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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

No one has yet conducted a definitive, prospective, controlled study in 35-50 year old women that examines the relationship between oral contraceptive (OC) use and thromboembolism, myocardial infarction (MI), stroke, and cancers of the breast and genital organs. The available data derive from large studies on women in all age groups. These studies, mostly from the US and the UK, demonstrate that older women are somewhat more likely to be at risk of thromboembolism, MI, and stroke. Yet, the risk does not tend to be limited to OC users and is likely associated with other risk factors for cardiovascular disease. The risk of thromboembolism is greatest in smokers. It is also associated with the estrogen dose, which is lower today than it was in the past (= or 50 mcg vs. = or 100 mcg). The relationship between breast cancer and OC use is not clear, but the data suggest that the risk of breast cancer is elevated slightly among current OC users. The data confirm, however, that OCs protect against endometrial and ovarian cancer. Since many women older than 35 years old need safe, reversible contraception, the US Food and Drug Administration Advisory Committee concluded that healthy older women with no risk factors can safely use OCs. Women who should avoid OCs include those with a hormone-related history of thromboembolism, coronary artery disease, hypertension, diabetes, and other conditions that might cause adverse effects. Women with a clear family history of endometrial or ovarian cancer could likely benefit from OC use. Prospective studies of such women who do use OCs should be conducted to determine whether the protective effects of OCs can be extended. If the results are favorable, providers can emphasize OC benefits rather than risks. OCs are safe and effective for women over 35 who have no risk factors.
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PMID:Risks of oral contraceptive use in women over 35. 812 Aug 60

Although most women cite breast and reproductive cancers as the diseases they most fear, in fact cardiovascular disease is much more likely to kill them: 500,000 American women die each year of diseases of the heart and blood vessels compared with 189,000 who die of all cancers combined. Women's focus on breast, uterine, and ovarian cancer is very much socially and culturally determined. It reflects an outmoded image of women as valuable principally by virtue of their ability to bear and raise children. While women died at about the age of 48 at the turn of the century, biomedical science was extended their life span to the point that a girl born today has an average life expectancy of 86 years. The focus of recent biomedical investigation reflects the changing experience and expectations of women, who will live a full third of their lives beyond the period of reproductive viability. Since 1988, a flood of new information established that the epidemiology, risk factors, clinical features, outcome and therapeutic choices physicians make for female patients with cardiovascular disease are significantly different from those of men. Regrettably, most of the new information we have acquired was almost exclusively harvested from data on Caucasian women: black women often are less than 10% of study populations. The information we do have, however, shows striking differences between women of different races in the severity and outcome of diseases of the heart and blood vessels: black women have significantly higher mortality rates from stroke and myocardial infarction than do white women. Intensive research has achieved gratifying corrections in the promptness with which physicians diagnose women with cardiovascular disease and in the aggressiveness of the therapy they offer to female patients. The result has been a reversal of the trend for women to have worse outcomes from revascularization procedures than men.
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PMID:Coronary artery disease in women. 882 5

Probable developments in HRT and non-HRT treatments for menopausal and post-menopausal problems have been reviewed. More information is required on potential benefits and side-effects of HRT. The major potential benefit is prevention against stroke amelioration of Alzheimer's disease: the major potential side-effect discussed in this chapter is ovarian cancer. At present, techniques for delivering oestrogens are more varied and advanced than those for progestogens. Non-oral delivery systems for progestogens which minimize side-effects will be introduced during the next decade. It is not clear whether benefits expected with new progestational agents will be realized. Preliminary data suggest that SERMs and phytoestrogens are worthy of further evaluation. Their development will provoke intense interest over the next 10 years.
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PMID:Treatments for menopausal and post-menopausal problems: present and future. 893 8

Ovarian carcinoma usually presents in an indolent manner, most often nonspecifically with complaints of abdominal pain or swelling, bloating, constipation, anorexia, early satiety, and evidence of ascites. We present a case of ovarian cancer with a cerebrovascular accident (CVA) as the presenting symptom, with minimal classic presenting signs and symptoms. The patient is a 43-year-old female with no cardiovascular risk factors who presented with a left parietal lobe infarct and advanced ovarian carcinoma. The patient underwent an extensive workup for the etiology of her CVA and possible hypercoagulation syndrome and eventually had surgical treatment. Ovarian carcinoma with a thromboembolic event as the initial presenting symptom is extremely rare. Although this patient did not appear to have hypercoagulability, consideration of this diagnosis should be given to patients presenting in this manner.
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PMID:Advanced ovarian carcinoma presenting with a cerebrovascular accident. 974 Jul 10

