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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Numerous non-contraceptive benefits of combined oral contraceptive (OC) use have been identified. The risk of endometrial cancer is reduced by 20% after 1 year of use, 50% after 4 years of use, and 71% after 12 years of use compared with the risk among non-users and this protective effect persists up to 15 years after OC discontinuation. There is a 30% overall reduction in ovarian cancer risk (50% after 5 years of OC use) and the protective effect lasts at least 10 years after ending pill use. For cervical cancer, OC use is associated with a slight increase in risk, although other causative factors may be implicated. The risk of follicular ovarian cysts is reduced by about 50%, while that of cysts from the corpus luteum declines by as much as 80%. Combined OCs also reduce the risk of fibrocystic breast disease and fibroadenomas by about 25%. Both low- and high-dose OCs reduce pelvic inflammatory disease by up to 50% and, if OC users do develop this infection, it is generally less severe than in non-users. Also recorded has been a 90% reduction in risk of ectopic pregnancy. Since OCs shorten the menstrual period and amount of blood loss, they protect against iron-deficiency anemia. Finally, OC users have a 60% reduced risk of dysmenorrhea.
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PMID:Non-contraceptive benefits of oral contraceptives. 1229

Oral contraceptive (OC) labeling disclosure of possible benefits from use of the products, was recommended by the U.S. Food and Drug Administration's (FDA) Fertility and Maternal Health Drugs Advisory Committee at its February 11 meeting. Committee member Howard Orr, Centers for Disease Control, noting the emphasis on cautionary and warning statements contained in current OC labeling maintained: "Women should make informed decisions and this is the other half. The package insert must include the benefits information." The recommendation by the committee represents a shift in the approach to what constitutes proper labeling for OC products. Since first approved, the drugs have never carried a discussion of benefits on their labels. "A number of additional benefits from OCs--other than contraception--have emerged from the large number of studies recorded in the literature on OC use," Ron Nelson, White Memorial Medical Center, stated. "Studies cited a more regular and lighter menstrual flow, resulting in less blood loss and lower iron deficiency and anemia in contraceptive pill users, and dysmenorrhea and premenstrual tension have been sifnificantly reduced." "Ovarian cysts and pelvic inflammatory disease occurred less frequently in pill users than in controls," Nelson continued, "and the incidence of fibrocystic disease of the breast were less. There are some instances where OCs may incur protection against the development of ovarian cancer, endometrial cancer, and rheumatoid arthritis." Orr added: "I think there are 2 good studies that show almost a total elimination of ectopic pregnancy with women who took the pill. Given that now there's an epidemic of the disease going around, I think it's worth adding." The committee was asked by FDA last November to recommend changes in the current physician and patient OC labeling. FDA's Solomon Sobel, MD, Endocrine and Metabolic Drugs Division, told the committee that an agency subcommittee would review the recommendations, present them to the committee in May for final comment, then publish them in the Federal Register.
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PMID:Oral contraceptive labeling disclosure of possible benefits. 1231 62

The use of oral contraceptives (OC) by an estimated 150 million women worldwide has prompted concern about their potential risks. But, there are also health conditions--medical and surgical disorders, reproductive tract cancers, and menstruation disorders--that oral contraceptives affect beneficially. OC users have a lower risk of iron deficiency anemia, an important consideration for nutritionally deficient women. The risk of developing pelvic inflammatory disease is also decreased in OC users, as is the risk of ectopic pregnancy. This is important for women in developing countries, where access to medical services for a life-threatening ectopic pregnancy might be limited. Using OCs lowers the incidence of surgery for benign breast disease, the incidence of retention cysts of the ovary, the risk of endometrial cancer, the risk of epithelial ovarian cancer, and relieves symptoms of dysmenorrhea and premenstrual syndrome. The risks associated with OC use, including stroke and heart attack, vary among age groups, smoking status, and other cardiovascular risk factors. For example, elevated serum cholesterol is lower among women in developing countries, so the associated risk of heart attack is lower for these women. Other complications associated with OC use are deep-vein thrombosis, pulmonary embolism, gallbladder disease, and hepatic adenoma. There is controversy about whether OC use increases the risk of cervical neoplasia. Studies that have attempted to define this risk are subject to methodological problems, in that increased surveillance of OC users results in a higher rate of detection. Some controversy exists about OC use and an increased risk of breast cancer, but no definitive results are available. Although the risks associated with OC use can be serious, these risks are only slightly higher among OC users compared with non-users. The benefits, such as reduced risk of serious diseases and gynecological disorders, seem to outweigh the risks, pointing to the need for accurate communication between health professionals and the women they advise about contraceptive choices.
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PMID:Beyond contraception: the health benefits and risks of the pill. 1231 33

