The women in the present study did not respond to a single dose
Characteristics and outcomes of women treated using methotrexate with or without
of methotrexate as well as those women treated for ectopic
misoprostol to terminate pregnancies with no gestational sac visible by ultrasound
pregnancies reported by Hajeniius et al. None of the women in
the present study was diagnosed with an ectopic pregnancy. The
higher rate of viable intrauterine pregnancies in this group may have
resulted in more women requiring extra medication to abort.
Methotrexate with misoprostol or alone appears to be an effective
method of treating women who present for abortion prior to
hCG decreased N15% in 48 hours before day 8 245 (71.6)
This research was supported by the Vancouver Foundation through a
Values are given as mean ± SD or number (percentage).
BC Medical Services Foundation grant to the Community Based ClinicalInvestigator (CBCI) Program at UBC's Department of Family Practice.
Secondary outcomes were pain, complications, and requirement forother treatment.
Between January 2006 and September 2008, 342 eligible women
were treated with methotrexate and misoprostol. Between September
 Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F. Inter-
2008 and December 2008, 30 women were treated with methotrexate
ventions for tubal ectopic pregnancy. Cochrane Database Syst Rev 2007;24(1):
alone. The 2 groups were similar in age, initial beta-hCG levels, and
obstetric history. Beta-hCG level dropped by more than 15% in the ﬁrst
 Schaff EA, Fielding SL, Eisinger S, Stadalius L. Mifepristone and misoprostol for early
abortion when no gestational sac is present. Contraception 2001;63(5):251–4.
week in 245 (71.6%) women who received methotrexate and mis-
 Edwards J, Carson SA. New technologies permit safe abortion at less than six weeks'
oprostol and in 16 (53.3%) women who received methotrexate alone
gestation and provide timely detection of ectopic gestation. Am J Obstet Gynecol
(P = 0.017) ). No surgery, hospitalizations, or transfusions were
 Wiebe E, Hempstock W. Comparison of four regimens of misoprostol after
required. Two women were given analgesia in emergency departments
methotrexate for early abortion. Int J Gynecol Obstet 2008;101(2):192–3.
0020-7292/$ – see front matter 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2009.04.015
Anne Marie Borchelt Elizabeth Conlisk Miriam Cremer
a School of Natural Science, Hampshire College, Amherst, MA, USAb New York University School of Medicine, New York, NY, USA
niques such as probit analysis. These unbiased methods include bothpre- and postmenopausal women in the analysis.
Age at menopause has been associated with sociodemographic and
reproductive risk factors such as smoking, educational status, and
parity , although these associations may be confounded bychronological age in studies that have no multivariate methods for
their analyses. The present cross-sectional study estimated median age
at menopause using status quo techniques and controlling for
chronological age in rural El Salvador.
In January 2005, a structured questionnaire on menopausal status
and risk factors was administered to 254 women aged 34–75 years atlocal heath clinics in the rural communities of Arcatao and San Pedro
Studies from low-income countries report average or median ages
Perulapán organized by the nongovernmental organization Basic Health:
at menopause in the range of 45–49 years, which is earlier than the
El Salvador. “Postmenopausal” was deﬁned as no menstruation for
range of 50–52 years reported for industrialized nations . These
12 months which was not secondary to injectable contraception,
ﬁndings may simply reﬂect a systematic difference in the statistical
surgery, breastfeeding, or pregnancy. Median age at menopause was
methodologies used. Most estimates from low-income countries have
estimated using probit analysis. Associations between menopausal
relied on recalled ages at menopause, which introduces downward
status and risk factors were examined in univariate and age adjusted
bias by excluding pre-menopausal women of the same ages In
contrast, studies from industrialized nations have consistently used
Median age at menopause was 48.9 years (95% CI, 47.5–50.2). The
survival techniques such as Kaplan-Meier analysis, or status quo tech-
unadjusted odds of being postmenopausal increased with higherparities, older ages at ﬁrst birth, older ages at menarche, fewer years of
education, and never having used injectable contraceptives ().
