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

Estrogen replacement therapy is effective for the prevention and treatment of postmenopausal osteoporosis and should be offered to all women at high risk for osteoporosis. Such therapy is particularly beneficial for prevention of spinal compression fractures; in addition, it alleviates menopausal symptoms (hot flushes, genitourinary symptoms, and changes in mood). In each patient, these benefits must be weighted against the potential risks of endometrial hyperplasia and carcinoma, breast tenderness, hypertension, vascular headaches, and the inconvenience of menstrual bleeding if the uterus is intact. The risk of endometrial cancer associated with estrogen replacement therapy can be considerably reduced by the addition of a progestin, and other side effects can be diminished or eliminated by use of the new transdermal estrogen preparations. Thus, estrogen replacement therapy should be considered in all women who have experienced natural or surgically induced menopause, and it is advisable in women who have osteoporosis or an increased risk for this disorder and no contra-indications to its use. Estrogen replacement therapy should be instituted as soon after menopause as possible and seems to be well tolerated until at least 75 years of age.
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PMID:Estrogen replacement therapy: current recommendations. 328 71

Oral hormonal contraception is a low risk and safe form of contraception for women between the ages of 15-35 without risk factors such as smoking, obesity, diabetes mellitus, hypertension, or hypercholesteremia. Women over 35 years of age should take the pill only when risk factors can be excluded. In general, low dose pills with less than 50 mcg ethinyl estradiol should be used since they have the lowest impact on the metabolism. Use of the pill could in fact have positive effects on health. For example, benign mamma tumors occur less frequently, dysmenorrhea generally improves, anemia and inflammatory adnexal diseases are less common occurrences, and there appears to be a clearly protective effect against morbidity of the endometrium and ovarian cancer. (author's modified)
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PMID:[Risk-benefit analysis of contraception with steroids]. 333 Mar 69

In Finland, the combinations of ethinyl estradiol (EE) and levonorgestrel (LNG) or desogestrel are most used for oral contraception (OC) and LNG, linestrol or nethisterone are employed in the pills containing only progestogen. Their effect is reduced by antiepileptics primarily phenytoin, carbamazepine, barbiturates, and primidone, however, clonazepam and sodium valproate do not exert any influence. The cause is the effect of the drugs on the liver as they accelerate the metabolism of steroids by enzyme induction. Phenytoin induces sex hormones binding globulin (SHGB) synthesized by the liver. In addition to natural hormones also LNG and norethisterone are bound to SHGB. The decrease of the effect of progestogens has not been documented, in fact, some research data indicate that progesterone exerts a beneficial effect in the treatment of epilepsy. Thus, combination OC tablets that contain at least 50 mcg of EE can be used for hormonal contraception of epileptics. Rifampicin applied in chemotherapy of tuberculosis (TB) also exhibits an effect inducing liver enzymes, and that is the reason why rifampicin treatment resulted in undesired pregnancy and bleeding disorders during contraception by combination tablets. Therefore, the concomitant use of both agents is contraindicated. In Finland data are scarce on this effect, as TB is very rare there. In the case of other antibiotics the incompatibility with OCs is proven. It must be noted, however, that as a secondary effect, diarrhea and gastroenteritis treated by antibiotics can produce an unwanted pregnancy. The treatment of diabetes and hypertension can also be contraindication to the use of hormonal contraception, although it may be permitted under medical supervision and control of diabetes.
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PMID:[Hormonal contraception and other drug treatments]. 333 Nov 52

Female spontaneously hypertensive rats (SHR) were injected subcutaneously with mestranol twice a week for 12 weeks. Isolated segments of thoracic aorta were then used to generate relaxation response curves to acetylcholine or ATP after precontraction with phenylephrine. Estrogen treatment attenuated the development of hypertension. Further, augmented endothelium-dependent relaxation to acetylcholine was seen in the estrogen-treated SHR. There was no difference, however, in the relaxation produced by ATP. Since the relaxation of both acetylcholine and ATP is endothelium-dependent, these findings suggest that different mechanisms may be involved in the relaxation produced by acetylcholine and ATP.
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PMID:Endothelium-dependent relaxation in estrogen-treated spontaneously hypertensive rats. 335 42

