Vaginal mucus from ewes treated with progestogen sponges affects quality of ram spermatozoa.

The use of intravaginal sponges (IS) to synchronize estrous onset in ewes provokes vaginitis, an increase in the vaginal bacterial load, and growth of bacterial species that are not present during spontaneous estrous behavior. The objective of the study was to compare the functional sperm parameters after incubating it with mucus collected from the vagina of ewes during spontaneous estrus or estrous synchronized with IS. Pooled spermatozoa were co-incubated with: (1) vaginal mucus collected from ewes in spontaneous estrus; (2) vaginal mucus collected from ewes in estrus pretreated with progestogen-impregnated IS; (3) synthetic mucus; and (4) medium without mucus as a control group. Sperm samples were evaluated after incubating it for 30 and 90 minutes. The number of colony-forming units (CFUs/mL), pH, and osmolality were greater in the mucus collected from ewes treated with IS than from those untreated (P = 0.046; P < 0.0001, and P < 0.0001, respectively). The percentage of sperm with progressive motility was lower after incubation with vaginal mucus collected from estrous ewes treated with IS than in the other three treatments both, 30 and 90 minutes after incubation (P = 0.0009 and P < 0.0001, respectively). The sample incubated for 30 minutes with mucus from ewes treated with IS had a lower percentage of sperm with intact plasma membrane than all the other treatments (P < 0.0001). The percentage of sperm with functional membrane was significantly lower in the sample incubated for 30 minutes with vaginal mucus from ewes treated with IS than in the other three treatments (P < 0.0001). After 90 minutes, the percentage was still lower than that in the sample collected from ewes during their spontaneous estrus (P = 0.0005). The lowest percentages of sperm with acrosome damage were observed in sperm incubated with mucus collected from sheep in spontaneous estrus for 30 and 90 minutes (P < 0.0001 and P = 0.008, respectively). The percentage of apoptotic spermatozoa was greater in samples incubated during 30 minutes with vaginal mucus collected from ewes treated with IS than in the other three groups (P = 0.0005). The functionality and the viability of ram sperm is negatively affected by the cervical mucus of ewes pretreated with progestagen-impregnated IS used in estrous synchronization treatments. This may partially explain the decrease in conception rate obtained with treatments with IS.

Metabolic effects of contraceptive implants in adolescents.

BACKGROUND: This prospective study analyzed the metabolic effects of an etonogestrel implant used for 1 year by adolescents. STUDY DESIGN: The study population comprised 47 postpartum adolescents (mean 17.2 years old) managed at the Family Planning Sector of São Paulo Federal University. Participants received an implant containing etonogestrel (68 mg) within 6 months of delivery (on average 102 days after giving birth) and were followed for 1 year. Blood was collected at baseline and 12 months later to assess total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), hemogram, urea, creatinine, sodium, potassium, fasting glucose, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and bilirubin. RESULTS: Three adolescents did not return after receiving the implant despite telephone messages and a telegram and were excluded from the clinical and final laboratory analyses. All 44 patients completed the 12 months of follow-up, resulting in a study discontinuation rate of 0%. No implants were removed. Laboratory analyses were completed in 37 adolescents. After 1 year of using the implant, there was a significant increase in mean hemoglobin, hematocrit and indirect bilirubin concentrations and of the HDL-C/TC and HDL-C/LDL-C ratios. Additionally, there was a significant decrease in mean TC level as well as LDL-C, very low-density lipoprotein cholesterol, TG, SGOT and SGPT. These results suggest that the etonogestrel implant does not interfere directly with the risk of cardiovascular diseases because it improves the lipid profile. There were no pregnancies during the study. CONCLUSION: Our results indicate that an etonogestrel implant used by adolescents for 1 year is associated with changes in the lipid profile and hepatic function without adverse clinical effects.

Effects of drospirenone/estradiol on steroid receptors and Bcl-2 in the postmenopausal endometrium.

