Assuntos
Carbazóis/administração & dosagem , Carbazóis/economia , Distúrbios Menstruais/complicações , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Triptaminas/administração & dosagem , Triptaminas/economia , Adulto , Carbazóis/efeitos adversos , Análise Custo-Benefício , Feminino , Hormônios Esteroides Gonadais/uso terapêutico , Humanos , Distúrbios Menstruais/tratamento farmacológico , Transtornos de Enxaqueca/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Agonistas do Receptor de Serotonina/administração & dosagem , Agonistas do Receptor de Serotonina/efeitos adversos , Agonistas do Receptor de Serotonina/economia , Resultado do Tratamento , Triptaminas/efeitos adversos , Vasoconstritores/administração & dosagem , Vasoconstritores/efeitos adversos , Vasoconstritores/economiaRESUMO
Women take oral contraceptives for contraception but also for menstrual dysfunction treatment. This raises the question of whether or not women with menstrual dysfunction are underrepresented in analyses of menstrual function because oral contraceptive users are excluded. To explore this, the authors examined the history of oral contraceptive use among 1322 Black women and White women, aged 35-49 years, who had been randomly selected from a large health plan's membership in Washington, DC, between 1996 and 1999. The women reported whether they took oral contraceptives during their teens, twenties, and thirties, and if so, the reason they took them (prevent pregnancy, medical problem, or both). They also reported their usual menstrual cycle length when not using oral contraceptives during these decades. The prevalence of oral contraceptive use strictly for medical problems was low for both Black women and White women (4-9% of women), and the distributions of usual cycle length were similar for women who did and did not take oral contraceptives. Thus, there was little evidence of substantial bias of estimates of cycle characteristics caused by excluding oral contraceptive users from analyses of menstrual function. However, our data indicate that, with only a few additional questions, information on usual menstrual cycle characteristics can be collected and used to evaluate bias in any given study.
Assuntos
Anticoncepcionais Orais/uso terapêutico , Coleta de Dados/métodos , Ciclo Menstrual/efeitos dos fármacos , Distúrbios Menstruais/tratamento farmacológico , Distúrbios Menstruais/epidemiologia , Adulto , Negro ou Afro-Americano , Viés , Fatores de Confusão Epidemiológicos , Anticoncepcionais Orais/farmacologia , Coleta de Dados/normas , District of Columbia/epidemiologia , Feminino , Sistemas Pré-Pagos de Saúde , Humanos , Pessoa de Meia-Idade , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Projetos de Pesquisa/normas , População BrancaRESUMO
BACKGROUND: The study was an audit of patients who attended the Menstrual Disorders Clinic at Glasgow Royal Infirmary over a five year period, and received gonadotrophin-releasing hormone analog (GnRHa). We aimed to identify the clinical indications for the use of GnRHa, and the effect of the latter in terms of symptom resolution and ultimate outcome. We aim to use this information to formulate a strategy for the use of GnRHa by targeting this expensive therapy to those situations where maximum benefit will be achieved. METHODS: A retrospective case review analysis of 201 patients. RESULTS: Thirty-eight percent of women presented with pelvic pain, 33% with disordered menstruation and 26% with premenstrual symptomatology. Overall, 74% of patients reported a beneficial effect of GnRHa. In the non-cyclical pelvic pain group, those patients with adhesions constituted a much greater proportion of those who did not derive benefit from GnRHa than those who did (43% vs. 16%; p<0.05; data not shown). In those patients with disordered menses, there was no difference between the diagnosis in those who did or did not derive benefit from GnRHa. Also with the exception of endometrial preparation prior to ablation and in the correction of anemia, the ultimate outcome was no different in the two groups. Of the patients with premenstrual symptomatology, the greatest proportion of those deriving benefit from GnRHa (41%) ultimately had an operative resolution. CONCLUSIONS: Our results enable us to use GnRHa as a first line in those clinical situations where maximum benefit will be achieved, either in terms of symptom resolution or as a tool to identify the most appropriate therapeutic option. We can therefore rationalize our prescribing both to the benefit of the patient and to our budget.
