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Oral Contraceptives (oral + contraceptive)
Kinds of Oral Contraceptives Terms modified by Oral Contraceptives Selected AbstractsCombined Oral Contraceptives do not Influence Post-Exercise Hypotension in WomenEXPERIMENTAL PHYSIOLOGY, Issue 5 2002Karen Birch The aim of the present study was to examine the pattern of cardiovascular recovery from exercise in 15 women (age, 20.3 ± 1.4 years; body mass, 61.5 ± 4.3 kg) across two phases of oral contraceptive (OC) use: 21 days of consumption and 7 days of withdrawal. Cardiovascular recovery was measured in the supine position for 60 min following 30 min of exercise at 60% maximal rate of oxygen consumption (V,O2,max). Central and peripheral haemodynamics were assessed during consumption and withdrawal of the OC pill using occlusion plethysmography, Doppler flowmetry and echocardiography. Significant hypotension occurred following exercise (P < 0.05), returning to baseline values after 60 min. The peak hypotension occurred 5 min into recovery. Cardiac output and heart rate were elevated for 60 min following exercise (P < 0.05), whilst stroke volume remained at baseline values. Heart rate was greater throughout recovery during consumption compared to withdrawal (P < 0.05); however, although there was a trend for greater responses during consumption, phase of OC use did not affect the other central cardiovascular variables (P > 0.05). Post-exercise blood flow parameters were not significantly affected by exercise or OC phase; however, calf blood flow was greater, and resistance to flow lower during consumption (P > 0.05). The pattern of post-exercise fluctuations in cardiovascular parameters may differ from those seen in men, whilst oestrogen variation may influence research findings. [source] 5-HT1B/1D Agonists, Oral Contraceptives, and Ischemic Colitis,A ResponseHEADACHE, Issue 6 2006James A. Charles MD No abstract is available for this article. [source] Fortifying Oral Contraceptives with Folic AcidNURSING FOR WOMENS HEALTH, Issue 1 2004How This Concept Could Benefit Women of Reproductive Age No abstract is available for this article. [source] Ovarian Cancer Protection from Oral Contraceptives Is Greatest with the Lowest Doses of HormonesPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 3 2007D. Hollander No abstract is available for this article. [source] Parents' Beliefs About Condoms and Oral Contraceptives: Are They Medically Accurate?PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 2 2004Marla E. Eisenberg CONTEXT: Parents are encouraged to be the primary sex educators for their children; however, little is known about the accuracy of parents' views about condoms and oral contraceptives. METHODS: Telephone surveys using validated measures provided data on beliefs about the effectiveness, safety and usability of condoms and the pill among 1,069 parents of 13,17-year-olds in Minnesota and Wisconsin in 2002. Pearson chi-square tests and multivariate logistic regression models were used to compare beliefs according to sex, age, race, religion, education, income and political orientation. RESULTS: Substantial proportions of parents underestimated the effectiveness of condoms for preventing pregnancy and sexually transmitted diseases (STDs). Only 47% believed that condoms are very effective for STD prevention, and 40% for pregnancy prevention. Fifty-two percent thought that pill use prevents pregnancy almost all the time; 39% thought that the pill is very safe. Approximately one-quarter of parents thought that most teenagers are capable of using condoms correctly; almost four in 10 thought that most teenagers can use the pill correctly. Fathers tended to have more accurate views about condoms than mothers did; mothers' views of the pill were generally more accurate than fathers'. Whites were more likely than nonwhites to hold accurate beliefs about the pill's safety and effectiveness; conservatives were less likely than liberals to hold accurate views about the effectiveness of condoms. CONCLUSION: Campaigns encouraging parents to talk with their teenagers about sexuality should provide parents with medically accurate information on the effectiveness, safety and usability of condoms and the pill. [source] ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Comparison of Androgens in Women with Hypoactive Sexual Desire Disorder: Those on Combined Oral Contraceptives (COCs) vs.THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2006Those not on COCs ABSTRACT Introduction., Approximately one out of four sexually active women in the United States uses some form of hormonal contraceptive method because they provide the most effective reversible method of birth control available. However, little attention has been paid to possible adverse effects of combined oral contraceptives (COCs) on sexual functioning. Aims., The aim of this study was to examine the potential effects of COCs on women with hypoactive sexual desire disorder (HSDD). It was hypothesized that female patients with generalized, acquired HSDD on COCs have lower androgen levels than those not on COCs. Methods., The patients were healthy premenopausal women with HSDD, aged 22,50 years. Subjects had a history of adequate sexual desire, interest, and functioning. Participants were required to be in a stable, monogamous, heterosexual relationship and were screened for any medication or medical or psychiatric disorders that impact desire. The patients met operational criteria for global, acquired HSDD. The 106 patients were divided into two groups: those on COCs (N = 43) and those not on COCs (N = 63). A two-tailed t -test comparison was made between the two groups comparing free and total testosterone and sex hormone-binding globulin (SHBG). Main Outcome Measures., The main outcome measures are the differences between the two groups comparing free testosterone, total testosterone, and SHBG. Results., These patients with HSDD on COCs had significantly lower free and total testosterone levels compared with those who were not on COCs. The SHBG was significantly higher in the group on COCs compared with those who were not on COCs. Conclusion., The result of this study suggests that COCs in premenopausal women with HSDD are associated with lower androgen levels than those not on COCs. Further research is required to determine if low androgen levels secondary to COCs impact female sexual desire. Warnock