"Tabela Periódica" da Anticoncepção ­ uma ferramenta na escolha contraceptiva / "Periodic Table" of Contraception ­ a tool in the contraceptive choice

Estima-se que 40% das gestações no mundo sejam não planejadas. Em países de baixa renda, complicações no parto são a maior causa de morte entre mulheres de 15 a 19 anos. A disponibilidade de métodos contraceptivos reversíveis é necessária para o adequado planejamento reprodutivo. Entre os métodos reversíveis, os de longa ação (LARCs) são os mais efetivos. Métodos de curta ação (SARCs) são preferenciais para pacientes que desejam gestar a curto prazo e para as quais a gestação não será indesejada. O presente estudo é uma revisão narrativa da literatura, de artigos em inglês e português publicados entre 2009 e 2020, utilizando as bases de dados SciELO, Medline e Embase. O objetivo desta revisão é apresentar os LARCs e SARCs em uma tabela com dados comparativos que auxiliem na tomada de decisão do médico e da paciente e permita estabelecer estratégias para um planejamento familiar adequado.(AU)

It is estimated that 40% of pregnancies in the world are unplanned. In low-income countries, complications in childbirth are the major cause of death among women aged 15 to 19 years. The availability of reversible contraceptive methods is necessary for proper reproductive planning. Among the reversible methods, long-acting reversible contraception (LARCs) is the most effective. Short-acting reversible contraception (SARCs) methods are preferred for patients who wish to become pregnant in the short term and for whom pregnancy will not be undesirable. The present study is a narrative review of the literature, of articles in English and Portuguese published between 2009 and 2020, using the databases SciELO, Medline and Embase. The purpose of this review is to present the LARCs and SARCs in a table with comparative data that assist in the decision making of the doctor and the patient and allow to establish strategies for adequate family planning.(AU)

A clinical study of transdermal contraceptive patch in Thai adolescence women.

OBJECTIVE: To study cycle control, compliance and safety of a transdermal contraceptive patch in adolescent Thai women. MATERIAL AND METHOD: Fifty-eight healthy women were assigned to receive 3 cycles of contraceptive patch (ethinyl estradiol 20 microg and norelgestromin 150 microg/day). All participants aged 16-20 years were invited to participate from the family planning clinic at King Chulalongkorn Memorial Hospital. Data were collected on adverse effects, perceived advantages and disadvantages, body weight, blood pressure, patch detachments and compliance. Data were analyzed using mean, percentage and student's t-test. RESULTS: The participants' average age was 19.4 years, height 158.8 cm, weight 51.8 kg, BMI 20.8 Kg/m2. The most location of patch application was the abdomen and the most adverse event was breast tenderness (31.0%) followed by application site reaction, nausea vomiting and headache respectively. The breast symptom was mild in severity. The participants reported decrease in dysmenorrhea and shorter duration of bleeding. There were no significant changes in body weight and blood pressure. The improvement of their facial acne was reported. There were no pregnancies during use and the adhesion of the contraceptive patch is excellent. Partial patch detachment was reported in only 6.9%. No completed patch detachment was found. CONCLUSION: The present study found an overall positive impression of a new transdermal contraceptive patch. The good compliance and few side effects were demonstrated. The adhesive patch contraceptive was excellent.

Effect of oral contraceptive with and without associated estriol on ultrasound measurements of breast fibroadenoma: randomized clinical trial

CONTEXT AND OBJECTIVE: Fibroadenomas are the most common benign tumors of the female breast. The aim of this study was to evaluate the proliferative activity of breast fibroadenoma as shown by ultrasound measurements, following administration of oral contraceptives with and without associated estriol. DESIGN AND SETTING: This was a randomized, double-blind, placebo-controlled clinical trial carried out in the Mastology Sector, Department of Gynecology, Universidade Federal de São Paulo. METHODS: We studied 33 women with fibroadenomas. Ten were placed in group 1 and took an oral contraceptive consisting of levonorgestrel and ethinyl estradiol together with placebo material in the same capsule, for four consecutive cycles with a seven-day interval between them. The other 23 patients constituted group 2 and took the oral contraceptive as above together with estriol in the same capsule, in the same way as done by the group 1 patients. We took ultrasound measurements of their tumors (in three dimensions) before and after the intake of medication. At the end of the study, all the patients had their tumors removed by surgery. RESULTS: We observed decreased fibroadenoma width among the users of oral contraceptives with placebo, and this decrease was statistically significant. In the other group, we did not observe any changes (in width, length or height). CONCLUSION: The results confirm that estriol may block the protective effect of oral contraceptives on fibroadenomas, since we observed decreased fibroadenoma width among the group 1 patients but not the group 2 patients.

