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

Many adolescents present with hirsutism and irregular menses. The challenge for the clinician is to distinguish physiologic anovulatory cycles from true menstrual disorders such as PCOS, and to differentiate PCOS from other causes of hyperandrogenism in hirsute adolescents. Common clinical features seen in adolescents with PCOS include hirsutism, acne, menstrual irregularity, and obesity. Biochemical abnormalities include hyperandrogenism, acyclic estrogen production, LH hypersecretion, decreased levels of SHBG, and hyperinsulinemia. Management strategies for a patient with PCOS include treatment of features which may cause distress to the adolescent, such as hirsutism, acne, and irregular menses, and prevention of long-term sequelae. Oral contraceptive pills, antiandrogens, and cosmetic treatments are used to treat hirsutism, acne, and menstrual irregularity. Oral contraceptive pills or medroxyprogesterone acetate are given to prevent endometrial hyperplasia and carcinoma. Counseling about weight loss and nutrition are essential, as weight loss may improve signs of hyperandrogenism and menstrual irregularity and may prevent NIDDM and cardiovascular disease. Insulin-sensitizing agents show promise in terms of decreasing hyperandrogenism, restoring ovulatory cycles, treating infertility, and preventing long-term sequelae. Finally, it is important to recognize that adolescents with PCOS may experience psychological distress because of the clinical manifestations of hyperandrogenism or when confronted with the information that they have a chronic illness. Psychological support should be available for these young women. Future research is likely to further elucidate the pathophysiology of PCOS, identify candidate genes, and clarify which adolescents are at risk for long-term sequelae. Prospective studies are needed to identify which therapies could potentially reduce the risk of infertility, diabetes, cardiovascular disease, and endometrial carcinoma in young women with PCOS.
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PMID:Polycystic ovary syndrome. 1037 Jul 13

A sizeable literature corroborates the multiple health benefits of oral contraceptive use. The first estrogen/progestin combination pills were marketed to treat a variety of menstrual disorders. Although currently used oral contraceptives no longer carry FDA-approved labeling for these indications, they remain important therapeutic options for a variety of gynecologic conditions. Well-established gynecologic benefits include a reduction in dysmenorrhea and menorrhagia, iron-deficiency anemia, ectopic pregnancy, and PID. Although older, higher-dose pills reduced the incidence of ovarian cysts, low-dose pills suppress follicular activity less consistently. Nevertheless, cycle-related symptoms, including functional cysts, dysmenorrhea, chronic pelvic pain, and ovulation pain (mittelschmerz), generally improve. Women with polycystic ovary syndrome note improvement in bleeding patterns and a reduction in acne and hirsutism. Symptoms from endometriosis also improve with oral contraceptive therapy. Current data suggest that oral contraceptive therapy increases bone density and that past use decreases fracture risk. Oral contraceptives also improve acne, a major health concern of young women. Oral contraceptives provide lasting reduction in the risk of two serious gynecologic malignancies--ovarian and endometrial cancer. The data with respect to ovarian cancer are compelling enough to recommend the use of oral contraceptives to women at high risk by virtue of family history, positive carrier status of the BRCA mutations, or nulliparity, even if contraception is not required. Health care providers must counsel women regarding these benefits to counteract deeply held public attitudes and misconceptions regarding oral contraceptive use. Messages should focus on topics of interest to particular groups of women. The fact that oral contraceptives increase bone mineral density and reduce ovarian cancer is of great interest to women in their forties and helps influence use and compliance in this group. In contrast, the beneficial effects of oral contraceptives on acne resonates with younger women. Getting the good news out about the benefits of oral contraceptives will enable more women to take advantage of their positive health effects.
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PMID:Health benefits of oral contraceptives. 1109 85

