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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Silastic implants containing the progestin, levonorgestrel, were tested as long-term contraceptives in 101 women. After three full years of exposure and 2,998 woman-months of use, no pregnancies had occurred. The continuation rates were 87% at 12 months, 79% at 24 months and 66% at 36 months. The most important side effect was excessive or irregular bleeding during the first year. No treatment was offered for this side effect other than vitamins and iron or change of method, with the exception of 3 cases where ethinyl estradiol was used one time for 2 weeks each. Bleeding disturbances led 8 patients to ask for removal of implants. Other side effects were headache, acne and lower abdominal pain. Blood and urine analysis tested 17 different parameters and all but plasma cortisol remained within normal limits throughout the study. A general tendency toward lowered cortisol values was observed and two subjects had more than one value below the normal limit for the population during the study. Glucose tolerance tests during the second year were abnormal in two women with familial diabetes but they returned to normal values spontaneously at the next test. It is concluded that levonorgestrel implants offer effective protection against pregnancy during the first three years of continuous use. Their acceptability and few side effects justify larger trials, especially if treatment of bleeding irregularities is introduced.
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PMID:A three-year clinical trial with levonorgestrel silastic implants. 38 43

Overall 1,021 patients with endometrial carcinoma were treated between 1965 and 1982 at the Department of Obstetrics and Gynecology and the Department of Radiology, Friedrich-Schiller-University, Jena. The 5-year-survival rate of all patients amounted to 63%. The 5-year-survival probability with primary surgery was 76.1%, with primary irradiation 34.4%. The frequency of risk factors in the patient group was compared with an age adjusted group of patients who underwent a D & C due to irregular bleeding of benign causes. Overweight and infertility were evaluated as significantly more frequent risk factors in cancer patients. There was no significant difference between the two groups concerning the factors hypertension, diabetes, heart-diseases, irregular bleeding and history of carcinoma in the family.
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PMID:[Results of therapy of endometrial carcinoma and analysis of risk factors in comparison with a control group]. 275 77

Endometrial adenocarcinoma is commonly seen in the perimenopausal and postmenopausal age groups. Certain medical conditions (such as diabetes, hypertension, and obesity) are often associated with development of this disease. Consequently, when irregular bleeding develops, a decision to sample the endometrium is often predicated on the patient's age and the presence of these associated conditions. Often, healthy young women receive empirical hormonal therapy for irregular bleeding without prior endometrial sampling. An unusual case of endometrial adenocarcinoma arising during lactation in a young healthy woman is presented.
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PMID:Occurrence of endometrial adenocarcinoma during lactation. 687 19

The author describes a range of contraceptive methods, and their side effects, which may be acceptable for new parents. The methods are the oral contraceptive pill, Norplant, Depo-Provera, and intrauterine devices (IUD). Natural methods and permanent contraception are options described in insets. The author notes that differences in the effectiveness rates among available types of oral contraceptive pills are small enough not to merit consideration when deciding which kind of pill may be appropriate. Combination birth control pills are taken daily at the same time for 21 out of 28 days. Combination pills are not recommended for women with a history of hypertension or other cardiovascular diseases, thrombophlebitis, migraine headaches, diabetes, active gallbladder disease, or mononucleosis. Any hormonal method may be particularly risky for smokers over age 35. The mini-pill, containing a smaller amount of progesterone and no estrogen, is taken every day and is also on a 28-day cycle. Containing no estrogen, the mini-pill is often recommended for women who are nursing, who are over age 35, or who suffer from hypertension or migraines. Both adverse and positive side effects may be experienced from use. Norplant is the brand name of a contraceptive system which releases progesterone from under the skin of a woman's upper arm over the course of a five-year period. The system has a theoretical effectiveness rate of more than 99%, although the duration of effectiveness may be less than five years in overweight women. The most common side effect is irregular bleeding, and removal is often a longer and more difficult procedure than insertion. The most commonly used injectable hormonal contraceptive is Depo-Provera, a progesterone solution which works for up to three months. The majority of users experience some side effects. Finally, IUDs are highly effective and need to be replaced only every 1-10 years depending upon how they are made. Women typically experience discomfort during IUD insertion, and they should not be used by women under age 20 years, who have never had children, or who have ever had a pelvic infection.
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PMID:Birth control for new parents. 1229 Aug 91

Family planning practitioners who work with women in the perimenopausal years should educate patients about the need for contraception until 1 year past the last menstrual period, rule out contraindications to specific fertility control methods, and provide women with the opportunity to choose the method best suited for them. Women in the perimenopausal years are at increased risk of aging-related problems such as cardiovascular disease and diabetes, genetic defects in offspring, morbidity with a pregnancy, and mortality from a pregnancy. In working with these women, clinicians should evaluate the absolute and strong relative contraindications of hormonal contraception, IUDs, barriers and spermicides, natural family planning (NFP), and sterilization. Any method of combination hormonal contraception is conttraindicated for smokers aged 35 years and over. Although progestin-only pills are safer for women at risk of hypertension, possible irregular bleeding during the menstrual cycle caused by these preparations can disquise progressively involutional periods or lead women to ignore cancer warning signs. Although the IUD can be considered for perimenopausal women, it should be reconsidered if intermenstrual bleeding occurs. Barrier methods are popular among women with decreased fertility potential who are largely monogamous. Uterine and urethral changes in older women may discourage diaphragm use. However, the spermicides in contraceptive jellies and sponges can provide lubrication for women with symptoms of dry vagina. Vaginal spermicides are used heavily by women in the final 1/3 of their childbearing years. Women nearing menopause should not use NFP methods because of the irregularity of mucus and temperture patterns. Finally, the 1-time risk of tubal sterilization poses less threat to healthy women ages 35-40 years than oral contraception or a term pregnancy.
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PMID:Contraception during perimenopausal years is important issue for patients, clinicians. 1233 14