Corresponding author. 201B Holden Green, Cambridge, MA 02138, USA. Tel.: +1 781
None of these associations remained statistically signiﬁcant in the age
poverty in El Salvador may be leading to the acceleration of ovarian
Unadjusted and adjusted odds ratios of behavioral, demographic, and reproductive
ageing. Living in a country with a low GNP has been associated with an
factors examined in relation to menopausal status.
earlier onset of menopause in Latin America .
After adjustment for age, none of the sociodemographic or
reproductive risk factors we considered were associated with
menopausal status, which underscores the importance of controlling
for this potential confounder. Further research on the determinants of
age at menopause using status quo techniques and controlling for age
and other confounders, is needed in this population. Because earlier
menopause increases the risk of some adverse health outcomes such
as cardiovascular disease , access to preventative health care for
postmenopausal women in rural El Salvador must be improved.
This study was supported by the Undergraduate Education Program
Grant of the Howard Hughes Medical Institute to Hampshire College:
HHMI #71100-503803, Basic Health El Salvador, and the Keck School of
Medicine International Travel Fellowship.
 Sievert LL. Menopause as a measure of population health: an overview. Am J Human
 Sievert LL, Hauteniemi SI. Age at menopause in Puebla, Mexico. Hum Biol 2003;75
Body mass index calculated as weight in kilograms divided by height in meters
 Castelo-Branco C, Blümel JE, Chedraui P, Calle A, Bocanera R, Depiano E, et al. Age at
menopause in Latin America. Menopause 2006;13(4):706–12.
Our estimate of age at menopause in rural El Salvador using an
 Hu FB, Grodstein F, Hennekens CH, Colditz GA, Johnson M, Manson JE, et al. Age at
natural menopause and risk of cardiovascular disease. Arch Intern Med 1999;159
unbiased status quo technique is 1–3 years lower than that reported in
industrialized nations. It is possible that exposures related to rural
0020-7292/$ – see front matter 2009 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. doi:10.1016/j.ijgo.2009.05.009
Attitudes of Greek gynecologists to prescription of hormone replacement therapy for
Dimitrios Vavilis, Dimitrios Athanatos , Theodoros D. Theodoridis, Grigorios Grimbizis,Theodoros Agorastos, Basil C. Tarlatzis
First Department of Obstetrics and Gynecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
are premenopausal will enter menopause because of extensive surgeryor radiation. Hormone replacement therapy (HRT) would appear to be
the treatment of choice for menopausal vasomotor symptoms.
No association between HRT in menopause and development
of epithelial cervical neoplasia has been proven The aim of the
present study was to evaluate the attitudes of Greek gynecologists toprescription of HRT for survivors of cervical cancer.
A questionnaire was randomly sent to 900 gynecologists registered
Cervical cancer survivorsHormone replacement therapy
as members of the Hellenic Society of Obstetrics and Gynecology
describing the following case: “A 47-year-old patient had undergoneradical hysterectomy with bilateral salpingo-oophorectomy at the ageof 44 years because of cervical neoplasia FIGO stage IA2, grade I.
Invasive cervical cancer is the second most common gynecologic
Clinical, laboratory, and imaging follow-up was negative for any sign
cancer worldwide Some of the women diagnosed with cervical
of recurrence. The patient presented with complaints of menopausal
cancer will already be menopausal, while a large proportion of those who
vasomotor symptoms.” The gynecologists were asked the followingquestions: (1) would they would prescribe HRT? (yes/no); (2) ifyes, which hormonal treatment would they prefer out of estrogen,
⁎ Corresponding author. Papadiamanti 1, Kalamaria, Thessaloniki, Greece. Tel.: +30
23 1048 8051; fax: +30 23 1099 1510.
estrogen/progestogen combination, or tibolone?; (3) if no, why?; and
(4) if no, which alternative therapy would they suggest?
ACTA CIENTÍFICA VENEZOLANA – Volumen 50 – N ° 1 1999 Artículos Articles Bioquímica Biochemistry Predisposición a la oxidación in vitro de la LDL aislada Predisposition to in vitrooxidation of LDL isolated from de pacientes con hipercolesterolemia. Interacción hy-percholesterolemic patients. Interaction with L. Barón and F. López L. Barón and F. López
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