Asunto(s)
Antiinflamatorios no Esteroideos , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/prevención & control , Femenino , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/administración & dosificación , Anticonceptivos Hormonales Orales/efectos adversos , Anticonceptivos Hormonales Orales/administración & dosificación , Factores de Riesgo , Anticoncepción Hormonal/efectos adversosRESUMEN
Oral contraceptive (OC) use can increase resting blood pressure (BP) in females as well as contribute to greater activation of group III/IV afferents during upper body exercise. It is unknown, however, whether an exaggerated BP response occurs during lower limb exercise in OC users. We sought to elucidate the group III/IV afferent activity-mediated BP and heart rate responses while performing lower extremity tasks during early and late follicular phases in young, healthy females. Females not taking OCs (NOC: n = 8; age: 25 ± 4 yr) and those taking OCs (OC: n = 10; age: 23 ± 2 yr) completed a continuous knee extension/flexion passive stretch (mechanoreflex) and cycling exercise with subsystolic cuff occlusion (exercise pressor reflex), which was followed by a 2-min postexercise circulatory occlusion (PECO) (metaboreflex). Data collection occurred on two occasions: once during the early follicular phase (days 1-4) and once during the late follicular phase (days 10-14) of their menstrual cycle (NOC) or during the placebo and active pill phases (OC). Resting mean arterial BP and heart rate were not different between phases in NOC and OC participants (P > 0.05). Hemodynamic responses to metaboreflex, mechanoreflex, and collective exercise pressor reflex activation were not different between phases in both groups (P > 0.05). In conclusion, although OCs are known to increase BP at rest, our findings indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during large, lower limb muscle exercise with or without group III/IV afferent activation in young, healthy females.NEW & NOTEWORTHY Sex differences in the cardiovascular response to exercise have been demonstrated and may be dependent on sex hormone levels. Furthermore, oral contraceptives (OCs) have been shown to exaggerate the blood pressure response to upper extremity exercise. The results of this study indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during lower extremity dynamic exercise or with group III/IV afferent activation in young, healthy females.
Asunto(s)
Ejercicio Físico , Frecuencia Cardíaca , Extremidad Inferior , Humanos , Femenino , Adulto , Adulto Joven , Frecuencia Cardíaca/efectos de los fármacos , Ejercicio Físico/fisiología , Presión Sanguínea/efectos de los fármacos , Músculo Esquelético , Reflejo , Fase Folicular , Anticonceptivos Hormonales Orales/farmacología , Anticonceptivos Hormonales Orales/administración & dosificaciónRESUMEN
Hormonal contraceptive (HC) users have a different ovarian hormonal profile compared to eumenorrheic women. Due to the prevalence of HC use amongst sportswomen, there has been increased research efforts to understand their impact on exercise performance. The aim was to audit this research. Studies identified were assessed for HC type, athlete calibre, performance outcome, study design, and quality of methodological control regarding ovarian hormonal profiles. Sixty-eight different HCs were reported across 61 studies. Monophasic combined oral contraceptive (OCP) pills represented 60% of HCs, followed by other pills [34%, phasic-combined, progestogen-only, and un-specified], phasic and long acting reversible contraceptives [5%, vaginal ring, patch, implant, injection, intrauterine system] and unspecified HCs (1%). Eleven percent of participants using HCs were classified as highly trained or elite/international with no participants being classed as world class. Whilst the number of studies involving HCs has increased two-fold over the past decade, the number of studies ranked as gold standard has not increased (HC; 2003-57%, 2011-55%, 2022-43%. OCP; 2003-14%, 2011-17%, 2022-12%). Future research assessing HCs and exercise performance should adopt high-quality research designs and include a broader range of HCs in highly trained to world-class populations to increase the reach and impact of research in this area.
