RESUMO
Hormonal contraceptives (HCs) are one of the most highly prescribed classes of drugs in the world used for both contraceptive and noncontraceptive purposes. Despite their prevalent use, the impact of HCs on the brain remains inadequately explored. This review synthesizes recent findings on the neuroscience of HCs, with a focus on human structural neuroimaging as well as translational, nonhuman animal studies investigating the cellular, molecular, and behavioral effects of HCs. Additionally, we consider data linking HCs to mood disorders and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and stress response as a potential mediator. The review also addresses the unique sensitivity of the adolescent brain to HCs, noting significant changes in brain structure and function when HCs are used during this developmental period. Finally, we discuss potential effects of HCs in combination with smoking-derived nicotine on outcomes of ischemic brain damage. Methodological challenges, such as the variability in HC formulations and user-specific factors, are acknowledged, emphasizing the need for precise and individualized research approaches. Overall, this review underscores the necessity for continued interdisciplinary research to elucidate the neurobiological mechanisms of HCs, aiming to optimize their use and improve women's health.
Assuntos
Encéfalo , Humanos , Animais , Feminino , Encéfalo/efeitos dos fármacos , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Contraceptivos Hormonais/farmacologia , Neurociências/métodos , Anticoncepcionais Orais Hormonais/farmacologiaRESUMO
Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.
Assuntos
Libido , Ciclo Menstrual , Comportamento Sexual , Humanos , Feminino , Libido/efeitos dos fármacos , Libido/fisiologia , Adulto , Ciclo Menstrual/fisiologia , Ciclo Menstrual/psicologia , Adulto Jovem , Comportamento Sexual/fisiologia , Comportamento Sexual/efeitos dos fármacos , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Aplicativos Móveis , Estudos Longitudinais , Estudos Retrospectivos , Adolescente , Contraceptivos Hormonais/administração & dosagem , Contraceptivos Hormonais/farmacologiaRESUMO
The cyclical changes in sex hormones across the menstrual cycle (MC) are associated with various biological changes that may alter resting metabolic rate (RMR) and body composition estimates. Hormonal contraceptive (HC) use must also be considered given their impact on endogenous sex hormone concentrations and synchronous exogenous profiles. The purpose of this study was to determine if RMR and dual-energy X-ray absorptiometry body composition estimates change across the MC and differ compared with HC users. This was accomplished during a 5-week training camp involving naturally cycling athletes (n = 11) and HC users (n = 7 subdermal progestin implant, n = 4 combined monophasic oral contraceptive pill, n = 1 injection) from the National Rugby League Indigenous Women's Academy. MC phase was retrospectively confirmed via serum estradiol and progesterone concentrations and a positive ovulation test. HC users had serum estradiol and progesterone concentrations assessed at the time point of testing. Results were analyzed using general linear mixed model. There was no effect of MC phase on absolute RMR (p = .877), relative RMR (p = .957), or dual-energy X-ray absorptiometry body composition estimates (p > .05). There was no effect of HC use on absolute RMR (p = .069), relative RMR (p = .679), or fat mass estimates (p = .766), but HC users had a greater fat-free mass and lean body mass than naturally cycling athletes (p = .028). Our findings suggest that RMR and dual-energy X-ray absorptiometry body composition estimates do not significantly differ due to changes in sex hormones in a group of athletes, and measurements can be compared between MC phases or with HC usage without variations in sex hormones causing additional noise.