Progestins in oral contraceptives (OCs) produce potential complications, as well as noncontraceptive benefits, according to Robert A. Hatcher, MD, MPH, professor of gynecology and obstetrics, Emory University Medical School. Hatcher told CTU that lowering the progestin content in an OC may decrease complications, but could also decrease the benefits experienced by women. "The extent to which that will happen remains to be seen," he said. Hatcher cited the following potential complications of progestins in OC: hypertension; decreased levels of high density lipoproteins; acne; oily skin; headaches between pill cycles; dilated leg veins; pelvic congestion syndrome; thrombosis of superficial leg veins; gallstones; Monilia vaginitis; cholestatic jaundice; and depression, fatigue, and decreased libido. Progestins, according to Hatcher, also produce these noncontraceptive benefits: protection against PID; decreased dysmenorrhea; decreased menstrual blood loss, decreased iron deficiency anemia; protection against endometrial cancer; protection against fibrocystic breast disease, and fibroadenomas of the breast; decreased bleeding from fibroids; decreased growth of fibroids. When ovulation is suppressed, Hatcher emphasized, additional benefits that may occur include the following: decreased risk of functional ovarian cysts; elimination of mittleschmerz pain; decreased rick of ovarian cancer; protection against endometriosis.
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PMID:Potential risks, benefits of progestins in birth control pills outlined. 1231 83

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

Modern medicine 1st made the oral contraceptive (OC), a combined OC, available to women in 1960, and much progress in improving OCs and reducing risks associated with them has occurred. Approximately 200 million women have used OCs worldwide and about 60 million women are currently using this contraceptive method. OCs are efficacious because the hormones in the OCs alter the physiology of the hypothalamo-pituitary-ovarian/uterine axis at 6 sites, e.g., altering the endometrium so implantation of the blastocyst cannot occur. Despite the effectiveness of OCs (virtually 100% effective) in comparison with other contraceptive methods, they often cause side effects and complications. Some side effects and complications from estrogen and predominantly estrogen OCs include vomiting, hypertension, and venous thrombosis/pulmonary embolism. Possible progestogen and predominatly progestogen OC side effects and complications are leucorrhea, urinary tract infections, epilepsy aggravation, and cholestatic jaundice. In addition, pregnancy, venous thromboembolism, heart disease, and malignancies of the breast and genital tract are absolute contraindications to OCs. On the other hand, OCs provide health benefits, in addition to preventing unwanted pregnancies, such as lowered incidence of pelvic inflammatory disease, acne improvement, and protection against endometrial carcinoma and ovarian epithelial neoplasia. In order to ensure that health benefits of OCs are maximized and the risks minimized, family planning practitioners worldwide must monitor OC users for side effects. Recent OC formulations now include the progestogen only OCs, multiphase OCs, low dose OC called gestodene, and the "morning after pill".
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PMID:Oral steroidal contraception: scientific basis and recent development. 1234 71

PCOS is a metabolic syndrome that exists throughout the world with much clinical heterogeneity. PCOS is now appreciated as encompassing two interrelated metabolic phenomena--insulin resistance and hyperandrogenism. Patients present with oligo-amenorrhea and clinical hyperandrogenism, and the diagnosis is based on clinical grounds with few laboratory tests necessary. Because patients are at higher than normal risk for diabetes, glucose intolerance, and hyperlipidemia, and perhaps at higher risk for coronary heart disease, newly diagnosed patients with PCOS should be evaluated for glucose intolerance and hyperlipidemia. The cornerstone of therapy today includes weight management, and further therapeutic intervention is focused on reproductive and cardiovascular health and treatment of insulin resistance. Clinical case continued The 17-year-old mentioned in the beginning of this article probably does have PCOS. She fits the clinical criteria: oligo-ovulation and hyper-androgenism (the acne and hirsutism). In addition, she is obese, which is also associated with PCOS. Her TSH and prolactin were normal, and as her presentation was not suggestive of an adrenal tumor or congenital adrenal hyperplasia (she had mild hirsutism, and those diagnoses are associated with more severe hyperandrogenism), no further laboratory evaluation was deemed necessary. Once the diagnosis was made, she was screened for lipid abnormalities and for glucose intolerance. Her LDL was 150, HDL 35; oral glucose tolerance test (OGTT) was normal. A pregnancy test was negative, and she was started on OCPs. Devoting herself to exercise and dietary change, she lost 10 pounds in her first 3 months after diagnosis. Her hirsutism and acne have improved with the OCPs and weight loss, and her menses are regular. She has elected to defer oral insulin sensitizers until her weight loss has stabilized. Findings PCOS is common in reproductive-aged women. Diagnosis is clinical and is supported by lab findings; there is significant clinical heterogeneity. Insulin resistance is likely central to the pathophysiology along with androgen excess. Health implications include infertility, diabetes, endometrial cancer, hyperlipidemia, and possibly coronary heart disease. Treatment is evolving and includes weight loss, OCPs, and insulin sensitizers.
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PMID:Polycystic ovary syndrome: a review for primary providers. 1502 92