Asunto(s)
Rendimiento Atlético , Humanos , Femenino , Rendimiento Atlético/fisiología , Ejercicio Físico/fisiología , Agentes Anticonceptivos Hormonales/administración & dosificación , Anticonceptivos Hormonales Orales/administración & dosificación , Proyectos de InvestigaciónRESUMEN
We examined performance across one menstrual cycle (MC) and 3 weeks of hormonal contraceptives (HC) use to identify whether known fluctuations in estrogen and progesterone/progestin are associated with functional performance changes. National Rugby League Indigenous Women's Academy athletes [n = 11 naturally menstruating (NM), n = 13 using HC] completed performance tests [countermovement jump (CMJ), squat jump (SJ), isometric mid-thigh pull, 20 m sprint, power pass and Stroop test] during three phases of a MC or three weeks of HC usage, confirmed through ovulation tests alongside serum estrogen and progesterone concentrations. MC phase or HC use did not influence jump height, peak force, sprint time, distance thrown or Stroop effect. However, there were small variations in kinetic and kinematic CMJ/SJ outputs. NM athletes produced greater mean concentric power in MC phase four than one [+0.41 W·kg-1 (+16.8%), p = 0.021] during the CMJ, alongside greater impulse at 50 ms at phase one than four [+1.7 N·s (+4.7%), p = 0.031] during the SJ, without differences between tests for HC users. Among NM athletes, estradiol negatively correlated with mean velocity and power (r = -0.44 to -0.50, p < 0.047), progesterone positively correlated with contraction time (r = 0.45, p = 0.045), and both negatively correlated with the rate of force development and impulse (r = -0.45 to -0.64, p < 0.043) during the SJ. During the CMJ, estradiol positively correlated to 200 ms impulse (r = 0.45, p = 0.049) and progesterone to mean power (r = 0.51, p = 0.021). Evidence of changes in testing performance across a MC, or during active HC use, is insufficient to justify "phase-based testing"; however, kinetic or kinematic outputs may be altered in NM athletes.
Asunto(s)
Rendimiento Atlético , Fútbol Americano , Ciclo Menstrual , Progesterona , Humanos , Femenino , Ciclo Menstrual/fisiología , Ciclo Menstrual/efectos de los fármacos , Rendimiento Atlético/fisiología , Progesterona/sangre , Adulto Joven , Fútbol Americano/fisiología , Estradiol/sangre , Adulto , Atletas , Anticonceptivos Hormonales Orales/administración & dosificación , Anticonceptivos Hormonales Orales/farmacología , Fuerza Muscular/efectos de los fármacos , Fuerza Muscular/fisiología , Fenómenos Biomecánicos , Estrógenos/sangre , Estrógenos/administración & dosificación , Prueba de EsfuerzoRESUMEN
Oral contraceptive pills, of all types, are used by approximately 151 million women worldwide; however, a clear understanding of the concentrations of endogenous and exogenous hormones across a 28-day combination monophasic oral contraceptive pill pack is not well described. In our study of 14 female participants taking various combination monophasic oral contraceptive pills, we found significant fluctuations in endogenous and exogenous hormone levels throughout the pill cycle. Our analysis revealed significantly greater levels of ethinyl estradiol on the 20th and 21st days of active pill ingestion, compared with days 1-2 (active) and days 27-28 (inactive pill ingestion). Conversely, estradiol concentrations decreased during active pill consumption, while progestin and progesterone levels remained stable. During the 7 days of inactive pill ingestion, estradiol levels rose sharply and were significantly higher at days 27-28 compared with the mid and late active phase time points, while ethinyl estradiol declined and progestin did not change. These findings challenge the previous assumption that endogenous and exogenous hormones are stable throughout the 28-day pill cycle.NEW & NOTEWORTHY The results from this study have wide-ranging implications for research and treatment in women's health including considerations in research design and interpretation for studies including women taking oral contraceptives, the potential for more precise and personalized methods of dosing to reduce unwanted side effects and adverse events, and the potential treatment of a variety of disorders ranging from musculoskeletal to neurological with exogenous hormones.