CONTEXTO E OBJETIVO: Fibroadenomas são os tumores benignos mais comuns na mama feminina. Avaliamos a atividade proliferativa do fibroadenoma mamário por medidas ultra-sonográficas após a administração de anticoncepcional hormonal combinado oral, associado ou não ao estriol. TIPO DE ESTUDO E LOCAL: Ensaio clínico randomizado, duplo-cego, placebo-controlado, realizado na Universidade Federal de São Paulo. MÉTODOS: Foram estudadas 33 pacientes portadoras de fibroadenoma, do setor de Mastologia da Disciplina de Ginecologia da Universidade Federal de São Paulo, sendo que 10 mulheres constituíram o grupo 1 e utilizaram anticoncepcional oral composto de levonorgestrel e etinilestradiol, associados a um comprimido de placebo, na mesma cápsula, por quatro ciclos consecutivos, com intervalo de sete dias entre os mesmos. As restantes 23 pacientes alocaram-se no grupo 2 e ingeriram, além do anticoncepcional oral descrito acima, um comprimido de estriol, que foi manufaturado conjuntamente ao anticoncepcional, em uma mesma cápsula, sendo utilizado da mesma forma que nas pacientes do grupo 1. Realizamos medidas ultra-sonográficas dos tumores (três dimensões) antes e após a ingestão da medicação. Ao término do estudo, as pacientes sofreram exérese de suas tumorações. RESULTADOS: Obtivemos diminuição da largura nos fibroadenomas de pacientes usuárias apenas de anticoncepcional oral e esse resultado foi estatisticamente significante. Não houve alteração de nenhuma dimensão (largura, altura ou comprimento) no outro grupo. CONCLUSÕES: Os resultados corroboraram que o estriol bloquearia o efeito protetor do anticoncepcional hormonal combinado oral sobre os fibroadenomas, já que observamos diminuição na largura dos fibroadenomas das pacientes do grupo 1 e não do grupo 2.

Evaluation of efficacy of rigevidon in treating pubertal menorrhagia at Institute for Protection of Mother and Newborn

Study on 80 symptomatic menorrhagia patients less than 18 years old treated at Institute for Protection of Mother and Newborn in the year 2000. Results: the rate of patients with irregular menstruation was highest (38.75%). 70% of patients lived in rural, so the rate of late hospital admission (>15 days) accounted for 73.75%. All patients suffered from anemia with 82.5% patients with moderate and severe anemia. Treatment with 2 tablets Rigevidon a day only one time in the evening until menorrhagia reduces, follows by 1 tablet a day for making artificial menstruation of 28 days, is effective in 96.25% patients. This finding showed that using Rigevidon for treating pubertal menorrhagia is simple, safe, and effective, no significant complication.

Digestive Phenotypic Flexibility in Post-Metamorphic Amphibians: Studies on a Model Organism

Studies of phenotypic flexibility are central to the understanding of evolutionary and comparative physiology. Research conducted on many vertebrate species has shown that the digestive system is highly responsive and sensitive to environmental cues. However, amphibians, which are a standard and classic model organism for the study of many physiological processes, have been poorly considered in the study of ecological consequences on digestive flexibility. Here we review and analyze the current information on this topic for amphibians. We identify three major bodies of empirical evidence: a) seasonal changes in gut development, b) lack of dietary modulation of gut attributes in adult individuals, c) a relationship between feeding habits and the magnitude of digestive performance regulation. Once the natural history characteristics of the species under study are taken into account, all the evidence is in full agreement with the predictions of digestive theory. We propose that evolutionary and comparative physiology could benefit greatly from the study of phenotypic flexibility in amphibians.

Oral contraceptive-induced central retinal artery occlusion.

Oral contraceptives are known to have ocular complications including retinal vascular lesions. The authors report a case of central retinal artery occlusion in a young woman on oral contraceptives.

