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An open, prospective, comparative study was done in healthy women, aged between 18 and 40 years, to study the effects of long-term etonogestrel treatment on bone mineral density (BMD). The control group used a non-hormone-medicated intrauterine device (IUD). The BMD was measured using a dual energy X-ray absorptiometry instrument. Measurements included the lumbar spine (L(2)-L(4)), the proximal femur (femoral neck, Ward's triangle, trochanter) and distal radius. The period of treatment was 2 years and 44 women in the Implanon group and 29 in the IUD group provided data. Groups were comparable at baseline with respect to age, weight, body mass index, BMD and 17beta-oestradiol status. Changes from baseline in BMD in the Implanon group were not essentially different from those in the IUD group. There was no relationship between 17beta-oestradiol concentrations and changes in BMD in this study population. The results of the present study indicate that Implanon((R)) can safely be used in young women who have not yet achieved their peak bone mass.

Objective To evaluate outcomes in caesarean sections repeated several times.Population Sixty-four women had had four or more (up to 10) caesarean sections.Methods The outcomes of these operations (N ¼ 149, study group) were compared with other caesarean sections.Results A quarter of the women in the study group complained of low abdominal pains during the late pregnancy. A thin or fenestrated isthmic myometrial layer was observed in 55% of their operations. Abnormal placentation with an increased risk of major operative complications occurred more often in the study group. No differences in post-operative complications or perinatal outcome emerged between the groups. Conclusion Thus, no definitive upper limit for the number of caesarean sections per individual woman can be given.

Summary. The release of 6‐keto‐prostaglandin F1α(6‐keto‐PGF1α), a metabolite of prostacyclin (PGI2) and thromboxane B2 (TxB2), a metabolite of thromboxane A2 (TxA2), was estimated in endometrial biopsies taken from 12 menorrhagic and 12 healthy women during the luteal phase of the cycle. The releases of 6‐keto‐PGF1α and TxB2 were normal, but the ratio TxB2/6‐keto‐PGF1α was inversely related to menstrual blood loss in women with measured menstrual blood loss exceeding 70 ml. In the second part of the study, 24 women with excessive menstrual bleeding (13 with primary menorrhagia, 10 with uterine fibro‐myomas, one with haemostatic factor VIII deficiency) were treated at random with ibuprofen (600mg/day and 1200mg/day) and with a placebo. Ibuprofen 1200 mg/day reduced (P<0.01) median blood loss from 146 ml (range 71–374 ml) to 110 ml (30–288 ml) in primary menorrhagia but had no effect on blood loss in women with uterine fibroids and factor VIII deficiency. Blood loss was normal in six women and was not affected by ibuprofen. Thus, our data suggest that there is a PGI2 dominance in the endometrium of patients with menorrhagia. In addition, primary, but neither fibromyoma nor coagulation defect‐associated menorrhagia, can be treated by ibuprofen.

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