Asunto(s)
Anticonceptivos Orales Combinados , Estradiol , Etinilestradiol , Ciclo Menstrual , Progesterona , Espectrometría de Masas en Tándem , Humanos , Femenino , Adulto , Anticonceptivos Orales Combinados/administración & dosificación , Espectrometría de Masas en Tándem/métodos , Etinilestradiol/administración & dosificación , Etinilestradiol/sangre , Progesterona/sangre , Ciclo Menstrual/efectos de los fármacos , Ciclo Menstrual/sangre , Adulto Joven , Estradiol/sangre , Cromatografía Liquida/métodos , Progestinas/sangre , Progestinas/administración & dosificación , Anticonceptivos Hormonales Orales/administración & dosificaciónRESUMEN
BACKGROUND: Increased risk of venous thromboembolism (VTE) is a life-threatening side effect for users of oral contraceptives (OCs) or hormone therapy (HT). OBJECTIVES: To investigate the potential for genetic predisposition to VTE in OC or HT users, we conducted a gene-by-environment case-only meta-analysis of genome-wide association studies (GWAS). METHODS: Use or nonuse of OCs (7 studies) or HT (8 studies) at the time of the VTE event was determined by pharmacy records or self-report. A synergy index (SI) was modeled for each variant in each study and submultiplicative/supramultiplicative gene-by-environment interactions were estimated. The SI parameters were first meta-analyzed across OC and HT studies and subsequently meta-analyzed to obtain an overall estimate. The primary analysis was agnostic GWAS and interrogated all imputed genotypes using a P value threshold of <5.0 × 10-8; secondary analyses were candidate-based. RESULTS: The VTE case-only OC meta-analysis included 2895 OC users and 6607 nonusers; the case-only HT meta-analysis included 2434 HT users and 12 793 nonusers. In primary GWAS meta-analyses, no variant reached genome-wide significance, but the smallest P value approached statistical significance: rs9386463 (P = 5.03 × 10-8). We tested associations for 138 candidate variants and identified 2 that exceeded statistical significance (0.05/138 = 3.62 × 10-4): F5 rs6025 (P = 1.87 × 10-5; SI, 1.29; previously observed) and F11 rs2036914 (P = 2.0 × 10-4; SI, 0.91; new observation). CONCLUSION: The candidate variant approach to identify submultiplictive/supramultiplicative associations between genetic variation and OC and HT use identified a new association with common genetic variation in F11, while the agnostic interrogations did not yield new discoveries.
Asunto(s)
Predisposición Genética a la Enfermedad , Estudio de Asociación del Genoma Completo , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/genética , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/inducido químicamente , Femenino , Factores de Riesgo , Adulto , Interacción Gen-Ambiente , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Medición de Riesgo , Anticonceptivos Hormonales Orales/efectos adversos , Anticonceptivos Hormonales Orales/administración & dosificación , Variación Genética , Terapia de Reemplazo de Estrógeno/efectos adversosRESUMEN
This study aimed to explore how natural menstrual cycle phases and dosage of oral hormonal contraceptives (OC) influence the diurnal rhythm of distal skin temperature (DST) under real-life conditions. Participants were 41 healthy females (23.9 ± 2.48 y), comprising 27 females taking monophasic hormonal oral contraceptives (OC users) and 14 females with menstrual cycles (non-OC users). Wrist DST was continuously recorded and averaged over two consecutive 24-hour days during (pseudo)follicular and (pseudo)luteal menstrual phases. Diurnal rhythm characteristics, i.e. acrophase and amplitude, describing timing and strength of the DST rhythm, respectively, were calculated using cosinor analysis. Results show that non-OC users experienced earlier diurnal DST maximum (acrophase, p = 0.019) and larger amplitude (p = 0.016) during the luteal phase than during the follicular phase. This was observed in most (71.4%) but not all individuals. The OC users showed no differences in acrophase or amplitude between pseudoluteal and pseudofollicular phases. OC users taking a higher dosage of progestin displayed a larger amplitude for DST rhythm during the pseudoluteal phase (p = 0.009), while estrogen dosage had no effect. In conclusion, monophasic OC cause changes in diurnal DST rhythm, similar to those observed in the luteal phase of females with menstrual cycles, suggesting that synthetic progestins act in a similar manner on skin thermoregulation as progesterone does.
Asunto(s)
Ritmo Circadiano , Ciclo Menstrual , Temperatura Cutánea , Humanos , Femenino , Ritmo Circadiano/efectos de los fármacos , Ritmo Circadiano/fisiología , Adulto , Temperatura Cutánea/efectos de los fármacos , Adulto Joven , Ciclo Menstrual/efectos de los fármacos , Anticonceptivos Hormonales Orales/farmacología , Anticonceptivos Hormonales Orales/administración & dosificación , Fase Luteínica/efectos de los fármacos , Fase Luteínica/fisiología , Regulación de la Temperatura Corporal/efectos de los fármacosRESUMEN
BACKGROUND: Extensive evidence is available on hormonal contraceptive (HC) use and the risk of a first venous thromboembolism (VTE) event. Despite recommendations to discontinue combined HC (CHC) use, some women continue or start its use after a first VTE. OBJECTIVES: We aimed to evaluate the VTE recurrence risk associated with HC use in premenopausal women. METHODS: Premenopausal women with a first VTE included in the Multiple Environmental and Genetic Assessment of Venous Thrombosis study between 1999 and 2004 were followed for a recurrence until 2010. Data on HC use were available through linkage to the Dutch Foundation for Pharmaceutical Statistics. The risk of recurrence was assessed 1) during anticoagulant therapy and 2) after cessation of anticoagulant therapy. Time-dependent Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% CIs adjusted for age and body mass index at baseline and thromboprophylaxis use during follow-up. RESULTS: Six hundred fifty women were uniquely linked and followed for a total of 3538 person-years (median, 6.1 years), during which 57 VTE recurrences occurred. Five occurred (8.8%) during anticoagulation treatment, with no clear risk difference for CHC use vs nonuse (HR, 0.8; 95% CI, 0.1-8.2). After anticoagulation cessation, CHC use was associated with a 2.4-fold higher risk of recurrence (HR, 2.4; 95% CI, 1.2-5.0) compared with nonuse. Recurrence risk for levonorgestrel-releasing intrauterine device use was similar to that for nonuse (HR, 0.9; 95% CI, 0.3-3.1). CONCLUSION: CHC use after a first VTE is safe during anticoagulant use but substantially increases the risk of a recurrent VTE event in absence of anticoagulant use. This study adds to the evidence regarding the use of a levonorgestrel-releasing intrauterine device as a safe alternative.