This article reviews epidemiological data on potential adverse effects of hormone replacement therapy (HRT) on the risk of breast, endometrial and ovarian cancer, on the risk of stroke, and on the risk of venous and pulmonary thromboembolism. As for the potential adverse effects on cancer risk, most information on HRT and breast cancer is included in a re-analysis of individual data from 51 epidemiological studies (including over 90% of the world's data), showing a 2.3% increase of the relative risk of breast cancer for each year of use which, however, levels off after stopping use. This corresponds to a cumulative excess of approximately 2 in 1,000 women who started taking HRT at age 50 and used it for 5 years, 6 in 1,000 women who used it for 10 years and 12 in 1,000 women who used it for 15 years. Unopposed estrogen use is strongly related to endometrial cancer risk mainly in lean women, but the cyclic combined oestrogen-progestin treatment appears to largely or totally reduce this effect if progestin is taken for more than 10 days per cycle. The data on epithelial ovarian cancer allows exclusion of any strong association with HRT, although a moderate positive relationship remains open to debate. As for other adverse effects of HRT, the relationship between HRT and stroke is still debated, although any strong and consistent association can be excluded. Current HRT use, but not past use, is associated with venous and pulmonary thromboembolism. Thus, most adverse effects of HRT are restricted to current or recent use, and long term HRT use should be carefully considered on an individual basis, taking into account any other personal risk factors for breast and endometrial cancer and for venous/pulmonary thromboembolism, and the potential benefits of HRT on cardiovascular disease and osteoporosis.
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PMID:The adverse effects of hormone replacement therapy. 1040 35

Paraneoplastic cerebellar degeneration (PCD) is a rare nonmetastatic neurological complication in cancer patients. Anti-Yo is one of the anti-onconeural antibodies found in PCD patients. It is believed that anti-Yo occurs almost always in women and is most likely associated with gynecologic or breast cancers, although exceptions exist. Here we report a PCD patient with ovarian cancer having high-titer anti-Yo. The acute onset of her PCD symptoms mimicked that of a stroke. Her ovarian cancer tissue contained abundant plasma cells and lymphocytes. After a thorough review of the literature, we propose a schematic hypothesis for the autoimmune pathogenesis of PCD. Despite anecdotal case reports of neurological improvement with different combinations of treatment, including IVIg, there is still no definitely effective treatment for PCD. Further research on the pathogenesis of PCD may lead to more effective therapies.
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PMID:Anti-Yo positive paraneoplastic cerebellar degeneration associated with ovarian carcinoma: case report and review of the literature. 1050 50

Increased expression of P-glycoprotein has been proposed as one important mechanism for inherent or acquired drug resistance of malignant disease to cytotoxic chemotherapy. In experimental systems, hormonal agents, including megestrol acetate (MA), have been shown to be capable of reversing P-glycoprotein-mediated multidrug resistance to natural products, including paclitaxel. Because paclitaxel is one of the most active cytotoxic agents in ovarian cancer (OC), we sought to determine whether retreating patients with well-defined paclitaxel-resistant OC with a combination of paclitaxel and MA would result in clinically relevant reversal of that resistant state. In this Phase I trial, 44 patients with OC or primary peritoneal carcinoma received paclitaxel (135-175 mg/m2 over 3 h) plus an oral loading dose (800-9600 mg over 24 h) and subsequent maintenance dose (800-3200 mg/day x 3 days) of micronized MA. Both the loading dose and maintenance therapy were delivered in four equal daily doses. Therapy was repeated every 21 days, assuming recovery from the toxicity of the prior course. There were no intrapatient dose escalations. The major toxicity of the regimen was peripheral neuropathy (32% of patients; 11% grade 2-3), although four individuals developed major venous blood clots and one suffered a stroke. Four patients exhibited biological evidence of antineoplastic effects, although only one patient experienced improvement in clinically relevant symptoms. Although pharmacokinetic studies were not performed as a component of this study, prior evaluation of MA pharmacokinetics and in vitro data examining the concentrations of the agent required to reverse P-glycoprotein-mediated paclitaxel resistance suggest that the majority of our patient population achieved levels of MA theoretically capable of producing this desired effect. We conclude that the level of activity and toxicity pattern observed in this trial, associated with the combination of paclitaxel and MA, does not provide strong support for further exploration of the regimen as a treatment strategy to overcome paclitaxel resistance in OC.
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PMID:Phase I trial of paclitaxel plus megestrol acetate in patients with paclitaxel-refractory ovarian cancer. 1110 32

