Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The article is primarily a general discussion of the pill's medical aspects, prefaced by a discussion of the normal human menstrual cycle. Aspects of oral contaceptives reviewed include mechanisms, effectiveness, product formulation, instructions for use, adverse reactions, contraindications, and current developments. Oral contraceptive mechanisms include 1) blockage of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release, 2) alteration of motility in the fallopian tubes 3) modification of endometrial maturation, and 4) rendering the cervical mucus hostile to sperm migration. Mild side effects of various oral contraceptives include nausea, mastalgia, edema, psychological changes, headaches, and failure of withdrawal bleeding. Moderate side effects include breakthrough bleeding, androgenic side effects, patches of increased skin pigmentation, and prolonged amenorrhea and infertility. Severe side effects include impaired liver function and jaundice, hypertension, and thromboembolic disorders. Topics of current research in steroidal contraception include depot therapy, continuous low-dose progestogen therapy, and postcoital estrogen therapy.
 ...
PMID:Pharmacology of contraceptive agents - new compounds with new problems? 1230 37

489 women from Sweden (n = 296) and from Great Britain and Germany (n = 193) took part in a test of 2 O.C. (oral contraceptive) preparations. 254 women used the triphasic SH B 264 AB preparation, while 235 women used Neovletta. A total of 2777 cycles was observed, during which no pregnancies occurred. The mean menstrual duration decreased nearly 2 days among Neovletta patients and 1 1/2 days among SH B 264 AB users (p .001). The rate of amenorrhea after 3 and 6 cycles was 1.6% and .5% respectively among SH B 264 AB users and 1.4% and 2.1% respectively among Neovletta users. Menstrual bleeding decreased. The rate of amenorrhea was significantly (p .001) greater among Neovletta users. The volume of menstrual bleeding decreased for users of both preparations. The incidence of bleeding irregularities was greater among those using Neovletta. 14.7% of the women discontinued O.C. use during the study, ca. 8% due to medical reasons, at about the same rate for both preparations. SH B 264 AB users more often reported side effects; the most frequent side effects for both preparations were headaches, mastodynia, and nausea.
 ...
PMID:[Fertility regulation using triphasic administration of ethinyl estradiol and levonorgestrel in comparison with the 30 plus 150 mcg fixed dose regime (Author's transl)]. 1230 81

35 predominantly multiparous, sexually active women aged 25-44 years were fitted with levonorgestrel 20 T (Schering) IUDS in the post- menstrual phase, or in rare instances, right after abortion. the devices contained 60 mg of levonorgestrel releasing 20 mcg/day with the life span of 5 years. The patients were followed up every 3-6 months to detect side effects and complications. The first year contained a total of 339 months of observation, while the figure rose to 461 months in the second year. Spotting lasting 15-20 days followed insertion, but in later months only 7% of patients complained of bleeding or menstrual spotting. 7-8% of cases tended to have oligomenorrhea in the first year; 1/3 to 1/2 of them had hypomenorrhea during the first and second year. True amenorrhea started in 20-30% of women, persisting through both years. Longer duration of flow occurred in 32.4-4.57.1% of cases during these 2 years. Hormonal effects (headache, acne, hirsutism, depression, mastalgia, and inflamed varicose veins) ranged from 18.2- 33.3%. Levonorgestrel 20 T demonstrated more superior contraceptive efficacy than Progestasert; however, serious menstrual cycle disorders associated with it also increased. All progestin-releasing devices (the minipill, Norplant, Progestasert) induced menstrual changes, thus their use is preferable for therapeutic indications such as hypermenorrhea and uterine fibroid.
 ...
PMID:[Two-year clinical performance of the Levonorgestrel 20 T IUD]. 1231 72

