Circulatory responses during spontaneous and stress induced menopausal flushes were measured by a plethysmographic technique. With the onset of symptoms there was an immediate and marked increase in hand blood flow which was sustained over three to four minutes and then fell to control levels over a further three minutes. Forearm and calf flow increased simultaneously though to a lesser extent and regained control levels within four-and-a-half minutes from the onset of symptoms. Mean pulse rate also increased during the flush but fell to control values at a time when limb flow was still elevated. There was no significant change in blood pressure during or after the flush. The peripheral circulatory changes are attributed to altered autonomic activity and may in part reflect a disturbance of thermoregulatory control in the menopause of which the flush is but one manifestation.

Abstract. In 50 women who had five successive pregnancies the difference was studied between the mean maternal weight at the 20th week of gestation and six weeks post partum. The difference changed from a weight loss to a weight gain in the fourth and fifth pregnancies. The maximum weight increment occurred between the end of the first pregnancy and the 20th week of the second, especially in obese multiparae.

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The effect of an alpha-adrenergic agonist. clonidine hydrochloride, on cardiovascular responses to noradrenaline, adrenaline and angiotensin was investigated in menopausal women with hot flushes. The increase in forearm blood flow induced by adrenaline, noradrenaline or angiotensin was significantly less in women treated for at least 6 weeks with clonidine compared with that induced in the women by infusions given before treatment. Pulse rate during the amine infusions was significantly lower after clonidine treatment but constrictor responses in the hand were unchanged. These findings cannot be wholly explained in terms of an action of clonidine confined to adrenergic mechanisms and suggest that the drug may influence peripheral vascular responsiveness. Such an effect could explain the mechanism of the beneficial clinical action of the drug in subjects with menopausal flushing or migraine.

Summary Bullous erythema multiforme is a disorder in which oral and genital erosions, ocular inflammation and cutaneous bullae may follow a viral or bacterial infection or the ingestion of certain drugs, such as sulphonamides. Unpleasant sequelae have been reported including residual scarring, and death may occasionally result from infection or renal failure; severe scarring can cause blindness and infrequently the genital tract is involved. We report a patient who developed complete vaginal stenosis following bullous erythema multiforme in pregnancy.

Case reportA 29 year old woman presented 86 h after uncomplicated vaginal delivery feeling generally unwell since the birth with increasing abdominal girth and persistent vomiting for the previous 48 h.She had been admitted in spontaneous labour at 38 weeks and 2 days of gestation after a normal antenatal course. Following admission, labour progressed rapidly with first and second stages of 35 min and 20min, respectively. Case report 1A previously healthy 32 year old women, the wife of a farmer, presented at 27 completed weeks of pregnancy with fever, rigor, headache, and a dry cough of one week's duration. A full blood count

A single-blind pilot study using combined estrogen and progestogen therapy was undertaken in 25 patients for a period of six months in an attempt to evaluate symptomatic control, the acceptability or otherwise of bleeding patterns, and the effect on endometrial pathology. Two different progestogens were employed, i.e. norgestrel and norethisterone acetate, and each was given in combination with estradiol valerate in a cyclical and a continuous regime. Symptomatic control was good in all groups, but there was a mild recrudescence of some symptoms during the tablet-free interval in the cyclical groups. Regular withdrawal bleeding was reported in almost all cases receiving cyclical therapy, and unscheduled bleeding was noted in those on continuous regimes. Endometrial hyperplasia did not occur following treatment in any of the groups, and there was a return to the normal histology in two patients in whom hyperplasia existed prior to treatment. These results support the view that endometrial hyperplasia is least likely to occur if progestogens are administered in combination with estrogen. There were no obvious differences between the effects of the two progestogens.