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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This general review describes the progestagens and estrogens and their combinations marketed in France, their biologic effects (on ovulation, pharmacological and hormonal effects, effects on the female reproductive organs), the mechanism of inhibiting ovulation, indications, and trivial and serious side effects. The 3 series of progestagens are 17-alpha-hydroxyprogesterone derivatives, 19-nor-testosterone and 3-deoxy-19-nor-testosterone derivatives; the estrogens are ethinyl estradiol and mestranol. Indications discussed here are therapeutic tests, functional uterine bleeding, endometriosis, polycystic ovary, amenorrhea, Stein-Levanthal syndrome, sterility, intermenstrual pain, premenstrual breast congestion, and acne. Minor side effects include vomiting, bleeding, weight gain, depression, and vaginitis. Complications mentioned are thromboembolism, virilization, cholasma, jaundice, and fibroids. Genetic and congenital defects are not more common in steroid users than in the general population; it is too early to predict whether these drugs are carcinogenic.
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PMID:[The steroids, inhibitors of ovarian function]. 574 50

Whether the differences in progestin-estrogen formulations of oral contraceptives (OCs) lead to any clinically significant differences is an important question, even though the concept of "tailoring the pill to the patient" has assumed less importance as the hormonal dosages have decreased. Each component can be evaluated individually, but it is often difficult to predict the result of their combined action. All of the new low-dose formulations contain the same estrogen, ethinyl estradiol (EE). Although the type of progestin in low-dose OCs is probably of little significance for efficacy and cycle control, it may be more important in regard to lipid and carbohydrate metabolism. Combined OC therapy acts simultaneously at various levels of the reproductive system, and contraceptive efficacy of pills with less than 50 mcg of estrogen probably results from these combined actions. The action of estrogen and progesterone is synergistic: the sustained estrogen component exerts negative feedback on gonadotropin secretion, provides stability to the endometrium, and increases the potency of the progestational agent, while progestin can influence only estrogen-primed tissue. The progestin suppresses luteinizing hormone secretion; in addition, progestational influence dominates estrogenic influence in affecting the remainder of the reproductive system. Previous OC usage may delay pregnancy by several months but does not impair longterm fertility potential or increase congenital anomalies or abortions if conception occurs subsequent to the 1st post-pill cycle. Breakthrough bleeding, which occurs in 15% of users, is the single most frequent cause of pill discontinuation but appears to be of no medical consequence. Breakthrough bleeding and amenorrhea may be controlled by changing the pill formulation. Depression has been reported in 5% of OC users, but pill use appears to alleviate premenstrual tension. The individual patient's risk-benefit ratio must be considered when noncontraceptive uses of the pill are contemplated. OC use has been cited as a cure for dysmenorrhea, although the mechanism is uncertain. The possible preservation of fertility or prevention of progression of endometriosis with cyclic pill use should be investigated. The controlled sloughing of a uniformily thinning endometrium prevents and controls dysfunctional uterine bleeding, endometrial hyperplasia, and the anemia that results. Use of OCs has been recommended in treatment of hirsutism to suppress ovarian function when the hypersecretion of androgens is documented. Since both adrenal and ovarian androgens are often involved in hirsutism, the combined suppressive actions of OCs frequently are beneficial. Estrogens also decrease sebum production and often result in indirect acne improvement. Cyclic estrogen-progesterone therapy is recommended for inducing sexual maturation in primary amenorrhea secondary to gonadal failure.
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PMID:Formulation and noncontraceptive uses of the new, low-dose oral contraceptive. 623 95

In an open, non-randomized prospective phase-III-study the clinical and endocrine efficacy as well as the safety of leuprorelin acetate depot (Enantone-Gyn Monats-Depot) were investigated. The therapeutic results of 198 patients, gathered from 5 university institutions and two city hospitals, are reported. Endometriosis was classified by the revised American Fertility Society score (r-AFS) before and at the end of treatment. Serum levels of LH, FSH, prolactin, estradiol, progesterone, androstenedione, testosterone and leuprorelin acetate were determined by radioimmunoassay. The mean total r-AFS score changed as follows: before surgical intervention during first-look laparoscopy 21 +/- 24 at the end of first-look laparoscopy 15 +/- 19 at the end of the GnRH-treatment 8 +/- 14 During leuprorelin acetate treatment the r-AFS stages changed as follows: [table; see text] Using the scoring system 85.2% of the patients improved. Relief of dysmenorrhoea could be achieved in 95.4%, relief of dyspareunia in 64% and of pelvic pain in 69.4% of patients. Baseline hormone levels dropped sharply during treatment. [table; see text] Androstenedione, testosterone, blood pressure, body weight, haematological parameters, liver enzymes, creatinine, electrolytes and HDL-/LDL-cholesterin remained more or less unchanged. Side effects being hot flushes, sweating, sleeplessness, headache, nausea, depression and vaginal dryness were due to estradiol deprivation. In 135 patients resumption of menstruation occurred in 95.6% within the first three months post-treatment. 23 patients of whom 21 were judged as infertile, became pregnant immediately after treatment was finished. The study results confirm the efficacy of leuprorelin acetate depot in the treatment of even advanced stages of endometriosis.
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PMID:[Treatment of endometriosis with the GnRH agonist leuprorelin acetate depot (Enatone-Gyn monthly depot): a multicenter study]. 784 80