The most important step in counseling patients about the use of oral contraceptives (OCs) is to uncover patient fears because patients will not use a product if they believe it is not good for them. Clinicians can ask patients what negative stories they have heard about OCs, and clinicians should also introduce such stories in the conversation. Clinicians can then provide accurate information about the risks of OCs and warn patients about the dangers of cigarette smoking. Then, clinicians should provide information on the health benefits of OC use. Some women can cite menstrual cycle benefits of OC use, but few US women know that OCs can protect against ovarian and endometrial cancer, anemia, ectopic pregnancy, pelvic inflammatory diseases, or benign breast disease. Health benefit counseling may improve patient continuation as well as compliance. Patients also need specific information on how to take the OC, what to do about a missed pill, how to handle common nuisance side effects, and who to call with questions. More frequent follow-up visits should be scheduled for teenagers.
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PMID:Patient counseling: the key to improving success with OCs. 1231 67

Some controversies regarding currently used contraceptive methods are reviewed. There are no newly available estrogens for oral contraceptives (OCs), but 2 progestins are coming into use: cyproterone acetate, which has a potent antiandrogenic action, and desogestrel, which combines a strong inhibitory effect on ovulaion and a marked peripheral progestin activity with very weak androgenic and anabolizing activity. New systems of administration will be used in the future to avoid the serum "peaks" observed in oral administration. The lack of agreement on the effects and secondary effects of various progestins will be a continuing source of discussion. 2 aspects of combined OCS, residual ovarian activity and androgenicity, are attracting increasing attention. Among new preparations, the combination of 2 mg cyproterone acetate and 50 mcg of ethinyl estradiol (EE) has been shown in multicenter European studies to have good effects on acne and satisfactory acceptance despite some hyperestrogenic secondary effects, which may be improved by a new dosage schedule. Triphasic preparations have given good results with significantly reduced steroid doses. There have been few recent findings concerning risks of OCs. The triphasic formulations and those containing desogestrel are too recent to have been subjected to epidemiologic study. The noncontraceptive benefits of OCs are becoming more apparent; they include protection against ovarian and endometrial cancer, functional ovarian cyst, ectopic pregnancy, salpingitis, benign breast disease, dysmenorrhea, rheumatoid arthritis, menorrhagia, and premenstrual syndrome. Improved knowledge of the mechanisms of action and local effects of IUDs permitted improved utilization. Ultastructural studies and endometrial exploration have show that non-fundally located IUDs entail greater risk of failure and complications. The question of early pregnancy with IUD use is still unresolved. Copper IUDs are now the most widely used type, but there are differences of apinion about whether the copper content should be increased or whether silver should be added to the core of the copper thread. IUDs with natural or synthetic progesterone may reduce bleeding and have other beneficial effects. Currently it is impossible to identify 1 particualr IUD as superior. IUD performance is improved by careful patient selection, choice of IUDs, and follow-up to identify and treat problems at an early stage. Improved spermicides such as Benzalkonjum chloride attracted greater attention to vaginal methods. The posibility of increased risk of toxic shock syndrome and teratogenic effects remain to be evaluated. Post-coital contraception continues to be important as yet no satisfactory new male methods have been developed. The US office of Technology Assessment has published a list of contraceptive developments or improvements expected by the year 2000.
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PMID:[Current issues in contraception]. 1233 71

Each year as a consequence of pregnancy and delivery at least 500,000 women die, 99% of them in developing countries. Most maternal deaths are avoidable. For each death, 10-15 other women suffer serious health effects which may lead to chronic pain or even social isolation. Childbirth is riskier for women who are too young or too old, who have many children, or whose births are too closely spaced. Limiting family size reduces both maternal and child deaths. In developed countries, 5-30 women die per 100,000 births, compared to 50-800 in developing countries. Maternal mortality rates at 2 hospitals in Yaounde, Cameroon, have declined significantly in recent years, probably due to establishment of high risk pregnancy clinics, improved monitoring during labor, and child spacing clinics. Improved obstetric services and child spacing could reduce maternal mortality in developing countries as they have in the developed world. The use of contraception has been a controversial topic in traditional African societies, but by now the majority of governments of developing countries include family planning programs in their development plans for their health as well as their economic benefits. Despite gradual increases, fewer than 5% of women in most African countries use modern contraception. African men play an insignificant role in family planning. The continuing practices of prolonged lactation and postpartum abstinence in rural areas have compensated to some extent for the absence of modern contraception. Oral contraceptives are the most widely used reversible method. They may protect against vaginal infection, iron deficiency anemia, ectopic pregnancy, benign breast disease, ovarian and endometrial cancer, dysmenorrhea, endometriosis, and rheumatoid arthritis. There is evidence that some steroid hormones have a beneficial effect in stabilizing the cellular membranes of red blood cells in women with sickle cell anemia. The danger of infection with the IUD is largely limited to the 1st 4 months of use and to women with sexually transmitted diseases. Careful selection of candidates, aseptic insertion, and regular follow-up are needed to ensure IUD safety. The IUD is contraindicated for nulliparas. Barrier methods provide contraception as well as some protection against sexually transmitted diseases. Condoms have a significant protective effect against HIV infection. Diaphragms, cervical caps, and vaginal sponges provide some protection against infections like gonorrhea and chlamydiae that invade the cervical cells. Many adolescents resist condoms because they diminish sensation. But condoms provide protection against sexually transmitted diseases and are appropriate for individuals with sporadic sex lives. Oral contraceptives are more effective but adolescents are at risk of forgetting pills. IUDs are the least attractive option for adolescents because of the danger of infection and subsequent infertility.
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PMID:[High risk pregnancies and family planning]. 1234 59