Efectos del estradiol, estradiol más noretisterona y tibolona sobre gl´sndula mamaria de ratas e impacto de los mismoa preparados en mujeres adultas ooforectomizadas evaluadas por mamografía / Effects of estradiol, estradiol with noretisterone and tibolone on mammary glads of rats and the impact of these medications in oophorectomized womwn evaluated by mammography

Pese a los importantes beneficios que brinda la terapia de reemplazo hormonal (TRH), su uso actual es limitado debido al temor general sobre el riesgo de cáncer de mama que pudiera asociarse con su aplicación.Se trata de un estudio prospectivo cuyo objetivo principal es establecer el impacto sobre la glándula mamaria de diversas alternativas utilizadas comúnmente en la terapia de reemplazo hormonal.El presente trabajo pretende observar, que terapéutica hormonal (Estradiol, Estradiol más Noretisterona y Tibolona) presenta mayor tendencia a la proliferación celular en la glándula mamaria de ratas y en mujeres entre 25 y 55 años de edad con menopausia quirúrgica y con esto brindar información acerca de posibles perjuicios y/o beneficios sobre la glándula mamaria con este tipo de terapias y probables beneficios que se pueden obtener al administrar Tibolona, probablemente una nueva alternativa en la TRH. En las pacientes en las que se utilizó estrógenos solos o combinados, hubo un aumento de la densidad mamaria de forma significativa; esto se correlaciona con los reportes histopatológicos de las glándulas mamarias de ratas a las que se les administró estradiol y estradiol más noretisterona produciéndose hiperplasia celular. las mujeres en tratamiento con tibolona mostraran reducción de la densidad mamográfica en forma significativa, lo cual también tiene relación con los reportes histopatológicos de las ratas que tomaron tibolona en las que los conductos galactóforos se encontraron normales con focos de hipotrofia glandular.

Altrough the important benefits of hormone replacement therapy (HRT) its use is limited because of a general fear about the risk of mammary cancer associated with it. The following work attempts to indicate that hormone therapy (Estradiol, Estradiol + Noretisterone and Tibolone) has the tendency of cellular proliferation in mammary glands of rats and women between the ages of 25 and 55 with surgical menopause and bring information about the possibilities of poor results and/or benefits for the mammary gland. This tape of terapy suggest the probable benefits that we could obtain administrating tibolone (possibly a new alternative to HRT.

The Effect of an Oral Contraceptive (Eugynon) Upon Lactation / 예방의학회지

There are a number of published reports aimed at clarifying the effect of hormonal contracept -ives upon the quantity and quality of breast milk during postpartum and lactation periods. As to the volume of milk produced by breast feeding mothers, many authors seem to have agreed on a decrease as an established pattern in the periods following regular administration of oral contraceptives containing estrogen in varying dosage. The quality of milk following administration of hormonal contraceptives, however, remsins a controversial issue. Korea's experience in oral contraceptive is rather a brief one, but use of Eugynon has been widespread and frequent since this hormonal contraceptive was introduced into the national program in 1967. The authors have reviewed the potential significance of data concerning regular use of an oral contraceptive as affecting lactation, and have sought to clarify the interrelationship between the administration of Eugynon and quantity and quality of breast milk from mothers contracepting. with Eugynon in different periods following confinement. A total of 85 women, who were at different periods following deliveries, have been divided into, two groups, one comprising 28 women regularly taking oral pills and the other (57 women) not resorting to hormonal contraceptives if they were contracepting at all. 1. Milk Volume. In view of the possible influence of suckling on the amount of milk produced, efforts were made in this study to standardize the technique by extracting breastmilk by applying manual pressures on one side of the maw-nae, While the nipple on the other side was being sucked by the mother's own baby. The effetct of an exogenic ovarian hormone on the quantity as well as quality of breastmilk is generally understood to be inapparent until the drug is administered to women whose milk secreting function has been normalized. ") In the present study, it was observed that the decrease in the ammount of milk obtained from mothers in the periods following the 4th cycle of oral contraceptives or thereafter has turned out to be statistically insignificant. This result conforms i.u the findings by Tubari and others. It is assumed that it takes at lest 2 to 3 cycles of use before mammary glands are functionally adjusted to the use of exogenic hormonal contraceptives. 2. Specific Gravity and Composition of Milk There was no noticeable change in the protein and chloride content following continuous administration of ore.l contraceptives, while meaningful changes were observed in fat (increase) and calcium (decrease up to the 5th cycle use) contents. Also, there was a rather significant decrease in the specific gravity in the period following administration of the first cycle of the oral contraceptive. The findings from the present study partially conforms the results published by Ramadan and others, who reported that little change was noticed in the contents of total solids. ash, chlorides and lactose in the breast milk of women who had taken 4 cycles of ovosiston, although in our study lactose was not measured. Ramaden, however, reported that fat content did increase in the same milk, as in our study. A definitive conclusion, however, could not be made unless measures are taken to rule out the physiological changes of the maternal body affecting the composition of milks.