OBJECTIVE: To evaluate the effect of drospirenone with 17ß-estradiol on the histology and expression of estrogen and progesterone receptors and of Bcl-2 protein, in endometrium of postmenopausal women. METHOD: Forty postmenopausal women, including controls, participated in this study evaluating oral hormone replacement treatment combining 2 mg/day of drospirenone with 1 mg/day of 17ß-estradiol administered for a 24-week period. The effect on the endometrium was assessed by histology and the apoptosis marker Bcl-2. The immunoexpression of estrogen (ER) and progesterone (PR) receptors in the endometrium was also measured. RESULTS: No increase in endometrial thickness was evident after either treatment, although endometrial histology was atrophic in most biopsies. The drospirenone/estradiol group showed higher expression of ER and PR in glandular epithelium compared to stroma, but the Bcl-2 protein was more immunoreactive in stroma than in glandular epithelium. Compared to controls, drospirenone/estradiol users showed higher immunoexpression of ER, PR and Bcl-2 in both glandular epithelium and endometrial stroma. CONCLUSION: A 24-week course of drospirenone with 17ß-estradiol resulted in low proliferation and was shown to lead to atrophic endometrium. The novel progestogen drospirenone seems to have favorable effects on the endometrium of postmenopausal women due to its pro-apoptotic action in glandular epithelium.

Induction of ovarian follicular wave emergence and ovulation in progestin-based timed artificial insemination protocols for Bos indicus cattle.

The present study aimed to evaluate the efficacy of different inducers of new follicular wave emergence (FWE) and ovulation in fixed-time artificial insemination (FTAI) synchronization protocols using norgestomet ear implants (NORG) in Bos indicus cattle. In Experiment 1, the synchronization of FWE was evaluated when two different estradiol esters in different doses [2mg estradiol benzoate (EB), 2.5mg EV or 5mg estradiol valerate (EV)] were administered with NORG implant insertion in B. indicus cattle (estrous cyclic heifers and cows with suckling calves; n=10 per treatment). After estradiol treatment, ovarian ultrasonic exams were performed once daily to detect the interval between treatment and FWE. There were significant treatment-by-animal category interaction (P=0.05) on the interval from the estradiol treatment to FWE. An earlier (P<0.0001) and less variable (P=0.02) interval from estradiol treatment to FWE was observed in heifers treated with EB (2.5±0.2; mean±SE) than in those treated with 2.5mg EV (4.2±0.3) or 5mg EV (6.1±0.6). Cows treated with 5mg EV (4.0±0.5) had longer (P=0.05) interval than cows receiving EB (2.5±0.2), however, there was an intermediate interval in those cows treated with 2.5mg EV (3.1±0.4). In Experiment 2, the number of uses of the NORG implant (new; n=305 or previously used once; n=314) and three different ovulation induction hormones [0.5mg estradiol cypionate (EC) at implant removal (n=205), 1mg EB given 24h after implant removal (n=219), or 100µg gonadorelin (GnRH) given at FTAI (n=195)] were evaluated in Nelore heifers (2×3 factorial design). Similar pregnancy per AI (P/AI; 30 days after FTAI; P>0.05) were achieved using each of the three ovulation induction hormones (EB=40.6%; EC=48.3%, or GnRH=48.7%) and with a new (47.2%) or once-used NORG implant (44.3%). In Experiment 3, the effect of different ovulation induction hormones for FTAI [1mg EC at NORG implant removal (n=228), 10µg buserelin acetate at FTAI (GnRH; n=212) or both treatments (EC+GnRH; n=215)] on P/AI was evaluated in suckled beef cows treated with a once-used NORG implant and EB to synchronize the FWE. Similar P/AI (P=0.71) were obtained using GnRH (50.9%), EC (51.8%) or both treatments (54.9%) as ovulation induction hormones. Therefore, both doses of EV (2.5 or 5.0mg) with NORG implant delayed and increased the variation of the day of new FWE compared with EB in B. indicus cattle. These effects were more pronounced in B. indicus heifers than cows. Synchronization protocols for FTAI with either a new or once-used NORG implant with EB at insertion to induce a new FWE and either the use of EB, EC or GnRH as ovulation induction hormones may be successful in B. indicus heifers. Also, when a once-used NORG implant was used, either the administration of EC, GnRH or both as ovulation inducers resulted in similar P/AI in suckled B. indicus cows, showing no additive effect of the combination of both ovulation induction hormones.