Polycystic ovary syndrome has been viewed primarily as a gynecologic disorder requiring medical intervention to control irregular bleeding, relieve chronic anovulation, and facilitate pregnancy. A large body of evidence has demonstrated an association between insulin resistance and polycystic ovary syndrome. The former condition has an established link with long-term macrovascular diseases such as type 2 diabetes mellitus, hypertension, and atherosclerotic heart disease, consequences that also are observed in women with polycystic ovary syndrome. In addition, chronic anovulation predisposes women to endometrial hyperplasia and carcinoma. The purpose of this review is to examine the clinical course of this syndrome, which spans adolescence through menopause, and suggest a simple and cost-effective diagnostic evaluation to screen the large numbers of women who may be affected. Therapy, which should be individualized, should incorporate steroid hormones, antiandrogens, and insulin-sensitizing agents. Weight loss by way of reduced carbohydrate intake and gentle exercise is the most important intervention; this step alone can restore menstrual cyclicity and fertility, and provide long-term prevention against diabetes and heart disease. Treatment alternatives should be directed initially toward the most compelling symptom. Longitudinal care is of paramount importance to provide protection from long-term sequelae.
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PMID:Current perspectives in polycystic ovary syndrome. 1531 31

Women with polycystic ovarian syndrome have chronic anovulation and androgen excess not attributable to another cause. This condition occurs in approximately 4% of women. The fundamental pathophysiologic defect is unknown, but important characteristics include insulin resistance, hyperandrogenism, and altered gonadotropin dynamics. Inadequate follicle-stimulating hormone is hypothesized to be a proximate cause of anovulation. Obesity frequently complicates polycystic ovarian syndrome but is not a defining characteristic. The diagnostic approach should be based largely on history and physical examination, thus avoiding numerous laboratory tests that don't contribute to clinical management. Women with polycystic ovarian syndrome typically present because of irregular bleeding, hirsutism, and/or infertility. These conditions can be treated directly with oral contraceptives, oral contraceptives plus spironolactone, and ovulation induction, respectively. However, women with polycystic ovarian syndrome also have a substantially higher prevalence of diabetes and increased risk factors for cardiovascular disease. They should also be screened, therefore, for these conditions and followed closely if any risk factors are uncovered. For obese women with polycystic ovarian syndrome, behavioral weight management is a central component of the overall treatment strategy.
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PMID:Polycystic ovary syndrome. 1470 63

The polycystic ovary syndrome (PCOS), then called the Stein-Leventhal syndrome, was first described in 1935. Originally, diagnosis required pathognomonic ovarian findings and the clinical triad of hirsutism, amenorrhea, and obesity. During fertility years, women with PCOS are often seen for immediate concerns such as infertility, menstrual irregularity, and symptoms of androgen excess. During the past two decades, however, such patients have been observed to have increased risk of cardiovascular disease, dyslipidaemia, hypertension and diabetes and increased risk for endometrial cancer. The management of polycystic ovary syndrome is now complex and includes life style modifications, dietary-induced weight loss, oral contraceptives, clomiphene citrate, gonadotropins, antiandrogens and insulin-sensitising agents. These observations have led to a unique clinical perspective about PCOS--one that recognizes the need to address the immediate issues of irregular bleeding, hirsutism, and infertility, but also emphasizes the long-term goals of preventing diabetes, heart disease, and cancer.
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PMID:[Long-term health consequences of polycystic ovaries syndrome: metabolic, cardiovascular and oncological aspects]. 1808 38

(1) Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation. The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly. In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years. There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception. However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD. The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection. There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections. In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use. The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy. The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception.
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PMID:Intrauterine devices: an effective alternative to oral hormonal contraception. 1963 36

Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. Chronic anovulation can lead to irregular bleeding, prolonged unopposed estrogen stimulation of the endometrium, and increased risk of endometrial cancer. Causes include polycystic ovary syndrome, uncontrolled diabetes mellitus, thyroid dysfunction, hyperprolactinemia, and use of antipsychotics or antiepileptics. Women 35 years or older with recurrent anovulation, women younger than 35 years with risk factors for endometrial cancer, and women with excessive bleeding unresponsive to medical therapy should undergo endometrial biopsy. Treatment with combination oral contraceptives or progestins may regulate menstrual cycles. Histologic findings of hyperplasia without atypia may be treated with cyclic or continuous progestin. Women who have hyperplasia with atypia or adenocarcinoma should be referred to a gynecologist or gynecologic oncologist, respectively. Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia. The levonorgestrel-releasing intrauterine system is an effective treatment for menorrhagia. Oral progesterone for 21 days per month and nonsteroidal anti-inflammatory drugs are also effective. Tranexamic acid is approved by the U.S. Food and Drug Administration for the treatment of ovulatory bleeding, but is expensive. When clear structural causes are identified or medical management is ineffective, polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation may be considered. Hysterectomy is the most definitive treatment.
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PMID:Evaluation and management of abnormal uterine bleeding in premenopausal women. 2223 Mar 7


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