The Norplant System of levonorgestrel implants and the Depo Provera contraceptive Injection of sterile medroxy progesterone acetate suspension (DMPA) are longterm, progestagen-based contraceptive delivery systems designed to overcome noncompliance which are under review for use in Canada. 150 mg of DMPA, a pregnane compound derived from progesterone, is injected every 3 months. Peak plasma concentrations are reached in 24 hours and plateau for 3-4 months before gradually declining. After termination, ovulation returns on average in 4.5 months, and conception occurs at a median time of 10 months. 90% conceive by 24 months. In the Norplant system, a steady daily supply of 50-80 mcg of levonorgestrel, a gonane progestin derived from the testosterone nucleus which has both progestogenic and androgenic receptor affinity, diffuses from 5 Silastic implants, which must be replaced every 5 years. Ovulation and fertility return rapidly after rod removal. The actual and lowest expected failure rates are equal for both systems. The failure rate for DMPA is .3 pregnancies per 100 women years, while that for levonorgestrel is .4% in 1 year. Although neither method affects blood pressure, DMPA appears to affect carbohydrate metabolism by impairing glucose tolerance and increasing insulin production. Lipid metabolism is also affected. 5% of those who use levonorgestrel discontinue it because of side effects, including headache, mastodynia, and acne; 19.1% of DMPA users did so, especially for weight gain and menstrual cycle abnormalities. Both methods have a higher frequency of menstrual abnormalities than normal. 27.7% of levonorgestrel users experienced prolonged bleeding, while 17% experienced spotting during the first 6 months. However, normal menses usually returned within a year, and only 7.9% discontinued use because of cycle abnormalities. In 1 study, less than 10% of DMPA users experienced normal cycles, and in another study 35% experienced amenorrhea (500/700 discontinued use). Amenorrhea replaced irregular bleeding with continued use, occurring in 68% of users by 2 years. There is also some concern about DMPA and breast cancer and bone loss. Based on 1 case-control study of 110 women with breast cancer who had taken DMPA, the relative risk is highest for those between ages 25 and 34 who use DMPA longer than 6 years. A WHO study concluded that the relative risk of developing breast cancer, because of DMPA, is inversely related to duration of use. A Phase IV study on DMPA and bone mineral density has been undertaken.
 ...
PMID:A comparison of levonorgestrel implants with depo-medroxyprogesterone acetate injections for contraception. 1231 30

Vaginal administration of oral contraceptives (OCs) has been shown to be an acceptable and effective method of contraception. The most widely tested vaginal contraceptive pill (VCP) contains 500 mcg of d-1 norgestrel and 50 mcg of ethinyl estradiol (EE) and is administered on the same 21-day schedule as the oral contraceptive. Other combination OCs used vaginally include 1 mg of norethisterone plus 50 mcg of mestranol, 250 mcg of levonorgestrel plus 50 mcg of EE, and 2 mg of cyproterone acetate plus 50 mcg of EE. Gestrinone, a potent antiestrogenic progestin, has also been used with success. Comparative studies of the various combination pills and Gestrinone revealed that plasma levels of the progestins rose at a slower pace and to a lower peak value after vaginal administration than after ingestion, but ovulation was suppressed in most cycles. Fertility control compared favorably with most low-dosage combined pills taken by mouth. No pregnancies occurred in a group of 124 women who used the vaginal route for 6-20 months totalling 1438 woman-months of use. Cycle control was good, and bleeding episodes occurred following discontinuation and lasted 3-5 days in 98% of cycles. Amenorrhea was rare, and breakthrough bleeding and spotting occurred in fewer than 10% of women. 22% of the women gained more than 2 kg and 9% lost weight. Blood pressure remained unchanged in most women, and fewer than 10% had headache, nausea, acne, nervousness, or mastalgia. Fewer than 20% had vaginal discharge requiring treatment, with Trichomonas vaginalis being the most common pathogenic agent. In 1 study, 44 women discontinued VCP use before completing 1 year of use, 7 for medical reasons (2 for mastalgia, 2 for vaginal irritation, 3 for vaginal discharge unresponsive to treatment), 6 to achieve pregnancy, and the remaining 31 to avoid daily vaginal insertion. The VCP achieved the same results as OCs with a minimum of side effects due to the low steroid levels and because VCPs bypass the liver on the 1st pass. The vaginal ring shares these advantages of the VCPs, but the bulky silastic rubber structure of the ring may cause erosion of the vaginal wall, interfere with coitus, and absorb release unpleasant odors. Problems with vaginal rings also include expulsion, difficulty of insertion and removal, and storage. The VCP may be a better alternative than the OC as the 1st prescribed contraceptive for family planning clinics because the low blood levels of steroid will reduce the occurrence of side effects in longterm use.
 ...
PMID:The vaginal contraceptive pill. 1233 69