Assuntos
Absorciometria de Fóton , Metabolismo Basal , Composição Corporal , Estradiol , Ciclo Menstrual , Progesterona , Humanos , Feminino , Composição Corporal/efeitos dos fármacos , Metabolismo Basal/efeitos dos fármacos , Ciclo Menstrual/efeitos dos fármacos , Adulto Jovem , Estradiol/sangue , Progesterona/sangue , Adulto , Estudos Retrospectivos , Contraceptivos Hormonais/administração & dosagem , Contraceptivos Hormonais/farmacologia , Atletas , AdolescenteRESUMO
BACKGROUND: We previously demonstrated the in vitro killing of AML cells by the combination of the lipid-lowering agent bezafibrate (BEZ) and the contraceptive hormone medroxyprogesterone acetate (MPA). A phase II trial demonstrated in vivo safety and efficacy of BEZ and MPA (BaP) in elderly, relapsed/refractory AML and high-risk myelodysplastic syndrome (MDS) patients. However, we observed dose-limiting toxicities in a second trial that attempted to improve outcomes via escalation of BaP doses. Thus we sought to identify a third repurposed drug that potentiates activity of low dose BaP (BaP 0.1 mM). METHODS AND RESULTS: We demonstrate that addition of a commonly used anti-epileptic, valproic acid (VAL) to low dose BaP (BaP 0.1 mM)(VBaP) enhanced killing of AML cell lines/primary AML cells to levels similar to high dose BaP (BaP 0.5 mM). Similarly, addition of VAL to BaP 0.1 mM enhanced reactive oxygen species (ROS), lipid peroxidation and inhibition of de novo fatty acid synthesis. Overexpression of Nrf2 in K562 and KG1a completely inhibited ROS production and rescued cells from VAL/BaP 0.1 mM/VBaP killing. CONCLUSIONS: Given the good safety data of low-dose BaP in elderly/relapsed/refractory AML patients, and that VAL alone is well-tolerated, we propose VBaP as a novel therapeutic combination for AML.
Assuntos
Antioxidantes/metabolismo , Bezafibrato/farmacologia , Leucemia Mieloide Aguda/tratamento farmacológico , Acetato de Medroxiprogesterona/farmacologia , Fator 2 Relacionado a NF-E2/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Ácido Valproico/farmacologia , Anticonvulsivantes/farmacologia , Linhagem Celular Tumoral , Contraceptivos Hormonais/farmacologia , Humanos , Hipolipemiantes/farmacologia , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patologia , Dose Máxima TolerávelRESUMO
Objectives of these two experiments were to determine if exogenous estradiol benzoate (EB) affects follicular, luteal, and uterine hemodynamics. In both experiments, 77 estrous-synchronized beef cows were assigned to one of two treatments: 1) Control (CON) or, 2) an injection of 1 mg EB the day before expected estrus (Day 0; Experiment 1) or on the day of estrus (Day 1; Experiment 2). There was transfer of an embryo (Day 7) into cows that expressed estrus. In Experiment 1, estradiol concentrations in circulation at Day 0 were greater in EB-treated cows (P = 0.003); however, concentrations of progesterone were only greater (P = 0.03) at Day 21 in cows of the EB-treated compared to those in the CON group. The follicular and luteal blood perfusion was similar, however, treatment with EB resulted in a greater uterine blood perfusion. In Experiment 2, treatment with EB did not affect size or blood perfusion of the corpus luteum (CL) on Day 7, 14, and 21. Only on Day 21, however, did pregnant cows have a larger CL than non-pregnant cows (P = 0.02). Blood perfusion to the CL was greater (P < 0.05) in all cows on Day 21 compared to 7 or 14 and those determined to be pregnant on Day 35 tended (P = 0.06) to have greater CL blood perfusion only on Day 21 compared to non-pregnant cows. In conclusion, EB treatment resulted in a greater blood perfusion of the uterus, and only affected the CL on Day 21 in Experiment 2.
Assuntos
Bovinos , Corpo Lúteo/efeitos dos fármacos , Endométrio/irrigação sanguínea , Estradiol/análogos & derivados , Hemodinâmica/efeitos dos fármacos , Folículo Ovariano/efeitos dos fármacos , Animais , Contraceptivos Hormonais/farmacologia , Estradiol/farmacologia , Sincronização do Estro , FemininoRESUMO
Background: Limited information exists about relationship dynamics and their role in HIV acquisition, HIV disclosure, hormonal contraceptive uptake, and condom use among women in Malawi.Methods: Ninety-seven women aged 18-45 years were randomly assigned to initiate the depot medroxyprogesterone acetate injectable or levonorgestrel implant from May 2014 to April 2015 in Lilongwe, Malawi. Women were recruited after randomisation to participate in semi-structured interviews about HIV and family planning using purposive sampling. Interviews were thematically analysed using within and between group comparisons.Results: We conducted individual interviews and/or focus group discussions with 41 women: 30 (73%) women living with HIV and 11 (27%) women not living with HIV. Most women living with HIV who participated in in-depth interviews disclosed their status to their partners, and most partners agreed to get HIV tested only after disclosure. Nearly all women said their partners agreed to use condoms, but few used them consistently. Nearly all women believed their current and former partners had outside partners. Most women living with HIV who participated in in-depth interviews believed their current or other serious partners were the source of their infection. Some women thought their partner's infidelity was due to their partner's disinterest in sex with them during menstrual/ breakthrough bleeding. Some women included their partners in contraceptive decision-making when the partner was supportive.Discussion: Relationship dynamics affected decision-making for contraceptive and condom use, as well as serodisclosure for the women living with HIV in the study. All women reported challenges with consistent condom use with their male partners, although contraceptive use was generally more acceptable. Women included their partners in their decision-making concerning contraceptive use when they were supportive.
