel wall, on serum lipids and some aspects of estradiol action in the brain.

The prescription of hormone replacement therapy (HRT) requires a pretherapeutic evaluation and an ongoing surveillance during treatment. Pretherapeutic evaluation identifies the indications and contraindications to HRT. It includes a clinical examination, a Papanicolaou smear, and other tests according to the clinical situation. Monitoring of HRT consists of a first follow-up visit 3 months after beginning treatment to assess the effectiveness, side effects, and compliance with the therapy. Following this, yearly medical examinations should be scheduled. This paper describes the most frequent clinical signs that suggest a modification of treatment or the need to perform further investigations.

Aim: To determine whether the term "fractional D&C" is justified with respect to the uterine cervix and corpus fractions, and what indications and results are found when a large population at a university hospital is analyzed., Methods: In this retrospective study covering a 3-year period at the Department of Gynecology, University Hospital of Zurich, indications and results of fractional D&C were obtained from hospital records stored in a data bank. The curettage results of hysterectomized women were compared with the histological findings of the hysterectomy specimens., Results: 938 women (mean age 52 years) underwent fractional D&C. 38% had postmenopausal, 36% premenopausal and 13% perimenopausal abnormal bleeding. For 5% there was a sonographic finding without bleeding disorders, 4% had cervical polyps, 1% breast cancer, and 3% other diagnoses. In 13% of the cases the corpus curettage material could not be evaluated. For 43%, the corpus material appeared normal and in 5% a malignancy was found. In 74% of the cervical fractions nothing abnormal was detected, in 14% no conclusive evaluation of the material was possible, and in 3% the histological report showed a malignancy. In 20% of the cases the cervix curettage material was contaminated with material from the uterus cavum., Conclusions: For cases with cancer of the cervix, the sensitivity of fractional D&C was 80%, compared with a specificity of 66.7%. With a positive predictive value of 52.2%, the term "fractional D&C" is in many cases not justified. Our data and recent literature have prompted us to draw up new criteria for evaluation of abnormal vaginal bleeding, or a new set of indications for fractional D&C and hysteroscopy.

Microinsemination is a new method of treating sterility. It improves the chance of fertilization in cases of severe male subfertility and of unexplained infertility. Fertilization is assisted by opening the zona pellucida with a microneedle (PZD), by introducing a small number of sperms with a micropipette into the perivitelline space (SUZI) or by direct insertion of a spermatozoon into the ooplasm (ICSI). We report on the first delivery achieved by microinsemination (SUZI) at the University Hospital Zurich and, as far as we know, in Switzerland.

Unlabelled: The first IVF-baby (in-vitro fertilization) was born in England in 1978 and was greeted enthusiastically. But, despite the enormous effort invested, pregnancy rates were disappointingly low. Although in recent years the clinical pregnancy rate has increased worldwide to 15-20% per retrieval, a vast number of people remained unaware of this improvement. To demonstrate and analyze the progress of IVF we evaluated all 196 IVF treatments effected from 1988-1991 at Zürich University Hospital. With an initial clinical pregnancy rate of only 6% per retrieval in 1988, the rate improved to 35% (p < 0.025) in 1991. The crucial factors relating to this improvement were the 1990 introduction of the programmed short-term protocol for ovarian stimulation and reevaluation of the previously used embryo freezing technique., Conclusion: After a difficult start, IVF has become, if accurately indicated, a method of sterility treatment with a realistic pregnancy and delivery prospect.

57 women suffering from seborrhea and acne were treated with low doses of estrogens and antiandrogens. A cyclic regimen comprising 21 tablets of 0.05 mg ethinylestradiol and 2 mg cyproterone acetate was used. Results were very favourable: within 6 months, 51 patients were healed or significantly improved. There were only minor side effects, and none of the women conceived. It is concluded that this combination not only provides very effective therapy but might also be the contraceptive of choice for women with skin problems.

Percutaneous application of estradiol in the postmenopause is considered to be a promising alternative to oral estrogen replacement therapy. Since it avoids the first liver passage, the resulting circulatory hormone patterns seem to be more physiological and the dose can be greatly reduced. The efficacy and some of the pharmacological effects of a newly developed hydroalcoholic gel containing 17 beta-estradiol were investigated in 114 postmenopausal women. Within 3 months the Kuppermann index, which scores 11 of the most important climacteric symptoms, dropped from 29.0 to 6.9 and from 29.0 to 9.3 points in ovariectomized patients. Vaginal atrophy was greatly improved, the maturation index increased from 2/31/66 to 29/54/12. The body weight and the blood pressure were not significantly influenced, total cholesterol, triglycerides, and LDL- and VLD-cholesterol decreased, while HDL-cholesterol remained unchanged. Local and systemic side effects were relatively rare: 6.1% of all women complained of breast tenderness and 2.6% recorded vaginal bleedings. The acceptability of the topical treatment was excellent. Since recent studies have shown effective prevention of postmenopausal bone loss, the gel could become an attractive method in clinical practice.

In 44 hirsute women treated with antiandrogens, sequential administration of cyproterone acetate and ethinylestradiol produced a success rate of 87%. The mean duration of treatment was 9 months, and side effects were rare. Antiandrogens are therefore superior to conventional cosmetic methods, though prior hormonal analysis is indispensable.

Some aspects of the pathogenesis, diagnosis and treatment of amenorrhea are presented. Careful clinical examination is still of great importance. Hormone analysis and sophisticated functional tests, although they permit precise localization of the dysfunction, are usually dispensable for practical purposes. Major progress has been achieved in therapy, though induction of ovulation, particularly by human menopausal gonadotropins, still requires experience and frequent hormonal monitoring.