The frequency of hormone replacement therapy (HRT) users has increased during the last 2 decades. A majority of women taking HRT prefer to use formulations that will not induce bleeding disturbances. Accordingly many women prefer continuous combined HRT to obtain amenorrhoea. Previously comparatively high doses of estrogens and progestogens were prescribed to women in the climacteric period. Low doses of estrogens such as estradiol 1 mg and conjugated equine estrogens 0.3 mg orally per day or transdermally applied estradiol 25 mug per 24 hours have been shown to be effective for the treatment of vasomotor symptoms and for prevention of bone loss. With low dose HRT in a continuous combined regimen amenorrhoea will be obtained in a majority of women after a few months of treatment. Low doses of progestogen especially if given on a continuous basis have been shown to protect the endometrium from hyperplasia. Favourable effects in lipid- and lipoprotein patterns have been reported. In addition, fewer side effects such as mastalgia have been found during treatment with low dose regimen compared to high doses. For women requesting HRT it might be a rational alternative to begin with low dose formulations since these doses are sufficient for the majority of women.
 ...
PMID:Low dose hormone replacement therapy: clinical efficacy. 1458 65

Vitex agnus castus L. (VAC) [Verbenaceae] is a deciduous shrub that is native to Mediterranean Europe and Central Asia. Traditionally, VAC fruit extract has been used in the treatment of many female conditions, including menstrual disorders (amenorrhoea, dysmenorrhoea), premenstrual syndrome (PMS), corpus luteum insufficiency, hyperprolactinaemia, infertility, acne, menopause and disrupted lactation. The German Commission E has approved the use of VAC for irregularities of the menstrual cycle, premenstrual disturbances and mastodynia. Clinical reviews are available for the efficacy of VAC in PMS, cycle disorders, hyperprolactinaemia and mastalgia, but so far no systematic review has been published on adverse events or drug interactions associated with VAC. Therefore, this review was conducted to evaluate all the available human safety data of VAC monopreparations. Literature searches were conducted in six electronic databases, in references lists of all identified papers and in departmental files. Data from spontaneous reporting schemes of the WHO and national drug safety bodies were also included. Twelve manufacturers of VAC-containing preparations and five herbalist organisations were contacted for additional information. No language restrictions were imposed. Combination preparations including VAC or homeopathic preparations of VAC were excluded. Data extraction of key data from all articles reporting adverse events or interactions was performed independently by at least two reviewers, regardless of study design. Data from clinical trials, postmarketing surveillance studies, surveys, spontaneous reporting schemes, manufacturers and herbalist organisations indicate that the adverse events following VAC treatment are mild and reversible. The most frequent adverse events are nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus and erythematous rash. No drug interactions were reported. Use of VAC should be avoided during pregnancy or lactation. Theoretically, VAC might also interfere with dopaminergic antagonists. Although further rigorous studies are needed to assess the safety of VAC, the data available seem to indicate that VAC is a safe herbal medicine.
 ...
PMID:Vitex agnus castus: a systematic review of adverse events. 1578 41

The purpose of this study was to characterize the clinical picture of macroprolactinemic patients and to further assess whether macroprolactinemia was part of an auto-immune syndrome. Eighty-two hyperprolactinemic (serum PRL > 1000 mU/l) patients were investigated and the PEG precipitation test identified 14 patients with macroprolactinemia (bb PRL). They were submitted to a hormonal and autoimmune screening and an IV TRH test. Bioactivity of their serum prolactin was evaluated, using an Nb2 assay. The biochemical nature of bb-PRL was investigated by immunoprecipitation with anti-IgG antibodies. Seventy-nine percent of the studied patients presented with infertility, amenorrhoea, galactorrhoea, mastodynia, gynaecomastia or erectile dysfunction. In most cases, however, these symptoms could be explained by the presence of other non hyperprolactinemia-related pathology. Despite the finding of in vitro biological activity in all macroprolactinemic sera tested, our results suggest a variable in vivo bioactivity of bb-PRL, probably related to a reduced capacity to cross vascular endothelium. In this study, we demonstrated that in 12 out of 13 samples (85%), bb-PRL consisted of PRL-IgG complexes. There was no clinical or laboratory evidence of auto-immunity.
 ...
PMID:Macroprolactinemia: clinical significance and characterization of the condition. 1627