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal-neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space. Complete resection of all disease in a debulking operation is essential; 11) appendectomy for symptoms of chronic appendicitis, and chronic right lower quadrant pain; 12) uterine suspension for symptoms of collision dyspareunia, pelvic congestion, severe dysmenorrhea, cul-desac endometriosis; 13) repair of all hernia defects whether sciatic, inguinal, femoral, Spigelian, ventral or incisional; 14) hysterectomy if relief has not been achieved by organ-preserving surgery such as resection of all endometriosis and presacral neurectomy, or the central pain continues to be disabling. Before such a radical step is taken, MRI of the uterus to confirm presence of adenomyosis may be helpful; 15) trigger point injection therapy for myofascial pain and dysfunction in pelvic and abdominal muscles. With application of all currently available laparoscopic modalities, 80% of women with chronic pelvic pain will report a decrease of pain to tolerable levels, a significant average reduction which is maintained in 3-year follow-up. Individual factors contributing to pain cannot be determined, although the frequency of endometriosis dictates that its complete treatment be attempted. The beneficial effect of uterosacral nerve ablation may be as much due to treatment of occult endometriosis in the uterosacral ligaments as to transection of the nerve fibers themselves. The benefit of the presacral neurectomy appears to be definite but strictly limited to midline pain. Appendectomy, herniorraphy, and even hysterectomy are all appropriate therapies for patients with chronic pelvic pain. Even with all laparoscopic procedures employed, fully 20% of patients experience unsatisfactory results. In addition, these patients are often depressed. Whether the pain contributes to the depression or the depression to the pain is irrelevant to them. Selected referrals to an integrated pain center with psychologic assistance together with judicious prescription of antidepressant drugs will likely benefit both women who respond to surgical intervention and those who do not. A maximum surgical effort must be expended to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibers, and treat surgically accessible disease. In addition, it is important to provide patients with chronic pelvic pain sufficient psychologic support to overcome the effects of the condition, and to assist them with underlying psychologic disorders.
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PMID:Surgical treatment for chronic pelvic pain. 987 26

Cutaneous endometriosis is a well known but rare phenomenon. We present a case of spontaneous umbilical endometriosis. The patient revealed a polypoid, brown-blue nodule within the umbilical depression with the typical history of monthly bleeding from the umbilicus. The differential diagnoses are summarized.
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PMID:Umbilical endometriosis. 1018 46

Endometriosis is one of the most common benign gynecological diseases, affecting an estimated 10-15% of all premenopausal women. In this open multicentric prospective study, we investigated the effectiveness and tolerance of a gonadotropin releasing hormone agonist (goserelin) for the treatment of symptomatic endometriosis. One hundred and thirteen patients were included in the study. During the treatment, we documented a relevant reduction in the rAFS score and in the additive diameter of the implants. In addition, we noted a reduction in pelvic pain and an improvement of symptoms on pelvic examination. These effects were also reported during the follow up visits (24 weeks). Only 12 patients had intolerable side effects (hot flushes, sweating during the night, vaginal dryness, depression), which could be managed with transdermal 17 beta estradiol, without reducing therapeutic effectiveness. In conclusion, gonadotropin releasing hormone analogs proved to be an excellent treatment for symptomatic endometriosis and are generally well tolerated.
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PMID:[Effectiveness and tolerance of a gonadotropin releasing hormone (goserelin) in treatment of symptomatic endometriosis]. 1035 39

Some chronic diseases have a favourable course and are cured spontaneously. Allergic diseases such as eczema, hay fever and asthma have a good outcome in more than 75% of cases within 7 to 25 years, depending on the kind of allergy. Migraines have also a good evolution in children and after menopause. Many symptoms due to menstruation such as dysmenorrhea, premenstrual syndrome or anemia, disappear after menopause as well as diseases due to estrogens such as uterine leiomyoma, endometriosis and prolactinoma. The risk of epilepsy relapse after a first seizure is about 40% after 2 years. The risk is lower in children. Attention deficit disorder affects 3 to 5% of children but is present in only 30% of them in adult age. The prevalence of depression decreases in women between 30 and 60 years of age. Functional somatic syndromes such as fibromyalgia, irritable bowel syndrome or dyspepsia decrease in 2/3 of cases within 5 to 10 years if there is no history of anxio-depressive symptoms. However, prognosis is reserved when initial symptoms are severe or if they are connected to sexual abuse, domestic violence or depression. Other diseases have a spontaneous favourable course such as myopia, idiopathic infertility, polycystic ovary disease or ventricular arrhythmia. The knowledge of a good prognosis enables to avoid unnecessary treatments and to reassure many patients.
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PMID:[The benefits of aging. I. Patience and cure: spontaneous beneficial course of certain diseases]. 1172 11