Níveis séricos de progesterona em vacas ovariectomizadas tratadas com Mad4® com diferentes concentrações e vias de administração / Serum progesterone levels in ovariectomised cows treated with mad-4® with different concentrations and routes of administration

Background: Progesterone and synthetic progestogens are used to prepare the uterus for pregnancy, and for the hypothalamus, pituitary and ovaries to respond to endogenous and exogenous gonadotropins. The object of this work was to check serum progesterone concentrations in ovariectomised cows, to determine pharmacokinetics of MAD-4 ® product. Materials, Methods & Results: A group of eigth Braford cows was divided into two groups, in two experiments. In experiment I, both groups received 250 mg of progesterone by different routes of application: intramuscular or subcutaneous. In experiment II, subcutaneous application was used in both groups, the differentiation of the treatments lying in the concentration of progesterone: treatment 2 received 250 mg progesterone and treatment 3 was administered 375 mg of progesterone. In the first 24 h samples were collected in intervals of 6 hours, then every 24 h up to 192 h (day 8). In experiment I there was a significant difference (P < 0.05) at 96 h, showing greater concentration in treatment 2 compared to treatment 1 (1.54 ng/mL vs. 0.48 ng/ mL, respectively). In experiment II, in the measures undertaken at 144 h, 168 h and 192 h with significant difference (P < 0.05), concentrations of progesterone in treatment 2 were lower when compared to treatment 3 (0.79 ng/mL vs. 1.63 ng/mL, 0.66 ng/ mL vs. 1.36 ng/mL and 0.49 ng/mL vs. 1.11 ng/mL respectively for hours and treatments). Due to the fact that the types of progestogens and doses used to control the estrous cycle in cattle may be less effective than endogenous progesterone (a corpus luteum) with respect to suppression of LH, the high frequency of LH pulses results in development of “persistent” follicles containing aged eggs of low fertility. In this study, the application of 250 mg of intramuscular and subcutaneous long action injectable progesterone elevated progesterone serum concentration above 1 ng/mL. Subcutaneous application presented levels exceeding 1 ng/mL for a longer time, from 6 to 96 h. This treatment probably suppresses LH pulses temporarily without staying very long in the bloodstream; for this reason it doesnt impair fertility. The same cannot be said in the treatment situation with the application of 375 mg subcutaneous long-action injectable progesterone, because, as long as progesterone was measured (day 8), the concentration remained higher than 1 ng/mL. Discussion: Vaginal silicone implants impregnated with 0.5 g of progesterone, when used for the second time (7 days each time), failed to maintain serum progesterone levels for more than 24 h higher than 1 ng/mL. In this study, treatment with 250 mg intramuscular long-action injectable progesterone showed similar serum concentrations over time, because between 24 and 48 h the levels were below 1 ng/mL. Parenteral routes of administration include, among others, the intramuscular (IM) and subcutaneous (SC). The intramuscular route is characterised by a relatively rapid absorption via the subcutaneous, is characterized by a slower absorption and continuous. Treatment of ovariectomised cows with long-acting injectable progesterone in different doses and by different routes resulted in significantly different serum concentrations at some moments, characteristic of each route of administration and doses used. In this study we can conclude that the seemingly more appropriate treatment is that which makes use of 250 mg of long-acting progesterone, subcutaneously injected, keeping progesterone serum levels higher than 1ng/mL per period of four days.(AU)

Níveis séricos de progesterona em vacas ovariectomizadas tratadas com Mad4® com diferentes concentrações e vias de administração / Serum progesterone levels in ovariectomised cows treated with mad-4® with different concentrations and routes of administration

