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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Oral contraceptives (OCs, long-acting progestins (LAPs), and IUDS are reviewed in terms of new information on safety and efficacy. OC formulations are described and their mechanism of action and efficacy indicated. Reports are provided for thromboembolism, hemorrhagic and thrombotic stroke, ischemic heart diseases, alterations in lipid and hypoprotein and carbohydrate metabolism, hypertension, coagulation changes, breast and cervical cancers, and such minor side effects as menstrual irregularities, nausea, headaches, weight gain, premenstrual syndrome effects, and mood and libido changes. Noncontraceptive health benefits and clinical considerations are discussed. Norplant, as the only long acting progestin available in the US is described in terms of its formulations, mechanism of action, sequelae and metabolic effects, menstrual irregularities, metabolic effects, nuisance side effects, candidates for insertion, method of insertion and removal, and continuation rates. 2 IUD types are identified as the only ones available in the US, Progestasert T and T-Cu-380A (Paragard). Mechanism of action, efficacy, candidates, major sequelae such as salpingitis, infertility, and uterine perforation, minor sequelae such as metrorrhagia and dysmenorrhea, and other considerations are indicated. OCs in the US contain an average of 35 mg of ethinyl estradiol and assorted progestins e.g.s, ethynodiol diacetate, norethindrone acetate, nortestosterone derivatives with a complex mechanism of action. The failure rate for use effectiveness is 6 pregnancies/100 woman years. Modern formulations have combined rates of no more than 50 to 100 adverse events/100,000 users. Some of the effects are indicated as follows: Thromboembolism accounts for 60% of adverse effects and appears to be declining along with hemorrhagic and thrombotic stroke, however, modern use studies are only partially available. Myocardial infarction related to OC use may be embolic, and has a low risk at 7/100,000 users. Low-dose contraceptives substantially reduce the associated risks. Those with risk factors need close monitoring. Norplant is useful for those not wanting to take a daily regimen and is commonly accompanied by menstrual irregularity and sometimes headaches. Continuation is 80% after the 1st year and 40% after 5 years. Candidates for IUDs are parous women in monogamous relationships, who are not at risk for salpingitis, which is related to IUD use, or sexually transmitted diseases. Continuation is 70% after 1 year compared with 50% of OC users.
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PMID:Modern trends in contraception. 212 11

Synthetic progestins derived from nortestosterone provide a promising contraceptive alternative for women with contraindications for estrogens. Progesterone and synthetic progestins reduce vasodilatation and edema induced by estrogens and stop estrogen-dependent cellular multiplication in target tissue. Progestins have 2 kinds of contraceptive affect: antigonadotropic action at sufficient doses, and peripheral action at lower doses. The cervical mucus is modified in composition and volume, becoming hostile to sperm; the endometrial mucus atrophies; and tubal motility is slowed. High dose progestins are administered from the 5th or 10th to the 25th cycle day, with the earlier date preferred for women with shorter cycles. They are an ideal method for women with endometrial hyperplasia or benign breast disease or histories of breast or uterine cancer, as well as for women over 40 with dysovulatory cycles. Contraindications to high dose progestins include obesity, hypertension, lipid metabolic anomalies, and diabetes. Low dose progestin-only pills are administered at the exact same time each day including during menstruation. They are attractive for some women because they contain no estrogen, a reduced progestin dose causing fewer headaches and less somnolence, and fewer metabolic effects. Low dose progestins are indicated for lactating women, those with contraindications to estrogens such as obesity, hypertension, hyperlipidemia, and diabetes, and those with renal or cardiac insufficiency with valvulopathy. Low dose progestins are also indicated for nulliparas and other women for whom IUDS are contraindicated. Women using low dose progestins should never take drugs that act as enzymatic inductors, which speed hepatic degradation of steroids and reduce their efficiency. A resulting pregnancy is likely to be extrauterine because of slowed tubal transport. The failure rate of low dose progestins ranges from .9-3%, with higher failure rates among younger women. About 30% of users initially experience spotting, which despite its usual disappearance after 2-3 months of use is the most common reason for discontinuing the method. Low dose progestins have no metabolic or vascular effects, but they may cause a relative hyperestrogenism is some users. Other modes of administration of progestin contraception include continuous high doses, never justified solely for contraception. Trimonthly injections of medroxyprogesterone acetate of norethindrone enanthate provide contraception through a long lasting antigonadotropic effect. Metrorrhagia and amenorrhea are among possible side effects. The method is used primarily in developing countries where its ease of use is a major advantage. Subcutaneous implants releasing continuous doses of levonorgestrel provide contraceptive protection for over 5 years. The cumulative failure rate is 1.7 at 5 years. Metabolic tolerance is good. The major side effect is menstrual irregularity.
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PMID:[Progestational contraception]. 365 94