Asunto(s)
Anticoagulantes , Premenopausia , Modelos de Riesgos Proporcionales , Recurrencia , Tromboembolia Venosa , Humanos , Femenino , Adulto , Factores de Riesgo , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/epidemiología , Países Bajos , Trombosis de la Vena/prevención & control , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/epidemiología , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven , Anticonceptivos Hormonales Orales/efectos adversos , Anticonceptivos Hormonales Orales/administración & dosificación , Medición de Riesgo , Agentes Anticonceptivos Hormonales/efectos adversos , Agentes Anticonceptivos Hormonales/administración & dosificación , Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Orales Combinados/administración & dosificaciónRESUMEN
Should Combined Hormonal Contraception Be Stopped in the Perioperative Period?A 34-year-old woman is scheduled to undergo surgery to manage a torn anterior cruciate ligament in her left knee. Her only medication is an estrogen- and progestin-containing oral contraceptive pill (OCP). Should she stop her combined oral contraception to reduce the risk of a postoperative blood clot?
Asunto(s)
Periodo Perioperatorio , Humanos , Femenino , Adulto , Anticonceptivos Hormonales Orales/administración & dosificación , Anticonceptivos Hormonales Orales/efectos adversos , Anticonceptivos Orales Combinados/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Anticoncepción HormonalRESUMEN
BACKGROUND: The long-term use of contraceptive methods that contain estrogens, progestogens or combinations of the above among women aged 15 to 49 years is extensive. Both estrogens and progestogens affect bone metabolism. OBJECTIVE: To systematically investigate and appraise the quality of the available evidence from animal studies regarding the impact of exogenous administration of female sex hormones on the rate of orthodontic tooth movement and root resorption. SEARCH METHODS: Search without restriction in seven databases (including grey literature) and hand searching were performed until May 2021. SELECTION CRITERIA: We looked for controlled animal studies investigating the effect from exogenous administration of formulations containing female sex hormones on the rate of orthodontic tooth movement and root resorption. DATA COLLECTION AND ANALYSIS: After study retrieval and selection, relevant data was extracted, and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. The quality of available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation. RESULTS: Three studies were identified, all being at unclear risk of bias. Overall, administration of progesterone and the combinations of estradiol with norgestrel and desogestrel were shown to significantly decrease the rate of orthodontic tooth movement when given for longer periods (>3 weeks). Inconsistent information was detected for shorter periods of consumption. Estradiol, with desogestrel use, resulted in less root resorption. The quality of the available evidence was considered to be low. CONCLUSIONS: Exogenous administration of female sex hormones may decelerate in the long term the rate of tooth movement and decrease orthodontically induced root resorption in animals. Until more information becomes available, an orthodontist should be able to identify a patient consuming such substances and understand the potential clinical implications and adverse effects that may arise. REGISTRATION: PROSPERO: CRD42017078208; https://clinicaltrials.gov/.