JK, Clayton A, Croft H, Segraves R, and Biggs FC. Comparison of androgens in women with hypoactive sexual desire disorder: Those on combined oral contraceptives (COCs) vs. those not on COCs. J Sex Med 2006;3:878,882. [source] Oral Contraceptives and Ovarian Cancer RiskCA: A CANCER JOURNAL FOR CLINICIANS, Issue 3 2008Article first published online: 31 DEC 200 No abstract is available for this article. [source] Impact of progestagens on activated protein C (APC) resistance among users of oral contraceptivesJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 9 2004M. Alhenc-Gelas Summary., Oral contraceptive (OC) use is associated with an increased risk of venous thromboembolism. Previous data reported higher thrombotic risk in women using third-generation combined OC than in those using second generation OC. The difference could be explained by differential effects of progestagens on plasma sensitivity to activated protein C (APC). The main purpose of this cross-sectional study was to assess the influence of a progestagen-only OC (chlormadinone acetate) as well as the effect of several combined OC with different progestagen components on APC resistance. The effect of APC on endogenous thrombin potential (ETP) was investigated in the plasma of healthy women using either combined OC (n = 82) or progestagen-only OC (n = 28), and in non-users (n = 64). Carriers of factor V Leiden were excluded. Compared with non-users, there was no significant change in APC resistance in women using progestagen-only OC. Women who used combined OC were less sensitive to APC than non-users (P < 0.001) and the difference was significantly more pronounced in women using third-generation OC (n = 41) than in those who used second-generation OC containing levonorgestrel (n = 22) (P < 0.05). Compared with OC containing levonorgestrel, use of norethisterone-containing OC (n = 9) was associated with an increased resistance to APC (P < 0.05). Women who used cyproterone-containing OC (n = 10) were less sensitive to APC than those using third-generation OC (P < 0.05) or second-generation OC containing levonorgestrel (P < 0.05). Protein S, factor II and FVIII levels explained in part the OC-related changes in APC sensitivity variations. ETP-based APC resistance may contribute to explain why different brands of OC can be associated with different levels of thrombogenicity. [source] Third S. S. Ratnam Memorial Lecture 2007.JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2009Ovarian cancer: Is there hope for women? Abstract Ovarian cancer is today the most lethal female cancer with an overall survival of only 49.9%. The currently available screening modalities are disappointing in detecting highly curable early stage ovarian cancer. Natural history of ovarian cancer is unknown; it appears it can develop quickly from normal looking ovaries. Timely referral of women with non-specific symptoms (such as abdominal bloating, pelvic pain) for an ultrasound scan or blood CA125 assessments may help in the early diagnosis. Patients with Stage IA or IB disease with grade 1 tumors have a cure rate of >90%; this is likely to be compromised by laparoscopic surgery. In selected patients fertility preservation with good obstetric outcome is possible. However, the relapse rate in ,high risk' early stage ovarian cancers is 40,45%; adjuvant chemotherapy is needed. Only 20,25% of those with stage III and IV disease are cured. Despite a high primary response (70%) majority (70,75%) will relapse and all are likely to succumb. Optimal debulking surgery followed by adjuvant chemotherapy are needed for stages III and IV disease; the outcome is superior if managed by gynecologic oncologists. Where cost of drugs is an important consideration, an alternative is carboplatin (an affordable and equally effective drug). The role of vaccines needs further study. When relapses occur palliation will be the aim in most instances. Oral contraceptives, breast feeding, tubal sterilization and hysterectomy also have a protective effect. Risk-reducing salpingo-oopherectomy has been suggested in women with BRCA mutations. [source] Impact of environmental and hereditary risk factors on the clinical manifestation of thrombophilia in homozygous carriers of factor V:G1691AJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 3 2004S. Ehrenforth Summary.,Background:,Limited data exist on the clinical manifestations of homozygous factor (F)V:G1691A mutation (FV Leiden) and the impact of environmental and genetic risk factors. Objectives:,To assess the contribution of these factors on the thrombophilic phenotype. Patients and methods:,In a retrospective multicenter cohort study 165 individuals with homozygous FV:G1691A mutation, of whom 129 had previous venous thromboembolism (VTE), were included. To study the role of environmental risk factors, patients were compared by the use of a standardized questionnaire to 165 sex- and age-matched individuals (reference group A); of these, two had previous VTE. To assess the role of genetic risk factors, factor (F)II:G20210A and MTHFR:C677T were determined in individuals homozygous for FV:G1691A and in 177 healthy individuals without previous VTE (reference group B). Results:,The first VTE occurred significantly earlier in women (median age 25 years) than men (35.5 years). In 81% of women and 29% of men an environmental risk factor was present before first VTE. Oral contraceptives increased the risk of thrombosis 4-fold [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.7, 10.4] in women with homozygous FV:G1691A. Postoperative and post-traumatic VTE as first manifestation occurred in 13% and 15% of surgical/traumatic events in patients and in 0.7% and 1.8% in reference group A, respectively (OR 19.7, 95% CI 2.5, 154 and OR 9.2, 95% CI 1.1, 79.4). Heterozygous FII:G20210A was more prevalent in symptomatic patients (11.7%) compared with reference group B (2.8%, OR 4.6, 95% CI 1.6, 13.2). The prevalence of homozygous MTHFR:C677T genotype was similar in patients and reference group B. Conclusions:,Our study supports the concept of thrombophilia as a multifactorial disorder. The knowledge of coexisting factors predisposing to VTE is useful for medical advice for primary and secondary prophylaxis in these patients. [source] Lack of genotoxicity induced by endogenous and synthetic female sex hormones in peripheral blood cells detected by alkaline comet assayENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 