Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present status of oral contraceptive steroids and the IUD, the 2 most effective and increasingly popular contraceptive methods (used by 41.6% of all U.S. married couples practicing contraception in 1970), is presented. Oral steroid contraceptives with varying quantity and activity of estrogen (ethinyl estradiol or mestranol) and progestogen (norethindrone, norethynodrel, ethynodiol diacetate, or norgestrel), are of 3 types: combination, sequential, and minidose progestogen alone. The most effective contraceptive available is the combined oral pill with a pregnancy rate of less than .2 % per 100 women after 1 year. Contraceptive action is exerted primarily through inhibition of ovulation and secondarily by alterations in cervical mucus, endometrial glands, the ovary, and in the oviduct and uterine muscle. In comparison, sequential oral contraceptives are less effective with greater side effects, and should only be used in women with amenorrhea. Effects of oral contraceptives other than contraception include those on the (1) the primary targets of the female reproductive system, (2) on other endocrine oragans and (3) on the remainder of the body. In the first group, changes may include transitory stromal fibrosis in the ovary, enlarged fibromyomata, intermenstrual bleeding or amenorrhea, increased amount of cervical mucus, polypoid hyperplasia of the endocervical glands, breast tenderness, and changes in lactation. Changes in the second category which may occur affect the adrenal glands, hypothalamus, the thyroid (increased thyroid-binding globulin), and pancreas (alterations in glucose metabolism). Effects on the rest of the body may include increase in serum lipids and changed atherogenic index, abnormalities in liver function, thromboembolism (incidence in oral contraceptive users 4.4 times that in non-users), melasma, alterations in the central nervous system with increased incidence of cerebral vascular accidents, hypertension, and increased body weight. Absolute contraindications to oral contraceptive therapy include cancer of the breast and uterus, pregnancy, active liver disease, hyperlipidemia, and history of gestational diabetes, thromboembolic phenomena or coronary artery disease. Relative contraindications include depression, migraine, myomata of the uterus, hypertension, epilipsy, oligomenorrhea and amenorrhea. Reliable epidemiologic data on IUDs from the Cooperative Statistical Program indicated first year pregnancy rate of 2.5%. Problems with the IUD include: 1) pregnancy with device in situ, which is associated with a higher incidence of spontaneous abortion; 2) ectopic pregnancy, which is prevented at a rate of only 90% compared with intrauterine pregnancies prevented in 97-98%; and 3) expulsions (20% of which are unnoticed), the expulsion rate being higher with decreasing age and parity, higher in the first than second year of use, and higher with smaller than larger devices. A major problem is discontinuation for medical reasons (15% rate in the first year), mainly bleeding and pain. Perforation, another serious complication, occurs initially at time of insertion with an incidence of 1 per 2500 insertions for the loop. IUDs were found to produce a sterile inflammatory tissue reaction, which is postulated as the primary causative factor for their contraceptive effect in humans.
 ...
PMID:Current status of contraceptive steroids and the intrauterine device. 459 80

The case of a 27-year-old woman treated with oral contraceptives (most recently with Anovlar) who developed intracranial hypertension is reported. The woman presented with visual disturbances, fatigue, and headaches. Oculo-circulatory and cerebral neoplastic diseases were not present, but high intracranial pressure was noted; no etiological clarification could be found. Discontinuation of contraceptive medication was followed by near-normalization of vision and disappearance of other symptoms. During a 3-year follow-up period no neurological disorders apart from mild limitation of the visual field could be observed. A connection between the elevated intracranial pressure and oral contraception seems probable.
 ...
PMID:[Benign increase in intracranial pressure during oral contraception (author's transl)]. 474 74