Background: Progesterone and synthetic progestogens are used to prepare the uterus for pregnancy, and for the hypothalamus, pituitary and ovaries to respond to endogenous and exogenous gonadotropins. The object of this work was to check serum progesterone concentrations in ovariectomised cows, to determine pharmacokinetics of MAD-4 ® product. Materials, Methods & Results: A group of eigth Braford cows was divided into two groups, in two experiments. In experiment I, both groups received 250 mg of progesterone by different routes of application: intramuscular or subcutaneous. In experiment II, subcutaneous application was used in both groups, the differentiation of the treatments lying in the concentration of progesterone: treatment 2 received 250 mg progesterone and treatment 3 was administered 375 mg of progesterone. In the first 24 h samples were collected in intervals of 6 hours, then every 24 h up to 192 h (day 8). In experiment I there was a significant difference (P < 0.05) at 96 h, showing greater concentration in treatment 2 compared to treatment 1 (1.54 ng/mL vs. 0.48 ng/ mL, respectively). In experiment II, in the measures undertaken at 144 h, 168 h and 192 h with significant difference (P < 0.05), concentrations of progesterone in treatment 2 were lower when compared to treatment 3 (0.79 ng/mL vs. 1.63 ng/mL, 0.66 ng/ mL vs. 1.36 ng/mL and 0.49 ng/mL vs. 1.11 ng/mL respectively for hours and treatments). Due to the fact that the types of progestogens and doses used to control the estrous cycle in cattle may be less effective than endogenous progesterone (a corpus luteum) with respect to suppression of LH, the high frequency of LH pulses results in development of “persistent” follicles containing aged eggs of low fertility. In this study, the application of 250 mg of intramuscular and subcutaneous long action injectable progesterone elevated progesterone serum concentration above 1 ng/mL. Subcutaneous application presented levels exceeding 1 ng/mL for a longer time, from 6 to 96 h. This treatment probably suppresses LH pulses temporarily without staying very long in the bloodstream; for this reason it doesn’t impair fertility. The same cannot be said in the treatment situation with the application of 375 mg subcutaneous long-action injectable progesterone, because, as long as progesterone was measured (day 8), the concentration remained higher than 1 ng/mL. Discussion: Vaginal silicone implants impregnated with 0.5 g of progesterone, when used for the second time (7 days each time), failed to maintain serum progesterone levels for more than 24 h higher than 1 ng/mL. In this study, treatment with 250 mg intramuscular long-action injectable progesterone showed similar serum concentrations over time, because between 24 and 48 h the levels were below 1 ng/mL. Parenteral routes of administration include, among others, the intramuscular (IM) and subcutaneous (SC). The intramuscular route is characterised by a relatively rapid absorption via the subcutaneous, is characterized by a slower absorption and continuous. Treatment of ovariectomised cows with long-acting injectable progesterone in different doses and by different routes resulted in significantly different serum concentrations at some moments, characteristic of each route of administration and doses used. In this study we can conclude that the seemingly more appropriate treatment is that which makes use of 250 mg of long-acting progesterone, subcutaneously injected, keeping progesterone serum levels higher than 1ng/mL per period of four days.

Treatment with an intravaginal progestagen and estradiol to prevent prolonged anestrus in crossbred zebu cows under tropical conditions.

To study the effectiveness of a treatment with an intravaginal progestagen in combination with estradiol-17beta (E-17beta) on estrus induction, prevention of prolonged anestrus and fertility in noncycling crossbred zebu cows, a trial was conducted in a farm in Zulia state, Venezuela. Fifty noncycling suckled crossbred cows (B. taurus x B. indicus) with 60 dpp were randomly allotted to one of the following treatments: MAP+E-17beta (n=22), intravaginal device (250 mg of MAP) during 7 days + 50 mg of MAP and 5 mg of E-17beta im (day 0) and 1.5 mg of E-17beta im (day 8) (Pregnaheat-E; VIATECA-Venezuela); CG (n=28), control group without hormonal treatment. The MAP+E-17beta group showed higher (P<0.05) estrus and synchronization rates (59.1 and 36.4 %) than CG (25.0 and 3.5 %). Cows receiving MAP had higher (P<0.05) overall pregnancy rate than CG (45.5 and 17.8 %, respectively). A decreased (P<0.05) anestrus rate was observed in MAP+E-17beta (31.8%) compared to CG (57.1%). Calving-conception interval was shorter (P<0.05) in MAP+E-17beta (132.5+/-16.8 days) than in CG (178.9+/-14.7 days). In conclusion, treatment with MAP+E-17beta at 60 days postpartum was effective to induce estrus, prevent prolonged anestrus, and reduce the calving-conception interval, improving reproductive performance in dual purpose crossbred Zebu cows.

