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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relation between history of several medical conditions and procedures and risk of breast cancer was evaluated in data from a hospital-based case-control study of 2663 cases of breast cancer and 2344 controls with acute conditions unrelated to any of the established or potential risk factors for breast cancer. Whereas previous diagnosis of diabetes mellitus, thyroid disease, hypertension at any age, hyperlipidaemia, cholelithiasis, pelvic inflammatory disease and physician-diagnosed subfertility were unrelated to cancer risk, history of severe obesity in postmenopausal women (odds ratio [OR] 1.4), benign breast disease (OR 1.8) and history of breast biopsies (OR 2.4) were associated with significant risk elevation. Conversely, lifelong history of menstrual irregularities (OR 0.6) seemed to confer some protection against onset of breast cancer. This study supports the hypothesis that, unlike endometrial cancer, breast cancer risk is not enhanced by medical conditions known or suspected to be linked with female hormones, with the exception of benign breast disease and severe overweight in postmenopausal women.
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PMID:Breast cancer risk and history of selected medical conditions linked with female hormones. 214 95

Progestins counteract the positive effect of the estrogen component in oral contraceptives (OCs) on cholesterol levels thus increasing the risk of atherosclerosis. Low androgenic potency progestins do not have a negative effect, however. Other research indicates that the lower the estrogen dose in OCs the lower the risk of deep vein and superficial thrombosis. OC users, especially low dose OC users, with no other risk factors (e.g. smoking and hypertension) are not at increased risk of cardiovascular disease. Some research demonstrates elevated risk of stroke in OC users, however. Elevated cholesterol, obesity, diabetes and other factors further increases the risk of stroke. Combined OCs protect against endometrial and ovarian cancer and this effect increases with use and continues after use. Moreover OC users are not at increased risk of pituitary adenoma. Results of some studies shows an increased risk of cervical cancer, but other only demonstrates a slight increase. So far research does not indicate the following to increase breast cancer risk among OC users: early age at 1st OC use, formulation, family history, and history of benign breast disease. There is an increased risk for liver tumors in OC users, nevertheless it is rare. OCs do not raise the risk of diabetes or gallbladder disease. High dose formulations increases the risk of high blood pressure, but not so with low dose formulations. OC use does not impair, fertility, but delayed conception often occurs. Most research demonstrates no increase in pelvic inflammatory disease in OC users. OCs do not cause congenital malformations. Combined OC use is contraindicated for breast feeding mothers, but progestin only OCs can be used with no advance effects. Results of 1 study demonstrates an increase in HIV infection in OC users, but another study has opposite results. The article concludes with recommended clinical management practices.
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PMID:Reassessment of the metabolic effects of oral contraceptives. 185 68

The overall risk of oral contraceptive (OC) use is minimal when women over 35 years of age, smokers, and those with multiple risk factors (thromboembolic disorders, cerebrovascular or coronary artery disease, liver tumors, breast cancer, estrogen-dependent neoplasms, undiagnosed abnormal genital bleeding, and congenital hyperlipidemia) are excluded. OC use increases the risk of hypertension by 1-5%, depending on age, parity, and duration of use, but even this small risk is decreased when multiphasic OCs are prescribed. Deep venous thrombosis in the leg is 4 times more prevalent in OC users than nonusers and the risk of superficial thrombosis is doubled. Again, fewer thromboembolic complications occur when the estrogen dosage is low. The risk of myocardial infarction is not believed to increase with OC use as long as other risk factors--smoking, obesity, hypertension, age over 35 years, hypercholesterolemia--are not present. Studies involving the original high-dose OCs revealed a 3-fold increase in the risk of thrombotic stroke and a 2-fold increase in the risk of hemorrhagic stroke, but low-dose OCs appear to have no effect on the potential for stroke. The impact of OC use on breast cancer cannot yet be determined given the very long latency period of this cancer. In terms of benign breast disease, OC users have been shown to be at substantially reduced risk of lesions, fibroadenomas, and fibrocystic changes. OCs also protect women from endometrial and ovarian cancer, although the pill seems to accelerate the progression of cervical dysplasia. Other beneficial effects of OC use include reductions in the incidence of pelvic inflammatory disease, endometriosis, ectopic pregnancy, and ovarian cysts.
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PMID:Oral contraceptive pills. Part II: Potential complications and health benefits. 228 19

This artical examines the risks and benefits associated with use of the oral contraceptive pill (OCP) by adolescents and the various alternatives and methods of prescribing OCPs. Any adolescent who is either sexually active or contemplating sexual activity should be offered a contraceptive method that is appropriate to her individual needs. The contraceptive needs to be highly effective, safe and within the means and desires of the adolescent. For the majority of teenagers, the contraceptive of choice will be the OCP. The IUD should almost never be prescribed to the adolescent. Most OCPs marketed today are combination pills containing both an estrogen and a progestin in each pill. A variety of contraceptive actions combines to create a contraceptive method that is 99.3-99.9% effective. OCPs provide some protection against the development of pelvic inflammatory disease (PID). Oral contraceptives also decrease the incidence of anemia by decreasing the amount and duration of menstrual flow. Ovarian cysts do not form in the ovaries of the OCP user. On the other hand, a serious risk of the use of OCPs is the increased danger of thromboembolic events including deep venous thrombosis, pulmonary embolus, and myocardial infarction. The increased risk of myocardial infarction in OCP users is additive with other risk factors including hypertension, hypercholesterolemia, cigarette smoking, obesity, diabetes mellitus, and age. OCP use seems to provide some protection against development of endometrial or ovarian cancer. Oral contraceptives are associated with the development of benign hepatocellular adenomas. A variety of metabolic and hormonal alterations also occur in pill users. Most appropriate for the adolescent is a formulation containing a low dose of estrogen because of the decreased risk of thromboembolic complications. Dysmenorrhea effects more than 1/2 of female adolescents, and can best be treated with ibuprofen.
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PMID:Oral contraceptives and dysmenorrhea. 354 24

