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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The concensus conclusions reached at a concensus development conference on Estrogen Use and Postmenopausal Women in September 1979 are based on 3 position papers prepared for the conference, the response of the panel, and the general discussion by the audience, followed by the panel and other conference participants. The evidence for the efficacy of estrogens in treating specific conditions associated with menopause was reviewed 1st. It was accepted that estrogens are more effective than placebo in decreasing the frequency and severity of vasomotor symptoms. Estrogens are effective in overcoming the atrophy of the vaginal epithelium and the associated symptoms. Present evidence does not justify the use of estrogens to treat primary psychological problems. The validity of 3 randomized trials indicating that exogenous estrogens can retard bone loss if given around the time of menopause was acknowledged. There is no convincing evidence that estrogens in customary doses increase the risk of thromboembolic phenomena, stroke, or heart disease in women who have undergone natural menopause. Evidence was also reviewed concerning adverse effects associated with post-menopausal estrogen use. In the absence of exogenous estrogens, the incidence of endometrial cancer is about 1/1000 postmenopausal women per year. This rate increases severalfold beginning after about 2-4 years of use of 0.625 or 1.25 mg of conjugated estrogens daily. Cystic hyperplasia of the endometrium, regarded as a premalignant condition, has been associated with unopposed estrogen, whether endogenous or exogenous.
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PMID:Estrogen use and postmenopausal women: a National Institutes of Health Consensus Development Conference. 4 37

A summary of what is currently known about the negative side effects associated with oral contraceptive usage is presented, and recommendations for prescribing OCs (oral contraceptives) are made. According to the results of several investigations, 2-18% of all women who take OCs develop hypertension. For most of these women the effects are mild; however, for some the increase in blood pressure is marked and results in renal damage. Several studies demonstrate that the risk of peripheral venous thrombosis and pulmonary embolism is enhanced for women who use OCs compared to nonusers. The risk is somewhat reduced for those who take low estrogen OCs. Women aged 30-39, who take OCs, are 3 times more likely to suffer a myocardial infarction than those who do not use OCs. This risk is markedly increased among OC users who either smoke or suffer from hypertension, diabetes, or hypercholesterolemia. OC users have a 9.5 times greater risk of thrombolic stroke and a 2.0 times greater risk of hemorrhagic stroke than nonusers. For women over 27 years of age, OC usage is associated with the development of benign hepatic adenoma. This risk increases markedly with duration of pill use and is greater for women who take pills containing mestranol compared to those who take pills containing ethinyl estradiol. Occasionally cases of pulmonary hypertension, peripheral arterial occlusion, mesenteric vascular insufficiency, Budd-Chiari syndrome, and noninflammatory cholestatic liver injury are reported among OC users. Recommendations are: 1) women with thromboembolic disorders and women over 34 years old, who smoke or who are obese or hypertensive should be advised to consider other forms of contraception; 2) prescriptions should be written for a 6 month supply and renewed only after a follow-up visit; 3) women who experience elevated blood pressure readings should be advised to discontinue usage; 4) serum triglyceride and cholesterol should be checked every 6 months; and 5) consider the use of low dose heparin for OC users who are recovering from trauma or surgery or who are confined to bed for long periods of time.
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PMID:A review: adverse effects of oral contraceptives. 22 69

Normal pregnancy changes include physiologic anemia, leukocytosis, and thrombocytopenia. Cardiac rate and stroke volume increase, vascular resistance falls, and creatinine clearance markedly rises. Thyroid binding globulin and cortisol binding globulin both increase, as do complement proteins and fibrinogen, the latter resulting in a normally high erythrocyte sedimentation rate. Estrogen and progesterone rise dramatically. Low back pain, hip and sacroiliac complaints are common. The cytolytic activity of natural killer (NK) cells is decreased, as are adhesion and chemotaxis of phagocytic cells. Antibody responses are normal. CD4 cells proportionately decrease. A large number of circulating proteins suppression lymphocyte proliferation, and T-cell interleukin-2 (IL-2) production may be suppressed. In studies of pregnant patients, controls must include normal pregnant women.
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PMID:Physiologic adaptations of pregnancy. 128 59