This article reviews the effects of estrogens on protein production by the liver, lipid metabolism, bone maturation and structure, and mineral metabolism. Also presented is a comparison of natural steroidal estrogens (estradiol, estrone, conjugated estrogens, and equine estrogens), synthetic steroidal estrogens (esters and 17-alpha-ethinyl estradiol), and nonsteroidal estrogens (diethylstilbestrol, dienestrol, and chlorotrianisene). Delivery of estrogens by different routes produces different effects. However, the metabolic changes that occur from enzyme induction within hepatic tissue are probably related to the type and dosage of estrogen rather than to the route of administration. Preparations containing estrogens that occur naturally in humans have the least exaggerated potency in the hepatic system relative to their estrogenicity, while conjugated estrogens that contain a mixture of equine estrogens are 2-3 times more potent in the hepatic system and ethinyl estradiol and diethylstilbestrol demonstrate a hepatic potency that is 4-18 fold greater than their estrogen potency. Estrogen is believed to induce a hypercoagulation state associated with both oral contraceptive (OC) use and pregnancy, but the clinical significance of increased levels of clotting factors remains undetermined. Estrogen appears to inhibit bone resorption in postmenopausal women and improve calcium balance. Although estrogen receptors are present in the kidney, their physiologic significance remains unknown. Estrogen does cause an increase in levels of plasma renin substrate, plasma renin activity, and angiotensin. Estrogen-induced increases in angiotensin, leading to renal sodium retention, appear to be the mechanism underlying the association of OCs with hypertension.
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PMID:Pharmacology of estrogens and estrogen-induced effects on nonreproductive organs and systems. 377 5

This paper presents a state-of-the-art review of oral contraceptives (OCs), termed one of the epochal developments of modern times. OCs have had both direct and indirect influences on moral, social, and cultural values and on the interaction of population resources and the environment. In recent years there has been a trend away from OC use because of increased mortality rates, especially in women over 35 years of age and smokers. However, epidemiologic studies have indicated that the incidence of death from cardiovascular disease, thromboembolic disease, and stroke was greatly reduced when newer preparations with lower steroidal doses became available. The reduction of the estrogen content from 150 mcg of ethinyl estradiol-3-methylether to 30-35 mcg of ethinyl estradiol and of the progestin component from 10 mg of norethindrone to 1 mg or less has not interefered with effective conception control. The progestin component of the pill was linked to high blood pressure, lipid changes, and cardiovascular changes with an unfavorable impact on arterial disease. Although many insist that the question of whether OCs cause or predispose to cardiovascular problems cannot be answered at this time, the potential risks involved in OC use are generally regarded to be outweighed by the benefits. Reductions in OC dosages have also reduced the incidence of galactorrhea, amenorrhea, and on-pill amenorrhea. New triphasic formulations that more closely imitate the hormonal fluctuations of the menstrual cycle are considered to hold much promise in terms of safety and effectiveness.
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PMID:Oral contraceptives: the state of the art. 391 70