Oral contrceptives (OCs), usd by over 30% of reproductive aged women in Belgium, are by far the most widely used contraceptive in that country. The various types of OCs include monophasic, biphasic, and triphasic combinations of an estrogen and a progestin, sequentials containing estrogen only for 7-14 days followed by a progestin through the 21st day; macrodose or microdose progestin only formulations, 3-month injectable progestins, and the morning after pill. Side effects of OCs are mainly due to metabolic effects on coagulation factors, the renin-angiotensin system, glucose tolerance, or the lipid profile. Users of OCs face increased risks of cholelithiases, thrombophlebitis, thromboembolism, cerebrovascular accidents, myocardial infarcts (among smokers over 35 years of age), and hepatic adenomas. The most troubling secondary effect is the excess cardiovascular morbidity and mortality show by contraceptive users, not just those who are obese, hypertensive, or who have histories of vascular pathology, but also those over 40 years of age and smokers. Lenght of use of OCs does not increase vascular risks. Epidemiologic studies demonstrate that vascular risks are reduced in lower dose formulations. Absolute contraindications to OC use include serious cardiovascular problems, severe hepatic pathology, estrogen-dependent tumors, pregnancy and undiagnosed gynecologic problems, and significant hyperlipidemia. Relative contraindications include severe headaches, cholelithiase, previous cholestasis of pregnancy, severe renal disease, fibromyomas, benign breast disease, age over 40 years, smoking, surgery anticipated within 4 weeks, infectious mononucleosis, falciform anemia, and immediate postpartum and lactation. Epilepsy, diabetes, depression, and varicose veins are not strictly speaking contraindications but require additonal surveillance. Lower dose formulations should be prescribed if possible. OC users should be followed up every 6-12 months. Among other steroidal contraceptive methods, sequential OCs and high dose progestin-only formulations are used for short-term treatment of specific conditions. Progestin-only minipills are used when an OC is desired but estrogens are contraindicated. Injectable progestins should be reserved for patients who for cultural or medical reasons can use no other type of contraceptive. Morning-after pills should not be considered a regular form of contraception. If OCs are used in adolescents, a low dose pill is indicated. Low dose OCs may be indicated for diabetics because of the danger of infection with IUDs and the lesser efficacy of barrier methods. If OCs are used in epileptics, they should be regular dosed because of the danger of drug interactions. Only low-dose formulations and progestin-only minipills should be used by women over 40.
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PMID:[The choice of oral contraception in 1984: general indications and specific cases]. 672 93

The article reports on 33 insertions of the progesterone-releasing IUD, Progestasert, in patients aged 17-45 with an average age of 31; most patients had 2 children. Insertion of the device was easy, and the device itself was extremely well tolerated; 12 of the original 33 patients carried the device for more than 24 months, and 5 carried it for more than 36 months. There were no pregnancies, 2 cases of spontaneous expulsion, 2 removals for pelvic pain, and 2 for desire of pregnancy. Not only were there no side effects, but a positive action of the device was noted against genital inflammation, together with marked improvement of mammary tension and intramenstrual occurrence of headache. Vaginal cytology remained normal or it improved.
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PMID:[A new intrauterine device with progesterone for control of reproduction]. 732 25

