RESUMO
BACKGROUND: Although the use of combined oral contraceptives (COCs) is associated with an increased risk of arterial and venous thromboembolic events, less is known about the impact of COCs on endothelial function. The present study evaluated the effects on the endothelium of healthy women of combinations of 30 mcg ethinylestradiol (EE)/2 mg chlormadinone acetate (CMA) and 30 mcg EE/150 mcg levonorgestrel (LNG). STUDY DESIGN: Sixty-four healthy women were evaluated, 21 using a nonhormonal contraceptive method (control) and 43 using COCs, randomized to EE 30 mcg /CMA 2 mg or to EE 30 mcg/LNG 150 mcg. Anthropometric parameters, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), ultrasound markers of endothelial function, flow-mediated dilation (FMD) of the brachial artery, intima-media thickness (IMT) and common carotid artery stiffness were measured at randomization and 6 months later. RESULTS: Relative to baseline, EE/CMA users showed a significant reduction in mean DAP at 6 months (p=.02), and EE/LNG users showed a significant increase in mean IMT (p=.02) and a significant reduction in mean FMD (p=.01) at 6 months. DAP at 6 months was significantly lower in COC users than in controls (p=.01). Intergroup evaluations showed that, at 6 months, mean SAP (p=.02) was significantly lower in EE/LNG users than in controls (p=.02) and that mean DAP was significantly lower in EE/CMA (p<.01) and EE/LNG (p=.01) users than in controls. EE/LNG users experienced a mean FMD reduction almost threefold greater than that of EE/CMA users. Compared to controls, EE/LNG users experienced a 7.5-fold greater reduction in mean FMD. CONCLUSIONS: COC containing LNG is associated with more pronounced changes in the FMD and IMT of healthy women than a COC containing CMA and nonhormonal contraception. Further studies are needed to determine whether these differences may lead to higher risk of arterial thromboembolic events.
Assuntos
Acetato de Clormadinona/efeitos adversos , Anticoncepcionais Orais Combinados/efeitos adversos , Endotélio Vascular/efeitos dos fármacos , Levanogestrel/efeitos adversos , Progestinas/efeitos adversos , Vasoconstrição/efeitos dos fármacos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/efeitos dos fármacos , Brasil/epidemiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/efeitos dos fármacos , Espessura Intima-Media Carotídea , Anticoncepcionais Orais Combinados/farmacologia , Endotélio Vascular/diagnóstico por imagem , Etinilestradiol/efeitos adversos , Feminino , Humanos , Estudos Longitudinais , Risco , Tromboembolia/induzido quimicamente , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Rigidez Vascular/efeitos dos fármacos , Vasoconstritores/efeitos adversos , Adulto JovemAssuntos
Carcinoma in Situ/etiologia , Acetato de Clormadinona/efeitos adversos , Anticoncepcionais/efeitos adversos , Dispositivos Intrauterinos/efeitos adversos , Medroxiprogesterona/efeitos adversos , Neoplasias do Colo do Útero/etiologia , Adolescente , Adulto , Carcinoma in Situ/induzido quimicamente , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Colo do Útero/cirurgia , Chile , Acetato de Clormadinona/administração & dosagem , Colposcopia , Preparações de Ação Retardada , Feminino , Humanos , Injeções , Medroxiprogesterona/administração & dosagem , Pessoa de Meia-Idade , Gravidez , Neoplasias do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Esfregaço VaginalRESUMO
PIP: Progesterones and estrogens normally inhibit milk production. 50 lactating mothers, who had received no steroid since giving birth, were given daily doses of chlormadinone .5 mg from 5 to 40 days postpartum. Mothers and babies were seen every 2 weeks for 8 weeks and then every month. Milk production lasted an average of 5.7 months, with 7 women continuing from 7 to 10 months. On the average, the younger mothers produced more milk; the older ones recommenced menstruation sooner. Several supplemented their milk with other nourishment from the 2nd or 3rd month. The babies gained well, following closely the average gain, according to the Mexican Pediatric Academy. The chlormadinone was 100% effective as a contraceptive and milk production was good.^ieng