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 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The combined progestogen/estrogen oral contraceptive is the most common form of contraception in the US. They contain 1 of 5 synthetic progestogens (derived from 19-nortestosterone) and 1 of 2 estrogens. 3 new progestin compounds are in use in Europe and Asia. They are norgestimate, desogestrel, and gestodene. Estrogen seems to cause vascular complications. Progestin may cause atherosclerosis. Desogestrel and gestodene were studied for 6 months. They have little effect on glucose and lipid metabolism. Triphasal ethinyl estradiol/levonorgestrel and ethinyl estradiol/norethindrone (Ortho Novum 7/7/7) were compared in a 12-month prospective clinical trial. There seems to be no consensus of a pattern of increased breast cancer associated with oral contraceptive use. The UK National Case Control Study Group analyzed women younger than 36 years at the time breast cancer was diagnosed. 91% of their cohort had used pills. A significant trend was found when risk was analyzed with duration of taking pills. Women who had taken the pill for 4 years had no increased risk of breast cancer. However, there was an increased relative risk of 1.7 (P0.001) for women who took pills for more than 8 years. Among women using the pill for 8 years, the relative risk was 2.6 (p0.0001). AMong women using pills with 50 ug. of estrogen, the trend to increased risk was (P0.10). The 1988 National Survey of adolescent males showed that 60% of men never married were active sexually. Among 17- to 19-year-old-men who live in metropolitan areas, condom use has more than doubled, compared with 1979. In 1988, a "new" copper-containing IUD was approved for use in the US by the Food and Drug Administration, the Copper T 380 A. Pregnancy rates are less with this than with older devices. IUDs may cause pelvic inflammatory disease with resulting tubal infertility. However, the risk was overstated earlier. Women who have only 1 sexual partner in their lifetime had no significant risk of tubal infertility. "lost" IUDs continue to be a problem.
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PMID:Contraception. 210 26

Progestins counteract the positive effect of the estrogen component in oral contraceptives (OCs) on cholesterol levels thus increasing the risk of atherosclerosis. Low androgenic potency progestins do not have a negative effect, however. Other research indicates that the lower the estrogen dose in OCs the lower the risk of deep vein and superficial thrombosis. OC users, especially low dose OC users, with no other risk factors (e.g. smoking and hypertension) are not at increased risk of cardiovascular disease. Some research demonstrates elevated risk of stroke in OC users, however. Elevated cholesterol, obesity, diabetes and other factors further increases the risk of stroke. Combined OCs protect against endometrial and ovarian cancer and this effect increases with use and continues after use. Moreover OC users are not at increased risk of pituitary adenoma. Results of some studies shows an increased risk of cervical cancer, but other only demonstrates a slight increase. So far research does not indicate the following to increase breast cancer risk among OC users: early age at 1st OC use, formulation, family history, and history of benign breast disease. There is an increased risk for liver tumors in OC users, nevertheless it is rare. OCs do not raise the risk of diabetes or gallbladder disease. High dose formulations increases the risk of high blood pressure, but not so with low dose formulations. OC use does not impair, fertility, but delayed conception often occurs. Most research demonstrates no increase in pelvic inflammatory disease in OC users. OCs do not cause congenital malformations. Combined OC use is contraindicated for breast feeding mothers, but progestin only OCs can be used with no advance effects. Results of 1 study demonstrates an increase in HIV infection in OC users, but another study has opposite results. The article concludes with recommended clinical management practices.
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PMID:Reassessment of the metabolic effects of oral contraceptives. 185 68

This review on the risks and benefits of oral contraceptives clarifies the risks and misperceptions, and discusses 10 potential health benefits. In the U.S. where maternal mortality is about 20.6/100,000, the risk of death from pills ranges from 1.8 for nonsmokers to 6.5 for smokers. It is likely that most of the small existing mortality risk of pill use is due to thromboembolism. Atherosclerosis, the major cause of death for U.S. women, may be reduced by the pill. It is still controversial whether pills increase risk of hepatocellular carcinoma and malignant melanoma; they protect against endometrial cancer (the 3rd greatest cancer killer) and ovarian (the 4th) cancer; they may increase risk slightly in some subgroups for breast and cervical cancer, although data are conflicting. Pills also protect against ectopic pregnancy, benign breast disease, pelvic inflammatory disease, ovarian cysts, iron deficiency anemia and possibly uterine fibroids and osteoporosis. It is no longer held that orals protect against toxic shock syndrome or rheumatoid arthritis. It is estimated that oral contraceptives avert 50,000 hospital admissions per year in the U.S.
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PMID:The health effects of oral contraceptives: misperceptions, controversies, and continuing good news. 266 76