Progesterone, the natural progestogen produced by the corpus luteum, changes the endometrium from proliferative to secretory. In early pregnancy, progesterone maintains the pregnancy until the placenta develops and assumes hormonal production. It stimulates mammary gland development, suppresses contractility of the uterus, and inhibits T-lymphocyte production, thereby preventing immunological fetal rejection. Progesterone also causes an increase in renal sodium retention in nonpregnant women, stimulates the appetite, and increases the blood glucose level. It has a few minutes half-life in the blood. Progestins are synthetic progestogens. Health care providers must have a general understanding of progestogens in order to use them safely and effectively in practice. The author discusses selective information on them, what they are, how they act, properties, and concerns related to effects. The focus is upon progestogens used in combined oral contraceptives and hormonal replacement therapy. Major concerns exist about potential untoward lipoprotein changes, carbohydrate metabolism alterations, and breast cancer. Other concerns are associated with coagulation effects, prostacyclin changes, sex hormone-binding globulin capacity, psychological disturbances, blood pressure alterations, breakthrough bleeding, headaches, and other side effects. These preparations have, however, evolved over the years into safer formulations with fewer apparent risks.
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PMID:Progestogens: a look at the "other" hormone. 827 90

The levonorgestrel (LNg) IUD releases 20 mcg LNg/day and protects against pregnancy for 5 years (Pearl index = 0.1/100 women years of use). Its mode of action is reduced amount of cervical mucus and suppression of the endometrium. A multicenter study in Denmark, Finland, Hungary, and Sweden comparing the LNg IUD and the Nova T IUD found the 5-year continuation rate of the LNg IUD to be 46.9% (44.5% for Nova T). The leading reasons for LNg IUD removal at 5 years were planning pregnancy (15.2%), bleeding (13.7%), and hormonal reasons (11.9%). Bleeding disturbances occurred significantly less often in the LNg IUD users than in the Nova T users (13.7% vs. 20.7%; p = .002). Since LNg has a strong effect on endometrium suppression, LNg IUD users were more likely to quit using the IUD due to amenorrhea than Nova T users (6% vs. 0; p = .0001). The cumulative gross expulsion rate after 5 years was 5.8. Termination for genital infections was more likely in Nova T users than LNg IUD users, especially when the infections were pelvic inflammatory disease (2.2% vs. 0.8%; p .01) and endometritis (4% vs. 1.5%; p .01). Hormonal side effects were acne, hirsutism, weight changes, mood changes, breast tenderness, nausea, and headache. Women in the LNg IUD group experienced return to fertility at a higher rate than those in the Nova T group (79.1% at 12 months and 86.6% at 24 months vs. 71.2% and 79.7%, respectively), but the differences were not significant. Progestin-releasing IUDs can be used to treat menorrhagia, thereby making them an alternative to hysterectomy or endometrial resection. The LNg IUD reduced menstrual blood loss by 86% at 3 months and by 97% at 12 months in women with menorrhagia, resulting in an increase in hemoglobin and serum ferritin. This IUD also effectively opposes the proliferative effect of estrogen on the endometrium in women on hormonal replacement therapy.
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PMID:Hormonal intrauterine devices. 848 51