Atypical endometrial hyperplasia has been associated with progression to endometrial cancer, the most common genital malignancy. There are multiple risk factors for endometrial cancer, such as early menarche, exogenous estrogen exposure, obesity and diabetes. Diabetics have a 3-4 fold relative risk of endometrial cancer. Also, several studies have demonstrated an association between insulin resistance and endometrial cancer. There is known the first description of atypical endometrial hyperplasia resistant to progestogen therapy, which was subsequently treated with an insulin-sensitizng agent, metformin. Metformin is a biguanide antihyperglycemic agent used in the treatment of adult-onset diabetes. Unlike the sulfonylureas, metformin does not act primarily by increasing insulin secretion. In contrast, metformin lowers the rate of gluconeogenesis in the presence of insulin. Therefore, it is considered an insulin-sensitizer. Increased insulin sensitivity may improve the metabolic effect of insulin and decrease its mitogenic effect by tissue-specific mechanisms. One explanation for tissue specific differences in insulin binding and action may be through the relative expression of the insulin receptor (IR) isoforms. The IR isoforms IR-A and IR-D differ by 12 amino acid residues, owing to the alternative splicing of exon. The IR-A is predominantly expressed in malignant tissues and may lead to mitogenic effects within the cell. The relative expressions of IR-A and IR-B in normal and malignant endometrial tissue is not known. Besides direct effects on the IR, several additional mechanisms have been proposed for the mitogenic effect of insulin in endometrial cancer. In addition to the possible direct mitogenic effects of insulin through the IR-A, insulin resistance may be associated with alterations in expression of insulin-like growth factors (IGFs) and the IGF binding proteins (IGFBPs) or may inhibit the protective effect of progestagens. Binding sites for IGF-1 and IGF-2 have been confirmed in both normal and malignant endometrium. Binding of IGF-1 is significantly higher in endometrial cancer compared to normal endometrium. In the Ishikawa human endometrial cancer cell line IGF-1 was a more potent mitogen than insulin or IGF-2. Insulin may increase mitogenicity by regulating the expression of IGFBPs. The IGFBPs are a family of proteins that have both proliferative and anti-proliferative effects. While all six high-affinity IGFBPs are expressed in the endometrium, IGFBP-1 is the best characterized. Hyperinsulinemia can decrease IGFBP-1 even in the presence of progesterone, perhaps inhibiting progesterone's protective effects. Interestingly, IGFBP-1 was undetectable or minimally expressed in endometrial cancers. Nestler discussed results of a 6-month treatment of 100 nonebese women with PCOS, which showed a somewhat greater effect of metformin than rosiglitazone and no benefit of administering both agents in combination. Long-term treatment with oral contraceptives decreases endometrial cancer, with a reduction in serum androgens and a decreases in hirsutism and acne, but may worsen insulin resistance and lead to deteriration in glucose tolerance. Insulin sensitizers, on the other hand, should decrease endometrial hyperplasia by inducing regular menses, but may not be as beneficial in improving androgen - related symptoms. Note that the Nurses Health Study (NHS) showed increased risk of diabetes in oral contraceptive users. These considerations may be related to the finding that women who used oral contraceptives have increased risk of myocardial infarction. Thus, in view of the particular increase in CVD risk among women with PCOS, one might be less likely to recommend oral contraceptives, while insulin sensitizers may be of particular benefit, decreasing androgens, improving ovulation and fertility, and reducing the risk of diabetes and CVD. Theoretically, metformin, a treatment which is now widely used to treat infertile women with PCOS, may have a role in preventing endometrial hyperstimulation by lowering insulin concentrations and restoring ovulation. However, the long-term effects of this drug in women with PCOS are not known and more studies are required before suggesting its use for preventing endometrial cancer.
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PMID:[Molecular action of insulin-sensitizing agents]. 1635 Jul 24