Oral contraceptives are one of the most highly effective forms of contraception and provide many short- and long-term noncontraceptive health benefits. They control menstrual cycle irregularities, such as breakthrough bleeding and amenorrhea, and are effective in treating dysfunctional uterine bleeding. In addition, for decades after oral contraceptive use is discontinued they are associated with substantial decreases in the risk of ovarian cancer (up to 80%) and of endometrial cancer (40%-50%), and nearly eliminate benign functional ovarian cysts. Long-term oral contraceptive use confers protection against benign breast disease and colorectal cancer, may help prevent rheumatoid arthritis, decreases ectopic pregnancy and hospitalizations for pelvic inflammatory disease, and helps preserve bone mineral density to reduce risk of fractures. Large bodies of evidence from extensive research have clarified the perceived association of oral contraceptive use with cardiovascular disease and with breast cancer. Findings indicate that there is no increased risk of myocardial infarction or stroke associated with oral contraceptive use in healthy, nonsmoking, normotensive women. Although there is a 3- to 4-fold increased risk of venous thromboembolism with current oral contraceptive use, the absolute risk is very small and is half that associated with pregnancy. Women of all reproductive ages, including perimenopausal women, can realize many health benefits through oral contraceptive use, including improved health status later in life.
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PMID:Current perspectives on oral contraceptive use. 1152 Nov 17

Oral contraceptives (OCs) and IUDs are still the most popular contraceptive methods; their small potential risk for users has been well advertized in recent years. Copper IUDs are more effective than inert IUDs; it seems that the T-Cu 380, the T-Cu220 C, and the T-Nova have low failure rates. Excessive menstrual bleeding still remains the main side effect, and pelvic infection the main complication. Risk of cerebrovascular accident is the main side effect of OCs; the risk increases greatly in smokers and in hypertensive women. After termination of OCs return to fertility is quick and easy; OCs can prevent pelvic infection and, possibly, ovarian cancer. New methods of fertility control, now still under experimentation, include subdermal implants of a silastic capsule containing a steroid which is released continuously. According to recent studies the failure rate of this method is only 0.4%, and acceptability is very high. Silastic vaginal rings releasing levonorgestrel-estradiol have also been tested with excellent results, and with a very low pregnancy rate; the only side effect seems to be leukorrhea. Failure rate for progesterone-releasing IUDs is only 1.9%, termination rate for bleeding and pain is 6.1%, and continuation rate is 82.8%. This new method has the advantage of decreasing the amount of menstrual bleeding. Intracervical devices releasing levonorgestrel are not more effective than regular IUDs; their insertion is much easier and can be done by paramedical personnel. LRH analog administration by nasal spray has also proven to inhibit ovulation.
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PMID:[Current trends in female contraception (author's transl)]. 1226 57

The place of steroidal and oral contraceptives (OCs) in the broad scheme of reproductive health worldwide is evaluated. After 30 years, about 70 million couples are using steroidal contraception, out of about 380 million contracepting couples and another 380 not using family planning. The public debate about the safety of OCs is skewed by peoples; inability to appreciate concepts of relative risk, attributable risk, risk-benefit ration, and the probabilistic nature of the growth of scientific knowledge. Nevertheless, people deserve access to objective, sound information about contraceptive choices. There are several established benefits of OCs prevention of pregnancy; control of irregular menstrual bleeding; and reduction of dysmenorrhea, iron deficiency anemia, benign breast disease, pelvic inflammatory disease, functional ovarian cysts, and endometrial ovarian cancer. Several possible benefits are likely, such as less bone loss. The established risks of OCs are: rare myocardial infarction, stroke, venous thromboembolism, and liver tumor. Possible risks include breast and cervical cancer. For most of these conditions, existing evidence suggests that the trends found in studies in developed countries can be applied to developing countries. The main differences are in disorders with widely different attributable risks, such as liver tumors, which are extremely rare, but much more common in developing countries. Current overall assessments conclude that the benefits of taking OCs far outweigh the risks in developed countries and are profoundly more life-saving in developing countries, where maternal mortality and morbidity due to pregnancy are many times higher. In these areas, there are 400 million couples with no access to family planning, 140 million who conceived unwanted pregnancies in 1988, and 30-50 million who have abortions. In addition, 95% of all infant deaths and 99% of maternal deaths occur in developing countries.
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PMID:Oral contraception: where do we stand? 1228 20


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