RESUMO
OBJECTIVE: To determine the influence of depot medroxyprogesterone acetate (MPA) on bone mineral density when used as a contraceptive method. DESIGN: Cross-sectional study. SETTING: Academic tertiary-care hospital. PATIENT(S): Fifty premenopausal women who had used depot MPA as a contraceptive method for > or =1 year and 50 women who had never used hormonal contraceptive methods. INTERVENTION(S): Bone mineral density was evaluated at the midshaft and at the distal radius of the nondominant forearm using single x-ray absorptiometry. MAIN OUTCOME MEASURE(S): Bone mineral density. RESULT(S): Bone mineral density at the midshaft of the forearm was lower in depot MPA users than in women who had never used hormonal contraceptive methods, but the difference was not statistically significant. At the distal portion, bone mineral density was significantly lower in the study group. The duration of depot MPA use was not related to bone mineral density. CONCLUSION(S): Women > or =35 years of age presented with a lower bone mineral density only at the distal portion of the forearm after the use of depot MPA for > or =1 year. However, this decrease was not related to the duration of depot MPA use. It is not possible to conclude that women who use depot MPA are at risk of osteoporosis.
PIP: The impact of depot medroxyprogesterone acetate use on bone mineral density was assessed in a cross-sectional study of 100 women recruited from a teaching hospital in Campinas, Brazil, during 1996-98. Bone mineral density, as evaluated at the midshaft and distal radius of the nondominant forearm by single x-ray absorptiometry, was compared in 50 women 35-45 years of age who had been using Depo-Provera for contraception for 1 year or more (mean duration, 46.4 +or- 38.6 months) but had never used any other hormonal method and 50 age- and weight-matched women who had never used any form of hormonal contraception. Although mean bone mineral density at the midshaft of the forearm was lower in Depo-Provera users than nonusers of hormonal contraception (0.459 +or- 0.042 vs. 0.474 +or- 0.049 g/sq. cm), the difference was not statistically significant. At the distal portion, bone mineral density was significantly lower in Depo-Provera users than nonusers of hormonal methods (0.362 +or- 0.040 vs. 0.392 +or- 0.049 g/sq. cm, p 0.001). The duration of Depo-Provera use was not related to bone mineral density, even when women had used the method for more than 5 years. Multiple regression analysis indicated that 4 pregnancies, White race, and Depo-Provera use were significantly associated with lower bone mineral density at the midshaft section of the forearm; at the distal section of the forearm, these variables were Depo-Provera use, more than 4 pregnancies, White race, older age at menarche, and habitual coffee drinking. These findings do not provide sufficient evidence to conclude that Depo-Provera users are at increased risk of osteoporosis.
Assuntos
Densidade Óssea/efeitos dos fármacos , Anticoncepcionais Femininos/farmacologia , Antebraço , Acetato de Medroxiprogesterona/farmacologia , Rádio (Anatomia)/efeitos dos fármacos , Ulna/efeitos dos fármacos , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Pré-Menopausa , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To analyse efficacy, tolerance and adverse events of reversible contraceptives in women with cardiac disease. METHODS: We studied prospectively during 24-39 (mean = 29) months, 89 women with heart disease with a mean age of 25.6 (16-42) years. Rheumatic heart disease was present in 73 (82%) cases, congenital heart disease in 11 (11%), coronary artery disease in 2 (2%) and cardiomyopathy in 3 (3%) case. The patients were divided in three groups: GCO--35 patients taking combined oral contraceptives (30 micrograms ethinyl estradiol and 75 micrograms gestodene--COs); GIT--27 using injectable progestagens (depot medroxyprogesterone acetate-DMPA) and GUID--27 with intrauterine device (IUD). RESULTS: In GCO occurred 4 (11.4%) cases of arterial hypertension, 1 (2.8%) of a transient cerebral isquemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amnorrhea e 1 (2.8%) pregnancy. Interruption of this method occurred in 4 (11.4%) cases due to hypertension (2), pregnancy (1) and amenorrhea (1). In group GIT there were 2 (7.4%) cases of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 (18.5%) due to amnorrhea (2), weight gain (2) and headache (1). In GUID there was 1 (3.7%) case of infeccion, 1 (3.7%) pregnancy and 1 (3.7%) spontaneous expulsion of IUD. Interruption of use took place in 3 (11.1%) cases due to infeccion, pregnancy and expulsion. The comparation between the groups demonstrated a difference in the incidence of amenorrhea (p < 0.005) and descontinuation of use of the method (p < 0.025). CONCLUSION: Use of reversible contraceptives in heart disease women was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups, however intolerance was more observed in GIT.