Asunto(s)
Anticonceptivos Hormonales Orales/administración & dosificación , Progestinas/efectos adversos , Resorción Radicular/epidemiología , Movilidad Dentaria/epidemiología , Adolescente , Adulto , Animales , Animales de Laboratorio , Anticonceptivos Hormonales Orales/efectos adversos , Modelos Animales de Enfermedad , Femenino , Hormonas Esteroides Gonadales , Humanos , Persona de Mediana Edad , Resorción Radicular/etiología , Factores de Tiempo , Movilidad Dentaria/etiología , Adulto JovenRESUMEN
OBJECTIVES: Progestin-only pills do not increase the risk of venous thromboembolism, stroke, and myocardial infarction but are associated with poor cycle control. A novel estrogen-free pill containing only drospirenone (DRSP) to improve bleeding patterns and tolerability and reduce discontinuation rates has been introduced into the market. The present study aims to describe the improvement in the acceptability of this DRSP-only pill, e.g. regarding the bleeding profile and the reduction in discontinuation rates due to unacceptable bleeding compared to desogestrel (DSG). STUDY DESIGN: Double-blind, double-dummy prospective phase III study in healthy women aged 18-45 years evaluating a total of 858 women with 6691 DRSP and 332 women with 2487 DSG treatment cycles. RESULTS: Overall, 82 (9.6%) women in the DRSP group and 44 (13.3%) women in the DSG group experienced treatment-emergent adverse events (TEAEs) leading to premature termination of the trial meaning that 32% more women in the DRSP group finished the trial in comparison to the DSG group (based on the AUC of Kaplan-Meier's curves). Discontinuation rates due to abnormal bleeding were 3.7% for DRSP and 7.3% for DSG users. This is a 55.7% lower discontinuation rate in the DRSP group compared to the DSG group. CONCLUSIONS: This report describes the improvement in acceptability and bleeding profile of women using the new DRSP-only oral contraceptive compared to DSG, providing a better quality of life and adherence to the contraceptive method as demonstrated by lower discontinuation rates of women using the estrogen-free DRSP-only pill.
Asunto(s)
Androstenos/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Desogestrel/efectos adversos , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Hemorragia Uterina/inducido químicamente , Adulto , Androstenos/administración & dosificación , Anticonceptivos Hormonales Orales/administración & dosificación , Desogestrel/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Cumplimiento de la Medicación , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Estudios ProspectivosRESUMEN
PURPOSE: To describe trends in hormonal contraceptive use, incidence of thromboembolism and presence of risk factors for thromboembolism among the users in Estonia. MATERIAL AND METHODS: Data of 223 312 female patients aged 15-49 years in 2005-2019 from national health insurance databases was derived. Annual prevalence rates of hormonal contraceptive users, incidence rates of thromboembolism and prevalence rates of risk factors were calculated. RESULTS: Between 2005-2019 usage of progestogen-only contraceptives (POCs) increased steadily (from 24 to 135 users per 1000 population), whereas combined hormonal contraceptive (CHC) use declined (from 209 in 2012 to 161 users per 1000 population in 2019). During the study period, 390 cases of venous thromboembolism and 108 arterial thromboembolism coincided with hormonal contraceptive use. Incidence rate for venous thromboembolism was 5.0 (95% CI 4.5-5.5) and for arterial thromboembolism 1.4 per 10 000 person-years (95% CI 1.1-1.7) among hormonal contraceptive users. Age adjusted incidence of venous thromboembolism among CHC users was 5.8 (95% CI 4.1-8.2) times higher than in POC users. Among CHC users, 10.3% had more than one risk factor for thrombosis. CONCLUSIONS: In regards to the risk of thromboembolism, wider use of POCs and declining prevalence of CHCs in Estonia is positive trend. Still, women with history of thrombosis receiving CHC is a serious concern.
