Obstetrics & Gynecology 2000;95:403-406
© 2000 by The American College of Obstetricians and Gynecologists
Direct Transport of Progesterone From Vagina to Uterus
ETTORE CICINELLI, MD ,DOMINIQUE DE ZIEGLER, MD ,CARLO BULLETTI, MD ,MARIA GIUSEPPINA MATTEO, MD ,LUCA MARIA SCHONAUER, MD and PIETRO GALANTINO, MD
From the 1st Institute of Gynecology and Obstetrics, University of Bari, Policlinico, Bari, Italy; the Department of Obstetrics and Gynecology and Reproductive Endocrinology, Nyon Medical Center, Nyon, Switzerland and Columbia Laboratories, Paris, France; and the Department of Obstetrics and Gynecology and Physiopathology of Reproduction, Ospedale "Infermi" Rimini, Rimini, Italy.
Address reprint requests to: Ettore Cicinelli, MD 1st Institute of Gynecology and Obstetrics University of Bari, Policlinico Piazza Giulio Cesare 70124 Bari Italy E-mail: cicinelli@gynecology1.uniba.it
Objective : To compare progesterone concentrations in serum and endometrial tissue from hysterectomy specimens after vaginal or intramuscular (IM) administration of progesterone gel.
Methods : This was a randomized open study of 14 post-menopausal women undergoing transabdominal hysterectomies. Participants received either vaginal progesterone gel, 90 mg, or IM progesterone, 50 mg, at 8:00 AM and 8:00 PM on the day before surgery and at 6:00 AM on the day of surgery. Venous blood samples for progesterone measurement were collected at 8:00 AM on the day before surgery (baseline) and during surgery. After removal of the uterus, the endometrium was sampled from the anterior and posterior walls. Results were expressed as ratios of endometrial to serum progesterone concentrations x100.
Results : Ratios of endometrial to serum progesterone concentrations were markedly higher in women who received vaginal progesterone (14.1 median, 8.5-59.4 range; 95% confidence interval [CI] 9.89, 38.79) compared with IM injections (1.2 median, 0.5-13.1 range; 95% CI -0.48, 7.39) ( P< .005).
Conclusion: Ratios of endometrial to serum progesterone concentrations were higher after vaginal administration of progesterone than after IM injections. Our findings in endometrial tissue specimens from hysterectomies excluded the possibility of contamination by progesterone that remained in the vagina.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10711552&dopt=Abstract
Eur J Gynaecol Oncol. 1998;19(1):22-4. Links
The fate of the retained ovaries following radical hysterectomy.
Pete I ,
Bosze P .
Department of Gynecology Oncology, National Institute of Oncology, Budapest, Hungary.
The authors studied the function of the preserved ovaries following radical hysterectomy in 65 patients with early stage cervical carcinoma. The ovaries were not displaced and fixed out of the pelvis. Squamous cell carcinoma was diagnosed in 91 cases and adenocarcinoma in 19 cases. Histologic studies of the 110 ovaries removed from 45 patients revealed no metastatic disease. None of the 65 women suffered from recurrent disease. Ovarian function was evaluated by: 1) the presence or absence of postmenopausal symptoms; 2) basal body temperature charts; 3) blood tests for FSH, LH, progesterone, and prolactin; and 4) evaluation of the cervical and vaginal epithelium (vaginal smears). The diagnosis of ovarian failure was based on high levels of FSH (> 30 U/L) on at least three occasions. Basal body temperature studied in 90 cycles of 25 patients revealed various curves indicating occasional anovulatory cycles and luteal-phase deficiency which were confirmed by low serum levels of progesterone. Serum prolactin levels were within the normal range in all cases. Ovarian failure was diagnosed in two instances. Both occurred within three years of radical hysterectomy. Three of the six patients experienced unilateral ovarian cyst formation following surgery, the other three had subsequent unilateral salpingo-oophorectomy at 6, 11, and 24 months after radical hysterectomy. Conclusions: Preservation of the ovaries at the time of radical hysterectomy and lymphadenectomy does not seem to compromise patient care. Impaired function or failure of the retained ovaries, however, is not uncommon; close post-treatment surveillance is therefore important in terms not only of recurrent disease but of function of the ovaries as well.