PIP: The aim of this study was to analyze efficacy, tolerance, and adverse events of reversible contraceptives in women with cardiac disease. The authors studied prospectively, during a period of 24-39 (mean = 29) months, 89 women with heart disease of mean age 25.6 (16-42) years. Rheumatic heart disease was present in 73 cases (82%), congenital heart disease in 11 (11%), coronary artery disease in 2 (2%), and cardiomyopathy in 3 (3%). The patients were divided into three groups: GCO--35 patients taking combined oral contraceptives (30 mcg ethinyl estradiol and 75 mg gestodene); GIT--27 patients using injectable progestagens (depot medroxyprogesterone acetate); and GUID--27 patients with IUDs. In the GCO group were found 4 cases (11.4%) of arterial hypertension, 1 (2.8%) of a transient cerebral ischemic attack, 3 (8.5%) of spotting, 1 (2.8%) of amenorrhea, and 1 (2.8%) of pregnancy. Interruption of this method occurred in 4 cases (11.4%): 2 due to hypertension, 1 due to pregnancy, and 1 due to amenorrhea. In the GIT group there were 2 cases (7.4%) of arterial hypertension, 18 (66.6%) of amenorrhea, and 3 (11.1%) of spotting. Interruption of use occurred in 5 cases (18.5%): 2 due to amenorrhea, 2 due to weight gain, and 1 due to headache. In the GUID group there was 1 case (3.7%) of infection, 1 (3.7%) of pregnancy, and 1 (3.7%) of spontaneous expulsion of the IUD. Interruption of use took place in 3 cases (11.1%): 1 due to infection, 1 due to pregnancy, and 1 due to expulsion. The comparison between the groups demonstrated a difference in the incidence of amenorrhea (p 0.005) and method discontinuation (p 0.025). Use of reversible contraceptives in women with heart disease was associated with an acceptable cardiovascular risk. Efficacy and side effects of the methods were comparable in the groups; however, intolerance was observed more in the GIT group. (author's modified)
Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Cardiopatias , Dispositivos Intrauterinos/efeitos adversos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Gravidez , Estudos Prospectivos , Resultado do TratamentoRESUMO
PIP: Family planning providers do not agree on whether it is good clinical practice to administer Norplant or Depo-Provera to mothers shortly after delivery. Manufacturers of both contraceptives recommend that providers not prescribe them before 6 weeks postpartum for lactating mothers. The hormones enter the breast milk, but the amount is minimal, and no studies show the small amount of hormones to be harmful. Some providers point to this lack of data as a reason to prescribe them to mothers immediately after delivery because progestin-only pills do neat adversely affect breast feeding. Some providers even claim Norplant should be inserted no later than 3 weeks. On the other hand, other providers, like a physician from Chile, stress that the lack of studies does not mean it is safe, just that there have not been enough studies. The Chilean physician is investigating the effect of hormones on infant health and central nervous system development. A nurse midwife at the University Medical Center in Jacksonville, Florida, reports that no woman using Depo-Provera has complained of breast-feeding problems. More than 50% of postpartum women leave this hospital after receiving an injection of Depo-Provera and those who do not come back for their 3-month injection are those who did not receive proper prenatal counseling about its side effects. The most upsetting side effect is bleeding which becomes less stressful with adequate counseling. Depo-provera extends the normal postpartum bleeding by a month. A director of services at a family planning clinic in San Marcos, Texas, notes that proper counseling, both before insertion and before removal, is also the key to proper management of Norplant acceptors. Providers at this clinic insert it 6 weeks postpartum. Hispanic women in San Marcos are concerned about bleeding because their partners do not want to have sex with a bleeding partner. Another side effect concerning clients is weight gain.^ieng
Assuntos
