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

Well over 100,000,000 women have used the combined oral contraceptive (OC) pill. As a result of the population explosion in the 1970s and 1980s, there will be almost one third more women in fertile age in the year 2000 than in 1991. In the developing world outside China, the total number of contraceptive users could double in roughly 10 years. China, the total number of contraceptive users could double in roughly 10 years. The pill has a low failure rate, but one study in Egypt found that 90% of women made errors in moving from one packet to the next. Similarly, a 60% error rate was found among users in Colombia. The vaginal ring delivers combined progestogen and estrogen through a silastic wall. The device can be left in place for 21 days out of 28, and such delivery would virtually eliminate the low risk of hepatocellular carcinoma among OC users. A vaginal progestogen ring is being tested. Over 700,000 women have used Norplant, the subdermal implant method with an effectiveness rate of 99%. Depo-provera and norethindrone enanthate injections last 2 to 3 months. The Progestasert IUD, containing 38 mg progesterone released at a rate of 65 mcg per day, is effective. Progesterone-releasing IUDs lasting from 3 to 5 years could complement subdermal implants. Ethinyl estradiol (205 mg) and diethylstilbestrol (25-50 mg) have both been used as postcoital agents taken within 36 hours for 5 consecutive days after unprotected intercourse. In more than 3000 cases there were 17 pregnancies (.05%). These regimens are replaced by giving combined oral contraceptive tables (e.g., .25 mg d-norgestrel and 50 mg ethinyl estradiol), taken 2 at a time and repeated 12 hours later, within 72 hours of unprotected intercourse. Epidemiological studies have confirmed that the use of the combined oral contraceptive for 3 to 5 years halves a woman's risk of ovarian or endometrial cancer, and the protection persists for 10 to 18 years after cessation of use.
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PMID:The future of hormonal contraception. 168 5

In a study carried out in Germany between 1985-89 unintended pregnancy was found in 7.9% of girls aged 15-21 in 1985 and in 5.2% in 1989. A study of 2905 young people aged 14-18 in Austria indicated that 75% of girls and 55% of boys had sexual intercourse by age 18 making contraception vital for adolescents. Among oral contraceptives (OCs) micropills with 20 mcg ethinyl estradiol barely affect the follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels, but the gestagen component can induce bleeding, spotting, and breast symptoms. Discontinuation quickly restores the normal connection of the hypophysis and ovary without affecting later pregnancy. 5.1 years after the end of high-dose combination OC use for 9-46 months only 3 out of 13 women did not become pregnant. OCs reduce bleeding disorders, anemia, and dysmenorrhea, ovarian cancer, and endometrial cancer. Their effect on breast cancer is not clear. Phenobarbital and rifampicin accelerate OC metabolism, and OCs reduce the effect of anticonvulsives and tolbutamide (for hypoglycemia). Neogynon and Stediril D are postcoital pills used within 48 hours of intercourse. IUDs are not recommended, as adnexal infection is 1.5-2 times higher in girls 14018 using IUDs. The effectiveness of the diaphragm and condom depend on motivation; creams and vaginal sponges are useful but they may cause irritation. The Billings method produced only a 2.9 Pearl-index reliability in 7000 cycles, thus natural methods often fail. Before age 14 girls must have parental consent for prescription of OCs, after 14 the physician is not liable for OC prescription, but induced abortion still requires parental consent until age 18.
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PMID:[Contraception in adolescents]. 174 70

Mortality is the greatest concern in assessing risks of modern reversible contraception. The problems identified with older oral contraceptives (OCs) have decreased with the lower doses in current OCs. These problems include cardiovascular and thrombotic effects, changes in lipid metabolism, breast cancer, liver cancer, increased risk of chlamydia cervicitis, no protection against sexually transmitted diseases (STDs) and HIV, and interferes with breast feeding. On the other hand, OCs protect against anemia, menstrual disorders, ectopic pregnancy, acute pelvic inflammatory disease (PID), and ovarian and endometrial cancer. Since the contraceptive implant, Norplant, has no estrogens, it does not have the cardiovascular risks associated with OCs. Possible risks from Norplant use include changes in carbohydrate, liver, and lipid metabolism but they tend to be clinically insignificant and no protection against STDs/HIV. Menstruation disorders are the major side effect. Apparent benefits of Norplant are protection against anemia and ectopic pregnancy and no effect on lactation. The injectable contraceptive, Depo-Provera, causes menstrual changes, may slightly increase the risk of breast cancer, may decrease bone density, and does not protect against STDs/HIV. It protects against endometrial cancer. It has no effect on metabolism. Risks associated with the IUD include PID, perforation, anemia, increased menstrual bleeding, and pregnancy. IUDs do not affect the quantity of composition of breast milk. They are best suited for women in a mutually monogamous, long-term relationship. Barrier methods provide some degree of protection against STDs/HIV and PID. Condoms provide the most protection. They do not affect lactation. Their major complications are contraceptive failure and risks associated with pregnancy. For all women, especially those in high risk categories, one must balance the risks of modern contraceptive use with the risks of childbearing and with their benefits.
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PMID:The safety of modern contraceptives. 784 6