PMID: 9476053 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9476053&dopt=Citation
Clin Endocrinol (Oxf). 1992 May;36(5):505-10. Links
Follow-up of ovarian endocrine function in premenopausal women after hysterectomy by daily measurements of salivary progesterone.
Vuorento T , Maenpaa J , Huhtaniemi I .
Department of Physiology, University of Turku, Finland.
OBJECTIVE: The effect of hysterectomy on ovarian endocrine function of premenopausal women was studied. DESIGN: The patients collected daily salivary samples during one preoperative cycle (1), the cycle of operation (2), the subsequent period of 30 days (3) and the cycle 6 months after operation (4). PATIENTS: Forty-one premenopausal women (aged 33-48 years) undergoing hysterectomy were studied; their preoperative cycles served as controls. The patients were also compared with a reference group of 17 younger fertile women. MEASUREMENTS: Salivary progesterone levels were measured by radioimmunoassay. RESULTS: Cycle 1 was more frequently short (P less than 0.01), with short luteal phase (P less than 0.01) and low progesterone secretion (P less than 0.05), than the cycles of younger women. Cycle 2 was longer than the other cycles (P less than 0.01), due to prolonged follicular phase (P less than 0.01). Cycle 3 differed from cycle 1 by the lesser frequency of short cycles (P less than 0.01). Cycle 4 and its follicular phase were longer than those measured in cycle 1 (P less than 0.05). Of the women with normal cycle 1, 39% (P less than 0.01) presented with luteal insufficiency (LPD, low luteal progesterone secretion) or anovulation (8%) in at least one of cycles 2 to 4. The frequency of LPD or anovulation was significantly higher in cycle 3 (P less than 0.05) but not in cycle 4, compared to 1. CONCLUSIONS: Acute luteal progesterone deficiency after hysterectomy in premenopausal women is common but in most cases reversible.
PMID: 1617802 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1617802&dopt=Citation
J Reprod Med. 1986 Jul;31(7):597-600. Links
Ovarian failure phenomena after hysterectomy.
Riedel HH ,
Lehmann-Willenbrock E ,
Semm K .
Previous studies have shown that simple hysterectomy with both ovaries left intact may cause ovarian failure. Questionnaires on climacteric symptoms were mailed to 243 patients between 27 and 42 years old who had been hysterectomized during the past ten years in the Kiel University obstetrics and gynecology clinic. From the 164 replies we found typical signs of ovarian failure in 39%. Some of the patients were asked to undergo endocrinologic investigation, which showed biphasic cycles in most cases. However, the average progesterone and estrogen concentrations in the suspected luteal phases were lower than in healthy women in the same age group.
PMID: 3746790 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3746790&dopt=Citation
Am J Obstet Gynecol. 1975 Jan 15;121(2):193-7. Links
The acute effect of hysterectomy on ovarian function.
Stone SC ,
Dickey RP ,
Mickal A .
The acute effect of abdominal and vaginal hysterectomy on the ovarian production of estradiol-17-beta (E2) and progesterone (P) was studied in a group of patients undergoing hysterectomy for various gynecologic indications. Plasma levels of steroids as well as gonadotropins (FSH and LH) were measured by RIA. There was a significant but transient drop of plasma E2 during the follicular phase and of plasma E2 and P during the luteal phase, following hysterectomy. No significant variations in the steroid plasma levels were found in a control group of patients undergoing laparoscopy for diagnostic purposes. No changes were noted in either group in the plasma levels of gonadotropins. The changes seen appear to be related to the surgical manipulation in the ovarian region rather than to the type of hysterectomy performed or the stress of surgery.
PMID: 123120 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=123120&dopt=Citation
