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

The US Food and Drug Administration finally approved the injectable contraceptive Depo-Provera (DMPA) in October 1992, 25 years after its introduction. Women return to a health facility every 90 days for an intramuscular injection of 150 mg DMPA, which provides them 99% effective contraception. Menstrual changes and spotting are the leading reasons for DMPA discontinuation. Eventually, more than 50% of DMPA users develop amenorrhea. During the first year, women gain about 2 kg and weight increases as time passes. Weight gain is the second leading reason for DMPA discontinuation. DMPA may adversely affect glucose tolerance in women at risk for diabetes, but it does not affect cardiovascular or metabolic functions. It may increase the risk of osteoporosis. A rare side effect is convulsions. 1-10% of DMPA users have other central nervous system effects, such as headaches, dizziness, and depression. Itching and rashes may develop. Fertility returns within 1 year after discontinuation. DMPA is linked to low birth weight. It apparently does not harm breast-fed infants or hinder lactation. A World Health Organization study shows that DMPA users less than 35 years old experience a slight increase in breast cancer but a reduced incidence of endometrial cancer. Nurses are instrumental in guiding women as they choose DMPA and in informing them about its potential side effects, including breast cancer risk. They must screen women for pregnancy and evaluate their risk of breast cancer. They must determine whether women are able to return every 3 months for DMPA injections. Women who select DMPA must use other contraception, e.g., barrier protection, within the first 24 hours after initial injection. Nurses should counsel them about the likely menstrual changes to reduce the likelihood of dissatisfaction. They should recommend a daily dose of 1200 mg of elemental calcium and daily exercise of long bones to minimize the risk of developing osteoporosis.
 ...
PMID:Depo-Provera. 849 47

This study presents a review of current clinical evidence on the usefulness of Depo Provera (medroxyprogesterone acetate, DMPA), a long-term method of reversible contraception. It is taken as an intramuscular long-acting agent (150 mg every 12 calendar weeks). The user failure rate approaches the method failure rate, which varies considerably with age. In terms of metabolic effects, it did not show changes in cholesterol or triglycerides and had no significant effect on hemostasis, which impairs the oral glucose tolerance test (OGTT) glucose response and increases insulin response. There were no significant adverse effects on long term growth and development in DMPA exposed children and no delays in return to fertility. For cancers, controlled surveillance of DMPA users found no overall increased risk of ovarian, liver or cervical cancer and even found a prolonged protective effect in reducing the risk of endometrial cancer. However, increased risk of breast cancer in recent users was observed; this could be due to enhanced detection of breast tumors of women using DMPA. The main DMPA disadvantages are menstrual disturbance and weight gain after 1 year. Bone mineral density (BMD) is found to be significantly lower. DMPA patients' sociodemographic characteristics and behavior placed then at higher risk for adverse pregnancy outcome in low infant birth weight and also possibly in polysyndactyl and chromosomal defects. Thus, for injectable progestogen, the data is again less conclusive. Risks may be similar to POP (progestogen-only contraceptive pill), but did not reach significance in the meta-analysis.
 ...
PMID:Depo Provera. Position paper on clinical use, effectiveness and side effects. 1089 62

Two injectable forms of hormonal contraception, depot medroxyprogesterone acetate (DMPA, Depo-Provera) and medroxyprogesterone acetate/estradiol cypionate (MPA/E(2)C, Lunelle), are now available to American women. Both formulations have demonstrated high degrees of efficacy, safety, and ease of use in international and U.S. trials. Data on DMPA have shown a number of noncontraceptive and therapeutic benefits, the most prominent of which is an 80% reduction in the risk of endometrial cancer. Although such benefits are less documented for MPA/E(2)C, they are expected to be similar to those seen with DMPA and oral contraceptives. Minor side effects of both formulations include menstrual irregularities in the early months of treatment and amenorrhea with DMPA. Patient counseling about the potential for these side effects, as well as possible risks, is important to long-term successful use of these contraceptive methods.
 ...
PMID:Current options for injectable contraception in the United States. 1172 75

A statement released by the Food and Drug Administration (FDA) concerning depot medroxyprogesterone acetate (DMPA) (Depo-Provera) found insufficient evidence linking DMPA to certain carcinoma-in-situ to withhold it from usage as a contraceptive agent. The FDA recommends usage limited to women to whom potential hazards have been fully explained, to those who cannot use other contraceptive methods, and to those who have completed childbearing. Presently 60 countries use DMPA. A recent review suggested that it is a justifiable contraceptive agent, there are few side effects other than irregular uterine bleeding and amenorrhea, and few reports of serious complications even when DMPA is used in larger doses for treatment of endometriosis or endometrial carcinoma. Evidence suggests that although the return of ovulation is slower than after discontinuing oral contraceptives or the IUD, the return rate after 1 year is high. Further evaluations are necessary concerning carcinogenicity and reversibility.
 ...
PMID:Injectable medroxyprogesterone. 1222 96