Assuntos
Preservativos , Contraceptivos Hormonais/farmacologia , Revelação , Infecções por HIV/prevenção & controle , Parceiros Sexuais , Adulto , Comportamento Contraceptivo , Feminino , Infecções por HIV/etiologia , Humanos , Masculino , Adulto JovemRESUMO
PURPOSE: To systematically evaluate the effect of progestin-primed ovarian stimulation (PPOS) in in vitro fertilization (IVF)/oocyte intracytoplasmic sperm injection-embryo transfer (ICSI-ET) in patients with poor ovarian response and to find an optimal ovulation induction protocol for such patients. METHOD: A literature search of PubMed, Medline, EBSCO, Cochrane Library, Vip.com, CNKI, and the Wanfang database was conducted to find case-control studies of PPOS with medroxyprogesterone acetate and other traditional stimulation regimens for ovulation induction in patients with poor ovarian response. The period of time searched was from the database establishment to August 2020. Patients in the experimental group underwent PPOS and those in the control group underwent another program (e.g., the gonadotropin-releasing hormone antagonist protocol). RevMan 5.3 software was used for meta-analysis. RESULTS: A total of sixteen case-control studies (one of them is randomized controlled trial), with 4422 induction cycles, were included. All the included patients met the 2011 Bologna diagnostic criteria for poor ovarian response. The numbers of mature eggs, available embryos, optimal embryos, and the rate of cumulative pregnancies in the PPOS group were all better than those in the control group (P<0.05). There was a lower Serum luteinizing hormone on the day of human chorionic gonadotropin (HCG) injection and a lower rate of cycle cancellation in the PPOS group (P<0.05). No other differences between PPOS and other treatments were statistically significant. CONCLUSION: PPOS can reduce the need for cycle cancellation, improve the follicles and embryos, and improve the pregnancy rate and thus, can present an effective choice for IVF/ICSI-ET in patients with poor ovarian response.
Assuntos
Acetato de Medroxiprogesterona/farmacologia , Indução da Ovulação/métodos , Resultado do Tratamento , Adulto , Estudos de Casos e Controles , Contraceptivos Hormonais/farmacologia , Contraceptivos Hormonais/uso terapêutico , Feminino , Humanos , Acetato de Medroxiprogesterona/uso terapêutico , Ovário/efeitos dos fármacos , Indução da Ovulação/instrumentaçãoRESUMO
PURPOSE: "Real-world" data incorporates studies performed outside of controlled environments, allowing for a better understanding of the effects of treatment in routine clinical practice. We, therefore, performed a systematic review to summarise available "real-world studies" reporting on the use of ulipristal acetate (UPA) for management of uterine fibroids. METHODS: We designed a prospective protocol according to PRISMA guidelines and registered it with PROSPERO (ID: CRD42019151393). We searched all major databases for relevant citations until 20th September 2019. Our screen included studies for risk of bias using an adapted structured quality assessment tool. Random-effects meta-analysis was used to calculate proportion estimates for each outcome including 95% confidence interval. Reported heterogeneity was assessed using I2. RESULTS: Initial search yielded 755 studies and 13 were included in the final synthesis. Administration of UPA resulted in reduction in the size of fibroids in 56.5% of women, improved menorrhagia in 83% of women, improved perception of pain in 80.1% of women and lead to an improvement in global symptom scores in 85.2% of women. Mean reduction in surgical blood loss and surgical time with use of UPA was 59.85 ml and 12.47 min, respectively. Qualitative analysis suggested that there was no difference in overall surgical experience for patients treated with UPA compared to those without pre-treatment. CONCLUSIONS: Our findings are consistent with previously reported data that UPA is an acceptable management option for women with fibroids. However, it provides limited benefits when used as a pre-operative adjunct, in terms of blood loss and surgical time.