5 2007Mariana Gobbo Braz Abstract The etiology of hormone-induced cancers has been considered to be a combination of genotoxic and epigenetic events. Currently, the Comet assay is widely used for detecting genotoxicity because it is relatively simple, sensitive, and capable of detecting various kinds of DNA damage. The present study evaluates the genotoxic potential of endogenous and synthetic sex hormones, as detected by the Comet assay. Blood cells were obtained from 12 nonsmoking and 12 smoking women with regular menstrual cycles and from 12 nonsmoking women taking low-dose oral contraceptives (OC). Peripheral blood samples were collected at three phases of the menstrual cycle (early follicular, mean follicular, and luteal phases), or at three different moments of oral contraceptive intake. Three blood samples were also collected from 12 healthy nonsmoking men, at the same time as oral contraceptive users. Results showed no significant difference in the level of DNA damage among the three moments of the menstrual cycle either in nonsmoking and smoking women, or between them. No significant difference in DNA damage was also observed among oral contraceptive users, nonusers, and men. Together, these data indicate lack of genotoxicity induced by the physiological level of the female sex hormones and OC as assessed by the alkaline Comet assay. In conclusion, normal fluctuation in endogenous sex hormones and use of low-doses of oral contraceptive should not interfere with Comet assay data when this technique is used for human biomonitoring. Environ. Mol. Mutagen., 2007. © 2007 Wiley-Liss, Inc. [source] Combined Oral Contraceptives do not Influence Post-Exercise Hypotension in WomenEXPERIMENTAL PHYSIOLOGY, Issue 5 2002Karen Birch The aim of the present study was to examine the pattern of cardiovascular recovery from exercise in 15 women (age, 20.3 ± 1.4 years; body mass, 61.5 ± 4.3 kg) across two phases of oral contraceptive (OC) use: 21 days of consumption and 7 days of withdrawal. Cardiovascular recovery was measured in the supine position for 60 min following 30 min of exercise at 60% maximal rate of oxygen consumption (V,O2,max). Central and peripheral haemodynamics were assessed during consumption and withdrawal of the OC pill using occlusion plethysmography, Doppler flowmetry and echocardiography. Significant hypotension occurred following exercise (P < 0.05), returning to baseline values after 60 min. The peak hypotension occurred 5 min into recovery. Cardiac output and heart rate were elevated for 60 min following exercise (P < 0.05), whilst stroke volume remained at baseline values. Heart rate was greater throughout recovery during consumption compared to withdrawal (P < 0.05); however, although there was a trend for greater responses during consumption, phase of OC use did not affect the other central cardiovascular variables (P > 0.05). Post-exercise blood flow parameters were not significantly affected by exercise or OC phase; however, calf blood flow was greater, and resistance to flow lower during consumption (P > 0.05). The pattern of post-exercise fluctuations in cardiovascular parameters may differ from those seen in men, whilst oestrogen variation may influence research findings. [source] Clinical Pharmacokinetics of FrovatriptanHEADACHE, Issue 2002P. Buchan PhD Objective.,To review available data on the clinical pharmacokinetics of frovatriptan. Background.,Preclinical data suggest that the pharmacokinetic profile of frovatriptan may differ from that of the currently available triptans. Methods.,Studies of healthy volunteers, subjects with renal or hepatic impairment, elderly subjects, and patients with migraine during and between attacks were reviewed. Results.,Oral bioavailability of frovatriptan is 22% to 30%, and although the time to maximum concentration is typically 2 to 3 hours, approximately 60% to 70% of plasma maximum concentration is achieved within 1 hour of dosing. Frovatriptan distributes into erythrocytes, with binding reversible and time dependent. The relatively long terminal elimination half-life (about 26 hours) confers good systemic exposure and may produce a long duration of therapeutic action, thus reducing migraine recurrence and the need for redosing. Systemic exposure to frovatriptan generally correlates with dose between 1 and 100 mg. Blood and plasma frovatriptan concentrations are consistently higher in females, but there is no need to adjust dose according to gender. Pharmacokinetics are essentially unaffected by food and were predictable after repeat dosing; steady state is approached in about 4 to 5 days. Pharmacokinetics were changed only slightly in subjects with renal impairment or mild-to-moderate hepatic impairment, elderly individuals, and during migraine attacks. Frovatriptan is principally metabolized by the CYP1A2 isoenzyme of cytochrome P-450 and is cleared by the kidney and liver, each having sufficient capacity to compensate for impairment of the other. Conclusions.,Frovatriptan can be taken without regard for food intake, and because of the large therapeutic margin and shallow dose-response curve, there is no need for dosage adjustment in the elderly, in women taking a combined oral contraceptive, in patients with mild-to-severe renal impairment, mild-to-moderate hepatic impairment, or according to gender. The long duration of exposure may reduce the likelihood of early migraine recurrence. [source] Centchroman, a selective estrogen receptor modulator, as a contraceptive and for the management of hormone-related clinical disordersMEDICINAL RESEARCH REVIEWS, Issue 4 2001M.M. SinghArticle first published online: 12 JUN 200 Abstract DL -Centchroman (67/20; INN: Ormeloxifene)1,2 synthesized at the Central Drug Research Institute, Lucknow, is a nonsteroidal once-a-week oral contraceptive. It was introduced in Delhi in July, 1991,3,5 marketed in India in 1992 as Saheli and Choice-7 (Hindustan Latex Ltd., Thiruvananthapuram) and Centron (Torrent Pharmaceuticals India Ltd., Ahmedabad),4,6 and included in the National Family Welfare Programme in 1995.5 According to post-marketing surveillance,5 ,100,000 women were using this pill and ,1100,000 menstrual cycles were covered until 1996. It is a unique need-oriented contraceptive being effective when taken immediately after coitus or routinely as a weekly pill2,5,19 and has the advantage of less frequent administration. Its contraceptive action is quickly reversible. It