The history of the development of oral contraceptives (OCs) has been a progressive reduction in dosage to what is now probably the lowest does that is compatible with the desired therapeutic effect -- to inhibit ovluation. Yet, controversy and argument continue. A table lists the OCs that are available in Australia. Many of these preparations, although having different trade names, have an identical composition. Since the withdrawal of sequential OCs from the Australian market, there are only 2 generic types. These are the progestogen only (mini) OCs, which consist of either 30 mcg of levonorgestrel or 350 mcg of norethisterone given at the same time every day; and the combined OCs, which contain an estrogen and a progestogen. In the last 12 months, some of the older high-dose OCs have been withdrawn, and it seems likely that further withdrawals will follow. Only 2 estrogens are used in the formulation of the OC, but there is a greater variety of progestogens. Ethinyl estradiol is used in most preparations. A small minority of OCs contain mestranol, the 3-methyl ether of ethinyl estradiol. Currently, there are only 4 OC agents that are available in Australia that contain mestranol and 2 of these contain the high doses of 100 mcg. Fundamentally, there are 2 types of progestogens -- those that contain, or are metabolized to, norethisterone and those that contain norgestrel or its close relative, desogestrel. With the exception of the norgestrel group and desogestrel, all other progestins, including norethisterone itself, are effective in vivo after they have been metablized to norethisterone. Mestranol is effective in humans after demethylation to ethinyl estradiol. In the norgesterel group, since d-norgestrel is inert endocrinologically, 250 mcg of levonorgestrel and 500 mcg of dl-norgestrel are equivalent. Levonorgestrel and desogestrel are of approximately equal potency. With the combined OC agents, the overwhelming mechanism of action is by the inhibition of the midcycle peak of luteinizing hormone (LH) secretion and, hence, the inhibition of ovulation. Progestogen-only OCs have additional actions such as effects on cervical and fallopian tube mucin. Minor side-effects include disturbance of the menstrual cycle, changes in weight, and changes in mood. Major side-effects relate to 4 areas -- subsequent reproduction, the cardiovascular system, other metabolic effects, and the risk of malignancy. A table presents the absolute contraindication contraindications. There is not the slightest doubt that a woman who is over 35, who smokes, and who, in addition, may be obese and has hypertension should not use OCs. Progestogen (mini) OCs have a slightly higher failure rate and a greater incidence of irregular bleeding than have combined OCs. The mini OC has little place in women who need effective hormonal contraception and good cycle control. The mini OC may have a place in a patient who finds other contraception unacceptable and in whom estrogens are contraindicated specifically.
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PMID:Oral contraceptive agents. 394 19

61 wmen with a past history of elevated blood pressure (high risk group) associated with oral contraceptive (OC) use (27 patients), unknown etiology (17 patients), or preeclampsia (17 patients) used a low-dose OC containing 0.4 mg norethindroen and 35 mcg ethinyl estradiol for 3-24 months. The highest blood pressuers recorded in the past were 141.0 +or- 14.9 (mean +or- SD) mm Hg systolic and 98.3 +or- 8.0 diastolc. 61 women without a past history of elevated blood pressure (low risk group), selected from a pool of 616 low risk patients, were matched with the high risk group for race, initial age, initial body weight, duration of use, history of smoking, and family history of hypertension. The blood pressures in the high risk group before and after OC therapy were significantly higher than those in the low risk group. Despite these differences, the mean systolic and diastolic blood pressures in these 2 groups of women using the low dose OC did not rise when compared with their own baseline blood pressures. 5 high risk patients (8.2%) discontinued therapy because of reoccurrence of their hypertension; however, blood pressures at discontinuance were comparable to the previous highest blood pressures.
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PMID:Low-dose oral contraception and blood pressure in women with a past history of elevated blood pressure. 396 3

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

490 women who used Stediril (.5 mg norgestrel and .05 mg ethinyl estradiol, combined) for a total of 5600 cycles or 466 woman-years over a 3 year period are presented. They all took the pills primairly for contraception; most were 20-30 years old, and took Stediril 3-6 months. Some other indications were 119 cases of menstrual irregularity, 15 of spaniomenorrhea, 14 of premenstrual syndrome and 3 of acne, all relieved. 46 of 50 cases of menorrhagia, 83 of 89 of dysmenorrhea and 32 of 34 with pelvic pain were relieved. Withdrawal bleeding was usually less than before and tended to diminish with time. There were 46 women with nausea, 3 of whom stopped Stediril. Migraines sometimes a ppeared, sometimes disappeared, but often occurred regularly on the first day between pill cycles. 52 women complained of breast congestion for the first time. Weight rose in 2301, fell in 98 and stayed constant in 134 after 3 months: weight was easily controlled with diet and appetite supressant drugs. No hypertension was observed. There were 19 single cycles of amenorrhea, several cases of persistant amenorrhea and 4 cases of amenorrhea after stopping. 2-3% of cycles were marked by metrorrhagia; 63 women had spotting, 8 had significant metrorrhagia; 7 had metrorrhagia followed by withdrawal bleeding in that cycle. 1 woman had a thromboembolism of the left leg after 2 pill cycles during which she gained 3 kg. There was 1 pregnancy due to irregular pill use.
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PMID:[Clinical study of an estro-progestative association in low doses. Experience of 3 years (490 patients-5600 cycles)]. 426 90


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