Laparoscopy is the most common mode of surgery for female tubal sterilisation. Hysteroscopic sterilisation is a new method which can be performed in the outpatient setting under local anaesthetic. We carried out a prospective cohort trial to determine whether women would actually favour hysteroscopic sterilisation over laparoscopic sterilisation. Data analysis in a cohort of 96 women showed that 77% would prefer laparoscopic sterilisation over the hysteroscopic procedure (23%), despite the advantages of an outpatient setting. Age, obstetric history, employment and marital status, access to transport and previous anaesthetic did not significantly influence the choice made.
One of the most common gynaecological causes of chronic pelvic pain is endometriosis. A lack of correlation between laparoscopic findings and pelvic pain has been reported. As endometriotic lesions are under hormonal influence, the effects of the gonadotrophin-releasing hormone (GnRH) analogues cause shrinkage of the deposits, reducing symptoms caused by them. We carried out a longitudinal, interventional pilot study, examining the effect of leuprorelin acetate 3.75 mg (Prostap SR, Wyeth) on pelvic pain prospectively. Preliminary data shows a decrease in pain scores from before to after treatment which is statistically significant (P<0.0001) as well as a general improvement in other symptoms. Laparoscopy showed that symptom intensity is not always related to severity of endometriosis and the worst symptoms may not necessarily be due to pathology. Therefore, it is beneficial to treat women with CPP with GnRH analogues as first-line management to relieve painful symptoms, avoid surgical risks and save money.
The purpose of this study was to determine the effectiveness of Prostap 3 M, a 3-month depot preparation of a gonadotrophin-releasing hormone agonist, in the relief of pelvic pain symptoms caused by endometriosis and to assess its effects on bone mineral density. A prospective cohort study was carried out at St. James's University Hospital, Leeds, and included 13 women with laparoscopically diagnosed endometriosis (n=13). Baseline investigations were performed to measure pain symptoms, bone mineral density and oestradiol levels. The women were then treated with 7 months of Prostap 3 M. At the end of treatment, the investigations were repeated. After the 7-month treatment phase, there was a statistically significant reduction in all the pain subset scores. The continuous GnRHa therapy resulted in a fall of serum oestradiol levels into the post-menopausal range. After treatment with Prostap 3 M, women with endometriosis showed a mean decrease of 5.57% in BMD of the lumbar spine and of 3.47% in femoral BMD. Both these falls are statistically significant. Prostap 3 M is effective in relieving the painful symptoms associated with endometriosis, and the continuous therapy over 7 months does indeed induce a hypo-oestrogenic state. However, the effects of Prostap 3 M on bone mineral density appear to be more detrimental than seen with monthly preparations.
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