Occasional Notes

ORMONE THERAPY IN OBSTETRICS AND GYNjECOLOGYJ By K. P. BHADURY, m.b1

fAssociate Professor of Midwifery and Gynecology, i National Medical Institute and Senior Visiting Obstetrician and Gynaecologist, Cliittaranjan Hospital,

Calcutta

The following hormones are generally used :

(1) CEstrin. (2) Progestin. (3) Anterior

pituitary hormone?(a) F.H.S. follicle stimulat- ing hormone and (b) L.H. luteinizing hormone. (4) Thyroid. (5) Testicular hormone.

Threatened abortion.?When other factors are excluded it is said to be due to deficiency of

corpus luteum hormone.

Treatment.?Rest, sedatives, vitamin E (Ephy- nal 10 mg. B.D.), corpus luteum hormone 10 mg. (Progestin or lutocyclin or proluton) daily for at least 6 days. Ethisterone 10 mg. B.D. per mouth. Haemorrhage per vaginum diminishes and then stops and pregnancy is continued in a group of cases.

Before the formation of placenta, i.e. before the 12th week of pregnancy, progestin is available

only from corpus luteum. After the formation of placenta progestin is available mainly from placenta. In threatened abortion my line of treatment

is as follows :?

After injecting morphine gr. % and atropine gr. 1/100, I send the catheter specimen of urine for recently evolved pregnancy test using the

Sept., 1951] HORMONE THERAPY IN OBSTETRICS : BHADURY 409

male toad. The report is available within a

few hours. The reports are of 3 groups : (1) strongly positive, (2) weakly positive, and (3) negative.

After excluding all other {etiological factors of abortion conservative treatment is continued in the 1st and 2nd group. The urine is again sent after a few days for pregnancy test. In the 1st

group the result is generally good specially when the 2nd report is strongly positive or positive. Generally haemorrhage stops and pregnancy is continued. In the 2nd group (weakly positive) pregnancy is continued in certain cases and in others it turns to inevitable abortion. When the pregnancy is continued the 2nd or

3rd examination report is generally positive. But when it turns to inevitable abortion the 2nd or 3rd report is generally negative or sometimes very weakly positive, though in some cases the haemorrhage stops completely but the patient aborts partially or completely within a few days or in some cases within a few weeks. In the

negative groups patient aborts or induction of abortion is done, if necessary. Reports of 17 cases : {A) Strongly positive?

5. (B) Weakly positive?9. (C) Negative?3. Conservative treatment was continued in

groups A and B.

In group A?Pregnancy continued in all 5. In group B?Two aborted within 10 days.

Three left the hospital because haemorrhage stopped and pain subsided but one returned after a week with severe bleeding, when evacuation was done after transfusion of blood. In another two pregnancy continued and the second urine report after a week came as

strongly positive. In two further cases 2nd and 3rd urine report after a month came as weakly positive, though the symptoms abated. As the

pregnancy was continued they were discharged. I got the report of urine examination again after a month and it was fairly positive but not

strongly positive. Now I got the report that both of them delivered healthy foetuses in due time. In group C?One aborted within a few days.

In other two evacuation was done.

In threatened abortion in one group of cases the fertilized ovum grows and in another group even after treatment it is aborted. One import- ant reason is the condition of the fertilized ovum at the time of treatment, whether the ovum is healthy or not. In some cases un-

healthy spermatozoon may be responsible for the unhealthy ovum.

Pre-eclamptic toxaemia.?Stilbcestrol 5 mg. or eticyclin 0.05 mg. twice daily after food is

given. Rest, salt-free diet, mostly carbohydrate and sedatives, are administered. In some carses B.P. comes down within 1 to 2 weaks. Albumen in the urine and oedema diminish.

Induction of labour in full-term 'pregnancy.? Eticyclin 0.05 to 1 mg. twice or thrice daily is

given for 4 to 5 days. In some cases castor oil is administered after that in the morning and an enema is given after 5 to 6 hours. In a series of 9 cases labour pain started within 5 days (without castor oil and enema) in 5 cas6s. In

only 2 cases castor oil was administered on the 5th day and enema was given after 5 hours. Labour pain started. In only 2 cases membranes were ruptured on the 6th day, labour pain started within 24 hours. This is useless when the

pregnancy is not advanced, i.e. before 9th month. To stop secretion of milk in the breast after

labour.?Stilbcestrol 5 mg. or eticyclin 0.05 mg. is administered thrice daily for 4 to 5 days. Then the dose is diminished. Generally engorge- ment of breast diminished within 48 to 96 hours. After a few days the breast becomes dry. The treatment should be started within 24 to 48 hours after delivery. When started later the secretion generally takes a long time to dry up. For the induction of secretion of milk.?Pro-

lactin was administered in a few cases but the result was not satisfactory. In gynecology.?For the following diseases

generally the hormones are used :? (1) Menorrhagia. (2) Functional uterine bleeding. (3) Metropathia hsemorrhagica. (4) Primary dysmenorrhcea. (5) Sterility. (6) Amenorrhcea?primary and secondary. (7) Menopausal disorders.

Menorrhagia.?History and vaginal examina- tion should be done to find out the cause. When

neoplasm and inflammatory groups are excluded the following treatment is adopted. Eticyclin 0.05 mg. T.D.S. for a few days administered.

Generally the haemorrhage stops but there is chance of bleeding a few days after the stoppage of eticyclin. Therefore it is better to administer

progestin 5 mg. daily for 6 days after the

stoppage of eticyclin. Testosterone propionate 25 mg. intramuscular injection daily for 3 to 6 days. Haemorrhage stops, but the treatment should be continued for 2 to 3 months. Injec- tion to be started with the onset of menses or one or two days before menses. One injection is

given daily for 3 days. Generally the result is

good. In some cases the voice is changed temporarily.