In the first revised version of the Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' a distinction is made between excessive (cyclical), irregular, breakthrough and postmenopausal bleeding. The diagnostic guidelines are aimed at identifying possible causes. However, in a considerable number of patients no underlying cause is found and the bleeding is assumed to be caused by hormonal fluctuations, for instance shortly after the menarche or premenopausal. Other causes can be: myomas, an intra-uterine device (IUD), medication, or endometrial carcinoma. Furthermore, lesions of the perineum, vulva or vagina, a pelvic inflammatory disease, Chlamydia infection, cervical carcinoma, imminent abortion or ectopic pregnancy also have to be excluded. In this practice guideline, the management guidelines are limited to the treatment of bleeding from the endometrium. In most cases bleeding caused by hormonal fluctuations is self-limiting. However, symptomatic treatment with progestogens or sub-50 oral contraceptives is possible. NSAIDs taken during the first three days of menstruation are the second-choice treatment in women with excessive bleeding. Tranexamic acid or a levonorgestrel-releasing IUD are other possibilities. Postmenopausal women with vaginal bleeding, first of all have to be examined by means of a cervical smear and transvaginal ultrasonography, to exclude an endometrial carcinoma. They can initially be reassured if the ultrasonography reveals an endometrial thickness of 4 mm or less. In the case of persistent or recurrent vaginal bleeding, they should still be referred to a gynaecologist.
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PMID:[Summary of the standard "Vaginal bleeding" (first revision) of the Dutch College of General Practitioners]. 1263 55

Irregular vaginal bleeding is a common symptom of women seeking gynecologic care. Etiologies of irregular vaginal bleeding can be classified into the following categories: pregnancy related (retained products of conception, threatened or missed abortion, or ectopic pregnancy), hormonal (disorders of ovulation, menopause, or hormonal contraceptive use), structural (polyps, myomas, or arteriovenous malformation), neoplasm (endometrial cancer), and infection (endometritis). After the history and physical examination, the initial evaluation of irregular vaginal bleeding has traditionally involved an endometrial biopsy. Transvaginal ultrasound has revolutionized the evaluation of the gynecologic ultrasound examination by providing a minimally invasive means to determine the etiology for the bleeding. Transvaginal ultrasound assessment of the endometrial cavity allows treatment to be tailored to the specific cause of irregular vaginal bleeding, thus saving women time, money, and exposure to unnecessary interventions. The purpose of this article is to give the clinician critical information regarding the capabilities of ultrasound to evaluate women with irregular vaginal bleeding.
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PMID:Ultrasound assessment of the endometrium for irregular vaginal bleeding. 1708 34

Although fibroids constitute the most common tumour in women of reproductive age, it is remarkable how very rarely they cause acute complications. However, when they do occur, the acute complications can cause significant morbidity (very occasionally, mortality), profoundly affecting a woman's quality of life. The complications include thrombo-embolism, acute torsion of subserosal pedunculated leiomyomata, acute urinary retention and renal failure, acute pain caused by red degeneration during pregnancy, acute vaginal or intra-peritoneal haemorrhage, mesenteric vein thrombosis and intestinal gangrene. The obstetrician will be most familiar with red degeneration and acute urinary retention, both of which tend to occur in association with pregnancy. It is difficult to quote an incidence rate for these acute complications as they are rare, and most are reported as cases or case series in the literature. The majority (except red degeneration, acute urinary retention and thrombo-embolism) presents as an acute abdomen and requires urgent exploratory surgery. The differential diagnosis would include twisted adnexa, ruptured ectopic pregnancy, haemorrhagic corpus luteum or follicular cyst, whilst that of the pelvic mass would be ovarian or endometrial carcinoma, uterine sarcoma or leiomyoma and, rarely, ovarian fibroma. Deep vein thrombosis is usually due to pelvic venous compression, and while some have advocated that its occurrence in association with a fibroid mass should be an absolute indication for hysterectomy, sophisticated use of radiological adjuncts at surgery, such as 'umbrellas' and haematological support with appropriate anticoagulation, could enable uterine-preserving surgery. The diagnosis of fibroids as a cause of acute urinary retention should be one of exclusion. The treatment of the acute fibroid in pregnancy is of course conservative, definitive treatment being postponed until postpartum.
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PMID:Acute complications of fibroids. 1926 55

Patients with hyperandrogenic syndromes and diseases exacerbated by pregnancy and those taking common dermatologic drugs associated with risk to the fetus require prescription of contraceptives by the dermatologist. In healthy, nonsmoking women, oral contraception does not increase the risk of cerebral or cardiac vascular disease and is associated with major benefits besides avoiding pregnancy. These include prevention of ovarian and endometrial carcinoma, ectopic pregnancy, pelvic inflammatory disease, ovulation pain, and menstrual cycle disorders. This article will review the mechanism of action, side effects, health risks, contraindications, initiation of the oral contraceptive regimen, and patient follow-up, as well as interactions between contraceptives and other drugs.
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PMID:[Oral contraceptives in dermatology]. 1970 48


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