Assuntos
Contraceptivos Hormonais/uso terapêutico , Leiomioma/tratamento farmacológico , Norpregnadienos/uso terapêutico , Contraceptivos Hormonais/farmacologia , Feminino , Humanos , Leiomioma/cirurgia , Norpregnadienos/farmacologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCTION: Norgestimate (NGM) is a testosterone derivative with peculiar receptor activities. AREAS COVERED: This is a narrative review of the available data on the pharmacotherapy of NGM in combined hormonal contraceptives (CHCs) in terms of contraceptive efficacy, venous thromboembolism (VTE) risk, safety, tolerability and bleeding patterns. A comprehensive literature review was conducted in August 2020 using PubMed with the keyword 'norgestimate'. EXPERT OPINION: NGM shows a mild estrogenic activity associated with anti-mineralocorticoid and anti-androgenic properties, largely responsible for the cardiovascular safety profile. The anti-androgenic property depends on the androgen receptor (AR) nuclear translocation (AR trafficking and its subnuclear distribution), the inhibition of 5α-reductase activity (it possesses higher activity compared to other available progestins), and the increase on sexual hormone binding globulin (SHBG) levels if combined with an estrogenic counterpart. NGM is one of the molecules that best modulates the power of ethinyl-estradiol on the thromboembolic risk, being associated with the lowest VTE risk between different CHCs. NGM has the advantage of retaining peripheral anti-androgenic activity, demonstrated by the impact on lipid and glucose metabolism, and it should be preferred if compared with other similar progestins of the same class of risk which are much more androgenic, such as levonorgestrel.
Assuntos
Contraceptivos Hormonais/administração & dosagem , Norgestrel/análogos & derivados , Tromboembolia Venosa/induzido quimicamente , Animais , Contraceptivos Hormonais/efeitos adversos , Contraceptivos Hormonais/farmacologia , Feminino , Humanos , Levanogestrel/administração & dosagem , Levanogestrel/efeitos adversos , Levanogestrel/farmacologia , Norgestrel/administração & dosagem , Norgestrel/efeitos adversos , Norgestrel/farmacologia , Risco , Tromboembolia Venosa/epidemiologiaRESUMO
Antiretroviral therapy has slowed the HIV/AIDS pandemic and is currently being used as a prophylactic measure for individuals at high risk of infection. However, concerns over adverse effects of long-term use need to be explored. We hypothesize that this may occur, at least in part, through off-target effects via select steroid receptors (SRs) that broadly regulate multiple physiological processes. We investigated the effects of maraviroc (MVC), tenofovir disoproxil fumarate (TDF), and dapivirine (DPV) on progesterone receptor B (PR-B) transcriptional activity. We found that MVC and TDF activate PR-B transcription in the absence of progestogens on a PR-regulated promoter reporter construct and on endogenous PR-regulated genes. MVC and TDF exhibited no direct binding to PR-B; however, increased PR-B phosphorylation was detected with TDF but not MVC. DPV transactivated gilz and ptgs2 in the absence of progestogens and exhibited PR-B binding while showing no effects on phosphorylation, suggesting that it may activate PR-B through a direct mechanism. Our study shows that potential off-target immunomodulatory effects of MVC, TDF and DPV occur in vitro and these are most likely mediated by different mechanisms of PR-B activation.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Maraviroc/efeitos adversos , Pirimidinas/efeitos adversos , Receptores de Progesterona/agonistas , Tenofovir/efeitos adversos , Fármacos Anti-HIV/farmacocinética , Ligação Competitiva , Linhagem Celular , Contraceptivos Hormonais/farmacocinética , Contraceptivos Hormonais/farmacologia , Infecções por HIV/tratamento farmacológico , HIV-1 , Humanos , Fatores Imunológicos/efeitos adversos , Técnicas In Vitro , Levanogestrel/farmacocinética , Levanogestrel/farmacologia , Maraviroc/farmacocinética , Fosforilação , Congêneres da Progesterona/farmacocinética , Congêneres da Progesterona/farmacologia , Pirimidinas/farmacocinética , Receptores de Progesterona/genética , Receptores de Progesterona/metabolismo , Tenofovir/farmacocinética , Ativação Transcricional/efeitos dos fármacosRESUMO
