Objective: To evaluate the impact on glucose and insulin metabolism of transdermal estrogen patches before and after the addition of cyclic dydrogesterone in postmenopausal women. Design: We studied 21 postmenopausal women seeking treatment for symptomatic menopause. All patients received transdermal 50 mg/day estradiol for 24 weeks. After 12 weeks of treatment, 10 mg/day dydrogesterone were added. Methods: During both regimens, insulin and C-peptide plasma concentrations were evaluated after an oral glucose tolerance test (OGTT); insulin sensitivity was evaluated by a hyperinsulinemic euglycemic clamp technique. Insulin and C-peptide response to OGTT were expressed as area under the curve (AUC) and as incremental AUC; insulin sensitivity was expressed as mg/kg body weight. Fractional hepatic insulin extraction (FHIE) was estimated by the difference between the incremental AUC of the C-peptide and insulin divided by the incremental AUC of the C-peptide. Plasma hormone and lipid concentrations were assessed at baseline and at 12 and 24 weeks of treatment. Results: Nine patients proved to be hyperinsulinemic and 12 were normoinsulinemic. Transdermal estrogen treatment significantly decreased the insulin AUC (P < 0.05) and the insulin incremental AUC in hyperinsulinemic patients; addition of dydrogesterone further decreased both the AUC and incremental AUC of insulin. Estrogen alone and combined with dydrogesterone evoked a significant increase in C-peptide AUC in hyperinsulinemic (79.2%) and normoinsulinemic (113%) patients. The treatment increased the values for FHIE and insulin sensitivity in all patients (P < 0.04) and in the hyperinsulinemic group (P < 0.01), whereas it did not affect such parameters in normoinsulinemic patients. Conclusions: Transdermal estrogen substitution alone and combined with cyclical dydrogesterone may ameliorate hyperinsulinemia in a selected population of postmenopausal women.

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Objective The aim is to stress the fundamental role of hysteroscopy in the diagnosis of the cause of endometrial pathologies. Subjects and methods The results of 10 years’ experience, between December 1984 and January 1995, in the gynaecological endoscopy outpatients' unit of the Catholic University of Rome are reported. A series of 6180 women undergoing diagnostic hysteroscopy is analysed and the indications, contraindications and side‐effects of hysteroscopic examination are discussed. Results Outpatients, mean age of 51 years (range 22–81), who underwent hysteroscopic examination had, as main indication, abnormal uterine bleeding (AUB). The differing distributions of hysteroscopic findings in pre‐ and postmenopausal women is stressed, along with the importance of focal endometrial pathologies such as polyps and submucosal myomas in premenopause, the high incidence of endometrial atrophy, and the significant occurrence of hyperplastic and neoplastic hysteroscopic findings in the postmenopause. Primary and secondary infertility are, after AUB, the second most common indications for hysteroscopic examination, and the role of malformation (septate and subseptate uterus), inflammation (intrauterine synechiae) and focal endometrial pathologies (polyps and submucosal myomas) is illustrated. Conclusions As a result of the introduction of hysteroscopy it is now possible to preserve organs, with the slight trauma of noninvasive treatment, rather than using extirpartive surgery. In premenopausal women with AUB (n=2132) the most frequent pathologies were low‐risk hyperlasia (25.3%), submucosal myoma (24.5%) and endometrial polyps (8.3%); there were normal findings in 40.2%. There is a low incidence of high‐risk hyperplasia (0.7%) and neoplastic pathology (0.5%). In postmenopausal women with AUB there is a high incidence of atrophy (23%), whereas high‐risk hyperplasia and neoplastic pathology are five and eight times more common, respectively, in these women than in premenopausal patients.

Sebbene la letteratura sulla moralità dell'aborto sia abbastanza ampia il dibattito si riferisce quasi sempre all'aborto provocato. Poco si discute invece sulla rilevanza morale dell'aborto spontaneo, cioè dell'interrompersi della gravidanza indipendentemente dalla volontà della donna o dal fatto che ella sappia di essere gravida. Gli autori presentano dapprima una breve sintesi di ordine scientifico sull'aborto ripetuto spontaneo, considerando la sua incidenza le cause e il trattamento. In particolare essi presentano l'esperienza nella Divisione di Ginecologia disfunzionale dell'Università Cattolica di Roma nella quale alcuni di essi lavorano. Successivamente essi discutono ampiamente il significato morale dell'aborto spontaneo esaminandolo alla luce delle due principali e contrapposte posizioni circa l'aborto volontario. Per gli autori non è accettabile identificare tutti gli eventi naturali con i precetti morali così che l'esistenza di una patologia in natura (e tale è l'aborto spontaneo) non significa che si sia obbligati a indurla. In altri termini il richiamo alla natura come fondamento della legge morale naturale non deriva dalla osservazione dei fenomeni che si presentano in natura ma dal concetto di natura umana. Considerando il rispetto dovuto alla vita umana sin dal concepimento gli autori concludono che si è moralmente obbligati a cercare di prevenire l'aborto spontaneo come pure a ricercare nuove modalità per rilevare il più presto possibile il concepimento sin dal momento in cui si verifica. Ogni elusione di queste responsabilità potrebbe identificare una negligenza moralmente rilevante nel determinarsi dell'aborto "spontaneo".

In some species the onset of labor is regulated by changes in the estrogen/progesterone ratio. The same change in fetal membranes has been suggested to be one of the triggering mechanisms of labor in humans. In order to examine if a gradient in steroid concentration existed in fetal membranes and if changes in concentrations could be observed with the onset and advancing labor, the concentration of progesterone (P), 20 alpha-dihydro-progesterone (20 alpha-OHP), estrone (E1) and 17 beta-estradiol (E2) were determined by specific radioimmunoassay in the near placental and most distant regions of human amnion and chorion laeve obtained at term, before, at the onset and in advanced labor. Both estrogen and progestin concentrations in the chorion were higher than in the amnion. No gradient in the concentration of steroids was found. No statistically significant differences in estrogen and progestin levels were associated with the onset of labor.

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