Asunto(s)
Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Anticoncepción Hormonal/tendencias , Tromboembolia/inducido químicamente , Tromboembolia Venosa/inducido químicamente , Adolescente , Adulto , Anticonceptivos Hormonales Orales/administración & dosificación , Estonia/epidemiología , Femenino , Anticoncepción Hormonal/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Vigilancia de la Población , Factores de Riesgo , Tromboembolia/epidemiología , Tromboembolia Venosa/epidemiología , Adulto JovenAsunto(s)
Androstenos/administración & dosificación , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Hormonales Orales/administración & dosificación , Anticonceptivos Orales/administración & dosificación , Estetrol/administración & dosificación , Administración Oral , Androstenos/efectos adversos , Anticonceptivos Orales/efectos adversos , Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Esquema de Medicación , Interacciones Farmacológicas , Estetrol/efectos adversos , Femenino , HumanosRESUMEN
OBJECTIVE: To assess whether the duration, recency, or type of hormonal contraceptive used is associated with antimüllerian hormone (AMH) levels, given that the existing literature regarding the association between hormonal contraceptive use and AMH levels is inconsistent. DESIGN: Cross-sectional study. SETTING: Baseline data from the Study of the Environment, Lifestyle and Fibroids Study, a 5-year longitudinal study of African American women. PATIENT(S): The patients were 1,643 African American women aged 23-35 years at the time of blood drawing (2010-2012). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Serum AMH level was measured by an ultrasensitive enzyme-linked immunosorbent assay. Linear regression models were used to estimate percent differences in mean AMH levels and 95% confidence intervals (CIs) according to use of hormonal contraceptives, with adjustment for potential confounders. RESULT(S): In multivariable-adjusted analyses, current users of hormonal contraceptives had 25.2% lower mean AMH levels than non-users of hormonal contraceptives (95% CI: -35.3%, -13.6%). There was little difference in AMH levels between former users and non-users of hormonal contraceptives (-4.4%; 95% CI: -16.3%, 9.0%). AMH levels were not appreciably associated with cumulative duration of use among former users or time since last use among non-current users. Current users of combined oral contraceptives (-24.0%; 95% CI: -36.6%, -8.9%), vaginal ring (-64.8%; 95% CI: -75.4%, -49.6%), and depot medroxyprogesterone acetate (-26.7%; 95% CI: -41.0%, -8.9%) had lower mean AMH levels than non-users. CONCLUSION(S): The present data suggest that AMH levels are significantly lower among current users of most forms of hormonal contraceptives, but that the suppressive effect of hormonal contraceptives on AMH levels is reversible.
Asunto(s)
Hormona Antimülleriana/sangre , Agentes Anticonceptivos Hormonales/administración & dosificación , Anticonceptivos Hormonales Orales/administración & dosificación , Adulto , Negro o Afroamericano , Biomarcadores/sangre , Agentes Anticonceptivos Hormonales/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Estudios Transversales , Regulación hacia Abajo , Esquema de Medicación , Duración de la Terapia , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Factores de Tiempo , Adulto JovenRESUMEN
Most patients can safely begin using hormonal contraception at any point in their menstrual cycle. An evidence-based, flexible, patient-centered approach to initiating contraception promotes health and enhances patients' reproductive autonomy. A recent Papanicolaou test is not necessary before prescribing hormonal contraception. Most patients can begin using progestin-only contraceptives immediately after childbirth. Patients can begin any appropriate contraceptive method immediately after an abortion or early pregnancy loss, except for an intrauterine device following septic abortion. Delaying contraception to wait for the next menses or for an appointment creates unnecessary barriers for patients. Clinicians can facilitate the use of hormonal contraception by providing anticipatory guidance about common side effects (e.g., spotting, other menstrual cycle changes), giving comprehensive information about available contraceptive choices, honoring patients' preferences, and eliminating office-related barriers. Prescribing or dispensing a one-year supply of contraceptives lowers costs and improves adherence. Counseling via telemedicine or a patient portal eliminates unnecessary office visits.
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Anticonceptivos Hormonales Orales/administración & dosificación , Anticoncepción Hormonal/métodos , Anticoncepción Hormonal/psicología , Dispositivos Intrauterinos , Autonomía Personal , Guías de Práctica Clínica como Asunto , Embarazo no Deseado/psicología , Adulto , Consejo , Curriculum , Educación Médica Continua , Femenino , Personal de Salud/educación , Humanos , Persona de Mediana Edad , EmbarazoRESUMEN
This study aimed to evaluate the efficacy and adverse effects of dienogest for the treatment of endometriomas. Dienogest (2 mg/day) was administered to patients with endometrioma continuously through the 6-month study period. The patients were prospectively examined on the efficacy and side effects at baseline, at third months, and sixth months of the treatment. Twenty-four out of 30 patients were able to complete the study. The mean volume of the endometrioma decreased significantly from 112.63 ± 161.31 cm³ at baseline to 65.47 ± 95.69 cm³ at a 6-month follow-up (-41%) (p = .005). The VAS score for pelvic pain decreased significantly from 7.50 to 3.00 (p < .001) at the sixth months of treatment. The most common side effects were menstrual irregularities. Laboratory parameters did not change during the study. Dienogest considered being effective for 6 months of use in decreasing the size of endometrioma, reducing endometriosis-associated pain with a favourable safety and tolerability profile.Impact statementWhat is already known on this subject? Laparoscopic excisional surgery for endometrioma is currently the most valid approach in the treatment of endometriomas. However, there are concerns about ovarian reserve damage during surgery.What do the results of this study add? Dienogest considered being effective in decreasing the size of endometrioma, reducing endometriosis-associated pain with a favourable safety and tolerability profile. Long-term use of dienogest in younger patients with endometriomas who are yet to give birth may reduce the possibility of surgery by reducing the size of the endometriomas and may preserve ovarian reserve.What are the implications of these findings for clinical practice and/or further research? Dienogest may reduce the incidence of infectious complications such as pelvic abscess after oocyte retrieval and the surgical procedures in infertile patients with endometrioma.