Different progestogens are widely used in hormonal therapy and mediate their therapeutic actions via the progesterone receptor (PR). Little published data exist on their relative efficacies and potencies via the PR, while those available may be confounded by off-target receptors, different methodologies and model systems. We performed dose-response analysis to investigate the efficacies and potencies for transcription of progesterone and several progestins widely used in contraception via the B isoform of human PR (PR-B). We compared responses using three different cell lines and two different transient transfection conditions. Results show that in vitro biological responses via PR-B for the select progestogens can vary significantly in biocharacter, rank order and absolute values for efficacies and potencies, depending on the cell line and transfection condition. Progestogen rank orders for published relative binding affinities are mostly different to those for relative efficacies and potencies. These in vitro differences suggest that rank orders and absolute values of the efficacies and potencies of the progestogens are likely to vary in vivo in a cell-specific and progestogen-specific manner, and cannot easily be extrapolated from in vitro data, as is usually the practice. While obtaining such data in vivo is not possible, these in vitro data show proof of concept for likely significant cell- and progestogen-specific PR-B effects.
Assuntos
Contraceptivos Hormonais/farmacologia , Progestinas/farmacologia , Receptores de Progesterona/metabolismo , Animais , Células COS , Linhagem Celular Tumoral , Chlorocebus aethiops , Contraceptivos Hormonais/química , Humanos , Progesterona/química , Progesterona/farmacologia , Progestinas/química , Transcrição Gênica/efeitos dos fármacos , TransfecçãoAssuntos
Desogestrel/efeitos adversos , Embolia/etiologia , Artéria Pulmonar/anormalidades , Adulto , Contraceptivos Hormonais/efeitos adversos , Contraceptivos Hormonais/farmacologia , Desogestrel/farmacologia , Embolia/fisiopatologia , Feminino , Humanos , Artéria Pulmonar/fisiopatologia , Tomografia Computadorizada por Raios X/métodosRESUMO
The current ovarian cycle paradigm postulates that ovulation is triggered by a critically sustained elevation of estradiol. However, an in-depth look into the published data reveals considerable uncertainty about the relative roles of progesterone and estradiol in the ovulation process.This review provides compelling evidences that the role of estradiol in ovulation has been misinterpreted and that the true physiological trigger of ovulation is a luteinizing hormone-independent preovulatory progesterone surge in the circulation to approximately 0.5 ng/mL. Furthermore, the current work reconciles the ability of progesterone to trigger ovulation, with its well-established ability to block ovulation during pregnancy, or when administered in the form of a synthetic progestin in birth control formulations and with experimental data that estradiol benzoate triggers ovulation in the complete absence of progesterone.
Assuntos
Gonadotropinas/sangue , Hipotálamo/metabolismo , Hormônio Luteinizante/sangue , Ciclo Menstrual/sangue , Ovário/metabolismo , Ovulação/sangue , Progesterona/sangue , Contraceptivos Hormonais/farmacologia , Estradiol/análogos & derivados , Estradiol/sangue , Estradiol/metabolismo , Estradiol/farmacologia , Feminino , Humanos , Ciclo Menstrual/efeitos dos fármacos , Ovário/efeitos dos fármacos , Ovulação/efeitos dos fármacos , Congêneres da Progesterona/farmacologia , Transdução de SinaisRESUMO
Turner Syndrome (TS) is associated with an increased risk of cardiovascular and metabolic complications. Furthermore, TS women need hormone replacement therapy (HRT), of which progestins can influence body weight. We aimed to analyze the metabolic and weight profile in a cohort of 111 TS women. They started receiving estrogen at 15.8 (±3.6) years old, with no change in hypertension, dysglycemia, and dyslipidemia incidence but with a tendency to increase overweight (p = 0.054). As the first used type of progestin, most had received cycles of 10 days per month of medroxyprogesterone (MPA) or levonorgestrel (LNG), then shifted to micronized progesterone (MP), which has currently become the most used one. By multiple linear regression analysis, we found that the prolonged use of MPA, LNG, or MP showed no metabolic change except for weight gain. The percentage of annual BMI increment was positive for all progestins used in TS women (MPA 2.2 ± 2.2; LNG 0.2 ± 1.2; and MP 2.2 ± 2.6 kg/m2), but LNG seemed to best prevent on weight gain over time (p < 0.05). In conclusion, metabolic comorbidities are prevalent in TS even before the HRT regimen, and LNG performed better on less weight gain than MPA and MP in our cohort of the TS population.