Sexual activity is quite common among women aged 14 to 20 in developed countries, averaging perhaps 10% at age 15 to about 70% at 19. Thus, the need for contraception may begin quite early in life and will continue for as long as 30 years. One of the best candidates for long-term contraception for young sexually active females is the oral contraceptive (OC), which provides health benefits besides contraception. Long-term benefits include lowered rates of ovarian and endometrial cancer, as well as of benign breast disease and ovarian cysts. Another benefit is protection against upper-tract sequelae of sexually transmitted diseases. Short-term benefits are correction of menstrual irregularity, reduction in menstrual flow, and diminished premenstrual syndrome and dysmenorrhea. Recent OC formulations contain only one-third the estrogenic potency of older OCs and therefore are associated with dramatic decreases in what were always the major side effects of OCs: heart attack, stroke, and pulmonary embolism. Other side effects of OCs have been most closely associated with the progestogenic component, and are related to the androgenic effects of progestins, particularly some synthetic progestins. However, some new synthetic progestins have been found to have minimal androgen receptor activity in preclinical testing and to cause minimal or no androgen-related side effects in clinical trials. One of these new progestins having a favorable androgenic profile is norgestimate. Its efficacy and safety in combination with low doses of ethinyl estradiol have been documented in the European and the American literature.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The androgenicity of oral contraceptives: the young patient's concerns. 136 88

Epidemiological data have revealed that the progestogen in oral contraceptives (OCs) is involved in hypertension, ischemic heart diseases, and stroke. Atherosclerotic lesions were implicated owing to the androgenic properties of progestogens. However, atherosclerosis did not develop despite reduced high density lipoprotein (HDL) and elevated low density lipoprotein (LDL), presumably because of the strong effect of ethinyl estradiol (EE) upon induction of hepatic LDL- and remnant-receptors. A series of findings indicate that vasospasms caused by the effect of progestogens are involved in arterial thromboses. In postmenopausal women, the addition of progestogens to the estrogen treatment may trigger ischemic diseases. Estrogens exert a vasodilatory effect and stabilize the vascular tonus through the responsiveness of the endothelium, neurotransmitter release, and direct blocking of calcium channels. Progestogens increase the sensitivity of arteries to vasoconstrictory compounds and reduce blood flow. In women treated with ovulation inhibitors, and EE-induced activation of the renin-angiotensin-aldosterone system was observed. Aldosterone acts vasodilatorily, while progestogens with high affinity to the aldosterone receptor may exert a strong vasoconstrictory effect. If vascular lesions are present, the vasoconstrictory action of progestogens may cause acute ischemic attacks. Therefore, the lowest effective dose of the progestogen has to be used for replacement therapy. In hysterectomized women, the extra administration of progestogens should be avoided and in women with arterial diseases they should be prescribed with discretion. Additional progestogens given for 14 days 3 months apart may suffice for the prevention of endometrial hyperplasia. Both the EE and progestogen doses in OCs should be reduced. Progestogen-dominant ovulation inhibitors should be restricted to cases with an additional indication.
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PMID:[Hormonal contraception and substitution therapy: the importance of progestogen for cardiovascular diseases]. 145

Researchers have found that oral contraceptives (OCs) change carbohydrate and lipoprotein metabolism and these changes are like those linked with increased risk of cardiovascular (CV) disease, especially myocardial infarction and stroke. Since CV disease is the major cause of death in US women, it is important that OCs not induce changes in carbohydrate and lipoprotein metabolism. A new progestin, norgestimate, has an advantage over other progestins in that it tends not to induce male traits. This is beneficial because androgenicity is related to atherosclerosis which increases the risk of myocardial infarction. Further studies show that the new combined OC (250 mcg norgestimate/35 mcg ethinyl estradiol) does not influence serum glucose tolerance levels. It also does not affect the physiologic regulating system of prostacyclin, the inhibitor of platelet aggregation, by high density lipoprotein (HDL). In addition, it increases prostacyclin metabolites and HDL which may indeed decrease the risk of occlusive thrombotic vascular diseases. Moreover a study in Germany demonstrates that it causes no changes in fibrinopeptide A,m the anticoagulation factors antithrombin III and protein C, or coagulation promoting factors fibrinogen, factor VII, and the components of VIII. In women, it is absorbed well and metabolized extensively before the body eliminates it. Moreover this new combined OC has an overall Pearl index of 0.25. Studies to data indicate that norgestimate/ethinyl estradiol may be more advantageous than other OC formulations. Yet only long term epidemiologic studies can determine if it can indeed decrease the risk of CV diseases linked with older OCs.
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PMID:Norgestimate: a clinical overview of a new progestin. 160 87

