Objective
To study fibrinolysis in the endometrium in women with normal menstruation and dysfunctional uterine bleeding (DUB).
Design
Tissue plasminogen activator activity (t‐PA) and antigen (t‐PAAg) and plasminogen activator inhibitor Type 1 antigen (PAI‐1) were measured in homogenates of endometrium sampled between 24 and 36 h after the onset of menstruation.
Subjects
Women complaining of menorrhagia who had negative findings at clinical examination and curettage had their menstrual blood loss (MBL) measured from the third cycle after D&C. Those with MBL greater than 80 ml per cycle formed the DUB group.
Measurements
Fibrinolytic enzyme antigen levels were measured with ELISAs. Tissue plasminogen activator activity was assayed by measuring the rate of conversion of Glu‐plasminogen to plasmin, using a chromogenic plasmin substrate.
Conclusions
There is a strong positive correlation between endometrial t‐PA activity on the second day of menstruation and measured menstrual loss (P<0.05). Concentrations of endometrial t‐PAAg and PAI‐1 antigen are higher in women with DUB compared with normal women during menstruation.
The diagnosis of menorrhagia is usually based on the subjective complaint of heavy menstrual bleeding, although up to 50% of women describing menorrhagia have measured menstrual loss within normal limits. Treatment is usually started without first establishing an objective diagnosis, because menstrual blood loss measurement is not widely available to clinicians. Current laboratory methods of measuring menstrual loss involve extraction of menses from sanitary wear. Many women find collection of sanitary wear unacceptable and laboratory staff find the menstrual extraction procedure unpleasant and time-consuming. We investigated the use of Gynaeseal, a vaginally placed latex menstrual seal, in women with normal menstrual loss (n = 10) and menorrhagia (n = 12) with regard to its suitability for the measurement of menstrual loss and efficacy as alternative sanitary protection. Twenty-one of the 22 women found the device easy to insert, but 16 found it messy to remove. All of the 6 couples having coitus found the device caused no discomfort. All women with menorrhagia and 4 of 12 women with normal menstrual losses were dissatisfied with the menstrual seal provided by gynaeseal. Gynaeseal does not contain menstrual blood efficiently in women with menorrhagia and is therefore unsuitable for the measurement of menstrual blood loss.
In view of the lack of unanimity on the effect of longterm intake of combined oral contraceptives (OC) on external sodium-dependent lithium efflux, otherwise known as sodium-lithium countertransport (SLC), we undertook a double-blind study to investigate the possible interaction between SLC and OC in healthy women with regular menstrual cycles.In a group of 17 volunteers, aged 27.0 ± 1.1 years (mean ± s.e.m.) and weighing 61.4 ± 2.0 kg, ingestion of 30 g ethinyloestradiol + 150 g desogestrel for 3 months caused an increase in SLC activity from a baseline value of 0.254 ± 0.017 mmol/lcell.h to 0.274 ± 0.017 mmol/lcell.h (P = 0.05). The activity of the transport system after 6 months treatment remained higher than at baseline (0.280 ± 0.016 mmol/lcell.h, P Ͻ 0.025) but was comparable to that at 3 months.
In a bid to minimise dosage and possible side-effects when relieving post episiotomy pain, the NSAID Indomethacin was studied in combination with a systemic haemostat Ethamsylate which has been shown to selectively inhibit some prostaglandins. Comparative groups also took Indomethacin alone and placebo in a double blind non-crossover comparison. Efficacy was judged in terms of side-effects and assessments of pain intensity, pain relief and global assessment of pain. There was some evidence of a beneficial interaction between Indomethacin and Ethamsylate when adjustments were made for the patient's age and initial pain score. Side-effects were most common in the combination therapy group.
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