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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Contraceptive use of normal dosed progestins continues to be useful for many women who cannot use other contraceptive methods, but appropriate use depends on perfect knowledge of their modes of action, advantages, disadvantages, dosages, and duration of action. Each progestin has its own indications, and contraindications, and not all progestins have contraceptive properties. Most progestins used for contraception are derived from 19 nor-testosterone. Structural modifications of progesterone and testosterone have produced synthetic progestins resistent to hepatic degradation and bioavailable through the oral route. 2 main groups of progestins may be distinguished: androgenic progestins, including the estrone derivatives ethynodiol diacetate and lynestrenol, which have stong antigonadotropic activity and a braking effect on endogenous estrogen secretion, and "pure" progestins derived from 17 OH progesterone, or norpregnanes, such as chlormadinone and promegestone, which have strong luteomimetic activity, no androgenic activity, and weak antiandrogenic activity. Norsteroids administered at normal doses for 21 days/month or in some cases 17 days have a Pearl index of around 1%. This type of contraception requires counting days and taking 1 or 2 pills, and should only be used for women with certain types of problems or hormonal imbalances requiring treatment. Indications may include some cases of uterine polyps, endometrial mucus hyperplasia, uterine fibromas, endometriosis, mastodynies, benign mastopathies, existence of several risk factors for breast cancer, age over 40 years, premenopausal luteal insufficiency, and smoking. Secondary effects, especially metabolic disturbances, may occur and vary according to the formulation, route of administration, and duration of treatment. The 19 nortestosterone progestins commonly used because of their antigonadotropic and antiestrogenic activity have measurable effects on lipid metabolism, apparently in relation to apoproteins A and B, and on glucose metabolism. Some have an effect on the renin substrate, but their role in provoking arterial hypertension appears to be modest. Androgenic effects such as seborrhea and acne may be produced at some dose levels. Medroxyprogesterone acetate, derived from 17 OH progesterone, causes significant metabolic changes including androgenic and hypertensive effects, undesirable effects on glucoregulation, and coagulation effects.
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PMID:[Contraception using normal dose progestins]. 1226 59

The choice of currently available oral contraceptives (OCs) includes combined formulations in varying dosages and monophaic, biphasic, or triphasic form, sequential pills, synthetic progestin-only pills in macro or microdose, and injectable synthetic progestins. Before the advent of microdose pills, products were characterized by progestin or estrogen dominance. Rumors that microdose pills do not completely inhibit ovulation have hindered their acceptance in France, but research has shown that they inhibit ovarian secretions as effectively as more strongly dosed products. Their les profound inhibition of the hypothalamo-pituitary axis raises hopes of a lessened incidence of postpill amenorrhea. Progestin-only microdose pills allow considerable ovarian estrogen secretion, creating a veritable iatrogenic luteal insufficiency. Following the suppression of mestranol, the only estrogen used in OCs is ethinyl estradiol (EE). The only 19-norsteroid progestins which are fixed directly to the progesterone receptors are norethindrone and norgestrel; others such as lynestrenol, ethynodiol diacetate and norethindrone acetate are prohormones. Menstrual problems are among the most frequent side effects of minidose combined pills, but their incidence had dimished with the appearance of biphasic pills and the triphasic pills should offer even greater improvements. The frequency of thromboembolic venous accidents is firectly correlated to the estrogen dose of OCs, but arterial accidents and possibly arterial hypertension appear to be linked to the progestin dose. Synthetic progestins appear to diminish the high density lipoprotein (HDL) fraction of cholesterol and disturb glucose tolerance, while synthetic estrogens augment the HDL fraction of cholesterol and the very low density lipoprotein (VLDL) fraction of triglycerides, modify some coagulation factors, and elevate the plasma level of angiotensinogene. Dose levels and chemical structures of the constituents influence the metabolic effects of pill formulations. In current practice, minidose products are preferred because they cause fewer metabolic changes and are less likely to entail vascular risks. Sequential pills are prescribed for 1 cycle following induced abortion but are not used for long periods because they are not 100% effective, they carry a risk of endometrial hyperplasia, and they appear to increase risks of venous thromboembolism. A combination of 50 mcg EE and 2 mg cyproterone acetate may be prescribed for acne, and minidose combination pills may be used in case of fibroma or endometriosis. In case of contraindications to estrogen, a microdose or injectable progestin can be prescribed if their shortcomings are kept in mind. The current popularity of macrodose progestin-only pills in France has more to do with fashion than with science. All hormonal contraception should be avoided for women at risk, including smokers and those with hyperlipidemia or a family history of vascular accidents.
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PMID:[How to choose an oral contraceptive in 1984]. 1226 9

A critical evaluation of hormonal contraceptives is presented. The pills have been used for more than 100 million women all over the world. During the 25 years of their commercialization, there has been an improvement in their composition, today being considered almost perfect. The side effects can be summarized in 3 groups: endocrine-sexual such as vomiting, headaches, menstrual irregularity; systemic such as thromboembolism, sodium retention, hypertension; and general such as irritability and sexual dysfunction. The pills have some protective effects in the endometrium against cancer, and also against pelvic inflammations. They also can be used to treat uterine bleeding and endometriosis.
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PMID:[A critical evaluation of hormonal contraceptives]. 1228 72

We present the case of a young female who, upon investigation for hypertension, was found to have a ureteric stricture secondary to endometriosis. After excision of the stricture and an end-to-end ureteric anastomosis the patient's blood pressure returned to normal. This case highlights the need to investigate fully hypertension in young people and to consider the possibility of endometriosis in any female who presents with obstructive uropathy.
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PMID:Reversible hypertension in a young female: ureteric obstruction due to endometriosis. 1229 21