The contraceptive pill has been a revolution of the last 40 years. In Italy, however, it is much less widely used than in other countries. Explanations for this phenomenon range from religious implications and customs to misinformation and word-of-mouth communication of negative experiences. The oral contraceptive pill is often used to correct menstrual disorders, leading to poor results and side-effects. Recent advances in oral contraception have led to a substantial reduction in doses and side-effects. Low-dose pills contain minimal doses of progesterones and estrogens and ensure good control of the menstrual cycle. Although reduction of ethinyl estradiol (EE) concentrations has reduced the incidence of negative systemic side effects such as water retention, edema and swollen breasts, the low estrogen dose may be associated with spotting and hypomenorrhea or amenorrhea in the long term, as well as dyspareunia due to reduced vaginal trophism, which may induce women to suspend use of the drug. It is also true that only one type of estrogen is used in the pill, albeit at different doses, whereas the progesterone may differ and in many cases is the cause of common side-effects. The choice of progesterone therefore involves not only its effect on the endometrium in synergy with estrogen, but also possible residual androgenic activity which may have negative metabolic repercussions. Indeed, addition of a progesterone, especially androgen-derived, attenuates the positive metabolic effects of estrogen. Two new monophasic oral contraceptives were recently released. They contain 30 microg (Yasmin) or 20 muicrog (Yasminelle) EE and a new progesterone, drospirenone, derived from spirolactone, which has antiandrogenic and antimineralcorticoid activity similar to endogenous progesterone. Like progesterone, the drospirenone molecule is an aldosterone antagonist and has a natriuretic effect that opposes the sodium retention effect of EE. It may, therefore, help to prevent the water retention, weight gain and arterial hypertension often associated with oral contraceptive use. Recent comparative studies recorded weight loss that stabilized after 6 months of treatment with drospirenone/EE. Overweight women may therefore benefit from the formulation with 20 microg EE, whereas the formulation with at least 30 microg EE should be more appropriate for underweight women. Women with slight to moderate acne, the formulation with 30 microg EE has been found to be as effective as 2 mg cyproterone acetate combined with 35 micrig EE (Diane). Menstrual cycle characteristics, however, remain the main factor determining the choice of formulation. Randomised control studies comparing the new formulation with others containing second or third generation progesterones have found similar efficacy in cycle control and incidence of spotting. From this point of view, it is not advisable to prescribe more than 30 microg EE (Yasmin or Yasminelle) for women with normal menstrual cycles, whereas in cases of hypomenorrhea and/or amenorrhea at least this dose of EE plus drospirenone may be used. Women with hypermenorrhea run the risk of spotting if an inappropriate drug is chosen. A solution is to use 30 microg EE/drospirenone from day 5 of the cycle. To control so-called minor side-effects, the dose of EE must be appropriate. In women with premenstrual tension a dose of at least 30 microg EE associated with drospirenone reduces or even prevents symptoms. On the other hand, in cases of chronic headache or headache as a side-effect of oral contraceptive use, a lower dose of estrogen is beneficial, and doses below 20 microg may be used. Although the progesterone component is not considered to affect headache, good results have been obtained with drospirenone, the antimineralcorticoid effects of which reduce blood pressure and improve symptoms. Formulations with 20 microg EE and drospirenone are particularly indicated in women with pre-existing mastodynia, fibrocystic breast manifestations or who develop mastodynia as a side-effect of oral contraceptive use. Since high plasma concentrations of androgens have been recorded in these women, a progesterone with antiandrogen and antiedema activity can be beneficial. Finally, it is worth recalling that monophasic pills with low estrogen doses, such as the formulations mentioned above, ensure good mood control, reducing the depressive symptoms often associated with oral contraceptive use. In conclusion, formulations containing drospirenone are a valid alternative to conventional oral contraceptives for the personalisation of these drugs.
 ...
PMID:[Individualization of low-dose oral contraceptives. Pharmacological principles and practical indications for oral contraceptives]. 1792 32


<< Previous 1 2