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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Precanceroses and early screening of endometrial carcinomas are reviewed. Measures are evaluated on how to prevent this malignancy with administration of gestagens in hyperplastical endometrial changes in climacteric conditions and manifestations of endometrial estrogenization in postmenopause. On the basis of clinical, laboratory and histological investigations, the total of 31 female subjects with dysfunctional bleeding was given medroxyprogesterone acetate (Provera Upjohn tbl.) in 10 mg daily doses for up to 10-13 days cyclically prior to the onset of menopause. Under the mentioned treatment any of them experienced the rebleed, and no endometrial carcinoma had been diagnosed with control vacuum curettage within one year of observation. In a total of 196 women operated on to endometrial carcinoma, the occurrence of risk-factors for the development of mentioned tumour (obesity, late menopause, i.e. menopause after 50 years of age, sterility and dysfunctional bleeding backed with anovulation, long-term estrogen administration, feminizing ovarian tumours, liver diseases, glycide metabolic disorders and hypertension) was evaluated. The present work was aimed on the screening of asymptomatic group of women. Two important signs (obesity and late menopause) were invariably determined with the addition of any other risk factor. Mentioned women are supposed to undergo regular yearly histological investigation of endometrium. Of most benefit the vacuum curettage is believed by authors as a result of comparing the validation of cytological and histological methods in order of early evidence.
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PMID:[Precanceroses and endometrial carcinoma]. 184 15

Medroxyprogesterone acetate injections (Depo-Provera) were given to 625 women at 3 monthly intervals involving 693 episodes. Ages at entry to the study ranged from 15-51 years with the majority in their 20s and a mean age of 30. Length of exposure ranged from 3-168 cycles. 4 women have received more than 160 continuous cycles of DMPA. Of the medication-induced reasons for discontinuing DMPA, bleeding was the most common with an incidence of 10.5% followed by depression (1.4%), weight gain (1.4%), and loss of libido (1.6%). No patient ceased treatment because of headaches, recurrent vaginal infections, mastalgia, nausea, chloasma, hypertension, or other vascular illnesses. The 59 women who move away or were lost to follow-up accounted for 405 cycles of treatment. The solitary unplanned pregnancy occurred in a 28-year-old obese woman who had previously had other method failures, once with an IUD and once with oral contraceptives (OCs). No association was found with carcinoma of the cervix. Of 80 women ceasing treatment to become pregnant, only 1 women has required the assistance of chlomiphene and conceived 2 years after ceasing DMPA. Amenorrhea was the side effect most appreciated by the women using DMPA. Due to the problem of irregular bleeding, it is wise to warn prospective patients about the lack of bleeding control that they have 1 chance in 10 of having relative menorrhagia. Women using OC subject to frequent vaginal moniliasis had a marked reduction in episodes after switching to DMPA. Chloasma, 1 of the minor stigmas of OC, was not induced in any of the patients. DMPA is a safe and efficient reversible method of contraception for women who have various gynecological conditions or problems associated with using OCs.
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PMID:Medroxyprogesterone acetate as an injectable contraceptive. 296 70