Asunto(s)
Anticonceptivos Hormonales Orales/administración & dosificación , Endometriosis/tratamiento farmacológico , Endometrio/patología , Nandrolona/análogos & derivados , Dolor Pélvico/tratamiento farmacológico , Enfermedades Uterinas/tratamiento farmacológico , Adulto , Anticonceptivos Hormonales Orales/efectos adversos , Endometriosis/complicaciones , Endometriosis/patología , Femenino , Humanos , Trastornos de la Menstruación/inducido químicamente , Nandrolona/administración & dosificación , Nandrolona/efectos adversos , Tamaño de los Órganos/efectos de los fármacos , Dimensión del Dolor , Dolor Pélvico/etiología , Dolor Pélvico/patología , Estudios Prospectivos , Resultado del Tratamiento , Enfermedades Uterinas/complicaciones , Enfermedades Uterinas/patologíaRESUMEN
OBJECTIVE: To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population, and to assess the impact of common PCOS treatments on sexual function. DESIGN: Secondary analysis of a randomized controlled trial, oral contraceptive pills and weight loss in PCOS. SETTING: Two academic medical centers. PATIENTS: Women with PCOS (N = 114) defined by the Rotterdam criteria. INTERVENTIONS: Continuous oral contraceptive pill (OCP) or intensive lifestyle modification (Lifestyle) or the combination (Combined) for 16 weeks. MAIN OUTCOME MEASURES: Change in Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores after 16 weeks. RESULTS: There was no change in total FSFI or FSDS-R score in any treatment group; however, an increase in the FSFI desire domain subscore was observed in the Lifestyle and Combined treatments, indicating improved sexual desire over the 16-week period. Overall, 33 participants (28.9%) met criteria for sexual dysfunction by FSFI criteria (baseline score ≤26.55). Among this group, FSFI score improved after 16 weeks of Lifestyle and Combined treatments. There was no change in prevalence of sexual dysfunction in treatment groups at 16 weeks. Use of OCPs did not alter FSFI scores. CONCLUSION(S): Female sexual dysfunction is highly prevalent among women with PCOS. Our findings suggest that common treatments for PCOS, including intensive lifestyle modification and the combination of intensive lifestyle modification and OCPs, have the potential to improve sexual function in these women; the mechanism for these improvements is likely multifactorial. CLINICAL TRIAL REGISTRATION NUMBER: NCT00704912.
Asunto(s)
Anticonceptivos Hormonales Orales/administración & dosificación , Síndrome del Ovario Poliquístico/epidemiología , Síndrome del Ovario Poliquístico/terapia , Conducta de Reducción del Riesgo , Disfunciones Sexuales Fisiológicas/epidemiología , Disfunciones Sexuales Fisiológicas/terapia , Adulto , Índice de Masa Corporal , Terapia Combinada/métodos , Femenino , Humanos , Libido/efectos de los fármacos , Libido/fisiología , Obesidad/epidemiología , Obesidad/fisiopatología , Obesidad/terapia , Síndrome del Ovario Poliquístico/fisiopatología , Disfunciones Sexuales Fisiológicas/fisiopatología , Pérdida de Peso/fisiologíaRESUMEN
BACKGROUND: Hereditary hemochromatosis typically presents in adulthood with organ damage secondary to iron overload. In women, menstrual periods are a protective mechanism allowing for monthly loss of iron stores. CASE: We report the case of a female adolescent whose family history, clinical presentation, and laboratory investigation revealed a diagnosis of hereditary hemochromatosis and von Willebrand disease. For control of heavy menstrual bleeding, menstrual suppression was started with a subsequent increase of her ferritin levels. SUMMARY AND CONCLUSION: No significant data exist regarding the management of women with hereditary hemochromatosis who require menstrual suppression. This case highlights the difficulty in balancing the need for hormonal menstrual suppression with its effect on treatment choices, monitoring, and managing iron levels.