has long terminal serum halflife of 168,hr in women and exhibits duration of anti-implantation/estrogen antagonistic action of 120,hr, despite a short (24.1,hr) serum halflife, in the rat. In lactating women, it is excreted in milk in quantities considered unlikely to cause any deleterious effect on suckling babies.20,21 In phase II and III multicentric trials as a contraceptive, children born of method-and-user failure pregnancies showed normal milestones, without any congenital anomaly. Reports of its promising action in the management of certain hormone-related clinical disorders are available. It has an excellent therapeutic index and is considered safe for chronic administration. © 2001 John Wiley & Sons, Inc. Med Res Rev, 21, No. 4, 302,347, 2001 [source] Latest news and product developmentsPRESCRIBER, Issue 19 2007Article first published online: 22 NOV 200 UK data suggest OCs may reduce cancer risk The latest analysis of the RCGP oral contraception (OC) study suggests that oral contraceptives may be associated with an overall reduction in the risk of cancer (Br Med J online: 11 September 2007; doi:10.1136/bmj.39289. 649410.55). The cohort of 46 000 women provided 744 000 woman-years for ever use of an oral contraceptive and 339 000 woman-years of never use. Longer use was associated with increasing risks of cervical (RR 2.73), and pituitary or CNS (RR 5.51) cancers, but decreasing risks of uterine (RR 0.57) and ovarian (RR 0.38) cancers. OC use was also associated with a lower overall risk of colorectal cancers. The overall risk of any cancer was reduced by 12 per cent (RR 0.88). CombAT two-year data Two-year data revealed at the 29th Congress of the Société Internationale d'Urologie in Paris in September show that dutasteride (Avodart) and tamsulosin combination therapy provides significantly improved symptom control in BPH compared with either therapy alone. The Combination therapy with Avodart (dutasteride) and tamsulosin (CombAT) study took over 4800 eligible men (age ,50 years with a prostate volume ,30cc, serum PSA level ,1.5-10ng per ml and IPSS ,12) who received placebo for four weeks before being randomised in a 1:1:1 ratio to either dutasteride monotherapy (0.5mg per day), tamsulosin monotherapy (0.4mg per day) or a combination of both drugs. At two years the primary efficacy end-point was achieved: combination therapy was significantly more effective than either monotherapy, and continuous improvement could be observed throughout the two years. The combination therapy was also well tolerated, although drug-related adverse events were more common with combination therapy (24 per cent) than either monotherapy (dutasteride 18 per cent, tamsulosin 14 per cent). Dutasteride, a 5-, reductase inhibitor, has been shown to be more effective for long-term use in men than tamsulosin, while tamsulosin, an alpha blocker, has been shown to be effective in the short term. CombAT is the first study to demonstrate that the combination therapy of both drugs could lead to greater symptom improvement over time than an alpha blocker alone. Aliskiren - new class of antihypertensive Novartis has introduced aliskiren (Rasilez), the first direct renin inhibitor for the treatment of hypertension. It is likely to be used in combination with other agents but is also licensed as monotherapy. The commonest adverse effect is diarrhoea. At the recommended dose of 150-300mg per day, a month's treatment costs £19.80-£23.80. MHRA updates drug safety advice The balance of benefit and risks from HRT may be more favourable for younger women, the MHRA says in its monthly bulletin, Drug Update (September 2007). GPs considering prescribing HRT should evaluate the potential risks and benefits for each individual, the MHRA says. The bulletin summarises the risks of cardiovascular events and cancers associated with HRT. Cardiovascular risk is a particular concern for women over 60, whose baseline risk is high; although evidence for the safety of HRT in younger women is limited, their baseline risk is lower. Overall, the lowest dose of HRT should be used for the shortest possible time, and HRT should be prescribed to prevent osteoporosis only when alternatives are not suitable. The MHRA also advises in the bulletin that: Individual risk of stroke, breast cancer and endometrial cancer should be considered before prescribing tibolone (Livial). Nasal formulations of desmopressin are no longer indicated for primary nocturnal enuresis; prescribers are reminded to adhere to product guidance on fluid intake. Patients and carers should be warned of the risk of psychiatric effects associated with corticosteroids; symptoms may develop within a few days or weeks in children and adults, and may be more common at higher doses. Patients taking steroids for more than three weeks are reminded not to stop treatment abruptly. A list of questions and answers for patients is available at www.mhra.gov.uk. The use of parenteral B vitamins plus ascorbic acid (Pabrinex) may rarely be associated with severe allergic reactions, but this should not preclude its use for patients who need it. Study claims statin switch may increase CV morbidity Switching patients from atorvastatin (Lipitor) to simvastatin may increase the risk of cardiovascular events, according to a UK study presented at the European Society of Cardiology Congress in Vienna. The analysis, from The Health Improvement Network database, included 11 520 patients taking atorvastatin for at least six months, of whom 2511 were switched to simvastatin. Switching was associated with a 30 per cent increase in the relative risk of cardiovascular events, though absolute figures have not been reported. Patients who were switched were also more likely to discontinue treatment (21 vs 8 per cent of those continuing atorvastatin). Details of the conduct of the study, which will be published in the British Journal of Cardiology, are not available. Glitazones controversy rumbles on New systematic reviews have fuelled the controversy over the cardiac safety of rosiglitazone and pioglitazone. A meta-analysis of four trials involving 14 291 patients and lasting one to four years found that rosiglitazone was associated with a significantly increased risk of myocardial infarction (relative risk, RR, 1.42) and heart failure (RR 2.09) but not cardiovascular mortality (RR 0.90) (J Am Med Assoc 2007;298:1189-95). The second review included 19 trials of pioglitazone involving 16 390 patients, with follow-up from four months to 3.5 years. Pioglitazone was associated with a lower risk of composite events (death, myocardial infarction, stroke; hazard ratio, HR, 0.82) but an increased risk of serious heart failure (HR 1.41) (J Am Med Assoc 2007;298: 1180-8). Neither review reported significant heterogeneity between the included studies. Another systematic review of eight controlled and cohort studies concluded that metformin is the only antidiabetic drug not associated with an increased risk of harm in patients with diabetes and heart failure (Br Med J Online First 30 August; doi:10.1136/bmj.39314. 