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in United States, affecting 6-10% of females in the reproductive age group. Recent studies have shown that insulin resistance plays an important role in the pathogenesis of PCOS. Traditionally, management of PCOS consisted mainly of ovulation induction, treatment of acne and hirsutism, and prevention of endometrial cancer. However, with mounting evidence showing that PCOS is associated with dysmetabolic syndrome and an increased risk for developing diabetes and heart disease, this can no longer be our sole focus. Current data support a strong recommendation that women with PCOS should undergo comprehensive evaluation for diabetes and recognized cardiovascular risk factors and receive appropriate treatment as needed. Lifestyle modifications remain the first-line therapy for all obese women with PCOS. However, many obese women with PCOS find weight loss difficult to achieve and maintain, and this is not an option for lean women with PCOS. For these reasons, insulin-sensitizing drugs are proving to be a promising and unique therapeutic option for chronic treatment of PCOS.
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PMID:Prevention of diabetes and cardiovascular disease in women with PCOS: treatment with insulin sensitizers. 1677 55

Polycystic ovary syndrome (PCOS) is the common endocrine disorder of reproductive age women which is characterized by hyperandrogenism, chronic anovulation, and increased risk for infertility, endometrial cancer, developing metabolic dysfunction (type II diabetes, dyslipidemia), hypertension and heart disease. The syndrome is also associated with some skin disorders: hirsutismus, alopecia androgenetica and acne. The successful dermatologic therapy requires the holistic diagnosis of the women with skin disorders described above and use the antiandrogenic treatment with conventional methods and laser depilation in hirsutismus. In this paper we present literature studies and our own experiences.
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PMID:[Polycystic ovary syndrome and hair unit function disturbances in dermatological practice]. 1742 3

The use of combined oral contraceptives (COCs) is associated with a reduced risk of developing endometriosis, myomas, and endometrial and ovarian carcinoma. The mechanisms involved are multiple; next to ovulation suppression, a reduction in inflammation in the genital tract is involved. This is accomplished through inhibition of the endometrial expression of enzymes related to the biosynthesis of prostaglandin and oestrogen, particularly cyclooxygenase type II (Cox-2) and aromatase. The blockade of these enzymatic systems by COCs explains the beneficial effects of these compounds in treating the symptoms, and halting the progression of myomas, endometriosis and adenomyosis, all of which are characterized by increased inflammation. Inhibition of aromatase and Cox-2 expression in the endometrium by COCs may explain their efficacy in controlling the pain and excessive uterine bleeding caused by these pathologies. The reduction of inflammation in the endometrium may also be the mechanism behind the lower incidence of endometrial carcinoma in COC users. The blockade of ovulation and ovarian steroidogenesis, on the other hand, may explain the lesser incidence of ovarian cancer and the improvement of acne in users. In conclusion, inflammation appears to play a pivotal role in the development of various benign and malignant gynecological diseases. COCs reduce inflammation in the female genital tract by blocking enzymes such as Cox-2 and aromatase.
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PMID:Non-contraceptive health benefits of oral contraceptives. 1796 79


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