This discussion identifies the risks and benefits of each of the hormonal methods of contraception -- combined estrogen-progesterone oral contraceptive (OCs), progestogen-only pills, and depot progestogen injections. It also explains the use of a profile of risk factors in considering the appropriate prescription for each individual in relation to her contraceptive needs. Information regarding medical risks has come from the consideration of mortality rates in large cohort studies. Looking at categories of the causes of 249 deaths in ever-users of the pill and controls, Layde and colleagues were able to show that there was an excess mortality in the pill group of 40% and that the extra risk was concentrated in cardiovascular causes: myocardial infarctions, cerebral thrombosis, and cerebral hemorrhage constituted the largest proportions. A small proportion of combined OC users may develop clinical hypertension but more suffer a reduction in the high-density lipoprotein (HDL) cholesterol fraction of the blood lipids. Both of these effects tend to increase the risk of cardiovascular complications and both are positively related to the dose of the progestogen components. In prescribing combined OCs, attention needs to be paid to further moves away from the norm towards the extremes: the presence of cardiovascular risk factors and the use of certain longterm medications or the presumptive designation as a "rapid metabolizer." An analysis of progestogen only pill (POP) users in the Oxford-Family Planning Association study confirmed the reasonably low rates of accidental pregnancy in POP users. There is a marked reduction with increasing age, and it is significant that many prescribers are now giving POP to older women for whom combined OCs are contraindicated because of cardiovascular risks. It also seems reasonable to use them in women with some medical disorders, for example, recurrent pulmonary embolism, hypertension, and diabetes. Initially, depot injections of progesterone were developed to provide a long-acting or sustained-release type of drug administration to assist users of the progestogen-only method which, unlike combined OCs, does not make use of regular drug-free intervals. In practice it has been found that the effectiveness against pregnancy is enhanced and the side-effects are increased in giving progestogen by depot injection. The 2 preparations currently licensed in Britain are Depo-Provera (medroxyprogesterone acetate) and Noristerat (norethisterone enanthate). In some cases proper and clear information may not have been given to the patient and proper consent not obtained before giving the drug. This problem is magnified because of the occurrence in some women of disturbed bleeding patterns, especially if given immediately after childbirth or an abortion. Also, in a small proportion of users anovulatory amenorrhea may supervene for some months or even as long as 2 years following depot injection.
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PMID:Hormonal contraceptive methods. 401 68

Drug companies have been at work throughout the 1960s, 1970s, and 1980s trying to reduce the steroid content of their oral contraceptives (OCs). Researchers have been successful in reducing steroid content while maintaining effectiveness, thereby making OCs safer. In the 1st half of the natural menstrual cycle, a woman secretes estrogen as the dominant steroid product. In the 2nd half, estrogen is the principal reproductive hormone. Estrogens inhibit ovulation, possibly by inhibiting implantation, altering ovum transplant, or in some way preventing corpus luteum function, which is necessary to maintain early pregnancies and the endometrium. There are still only 2 estrogens and 6 progestins on the market today. They are probably the most thoroughly studied chemical ever seen in the history of pharmacy or medicine. 1 of the estrogens, mestranol, is really a drug of the past. In the body, mestranol is converted to ethinyl estradiol, the other estrogen on the market. Consequently, there is no reason to use mestranol itself. Within the dose range of 50-100 mcg, there's little difference in contraceptive effect. Progestins are the other active ingredient in the combination OC. Their principal action is the thickening of the cervical mucus, which prevents sperm penetration. Also, with sufficient progesterone, ovulation is inhibited, but this happens in only 40% of those patients taking, for instance, the "mini-pill" (which consists of progesterone only). The progestins and the estrogens work in concert to make OCs a highly effective contraceptive method. Recent surveys conducted by the Centers for Disease Control and National Cancer Institute looked into the relative effectiveness of OCs. Nordette had a use effectiveness failure rate of 3.5; Ovral, 3.6. Loestrin 1/20 -- norethindrone acetate, 1 mg, and estinyl estradiol, 20 mcg -- shows a failure rate of 4.5. This indicates that the threshold for an effective dose of estinyl estradiol in OCs is 30 mcg. For 1 mini-pill, Ovrette, the failure rate is 9.5 -- much higher. Depo-Provera has a failure rate of 0.7. The primary complaint from women taking OCs is spotting and breakthrough bleeding during the cycle. 30-50% of women given OCs stop taking them within a year. OC side effects include nausea, fluid retention, breast tenderness, leukorrhea, hypomenorrhea, headaches, spotting around the face, hypertension, and visual changes. 1 of the risks of birth control pills may be cervical dysplasia -- changes in the cells of the cervix. The relative risk of cervical cancer with OCs after 5-9 years is approximately 1.8. Clinical cases of deep vein thrombosis number 1/1000 per year among nonusers of OCs. Among users, the rate is 3 times as high: 3/1000. The most serious potential adverse effect is myocardial infarction. Of the excess deaths attributed to OCs (23.3 total per 100,000 users), 22.7 are due to myocardial infarctions and hemorrhage. The discussion also briefly reviews other methods of contraception -- Depo-Provera, male contraceptives, implants, the diapragm, and IUDs.
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PMID:Prescription contraceptives: countering the risks. 405 Jun 70