In 1978, the Centers for Disease Control initiated a multicenter prospective study to assess the safety of the various female sterilizing operations and the ways in which they could be made safer. During the first 31 months, 3500 women who underwent interval laparoscopic tubal sterilization by electrocoagulation or Silastic banding without other concurrent operations were enrolled in the study. When a standard definition of complications was used, the overall rate of an intraoperative or postoperative complication was 1.7 per 100 women. Several patients factors increased the risk of complications twofold or more: diabetes mellitus, previous abdominal or pelvic surgery, lung disease, a history of pelvic inflammatory disease, and obesity. There was a fivefold difference in complication rates between procedures performed under general anesthesia and those done under local anesthesia.
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PMID:Complications of interval laparoscopic tubal sterilization. 621 31

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

Oral contraceptives (OCs) were first introduced more than 30 years ago. OC manufacturers have reduced the dosage of synthetic estrogens (e.g., ethinyl estradiol, 100-150 mcg to 20-35 mcg) and progestins to limit their metabolic effects on lipoproteins, carbohydrates, and hemostasis. In addition to protection from pregnancy, OC benefits include lower incidence of painful periods, excessive bleeding, and iron deficiency anemia; reduction of ovarian cysts, benign breast tumors, and pelvic inflammatory disease; and protection against endometrial and ovarian cancers. The risk of a cardiovascular event (myocardial infarction, cerebrovascular events, venous thromboembolism, and deep vein thrombophlebitis) in OC users is 1-2/100,000 women years. Cardiovascular risk factors include smoking, hypertension, lipid disorders, severe obesity, diabetes mellitus, and cardiovascular events in first degree relatives before age 40. Thus, women with any of these risk factors should not use OCs. OCs do not increase the risk of breast cancer in women less than 59 years old. They may increase this risk if used over a long duration before the first fullterm pregnancy. OCs may cause a modest increase in cervical neoplasia. Low-dose OCs have a small effect on lipid metabolism. OCs increase serum triglycerides 30-50%. OCs increase insulin secretion and hyperinsulinemia increases the cardiovascular risk. Practitioners should evaluate clients before prescribing OCs. They should not prescribe OCs to women with hypertension, diabetes mellitus, lipid disorders, gynecological cancers, and previous cardiovascular disorders. Practitioners should tell clients that smoking is a leading risk factor and about OC's side effects (e.g., menstrual disturbances). The physical exam should include a cervical PAP smear, gynecological exam of the uterus and the ovaries, and a breast exam. Practitioners should test cholesterol and triglycerides before and during OC use. Premenopausal healthy women with no risk factors can use low-dose OCs.
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PMID:Update on oral contraception. 836 2

Included in this article is a table adapted from World Health Organization medical eligibility guidelines developed to assist practitioners in the prescription of low-dose oral contraceptives (OCs). These guidelines are part of a broader project aimed at improving access to all available methods of contraception without creating unacceptable risk. They were formulated in response to concerns that current practices are based on scientific studies of contraceptive products that are no longer in wide use, the bias of service providers, and a tendency to render relative contraindications absolute. If the presence of a condition creates no obstacle to method use, a Category I rating is assigned. If the benefits of a method generally outweigh the risks, the condition receives a Category 2 rating. Category 3 applies to conditions carrying risks that generally outweigh benefits, while Category 4 applies to conditions carrying unacceptable health risks. Health conditions categorized in association with low-dose OC use are post-abortion, diabetes, superficial venous thrombosis, known hyperlipidemias, headaches, vaginal bleeding patterns, unexplained vaginal bleeding, breast disease, pelvic inflammatory disease, sexually transmitted diseases, HIV/AIDS, viral hepatitis, uterine fibroids, past ectopic pregnancy, obesity, thyroid disorders, trophoblast disease, and sickle cell disease.
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PMID:Increasing access to combination oral contraceptives. 1229 65

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

Since the introduction of hormonal contraceptives in the 1960s, there have been a variety of both health benefits and safety concerns attributed to their use. In most instances, the noncontraceptive benefits of oral contraceptives (OCs) outweigh the potential cardiovascular risks. In fact, the probability of a patient experiencing a cardiovascular event while taking a low-dose OC is very low. However, smoking, hypertension, obesity, and diabetes are risk factors that must be taken into account when prescribing OCs. The neoplastic effects of hormonal contraceptives have been extensively studied, and recent meta-analyses indicate that there is a reduction in the risk of endometrial and ovarian cancer, a possible small increase in the risk for breast and cervical cancer, and an increased risk of liver cancer. Finally, many women will experience noncontraceptive health benefits with OCs that expand far beyond pregnancy prevention. Some of these benefits include reduction in menstrual-related symptoms, fewer ectopic pregnancies, a possible increase in bone density, and possible protection against pelvic inflammatory disease.
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PMID:Safety concerns and health benefits associated with oral contraception. 1510 94


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