20-30 million women use oral contraceptives. The estrogen component, either ethinyl estradiol or mestranol, inhibits the release of the ovum and affects the cervical secretions, the endometrium, the ovaries, and the Fallopian tubes. The gestagen component is derived from 19-nortestosterone or 17-hydroxyprogesterone, and the metabolism of the gestagen component is not fully known. Disposition to thrombosis, liver illness, diabetes, hypertension, amenorrhea, oligo menorrhea, or tumorous changes in the uterus or breasts should not use oral contraceptives. Menstrual disturbances and endometriosis can be controlled by the use of oral contraceptives. Urine samples, blood pressure, and weight should be monitored during oral contraceptive use.
 ...
PMID:[What do oral contraceptives do? What are oral contraceptives?]. 513 57

Several British and U.S. retrospective studies on thromboembolism among users of oral contraceptives prompted the Dunlop Committee to recommend that pills with over 50 mcg mestranol or ethinyl estradiol be avoided to reduce mortality risks by 50%. It is noted that the incidence of idiopathic cases of thromboembolism seems to be increasing, and cigarette smoking may be a cause. Possible etiologic factors, such as lesions in the endothelium of the blood vessels, clotting factors, blood lipids, hypertension, all due to estrogen intake, are discussed. A thromboembolism is sometimes predictable in individuals if there is migraine, visual disturbance, or certain predispositions seen in pregnancy such as toxemia or hypertension. The risks should be weighed against those of other methods of contraception, and against those of pregnancy, but not against those of illegal abortion, which is an unrelated social problem. Women with serious medical indications for effective contraception should be considered differently from those who desire family planning only.
 ...
PMID:[What is to be thought of the Dunlop Committee recommendation concerning the anti-ovulation pills?]. 554 11

The data in the literature on clinical and experimental studies of cardiovascular disorders caused by hormonal contraception are reviewed. The review indicates that even small doses of estrogens and progesterone increase the volume of circulating blood. Estrogen/gestagen preparations cause increased serum levels of low-density lipoproteins and, therefore, can contribute to the development of cardiovascular diseases. From these data, it is concluded that hormonal contraceptives should not be given to women with lipid metabolism disorders. Risk analysis shows that short-term (less than 12-18 months) use of contraceptive estrogens and gestagens produces only insignificant and reversible changes in the cardiovascular system. High risks of arterial hypertension, thromboembolism, and myocardial infarction are caused by uncontrolled, long-term use of pills containing high gestagen doses (over 50 ug).
 ...
PMID:[Effect of hormonal contraceptives on cardiovascular function]. 636 72

After widespread publicity about major adverse reactions to oral contraceptive agents, combinations were tested that contained lower doses of sex steroids than had been used before. Among them, the combination of levonorgestrel, 150 micrograms, and ethinyl estradiol, 30 micrograms, was studied intensively. European studies exclusive of the British Isles were conducted on 3,733 patients through approximately 36,000 cycles. There were nine pregnancies, for a Pearl index of 0.3. Cycle regulation was excellent, with normalization of menstrual flow. Amenorrhea was reported in 2.3% or less of cycles. No serious side effects were reported. The decrease in estrogen dosage, usually accompanied by a decrease in the progestational component, has resulted in a decrease in reported thromboembolic disease. Factors still important are diabetes mellitus, hypertension, obesity and cigarette smoking.
 ...
PMID:Clinical experience with a low-dose contraceptive agent. European studies. 640 3