Depot medroxyprogesterone acetate (DMPA) is the only injectable contraceptive available in the United States. After more than 20 years of regulatory review, the Food and Drug Administration approved DMPA for contraceptive use in 1992 after the publication of reassuring data about its possible association with breast cancer. It has been used by 30 million women in more than 90 countries. The recommended dosage, 150 mg intramuscularly every 3 months, has a contraceptive efficacy exceeding 99%. After a 150 mg dose, ovulation is inhibited for at least 14 weeks. Almost all users experience menstrual changes, typically episodes of unpredictable irregular spotting and bleeding, particularly during the first year of use. With continued use, spotting and bleeding decrease, and amenorrhea becomes common. Although ovulation suppression may rarely persist for as long as 18 months after the last injection, DMPA does not permanently affect fertility. Long-term DMPA use reduces menstrual blood loss, has been associated with a decreased incidence of candidal vulvovaginitis and pelvic inflammatory disease, and dramatically lowers the risk of endometrial cancer. Prolonged DMPA use may be associated with reversible reduction in bone density, probably related to suppression of endogenous production of estrogen. The most recently published data suggest that long-term use of DMPA induces moderate changes in lipid metabolism that are unfavorable in terms of risk of atherosclerosis. DMPA should be considered a highly effective, safe, convenient, and reversible contraceptive option for appropriately selected patients.
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PMID:Long-acting injectable contraception with depot medroxyprogesterone acetate. 817 4

Chlamydia are obligate intracellular eubacteria that are phylogenetically separated from other bacterial divisions. C. trachomatis and C. pneumoniae are both pathogens of humans but differ in their tissue tropism and spectrum of diseases. C. pneumoniae is a newly recognized species of Chlamydia that is a natural pathogen of humans, and causes pneumonia and bronchitis. In the United States, approximately 10% of pneumonia cases and 5% of bronchitis cases are attributed to C. pneumoniae infection. Chronic disease may result following respiratory-acquired infection, such as reactive airway disease, adult-onset asthma and potentially lung cancer. In addition, C. pneumoniae infection has been associated with atherosclerosis. C. trachomatis infection causes trachoma, an ocular infection that leads to blindness, and sexually transmitted diseases such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and epididymitis. Although relatively little is known about C. trachomatis biology, even less is known concerning C. pneumoniae. Comparison of the C. pneumoniae genome with the C. trachomatis genome will provide an understanding of the common biological processes required for infection and survival in mammalian cells. Genomic differences are implicated in the unique properties that differentiate the two species in disease spectrum. Analysis of the 1,230,230-nt C. pneumoniae genome revealed 214 protein-coding sequences not found in C. trachomatis, most without homologues to other known sequences. Prominent comparative findings include expansion of a novel family of 21 sequence-variant outer-membrane proteins, conservation of a type-III secretion virulence system, three serine/threonine protein kinases and a pair of parologous phospholipase-D-like proteins, additional purine and biotin biosynthetic capability, a homologue for aromatic amino acid (tryptophan) hydroxylase and the loss of tryptophan biosynthesis genes.
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PMID:Comparative genomes of Chlamydia pneumoniae and C. trachomatis. 1019 88

The general benefits of the use of methods of contraception are the documented decrease of maternal and fetal mortality and morbidity, the diminution of the rate of prematurity and low birth weight, the decrease in induced abortion and sexually transmitted diseases (STDs) and certain gynecological cancer types. Natural methods of contraception pose the benefit of lacking effects on the organs and not introducing any external factors into the body. Barrier methods provide protection against STDs (a 50% reduction) and against cervical cancer (human papilloma virus), especially for adolescents and those with multiple sex partners. The chemical methods provide local antiseptic and antibiotic action that can be beneficial for vaginal and cervical infections. Hormonal methods, namely the oral contraceptive (OC) pill, also possess noncontraceptive benefits: regulation of the menstrual cycle, including diminution of dysmenorrhea, menstrual pain, menstrual flow, and anemia; reduced risk of pelvic inflammatory disease, endometrial and ovarian cancer, benign breast pathology, acne, and hirsutism; in addition to the therapy of polycystic ovarian syndrome, hypothalamic amenorrhea, and dysfunctional hemorrhage. Further benefits include the decrease of the risk of osteoporosis, rheumatoid arthritis by 60% in families at risk, ectopic pregnancy, atherosclerosis, uterine myomas by up to 31%, and ovarian cysts. Contraceptives that contain progestational hormones (oral, injectable, implant, or IUD forms) are also beneficial for endometrial hyperplasia and uterine polyps. IUDs (except for progestational IUDs) have local effect without the potential side effects of hormones. Terminal methods of contraception (tubal ligation and ligation of the vas deferens) are reliable without causing alterations in the physiology of the organs.
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PMID:[Non-contraceptive benefits of contraception]. 1217 57