Prescribing contraceptives to diabetic women requires cognizance of metabolic effects and the risks of type I or type II and gestational diabetes mellitus (GDM) in prediabetic women. Studies have show that poor maternal glycemic control in the 1st trimester in diabetic women has resulted in a twofold to threefold increased risk for congenital malformations. A reduction from 6.6% to 1.1% in malformations could be realized by euglycemic control before conception and during the first 8 weeks of gestation. A low-estrogen preparation should be selected and blood pressure should be monitored regularly. Progestins adversely affect carbohydrate and lipid metabolism, as they decrease glucose tolerance by increased insulin resistance, thus the selection of proper progestin dose/potency is important in prescribing OCs. The lowest-dose OCs may be prescribed under close medical supervision to women with insulin-dependent diabetes mellitus (IDDM) without serious vascular complications. Patients should be evaluated after the 1st cycle of OC use and every 3-4 months thereafter with monitoring of weight, blood pressure, postprandial glucose, and glycosylated hemoglobin levels. Women with prior GDM should be evaluated annually utilizing a 2-hour, 75-g glucose tolerance test (OGTT) at the postpartum visit. For OCs, a low-dose estrogen ( 0.05 mg ethinyl estradiol) and a low-dose/potency progestin (or = 0.50 mg of norethindrone or or= 0.100 mg of levonorgestrel) should be selected. The safety of prescription of OCs to women with type II diabetes is unclear, but a supervised program similar to that of IDDM patients is recommended. Currently neither of the long-term contraceptives, depo-medroxy-progesterone acetate (Depo-Provera) injection or the levonorgestrel-containing implant, Norplant, are recommended as first-time methods for women with diabetes. On the other hand, the IUD is an effective, reversible method, particularly for older women with hypertension, provided antibiotic prophylaxis is undertaken at the time of insertion.
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PMID:Contraception in the diabetic woman. 822 75

1025 women who had used Depo-Provera 150 mg injections for contraception for 3-8 1/2 years were studied to assess the effects of prolonged use. 24.4% were aged 25-29, 33.7% were 30-34, 25.1% were 35-39, 11.2% were 40-44, and the rest were 24 and under. 47.2% had had 5-8 pregnancies and 36.3% had had 9 or more. 78.3% had had at least 5 births. 93.4% had menstrual cycles averaging 26-32 days before treatment. 74% had used no previous contraception, 18.9% used oral contraceptives (OCs), .9% used a monthly injectable, 2.9% used another trimonthly injectable, 3.1% used IUD, and .1% each used condoms and rhythm. 58.6% had amenorrhea while using Depo-Provera and 73.5% of the others had short bleeding episodes of 1-2 days. 62% of 92 endometrial biopsies indicated varying degrees of endometrial atrophy. 5 cases of benign breast adenomas were confirmed by biopsy. 71 women complained of moderate breast tenderness. No cases of breast cancer were observed. 73% gained and 9.2% lost at least 1 kg in weight. No significant changes in blood pressure were noted. The proportion of women reporting inorgasmic sexual response increased from 50.3% at the beginning of use to 75.3% after 12-38 doses of Depo-Provera. 3 pregnancies occurred, 2 possibly resulting from faulty injection technique. A follow-up study of 80 former users for 1 year showed that 39 of 58 cases of amenorrhea resumed menses in an average time of 8-9 months, and 19 did not resume menstruation. 10 of 48 with weight changes did not return to the former weight. Nervousness, amenorrhea, and acne were the symptoms requiring the longest time to disappear. 29 of 46 women complaining of frigidity and 2 of 15 complaining of dyspareunia failed to improve. 11.2% of the 80 women terminated use to achieve pregnancy. Other factors were amenorrhea (72.5%), weight gain (60%), edema (50%), nervousness (45%), sexual problems (81.2%), and hypertension (3.7%).
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PMID:[Prolonged use of medroxyprogesterone acetate for contraception]. 1227 35