A case of acute intestinal vascular necrosis in a 19-year-old user of oral contraceptives (OCs) is described, and hypotheses explaining the digestive complications of synthetic estrogens are reviewed. The patient had originally presented with a violent gastric pain that subsequently spread to the entire abdomen. An abrupt worsening of her condition involved cardiovascular collapse associated with a peritoneal syndrome, vomiting and dehydration, and hyperleukocytosis. Emergency opening of the peritoneum was followed by evacuation of a large quantity of fetid gas and alimentary debris, and observation of a completely necrosed stomach. A careful lavage of the entire intestinal cavity led to temporary improvement, but it became clear during an attempt at gastrectomy that further treatment would be unavailing and the patient died shortly thereafter. Estrogens were believed to be responsible for the digestive necrosis because it occurred in a young woman who had used an estrogen-rich OC for 3 years and who smoked; a hapatic biopsy confirmed the diagnosis. No traces of other risk factors such as hypertension, hyperlipidemia, diabetes, neoplasia, or obesity were observed. Recent publications indicate that OCs are responsible for a certain number of digestive problems, which may include acceleration of intestinal transit, severe diarrhea, rectorrhagia, ischemic or ulcerative colitis, intestinal infarct which is usually localized, and hepatocellular problems ranging from moderate hepatic insufficiency to malignant tumor and Budd-Chiari syndrome. OCs do not modify hemodynamic regimes, but they may cause elevation of fibrinogen and thrombin, diminution of antithrombin III acitivty, increased platelet adhesivity, and decreased fibrinolysis leading to hypercoagulability. These modifications in hemostasis occur in all OC users and are not statistically correlated with occurence of thrombotic accidents. OCs are probably responsible for parietal vascular lesions; experimental injection of synthetic estrogens is associated with both arterial and venous lesions. The most characteristic anomaly is at the level of the intima, with proliferation of smooth muscle cells and increased conjunctive tissue fibers associated with proliferation of the media or the endothelium. The absence of lipid deposits, the simultaneous appearance of arterial and venous lesions, and other evidence argues against and atheromatous origin of parietal lesions. A significant correlation has been found between high levels of anti-synthetic ethinyl estradiol antibodies and the presence of vascular lesions. It is hypothesized that these circulating immune complexes penetrate the vascular walls of OC users and produce lesions, which may depend on factors such as smoking.
 ...
PMID:[Digestive complications of oral contraceptives: a case of extensive digestive necrosis in a young woman]. 647 54

Low dose estrogen tablets, containing less than 50 mcg of ethinyl estradiol, were formulated because of the recognized dose response relationship with the steroid content of the tablet and side effects. These new oral contraceptives (OCs) are as effective as the older high-dose OCs, and available evidence reports fewer side effects. This discussion reviews pharmacology of these new OCs, the mechanism of action, contraindications, side effects, and problems with the low-dose estrogen OC. Ethinyl estradiol is the only estrogen used in the low-dose combination OC. There are several synthetic progestins: norethindrone, norethindrone acetate, norgestrel, levonorgestrel, and ethynodiol diacetate. These progestins have different potencies so the pharmacologic activity cannot be accurately predicted based on the amount present in the tablet. The synthetic steroids in OCs are absorbed in the small intestine, metabolized in the liver, excreted in the bile and feces with a half-life of 24 hours. The low-dose estrogen combination preparation is taken 3 out of every 4 weeks. Its contraceptive effect is primarily a result of hypothalamic mediated gonadotropin suppression with subsequent inhibition of ovulation. Contraindications to taking the low-dose OC are the same as for the higher dose OC: thromboembolic or cardiovascular disease, estrogen dependent neoplasia, markedly impaired liver function, undiagnosed genital bleeding, congenital hyperlipidemia, pregnancy, and women over age 30 who smoke. Relative contraindications include hypertension, diabetes mellitus, migraine headaches, uterine myomas, and epilepsy. The often quoted 2-5-fold increased incidence of thromboembolic disease, myocardial infarction, and stroke is based on large epidemiologic studies involving patients taking the older higher dose OCs. Current data from patients taking the newer low-dose medication demonstrate minimal if any increased incidence of these problems in young women who do not smoke. The low-dose estrogen OCs have minimal effect on lipid levels. Early reports of patients using the low-dose OC have shown little if any increased incidence of hypertension. The low-dose contraceptives have little effect on glucose tolerance, and there is no evidence to show an increased incidence of overt diabetes in OC users. There is no evidence that use of the combination OC causes an increase in cancer of the cervix, uterus, or ovaries. Clinical complaints of nausea, breast discomfort, chloasma, weight changes, and depression are reduced with the low-dose estrogen preparation. Hypomenorrhea while taking the OC occasionally occurs because the lower dose of estrogen is insufficient to stimulate the endometrial growth in face of the predominant progestin-atrophy effect.
 ...
PMID:Oral contraceptives in 1984. 649 Mar 38