Follicle deviation and ovulatory capacity in Bos indicus heifers.

The objectives of Experiment 1 were to determine the interval from ovulation to deviation, and diameter of the dominant follicle (DF) and largest subordinate follicle (SF) at deviation in Nelore (Bos indicus) heifers by two methods (observed and calculated). Heifers (n = 12) were examined ultrasonographically every 12 h from ovulation (Day 0) to Day 5. The time of deviation and diameter of the DF and largest SF at deviation did not differ (P>0.05) between observed and calculated methods. Overall, deviation occurred 2.5+/-0.2 d (mean +/- S.E.M.) after ovulation, and diameters for DF and largest SF at deviation were 6.2+/-0.2 and 5.9 +/- 0.2 mm, respectively. Experiment 2 was designed to determine the size at which the DF acquires ovulatory capacity in B. indicus heifers. Twenty-nine heifers were monitored every 24 h by ultrasonography, from ovulation until the DF reached diameters of 7.0-8.4 mm (n=9), 8.5-10.0 mm (n=10), or >10.0 mm (n=10). At that time, heifers were treated with 25 mg of pLH and monitored by ultrasonography every 12 h for 48 h. Ovulation occurred in 3 of 9, 8 of 10, and 9 of 10 heifers, respectively (P<0.05). In summary, there was no significant difference between observed and calculated methods of determining the beginning of follicle deviation. Deviation occurred 2.5 d after ovulation when the DF reached 6.2 mm, and ovulatory capacity was acquired by DF as small as 7.0 mm.

Reproductive response in suckling Corriedale ewes to the ram effect during the non-breeding season: effect of postpartum condition and the use of medroxyprogesterone priming.

The response to the ram effect and the use of progestagen priming was studied in postpartum suckling Corriedale ewes. Two experiments were carried out during the non-breeding season. In experiment 1, the effectiveness of the ram effect to induce fertile oestrus in postpartum ewes was determined. While no significant differences in the frequency of ewes in oestrus were found, the overall conception rate was significantly higher in ewes that were weaned at least 6 months before the study started (63.3%) than in 60-90 days postpartum ewes (45.3%, p < 0.01). In experiment 2, the influence of medroxyprogesterone acetate priming on the response to the ram effect in suckling Corriedale ewes was determined. The frequency of ewes in oestrus and conception rate between ewes that remained unprimed and 6-days-primed ewes were similar. We conclude that it is possible to induce oestrus in postpartum suckling Corriedale ewes using the ram effect during the non-breeding season and that the use of progestagen priming seems to be ineffective in improving the response of postpartum ewes to the ram effect.

Effect of a combination of ethinylestradiol 30 microg and drospirenone 3 mg on tolerance, cycle control, general well-being and fluid-related symptoms in women with premenstrual disorders requesting contraception.

PURPOSE: Positive effects on premenstrual symptoms have been observed with low-dose oral contraceptives. Drospirenone is a synthetic progestogen with antiandrogenic and antimineralocorticoid effects. This open-label, multicenter study evaluated the effects of a combination of ethinylestradiol 30 microg and drospirenone 3 mg on safety, cycle control, general well-being and fluid-related symptoms in women with premenstrual disorders requesting contraception. MATERIALS AND METHODS: A total of 241 healthy volunteers with symptoms of premenstrual disorder was enrolled in the study. Of the final sample, 203 completed the six-cycle treatment and were included in the efficacy analysis whereas 236 were included in the tolerability analysis. The subjects recruited to the study were required to fill up the Psychological General Well-Being Index (PGWBI). RESULTS: There was no significant change in body weight or blood pressure throughout the treatment. Adverse events reported by patients during treatment consisted of those already known to be associated with oral contraceptive use. PGWBI scores were significantly higher after six cycles of treatment compared with baseline values (p<.0001). A total of 198 (84.2%) subjects reported a great improvement in premenstrual symptoms. CONCLUSIONS: The results of this study confirm that oral use of a combination of ethinylestradiol 30 microg and drospirenone 3 mg provides good cycle control, is well tolerated and has a positive impact on symptoms of premenstrual disorder.