1. The effects of progesterone, its A-ring-reduced metabolites, allopregnanolone, tetrahydroxydeoxycorticosterone and the synthetic neuroactive steroid alphaxalone were evaluated in a rat model of plasma extravasation within the meninges following unilateral electrical stimulation (ES) of the trigeminal ganglion (0.6 mA, 5 ms, 5 min) or substance P administration (1 nmol kg-1, i.v.). 2. When administered 55 min prior to electrical stimulation, progesterone (> or = 500 micrograms, s.c.) dose-dependently decreased plasma extravasation within the meninges (ED50: 650 micrograms) but not within conjunctiva and tongue. Promegestone (R5020), a non-metabolized progesterone agonist (1000 micrograms, i.p.) was ineffective. The administration of progestrone (> or = 500 micrograms s.c.) 55 min prior to substance P partially suppressed plasma extravasation within the meninges (ED50: 550 micrograms). 3. The GABAA-antagonist, bicuculline (ED50: 8.2 micrograms kg-1, i.p.) but not the GABAB-antagonist, phaclofen (100 micrograms kg-1, i.p.) attenuated the effects of progesterone after electrical stimulation and substance P administration. 4. The metabolites of progesterone, allopregnanolone (3 alpha-hydroxy-5 alpha- pregnan-20-one (THP); ED50: 0.58 micrograms kg-1, i.p.), tetrahydroxydeoxycorticosterone (3 alpha,21- dihydroxy-5 alpha-pregnan-20-one (THDOC); ED50: 1.2 micrograms kg-1, i.p.) as well as the synthetic steroid alphaxalone (3 alpha-hydroxy-5 alpha-pregnane-11,20-dione; ED50: 1.8 micrograms kg-1, i.p.) suppressed plasma extravasation dose-dependently following ES, whereas the epimer of allopregnanolone, 3 beta-hydroxy-5 alpha-pregnan-20-one (100 micrograms kg-1, i.p.), did not. Extravasation caused by SP administration was partially suppressed by allopregnanolone (> or = 1 microgram kg-1, i.p.) (ED50: 2.1 micrograms kg-1). 5. The effect of progesterone (1000 micrograms, s.c.) and allopregnanolone (100 micrograms kg-1, i.p.) on neurogenic plasma extravasation was reversed by bicuculline (10 micrograms kg-1, i.p.) or by a congener, bicuculline-methiodide (10 micrograms kg-1, i.p.) which does not cross the blood brain barrier. 6. Progesterone (1000 micrograms, s.c.) had no effect on mean arterial blood pressure or heart rate when measured for 60 min after administration. 7. These results indicate that neurosteroid modulation of a GABAA-receptor located outside the blood brain barrier suppresses neurogenic and substance P-induced plasma extravasation within the meninges. The findings are consistent with previously reported data showing that valproic acid and muscimol inhibit meningeal oedema by bicuculline-sensitive mechanisms. Drugs which activate GABAA-receptors and its modulatory sites might be clinically effective in the treatment of migraine and cluster headache.
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PMID:GABAA-receptor-mediated effects of progesterone, its ring-A-reduced metabolites and synthetic neuroactive steroids on neurogenic oedema in the rat meninges. 882 49

1. The purpose of this study was to investigate the mechanism of nicotine-evoked relaxation of the guinea-pig isolated basilar artery and to study the effects of drugs associated with the aetiology or treatment of migraine on the nicotine response. 2. The guinea-pig isolated basilar artery, pre-contracted with prostaglandin F2alpha (PGF2alpha), in the presence of atropine (3 microM) and guanethidine (3 microM), relaxed on addition of nicotine (0.1 mM) in approximately 50% of preparations. The responses to nicotine were of short duration and blocked in preparations pre-treated for 10 min with capsaicin (1 microM) and are therefore probably a consequence of the stimulation of trigeminal C fibre terminals. 3. Responses to nicotine were reduced in the presence of 5-carboxamidotryptamine, 5-hydroxytryptamine and sumatriptan in that order of potency. This is consistent with a 5-HT1 receptor mechanism. These agonists evoked small additional contractions in vessels pre-contracted with PGF2alpha. 4. Indomethacin (0.3-10 microM), aspirin (10-30 microM), and nitro-L-arginine methyl ester (L-NAME, 0.1 mM) reduced nicotine-evoked relaxation of the basilar artery, suggesting the involvement of both nitric oxide and cyclo-oxygenase products in this response. 5. Progesterone (1 microM) markedly reduced the response to nicotine, a possible reflection of the ion channel blocking activity of high concentrations of this compound. 6. The guinea-pig basilar artery is a preparation in which the effects of drugs on responses to stimulation of trigeminal nerve terminals can be studied in vitro and may thus be of interest in assessing the actions of drugs used in treatment of headache.
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PMID:The inhibition of nicotine-evoked relaxation of the guinea-pig isolated basilar artery by some analgesic drugs and progesterone. 1019 81