The Second Asian Regional Workshop on Injectable Contraceptives held in Thailand in November 1981 discussed many scientific aspects of the use of injectable contraceptives, including depot medroxyprogesterone acetate--Depo-Provera (DMPA), norethisterone oenanthate--Norigest (Net-Oen), and newer techniques such as microcapsules and subdermal implants. Injectable contraceptives are applicable for use in both developed and developing countries because they are highly effective, safe, and can be made readily available especially in areas where couples may not have access to other similarly effective methods. Injectables act primarily by temporary inhibition of ovulation. Menstrual disturbances may occur but do not pose health hazards. Delay in return of regular menstrual periods and fertility following discontinuation of DMPA averages about 6 months; the delay is somewhat less for Net-Oen. Side effects are minor and there are no observed clinically significant hormonal or metabolic disturbances. Lactation is not affected and inadvertent administration in pregnant women does not cause congenital abnormalities in the offspring. The long duration of action frees women from the responsibility of pill taking. There has never been any mortality or serious morbidity associated with DMPA and Net-Oen, and there are very few contraindications to their use. The carcinogenic potential in humans have never been established. On the contrary, DMPA may even have a protective effect against endometrial cancer, as it is used to treat this disease. DMPA is currently being used in more than 80 developed and developing countries, but not in the U.S. The ban in the U.S. has caused undue concern among women and health care professionals in developing countries, and has resulted in international criticism that the U.S. practices a "double standard" and that drugs are being "dumped" in unsuspecting Third World countries. The Workshop recommends that continued research and surveillance be carried out to monitor the long-term safety of these drugs. The Workshop members endorse injectable contraceptives as safe and effective and recommend that they be made available to all women.
 ...
PMID:Injectable contraceptives: safe and effective. 1226 96

For 1 week a drug company's representatives, officials from the US Food and Drug Administration (FDA), and other interested individuals debated whether Depo-Provera (medroxyprogesterone acetate or DMPA) can be safely used, but they failed to resolve the issues. "Contraceptive Technology Update" attended these hearings and interviewed witnesses to bring its readers a comprehensive report on the issues. 9 articles summarize the presentations at he hearing. The FDA public board of inquiry sought to resolve the following issues concerning Depo-Provera: in comparison with other contraceptive drugs, do the benefits outweigh the risks; do data from animal studies indicate a potential risk of breast or endometrial cancer in humans from Depo-Provera; can the human studies' data refute the risk of human cancer suggested by the animal data; are there labeling conditions and distribution controls that would permit marketing of Depo-Provera as a safe and effective drug on a limited basis; would marketing approval of Depo-Provera as a contraceptive increase the use of the drug under conditions not stipulated in the approval; does use of Depo-Provera increase the risk of teratogenic effects to a greater extent than other systemic contraceptives in the event of a failure; and is estrogen therapy likely to be prescribed for a significant number of patients using Depo-Provera. The issues raised have blocked marketing of Depo-Provera as a contraceptive in the US for a number of years. In 1968 the Upjohn Company began the lengthly process for having a drug approved for use in the US by filing with the FDA a New Drug Application (NDA) for Depo-Provera's use as a contraceptive. Although Depo-Provera has not been approved for use in the US, Upjohn manufactures the contraceptive in Belgium and France and estimates that more than a million women in 80 countries use the contraceptive. DMPA is still approved as adjunctive therapy for metastatic endometrial carcinoma and renal carcinoma. Because of that approved use, the drug has reportedly been prescribed as a contraceptive in this country, contrary to its current label indications. The FDA's obstetrics and gynecology advisory committee recommended approval of Depo-Provera in 1975, but the Public Citizen Health Research Group and some congressmen asked that the FDA not approve the drug. In 1978 the FDA notified Upjohn that its NDA would not be approved. Upjohn then requested a hearing in the form of a Public Board of Inquiry. The board held the hearing in January 1983. The controversy over Depo-Provera involves noted groups and individuals on both sides.
 ...
PMID:FDA board investigates Depo-Provera safety. 1226 61