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

This article discusses oral contraceptive (OC) and IUD use among women with cardiac disease. OCs are associated with the side effects of fluid retention and hyperlipidemia, contraindicating their use in women with preexisting hypertension, thromboembolic disorders, cerebrovascular disease, and coronary artery disease. A further contraindication is the presence of more than 1 cardiac risk factor (smoking, diabetes, hypertension, hyperlipidemia, and obesity). Since the cardiovascular side effects of OCs are related both to the estrogen and progestin components, clinicians are advised to prescribe a pill with 50 mcg or less of estrogen and the equivalent of 1 mg or less of norethindrone. progestin only OC causes fewer side effects in women with cardiac disease, but should be used in conjunction with a backup method such as foam or condoms if pregnancy would pose a significant health risk. Safe but less reliable methods of contraception (condoms, foam, diagphragm) are recommended only for highly moviated couples. The IUD is not considered an appropriate choice for cardiac patients with a history of pelvic inflammatory disease and multiple sex partners. Such patients are at increased risk of developing endometriosis. In patients with mitral valve prolapse, antibiotic prophylaxis should be administered during IUD insertion.
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PMID:Contraception and cardiac disease: can the pill, IUD be prescribed? 1233 73

There is increasing concern among Canadian women that unwitting and unwanted exposures to environmental contaminants are adversely affecting their health, particularly their ability to become pregnant and have a healthy baby. Evidence of adverse reproductive outcomes among populations exposed to environmental contaminants in the workplace via accidental poisoning, together with detection of environmental contaminant residues in serum and ovarian follicular fluid, has led to the hypothesis that chemical contaminants may be contributing to adverse reproductive outcomes such as infertility, endometriosis, polycystic ovary syndrome, spontaneous abortion, preterm labour, intrauterine growth restriction, and pregnancy-induced hypertension in the general population. The lack of clear evidence concerning the association between exposure to environmental contaminants and adverse reproductive outcomes hampers the clinician's ability to counsel women who are trying to conceive or who have concerns about their pregnancy. This review summarizes the evidence linking environmental contaminant exposure to selected adverse health outcomes by examining the changes in health-outcome trends, the consistency of the epidemiological evidence of an association between the health outcome of concern and exposure to environmental contaminants, and the biological plausibility for environmental contaminant mediated effects on human reproductive health. At best, only a moderate association can be found linking exposure to environmental contaminants with evidence of deleterious reproductive effects in women. Lack of disease trend data, weak exposure assessments, and limited mechanistic data supporting the biological plausibility of potential effects are the primary limitations to the hypothesis that exposure to environmental contaminants adversely affects human reproductive physiology.
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PMID:Do environmental contaminants adversely affect human reproductive physiology? 1254 23

A late consequence of ureteral endometriosis is the silent loss of renal function caused by progressive "enclosure" of the lower part of the ureter by the endometriosis. In our experience, in cases of severe loss of renal function with cortical atrophy and residual kidney function (evaluated by Tc99 DMSA scintigraphy) of less than 15%, removal of the endometriosis combined with ureterolysis does not allow recovery of renal function. A nonfunctioning kidney associated with hydronephrosis is a risk factor for vascular hypertension, recurrent pyelonephritis, or kidney stones and therefore an indication for nephrectomy. By means of a case report, this paper describes the combination of laparoscopic nephrectomy, ureterectomy, removal of the rectovaginal endometriotic nodule, and extraction of the kidney through the vagina.
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PMID:Combined laparoscopic and vaginal approach for nephrectomy, ureterectomy, and removal of a large rectovaginal endometriotic nodule causing loss of renal function. 1736 68

The hormones with a strong influence on the lipid spectrum and the development of atherosclerosis include cortisol, growth hormone and oestrogens. Cortisol accelerates atherosclerosis both through dyslipidemia and through an increase in visceral fat, hypertension, increased insulin resistance and the development of reduced glucose tolerance which may result in diabetes mellitus. Even when a cortisol excess disappears, as is the case of patients cured of Cushing syndrome, arterial walls remain permanently vulnerable to the atherosclerotic process. In conditions involving a lack of growth hormone, dyslipidemia develops and increases the burden on the cardiovascular system if not treated in a timely manner by the substitution of growth hormone. Oestrogens have a double effect: they have an anti-atherogenic effect on artery walls that are not yet damaged by an atherosclerotic process, but where atherosclerosis has already developed they have a prothrombotic effect and destabilise the atheromatous plaques. If oestrogen is to be used as protection against the onset of atherogenesis, it is necessary to start in a period when the atherosclerotic process has not yet begun to damage the woman's arterial walls and it is best to use natural hormones (estradiol) and to prevent endometriosis it should be combined with crystalline progesterone applied locally--inravaginally. Oestrogens should be given in small doses, preferably parenterally. Even this will not prevent genetic oestrogen effects though.
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PMID:[How corticoids, growth hormone and oestrogens influence lipids and atherosclerosis]. 1757 71

Pseudotumor cerebri (PTC) is a seldom seen entity characterized by signs and symptoms associated with the intracranial hypertension (IH) without obvious causes. Some medical disorders and exogenous agents have been implicated in the development of PTC. Danazol is a popular gonadotropin inhibitor used for the treatment of endometriosis, breast disease and hereditary angioedema. While PTC has been occasionally reported in patients receiving danazol treatment, it is barely mentioned in those who discontinued danazol therapy abruptly. Here we report a case of IH developed soon after the withdrawal of danazol.
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PMID:Intracranial hypertension associated with danazol withdrawal: a case report. 1796 58


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