There are inconsistent data on the age/sex prevalence pattern of back pain and on chest pain. However, it is possible that for chest pain, the rates are higher in younger women and older men. Neck pain, joint pain, and fibromyalgia all appear to increase with age in both genders, whereas abdominal pain and tension-type headaches decrease with age, and migraine headache and TMD appear to peak in the reproductive years. A concluding example illustrates how epidemiologic data can be used to enhance our understanding of the causes of pain. A higher prevalence in women and a peak prevalence during the reproductive years as seen in TMD suggest that either biologic or psychosocial factors unique to women in this period of life could increase the risk of developing or maintaining this pain. As female reproductive hormones can play a role in migraine, at least for some women, it would be interesting to examine whether hormones play a role in TMD. The situation that occurs when menopause is followed by hormone replacement therapy (HRT) provides a natural experiment similar to a laboratory experiment in which female animals are deprived of the natural sources of hormones and then hormones are replaced exogenously. In women, of course, the decision to receive HRT may be associated with a number of psychosocial variables that might also influence pain. Recognizing these limitations, data from records of a large health maintenance organization were examined to ascertain whether use of estrogen or progestin (or both) in postmenopausal women might be associated with the occurrence of TMD pain and, thus, whether the hormone hypothesis might be worthy of further investigation. More women with TMD than controls used estrogen replacement therapy, and slightly more patients than controls used progestin. The use of estrogen significantly increased the odds of having TMD. Progestin use showed a weaker association, which did not hold up after other factors were controlled. However, the risk of TMD appears to increase with increasing doses of estrogen. A review of the epidemiologic literature indicates that there are definite age and sex differences in the prevalence of many chronic pain conditions. There is little basic information about the source of these differences, such as different onset rates, different probabilities of recurrence, or different durations of pain, or combinations of these in women and men. Nevertheless, a systematic examination of the existing epidemiologic data may be an important step in helping pain researchers to generate hypotheses in the search for a better understanding of chronic pain in both sexes.
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PMID:Chronic pain conditions in women. 1032 86

Progestin only birth control pills appeared on the US market in 1973. As there is no estrogen in these mini pills, they may have fewer dangerous side effects than the combined pills. Some clinics suggest mini pills for women who suffer from estrogen excess side effects. The 3 mini pills available in the U.S. are called Micronor, NOR-QD, and Ovrette. Instructions are presented for patients who are interested in using mini pills. The mini pills most likely work by affecting a women's fertility in several ways: act as a messenger to the woman's ovaries and uterus to prevent the release of an egg; thicken the mucous on the cervix, making it difficult for the sperm to "get through" the cervix and reach the egg; and change the lining of the uterus so that it may not develop properly for the fertilized egg to grow. The mini pills can be 97% effective is used perfectly. The mini pills are only effective for as long as a woman takes them. A woman must take a pill every day to prevent pregnancy. A woman should not use the mini pill if she has or ever has had any of these problems: blood clotting problems in veins; stroke; cancer of the breast or reproductive parts of the body; suspected pregnancy, current pregnancy; and undiagnosed, abnormal genital bleeding. Possible benefits for a woman using mini pills include: an effective method of birth control; a method for nursing mothers since it does not seem to affect the amount of their breast milk; and a possible reduction in premenstrual cramps. Possible risks for a woman using mini pills include: irregular periods; and a less effective method if the patient does not take a pill every day. The danger signals to look for are abdominal pain, chest pain, headaches, eye problems, and severe leg pain. A patient should revisit a clinic in the following situations: has not had a period within 45 days of the last period; severe abdominal pains while taking mini pills; experiences a warning signal; any time one thinks the pills are causing trouble; and once a year for a pap smear, breast examination, and laboratory tests.
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PMID:How to use mini-pills: helpful patient instructions. 1226 79


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