Assuntos
Contraceptivos Hormonais/administração & dosagem , Terapia de Reposição de Estrogênios/métodos , Levanogestrel/administração & dosagem , Síndrome de Turner/tratamento farmacológico , Aumento de Peso/efeitos dos fármacos , Adolescente , Adulto , Índice de Massa Corporal , Contraceptivos Hormonais/farmacologia , Estudos Transversais , Feminino , Humanos , Levanogestrel/farmacologia , Medroxiprogesterona/administração & dosagem , Medroxiprogesterona/farmacologia , Progestinas/administração & dosagem , Progestinas/farmacologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: This study aimed at investigating the efficacy and safety of dinoprostone 3 mg vaginally prior to levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in women undergoing elective cesarean delivery (CD). METHODS: We conducted a prospective, randomized, double-blinded, placebo-controlled trial at family planning clinic of Cairo University hospitals from August 2019 to January 2020. We included 200 women aged ≥ 18 years who previously delivered by elective CD willing to receive LNG-IUS. Women were randomly assigned with a 1:1 allocation ratio to receive 3 mg vaginal dinoprostone or placebo tablets two hours before LNG-IUS insertion. Our main outcomes were patient-reported pain during insertion and 30 min post-procedure, ease of insertion, satisfaction, duration of insertion, and different side effects. RESULTS: Patient-perceived pain during LNG-IUS insertion was significantly reduced in dinoprostone compared to placebo (4.1 ± 1.7 vs 6.4 ± 1.3; p < 0.001). Dinoprostone reduced pain scores 30 min post-procedure compared to placebo, but the difference was not statistically significant (3.5 ± 1.1 vs 3.7 ± 1.6; p = 0.25). Satisfaction score was higher in dinoprostone compared to placebo (7.9 ± 1.0 vs 5.9 ± 0.8; p < 0.001). The insertion was significantly easier and shorter in dinoprostone than placebo (3.9 ± 1.1 vs 5.9 ± 1.1; p < 0.001) and (5.6 ± 0.9 vs 7.2 ± 0.8; p < 0.001), respectively. Adverse events were not significantly different between both groups. CONCLUSION: Dinoprostone administration 2 h before LNG-IUS insertion in women delivered by elective CD effectively reduced pain during insertion and 30 min post-procedure. Women received dinoprostone had easier and shorter insertion and were more satisfied with tolerable side effects.
Assuntos
Cesárea/métodos , Contraceptivos Hormonais/uso terapêutico , Dinoprostona/uso terapêutico , Dispositivos Intrauterinos Medicados/normas , Levanogestrel/uso terapêutico , Ocitócicos/uso terapêutico , Adulto , Contraceptivos Hormonais/farmacologia , Dinoprostona/farmacologia , Método Duplo-Cego , Feminino , Humanos , Levanogestrel/farmacologia , Ocitócicos/farmacologia , Gravidez , Estudos ProspectivosRESUMO
The aim of these experiments was to study ovarian dynamics and fertility of Bos indicus beef cattle submitted to 7-d progesterone (P4)-based fixed-time AI (FTAI) protocols using different hormonal treatments. In Exp. 1, 2 yr old Nelore heifers (n = 973) were randomly assigned to one of four treatments: EB-0 (estradiol benzoate, EB on D0 and no GnRH at AI), EB-G (EB on D0 and GnRH at AI), G-0 (GnRH on D0 and no GnRH at AI), or G-G (GnRH on D0 and at AI). On D0, heifers received an intravaginal P4 implant (0.5 g) for 7 d and EB (1.5 mg) or GnRH (16.8 µg). On D7, the P4 implant was withdrawn and heifers received cloprostenol (PGF; 0.5 mg) and estradiol cypionate (EC, 0.5 mg). Heifers in G groups also received PGF and eCG (200 IU) on D6, whereas EB heifers received eCG on D7. At FTAI on D9, only EB-G and G-G groups received GnRH (8.4 µg). In Exp. 2, Nelore cows (n = 