Effects of a single Silastic contraceptive implant containing nomegestrol acetate (Uniplant) on endometrial morphology and ovarian function for 1 year.

PURPOSE: This study was undertaken to evaluate the effects of a subdermal implant containing nomegestrol acetate (Uniplant) on endometrial histology and ovarian function. METHODS: Twenty healthy female volunteers of reproductive age were included and completed a menstrual diary throughout the study. Hysteroscopy, transvaginal sonography and blood sampling were performed prior to implant insertion (control cycle) and following 6 and 12 months of Uniplant use. Transvaginal sonography was performed every other day from Day 8 of the cycle up to the obtainment of sonographic evidence of a 12-mm follicle, then every day until the obtainment of sonographic evidence of follicular rupture and thereafter every other day until the next menstrual bleeding. Blood samples were taken for the measurement of estradiol, follicle-stimulating hormone, luteinizing hormone and progesterone on the same days on which transvaginal sonography was performed. The implants were removed after 1 year. RESULTS: Twenty percent of cycles were ovulatory, and 80% were anovulatory. The development of persistent nonluteinized follicle occurred in 40% of all cycles studied, inadequate luteal phase occurred in 20% of cycles and no follicular development occurred in 40%. Endometrial thickness remained below 8 mm in all cycles studied. Alterations in endometrial vascularization were observed in all treated cycles. CONCLUSION: Our results suggest that this long-acting contraceptive method affects follicular growth and endometrial vascularization, disrupts endometrial architecture and leads to inadequate luteal phase.

Clinical experience and acceptability of the etonogestrel subdermal contraceptive implant.

OBJECTIVE: To evaluate efficacy, adverse effects, and user continuation rate of an etonogestrel subdermal single-rod contraceptive implant. METHODS: A total of 417 healthy volunteers of childbearing age were included in this multicenter trial. After implant insertion, the women were followed up during the 3 years of contraceptive action. At each visit, clinical findings, side effects, and bleeding patterns were recorded. Efficacy and continuation rates were analyzed using the Pearl Index and Kaplan-Meier life tables, respectively. RESULTS: The observation period totaled 958.5 woman-years (27.5 months per woman). The Pearl Index score was 0. Side effects were reported by 44.4% of users, but the proportion had decreased to 16.5% by the end of the study. The continuation rate was 61.4%. The most common reason for early discontinuation (in 21.1% of the participants) was menstrual disturbances. CONCLUSIONS: Etonogestrel subdermal contraceptive implants demonstrated high efficacy and an acceptable continuation rate. Counseling potential users explicitly about the side effects will optimize patient success with this long-acting contraceptive.

Progesterone receptor expression in medroxyprogesterone acetate-induced murine mammary carcinomas and response to endocrine treatment.

Using medroxyprogesterone acetate (MPA) as a carcinogen, we were able to induce in BALB/c female mice, several progestin-dependent mammary ductal carcinomas that regress completely with estrogen or antiprogestins and are maintained by serial transplantations in syngeneic mice. Progestin-independent variants were subsequently generated or appeared spontaneously. Based on their response to estrogen or antiprogestins, we subdivided them into responsive progestin-independent (R-PI) variants which regress completely and unresponsive progestin-independent (UR-PI) carcinomas which are resistant to both families of compounds. In this study we have investigated progesterone receptor (PR) expression in six responsive progestin-dependent, six R-PI, and three UR-PI tumors. Progestin-dependent and R-PI tumors disclosed a higher expression of the PR(A) isoform as compared with PR(B), as well as an additional band of 78 kDa that was not detected in uterine tissue; all were down-regulated by progestins. UR-PI tumors expressed lower levels of all bands in western blots, but were highly reactive by immunohistochemistry. PR RNA expression was detected in both, UR-PI and R-PI tumors. PR binding was comparable in progestin-dependent and R-PI tumors. In the three UR-PI tumors, only 29/61 (48%) of the samples evaluated showed low binding levels, the rest were negative. This report is the first to describe in an experimental model of breast cancer the expression of PR isoforms and their distribution. Our results suggest the expression of functionally altered isoforms in a subgroup of mammary carcinomas, which may explain their lack of hormone response.