Aleitamento Materno , Aconselhamento , Estudos de Avaliação como Assunto , Lactação , Acetato de Medroxiprogesterona , Mães , Período Pós-Parto , Instituições de Assistência Ambulatorial , América , Biologia , Chile , Anticoncepção , Anticoncepcionais , Anticoncepcionais Femininos , Países Desenvolvidos , Países em Desenvolvimento , Características da Família , Serviços de Planejamento Familiar , Relações Familiares , Florida , Saúde , Planejamento em Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , América do Norte , Fenômenos Fisiológicos da Nutrição , Organização e Administração , Pais , Fisiologia , Gravidez , Reprodução , América do Sul , Estados UnidosRESUMO
Preliminary results of a study of the possible relationship of depot-medroxy-progesterone acetate (DMPA) to invasive cervical cancer are presented. The findings are based on data from three participating centres in Thailand and one in Mexico. A relative risk for cervical cancer of 1.2 was observed in women who had ever used DMPA; this was not statistically significant. No consistent increase in risk with duration of use was observed, although a relative risk of 2 was found in women who had used DMPA for more than 5 years. This observed increase in risk was confined to women who were aged under 46 years or who had first been exposed to DMPA before 30 years of age. These findings are based on small numbers of subjects, and may not represent a causal relationship.
Assuntos
Anticoncepcionais Femininos/efeitos adversos , Medroxiprogesterona/análogos & derivados , Neoplasias do Colo do Útero/induzido quimicamente , Preparações de Ação Retardada , Feminino , Humanos , Medroxiprogesterona/efeitos adversos , Acetato de Medroxiprogesterona , México , Risco , Tailândia , Neoplasias do Colo do Útero/epidemiologiaRESUMO
The preliminary results of a study of the incidence of breast cancer in relation to use of depot-medroxyprogesterone acetate (DMPA) are presented. The findings are based on data from three participating centres in Thailand, and one each in Kenya and Mexico. A relative risk for breast cancer of 0.7 was observed in women who had ever used DMPA; this was not statistically significant. Although no consistent decrease in risk with duration of use was observed, the lowest relative risk (0.5) was observed in women who had used DMPA for three or more years. These findings are based on small numbers and must be considered preliminary. However, they provide no evidence that DMPA increases the risk of breast cancer, and suggest that it may exert a protective effect, particularly in long-term users.
Assuntos
Neoplasias da Mama/induzido quimicamente , Anticoncepcionais Femininos/efeitos adversos , Medroxiprogesterona/análogos & derivados , Neoplasias da Mama/epidemiologia , Preparações de Ação Retardada , Feminino , Humanos , Quênia , Medroxiprogesterona/efeitos adversos , Acetato de Medroxiprogesterona , México , Risco , TailândiaRESUMO
PIP: 1025 women who had used Depo-Provera 150 mg injections for contraception for 3-8 1/2 years were studied to assess the effects of prolonged use. 24.4% were aged 25-29, 33.7% were 30-34, 25.1% were 35-39, 11.2% were 40-44, and the rest were 24 and under. 47.2% had had 5-8 pregnancies and 36.3% had had 9 or more. 78.3% had had at least 5 births. 93.4% had menstrual cycles averaging 26-32 days before treatment. 74% had used no previous contraception, 18.9% used oral contraceptives (OCs), .9% used a monthly injectable, 2.9% used another trimonthly injectable, 3.1% used IUD, and .1% each used condoms and rhythm. 58.6% had amenorrhea while using Depo-Provera and 73.5% of the others had short bleeding episodes of 1-2 days. 62% of 92 endometrial biopsies indicated varying degrees of endometrial atrophy. 5 cases of benign breast adenomas were confirmed by biopsy. 71 women complained of moderate breast tenderness. No cases of breast cancer were observed. 73% gained and 9.2% lost at least 1 kg in weight. No significant changes in blood pressure were noted. The proportion of women reporting inorgasmic sexual response increased from 50.3% at the beginning of use to 75.3% after 12-38 doses of Depo-Provera. 