Since the last in a series of childbirth education classes discusses contraception, educators must know about various family planning methods. Oral contraceptives (OCs) comprise combined OCs, phasic OCs, and minipills. Combined OCs inhibit secretion of gonadotropin-releasing hormone, which in turn keeps the follicle-stimulating hormone from inducing the ovarian follicle to grow and keeps luteinizing hormones from activating ovulation. They also thicken cervical mucus. Minipills also thicken cervical mucus and render the endometrium unreceptive to fertilized egg implantation. They do not always inhibit ovulation, however. OCs can induce side effects, such as nausea, hypertension, increased risk of atherosclerosis, and fatigue. The IUD prevents pregnancy either by inhibiting implantation of a fertilized egg or by an inflammatory reaction of the endometrium resulting in a release of macrophages which may destroy sperm. The no-longer-produced Dalkon Shield IUD increased the risk of pelvic inflammatory disease and damaged the reputation of other IUDs. Rare IUD complications are uterine perforation, salpingitis, tubal scarring, pelvic inflammatory disease, and infertility. Diaphragms, cervical film, and condoms serve as barriers between the egg and sperm. The main problem with barrier methods is the increased risk of developing toxic shock syndrome. Spermicide increase the effectiveness of diaphragms, cervical caps, and condoms. Vasectomy keeps sperm from arriving at storage sites. Shortterm side effects are swelling, discomfort, and occasional rejoining of the cut ends of the vas. Research hints at a link between vasectomy and prostate cancer. Some complications of tubal ligation are urinary tract infections, accidental electrical burns, and pelvic infections. Natural family planning methods include withdrawal, the rhythm method, and the sypto-thermal method. Controversial injectable contraceptives are Depo-Provera (medroxyprogesterone acetate) and Noristerate (norethisterone enanthate).
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PMID:Birth control update for childbirth educators. 1234 29

The ability to cause persistent infection is one of the major characteristics of all chlamydial species in their appropriate hosts. Persistent infection with Chlamydia trachomatis and Chlamydia pneumoniae has been implicated in the pathogenesis of many chronic diseases, some initially not thought to be infectious, including pelvic inflammatory disease, arthritis, asthma, and atherosclerosis. Chlamydiae have a unique developmental cycle with morphologically distinct infectious and reproductive forms: elementary (EB) and reticulate bodies (RB). Chlamydiae appear to circumvent the host endocytic pathway and inhabit a nonacidic vacuole that is dissociated from late endosomes and lysosomes. Chlamydiae also have been demonstrated to enter a persistent state after treatment with cytokines such as interferon-gamma (IFN-gamma), treatment with antibiotics, or restriction of certain nutrients, or to enter this state spontaneously under certain culture conditions. While the organism is in the persistent state, metabolic activity is reduced, and the organism is often refractory to antibiotic treatment. Ultrastructural analysis of IFN-gamma-treated C pneumoniae demonstrates atypical inclusions containing large reticulate-like aberrant bodies with no evidence of redifferentiation into EBs. Persistent C pneumoniae infection appears to be associated with continued expression of genes associated with DNA replication but not with those genes involved with bacterial cell division. The latter observation may explain the appearance of the large abnormal RBs seen in ultrastructural studies. Studies of the association of chlamydiae with chronic disease have been hampered by difficulties in diagnosing chronic, persistent infection with the organism, which, in turn, render determining the efficacy of antibiotic therapy very difficult.
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PMID:The intracellular life of chlamydiae. 1249 Dec 29

Rifalazil represents a new generation of ansamycins that contain a unique four-ring structure. Originally rifalazil was developed as a therapeutic agent to replace rifampin as part of a multiple drug regimen in the treatment of tuberculosis. As a result of its superior antimicrobial activity and high intracellular levels, rifalazil has potential to treat indications caused by the intracellular pathogen, Chlamydia trachomatis, which causes non-gonococcal urethritis and cervicitis, often leading to pelvic inflammatory disease. Rifalazil also has potential to treat the related microorganism, Chlamydia pneumoniae, which may be involved in chronic inflammatory processes thought to be partly responsible for atherosclerosis. Due to its favourable antimicrobial spectrum and other positive attributes, rifalazil may also prove valuable in the treatment of gastric ulcer disease, caused by Helicobacter pylori, and antibiotic-associated colitis, the result of toxin production following the growth of Clostridium difficile in the colon. The potential value of rifalazil in the treatment of these indications will be assessed in human clinical trials.
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PMID:Development potential of rifalazil. 1255 19

Members of the genus Chlamydia cause a plethora of ocular, genital and respiratory diseases, with severe complications, such as blinding trachoma, pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility, interstitial pneumonia, and chronic diseases that may include atherosclerosis, multiple sclerosis, adult-onset asthma and Alzheimer's disease. The current medical opinion is that an effective prophylactic vaccine would constitute the best approach to protect the human population from the most severe consequences of these infections. There are three essential and mutually inclusive areas of challenge confronting researchers developing Chlamydia vaccines. These are to define the elements of protective immunity and the basis of vaccine evaluation, the judicious selection of an immunogenic and safe antigen(s) to form the basis of a subunit vaccine, and to develop effective delivery systems that boost the immune response to achieve long-lasting protective immunity. The development of delivery vehicles and adjuvants to boost protective long-term immunity against chlamydiae currently poses the greatest challenge in vaccine research. However, enormous progress is being made in the construction of novel delivery systems, such as DNA and plasmid expression systems, viral vectors, and living and non-living bacterial delivery systems, and the use of chemical adjuvants. In addition, there is increasing effort being made in designing delivery strategies involving specific immunomodulatory procedures that modify the cytokine and chemokine environment, upregulate co-stimulatory molecules and target vaccines to specific mucosal sites. These efforts will likely culminate in an efficacious chlamydial vaccine in the near future.
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PMID:Developing effective delivery systems for Chlamydia vaccines. 1519 31


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