At the gynecologic clinic of San Francisco General Hospital in California, 18 women aged 27-44 who had used Norplant contraceptive implants for the full 5 years of effectiveness and who had at least 1 year of recurrent episodes of vaginal bleeding agreed to have an endometrial biopsy and a venipuncture for determination of serum estradiol, progesterone, and levonorgestrel levels. Investigators wanted to learn whether hormonal factors contributed to abnormal bleeding patterns in women who had used levonorgestrel-releasing contraceptive implants for 5 years. At the time of biopsy and venipuncture, 13 (72%) women had normal bleeding patterns. Two women had no apparent follicular activity. Six other women (44%) had a low estradiol level (i.e., 100 pg/ml). 14 women (77%) had no signs of luteal development (i.e., progesterone level 3 ng/ml). None of the women had hyperplastic endometrium. The endometrial index was used to describe endometrial histology and ranged from secretory to proliferated characteristics of the endometrium. It differed significantly between Norplant users with normal bleeding and those with abnormal bleeding (0.32 [a mixture of secretory and proliferative characteristics, but especially secretory characteristics] vs. 0.9 [close to full proliferation of the endometrium]; p 0.01). Serum estradiol, progesterone, and levonorgestrel levels were not significantly different between the two groups. These findings suggest that a proliferative endometrium, rather than sex steroid levels, was linked to abnormal bleeding. Thus, abnormal bleeding among long-term Norplant users is probably not a risk factor for developing endometrial cancer.
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PMID:Serum concentrations of estradiol, progesterone, and levonorgestrel are not determinants of endometrial histology or abnormal bleeding in long-term Norplant implant users. 883 86

Changes in endometrial histology and cervical cytology related to use of two contraceptive implants were investigated in a 2-year prospective study conducted at Birmingham (UK) Women's Hospital. 60 women with regular menstrual cycles were randomly assigned to receive either Implanon (etonogestrel/3-keto-desogestrel) or Norplant (levonorgestrel). After 12 months of implant use, most endometrial samples in both groups were inactive or only weakly proliferative. After 24 months, this pattern remained unchanged in the Implanon group. It was more diverse, however, in the Norplant group, where there was evidence of proliferative-phase endometrium. Endometrial thickness, assessed quarterly by transvaginal ultrasound scans, was significantly reduced in users of both implants. Cervical cytology remained unchanged from baseline to 24 months. These findings suggest that users of both implant systems are not at increased risk of endometrial hyperplasia, endometrial carcinoma, cervical intra-epithelial neoplasia, or cervical carcinoma.
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PMID:A 2-year comparative study of endometrial histology and cervical cytology of contraceptive implant users in Birmingham, UK. 985 56

This article concerns the essential findings of the task force created by the Special Programme of Research, Development, and Research Training in Human Reproduction in 1985 to conduct research on the safety and efficacy of fertility-regulating methods. The task force had 9 research priorities which include: 1) effects of contraceptive use during lactation; 2) pelvic inflammatory disease and contraception; 3) cardiovascular disease and hormonal contraception; 4) cancer and hormonal contraception; 5) interactions between contraceptive use and disease; 6) morbidity due to female sterilization; 7) induced abortion; 8) safety of Norplant; and 9) IUDs. It then established epidemiological studies in 47 countries, which were mostly from the developing world. Some main achievements were: 1) identification of the beneficial and possible adverse effects of oral contraceptives (OCs) on the risk of neoplasia; 2) demonstrating that injectable depot-medroxyprogesterone acetate protects against endometrial cancer and does not increase the overall risk of breast cancer; 3) clarifying which groups of women are prone to the complications of OCs; and 4) establishing the long-term effectiveness and safety of IUDs. Furthermore, the valuable information produced by this research program has already had a significant impact on family planning policies and practice. This venture also strengthens the value of mission-oriented research and demonstrates the potential of collaborative research between developing and developed countries.
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PMID:Safety and efficacy of fertility-regulating methods: a decade of research. 1053 94