620174.80). The Canadian authors found methodological problems with all studies, and concluded that results for sulphonylureas were conflicting due to differences between the studies. Asthma prescribing education Health professionals need more education about rational prescribing for children with asthma, say researchers from Australia (Arch Dis Child online: 4 September 2007; doi: 10. 1136/adc.2007.119834). Analysing trends in asthma medication prescriptions for children in the UK between 2000 and 2006, they found the proportion of steroid inhalers prescribed as combinations increased from 2.7 per cent in 2000 to 25 per cent in 2006. The authors say this excessive increase is inconsistent with guidance that steroid-only inhalers should be the mainstay for most people with asthma. Copyright © 2007 Wiley Interface Ltd [source] Vulvar Vestibulitis Syndrome and Estrogen Dose of Oral Contraceptive PillsTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2007Alexander Greenstein MD ABSTRACT Introduction., Vulvar vestibulitis syndrome (VVS) is a diverse, multifactorial phenomenon. Its precise etiology is unknown. Aim., To define the association between oral contraceptive (OC) estrogen dosage and VVS. Methods., Women diagnosed as having VVS participated in the study. Main Outcome Measures., Data on type and usage of oral contraceptive pills (OC) were obtained by a questionnaire, and they were compared for the data on OC usage in the general population. Results., Available commercial data on Israeli women taking OC showed that 51% of them use low-dose estrogen (,20 µg) OC and 49% use higher-dose estrogen (30,35 µg) OC. Of the 132 women in the study, 86 (65%) used OC: 68 (79%) used low-dose estrogen OC (P < 0.002 compared to the general population), while only 18 (21%) used high-dose estrogen OC (P < 0.002 compared to the general population). Conclusion., Significantly more patients who are treated in our clinic for VVS use low-dose estrogen than those who use high-dose estrogen OC. Greenstein A, Ben-Aroya Z, Fass O, Militscher I, Roslik Y, Chen J, and Abramov L. Vulvar vestibulitis syndrome and estrogen dose of oral contraceptive pills. J Sex Med 2007;4:1679,1683. [source] Effect of an oral contraceptive preparation containing ethinylestradiol and gestodene on CYP3A4 activity as measured by midazolam 1,-hydroxylationBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2000Sanna Palovaara Aims,To characterize the effect of an oral contraceptive (OC) containing ethinylestradiol and gestodene on the activity of CYP3A4 in vivo as measured by the 1,-hydroxylation of midazolam. Methods,In this randomised, double-blind, cross-over trial nine healthy female subjects received either a combined OC (30 µg ethinylestradiol and 75 µg gestodene) or placebo once daily for 10 days. On day 10, a single 7.5 mg dose of midazolam was given orally. Plasma concentrations of midazolam and 1,-hydroxymidazolam were determined up to 24 h and the effects of midazolam were measured with three psychomotor tests up to 8 h. Results,The combined OC increased the mean AUC of midazolam by 21% (95% CI 2% to 40%; P = 0.03) and decreased that of 1,-hydroxymidazolam by 25% (95% CI 10% to 41%; P = 0.01), compared with placebo. The metabolic ratio (AUC of 1,-hydroxymidazolam/AUC of midazolam) was 36% smaller (95% CI 19% to 53%; P = 0.01) in the OC phase than in the placebo phase. There were no significant differences in the Cmax, tmax, t½ or effects of midazolam between the phases. Conclusions,A combined OC preparation caused a modest reduction in the activity of CYP3A4, as measured by the 1,-hydroxylation of midazolam, and slightly increased the AUC of oral midazolam. This study suggests that, at the doses used, ethinylestradiol and gestodene have a relatively small effect on CYP3A4 activity in vivo. [source] Medical treatment of hirsutismDERMATOLOGIC THERAPY, Issue 5 2008Ulrike Blume-Peytavi ABSTRACT:, Hirsutism is usually the result of an underlying adrenal, ovarian, or central endocrine abnormality mainly due to polycystic ovary syndrome but may also be idiopathic or drug induced. The aim of medical treatment of hirsutism is to rectify any causal hormonal balance, slow down or stop excessive hair growth, and improve the aesthetic appearance of hirsutism, thereby positively affecting the patient's quality of life. Today, for the majority of women, a monotherapy with oral contraceptives that have antiandrogenic activity is recommended as a first-line treatment for hirsutism. Combining an oral contraceptive pill with an antiandrogen is recommended if clinical improvement of hirsutism is insufficient after 6,9 months' monotherapy. In women who present with hirsutism, hyperandrogenism, and insulin resistance, insulin sensitizers are effective for the hirsutism as well as the hyperinsulinemia, hyperandrogenism, and infertility but there is no convincing evidence that they are effective for hirsutism alone. Topical eflornithine is a medical therapy that can be a useful adjuvant for hirsutism when used in conjunction with systemic medications or with laser/photoepilation. [source] Bipolar disorder in women: reproductive events and treatment considerationsACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2005M. P. Freeman Objective:, Bipolar disorders are prevalent in women. Women with bipolar disorder often present with different clinical features than men. Reproductive events and hormonal treatments may impact the course of bipolar disorder. Our main objectives are to i) assess the impact of reproductive events on the course of the disorder, and ii) to discuss the relationships between reproductive events and psychiatric treatments. Method:, A literature search was conducted of MEDLINE journals from 1965 to present. Manual literature searches were also conducted. We review the