Assuntos
Gosserrelina/uso terapêutico , Distúrbios Menstruais/tratamento farmacológico , Adulto , Análise Custo-Benefício , Uso de Medicamentos/estatística & dados numéricos , Feminino , Gosserrelina/economia , Humanos , Dor Pélvica/tratamento farmacológico , Síndrome Pré-Menstrual/tratamento farmacológico , Estudos RetrospectivosRESUMO
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of the symptoms of osteoarthritis (OA), rheumatoid arthritis (RA), sprains and strains, sports injuries and menstrual disorders, and have a small role in the management of patent ductus arteriosus in the neonate. In patients with RA, symptom relief through use of NSAIDs is firmly established, although it remains unclear whether they influence the course and outcome of the disease. For the average patient with RA taking NSAIDs, the attributable risk of hospitalisation with gastrointestinal problems related to NSAIDs is 1.3 to 1.6% annually and risk of death is 0.15%. Associations of therapy with risk are greatest with age, corticosteroid use and previous NSAID-related gastrointestinal adverse effects, and less marked with disability and high NSAID dose. These are important data in attempting to balance risk of therapy with clinical efficacy in an individual patient, and assessing the cost-effectiveness of prophylaxis. Although half of all NSAID consumption is for control of pain associated with degenerative conditions, their superiority over simple analgesics in osteoarthritis is poorly documented. This finding supports the use of the simple analgesic paracetamol (acetaminophen) as the preferred therapy of osteoarthritis, especially when its lower cost and low incidence of adverse effects are taken into consideration. Consistent differences in clinical effectiveness of individual NSAIDs have not been demonstrated, although unpredictable interpatient variation in response to individual agents is of considerable clinical importance, and a more expensive NSAID may prove cost effective for some patients. Cost effectiveness can be improved by a self-adjusted dosage regime which also leads to lower overall drug consumption. The adverse gastrointestinal effects of these drugs account for about 30% of the overall cost of arthritis treatment, and although studies to date have been too limited to assess the relative risk of gastrointestinal toxicity of the different NSAIDs reliably, ibuprofen appears to be one of the least hazardous, and azapropazone one of the most hazardous. Although the effectiveness of prophylaxis with H 2-antagonists and with prostaglandin E 1 analogues (prostaglandin-E 1 analogues) has been established, estimates of cost-benefit ratios are widely divergent. To establish the most cost-effective therapy with NSAIDs, more data are required to establish multivariable risk profiles for identification of patients at particular risk, the optimal drug, and its optimal dosage and duration of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
Assuntos
Anti-Inflamatórios não Esteroides , Farmacoeconomia , Anti-Inflamatórios não Esteroides/economia , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/economia , Artrite Reumatoide/terapia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Sistema Digestório/efeitos dos fármacos , Permeabilidade do Canal Arterial/economia , Permeabilidade do Canal Arterial/terapia , Farmacoeconomia/tendências , Previsões , Humanos , Distúrbios Menstruais/tratamento farmacológico , Distúrbios Menstruais/economia , Sistema Musculoesquelético/lesões , Osteoartrite/economia , Osteoartrite/terapia , Resultado do Tratamento , Úlcera/induzido quimicamente , Úlcera/prevenção & controleRESUMO
This article considers the benign yet debilitating conditions of menorrhagia, dysmenorrhoea and irregular menstrual bleeding. Surprisingly little has been reported in the literature concerning these common ailments which can detract from the quality of female life during the reproduction years. Both dysmenorrhoea and menorrhagia are subjective complaints, but despite accurate means of measuring menstrual blood loss such quantification is rarely performed. This lack of diagnostic accuracy is a cause for concern, especially as both medical and surgical treatment are not without risk. The therapeutic alternatives which are commonly prescribed in an attempt to rectify such menstrual disorders are discussed. These include the nonsteroidal anti-inflammatory agents, the combined oral contraceptives, danazol, progestogens, antifibrinolytics, haemostatics, luteinising hormone releasing hormone analogues and clomiphene. The results of clinical trials which have utilised these various agents are considered in terms of both the effectiveness of treatment and its potential adverse effects.