Asunto(s)
Anticonceptivos Hormonales Orales/administración & dosificación , Dismenorrea/tratamiento farmacológico , Hemocromatosis/diagnóstico , Menorragia/tratamiento farmacológico , Enfermedades de von Willebrand/diagnóstico , Dismenorrea/etiología , Femenino , Ferritinas/sangre , Hemocromatosis/complicaciones , Humanos , Menorragia/etiología , Adulto JovenRESUMEN
Oral contraceptives (OCs) have been associated with long-term lower endometrial cancer risk; relatively little is known about associations with more recent OC formulations and associations with longer-term risk. A total of 107,069 women from the Nurses' Health Study II recalled OC use from age 13 to baseline (1989); biennial questionnaires updated data on OC use until 2009. OCs were classified by estrogen and progestin type, dose, and potency based on reported brand. 864 incident endometrial cancer cases were identified through 2017. Multivariable Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals [95% CI] for the association of OC use with endometrial cancer risk. OC use was associated with lower endometrial cancer risk (ever use, HR 0.77 [95% CI 0.65-0.91]; >10 years of use, 0.43 [0.32-0.58] vs. never OC use). Inverse associations for duration were evident regardless of time since last use. Longer durations (> 5 years) of ethinyl estradiol (0.52 [0.41-0.67]) and second-generation progestins (0.43 [0.30-0.61]), both versus never use, were more strongly associated with lower risk than mestranol (0.66 [0.50-0.88], p-het = 0.01) and first-generation progestins (0.62 [0.49-0.78], p-het = 0.03). Inverse associations were generally observed for cross-classified cumulative average estrogen and progestin dose and potency (< vs. ≥ median; ever use vs. never OC use), with the exception of high estrogen and low progestin dose. OCs were associated with lower endometrial cancer risk, independent of time since last use. Use of ethinyl estradiol and second-generation progestins were more strongly inversely associated with risk compared with older formulations.
Asunto(s)
Anticonceptivos Hormonales Orales/efectos adversos , Neoplasias Endometriales/inducido químicamente , Adulto , Anciano , Estudios de Cohortes , Anticonceptivos Hormonales Orales/administración & dosificación , Neoplasias Endometriales/epidemiología , Estrógenos/administración & dosificación , Estrógenos/efectos adversos , Etinilestradiol/administración & dosificación , Etinilestradiol/efectos adversos , Femenino , Humanos , Mestranol/administración & dosificación , Mestranol/efectos adversos , Persona de Mediana Edad , Progestinas/administración & dosificación , Progestinas/efectos adversos , Estudios ProspectivosRESUMEN
The use of oral contraceptives (OCs) by female athletes may lead to improved iron status, possibly through the regulation of hepcidin by sex hormones. The present work investigates the response of hepcidin and interleukin-6 (IL-6) to an interval exercise in both phases of the OC cycle. Sixteen endurance-trained OC users (age 25.3 ± 4.7 years; height 162.4 ± 5.7 cm; body mass 56.0 ± 5.7 kg; body fat percentage 24.8 ± 6.0%; peak oxygen consumption [VO2peak ]: 47.4 ± 5.5 mL min-1 kg-1 ) followed an identical interval running protocol during the withdrawal and active pill phases of the OC cycle. This protocol consisted of 8 × 3 minutes bouts at 85% VO2peak speed with 90 seconds recovery intervals. Blood samples were collected pre-exercise, and at 0 hour, 3 hours, and 24 hours post-exercise. Pre-exercise 17ß-estradiol was lower (P = .001) during the active pill than the withdrawal phase (7.91 ± 1.81 vs 29.36 ± 6.45 pg/mL [mean ± SEM]). No differences were seen between the OC phases with respect to hepcidin or IL-6 concentrations, whether taking all time points together or separately. However, within the withdrawal phase, hepcidin concentrations were higher at 3 hours post-exercise (3.33 ± 0.95 nmol/L) than at pre-exercise (1.04 ± 0.20 nmol/L; P = .005) and 0 hour post-exercise (1.41 ± 0.38 nmol/L; P = .045). Within both OC phases, IL-6 was higher at 0 hour post-exercise than at any other time point (P < .05). Similar trends in hepcidin and IL-6 concentrations were seen at the different time points during both OC phases. OC use led to low 17ß-estradiol concentrations during the active pill phase but did not affect hepcidin. This does not, however, rule out estradiol affecting hepcidin levels.