presentation, clinical course, and treatment considerations of bipolar disorder in women, with emphasis on treatment considerations in the context of reproductive events. Treatment-related issues such as teratogenicity, breastfeeding, polycystic ovarian syndrome, weight gain and obesity, and medication interactions with oral contraceptives are reviewed. Results:, Women with bipolar disorder may be more vulnerable to mood episodes in the context of reproductive events, particularly postpartum. In women of reproductive age, mood stabilizers must be selected with teratogenic risks in mind, with the highest reported risks in pregnancy with valproate, and the greatest concern during breastfeeding with lithium use. In the areas of the perimenopause and polycycstic ovarian syndrome, more data are needed to advise treatment decisions. Conclusion:, We urgently need further study in these areas to deliver care that is appropriate to women with bipolar disorder. [source] Lack of genotoxicity induced by endogenous and synthetic female sex hormones in peripheral blood cells detected by alkaline comet assayENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 5 2007Mariana Gobbo Braz Abstract The etiology of hormone-induced cancers has been considered to be a combination of genotoxic and epigenetic events. Currently, the Comet assay is widely used for detecting genotoxicity because it is relatively simple, sensitive, and capable of detecting various kinds of DNA damage. The present study evaluates the genotoxic potential of endogenous and synthetic sex hormones, as detected by the Comet assay. Blood cells were obtained from 12 nonsmoking and 12 smoking women with regular menstrual cycles and from 12 nonsmoking women taking low-dose oral contraceptives (OC). Peripheral blood samples were collected at three phases of the menstrual cycle (early follicular, mean follicular, and luteal phases), or at three different moments of oral contraceptive intake. Three blood samples were also collected from 12 healthy nonsmoking men, at the same time as oral contraceptive users. Results showed no significant difference in the level of DNA damage among the three moments of the menstrual cycle either in nonsmoking and smoking women, or between them. No significant difference in DNA damage was also observed among oral contraceptive users, nonusers, and men. Together, these data indicate lack of genotoxicity induced by the physiological level of the female sex hormones and OC as assessed by the alkaline Comet assay. In conclusion, normal fluctuation in endogenous sex hormones and use of low-doses of oral contraceptive should not interfere with Comet assay data when this technique is used for human biomonitoring. Environ. Mol. Mutagen., 2007. © 2007 Wiley-Liss, Inc. [source] Ethinyl Estradiol, Not Progestogens, Reduces Lamotrigine Serum ConcentrationsEPILEPSIA, Issue 9 2005Arne Reimers Summary:,Purpose: To study the interaction between lamotrigine (LTG) and hormonal contraception. Methods: LTG serum concentrations of female patients using either no hormonal contraception (n = 18), an ethinyl estradiol (EE)-containing (n = 11), or a progestogen (PG)-only,containing compound (n = 16) were analyzed. Patients were recruited prospectively, and blood samples were drawn during drug fasting and at steady-state conditions. Comedication with enzyme inducers, valproate, topiramate, or sertraline was not allowed. Some patients changed groups and thus served as their own controls. Samples were analyzed by a gas chromatography/ mass spectroscopy method. The Mann,Whitney U test was used for statistical comparison of the groups. Results: The LTG serum concentration-to-dose ratio (CDR), expressed as (mg/L)/(mg/d) was significantly lower in women using EE than in the control group (mean ± SD, 0.010 ± 0.004 vs. 0.017 ± 0.006; p = 0.003). The CDR in women using PG was 0.02 ± 0.007, which was not statistically different from controls. No difference was found in CDR between women using either oral, topical, or parenteral PG. Five women switched from the control to the EE group and experienced a considerable reduction in CDR. An increase of the CDR toward control level was seen in the two women who changed from EE to PG. Conclusions: It is the EE component of oral contraceptives that interacts with LTG. The PG-only compounds did not alter LTG serum concentrations in this study. These findings should be considered when counselling women with epilepsy in the childbearing ages. [source] Environmental factors in inflammatory bowel disease: A co-twin control study of a Swedish-Danish twin populationINFLAMMATORY BOWEL DISEASES, Issue 10 2006Jonas Halfvarson MD Abstract Background: Genetics and environmental factors are implicated in the etiology of inflammatory bowel disease (IBD). We studied environmental factors in a population-based Swedish-Danish twin cohort using the co-twin control method. Subjects and Methods: A questionnaire was sent to 317 twin pairs regarding markers of exposures in the following areas: infections/colonization and diet as well as smoking, appendectomy, and oral contraceptives. Odds ratios (OR) were calculated by conditional logistic regression. When confounding appeared plausible, multivariate conditional logistic regression was added. The questions were also divided into topic groups, and adjustment was made for multiple testing within each of the groups. Results: The response rate to the questionnaire was 83%. In consideration of the study design, only discordant pairs were included (Crohn's disease [CD], n = 102; ulcerative colitis [UC], n > = 125). Recurrent gastrointestinal infections were associated with both UC (OR, 8.0; 95% confidence interval [CI], 1.0,64) and CD (OR, 5.5; 95% CI, 1.2,25). Hospitalization for gastrointestinal infections was associated with CD (OR, 12; 95% CI, 1.6,92). Smoking was inversely associated with UC (OR, 0.4; 95% CI, 0.2,0.9) and associated with CD (OR, 2.9; 95% CI, 1.2,7.1). Conclusions: The observed associations indicate that markers of possible infectious events may influence the risk of IBD. Some of these effects might be mediated by long-term changes in gut flora or alterations in reactivity to the flora. The influence of smoking in IBD was confirmed. [source] Cervical cancer screening program integrating Pap smear and HPV DNA testing: A population-based studyINTERNATIONAL JOURNAL OF CANCER, Issue 12 2008Angel Chao Abstract We conducted a population-based cohort study