The intrauterine device (IUD) is a highly effective method of contraception that, as opposed to other countries around the world, is underutilized in the United States by women of all ages. Lingering concerns about the safety of IUDs are in large part responsible for their lack of adoption, but a systematic review published recently nullified some of the major safety concerns about IUD use. The author summarized the methodologically sound evidence regarding the risk of upper-genital-tract infection and infertility associated with IUD use and reported that a slightly increased risk of pelvic inflammatory disease (PID) exists only in the first month following IUD insertion; that the risk of PID in women with symptomless sexually transmitted diseases (STDs) having an IUD inserted is similar to the risk in women not having an IUD inserted; and that there appears to be no negative effect on fertility following IUD removal. In addition, Mirena provides noncontraceptive benefits, such as treatment for menorrhagia, dysmenorrhea, and anemia, and ParaGard may help protect against endometrial cancer. An IUD is also a safer alternative to sterilization for perimenopausal women seeking a long-term and also reversible method of contraception. While both IUDs are suitable for many women of all ages, there are differences in their mechanisms of action, physical characteristics, and clinical effects that make each more or less appropriate for certain women.
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PMID:Compelling reasons for recommending IUDs to any woman of reproductive age. 1199 35

Outlined is a protocol for the administration of emergency contraceptive pills. The indication for such treatment is unprotected intercourse within the past 72 hours. Absolute contraindications include the possibility of an existing pregnancy and a family history of stroke, heart attack, thrombophlebitis, breast or endometrial cancer, or liver tumor. Possibly excluded, depending on evaluation by a physician, are women with abnormal vaginal bleeding, active hepatitis, active gallbladder disease, high blood pressure, acute focal migraine, breastfeeding women, and those unable to understand instructions. The recommended regimen consists of six tablets of Ovral (two taken immediately, two more in 12 hours) or 12 tablets of Lo/Ovral, Nordette, or Levlen (four taken immediately, repeat dosage in 12 hours). The extra pills are to be used in cases of vomiting within three hours of pill ingestion. Women with a history of oral contraceptive-related nausea and vomiting should be provided with Compazine. Women should be informed that this method is effective in only about 92% of cases. All women who receive emergency contraception should be counseled that this is strictly a back-up method and helped to formulate a long-term birth control strategy.
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PMID:Emergency contraceptive pills (ECP) protocol. 1228 80

Women 30 years or older have 4 reversible contraceptive methods that are at least as effective as sterilization: oral contraceptives (OCs), the IUD, Norplant implants, and the injectable, Depo-Provera. Physicians have not done a good job educating women about these contraceptive options. 80-95% of women do not know about the key noncontraceptive benefits of OCs. Women delay childbearing longer than did their predecessors. Women who have completed their families and have not reached menopause face 4 key issues about contraceptive selection: risk for unplanned pregnancy, increase in incidence and severity of many gynecologic problems (e.g., irregular bleeding), increased risk of breast cancer and/or ovarian and endometrial cancers; and reduced bone mass with decline in ovarian function. Each woman of advanced reproductive age should be fully aware of all contraceptive options, the benefits and risks linked to each, and the effect of each on her future health, when she chooses her own contraceptive method. Women in their late 20s or early 30s who are not 100% sure that they do not want anymore children should not choose tubal sterilization because it is more or less permanent. Physicians should provide to women considering sterilization information about reversible methods as well. Healthy, nonsmoking women over 40 can safely use OCs. They also derive noncontraceptive health benefits from OC use, e.g., reduced incidence of endometrial and ovarian cancers and of severe rheumatoid arthritis and good menstrual cycle control. The IUD is an option for smokers 35 and older. A copper IUD can be used for up to 10 years. Long-acting progesterone methods (implants and injectables) are linked to an increase of clinical side effects. Depo-Provera is associated with a reduced risk of endometrial cancer. Motivation is required for condom use and periodic abstinence.
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PMID:Contraception in the later reproductive years: a valid aspect of preventive health care. 1228 79

Oral contraceptives (OCs) remain the leading choice of reversible contraception for American women. In the 1999 Contraceptive Technology Update Contraceptive survey, more than 60% of the providers say that 50 or more women leave their offices each month with pill prescriptions in hand. Of the available OCs in the market, a 20-mcg Alesse pill and 20- and 30-mcg Loestrin pills are the top choices among older nonsmoking women because they help them through the perimenopausal stage. Among younger nonsmoking women, the 35-mcg Ortho Tri-Cyclen pill is the top choice because it is effective, leads to few complications and side effects, and has easy-to-use packaging. Research has established that OCs protect women against dysmenorrhea and menorrhagia, menstrual cycle irregularities, iron deficiency anemia, ectopic pregnancy, pelvic inflammatory disease, ovarian cysts, benign breast cancer disease, endometrial cancer, and ovarian cancer. Aside from the noncontraceptive health benefits, OCs have proven valuable in the management of a variety of gynecologic disorders. Providers are moving toward prescription of OCs specifically for noncontraceptive benefits, but respondents are still unwilling to see OCs offered as over-the-counter drugs.
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PMID:Pills remain the top choice among reversible contraceptive options. 1229 Mar 80


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