Postcoital treatment with levonorgestrel does not disrupt postfertilization events in the rat.

Levonorgestrel (LNG), a progestin widely used for regular hormonal contraception, is also used for emergency contraception (EC) to prevent pregnancy after unprotected intercourse. However, its mode of action in EC is only partially understood. One unresolved question is whether or not EC prevents pregnancy by interfering with postfertilization events. Here, we report the effects of acute treatment with LNG upon ovulation, fertilization and implantation in the rat. LNG inhibited ovulation totally or partially, depending on the timing of treatment and/or total dose administered, whereas it had no effect on fertilization or implantation when it was administered shortly before or after mating, or before implantation. It is concluded that acute postcoital administration of LNG at doses several-fold higher than those used for EC in women, which are able to inhibit ovulation, had no postfertilization effect that impairs fertility in the rat.

[Ultrasonographic and lipid changes in polycystic ovary syndrome according to the type of treatment ]. / Cambios ultrasonográficos y en lípidos en el síndrome de ovario poliquístico de acuerdo al tipo de tratamiento.

OBJECTIVE: To determine the ultrasonographic and lipid changes in women with polycystic ovary syndrome (PCOS) according to the type of hormonal treatment. STUDY DESIGN: Thirty-two women with clinical and ultrasonographic diagnosis of PCOS were studied and randomly distributed in one or another treatment group. Group I: chlormadinone (2 mg/day for 5 days every month) (n = 16) and Group II: ethinylestradiol 35 micrograms plus desogestrel 150 mg (21 days every month) (n = 16). At baseline and at third month a pelvic ultrasound was done to assess the number and size of follicles, also total cholesterol and triglycerides were measured. RESULTS: In both groups a significant decrease was found in the number of follicles in both ovaries, but only in group II there was a significant decrease in follicular size in both ovaries. No differences were found between the groups in the number of follicles or in the final follicular size. In both groups, a significant decrease was found in total cholesterol levels, without changes in triglycerides levels. CONCLUSION: Only combined therapy decreased follicular size. So the type of treatment should be based on patient expectations such as sexual activity, or for control of androgen excess.

Therapeutic use of levonorgestrel-releasing intrauterine system in women with menorrhagia: a pilot study(1).

The objective of this study was to evaluate the efficacy and performance, for up to 1 year, of an intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS, Mirena) in the treatment of women with menorrhagia. It was a descriptive, prospective, non-comparative study. A 20 microg/day LNG-releasing-IUS was inserted on any day during bleeding to 44 women (between 24 and 49 years of age) who presented with menorrhagia after medical therapies had failed. Menstrual patterns were assessed, and hemoglobin concentrations were measured before LNG-IUS was inserted and at 3, 6, 9, and 12 months of use. The most common bleeding pattern at 3 months after insertion was spotting, and after 6, 9, and 12 months the majority of women presented with amenorrhea or oligomenorrhea. Three women requested removal of the LNG-IUS because of spotting, and six women expelled it spontaneously. Hemoglobin levels were improved from 102 g/L to 123 and 128 g/L at 3 and 12 months, respectively, after insertion of the LNG-IUS (p < 0.01). At 12 months 79.5% of participants continued the use of LNG-IUS. In conclusion, LNG-IUS was an effective treatment for three out of four women with menorrhagia and could be an alternative treatment for women with menorrhagia who are either contraindicated for or refuse hysterectomy or endometrial ablation.