Impact of Global Consensus Statement on compliance with hormonal therapy for surgical menopause

OBJECTIVE

Initiation of and compliance with menopausal hormonal therapy (MHT) have been dropping due to the 2002 Women's Health Initiative (WHI) publication. We evaluated the change in practice of MHT for surgical menopause after implementing the 2013 'Global Consensus Statement on MHT' to our institutional guideline.

METHODS

A retrospective study was conducted in surgically menopausal women newly registering at the Siriraj Menopause Clinic in a university hospital, Thailand, from 1995 to 2013. The patients were categorized into four groups according to periods of MHT initiation: 1995-1998 (control), 2000-2003 (WHI affected), 2005-2008 (post WHI) and 2010-2013 (Global Consensus Statement affected). Their 3-year compliance with MHT was compared using forward stepwise regression analysis.

RESULTS

There were 288, 156, 107 and 104 cases in the 1995-1998, 2000-2003, 2005-2008 and 2010-2013 groups. Their mean age at surgery was 42.8 ± 4.7 years. After the first, second and third years, overall compliance was 82.4%, 70.9% and 61.2%, respectively. The 3-year compliance drastically dropped in the 2000-2003 group, and then improved to control level in the 2010-2013 group (51.9% vs. 77.9%, p = 0.035).

CONCLUSION

The initiation of MHT continuously dropped during 2000-2013; however, compliance with MHT initiated during 2010-2013 improved after implementing the 2013 'Global Consensus Statement on MHT' to our institutional guideline. Each institute should have a strategy to encourage the initiation of and compliance with MHT for surgical menopause to achieve long-term health benefits.

Compliance and health consequences of menopausal hormonal therapy after surgical menopause: A retrospective study in Thailand

AIM

To study compliance with menopausal hormonal therapy (MHT) until age ≥ 50 year and health consequences after surgical menopause.

METHODS

A retrospective cohort study of 1000 consecutive surgically menopausal patients who underwent premenopausal surgery before 50 years of age from benign indications during 1996-2012 was performed. Main outcomes were number in year of MHT compliance and health consequences: hypertension (HT), diabetes mellitus (DM), dyslipidemia (DLP), ischemic heart disease (IHD)/myocardial infarction (MI), venous thromboembolism (VTE), stoke, osteopenia/osteoporosis, cognitive impairment/dementia/Alzheimer's disease (AD) /Parkinsonism and breast/other cancers. The MHT nonuser subgroup served as the control.

RESULTS

Of the 1000 patients, 855 cases used MHT. The median overall follow-up time from surgery for 145 MHT nonuser patients, 435 MHT users until age <50 year and 420 MHT users until age ≥50 year was 12.0 years. Compliance until age ≥50 year was only 49.1%. For MHT users, the overall median age of stopping MHT was 47.0 year with a median MHT use of 6.0 year. After age adjustment at the time of follow-up of all subgroups by forward stepwise logistic regression analysis, the only significantly different health consequence was osteopenia (32.4%, 10.6% and 21.4% in the MHT nonusers, users until age <50 year and users until age ≥50 year, respectively [P < 0.001]). Prevalence of breast cancer, colon cancer and other cancers were not different among subgroups.

CONCLUSION

The majority of patients used MHT with low compliance until age ≥50 year. In addition, MHT initiation after surgery possibly prevented osteopenia compared with MHT nonusers.

The effectiveness of quick starting oral contraception containing nomegestrol acetate and 17-β estradiol on ovulation inhibition: A randomized controlled trial

To determine the effectiveness of quick starting combined oral contraception (COC) contain 2.5 mg nomegestrol acetate and 1.5 mg estradiol (NOMAC/E2) comparing with 0.075 mg gestodene and 0.02 mg ethinyl estradiol (GS/EE) on ovarian ovulation inhibition rate, we conducted a non-inferiority randomized controlled trial involving 69 healthy female volunteers aged 18–40 years who had normal menstrual history and were randomized at a 2:1 ratio to take one pack of COC containing either NOMAC/E2 (study group) or GS/EE (control group) starting on menstrual cycle Day7–9. The ovarian activity was assessed by using Hoogland and Skouby grading. Forty-six and 23 participants were randomized to NOMAC/E2 and GS/EE groups, respectively. Baseline characteristics were similar between groups. No significant difference was observed between the study and control groups for ovulation inhibition rate (93.4% vs. 95.6%, risk difference: –2.2%, 95% CI: –13.1, 8.8), ovarian quiescence rate (91.2% vs. 91.2%, P = 1.000), persistent cyst rate (2.2% vs. 4.4%, P = 1.000), and ovulation rate (6.6% vs. 4.4%, P = 1.000). Quick starting COC during day7–9 of menstrual cycle can inhibit ovulation for more than 90%. The quick starting NOMAC/E2 is non-inferior to GS/EE for preventing ovulation and suppressing follicular growth.