4 kinds of progestin only oral contraceptives (OCs) and numerous combined OCs containing ethinyl estradiol (EE) or occasionally mestranol and either norgestrel or norethindrone are currently available in Australia. All progestins except norgestrel are effective in vivo after metabolism to norethindrone. Mestranol is effective in the human after demethylation to EE. The main side effects of OCs, including menstrual disturbances and changes in weight and mood, are primarily of nuisance value. Menstrual blood loss with OCs is almost invariably less than during spontaneous menses, but breakthrough bleeding and midcycle spotting may cause concern in patients. Amenorrhea and weight gain are rare with low dose pills. Approximately 6 in 1000 women remain anovulatory for 12 months or more after discontinuing OCs, but it is not yet know whether the amenorrhea is related to pill use and it is usually corrected by induction of ovulation. Cardiovascular side effects including venous thrombosis and pulmonary embolism are seen less frequently with new lower dose pills. The effects of OCs on the cardiovascular system are complex and depend on the interaction of estrogen and progestin. Amounts of estrogen and progestin should be the lowest possible to prevent ovulation, and routine monitoring should be provided for all women using pills. Older high dose formulations altered lipid metabolism in the direction of greater risk of coronary heart disease. Although research suggests the lowest dose triphasic pills have no significant effect, not enough large studies have been done with matched controls. Any effects on carbohydrate metabolism of the low dose pills are apparently minor and of little clinical significance. Insulin dependent diabetics with adequate supervision may safely use low dose pills. Combined OCs reduce the incidence of endometrial and ovarian malignancy. No relationship between OCs and the risk of breast cancer has been demonstrated except possibly in women under 35 when the cancer developed. The risk of intraepithelial neoplasia may be increased in women taking OCs for more than 8 years. Data on drug interactions are inconclusive, but women on rifampicin should use some other method. Absolute contraindications to OCs include breast cancer, history of deep venous thrombosis or pulmonary embolism, active liver disease, use of rifampicin, familial hyperlipidemia, previous arterial thrombosis, and pregnancy, while relative contraindications include smoking, age over 35, hypertension, breastfeeding, and irregular spontaneous menstruation. Progestin only OCs have a higher rate of failure and irregular bleeding than combined pills and their main use is for breastfeeding women and those with contraindications to estrogen. The pill of 1st choice should be a triphasic low-dose formulation.
 ...
PMID:Oral contraceptives. 650 52

A cohort of 23 233 women who had received estrogen prescriptions was recruited for a prospective study of estrogen therapy and the associated risk of endometrial cancer. For a detailed study, a comprehensive questionnaire was mailed to 735 randomly sampled cohort members, and 89 per cent of them responded. Estrogen exposure and its implications were described in a preceding paper (part I). The present paper reports the distribution in the cohort sample of personal features known to be risk factors for endometrial cancer. A comparison with results from various materials derived from population-based surveys and case-control studies implied that the cohort members might have a lower proportion of nulliparity (infertility) and a somewhat higher prevalence of hypertension. Differences in the distributions of age at menarche or menopause, weight, height and prevalence of diabetes were according to these comparisons slight and probably without clinical significance. It was concluded that the prevalence of risk factors for endometrial cancer other than estrogen exposure was not higher in the cohort than in the background population. Moreover, approximately one-fifth of the estrogen takers had been freed of their risk through hysterectomies.
 ...
PMID:Characteristics of estrogen-treated women. A descriptive epidemiological study of a Swedish population. Part II. 663 3


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>