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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Women predominate at all ages among patients diagnosed as having primary fibromyalgia. Of 100 patients reviewed, the average age at onset of fibromyalgia was 46. Of 65 patients in whom menopause occurred before diagnosis of fibromyalgia, the average age at menopause was 42, and most of these women had menopause related to surgery and insufficient estrogen therapy. Estrogen deficit is, thus, a prominent promoting factor in the majority of fibromyalgia patients and is likely to have an effect on sleep, mood, and anxiety state. These emotional responses may subsequently be somatized as pain. Therefore, estrogen therapy should be added to the treatment armamentarium for fibromyalgia in selected patients.
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PMID:Fibromyalgia and menopause. Examination of the relationship. 346 50

Paraballism in a 28-year old woman, associated with her 4 month intake of oral contraceptives, is described here. This constitutes only the 14th such case in the literature, and the only one in a pill user. The woman had pain in the head and neck when she first took the pill, Ovostat (1 mg lynestrenol, and 50 mcg ethinyl estradiol. Later she developed abnormal movements in the arms, neck and face. She was hospitalized in a psychiatric ward for depression, in response to the movements, and treated briefly with propanolol for palpitations. Her neurological findings were ballet-like movements of both arms, torsion movements of the neck, grimacing of the face, choreiform movements of both hands, and involuntary kicking while walking. The only other findings were an ejection murmur, and hypertrophied interventricular septum on the echocardiogram. When the pill was discontinued, the ballistic movements disappeared within days and the chorea within 2 weeks. The woman was discharged in a month with no complaints. A year later she bore her first child, with no return of abnormal movements.
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PMID:Oral contraceptive induced paraballism. 356 21

Calmodulin concentration in pregnant rat uteri increased gradually and reached a level about three times that in non-pregnant rat at term. In human beings, uterine calmodulin content at term was about three times that in non-pregnant uteri, but there was no significant difference between the levels in uteri at term with and without labor pain. Estrogen increased the rat uterine calmodulin concentration, but progesterone did not change it.
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PMID:Calmodulin concentration in the uterus during pregnancy and influence of sex steroids. 402 72

Ovostat, sold in Belgium as Pregnon 28 (1 mg lynestrenol and 50 mcg ethinyl estradiol) was taken by 146 women for up to 12 cycles without any pregnancies. The patients ranged in age from 17-51, and included 80 without and 66 with oral contraceptive experience. Pill cycles tended to have lighter and shorter flow, a 2-3 day latency period, and duration of 3-5 days in 90%. 25 incidents of amenorrhea were reported and 3 patients stopped because of spotting or breakthrough bleeding. 18 (12.3%) experienced nausea, 13 (8.9%) headache, 14 (9.6%) breast pain, and 19 (13%) depression or nervousness. 8 dropped out for drug-related reasons and 17 for personal reasons.
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PMID:[Clinical study of a new oral contraceptive: ovostat]. 458 59

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.
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PMID:Current status of contraceptive steroids and the intrauterine device. 459 80

A 32-year-old mother of 3 who had taken .05 mg ethinyl estradiol and .5 mg norgestrel for 3 months had a severe right thoracic pain of 2 weeks' duration, which was diagnosed as pulmonary arterial thrombosis and treated with high doses of urokinase. She was first given 600 mg heparin/24 hours, then 300,000 U of urokinase over 12 hours. There was some improvement, so urokinase was repeated and heparin continued. The patient was then asymptomatic, but she was found to have hyperlipidemia, hyperglycemia, insulinemia, and uricemia. She was well 6 months later on a carbohydrate- and fat-controlled diet. High doses of urokinase are preferred by some who believe that urokinase is thrombolytic in proportion to dose, well tolerated, and not antigenic.
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PMID:[Pulmonary artery thrombosis during hormonal contraceptive therapy. Treatment with urokinase]. 483 96

The authors report on a clinical evaluation of Rigevidon, a Hungarian contraceptive produced by Gedeon-Richter. The contraceptive contains 0.15 mg d-norgestrel and 0.03 mg ethinyl estradiol. 45 women ages 20-35 received this contraceptive for between 3-18 cycles. No pregnancies were observed and the Pearl's index was 0.0/100 women/year. Adverse reactions developed in 12 women (26.67%), mostly in the form of weight gain and intermenstrual bleeding. Such adverse reactions appeared in cycles 1-3 and regressed spontaneously without treatment. In 2 cases, Rigevidon was withdrawn because of pain in an isolated crural varix. Its effectiveness and the fact that it was well-tolerated, as well as the low incidence of adverse reactions, suggests that Rigevidon is a good contraceptive. (author's modified)
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PMID:[Clinical evaluation of Rigevidon used for contraception]. 639 73