to evaluate the complementary value of HPV testing to Papanicolaou (Pap) smear and the prevalence and genotype distribution of HPV in Taiwan. In this report, we described the design of the whole study and analyzed the cross-sectional results. Female residents (age , 30 years) of Taoyuan, Taiwan were invited. After signing informed consent, every participant had a Pap smear and a HPV testing. Patients with Pap , atypical squamous cell of undetermined significance (Group I) or those with HPV-positive but normal cytology (Group II) were referred for a colposcopic examination. A total of 10,014 women were eligible. The overall HPV prevalence was 10.8% (95% confidence interval 10.5%,11.4%) in the study population. A total of 37 types of HPV were identified and the leading three were HPV-52, -18 and -58. There was a significant positive correlation of HPV prevalence with older age, postmenopausal status, current-user of oral contraceptives and never-user of hormone replacement therapy. Past users of oral contraceptives and never users of Pap were associated with higher risk of abnormal Pap, while age 40,49 strata had lower risk. Fifty-nine cases of cervical intraepithelial neoplasia (CIN) 2 from Group I and additional 11 from Group II were identified. The improvement of sensitivity with additional HPV testing was 15.3%. Besides, no specific subgroup was found to most benefit from the combined strategy. The value of adding HPV test to conventional Pap smear has to be evaluated after longer-term follow-up of this population-based cohort. © 2008 Wiley-Liss, Inc. [source] Oral contraceptive use, hormone replacement therapy, reproductive history and risk of colorectal cancer in womenINTERNATIONAL JOURNAL OF CANCER, Issue 3 2008Geoffrey C. Kabat Abstract Evidence from epidemiologic studies suggests a possible role of exogenous and endogenous hormones in colorectal carcinogenesis in women. However, with respect to exogenous hormones, in contrast to hormone replacement therapy, few cohort studies have examined oral contraceptive use in relation to colorectal cancer risk. We used data from a large cohort study of Canadian women enrolled in a randomized controlled trial of breast cancer screening to assess the association of oral contraceptive use, hormone replacement therapy and reproductive factors with risk of colorectal cancer, overall and by subsite within the colorectum. Cancer incidence and mortality were ascertained by linkage to national databases. Among 89,835 women aged 40,59 at enrollment and followed for an average of 16.4 years, we identified 1,142 incident colorectal cancer cases. Proportional hazards models were used to estimate the associations between the exposures of interest and risk of colorectal cancer. Ever use of oral contraceptives at baseline was associated with a modest reduction in the risk of colorectal cancer (hazard ratio 0.83, 95% confidence interval 0.73,0.94), with similar effects for different subsites within the colorectum. No trend was seen in the hazard ratios with increasing duration of oral contraceptive use. No associations were seen with use of hormone replacement therapy (ever use or duration of use) or reproductive factors. Our results are suggestive of an inverse association between oral contraceptive use and colorectal carcinogenesis. However, given the lack of a dose,response relationship and the potential for confounding, studies with more complete assessment of exogenous hormone use throughout the life course are needed to clarify this association. © 2007 Wiley-Liss, Inc. [source] Education and risk of breast cancer in the Norwegian-Swedish women's lifestyle and health cohort studyINTERNATIONAL JOURNAL OF CANCER, Issue 4 2004Tonje Braaten Abstract A positive relationship between level of education and female breast cancer risk is well supported by scientific evidence, but few previous studies could adjust for all relevant potential confounding factors. The authors' purpose was to examine how risk for breast cancer varies with level of education and to identify factors that explain this variation, using data from a prospective cohort study including 102,860 women from Norway and Sweden who responded to an extensive questionnaire in 1991/1992; 1,090 incident primary invasive breast cancer cases were revealed during follow-up, which ended in December 1999. The Cox Proportional Hazards Model was used to calculate relative risks (RR) with 95% confidence intervals (CI). Women with more than 16 years of education had a 36% increased risk compared to the lowest educated (7,9 years) (Age adjusted RR=1.36, 95% CI: 1.10, 1.68). This relationship was slightly stronger among postmenopausal (RR 1.51) than among premenopausal (RR 1.25) women. In both groups, however, the relative risk estimates turned close to unity by adjustment for parity, age at first birth, body mass index (BMI), height, age at menarche, menopausal status, use of oral contraceptives and consumption of alcohol. The overall multivariate relative risk among the highest educated women was 1.04 (95% CI 0.82,1.32). The results of our study suggest a clear positive gradient in risk for breast cancer by level of education, which can be fully explained by established breast cancer risk factors. © 2004 Wiley-Liss, Inc. [source] Anorexia nervosa and Raynaud's phenomenon: A case reportINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 8 2007Basak Yucel MD Abstract Objective: To describe and discuss potential relationships between anorexia nervosa (AN) and Raynaud's phenomenon, the course and concurrent treatment of these two disorders as they appeared simultaneously, and a potential treatment modification entailed in such concurrent therapies. Background: Although Raynaud's phenomenon has been described during the course of AN, the associations and interactions between these two conditions are not clear. Method: We report the medical workup, treatment, and outcomes in a 19-year old female patient who developed Raynaud's phenomenon following the onset of AN. Results: After treatment with nutritional rehabilitation, counseling, and individual and group therapy, the patient's weight, eating disorder-related behaviors, and attitudes improved significantly. Raynaud's related symptoms improved, following treatment with a calcium channel blocker and antiaggregant therapy. In conjunction with nutritional efforts to treat the patient's long-standing amenorrhea and osteopenia, the treatment