5 cases of ischemic strokes in young women who used oral contraceptives and smoked cigarettes are described in clinical and angiographic detail, the risk factors for moyamoya disease are discussed in a review or strokes in pill users, and the notion that oral contraceptive and smoking may cause a moyamoya pattern of stroke is proposed. The women were aged 20-32, used the pill from 2 weeks-8 years, had smoked approximately 10-20 pack-years. 2 women had headaches and 4 had transient ischemic attacks before their multifocal symptoms in visual, somatosensory and motor function, language, speech and cognition. 2 had seizures. Angiographic patterns of either supraclinoid stenosis (4) or proximal carotid artery stenosis (1) with the collateral circulation characteristic of moyamoya disease were evident in all, but there was no evidence of hemorrhagic infarction. There were no signs of atherosclerosis. Subtle signs of an immunologic process included antinuclear antibody titer of 1:160 in 1 woman, elevated sedimentation rate and elevated circulating immune complexes in another patient, and elevated cerebrospinal protein and IgG in a third woman. 4 of the patients remained stable after stopping oral contraceptives and stopping or reducing smoking. The 5th, who continued smoking, had progressive symptoms for 10 years. It was suggested that antibodies to ethinyl estradiol, a possible cause of this disorder, be further investigated.
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PMID:Accelerated intracranial occlusive disease, oral contraceptives, and cigarette use. 841 56

Current findings and controversies between oral contraceptives (OCs) and cardiovascular disease and cancers. Specifically, venous thromboembolism, stroke, myocardial infarction, (MI), atherosclerosis, breast cancer, cervical cancer, endometrial cancer, and ovarian cancer are reviewed. The concentration in the literature is on higher dose estrogen (at least 50 mg) studies which suggest that there is with current users, particularly older women who smoke, a risk of myocardial infarction, venous thrombosis, and subarachnoid hemorrhage. Of the 11 case control studies and 4 cohort studies it appears that venous thrombosis increases in risk with an increase in estrogen content and remains constant for duration of use. However, definitive studies have not been completed on 50 mg doses of ethinyl estradiol (EE) and mestranol (ME). The actual individual risk may be small, 1/1000 current users/year. Thrombotic and hemorrhagic stroke in the 1970s had a risk of 37/100,000 users per year, mostly among smokers 35 years and older with predisposing medical conditions. It is suggested that although there were mixed findings between current and past users in the 1970s low dose current or past users are not substantially at risk. The pre-mid 1970 risk of MI was 7 and 67 cases/100,000 current users ged 30-39 respectively per year. The risk group is similar to stroke. Thrombosis seems to be responsible for the increased risk, rather than atherosclerosis. More data are needed on low preparations; however limited findings suggest little if any risk. There is no available data on the risk for coronary artery atherosclerosis due to OC use, even though 50% of all women die from atherosclerosis-related processes regardless of OC use. Non human primate studies, however, suggest that there may be a reduced risk, perhaps due to the presence of estrogen receptors in arterial endothelium and smooth muscles. Data clearly indicate that the overall risk of breast cancer pre and post 1950 is the same, but age may be a factor with younger OC users at risk; parity protects. The association for lifetime risk, however, cannot be determined since most use occurred in the 1960s. For cervical cancer, 8 found no increased risk and 9 did, and the suggestion is the 5 years use is related to increased risk. Biases related to sexual behavior confound control and analysis of data. The most common cancer in developing countries is cervical, which warrants greater Pap smear screening to reduce this preventable cancer. Protection from cancer of the endometrium occurs for 15 years following 12 months of OC use at a 40% reduced risk. A protected effect is also found for epithelial ovarian cancer, with a 40% risk reduction. It is concluded that health benefits of OCs far exceed the health risks.
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PMID:Long-term health risks and benefits of oral contraceptive use. 209 41