Gynecologists use either oral or parenteral progestogens either alone or in combination with estrogens to treat various conditions. Parenteral routes of progestogen delivery are intramuscular injections, intravaginal pessaries, subcutaneous implants, and vaginal rings. Progestogens treat dysfunctional uterine bleeding by first controlling the acute bleeding episode and then by establishing normal ovulatory cycles. 1-2 tablets of medroxyprogesterone acetate (MPA)/day or 1-3 tablets of norethindrone/day should stop uterine bleeding in 72 hours. If not, 25 mg intravenous premarin should control it in 6-24 hours. Cyclical progestational (e.g., MPA) therapy for 3-6 cycles should establish normal ovulatory cycles. After appropriate laparoscopic staging by double puncture technique, progestogens can be used to treat mild-moderate endometriosis. Gynecologists should consider the following criteria when selecting the ideal progestin for hormone replacement therapy: adjustment of dosage of progestin and estrogen over 3-6 months to maintain the beneficial effects of the estrogen and to minimize the adverse effects of the progestin, progestin dosage sufficient to protect against endometrial hyperplasia and cancer, economical progestin, and minimization of weight gain, depression, oral intolerance, and androgenic action. Hydrogesterone and MPA meet these criteria. Oral contraceptives with a progestin and the smallest possible dose of estrogen are well-tolerated, cause no break-through bleeding, produce minimal side effects, and protect against pregnancy (99% contraceptive effectiveness rate). They also protect against endometrial cancer, endometriosis, premenstrual tension, dysmenorrhea, and irregular cycles. Intramuscular injections of progestins (MPA, NET-EN), subcutaneous levonorgestrel implant, and the levonorgestrel IUD are new contraceptive developments and provide a high degree of contraceptive efficacy. MPA at very high doses cause remission of breast endometrial lesions.
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PMID:Progestogens in gynaecological practice. 1217 92

Progestins in oral contraceptives (OCs) produce potential complications, as well as noncontraceptive benefits, according to Robert A. Hatcher, MD, MPH, professor of gynecology and obstetrics, Emory University Medical School. Hatcher told CTU that lowering the progestin content in an OC may decrease complications, but could also decrease the benefits experienced by women. "The extent to which that will happen remains to be seen," he said. Hatcher cited the following potential complications of progestins in OC: hypertension; decreased levels of high density lipoproteins; acne; oily skin; headaches between pill cycles; dilated leg veins; pelvic congestion syndrome; thrombosis of superficial leg veins; gallstones; Monilia vaginitis; cholestatic jaundice; and depression, fatigue, and decreased libido. Progestins, according to Hatcher, also produce these noncontraceptive benefits: protection against PID; decreased dysmenorrhea; decreased menstrual blood loss, decreased iron deficiency anemia; protection against endometrial cancer; protection against fibrocystic breast disease, and fibroadenomas of the breast; decreased bleeding from fibroids; decreased growth of fibroids. When ovulation is suppressed, Hatcher emphasized, additional benefits that may occur include the following: decreased risk of functional ovarian cysts; elimination of mittleschmerz pain; decreased rick of ovarian cancer; protection against endometriosis.
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PMID:Potential risks, benefits of progestins in birth control pills outlined. 1231 83

To our knowledge, this is the first case reported in the literature of umbilical endometriosis in a pregnant woman. We report a case of umbilical endometriosis in a pregnant woman at 16 weeks of gestation. The patient revealed a reddish-brown polypoid nodule within the umbilical depression, with the typical history of monthly bleeding from the umbilicus. A nodule biopsy, testing of serum levels of CA-125 and a transabdominal ultrasound examination were performed. The diagnosis of endometriosis was confirmed by pathological examination. Serum levels of CA-125 were slightly increased and the pelvic ultrasound examination did not identify ovarian cysts of a possible endometriotic nature. The patient was also examined at 24 weeks' gestation, after delivery and in the late postpartum period. No therapy was given and the lesion resolved spontaneously 2 months after the biopsy was taken.
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PMID:Umbilical endometriosis in pregnancy: a case report. 1519 4


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