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

There are hormones from 2 sources which determine the menstrual cycle. The pituitary produces luteinizing hormone and follicle stimulating hormone and the ovaries secrete estrogen and progesterone. For clinical use, a cheap source of progesterone has been found in the Mexican yam. Since the 1st oral contraceptives were tested in Puerto Rico in the late 1950s, there has been a trend toward reducing the dosage. Estrogen prevents ovulation in 95-98% of patients. Other factors are also involved. Although it is estimated that 80-100 million women in the world today use oral contraceptives, this method is not always followed for long periods. From 25 to 60% discontinue the use within the 1st year. Increased risk of unfavorable side effects occurs in those with high blood pressure, migraine headaches, diabetes, epilepsy, undiagnosed genital bleeding, or gallbladder disease. Women over age 40 run a greater risk of heart attacks. Intravenous blood clots are the major risk. Severe abdominal, chest, or leg pains, severe headaches, and eye problems may be symptoms of blood clots. With the 21-day package the user takes a pill a day for 3 weeks and then none during menstruation. The sequential type of medication is no longer used. Minipills are taken every day. Missing taking pills is the most common cause of failure of the method. Estrogen replacement therapy for menopausal women is a temporary treatment to relieve physical distress. Depo-Provera, containing a long-acting progesterone agent, may be injected every 3 months instead of daily oral contraceptives. When progesterone is used with an IUD it acts locally. Hormones to maintain pregnancy are no longer used. Use of hormones as a test for pregnancy has been discontinued. Estrogen-progesterone injections given to inhibit milk production may cause serious side effects.
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PMID:The pills: oral contraceptives and other hormones. 1230 26

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

This article discusses the potential availability of Cyclo-Provera, a monthly injectable similar to Depo-Provera that is being considered for approval by the US Food and Drug Administration (FDA). A new drug application was filed by its marketing company, Pharmacia and Upjohn of Kalamazoo, Michigan, in September 1997. The company wants mutual recognition by the FDA in US and European markets. The Jones Institute for Reproductive Medicine at the Eastern Virginia Medical School in Norfolk recently completed a company-sponsored clinical trial of the drug. This Institute is 1 of 44 sites conducting nationwide clinical trials among a total sample of 1200 women over 5 years. Cyclo-Provera is comprised of depomedroxyprogesterone acetate (DMPA), which is the same ingredient in Depo-Provera. Cyclo-Provera has a lower dose of DMPA (25 mg) combined with 5 mg of estradiol cypionate. The ingredients are expected to provide improved monthly menstrual cycle control. Cyclo-Provera is marketed outside the US under the name Cyclofem. Cyclofem is mainly used in China and Latin America. Germany produces a similar drug. The World Health Organization (WHO) has conducted multinational studies on both drugs. WHO recommends Cyclofem for most women who desire effective, reversible contraception and who are not at risk for most cardiovascular complications. The estrogen in Cyclofem is less potent and has a shorter life span than the estrogen in combined contraceptives. WHO guidelines suggest that Cyclofem has advantages that outweigh disadvantages for smokers under 35 years old, light smokers older than 35, women with mild hypertension (160/100), women with current or medically treated gall bladder disease, or women with mild cirrhosis. Cyclofem is not recommended for heavy smokers over 35 years old, women with a history of hypertension, and women with severe cirrhosis.
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PMID:New year, new option: Cyclo-Provera awaits word. 1234 12


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