3 pregnancies occurred, 2 possibly resulting from faulty injection technique. A follow-up study of 80 former users for 1 year showed that 39 of 58 cases of amenorrhea resumed menses in an average time of 8-9 months, and 19 did not resume menstruation. 10 of 48 with weight changes did not return to the former weight. Nervousness, amenorrhea, and acne were the symptoms requiring the longest time to disappear. 29 of 46 women complaining of frigidity and 2 of 15 complaining of dyspareunia failed to improve. 11.2% of the 80 women terminated use to achieve pregnancy. Other factors were amenorrhea (72.5%), weight gain (60%), edema (50%), nervousness (45%), sexual problems (81.2%), and hypertension (3.7%).^ieng
Assuntos
Acne Vulgar , Amenorreia , Anticoncepção , Anticoncepcionais Femininos , Injeções , Estudos Longitudinais , Acetato de Medroxiprogesterona , Aceitação pelo Paciente de Cuidados de Saúde , Substâncias para o Controle da Reprodução , Comportamento Sexual , Tempo , América , Comportamento , Anticoncepcionais , Demografia , Dermatite , Países em Desenvolvimento , Doença , Serviços de Planejamento Familiar , Planejamento em Saúde , América Latina , Distúrbios Menstruais , México , América do Norte , População , Dinâmica Populacional , Pesquisa , Fatores de TempoRESUMO
PIP: From 1969 to 1975, 54,650 new acceptors over 30 years of age or with 4 or more children were administered 150 mg Depo-Provera by injection every 90 days. A total of more than 400,000 90-day cycles of clinical observation of the menstrual, metabolic changes, body-weight fluctuations, systemic side effects, and return of fertility were recorded. The rate of pregnancy was .35; the longer the time under treatment, the less abnormal bleeding and greater amenorrhea was noted. Weight gain was between 2-9 kg over 12-36 months. Pregnancy occurred 6-24 months after discontinuation of therapy to achieve pregnancy. Treatment did not affect lactation adversely. There was a continuation rate of 56% during the first 12 months and 54% in the following 18 months. Advantages of use are: 1) can be used on large scale, 2) can be alternative to sterilization, 3) is effective with a minimum of motivation, 4) does not affect lactation, 5) continuity rates are higher than those of oral contraceptives, 6) cost is low, 7) allows use of paramedical personnel, and 8) can be administered postpartum and postabortion.^ieng
Assuntos
Amenorreia , Apetite , Estudos de Avaliação como Assunto , Acetato de Medroxiprogesterona , Metrorragia , Pesquisa , Sistema Nervoso Central , Anticoncepção , Anticoncepcionais , Anticoncepcionais Femininos , Sistema Digestório , Doença , Serviços de Planejamento Familiar , Hemorragia , Injeções , Distúrbios Menstruais , Sinais e SintomasRESUMO
PIP: The contractability of the Fallopian tubes is instrumental in the transport of the ovum to the uterus. Various studies have been done to determine the effect of different hormones on this property of the tubes, but they have been inconclusive. 34 patients who were scheduled for salpingectomies for reasons of birth control and who had been using steroid contraceptives for at least 3 months prior to the operation were selected for study. Half the sample had used pure progestagens (Depo-Provera or chlormadinone) and half had used a combined preparation (quinestrol + quingestanol or deladroxate). All were between 29-41 years of age with numbers of pregnancies ranging from 5 to 21. The intensity and frequency of the contractions and the general activity of the isthmus portion of the tubes were studied for 10-minute periods in 2 cm segments. Also, histological studies were done using hematoxylin eosin tincture and Van Giessen tincture, and histochemical tests were performed. The 17 cases on combined orals exhibited a significantly higher rate of activity than those on pure progestins, but were also subject to contractions of greater intensity. The histochemical studies showed a decrease in the energetic material and in the enzymatic activity related to carbohydrate metabolism in the tubes of the progestin group. The depression of motor activity and energetic metabolism was, however, neutralized by administering estrogens.^ieng