A case series detailing the successful reversal of the effects of mifepristone using progesterone.

BACKGROUND: Some women who take mifepristone, a progesterone receptor antagonist, in order to terminate their pregnancies, change their minds and desire to stop the medical abortion process. There are only two articles in the medical literature documenting the reversal of the effects of mifepristone. OBJECTIVE: We present and analyze a series of women who attempted to reverse the effects of mifepristone by taking supplemental progesterone to determine if the reversal of the effects mifepristone with progesterone is possible and safe. Additionally, we compare different progesterone regimens to determine relative efficacies. METHODS: This is an observational case series of 754 patients who decided to attempt to reverse the medical abortion process after taking mifepristone but before taking the second drug in the protocol, misoprostol. We followed the patients, who were given progesterone in an effort to reverse the effects of mifepristone, and conducted statistical analyses to determine the efficacies of different protocols compared to a control mifepristone embryo survival rate, derived from the literature. RESULTS: Intramuscular progesterone and high dose oral progesterone were the most effective with reversal rates of 64% (P < 0.001) and 68% (P < 0.001), respectively. There was no apparent increased risk of birth defects. Conclusions: The reversal of the effects of mifepristone using progesterone is safe and effective.

Induced abortion as an independent risk factor for breast cancer: a systematic review and meta-analysis of studies on south asian women.

OBJECTIVE: South Asia, a historically low-incidence region for breast cancer, has produced many recent studies examining reproductive factors. We compiled these studies to confirm the reality of the significant association reported in the first, 1996 review of induced abortion as a risk factor, independent of abortion's known effect in abrogating the protection afforded by full-term pregnancy. METHODS: We searched the medical literature for English language studies on breast cancer incidence in women in South Asia published from 1 January, 2000 through 30 June, 2017, using Pubmed, Scholar-Google, and bibliographic searches. Studies were included which reported overall data on induced abortion and/or abortion non-specifically. All 20 eligible studies were of retrospective, case-control design. Data from individual studies were combined using random effects modeling, following the determination of significant heterogeneity. RESULTS: Cumulative OR for all 20 studies was 2.51 (95%CI: 1.67-3.75) and 3.91 (95%CI: 1.02-14.97) for the five studies which reported specific data on induced abortion. Significant dose-dependence was observed among all 5 studies which stratified by number of abortions. Meta-regression of OR v. abortion prevalence among controls was statistically significant, as observed in a 2013 meta-analysis in China. CONCLUSION: The moderately strong association identified between abortion and breast cancer explains in part the spread of the breast cancer epidemic to South Asia as it has become Westernized. Continuing denial of the abortion-breast cancer association can only ensure that the acknowledged worldwide breast cancer epidemic will continue to worsen, costing many millions of women their lives over the next several decades.

Risk of HIV Infection in Depot-Medroxyprogesterone Acetate (DMPA) Users: A Systematic Review and Meta-analysis.

OBJECTIVE: As the HIV/AIDS epidemic continues to spread in Africa and Asia, use of the injectable contraceptive steroid DMPA is widespread and has been increasing. Since studies dating back to 1992 have suggested that DMPA may increase the transmission of HIV to women, we endeavored to determine if the extant epidemiological and biological evidence is sufficient to conclude that DMPA use constitutes a definite hazard to women's health. METHODS: We searched Medline using the search terms: contraceptives or contraception AND HIV and searched bibliographies of articles thus identified. We included in the meta-analysis all studies examining the association between use of DMPA (or injectable contraceptives comprising mostly DMPA) and the presence (cross-sectional studies, n = 8) or acquisition (longitudinal studies, n = 16) of HIV+ status in women, using a random effects models to estimate odds ratios (ORs; cross-sectional studies) and hazard ratios (HRs; longitudinal studies). Studies were excluded if the comparison group included women using any form of steroidal contraception. RESULTS: Statistically significant positive associations between DMPA use and HIV positivity were observed both in cross-sectional (OR = 1.41, 95% CI 1.15 - 1.73) and longitudinal studies (HR = 1.49, 95% CI 1.28 - 1.73). The biological plausibility of increased vulnerability to HIV infection due to progestational action (via thinning of the vaginal epithelial barrier and immunosuppression) as well as glucocorticoid agonistic immunosuppression, are discussed. CONCLUSION: The epidemiological and biological evidence now make a compelling case that DMPA adds significantly to the risk of male-to-female HIV transmission.