Comparison of change in body weight between contraception containing 30-μg ethinylestradiol/2-mg chlormadinone acetate or 30-μg ethinylestradiol/3-mg drospirenone: a randomised controlled trial

Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-μg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-μg EE and 3-mg drospirenone (DRSP).Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment.Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs -0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs -0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups.Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.

Prevalence and associated factors of breastfeeding in women with gestational diabetes in a University Hospital in Thailand

Background

Gestational diabetes mellitus (GDM), which is a medical complication that develops during pregnancy, is associated with several long-term health problems. Despite several benefits of exclusive breastfeeding (EBF), including reduction in long-term health problems in mothers with GDM, few studies have investigated breastfeeding in women with GDM and information in the Thai population is lacking. The aim of the study was to determine the prevalence of breastfeeding and the factors associated with breastfeeding during the first six months postpartum in women with GDM.

Methods

A questionnaire-based prospective study was conducted during November 2014 to June 2017. Study participants were first interviewed on the second day post-delivery, and then by telephone at 6 weeks, 3 months and 6 months postpartum. Breastfeeding assessment based on infant feeding practice in the last 24-h period was classified according to World Health Organization definitions.

Results

A total 229 women were enrolled in this study. Prevalence of any breastfeeding at 24 h, 6 weeks, 3 months, and 6 months postpartum was 28.8% (n = 66), 94.3% (n = 214), 71% (n = 154), and 49.8% (n = 104), respectively. Prevalence of EBF was 35.9% (n = 78) at 3 months, and 23% (n = 48) at 6 months after delivery. Maternal intention to breastfeed for 6 months was an independent predictor for both 6 months EBF (RR 16.38; 95% CI 2.29, 116.99) and any breastfeeding (RR 2.65; 95% CI 1.65, 4.25). Breastfeeding initiation within 24 h postpartum (RR 1.38; 95% CI 1.08, 1.76) and being a government officer or private business owner (RR 1.66; 95% CI 1.03, 2.68) were independent predictors of any breastfeeding and EBF for 6 months, respectively.

Conclusion

The prevalence of breastfeeding in Thai women with GDM was lower than the national and global target goal. Maternal intention to breastfeed for at least 6 months and breastfeeding initiation were important factors associated with 6 months' breastfeeding. In order to improve the breastfeeding rate and duration, health care providers should support women's feeding decision, emphasize the benefits of breastfeeding to enhance breastfeeding intention, seek to remove or minimize barriers to the initiation of breastfeeding and reduce mother-infant separation time.

Prevalence of Documented Excessive Weight Gain Among Adolescent Girls and Young Women Using Depot Medroxyprogesterone Acetate

Background

Depot medroxyprogesterone acetate (DMPA) is an accessible contraception with high efficacy among adolescents. However, concern of weight gain can impede DMPA use. The objective of this study was to determine prevalence of excessive weight gain associated with DMPA injection in young women and its predicting factor.

Methods

This retrospective chart review included young women aged 10 - 24 years who had used DMPA and attended at Family Planning and Reproductive Medicine Unit, Siriraj Hospital for at least 6-month period during January 2010 to June 2016. Baseline clinical data, weight at beginning of contraception, and weight at 6 and 12 months thereafter were reviewed. Excessive weight was defined as weight gain of > 5% of their baseline weight at 6 months. Various baseline variables were compared between groups with and without excessive weight gain.

Results

Among 231 DMPA users in this study, there were 28 women (12.1%, 95% confidence interval (CI): 7.8 - 16.3) who had an excessive weight gain at 6 months. Age, baseline body mass index, or race did not affect the likelihood of excessive weight gain. The excessive weight gain group had significant higher proportion of nulliparity, unmarried status and DMPA-ever used history compared to another one. Six of 13 (46.2%) excessive weight gainers at 6 months who continued DMPA use had gain even more weight (> 10% of their baseline weigh) at 12 months.

Conclusions

The majority of adolescent girls using DMPA had no excessive weight gain in 6 months. However, DMPA users who had excessive weight at 6 months were at high risk of gaining even more weight at 1 year.