804) received the same treatments (EB-0, EB-G, G-0, or G-G) using a 1.0 g P4 implant, 2.0 mg EB, and 300 IU eCG. Effects were considered significant when P ≤ 0.05. After treatment on D0, G had more ovulations than EB in heifers (60.3 [287/476] vs. 12.7% [63/497]) and cows (73.7 [83/112] vs. 24.4% [28/113]). Luteolysis after D0 was greater in EB than G in heifers (39.2 [159/406] vs. 20.0% [77/385]) and cows (25.5 [14/55] vs. 1.6% [1/64]). Heifers in G had larger follicles (mm) than EB on D7 (10.3 ± 0.2 vs. 9.2 ± 0.2) and at AI (11.9 ± 0.2 vs. 11.3 ± 0.2). Cows had larger follicles in G than EB on D7 (11.0 ± 0.3 vs. 9.9 ± 0.3) but not at AI. More estrus was observed in G than EB for heifers (80.3 [382/476] vs. 69.6% [346/497]) and cows (67.6 [270/400] vs. 56.2% [227/404]). There was no interaction between D0 and D9 treatments on pregnancy per AI (P/AI) in heifers (EB-0: 56.7 [139/245], EB-G: 53.6 [135/252], G-0: 52.6 [127/241], and G-G: 57.5% [135/235]). However, cows from EB-G had greater P/AI than EB-0 (69.5 [142/204] vs. 60.2% [120/200]), whereas P/AI for G-0 (62.7% [127/203]) was similar to G-G (60.9% [120/197]). In heifers, there was no interaction of GnRH at AI with estrus, however, cows that did not display estrus had greater P/AI if they received GnRH at AI (GnRH = 59.1 [91/154] vs. No GnRH = 48.2% [78/162]). Thus, protocols initiated with EB or GnRH for Bos indicus heifers and cows had differing ovarian dynamics but similar overall fertility, enabling their use in reproductive management programs. Treatment with GnRH at time of AI increased fertility in some instances in Bos indicus cows but not in heifers.
Assuntos
Busserrelina/farmacologia , Bovinos/fisiologia , Estradiol/análogos & derivados , Inseminação Artificial/veterinária , Animais , Busserrelina/administração & dosagem , Gonadotropina Coriônica/administração & dosagem , Gonadotropina Coriônica/farmacologia , Cloprostenol/administração & dosagem , Cloprostenol/farmacologia , Contraceptivos Hormonais/administração & dosagem , Contraceptivos Hormonais/farmacologia , Esquema de Medicação , Estradiol/administração & dosagem , Estradiol/farmacologia , Feminino , Fármacos para a Fertilidade/administração & dosagem , Fármacos para a Fertilidade/farmacologia , Inseminação Artificial/métodos , Luteolíticos/administração & dosagem , Luteolíticos/farmacologia , Gravidez , Progesterona/administração & dosagem , Progesterona/farmacologia , Progestinas/administração & dosagem , Progestinas/farmacologiaAssuntos
Humanos , Feminino , Anticoncepcionais Pós-Coito/farmacologia , Contraceptivos Hormonais/administração & dosagem , Contraceptivos Hormonais/efeitos adversos , Contraceptivos Hormonais/uso terapêutico , Contraceptivos Hormonais/farmacologia , Progestinas , Progesterona , Testosterona , Protocolos Clínicos , Levanogestrel , Acetato de Medroxiprogesterona , Desogestrel , Medição de Risco , Contraindicações de Medicamentos , Eficácia de Contraceptivos , NoretindronaRESUMO
Contraception is widely used in the United States, and nurses in all settings may encounter patients who are using or want to use contraceptives. Nurses may be called on to anticipate how family planning intersects with other health care services and provide patients with information based on the most current evidence. This article describes key characteristics of nonpermanent contraceptive methods, including mechanism of action, correct use, failure rates with perfect and typical use, contraindications, benefits, side effects, discontinuation procedures, and innovations in the field. We also discuss how contraceptive care is related to nursing ethics and health inequities.