Ignorance of the law is 1 of the reasons that more family planning practitioners do not use Depo-Provera, an excellent hormonal preparation and a highly effective contraceptive (99+%). If the Food and Drug Administration (FDA) approves a drug for use in the US, physicians may prescribe that drug for any use they feel is medically justified. The FDA can give its opinion about the drug's safety, but it cannot tell doctors how to use it. The FDA has approved Depo-Provera for use in the US to treat endometriosis and endometrial carcinoma. Thus, physicians who do not use Depo-Provera as a contraceptive have 1 of 2 reasons: either they have not formed an opinion on Depo-Provera's safety and effectiveness as a contraceptive; or they are tacitly admitting that the FDA has more jurisdiction over their practices than it actually does. Some basic information is required if a physician decides to provide Depo-Provera to his/her patients. Depo-Provera should be administered (150 mg intramuscularly) every 90 days for contraception. Women whould be warned in advance to expect erratic bleeding. After 2-3 injections, their periods should decrease or disappear and remain that way as long as they take the injections. Some women will gain weight with Depo-Provera, but the gain rarely exceeds 10 pounds. Others will lose weight. Occasionally, a woman will bleed excessively. In that case, she should contact the clinic and begin receiving daily ethinyl estradiol for 10 days. That will control the bleeding unless she has an underlying pathology. When a woman wants to discontinue Depo-Provera use, she simply does not get her next injection. Her period may not return for 6-10 months. No evidence indicates that Depo-Provera decreases fertility after discontinuation.
 ...
PMID:Depo-Provera highly effective as injectable contraceptive. 1228 Mar 1

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.
 ...
PMID:Contraception in the later reproductive years: a valid aspect of preventive health care. 1228 79

Progestin-only injectables are among the most effective and safe of all contraceptives, yet they are not widely used in many countries. This limited use is in part due to a lack of accurate information about health concerns, inadequate counseling for users about managing side effects, and their limited availability. Where they are available, progestin-only injectables rapidly become one of the preferred methods. Depot-medroxyprogesterone acetate (DMPA) and norethindrone enanthate (NET-EN) are the two progestin-only injectables in use worldwide. The former drug is sold under the brand name Depo-Provera, and the latter as Noristerat. DMPA is delivered in a water-based, crystalline suspension and absorbed gradually by the body. The normal injection of 150 mg is intended to be administered every three months, but contraceptive protection continues for an additional two weeks to provide a grace period for women who are late receiving their next injection. NET-EN is an oily solution which requires a larger needle than DMPA for injection. A 200 mg injection of NET-EN is usually administered every two months. Both of these safe, highly effective drugs are injected in either the upper arm or buttocks. DMPA and NET-EN can be distributed easily in nonclinical settings where nonphysicians can provide them to clients. The main disadvantage of the method is the disruption of the menstrual cycle, but that is generally not a serious medical problem. Focusing mainly upon DMPA, this article includes discussion of menstrual irregularity, the reduced risk of endometrial cancer among DMPA users, and method availability.
 ...
PMID:Progestin-only injectables offer many advantages. 1228 28

New types of contraception approved for use in the US include two long-lasting, hormone-based contraceptives, Depo-Provera and Norplant, and the female condom. The female condom is made of polyurethane, which is thinner, stronger, and a better conductor of heat than latex. Its inner ring fits over the cervix and the outer ring protects the labia and the base of the penis. Its typical-use and perfect-use failure rates are 21-26% and around 5%, respectively. One injection of Depo-Provera blocks ovulation for 3 months. Irregular periods are common with Depo-Provera use. Fertility may not return for 6-12 months after discontinuation. Depo-Provera may protect against endometrial cancer. The 6-capsule system Norplant is inserted subdermally in the arm and releases levonorgestrel for up to 5 years. Since its arrival on the US market, more than 900,000 women have used Norplant. Contraindications to Norplant are liver disease, blood clots, inflammation of the veins, history of breast cancer, or breast feeding in the first 6 weeks postpartum. More than 600,000 US women undergo sterilization annually. 25% of all heterosexually active, fertile women of reproductive age and 60% of these women ages 35-44 have had a tubal ligation. Vasectomy is less risky than tubal ligation. Both vasectomy and tubal sterilization are more than 99% effective. Oral contraceptives (OCs) suppress ovulation. 28% of US women of reproductive age use OCs. OCs are more than 99% effective. OCs appear to increase the risk of blood clots, heart attack, and stroke for smokers over 35. Health benefits of OCs include protection against ovarian cancer, endometrial cancer, pelvic inflammatory disease, ovarian cysts, and benign breast tumors. Barrier methods keep sperm from joining the egg. Latex condoms protect against sexually transmitted diseases (STDs). IUDs interfere with sperm transport and egg fertilization. In the US, there is a perception that IUD use is unsafe. Women with new or multiple partners should use condoms to protect against STDs.
 ...
PMID:Choosing a contraceptive. What's best for you? 1229 May 58


<< Previous 1 2 3 4 5 Next >>