Progestin 5 to 10 mg. daily may be given for 3 to 6 days.

Injection should be started 6 days before the expected date of menstruation, but the result

is not satisfactory in all cases. Functional uterine bleeding.?Eticyclin 0.05

mg. or stilbcestrol 5 mg. thrice daily. Generally the bleeding stops. After that progestin 5 mg. is given intramuscularly on every 3rd day, 6 injec- tions. But all the patients are not cured. I have obtained good result in a few cases with antuitrin S 2 cc. daily for 5 to 10 days. But in 3 cases no

410 THE INDIAN MEDICAL GAZETTE [Sept., 1951

treatment could cure the cases including curett- age. In one it was done thrice. Then

peranden 25 mg. was administered daily for 6

days in one case, 9 days in another and 12 days in the 3rd. The bleeding stopped. The treat- ment was continued for 3 months. The patients were cured. Now one of them is the mother of one child, another mother of 2 children. With the 3rd I am not in touch because she went to Pakistan after 1947.

Metropathia hemorrhagica.?Neoplasm and

inflammatory causes should be first excluded. (Estrin temporarily stops the bleeding. But testicular hormone peranden or testosterone pro- pionate is the best, 25 mg. daily intramuscularly, 6 to 9 injections. The treatment should be continued for at least 3 months. Curettage should be done to exclude malignancy or

polyp. The result with progestin is not favour- able. If not cured deep therapy should be administered.

Amenorrhea.?Primary : Stilbcestrol 5 mg. or eticyclin 0.05 mg. twice daily after food for 20 days after mense. Then progestin 2 to 5 mg. daily for 6 days. Thyroid g. ? to g. 1 daily at bedtime where basal metabolic rate is low. The treatment should be continued for 3 months. In certain cases the result is good. In others there is no menses a few months after the

stoppage of treatment.

Secondary.?When the patient is aneemic she should be treated for anaemia. WThen the health

improves generally menstruation begins auto-

matically. If not, the same treatment of

primary amenorrhea should be given. Generally the result is good. Primary dysmenorrhea.?In a large group of

cases vaginal examination will reveal that the external os is small, cervix elongated, fundus

small, anteverted and anteflexed, i.e. the

development of the uterus imperfect. Generally it is due to deficiency and derangement of hormones.

Treatment.?If the general health is not good nourishing diet, vitamins, moderate exercise and fresh air are essential. To relieve pain palliative treatment with sedatives is necessary.

Stilbcestrol 2 to 5 mg. or eticyclin 0.05 mg. twice daily after food for 15 days, to begin just after the stoppage of menses. Progestin 5 mg. every alternate day, 3 to 6 injections a month. When the basal metabolic rate is low thyroid g. '2 to g. 1 at bedtime. Nothing to be given during menses. If the pain is excessive sedatives to be given. The treatment should be continued for 3 months. Vitamin E ephynal 10 mg. daily for 20 to 25 days a month for 3 months.

Generally the patient improves. If the trouble recurs the treatment should be continued for another 3 months.

Synapoidin (anterior pituitary hormone) intramuscularly 1 cc. daily or 2 cc. every alter- nate day after the stoppage of menses?at least

20 cc. every month. This should be continued for 2 to 3 months. Thyroid g. ^ to g. 1 at bed- time when the B.M.R. is low. If only cestrin, stilbcestrol or eticyclin, 0.05 mg. B.D. is given for 15 to 20 days in a month, pain is relieved

during menses but the bleeding is generally anovular. Therefore the treatment is contra- indicated in cases of dysmenorrhea with sterility. The treatment may be given to unmarried girls to relieve the pain temporarily. But when the

drug is discontinued pain reappears. This treatment should not be continued for a long period.

Sterility.?Investigation of both male and female should be done to ascertain the cause of

sterility. Patency of fallopian tubes must be tested. Male partner should be examined. Semen should be thoroughly examined. When there is patency of fallopian tube and no defect in the male partner, it is in most cases due to

derangement of internal secretion in the female. Patient will complain of scanty mense and some- times the interval is prolonged. In some cases the patient is complaining of primary dys- menorrhcea. Vaginal examination will reveal cervix elongated, external os, small fundus? sometimes acutely anteverted and anteflexed.

Treatment.?Balanced diet and exercise. Treatment for primary dysmenorrhea which as

mentioned before should be continued. In more than 50 per cent of cases the woman becomes

pregnant within a year or two. Husband should be advised to copulate daily or every alternate day, a week after the stoppage of

menses, for about 10 to 12 days only in a month, i.e. after the 12th day up to 22nd day from the beginning of menstruation.

Menopausal disorders.?Sometimes the woman complains of hot flushes, giddiness, sleeplessness, etc. Husband complains of irritability of

temper of the wife. Here stilbcestrol 1 to 2 mg. twice daily or eticyclin - 0.05 mg. twice daily after food with sedatives relieves the symptoms. Then the dose should be reduced gradually, then discontinued. Vitamin E ephynal 10 mg. twice daily with the above gives good result within a short period.

Leukoplakia vulva; and kraurosis vulvce.? Urine should be examined for sugar. Vaginal discharge should be microscopically examined carefully for monilia and cancer cells. In

certain group of cases when other causes are

excluded it is due to the deficiency of cestrin hormone. When B.M.R. is low it is probably due to hypothyroidism. The patient should be examined regularly to safeguard against cancer.

Treatment.?Stilbcestrol 2.5 mg. or eticyclin 0.05 mg. twice daily after food. If B.M.R. is low thyroid g. % to g. 1 at bedtime. The rather

widespread use of oestrogen has demonstrated

that it is useful for this affection. Thyroid sub- stance is of definite value specially when B.M.R. is low.