Oral contraceptives (OCs, long-acting progestins (LAPs), and IUDS are reviewed in terms of new information on safety and efficacy. OC formulations are described and their mechanism of action and efficacy indicated. Reports are provided for thromboembolism, hemorrhagic and thrombotic stroke, ischemic heart diseases, alterations in lipid and hypoprotein and carbohydrate metabolism, hypertension, coagulation changes, breast and cervical cancers, and such minor side effects as menstrual irregularities, nausea, headaches, weight gain, premenstrual syndrome effects, and mood and libido changes. Noncontraceptive health benefits and clinical considerations are discussed. Norplant, as the only long acting progestin available in the US is described in terms of its formulations, mechanism of action, sequelae and metabolic effects, menstrual irregularities, metabolic effects, nuisance side effects, candidates for insertion, method of insertion and removal, and continuation rates. 2 IUD types are identified as the only ones available in the US, Progestasert T and T-Cu-380A (Paragard). Mechanism of action, efficacy, candidates, major sequelae such as salpingitis, infertility, and uterine perforation, minor sequelae such as metrorrhagia and dysmenorrhea, and other considerations are indicated. OCs in the US contain an average of 35 mg of ethinyl estradiol and assorted progestins e.g.s, ethynodiol diacetate, norethindrone acetate, nortestosterone derivatives with a complex mechanism of action. The failure rate for use effectiveness is 6 pregnancies/100 woman years. Modern formulations have combined rates of no more than 50 to 100 adverse events/100,000 users. Some of the effects are indicated as follows: Thromboembolism accounts for 60% of adverse effects and appears to be declining along with hemorrhagic and thrombotic stroke, however, modern use studies are only partially available. Myocardial infarction related to OC use may be embolic, and has a low risk at 7/100,000 users. Low-dose contraceptives substantially reduce the associated risks. Those with risk factors need close monitoring. Norplant is useful for those not wanting to take a daily regimen and is commonly accompanied by menstrual irregularity and sometimes headaches. Continuation is 80% after the 1st year and 40% after 5 years. Candidates for IUDs are parous women in monogamous relationships, who are not at risk for salpingitis, which is related to IUD use, or sexually transmitted diseases. Continuation is 70% after 1 year compared with 50% of OC users.
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PMID:Modern trends in contraception. 212 11

5 cases of vascular complications--hemorrhagic stroke, myocardial infarction, retinal vein thrombosis, thrombotic stroke and deep vein thrombosis--in young women taking low dose oral contraceptives are described from the Department of Obstetrics and Gynecology, University of the Witwatersrand, Johannesburg, South Africa. The hemorrhagic stroke occurred in 1987 in a 24-year old heavy smoker taking Triphasil (Wyeth) for 12 months. She recovered fully. A 34-year old woman had an anteroseptal infarction while on Minovlar ED (Schering, 50 mcg ethinyl estradiol and 1 mg norethisterone acetate) for 2 years. She had no risk factors other than smoking 5 cigarettes daily. The woman with retinal vein thrombosis had 2 episodes, the 1st while taking Restovar 28 (Organon, 37.5 mcg ethinyl estradiol and 0.75 mg lynestrenol) for 7 years. 19 months later she began Diane (Schering AG, 50 mcg ethinyl estradiol and 2 mg cyproterone acetate) and had a bilateral retinal vein thrombosis leaving her partially blind. The woman with thrombotic stroke was 24 when she was struck in 1986, after 1 year of taking Logynon ED (Schering AG, 6/5/7 days, 30,40/40 mcg ethinyl estradiol and o.5/0.75/0.125 mg levonorgestrel). The patient with deep vein thrombosis was 19, smoked, and had used Triphasil for 2.5 years.
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PMID:Vascular complications in women using the low steroid content combined oral contraceptive pills: case reports and review of the literature. 220 50


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