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Endometriosis in the adolescent has, in recent years, been discovered to be a challenging problem in gynaecology. Although the pain may start at a young age, even before the onset of menstruation, the diagnosis by laparoscopy is almost always postponed for several years, by which time destructive lesions have affected the tubo-ovarian structures and severely compromised fecundability. Several factors may play a role, but one important reason for this disease progression is likely to be the delay in diagnosis. Therefore, transvaginal ultrasounds and transvaginal access with a less invasive needle endoscopy are recommended for exploration of the pelvis, diagnosis of endometriosis and treatment at an early stage before severe lesions develop. [ABSTRACT FROM AUTHOR]

The relatively short history of hormonal contraception has been marked by a series of 'pill scares', all of which-after creating panic among users- were proven to be unfounded in terms of public health impact. The latest pill scare, provoked by regulatory action in the United Kingdom and the Federal Republic of Germany in response to the publication of a series of articles indicating a doubling of risk of deep venous thrombosis in users of oral contraceptives containing third-generation progestins, seems finally settled: both the British and the German Drug Regulatory Authorities have now reverted their verdict. The damage unfortunately stays: hundreds of thousands of women have been compelled to abandon the pill of their choice, often deciding to drop contraception altogether, thereby exposing themselves to unwanted pregnancy and-in a number of cases -to pregnancy termination. This latest episode should be turned into something positive: we need to learn that, in the case of drugs in widespread use, before restrictive action is taken-and except for very rare and specific instances-the scientific community must carry out an exhaustive debate on the reality and importance of the observed effects. Although the public should, in each instance, be properly informed, it is only after this process has been completed that restrictive action should be taken. It is hoped that, after this last episode, all concerned have learned this simple principle and will accept being guided by it from now on. [ABSTRACT FROM PUBLISHER]

The history of endometriosis is reviewed in the light of today's clinical and pathological knowledge of this disease. Prior to Sampson's report in 1921, attention was focused on the enclosed type of endometriosis, sited deep in the pelvis and called adenomyosis externa. Sampson's first hypothesis, that rupture of an ovarian endometrioma caused superficial peritoneal endometriosis, was probably changed after this observation that the free, superficial peritoneal implants reacted like eutopic endometrium. These implants were recognized as implants from menstrual blood regurgitated into the pelvic cavity. Adenomyosis externa, ovarian endometrioma and peritoneal endometriosis then came to be regarded as the same disease. In the light of today's knowledge, it may be important to remember this progressive understanding in the nosology of what is now universally called pelvic endometriosis. [ABSTRACT FROM PUBLISHER]

Progestasert devices releasing 65 μg of [14C]progesterone daily were inserted in 10 women 3 months prior to elective hysterectomy. Following surgery, specimens were examined by light and electron microscopy and by autoradiography. In three uteri, removed during the early follicular phase, there was a clear contrast between the appearance of the superficial portion of the endometrium in the zone immediately adjacent to the device, when compared to areas away from the progestasert. This difference became more pronounced in four specimens obtained at mid-cycle and tended to diminish during the luteal phase: the number of glands was still lower than normal, but stromal decidual reaction was apparent throughout the functional layer of endometrium; in addition, in portions away from the device, glands showed the characteristics of a secretory phase. Progesterone and/or its metabolites were abundant in the superficial epithelium and in the portion of the glands adjacent to the surface; and also well distributed in the stroma and in the capillary walls. Historadiography however, clearly showed that progesterone barely penetrated the deeper portion of the endometrium. This picture does not substantially change during the entire cycle [ABSTRACT FROM PUBLISHER]

Progestasert devices releasing 65 micrograms of [14C]progesterone daily were inserted in 10 women 3 months prior to elective hysterectomy. Following surgery, specimens were examined by light and electron microscopy and by autoradiography. In three uteri, removed during the early follicular phase, there was a clear contrast between the appearance of the superficial portion of the endometrium in the zone immediately adjacent to the device, when compared to areas away from the progestasert. This difference became more pronounced in four specimens obtained at mid-cycle and tended to diminish during the luteal phase: the number of glands was still lower than normal, but stromal decidual reaction was apparent throughout the functional layer of endometrium; in addition, in portions away from the device, glands showed the characteristics of a secretory phase. Progesterone and/or its metabolites were abundant in the superficial epithelium and in the portion of the glands adjacent to the surface; and also well distributed in the stroma and in the capillary walls. Historadiography however, clearly showed that progesterone barely penetrated the deeper portion of the endometrium. This picture does not substantially change during the entire cycle. [ABSTRACT FROM AUTHOR]