Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0476089 (endometrial cancer)
 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The progestogen-only minipill is used by few of the 50 million women worldwide who use oral contraceptives. This review deals mainly with minipills containing norethindrone (NET) 350 mcg or levonorgestrel (LNG) 30 mcg. The minipill exerts its antifertility influence at the endometrial, ovarian, tubal ephithelial, follicular, and luteal levels as well as on the cervix and cervical mucus. Although some earlier trials indicated pregnancy rates of 1.4-4.3/100 woman years, later combined pregnancy rates in trials of 5 different progestogen-only pills varied from .9-3 pregnancies/100 woman years. Recent indications show, in general large scale usage, minipill pregnancy rates similar to that of combined pills. Several small studies show an increase in the proportion of ectopic pregnancies in minipill users. Variability of menstrual cycle lengths is a controversial aspect of the minipill. In 2 studies using NET and norgestrel, 46-66% of cycles fell in the 25-35 day range. Vaginal bleeding lasted 4-6 days in 78% of cycles. 20-30% of patients notice spotting or breakthrough bleeding, which occurs in 5.8-16.2% of cycles. Intermenstrual bleeding problems are a major concern with progestogen-only methods, and prospects for avoiding the problem completely are limited. The progestogen-only minipill appears to cause no deterioration in carbohydrate tolerance, to have little or no effect on blood lipids and to cause no detectable change in liver function, blood clotting and platelet aggregation, thyroid function, or pituitary-adrenal responsiveness. There is no evidence linking LNG or NET used as a minipill to breast, cervix, or endometrium cancer. Progestogen may protect against endometrial cancer. No cases of congenital abnormality have been reported in babies born to women taking the minipill at conception. Progestogen tends to have no effect on breast milkvolume or may cause a slight increase. No effect of progestogen taken by the lactating mother has been demonstrated on the health or growth rate of the baby.
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PMID:The progestogen-only mini-pill. 675 29

Concerns about abnormal menstrual bleeding are a common reason for women to consult a primary care physician. The first step in the evaluation is to determine the patient's ovulatory status. Women with heavy bleeding but normal ovulatory cycles should be evaluated for coagulopathies, structural lesions, and hypothyroidism. In the absence of a systemic or structural cause, menorrhagia can be treated with OCPs or NSAIDs. Intermenstrual bleeding in OCP users may be due to noncompliance or the use of low-dose pills. Encouraging patient compliance and adjustment of the estrogen dose can often solve the problem. If the patient is not on OCPs, intermenstrual bleeding is usually due to a structural or inflammatory lesion. The differential diagnosis for anovulatory bleeding is extensive. Pregnancy, systemic illnesses, and structural lesions should be ruled out by history, physical examination, and laboratory evaluation. Endometrial biopsy is indicated in patients over age 35 and younger patients with risk factors for endometrial cancer, such as chronic anovulation and obesity. Dysfunctional uterine bleeding is a nonspecific term for abnormal uterine bleeding in the absence of systemic or structural disease. It is usually associated with anovulation. Adolescents frequently have dysfunctional uterine bleeding owing to immaturity of the hypothalamic-pituitary-ovarian axis. Perimenopausal women have an increased incidence of irregular bleeding secondary to decreased estrogen production by the ovary. Obesity, polycystic ovary syndrome, stress, crash diets, and vigorous exercise can all disrupt normal ovulatory function. Treatment options for dysfunctional uterine bleeding include oral contraceptives, cyclic progesterone, or hormone replacement with estrogen and progesterone. Patients with structural lesions or those who do not resume normal withdrawal bleeding patterns on hormone therapy should be referred to a gynecologist for further evaluation and treatment.
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PMID:Abnormal uterine bleeding. 787 94