team elected to also administer estrogen hormone in addition to oral calcium and vitamin D supplementation. Since oral contraceptives are to be avoided in patients with Raynaud's phenomenon who show clinical findings suggesting connective tissue disorder, the treatment team elected to treat this patient with transdermal hormone replacement therapy. Conclusion: The co-occurrence of AN and Raynaud's phenomenon merits close and persistent follow-up by a multidisciplinary team and may lead to alterations of usual therapeutic approaches. © 2007 by Wiley Periodicals, Inc. [source] Accuracy of reported weight and menstrual status in teenage girls with eating disordersINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2005Ingemar Swenne MD Abstract Objective The current study investigated the accuracy of reported current and historical weights and of menstrual status in teenage girls with eating disorders. Method Reported current weight in one interview was compared with measured weight at another occasion. Reported historical weights were compared with documented weights from growth charts of the school health services. Reports of menstrual status from two different interviews were compared. Results The overall correlation between reported and measured/documented weight was high. Current weight was reported with high accuracy in all diagnostic groups and without tendencies to underreport. Patients with bulimia nervosa, but not those with anorexia nervosa, underreported their historical top weight. The most common reason for large discrepancies between reported and documented historical weights was that the two weights compared referred to different time points. The reports on menstrual status were divergent for 13% of the patients, most notably 4 of 15 patients on oral contraceptives had been categorized as having menstruations in one of the interviews. Conclusion Reported weight history and menstrual status are of high accuracy in teenage girls with eating disorders. © 2005 by Wiley Periodicals, Inc. [source] Vasectomy within the public health services in Campinas, São Paulo, BrazilINTERNATIONAL NURSING REVIEW, Issue 2 2010N.M. Marchi rn MARCHI N.M., DE ALVARENGA A.T., OSIS M.J.D., DE AGUIAR GODOY H.M., SIMÕES E SILVA DOMENI M.F. & BAHAMONDES L. (2010) Vasectomy within the public health services in Campinas, São Paulo, Brazil. International Nursing Review57, 254,259 Objective:, To describe some of the characteristics of men who underwent a vasectomy in the public health network of Campinas, São Paulo, Brazil. Methods:, A descriptive study including 202 men randomly selected from a list of all the men vasectomized between 1998 and 2004 in the public health network. Results:, Most of the men were 30 years of age or older when vasectomized, had completed elementary school and had two or more children of both sexes. Most of the men came from the lowest income segment of the population: 47.6% in 1998,1999 and 61.3% in 2003,2004. Although the men knew various contraceptive methods, 51.2% reported that their partners were using combined oral contraceptives at the time of surgery. Most men initially sought information on vasectomy at health-care clinics where care was provided by a multidisciplinary team; most received counselling, however, 47.9% of the men waited more than 4 months for the vasectomy. Conclusions:, The profile of the vasectomized men in this study appears to indicate that the low-income population from Campinas, São Paulo, Brazil has access to vasectomy; however, the waiting time for vasectomy reveals that difficulties exist in obtaining this contraceptive method in the public health service. [source] Breast cancer risk factors in Korean women: a literature reviewINTERNATIONAL NURSING REVIEW, Issue 3 2008S.-M. Lee rn Aim:, To compile a complete list of risk factors from the Korean breast cancer studies to obtain relevant predictor information essential in developing a predictive model for breast cancer. Background:, Breast cancer is the most commonly diagnosed female cancer in Korea. However, the breast cancer-screening rate in Korea is relatively low compared with that in other countries. In order to promote early health screening, there is a need to identify those individuals who are most likely to develop breast cancer by using an accurate predictive model. Methods:, Thirty-four breast cancer studies were selected from MEDLINE and two Korean literature databases. Two researchers summarized the risk factors and their effects in each article using a checklist. Findings:, Most of the studies were case,control studies conducted after 2000. In 34 articles, a total of 84 risk factors for breast cancer in Korean women were identified; of these, 58 factors were determined as statistically significant factors. The factors identified most often were body mass index, menarche, menopause, family history, pregnancy and delivery, breastfeeding, alcohol use, smoking habits, diet, education and use of oral contraceptives. None of 34 studies looked at stress as a risk factor of which influence on cancer has been reported in other populations. Conclusion:, The next steps will be to construct a questionnaire consisting of relevant variables based on these study results and to develop a predictive model. This would be used to encourage those Koreans who are more likely to develop breast cancer to have early check-ups. [source] Risk of hormone replacement therapy in stroke patientsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2000Damczyk BSc Hormone replacement therapy (HRT) (oestrogen with or without progestin) is often initiated with the onset of menopause to decrease symptoms of oestrogen deficiency, such as vasomotor instability (hot flashes) and urogenital effects ( 1,3). HRT can also prevent long-term consequences of oestrogen deficiency, such as osteoporosis and cardiovascular disease ( 1,3). The decision to start HRT in peri- and postmenopausal women is complicated by concerns of increased risk for thromboembolic events, uterine cancer and breast cancer ( 2,4). Thromboembolic stroke is a particular concern due to its association with the use of oral contraceptives with high oestrogen content ( 3, 4). However, for older women it has been suggested that HRT use decreases or has no effect on stroke risk ( 5,9). Should these findings apply to a women with a history of thromboembolism, in this case ischemic stroke? [source] | ||||||||||||||||||||||||||||||||||||||||