This case study reports on an obstetric rarity -- an intrauterine and an extrauterine pregnancy of a patient with an IUD in place. The 26-year-old primigravid patient had a previous history of cesarean section for cephalopelvic disproportion. 10 months after the cesarean section a Lippes Loop D was inserted. 2 months after the insertion she was hospitalized for heavy vaginal bleeding following a menstrual delay of 3 weeks. The IUD was shown to be correctly inserted. The uterine cervix was soft and half open. Upon palpation the uterus was found to be enlarged. The probable diagnosis was incomplete spontaneous abortion. IUD removal was followed by curettage. The pathologist's report confirmed the diagnosis of spontaneous abortion. A week after the curettage the patient again complained of scant vaginal bleeding and cramping pain localized in the lower abdomen. She was given ethinyl nortestosterone acetate and ethinyl estradiol for 10 days. After 48 hours of treatment the bleeding stopped. A month later the patient reported copious vaginal bleeding. Another curettage was performed in which several clots were removed. A puncture of the posterior fornix was performed with negative results. Examination of the patient under anesthesia revealed a small mass in the right lower quadrant. The 2nd pathology report on the clots referred to "endometrial tissue with signs of progesterone treatment" without an Arias-Stella image. 5 days after the last curettage the patient was admitted with abdominal pains, vaginal bleeding, weakness, and dizziness. An extrauterine pregnancy was suspected and a laparoscopy was performed. A ruptured right tubal pregnancy was found. A salpingectomy was then performed. Because of the reliability of the patient, it is certain that she did not have intercourse after the 1st curettage. This fact invalidates the possibility of an ectopic pregnancy occurring after her normal pregnancy.
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PMID:Double (uterine and ectopic) pregnancy of a patient using an intrauterine contraceptive device. 646 63

102 patients using Trinordiol, a triphasic oral contraceptive (OC) containing ethinyl estradiol and d-norgestrel, were followed for 932 cycles in a study of secondary effects. Follow-up visits were scheduled after 1,3, and 6 months and every 6 months thereafter. 26 patients discontinued use of the pills during the study after using them for a total of 159 cycles. 5 discontinued because of abdominal pain, 1 for breast tenderness, and 1 because of headaches or migraines. 7 discontinued because of metrorrhagia, 4 for weight gain, 3 for amenorrhea, 2 for nausea and vomiting, and 1 each for nervousness, water retention, acne, desire for pregnancy, leaving the country, hypertension, and unknown motivation. the average age of patients was 23.6 years, with a range from 14-48. 76% were aged 15-29 years. 52.9% were nulliparas. 58.8% were Belgian, 21.6% were from Mediterranean Europe, 10.8% were Moroccan, and 7.9% were from black Africa. Only 1 patient, a 37 year old, developed hypertension. 15 patients gained more than 2 kg and 17 lost more than 2 kg. 15.8% complained of spotting during the 1st cycle compared to 3.1% during the 6th cycle, 5.2% during cycle 7-12, and 9.1% during cycle 13-30. Among 35 patients who did not discontinue treatment, 7 complained of amenorrhea and 1 of scanty menstrual bleeding, 14 of pain including 7 cases of pelvic pain, 2 of dysmenorrhea, 3 of breast tenderness, and 2 of headaches, 15 of leukorrhea, 3 of nausea, 2 of dizziness, and 1 each of fatigue, acne, galactorrhea, and cutaneous pruritus. 1 case of myoma at the level of the uterine cornu was identified after 24 cycles of treatment. In all, 61 patients had some complaint, while 41 were totally satisfied. No patient became pregnant during the study.
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PMID:[Clinical study of the secondary effects associated with taking a triphasic anti-ovulatory contraceptive]. 670 4

1 out of 4-5 women develop uterine leiomyomata, the most common solid pelvic tumors in women. This paper assesses the reports of 4714 myomectomies and records of 59 personal cases. Townsend et al. suggested that leiomyomata are unicellular in origin. Estrogen, growth hormone, and progesterone may influence the growth of the tumors. In the performance of myomectomy, the 2 major technical concerns are the minimization of blood loss and the prevention of postoperative adhesions. Although most leiomyomata are asymptomatic and grow slowly, 20-50% of the tumors are estimated to produce symptoms, the severity of which depends upon the number, size, and location of the tumors. The symptoms include menorrhagia, infertility, fetal wastage, pelvic pain/pressure, polycythemia, ascites, impingement, and related complications (e.g., ulceration and infection, fever, pain, uterine inversion, sarcomatous change). Asymptomatic patients with uteri of less than 10-12 weeks' gestational size require no more than observation at 6-month intervals regardless of fertility status. For women with uteri of 10-12 weeks gestational size or longer, management will depend on the patient's desire for fertility. Women desirous of fertility should have a 6-12 month trial for conception. If tumor growth is rapid, myometomy may be performed earlier. Women not desirous of fertility (e.g., pre- and post-menopausal) should have total abdominal hysterectomy and bilateral salpingo-oophorectomy. For symptomatic patients desirous of fertility, myomectomy using the transabdominal approach or hysteroscopy should be performed. For symptomatic patients not desiring fertility, dilatation and curettage and hysterectomy should be performed. With regard to oral contraceptive use, no studies have yet demonstrated that women on oral pills are at increased risk for growth of these tumors. Low-dose contraceptives should not be contraindicated in patients with leiomyomata if they desire to use this form of contraceptive. With IUD users, the device should be discontinued if bleeding occurs.
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PMID:Uterine leiomyomata: etiology, symptomatology, and management. 702 95


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