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Oral presentations, fc14determine whether cutaneous perfusion alterations are a Venlafaxine alters cutaneous microvascular peripheral response to central control or local changes. In perfusion, Beta-CIT binding and BDI scores in addition, Beta CIT reduction predicts variance in reduced BDI II scores, in a group of women not diagnosed with depression, whenflushes are improved with venlafaxine.
Sassarini, J1; Krishnadas, R1; Cavanagh, J1;Nicol, A2; Pimlot, S1; Ferrell, W1; Lumsden, MA11University of Glasgow, Glasgow, United Kingdom; 2Southern GeneralHospital, Glasgow, United Kingdom FC14.02The age of ovarian failure following pre- Objectives Although 70% of postmenopausal women suffer from hot flushes the pathophysiology is poorly understood. Vascular reactivity appears to be enhanced, but the impact of effective Edey, KA1; Read, MD2; Hapeshi, J2; Foy, C2 treatments is uncertain. Estrogen replacement provides 1St Michael’s Hospital, Bristol, United Kingdom; 2Cranfield University, symptomatic relief, but its use has declined. The serotonergic system is thought to be involved, and venlafaxine (serotonin andnoradrenaline reuptake inhibitor, SNRI) has been shown to be an Objective To test the hypothesis that premenopausal effective alternative for vasomotor symptoms, however the hysterectomy compromises ovarian function and accelerates mechanism is unknown. We aimed to assess the role of serotonin in the mechanism of flushing, peripherally by examining Methods Longitudinal prospective cohort study. Annual follow- cutaneous microvascular perfusion, and centrally using single up with serum follicular stimulation hormone (FSH) levels all photon emission computed tomography (SPECT) to study the women aged 46 or less at the time of hysterectomy for benign central serotonin transporter (SERT) in vivo using a radioligand, disease. Setting: Gloucestershire Royal Hospital, Gloucester, UK.
[123I] -b-carbomethoxy-3-b-(4 iodophenyl)tropane (Beta-CIT), Participants: 531 women recruited over a 4-year period from 1994 that binds with high affinity to SERT.
to 1997 and followed up for 10 years.
Methods Cutaneous microvascular perfusion was assessed in 14 Results The mean age of women in the study was 37.4. Women postmenopausal women, with flushing, using laser Doppler had earlier ovarian failure after unilateral oophorectomy (95% CI imaging with iontophoresis, before and after 8 weeks of treatment 1.48–4.00) and after vaginal hysterectomy (95% CI 1.38–2.99) with venlafaxine; 75 mg. SPECT imaging was carried out at both compared to abdominal hysterectomy. The mean age of ovarian time points. Participants recorded flushes, and Becks Depression failure across all groups was 45.87 (Æ3.58) and 59 (11%) women Inventory (BDI II) scores were assessed.
remained in the study at the end of 10 years who had not yet Results There was a significant reduction in Beta-CIT binding, BDI scores, flushing scores and the endothelial dependent Conclusions This is the largest number of cases collected perfusion response (Acetylcholine, ACh), but not in the prospectively looking at ovarian failure after hysterectomy. Earlier endothelial independent response (Sodium Nitroprusside, SNP) ovarian failure occurred in those women having unilateral (Table 1). Beta CIT reduction predicted significant variance in oophorectomy or vaginal hysterectomy. Early ovarian failure was BDI reduction (r2 = 0.54; F = 8.8; P = 0.004), but not in flushing not confirmed across the study group, with only 4% of women having confirmed ovarian failure in the 2 years following surgery(21 of 531).
Conclusions These results support the role of serotonin in thepathophysiology of flushing; further study is required to ª 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2013 RCOG Results The current diagnostic Daily Record of Severity ofProblems (DRSP) chart does not include physical symptoms, which are a major part of the diagnosis. GnRH analogues are not Guideline no. 48 – Management of Premenstrual discussed as a diagnostic tool. GnRH analogues can help distinguish between psychiatric aetiology and classical or variant PMD. There is no evidence to support lifestyle changes. Althoughthere is strong evidence to support Cognitive Behavioural University Hospitals of North Staffordshire NHS Trust, Stoke-On-Trent, United Kingdom Therapy, this as a resource is not readily available. No availablecomparison in efficacy between Serotonin Selective Reuptake Objectives To review the current RCOG Green Top Guidance Inhibitors (SSRI) and ovulation suppression. Lack of long term No. 48 and appraise its validity in the management of safety with ovulation suppression methods. Lack of advice relating premenstrual syndrome (PMS) against the evidence available to different age groups. The RCOG guidance renewal date of today, in order to optimise the guidance available to gynaecologists, general practitioners and psychiatrists. This is Conclusion Although there is still much evidence to gather with particularly salient as PMS is a common condition that is poorly regards to treatment of PMS, there still exists a wide breadth of managed due to a lack of belief and knowledge. In light of the knowledge in the literature, which needs to imparted in a clear recent ISPMD consensus statement on classification and manner. GnRH analogues need to be emphasised in secondary management, further advice is available to professionals, which care as an important diagnostic tool before commencing ovulation should be incorporated into current guidance.
suppression, which may carry significant long term risks. Further Methods A review of the current RCOG Green Top Guideline guidance should include treatment depending on age – as No. 48 along with the literature available using MEDLINE and perimenopausal women present a much more complicated picture.
Ovid Online. Keywords included PMS, PMDD, premenstrual Further research needs to look into risks of long-term ovulation syndrome, premenstrual disorder (PMD).
suppression and comparison of SSRIs and ovulation suppression.
ª 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2013 RCOG
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